The Evidence Based Medicine Workbook [antikvár]

Foreword Evidence based medicine, whose philosophical origins extend back to mid-nineteenth century Paris and earlier, is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (1). The practice of evidence based medicine (EBM) means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise I mean the proficiency and judgement that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence I mean clinically relevant research, often from the basic sciences of medicine, but especially from patient-centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence often supports current practice, but frequently invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer. Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients. The practice of EBM, then, is a process of life-long, self-directed learning in which caring for our own patients creates the need for clinically-important information about diagnosis, prognosis, therapy, and other clinical and health care issues, and in which we: convert these information needs into answerable questions; track down, with maximum efficiency, the best evidence with which to answer them (whether from the clinical examination, the diagnostic laboratory, the published literature, or other sources);