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. 2013 Jul;40(4):475-81.
doi: 10.1017/s0317167100014554.

The Evidence-Based Medicine Paradigm: Where Are We 20 Years Later? Part 2


The Evidence-Based Medicine Paradigm: Where Are We 20 Years Later? Part 2

Shashi S Seshia et al. Can J Neurol Sci. .


In Part 2, we discuss the challenges of keeping up with the 'literature,' evidence-based medicine (EBM) in emerging economies and the Neurosciences, and two recent approaches to classifying evidence. We conclude by summarizing information from Parts 1 and 2 which suggest the need to critically re-appraise core elements of the EBM paradigm: (1) the hierarchical ranking of evidence, (2) randomized controlled trials or systematic reviews as the gold standard for all clinical questions or situations, (3) the statistical tests that have become integral to the 'measurements' for analyzing evidence, and (4) re-incorporating a role for evidence from basic sciences and pathophysiology. An understanding of how cognitive processes influence clinical decisions is also necessary to improve evidence-based practice. Emerging economies may have to modify the design and conduct of clinical research to their settings. Like all paradigms, EBM must keep improving with input from the grassroots to remain beneficial.

Comment in

  • Can J Neurol Sci. 2014 Jan;41(1):129
  • Evidence-based medicine 20 years on: a view from the inside.
    Agoritsas T, Guyatt GH. Agoritsas T, et al. Can J Neurol Sci. 2013 Jul;40(4):448-9. doi: 10.1017/s0317167100014499. Can J Neurol Sci. 2013. PMID: 23786723 No abstract available.
  • To the editor.
    Muckart DJ. Muckart DJ. Can J Neurol Sci. 2014 Jan;41(1):128-9. doi: 10.1017/s0317167100016437. Can J Neurol Sci. 2014. PMID: 24384354 No abstract available.
  • Response to the Letter to the Editor.
    Seshia SS, Young GB. Seshia SS, et al. Can J Neurol Sci. 2014 Jan;41(1):129. doi: 10.1017/s0317167100017479. Can J Neurol Sci. 2014. PMID: 26693536 No abstract available.

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