EVIDENCE-BASED MEDICINE: Interpreting Studies and Setting Policy**
Section snippets
EVALUATING THE QUALITY OF EVIDENCE
The first principle of systematic reviews is to gather all relevant evidence. Assessments of evidence that do not ensure a comprehensive search of the literature are vulnerable to bias from the selective collection of studies.58 Systematic reviews emphasize explicit search rules that clearly define the inclusion and exclusion criteria for admissible evidence, which keywords were used, which databases (e.g., Medline, Embase) were searched, and the number of articles included and excluded. They
SETTING POLICY
The endpoint of the process described in the previous section is to state what the evidence shows (science), not to prescribe what practitioners or policy makers should do (policy). The additional step of determining appropriate policy involves considerations that reach beyond data, either because firm scientific evidence is lacking or because other factors (e.g., clinical experience, standards of care, resource constraints, cost, public acceptability, politics) enter into the calculation of
SUMMARY
The ascendancy of EBM has been accompanied by a greater awareness of its shortcomings. It is increasingly evident from the cost, length, and difficulty of performing RCTs that studies cannot be launched to address every question in medicine. Good evidence is often lacking in medicine.60, 77 Epistomologists question the very notions of evidence and the suitability of current study designs and measurement tools to research the salient issues of concern to patients and others concerned with
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Cited by (41)
REPRINT OF: Current Methods of the U.S. Preventive Services Task Force: A Review of the Process
2020, American Journal of Preventive MedicineCitation Excerpt :Guidelines developed by an evidence-based approach tend to be based on conclusions supported more by scientific evidence than by expert opinion.1 Efforts are made to link the strength of recommendations to the quality of evidence; to make that linkage transparent and explicit, and to ensure that the review of evidence is comprehensive, objective, and attentive to quality.2 Methods for reviewing the evidence have matured over the years as groups have gained experience in developing evidence-based guidelines.
Therapeutic Decision Making and Planning in Veterinary Dentistry and Oral Surgery
2013, Veterinary Clinics of North America - Small Animal PracticeCitation Excerpt :The concept of evidence-based medicine, or perhaps more appropriately called evidence-based practice, integrates clinicians’ individual expertise with currently available external information sources in an attempt to improve patient outcomes.2 Evidence-based practice is not a new concept: it was used in part by clinicians in ancient Greece.3 Recent interest in evidence-based practice has arisen in part because of justification of the rising costs of human health care.
Evidence-based dermatology
2013, Dermatologica SinicaCitation Excerpt :However, a large number of senior doctors did not have an opportunity to learn EBM in medical schools. The idea of using the evidence for medical practice could be traced back to the time of ancient Greece.1 However, it was not until the postwar period that EBM began to appear in modern medicine.
What Constitutes Evidence for Best Practice?
2008, Journal of Manipulative and Physiological TherapeuticsThymic Epithelial Neoplasms: A Review of Current Concepts Using an Evidence-Based Pathology Approach
2008, Hematology/Oncology Clinics of North AmericaCitation Excerpt :The third step in the systematic EBP approach to information is to evaluate the quality of available evidence. Most studies in pathology are observational studies that have used retrospective case series and retrospective case-control designs; the results obtained by these study designs can be particularly influenced by multiple sources of bias [17–20]. Several schemas have been proposed to “grade” the quality of evidence using four to five classes.
Study Designs for Effectiveness and Translation Research. Identifying Trade-offs
2007, American Journal of Preventive MedicineCitation Excerpt :The demand for public health and healthcare practice and policy to be based on scientific evidence continues to grow, affecting programs, services, and research.1–6
Address reprint requests to Steven H. Woolf, MD, MPH, Department of Family Practice, Medical College of Virginia, 3712 Charles Stewart Drive, Fairfax, VA 22033
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The practice guideline panel on idiopathic thrombocytopenic purpura described in this report was funded by the American Society of Hematology.