Author Affiliations: Departments of Clinical Epidemiology and Biostatistics (Drs Guyatt, Haynes, and Cook) and Medicine (Drs Haynes and Jaeschke), McMaster University, Hamilton, Ontario; Department of Medicine and Office of the Dean, Faculty of Medicine, University of Toronto, Ontario (Dr Naylor); Department of Family Medicine, University of Michigan, Ann Arbor (Dr Green); Department of Medicine, Wake-Forest University School of Medicine, Winston-Salem, NC (Dr Wilson); and Departments of Ambulatory Care and Research, South Texas Veterans Health Care System and Medicine, University of Texas Health Sciences Center, San Antonio (Dr Richardson).The original list of members with affiliations appears in the first article of the series (JAMA. 1993;270:2093-2095). A list of new members appears in the 10th article of the series (JAMA. 1996;275:1435-1439). The following member of the Evidence-Based Medicine Working Group contributed to this article: Anne Holbrook, MD, MSc.
Users' Guides to the Medical Literature Section
Editor: Drummond Rennie, MD, Deputy Editor.
This series provides clinicians with strategies and tools to interpret
and integrate evidence from published research in their care of patients.
The 2 key principles for applying all the articles in this series to patient
care relate to the value-laden nature of clinical decisions and to the hierarchy
of evidence postulated by evidence-based medicine. Clinicians need to be able
to distinguish high from low quality in primary studies, systematic reviews,
practice guidelines, and other integrative research focused on management
recommendations. An evidence-based practitioner must also understand the patient's
circumstances or predicament; identify knowledge gaps and frame questions
to fill those gaps; conduct an efficient literature search; critically appraise
the research evidence; and apply that evidence to patient care. However, treatment
judgments often reflect clinician or societal values concerning whether intervention
benefits are worth the cost. Many unanswered questions concerning how to elicit
preferences and how to incorporate them in clinical encounters constitute
an enormously challenging frontier for evidence-based medicine. Time limitation
remains the biggest obstacle to evidence-based practice but clinicians should
seek evidence from as high in the appropriate hierarchy of evidence as possible,
and every clinical decision should be geared toward the particular circumstances
of the patient.
Guyatt GH, Haynes RB, Jaeschke RZ, Cook DJ, Green L, Naylor CD, Wilson MC, Richardson WS, for the Evidence-Based Medicine Working Group . Users' Guides to the Medical LiteratureXXV. Evidence-Based Medicine: Principles for Applying the Users' Guides to Patient Care. JAMA. 2000;284(10):1290-1296. doi:10.1001/jama.284.10.1290