✍ Scribed by Patricia Aikins Murphy
No coin nor oath required. For personal study only.
Evidence-based care (often termed evidence-based medicine) is becoming the paradigm for clinical practice in contemporary Western health care. Based on principIes of&nicalepklemiology(l),itdemandsthateueyeffort be made to base practice on systematic and scientific ob servation, preferably the type of evidence drawn from weli-dcne randomized clinicA trials (2). Such an approach should allow an unbiased description of the risks, benefits, and efficacy of cknical interwntions. This ap-proachto&nicalcamisincre&r&beingtaughtin medical, dental, nursing, and other health professional schools. Journal articles and tex&ooks are devoted to its principles and theii application (2-5). National task forcesbasethedew&pmentofcknicalpracticeguidelinesonthispamd@n(6);arecentartic&inthisjoumal reviewedthe~Jor~selectionof screen@ tests (7). Managed cam and other organizations with an interest in t.ea\th cam delivery and costs have adopted the &andard while looking for evidence that outcomes are improved with certain approaches to care. There is even a new journal, &&fence Based Med-i&e, which made its debut in late 1996. Althoughmost&icianswouklproba~protestthat theyhaueakhqsbasedtheiicareonevidewe,theimpetus for this mclvemmttowardevklence-basedcareis often credited to Archie Cochrane, who wrote a seminal piece in 1972 on the effectiveness and effk&nq of heaIth care (8). In it, he decried the medical profession's ignoranceoftheeffectsofheaithcarepmctices.Headvacated that critical ammarks 0faUrelevantclinicaltrial resea&bedone,updatedpe&&aRy,andmadeavailabkztoprwidersandconswws ofhealthcare.Agroup of perinata1 spe&&ts responded to this chalfenge, and prodwedamasstvepieceofwc&"EffectiveCarein Pregnaq and Childbii' (9), which was revkwed in this journal in 1993 (10). lhis tome provides solid, re-swch&wdev&nceabwtthoseobstetricalinterven-&Xrsthatareeffectiveandthosethatarenot(11). 5ub seqwntty,similarcriticalreviewgroup6,calledcochrane colklborat%XlsinhonorofDr.co&rane,hauebeen formt?dannutdtheworHinordertocarythisuxxkinto otherkkkand,!zysitematicanycoKectanddissectcKnicai trialfAdenceaboutprcdceoptlons.hareCoch-dotmdd~.Vd.42.No.1,~~1~7
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