REview of LiteratureHaynes
docx
keyboard_arrow_up
School
DeVry University, Keller Graduate School of Management *
*We aren’t endorsed by this school
Course
432
Subject
Medicine
Date
Apr 3, 2024
Type
docx
Pages
7
Uploaded by EarlIce13704
1
Review of Literature on Evidence-based Medicine
Ita Haynes
DeVry University
LAS432 Technology, Society, and Culture
Professor Gooch
March 24, 2024
2
Review of Literature on Evidence-Based Medicine
Within the healthcare industry, evidence-based medicine is considered the standard of care. The consensus agrees that clinical decisions should be based on the highest quality scientific evidence for better patient outcomes, which promotes effective treatments. However, there are debates regarding the effectiveness due to misunderstanding the information that randomized clinical trials provide and doctors’ interpretation of the best practical use. To apply EBM successfully it requires the ability to decern how well it applies on an individual patient basis. In this context, we will analyze the role of evidence-based medicine in clinical decision-making from different perspectives. Points of Agreement
3
It is widely acknowledged from all sources that EBM is an important component of clinical practice. They believe that the integration of the best available evidence along with knowledge of
patient preference’s implementation of EBM improves patient care (Baig et al., 1969). Doctors generally have a positive attitude toward EBM. However, they also have stated limitations bridging the gap between evidence regarding efficacy, effectiveness, and cost-effectiveness (Sadeghi-Bazargani et al., 2014). In addition, Basic knowledge of EBM processes are not always
in alignment with doctors perceptions which poses challenges in application. Points of Disagreement
One of the major concerns across all sources is EBM’s methodology and reliance on randomized controlled trials. Emphasizing a more comprehensive approach rather than solely relying on one specific method. It has been argued that RCT’s exclusively may overlook other sources. For which Mebius (2014) takes a stance towards corroborating evidence from different methodologies and study designs. Rocca (2018) also highlights the consideration of quantitative evidence and clinical judgment. In contrast, James (2017) “the promise of EBM to effect transformational change in health care will remain unfulfilled until (i) studies of effectiveness and cost-effectiveness are pursued with some of the same fervor that previously succeeded in elevating the status of the randomized controlled trial, and (ii) ways are found to defeat threats to
scientific integrity posed by commercial conflicts of interest.” Because EBM relies so heavily on data from RCTs, the data do not include many types of treatments or patients seen in clinical practice; the results show the efficacy of treatment for an “average” randomized patient, not those in subgroups formed by cogent clinical features such as
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
4
severity of illness, comorbidity or other clinical nuances; or psychosocial features such as stress, allostasis, or neighborhood deprivation that are known to affect both risk for disease and response to treatment. Randomized trial data are also seldom available for issues that are prominent in clinical practice such as etiology, diagnosis, and prognosis of disease. Physicians who seek to provide counseling to patients or take their personal preferences into account or learn strategies for giving comfort or reassurance to patients will find little help from the literature of EBM (Horwitz & Singer, 2017).
Influential /Outliners
The articles presented diverse perspectives and insight into evidence-based medicine. The
emphasis on integrating clinical expertise, quantitative evidence, and clinical judgment
highlights the barriers and doctors’ perspectives toward EBM. None of which, in my opinion,
stood out as influential or authoritative. However, I agree with the arguments posed by Mebius
(2014) and James (2017). The overall strength of evidence should be the main focus in the
relationship between evidence methodology and study design. As well as closing the gap
between internal and external validity. Change over Time
In the article by Rajit et al. (2024), the future of EBM looks at the evidence
ecosystem and a learning health system as a solution to align technology,
people, and the culture of healthcare’s continuous improvement. The LHS would
5
be data-driven and iterative learning. Even though EBM has made substantial
progress, challenges still arise from gaps in person-centered care and evidence-
based medicine. The LHS contextualizes the integration of evidence, patient
values, and clinical experiences. To conclude, there are many factors to consider when clinical decision-making
that should not be followed blindly. Evidence-based medicine is a complex and
unique way of evaluating patient care, and individual patient profiles are needed
to guide clinical decision-making. Essentially, it focuses on the quality, and
relevance of evidence instead of the methodology used. In the words of Horwitz &
Singer, (2017), “Al
l who are involved in the care of patients need to recognize that the
best decisions for the care of patients require the role of judgment in the research
that generates evidence, judgment in the interpretation of evidence, and judgment
in the application of evidence to the care of individual patients.
6
.
References
Pandey, D., & Garg, P. K. (2022). Do we need evidence for evidence‐based medicine? Journal of Evaluation in Clinical Practice, 28(5), 731–732. https://doi-org.devry.idm.oclc.org/10.1111/jep.13577
Horwitz, R. I., & Singer, B. H. (2017). Why evidence-based medicine failed in patient care and medicine-based evidence will succeed. Journal of Clinical Epidemiology, 84, 14-17. https://doi.org/10.1016/j.jclinepi.2017.02.003
Rocca, E. (2018). The judgements that evidence‐based medicine adopts. Journal of Evaluation in Clinical Practice, 24(5), 1184–1190. https://doi-org.devry.idm.oclc.org/10.1111/jep.12994
Mebius, A. (2014). Corroborating evidence-based medicine. Journal of Evaluation in Clinical Practice, 20(6), 915–920. https://doi-org.devry.idm.oclc.org/10.1111/jep.12129
James, J. E. (2017). Reviving Cochrane’s contribution to evidence-based medicine: bridging the gap between evidence of efficacy and evidence of effectiveness and cost-effectiveness. European Journal of Clinical Investigation, 47(9), 617–621. https://doi-
org.devry.idm.oclc.org/10.1111/eci.12782
Rajit, D., Johnson, A., Callander, E., Teede, H., & Enticott, J. (2024). Learning health systems and evidence ecosystems: a perspective on the future of evidence-based medicine and evidence-based guideline development. Health Research Policy and Systems, 22, 1-6. https://doi.org/10.1186/s12961-023-01095-2
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
7
Sadeghi, B. H., Tabrizi, J. S., & Azami, A. S. (2014). Barriers to evidence-based medicine: a systematic review. Journal of Evaluation in Clinical Practice, 20(6), 793–802. https://doi-
org.devry.idm.oclc.org/10.1111/jep.12222
Baig, M., Sayedalamin, Z., Almouteri, O., Algarni, M., & Allam, H. (2016). Perceptions, perceived barriers and practices of physicians' towards Evidence-Based Medicine. Pakistan Journal of Medical Sciences Quarterly, 32(1), 49-54. https://doi.org/10.12669/pjms.321.8841