Evidence based medicine guidelines: a solution to rationing or politics disguised as science?

Saarni, Samuli I.; Gylling, Heta Aleksandra

doi:10.1136/jme.2003.003145

Cited by 83 publications

(62 citation statements)

References 31 publications

(15 reference statements)

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“…However, evidence-based medicine has its limitations and possible stumbling blocks (Driever, 2002;Saarni et al, 2004;Miles et al, 2008;Shahar, 2008;Miles et al, 2011), in particular when it concerns diseases as complex as CF for which numerous therapeutic modalities have simply not yet been adequately studied (Cheng et al, 2000;David, 2001;Briggs et al, 2006;Kraynack et al, 2009). Best practice remains individualized in part, although a coherent foundation of evidence-based medicine is absolutely necessary.…”

Section: Marked Differences In Clinical Results Between Cf Centres: Why?mentioning

confidence: 99%

The Prognosis of Cystic Fibrosis - A Clinician's Perspective

Lebecque¹

2012

Cystic Fibrosis - Renewed Hopes Through Research

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Section: Marked Differences In Clinical Results Between Cf Centres: Why?mentioning

confidence: 99%

The Prognosis of Cystic Fibrosis - A Clinician's Perspective

Lebecque¹

2012

Cystic Fibrosis - Renewed Hopes Through Research

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“…18,[20][21][22][23] Concerns have been expressed in the past regarding familiarity and ease of access to EBS literature and practical applicability of EBS. Ethical concerns include the use of evidence-based medicine to deny lifesaving emergency services to areas which truly required them, 24 loss of therapeutic freedom of the clinicians, 25 denial of funding to clinical researchers on the grounds of lack of evidence, 26 and exploitation of EBM data by pharmaceutical companies to market products aggressively. 27 Our survey was designed to assess the prevalence of these concerns among surgeons.…”

Section: Discussionmentioning

confidence: 99%

Evidence-based surgery – evidence from survey and citation analysis in orthopaedic surgery

Kumar¹,

Gopalakrishna²,

Swaminath³

et al. 2011

Ann R Coll Surg Engl

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INTRODUCTIONThe results of a survey on evidence-based surgery (EBS) among members of the American Academy of Orthopedic Surgeons (AAOS) and the British Orthopaedic Association (BOA) are presented. The study also analyzes the citations earned by articles with different levels of evidence (LOE) to see if LOE have any bearing on the importance attached to the articles by authors and contributors to the journals. SUBJECTS AND METHODS The questionnaire was e-mailed to 1000 randomly chosen consultant orthopaedic surgeons who were members of either the AAOS or the BOA. Participants were provided with the option of responding through web-based entry. For citation analysis, citation data were gathered from the Journal of Bone and Joint Surgery (American volume) between the years 2003 and 2007 (5-year period). RESULTS The survey showed that awareness and access to EBS have improved greatly over the years. At the present time, these factors are not important barriers to the implementation of EBS in clinical practice in developed countries. There was a statistically significant difference in those with and without additional qualifications with regard to the approach to EBS. However, an equal percentage of surgeons with and without additional qualifications felt that it was difficult to adhere to EBS guidelines in daily clinical practice. Citation analysis showed that readers of professional journals attach importance to LOE category of the article and tend to cite level-I evidence articles more than other articles.

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“…29 The weight of writing in this area, however, argues a "horses for courses" approach with "methodological pluralism rather than continuing paradigmatic antagonisms, seeking complementary contributions from different research designs rather than epistemological competition" 30 or "different stages of the policy process [possibly calling] for different types of evidence." 31 Clearly "context," and its relevance and importance for the applicability of a particular piece of guidance, is the fulcrum around which swing these two views of the role of science.…”

Section: Two Views On the Role Of Scientific Evidence -Context-free Vmentioning

confidence: 99%

Wildlife Health 2.0: Bridging the Knowledge-to-Action Gap

Stephen

2017

Journal of Wildlife Diseases

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OUR PURPOSE VisionOur vision is a strong Canadian healthcare system that is guided by solid, research-based management and policy decisions. MissionTo support evidence-based decision-making in the organization, management, and delivery of health services through funding research, building capacity, and transferring knowledge. StrategyTo establish and foster linkages between decision makers (managers and policy makers) and researchers in the governance of the foundation and in the design and implementation of programs to support research, develop researchers, and transfer knowledge. Main Messages• At a basic level, the notion of evidence concerns facts (actual or asserted) intended for use in support of a conclusion.• Most decision makers view evidence colloquially -"anything that establishes a fact or gives reason for believing something" -and define it by its relevance. Most researchers view evidence scientifically -the use of systematic, replicable methods for production -and define it by its methodology.• Scientists' views on the role of evidence divide into those who emphasize more context-free universal truths (identified closely with "evidence-based medicine") and those who emphasize a context-sensitive role for evidence in a particular decision (identified closely with the applied social sciences).• The appropriate methods for obtaining scientific evidence on context factors are not the same as those for obtaining scientific evidence on program or intervention effectiveness -but this makes such evidence no less "scientific."• Scientific evidence on context can usefully be divided into evidence about attitudes, implementation, organizational capacity, forecasting, economics/finance, and ethics.• Colloquial evidence can usefully be divided into evidence about resources, expert and professional opinion, political judgment, values, habits and traditions, lobbyists and pressure groups, and the particular pragmatics and contingencies of the situation.• These three different forms of evidence -colloquial evidence, scientific evidence on effectiveness, and scientific evidence on context -will not combine of themselves to produce health system guidance; combining and interpreting them requires a deliberative process.• A deliberative process is participative and often follows a period of consultation with relevant stakeholders; it entails both the eliciting and the combining of various types of evidence in order to reach an evidence-based judgment.• There is little evidence on the effectiveness of deliberative processes, though there is much to be said in favour of them on grounds of principle.• The design of a deliberative process is not neutral and may well influence the relative weights assigned to each of the three forms of evidence, thus influencing the extent to which guidance is "evidence-based."• Characteristics of a deliberative process likely to ensure evidence-based guidance include consultation with all parties affected by the outcome, fair representation of scientists and stakeholders, high-quality s...

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Evidence based medicine guidelines: a solution to rationing or politics disguised as science?

Cited by 83 publications

References 31 publications

The Prognosis of Cystic Fibrosis - A Clinician's Perspective

The Prognosis of Cystic Fibrosis - A Clinician's Perspective

Evidence-based surgery – evidence from survey and citation analysis in orthopaedic surgery

Wildlife Health 2.0: Bridging the Knowledge-to-Action Gap

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