Full Answer
What are the approaches to drug treatment?
Each approach to drug treatment is designed to address certain aspects of drug addiction and its consequences for the individual, family, and society. This section presents examples of treatment approaches and components that have an evidence base supporting their use.
How do we evaluate the efficacy of treatments?
Methods for evaluating efficacy often begin with health care professionals' judgments and then progress through more highly systematized research strategies. For some treatments, the most accessible source of information on treatment efficacy may be the judgment of health care professionals and patients who have experience with the treatments.
What is the best source of information on treatment efficacy?
For some treatments, the most accessible source of information on treatment efficacy may be the judgment of health care professionals and patients who have experience with the treatments. It is important to distinguish between the context of discovery of an intervention and the context of verification of its clinical efficacy.
What is the role of non-randomised studies in evaluating treatments?
The role of non-randomised (observational) studies in evaluating treatments is contentious: deliberate choice of the treatment for each person implies that observed outcomes may be caused by differences among people being given the two treatments, rather than the treatments alone.
Which type of study is the most reliable?
Why should we read systematic reviews?
What is a trustworthy guideline?
Why can't we base our health decisions on the results of studies?
Why is clinical experience important?
How many medical journals are there?
What is considered an expert opinion?
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About this website
Which type of study provides the best evidence?
Systematic Reviews and Meta Analyses Well done systematic reviews, with or without an included meta-analysis, are generally considered to provide the best evidence for all question types as they are based on the findings of multiple studies that were identified in comprehensive, systematic literature searches.
What is the most reliable type of evidence-based medical research?
For treatment decisions, there is a consensus that the most reliable primary study is the randomized controlled trial (RCT). In this type of study, patients are randomly assigned to have either the treatment being tested or a comparison treatment (sometimes called the control treatment).
Which type of study provides the best source of evidence about prognosis?
cohort studyBecause a prognosis question does not involve comparing treatments, the highest evidence would come from a cohort study or a systematic review of cohort studies.
What provides the best clinical evidence?
Randomised controlled trials that are well conducted remain the gold standard for evidence of efficacy.
What is the best and most reliable type of evidence?
Evidence provided by original documents is more reliable than evidence provided by photocopies or facsimiles, or documents that have been filmed, digitized, or otherwise converted into electronic form, the reliability of which depends on the controls over the conversion and maintenance of those documents.
What are the most reliable evidence-based sources?
Peer-reviewed journal articles based on research studies are your best sources of evidence-based information.
What makes good evidence based research?
Evidence-based interventions or programmes are those which have been proven effective in multiple, high-quality randomised controlled trials (RCTs).
Why are systematic reviews the best?
Systematic reviews systematically evaluate and summarize current knowledge and have many advantages over narrative reviews. Meta-analyses provide a more reliable and enhanced precision of effect estimate than do individual studies.
Which is the most superior class of evidence?
Primary evidence is considered to be the superior class of evidence. Such evidence is an original document that needs to be submitted before the court for inspection. It is admissible without any prior notice. Such evidence must be presented before the court before the secondary evidence.
Are systematic reviews the best evidence?
Systematic review and meta-analysis is a way of summarizing research evidence, which is generally the best form of evidence, and hence positioned at the top of the hierarchy of evidence.
How to find evidence when you need it, part 1: Databases, search ...
[Corrall CJ, Wyer PC, Zick LS, Bockrath CR. How to find evidence when you need it, part 1: databases, search programs, and strategies. Ann Emerg Med. …
Evidence based medicine: what it is and what it isn't - PubMed
Evidence based medicine: what it is and what it isn't BMJ. 1996 Jan 13;312(7023):71-2. doi: 10.1136/bmj.312.7023.71. Authors
Critical Appraisal tools — Centre for Evidence-Based Medicine (CEBM ...
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The hierarchy of evidence: Levels and grades of recommendation
Study design. Surgical literature can be broadly classified as those articles with a primary interest in therapy, prognosis, harm, economic analysis or those focusing on overviews to name a few. 5 Within each classification there is a hierarchy of evidence, that is, some studies are better suited than others, to answer a question of therapy, for example, and may more accurately represent the ...
5 Identifying the evidence: literature searching and evidence ...
5.2 Search protocols . Search protocols should be developed by the information specialist and agreed with the other members of the developer's team before undertaking a systematic search. Search protocols are part of the review protocol (see the appendix on the review protocol template), which is signed off by the committee.When developing search protocols, the information specialist may ask ...
Which type of study is the most reliable?
For treatment decisions, there is consensus that the most reliable primary study is the randomised controlled trial (RCT). In this type of study, patients are randomly assigned to have either ...
Why should we read systematic reviews?
The best answers are found by combining the results of many studies. A systematic review is a type of research that looks at the results from all of the good-quality studies .
What is a trustworthy guideline?
Trustworthy guidelines, especially if developed with high standards, such as the Grading of Recommendations Assessment, Development, and Evaluation ( GRADE) approach, offer systematic and transparent guidance in moving from evidence to recommendations.
Why can't we base our health decisions on the results of studies?
Sometimes the research hasn’t been done because doctors are used to treating a condition in a way that seems to work. This is often true of treatments for broken bones and operations.
Why is clinical experience important?
However, clinical experience is key to interpret and apply research evidence into practice, and to formulate recommendations, for instance in the context of clinical guidelines. In other words, research evidence is necessary but not sufficient to make good health decisions.
How many medical journals are there?
A conservative estimation is there are more than 35,000 medical journals and almost 20 million research articles published every year. On the other hand, up to half of existing data might be unpublished.
What is considered an expert opinion?
Anything not fulfilling this definition is typically classified as “expert opinion”, the basis of which includes experience with patients, an understanding of biology, knowledge of preclinical research, as well as of the results of studies.
Why do nurses use evidence based practice?
To provide patient care of the highest quality, nurses utilize an evidence-based practice approach because evidence-based practice is#N#a. A guide for nurses in making clinical decisions.#N#b. Based on the latest textbook information.#N#c. Easily attained at the bedside.#N#d. Always right for all situations.
What is systematic review?
In a systematic review or meta-analysis, an independent researcher reviews all of the RCTs conducted on the same clinical question and reports whether the evidence is conclusive, or if further study is needed. A single RCT is not as conclusive as a review of several RCTs on the. same question.
What is the gold standard for research?
Individual RCTs are the gold standard for research. A peer-reviewed article means that a panel of experts has reviewed the article; this is not a research method. Qualitative research is valuable in identifying information about how patients cope with or manage various health.
Where is expert opinion on the pyramid?
Expert opinion is on the bottom of the hierarchical pyramid of evidence . The nurse is writing a research article on a patient care topic. The nurse realizes that the section that will get the reader to read the article because of the value of the topic for the reader is the. a.
Does nursing research randomize subjects?
nursing research does not usually randomize its subjects. Control studies determine whether there is an association between one or more predictor variables and the condition. The nurse has used her PICO question to develop an evidence-based change in protocol for a certain nursing procedure.
Is EBP appropriate for all settings?
EBP is not to be blindly applied without using good judgment and critical thinking skills. It is not appropriate for all settings. Click again to see term 👆. Tap again to see term 👆. In caring for patients, it is important for the nurse to realize that evidence-based practice is. a.
What is the best scientific evidence?
The best scientific evidence is considered to be a randomized controlled clinical study conducted on the amount of respondents that can prove the effectiveness of many drugs, as well as the harm and the inefficacy of others in comparison with the best existing therapy (3).
What is evidence based medicine?
Evidence based medicine (EBM) is conscious, specific, reasonable use of modern, best evidences in making decisions about treatment of individual patients. It is not a medical cook-book with recipes, but its good application brings cost-effective and better health care.
When was evidence based medicine first used?
The term “evidence based” was first used in 1990 by David Eddy. (7,8) The term “evidence-based medicine” first appeared in the medical literature in 1992 in a paper by Guyatt et al. (9). The idea of EBM appeared at the Mc Master University in Canada in 1988, but during the 1990s became known throughout the world.
What is the purpose of a clinical visit?
All clinical visits, whether acute or chronic, are opportunity for preventive counseling and planned care for pediatric patients . There are specific intervals when a healthy child should visit a doctor.
What are the achievements of evidence based medicine?
One of the greatest achievements of evidence-based medicine has been the development of systematic reviews and meta-analyses, methods by which researchers identify multiple studies on a topic, separate the best ones and then critically analyze them to come up with a summary of the best available evidence.
Is evidence based medicine a cookbook?
Evidence based medicine is not “cookbook” medicine.
What is a treatment with proven effectiveness in one type of setting?
A treatment with proven effectiveness in one type of setting (e.g., the home, the school, day treatment, the clinic, the office, or the institution) may vary in effectiveness when it is offered in other settings. Good guidelines specify the settings in which the treatment has been documented to be effective.
Why are guidelines important for treatment?
Good guidelines allow for flexibility in treatment selection so as to maximize the range of choices among effective treatment alternatives.
Why are guideline panels recommended?
It is recommended that guideline panels make detailed recommendations to facilitate independent evaluation of the reliability of the guidelines they produce. Ascertaining whether the guidelines are interpreted and applied consistently by health care professionals comprises one assessment of reliability.
What is a criterion 7.2?
Criterion 7.2 It is recommended that guidelines take into account the effects on treatment outcome of interactions between the patient's and the health care professional's characteristics , including but not limited to language, ethnicity, background, sex, and gender.
What is the purpose of failure to disclose scientific justification for a guideline?
Moreover, failure to disclose the scientific justification for a guideline violates a basic principle of science, which requires open scrutiny and debate. Without the disclosure of adequate scientific information, guidelines are mere expressions of opinion.
Why are guidelines promulgated?
Guidelines are promulgated to encourage high quality care. Ideally, they are not promulgated as a means of establishing the identity of a particular professional group or specialty, nor are they used to exclude certain persons from practicing in a particular area.
What factors affect outcome?
Such factors as the professional's skill, experience, gender, language, and ethnic background can affect outcome in ways that are only partly understood. Criterion 7.1 It is recommended that guidelines take into account the effect of the health care professional's training, skill, and experience on treatment outcome.
Which type of study is the most reliable?
For treatment decisions, there is consensus that the most reliable primary study is the randomised controlled trial (RCT). In this type of study, patients are randomly assigned to have either ...
Why should we read systematic reviews?
The best answers are found by combining the results of many studies. A systematic review is a type of research that looks at the results from all of the good-quality studies .
What is a trustworthy guideline?
Trustworthy guidelines, especially if developed with high standards, such as the Grading of Recommendations Assessment, Development, and Evaluation ( GRADE) approach, offer systematic and transparent guidance in moving from evidence to recommendations.
Why can't we base our health decisions on the results of studies?
Sometimes the research hasn’t been done because doctors are used to treating a condition in a way that seems to work. This is often true of treatments for broken bones and operations.
Why is clinical experience important?
However, clinical experience is key to interpret and apply research evidence into practice, and to formulate recommendations, for instance in the context of clinical guidelines. In other words, research evidence is necessary but not sufficient to make good health decisions.
How many medical journals are there?
A conservative estimation is there are more than 35,000 medical journals and almost 20 million research articles published every year. On the other hand, up to half of existing data might be unpublished.
What is considered an expert opinion?
Anything not fulfilling this definition is typically classified as “expert opinion”, the basis of which includes experience with patients, an understanding of biology, knowledge of preclinical research, as well as of the results of studies.
Why Is Research Evidence Better Than Expert Opinion Alone?
What Studies Are More Reliable?
- Not all evidence is equally reliable. Any study design, qualitative or quantitative, where data is collected from individuals or groups of people is usually called a primary study. There are many types of primary study designs, but for each type of health question there is one that provides more reliable information. For treatment decisions, there is consensus that the most reliable pri…
Why We Shouldn’T Read Studies
- An enormous amount of effort is required to be able to identify and summarise everything we know with regard to any given health intervention. The amount of data has soared dramatically. A conservative estimation is there are more than 35,000 medical journals and almost 20 million research articles published every year. On the other hand, up to half of existing data might be un…
Why We Should Read Systematic Reviews
- Most of the time a single study doesn't tell us enough. The best answers are found by combining the results of many studies. A systematic review is a type of research that looks at the results from all of the good-quality studies. It puts together the results of these individual studies into one summary. This gives an estimate of a treatment's risk...
Three Reasons Why We Shouldn’T Read (Most) Systematic Reviews
- Firstly, systematic reviews have proliferated over time. From 11 per day in 2010 , they skyrocketed up to 40 per day or more in 2015. Some have described this production as having reached epidemic proportions where the large majority of produced systematic reviews and meta-analyses are unnecessary, misleading, and/or conflicted. So, finding more than one systematic reviewfor …
How to Find The Best Available Evidence?
- Considering the massive amount of information available, we can quickly discard periodically reviewing our favorite journals as a means of sourcing the best available evidence. The traditional approach to search for evidence has been using major databases, such as PubMed, or EMBASE. These constitute comprehensive sources including millions of relevant, but also irrelevant article…
Three Alternatives to Access The Best Evidence?
- Alternative 1 - Pick the best systematic review Mastering the art of identifying, appraising and applying high-quality systematic reviews into practice can be very rewarding. It is not easy, but once mastered it gives a view of the bigger picture: of what is known, and what is not known. The best single-source of highest-quality systematic reviews is produced by an international organis…
The Future
- Finding the best available evidence is more challenging than it was in the dawn of the evidence-based movement, and the main cause is the exponential growth of ‘evidence-based’ information, in any of the flavours described above. However, with a little bit of patience and practice, the busy clinician will discover evidence-based practice is far easier than it was 5 or 10 years ago. We ar…
References
- Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med. 2010 Sep 21;7(9):e1000326. doi: 10.1371/journal.pmed.1000326
- Epistemonikos database [filter= systematic review; year=2015]. A Free, Relational, Collaborative, Multilingual Database of Health Evidence.https://www.epistemonikos.org/en/s…
- Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med. 2010 Sep 21;7(9):e1000326. doi: 10.1371/journal.pmed.1000326
- Epistemonikos database [filter= systematic review; year=2015]. A Free, Relational, Collaborative, Multilingual Database of Health Evidence.https://www.epistemonikos.org/en/search?&q=*&classificatio...
- Ioannidis JP. The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses. Milbank Q. 2016 Sep;94(3):485-514. doi: 10.1111/1468-0009.12210.
- Page MJ, Shamseer L, Altman DG, et al. Epidemiology and reporting characteristics of syste…
