Thursday, 17 September 2015

Evidence Based Medicine : Pharmacist for Better Clinical Practice

Evidence-based medicine (EBM) is a process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients. In 1990's the term Evidence Based Medicine was introduced by "David Sackett and Gordon Guyatt". EBM includes the production of evidence through research and scientific review; production of evidence based clinical guidelines; Implementation of evidence-based, cost-effective practice through education and management; Strategical calculation of outcomes through evaluation of compliance. 

The Cochrane Library serves as the most valuable single access point with high-quality, independent evidence to inform healthcare decision-making. The various databases of Cochrane library includes: 
  1. The Cochrane Database of Systematic Reviews : 3625 reviews and 1921 protocols.
  2. The Database of Abstracts of Reviews of Effects (DARE) : 9025 systemic reviews.
  3. The Cochrane Central Register of Controlled Trials : 550,000 studies.
  4. The Health Technology Assessment Database : 7,528 health technology assessments.
  5. The National Health Service (NHS) Economic Evaluation Database : 24,451 critical appraisals.

SIGN classification of grading Evidence:

1++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias.
1+ Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias.
1– Meta-analyses, systematic reviews, or RCTs with a high risk of bias.
2++ High-quality systematic reviews of case-control or cohort studies High-quality case-control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal.
2+ Well-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal.
2– Case-control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal.
3 Non-analytic studies; for example, case reports, case series.
4 Expert opinion.

Views of Pharmacist: 

Being an active part of health care system every pharmacist strives to provide the best possible care for patients. However, it is not always possible to translate the current developments into clinical practice. Although pharmacotherapy can be beneficial in all the patients, it can also lead to drug-related problems (DRPs), including untreated indications, drug use without an indication, improper drug selection, subtherapeutic dosage, overdosage, medication error, medication nonadherence, drug interactions, adverse drug reactions, adverse drug withdrawal events, and therapeutic failure. Clinical pharmacy services have a positive impact on drug-related problems and health outcomes reducing the burden and improving the quality of life of patient through Evidence based practice.

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