Today, more attention is paid to evidence-based medicine (EBM) as it is argued to be effective way to treat all health problems and to contribute significantly to development of medical science. Evidence-based medicine is modernization of old principles and practices; it is a fresh look on the old problems and challenges. Evidence-based medicine is defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”.
(Ebell, 1998) The EBM process encompasses the following steps: to raise a clinical problem or issue; to construct a clinical question; to select proper resources for conducting search; to evaluate the validity of evidence; to integrate the evidence with expertise; and to evaluate the performance with the patient. (Clark, p. 4) Some researchers argue that the EBM is able to provide necessary changes and modernization in teaching, doing research and practicing. However, Ebell cites Sackett who argues that evidence alone will fail to provide effective care and treatment.
Thus, the EBM is a complex process that embraces prognosis, evidence, diagnosis, meta-analysis, etc. Moreover, the EBM should be combined with clinical expertise and practice. For example, knowledge of the patient and his family, expertise in physical examination and history, and relation with the patient are equally important for successful treatment outcomes. (Ebell, 1998) The positive moment is that the EBM offers distortion from old traditions and dogmas meaning that physicians are provided with fresh methods of treatment and diagnosis.
The EBM is patient-oriented meaning that the physician pays thorough attention to symptoms, signs, quality of life and mortality. For example, Ebell stresses that “taking an evidence-based approach to the care of patients is an intellectually exciting style of practice, which leads you down a path of exploration and lifelong learning”. (Ebell, 1998) He means that physician is provided with necessary knowledge when and how to adopt new therapies, treatment methods and tests, when to look for the clinical questions, etc.
Clark provides evidence pyramid placing the elements in the following order: animal research, case series, case control studies, cohort studies, randomized controlled trial, systematic review and meta-analysis. (Clark, p. 4) The EBM focuses on the ability to ask the right questions and to find the right solutions. Further, the EBM suggests that treatment decisions depend on the prognosis that is argued to be important factor. Prognosis affects the choice of treatment therapy, what test is ordered, when the patient will be allowed to return for follow-up.
Prognosis studies are often cohort studies used to identify prognostic factors and additional biases. Meta-analysis is effective in resolving medical controversies and challenges. Moreover, it offers alternative for old treatment therapies, for designing future studies and for identifying study characteristics. Meta-analysis as a social science emerged in the middle of the 1970s. Today, a number of meta-analyses is dramatically growing. Finally, decision analysis plays also important role in the EBM.
In the 1920s Lee Lusted proposed decision analysis as a method for medical research, and the method was firstly applied in 1967 by Henschke. Decision analysis helps to discard expensive and time-consuming trials. Generally, decision-analysis is used in complex and high-stake decisions that suggest uncertainty. (Ebell, 1998) Summing up, evidence-based medicine promotes evidence as the key to finding the best available treatment for the patient.
The EBM helps to address certain limitations of the medical field and to have modernized medical literature. The EBM ensures effective communication with consultants, the best use of informational sources and avoiding the pitfalls of clinical decision-making.
References
Clark, Nancy. (2009). Intro to Evidence Based Medicine Resources. Power Point Presentation. Ebel,, Mark H. (1998). An Introduction to Information Mastery. Retrieved January 15, 2009, from http://www. poems. msu. edu/InfoMastery/