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What's the evidence?

BMJ 2005; 330 doi: (Published 01 March 2005) Cite this as: BMJ 2005;330:0503124
  1. Sharon E Strauss, associate professor1,
  2. Manique Wijesinghe, second year medical student2
  1. 1Department of Medicine, University of Toronto, Canada
  2. 2University of Southampton

With just the click of a mouse, you can access thousands of research articles of variable credibility about lots of different medical conditions. But how do you actually apply them to clinical practice? Manique Wijesinghe and Sharon Strauss describe how you should use evidence based medicine

Practising evidence based medicine (EBM) is one way for medics to keep abreast of the clinical literature. The term EBM was coined about 10 years ago, but its origins date even earlier. EBM refers to “the judicious application of best current knowledge to the condition and values of the individual patient.”1

Teaching EBM and integrating it into routine clinical practice

Medical students and doctors need critical appraisal skills to make sense of the overwhelming volume of information available. A study in the BMJ showed that teaching these skills so that they are integrated into clinical practice has greater benefits than traditional methods such as workshops and standalone courses.2

Since 1997, the Hospital for Tropical Diseases in London has been holding regular meetings at which the evidence about a particular clinical problem is reviewed. When the reviewers believe that that research supports it, they change existing treatment plans.3 This approach stresses the practical clinical application of evidence.

Evidence often not used in clinical practice

The United Kingdom's National Institute for Clinical Excellence (NICE) issues evidence based guidelines for use by clinicians in hospital and primary care environments.4 A study in the BMJ shows that implementation of NICE guidelines is variable.4 Guidance is more likely to be adopted when professional support is strong, the evidence base stable and convincing, and no increased or unfunded costs …

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