EVIDENCE BASED MEDICINE – CLOSER TO PATIENTS OR SCIENTISTS? Edited by Nikolaos M Sitaras Evidence Based Medicine – Closer to Patients or Scientists? Edited by Nikolaos M Sitaras Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work Any republication, referencing or personal use of the work must explicitly identify the original source As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher No responsibility is accepted for the accuracy of information contained in the published chapters The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book Publishing Process Manager Martina Blecic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published April, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechopen.com Evidence Based Medicine – Closer to Patients or Scientists?, Edited by Nikolaos M Sitaras p cm ISBN 978-953-51-0504-6 Contents Preface IX Chapter Designing, Conducting and Reporting Randomised Controlled Trials: A Few Key Points Hamidreza Mahboobi, Tahereh Khorgoei and Neha Bansal Chapter Innovating Medical Knowledge: Understanding Evidence-Based Medicine as a Socio-Medical Phenomenon 11 Maya J Goldenberg Chapter Twenty Lessons to Incorporate EBM Concept and Practices into Medical Education Madhur Dev Bhattarai Chapter A Post-Structuralist View of Evidence-Based Medicine (EBM) Brian Walsh 29 55 Chapter Information Mastery – Changing the Paradigm of Patient Care with Patient-Oriented Evidence That Matters (POEM) 79 Shepard Hurwitz, David Slawson and Allen Shaughnessy Chapter Evidence Based Information Prescription (IPs) in Developing Countries Vahideh Zarea Gavgani Chapter Chapter 89 Changing Attitudes in Obstetrics and Gynecology – How Evidence Based Medicine is Changing Our Practice? Hesham Al-Inany and Amr Wahba Evidence-Based Cervical Cancer Screening: The Modern Evolution of the Pap Smear 117 Justin Lappen and Dana R Gossett 99 VI Contents Chapter Chapter 10 Evidence-Based Medicine – Perspectives of a Community-Based Pediatrician 139 Richard Haber EBM in Clinical Practice: Implementation in Osteopathic Diagnosis and Manipulative Treatment for Non-Specific Low Back Pain Patients Rafael Zegarra-Parodi, Jerry Draper-Rodi, Laurent Fabre, Julien Bardin and Pauline Allamand 147 Preface Evidence-based, in general, is the term that characterizes many decision making processes in modern society and science From justice to politics To medicine Evidence-based medicine (EBM) was introduced transformed the pathophysiological approach treatments Disease- oriented to patient- oriented practice from patient oriented to case oriented paternalistic way of medical practice And tendency towards partnership to the best benefit of the patient It has to the outcome approach of today’s medicine And, for some, daily medical medicine Evidence has changed the gave room to patients, who show a The only certain in medical science is uncertainty Therefore, medicine relies more and more to statistics But the significant does not always dignify the essential As William Osler quoted, “if it was not for differences among individuals, the Art of Medicine could be Science in addition” Statistical significance is not enough Importance is hidden under the clinical influence of evidence And according to Gertrude Stein, “for a difference to be different it must make a difference” Although EBM has introduced a different way of thinking in the day to day medical practice, there is plenty of space for implementation and improvement And the dispute remains: should “Evidence-based Medicine” be the new “Faith-based Medicine”? Dr Nikolaos M Sitaras Athens University, Medical School, Department of Experimental Pharmacology, Athens, Greece 152 Evidence Based Medicine – Closer to Patients or Scientists? as assessed with palpation with bone mineral density (BMD) among LBP and healthy patients They observed that lumbar segments with palpated rotational asymmetry had higher mean BMD T scores than lumbar segments with no asymmetry (p=0.002) Lumbar segments with anterior motion restriction had higher mean BMD T scores than lumbar segments with no motion restriction (p=0.03) LBP patients demonstrated higher regional mean lumbar BMD T scores than those without LBP (p