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EBM challenges

Transforming the Communication of Evidence for Better Health

14 Jun, 16 | by BMJ Clinical Evidence

MontoriBy Victor Montori

The main job is to care for the patient. Evidence-based medicine makes use of an adjectival phrase, evidence-based, to note that this is a form of special medical practice, but still it is medicine, it is care. The adjective that modifies this noun, and the verb – to care — it implies, signals the importance of considering the scientific basis of our practice, and the need to use evidence judiciously in the care of patients. This was an important development, maturing in early 90s when the idea and the term, coined by Gordon Guyatt, came into use. The term, and the practice, influenced my late medical training, and have been fundamental in my first two decades at the honorable place of the patient’s bedside.

In some instances, the adjective “evidence-based” took precedence over the noun, and the practice of medicine, the care of the patient, became relegated. The limelight shone on the significant result in a mega trial, an effect on a surrogate or a composite, in a trial stopped earlier than planned, and financed by the company that will profit by using these results in marketing its product. These marketing efforts disguised as evidence-based messages, actively disseminated by those who hold the power of telling us what to know. In 2007, we published with Gordon Guyatt how the corruption of the evidence threatened the practice of EBM and suggested several solutions: more…

Policy, practice, and politics

21 Apr, 16 | by BMJ Clinical Evidence

Van photoBy Van Charles Lansingh

In the advent of the Zika scare, it is clear that the need for evidence and sensationalism are difficult to balance, and due to the pressure from the media, many governments and various entities, responded in haste and with probably very little time to analyze their recommendations. A similar case was seen in the wake of the Ebola outbreak. The global community has seen and experienced the consequences: fear and confusion of managing and controlling a disease that has limited evidence and knowledge base, and lack of historical antecedents to support the actions taken.

However, we often do have the evidence more or less readily available to respond to the health information needs and to the requests from policy makers. Unfortunately, more often than not, this information is too complex and difficult to determine what is correct and what is simply popular belief. The plethora of publications makes it difficult to sift through and summarize, so that there is an adequate process of translation from evidence generated by researchers, to policy and practice. more…

Dabigatran Reversal

28 Jan, 16 | by BMJ Clinical Evidence

Ken MilneBy Ken Milne

Case: A 62-year-old woman presents to the emergency department with a history of atrial fibrillation and gastroesophageal reflux. She is on metoprolol 25mg twice daily, dabigatran 150mg twice daily, and omeprazole 20mg once daily. She noted some mild epigastric pain over the last week and had a coffee ground emesis that morning. She arrives via EMS with a blood pressure of 110/60, heart rate of 64bmp and O2 saturation of 97% on room air. You wonder if there is a specific agent that can safely and effectively reverse dabigatran? more…

High Flow Nasal Oxygen

4 Dec, 15 | by BMJ Clinical Evidence

Ken Milne

By Ken Milne

Case: A 55-year-old woman presents to the emergency department with a 48-hour history of cough, fever and increasing shortness of breath. She has no history of chronic respiratory problems. On examination, she febrile, tachycardic, tachypneic, and her oxygen saturation is 88% despite facemask oxygen. You wonder if you should try out the new high flow nasal oxygen (HFNO) machine? more…

The Straw Men of Integrative Health and Alternative Medicine

22 Oct, 15 | by BMJ Clinical Evidence

By Timothy Caulfield

Debating the value of integrative health and complementary and alternative medicine (CAM) can be a frustrating endeavour. Proponents are often passionate. For many, it is like a religion and, as a result, they usually don’t care about what the science says. (Obviously.) But what I find most exasperating is the continued use of numerous logical fallacies, such as the straw man argument. In order to bolster their cause, CAM supporters suggest that skeptics like me hold a host of ridiculous and uninformed positions.

In an effort to put an end to this practice (a man can dream!), below are the four most annoying CAM straw man arguments. more…

Genetics and Personalized Medicine: Where’s the Revolution?

23 Jul, 15 | by BMJ Clinical Evidence

By Tim CaulfieldTimothy Caulfield

I started my academic career in the early 90s working on the policy issues associated with something called the “genetic revolution”, which we were constantly told (by researchers, government and the media) was just around the corner. As a result of this impending seismic shift, we needed to ready ourselves for all the profound social implications – or so the story (and the arguments for grant money) went.

Since then, the claims that we are in the middle of a genetic revolution have come at a steady pace, but the nature of alleged, near-future, healthcare transformation have evolved. First it was going to be gene therapy (it didn’t really pan out as planned). Then it was highly predictive disease genes (ditto). And now the revolution has taken the form of personalized medicine, also known as personalized genetics, personalized genomics or, in accordance with the latest semantic tweak, precision medicine. more…

A brief introduction to the concept of Evidence-Based Research

7 May, 15 | by BMJ Clinical Evidence

 

by Hans Lund

The scientific ideal
On 15th of February 1676, in a letter to his colleague (and rival) Robert Hooke, Sir Isaac Newton wrote the following well-known sentence: “If I have seen farther it is by standing on the shoulders of giants”. Newton referred to influential scientists before him such as Copernicus, Galilei and Kepler and emphasised one of the fundamental aspects of science – science is cumulative with each new discovery dependent on previous knowledge. more…

Evidence-Based Practice in Nursing in 2015: The Challenges

30 Apr, 15 | by BMJ Clinical Evidence

Alison Twycrossby Alison Twycross

I have been editor of Evidence-Based Nursing for the past five years.

Earlier this month I presented a paper at Evidence Live 2015 reflecting on my views about the challenges for evidence-based nursing in 2015. This Blog is a summary of that paper. more…

The way forward from ‘rubbish’ to ‘real’ EBM in the wake of Evidence Live 2015

24 Apr, 15 | by BMJ Clinical Evidence

by Huw LlewelynHuw Llewelyn

At Evidence Live, Iona Heath (video) reminded us that EBM should not interfere with wisdom and common sense. Trish Greenhalgh (video) gave a hilarious example of ‘rubbish EBM’ when a ‘falls protocols for elders’ was invoked after she went over her bicycle handlebars at speed! The answer is to arrive at initial impressions and decisions based on one’s current knowledge and then AFTERWARDS to check them against transparent reasoning and evidence. more…

An EBM Challenge: When randomized trials are difficult, and belief is strong and hopeful

16 Apr, 15 | by BMJ Clinical Evidence

The case of so-called “moderate” drinking

by Richard Saitz

It is “bad” enough when we have randomized trials to guide practice. What I mean is, of course solid consistent evidence from numerous trials should be used to inform practice, but even then it is challenging: do the benefits outweigh the risks? Do the benefits in tightly controlled trials persist in practice? more…

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