Evidence Based Medicine: Changing the Modern Clinical Practice
Abstract
Someone once asked the anthropologist Margaret Mead (1901-1978), "What is the first sign you look for, to tell you of an ancient civilization?" She said she knew that ancient people had reached the point of becoming an actual society whenever she found a healed femur."
Medicine has evolved from an individual's interest to care for the sick to treating the sick in an institutional setup based on knowledge acquired from enormous scientific research. The modern era of clinical sciences has grown from purely research-based practice to evidence-based practice. As more and more professionals embraced the advantages of clinical practice based on evidence, the concept of evidence-based medicine has expanded to evidence-based practice.
The scope of evidence-based practice is so broad and vast that many definitions coined so far have all remained insufficient. It was Guyatt et al in 1992 who coined the term "Evidence based Medicine" and Sackett et al in 1996 explained evidence-based clinical decision making as a combination of best available research evidence, clinical expertise and patient's preferences.1, 2 A trans-disciplinary model for evidence-based practice by Satterfield et al in 2009 depicted the three core components of evidence based practice within the broader clinical or organizational context.3 Dawes et al. defined Evidence-Based Practice requiring that decisions about health care be based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care within the context of available resources.4 The process of developing evidence-based practices goes through five steps.4
- Translation of uncertainty to an answerable question.
- Systematic retrieval of the best evidence available.
- Critical appraisal of evidence for validity, clinical relevance and applicability.
- Application of results in practice.
- Evaluation of performance.
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References
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