Transcript Chapter 4: EBM: An historical perspective

Chapter 4
EBM: A Historical Perspective
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview of Chapter
• Drs. David Sacket, Gordon Guyatt, and colleagues coined
the term clinical epidemiology: the vehicle through which
evidence-based health care is practiced.
• Understand the role of clinical epidemiology in evidencebased medicine.
• Explain the differences between basic research, field
research, and translational research.
• Clinical research asks questions about the usefulness of
diagnostic tools and the effectiveness of prevention and
treatment efforts.
• Understand the general goals of clinical research and
evidence-based practice.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
History and Direction of Clinical Fields
• The flaws in the assumption that the preparation and practice of
physicians consistently results in optimal care are revealed:
1. When research fails to demonstrate the efficacy of
interventions and the effectiveness of care.
2. When the management of patients with similar conditions
varies widely among providers, care facilities, and regions.
• The paradigm of evidence-based practice has emerged so that the
best clinical research is applied to the treatment decisions made on
similar patients across disciplines, facilities. and regions.
• The best evidence is now more widely available to care providers
everywhere because of the advances in information technology
practice patterns.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Research in Medicine
• Biomedical research is the field in which questions
related to the functions of the body, disease,
responses to medications, injury mechanisms,
disease and injury patterns, among others, are
addressed.
• Biomedical research is much like a spider web, with
strands representing areas of study that are often
intricately connected to address complex problems.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Research
• Basic Science or Bench Research
– Conducted in a laboratory environment under
tightly controlled conditions
• Field Research
– Conducted away from the laboratory, often in a
natural setting
• Translational Research
– Used to describe investigations that apply the
results from basic science to the care of patients
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Clinical Research
• Clinical Research:
– Asks questions about the usefulness of diagnostic
tools and the effectiveness of prevention and
treatment efforts by enrolling patients and at-risk
individuals.
– Completes the translation from basic science to
patient applications and lies at the heart of evidencebased medicine.
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Clinical Research and Evidence-Based Practice
• Clinical research addresses issues of patient care:
– Screening and diagnostic accuracy
– Prognosis
– Effectiveness of prevention and treatment strategies
– Cost analyses
• Clinical epidemiology is the use of data collected from the
study of samples to make decisions about the care of
individual patients.
• The general goal of clinical research and EBM is to seek
tests and procedures that will identify problems when they
exist (specificity) but that rarely lead to false-positive
findings (sensitivity).
• Clinicians also want to recommend prevention efforts that
are generally effective and pose a low risk of adverse
events.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Research and Evidence-Based Practice
• Prognosis studies can assist in identifying treatments
that are most likely to lead to a favorable outcome.
• Once a level of proficiency is developed in consuming
and critically appraising research related to
screening, diagnosis, prevention, and treatment, the
study of cost analysis will bring additional evidence
to the decision-making process.
• This information is increasingly of interest to patients
and consumers bearing an increased responsibility
for paying for the services they receive.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter Summary and Key Points
• The term “evidence-based medicine” first appeared in print in
papers authored by Dr. Gordon Guyatt in 1991 and 1992.
• The efforts of Archie Cochrane to promote the use of
randomized clinical trials to collect data to inform clinical
practice were important in the development of the paradigm of
evidence-based medicine.
• The paradigm of evidence-based health care is neither old nor
fully established.
• Greater emphasis on translational research seeks to speed the
use of new information and technology in patient care.
• Clinical research is essential to informing the practices of
individual providers.
• Learning how to practice evidence-based health care is not
about the provider but rather about the improved care
delivered to the patient. We are all patients many times in our
lives.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins