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WHAT IS EVIDENCE BASED MEDICINE?
The concept of evidence based medicine (EBM), defined as the "integration of best research evidence with clinical expertise and patient values", 1 has been gaining popularity in the past decade. The practice of EBM involves a process of lifelong self directed learning in which caring for patients creates the need for important information about clinical and other health care issues. EBM recognises that the research literature is constantly changing. 2 What the evidence points to as the best method of practice today may change next month or next year. The task of staying current, although never easy, is made much simpler by incorporating the tools of EBM such as the ability to track down and critically appraise evidence, and incorporate it into everyday clinical practice.
The work of people in the field of paediatrics and child health centres on the problems of children and their families and carers. Questions about diagnosis, prognosis, and treatment often arise and sometimes the answers to these questions need to be sought. EBM allows the integration of good quality published evidence with clinical expertise and the opinions and values of the patients and their families or carers. Deciding on how to treat patients should not be based solely on the available evidence. Other factors such as personal experience, judgement, skills, and more importantly patient values and preferences must be considered.
The practice of EBM should therefore aim to deliver optimal patient care through the integration of current best evidence and patient preferences, and should also incorporate expertise in performing clinical history and physical examination. Figure 1 illustrates a typical flow chart of EBM, depicting how knowledge and experience may be integrated with patients' preferences and available evidence in the making of clinical decisions.
WHY EVIDENCE BASED MEDICINE?
The most important reason for practising EBM is to improve quality of care through the identification and promotion of practices that work, and the elimination of those that are ineffective or harmful. 4 EBM promotes critical thinking. It demands that the effectiveness of clinical interventions, the accuracy and precision of diagnostic tests, and the power of prognostic markers should be scrutinised and their usefulness proven. It requires clinicians to be open minded and look for and try...