Principles Of EBM Research Articles

Exploring evidence-based decision-making competencies among homoeopathic medical students: insights from a cross-sectional pilot investigation

Background: The healthcare landscape requires integrating traditional principles with evidence-based practices. This study addresses the vital need to assess and enhance Evidence-Based Decision-Making (EBDM) understanding among students in homeopathic medicine. Challenge: Homeopathic medicine, rooted in tradition, must align with modern healthcare standards emphasizing evidence-based approaches. Bridging this gap is crucial for optimizing patient outcomes and maintaining the relevance of homeopathic practices. Objective: This study aimed to scrutinize the comprehension and implementation of EBDM among undergraduate homeopathic medical students. Identifying discrepancies in perception and actual understanding, the goal was to outline interventions enhancing EBM competence and harmonizing traditional and evidence-based practices. Methodology: Using a cross-sectional design, data were collected through a questionnaire distributed via Google Forms. 203 undergraduate students from Vinayaka Mission’s Homoeopathic Medical College participated, providing insights into their EBDM grasp, ability to discern reliable evidence sources, understanding of research study designs, and self-reported EBM practices. Expected results: Initial analyses reveal a misalignment between perceived and actual understanding of EBDM concepts. Academic progression correlates with increased use of evidence-based resources and improved statistical literacy. Barriers include resource constraints, insufficient critical appraisal skills, and time limitations. Facilitators include user-friendly resources, institutional policies, curriculum integration, and mentor support. Anticipated outcomes stress the need for tailored educational interventions, enhancing EBM competence, and integrating EBM principles into traditional homeopathic practice.

Towards the revision of the Italian code of medical ethics: thoughts of an extremist.

In November 2022 the Italian medical council (Federazione nazionale degli ordini dei medici chirurghi e odontoiatri) started the revision of the Italian Code of medical ethics (Cme) with the first race dating back ten years. Since then, the Italian doctors are dealing with the scientific, ethical and economic challenges together with the more recent ones posed by the Sars-CoV-2 pandemic to the National health system underlying the ongoing crisis of the medical profession. Additionally, this critical context requires the doctors to develop new technological skills, a complete and effective adherence to the Ebm principles, a new view regarding the relationship with the other health care professionals and the related changes of clinical practices fostering a responsible use of resources. In brief, what is required nowadays from doctors is to rethink about the meaning of science, ethics, economics and public health and to make new and more appropriate connections between the instances conveyed by these different disciplines. The Cme main aim consists in providing appropriate rules in step with the current transformations of medicine and society to doctors for ethically acting in clinical practice, assuring the citizens, the institutions and law of the scientific competence, the protection of the fundamental rights of the sick person in compliance with the constitutional principles. Under this assumption and in line with the above mentioned professional crisis, at least the overall guidelines aimed to solve it should have been settled before starting the Cme review also in order to ensure the necessary coherence between the new contents drawing the doctors new social function and its codal systemisation. Unfortunately this stepwise approach was not considered.Lastly, to develop the new Cme looking towards the progress of medical profession, systematic and methodologically appropriate consultations would have been necessary to know, value and balance all the different positions of doctors, allowing them to be responsible for the change of their profession. However, such a decision was not made.

Critical appraisal of medical literature in undergraduate and postgraduate medical students

BackgroundCritical appraisal of medical literature is a challenging competency which is mandatory in the practice of evidence-based medicine. Achieving this competency has been reported to vary according to many factors including the students’ background, gender, or specialty. The majority of the articles published in this field mainly assessed the students’ satisfaction or their cognitive knowledge. The authors aimed to assess the possibility of performing the same training of critical appraisal of medical literature to students with different backgrounds to highlight the link between the critical appraisal practice and the reflexive, cognitive, attitudes and conative profile of the students according to their level.MethodsStudents in the second year (SYME) and third year (TYME) of medical education and students performing continuing medical education (CME) and family doctors (FD) were invited to voluntarily participate in the training. This study occurred from September 2020 to June 2022. Before the workshop, the students were invited to answer a self-assessment questionnaire and a prerequisite test. Two original manuscripts dealing with COVID-19 were analyzed using published checklists. At the end of the workshops, all of the students fulfilled a second self-assessment questionnaire and a Fresno-adapted final test assessing their knowledge. Both self-assessment questionnaires were conceived by an expert committee according to the different steps of questionnaires’ validation. They assessed the cognitive, conative, motivational, and reflexive students’ profile using Likert scale questions. Also, the participants were invited to answer a semi-structured interview.ResultsNinety-five participants were included with 6 participants in SYME, 54 in TYME, 16 in CME, and 19 FD. The results highlighted the possibility of using the same program independently from the students’ level when using manuscripts dealing with a widely known and confusing disease such as COVID-19. The analysis of the different pre- and postworkshop questionnaire scores highlighted mild or negative scores in the TYME and intermediate or good scores in the other levels. The variation of the mean scores according to the students’ level revealed a significant difference in prerequisite, final test, pre and postworkshop attitudes, postworkshop cognitive, postworkshop conative and satisfaction scores. 11 students from different levels were interviewed. The content analysis highlighted 4 themes including the teaching organization, the institutional assessment, the impact on the research practice and the impact on the patients’ management with the emphasis of the TYME students on the necessity of integrating the teaching and the assessment of the EBM principles in the curriculum.ConclusionOur results put emphasis on the necessity of introducing the teaching of critical appraisal of medical literature early in the curriculum in order to avoid negative behaviorism during the clerkship period.

Risk assessment for marine ecosystem‐based management (EBM)

AbstractEcosystem‐based management (EBM) is a holistic way to manage the marine environment, involving partnerships between people and the recognition of ecological complexity. As we progress towards EBM, risk assessments must move beyond an evaluation of the direct impacts of a single stressor on a species or habitat. Here, we propose 12 risk assessment criteria that explicitly reflect the principles of EBM. These criteria include the need to assess risk to multiple ecosystem components and values, evaluate place and time‐specific ecological complexity, evaluate recovery, accommodate different knowledge types and communicate uncertainty. Contemporary risk assessment approaches rarely meet all 12 criteria and whilst many approaches could be adapted to do so, some are more easily modified than others. Risk assessment approaches that meet our criteria have the greatest potential to support decision‐making in an EBM context and thereby safeguard our marine environments and their values for future generations.

777Teaching evidence-based medicine using authentic assessment the Whack-a-mole project

Abstract Introduction Authentic assessments facilitate student’s application of complex problem-solving skills and knowledge to real-world tasks. The whack-a-mole (WAM) project includes key critical thinking, biostatistics and epidemiology skills as well as elements of complexity and creativity skills that are particularly important when teaching evidence-based medicine to health professionals. Complementary and alternative medicines (CAMs) provide the current context as they are widely used in the Australian population making them an important subject amongst primary health care professional and policy makers. Aim To report student perceptions and learning after completion of the real-world authentic assessment WAM. Methods WAM required students to choose, document, investigate, identify, critically appraise and report on a complementary medication for sale in Australia. A total 464 students enrolled in a 3rd Biomedical Science capstone unit completed the WAM project report and video assessments in teams. Data on student perceptions was collected using an online questionnaire and analysed using SPSS 25 and NVIVO 11. Results The average overall mark for the WAM assessment was 52/60 (86%). 116 students (25%) completed the online questionnaire of which 92% of students indicated the whack-a-mole project changed their perceptions of complementary medicine and/or the regulation of goods and services in Australia. The majority of students found no (43%) or insufficient (55%) evidence to support product claims. These findings were supported by qualitative feedback. Conclusion Students applied the principles of EBM to the WAM project and in doing so altered their perceptions of CAM, regulation and scientific evidence. Key messages Authentic assessments play a key role in engaging student in real-world problem solving to advance their critical thinking and evidence-based medicine.

Clinical Epidemiology in China series. Paper 1: Evidence-based medicine in China: An oral history study

ObjectiveTo describe and record the evolution of EBM in China. Study Design and SettingWe conducted the study following the general methodology of oral history. The interviews were done at Lanzhou University, between 18th and 22nd April 2019 using pre-defined questions. All interviews were videorecorded. Two investigators extracted and analyzed the information from the interviews independently. ResultsOne international expert and ten Chinese experts participated in the interviews. After the introduction of EBM in China in the mid-1990s, more than 20 EBM centres have been established. According to the interviewees, Gordon Guyatt, David Sackett and Iain Chalmers are the international experts who played the most important role in the development of EBM in China. China has contributed to EBM on the international level by conducting systematic reviews, developing reporting checklists, and introducing the principles of EBM into Traditional Medicine. The Chinese Cochrane Centre and the EBM Centre of Lanzhou University were ranked the top two EBM Centres in China by the interviewees. ConclusionEBM has been developing in China for nearly a quarter of a century. Many achievements have been reached, however, EBM is still facing many challenges in China, including shortages of funding support and personnel, as well as limited local high-quality evidence.

A practical tool to support ecosystem-based management in a river ecosystem: a case study of the Yellow River in China

Abstract Ecosystem-based management (EBM) is widely applied in marine and coastal ecosystems. However, its implementation in river basins is limited. This limitation is attributed to the lack of practical tools, which combine the general principles of EBM and the unique features of river ecosystems, to provide information for policy-making. A method to support EBM in rivers is proposed in the present study. This method analyzes the ecosystem by quantifying multiple relationships among natural and human components and considering the spatial heterogeneity in external activities and ecosystem resilience. Using this method, policies are prioritized in an EBM plan by systematically evaluating the effects of external activities on the ecosystem services. The application of this method in policy-making in the EBM context is presented in a case study using the Yellow River in China. As a practical tool, this method can help practitioners improve the implementation of EBM in river ecosystems.

PHP253 - WAYS OF IMPROVING PHARMACEUTICAL ASSISTANCE IN UKRAINE THROUGH THE DEVELOPMENT OF PHARMACEUTIST PROTOCOLS

Since 2010, the system of regulating the use of OTC medicines has been implemented in Ukraine through the approval of the pharmaceutist protocols. This is an effective tool for informational support of specialists in the pharmacy on the principles of EBM and patients-oriented using of medicines. To evaluate the current state of pharmaceutical assistance (PA) implementation in Ukrainian pharmacies and identify lacks in its practical implementation. A survey of pharmacy specialists in 280 pharmacies was carried out in 10 Ukrainian regions using the questionnaire ‘Self-assessment tool for pharmaceutical care`. It was developed by CD-P-PH, CD-P-PH/PC and adapted for Eastern European countries. The evaluation of the results was carried out using statistical methods. It was found that the highest quality of PA is provided when OTC drugs are released, and the quality of PA in the release of Rx drugs and the provision of diagnostic services in most of the pharmacies under investigation is assessed as unsatisfactory. Assessment of the five factors of quality assurance of the PA has shown that the actual state of their implementation is low. This result may be explained by the fact that during the release of OTC drugs, experts can use pharmaceutist protocols approved by the MoH of Ukraine. The conducted analysis of the state of PA implementation in pharmacies showed that there is a need for further development of pharmaceutist protocols for supporting pharmaceutical specialists to provide PA not only at the release of OTC drugs but also Rx drugs.

Teaching Evidence Based Medicine in Surgical Education; the Challenges and Techniques in Training

Evidence Based Medicine integrates clinical expertise, best available clinical evidence, as well as patient’s values and preferences to manage the care of patients. Surgeons have traditionally performed surgery according to their mentor teachings, these techniques being passed down through several generations. Current surgeon culture must evolve to integrate EBM into their clinical practice. The knowledge and skills required for searching and appraising critical literature needs to be taught to enable surgeons to implement it effectively. Evidence based surgery (EBS) will encourage surgeons to apply the best up-to-date knowledge to find the most effective surgical management plan for their patients. Several methods of teaching EBS to surgical trainees have shown to be effective including workshops, small group discussions, lecture style teaching and courses involving a combination of techniques. Journal clubs have gained in popularity and provided excellent teaching environments for surgeons to learn critical appraisal. Recently EBM has been introduced into the undergraduate programme to provide young medical practitioners with a strong foundation in EBM competency, and a positive attitude towards applying EBM to clinical practice. In this review, we aim to provide an overview of the principles of EBM and the success and challenges of teaching methods to deliver EBM for the surgical field.

A Cross-Sectional Study of Medical Student Knowledge of Evidence-Based Medicine as Measured by the Fresno Test of Evidence-Based Medicine

BackgroundEvidence-based medicine (EBM) has been included in the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine (ABEM) milestones project as a required component during emergency medicine (EM) residency training. Milestone Level One states that graduating medical students must be able to “describe basic principles of EBM.” ObjectiveWe sought to identify the EBM skills of third- and fourth-year medical students. MethodsOur institution, a network with 17 different residencies, hosts U.S. osteopathic and allopathic medical students. As a part of orientation, students are required to complete an entry Fresno Test of EBM (FTEBM). Retrospectively, medical student FTEBM scores from 2011 were assessed using descriptive statistics. ResultsFour hundred seventeen FTEBM scores were analyzed. Participants represented 40 medical schools, including 17 allopathic (MD) and 23 osteopathic (DO) schools. Fifty percent of participants (n = 210) were female, and 51.6% (n = 215) were from a DO medical school. Overall mean performance for the FTEBM was 47.2%. Exploring the results by individual question were (individual EBM question topics are in parentheses): 1A (study question), 62.0%; 1B (study question), 64.4%: 2 (sources of evidence), 67.6%; 3 (study design), 57.1%; 4 (search strategies), 53.2%; 5 (relevance), 41.2%; 6 (internal validity), 43.6%; 7 (magnitude), 37.8%; 8 (two-by-two grids), 30.0%; 9 (number needed to treat), 16.9%; 10 (confidence intervals), 34.3%; 11 (diagnosis), 5.0%; and 12 (prognosis), 43.4%. ConclusionsAs measured by the FTEBM, senior medical students demonstrate understanding of about half of EBM. EM residencies can anticipate the need to instruct their residents in EBM concepts in order to meet ACGME/ABEM milestone requirements.

Good publication practices in clinical pharmacology: transparency, evidence-based medicine and the 7-D assessment.

Transparency and evidence-based medicine are cornerstones of good publication practices (GPP), and concern publishers, editors, research investigators, and reviewers alike. Methods for implementing these principles within the framework of GPP are described. The main aspects include obtaining a Manuscript Agreement Contract, a Statement on Transparency of Authorship and a Declaration of Conflicts of Interest from the authors. Assessing whether a manuscript meets the requirements of EBM is demonstrated using the “7-D assessment”. The main purpose of this tool is to established that the (1) right Design, (2) right Diagnosis, (3) right Drug molecule, (4) right Dosage, (5) right Data, (6) right Deductions, and (7) right Documentation have been implemented in order to meet the objectives of the investigation. If the findings from any one of these assessments is questionable, the compliance of the research with EBM principles will be weakened and the reviewers and editors will make recommendations to the publisher accordingly. The guidelines described will help to provide a fair and transparent process of scientific publication and foster the freedom of clinical pharmacological research.

TRAINING 3‐YEAR STUDENT ON EVIDENCE‐BASED MEDICINE

Modernization of medical education in the Republic of Kazakhstan in the light of the Bologna process envisages the need for staff training of the new formation. In this regard, the ongoing reform of medical education in Kazakhstan focuses on the quality of professional graduates training of medical schools. In 2006, a new national state standard of medical education of the Republic of Kazakhstan was worked out, where the final goals of specialist training in the public health service at diverse education stages are clearly marked. The peculiarities of SES‐2006 are: the transition to 3‐level education, a focus on competence‐orient education, availability of components for the selection and the emergence of new disciplines, including such disciplines as “Evidence‐based medicine”, “Communication skills”, “Biostatistics” “Epidemiology”. The Knowledge of the issues of evidence ‐ based medicine at the present is necessary for each clinician. Medical students in training must learn to think and work in accordance with the principles of EBM.The Purpose of training on “Basics of EBM” is the creation of knowledge bases of EM, the formation of skills that will permit to evaluate medical information critically for rational use in further practice. The objectives of the training are to acquaint students with the basic terms of EM, the main types of clinical research, usingmethods of EM database, to develop the ability.

Norwegian Physicians' Knowledge of and Opinions about Evidence-Based Medicine: Cross-Sectional Study

ObjectiveTo answer five research questions: Do Norwegian physicians know about the three important aspects of EBM? Do they use EBM methods in their clinical practice? What are their attitudes towards EBM? Has EBM in their opinion changed medical practice during the last 10 years? Do they use EBM based information sources?DesignCross sectional survey in 2006.SettingNorway.Participants966 doctors who responded to a questionnaire (70% response rate).ResultsIn total 87% of the physicians mentioned the use of randomised clinical trials as a key aspect of EBM, while 53% of them mentioned use of clinical expertise and only 19% patients' values. 40% of the respondents reported that their practice had always been evidence-based. Many respondents experienced difficulties in using EBM principles in their clinical practice because of lack of time and difficulties in searching EBM based literature. 80% agreed that EBM helps physicians towards better practice and 52% that it improves patients' health. As reasons for changes in medical practice 86% of respondents mentioned medical progress, but only 39% EBM.ConclusionsThe results of the study indicate that Norwegian physicians have a limited knowledge of the key aspects of EBM but a positive attitude towards the concept. They had limited experience in the practice of EBM and were rather indifferent to the impact of EBM on medical practice. For solving a patient problem, physicians would rather consult a colleague than searching evidence based resources such as the Cochrane Library.

Evidence-based policy-making: The implications of globally-applicable research for context-specific problem-solving in developing countries

In the past 15 or so years, the "evidence-based medicine" (EBM) framework has become increasingly institutionalized, facilitating its transfer across the globe. In the late 1990s, the basic principles of EBM began to have a marked influence in a number of non-clinical public policy arenas. Policy-makers working in these areas are now being urged to move away from developing policies according to political ideologies to a more legitimate approach based on "scientific fact," a process termed "evidence-based policy-making" (EBPM). The conceptual diffusion of EBM to non-clinical arenas has exposed epistemologically destabilizing views regarding the definition of "science," particularly as it relates to the demands of global versus national/sub-national policy-making. Using the maternal and neonatal subfield as an ethnographic case-study, this paper explores the effects of these divergences on EBPM in 5 developing countries (Bangladesh, Burkina Faso, Ghana, Malawi and Nepal). In doing so, our analysis aims to explain why EBPM has thus far had a limited impact in the area of context-specific programmatic policy-development and implementation at the national and sub-national levels. Results highlight that the political contexts in which EBPM is played out promote uniformity of methodological and policy approaches, despite the fact that disciplinary diversity is being called for repeatedly in the public health literature. Even in situations where national EBPM diverges from international priorities, national evidence-based policies are found to hold little weight in countering global policy interests, which some informants claim are themselves legitimated, rather than informed, by evidence. Informants also highlight the way interpretations of research findings are shaped by the broader political context within which donors set priorities and distribute limited resources - contexts that are driven by the need to provide generalisable research recommendations based on scientifically replicable methods. Added to this are clear rifts between senior and junior-level experts within countries that constrain national and sub-national research agendas from serving as tools for empowered knowledge production and problem-solving. We conclude by arguing for diverse forms of research that can more effectively address context-specific problems. While such diversity may render EBPM more conflict-ridden, debate is by no means an undesirable characteristic in any evolving system of knowledge, for it has the potential to foster critical insight and localized change.

The attitude of Belgian social insurance physicians towards evidence-based practice and clinical practice guidelines

BackgroundEvidence-based medicine has broadened its scope and is starting to reach insurance medicine. Although still in its initial stages, physicians in the area of insurance medicine should keep up-to-date with the evidence on various diseases in order to correctly assess disability and to give appropriate advice about health care reimbursement. In order to explore future opportunities of evidence-based medicine to improve daily insurance medicine, there is a need for qualitative studies to better understand insurance physicians' perceptions of EBM. The present study was designed to identify the attitude of insurance physicians towards evidence-based medicine and clinical practice guidelines, and to determine their ability to access, retrieve and appraise the health evidence and the barriers for applying evidence to practice.MethodsA cross-sectional survey study was carried out among all Dutch-speaking insurance physicians employed at one of the six Belgian social insurance sickness funds and at the National Institute of Disability and Health care Insurance (n = 224). Chi-square tests were used to compare nominal and ordinal variables. Student's t-tests, ANOVA, Mann-Whitney and Kruskal-Wallis were used to compare means of continuous variables for different groups.ResultsThe response rate was 48.7%. The majority of respondents were positive towards evidence-based medicine and clinical practice guidelines. Their knowledge of EBM was rather poor. Perceived barriers for applying evidence to practice were mainly time and lack of EBM skills.ConclusionAlthough the majority of physicians were positive towards EBM and welcomed more guidelines, the use of evidence and clinical practice guidelines in insurance medicine is low at present. It is in the first place important to eradicate the perceived inertia which limits the use of EBM and to further investigate the EBM principles in the context of insurance medicine. Available high-quality evidence-based resources (at the moment mainly originating from other medical fields) need to be structured in a way that is useful for insurance physicians and global access to this information needs to be ensured.

Judith A. Layzer (Ed): Natural Experiments: Ecosystem-Based Management and the Environment

Ecosystem-based approaches (EBM) to natural resource management are at the forefront of progressive science and policy discussions. This holistic approach is inherently multi-dimensional. Managers and decision-makers must orient their view to all components of an ecosystem, including human interests. Three key underlying principles of EBM include landscape-scale planning that is intentionally collaborative (trans-jurisdiction/trans-sector) with an experimental, adaptive nature. The common single sector approach attends to human activities each in isolation from one another. This approach fails to address, much less maintain, the integrity of the interactions between the management sectors. This leads to a loss of valued ecosystem goods and services and ignorance about fundamental ecological and socio-economic linkages. Through a systematic empirical analysis, this book investigates the ways, and extent to which, seven cases throughout the US employ the three principles above with a goal of understanding whether the promise of EBM theory is effective in practice. Specifically, the author seeks to understand the circumstances that facilitate innovative management practices whose policies “conserve and restore ecosystem health.” Through a “focused comparison method,” evidence of environmental improvements, such as habitat restoration and species conservation, is assessed. Informed judgments are made to determine the ways in which the three principles of EBM affect each case’s outcomes. The first two chapters are contextual in that they place the author’s research aims among scholars’ arguments for and against an EBM approach. This results in both an optimistic and pessimistic model of EBM. These models serve as a baseline from which the author systematically assesses the evidence from each case. The optimistic approach praises EBM aspirations of bringing together otherwise disparate interests to create place-based plans and policies. The intended adaptive and flexible nature of these types of collaborations are hailed as one that promotes individual and institutional learning leading to improved management systems. The pessimistic approach cautions that the inertia infiltrating existing management is stronger than the willingness to create change. In addition, this model holds that stakeholder collaboration will not necessarily lead to consensus and shared goals. Rather, representatives will unknowingly uphold the status quo, act independently, and use power struggles to maintain sectorbased interests. The next seven chapters are each devoted to a case study, all of which have been acknowledged as initiatives experimenting with implementation of EBM principles. Cases include internationally-recognized initiatives and are grouped by terrestrial examples (Austin’s Balcones Canyonlands Conservation Program, San Diego Multiple Species Program) and aquatic examples (Comprehensive Everglades Restoration Plan, California Bay Delta Program), or are studied for comparison (Arizona Sonoran Desert Conservation Plan, Florida’s Kissimmee River, California Mono Basin). Some follow a more optimistic model of EBM with unintended benefits such as the development of innovative models that provoke thinking about the social and natural interrelationships of a system. Some cases are more in-line with the pessimistic model and have unintended consequences such as the disappointing Hum Ecol (2009) 37:251–252 DOI 10.1007/s10745-009-9229-2

Knowledge and beliefs concerning evidence-based practice amongst complementary and alternative medicine health care practitioners and allied health care professionals: a questionnaire survey.

BackgroundEvidence-based practice (EBP) has become an important competency in many allied and complementary and alternative medicine (CAM) health care practitioners' professional standards of proficiency.MethodsTo compliment an EBP course for allied health care professionals and CAM practitioners, we undertook a questionnaire survey to assess learning needs. We developed a questionnaire to measure allied health care professionals and CAM practitioners' basic knowledge, skills and beliefs concerning the main principles of EBP. The questionnaires were administered to all attendees of one-day EBP workshops.ResultsDuring 2004–5 we surveyed 193 allied health care professionals and CAM practitioners who attended one-day EBP courses prior to commencement of teaching. Of the respondents 121 (62.7%) were allied health care professionals and 65 (33.7%) practitioners stated that they work in the CAM field Our survey found that the majority of the respondents had not previously attended a literature appraisal skills workshop (87.3%) or received formal training in research methods (69.9%), epidemiology (91.2%) or statistics (80.8%). Furthermore, 67.1% of practitioners specified that they felt that they had not had adequate training in EBM and they identified that they needed more training and education in the principles of EBM (86.7%). Differences in knowledge and beliefs concerning EBP amongst allied and CAM practitioners were found and length of time since qualification was also found to be an important factor in practitioner's beliefs. More CAM practitioners compared to allied health professionals accessed educational literature via the Internet (95.3% v 68.1%, p = 0.008). Whilst, practitioners with more than 11 years experience felt that original research papers were far more confusing (p = 0.02) than their less experienced colleagues.ConclusionThe results demonstrate that practitioner's learning needs do vary according to the type of profession, time since graduation and prior research experience. Our survey findings are exploratory and will benefit from further replication, however, we do believe that they warrant consideration by allied health care and CAM tutors and trainers when planning EBP teaching curricula as it is important to tailor teaching to meet the needs of specific subgroups of trainees to ensure that specific learning needs are met.

The philosophy of Evidence-based Medicine

Evidence-based Medicine is the application of the best evidence available in the care of individual patients, using mathematical estimates of probability and risk. Although elements of EBM have appeared centuries ago, the term Evidence-based Medicine has been used for 10 years only. The spread of EBM followed studies which had shown that in contemporary medicine a significant proportion of interventions, although they are considered as the standard of care, have not proven efficacy. The two principles of EBM are that evidence alone is not enough for clinical decision making and that there is a hierarchy of evidence. Evidence-based medicine can be practiced in up to five steps i.e. formulating answerable clinical questions, searching for the best available evidence, critically appraising the evidence, applying the evidence in clinical situations and evaluating one’s effectiveness and efficiency. One does not have to go through all steps in practicing EBM, e.g. there now exist the so called secondary publications which are systematic reviews or meta-analyses of all available studies on a clinical problem or journals entirely devoted in appraisal of original studies. Notwithstanding the “success” of EBM there is a strong current of criticism on subjects practical and philosophical alike. The strongest point against EBM however is that there is no evidence that practicing EBM improves patients’ outcomes. In our opinion, EBM is a very useful instrument with wide-ranging applications in the practice of medicine. However EBM is neither a new scientific field nor a paradigm shift in contemporary medicine. As an empirical approach to clinical problems, EBM does not produce scientific knowledge and therefore it should not be given more room than it deserves, neglecting basic or clinical research. “...between man and angel there is this difference, that an angel perceives the truth by simple apprehension, whereas man becomes acquainted with a simple truth by a process from manifold data” Thomas Aquinas, Summa Theologica.

Is the information about a test important? Applying the methods of evidence-based medicine to the clinical examination of swallowing

A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination’s (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine’s (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report. The study’s purpose from which data for this report are drawn was to determine the relationship among signs elicited by a CSE and aspiration on a subsequent videofluoroscopic swallowing examination (VFSE). Sensitivity, specificity; positive and negative predictive values (NPV); likelihood ratios; and post-test probabilities for a variety of signs in isolation and in combinations are reported. These data, if judiciously selected and interpreted contribute to the clinician’s knowledge about whether to follow a CSE with a VFSE and about what to expect if the VFSE is completed. Learning outcomes (1) Clinicians will learn how to use EBM principles in conjunction with clinical assessments of swallowing to enhance patient care. (2) Clinicians will learn how to identify combinations of patient signs during he CSE to predict VFSE performance.

Is the information about a test important? Applying the methods of evidence-based medicine to the clinical examination of swallowing

A hotly debated topic in oropharyngeal dysphagia is the Clinical Swallowing Examination’s (CSE) importance in clinical practice. That debate can profit from the application of evidence-based medicine’s (EBM) principles and procedures. These can guide both appropriate data collection and interpretation as will be demonstrated in the present report. The study’s purpose from which data for this report are drawn was to determine the relationship among signs elicited by a CSE and aspiration on a subsequent videofluoroscopic swallowing examination (VFSE). Sensitivity, specificity; positive and negative predictive values (NPV); likelihood ratios; and post-test probabilities for a variety of signs in isolation and in combinations are reported. These data, if judiciously selected and interpreted contribute to the clinician’s knowledge about whether to follow a CSE with a VFSE and about what to expect if the VFSE is completed. (1) Clinicians will learn how to use EBM principles in conjunction with clinical assessments of swallowing to enhance patient care. (2) Clinicians will learn how to identify combinations of patient signs during he CSE to predict VFSE performance.