Evidence-based medicine is the integration of the best arguments of science with clinical experience and patient needs. It is a detailed and rational use of the best achievements of our time in the decision-making process in the treatment of patients. In this case, only those arguments that are obtained from systematic reviews are used. The foundations of evidence-based medicine are clinically relevant studies that take into account the interests of the patient. Confirmations result in the reliability and accuracy of diagnostic tests and examinations, the importance of prognostic indicators, the effectiveness and safety of therapy, rehabilitation and prevention.
History of Appearance
In 1940, the first randomized (randomly distributed) studies of the use of Streptomycin in the treatment of tuberculosis were carried out. In 1962, the United States Committee, which controlled the quality of pharmaceuticals and food, introduced rules aimed at studyingnew types of medicines. Nine years later, epidemiologist Archie Cochran raised the issue of the lack of scientific evidence. Three years later, inconsistencies between theory and practice were discovered. In the late 1980s and early 1990s, attention was drawn to the need to introduce systematic reviews into clinical guidelines. The term "evidence-based medicine" was first proposed in 1988 by epidemiologists and clinicians who worked at McMaster University in Canada. Archie Cochran gave a description of how to bring scientific research to the attention of experts. In addition, he helped to ensure that their results became a criterion for discussion and accurate analysis. Cochran and his colleagues at the British Medical Research Council have worked together to establish modern evidence-based medicine. It was he who, in 1979, came to the conclusion that science lacks the critical conclusions of randomized controlled trials. Cochran founded the first Center for Evidence-Based Medicine, which was named after him. He started working at Oxford 10 years ago. There are currently 15 such centers around the world. They lead the activities of an international team of researchers.
Steps
There are five levels of evidence-based medicine:
- Ask a question that can be answered.
- Find optimal confirmations.
- Evaluate the data with a critical eye.
- Review evidence based on clinical expertise and interestssick.
- Assess the feasibility of using confirmatory technologies.
Principles of evidence-based medicine. Finding the best evidence
Professionals search for evidence based on keywords: patient, intervention, comparison, outcome. Systematic reviews and randomized controlled trials should be considered first, as they are more reliable. If no evidence is found, it is recommended to start looking for lower level evidence. These include cohort studies, case-control studies, and others.
Critically evaluating evidence
Using this assessment, you can determine how reliable the evidence found and the results of the study are. To test the reliability of randomly distributed controlled trials, the following questions need to be answered:
- Have patients been randomized?
- Have all patients participating in the study completed it?
- Have patients been analyzed in the groups they were randomized to?
- Was the treatment "blind" for researchers and patients?
- Was there any similarity in the groups prior to the study?
- Was the same treatment used other than the experimental one?
In the case of a qualitative study, you can start evaluating the results.
Practice analysis
This assessment is accompanied by the followingquestions:
- What am I doing?
- Why is this being done, what is the expected result?
- What guarantees the effectiveness and safety of this work?
- Is there an even better, more appropriate method to achieve your goal?
Study Opportunities
In order for the search for arguments and their critical analysis to be of the highest quality, the clinician must have the necessary experience and time. In addition, he can use discipline journals and other scientific literature. It would be useful to refer to summaries of evidence-based medicine compiled by other specialists. This may be the Cochrane database, a book by M. Enkin, other literature in this area. It is also recommended that you familiarize yourself with ready-made protocols that are prepared on the basis of evidence-based medicine.
Periodical Literature Review
Traditional wisdom says that only a small proportion of medical interventions have strong scientific evidence. It is about 15%. Every day, medical professionals around the world need to obtain important new evidence necessary for the effectiveness and correct treatment of patients. To do this, doctors should find special information on this profile. It is recommended to use the medical literature, which is currently very much. Its number has doubled since 1970. In addition, it is growing daily. Each year, the editors publish about 6,000 articles in areas such as gynecology and obstetrics. In order for the level of knowledgecorresponded to the present, the doctor needs to read about 20 articles daily. Another question is whether a medical worker has time for this? It is also necessary to take into account the fact that many articles do not meet even the minimum quality standards.
Correct activity
Part of medical knowledge is recognized as erroneous or obsolete after five years after the graduation of a student from a higher educational institution. True, it is not known which part. Medical literature can be likened to the jungle as it grows at a rapid pace and is full of "dead trees", "spiders" and "snakes", yet treasures are hidden somewhere.
Basic Information
Evidence-based medicine is a specific approach to decision making. In doing so, the clinician applies the best available arguments and professional experience. The decision is made together with the patient, taking into account his interests. Every day, he althcare workers need different kinds of sources to find answers to their recurring questions. For example, students studying in this area need basic information that combines the causes of the disease and its pathogenesis, physical characteristics and other information. The main data relate to various sciences. This, in particular, physiology, pathogenesis, anatomy, etiology. Basic information is relatively stable, found in reference books, textbooks, and other general medical sources. However, most often, doctors need to answer questions related directly to patient care and treatment. Here are some examples of questions that relate to a disease or condition but are not specific to clinical practice:
- What does…?
- What is otitis media?
- Which microorganisms contributed to the development of otitis media?
Answers to questions of this type can be found in textbooks, reference books and other sources.
Case management information
In addition to basic knowledge, the doctor needs information that is directly related to the management of the patient, methods of diagnosis, treatment and prognosis. This is what evidence-based medicine is all about. The key words here are "diagnosis, treatment, prognosis". To get the highest result and the best answer, it is necessary to formulate the question correctly.
Clinical example
May consider taking Diethylstilbestrol to prevent miscarriages in women. The reason for the use of this remedy is the frequent termination of pregnancy. In this regard, the use of estrogen as a drug to prevent miscarriage is considered logical. In patients taking this medication, pregnancy, in general, persisted. In the 50s, as a result of six non-randomized studies, a reduction in the number of miscarriages during the use of the drug "Diethylstilbestrol" was confirmed. AlsoThere were five studies in which patients were randomly divided into two groups. The first took the drug "Diethylstilbestrol", the second - a placebo. According to the results of the experiment, in women using this remedy, miscarriages occurred in 7% of cases. Termination of pregnancy in the second group was 5%. Due to these results, clear signs were obtained that the drug is not useful. But despite this, its use still continued. Until 1970, millions of women were treated with it. Evidence-based medicine requires more than just reading the right materials at the right time. It is also important to change your own and other people's practices, taking into account the emergence of new information. Evidence-based medicine provides the prerequisites for an objective assessment of the effectiveness of medical interventions, as well as the application of its consequences in clinical practice. Of course, this is not easy, because both in finding confirmation, and in disseminating it and introducing changes, one can encounter obstacles that arise throughout the work process.
Generating ideas
Evidence-based medicine for all is growing exponentially around the world. Starting from the 90s, the period of its formation, and up to the present day, the number of monographs, forums and centers in this direction is in the tens, and the number of publications is in the hundreds. In 1997, 12 such centers received subsidies for 5 years from the US Agency for Policy, Science and He alth. These organizations were founded inleading universities and research institutions in various states. The number of centers for highly specialized problems, such as children's and mental he alth, first aid and other areas, has increased. Their common position is the application of the principle of evidence at every level of decision-making, from the state program to the appointment of individual treatment. In Russia, the most famous institutions are located in St. Petersburg and Moscow. Also among the popular is the Clinic of Evidence-Based Medicine, Nizhnevartovsk. The institution specializes in diagnostics, neurology, pediatrics and urology, andrology and gynecology, gastroenterology and ENT diseases.
OSMD
Evidence-based medicine in Russia is also developing rapidly. In Russia, there is an Interregional community of condominiums. It received registration in 2003. The Society of Evidence-Based Medicine is a voluntary non-profit association. It operates in accordance with the Charter. The main activities of condominiums:
- Teaching work related to the methodological problems of conducting epidemiological and clinical studies, the systematics of information in the field of science, evaluation of publications and statistical analysis of data.
- Publication of the results of the main scientific experiments.
- Introducing advances into medical practice.
- Conducting an examination of the quality of scientific publications, patient management protocols and others.
- Socioepidemiological and biomedical research.
Member principlesOSMD:
- dissemination of scientifically sound information about medical interventions and options for acquiring such data;
- refrain from disclosing performance information that has not been scientifically proven;
- declaration of the existing inconsistency of interests.
The employees of the organization are doctors who adhere to these principles and put them into practice. To date, the association has 17 regions and more than 300 members. The heads of the regional departments are highly qualified specialists in medicine and he althcare.
Evidence Based Medicine Center (Prosveshcheniya, 14, St. Petersburg)
The institution operates from eight in the morning to seven in the evening and has one day off, falling on Sunday. This Northwestern Center for Evidence-Based Medicine provides a wide range of services to the community. Here you can get advice and therapy from doctors of narrow specializations, undergo laboratory diagnostics, colposcopy, ultrasound, and a massage course. The Center for Evidence-Based Medicine also performs daily ECG+BP monitoring. All employees working in the institution are highly qualified doctors. The Northwestern Center for Evidence-Based Medicine specializes in diseases such as:
- spinal osteochondrosis aggravated by vertebrogenic cervicalgia, discogenic sciatica and lumbalgia;
- compression-ischemic neuropathy, the symptom of which is numbness of the fingers;
- deformingosteoarthritis at different stages (medical blockades are used as a treatment, hyaluronic acid is used);
- pathological disorders of tendons and ligaments (tenosynovitis, enthesopathy, and others);
- pathology of articular bags, "spurs" on the heels.
St. Petersburg's second famous institution
The Center for Evidence-Based Medicine (Leninsky, 88) is open from eight in the morning until eight in the evening. The institution is located in a residential building, on the first floor. Modern equipment, a high level of service, advanced diagnostic methods - this is not a complete list of the advantages that this Center for Evidence-Based Medicine has. Reviews of many patients indicate that here every visitor will be given maximum attention. The quality of the services provided was highly appreciated. Here you can seek help from such specialists as a gynecologist and a gastroenterologist, a neurologist and a therapist, a cardiologist and an oculist, an endocrinologist, a urologist, etc. The Evidence-Based Medicine Clinic also offers laboratory diagnostics, ultrasound, echocardiography, calposcopy, massage, electrocardiography. Oncologist Beinusov Dmitry Sergeevich was appointed the head physician of the institution. Test results can be obtained by calling or by mail. In addition to the medical center, the activities of specialists also extend to city hospitals. A doctor's consultation costs 1200 rubles.
