scholarly journals Towards person-centered healthcare via realistic evidence-based medicine – informing the debate historically

2015 ◽  
Vol 3 (3) ◽  
pp. 275
Author(s):  
Timo Bolt ◽  
Frank Huisman
Keyword(s):  
Evidence Based Medicine ◽  
Historical Analysis ◽  
Current Debate ◽  
Evidence Based ◽  
Initial Program ◽  
The Many ◽  
Based Medicine

There is a widespread feeling that, despite the many successes of evidence based medicine (EBM), the movement is now facing a serious crisis. The current debate on this ‘crisis’ may be understood as resulting from four interrelated evolutions which EBM went through. Our historical analysis of these evolutions leads us to two conclusions. First, it looks like the spirit of anti-authoritarianism, (self-)criticism, independence of thought and empowerment of individual physicians of the early days has gone. Second, the often-invoked image of the ‘golden past’ of ‘real EBM’ is distorted, as it reflects contemporary nuanced ideas rather than the initial program of the movement. Thus, history teaches us that we should forget about the idealized image of ‘real EBM’ and embrace realistic EBM instead.

scholarly journals The difficult crossroads of decisions at COVID-19: how can the deontology implicit in Evidence-Based Medicine help us to understand the different attitudes of doctors at this time?

2020 ◽  
Vol 47 ◽  
Author(s):  
MIGUEL PRESTES NACUL ◽  
MARCO ANTÔNIO AZEVEDO
Keyword(s):  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Well Being ◽  
Medical Decision ◽  
Evidence Based ◽  
Conservation Of Resources ◽  
Health Measures ◽  
The Many ◽  
Based Medicine

ABSTRACT One of the struggles faced by physicians in clinical decisions during the COVID-19 pandemic is how to deal with already available or lacking scientific evidence. The COVID-19 pandemic has a large impact in the routine of the many health services, including surgery, which demanded changes in assist protocols. Questions began to arise about well-established surgery conducts due to situations related to SARS-COV-2 infection, and, according to public health measures that are necessary to fight the pandemic. In situations of scarce available evidence, it is natural for us to have to deal with systematically more fragile, provisory and bias-susceptible information. Considering the principles that guide Evidence Based Medicine and Bioethical, the authors analyze the complexity of the medical decision-making during this time. Medical conducts must be adapted to the context of fighting the pandemic and consider patients and healthcare providers exposure and well-being and, lastly, the conservation of resources. The authors conclude that acceptance and tolerance to divergence is commendable, being a path to achieving unity in the diversity of medicine in times of little safe knowledge.

Disease specificity and evidence-based medicine: a historical perspective

2020 ◽  
Vol 8 (3) ◽  
pp. 308
Author(s):  
Timo Bolt ◽  
F G Huisman
Keyword(s):  
Evidence Based Medicine ◽  
Historical Perspective ◽  
Clinical Epidemiology ◽  
Unintended Consequences ◽  
Current Debate ◽  
Evidence Based ◽  
Negative Consequences ◽  
Based Medicine ◽  
Ontological Concept

This paper seeks to inform the current debate on an alleged ‘crisis’ and the ‘unintended negative consequences’ of evidence-based medicine (EBM) from a historical perspective. EBM can be placed against the background of a long term process of medical quantification and objectification. This long term process was accompanied by a ‘specificity revolution’, which made the ontological concept of diseases as specific entities the central ordering and regulatory principle in healthcare (as well as in clinical epidemiology and EBM). To a certain extent, the debate about EBM’s alleged crisis can be understood as resulting from this specificity revolution. When the ontological concept of disease is applied too rigidly, this will contribute to ‘negative unintended consequences’ of EBM such as ‘poor mapping of multimorbidity’ and medical practice ‘that is management-driven rather than patient-centered’.

scholarly journals Users’ Guide to the Medical Literature - A Manual for Evidence Based Clinical Practice

2003 ◽  
Vol 1 (3) ◽  
Author(s):  
Stephen Burgess
Keyword(s):  
Clinical Practice ◽  
American Medical Association ◽  
Medical Association ◽  
Evidence Based Medicine ◽  
Medical Literature ◽  
Canadian Medical Association Journal ◽  
Evidence Based ◽  
Small Series ◽  
The Many ◽  
Based Medicine

This book is the result of what began more than a decade ago as a series of articles that were published in the Journal of the American Medical Association (JAMA). The series ran from 1993 to 2000. The forebears of this series were a similar but small series of articles published in the Canadian Medical Association Journal, beginning in 1981. But as well as a genealogy, this book has a pedigree. The father of evidence based medicine; David Sackett worked closely with at least some of the editors and contributors to this volume, and has clearly provided inspiration to the many fine contributors. His intellectual fingerprints are all over these pages – and a good thing too.

Introduction

2018 ◽  
pp. 1-20
Author(s):  
Erwin B. Montgomery
Keyword(s):  
Evidence Based Medicine ◽  
Historical Analysis ◽  
Evidence Based ◽  
Randomized Control Trials ◽  
Logical Deduction ◽  
New Knowledge ◽  
Objective Tests ◽  
Randomized Control ◽  
Logical Fallacies ◽  
Based Medicine

The critical and historical analysis of medical reasoning begins from the central importance of certainty in practice and research. The need for certainty manifests in preference for objective tests, particularly their overutilization, and evidence-based medicine used synonymously with randomized control trials. The variety of manifestations in each patient and each subject of research is a challenge to certainty. The response is a choice of epistemic perspectives. Either there are as many “diseases” as there are patients, or there is an economical set of diseases, defined by principles and facts, by which any patient can be understood. The latter suggests a type of logical deduction, and deductive logic is indeed the model. However, deduction, while providing certainty, does not generate new knowledge. Rather, derivative logical fallacies must be used that provide utility at the expense of certainty. Similarly, induction also is problematic. The implications of the conundrum and responses are introduced.

Standardization of methods for determining ESR

2021 ◽  
Vol 66 (5) ◽  
pp. 271-278
Author(s):  
Alexey Alexeevich Kishkun ◽  
M. Yu. Siniak
Keyword(s):  
Quality Control ◽  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Historical Analysis ◽  
Evidence Based ◽  
Based Medicine

The study presents a historical analysis of the problems of standardization of methods for determining ESR. The modern approaches to the automation of ESR research are presented. It is shown that the solution to the problems of standardization of methods for determining ESR lies in the plane of regular intra-laboratory quality control. In accordance with the principles of evidence-based medicine, recommendations are given on the use of methods for determining ESR in clinical practice.

Cholangiokarzinome

Praxis ◽  
2002 ◽  
Vol 91 (34) ◽  
pp. 1352-1356
Author(s):  
Harder ◽  
Blum
Keyword(s):  
Supportive Care ◽  
Evidence Based Medicine ◽  
Best Supportive Care ◽  
Evidence Based ◽  
Systemische Chemotherapie ◽  
Chirurgische Resektion ◽  
Multimodale Therapiekonzepte ◽  
Based Medicine

Cholangiokarzinome oder cholangiozelluläre Karzinome (CCC) sind seltene Tumoren des biliären Systems mit einer Inzidenz von 2–4/100000 pro Jahr. Zu ihnen zählen die perihilären Gallengangskarzinome (Klatskin-Tumore), mit ca. 60% das häufigste CCC, die peripheren (intrahepatischen) Cholangiokarzinome, das Gallenblasenkarzinom, die Karzinome der extrahepatischen Gallengänge und das periampulläre Karzinom. Zum Zeitpunkt der Diagnose ist nur bei etwa 20% eine chirurgische Resektion als einzige kurative Therapieoption möglich. Die Lebertransplantation ist wegen der hohen Rezidivrate derzeit nicht indiziert. Die Prognose von nicht resektablen Cholangiokarzinomen ist mit einer mittleren Überlebenszeit von sechs bis acht Monaten schlecht. Eine wirksame Therapie zur Verlängerung der Überlebenszeit existiert aktuell nicht. Die wichtigste Massnahme im Rahmen der «best supportive care» ist die Beseitigung der Cholestase (endoskopisch, perkutan oder chirurgisch), um einer Cholangitis oder Cholangiosepsis vorzubeugen. Durch eine systemische Chemotherapie lassen sich Ansprechraten von ca. 20% erreichen. 5-FU und Gemcitabine sind die derzeit am häufigsten eingesetzten Substanzen, die mit einer perkutanen oder endoluminalen Bestrahlung kombiniert werden können. Multimodale Therapiekonzepte können im Einzellfall erfolgreich sein, müssen jedoch erst in Evidence-Based-Medicine-gerechten Studien evaluiert werden, bevor Therapieempfehlungen für die Praxis formuliert werden können.

The Commitment of the Documentation Service of the Swiss Academy of Medical Sciences for the Impartment of Evidence Based Medicine

Swiss Surgery ◽  
1999 ◽  
Vol 5 (4) ◽  
pp. 183-185
Author(s):  
Bleuer
Keyword(s):  
Evidence Based Medicine ◽  
Cochrane Library ◽  
Evidence Based ◽  
Medical Sciences ◽  
Based Medicine

Die mit dem Aufkommen der elektronischen Medien einhergehende Informationsflut hat die Erwartungen an den Dokumentationsdienst (DOKDI) der Schweizerischen Akademie der Medizinischen Wissenschaften verändert: Insbesondere Evidence Based Medicine (EBM) verlangt nicht nur die Beschaffung von Information, sondern auch eine Selektion hinsichtlich Qualität und Relevanz: Die sich aus der klinischen Situation ergebende Frage fordert eine Antwort, die inhaltlich richtig ist und in der konkreten Situation auch weiterhilft. Dem Ideal, sich durch kritische Lektüre der Originalarbeiten ein Bild über die vorhandene Evidenz für die Richtigkeit eines bestimmten Prozederes zu verschaffen, stehen in der Praxis meist Zeitmangel und methodische Schwierigkeiten im Weg; man wird sich deshalb oft auf die durch andere erarbeitete Evidenz abstützen müssen und z.B. die Cochrane Library konsultieren. Der DOKDI engagiert sich sowohl bei der Erarbeitung von systematischen Übersichtsarbeiten als auch bei der Dissemination der gefundenen Evidenz, indem er seine Erfahrung in der Dokumentation mit elektronischen Medien und die entsprechende Infrastruktur zur Verfügung stellt. Als Ergänzung zu diesen Aktivitäten hat die Akademie einen Grant zur Ausbildung von EBM-Tutoren gesprochen. In einem einwöchigen Kurs in Oxford werden Kliniker zu EBM-Tutoren ausgebildet: Dies wird zukünftig ermöglichen, vermehrt EBM-Workshops in der Schweiz durchzuführen.

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