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Evidence-based medicine

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Evidence-based medicine

Evidence-based medicine (EBM), sometimes known within healthcare as evidence-based practice (EBP), is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. [citation needed] The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.

The EBM Pyramid is a tool that helps in visualizing the hierarchy of evidence in medicine, from least authoritative, like expert opinions, to most authoritative, like systematic reviews.

Adoption of evidence-based medicine is necessary in a human rights-based approach to public health and a precondition for accessing the right to health.

Medicine has a long history of scientific inquiry into the prevention, diagnosis, and treatment of human disease. In the 11th century AD, Avicenna, a Persian physician and philosopher, developed an approach to EBM that was mostly similar to current ideas and practises.

The concept of a controlled clinical trial was first described in 1662 by Jan Baptist van Helmont in reference to the practice of bloodletting. Wrote Van Helmont:[citation needed]

Let us take out of the Hospitals, out of the Camps, or from elsewhere, 200, or 500 poor People, that have fevers or Pleuritis. Let us divide them in Halfes, let us cast lots, that one halfe of them may fall to my share, and the others to yours; I will cure them without blood-letting and sensible evacuation; but you do, as ye know ... we shall see how many Funerals both of us shall have...

The first published report describing the conduct and results of a controlled clinical trial was by James Lind, a Scottish naval surgeon who conducted research on scurvy during his time aboard HMS Salisbury in the Channel Fleet, while patrolling the Bay of Biscay. Lind divided the sailors participating in his experiment into six groups, so that the effects of various treatments could be fairly compared. Lind found improvement in symptoms and signs of scurvy among the group of men treated with lemons or oranges. He published a treatise describing the results of this experiment in 1753.

An early critique of statistical methods in medicine was published in 1835, in Comtes Rendus de l'Académie des Sciences, Paris, by a man referred to as "Mr Civiale".

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