EVIDENCE-BASED MEDICINE for the management of SPINAL DISORDERS - Prof Nicandro скачать в хорошем качестве

EVIDENCE-BASED MEDICINE for the management of SPINAL DISORDERS - Prof Nicandro

EVIDENCE-BASED MEDICINE for the management of SPINAL DISORDERS How to use evidence-based medicine for the clinical practice? ABSTRACT Background: Evidence-based medicine (EBM) is a process by which the literature may be evaluated in a comprehensive and systematic fashion in order to answer clinical questions with varying levels of certainty. In short, evidence-based medicine combines a critical evaluation of the literature with physician judgment and patient values to arrive at a "best guess" solution for a particular problem. When there is high-quality medical evidence to support a particular treatment strategy, then the "best guess" is likely to actually be the best treatment strategy for that particular patient with that particular disorder. If the medical evidence is questionable, then the "best guess" may simply be a treatment strategy that truly represents a well-intentioned and informed guess. Objectives: To describe and discuss the main concepts and the use of Evidence-based medicine for the management of spinal disorders. Methods: Evidence-based medicine have been applied to many areas of the medicine. The use of EBM for spine surgery is presented at this lecture by the analyses of some papers, guidelines and studies to exemplify it’s use for the clinical practice. The main concepts, including graduation level of evidence and recommendation grades are presented according to the North American Spine Society (NASS) guidelines. Result: Three different scenarios are presented as examples of the use of EBM for management of spinal disorders: Evidence-based Medicine for a Study Project; EBM for the management of a difficult case; and EBM to assist on the solution of a complex spinal case. Conclusion: The practice of spinal surgery is under intense scrutiny from the lay press, professional press, and third-party payors. Evidence-based methodologies allow for a summary and grading of evidence available in the medical literature. Recommendations and shortcomings in the literature identified by evidence-based reviews are fertile areas for further research. Randomized controlled studies are the gold standard for medical research, however, their application to surgical patient populations are not always practical or ethical