Evidence Based Medicine (EBM)

Use the term 'Evidence-Based Medicine' to represent medicine that works, rather than Allopathy, Ayurveda, Yoga, or Alternative Therapies.

The terms "allopathy" and "alternative medicine" can be misleading and confusing. Instead, it is more accurate and useful to refer to "Evidence-Based Medicine" (EBM), which is the conscientious, explicit, and judicious use of the best available research evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information, and it requires new skills such as efficient literature searching and the application of formal rules of evidence in evaluating clinical literature.

The key difference between EBM and traditional medicine is that EBM demands better evidence than has traditionally been used. Evidence-based medicine categorizes different types of clinical evidence and ranks them according to the strength of their freedom from various biases that affect medical research. This ranking system helps clinicians make better-informed decisions about patient care.

By focusing on EBM, we can promote a more accurate understanding of modern medical practice and ensure that healthcare decisions are based on the best available evidence.

Evidence Based Medicine – New Approaches and Challenges

CLASSIFICATION OF EVIDENCE – INFORMATION LEVELS

Evidence-based medicine categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research.

  • 1. Evidences obtained by meta-analysis of several randomized controlled research (RCR).
  • 1b. Evidences from only one RCR.
  • 2a. Evidences from well designed controlled research RCR.
  • 2b. Evidences from one quasi experimental research.
  • 3. Evidences from non experimental studies (comparative research, case study), according to some, for example Textbooks.
  • 4. Evidences from experts and clinical practice.

HOW TO START: 5 STEPS PROCESS FOR USE OF EVIDENCE ORIENTED APPROACH IN FAMILY MEDICINE

How will family medicine doctors start, if they want to apply evidence based approach in their daily practice? Group for Evidence Based Medicine Resource from McMaster University identified the approach in 5 steps that each individual physician in the application of this approach must follow.

a. problem definition,

b. search for wanted sources of information,

c. critical evaluation of the information,

d. application of information of the patient,

e. efficacy evaluation of this application on a patient.

Step 1. Defining problem

Each doctor several times a day is in the position of making various medical decisions. Often in the process of medical decision-making occur questions such as: for and against the use of certain therapies, whether to use a diagnostic test or screening procedure, the risk or prognosis of a particular disease or cost-effectiveness of specific interventions. It is clear that the already busy doctor, will not be able to answer in this way all the questions that come in practice and therefore must resort to the process of determining priorities, as well as refining issues that needs to be asked.

A clinician starts his or her search for the best and newest data needed to solve individual patient’s problem by formulating an answerable clinical question. Good clinical question must be clear, directly focused on the problem, and answerable by searching the medical literature.

a. PICO format

A good clinical question should have four essential components structured in the PICO format (Patient or problem, Intervention, Comparison, Outcome).

PICO format:

  • the patient or problem – who are the relevant patients, what kind of problem we try to solve?
  • the intervention – what is the management strategy, diagnostic test or exposure (drugs, diagnostic test, foods or surgical procedure)?
  • comparison of interventions – what is the control or alternative management strategy, test or exposure that we will compare? - the outcome – what are the patient-relevant consequences of the exposure in which we are interested?

b. Type of clinical question

The most common type of clinical question is about how to treat a disease or condition. Such questions are questions about intervention.

Types of clinical questions:

  • questions about intervention

  • questions about etiology and risk factors

  • questions about frequency and rate

  • questions about diagnosis

  • questions about prognosis and prediction

  • question about cost-effectiveness

  • question about phenomena

Step 2. Search for wanted sources of information

After formulating the clinical question, which stems from a concrete patient, the next step is to search for relevant evidence that will provide the answer to the question.

This is not always easy, especially in Family medicine, in which the problems caries the poorly defined problems in the start. However, there are numerous sources of information that may be of assistance, including medical journals, which treat certain problems in the field of Family medicine, search of electronic databases and communication with colleagues.

The ideal information source is valid (contains high quality data), relevant (clinically applicable), comprehensive (has data on all benefits and harms of all possible interventions), and is user-friendly (is quick and easy to access and use).

Step 3. Critical evaluation of the information

When we decide which magazine to read, it is important to read it carefully, because not all the published information is of equal importance and value. Critical assessment of the articles is a process that involves careful reading and analysis of methodology, contents and conclusions. A key question that should be kept in mind is “Do I believe in the results enough that I’ll be ready to a similar approach, or in achievement of similar results with my patients?” Skills to obtain the ability of critical evaluation should be learned and practiced as any other clinical skills.

Step 4. Application of information of the patient

The fourth step in the process of the use of Evidence Based Medicine in practice is the decision how to apply acquired information on the special circumstances pertaining to each patient. This is probably a crucial step in the process, if not the most complex. Now it is necessary to decide whether there is something in relation to our patient because of which it would be necessary to discard the acquired information.

The questions that we should ask before the decision to apply the results of the study are:

a. Are the participants in the study similar enough to my patient?

b. Is the treatment available and is health care system prepared to fund it?

c. What alternatives are available?

d. Do the potential side effects of the drug or procedure outweigh the benefits?

e. Are the outcomes appropriate to the patient? Does the treatment conflict with the patient’s values and expectations?

If something does not exist, it is necessary to weigh the potential harm from the benefit and do all that in partnership with the patient, where our decision in the end, in fact, will be shared.

Step 5. Efficacy evaluation of EBM application on a patient

The final step is the evaluation of Evidence - based approach and efficiency of its application to a specific patient. During this process it is important to assess whether certain evidence, which is applied to the patient, caused changes to better and that to the extent that it is confirmed by research. If the data differ significantly, it would be necessary to investigate why some patients did not respond to the changes introduced in the expected way and what can be done to change it.

The EBM-oriented clinicians of tomorrow have three tasks:

  1. To use evidence summaries in clinical practice;
  2. To help develop and update selected systematic reviews or evidence-based guidelines in their area of expertise; and
  3. To enrol patients in studies of treatment, diagnosis and prognosis on which medical practice is based.

Comprehensive Approaches to Managing Lifestyle Diseases: Beyond Pharmaceuticals

Some examples include diseases like diabetes, high blood pressure, and depression, which often require a comprehensive approach beyond pharmaceutical interventions alone. Incorporating various strategies such as yoga, exercise, a balanced diet, herbal medicine, cognitive-behavioral therapy, and relationship management can significantly enhance disease management.