Evidence based medicine | Bio informatics

Evidence based medicine 


Evidence Based Medicine (EBM), is that clinical care should be guided by the best scientific evidence.  addition to this evidence influence medical decision-making when evidence is used in a decision, it should be of the highest quality. In fact, EBM is really just a set of tools to inform clinical decision-making. It allows clinical experience (art) to be integrated with best clinical science. Also, EBM makes the medical literature more clinically applicable and relevant. In addition, it requires the user to be facile with computers and IR systems. There are many well-known resources for EBM. 

process of evidence based medicine


The process of EBM involves three general steps:

l Phrasing a clinical question that is pertinent and answerable 
l Identifying evidence (studies in articles) that address the question 
l Critically appraising the evidence to determine whether it applies to the patient

The phrasing of the clinical question is an often-overlooked portion of the EBM process. There are two general types of clinical question: background questions and foreground questions.

Background questions ask for general knowledge about a disorder, whereas foreground questions ask for knowledge about managing patients with a disorder. Background questions are generally best answered with textbooks and classical review articles, whereas foreground questions are answered using EBM techniques. 

Background questions contain two essential components: a question root with a verb (e.g., what, when, how) and a disorder or aspect of a disorder. Examples of background questions include, What causes pneumonia? and When do complications of diabetes usually occur? Foreground questions have four essential components, based on the PICO mnemonic: the patient and/or problem, the intervention, the comparison intervention  (if applicable), and the clinical outcome(s). Some expand the mnemonic with two additional letters, PICOTS, adding the time duration of treatment or follow-up and the setting (e.g., inpatient, outpatient, etc.). 

There are four major categories of foreground questions: 

l Therapy (or intervention) – benefit of treatment or prevention
l Diagnosis – test diagnosing disease
l Harm – etiology of disease
l Prognosis – outcome of disease course

EBM has evolved since its inception. The original approach to EBM, called ‘‘firstgeneration’’
EBM, focused on finding original studies in the primary literature and applying critical appraisal. As already seen, accessing the primary literature is challenging and time-consuming for clinicians for a variety of reasons. This led to what Hersh (1999) called ‘‘next-generation’’ EBM and was focused on the use of syntheses, where the literature-searching, critical appraisal, and extraction of statistics operations were performed ahead of time. This approach Health and Biomedical Information put EBM resources in the context of more usable information resources as advocated in the InfoMastery concept of Shaughnessy et al. (1994) and JIT (just in time) information model of Chueh and Barnett (1997). One statement was recently published by a group of experts who defined evidence based practice (EBP) as medical practice requiring that health-care decisions be based on the ‘‘best available, current, valid, and relevant evidence’’. They defined a five-step model of EBP that included the following:

1. Translation of uncertainty to an answerable question
2. Systematic retrieval of the best evidence
3. Critical appraisal of the evidence for validity, clinical relevance, and applicability
4. Application of results in practice
5. Evaluation of performance

They also advocated that EBP practitioners need to be able to distinguish ‘‘evidence from propaganda, probability from certainty, data from assertions, rational belief from superstitions, and science from folklore.’’ Of course, in light of the manipulation of evidence by the manufacturers of COX-2 inhibitors and other treatments described earlier in the chapter, additional help may be needed to truly sort out fact from fiction. Slawson and Shaughnessy (2005) argue that teaching clinicians to find evidence, such as that in synopses, is a much more important skill than critical appraisal. They advocate for three skills to be taught in medical training that are essential to applying evidence: foraging – keeping up with new knowledge, hunting – finding important information just in time, and the ability to make the best decisions based on applying evidence in specific scenarios of care. Ogrinc et al. (2003) have developed learning objectives for teaching EBM and related topics in the larger framework of improving health-care quality. despite the progress, much remains to get the best evidence to clinicians and allow them to apply it in their practices. Gray (2004) argues that we also need to be more evidence-based in health-care policy.

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