Evidence-based medicine

evidence-basedmedical evidenceevidenceclinical evidencehigh-quality clinical evidenceevidence basedscientific evidenceEvidence Based Medicinescience-based medicinemedicine
Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research.wikipedia
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Evidence-based practice

evidence-based practicesevidence-basedevidence based practice
It has subsequently spread to describe an approach to decision-making that is used at virtually every level of health care as well as other fields (evidence-based practice).
Evidence-based practices have been gaining ground since the formal introduction of evidence-based medicine in 1992, and have spread to the allied health professions, education, management, law, public policy, and other fields.

Archie Cochrane

A. L. CochraneArchibald Leman CochraneArchie Cochranes
In 1972, Archie Cochrane published Effectiveness and Efficiency, which described the lack of controlled trials supporting many practices that had previously been assumed to be effective.
He is known as one of the fathers of modern clinical epidemiology and evidence-based medicine and is considered to be the originator of the idea of evidence-based medicine in the current era.

David Sackett

David Lawrence Sackett
In the mid 1980s, Alvin Feinstein, David Sackett and others published textbooks on clinical epidemiology, which translated epidemiological methods to physician decision making.
David Lawrence Sackett, (November 17, 1934 – May 13, 2015) was an American-Canadian physician and a pioneer in evidence-based medicine.

National Institute for Health and Care Excellence

National Institute for Health and Clinical ExcellenceNICENational Institute for Clinical Excellence
In 1999, the National Institute for Clinical Excellence (NICE) was created in the UK.
These appraisals are based primarily on evidence-based evaluations of efficacy, safety and cost-effectiveness in various circumstances.

Gordon Guyatt

In the autumn of 1990, Gordon Guyatt used it in an unpublished description of a program at McMaster University for prospective or new medical students.
He is known for his leadership in evidence-based medicine, a term that first appeared in a single-author paper he published in 1991.

National Guideline Clearinghouse

National Quality Measures Clearinghouse
In the same year, a National Guideline Clearinghouse that followed the principles of evidence-based policies was created by AHRQ, the AMA, and the American Association of Health Plans (now America's Health Insurance Plans).
National Guideline Clearinghouse (NGC) is a database of evidence-based clinical practice guidelines and related documents.

Cochrane (organisation)

Cochrane reviewCochrane CollaborationCochrane
The Cochrane Collaboration is one of the best-known organisations that conducts systematic reviews.
Cochrane (previously known as the Cochrane Collaboration) is a British charity formed to organise medical research findings so as to facilitate evidence-based choices about health interventions faced by health professionals, patients, and policy makers.

Systematic review

systematic reviewsreviewsystematic literature review
Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. Evidence quality can be assessed based on the source type (from meta-analyses and systematic reviews of well-blinded randomized clinical trials with perfect concealment of allocation, no attrition, and no unblinding at the top end, down to conventional wisdom at the bottom), as well as other factors including statistical validity, clinical relevance, currency, and peer-review acceptance.
For example, systematic reviews of randomized controlled trials are key to the practice of evidence-based medicine, and a review of existing studies is often quicker and cheaper than embarking on a new study.

Alternative medicine

complementary and alternative medicineholistic healthintegrative medicine
A review of 145 alternative medicine Cochrane reviews using the 2004 database revealed that 38.4% concluded positive effect or possibly positive (12.4%) effect, 4.8% concluded no effect, 0.7% concluded harmful effect, and 56.6% concluded insufficient evidence.
Loose terminology may also be used to suggest meaning that a dichotomy exists when it does not, e.g., the use of the expressions "Western medicine" and "Eastern medicine" to suggest that the difference is a cultural difference between the Asiatic east and the European west, rather than that the difference is between evidence-based medicine and treatments that do not work.

Randomized controlled trial

randomized controlled trialsrandomized clinical trialrandomized control trial
Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations.

McMaster University

McMasterCanadian Literary InstituteMcMasters University
In the autumn of 1990, Gordon Guyatt used it in an unpublished description of a program at McMaster University for prospective or new medical students.
A McMaster research group led by David Sackett and later Gordon Guyatt had been credited for establishing the methodologies used in evidence-based medicine.

Acupuncture

acupuncturistacupuncture pointacupuncture points
However, they differ on the extent to which they require good evidence of effectiveness before promoting a guideline or payment policy; hence, the distinction sometimes made between evidence-based medicine and science-based medicine, which also takes into account factors, such as prior plausibility and compatibility with established science as when medical organizations promote controversial treatments such as acupuncture.
Using the principles of evidence-based medicine to research acupuncture is controversial, and has produced different results.

Health care

healthcarehealth servicesmedical care
It has subsequently spread to describe an approach to decision-making that is used at virtually every level of health care as well as other fields (evidence-based practice).
Many important advances have been made through health research, biomedical research and pharmaceutical research, which form the basis for evidence-based medicine and evidence-based practice in health care delivery.

Meta-analysis

meta-analysesmeta analysismeta-analytic
Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types (coming from meta-analyses, systematic reviews, and randomized controlled trials) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. Evidence quality can be assessed based on the source type (from meta-analyses and systematic reviews of well-blinded randomized clinical trials with perfect concealment of allocation, no attrition, and no unblinding at the top end, down to conventional wisdom at the bottom), as well as other factors including statistical validity, clinical relevance, currency, and peer-review acceptance.
Although meta-analysis is widely used in epidemiology and evidence-based medicine today, a meta-analysis of a medical treatment was not published until 1955.

Evidence-based policy

evidence-basedCoalition for Evidence-Based Policyevidence based policy
The concept had also spread outside of healthcare; for example, in his 1996 inaugural speech as President of the Royal Statistical Society, Adrian Smith proposed that "evidence-based policy" should be established for education, prisons and policing policy and all areas of government work.
Many scholars see the term evidence-based policy as evolving from "evidence-based medicine", in which research findings are used as the support for clinical decisions and evidence is gathered by randomized controlled trials (RCTs), which is comparing a treatment group with a placebo group to measure results.

Blinded experiment

double-blinddouble blindblinded
Evidence quality can be assessed based on the source type (from meta-analyses and systematic reviews of well-blinded randomized clinical trials with perfect concealment of allocation, no attrition, and no unblinding at the top end, down to conventional wisdom at the bottom), as well as other factors including statistical validity, clinical relevance, currency, and peer-review acceptance.
In some fields, such as medicine, it is considered essential.

Medicine

medicalmedical scienceclinical medicine
Although evidence-based medicine is regarded as the gold standard of clinical practice, there are a number of limitations and criticisms of its use.
In the developed world, evidence-based medicine is not universally used in clinical practice; for example, a 2007 survey of literature reviews found that about 49% of the interventions lacked sufficient evidence to support either benefit or harm.

Conventional wisdom

Received viewreceived wisdomaccepted wisdom
Evidence quality can be assessed based on the source type (from meta-analyses and systematic reviews of well-blinded randomized clinical trials with perfect concealment of allocation, no attrition, and no unblinding at the top end, down to conventional wisdom at the bottom), as well as other factors including statistical validity, clinical relevance, currency, and peer-review acceptance.
Evidence-based medicine is a deliberate effort to acknowledge expert opinion (conventional wisdom) and how it coexists with scientific data.

Publication bias

File drawer problemfile drawer effectself-selecting nature of the positive reports
For example, evidence-based medicine is increasingly reliant on meta-analysis to assess evidence.

The BMJ

British Medical JournalBMJThe British Medical Journal
The BMJ is an advocate of evidence-based medicine.

Number needed to harm

The NNH is an important measure in evidence-based medicine and helps physicians decide whether it is prudent to proceed with a particular treatment which may expose the patient to harms while providing therapeutic benefits.

Receiver operating characteristic

ROC curveAUCROC
ROC curves are also used extensively in epidemiology and medical research and are frequently mentioned in conjunction with evidence-based medicine.

Hypocognition

Hypocognition has been blamed for preventing the practical application of evidence-based medicine in areas where frames (contextual and presentational influences on perceptions of reality) obscure facts.

Gold standard (test)

gold standardgold standard testbenchmark
Although evidence-based medicine is regarded as the gold standard of clinical practice, there are a number of limitations and criticisms of its use.

Decision-making

decision makingdecisionsdecision
Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research.