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Evidence-based medicine (EBM) is "the conscientious,explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research." The aim of EBM is to integrate the experience of the clinician,the values of the patient,and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.
Gastroenterology is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract,sometimes referred to as the GI tract, which includes the esophagus,stomach,small intestine and large intestine as well as the accessory organs of digestion which include the pancreas,gallbladder,and liver.
Medicine is the science and practice of caring for patients,managing the diagnosis,prognosis,prevention,treatment,palliation of their injury or disease,and promoting their health. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences,biomedical research,genetics,and medical technology to diagnose,treat,and prevent injury and disease,typically through pharmaceuticals or surgery,but also through therapies as diverse as psychotherapy,external splints and traction,medical devices,biologics,and ionizing radiation,amongst others.
Internal medicine,also known as general internal medicine in Commonwealth nations,is a medical specialty for medical doctors focused on the prevention,diagnosis,and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as internists,or physicians in Commonwealth nations. Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone postgraduate training in internal medicine,and should not be confused with "interns",a term commonly used for a medical doctor who has obtained a medical degree but does not yet have a license to practice medicine unsupervised.
A medical error is a preventable adverse effect of care ("iatrogenesis"),whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease,injury,syndrome,behavior,infection,or other ailment.
The American College of Physicians (ACP) is a Philadelphia-based national organization of internal medicine physicians,who specialize in the diagnosis,treatment,and care of adults. With 161,000 members,ACP is the largest medical-specialty organization and second-largest physician group in the United States. Its flagship journal,the Annals of Internal Medicine,is among the most widely cited peer-reviewed medical journals in the world.
A medical specialty is a branch of medical practice that is focused on a defined group of patients,diseases,skills,or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics),cancer (oncology),laboratory medicine (pathology),or primary care. After completing medical school or other basic training,physicians or surgeons and other clinicians usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a specialist.
Gordon Henry Guyatt is a Canadian physician who is Distinguished University Professor in the Departments of Health Research Methods,Evidence and Impact and Medicine at McMaster University in Hamilton,Ontario. He is known for his leadership in evidence-based medicine,a term that first appeared in a single-author paper he published in 1991. Subsequently,a 1992 JAMA article that Guyatt led proved instrumental in bringing the concept of evidence-based medicine to the world's attention.[2] In 2007,The BMJlaunched an international election for the most important contributions to healthcare. Evidence-based medicine came 7th,ahead of the computer and medical imaging. [3][4] Guyatt's concerns with the role of the medical system,social justice,and medical reform remain central issues that he promoted in tandem with his medical work. On October 9,2015,he was named to the Canadian Medical Hall of Fame.
Defensive medicine,also called defensive medical decision making,refers to the practice of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient,but mainly serves to protect the physician against the patient as potential plaintiff. Defensive medicine is a reaction to the rising costs of malpractice insurance premiums and patients’biases on suing for missed or delayed diagnosis or treatment but not for being overdiagnosed.
David Lawrence Sackett was an American-Canadian physician and a pioneer in evidence-based medicine. He is known as one of the fathers of Evidence-Based Medicine. He founded the first department of clinical epidemiology in Canada at McMaster University,and the Oxford Centre for Evidence-Based Medicine. He is well known for his textbooks Clinical Epidemiology and Evidence-Based Medicine.
A clinical prediction rule or clinical probability assessment specifies how to use medical signs,symptoms,and other findings to estimate the probability of a specific disease or clinical outcome.
The Users’Guides to the Medical Literature is a series of articles originally published in the Journal of the American Medical Association,later rewritten and compiled in a textbook,now in its third edition. The guides provide practical,clinician-friendly advice on all aspects of evidence-based medicine.
The history of medical diagnosis began in earnest from the days of Imhotep in ancient Egypt and Hippocrates in ancient Greece but is far from perfect despite the enormous bounty of information made available by medical research including the sequencing of the human genome. The practice of diagnosis continues to be dominated by theories set down in the early 20th century.
Choosing Wisely is a United States-based health educational campaign,led by the ABIM Foundation,about unnecessary health care.
Chronic Lyme disease (CLD) is the name used by some people with non-specific symptoms,such as fatigue,muscle pain,and cognitive dysfunction to refer to their condition,even if there is no evidence that they had Lyme disease. Both the label and the belief that these people's symptoms are caused by this particular infection are generally rejected by medical professionals. Chronic Lyme disease is distinct from post-treatment Lyme disease syndrome,a set of lingering symptoms which may persist after successful antibiotic treatment of infection with Lyme-causing Borrelia bacteria,and which may have similar symptoms to those associated with CLD.
The tomato effect occurs when effective therapies for a condition are rejected,usually because they do not make sense in the context of the current understanding or theory of the disease in question. The name refers to the fact that tomatoes were rejected as a food source by most North Americans until the end of the 19th century,because the prevailing belief at the time was that they were poisonous.
Vinayak K. Prasad is an American hematologist-oncologist and health researcher. He is a professor of Epidemiology and Biostatistics at the University of California,San Francisco (UCSF). He is the author of the books Ending Medical Reversal (2015) and Malignant (2020).
Medical reversal refers to when a newer and methodologically superior clinical trial produces results that contradict existing clinical practice and the older trials on which it is based. This leads to an intervention that was widely used falling out of favor,because new evidence either demonstrates that it is ineffective or that its harms exceed its benefits. It is distinct from replacement,which occurs when a newly developed medical treatment supersedes an older,less effective one as the standard of care. Medical reversals are caused when a treatment is widely adopted even when there is not compelling evidence for its safety and effectiveness. For example,an intervention may be adopted because it "makes sense",or because there are observational studies supporting its putative benefits. The negative effects of such reversals include harm to patients who received the intervention when it was considered relatively safe and effective,as well as reducing public trust in medicine.
Robert Brian Haynes OC is a Canadian physician,clinical epidemiologist,researcher and an academic. He is professor emeritus at McMaster University and one of the founders of evidence-based medicine.
Ending Medical Reversal:Improving Outcomes,Saving Lives is a nonfiction book written by Vinay Prasad and Adam Cifu,published in 2015 by Johns Hopkins University Press.
References
- 1 2 3 "Adam Cifu, MD".
- ↑ Stern, Scott D. C.; Cifu, Adam S.; Altkorn, Diane (31 October 2019). Symptom to Diagnosis An Evidence-Based Guide, Fourth Edition. ISBN 9781260121117.
- ↑ Prasad, Vinayak (2015). Ending Medical Reversal. doi:10.1353/book.49286. ISBN 9781421417738.
- 1 2 S2D: THE SYMPTOM TO DIAGNOSIS PODCAST. McGraw-Hill Education. 2020.
- 1 2 "The Clinical Excellence Podcast on Apple Podcasts". Apple Podcasts. Retrieved 2022-11-12.
- ↑ "The Frequency of Medical Reversal".
- ↑ Prasad, Vinay; Vandross, Andrae; Toomey, Caitlin; Cheung, Michael; Rho, Jason; Quinn, Steven; Chacko, Satish Jacob; Borkar, Durga; Gall, Victor; Selvaraj, Senthil; Ho, Nancy; Cifu, Adam (2013). "A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices". Mayo Clinic Proceedings. 88 (8): 790–798. doi: 10.1016/j.mayocp.2013.05.012 . PMID 23871230.
- ↑ "Reversals of Established Medical Practices: Evidence to Abandon Ship".
- ↑ Zuger, Abigail (30 October 2015). "Book Review: 'Ending Medical Reversal' Laments Flip-Flopping". The New York Times.
- ↑ "Symptom to Diagnosis An Evidence Based Guide, Fourth Edition / Edition 4".
- ↑ "A Place of Memory and Learning".
- ↑ Cifu, A. S. (2019). "Long-term Physician-Patient Relationships-Persevering in a Practice". JAMA Internal Medicine. 179 (2): 141–142. doi:10.1001/jamainternmed.2018.6735. PMID 30508031. S2CID 54465892.
- ↑ Cifu, Adam Seth (2014). "Of Leaves, Trees, Forests, and Primary Care". Annals of Internal Medicine. 160 (11): 806. doi:10.7326/M13-2984. PMID 24887620. S2CID 34624512.
- ↑ "Advice for a Student Starting Medical School".