EDITORIAL
81
Acta Medica Indonesiana - The Indonesian Journal of Internal Medicine
The Practice of Evidence-based Medicine:
Time for us to Change
Esthika Dewiasty
1,21 Department of Internal Medicine, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia. 2 Center for Clinical Epidemiology and Evidence-based Medicine, Faculty of Medicine, University of Indonesia- Cipto Mangunkusumo Hospital, Jakarta Indonesia.
Correspondence mail:
Division of Geriatric, Department of Internal Medicine, Faculty of Medicine, University of Indonesia-Cipto Mangunkusumo Hospital. Jl. Diponegoro 71, Jakarta Pusat 10430, Indonesia. email: [email protected], [email protected].
Clinical practice continues to evolve and adapt. Evidence-based medicine, which has been developed in the last two decades, remains a trending topic for clinicians.There are now many workshops on evidence based-practice, many evidence-based medicine journals have been published, and this science has now matured.
But enthusiasm has been tempered with some doubts.1,2
Description of what EBM is all about guides us to clarify its application. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence. Good clinicians always take into account both aspects comprehensively, and never rely on a single aspect alone.1 Evidence-based medicine aims to provide clinicians and patients with choices about the most effective care based on the best available research evidence.3 To patients this is an ideal expectation, yet some clinicians think it is difficult to do.3,4 The main problem that clinicians have in handling all medical information provided in journals is the gap between time required for reading the studies and the time available in their busy schedule. However, studies showed that busy clinicians who are able to utilize their few reading time to do selective, efficient, and mastering critical appraisal; are able to apply evidence-based practice.1 Now we
can easily find systematic reviews and meta- analyses which summarize the best available evidence on a topic. Furthermore, nowadays there are many EBM resources that continually search, appraise and summarize literature, which lead to easier clinical application.4
The world of healthcare has been developed since evidence-based practice was introduced.2 Evidence-based practice helps clinicians to make decisions based on best available, current,valid, important, and relevant evidence. Healthcare delivered in ignorance of best available evidence potentially reduce patient’s benefit and may increase harm.5 Now is the right time for us to refine where we are now and where we are going to go. It is a time of change toward better improvement for our daily practice, as well as for our journal. In this issue, we present a new format of article: an evidence base case report (EBCR). An EBCR shows how evidence can be applied at all stages of patient care. It represents how research evidence has been applied to the management of a particular case. The clinical scenario in the case can be posed into a clinical question, and find out the best available evidence to answer the question by doing systematic literature searching and critical appraisal, then finally conclude in a form of recommendation for the case. It is important to differentiate it from the “traditional” case report, which describes a
Esthika Dewiasty Acta Med Indones-Indones J Intern Med
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clinical case based on the presenting symptom and signs, and then evaluating the progress or treatment compared to scientific knowledge.6 Nonetheless, both formats have their own specific aim and rationale on presenting the case.
Last but not least, the main aim of this journal remains the same: to provide you updated information that is valid, important, and relevant for clinical practice in the internal medicine.
Hopefully this journal will continue to be a useful source which provide you with the best available clinical evidence for your practice.
REFERENCES
1. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn’t. BMJ. 1996;312:71-2.
2. Saitz R, Evidence-based medicine: time for transition and translation (to practice). Evidence-based medicine.
2010;15(4):103-4.
3. Glasziou P, Haynes B. The paths from research to improved health outcomes. ACP J Club. 2005;142(2).
(editorial)
4. White B. Making evidence-based medicine doable in everyday practice. Fam pract manag. 2004:51-8.
5. Dawes M, Summerskill W, Glasziou P, et al. Sicily statement on evidence-based practice. BMC Med Edu.
2005;5:1. doi:10.1186/1472-6920-5-1.
6. Godlee F. Applying research evidence to individual patients. Evidence-based case reports will help. BMJ.
1998;316(7145):1621-2.
