Creating Waves of Awareness
Evidence based practice [EBP]
evidence based practice is an interdisciplinary approach to clinical practice which is introduced in1992.it started as evidence based medicine and later spread to other sectors like nursing,dentistry,social science, psychology etc. the essence of evidence based medicine[EBM] is judicious and explicit use of currently available best evidence in every aspect of patient care-investigative, diagnostic and therapeutic.
It is based on 3 principles.
1 best available clinical evidence about treatment
2 clinical expertise [clinical judgment and experience]
3client preferences and values
The core activities at the root of EBP can be identified as:----------
1Questioning approach leading to scientific experimentation
2Meticulous observation, enumeration, analysis
3 recording for systematic retrieval
Today’s EBP techniques were formulated by Archie Cochrane, an epidemiologist. According to him most reliable evidence come from RCTs
Evidence based practice in psychology means they should use psychological approaches and techniques based on best available research evidence. Some therapy approaches may work better than others. Therapy is considered efficacious and specific if there is evidence from 2 settings that that is superior to a pill or placebo. If it is supported by 1 setting then it is called possibly efficacious therapy.
Eddy was the first to introduce Markov models to clinical medicine. He first began to use the term “evidence-based” in 1988 in his workshops to teach specialty societies how to use formal methods to design guidelines. Eddy was also the first to publish the term evidence based. Eddy first published the term “evidence-based” in March, 1990 in an article in the Journal of the American Medical Association that laid out the principles of evidence-based guidelines and population level policies,
Evidence based treatment:--------- EBT is an approach that tries to specify the way in which professionals and other decision makers to make decisions identifying evidences that are scientifically sound.
Evidence based design and decisions are made after reviewing information from rigorous data gathering and verifying them. Evidence based diagnosis and evidence based treatments are important parts of evidence based medicine .Evidence based practice has now spread to diverse areas outside health sectors like economics, social work, education ,industries etc.
Sources of evidence---evidence are generated by good and ethical research .the outcome yields clinical evidence for practice of EBM.
1. Cochrane data base of systematic reviews.
This include systematic reviews based on quantitative research which summarizes the the currently available results of randomized controlled trials on a specific topic.
The inclusion criteria of studies are strict in this data base. Cochrane data can be depicted using forest plots.
Rectangles on horizontal line [95%confidence interval] gives RR /OR.
Diamonds summarizes the collective OR. If OR is 1 then it implies that that intervention is not beneficial.
2 other Meta analyses
3 randomized controlled trials
4 reproductive health library of WHO.
5 cohort studies
6 case control studies
7 review articles
8 cross sectional studies
9 case series and case report
11 clinical practice guidelines
12 data provided by MedLine, EmBase, medIND, springerlink
13 text books provide basic knowledge although not up to date.
Along with evidence of benefits, resulting hazards also needs to be weighed.
Evidence based practice propagates the idea that if 2 therapies are equally effective it is recommended to choose the one with lesser side effects or complications.
Every clinician must read journals [preferably one national and one international] to keep abreast of latest knowledge, information enabling evidence based medical practice. While reading journals research studies must be weighed regarding its study design, inclusion, exclusion criteria, quality of methodology etc.
Levels of evidence are stratified by U.S preventive services task force for ranking the effectiveness of treatments or screening.
Level-evidence obtained from well designed RCT.
Level 2a- evidence from well designed non randomized controlled trials
Level 2b evidence from analytic studies verified by more than one group of researchers.
Level2c-evidence from multiple series with or without intervention.
Level3- opinions of respected authorities based on clinical experiences, descriptive studies or reports of expert committee.
Whether applied to medical education, decisions about individuals, guidelines and policies applied to populations,
Or administration of health services in general, evidence-based medicine advocates that to the greatest extent possible, decisions and policies should be based on evidence, not just the beliefs of practitioners, experts, or administrators.
The term “evidence-based medicine” has two main tributaries. The first is the insistence on explicit evaluation of evidence of effectiveness when issuing clinical practice guidelines and other population-level policies. The second is the introduction of epidemiological methods into medical education and individual patient-level decision-making.
readers please share your views. In the wake of dire scenario like banning homeopathy in Australia and warning by FDA homeopathy product regulation what is the relevance of evidence based homeopathy?