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Evidence-Based Medicine: Levels of Evidence and Evaluation Systems

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Difficult Decisions in Thoracic Surgery

Abstract

Evidenced-based medicine (EBM) is a philosophic approach to clinical problems introduced in the 1980s by a group of clinicians at McMaster University in Canada with an interest in clinical epidemiology. The concepts associated with EBM have been widely disseminated. While many feel EBM represents a paradigm shift,1,2 others have debated the usefulness of this approach.3

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References

  1. Guyatt G, Rennie D. User’s Guides to the Medical Literature. Essentials of Evidence-based Clinical Practice. Chicago, IL: AMA Press; 2002.

    Google Scholar 

  2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn’t. BMJ. 1996;312(7023):71–72.

    Article  PubMed  CAS  Google Scholar 

  3. Djulbegovic B, Guyatt GH, Ashcroft RE. Epistemologic inquiries in evidence-based medicine. Cancer Cont. 2009;16:158–168.

    Google Scholar 

  4. Sackett D, Richardson S, Rosenberg W, Haynes R. Evidence-based Medicine: How to Practice and Teach EBM. 1 ed. Edinburgh: Churchill Livingston; 1998.

    Google Scholar 

  5. Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA. 1992;268:240–248.

    Article  PubMed  CAS  Google Scholar 

  6. Oxman AD, Guyatt GH. The science of reviewing research. Ann NY Acad Sci. 1993;703:125–134.

    Article  PubMed  CAS  Google Scholar 

  7. Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behaviour or health care outcomes? JAMA. 1999;282:867–874.

    Article  PubMed  CAS  Google Scholar 

  8. Fingerhut A, Borie F, Dziri C. How to teach evidence-based surgery. World J Surg. 2005;29:592–595.

    Article  PubMed  Google Scholar 

  9. Krumholz H, Radford M, Wang Y, Chen J, Heiat A, Marciniak T. National use and effectiveness of ß-blockers for the treatment of elderly patients after acute myocardial infarction. JAMA. 1998;280:623–630.

    Article  PubMed  CAS  Google Scholar 

  10. Krumholz HM, Radford MJ, Ellerbeck EF, Hennen J, Meehan TP, Petrillo M, Wang Y, Jencks SF. Aspirin for secondary prevention after acute myocardial infarction in the elderly: prescribed use and outcomes. Ann Intern Med. 1996;124:292–298.

    Article  PubMed  CAS  Google Scholar 

  11. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–926.

    Article  PubMed  Google Scholar 

  12. Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med. 2000;342:1878–1886.

    Article  PubMed  CAS  Google Scholar 

  13. Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000;342:1887–1892.

    Article  PubMed  CAS  Google Scholar 

  14. Pocock SJ, Elbourne DR. Randomized trials or observational tribulations? N Engl J Med. 2000;342:1907–1909.

    Article  PubMed  CAS  Google Scholar 

  15. Ciccone AM, Meyers BF, Guthrie TJ, Davis GE, Yusen RD, Lefrak SS, Patterson GA, Cooper JD. Long-term outcome of bilateral lung volume reduction in 250 consecutive patients with emphysema. J Thorac Cardiovasc Surg. 2003;125:513–525.

    Article  PubMed  Google Scholar 

  16. Echt DS, Liebson PR, Mitchell LB, Peters RW, Obias-Manno D, Barker AH, Arensberg D, Baker A, Friedman L, Greene HL, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. N Engl J Med. 1991;324:781–788.

    Article  PubMed  CAS  Google Scholar 

  17. Ruckdeschel JC, Codish SD, Stranahan A, McKneally MF. Postoperative empyema improves survival in lung cancer. Documentation and analysis of a natural experiment. N Engl J Med. 1972;287:1013–1017.

    Article  PubMed  CAS  Google Scholar 

  18. McKneally MF, Maver C, Kausel HW. Regional immunotherapy of lung cancer with intrapleural BCG. Lancet. 1976;1(7956):377–379.

    Article  PubMed  CAS  Google Scholar 

  19. Mountain CF, Gail MH. Surgical adjuvant intrapleural BCG treatment for stage I non-small cell lung cancer. Preliminary report of the National Cancer Institute Lung Cancer Study Group. J Thorac Cardiovasc Surg. 1981;82:649–657.

    Google Scholar 

  20. Brozek JL, Akl EA, Alonso-Coello P, Lang D, Jaeschke R, Williams JW, Phillips B, Lelgemann M, Lethaby A, Bousquet J, Guyatt GH, Schünemann HJ; GRADE Working Group. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy. 2009;64:669–677.

    Article  PubMed  CAS  Google Scholar 

  21. Falck-Ytter Y, Kunz R, Guyatt GH, Schünemann HJ. How strong is the evidence? Am J Gastroenterol. 2008;103:1334–1348.

    Article  PubMed  Google Scholar 

  22. Schünemann HJ, Fretheim A, Oxman AD. Improving the use of research evidence in guideline development: 9. Grading evidence and recommendations. Health Res Policy Syst. 2006;4:21.

    Article  PubMed  Google Scholar 

  23. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henryn D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton, P, Mrukowicz J, O’Connell D, Oxman AD, Phillips P, Schünemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW Jr, Zaza S; GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490.

    Article  PubMed  Google Scholar 

  24. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendation. BMJ. 2008;336(7651):924–926.

    Article  PubMed  Google Scholar 

  25. Schünemann HJ, Best D, Vist G, Oxman AD. Letters, numbers, symbols and words: how to communicate grades of evidence and recommendations. CMAJ. 2003;169:677–680.

    PubMed  Google Scholar 

  26. Graham AJ, Gelfand G, McFadden SD, Grondin SC. Levels of evidence and grades of recommendations in general thoracic surgery. Can J Surg. 2004;47:461–465.

    PubMed  Google Scholar 

  27. Lee JS, Urschel DM, Urschel JD. Is general thoracic surgical practice evidence based? Ann Thorac Surg. 2000;70:429–431.

    Article  PubMed  CAS  Google Scholar 

  28. Guyatt GH, Oxman AD, Vist GE, Falck-Ytter Y, Schünemann HJ; GRADE Working Group. GRADE: What is “quality of evidence” and why is it important to clinicians. BMJ. 2008;336(7651):995–998.

    Article  PubMed  Google Scholar 

  29. Guyatt G, Schunëmann H, Cook D, Jaeschke R, Pauker S, Bucher H. Grades of recommendation for antithrombotic agents. Chest. 2001;119(1 suppl):3S–7S.

    Article  PubMed  CAS  Google Scholar 

  30. Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EH, Phillips B, Raskob G, Zelman Lewis S, Schünemann HJ. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians Task Force. Chest. 2006;129:174–181

    Article  PubMed  Google Scholar 

  31. Ricci S, Celani MG, Righetti E. Development of clinical guidelines: methodological and practical issues. Neurol Sci. 2006;27(suppl 3):S228–S230.

    Article  Google Scholar 

  32. Slim K. Limits of evidence-based surgery. World J Surg. 2005;29:606–609.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery Foothills Medical Centre, University of Calgary, Calgary, AB, Canada

    Sean C. Grondin & Colin Schieman

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  1. Sean C. Grondin
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  2. Colin Schieman
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Editor information

Editors and Affiliations

  1. Dept. Surgery, Mail Code 5035, University of Chicago, S. Maryland Avenue 5841, Chicago, 60637, Illinois, USA

    Mark K. Ferguson

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Grondin, S.C., Schieman, C. (2011). Evidence-Based Medicine: Levels of Evidence and Evaluation Systems. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84996-492-0_2

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  • DOI: https://doi.org/10.1007/978-1-84996-492-0_2

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  • Print ISBN: 978-1-84996-364-0

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