By Gordon Guyatt, Drummond Rennie, Maureen O. Meade, Deborah J. Cook
The best consultant to the rules and scientific purposes of evidence-based drugs.
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Additional info for A Manual for Evidence-Based Clinical Practice (3rd Edition) (Users' Guides to the Medical Literature)
To the detriment of patients who did not receive thrombolytic therapy during this period, it took a decade for the experts to catch up with the evidence. Figure 2-2 tells a perhaps even more disturbing story. This cumulative meta-analysis reveals that there was never any RCT evidence that suggested a lower mortality with prophylactic lidocaine after myocardial infarction—indeed, point estimates suggested an increase in death rate. Nevertheless, although we 31-10-2014 11:44:49 2: What Is Evidence-Based Medicine?
At the core of EBM is a care and respect for patients who will suffer if clinicians fall prey to muddled clinical reasoning and to neglect or misunderstanding of research findings. Practitioners of EBM strive for a clear and comprehensive understanding of the evidence underlying their clinical care and work with each patient to ensure that chosen courses of action are in that patient’s best interest. Practicing EBM requires clinicians to understand how uncertainty about clinical research evidence intersects with an individual patient’s predicament and preferences.
Indd 9 in the forest plots had been available to the experts, they would have grasped the benefits of thrombolytic therapy far earlier than they did and abandoned prophylactic lidocaine far earlier. Indeed, following EBM principles that limit reliance on biologic rationale and place far more emphasis on empirical evidence (see Chapter 3, Evidence-Based Medicine and the Theory of Knowledge), the experts may never have started using lidocaine. 31-10-2014 11:44:49 10 The Foundations Figure 2-2 Prophylactic Lidocaine in Acute Myocardial Infarction Relative risk (CI) Recommendations Not Yes No mentioned Cumulative Year No.