Document Detail

Evidence-based medicine for neurosurgeons: introduction and methodology.
MedLine Citation:
PMID:  17033146     Owner:  NLM     Status:  MEDLINE    
Evidence-based medicine is a tool of considerable value for medicine and neurosurgery that provides a secure base for clinical practice and practice improvement, but is not without inherent drawbacks, weaknesses and limitations. EBM finds answers to only those questions open to its techniques, and the best available evidence can be a far cry from scientific truth. With the support and backing of governmental agencies, professional medical societies, the AAMC, the ACGME, and the ABMS, EBM is likely here to stay. The fact that: (1) EBM philosophy and critical appraisal techniques have become fully integrated into the training and culture of our younger colleagues, (2) that maintenance of certification will require individuals to demonstrate personal evidence based practice based on tracking and critical analysis of personal practice outcomes as part of the performance-based learning and improvement competency, and (3) that the progressively growing national healthcare expenditures will necessitate increasing basis of reimbursement and funding based on evidence-based effectiveness and guidelines, all point to the likelihood that complete immersion of neurosurgical practice in EBM is inevitable. This article thoroughly explores the history of EBM in medicine in general and in neurosurgery in particular. Emphasis is placed on identifying the legislative and regulatory motive forces at work behind its promulgation and the role that organized medicine has taken to facilitate and foster its acceptance and implementation. An accounting of resources open to neurosurgeons, and a detailed description EBM clinical decision-making methodology is presented. Special emphasis is placed on outlining the methodology as well as the limitations of meta-analyses, randomized clinic trials, and clinical practice parameter guidelines. Commonly perceived objections, as well as substantive problems and limitations of EBM assumptions, tools, and approaches both for individual clinical practice and health policy design and implementation are explored in detail.
Mark E Linskey
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Publication Detail:
Type:  Historical Article; Journal Article; Review    
Journal Detail:
Title:  Progress in neurological surgery     Volume:  19     ISSN:  0079-6492     ISO Abbreviation:  Prog Neurol Surg     Publication Date:  2006  
Date Detail:
Created Date:  2006-10-11     Completed Date:  2007-05-30     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0076033     Medline TA:  Prog Neurol Surg     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  1-53     Citation Subset:  IM    
Department of Neurological Surgery, University of California, Irvine and UCI Medical Center, Orange, CA, USA.
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MeSH Terms
Decision Making
Evidence-Based Medicine / history*,  methods
Health Policy
History, 20th Century
History, 21st Century
Meta-Analysis as Topic
Neurosurgical Procedures / history*
Practice Guidelines as Topic
Professional Practice
Randomized Controlled Trials as Topic / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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