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Summary. Presenting a cornucopia of topics seldom seen in a single resource, Foundations of Evidence-Based Medicine explores the principles of formal logic .
Table of contents
- Values-Based Medicine (VsBM) and Evidence-Based Medicine (EBM)
- Bibliographic Information
- Fundamentals of Evidence Based Medicine | Kameshwar Prasad | Springer
- Fundamentals of Evidence Based Medicine
Several scholars and ethicists have raised concern about using the stereotype of evidence to promote a chosen type of therapy or surgery [ 8 ]. This attitude may cause bias in selecting evidence to justify certain methods of treatment. That concept became very popular in a very short time. The main reason being that it offers a strong foundation for the justification of decision-making in the course of management of clinical cases.
The implementation of the concept of EBM is significantly helpful and challenging for many practitioners for several reasons such as: EBM aims to manage uncertainty regarding the short- and long-term outcome of management of certain cases.
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However, this aim cannot be always achieved. In the cases when good and suitable evidence are not found or not agreed about, the integration of the principles of values-based medicine is a must.
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In the cases of medical litigation or argument, the documents of the best evidence have an important value to balance the argument. EBM documents should have an important value in a court of law. EBM has also important educational values as it challenges all the practitioners to continuously update their knowledge in the course of their striving to find the best evidence.
EBM seeks to inculcate lifelong learning process. In daily clinical practice, the application and implementation of EBM simply means that choosing a treatment for a patient is based on the strongest available evidence. In fact, the implementation of EBM does not generally seek patients sharing in decision-making. Several studies showed the importance of the patient being a partner in decision-making [ 12 , 13 ]. However, the use of EBM shows these limitations: Patient preferences and values were not always considered during the decision-making process [ 7 ].
Limitations in incorporating health-related quality of life HRQoL [ 14 ]. EBM is based on finding and following the highest-quality evidence. However, in the absence of randomized clinical trials, the veracity of the evidence comes into question. Ethically there are a few serious questions regarding presumed evidence collection.
Those queries are legitimate as most of the evidence is obtained from the analysis of large data meta-analysis which has subsequently inherited all the problems of analyzing the large data of multiple sources. This problem has been discussed by several authors including Dagi [ 15 ]. The question of what should be done with probabilities and statistics is not statistical in the least: it is entirely a value judgment.
This is the sum of all our experimental conclusions. The idea of linking what ought to be to what is, is seriously ethically and clinically challenged. Randomized controlled studies are the main factors that were used to level validity and strength of evidence. Ethical concerns have been raised about double-blind randomized controlled studies. It has been debated that denying a group of patients control group , the experimental treatment or method of management believed to be beneficial, is ethically challenged. There is also an ethical issue concerning the validity of evidence which is a result of double-blind randomized controlled studies which were carried out in certain circumstances, homogenous or not subjects, variable controls, and particular role to be used as the base for making decision for treating patients in different circumstances.
Therefore, the integration of the best research evidence with clinical expertise and patient values should be carefully and cautiously considered. There is a very important and distinct difference between the methods and approaches of clinical randomized controlled studies and the methods and approaches to established treatment. In the cases of clinical research, the physician researcher in that case and the patient are not standing on the same platform and may not have the same motivation and goals of the treatment. Therefore ideal clinical equipoise may not be achieved in such cases.
Clinical equipoise should be carefully observed in any clinical research. The patient-physician relationship is a complex relationship regardless of the circumstances or the status of the patient. The patient has rights which should be and must be respected fully. The treating physician or surgeon should be a partner who has the main task to provide the best available treatment to the patient and share the very same goals with patient to cure the medical illness.
Respecting and observing patient values and quality of life are core to the implementation of VsBM. These principles and values somehow are overlooked by evidence-based medicine [ 12 , 13 ]. The obtained and presented clinical evidence should not be out of the ethics frame values-based medicine. The evidence should be valid and applicable in that particular condition, scientifically proven and adherent to the ethical principles and rules.
Values-Based Medicine (VsBM) and Evidence-Based Medicine (EBM)
Rather than being seen as distinct spheres, ethics and evidence become part of an integrated whole. Values-based medicine is an expression of medical ethics, considering patient as the center of care. Medical ethics should guide decisions in the daily medical practice. There are several branches of ethics which are normative ethics, applied ethics, descriptive ethics, and metaethics. Normative ethics are ethical theories which highlight what is morally right or wrong in order to lead to proper decision.
Deontological theory considers the moral rights according to observing laws and authorities. Consequentialist theory —which suggests the ends justify the means. It is an outcome-based ethic that says the moral right depends on the positive results. According to this theory, the characters of individuals or groups prevail. Ethic of caring theory —which considers the subjective values is the determining factor to identify what is right and what is wrong.
This theory suggests that relationships should be a deciding factor in deciding what is right and wrong. Ethical intuitionism theory —which suggests that intuitions may be distorted by not accurate or complete information, prejudice, and bias. Applied ethics may be described as it mandates the professional code of ethics or ethical guidelines for a certain profession such as medical profession or counseling.
Comparative ethics focus on the beliefs of individuals, what people believe. Descriptive ethics is concerned with what is believed, not what should be believed. Your points will be added to your account once your order is shipped. Click on the cover image above to read some pages of this book!
The text assumes no prior knowledge and is written in an appealing, accessible style using examples to demonstrate the relevance and practical application of research to health care practice. Written to be inclusive of all health professions, fostering a team-based approach to health care practice. Covers qualitative, quantitative and mixed method research methods. Shows how to decide which research method to use and when.
Draws sensible links between evidence-based practice and research methodology. Introduces ways in which you can make sense of the research data you have collected and instructions on how to write up the data in a more meaningful way. It looks at salient issues that researchers must consider in designing and planning for their research. It illustrates the differences between qualitative and quantitative research and includes content on literature review and research proposals.
Fundamentals of Evidence Based Medicine | Kameshwar Prasad | Springer
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Fundamentals of Evidence Based Medicine
Link Either by signing into your account or linking your membership details before your order is placed. It is updated daily. Searches can be filtered by content type, by specialty, by time and relevance. Explore the enriched, intuitive interface, Smart Search technology for top speed to answers, deep access to trusted evidence, and quick finding of relevant data for optimal productivity at the point-of-care.
Clinical Pharmacology contains current, concise and clinically-relevant drug monographs for all U. Cochrane Library Independent medical evidence on which to base clinical treatment decisions. The Cochrane Library is a collection of databases that contain independent evidence on which to base clinical treatment decisions. DynaMed Plus DynaMed Plus is an evidence-based information resource used by physicians around the world to answer clinical questions quickly and easily.
DynaMed Plus includes thousands of topics covering emergency medicine, cardiology, oncology, infectious diseases, pediatrics, obstetrics and gynecology and much more. Note: if you get an error message, close the browser and try accessing the site again. DynaMed Plus with Isabel Medical information database of clinical topic summaries, including a grading the quality of evidence cited, designed primarily for point-of-care use. Includes Isabel which is used by physicians to help construct or broaden a differential diagnosis. Note: If you get an authentication failed message, close your browser and try accessing the site again.
Essential Evidence Plus Current answers to clinical medicine questions at the point of care.