13. Evidence-based medicine and prevention

From greek.doctor
  • 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