The need for evidence-based, non-drug medicine

2012 ◽  
Vol 24 (2) ◽  
Author(s):  
Søren Ventegodt ◽  
Gary Orr ◽  
Joav Merrick
Keyword(s):  
Scientific Evidence ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Pharmaceutical Drugs ◽  
Pharmacological Agents ◽  
Relevant Evidence ◽  
Hierarchy Of Evidence ◽  
Patient Values ◽  
Patient At Risk

Abstract Evidence-based medicine (EBM) is defined as “the integration of best research evidence with clinical expertise and patient values.” EBM is based on three equally important key factors: i) the best available scientific evidence; ii) the physician’s experience and intuition; and, iii) the preferences and values of the patient. EBM uses a hierarchy of evidence and critical appraisal of the sources, which makes it possible to balance high quality evidence with documented effectiveness. A treatment that is more safe and effective, but less well documented may very well be the treatment of choice. Ethics (not putting the patient at risk of harm with a treatment if this can be avoided at all) is an important part of EBM. Many pharmaceutical drugs have a number needed to treat (NNT) of approximately 20 [NNT=20, confidence interval CI (5–50)] and the number needed to harm is less well understood and documented. The adverse effect profile of pharmacological agents can be more harmful than non-drug medicine. Most EBM-treatments are likely to be non-drug treatments in the future. There are six steps to the practice of EBM: i) the patients and the physician must work together to define the problem; ii) the patients and the physician must explore the patient’s values and preferences; iii) the information about the possible alternative medical interventions must be discussed and critically appraised; iv) the best, relevant evidence must be applied to the patient as a treatment or cure; v) together, the patient and the physician must evaluate how useful the intervention was; and vi) if the intervention did not help sufficiently, the process must begin again. In this review, we explain, in our opinion, how non-drug EBM should be practiced.

Quality assurance and quality improvement in medical practice – Part 2. Evidence-based medicine

2012 ◽  
Vol 153 (4) ◽  
pp. 137-143 ◽  
Author(s):  
Sándor Gődény
Keyword(s):  
Medical Practice ◽  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Cost Effective ◽  
Quality Of Healthcare ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Health Technologies ◽  
Patient Values ◽  
Based Medicine

For assuring and improving quality of healthcare, everyday medical practice should be based on appropriate scientific evidence and results of health technology assessment. Evidence-based medicine is the integration of clinical expertise, patient values, and the best evidence into the decision making process for patient care, when health technologies are used. On one hand health technologies which proved to be effective should be available for all patients, on the other hand, because of the limited financial resources of the health care system, they should be cost-effective, not to spend on interventions proved to be ineffective or even harmful. For effective implementation of evidence-based practice, development of more clinical guidelines, that contain explicit recommendations, and improvement of quality approach are necessary in Hungary. Orv. Hetil., 2012, 153, 137–143.

scholarly journals The Use of Evidence-Based Acupuncture: Current Evidence

2022 ◽  
Author(s):  
Dedi Ardinata
Keyword(s):  
Clinical Evidence ◽  
Scientific Evidence ◽  
Current Evidence ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Evidence Quality

Evidence-based medicine (EBM), which emphasizes that medical decisions must be based on the most recent best evidence, is gaining popularity. Individual clinical expertise is combined with the best available external clinical evidence derived from systematic research in the practice of EBM. The key and core of EBM is the hierarchical system for categorizing evidence. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system divides evidence quality into four categories: high, moderate, low, and very low. GRADE is based on the lowest quality of evidence for any of the outcomes that are critical to making a decision, reducing the risk of mislabeling the overall evidence quality, when evidence for a critical outcome is lacking. This principle is also used in acupuncture as a complementary and integrative treatment modality, but incorporating scientific evidence is more difficult due to a number of factors. The goal of this chapter is to discuss how to establish a clinical evidence system for acupuncture, with a focus on the current quality of evidence for a variety of conditions or diseases.

Evidence-based medicine in anaesthesia

2017 ◽  
Author(s):  
Ann Merete Møller
Keyword(s):  
Evidence Based Medicine ◽  
Meta Analysis ◽  
Consort Statement ◽  
Current Evidence ◽  
Evidence Based ◽  
Clinical Question ◽  
Clinical Expertise ◽  
Clinical Databases ◽  
Patient Values ◽  
Based Medicine

Evidence-based medicine (EBM) is defined as ‘The judicious use of the best current evidence in making decisions about the care of individual patients’. Evidence-based medicine (EBM) is meant to integrate clinical expertise with the best available research evidence and patient values. The purpose of EBM is to assist clinicians in making the best decisions. Practising EBM includes asking an answerable, well-defined clinical question, searching for information, critically appraising information retrieved, extracting data, synthesizing data, and making conclusions about the overall effect. The clinical question includes information of the following elements: the population, the intervention, and the clinically relevant outcomes in focus. The clinical question is a tool to make the focus of the question clearer, and an aid to build the following search strategy. A comprehensive and reproducible literature search is essential for conducting a high-quality and up-to-date search. The search should include all relevant clinical databases. Papers retrieved after the search must be critically appraised and evaluated for the risk of bias. Evidence-based methods are used in the production of systematic reviews, and the development of clinical guidelines. Whether a meta-analysis should be performed depends on the quality and nature of the extracted data. Practising EBM may be challenged by a lack of well-performed trials, various types of bias (including publication bias), and heterogeneity between existing trials. Several tools have been constructed to help the process; examples are the CONSORT statement, the PRISMA statement, and the AGREE instrument.

Improving quality of cancer care by rapid adoption of new scientific evidence.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 62-62
Author(s):  
Joanne Schottinger ◽  
Violeta Rabrenovich ◽  
David Campen ◽  
Dean Fredriks
Keyword(s):  
Cancer Care ◽  
Scientific Evidence ◽  
Care Program ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Patient Centered ◽  
Chemotherapy Administration ◽  
Inpatient Settings ◽  
New Evidence

62 Background: The goal of the Kaiser Permanente (KP) Cancer Care Program is to provide patient-centered, evidence-based, safe care for all KP oncology patients. Multiple processes and information technology tools support KP’s clinicians in delivering the best care to our patients. Prior to 2008, chemotherapy ordering and administration across KP was paper-based, and the standardization of chemotherapy regimens was driven by prescribers’ preferences. KP Oncologists used more than 1,400 chemotherapy protocols. Pharmacy had varying systems for dosing alerts, and reliable chemotherapy administration data was not available for clinical quality improvement. Methods: By 2012, all KP regions had implemented the KP HealthConnect Beacon (KPHCB) system, which incorporates chemotherapy ordering, alerting, verifying, dispensing, and administration in ambulatory and inpatient settings. Important outcomes of the KPHCB implementation include: 1) our success in gaining agreements on standardization of chemotherapy protocols across the Program, and 2) implementation of a rapid process for adoption of new scientific evidence. Our approach includes an evaluation of the quality of the relevant scientific literature and an assessment of a particular treatment. The KP multidisciplinary team discusses and integrates the scientific evidence and clinical expertise of KP clinicians into KPHCB chemotherapy protocols. The new evidence-based protocols with supporting literature references are imbedded as a web link at the end of the each protocol and are available to clinicians within days following the publishing of new evidence. Results: An example of a rapid dissemination and adoption of evidence is the 2010 Pfizer’s and FDA’s announcement that the sale of Mylotarg would be voluntarily discontinued due to a fatal liver veno-occlusive disease. Within 48 hours, we identified 12 patients who received Mylotarg in 2010, and the treating oncologists were individually contacted and provided with the new information to discuss with patients, as appropriate. Conclusions: The benefits of KP’s rapid adoption of new evidence methodology are reaching over 40,000 cancer patients, receiving over 250,000 chemotherapy treatments annually.

Deconstructing the Three Pillars of Evidence-Based Practice to Facilitate Social Justice Work in Speech Language and Hearing Sciences

2021 ◽  
pp. 130-150
Author(s):  
Reem Khamis-Dakwar ◽  
Melissa Randazzo
Keyword(s):  
Qualitative Research ◽  
Social Justice ◽  
Evidence Based Practice ◽  
Scientific Evidence ◽  
People Of Color ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Systemic Racism ◽  
Cultural Mismatch ◽  
Communication Impairments

This chapter reviews the limitations of the evidence-based practice (EBP) framework adopted by American Speech Language Hearing Association for the field of speech, language, and hearing sciences (SLHS) in addressing systemic racism. The authors argue that a shift from a medically-based EBP model to a pluralistic EBP model would better serve the needs of black, indigenous, people of color (BIPOC) with communication impairments in the current sociopolitical landscape. The authors examine the three pillars of EBP through the lens of social justice work. They describe how the current EBP model limits the development of social justice work in SLHS. They describe the need to refine the EBP model by validating the contribution of qualitative research as scientific evidence, reevaluating the basis of clinical expertise in client-clinician cultural mismatch, and address the importance of integrating policy and culture in consideration of client and family preferences. These transformations are critical in light of the under-representation of BIPOC clinicians in the field of SLHS profession.

scholarly journals Partnership development of the COVID-19 Front Door: a best evidence resource

2021 ◽  
Vol 109 (4) ◽  
Author(s):  
Nancy J. Allee ◽  
Charles P. Friedman ◽  
Allen J. Flynn ◽  
Chase Masters ◽  
Kai Donovan ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Scientific Evidence ◽  
Direct Access ◽  
Evidence Based ◽  
Care Providers ◽  
High Quality ◽  
Front Door ◽  
Partnership Development ◽  
Relevant Evidence ◽  
Meta Analyses

This project describes the creation of a single searchable resource during the pandemic, called the COVID-19 Best Evidence Front Door, with a primary goal of providing direct access to high-quality meta-analyses, literature syntheses, and clinical guidelines from a variety of trusted sources. The Front Door makes relevant evidence findable and accessible with a single search to aggregated evidence-based resources, optimizing time, discovery, and improved access to quality scientific evidence while reducing the burden of frontline health care providers and other knowledge-seekers in needing to separately identify, locate, and explore multiple websites.

Achieving Evidence-Based Practices in Colorectal Surgery

2014 ◽  
Author(s):  
Imran Hassan
Keyword(s):  
Colorectal Surgery ◽  
Evidence Based Medicine ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
The Past ◽  
Hierarchy Of Evidence ◽  
Evidence Based Surgery ◽  
Key Resources ◽  
Based Medicine

The concept of evidence-based medicine (EBM) and evidence-based surgery (EBS) involves combining the best scientific evidence available with the clinician’s judgment while also considering the patient’s needs and preferences. In the past, the practice of colorectal surgery was based on tradition and anecdotal experience from experts rather than scientific rationale. However, the rise of EBM has led to changes in how colorectal surgery is performed. This review discusses the hierarchy of evidence, fundamental principles of EBS, and practicing evidence-based colorectal surgery. Tables review the Oxford Centre for Evidence-Based Medicine revised levels of evidence, four steps of evidence-based surgery, key resources for evidence-based surgery, the “PICO” technique, and the Dindo-Clavien classification system. This review contains 5 tables and 69 references.

Psychotherapy Relationships that Work

2019 ◽  
Keyword(s):  
Evidence Based ◽  
Clinical Expertise ◽  
Clinical Practices ◽  
Definitive Evidence ◽  
The Third ◽  
What Works ◽  
Psychotherapy Relationship ◽  
Patient Values ◽  
Meta Analyses ◽  
And Training

Psychotherapy Relationships That Work is the definitive, evidence-based book on the psychotherapy relationship: what works in general (Volume 1) and what works for particular patients (Volume 2). Each chapter presents definitions, clinical examples, landmark studies, comprehensive meta-analyses, diversity considerations, and training implications and ends with bulleted clinical practices. The third edition of the classic Psychotherapy Relationships That Work features expanded coverage and updated reviews with an enhanced practice focus. The result is a compelling synthesis of best available research, clinical expertise, and patient values that underscores the power of the therapist-client connection.

scholarly journals Perceived attitudes and benefits towards teaching evidence based practice among physiotherapy lecturers at tertiary institutions in South Africa

2009 ◽  
Vol 65 (1) ◽  
Author(s):  
J.M. Frantz ◽  
I. Diener
Keyword(s):  
South Africa ◽  
Mixed Model ◽  
Evidence Based Practice ◽  
Work Load ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Tertiary Institutions ◽  
Mixed Model Approach ◽  
University Departments ◽  
Patient Values

Evidence-based practice (EBP) is gaining momentum in the physiotherapy profession. The main focus of EBP, however, has been in clinical practiceand in the move towards global EBP, very little attention has been given tothe contents of physiotherapy education programs. There is very limitedinformation regarding the attitudes of health professional lecturers, especially physiotherapists, towards the teaching of evidence based practice.The aim of this study was to determine the attitudes of lecturers and use ofevidence in teaching among physiotherapists at tertiary institutions in South Africa. The study employed a within stage mixed model approach. The study population consisted of all physiotherapy lecturers at the 8 training institutions in South Africa. Out of 76 physiotherapy lecturers at the 8 insti-tutions, the response rate to the questionnaire was 47% (35). Respondents identified that teaching EBP depends on personal experience, current literature, and availability of time, current practice patterns and CPD courses. Barriers toincluding evidence in the content of what is being taught were mainly time constraints, accessibility of journals, work-load and knowledge on how to obtain the evidence. Facilitators to including evidence in subject content were adequateresources and a well equipped library, the environment and departmental support/encouragement. Teaching EBPrequires the integration of factors such as research evidence, clinical expertise and patient values. Although the majority of respondents in the current study demonstrated a positive attitude towards teaching EBP, they reported finding it difficult to implement it in practice due to several identified barriers. It can only be to the benefit of lecturers, studentsand patients if university departments create favourable circumstances for lecturers to facilitate teaching of EBP.

scholarly journals The Role of Public Nutrition Research Organizations in the Construction, Implementation and Evaluation of Evidence-Based Nutrition Policy: Two National Experiences in Mexico

Nutrients ◽  
2019 ◽  
Vol 11 (3) ◽  
pp. 594 ◽  
Author(s):  
Juan Rivera Dommarco ◽  
Teresita González de Cosío ◽  
C. García-Chávez ◽  
M. Colchero
Keyword(s):  
Risk Factors ◽  
Policy Design ◽  
Scientific Evidence ◽  
Nutrition Policy ◽  
Evidence Based ◽  
Relevant Evidence ◽  
Nutrition Research ◽  
Nutrition Policies ◽  
Policies And Programs

Malnutrition and poor diet are the largest risk factors responsible for the global burden of disease. Therefore, ending all forms of malnutrition by 2030 is a global priority. To achieve this goal, a key element is to design and implement nutrition policies based on the best available scientific evidence. The demand for evidence-based nutrition policies may originate directly from policymakers or through social actors. In both cases, the role of research institutions is to generate relevant evidence for public policy. The two key objects of analysis for the design of an effective policy are the nutrition conditions of the population and the policies and programs available, including the identification of delivery platforms and competencies required by personnel in charge of the provision of services (social response). In addition, systematic literature reviews about risk factors of malnutrition, as well as the efficacy and effectiveness of policy actions, lead to evidence-based policy recommendations. Given the multifactorial nature of malnutrition, the drivers and risk factors operate in several sectors (food and agriculture, health, education, and social development) and may be immediate, underlying or basic causes. This multilevel complexity should be considered when developing nutrition policy. In this article, we show two models for the evidence-based design of nutrition policies and programs that may be useful to academia and decision makers demonstrated by two examples of policy design, implementation and evaluation in Mexico.

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