Evidence-based medicine - history
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Finding, assessing and applying evidence in medical research is the basis of clinical practice in the 21st century and is a concept attributed to British epidemiologist Archie Cochrane (Woods, 2012). By analyzing patient outcomes at British hospitals, Cochrane noticed that clinical practice was based more on traditions than empirical evidence. He discovered that patients whose care was supported by medical evidence received higher quality care and had better health outcomes than those patients who were treated differently. Moreover, evidence-based medicine lowered the overall costs at the hospital. His work has had a profound impact on the healthcare community since the 1970s and generated the widely-accepted shift towards evidence-based health care.
Evidence-based movement of the 20th century
The evaluation of interventions has existed for centuries but Scottish epidemiologist, Archie Cochrane, promulgated the principles in his 1972 book Effectiveness and efficiency: random reflections on health services. His advocacy of empirical methods has placed an emphasis on using the evidence from research trials in order to make clinical decisions. Cochrane's work is honoured through the international Cochrane Collaboration and the Cochrane Library. Explicit methodologies are used in the Cochrane initiatives to determine "best evidence" and were established by prominent names at McMaster such as David Sackett and Gordon Guyatt.
The term "evidence-based medicine" can be traced back to a 1992 paper by Gordon Guyatt and others. During the 1990s, evidence-based medicine emerged as one of the premier research methods in evaluating clinical interventions. What made evidence-based health care different was that it combined the best medical evidence with the values of patients. The available medical literature that applied to patients made it possible to diagnose their problems and to choose treatments that were quantitatively evaluated. By using these methods in large groups of patients with the same illness, doctors were able to develop clinical practice guidelines for the evaluation and treatment of human diseases and conditions. Clinical practice guidelines have been used to aid physicians in the evaluation of their performance and identifying new areas for study.
Systematic reviews of the medical literature, large randomized controlled trials (the best way to assess efficacy of treatments), and large prospective studies (followed up over time) are three potentially important types of medical research as they are seen to be high up on the evidence-based pyramid of evidence about tests and treatments. Reports of the experiences of individual patients or small groups provide less reliable evidence, although they too can provide insight into the many possible adverse effects of treatments.
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