Medicina Basada En Evidencia Que Es Y Que No Es

  • May 2020
  • PDF

This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA


Overview

Download & View Medicina Basada En Evidencia Que Es Y Que No Es as PDF for free.

More details

  • Words: 4,230
  • Pages: 11
BMJ 1996;312:71-72 (13 January)

Editorials Evidence based medicine: what it is and what it isn't It's about integrating individual clinical expertise and the best external evidence Evidence based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, remains a hot topic for clinicians, public health practitioners, purchasers, planners, and the public. There are now frequent workshops in how to practice and teach it (one sponsored by the BMJ will be held in London on 24 April); undergraduate1 and postgraduate2 training programmes are incorporating it3 (or pondering how to do so); British centres for evidence based practice have been established or planned in adult medicine, child health, surgery, pathology, pharmacotherapy, nursing, general practice, and dentistry; the Cochrane Collaboration and Britain's Centre for Review and Dissemination in York are providing systematic reviews of the effects of health care; new evidence based practice journals are being launched; and it has become a common topic in the lay media. But enthusiasm has been mixed with some negative reaction.4 5 6 Criticism has ranged from evidence based medicine being old hat to it being a dangerous innovation, perpetrated by the arrogant to serve cost cutters and suppress clinical freedom. As evidence based medicine continues to evolve and adapt, now is a useful time to refine the discussion of what it is and what it is not. Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer. Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients. This description of what evidence based medicine is helps clarify what evidence based medicine is not. Evidence based medicine is neither old hat nor impossible to practice. The argument that "everyone already is doing it" falls before evidence of striking variations in both the integration of patient values into our clinical behaviour7 and in the rates with which clinicians provide interventions to their patients.8 The difficulties that clinicians face in keeping abreast of all the medical advances reported in primary journals are obvious from a comparison of the time required for reading (for general medicine, enough to examine 19 articles per day,

365 days per year9) with the time available (well under an hour a week by British medical consultants, even on self reports10). The argument that evidence based medicine can be conducted only from ivory towers and armchairs is refuted by audits from the front lines of clinical care where at least some inpatient clinical teams in general medicine,11 psychiatry (J R Geddes et al, Royal College of Psychiatrists winter meeting, January 1996), and surgery (P McCulloch, personal communication) have provided evidence based care to the vast majority of their patients. Such studies show that busy clinicians who devote their scarce reading time to selective, efficient, patient driven searching, appraisal, and incorporation of the best available evidence can practice evidence based medicine. Evidence based medicine is not "cookbook" medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients' choice, it cannot result in slavish, cookbook approaches to individual patient care. External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision. Similarly, any external guideline must be integrated with individual clinical expertise in deciding whether and how it matches the patient's clinical state, predicament, and preferences, and thus whether it should be applied. Clinicians who fear top down cookbooks will find the advocates of evidence based medicine joining them at the barricades. Some fear that evidence based medicine will be hijacked by purchasers and managers to cut the costs of health care. This would not only be a misuse of evidence based medicine but suggests a fundamental misunderstanding of its financial consequences. Doctors practising evidence based medicine will identify and apply the most efficacious interventions to maximise the quality and quantity of life for individual patients; this may raise rather than lower the cost of their care. Evidence based medicine is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions. To find out about the accuracy of a diagnostic test, we need to find proper cross sectional studies of patients clinically suspected of harbouring the relevant disorder, not a randomised trial. For a question about prognosis, we need proper follow up studies of patients assembled at a uniform, early point in the clinical course of their disease. And sometimes the evidence we need will come from the basic sciences such as genetics or immunology. It is when asking questions about therapy that we should try to avoid the non-experimental approaches, since these routinely lead to false positive conclusions about efficacy. Because the randomised trial, and especially the systematic review of several randomised trials, is so much more likely to inform us and so much less likely to mislead us, it has become the "gold standard" for judging whether a treatment does more good than harm. However, some questions about therapy do not require randomised trials (successful interventions for otherwise fatal conditions) or cannot wait for the trials to be conducted. And if no randomised trial has been carried out for our patient's predicament, we must follow the trail to the next best external evidence and work from there. Despite its ancient origins, evidence based medicine remains a relatively young discipline whose positive impacts are just beginning to be validated,12 13 and it will continue to evolve. This evolution will be enhanced as several undergraduate, postgraduate, and continuing medical education programmes adopt and adapt it to their learners' needs. These programmes, and their evaluation, will provide further information and understanding about what evidence based medicine is and is not.

Professor NHS Research and Development Centre for Evidence Based Medicine, Oxford Radcliffe NHS Trust, Oxford OX3 9DU Clinical tutor in medicine Nuffield Department of Clinical Medicine, University of Oxford, Oxford Director of research and development Anglia and Oxford Regional Health Authority, Milton Keynes Professor of medicine and clinical epidemiology McMaster University, Hamilton, Ontario Canada Clinical associate professor of medicine University of Rochester School of Medicine and Dentistry, Rochester, New York, USA David L Sackett, William M C Rosenberg, J A Muir Gray, R Brian Haynes, W Scott Richardson

1.

British Medical Association. Report of the working party on medical education. London: BMA, 1995.

2.

Standing Committee on Postgraduate Medical and Dental Education. Creating a better learning environment in hospitals. 1. Teaching hospital doctors and dentists to teach. London: SCOPME, 1994.

3.

General Medical Council. Education committee report. London: GMC, 1994.

4.

Grahame-Smith D. Evidence based medicine: Socratic dissent. BMJ 1995;310:1126-7. [Free Full Text]

5.

Evidence based medicine; in its place [editorial]. Lancet 1995;346:785. [Medline]

6.

Correspondence. Evidence based medicine. Lancet 1995;346:1171-2.

7.

Weatherall DJ: The inhumanity of medicine. BMJ 1994;309;1671-2.

8.

House of Commons Health Committee. Priority setting in the NHS: purchasing. First report sessions 1994-95. London: HMSO, 1995. (HC 134-1.)

9.

Davidoff F, Haynes B, Sackett D, Smith R. Evidence based medicine: a new journal to help doctors identify the information they need. BMJ 1995;310:1085-6. [Free Full Text]

10. Sackett DL. Surveys of self-reported reading times of consultants in Oxford, Birmingham, MiltonKeynes, Bristol, Leicester, and Glasgow. In: Rosenberg WMC, Richardson WS, Haynes RB, Sackett DL. Evidence-based medicine. London: Churchill Livingstone (in press). 11. Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient general medicine is evidence based. Lancet 1995;346:407-10. [Medline]

12. Bennett RJ, Sackett DL, Haynes RB, Neufeld VR. A controlled trial of teaching critical appraisal of the clinical literature to medical students. JAMA 1987;257:2451-4. [Abstract] 13. Shin JH, Flaynes RB, Johnston ME. Effect of problem-based, self-directed undergraduate education on life-long learning. Can Med Assoc J 1993;148:969-76. [Abstract]

Related Articles Evidence based prescribing Simon R J Maxwell BMJ 2005 331: 247-248. [Extract] [Full Text]

Evidence based medicine: does it make a difference?: Use wisely Benjamin Druss BMJ 2005 330: 92. [Extract] [Full Text]

This article has been cited by other articles: (Search Google Scholar for Other Citing Articles)



Gerber, A., Hentzelt, F., Lauterbach, K. W (2007). Can evidence-based medicine implicitly rely on current concepts of disease or does it have to develop its own definition?. J. Med. Ethics 33: 394399 [Abstract] [Full text]



Hollingworth, W., Jarvik, J. G. (2007). Technology Assessment in Radiology: Putting the Evidence in Evidence-based Radiology. Radiology 244: 31-38 [Abstract] [Full text]



Klett, R., Lange, U., Haas, H., Voth, M., Pinkert, J. (2007). Radiosynoviorthesis of medium-sized joints with rhenium-186-sulphide colloid: a review of the literature. Rheumatology (Oxford) 0: kem155v1-7 [Abstract] [Full text]



Boothroyd, A. (2007). Adult Aural Rehabilitation: What Is It and Does It Work?. TRENDS AMPLIF 11: 63-71 [Abstract]



Ammenwerth, E., de Keizer, N. (2007). A Viewpoint on Evidence-based Health Informatics, Based on a Pilot Survey on Evaluation Studies in Health Care Informatics. J. Am. Med. Inform. Assoc. 14: 368-371 [Abstract] [Full text]



Malone, D. E., Staunton, M. (2007). Evidence-based Practice in Radiology: Step 5 (Evaluate)-Caveats and Common Questions. Radiology 243: 319-328 [Abstract] [Full text]



Sicras-Mainar, A., Serrat-Tarres, J., Navarro-Artieda, R., Llausi-Selles, R., Ruano-Ruano, I., Gonzalez-Ares, J. A. (2007). Adjusted Clinical Groups use as a measure of the referrals efficiency from primary care to specialized in Spain. Eur J Public Health 0: ckm044v1-7 [Abstract] [Full text]



Halligan, S., Altman, D. G. (2007). Evidence-based Practice in Radiology: Steps 3 and 4--Appraise and Apply Systematic Reviews and Meta-Analyses. Radiology 243: 13-27 [Abstract] [Full text]



Chapman, R. L. (2007). Educational Perspectives: Strategies for Teaching and Practicing Evidence-based Neonatology. NeoReviews 8: e105-e109 [Full text]



Hamlin, R. G. (2007). An Evidence-Based Perspective on HRD. Advances in Developing Human Resources 9: 42-57 [Abstract]



Braye, S., Preston-Shoot, M. (2007). On Systematic Reviews in Social Work: Observations from Teaching, Learning and Assessment of Law in Social Work Education. Br J Soc Work 37: 313-334 [Abstract] [Full text]



Taylor, B. J., Dempster, M., Donnelly, M. (2007). Grading Gems: Appraising the Quality of Research for Social Work and Social Care. Br J Soc Work 37: 335-354 [Abstract] [Full text]



Rubin, A., Parrish, D. (2007). Views of Evidence-Based Practice Among Faculty in Master of Social Work Programs: A National Survey. Research on Social Work Practice 17: 110-122 [Abstract]



Gibbs, L. (2007). Applying Research to Making Life-Affecting Judgments and Decisions. Research on Social Work Practice 17: 143-150 [Abstract]



Malone, D. E. (2007). Evidence-based Practice in Radiology: An Introduction to the Series. Radiology 242: 12-14 [Full text]



Kampen, W. U., Voth, M., Pinkert, J., Krause, A. (2007). Therapeutic status of radiosynoviorthesis of the knee with yttrium [90Y] colloid in rheumatoid arthritis and related indications. Rheumatology (Oxford) 46: 16-24 [Abstract] [Full text]



Grypdonck, M. H. F. (2006). Qualitative health research in the era of evidence-based practice.. Qual Health Res 16: 1371-1385 [Abstract]



Smith, B. J., Tang, K. C., Nutbeam, D. (2006). WHO Health Promotion Glossary: new terms. HEALTH PROMOT INT 21: 340-345 [Abstract] [Full text]



Fairhurst, K., May, C. (2006). What General Practitioners Find Satisfying in Their Work: Implications for Health Care System Reform. Ann Fam Med 4: 500-505 [Abstract] [Full text]



Rodrigo, G. J. (2006). Rapid effects of inhaled corticosteroids in acute asthma: an evidence-based evaluation.. Chest 130: 1301-1311 [Abstract] [Full text]



Kelly, B. D., Feeney, L. (2006). What every psychiatrist should know. Adv. Psychiatr. Treat. 12: 462-468 [Abstract] [Full text]



Ratner, N. B. (2006). Evidence-Based Practice: An Examination of Its Ramifications for the Practice of Speech-Language Pathology. LSHSS 37: 257-267 [Abstract] [Full text]



Gillam, S. L., Gillam, R. B. (2006). Making Evidence-Based Decisions About Child Language Intervention in Schools. LSHSS 37: 304-315 [Abstract] [Full text]



Norberg, A. (2006). The meaning of evidence-based nursing.. Nurs Ethics 13: 453-454



Kelly, B. D., Feeney, L. (2006). Psychiatry: no longer in dissent?. Psychiatr. Bull. 30: 344-345 [Full text]



Geddes, J. (2006). Providing the best available evidence: INVITED COMMENTARY ON... THE ANTIDEPRESSANT TALE. Adv. Psychiatr. Treat. 12: 327-328 [Abstract] [Full text]



Polin, R. A., Lorenz, J. M., Bateman, D. A. (2006). Evidence-based Neonatology. NeoReviews 7: e474-e485 [Full text]



Palisano, R. J (2006). A Collaborative Model of Service Delivery for Children With Movement Disorders: A Framework for Evidence-Based Decision Making. ptjournal 86: 1295-1305 [Abstract] [Full text]



Cremonesi, A., Setacci, C., Bignamini, A., Bolognese, L., Briganti, F., Di Sciascio, G., Inzitari, D., Lanza, G., Lupattelli, L., Mangiafico, S., Pratesi, C., Reimers, B., Ricci, S., de Donato, G., Ugolotti, U., Zaninelli, A., Gensini, G. F. (2006). Carotid Artery Stenting: First Consensus Document of the ICCS-SPREAD Joint Committee. Stroke 37: 2400-2409 [Abstract] [Full text]



Lenfant, C. (2006). Will Lung Volume Reduction Surgery Be Widely Applied?. Ann. Thorac. Surg. 82: 385-387 [Full text]



Smith, F. G., Tong, J. L, Smith, J. E (2006). Evidence-based medicine. Contin Educ Anaesth Crit Care Pain 6: 148-151 [Full text]



Weissman, M. M., Verdeli, H., Gameroff, M. J., Bledsoe, S. E., Betts, K., Mufson, L., Fitterling, H., Wickramaratne, P. (2006). National survey of psychotherapy training in psychiatry, psychology, and social work.. Arch Gen Psychiatry 63: 925-934 [Abstract] [Full text]



Hurwitz, S. R., Tornetta, P. III, Wright, J. G. (2006). An AOA Critical Issue How to Read the Literature to Change Your Practice: An Evidence-Based Medicine Approach. J. Bone Joint Surg. Am. 88: 1873-1879 [Full text]



Dracup, K., Bryan-Brown, C. W. (2006). Evidence-based practice is wonderful ... Sort of.. Am J Crit Care 15: 356-358 [Full text]



Jackson, R., Ameratunga, S., Broad, J., Connor, J., Lethaby, A., Robb, G., Wells, S., Glasziou, P., Heneghan, C. (2006). The GATE frame: critical appraisal with pictures. Evid. Based Nurs. 9: 68-71 [Full text]



Nail-Chiwetalu, B. J., Ratner, N. B. (2006). Information literacy for speech-language pathologists: a key to evidence-based practice.. LSHSS 37: 157-167 [Abstract] [Full text]



Waldman, M. H. (2006). Evidence-based medicine: how to translate research into patient care.. J. Am. Podiatr. Med. Assoc. 96: 374-377 [Abstract] [Full text]



Gibson, M., Santa, J. (2006). The Drug Effectiveness Review Project: An Important Step Forward. Health Aff (Millwood) 25: W272-W275 [Abstract] [Full text]



McElwee, N. E., Ho, S. Y., McGuigan, K. A., Horn, M. L. (2006). Evidence-Based Coverage Decisions? Primum Non Nocere. Health Aff (Millwood) 25: W279-W282 [Abstract] [Full text]



Gottrup, F. (2006). Evidence is a challenge in wound management.. INT J LOW EXTREM WOUNDS 5: 74-75



Lempp, H., Scott, D., Kingsley, G. (2006). The personal impact of rheumatoid arthritis on patients' identity: a qualitative study. Chronic Illness 2: 109-120 [Abstract]



Riehl, C. (2006). Feeling Better: A Comparison of Medical Research and Education Research. EDUCATIONAL RESEARCHER 35: 24-29 [Abstract]



Hinze, A., Buchanan, G., Jung, D., Adams, A. (2006). HDLalert - a healthcare DL alerting system: from user needs to implementation.. Health Informatics Journal 12: 121-135 [Abstract]



Staller, K. M. (2006). Railroads, Runaways, & Researchers: Returning Evidence Rhetoric to Its Practice Base. Qualitative Inquiry 12: 503-522 [Abstract]



French, J, Steel, A, Clements, R, Lewis, S, Wilson, M, Teasdale, B, Mackenzie, R, Black, J (2006). Best Bets: A call for scrutiny.. Emerg. Med. J. 23: 490-490 [Full text]



Woolf, S. H. (2006). Weighing the evidence to formulate dietary guidelines.. J. Am. Coll. Nutr. 25: 277S-284S [Abstract] [Full text]



Lai, T. Y. Y., Leung, G. M., Wong, V. W. Y., Lam, R. F., Cheng, A. C. O., Lam, D. S. C. (2006). How Evidence-Based Are Publications in Clinical Ophthalmic Journals?. IOVS 47: 1831-1838 [Abstract] [Full text]



Gambrill, E. (2006). Evidence-Based Practice and Policy: Choices Ahead. Research on Social Work Practice 16: 338-357 [Abstract]



Pincus, T., Sokka, T. (2006). Should aggressive therapy for rheumatoid arthritis require early use of weekly low-dose methotrexate, as the first disease-modifying anti-rheumatic drug in most patients?. Rheumatology (Oxford) 45: 497-499 [Full text]



Jackson, R., Ameratunga, S., Broad, J., Connor, J., Lethaby, A., Robb, G., Wells, S., Glasziou, P., Heneghan, C. (2006). The GATE frame: critical appraisal with pictures. Evid. Based Med. 11: 3538 [Full text]



Gluud, L. L. (2006). Bias in Clinical Intervention Research. Am J Epidemiol 163: 493-501 [Abstract] [Full text]



Mccormack, B. (2006). Evidence-based practice and the potential for transformation. Journal of Research in Nursing 11: 89-94



Rycroft-Malone, J. (2006). The politics of the evidencebased practice movements: Legacies and current challenges. Journal of Research in Nursing 11: 95-108 [Abstract]



Gilgun, J. F. (2006). The Four Cornerstones of Qualitative Research. Qual Health Res 16: 436-443 [Abstract]



Cohen, A.M., Hersh, W.R., Peterson, K., Yen, P.-Y. (2006). Reducing Workload in Systematic Review Preparation Using Automated Citation Classification. J. Am. Med. Inform. Assoc. 13: 206219 [Abstract] [Full text]



Maier, R. V. (2006). What the surgeon of tomorrow needs to know about evidence-based surgery.. Arch Surg 141: 317-323 [Full text]



Thornhill IV, J. T., Tong, L. (2006). From Yoda to Sackett: The Future of Psychiatry Medical Student Education. Acad. Psychiatry 30: 23-28 [Abstract] [Full text]



Johnson, C. J. (2006). Getting started in evidence-based practice for childhood speech-language disorders.. AJSLP 15: 20-35 [Abstract] [Full text]



Bauchner, H. (2006). Atoms. Arch. Dis. Child. 91: 95-95 [Full text]



Thorne, S. (2006). Reflections on "Helping practitioners understand the contribution of qualitative research to evidence-based practice". Evid. Based Nurs. 9: 7-8 [Full text]



Best, M, Neuhauser, D (2005). Pierre Charles Alexandre Louis: Master of the spirit of mathematical clinical science. Qual Saf Health Care 14: 462-464 [Full text]



Murray, I R, Murray, S A, MacKenzie, K, Coleman, S, Cullen, M (2005). How evidence based is the management of two common sports injuries in a sports injury clinic? * Commentary. Br. J. Sports. Med. 39: 912-916 [Abstract] [Full text]



Burkiewicz, J. S, Vesta, K. S, Hume, A. L (2005). Update in Handheld Electronic Resources for Evidence-Based Practice in the Community Setting. The Annals of Pharmacotherapy 39: 21002103 [Abstract] [Full text]



Brophy, R. H., Gardner, M. J., Saleem, O., Marx, R. G. (2005). An Assessment of the Methodological Quality of Research Published in The American Journal of Sports Medicine. Am J Sports Med 33: 1812-1815 [Abstract] [Full text]



Carney, S. (2005). Competences for the foundation programme--part 3: Evidence based medicine. BMJ CAREER FOCUS 331: 231-232 [Full text]



Wolff, A. C., Desch, C. E. (2005). Clinical Practice Guidelines in Oncology: Translating Evidence Into Practice (and back). J Oncol Pract 1: 160-161 [Full text]



Alper, B. S., White, D. S., Ge, B. (2005). Physicians Answer More Clinical Questions and Change Clinical Decisions More Often With Synthesized Evidence: A Randomized Trial in Primary Care. Ann Fam Med 3: 507-513 [Abstract] [Full text]



Staunton, M., Dodd, J. D., McCormick, P. A., Malone, D. E. (2005). Finding Evidence-based Answers to Practical Questions in Radiology: Which Patients with Inoperable Hepatocellular Carcinoma Will Survive Longer after Transarterial Chemoembolization?. Radiology 237: 404-413 [Abstract] [Full text]



Scott Richardson, W, Dowding, D. (2005). Teaching evidence-based practice on foot. Evid. Based Nurs. 8: 100-103 [Full text]



Lorenz, K. A., Ryan, G. W., Morton, S. C., Chan, K. S., Wang, S., Shekelle, P. G. (2005). A qualitative examination of primary care providers' and physician managers' uses and views of research evidence. Int J Qual Health Care 17: 409-414 [Abstract] [Full text]



Sedrakyan, A. (2005). Improving clinical outcomes in coronary artery bypass graft surgery. Am J Health Syst Pharm 62: S19-S23 [Abstract] [Full text]



Aoun, S. M, Kristjanson, L. J (2005). Challenging the framework for evidence in palliative care research. Palliat Med 19: 461-465 [Abstract]



Williams, M. T., Hord, N. G. (2005). The Role of Dietary Factors in Cancer Prevention: Beyond Fruits and Vegetables. Nutr Clin Pract 20: 451-459 [Abstract] [Full text]



Wambach, K., Campbell, S. H., Gill, S. L., Dodgson, J. E., Abiona, T. C., Heinig, M. J. (2005). Clinical Lactation Practice: 20 Years of Evidence. J Hum Lact 21: 245-258 [Abstract]



Richardson, W S. (2005). Teaching evidence-based practice on foot. Evid. Based Med. 10: 98-101 [Full text]



Mosconi, P., Poli, P., Giolo, A., Apolone, G. (2005). How Italian health consumers feel about clinical research: a questionnaire survey. Eur J Public Health 15: 372-379 [Abstract] [Full text]



Maxwell, S. R J (2005). Evidence based prescribing. BMJ 331: 247-248 [Full text]



Turner-Stokes, L (2005). The national service framework for long term conditions: a novel approach for a "new style" NSF. J. Neurol. Neurosurg. Psychiatry 76: 901-902 [Full text]



Cooney, W. P. III (2005). Evidence-based Medicine. J Am Acad Orthop Surg 13: 219-219 [Full text]



Spindler, K. P., Kuhn, J. E., Dunn, W., Matthews, C. E., Harrell, F. E. Jr, Dittus, R. S. (2005). Reading and Reviewing the Orthopaedic Literature: A Systematic, Evidence-based Medicine Approach. J Am Acad Orthop Surg 13: 220-229 [Abstract] [Full text]



Osser, D. N., Patterson, R. D., Levitt, J. J. (2005). Guidelines, Algorithms, and Evidence-Based Psychopharmacology Training for Psychiatric Residents. Acad. Psychiatry 29: 180-186 [Abstract] [Full text]



Hise, M. E., Kattelmann, K., Parkhurst, M. (2005). Evidence-Based Clinical Practice: Dispelling the Myths. Nutr Clin Pract 20: 294-302 [Abstract] [Full text]



Parker, M (2005). False dichotomies: EBM, clinical freedom, and the art of medicine. Med. Humanities 31: 23-30 [Abstract] [Full text]



Couvillon, J. S. (2005). How to Promote or Implement Evidenced-Based Practice in a Clinical Setting. Home Health Care Management Practice 17: 269-272 [Abstract]



Giuse, N. B., Koonce, T. Y., Jerome, R. N., Cahall, M., Sathe, N. A., Williams, A. (2005). Evolution of a Mature Clinical Informationist Model. J. Am. Med. Inform. Assoc. 12: 249-255 [Abstract] [Full text]



Bradley, P., Oterholt, C., Nordheim, L., Bjorndal, A. (2005). Medical Students' and Tutors' Experiences of Directed and Self-Directed Learning Programs in Evidence-Based Medicine: A Qualitative Evaluation Accompanying a Randomized Controlled Trial. Eval Rev 29: 149-177 [Abstract]



Guzelian, P. S, Victoroff, M. S, Halmes, N C., James, R. C, Guzelian, C. P (2005). Evidence-based toxicology: a comprehensive framework for causation. Hum Exp Toxicol 24: 161-201 [Abstract]



Cheng, D. C. H., Martin, J. E. (2005). Raising the Bar: A Primer On Evidence-Based DecisionMaking. SEMIN CARDIOTHORAC VASC ANESTH 9: 1-4



Redwood, S. (2005). Colliding discourses: Deconstructing the process of seeking ethical approval for a participatory evaluation project. Journal of Research in Nursing 10: 217-230 [Abstract]



Curran, S. A., Dananberg, H. J. (2005). Future of Gait Analysis: A Podiatric Medical Perspective. J. Am. Podiatr. Med. Assoc. 95: 130-142 [Abstract] [Full text]



Stobie, I., Boyle, J., Woolfson, L. (2005). Solution-Focused Approaches in the Practice of UK Educational Psychologists: A Study of the Nature of Their Application and Evidence of Their Effectiveness. School Psychology International 26: 5-28 [Abstract]



Bourret, P. (2005). BRCA Patients and Clinical Collectives: New Configurations of Action in Cancer Genetics Practices. Social Studies of Science 35: 41-68 [Abstract]



Wright, D, Crouch, R, Clancy, M (2005). Role of networks in supporting emergency medicine research: findings from the Wessex emergency care research network (WECReN). Emerg. Med. J. 22: 80-83 [Full text]



Druss, B. (2005). Evidence based medicine: does it make a difference?: Use wisely. BMJ 330: 9292 [Full text]



Hammick, M. R. (2005). Evidence-Informed Education in the Health Care Science Professions. jvme 32: 399-403 [Abstract] [Full text]



Gilgun, J. F. (2005). The Four Cornerstones of Evidence-Based Practice in Social Work. Research on Social Work Practice 15: 52-61 [Abstract]



Stewart, R., Hargreaves, K., Oliver, S. (2005). Evidence informed policy making for health communication. Health Education Journal 64: 120-128 [Abstract]



Eddy, D. M. (2005). Evidence-Based Medicine: A Unified Approach. Health Aff (Millwood) 24: 9-17 [Abstract] [Full text]

Rapid Responses: Read all Rapid Responses Evidence Based Medicine as Frame of Phytotherapy F Firenzuoli bmj.com, 15 Aug 2000 [Full text]

Re: Is EBM a Belief? Peter Morrell bmj.com, 5 Dec 2000 [Full text]

Re: Re: Is EBM a Belief? Joseph Watine bmj.com, 5 Dec 2000 [Full text]

Evidence-Based Medicine Revisited

Abd H Mat Sain bmj.com, 26 Jan 2004 [Full text]

Evidence-based Medicine: Why in Genuinely Protestant Countries? Andreas U Gerber, et al. bmj.com, 22 Apr 2004 [Full text]

Re: Evidence-based Medicine: Why in Genuinely Protestant Countries? John D Stone bmj.com, 23 Apr 2004 [Full text]

Related Documents

Que-es
November 2019 33
Que Es
November 2019 32
Que Es
June 2020 13
Es Que
June 2020 15