Evidence-based medicine is the integration of optimal science arguments with clinical experience and patient needs. It is a detailed and rational use of the best achievements of our time in the decision-making process in the treatment of patients. In this case, only those arguments are used that are obtained from systematic reviews. The basics of evidence-based medicine are in clinically relevant studies that take into account the interests of the patient. Confirmations result in the reliability and accuracy of diagnostic tests and examinations, the importance of prognosis indicators, the effectiveness and safety of therapy, rehabilitation and prevention.
Appearance story
In 1940, the first randomized (randomly distributed) studies were conducted on the use of Streptomycin in the treatment of tuberculosis. In 1962, the United States Committee, which monitored the quality of pharmaceuticals and food products, introduced rules aimed at exploring new types of drugs. Nine years later, epidemiologist Archie Cochran brought up the issue of a lack of scientific evidence. Three years later, discrepancies between theory and practice were discovered. In the late 80s and early 90s, attention was drawn to the need for systematic reviews in clinical guidelines. The term “evidence-based medicine” was first proposed in 1988 by epidemiologists and clinicians who worked at McMaster University in Canada. Archie Cochran gave a description of how to present scientific research to the attention of specialists. In addition, he contributed to making their results a criterion for discussion and accurate analysis. Cochran and his colleagues, members of the British Medical Research Council, have done a lot of work together to make modern evidence-based medicine. It was he who, in 1979, came to the conclusion that science lacks the critical conclusions of randomized controlled trials. Cochran founded the first Center for Evidence-Based Medicine, which was named after him. He started working at Oxford 10 years ago. There are currently 15 such centers worldwide. They lead the work of an international group of researchers.
Stages
There are five levels of evidence-based medicine:
- Ask a question for which there is an opportunity to get an answer.
- Find the best confirmation.
- Evaluate the data with a critical eye.
- Consider evidence based on clinical examination and patient interests.
- Assess the feasibility of using confirmatory technologies.
Principles of evidence-based medicine. Finding the best confirmations
Specialists are looking for evidence based on the keywords: patient, intervention, comparison, outcomes. First you need to start systematic reviews and randomized controlled trials, as they are more reliable. If evidence is not found, it is recommended that you start looking for evidence of a lower level. These include cohort, case-control, and others.
Critical Evaluation of Confirmations
Using this assessment, you can determine how reliable the evidence is and the results of the study. To check the reliability of randomly distributed controlled trials, it is necessary to answer the following questions:
- Was patients randomized?
- Did all patients participating in the study complete it?
- Was the analysis of patients in the groups in which they were randomized?
- Was the treatment “blind” to researchers and patients?
- Was there similarity in the groups before the study?
- Was the same treatment used except experimental?
In the case of a qualitative study, you can begin to evaluate the results.
Practice analysis
This assessment is accompanied by the following questions:
- What am I doing?
- Why is this done, what result are you planning to get?
- What are the guarantees of the effectiveness and safety of this work?
- Is there an even better, more suitable method to achieve this goal?
Learning opportunities
In order for the search for arguments and their critical analysis to be of the highest quality, the clinician must have the necessary experience and time. In addition, he can use journals in the discipline and other scientific literature. It would be useful to turn to a summary of evidence-based medicine compiled by other specialists. This may be a Cochran database, a book by M. Enkin, other literature in this area. It is also recommended to familiarize yourself with ready-made protocols that are prepared on the basis of evidence-based medicine.
Periodic literature review
Traditional wisdom says that only a small fraction of medical interventions has serious scientific evidence. It is about 15%. Every day, medical professionals around the world are required to obtain new important evidence necessary for the effectiveness and proper treatment of patients. For this, doctors should find specific information on this profile. It is recommended to use medical literature, which is currently very much. Its number has doubled since 1970. In addition, it grows daily. Each year, editions publish about 6,000 articles in the fields of gynecology and obstetrics. In order for the level of knowledge to correspond to the present, the doctor needs to read about 20 articles daily. Another question is whether the health worker has time for this? It is necessary to take into account the fact that many articles do not meet even the minimum quality standards.
Correctness of activity
A part of medical knowledge is recognized as erroneous or expires after five years after the student graduates from a higher educational institution. True, it is not known which part. The medical literature can be compared to the jungle, as it is growing at a fast pace, it has a lot of "dead trees", "spiders" and "snakes", however, treasures are still hidden somewhere.
Basic information
Evidence-based medicine is a definite decision-making approach. In this case, the clinician applies the best arguments that are available, and professional experience. The decision is made with the patient, taking into account his interests. Every day, healthcare professionals require different types of sources to find answers to recurring questions. For example, students studying in this direction need basic information that combines the causes of the disease and its pathogenesis, physical characteristics and other information. Basic data relate to various sciences. This, in particular, physiology, pathogenesis, anatomy, etiology. Basic information is relatively stable, located in reference books, textbooks, as well as other general medical sources. However, most often doctors need to answer questions directly related to patient care and treatment. Here are some examples of questions that relate to a disease or condition, but are not specific to clinical practice:
- What does it mean ...?
- What is otitis media?
- What microorganisms contributed to the occurrence of otitis media?
Answers to questions of this type can be found in textbooks, reference books and other sources.
Patient Management Information
In addition to basic knowledge, the doctor needs information that is directly related to patient management, methods of diagnosis, treatment and prognosis. Evidence-based medicine deals with these issues. The key words here are "diagnosis, treatment, prognosis." To get the best result and the best answer, you need to correctly formulate the question.
Clinical example
You can consider taking the drug "Diethylstilbestrol" to prevent miscarriage in women. The reason for the use of this tool is frequent termination of pregnancy. In this regard, taking estrogen as a drug to prevent miscarriage is considered logical. In patients taking this medication, pregnancy was mainly preserved. In the 1950s, as a result of six non-randomized studies, a reduction in the number of miscarriages during the use of Diethylstilbestrol was confirmed. Five studies were also conducted, in which patients were divided into two groups by random sampling. The first took the drug "Diethylstilbestrol", the second - a placebo. According to the results of the experiment, women using this drug had miscarriages in 7% of cases. The abortion in the second group was 5%. Due to these results, clear signs were obtained that the drug was not beneficial. But, despite this, its use continued anyway. Until 1970, they treated millions of women. Evidence-based medicine requires not only reading the required materials at a specific time. It is also important to change our own and others' practices, taking into account the emergence of new information. Evidence-based medicine provides the prerequisites for an objective assessment of the effectiveness of medical interventions, as well as the application of its effects in clinical practice. Of course, this is not easy, because both in the search for evidence, and in their dissemination and introduction of changes, one can encounter obstacles that arise throughout the entire process of work.
Idea Formation
Evidence-based medicine for all around the world is developing exponentially. Starting from the 90s, the period of its formation, and to this day, the number of monographs, forums and centers of this direction is tens, and the number of publications is hundreds. In 1997, 12 such centers received subsidies for 5 years from the American Agency for Politics, Science and Health. These organizations were founded at leading universities and research institutions in various states. The number of centers for highly specialized problems, such as child and mental health, first aid and other areas, has increased. The common position for them is the application of the principle of evidence at every level of decision-making, starting from a state program and ending with the appointment of individual treatment. In Russia, the most famous institutions are located in St. Petersburg and Moscow. Also among the popular is the Clinic for Evidence-Based Medicine, Nizhnevartovsk. The institution specializes in diagnostics, neurology, pediatrics and urology, andrology and gynecology, gastroenterology and ENT diseases.
OSMD
Evidence-based medicine of the Russian Federation is also developing rapidly. In Russia, there is the Interregional Community of OSMD. It received registration in 2003. The Society of Evidence-Based Medicine Specialists is a voluntary non-profit association. It acts in accordance with the Charter. The main activities of the OSMD:
- Educational work related to methodological problems of conducting epidemiological and clinical studies, systematization of information in the field of science, evaluation of publications and statistical data analysis.
- The publication of the results of basic scientific experiments.
- Implementation of achievements in medical practice.
- An examination of the quality of scientific publications, patient management protocols and others.
- Socioepidemiological and biomedical research.
Principles of members of the OSMD:
- dissemination of scientific evidence about medical intervention and options for acquiring such data;
- abstinence from announcing performance information that has not been scientifically proven;
- declaration of existing inconsistency of interests.
The organization’s employees are doctors who adhere to these principles and put them into practice. Today, the association consists of 17 regions and more than 300 members. The heads of the regional departments are highly qualified specialists in medicine and healthcare.
Center for Evidence-Based Medicine (Enlightenment, 14, St. Petersburg)
The institution operates from eight in the morning until seven in the evening and has one day off on Sunday. This Northwest Center for Evidence-Based Medicine provides a wide range of services for the public. Here you can get advice and therapy from doctors of narrow specializations, undergo laboratory diagnosis, colposcopy, ultrasound, and a massage course. The evidence-based medicine center also carries out daily monitoring of ECG + blood pressure. All employees working in the institution are highly qualified doctors. The Northwest Center for Evidence-Based Medicine specializes in diseases such as:
- osteochondrosis of the spine, aggravated by vertebrogenic cervicalgia, discogenic radiculitis and lumbalgia;
- neuropathies of compression-ischemic nature, a symptom of which is numbness of the fingers;
- deforming osteoarthritis at different stages (medicamentous blockades are used as treatment, hyaluronic acid is used);
- pathological disorders of tendons and ligaments (tenosynovitis, enthesopathy, and others);
- pathology of the articular bags, "spurs" on the heels.
The second famous institution of St. Petersburg
The evidence-based medicine center (Leninsky 88) is open from eight in the morning until eight in the evening. The facility is located in a residential building, on the ground floor. Modern equipment, a high level of service, advanced diagnostic methods - this is not a complete list of the advantages that this evidence-based medicine center has. Reviews of many patients indicate that here maximum attention will be paid to each visitor. The quality of the services provided was praised. Here you can seek the help of such specialists as a gynecologist and gastroenterologist, neurologist and therapist, cardiologist and ophthalmologist, endocrinologist, urologist, etc. The clinic of evidence-based medicine also offers diagnosis in the laboratory, ultrasound, echocardiography, calposcopy, massage, electrocardiography. Oncologist Dmitry Beinusov was appointed the head doctor of the institution. The test results can be found by calling or receiving them by mail. In addition to the medical center, the activities of specialists also extend to city hospitals. A doctor's consultation costs 1200 rubles.