For course times, contact: +370 37 327222; e-mail: Asta.Burbulyte@lsmu.lt
EVIDENCE BASED PRACTICE
Evidence-based medicine is the honest, accurate and intelligent use of existing modern evidence, applying individual treatment or health care measures in the treatment of patients (D. Sackett, 1996). One name is inseparable from this concept – the “Cochrane Society”. British epidemiologist A. Cochrane said in 1979:
“It is undoubtedly a major shortcoming of our professional community that there is no system of critical reviews that includes all important randomised controlled trials, structured by specialisations and sub-specialisations, and periodically updated”
In other words, although a lot of medical research data has been accumulated, the work of systematising them has not been done. This observation gave rise to what is now known as the Cochrane Community, which currently unites 14 Cochrane centres on all continents. The activities of these centres cover all medical fields and specialisations. Its purpose is to find and present the most reliable of the currently known scientifically confirmed facts on the treatment of specific diseases.
- Formulation of the question. This is the conversion of an information need into an accurate clinical query. The quality of the results will depend on how precisely the question is formulated.
- Efficient best-evidence literature search. At this stage, clinicians are best assisted by an information specialist.
- Critical evaluation of the evidence found. At this stage, it is necessary to “know how to read” the publication, it is necessary to review the structure of the article, pay attention to the type of publication, what research methodology was used during the scientific research and assess the reliability of the evidence.
- Analysis of evidence, reconciliation with clinical experience and patient specificity. The integration of these three parts is a prerequisite for the practice of evidence-based medicine.
- Decision making in clinical practice.
The first step is to determine the type of question: whether it will be a general question about conditions and diseases, or a question specific to a specific clinical action or decision.
TYPES OF QUESTIONS
General questions are about some disease, its course and necessarily consist of two essential components: question words what, how, when and a verb, for example:
- How many people have a certain disease/condition..? (prevalence)
- What causes the disease/condition…? (aetiology)
- How can you tell if someone has a certain disease/condition? (diagnosis)
- How can the disease/condition be treated? (effect)
- What is the likely course of the disease/condition? (prognosis)
- How do patients with this disease/condition feel? (experience/attitude)
Specific questions start with the word “do/does” and only one answer is possible: YES or NO and related to the patient’s specific disease and consists of 3 or 4 components:
- Problem (patient, problem)
- Intervention (intervention, treatment, cause of disease)
- Outcome (results, effect)
When searching for information, it is important to correctly identify the category because it denotes the research methods and type of publication we can expect to find, and which sources should be searched for information.
The types of publications and studies differ not only in terms of quantity in databases, but also in quality. The pyramid below provides a ranking of the different types of publications based on the validity and reliability of the scientific evidence. At the top of the pyramid, the most reliable type of publication in the meta-analysis is represented, and in descending order, the reliability of publication types decreases. However, it should also be noted that the number of types in the higher positions of the pyramid decreases, which means that it is significantly more difficult to find them in the databases:
Reviews of evidence-based medicine can be searched in many databases, but the most well-known database of the Cochrane Society is the Cochrane Library.