EVIDENCE BASED MEDICINE – CLOSER TO PATIENTS OR SCIENTISTS? pdf

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. 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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 1 Designing, Conducting and Reporting Randomised Controlled Trials: A Few Key Points 1 Hamidreza Mahboobi, Tahereh Khorgoei and Neha Bansal Chapter 2 Innovating Medical Knowledge: Understanding Evidence-Based Medicine as a Socio-Medical Phenomenon 11 Maya J. Goldenberg Chapter 3 Twenty Lessons to Incorporate EBM Concept and Practices into Medical Education 29 Madhur Dev Bhattarai Chapter 4 A Post-Structuralist View of Evidence-Based Medicine (EBM) 55 Brian Walsh Chapter 5 Information Mastery – Changing the Paradigm of Patient Care with Patient-Oriented Evidence That Matters (POEM) 79 Shepard Hurwitz, David Slawson and Allen Shaughnessy Chapter 6 Evidence Based Information Prescription (IPs) in Developing Countries 89 Vahideh Zarea Gavgani Chapter 7 Changing Attitudes in Obstetrics and Gynecology – How Evidence Based Medicine is Changing Our Practice? 99 Hesham Al-Inany and Amr Wahba Chapter 8 Evidence-Based Cervical Cancer Screening: The Modern Evolution of the Pap Smear 117 Justin Lappen and Dana R. Gossett VI Contents Chapter 9 Evidence-Based Medicine – Perspectives of a Community-Based Pediatrician 139 Richard Haber Chapter 10 EBM in Clinical Practice: Implementation in Osteopathic Diagnosis and Manipulative Treatment for Non-Specific Low Back Pain Patients 147 Rafael Zegarra-Parodi, Jerry Draper-Rodi, Laurent Fabre, Julien Bardin and Pauline Allamand 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 to the best benefit of the patient. It has transformed the pathophysiological approach to the outcome approach of today’s treatments. Disease- oriented to patient- oriented medicine. And, for some, daily medical practice from patient oriented to case oriented medicine. Evidence has changed the paternalistic way of medical practice. And gave room to patients, who show a tendency towards partnership. 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 [...]... hospital Australasian Medical Journal 2010;1(2):180-2 10 Evidence Based Medicine – Closer to Patients or Scientists? Mahboobi H, et al Evidence- based medicine for medical students Aust Med J 2010;1:1903 Mahboobi H, et al Have we something to replace evidence based medicine? Annals of Cardiac Anaesthesia 2011;14(3):246 Mahboobi H, et al Mentorship in Medical Students researches Electronic Physician... is a sort of obviousness to EBM that has prompted critics to charge EBM with offering “nothing new” (Benitez-Bribiesca, 1999): 12 Evidence Based Medicine – Closer to Patients or Scientists? Evidence based medicine, ” one chemist said to me, “What other kind of medicine could there possibly be?” and a consultant physician said gruffly: “We have always practiced evidence based medicine (Hope, 1995).1... clinical categories such as prognosis, aetiology, and diagnosis (Centre for Evidence- Based 18 Evidence Based Medicine – Closer to Patients or Scientists? Medicine, 2006; Sackett et al., 1997) At the bottom of each of these clinical scales is evidence obtained from case reports and personal experience The logic behind the ranking of evidence is simple: randomization is the best method for distinguishing... centred care” (Borgmeyer, 2005), and evidence- based patient choice” (Hope, 1996; Edwards & Elwyn, 2001; Parker, 2001) The literature also includes an effort to overcome (or possibly deny) the evidence/ judgment divide (Downie et al., 2000) 16 Evidence Based Medicine – Closer to Patients or Scientists? and what qualifies as the most rigorous methods of empirical research Rather than a revolution or paradigm... something new to medicine The critics who deny this claim likely do so because they misunderstand EBM to be asking for no more than rigorous empirical research in medicine But the term evidence based amounts to much more While the evidence based approach certainly does call for rigorous empirical research in medicine, this call is accompanied by novel accounts of what counts as valid evidence 2 Among... (1999) The movement for improved quality of health care New England Journal of Medicine 340, 6, (February 1999), pp 488-492, 0028-4793 Borgmeyer, C (2005) Guideline showcases AAFP’s commitment to evidence- based, patientcentered care Annals of Family Medicine, Vol 3, No 4, (July-August 2005), pp 378380, 1544-1709 24 Evidence Based Medicine – Closer to Patients or Scientists? Britton, A., McKee, M., Black,... for Health Care Research and Quality, n.d.) This move towards 4 Relman later lamented that this “third revolution” was never realized due to lack of government initiative by any of the US governmental administrations elected since the 1988 writing of his editorial (Relman, 2009) 22 Evidence Based Medicine – Closer to Patients or Scientists? accountability is supposed to serve as a rational basis for... investigators with relationships or experience with a subject form expectations with respect to treatment outcomes that make them less able to produce objective reviews of scientific evidence than non-experts trained in critical appraisal of evidence (Oxman & Guyatt, 1993) A logical deductive framework for interpretation of evidence is therefore argued to be needed if we are to avoid practicing medicine based. .. On evidence and evidence- based medicine: Lessons from the philosophy of science Social Science and Medicine, Vol 62, No 11 (June 2006), pp 2621-2632, 0277-9536 Gray, J A M (1997) Evidence- Based Healthcare: How to Make Health Policy and Management Decisions Churchill Livingstone, 978-0443057212, London Greenhalgh, T (1999) Narrative based medicine: Narrative based medicine in an evidence based world... Journal of Medical Ethics, Vol 21, No 5, (October 1995), pp 259-260, 0306-6800 Hope, T (1996) Evidence Based Patient Choice, King’s Fund Publishing, 9781857171297, London 26 Evidence Based Medicine – Closer to Patients or Scientists? Horner, R H., Carr, E G., Halle, J., McGee, G., Odom, S., & Wolery, M (2005) The use of single-subject research to identify evidence- based practice in special education Exceptional . EVIDENCE BASED MEDICINE – CLOSER TO PATIENTS OR SCIENTISTS? Edited by Nikolaos M. Sitaras Evidence Based Medicine – Closer to Patients or Scientists? Edited. Australasian Medical Journal. 2010;1(2):180-2. Evidence Based Medicine – Closer to Patients or Scientists? 10 Mahboobi H, et al. Evidence- based medicine for medical students. Aust Med J. 2010;1:190- 3 currently called evidence- based medicine Evidence Based Medicine – Closer to Patients or Scientists? 4 6. Evidence supporting randomised trials Enough evidence exists that a successful RCT is