Introduction / Definition
Evidence Based Medicine (EBM) is a medical procedure that
is not orientated to intuition, non-systematic individual
experiences or, in the best cases, obsolete textbooks; but
tries to make medical decisions on the base of scientific
data'.
In the last years EBM has been and more
recognized and you find it e.g. in the area of guideline
developments as well as clinical practice. The reason is,
on one hand, the fast growing amount of new evidence, which
is generated on a daily base by the medical community and
on the other hand the individual medical doctor who has
less and less own research time available. Furthermore,
the evidence based evaluation of medical literature represents
an important contribution to quality improvement and quality
assurance in the clinical practice and in health care. The
EBM based work of the Cochrane
Collaboration (CC) gives an important contribution to
the Medical Community by formulating profound scientific
answers to questions of clinical practice with a high validity
and minimal falsification (bias).
EBM focuses on the individual patient
for whom the best possible diagnosis or/and therapy is to
be chosen. Applying the concept of D.L. Sackett results
in a standard procedure: At first stands the formulation
of an answerable clinical question. The next steps are the
highly standardized search and the critical evaluation of
the retrieved evidence. After applying the evidence to the
patient the decision process has to be itself reviewed.
.
This standardized procedure is highlighted
by the example of evidence based case reports. The evidence
based case reports were first initiated in 1998 by F. Godlee
in the British Medical Journal. The objective of the case
studies is to show the treating doctor ways to sustain a
therapy decision for an individual patient on an evidence
based basis.
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Structure of an evidence based case report
- Question: How do I treat this disease best?
- Searching strategy: What are key-words of the
search, how are the search strings formulated?
- Critical evaluation of the papers found: How
reliable are these references (e.g. quality of
the studies)? What are the results?
- Therapy decision: For these patients this or
that treatment is choosen.
- Explanation and discussion: Why did I end up
with this decision and did I really follow an
evidence based strategy?
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Evidence based medicine should not only
be considered as the summing up things that are already
known. It also has an innovative aspect. Structured systematic
reviews such as the Cochrane Collaboration recoup the existing
knowledge and reveal research deficiencies. Thus, the basis
for future clinical controlled studies is set. Epidemiology
and statistics provide the methodological base in order
to carry out these studies.
Objectives
The research of the 'Division of Evidence
Based Medicine' (dEBM) at the clinic for Dermatology, Venerology
and Allergology of the Charité is led by three principles:
- Quality in methodology and implementation
- Clinical relevance
- Independence
The objective of the dEBM is the development and distribution
of EBM in dermatology, venerology and allergology. This
is supposed to be reached, on one hand through the critical
appraisal of the etiology and therapy of dermatological
diseases. On the other hand, it is reached by generating
new evidence through the planning and implementation of
epidemical and clinical studies.
The dEBM is available for other research groups and advises
them. There is a close connection to the Coordination Center
of Clinical Studies at the Charité. Within the DDG
(Deutsche Dermatologische Gesellschaft) the development
of evidence based guidelines regarding diagnosis and therapy
of dermatological diseases is supported.
Structure
The basis of the dEBM is the professorship
for 'Evidence Based Medicine in Dermatology'. This professorship
is sponsored through the ‘Stifterverband der Deutschen
Wissenschaft’.
The following areas are covered through
the dEBM:
Research:
Development and distribution of "Evidence
Based Dermatology"
- Preparation of systematic reviews
(e.g. Cochrane Reviews) for clinical relevant questions
(with meta analysis, if possible)
- Preparation of the 'Evidence Based
Case Reports'
- Methodological assistance of
the development of evidence based guidelines in dermatology
and in other specialties
Planning and implementation of epidemiological
studies
- Support and implementation of analytical and descriptive
dermatoepidemiological studies:
- Validity studies of diagnosis criteria as well
as severity scores
- Case-control-studies of risk factors of dermatological
diseases
Planning, implementation and evaluation of clinical
controlled studies
- Implementation and coordination of clinical controlled
studies in phase II-IV
- Study planning: Preparation of study protocols, CRF's,
- Implementation: Recruiting of patients, setting
up the databases, data entry
- Evaluation: Statistical evaluation, preparation
of the final reports
- Configuration of networks
- Configuration of patient database which allows quick
recruitment of study patients
Teaching:
For the students’
For Medical
Doctors and non-medical staff (e.g. study nurses)
- Workshops on EBM and the work of the
Cochrane collaboration
- Training for carrying out clinical
controlled studies after ‘Good Clinical Practice'
criteria in cooperation with the Koordinationszentrum
für Klinische Studien (Coordination Center for Clinical
Trials) of the Charité.
Thematic development
Thematically the dEBM is open for all
clinical relevant questions in the field of dermatology,
venerology and allergology. One special interest of the
dEBM is the implementation of EBM in Aesthetic Medicine.
Alliances
The dEBM cooperates closely with the
existing national and international institutions which aim
is the implementation of 'Evidence Based Medicine', clinical
controlled studies after the criteria of 'Good Clinical
Practice' and dermatoepidemiology.
Within the Charité there is a
close cooperation with the Koordinationszentrum für
Klinische Studien (Coordination Center for Clinical Trials).
Together with the DDG (Deutschen Dermatologischen
Gesellschaft) evidence based guidelines for diagnosis and
therapy of dermatological diseases are developed.
The following cooperations currently
exist:
In Berlin:
In Germany:
-
German
Cochrane Center
-
EBM-network
- EBI (Study group epidemiology, biometrics and computer
science of the DDG)
- DAE (German study group for epidemiology)
- Health insurances (private / legal)
- Other Clinical Research Organisations
- Study groups of the DDG (Deutsche Dermatologische Gesellschaft)
and
- ADF (Arbeitsgemeinschaft Dermatologischer Forschung)
In Europe:
Outside of Europe:
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