PURPOSE: To provide an overview of evidence-based medicine (EBM) in relation to radiology and to define a policy for adoption of this principle in the European radiological community. RESULTS: Starting from Sackett's definition of EBM we illustrate the top-down and bottom-up approaches to EBM as well as EBM's limitations. Delayed ...

This article aims to (1) describe the steps in the development of a meta-analysis, (2) discuss the use of meta-analysis in developing an evidence base for case management practice, and (3) provide some basic guidelines for evaluating the meta-analysis. Evidence-based practice (EBP) is a mandate for all healthcare professionals, regardless ...

OBJECTIVES: Our objective is to highlight a few surgical practices that are not based on evidence but are still taught in surgical education, and to assess our experience with these practices. DESIGN: We identified 3 practices (clamping of nasogastric tubes before removal, bowel preparation before elective colon resection, and elective ...

OBJECTIVE: To evaluate the benefits and limitations of randomized controlled trials (RCTs), clinical practice guidelines (CPGs), and clinical judgment in the management of osteoporosis. METHODS: A review was conducted of the English-language literature on the origins and applications of RCTs, CPGs, evidence-based medicine, and clinical judgment in the management of ...

Proponents of evidence-based medicine (EBM) provide the "hierarchy of evidence" as a criterion for judging the reliability of therapeutic decisions. EBM's hierarchy places randomized interventional studies (and systematic reviews of such studies) higher in the hierarchy than observational studies, unsystematic clinical experience, and basic science. Recent philosophical work has questioned ...

With the increasing prominence of the notions of "recovery" and "recovery-oriented practice," practitioners, program managers, and system leaders are increasingly asking about the relationship between "evidence-based practices" and recovery. After reviewing the concepts of recovery from mental illness, being in recovery with a mental illness, recovery-oriented care, and evidence-based medicine, ...

The management of advanced non-small-cell lung cancer (a-nsclc) is currently undergoing one of its rare paradigm shifts. Just as the nihilism of the 1970s gave way to the empiricism of the 1980s and 1990s, so the current decade has seen the first truly rational therapies based on informed design. In ...

One could be forgiven for thinking that the only road to evidence-based clinical practice is the application of results from randomised controlled trials (or systematic reviews of such). By contrast, single-subject designs in the context of evidence-based clinical practice are believed by many to be strange bedfellows. In this paper, ...

The Leapfrog Group aims to improve patient safety and outcomes in hospitals through promoting the routine use of evidence-based medicine (EBM) practices such as the perioperative use of beta-blocker medications during elective abdominal aortic aneurysm (AAA) repair. The emergence of recent evidence, however, has sparked debate about the benefits of ...

BACKGROUND: Health care managers are urged to adopt evidence-based management as a new and exemplary decision-making process. Three assumptions underlie advocacy for the practice: (a) Decisions based on evidence will yield anticipated results, (b) these results are generalizable across organizations, and (c) evidence is objective and context free. PURPOSE: This ...

An evidence-based practice (EBP) movement is underway in social work that promises to change the very nature and methods of clinical education and practice. Growing demands for accountability, increasingly sophisticated clients, heightened threats of malpractice liability, and a host of additional factors arising within and external to the profession have ...

Evidence-based management is emerging in the helping professions in response to heightened demands for public accountability and organizational performance. This paper defines evidence-based management and reviews its origins in the health care and business sectors and its recent incorporation into the social work profession. A case study describes the efforts ...

The research presented here reports on sustainability of the practices within the National Implementing Evidence Based Practices Project for people with serious mental illness. Forty-nine sites completed the initial 2-year implementation phase and were the focus of our study. Our aims were to discern the number of sites that sustained ...

Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature ...

The vasculitides associated with antineutrophil cytoplasmic antibodies (ANCAs) present to and are managed by a wide spectrum of physicians, reflecting the multi-organ nature of the conditions. Treatment strategies for these primary inflammatory vascular diseases have varied based on the outcomes of different clinical trials and practice reviews. The individual drugs ...

In developing the evidence-based Enteral Nutrition Practice Recommendations, the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) formed a task force to address the many aspects of safety in the delivery and provision of enteral nutrition support. This recently published document provides healthcare professionals with recommendations that are derived from ...

The use of magnesium for prevention of cerebral palsy in preterm infants has been a pressing clinical question for some time. This issue was recently brought to the forefront again after the completion of a large trial conducted by the Maternal-Fetal Medicine Units Network and published by Rouse et al ...

Tonsillectomy is one of the most common surgical procedures, and nearly two thirds of those performed annually in England and Wales are paediatric cases. Over the years the associated complications have not changed and the indications continue to be controversial. This article looks at the evidence base for current UK ...

BACKGROUND: Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel ...

The exact incidence of paediatric primary spontaneous pneumothorax (PSP) is unclear, although PSP incidence in the general population is between 6 and 18 per 100,000. PSP has been reported throughout the paediatric age range. A potential genetic predisposition for familial cases has been recently identified. Whilst there is universal consensus ...

The statistical research on bladder stones conducted by Paris urologist Jean Civiale in the early 19th century provided historical roots for evidence-based medicine. Translations of original documents by Civiale describing his work on treating bladder stones, and the discussion by members of the Paris Academy of Sciences that commented on ...

OBJECTIVES: To elaborate a how-to-use abatacept material intended to help physicians in the management of patients with inflammatory diseases treated with this drug in routine practice. METHODS: 1) Selection of the relevant domains by a rheumatologists' panel; 2) Search for published evidence in each domain; 3) Elaboration of the clinical ...

Due to the exponential increase in the quantity and quality of podiatric medicine-related research during the past decade, podiatric physicians are inundated with an insurmountable volume of research relevant to clinical practice. Systematic reviews can refine this literature by using explicit, rigorous, and reproducible methods to identify, critically appraise, and ...

OBJECTIVE: Studies examining therapists' attitudes toward evidence-based practices, which have at times become conflated with "manualized treatments," have indicated a number of concerns regarding perceived inflexibility, a lack of attention to the therapeutic alliance between provider and client, and a lack of emphasis on clinical judgment. This investigation examined the ...

The Global Alliance to Improve Outcomes in Acne published recommendations for the management of acne as a supplement to the Journal of the American Academy of Dermatology in 2003. The recommendations incorporated evidence-based strategies when possible and the collective clinical experience of the group when evidence was lacking. This update ...

BACKGROUND: Since the term "evidence-based medicine" (EBM) first appeared in the scientific literature in 1991, the concept has had considerable influence in many parts of the world. Most professional societies, the public,and funding agencies have accepted EBM with remarkable enthusiasm. The concept of evidence-based practice is now applied in management, ...

A sequential, evidence-based bundle of 10 best bedside practices serves as a template for professional practice and becomes a shared language and standards for interdisciplinary team communication and development. Improvements in registered nurse leadership skill levels, corresponding clinical outcomes, and patient and staff satisfaction have been realized through implementation of ...

Early discharge from the maternity hospital is almost becoming the rule: it is not clear if this practice actually increases the rate of newborn rehospitalization, but it surely poses some problems for jaundice management, since hyperbilirubinemia is the most frequent reason for hospital readmission. Available guidelines for jaundice management and ...

This article describes the process of incorporating evidence into policies and procedures, resulting in the establishment of evidence as a basis for safe practice. The process described includes use of the Rosswurm and Larrabee model for change to evidence-based practice. The model guided the work of evidence-based practice mentors in ...

The objective of this study is to update evidence-based best practice guidelines for specialized facilities and resources for weight loss surgery (WLS). We performed systematic search of English-language literature on WLS and facilities, equipment, and resources published between April 2004 and May 2007 in PubMed, MEDLINE, and the Cochrane Library. ...

Seizures in the newborn period are common and frequently indicate serious underlying brain injury. Although accumulating evidence suggests that they may impair brain development, there are currently no evidence-based guidelines for evaluation and management of neonatal seizures. In this review, we will address some of the current controversies facing child ...

Chronic diseases with a lifestyle-based aetiology currently make up a significant proportion of primary care consultations, but management often falls between the demands of public and clinical health. A modified clinical approach, based around the concept of "lifestyle medicine", helps fill the gap by adding behavioural, motivational and environmental skills ...

Agents that inhibit epidermal growth factor receptor (EGFR) signaling are associated with dermatologic effects, primarily a papulopustular rash. These effects are generally mild-to-moderate in severity, but may negatively affect quality of life and lead to treatment delays, dose modifications, and discontinuation of therapy. These findings underscore the need for effective ...

The six competencies of the Accreditation Council for Graduate Medical Education include the lifelong learning skills of evidence-based medicine (EBM)/information mastery. We developed and tested an Objective Structured Clinical Examination (OSCE) station that would measure these skills in family medicine residents. This EBM OSCE station is a 30-minute station within ...

BACKGROUND: Evidence supports dietary modifications in the management of gout. Despite this, the degree of implementation of this evidence by nutrition professionals and rheumatologists and those affected by gout is unknown. The present study aimed to compare usual dietary practices of patients with gout to evidence for dietary management of ...

Human bite injuries are a common injury, roughly accounting for around 0.1% of attendances to Emergency Medicine departments. Morbidities associated with such injuries are legion. Of paramount importance is the potential for infection of the wound site, both bacterial and viral. A retrospective 4-year review of 3136 case notes was ...

Very long chain acyl-CoA dehydrogenase (VLCAD) deficiency is a disorder of oxidation of long chain fat, and can present as cardiomyopathy or fasting intolerance in the first months to years of life, or as myopathy in later childhood to adulthood. Expanded newborn screening has identified a relatively high incidence of ...

The aim of this study was to evaluate a novel patient-held manual designed to reduce the evidence-practice gap in chronic obstructive pulmonary disease (COPD). The intervention manual contained summaries of research evidence. It was developed using current best practice for patient information materials and designed to cause discussion of evidence ...

Patients have the right to make decisions regarding their medical care, including the right to refuse treatment or to issue do-not-resuscitate orders as part of an advance directive. Health care providers must comply with the patient's wishes regarding care. Automatic suspension or continuation of a do-not-resuscitate order for a patient ...

We should not assume that medieval physicians did not take pains to found their practice upon evidence. Academic physicians at Montpellier ca. 1300 were cautious about accepting textbook claims for the powers of drugs, and tried to verify each drug's physiological effects before using it; yet they were also flexible, ...

SUMMARY: The use of evidence has become a force in American medicine to improve the quality of health care. Funding decisions from payers will demand studies with high-level evidence to support many of the costly interventions in medicine. Plastic surgery is certainly not immune to this national tidal wave to ...

This essay is a "prespective"-the musings of a soon-to-be MD/PhD student on various aspects of the practice of medicine, written just before he began his training in the fall of 2008. It discusses some of the issues-genomic medicine, healthcare reform, and evidence-based medicine-that will likely impact medicine and medical care ...

Providing evidence-based care to patients involves turning a clinical problem into an answerable question, systematically searching for the best evidence relevant to the question, critically appraising that evidence, and, finally, using the evidence as the basis for clinical decisions to solve the problem. While the overload of medical information today ...

BACKGROUND: The philosophy of evidence-based medicine (EBM) was introduced in the early 90s as a new approach to the practice of medicine, using the best available evidence to make decisions about health care. Despite ongoing controversy, EBM has developed enormously and physicians' attitude towards it is generally positive. Nevertheless, in ...

Evidence-based medicine (EBM) is defined as using the best available evidence for managing patients in daily healthcare practice. Although this approach has been applied successfully in many medical fields, it has not been addressed fully in the radiological discipline in general and nuclear medicine in particular. In this review, the ...

Because "evidence" is at issue in evidence-based medicine (EBM), the critical responses to the movement have taken up themes from post-positivist philosophy of science to demonstrate the untenability of the objectivist account of evidence. While these post-positivist critiques seem largely correct, I propose that when they focus their analyses on ...

Despite being the central concept to evidence-based medicine (EBM), evidence remains an elusive and controversial notion. Ongoing debates regarding evidence primarily serve to confuse and obfuscate. Examination of the nature of medical decision making without any appeal to evidence reveals a more complete understanding of the optimal practice of clinical ...

Central to Don Bates's thesis about the role of medicine in the Scientific Revolution is the Greek concept of psyche. This article explores this connection in relation to Galen. Paradoxically, Galen declined to commit himself to any particular view of the soul's real nature, and held aloof from both materialist ...

BACKGROUND: Evidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care ...

The evidence-based medicine (EBM) movement was established to combat capricious reasoning in clinical care, particularly arguments from authority. Critique of authority and appraisal of evidence remain EBM's core values and should be revisited in this era of EBM's maturity and influence. We are now faced with a new form of ...