Evidence-based medicine

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Evidence-based medicine (better known as EBM) is defined as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients." [1]. Why should such an approach to clinical medicine merit its own name, let alone another acronym in the medical literature? Don't physicians ordinarily conscientiously and judiciously use scientific evidence in treating patients? Isn't that simply routine medical care? In fact, most of the specific practices of physicians and surgeons are based on traditional techniques learned from their seniors in the care of patients during training, that are modified with personal clinical experience and information gleaned from the medical literature and continuing education courses. Although these practices almost always have a rational basis in biology, the actual efficacy of treatments is rarely explicitly proven by experimental trials in people. Evidence-based medicine includes only that collection of practices that has been shown, through the scientific method to have validity by empiric proof. As such, it currently encompasses only a small minority of clinical practices. Evidence based medicine is also a philosophy, however,

This article will discuss the field of evidence based medicine. In order to understand this approach to clinical care, some background in the history of medicine, experimental evidence in clinical medicine, and the ethics of medical experimentation must also be included.

Evidence-Based Health Care extends the application of the principles of EBM to all professions associated with health care, including purchasing and management [2].

Practicing clinicians usually cite the lack of time for reading newer textbooks or journals. However, the emergence of new types of evidence can change the way doctors treat patients. Unfortuantely the recent scientific evidence gathered through well controlled clinical trials usually do not reach the busy clinicians in real time. Another potential problem lies in the fact that there may be numerous trials on similar interventions and outcomes but they are not systematically reviewed or meta-analyzed.

An essential adjunct to the practice of evidence-based medicine (EBM) is medical informatics (MI) which focuses on creating tools to access and apply the best evidence for making decisions about patient care [Sackett et al, 2000].

Before practicing EBM, informaticians (or informationists) must be familiar with medical journals, literature databases, medical textbooks, practice guidelines, and the growing number of other dedicated evidence-based resources, like the Cochrane Database of Systematic Reviews and Clinical Evidence [Mendelson and Carino 2005].

Similarly, for practicing medical informatics properly, it is essential to have an understanding of EBM, including the ability to phrase an answerable question, locate and retrieve the best evidence, and critically appraise and apply it [Hersh 2002, Shearer et al., 2001].

References

  1. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM. 2nd ed. New York, NY: Churchhill Livingstone, 2000.
  2. Mendelson D, Carino TV, Evidence-Based Medicine In The United States-De Rigueur Or Dream Deferred? Health Affairs, 2005, 24: 133 - 136. doi: 10.1377/hlthaff.24.1.133
  3. Hersh W, Medical informatics education: an alternative pathway for training informationists, J Med Libr Assoc, 2002, 90(1): 76 - 79.
  4. Shearer BS, Seymour A, Capitani C. Bringing the best of medical librarianship to the patient team, J Med Libr Assoc 2001; 90: 22-31.

See also

External links

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