While evidence-based medicine may be trumpeted by zealots, managers and politicians, incorporating it into clinical practice is easier said than done. The present article aims to show that it can be achieved and gives some clinical examples to illustrate this. An appendix contains a summary of useful databases and websites ...

Knowledge translation is the process of taking evidence from research and applying it in clinical practice. In this article I will cite some pivotal moments in the history of medicine to highlight the difficulties and delays associated with getting evidence into practice. These historical examples have much in common with ...

The aim of this project was to develop evidence-based guidelines regarding psychosocial aspects of diabetes mellitus in an effort to help the clinician bridge the gap between research and practice. Recommendations address the following topics: patient education, behavioural medicine, and psychiatric disorders of particular relevance to diabetes: depression, anxiety disorders, ...

In this article I will discuss the various definitions of evidence-based medicine (EBM), and summarize the application, criticisms and limitations of EBM. The spectrum of evidence, from pathophysiological inference to randomized controlled trials, will be presented as a mechanism for filtering bias with more rigorous evidence being required when bias ...

Because the landmark trials of lipid-lowering statin drugs excluded patients with very high triglyceride levels, the optimal management of hypertriglyceridemia for atherosclerosis prevention is unknown. The third report of the National Cholesterol Education Program's Adult Treatment Panel (ATP-III) provides a much-needed strategy for managing patients with high triglycerides, based on ...

Many scientific articles are written merely to get something published, neglecting the clinician who would like the medical literature to guide their practice. Evidence-based medicine is expected to help in clinical decision-making. Systematic reviews of the literature followed by a meta-analysis of randomized, controlled trials (RCT) have claimed to represent ...

The use of placebos is the "gold standard" in studies of investigational drugs, and of other medical procedures as well. Several recent trends have suggested the use of placebos in studies of psychotherapy to isolate effective treatment components, and as a basis for establishing lists of empirically supported treatments. Unlike ...

To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine. Incorporating the best evidence into ...

The use of complementary and alternative medicine (CAM) continues to grow in the United States. The Agency for Healthcare Research and Quality has devoted a substantial proportion of the Evidence-based Practice Center (EPC) program to systematic reviews of CAM. Such syntheses present different challenges from those conducted on western medicine ...

The University of Iowa Hospitals and Clinics is a recognized leader in evidence-based practice. Creating organizational excellence in evidence-based practice takes leadership and a committed effort at all levels. Building the capacity, culture, and vision at the organizational and unit levels is needed to promote use of evidence in practice. ...

Both the American Congress of Rehabilitation Medicine and the field of physical medicine and rehabilitation have entered an age of evidence-based rehabilitation. Despite some concerns over the difficulties in applying the methods of evidence-based practice to rehabilitation research, there is little question that we will continue to move in this ...

Systematic reviews form a potential method for overcoming the barriers faced by clinicians when trying to access and interpret evidence to inform their practice. This fourth article in the Evidence-Based Medicine and Healthcare series of the Singapore Medical Journal introduces readers to systematic reviews, outlining why they are important, describing ...

Several recent advances have been made in the evaluation and management of acute lower gastrointestinal bleeding. This review focuses on the management of lower gastrointestinal bleeding, especially acute severe bleeding. The aim of the study was to critically review the published literature on important management issues in lower gastrointestinal bleeding, ...

According to numerous commentators, clinical freedom, the art of medicine, and, by implication, a degree of patient welfare, are threatened by evidence based medicine (EBM). As EBM has developed over the last fifteen years, claims about better evidence for medical treatments, and improvements in healthcare delivery, have been matched by ...

OBJECTIVE: To examine the reasons and search strategies related to physicians' search for evidence and to compare clinician and physician manager approaches. DESIGN: Qualitative analysis of verbatim transcripts of four focus groups in 2002. Study setting. Clinicians and managers in community practices in Southern California. PARTICIPANTS: Pediatricians, family practitioners, and ...

Male infertility affects 10% of couples of reproductive age worldwide, and is treatable in many cases. In addition to well-established etiologies, genetic causes of male infertility are now diagnosed more commonly, as our knowledge of genomic medicine advances. Using principles of evidence-based medicine, this review outlines diagnostic and treatment algorithms ...

In clinical research investigators generalize from study samples to populations, and in evidence-based medicine practitioners apply population-level evidence to individual patients. The validity of these processes is assessed through critical appraisal of published articles. Critical appraisal is therefore a core component of evidence-based medicine (EBM). The purpose of critical appraisal ...

Evidence-based medicine (EBM) is a school of thought that has spread rapidly through medicine in the past 2 decades and is eliciting an increasing interest in Anatomic Pathology and Laboratory Medicine. It has been defined as "the conscientious, explicit, and judicious use of current best evidence in making decisions about ...

OBJECTIVES: To develop French evidence-based recommendations for the structural evaluation of rheumatoid arthritis (RA) in everyday practice. METHODS: A scientific committee selected 10 questions using the Delphi consensus procedure. Evidence-based responses to each question were sought by searching the PubMed and Ovid databases and the abstract databases for the 2002, ...

Eight polyoxypregnane glycosides, marsdenosides A-H, were isolated from the CHCl(3)-soluble fraction of the ethanolic extract of the stem of Marsdenia tenacissima, along with six known glycosides and two known polyoxypregnane aglycones. Three polyoxypregnanes, 12beta-O-2-methylbutyryl-tenacigenin A, 11alpha,12beta-di-O-acetyltenacigenin B, and 11alpha-O-tigloyltenacigenin B were also obtained. Their structures were established on the basis ...

Evidence-based medicine can be summarized as the use of current best evidence in the care of individual patients. When applied to surgical practice, it appears clearly that the concept of evidence-based medicine involves some limitations. To discuss these limits, the author went back over the terms of the evidence-based medicine ...

This guideline is based on the evidence report and accompanying background papers developed by the Southern California Evidence-Based Practice Center. The American College of Physicians nominated this topic to the Agency for Healthcare Research and Quality Evidence-Based Practice Center program as part of a concerted effort to complement the guidelines ...

Evidence-based medicine (EBM) was introduced in the early 1990s. In less than 15 years, it has dramatically changed the way that medicine is practiced and taught. Improvements in informatics and evidence resources have helped overcome some of the initial problems and allowed busy clinicians to use EBM in practice. Many ...

This paper proposes the emergent entanglement theory of homeopathy. This is based on the lack of evidence that choice of homeopathic medicine is important and predicts links between effectiveness of homeopathic medicines and their manufacturers. It predicts that there will be a consistent variation, in terms of outcome, between homeopaths, ...

This ethnographic investigation responds to calls for more social science research on -- versus for or against -- evidence-based medicine (EBM). It centers on the recommendations endorsed, in a set of clinical practice guidelines, by Canadian specialists in the late 1990s for diagnosing diabetes. Empirically, the article mainly relies on ...

There is growing interest in the use of ozone in oral healthcare and the National Institute for Clinical Excellence (NICE) is at present reviewing the evidence for its effectiveness in the management of occlusal and plain surface caries. These are only two of the clinical problems for which ozone can, ...

Most models of choice response time base decisions on evidence accumulated over time. A fundamental distinction among these models concerns whether each piece of evidence is equally weighted (lossless accumulation) or unequally weighted (leaky accumulation). The authors tested a hypothesis derived from A. Heathcote and S. Brown's (2002) self-exciting expert ...

Most aspiring child mental health professionals would support the premise that clinical practice should have a scientific foundation. Why, then, is the implementation of evidence-based practice in child and adolescent psychiatry so difficult? Considering the multiple stakeholders in clinical work, impediments are not surprising. Practitioner delays in implementation of research ...

Some tasks produce a performance advantage for conditions that require the processing of stimuli in two visual fields compared to conditions where single hemifield processing is sufficient. This advantage, however, disappears with practice. Although no definitive evidence yet exists, there are several possible mechanisms that might lead to improved performance ...

Evidence-based medicine has been used to guide healthcare that works, but sometimes, the system delivers care that ends up too little, too much, or just wrong. Participants at a Washington, DC, forum looked recently at what can be done to make a smoother path to the most effective set of ...

Most of the Swedish coastal fisheries are not sustainable from either a social, economic or ecological point of view. We propose the introduction of local fisheries management (LFM) as a tool for restructuring the present large-scale management system in order to achieve sustainability. To implement LFM two questions need to ...

Evidence-based dermatology (EBD) is the application of the principles of evidence-based medicine to the diagnosis and treatment of skin disorders. EBD does not discount the individual dermatologist's clinical judgment. In fact, EBD is based on the interaction of external evidence, the physician's clinical experience, and the patient's experience. Randomized controlled ...

Despite the plethora of information on human gait analysis, its continued use as a clinical tool remains uncertain. Analysis of gait dysfunction has become integral to podiatric medical practice, and, like many specialized fields, it is rapidly changing to meet the needs of the future. Practice in the 21st century ...

PURPOSE OF REVIEW: This review is intended to update readers on recent developments in the evidence-based practice of rheumatology. RECENT FINDINGS: Several new or updated evidence-based practice guidelines have recently emerged. In addition, a large body of evidence upon which to base practice has been addressed in the many systematic ...

This article discusses the hyperventilation theory (HVT) of panic attacks (PAs) proposed by R. Ley in the context of criticisms raised by W. T. Roth, F. H. Wilhelm, and D. Pettit. Their interpretation of HVT is flawed by misunderstanding, misinterpretation, and oversimplification of the complex psychophysiological principles on which current ...

BACKGROUND: Evidence-based guidelines exist to guide inpatient management of chronic obstructive pulmonary disease (COPD) exacerbations, but we do not know how well these recommendations are adhered to. AIMS: The aims of this study were: (i) to examine concordance with evidence based guidelines for inpatient management of COPD and (ii)to address ...

This paper discusses the significance of postmodernism for healthcare practice, specifically the discourse known as 'evidence-based practice'. It considers two texts, both of which present postmodern analyses of contemporary issues. One text presents a deconstruction of evidence-based practice in an attempt to reveal its 'true' nature, which is portrayed as ...

The heel prick is a common procedure, mainly carried out by midwives. This paper argues that midwifery practice is often based on tradition and habit rather than evidence. Firstly, the evidence on which midwives choose a site for heel prick is examined, and it is argued that practice is based ...

The evidence-based medicine (EBM) is a new medical mode that is completely different from traditional experience-based medicine. The core of EBM is that decision-making during clinical practices must be based on objective research results. With the rapid development of modern ophthalmology, some former viewpoints according to experience-based medicine face challenges. ...

From April 1, practice-based commissioning will be operational; meaning practices can request indicative budgets from PCTs. Practices should be incentivised to take on budget deficits. There are concerns that the role of practice-based commissioning as a counterweight to payment by results will reinforce divisions between acute and primary care.

This chapter looks at the evidence base for the practice of fetal medicine and surgery. There is very little good-quality research and much activity is based on case reports and series. However, the philosophy of evidence-based practice is now accepted and new randomized trials are being published in the literature ...

Evidence-based medicine (EBM) has grown in popularity and prominence in the world of orthodox medicine since the 1980s. The focus of this article is on the process of developing practice guidelines (one type of EBM) and its effects upon chiropractic, a profession with a "philosophy, science and art" that is ...

CONTEXT: While current practice guidelines provide an evidence-based approach to management of acute coronary syndromes (ACS), application of the evidence by individual physicians has been suboptimal. OBJECTIVE: To assess and synthesize the evidence regarding optimal management of non-ST-segment elevation ACS (NSTE-ACS). DATA SOURCES: Systematic searches of peer-reviewed publications were performed ...

A lack of high-quality managers and a need for more commissioning muscle will encourage PCTs to merge. They will not be forced to do so by the government. Practice-based commissioning will take some responsibilities away from PCTs, but they will still have a big agenda. Trusts that have merged in ...

Behind the wide acceptance of the idea of "evidence-based medicine" are two curious facts: There are two very different approaches to applying evidence to medicine, and the most commonly cited definition applies to only one of them. This paper describes the problem that we are asking "evidence" to solve and ...

Although evidence-based medicine (EBM) has gained prominence in current medical practice and research, it has also had to deal with a number of problems and inconsistencies. For example, how do clinicians reconcile discordant results of randomized trials or how do they apply results of randomized trials to individual patients? In ...

An old joke states that one need not worry about one's enemies, but may be in danger from one's friends. We review a number of "enemies" and "friends" of evidence-based medicine (EBM). To understand where these enemies and friends have come from, it is important to see how the rise ...

BACKGROUND: The development of acute pain services (APS), education programmes, and protocols assumed an expectation that health care professionals would integrate evidence into everyday practice. However, research evidence into pain management would suggest that this is not the case. APPROACH: Through a review of the literature, the authors aim to ...

Aeromedical decisions take many forms and are made by different groups and individuals. Because of the ubiquity of aviation in the world today, it is important that aeromedical decisions are of the highest quality that can be reasonably achieved. A paradigm of evidence-based aeromedical risk management is reported on here. ...

BACKGROUND: Evidence-based medicine (EBM) is a required component of the Accreditation Council for Graduate Medical Education's Practice-Based Learning core competency. PURPOSE: To compare the efficacy of conferences and small-group discussions in enhancing EBM competency. METHODS: EBM conferences and small-group discussions were integrated into an internal medicine curriculum. EBM competency was ...