Evidence-Based Medicine Working Group. (1992). Evidence-Based medicine: A new approach to teaching the practice of medicine. JAMA, 268 (17), 2420-2425.
Evidence-based medicine is a new paradigm that places emphasis on new skills for physicians that include: performing efficient in performing literature searches and applying formal rules of evidence in examining clinical literature (critical appraisal exercise, which applies when authority is not trusted, the answer unknown, or there are divergent opinions). This is in addition to traditional clinical skills, understanding patients' emotional needs
This represents a shift from old processes used by physicians such as intuition, unsystematic clinical experience, and pathophysiologic rationale. Discusses Kuhn's notions of paradigms and paradigm shifts: paradigms are ways of viewing the world that define the problems addressed and the range of admissible evidence that can be used to solve them. Paradigm shifts occur when the old paradigm does not answer problems and a new paradigm in line with the evidence replaces it.
Paradigm shifts in medicine developed due to randomized controlled trials (RCTs; rare up until 30 years before this article), applications of RCTs in diagnostic tests and surgical therapies, meta-analysis usage, profusion of articles published and their structure, practice guidelines, updated textbooks that review the literature.
The former paradigm is characterized by: 1) Using unsystematic clinical observations to build knowledge, 2) believing that understanding the basic pathology of disease is a guide for practice, 3) medical training and common sense allow the physician to evaluate the efficacy of medical treatments, 4) clinical experience and content expertise are sufficient to generate valid guidelines for clinical practice, 5) authority and expert opinions.
The new paradigm is characterized by: 1) understands the value of clinical experience but experiences and observations should be recorded systematically and evaluated for biases and be replicable in other settings, 2) studying pathophysiology and disease are necessary but not sufficient to guides and predictions made without empirical evidence may be flawed, 3) understanding the rules of evidence is required to evaluate the literature concerning causes, prognoses, tests, and treatment strategies, 3) regularly updating the literature and reading it keeps the process current, 4) on evidence.
Methodological criteria 1) diagnosis test applied to appropriate sample, 2) random assignment to treatment conditions and dropouts accounted for, 3) review articles determined explicitly.
Misinterpretations: 1) Ignores clinical intuition and experts- answer no, and expertise is developed by this method, intuitions are tested, 2) understanding pathophysiology plays no part- answer, it is necessary for interpretation of observations and evidence, 3) ignores standard aspects of training such as physical exam- no these provide much information and are empirically evaluated.
Barriers to teaching 1) topic threatening 2) it's work! 3) lack of evidence for some questions 4) people find change hard.
Barriers to practice 1) lit not there 2) economic issues 3) time constraints.
Evidence for effectiveness -at time of paper no long-term studies; short-term studies indicate evidence-based trainees more up-to-date on HTN guidelines than traditional
Smith, C.G., Herzka, A.S., & Wenz, J.F. (2004). Searching the medical literature. Clinical Orthopaedics and Related Research 421, 43-49.
MEDLINE
MEDLINE from the National Library of Medicine (NLM) indexes 4498 journals, whereas there are 40, 000 medical journals world-wide. Medline became free (6-26-97) and more leading to the misconception that searching was easy -- the authors report that this is a skill that takes practice and offer advice.
MEDLINE interfaces are Gateway (access to MEDLINE [1966-present]; oldMEDLINE [1958-1965]; and PreMEDLINE [still in process]) and PUBMED (MEDLINE and PreMEDLINE). These NLM indexes use MeSH (medical subject headings) vocabulary. Using more descriptors reduces error rates. NLM interfaces are not only access points; commercial sources also provide interfaces with own search methods and tutorials
Text word searching looks for text anywhere in articles, but matches letter sequence in the search and does not search by content. Can use all possible terms separated by Boolean "OR" operator will reduce this issue.
Subject word searchers are arranged in a MeSH tree from greatest generality to greatest specificity. You do not need to specify all forms for a subject, spellings, or synonyms. A problem is that articles indexed before a term was introduced are indexed under the closest related topic and not the term.
Search subject terms involves making a question, breaking it down in to conceptual parts, accessing MeSH database, entering in each concept, selecting LINKS to the right of the term wanted. Links choices PubMed (will run search) and NLM MeSH database (gives additional indexing info and displays tree)
Automatic explosion occurs when a broad term is used narrower related terms will be searched. Can turn off by clicking "Restrict Search to Major Topic Headings" and "Do not explode this term." Other techniques can be found in tutorials listed in Table One
By entering a term and selecting LIMITs link one can search select fields,...
Ebm Evidence-based practice is a fairly recent paradigm in medicine that places emphasis on applying new skills for healthcare workers such as nurses and physicians that include performing efficient literature searches and applying formal rules of evidence in examining the clinical literature in order to find the best answer to a problem (Evidence-Based Medicine Working Group, 1992). These skills are in addition to traditional clinical skills and understanding patients' emotional needs.
. Even when the child in a home where DV occurs is not physically harmed, most of the time, these children know about the violence. As a result, they may experience emotional and behavior problems (The Domestic Violence…, N.d.). A victim of DV needs to be reminded: She is not alone. She is not at fault. Help is available. In The physician's guide to domestic violence, P.R. Salber and E. Taliaferro (N.d.). about stress
Fault: An Alternative to the Current Tort-Based System in England and Wales The United Kingdom statistics regarding claims THE NATIONAL HEALTH SYSTEM OBSTACLES TO DUE PROCESS THE CASE FOR REFORM THE REGULATORY ENVIRONMENT THE RISING COST OF LITIGATION LORD WOOLF'S REFORMS MORE COST CONTROLS THE UNITED STATES PAUL'S PULLOUT THE INSURANCE INDUSTRY TORT REFORM IN AMERICA FLEEING PHYSICIANS STATISTICS FOR ERROR, INJURY AND DEATH THE CALL FOR REFORM IN 2003: A FAMILIAR REFRAIN THE UNITED STATES SITUATION, IN SUMMARY NEW ZEALAND CASE STUDIES THE SWEDISH SCHEME COMPARISON: WHICH SYSTEM IS
disparities original "medicine chest" clause Aboriginal Treaties Canada, failure Canadian government meet health care Aboriginal people today Policy Change for Improvement The aboriginals of Canada comprise of the indigenous people who are within North America, but dwell in the boundaries of Canada. Nevertheless, people have continuously view them discriminatively. This is what has led to the formulation of numerous policies, which will favor the aboriginals and make them feel part of
, 1999). In many areas of the country this may be very accurate. Another problem that comes into the picture where obesity in children is concerned is that many parents must work very long hours today to pay bills and have money for what their family needs (Mokdad, et al., 1999). Because of this, many children are latchkey kids and are not watched as closely by their parents as they used
Employing Evidence-Base Practice The influence of evidence-based practice (EBP) has found reverberations in the field of medical care giving, academia and scientific endeavors. The need for evidence-based quality arises from the need to afford improved healthcare services that are faster, accurate, and more effective. The nurses have responded to the emerging guidelines set by National expert groups. They have reoriented their practices along the lines of the evidence-based practices that have
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