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, et al. Users' Guides to the Medical Literature: XXV. 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
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