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Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types can yield strong recommendations; weaker types can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations. It has subsequently spread to describe an approach to decision-making that is used at virtually every level of health care as well as other fields.
Mammography is the process of using low-energy X-rays to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses or microcalcifications.
Hypercholesterolemia, also called high cholesterol, is the presence of high levels of cholesterol in the blood. It is a form of hyperlipidemia, high blood lipids, and hyperlipoproteinemia.
In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patient's medical history followed by an examination based on the reported symptoms. Together, the medical history and the physical examination help to determine a diagnosis and devise the treatment plan. This data then becomes part of the medical record.
A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine. They usually include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of his or her profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.
A medical algorithm is any computation, formula, statistical survey, nomogram, or look-up table, useful in healthcare. Medical algorithms include decision tree approaches to healthcare treatment and also less clear-cut tools aimed at reducing or defining uncertainty. A medical prescription is also a type of medical algorithm.
An evidence-based practice (EBP) is any practice that relies on scientific and mathematical evidence to form strong inductive or deductive arguments for guidance and decision-making. Practices that are not evidence-based may rely on tradition, intuition, or other unproven methods. Evidence-based practices have been gaining ground since the formal introduction of evidence-based medicine in 1992, and have spread to the allied health professions, education, management, law, public policy, and other fields. In light of studies showing problems in scientific research, there is also a movement to apply evidence-based practices in scientific research itself. Research into the evidence-based practice of science is called metascience.
A hierarchy of evidence is a heuristic used to rank the relative strength of results obtained from scientific research. There is broad agreement on the relative strength of large-scale, epidemiological studies. More than 80 different hierarchies have been proposed for assessing medical evidence. The design of the study and the endpoints measured affect the strength of the evidence. In clinical research, the best evidence for treatment efficacy is mainly from meta-analyses of randomized controlled trials (RCTs). Typically, systematic reviews of completed, high-quality randomized controlled trials – such as those published by the Cochrane Collaboration – rank as the highest quality of evidence above observational studies, while expert opinion and anecdotal experience are at the bottom level of evidence quality. Evidence hierarchies are often applied in evidence-based practices and are integral to evidence-based medicine (EBM).
The United States Preventive Services Task Force (USPSTF) is "an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services". The task force, a panel of primary care physicians and epidemiologists, is funded, staffed, and appointed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality.
James Michael McGinnis is a US physician, epidemiologist, and long-time contributor to national and international health programs and policy, including continuous policy responsibilities for leadership in disease prevention and health promotion through four US Government Administrations. An elected member of the Institute of Medicine of the National Academies, he currently also serves as IOM Senior Scholar, as well as Executive Director of its Roundtable on Value & Science-Driven Health Care.
Harold 'Hal' Sox is an Editor Emeritus of the Annals of Internal Medicine and member of the National Academy of Medicine. Sox was an associate editor of Scientific American Medicine, a consulting associate editor of The American Journal of Medicine and a member of the editorial boards of three medical journals, including The New England Journal of Medicine.
Cancer screening aims to detect cancer before symptoms appear. This may involve blood tests, urine tests, DNA tests other tests, or medical imaging. The benefits of screening in terms of cancer prevention, early detection and subsequent treatment must be weighed against any harms.
Albert Siu is an internist and geriatrician and the Ellen and Howard C. Katz Chairman and Professor of the Brookdale Department of Geriatrics and Palliative Medicine at Mount Sinai Hospital in New York City. He is also the director of the Geriatric Research, Education, and Clinical Center at the James J. Peters VA Medical Center in The Bronx, a senior associate editor of Health Services Research, a senior fellow of the Brookdale Foundation and a former trustee of the Nathan Cummings Foundation.
David M. Eddy is an American physician, mathematician, and healthcare analyst who has done seminal work in mathematical modeling of diseases, clinical practice guidelines, and evidence-based medicine. Four highlights of his career have been summarized by the Institute of Medicine of the National Academy of Sciences: "more than 25 years ago, Eddy wrote the seminal paper on the role of guidelines in medical decision-making, the first Markov model applied to clinical problems, and the original criteria for coverage decisions; he was the first to use and publish the term 'evidence-based'."
Diane Medved Harper is a professor in the Department of Family Medicine at the University of Michigan. From 2013 to 2017 she was a professor and chair of the department of Family and Geriatric Medicine at the University of Louisville. From 2009 to 2013 she was a professor at the University of Missouri Kansas City's department of Biomedical and Health Informatics. From 1996 to 2009 she held a clinical, teaching, and research post at Dartmouth Medical School. Her area of expertise is human papillomavirus (HPV) and the diseases associated with it, as well as colposcopy, and she was the principal investigator of the clinical trials of Gardasil and Cervarix, vaccines against HPV.
Chronic Lyme disease (CLD) is the name used by some people with "a broad array of illnesses or symptom complexes for which there is no reproducible or convincing scientific evidence of any relationship to Borrelia burgdorferi infection" to describe their condition and their beliefs about its cause. Both the label and the belief that these people's symptoms are caused by this particular infection are generally rejected by medical professionals, and the promotion of chronic lyme disease is an example of health fraud. Chronic Lyme disease in this context should not be confused with genuine Lyme disease, a known medical disorder caused by infection with Borrelia burgdorferi, or with post-treatment Lyme disease syndrome, a set of lingering symptoms which may persist after successful treatment of infection with Lyme bacteria.
Cynthia Mulrow is an American physician and scholar from Edinburg, Texas. She has regularly contributed academic research on many topics to the medical community. Her academic work mainly focuses on systematic reviews and evidence reports, research methodology, and chronic medical conditions.
Kirsten Bibbins-Domingo is an American physician and epidemiologist at University of California, San Francisco. She is the inaugural Vice Dean for Population Health and Health Equity in the UCSF School of Medicine, and she is the Chair of the UCSF Department of Epidemiology and Biostatistics. She is a general internist and attending physician at San Francisco General Hospital. She holds the Lee Goldman, MD Endowed Chair in Medicine at UCSF.
Lisa Bodnar is an American nutritional and perinatal epidemiologist. She is the Vice-Chair for Research and a tenured professor at University of Pittsburgh. Her faculty web page provides additional information not shown here.
A fact box is a simplified display format that presents evidence based data about the benefits and harms of medical treatments, screenings or interventions.
References
- ↑ Council of Europe, Developing a methodology for drawing up guidelines on best medical practice (Recommendation Rec(2001)13 and explanatory memorandum), Strasbourg: Council of Europe Publishing, 2002.
- ↑ "Guidelines for Ensuring the Quality of Information Disseminated to the Public". United States Department of Health and Human Services. 13 December 2006. Retrieved 18 August 2013.