Evidence-based medicine

Abstract

Evidence-based medicine (EBM) originated from the new science that resulted from combining the methods of epidemiology and clinical research. At a time when clinicians and epidemiologists were beset by rivalry, Archibald Cochrane integrated knowledge from these two fields and created what came to be known as clinical epidemiology. With help from his collaborators, including Professor Kerr L. White, he set out his clamor for efficacy, effectiveness and efficiency in clinical teaching, practice and research.EBM crowns the fundamental concepts of medicine and healthcare through requiring evidence of effectiveness, efficiency and safety to guide decision-making such that there will be greater likelihood of making correct decisions. The concept of EBM was introduced at the beginning of the 1990s and was followed by establishment of the Cochrane Collaboration in 1992,by Professor Iain Chalmers in Oxford. Supporting medical practices on the basis of the best evidence, coming from rigorous methodologies that give this evidence comparative validity, is a civilizing process. This process was started by René Descartes at the beginning of the 18 th century and was followed by publication of the first controlled clinical trial by James Lind. 2 Lind's work brought in the cure for scurvy and changed the course of human history. Moreover, it changed Brazilian history through avoidance of thousands of deaths among professionals of strategic importance for this country's development, who were brought to Brazil by Dom João VI in 1808. 3 In 1834, Alexander Louis went against the prevailing practice of treating all diseases through bloodletting, by conducting comparative studies (with or without bloodletting). He found that there was no benefit from this cruel practice, which was based on fanciful beliefs and on the authority of certain individuals who called themselves doctors. 4,5 In 1948, Bradford Hill and Archibald Cochrane conducted the first blinded randomized controlled clinical trial, to test use of streptomycin for treating tuberculosis. 6 The study design in itself represented a revolution within medicine, since it created randomization and started "blinded" reading of radiographs by three observers. Furthermore, this study provided the first description of the cure for tuberculosis. In this manner, blinded randomized clinical trials became the research design model for comparing any proposed new treatment with placebo initially, if ethical, and subsequently with the traditional treatment when necessary.The entire new methodology that was proposed had the objective of rationalizing how studies were conducted, with the aim of supplanting the bias caused through fantasies, emotions, beliefs and interests. In particular, it aimed to combat financial interests: not only among individuals but also among major corporations that seek to make profits. Few attitudes can lead to so much efficiency and avoid so much suffering and waste of money and lives as the use of evidence for making decisions, not only in relation to human healt...

Construction of Clinical Pathway Information Management System under the Guidance of Evidence-Based Medicine

“…Before the 1980s, the medical research and practice were guided by traditional empirical medicine, which involved personal experience, textbooks, instructions from superior doctors, and some professional journals and literature [ 1 ]. With the passage of time, people gradually discovered the following problems in traditional medicine: the conclusions obtained from animal experiments are directly used in clinical practice, and their efficacy and safety cannot be determined; the popularization of observational studies or empirical results in the clinic leads to contradictions between clinical diagnosis and treatment methods; there are differences between actual treatment effects and clinical treatment effects that are inferred only based on the physiological/pathological mechanism of the disease [ 2 , 3 ]. They all reflect the limitations under the guidance of traditional medicine.…”

Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II’s method

“…The Evidence-Based Medicine movement was introduced in the early 1990s, being later expanded to Evidence-Based Health Care, with the primary goal to ensure that clinical decision-making was guided and supported by the best currently available evidence from scientific research studies (1–3). To achieve this goal, evidence-based clinical practice guidelines (CPGs) have been developed to provide recommendations based on a systematic search, selection and evaluation of the existing literature and potentially improve health care decisions as well as their overall quality and outcomes (4,5).…”

Cochrane Library: the best evidence within everyone's reach

“…It is among the ten most important medical journals worldwide and is available to Brazilians openly and free of charge. 1 – 2 …”