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John and the list, I am sorry to reply this late, but have been away and then tied up, and I don't recall seeing any answer to this thread. What is wrong with basing medical care on empirical evidence? In the late 1700's bleeding was thought to be efficacious. In 1830, Dr. Louis in France showed empirically that it was not, and it stopped being useful. We have a never ending list of therapies that "ought to be good" and seem to be good for an individual patient (take antiarrhythmics for acute MI as an example) and then when studied in populations, turn out to be junk (or in that case, killers). I think we physicians need to reevaluate our view about empiricism. Dan **************************************************************************** Dan Mayer, MD Professor of Emergency Medicine Albany Medical College 47 New Scotland Ave. Albany, NY, 12208 Ph; 518-262-6180 FAX; 518-262-5029 E-mail; [log in to unmask] **************************************************************************** >>> John Barclay <[log in to unmask]> 09/16/2004 5:21:19 PM >>> Dear James Osborne Thank you for clarifying the origin of the acronym "EBM". Are you sure it is still the same today? I would have thought "EBM" as meaning "Empirically Biased Medicine". This seems a more appropriate translation of the acronym, given the role of NICE in the UK (and also some European institutions) in providing practice guidelines and recommendations which appear to be driven more by the limitation of costs to political entities than by improving outcomes for individual patients... Sincerely. Dr John Barclay. ----- Original Message ----- From: Osborne, James To: [log in to unmask] Sent: Thursday, September 16, 2004 7:10 PM Subject: Re: evidence based medicine [MeSH] Jon The quick (but maybe not that explanatory) answer is as follows; ---------------------------- EVIDENCE-BASED-MEDICINE Scope Note The process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions. Evidence-based medicine asks questions, finds and appraises the relevant data, and harnesses that information for everyday clinical practice. Evidence-based medicine follows four steps: formulate a clear clinical question from a patient's problem; search the literature for relevant clinical articles; evaluate ( critically appraise) the evidence for its validity and usefulness; implement useful findings in clinical practice. The term "evidence based medicine" (no hyphen) was coined at McMaster Medical School in Canada in the 1980's to label this clinical learning strategy, which people at the school had been developing for over a decade. (From BMJ 1995; 310:1122). ---------------------------- This information is taken from the expansion note attached to the MESH Heading taken from the NHS-Dialog system. The MESH term was introduced in 1997. Also of interest is how the other bibliographic databases handle the term. For example, Cinahl had a term PROFESSIONAL-PRACTICE-RESEARCH-BASED used from 1997 to 2000, then replaced by the term PROFESSIONAL-PRACTICE-EVIDENCE-BASED from 2000 to 2002, when they split the terms into MEDICAL-PRACTICE-EVIDENCE-BASED and NURSING-PRACTICE-EVIDENCE-BASED. Cinahl's 'definition' of MEDICAL-PRACTICE-EVIDENCE-BASED is 'Medical practice that bases clinical decisions on research, clinical expertise, patient choices, and critical evaluation of the literature'. Whatever the bibliographic database, because we know (anectodatally?) that the practice of MESH mapping and similar can occasionally be less than perfect, that's why good searchers will complement their use with sensible text-word searching. To really answer your question, I suspect you'll need to tap a NLM librarian. James Osborne Clinical Effectiveness Coordinator United Bristol Healthcare NHS Trust Bristol -----Original Message----- From: Jon Brassey [mailto:[log in to unmask]] Sent: 16 September 2004 17:31 To: [log in to unmask] Subject: evidence based medicine [MeSH] Does anyone know the criteria that the NLM uses to assign the "evidence based medicine" MeSH term? Best wishes jon ----------------------------------------- Email provided by http://www.ntlhome.com/