Evidence-Based Medicine Working Group. ) Peer Reviewed Journal

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More interaction among researchers, policymakers, and clinicians, so studies can be aimed at answering questions of interest to policymakers and clinicians.

Policymakers should commission RTs of policy-relevant questions

Authors of reviews should provide more contextual information or refer readers to easy-to-find articles

Authors of reviews should develop user-friendly formats: this article suggests 3 formats: a 20-second version of 1-paragraph to 1-page bottom-line summary; a 2-minute version of 2- to 3-page summary focusing on validity and applicability; a 2-hour complete version.

Waldman, M.H. (2006). Evidence-based medicine. How to translate research into patient care. Journal of the American Podiatric Medical Association 96(4), 374-377.

Evidence-based medicine (EBM) consists of integrating clinical experience with the best evidence from systematic research to improve patient care

Must learn how to critically appraise medical studies

Paradigm developed by Canadian physicians at McMaster University in Hamilton, Ontario

Viewed as a paradigm shift described by T. Kuhn

Represents intersection of "epochal scientific hypothesis; an ever evolving body of evidence; and an idealized professional process -- a way of practicing medicine."

New way of thinking about providing best care for patients. Incorporated by many major medical journals

Confusing and threatening to physicians as few taught its philosophy and applications

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Vast array of info 10,000 medical journals; 40,000 new articles week, and 30 minutes a day physicians have to review the literature- if could read all day for 6 weeks would be a century behind

Much of medical training is quickly obsolete and patients are more educated

EBM requires new skills- 5 steps in practice: 1. asking answerable questions; 2. finding the best evidence, 3. critically appraising the evidence (this is the most important of the steps); 4. acting on the evidence, and 5. Evaluating one's performance.

Not all evidence is equally valid.

Peer Reviewed Journal on Evidence-Based Medicine Working Group. (1992). Assignment

Figure one is a pyramid that presents least to most reliable evidence: animal/lab research; case studies; case-control studies; cohort studies; randomized controlled trials; systematic reviews; meta-analyses

Best to divide evidence into patient -oriented and disease-oriented categories

Must learn to do a search; First, the question must define the issue in order to allow a literature search to succeed.

The ability to frame a question involves a learning curve

Use the acronym PICO: the patient or problem being addressed; the intervention or exposure being considered; the comparison intervention or exposure; and the clinical outcomes of interest.

Step three in 5 steps above is the most important- because it is where specific questions about an individual patient… [END OF PREVIEW] . . . READ MORE

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