tailieunhanh - Chapter 003. Decision-Making in Clinical Medicine (Part 9)

Evidence-Based Medicine The "art of medicine" is traditionally defined as a practice combining medical knowledge (including scientific evidence), intuition, and judgment in the care of patients (Chap. 1). Evidence-based medicine (EBM) updates this construct by placing a much-greater emphasis on the processes by which the clinician gains knowledge of the most up-to-date and relevant clinical research. The key processes of EBM can be summarized in four steps: 1. Formulating the management question to be answered 2. research data Searching the literature and on-line databases for applicable 3. and relevance Appraising the evidence gathered with regard to its validity 4. Integrating this appraisal with knowledge about the unique aspects. | Chapter 003. Decision-Making in Clinical Medicine Part 9 Evidence-Based Medicine The art of medicine is traditionally defined as a practice combining medical knowledge including scientific evidence intuition and judgment in the care of patients Chap. 1 . Evidence-based medicine EBM updates this construct by placing a much-greater emphasis on the processes by which the clinician gains knowledge of the most up-to-date and relevant clinical research. The key processes of EBM can be summarized in four steps 1. Formulating the management question to be answered 2. Searching the literature and on-line databases for applicable research data 3. Appraising the evidence gathered with regard to its validity and relevance 4. Integrating this appraisal with knowledge about the unique aspects of the patient including preferences Steps 2 and 3 are the heart of EBM as it is currently used in practice. The process of searching the world s research literature and appraising the quality and relevance of studies thus identified can be quite time-consuming and requires skills and training that most clinicians do not possess. Thus the best starting point for most EBM searches is the identification of recent systematic overviews of the problem in question Table 3-3 . Table 3-3 Selected Tools for Finding the Evidence in Evidence-Based Medicine Name Descriptio n Web Address Availab ility Eviden ce-Based Medicine Reviews Comprehe nsive electronic database that combines and integrates 1. The Cochrane Database of Systematic Reviews 2. ACP Journal Club 3. The Database of Abstracts of Reviews of Effectiveness http www. Subscrip tion required available through medical center libraries and other institutions Cochra Collection http www. cochrane. org .