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While current initiatives in the EBHC movement may concede the existence of a middle kingdom—that is, they accept that research evidence cannot sit above history, culture, or politics but is recursively linked 1 to all 3—there remains an important paradox. As Latour argued about science in general in We have never been modern , EBHC cannot acknowledge this middle kingdom without ceasing to be modern and collapsing back into premodernism. But EBHC can never fully embrace this middle kingdom without effectively rejecting the very concept of evidence on which its central claims are based. Latour argues that while modernity is built on a myth the separability of nature and culture , it nevertheless produces benefits.

The practice of purification also leads very efficiently to many new insights smoking leads to cancer , concepts statistical significance , and natural objects DNA.

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Indeed, it is hard to underestimate the impact EBHC has had with its renewed methods of induction as means to purify clinical reality into more or less stable rules and recommendations. We contend that any new interpretation of EBHC should not seek to refute the fundamental principles of clinical epidemiology or the position of the RCT as the best study design for reducing bias in human experiments. As Contandriopoulos points out: Collective knowledge exchange and use are phenomena so deeply embeded in organizational, policy, and institutional contexts that externally valid evidence pertaining to the efficacy of specific knowledge exchange strategies is unlikely to be forthcoming.

The new EBHC recognizes that all evidence—whether derived from science on the one hand or from human culture patient preferences, opinions, insights, etc on the other—requires translation and interpretation. The danger of the dominant discourse of rationality is that by marginalising and devaluing the role of individual judgement, it undermines rather than strengthens actors' capacity to act.

Latour's framework unveils EBHC as just one of the activities practices of everyday health care. It is the practice of purification in that realm: making inferences to produce new insights and good decisions. But as a result of the focus on purification practices of early EBM, the purpose of health care itself became skewed towards aiming for objective evidence from nature at the expense of care and equity. The concept of health care as caring, loving, and nurturing has largely been lost in the process.

This was not intended.

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For Archie Cochrane, who the early EBM proponents often cited in support of their view, health care had 2 equality important dimensions: I see the NHS, rather crudely, as supplying on the one hand therapy, and on the other board and lodging and tender, loving, care. Purification and hybridization have their place, but not predominantly.

An ongoing dialogue within the movement is needed about the role, the paradox, and benefits and harms of the modernist practice of purification. Volume 23 , Issue 5. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account.

If the address matches an existing account you will receive an email with instructions to retrieve your username. Tools Request permission Export citation Add to favorites Track citation. Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Figure 1 Open in figure viewer PowerPoint. Evidence based medicine: a movement in crisis? Google Scholar.

Evidence-based medicine; climbing a mountain for a better decision-making

Wiley Online Library Google Scholar. Crossref PubMed Google Scholar. Crossref Google Scholar. Citing Literature. Figures References Related Information. Close Figure Viewer. Browse All Figures Return to Figure. Previous Figure Next Figure. Patient values and preferences, clinician expertise and the patient's clinical state and circumstances are also accounted for in the EBM model. Because the emphasis in EBM is on translating the best evidence from the research literature into clinical practice, efficient literature searching and application of formal rules of evidence in appraising research findings comprise core skills of EBM practice 1.

The goals of this tutorial are to clearly outline the theory of evidence based medicine and to explain how that theory can be put to practice in the day-to-day work of caring for patients. The cycle begins again with an assessment of the patient and the patient's care 2. The tutorial is focused primarily on the second and third steps of the Evidence Cycle: asking questions and acquiring the best evidence.

Evidence Based Medicine Guide: Introduction

In particular, it suggests specific strategies for finding evidence from primary studies, systematic reviews and meta-analyses using tools currently available in PubMed's MEDLINE interface. Such trials are unlikely to be supported by the private industry and call for a renewed interest by public funding agencies. The model is realistic instead of idealistic, and in its comprehensive consideration of complex variables may give a new input to clinical research. It may be frustrating to those who have little familiarity with the clinical process, but it is more in keeping with what the physician faces in everyday patient management.

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Structured Evidence Based Medicine-Developing a PICO

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