Evidence based medicine (EBM) was first introduced by Gordon Guyatt at McMaster University
in Canada in 1992. EBM is the integration of best research-evidence with clinical
expertise and patient values. This leads to a diagnostic and therapeutic alliance,
which optimises clinical outcome and quality of live. So, EBM is more than just scoring
the quality of the available evidence. How does it work in daily practice?
Step 1: identifying the need for information and convert this into a question, step
2: looking for the best evidence to answer this question, step 3:critical appraisal
of the available evidence, step 4:integration the critical appraisal into our clinical
practice, step 5: evaluation steps 1–4. Many of the EBM principle are generally practised
today by physicians all over the world. It is recently that insurance companies, governmental
health care organisations and patient interest groups are focussing on EBM. Their
aim is to improve quality, to rationalize health providing and to cut on costs. This
all reflects in national or local guidelines which are more and more adopted by scientific
medical organisations and healthcare providers. Looking at the evidence which is available
for IR we have to acknowledge that most evidence is of low scientific level and does
not apply to the current standards of EBM. This can often be explained historically
from the fast growing experimental-inventor nature of IR, were many new milestones
were based on the work of individuals. However most of the publications we see in
our IR journals today still never rise above this level of an anecdotal report. Proper
study design is rare and study endpoints hardly ever answer clinical questions. Many
studies have investigator and/or industry related bias. It is now time to change this
attitude in order to be taken seriously as a healthcare provider and to survive as
a serious medical subspecialty.
Lernziele:
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EBM is not very well known in vascular interventions.
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Good studies to answer important clinical questions concerning vascular interventions
are hardly available.
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Without real scientific evidence vascular interventions are at risk.
Korrespondierender Autor: Reekers JA
Academic Medical Center, Departments of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam
E-Mail: j.a.reekers@amc.uva.nl
