Sicily statement on evidence-based practice

Martin Dawes, William Summerskill, Paul Glasziou, Antonino Cartabellotta, Janet Martin, Kevork Hopayian, Franz Porzsolt, Amanda Burls, James Osborne, Second International Conference of Evidence-Based Health Care Teachers and Developers, Martin Dawes, William Summerskill, Paul Glasziou, Antonino Cartabellotta, Janet Martin, Kevork Hopayian, Franz Porzsolt, Amanda Burls, James Osborne, Second International Conference of Evidence-Based Health Care Teachers and Developers

Abstract

Background: A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC").

Discussion: Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources. Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available.

Summary: All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice'.

References

    1. Goethe JW. "Denken und Tun". Maximen und Reflexionen. 1833.
    1. Dopson S, Mant J, Hicks N. Getting research into practice: facing the issues. J Manag Med. 1994;8:4–12. doi: 10.1108/02689239410073385.
    1. Ordonez GA, Phelan PD, Olinsky A, Robertson CF. Preventable factors in hospital admissions for asthma. Arch Dis Child. 1998;78:143–147.
    1. Venturini F, Romero M, Tognoni G. Patterns of practice for acute myocardial infarction in a population from ten countries. Eur J Clin Pharmacol. 1999;54:877–886. doi: 10.1007/s002280050570.
    1. Culham E. Evidence based practice and professional credibility (editorial) Physiotherapy Theory and Practice. 1998;14:65–67.
    1. NMC Nursing & Midwifery Council (2002) Code of Professional Conduct. 2002. p. 8.
    1. Dawes MG. On the need for evidence-based general and family practice. Evidence-Based Medicine. 1996;1:68–69.
    1. Richards D, Lawrence A, Sackett DL. Bringing an evidence-base to dentistry. Community Dent Health. 1997;14:63–65.
    1. Geddes JR. On the need for evidence-based psychiatry. Evidence-Based Medicine. 1996;1:199–200.
    1. CSP Standards of Physiotherapy Practice. Chartered Society of Physiotherapy. 2000.
    1. Group EBMW. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA. 1992;268:2420–2425. doi: 10.1001/jama.268.17.2420.
    1. GIMBE
    1. Humphreys BL, McCutcheon DE. Growth patterns in the National Library of Medicine's serials collection and in Index Medicus journals, 1966-1985. Bull Med Libr Assoc. 1994;82:18–24.
    1. Arndt KA. Information excess in medicine. Overview, relevance to dermatology, and strategies for coping. Arch Dermatol. 1992;128:1249–1256. doi: 10.1001/archderm.128.9.1249.
    1. Hook O. Scientific communications. History, electronic journals and impact factors. Scand J Rehabil Med. 1999;31:3–7. doi: 10.1080/003655099444669.
    1. Wilson MP DCDKDF. Extramural programs of theNational Library of Medicine: program objectives and present status. Bull Med Libr Assoc. 1966;54:293–310.
    1. Delamothe T, Smith R. The BMJ's website scales up. BMJ. 1998;316:1109–1110.
    1. PEDro
    1. C2-SPECTR
    1. Hojat M, Nasca TJ, J E, Frsiby A, Veloski J, Gonnella J. An operational measure of physician lifelong learning:its development, components and preliminary psychometric data. Med Teach. 2003;25:433–437.
    1. Ely JW, Osheroff JA, Ebell MH, Chambliss ML, Vinson DC, Stevermer JJ, Pifer EA. Obstacles to answering doctors' questions about patient care with evidence: qualitative study. BMJ. 2002;324:710. doi: 10.1136/bmj.324.7339.710.
    1. Montgomery AA, Fahey T, Peters TJ. A factorial randomised controlled trial of decision analysis and an information video plus leaflet for newly diagnosed hypertensive patients. Br J Gen Pract. 2003;53:446–453.
    1. Walker A, Grimshaw J, Johnston M, Pitts N, Steen N, Eccles M. PRIME PRocess modelling in ImpleMEntation research: selecting a theoretical basis for interventions to change clinical practice. BMC Health Serv Res. 2003;19:1–12.
    1. Maudsley G S. 'Science', 'critical thinking' and 'competence' for Tomorrow's Doctors. A review of terms and concepts. J:Med Educ. 2000;34:53–60. doi: 10.1046/j.1365-2923.2000.00428.x.
    1. Stenmark D. "Information vs. Knowledge: The Role of intranets in Knowledge Management". IEEE Press, Hawaii, January 7-10, 2002; 2002.
    1. Guyatt G. Evidence-Based Medicine. ACP J Club. 1991;A-16:114.
    1. Oxman AD, Sackett DL, Guyatt GH. Users' guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA. 1993;270:2093–2095. doi: 10.1001/jama.270.17.2093.
    1. Guyatt GH, Rennie D. Users' guides to the medical literature [editorial] JAMA. 1993;270:2096–2097. doi: 10.1001/jama.270.17.2096.
    1. Doust JA, Del Mar CB. Why do doctors use treatments that do not work? BMJ. 2004;328:474–475. doi: 10.1136/bmj.328.7438.474.
    1. Gambrill E. Evidence-based practice: Sea change or emperor's new clothes? J Social Work Educ. 2003;39:3–23.
    1. McAlister FA, Graham I, Karr GW, Laupacis A. Evidence-based medicine and the practicing clinician. J Gen Intern Med. 1999;14:236–242. doi: 10.1046/j.1525-1497.1999.00323.x.
    1. Juni P, Egger M. Allocation concealment in clinical trials. JAMA. 2002;288:2407–8; discussion 2408-9.
    1. Cochrane-Collaboration
    1. Clinical-Evidence
    1. Evidence-Based-Medicine
    1. Haynes RB. Of studies, syntheses, synopses, and systems: the "4S" evolution of services for finding current best evidence. ACP J Club. 2001;134:A11–3.
    1. Cook DJ, Jaeschke R, Guyatt GH. Critical appraisal of therapeutic interventions in the intensive care unit: human monoclonal antibody treatment in sepsis. Journal Club of the Hamilton Regional Critical Care Group. J Intensive Care Med. 1992;7:275–282.
    1. Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based decisions [editorial] ACP J Club. 1995;123:A12–3.
    1. Rosenberg WM, Deeks J, Lusher A, Snowball R, Dooley G, Sackett D. Improving searching skills and evidence retrieval. J R Coll Physicians Lond. 1998;32:557–563.
    1. Parkes J, Hyde C, Deeks J, Milne R. Teaching critical appraisal skills in health care settings. Cochrane Database Syst Rev. 2001:CD001270.
    1. Epling J, Smueny J, Patil A, Tudiver F. Teaching evidence-based medicine skills through a residency developed guideline. Family Medicine. 2002;34:646–648.
    1. Jamtvedt G, Young JM, Kristoffersen DT, Thomson O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2003:CD000259.
    1. Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving. BMJ. 1995;310:1122–1126.
    1. Guyatt G, Meade MO, Jaeschke R, Cook DJ, Haynes B. Practitioners of evidence based care. BMJ. 2000;320:934–935. doi: 10.1136/bmj.320.7240.954.
    1. Hurd PDH. Scientific Literacy: New Minds for a Changing World. Science Education. 1998;82:407–416.
    1. GMC . Tomorrow's Doctors. London, General Medical Council; 2002.
    1. Shin JH, Haynes B, Johnston M. Effect of problem-based, self directed undergraduate education on life-long learning. CMAJ. 1993;141:969–976.
    1. Reece I, Walker S. Teaching and training in Learning. 4th. Sunderland, Business Education Publishers, Ltd.,; 2002.
    1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312:71–72.
    1. Grad R, Macaulay AC, Warner M. Teaching evidence-based medical care: description and evaluation. Fam Med. 2001;33:602–606.
    1. Dobbie AE, Schneider FD, Anderson AD, Littlefield J. What evidence supports teaching evidence-based medicine? Acad Med. 2000;75:1184–1185.
    1. BEME G. Best evidence medical education(BEME): report of meeting 3-5 December 1999, London, UK. Medical Teacher. 2000;22:242–245. doi: 10.1080/01421590050006197.
    1. Ramos KD, Schafer S, Tracz SM. Validation of the Fresno test of competence in evidence based medicine. BMJ. 2003;326:319–321. doi: 10.1136/bmj.326.7384.319.
    1. Fliegel JE, Frohna JG, Mangrulkar RS. A computer-based OSCE station to measure competence in evidence-based medicine skills in medical students. Acad Med. 2002;77:1157–1158.
    1. Green ML. Evidence-based medicine training in graduate medical education: past, present and future. J Eval Clin Pract. 2000;6:121–138. doi: 10.1046/j.1365-2753.2000.00239.x.
    1. CASP
    1. Fritsche L, Greenhalgh T, Falck-Ytter Y, Neumayer HH, Kunz R. Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine. BMJ. 2002;325:1338–1341. doi: 10.1136/bmj.325.7376.1338.
    1. Straus SE, Sackett DL. Applying evidence to the individual patient. Ann Oncol. 1999;10:29–32. doi: 10.1023/A:1008308211595.
    1. Bradley P, Humphris G. Assessing the ability of medical students to apply evidence in practice: the potential of the OSCE. Med Educ. 1999;33:815–817. doi: 10.1046/j.1365-2923.1999.00466.x.
    1. Sackett DL, Straus S, Richardson WS, Rosenberg W, Haynes B. Evidence-Based Medicine. How to Practice and Teach EBM. Edinburgh, Churchill Livingstone; 2000.
    1. Johnston JM, Leung GM, Fielding R, Tin KYK, Ho LM. The development and validation of a knowledge, attitude and behaviour questionnaire to assess undergraduate evidence-based practice teaching and learning. Med Educ. 2003;37:992–1000. doi: 10.1046/j.1365-2923.2003.01678.x.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren