PakMediNet Discussion Forum : Medical Education inside Pakistan : Evidenced Based Medicine - Basics
Evidenced Based Medicine - Basics
I suggest that users should discuss something on the "Evidence Based Medicine" here.
Evidence based medicine means that medicine should be practiced on the basis of clinical evidence, supported by research studies. Research studies are:
1. Randomized Clinical Trails
2. Systemic Reviews
3. Meta-analysis
In a medical practice, "Clinical Questions" should be made regarding the clinical problem requiring evidence. These questions should be formulated on the basis of a pneumonic
P I C O
P = Patients
I = Intervention
C = Comparison
O = Outcome
After that you search PubMed or other related Databases (eg. Embase, Cochrane) on the basis of the clinical question & PICO.
For example:
Clinical Question: Role of low dose steroids in reduction of joint deformities in the patients with Rheumatoid Arthritis.
PICO would be:
P = Patients with RA
I = Low dose steroids
C = without steroids etc
O = no joint deformities
Then you search PubMed by applying "limits" for RCTs / Systemic Reviews / Meta analysis. Search keywords should be simple and shortest possible, for example: in this case:
low dose steroids AND joint deformities AND Rheumatoid Arthritis
This would give reasonable answers which would answer the required question.
Comments please!
Posted by: docosamaPosts: 333 :: 26-05-2006 :: | Reply to this Message
Re: Evidenced Based Medicine - Basics
Nothing new about "Evidence Based Practice of Medicine", being a long term practitioner,that's what I call it and here's something that I read long time ago:
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.
Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.
BMJ 1996;312:71-72 (13 January)
Posted by: chameedPosts: 173 :: 01-06-2006 :: | Reply to this Message