Evidence based medicine

Developed as a reaction against poorly designed observational treatment research and position reliance on personal experience.

Requires integration of the best research evidence with clinical expertise and the patient’s unique values and circumstances.

Is an important advance over that intuition-based medicine that preceded it.

Leads to the development of clinical guidelines intended to provide recommendations aimed at optimizing patient care by summarizing and evaluating the available evidence supporting or refuting the use of diagnostic studies for therapeutic approaches.

Recommendation categories are based on evidence type, balance between desirable and undesirable effects, values and preferences, and resource allocation.

Randomized controlled trial‘s and meta-analyses are the major tools of evidence-based medicine and the source of the evidence that describes results for patients.

Category A recommendation: applies to all persons, and most patients should receive the recommended course of action.

Category B recommendation: individual decision making the deal: different choices will be appropriate for different patients.

Evidence type is based on study designs as well as a function of limitations in study design or implementation, imprecision of estimates, variability in findings, indirectness of evidence, publication bias, magnitude of treatment effects, dose response gradient, and constellation of plausible biases that could change effects.

Type I evidence: randomized clinical trial of overwhelming evidence from observational studies.

Type 2 evidence: randomized clinical trials with important limitations or exceptionally strong evidence from observational studies.

Type 3 evidence: observational studies in randomized clinical trials with notable limitation.

Type 4 evidence: clinical experience and observations, observational studies with important limitations, or randomized clinical trials with several major limitations.

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