Evidence-Based Medicine

Question 1

Describe what is meant by ‘evidence-based medicine’.

Answer 1

• The integration of the best research evidence combined with clinical expertise and patient values and circumstances.
  
  • It is NOT simply about using quantitative data.

Question 2

Outline the historical context of evidence-based medicine?

Answer 2

• In 1951 Richard Doll and Bradford Hill publish the results of a case control study which shows an association between smoking and lung cancer.
• Archie Cochrane (1909-1988) – Cochrane reviews. Gives a high-quality systematic review of published medical literature.

Question 3

What are the problems with the medical literature?

Answer 3

• Unwieldy
  
  • Over 2,000 biomedical articles published each year.
  • Doctors get less than 1 hour / week for reading.
• Disorganised
• Biased
  
  • Bias can threaten the validity of all methods of clinical evaluation.
  • Investigator bias
  • Publication bias – the selective publication of statistically significant findings and the non-publication of those without such findings.

Question 4

What are the 6 qualities a systematic review should always have?

Answer 4

• A focused question
• A pre-defined search strategy
• Explicitly stated inclusion and exclusion criteria
• Clearly defined outcome measures
• Quality assessment
• A description of studies
• Reviewers conclusions