How EMB is usedIn order to utilise EBM effectively, one has to ask a clinical question that is specific to the case of the patient and must contain the following components: patient, intervention, comparison of interventions and outcome. Essentially, in the ‘patient’ component, the problem in the patient that needs to be addressed must be considered; in the ‘intervention’ component, the healthcare provider needs to consider the strategy for diagnosis, treatment and management; in the “comparison of interventions” components, the healthcare provider needs to think about the control that will be used to compare the chosen strategy; lastly, in the “outcome” component, the healthcare provider must be certain of the specific outcome needed from the intervention.
When the clinical question has been formulated, sources need to be acquired such as from research studies, clinical trials and case studies in medical journals for information related to the clinical question. When gathering information from these sources, it is important to determine the quality of the study. In most cases, meta-analyses of randomised controlled research proved to have the best quality of evidence as it is unbiased and is not extrapolated.
Another way of classifying the levels of evidence includes the assignment of grades in the form of letters, A, B, C, D, each with a corresponding classification. A is based on hierarchy I evidence, B is based on hierarchy II evidence or extrapolated from hierarchy I evidence; C is based on hierarchy II evidence or extrapolated from hierarchy I or II evidence; D is directly based on hierarchy IV evidence or extrapolated from hierarchy I, II or III evidence.
The next step would be to incorporate the evidences gathered in the clinical decision to address the problem of the patient. After treatment, follow-ups are made in order to check on the resolution of the disease or disorder and to see if there are complications encountered when applying the intervention. This would then prompt the practicing physician to take note of the results and conduct a case study to contribute to the ever-growing reservoir of medical information.
There are guidelines in the approach to diagnosis, treatment and management of diseases and disorders that use the number classification or the letter classification of evidences, but the rationale for each classification is the same. The assessment or appraisal of these research studies and clinical trials are done in conferences and conventions wherein a board or body will determine whether the evidence acquired is of high or low quality. These evidences are then added to the guidelines as recommendations of the board or body.
In the field of healthcare, these recommendations prove to be useful as they are based on critical appraisal of evidences gathered, are up-to-date and can help in the diagnosis, treatment, and management of the patient. Medicine is a fast and ever-changing profession with the constant acquisition of new scientific information that would render the information of minutes ago obsolete. It is therefore important for physicians to keep abreast with the latest updates in diagnosis, treatment, and management of the different diseases and disorders that plague the patient. MIMS
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Lewis, S.J. & Orland, B.I. The importance and impact of evidence-based medicine. USA: Journal of Managed Care Pharmacy. September 2004; Vol. 10, No. 5A. pp. 3-5
Gopal, K.S. & Varghese, M. Evidence Based Medicine: Why should we be practicing it all the time? India: Indian Journal of Ophthalmology. May 2013; Vol. 61, No. 5. pp. 193-195