Comparing Clinical Appraisal And Evidence Based Medicine

Evidence generated from research is not all the same. Some evidence is better than others.

Whenever one searches for evidence, he should start looking for the best available one that is obtained from the following types of research: Systematic reviews and meta-analysis

* Randomized controlled studies.

* Non-randomized controlled studies.

* Cohort studies.

* Case control studies.

* Case series.

* Case reports.

* Opinions of experts.

* Animal.

Appraisal of the evidence includes assessment of the validity and relevance of the evidence (clinical applicability). However, evidence could be pre-appraised evidence as in the Cochrane Library, clinical evidence. Finally, clinicians must integrate the evidence with clinical experience and patient

UIC Library, Research and Subject Guides, Evidence Based Medicine, 2014.

How to use EBM:

The easiest way for a clinician is to start practicing EBM as an evidence who follow EBCG. Therefore, he does not have to go into steps 3 & 4 (searching & appraising). Another way of practicing EBM is to be an evidence "user" who can search for readily pre-appraised evidence directly without going into step 4 (appraising). In such circumstances, a clinician has to do critical appraisal and practice as evidence (Straus, et al, 2005).

EBM statement in Egypt and other countries:

In USA: Although EBM is an important concept for promoting value in health care, meaningful application of EBM tools in commercial settings has proceeded slowly. Barriers to the use of EBM include patient preference, physician resistance, the lack of automated decision support systems, managed care failures, lack of research on which to base decisions, and the inherent subjectivity of interpretations of evidence. Medicare still lacks clear authority to apply many evidence-based decision tools (Mendelson, et al,

The intervention affected attitudes and knowledge, but had little impact on physicians’ ability to utilize pre-appraised resources at the point of care. Using EBM resources during consultation was perceived to be a complex task and impractical in a busy setting. Physicians generally had positive attitudes towards EBM. They considered evidence helpful in decision making, agreed it improved patient outcome, but also felt that EBM clashed with “the art of medicine,” thereby, reducing clinical autonomy. Physicians believed intuition plays a vital role in primary care and that evidence should be considered alongside patient preferences and clinical judgment. In addition, family physicians questioned the applicability of research findings to general practice. Local specialists, rather than the medical literature, were important sources and interpreters of evidence and were trusted because of previous success with joint patient care. The main barriers to integrating EBM into day-to-day clinical practice were lack of time because of heavy workloads, lack of familiarity with evidence-based resources, difficulty in retrieving information, and limited access to the web in clinics (Shuval, et al,