Evidence Based Medicine: Definition

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Table of Contents

Introduction
The 5 step process of evidence-based medicine
Defining a clinical question using PICO
Tools of Evidence-based medicine
Conclusion
References

Introduction

Over the years the healthcare sector has greatly been affected by the concept of evidence-based medicine, a concept that relies on research findings. In the healthcare system, evidence-based medicine has been incorporated as an analog. The incorporation of evidence-based design in the healthcare sector dates back to the era of Archie Cochrane, an epidemiologist who insisted on the evaluation of evidence and the importance of practicing medicine based on the evidence attained and reliable studies.

Evidence-based medicine is defined as the “conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” This definition which was developed by Sackett in 1996 was later on found to be difficult to implement this resulted in a more revised definition. The revised definition defined evidence-based medicine as “the integration of the best research evidence with clinical expertise and patient values” (Van Durme and Clark, 2011, p. 6).

The 5 step process of evidence-based medicine

Over the years numerous processes of evidence-based medicine have emerged. Some of these processes have emerged to be complex, time-consuming, and labor-intensive. However, the 5-step evidence-based process has sought to alleviate the complexity and at the same time maintain the appropriate rigor. With the simplicity brought forth by the 5-Step evidence-based process, the practitioner can implement the process in his or her day-to-day, population-based or individual patient.

Defining a clinical question using PICO

The framing of a clinical question using PICO is important as it provides a way forward on the remaining evidence-based process. Defining a clinical question using PICO that stands for Patient, Intervention, Comparison and Outcomes entails various components among them incorporating:

atients: Under the patient category the importance will dwell on what patient population or individual patient is and if there is any special attention to be accommodated to any existing patient subgroups.
Interventions: In this category, the main focus is on the potential interventions that can be of use in that particular clinical situation.
Comparison: In comparison, the intervention chosen as compared to any other intervention that can be added.
Outcome: The outcome entails the result that is appropriate for a particular patient, patient sub-group, or patient population (Bryant and Pace, 2009, p. 43).

Sackett and his colleagues however have simplified the clinical question by dissecting its crucial components to end up with three steps. The first step is defining to whom the question is attributed. The second step is to describe the type of maneuver the patient or population is bound to receive e.g. drug treatment and the last step is to define the probable outcome e.g. better life or the overall cost savings (Greenhalgh, 2010, p. 10).

In the second step, it is not compulsory for surgical operation, drug treatment, or any other intervention to be incorporated as the maneuver could have resulted from a source such as putative carcinogen. In the majority of the clinical cases that pertain to individual patients, the maneuver is considered to comprise of a particular intervention that has occurred due to a health professional.

Tools of Evidence-based medicine

One of the crucial developments that have occurred since the inception of evidence-based medicine is the incorporation of new concepts that help in demonstrating how medicine works. Some of these concepts include confidence intervals, post-hoc power, and power.

Power

The power of study has steadily risen in recent years. In case of a 100% decrease in mortality, a minimal study is bound to have great power and in case of a small expectation in the mortality, then a huge study must be conducted. However, the dilemma concerning whether the statistical value has any clinical relevance has to be addressed.

Confidence intervals

The majority of the pharmacists are knowledgeable about the p-value in regards to an answer being relevant or not in a statistical perspective. This however is not the case at the moment as the p-value is not in use any more thanks to new methods of indicating significance.

The declining use of p-value has resulted in the increased use of confidence interval (CI). The confidence interval is attributed to 95% limits as it is a comprehensive and visual means of indicating confidence suitable for a result. It is largely incorporated in meta-analysis, systematic reviews, and defining NNTs (Wiffen, 2001, p. 41).

Post-hoc power

A question that is becoming common in modern times is whether the observed difference was able to detect the power of the study. Researchers however have pointed out why the posed question is inappropriate and also provided a way forward on placing reliance on CIs.

Conclusion

Evidence-based medicine is regarded as a movement that was incorporated in the medical industry to assist professionals in this industry to make systematic decisions with their patients. This movement is evident in the current profusion of literature as well as the course work that pertains to evidence-based medicine. This profusion of literature as well as the course work that pertains to evidence-based medicine has been regarded as a paradigm shift from the traditional medical paradigm to the modern evidence-based medicine paradigm.

References

Bryant, J. P. and Pace, A. H. (2009). The Pharmacist’s Guide to Evidence-Based Medicine for Clinical Decision Making. MD: American Society of Health-System Pharmacists.

Greenhalgh, T. (2010). How to Read a Paper: The Basics of Evidence-Based Medicine. NJ: John Wiley & Sons Ltd.

Van Durme, J. D. and Clark.N. (2011). Selecting the Best Evidence-Based Medicine Resources. Florida: Florida State University. Web.

Wiffen, P. (2001). Evidence-based pharmacy. Oxon: Radcliffe Medical Press Ltd.

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