Foundation For Evidence-based Medicine Research Articles

Evidence-based healthcare and health informatics: derivations and extension of epidemiology.

Epidemiology provides extremely valid information and evidence regarding human health. Epidemiologic findings with regard to major illnesses must be amassed, enhanced, and expanded further into related areas as a foundation for evidence-based medicine that is based on clinical practice, as well as for evidence-based healthcare that includes public health-related issues. Epidemiology should be recognized not only by epidemiologists but also by a variety of people, including specialists in other areas for healthcare and medicine, people in law and media, policy makers, and the general public. A system is needed that can create information for facilitating appropriate decision-making with issues related to clinical medicine and public health. The principles and methodology of epidemiology are used as a base for developing a field of health informatics. The objective of health informatics is to establish a system for facilitating the flow and circulation of health and medical information. Health informatics has potential applications for the creation, communication, and use of information, and the discipline is being expanded as a practical applied science in search of solutions. This report represents an effort to expand the scope of health informatics and extend the applications of epidemiology by working with individuals in other disciplines and the public.

Candidates for Member-in-Training Trustee-Elect

Back to table of contents Previous article Next article INFORMATION ON THE CANDIDATESFull AccessCandidates for Member-in-Training Trustee-ElectRobert Kelly, M.D., Robert KellySearch for more papers by this author, M.D., Member-in-Training (Member Since 2003)Published Online:3 Dec 2004https://doi.org/10.1176/pn.39.23.00390050b Psychiatry Resident, Beth Israel Medical Center, New York, 2002-Co-Chair, Residents Committee, New York County District Branch, APA, 2004-Resident Representative, Graduate Medical Education Committee, Beth Israel, 2004-Zirinsky Fellow, Beth Israel Division of Biological Psychiatry, 2004-Lund University, School of Medicine, Lund, Sweden, 1990-96California Institute of Technology, Engineering and Applied Science, Pasadena, 1980-84Never before has there been such a focus on mental health issues. The public is hungry for knowledge, as evidenced by the number of inquiries to the Internet concerning mental health. With proper care and attention, we will be the ones who provide the public and our politicians with the answers they seek.High on my priority list are to educate the media and influence media programming to reduce stigma and increase public understanding of mental health issues. The media often portray mental illness and mental health issues in negative and misleading ways. We must use our knowledge and influence to hold the media accountable for accurate reporting. We should also encourage film productions that portray the mentally ill and their families in sensitive ways with which viewers can identify. I recently had the pleasure of hosting a presentation of one such film, “Out of the Shadow,” during this year's annual meeting. This touching and informative movie portrays the struggles of a woman who suffers from schizophrenia and how her illness affects her family. We could use more films like this one.Interacting effectively with the media is a skill that is not taught in medical school or residency training. Understandably, many psychiatrists are reluctant to tread on this alien terrain. I wholeheartedly support APA's initiative to educate psychiatrists to deal with journalists, newscasters, policymakers, and the public at large. As we master these skills, we will be better able to successfully advocate for our patients and our profession.Psychiatrists are seeing more and more of their time being deflected from direct patient care to administrative issues. This deflection decreases the quality of patient care and the quality of education. Psychiatrists and members-in-training are spending valuable time on uninteresting administrative tasks rather than the ones for which they were trained. Increasing the efficiency of working conditions by reducing administrative burdens is likely to increase morale.With careful planning and incremental changes, we can greatly improve our increasingly cumbersome and bureaucratic health care system. Some of my previous work and life experience may be useful toward that end. While getting my engineering degree at Caltech, I worked for the Voyager Space Project and an IBM research center. After graduation, I worked at the IBM Nordic Lab as a project leader. I have also worked in a number of hospitals and clinics in Denmark, Norway, and Sweden. We can and should improve the information-sharing process between hospitals and health care providers. One way is to develop unified standards for electronic data storage, so that software from all vendors will be able to use data transferred from within or across organizations.We need to devote more attention to psychiatric research. Many studies, including my own presented at the last APA annual meeting, indicate that the validity of our research may be in jeopardy. We need to preserve the integrity of research from biased underwriters, methodologies, analyses, and publishers. Without this, the foundation of evidence-based medicine may be compromised, and we will be back to evaluating treatments on the basis of clinical anecdotes. Finally, promoting research in rural areas would provide a broader research base and help rural psychiatrists engage in collaborative ventures with others. Expanding research opportunities may also encourage more psychiatrists to work in these underserved areas.It would be an honor and a pleasure to serve as MIT trustee. With your support, I will work toExert our influence with the media to reduce stigma and increase public understanding of mental health issues.Promote training of psychiatrists so that we can effectively advocate for our patients and our profession.Improve patient care, education, and morale by reducing administrative burdens.Preserve research integrity and expand research opportunities to rural areas.Pursue mental health parity.Primary Professional Activities and Sources of IncomeProfessional Activities100%—Beth Israel Medical Center, New YorkIncome100%—Beth Israel Medical Center, New York ISSUES NewArchived

Foundations of Evidence-Based Medicine

Foundations of Evidence-Based Medicine

Foundations of Evidence-Based Medicine

Foundations of Evidence-Based Medicine

Foundations of Evidence-Based Medicine

Foundations of Evidence-Based Medicine

Positivism resurgent: the epistemological foundations of evidence-based medicine

The aim of evidence-based medicine (EBM) is to introduce scientific coherence into what clinical epidemiologists characterise as the unscientific practice of medicine and, in particular, variations in diagnoses, treatment and prescribing. This paper lays out the claims of EBM—its concept of scientific knowledge, its model of disease and its construction of the role of epidemiology in medicine—and analyses them in the framework of a sociology of medical knowledge. It argues that rather than a paradigmatic restructuring of medicine, EBM is an appeal to positivistic canons of scientificity which have been systematically challenged by both the philosophy and the sociology of medicine. The paper concludes by providing a brief account of sociological explanations of practice and diagnostic variation in modern medicine. Taking these sociological explanations into account would much improve the delivery of medicine.

Principles and problems of assessing the results of medical treatment.

The integration of clinical expertise with the best available evidence from systematic research is the foundation of evidence-based medicine (EBM). The results from a well-designed randomised controlled trial (RCT) is regarded as the best evidence on which to base treatment. In neurosurgical practice fewer treatments are based on the results of RCTs than in medical practice. The reasons are historical, ethical, practical and can be compounded by the surgical learning curve. In neurosurgical practice treatment protocols and surgical indications vary widely. In addition there is a lack of patient orientated, disease specific and generic outcome measures. However, it is a neurosurgical responsibility to provide hierarchical evidence upon which treatment can be based. Comparative audit may offer a solution provided there is high quality data collection, relevant measures of outcome, a defined case-mix and a representative population. Comparative audit can produce bias but neurosurgeons will need to meet the challenge of EBM. Their patients will expect it.