Evidence-based medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”
= the process of turning clinical problems into questions and then systematically locating, appraising, and using contemporaneous research findings as the basis for clinical decisions
EBM is the gold standard of clinical practice
Uses information gathered from randomized control trials, case controls, cohort studies, etc.
Meta-analyses and systemic review combine the result of multiple trials into the strongest evidence
Process of EBM
A patient problem occurs
A clinical or preventional question is formulated
Evidence is searched for or produced
The evidence is critically evaluated
The results are integrated into clinical practice
Some clinical practices which changed due to evidence-based medicine
Antiarrhythmic drugs much less used
Thalidomide contraindicated in pregnancy
Grading of evidence shows the quality of evidence which underlies a clinical recommendation
Grade A refers to a recommendation which is the result of many randomized clinical trials
Grade B refers to a recommendation which is the result of one randomized trial, or multiple nonrandomized trials
Grade C refers to a recommendation which is based on expert consensus, without good clinical trials
Classification of evidence shows the strength of the clinical recommendation
A class I recommendation is one where the procedure or treatment is recommended, as the evidence shows that the procedure or treatment is clearly beneficial
A class IIa recommendation is one where the procedure or treatment should be considered, as the evidence shows that the procedure or treatment is beneficial in most cases
A class IIb recommendation is one where the procedure or treatment may be considered, as the evidence shows that the procedure or treatment is beneficial in some cases
A class III recommendation is one where the procedure or treatment is not recommended, as the evidence shows that the procedure or treatment is ineffective or harmful
