4P-S2-1

EVIDENCE BASED MEDICNE �C A NEW APPROACH TO PEDIATRIC CLINICAL PRACTICE

Gui YH

Children��s Hospital of Fudan University, Shanghai, China

The phrase evidence-based medicine(EMB) was coined by a group of physicians at McMaster University in Ontario in the early 1990s. The meaning of EBM has evolved since then; its most recent definition is ��the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients��. To effectively practice evidence-based pediatrics, clinicians must be aware of the evidence in support of their clinical decisions and the strength of that evidence. Some believe this is how we have always practiced, but the wide variation in practice patterns from one physician to the next rebuts that idea. In fact, the EBM philosophy challenges much of what we learned in medical school. For example, EBM acknowledges the limitations of applying basic science research directly to the clinical situation, and EBM also places less value on "expert" opinion than in the past. However, EBM does not discount the need for clinical skills. Rather, it recognizes that both knowledge of the evidence and clinical expertise is necessary and that neither alone is sufficient for the best practice of medicine. Clearly, clinical expertise is required to decide whether the available evidence is relevant, applicable, and acceptable to a particular patient. On the other hand, clinicians who do not seek the recent evidence relevant to their patients risk using outdated tests and treatments, which result in suboptimal care and outcomes. In pediatrics, our failure to act on the available evidence has previously resulted in a delay in the use of beneficial treatments, such as antenatal steroids in preterm labor to prevent neonatal respiratory distress and avoidance of prone sleeping to minimize the risk of sudden infant death syndrome. Applying evidence to the care of patients represents the final step of a four-step process: creating evidence, summarizing evidence, disseminating evidence, and implementing evidence.