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A contribuição da medicina baseada em evidências para a introdução de novo conhecimento na prática clínica; The importance of evidence-based medicine concepts for the clinical practitioner

MALUF-FILHO, Fauze
Fonte: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED Publicador: Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia - IBEPEGE Colégio Brasileiro de Cirurgia Digestiva - CBCD Sociedade Brasileira de Motilidade Digestiva - SBMD Federação Brasileira de Gastroenterologia - FBGSociedade Brasileira de Hepatologia - SBHSociedade Brasileira de Endoscopia Digestiva - SOBED
Tipo: Artigo de Revista Científica
POR
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Com a vasta produção científica e o surgimento de novas terapias e equipamentos, torna-se fundamental que o gastroenterologista lance mão de instrumentos que o auxiliem na avaliação crítica do "novo" conhecimento, que poderá ou não ser incorporado a sua prática clínica. A medicina baseada em evidências consiste neste instrumento. Associando conceitos da informática médica e da epidemiologia clínica, a medicina baseada em evidências tem como único e maior objetivo o paciente. Assim, na análise crítica do "novo conhecimento", o movimento da medicina baseada em evidências valoriza os ensaios clínicos corretamente aleatorizados, com grupo controle e casuística adequados, com desfechos claramente expostos e clinicamente válidos. Quando os resultados dos ensaios clínicos são conflitantes, o movimento valoriza o instrumento da revisão sistemática, de preferência tratada do ponto de vista estatístico, conhecida como metanálise. Utilizando estas ferramentas, torna-se mais objetiva e ética a incorporação de novos tratamentos à prática gastroenterológica.; The acceptance or refusal of new therapies and technologies pose a formidable problem for the daily practice of the gastroenterologist. It is of utmost importance to adopt clear strategies to select the true evidences from the huge amount of new medical information. Gathering fundamental concepts of clinical epidemiology and medical informatics...

A pauta é saúde : uma análise da influência da Medicina Baseada em Evidências no jornalismo; Health in the headlines : an analysis of the influence of Evidence-Based Medicine on journalism

Patricia Aline dos Santos
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 23/08/2013 PT
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Este trabalho analisa mudanças na área médica que se inter-relacionam com o campo do jornalismo em saúde, tendo como referencial os Estudos Sociais da Ciência e Tecnologia (ESCT). O enfoque nesta dissertação é a Medicina Baseada em Evidências (MBE), abordagem na qual estudos clínicos com base em amostras populacionais são usados para a tomada de decisão na área médica. A MBE vem sendo incorporada formalmente na literatura médica desde os anos 1990, a partir do Canadá, Estados Unidos e Reino Unido e, atualmente, forma um conjunto de práticas adotadas em nível global, inclusive no Brasil. Essa perspectiva tem redefinido a racionalidade biomédica e clínica; tem influenciado as relações de poder nos diversos âmbitos da saúde, como as políticas públicas e os papéis dos profissionais e do paciente. O impacto da MBE vai além da produção e uso do conhecimento científico na medicina chegando às atividades de popularização do conhecimento sobre saúde. O jornalismo, como parte da dinâmica de difusão da ciência, também é permeado pelas novas configurações formadas no campo da saúde e, sobretudo, participa da elaboração da noção que a sociedade constrói sobre a área. Neste estudo, analisamos processos de trabalho de jornalistas e identificamos relações com as mudanças trazidas pela MBE. Essa influência no modo de fazer jornalismo se dá principalmente na seleção de temas para matérias jornalísticas...

Global health: the importance of evidence-based medicine

Birbeck, Gretchen L; Wiysonge, Charles S; Mills, Edward J; Frenk, Julio J; Zhou, Xiao-Nong; Jha, Prabhat
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
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Global health is a varied field that comprises research, evaluation and policy that, by its definition, also occurs in disparate locations across the world. This forum article is introduced by our guest editor of the Medicine for Global Health article collection, Gretchen Birbeck. Here, experts based across different settings describe their personal experiences of global health, discussing how evidence-based medicine in resource-limited settings can be translated into improved health outcomes.

“Appropriate” diagnostic testing: supporting diagnostics with evidence-based medicine and shared decision making

Polaris, Julian JZ; Katz, Jeffrey N
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
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Background: Evidence-based medicine is an important approach to avoiding care that is unlikely to benefit patients in both the treatment and the diagnostic context. The medical evidence alone may not determine the most appropriate care decision. Patient interests are best served when the advantages and risks of a diagnostic test are viewed through the lens of the patient’s values. That is, the paradigm of evidence-based medicine should be complemented by the paradigm of shared decision making. Analysis Diagnostic testing may offer physiological and psychological benefits. Clinicians should also discuss the potential harms, however, which may be physiological (e.g. radiation or scarring), psychological (e.g. anxiety), and financial (e.g. cost-sharing burdens). All three of these concerns are compounded by the risk of false positives or incidental findings that are not serious, but which require decisions about further testing or treatment. Conclusion: We suggest that patient-centered decision making around diagnostic testing involves a two-step inquiry: Is the test medically appropriate? Does the available evidence documenting short- and long-term risk and benefits support the test for its intended use, given the patient’s characteristics and symptoms?Is the test appropriate for this patient? Has the provider initiated a conversation about tradeoffs that helps the patient evaluate whether the balance of risks and benefits is consonant with the patient’s own values and preferences? Potential benefits and harms to consider include the physiological...

Evidence based environmental management: what can medicine and public health tell us?

Frazey, Ioan; Salisbury, Janet
Fonte: Universidade Nacional da Austrália Publicador: Universidade Nacional da Austrália
Tipo: Working/Technical Paper Formato: 75958 bytes; 366 bytes; application/pdf; application/octet-stream
EN_AU
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Introduction: Ioan welcomed participants and explained that the central theme of the workshop was that environmental managers could learn much from the approach to systematically reviewing and critically appraising scientific literature that has been developed in medicine and public health over the last 30 years. This method, referred to as ‘evidence-based medicine’ (EBM), has turned clinical medicine around from being based largely on ad hoc literature reviews, trial and error and expert opinion, to being firmly based on the best quality evidence available internationally. The idea that the model of EBM can be applied to environmental management has now originated in at least three ‘nodes’ where people either work or are linked in some way across scientific disciplines. Janet Salisbury made this connection when her consultancy work in science information took her between writing about clinical and public health issues for the NHMRC, on the one hand, and about environmental science and resource management issues on the other. She noticed that whereas in the medical and health areas there is a systematic approach to gathering, ranking and critically appraising evidence (eg for the efficacy of a clinical procedure or lifestyle change)...

Evidence-based medicine in practice - surgery

Maddern, G.
Fonte: Australasian Med Publ Co Ltd Publicador: Australasian Med Publ Co Ltd
Tipo: Artigo de Revista Científica
Publicado em //2001 EN
Relevância na Pesquisa
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Initial reticence on the part of some surgeons, combined with a lack of, or unsuitability of, randomised controlled trial evidence, has slowed the uptake of the evidence-based revolution in surgery. An important positive step has been the establishment of the Australian Safety and Efficacy Register of New Interventional Procedures--Surgical (ASERNIP-S) to evaluate new surgical procedures in an evidence-based manner. To supplement information from systematic reviews, ASERNIP-S has been involved in national data collection, which is important for production and evaluation of clinical practice guidelines. Evidence-based practice in surgery, as in other disciplines, must be adequately resourced if it is to be widely and successfully applied.; http://www.ncbi.nlm.nih.gov/pubmed/11419776; G.J. Maddern; © Australasian Medical Publishing

Evidence-based medicine evaluation of electrophysiological studies of the anxiety disorders

Clark, C.; Galletly, C.; Ash, D.; Moores, K.; Penrose, R.; McFarlane, A.
Fonte: Electroencephalography and Clinical Neuroscience Society Publicador: Electroencephalography and Clinical Neuroscience Society
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
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We provide a systematic, evidence-based medicine (EBM) review of the field of electrophysiology in the anxiety disorders. Presently, electrophysiological studies of anxiety focus primarily on etiological aspects of brain dysfunction. The review highlights many functional similarities across studies, but also identifies patterns that clearly differentiate disorder classifications. Such measures offer clinical utility as reliable and objective indicators of brain dysfunction in individuals and indicate potential as biomarkers for the improvement of diagnostic specificity and for informing treatment decisions and prognostic assessments. Common to most of the anxiety disorders is basal instability in cortical arousal, as reflected in measures of quantitative electroencephalography (qEEG). Resting electroencephalographic (EEG) measures tend to correlate with symptom sub-patterns and be exacerbated by condition-specific stimulation. Also common to most of the anxiety disorders are condition-specific difficulties with sensory gating and the allocation and deployment of attention. These are clearly evident from evoked potential (EP) and event-related potential (ERP) electrical measures of information processing in obsessive compulsive disorder (OCD)...

The effectiveness of a clinically integrated e-learning course in evidence-based medicine: a cluster randomised controlled trial

Kulier, R.; Coppus, S.; Zamora, J.; Hadley, J.; Malick, S.; Das, K.; Weinbrenner, S.; Meyerrose, B.; Decsi, T.; Horvath, A.; Nagy, E.; Emparanza, J.; Arvanitis, T.; Burls, A.; Cabello, J.; Kaczor, M.; Zanrei, G.; Pierer, K.; Stawiarz, K.; Kunz, R.; et al.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
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BACKGROUND: To evaluate the educational effects of a clinically integrated e-learning course for teaching basic evidence-based medicine (EBM) among postgraduates compared to a traditional lecture-based course of equivalent content. METHODS: We conducted a cluster randomised controlled trial in the Netherlands and the UK involving postgraduate trainees in six obstetrics and gynaecology departments. Outcomes (knowledge gain and change in attitude towards EBM) were compared between the clinically integrated e-learning course (intervention) and the traditional lecture based course (control). We measured change from pre- to post-intervention scores using a validated questionnaire assessing knowledge (primary outcome) and attitudes (secondary outcome). RESULTS: There were six clusters involving teaching of 61 postgraduate trainees (28 in the intervention and 33 in the control group). The intervention group achieved slightly higher scores for knowledge gain compared to the control, but these results were not statistically significant (difference in knowledge gain: 3.5 points, 95% CI -2.7 to 9.8, p = 0.27). The attitudinal changes were similar for both groups. CONCLUSION: A clinically integrated e-learning course was at least as effective as a traditional lecture based course and was well accepted. Being less costly than traditional teaching and allowing for more independent learning through materials that can be easily updated...

Harmonising evidence-based medicine teaching: a study of the outcomes of e-learning in five European countries

Kulier, R.; Hadley, J.; Weinbrenner, S.; Meyerrose, B.; Decsi, T.; Horvath, A.; Nagy, E.; Emparanza, J.; Coppus, S.; Arvanitis, T.; Burls, A.; Cabello, J.; Kaczor, M.; Zanrei, G.; Pierer, K.; Stawiarz, K.; Kunz, R.; Mol, B.; Khan, K.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2008 EN
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BACKGROUND We developed and evaluated the outcomes of an e-learning course for evidence based medicine (EBM) training in postgraduate medical education in different languages and settings across five European countries. METHODS We measured changes in knowledge and attitudes with well-developed assessment tools before and after administration of the course. The course consisted of five e-learning modules covering acquisition (formulating a question and search of the literature), appraisal, application and implementation of findings from systematic reviews of therapeutic interventions, each with interactive audio-visual learning materials of 15 to 20 minutes duration. The modules were prepared in English, Spanish, German and Hungarian. The course was delivered to 101 students from different specialties in Germany (psychiatrists), Hungary (mixture of specialties), Spain (general medical practitioners), Switzerland (obstetricians-gynaecologists) and the UK (obstetricians-gynaecologists). We analysed changes in scores across modules and countries. RESULTS On average across all countries, knowledge scores significantly improved from pre- to post-course for all five modules (p < 0.001). The improvements in scores were on average 1.87 points (14% of total score) for module 1...

How far did we get? How far to go? A European survey on postgraduate courses in evidence-based medicine

Kunz, R.; Nagy, E.; Coppus, S.; Emparanza, J.; Hadley, J.; Kulier, R.; Weinbrenner, S.; Arvanitis, T.; Burls, A.; Cabello, J.; Decsi, T.; Horvath, A.; Walzak, J.; Kaczor, M.; Zanrei, G.; Pierer, K.; Schaffler, R.; Suter, K.; Mol, B.; Khan, K.
Fonte: Blackwell Publishing Publicador: Blackwell Publishing
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
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Background:  Over the past decade, evidence-based medicine (EBM) has gained recognition as a means to improve the quality of health care provision. However, little is known about learning opportunities to acquire EBM-associated skills. The EUebm-Unity partnership explored current educational activities for EBM practice for doctors across Europe. Methods:  We surveyed organizations offering postgraduate EBM courses across Europe inquiring about their course programme, teaching content and strategies, and interest in a Europe-wide curriculum in EBM. Results:  One hundred and fifty-six organizers in eight European countries reported 403 courses that had started first-time from 1996 to 2006. Despite a steady increase, in absolute terms, the frequency of courses was low and varied from 1 first-time offering of a course per 640 doctors (Spain) to 1 first-time offering per 5600 doctors (Austria) over 10 years. Most adopted the McMaster EBM teaching concept of small group, problem-based learning focussing on interventions, diagnostic tests and guidelines, and included efforts to link EBM to patient care. Teaching staff consisted of doctors from academic and non-academic settings, supported by methodologists. Efforts to formally integrate EBM in postgraduate activities were only partially successful. Most organizations welcomed a standardized European qualification in EBM. A limitation of the survey is the lack of follow-up information about the continuation of courses following the first-time offering. Conclusions:  All countries offer some EBM courses with varying teaching intensity. Learning opportunities are insufficient to ensure widespread dissemination of knowledge and skills. Most countries welcome more efforts to develop inexpensive and feasible educational activities at a postgraduate level.; Regina Kunz...

Effectiveness of an e-learning course in evidence-based medicine for foundation (internship) training

Hadley, J.; Kulier, R.; Zamora, J.; Coppus, S.; Weinbrenner, S.; Meyerrose, B.; Decsi, T.; Horvath, A.; Nagy, E.; Emparanza, J.; Arvanitis, T.; Burls, A.; Cabello, J.; Kaczor, M.; Zanrei, G.; Pierer, K.; Kunz, R.; Wilkie, V.; Wall, D.; Mol, B.; et al.
Fonte: Royal Society of Medicine Press Publicador: Royal Society of Medicine Press
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
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AIM To evaluate the educational effectiveness of a clinically integrated e-learning course for teaching basic evidence-based medicine (EBM) among postgraduate medical trainees compared to a traditional lecture-based course of equivalent content. METHODS We conducted a cluster randomized controlled trial to compare a clinically integrated e-learning EBM course (intervention) to a lecture-based course (control) among postgraduate trainees at foundation or internship level in seven teaching hospitals in the UK West Midlands region. Knowledge gain among participants was measured with a validated instrument using multiple choice questions. Change in knowledge was compared between groups taking into account the cluster design and adjusted for covariates at baseline using generalized estimating equations (GEE) model. RESULTS There were seven clusters involving teaching of 237 trainees (122 in the intervention and 115 in the control group). The total number of postgraduate trainees who completed the course was 88 in the intervention group and 72 in the control group. After adjusting for baseline knowledge, there was no difference in the amount of improvement in knowledge of EBM between the two groups. The adjusted post course difference between the intervention group and the control group was only 0.1 scoring points (95% CI −1.2–1.4). CONCLUSION An e-learning course in EBM was as effective in improving knowledge as a standard lecture-based course. The benefits of an e-learning approach need to be considered when planning EBM curricula as it allows standardization of teaching materials and is a potential cost-effective alternative to standard lecture-based teaching.; Julie Hadley ... Ben WJ Mol ... et al.

How are "teaching the teachers" courses in evidence based medicine evaluated? A systematic review

Walczak, J.; Kaleta, A.; Gabrys, E.; Kloc, K.; Thangaratinam, S.; Barnfield, G.; Weinbrenner, S.; Meyerrose, B.; Arvanitis, T.; Horvath, A.; Zanrei, G.; Kunz, R.; Suter, K.; Burnand, B.; Arditi, C.; Oude Rengerink, K.; Harry, G.; Mol, B.; Khan, K.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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BACKGROUND Teaching of evidence-based medicine (EBM) has become widespread in medical education. Teaching the teachers (TTT) courses address the increased teaching demand and the need to improve effectiveness of EBM teaching. We conducted a systematic review of assessment tools for EBM TTT courses. To summarise and appraise existing assessment methods for teaching the teachers courses in EBM by a systematic review. METHODS We searched PubMed, BioMed, EmBase, Cochrane and Eric databases without language restrictions and included articles that assessed its participants. Study selection and data extraction were conducted independently by two reviewers. RESULTS Of 1230 potentially relevant studies, five papers met the selection criteria. There were no specific assessment tools for evaluating effectiveness of EBM TTT courses. Some of the material available might be useful in initiating the development of such an assessment tool. CONCLUSION There is a need for the development of educationally sound assessment tools for teaching the teachers courses in EBM, without which it would be impossible to ascertain if such courses have the desired effect.; Jacek Walczak ... Ben WJ Mol ... et al.

Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project

Thangaratinam, S.; Barnfield, G.; Weinbrenner, S.; Meyerrose, B.; Arvanitis, T.; Horvath, A.; Zanrei, G.; Kunz, R.; Suter, K.; Walczak, J.; Kaleta, A.; Rengerink, O.K.; Gee, H.; Mol, B.; Khan, K.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
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BACKGROUND Evidence based medicine (EBM) is considered an integral part of medical training, but integration of teaching various EBM steps in everyday clinical practice is uncommon. Currently EBM is predominantly taught through theoretical courses, workshops and e-learning. However, clinical teachers lack confidence in teaching EBM in workplace and are often unsure of the existing opportunities for teaching EBM in the clinical setting. There is a need for continuing professional development (CPD) courses that train clinical trainers to teach EBM through on-the-job training by demonstration of applied EBM real time in clinical practice. We developed such a course to encourage clinically relevant teaching of EBM in post-graduate education in various clinical environments. METHODS We devised an e-learning course targeting trainers with EBM knowledge to impart educational methods needed to teach application of EBM teaching in commonly used clinical settings. The curriculum development group comprised experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions in seven European countries. The e-learning sessions were designed to allow participants (teachers) to undertake the course in the workplace during short breaks within clinical activities. An independent European steering committee provided input into the process. RESULTS The curriculum defined specific learning objectives for teaching EBM by exploiting educational opportunities in six different clinical settings. The e-modules incorporated video clips that demonstrate practical and effective methods of EBM teaching in everyday clinical practice. The course encouraged focussed teaching activities embedded within a trainer's personal learning plan and documentation in a CPD portfolio for reflection. CONCLUSION This curriculum will help senior clinicians to identify and make the best use of available opportunities in everyday practice in clinical situations to teach various steps of EBM and demonstrate their applicability to clinical practice. Once fully implemented...

Extracting Physician Group Intelligence from Electronic Health Records to Support Evidence Based Medicine

Weber, Griffin M.; Kohane, Isaac S.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
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Evidence-based medicine employs expert opinion and clinical data to inform clinical decision making. The objective of this study is to determine whether it is possible to complement these sources of evidence with information about physician “group intelligence” that exists in electronic health records. Specifically, we measured laboratory test “repeat intervals”, defined as the amount of time it takes for a physician to repeat a test that was previously ordered for the same patient. Our assumption is that while the result of a test is a direct measure of one marker of a patient's health, the physician's decision to order the test is based on multiple factors including past experience, available treatment options, and information about the patient that might not be coded in the electronic health record. By examining repeat intervals in aggregate over large numbers of patients, we show that it is possible to 1) determine what laboratory test results physicians consider “normal”, 2) identify subpopulations of patients that deviate from the norm, and 3) identify situations where laboratory tests are over-ordered. We used laboratory tests as just one example of how physician group intelligence can be used to support evidence based medicine in a way that is automated and continually updated.

Reconstructing data : evidence-Based Medicine and Evidence-Based Public Health in context

Davidovitch, Nadav; Filc, Dani
Fonte: Universidade Autônoma de Barcelona Publicador: Universidade Autônoma de Barcelona
Tipo: Artigo de Revista Científica Formato: application/pdf
Publicado em //2006 ENG
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The emergence of Evidence-Based Medicine (EBM) as the gold-standard practice in biomedicine and public health practices represents a significant epistemological turn in modern medicine. The development of Evidence-Based Public Health (EBPH) followed the emergence of Evidence-Based Medicine, as an attempt to ground health policies and interventions on «sound facts». The present paper analyzes the historical and sociological roots of this turn. We evaluate the ethical and social consequences of this transformation, both within the medical profession (the polarization between a medical elite which strengthened its professional status, and a rank and file which experienced a process of «de-professionalization») and in its relationship to the welfare state (the link between the medical elite, EBM, EBPH and the commodification of health care and public health).

The importance of values in evidence based medicine

Kelly, Michael P.; Heath, Iona; Howick, Jeremy; Greenhalgh, Trisha
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Article; published version
EN
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This is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s12910-015-0063-3; Background: Evidence-based medicine (EBM) has always required integration of patient values with ?best? clinical evidence. It is widely recognized that scientific practices and discoveries, including those of EBM, are value-laden. But to date, the science of EBM has focused primarily on methods for reducing bias in the evidence, while the role of values in the different aspects of the EBM process has been almost completely ignored. Discussion: In this paper, we address this gap by demonstrating how a consideration of values can enhance every aspect of EBM, including: prioritizing which tests and treatments to investigate, selecting research designs and methods, assessing effectiveness and efficiency, supporting patient choice and taking account of the limited time and resources available to busy clinicians. Since values are integral to the practice of EBM, it follows that the highest standards of EBM require values to be made explicit, systematically explored, and integrated into decision making. Summary: Through ?values based? approaches, EBM?s connection to the humanitarian principles upon which it was founded will be strengthened.

Proliferação das rupturas paradigmáticas: o caso da medicina baseada em evidências; Proliferation of paradigmatic ruptures: the case of evidence-based medicine

Vasconcellos-Silva, Paulo Roberto; Castiel, Luis David
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/06/2005 POR
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O presente trabalho descreve o fenômeno da proliferação das rupturas paradigmáticas publicadas na literatura biomédica. É discutida a distorção que, com o passar das décadas, atribuiu um sentido oposto ao original proposto por Thomas Khun. Na sua grande maioria percebemos que essas pseudo-rupturas se relacionam meramente a detalhes técnicos ligados a contextos específicos. Destaca-se o caso da medicina baseada em evidências (MBE), anunciada como uma dessas rupturas, em cuja essência se reafirmam antigas concepções. Alguns equívocos conceituais são enfatizados como tentativas de aplicar os pressupostos da MBE a fenômenos ligados à subjetividade e à dinâmica social, além de outros objetos de estudo peculiares às ciências sociais. São citadas 12 metanálises inconclusivas, que originam paradoxos quando estudados por esta via. A crítica a alguns aspectos da MBE é sintetizada pelo de seu efeito de confundimento epistemológico. Há imprecisões conceituais do termo relacionadas ao efeito de "entrincheiramento", ao qual são induzidos outros modelos epistemológicos não alinhados, assim como a tendência à compreensão universal dos fenômenos pela perspectiva dos estudos duplo-cego randomizados.; The present study describes the phenomenon of paradigmatic ruptures proliferation in the biomedical literature. The current distortion is discussed...

Diagnostic use of procedures and measurements used during clinical lumbosacral radiculopathy examination according to the principles of evidence-based medicine: a systematic review; Utilidade diagnóstica dos procedimentos e medidas no exame clínico de radiculopatias lombossacrais segundo os princípios da Medicina Baseada em Evidências: revisão sistemática

Santos Filho, Carlos Souto dos; Sá, Eduardo Costa
Fonte: Universidade de São Paulo. Faculdade de Medicina Publicador: Universidade de São Paulo. Faculdade de Medicina
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf
Publicado em 11/09/2011 POR
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A importância da incorporação da Medicina Baseada em Evidência na capacidade dos testes e medidas clínicas em predizer diagnósticos de radiculopatias não pode ser menosprezada. A síndrome radicular lombossacral é auto-limitante na maioria dos casos e os sintomas desaparecem espontaneamente em semanas ou meses. Já a cronificação produz importante incapacidade física e laboral. Diante da falta de conhecimento técnico, fez-se uma revisão de literatura sobre a utilidade diagnóstica dos testes clínicos para esta patologia. Este estudo teve por objetivo pesquisar as melhores práticas médicas baseada em evidências científicas dos procedimentos e medidas no exame clínico e os critérios diagnósticos das radiculopatias lombossacrais, listar os testes mais utilizados, levantar as propriedades diagnósticas dos testes, além de avaliar a objetividade destes. Os autores realizaram uma discussão de 53 artigos selecionados nas bases de dados Medline, Web of Science, Embase, Scopus, Lilacs e SciELO, usando como descritores “Evidence-based Medicine”, “Diagnostic Techniques and Procedures”, “Radiculopathy”, “Lumbosacral Region”, “Diagnostic Tests”, “Nerve Compression Syndromes”, “Diagnostic Techniques...

Evidence-based medicine: what it can and cannot do

Freddi,Goffredo; Romàn-Pumar,José Luis
Fonte: Istituto Superiore di Sanità Publicador: Istituto Superiore di Sanità
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2011 EN
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Evidence-based medicine (EBM) is not a old hat, a "cookbook" medicine perpetrated by arrogant to serve cost cutters to suppress clinical freedom, a mandatory, deterministic, totalitarian practice of medicine, a way to control cost and to ignore patient preferences, a limit to personal/humanistic/individual medicine. EBM is a reference of excellence to guide clinical decisions, the integration of own expertise with others' expertise and patient preferences, a way to improve medical practice and limit the variability and errors created when there is not evidence to identify the gold standard and differentiate among alternatives available. But evidences need to be integrated with a new thinking based on Complexity Science. Health care systems operates as complex adaptative systems rather than rigid, linear or mechanical organizations and innovation is a critical outcome of Complexity Science. How does EBM impact drug innovation? New drug approvals are not keeping pace with rising Research and Development spending, clinical approval success rate for new chemical entities (NCEs) is progressively dropping and maybe, through these indicators, we are seeing the worst face of EBM: its limiting, blocking, and controlling side. If that is the case...

The personalised medicine: a paradigm of evidence-based medicine

Kumar,Dhavendra
Fonte: Istituto Superiore di Sanità Publicador: Istituto Superiore di Sanità
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2011 EN
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The practice of "evidence-based medicine" aims at the conscientious, explicit and judicious use of the current best evidence in making decisions about the individualised patient care. The clinical genetics evolved from translational genetics research and contributes to the clinical care of patients and families through evidence-based health care in managing inherited disorders through accurate diagnosis, molecular pathology and assessing phenotypic correlations. Translational genetics and genomics research has led to the development of powerful tools for clinical diagnosis, assessing individual's genomic profile for disease prediction/prevention, high-throughput genome-wide screening for predisposition and/or protection to complex medical conditions, and discovery and development of new drugs and vaccines. Gene mapping and deciphering pathogenic mutations have helped in unravelling the basic biological mechanisms leading to new drug discovery and development. Targeted pharmacotherapy is now possible for managing the highly penetrant multi-system dominantly inherited conditions. Notable examples include rapamycin (sirolimus) in suppressing the mTOR pathway associated hamartomas in dominantly inherited cancer family syndromes and angiotensin converting enzyme receptor blockers (ACE-RB) in preventing aortic dilatation in Marfan syndrome and related familial arteriopathies. The translational genomic research is the essential prerequisite for developing sound evidence-based diagnostic...