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In the past, physicians passively applied their knowledge of pathophysiology and pharmacology to treat their patients. While a keen understanding of human physiology (and disease processes) is crucial, several groundbreaking epidemiologists believed it was not enough for the care of patients. Especially in this modern era of explosive growth in technology and new drugs on the market, there is a surplus of information available to health care professionals.

In 1981, a group led by Dr. David Sackett introduced the concept of critical appraisal. Critical appraisal was a term that implied an ability to systematically scrutinize medical literature and apply the findings to patients. However, it was not until 1991 when Dr. Gordon Guyatt published an article in ACP Journal Club where he coined the now ubiquitous term evidence-based medicine. Sackett defines it as the “integration of the best research evidence with clinical expertise and patient values.” Therefore, the practice of evidence-based medicine (EBM) does not blindly appraise the medical literature; nor does it absolve physicians from their duties to apply common sense and work closely with their patients to determine the best course of care. In fact, to practice EBM, physicians must adhere to two underlying principles:

  1. “Best evidence” is determined using a rigorous process of data extraction and interpretation that weights some forms of evidence over others.

  2. Evidence must be interpreted in the setting of the individual patient and his or her characteristics.

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Practice Point

To practice evidence-based medicine, physicians must adhere to two underlying principles:

  1. “Best evidence” is determined using a rigorous process of data extraction and interpretation that weights some forms of evidence over others.

  2. Evidence must be interpreted in the setting of the individual patient and his or her characteristics.

Evidence-based medicine is vital to providing the best patient care. The focus of this chapter will be on evidence-based interpretation of the medical literature; however, other tenets of EBM should not be overlooked.

Assessing the quality of evidence and applying evidence-based principals requires familiarity with a number of “buzzwords” and basic concepts. This knowledge provides the foundation for a better understanding of the fundamentals of assessing the quality of medical literature.

Cointerventions

Cointerventions are treatments or interventions that may be differentially applied across experimental and/or control groups that may have an effect on the target outcome, and hence lead to biased results. For example, a study is designed to determine the impact of a novel chemotherapeutic agent to palliate patients with end-stage myeloma. This double-blind, randomized controlled trial (RCT) shows that patients receiving the experimental agent have less bony pain. However, after study completion and careful review, investigators discovered that the chemotherapeutic agent caused an intractable cough that could only be treated with a narcotic-containing syrup. Investigators are now unable to determine whether the reduction in bony pain was secondary to ...

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