الفهرس 
Overview of Evidence-based Medicine (EBM)Only 14 pages are availabe for public view
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Abstract
Evidence-based medicine (EBM) is defined as the ”conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’ ”. Recently EBM has emerged as a new paradigm for medical practice. It involves integrating individual clinical expertise with the best available external clinical evidence and the individual patients’ rights and preferences in making clinical decisions about their patient care.
Traces of evidence-based medicine’s origin can be found in ancient Greece. It was only in the 20th century that this effort evolved to impact almost all fields of health care and policy. Over the past decade, the term ”evidence-based medicine” (or EBM) has gained considerable currency. EBM has been described as a ”paradigm shift” that will ”change medical practice in the years -ahead”.
No one would deny that the teaching methods have changed over the past several centuries. A timeline in the development of EBM has been closely traced. The initial period was termed ancient era EBM. Ancient era EBM consists of ancient historical or ancedotal accounts of what may be loosely termed EBM. Teaching during this time was mainly authoritative and passed on with stories. This was followed by the development of the renaissance era of EBM, which began roughly during the seventeenth century. During this era personal journals were kept, and textbooks began to become more prominent. This was followed by the 1900s in the transitional era of EBM (1900-1970s). Knowledge during this era could be shared more easily in textbooks and eventually peer-reviewed journals. Finally, during the 1970s we entered the modern era of EBM. During this era we have had an information explosion with online journals and large databases. As history brings us closer to the present day, one theme emerges. The presence of evidence does not immediately translate into the practice of EBM but decrease the lag time between discovery and application.
There are two main ways of using evidence to improve health care both are necessary, and offer a new definition of EBM that better captures how it is actually being applied.
A- Evidence - based guidelines (EBG).
B- Evidence-Based Individual decision making (EBID).
Guidelines were merely a way for experts to pass occasional pieces of advice to non experts. These guidelines and related types of policies should be based on evidence, not on subjective judgment or consensus.
Guidelines need to be tailored to individual cases, and EBID improves physicians’ ability to do this. Many problems fall through the cracks of guidelines, and EBID is the only way to get evidence-based medicine to them. Physicians work on guideline teams, and the educational approach of EBID enables them to be better participants. EBID also helps physicians understand the rationale for evidence-based guidelines, which greatly improves their acceptance, especially when the evidence contradicts a time-honored practice.
The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Working Group has developed a system, which separates the grading of the strength of recommendations from grading the quality of evidence. In this scheme, the strengths of recommendations are decided based on the balance between benefits and downsides, explicitly taking into account patient values.
The GRADE system has two components. First, an assessment of the quality of evidence (which is graded as high, moderate, low or very low), and second the strength of recommendation (which may be strong or weak).
Evidence-based medicine (EBM) is much more than just reading papers but it requires from clinicians not only to read papers, but also to read the right papers at the right time, and then to alter their behavior. Practicing of EBM includes the following steps (5A models):
i. Assessment of the patient.
ii. Asking clinical questions about the patients’ problem.
iii. Acquiring the best available evidence that answer these questions.
iv. Appraisal of the evidence for its validity and usefulness.
v. Applying the result of the appraised evidence to the patient.
Traditionally levels of evidence are represented as a pyramid, with systematic reviews positioned grandly at the top, followed by well designed randomized controlled trials (RCTs), then observational studies such as cohort studies or case-control studies, with case studies and ‘expert opinion’ somewhere near the bottom .
If clinical practice is based on high quality research and ignore the poor one this will improve the performance. Thus, critical appraisal is the way to evaluate any research to be sure that it is telling the truth (valid). Suitable to the patient (relevant) and the result of the research is worth to be used in the clinical practice.
Finally, clinicians must integrate the evidence with clinical experience and patient values before applying it to their individual patients.
The main cornerstone of evidence –based medicine is the use of randomized clinical trials to determine the safety and efficacy of the intervention taking into account clinical status of the patient and the physician experience. There are many advantages to practicing EBM. Those patients who receive evidence-based therapies have better outcomes than those who do not.