Evidence based medicine: new tool or new enemy?
Medical knowledge changes every day, the previously accepted data become old, whereas the volume of new scientific information is huge. Evidence based medicine (EBM) which originates in the second half of the 19th century and earlier, remains a very interesting topic among the health professionals, such as clinicians and health practitioners (Sackett 1997). EBM is defined as the conscious and reasonable use of current best scientific evidence in making decisions in treatment of each individual patient. Another feature of EBM is that it emphasises the importance of outcomes and states that a doctor makes his/her decision according to the best available knowledge and that knowledge comes from the best scientific methods (Sackett 1997, Masic et al. 2008).
The primary goal of the EBM is to improve health outcomes through the deployment of the most effective interventions. At this point, it is necessary to distinguish two different terms: EBM and Evidence Based Health Care. The first one is referred to the approach of the physician in making decisions related to the individual patient. On the other hand, Evidence Based Health Care is a broader definition that includes advanced approach to understanding the patients, families and doctors’ beliefs, values and attitudes and it is based on population level (Masic et al. 2008).
A number of skills are necessary in order to practice EBM. There are five steps:
- Develop an answerable question
- Search the literature
- Critical appraisal of the evidence. EBM is categorized in different types of clinical evidence. At the bottom of the pyramid there is the evidence from the experts and clinical practice (less reliable evidence, class D evidence). Above it, there is the evidence from non-experimental studies, like case studies and comparative research and then the evidence from one experimental research (Class C and Class B evidence). In the last three positions of the pyramid there is the evidence from well designed, controlled, randomized research trial, the evidence from only one randomized, controlled study and the last but the most important are the evidence obtained from meta-analysis of several randomized controlled researches (the “best evidence”, Class A evidence) (Masic et al. 2008, Vandeweerd et al. 2012).
- Integrate appraisal results with clinical expertise and patient values
- Evaluate the outcomes (Schmidt 2007, Masic et al. 2008)
Evidence based veterinary medicine (EBVM) is the application of EBM in the veterinary field (Vandeweerd et al. 2012). There is a lot of discussion what is EBVM and how it can be used in clinical practice. Some believe that EBVM is a progression of clinical medicine and others that it is a method of practice coming from academic people who are against the traditional techniques. There are also some others who believe that it is only a new fashion in veterinary medicine without any clinical practice (Schmidt 2007).
Nowadays, in veterinary medicine, there are many authors who encourage students, academics and other veterinarians in EBVM. Veterinarians can access literature articles in a larger scale than in past and as a result they can use new ideas and methods in their clinical practice. However, it is not always obvious to understand and evaluate the benefits from the application of EBVM in veterinary clinical practice, especially to students (Schmidt 2007, Vandeweerd et al. 2012).
We, in the Editorial Board of the Hellenic Journal of Companion Animal Medicine, believe that EBVM is the tool of outmost importance, to develop veterinary clinical practice, for the benefit of our patients and their caregivers. In the first years of the Hellenic Journal of Companion Animal Medicine, the majority of the published papers were case reports and narrative reviews. A new era for the journal has begun; the main target of the journal will be the publication of more well designed, controlled, randomized, clinical trials, along with systematic reviews, and less case reports. We are looking forward to elevating the quality of our journal, by implementing and incorporating high level of EBVM, so as more clinical knowledge will allow the veterinarians to explore new areas of specialty.
Kiriaki Pavlidou, DVM, PhD
- Masic I, Miokovic M, Muhamedagic B (2008) Evidence Based Medicine - New Approaches and Challenges. Acta Inform Medica 16, 219.
- Sackett DL (1997) Evidence-based medicine. Semin Perinatol 21, 3–5.
- Schmidt PL (2007) Evidence-Based Veterinary Medicine: Evolution, Revolution, or Repackaging of Veterinary Practice? Vet Clin North Am - Small Anim Pract 37, 409–417.
- Vandeweerd JM, Kirschvink N, Clegg P et al. (2012) Is evidencebased medicine so evident in veterinary research and practice? History, obstacles and perspectives. Vet J 191, 28–34.