There based on its own merit. Regardless, it should

There is a constant search for the best
evidence in an effort to prevent or cure physical, mental or social ailments
and to promote the best possible health. Evidence based medicine can be: any
data or information, whether solid or weak, obtained through experience,
observational research or experimental trials. This data or information must be
relevant and convincing to some degree either to the understanding of the case
or to the clinical decisions made about the case. The hoped-for outcome:
significantly improved quality of care. Evidence based medicine emphasizes on
ongoing research for all kinds of patient health care. This new paradigm may
confirm or reject previous acceptable practice methods or may suggest new care
methods which are more effective and efficient and less vulnerable. I feel the
main challenge today is the transfer and translation of knowledge which help
physicians to make the best clinical decisions based on the best evidence in
the minimum amount of time.

Translating existing research findings
into practice, or to use research findings to guide decision making will depend
on using what is deemed to be the best scientific evidence to obtain complete,
satisfactory and useful results and it must be evaluated, graded and used based
on its own merit. Regardless, it should be effective enough for obtaining
information on the current method for the integration of the best available
evidence with clinical experiences and patients’ preferences. Hence, the
different kinds of evidence based medicine are case control studies in which
patients who already have a specific condition are compared with people who do
not have the condition to identify factors or exposures that might be
associated with the illness.  There is a
reliance on medical records and patient recall for data collection. These types
of studies are often less reliable than randomized controlled trials and cohort
studies because showing a statistical relationship does not mean than one
factor necessarily caused the other. Cohort studies identify a group of
patients who are already taking a particular treatment or have an exposure,
follow them forward over time, and then compare their outcomes with a similar
group that has not been affected by the treatment or exposure being studied.
Cohort studies are observational and not as reliable as randomized controlled
studies, since the two groups may differ in ways other than in the variable
under study (Timmersmans, 2007). 

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Randomized controlled clinical trials (RCTs)
are carefully planned experiments that introduce a treatment or exposure to
study its effect on real patients. They include methodologies that reduce the
potential for bias (randomization and blinding) and that allow for comparison
between intervention groups and control (no intervention) groups.  A randomized controlled trial is a planned
experiment and can provide sound evidence of cause and effect.  Systematic Reviews focuses on a clinical
topic and answer a specific question. An extensive literature search is
conducted to identify studies with sound methodology. The studies are reviewed,
assessed for quality, and the results summarized according to the predetermined
criteria of the review question. Meta-analysis will thoroughly examine a number
of valid studies on a topic and mathematically combine the results using
accepted statistical methodology to report the results as if it were one large
study.  Cross-sectional studies describe
the relationship between diseases and other factors at one point in time in a
defined population. Cross sectional studies lack any information on timing of
exposure and outcome relationships and include only prevalent cases.  They are often used for comparing diagnostic
tests.  Studies that show the efficacy of
a diagnostic test are also called prospective, blind comparison to a gold
standard study (Timmermans, 2007).

Evidence based medicine is conducted using
one or some of the following measurements: questionnaires, observations,
interviews, testing, biological measurements, surveys, and existing hospital
data such as the number of falls, the number of nosocomial infections, length
of stay, cost per discharge, or other such organizational or health information
data. The type of analysis used to review the data is dependent on the design
of the study (qualitative or quantitative); the type of data being gathered;
the level of measurement (nominal, ordinal, interval, or ratio); and the types
of questions being asked. As such, epidemiology and biostatistics will gave the
health sciences reassuring definitions, quantitative information and their
interpretation. In other fields, such as psychology, psychiatry and nursing, a
desire to better understand what was ‘behind and beside the numbers’ will use
of qualitative research approach. Today, clinical reporting reflects the new
tendency to integrate both quantitative and qualitative research in our
understanding of health and disease (Strauss, et. al., 2005).

Other ‘evidence’ has also been gathered
from occurrence studies, etiological research, clinical trials, field
epidemiological intelligence and intervention, prognostic studies, risk and
disease surveillance. The identification of the best evidence from among all
these sources and the use of this evidence to make medical decisions will
depend on the type of study conducted. These search focuses on the following
questions: What method most easily diagnoses a problem? What is the most
effective treatment? What will allow the development of the most accurate
prognosis and the choice of an appropriate course of action for patient
outcomes? (Viets, 2009).

­­            In 2014, a clinical trial examined
the prevalence of post-traumatic stress disorder (PTSD) in soldiers, persons
injured in accidents, and victims of domestic violence as many studies show
that traumatic events also play a role in serious psychological illnesses such
as depression, bipolar disorder, psychosis, anxiety disorders, and alcoholism
and have found associations between traumatic events and multiple physical
illnesses, such as chronic obstructive pulmonary disease (COPD), rheumatic
diseases, cardiovascular diseases, and cancers The clinical trial study
employed a meta-analysis systematic review methodology and selectively reviewed
the literature in the PubMed database and pertinent journals, with additional
consideration of the recommendations and guidelines of medical societies from
Germany and abroad. This methodology was chosen as the best evidence available
for cognitive behavioral therapy as the effectiveness of treatment involving
cognitive processing of the traumatic experience has been demonstrated in a
number of randomized controlled trials. The primary outcome of interest was
severity of PTSD, measured continuously using a validated self-report or
clinician-rated measures. This was qualified by the mean score value (M) and
standard deviation (SD) on these measures (Frommberger, et. al., 2014).

Nonetheless, it is argued that systematic
reviews with meta-analyses cannot always be conducted with the same scientific vigor
as a RCT with pre-defined high-quality methodology, addressing an a priori
hypothesized intervention effect. Systematic review authors will often know
some of the RCTs before they have prepared their protocol for the systematic
review, and hence, the review methodology will be at least partly data driven.
Hence, a cornerstone of a high quality systematic review is the application of
transparent, rigorous, and reproducible methodology (Simblett, et. al, 2017).

Opponents of evidence
based medicine, rejects the idea of changing how they practice on the basis of
even the best studies. They variously argue that science can’t predict the
pathophysiological behavior of individual patients; that there’s uncertainty in
applying even the most carefully validated medical evidence
to individuals; that randomized controlled trials are often conducted on
patients who aren’t similar to those seen in practice; and that the results of
these trials apply to the average patient with a certain condition, not to
subgroups with particular clinical features. For supporters, evidence-based
medicine is the answer to incompetent physicians, clinicians overwhelmed by an
endless stream of research articles, lack of efficient interventions, practice
variation, cost-overruns, lingering clinical uncertainties, stale medical
education, and health care inequities (Viets, 2009).  

In
2013, a clinical trial maintained by the U. S. National Institute of Health looked
at the biological effects of domestic violence and abuse (DVA) on women’s
mental health. The purpose of the study was:

       I.         
To evaluate the profiles of the awakening
response of cortisol, the diurnal variation and the mean salivary cortisol concentration
in women with experience of DVA and in non-abused controls.

    
II.         
To estimate whether cortisol secretion is
associated with type, severity, duration and cessation of DVA.

  
III.         
To investigate whether cortisol acts as
mediator between DVA and mental health state.

  IV.         
To examine whether there is any
distinction in cortisol levels between those women exposed to both childhood
abuse and DVA and those experienced only the latter.

    V.         
To explore whether cortisol secretion
differs between women, living in a domestic violence refuge/safe house and
those still living in the community (after adjustment for confounding effects
of abuse severity and continuing contact with abuser).

The
clinical trial was for 6-month, using a control group employed an observational
study based on a convenience sample; also, a meta-analysis of studies measuring
the relationship between DVA and mental disorders. Participants were recruited
from the pool of women referred to specialized domestic violence agency SURVIVE
South Gloucestershire, UK and Bristol, UK for community outreach support or
refuge accommodation by other agencies or self-referred. Inclusion criteria for
participants were female and ages 18 years or older. Exclusion criteria included
the inability to read English, current use of steroid-based medications,
pregnancy, presence of pituitary and/or adrenal gland disorder, and symptomatic
psychotic illness. No participant was excluded on the basis of their
disability, ethnicity, religion or sexual orientation. This study consisted of
one baseline and two follow up measurements. Baseline evaluation was carried
out at the first face-to-face meeting between researcher and woman and during
the following week with a follow-up assessment at 3 and 6 months after joining
the study. Each assessment included: (1) numerous standardized
self-administered questionnaires to assess socio-demographics, mental and
physical health, (2) weight and height measurement, and (3) self-completion of
three saliva samples (Lokhmatkina et. al., 2013)

Advantages
of the study will increase understanding of the psychological mechanisms of DVA
impact on a woman’s health and explain causal pathway between abuse and mental
health consequences in female survivors. Also, it will guide researchers and
practitioners about the possibility of using cortisol as an indicator to
diagnose abuse-related health problems and assess effectiveness of medical care
for abuse survivors. Likewise, will improve understanding of symptoms associated
with abuse and mental health status, potentially leading to studies of
prognosis and more targeted management of women who have experienced DVA. The
disadvantages of the study is the participant preparedness to join the study
group and willingness to re-live the traumatic experience.

Evidence-based practice for various
disciplines and share these common elements: (1) problem-solving approach to
decision making that (2) integrates the best available scientific evidence with
the (3) best experiential evidence from healthcare providers; (4) considers
internal and external influences on practice (budget, resources, community
standards, etc.); and (5) encourages critical thinking in the careful
application of such evidence to improve the quality of healthcare facilities. I
feel its purpose is to guide practice with evidence in contrast to designing
using “traditional approaches,” and to direct practice or design
changes using a foundation of evidence.

In conclusion, research outcomes generate
new knowledge or validate existing knowledge, whereas evidence based medicine
creates a change in practice using evidence as the basis for the change. Well
evaluated treatment procedures involving the methods mentioned above have been
available for several years and can effectively help alleviate the roadblocks to
improving healthcare. Since replications of findings are needed for
interventions across diagnostics groups and health settings, the results from
these types of clinical trials could benefit from research to better understand
which specific intervention packages or components work best and for whom.