Evidence-Based Medicine And Clinical Guidelines

Doctors have always been convinced that their decisions are based on evidence, so the new term is an “evidence-based medicine” somewhat misleading. However, for many doctors is the “evidence” often a vague combination of strategies that were often effective in previous patients, advice from professors and peers, and a general feeling of “knowing what to do” due to various technical articles, papers, symposia and drug commercials. This kind of approach leads to a wide range of strategies for diagnosing and dealing with similar situations, even if strong evidence for one or the other strategy exist. There are also differences between different countries, different regions, different hospitals and even within individual group practices. These differences have led to a demand for a systematic approach to find the most appropriate strategy for an individual patient. This approach is referred to as evidence-based (empirically supported) Medicine (EBM). EBM is based on reviews of the relevant medical literature and follows a specific sequence of individual steps. Evidence-based medicine EBM is not the blind applying advice from recently published literature on individual health problems. Rather, the EBM requires the sequence of a series of steps to collect enough useful information for a thorough diagnosis for each individual patient. The principles of EBM fully take into account also means the inclusion of the patient’s value system, which in turn touches on the issues of cost, ethics and independence of the patient. The application of the principles of EBM usually involves the following steps: formulating a clinical question empirical evidence to answer the question assessing the quality and validity of the evidence deciding how the evidence should be translated into concrete care of a particular patient formulating a clinical question questions must be specific. Specific questions are most likely addressed in the medical literature. the type of intervention (diagnostic test, treatment), various treatment approaches and the result will be prompted for the population. “What is best to do to help someone with abdominal pain?” is not a very good question. Better, namely more specific question would be “If a CT or ultrasonography more useful to confirm the diagnosis of acute appendicitis in a 30-year-old man with acute abdominal pain?” Empirical evidence to answer the question a broad range of relevant studies can be obtained from a review of the literature. Standard resources are consulted (z. B. MEDLINE, the Cochrane Collaboration [treatment options], the National Guideline Clearinghouse, ACP Journal Club) .Bewertung the quality and validity of the evidence Not all scientific studies are of equal value. Various types of studies have different strengths and scientific relevance and vary for each study, individual examples in quality of methodology, validity and generalizability of the results (external validity). The quality of evidence is rated scale of 1 to 5 in descending order of quality. The studies on each rank are a little different in clinical issues (eg. As the diagnosis, treatment or the cost analysis), typischerwese However, studies of the highest ranking (level 1) are a compilation of systematic reports or meta-analyzes of randomized controlled studies and hochqualitatitiven individual randomized controlled trials. Studies of stage 2 are well worked out cohort studies. Studies of the stage 3 consist of systematically controlled case studies. Studies Level 4 are case studies and poor quality cohort studies and controlled case studies. Studies Level 5 are expert opinions that are not based on critical assessment, but on considerations of physiology or experimental research or the underlying principles. For the EBM analysis, the highest level of evidence available is selected. Ideally, there is a considerable number of large, well-conducted studies of stage 1 is available. However, since the number of high-quality, randomized controlled trials is vanishingly small compared with the number of potential clinical questions, a document from Level 4 or 5 is often all often what is available. Lower quality evidence does not mean that the EBM can not be carried out but that the conclusion ist.Entscheidung weaker founded, as the evidence is to be implemented in the specific care of a particular patient, since the best available evidence may come from studies of populations, the other properties than de patient, a certain amount of judgment is required. In addition, the wishes of the patient must be considered in terms of aggressive or invasive testing and treatment, as well as their ability to discomfort, risk and uncertainty to bear. For example, it may be that there is good evidence that a 3-month aggressive chemotherapy in a particular form of cancer can be successful. Nevertheless, the patient can possibly do not agree to bear the additional discomfort of treatment. The costs of tests and treatments can also influence the decision of the doctor and patient, especially if some of the alternatives much more expensive for the patient sind.Einschränkungen dozens of clinical questions are raised in the course of a single day in a busy practice. Although some may be the subject of a pre-existing EBM guideline of these issues, this is among the most questions not the case, and creating a EBM analysis is too time consuming to be useful in busy practice or hospital everyday to. Even if the time should not be a factor, there are some clinical questions no relevant studies in the literature. Clinical guidelines Clinical guidelines have been established in medicine, and many medical societies have published such guidelines. Most well-designed clinical guidelines are created using a specified method that incorporates the principles of EBM and general recommendations of a panel of experts. Although clinical guidelines describe a common practice, clinical guidelines do not in themselves constitute grounds the standard of care for the individual patient. Some clinical guidelines are based on logical “if-then” rules (eg. As when a patient with fever is neutropenic, then broad-spectrum antibiotics are attached). More complex, multi-level rules can be formalized as algorithms. Guidelines and algorithms are straightforward and easy to handle, as a rule, but should be used only in patients whose clinical features (eg. As demographics, comorbidities, clinical features) are comparable to those of the investigated in the guidelines patient group. In addition, guidelines do not take into account the uncertainty that is always on test results in space, or even with the probability of treatment success and the relative risks and benefits of each activity. To integrate this uncertainty and the value of the treatment results in clinical decision making, doctors often have to follow the principles of quantitative or analytical medical decision-making.

Health Life Media Team

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