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THE RETURN OF AMPHETAMINE-LIKE ANORECTICS: A BACKWARD STEP IN THE PRACTICE OF EVIDENCE-BASED MEDICINE IN BRAZIL
La vuelta de los anorexígenos de tipo anfetamínico: un paso atrás en la práctica de la medicina basada en la evidencia en Brasil
Paumgartten, Francisco José Roma | Fecha del documento:
2017
Titulo alternativo
A volta dos anorexígenos anfetamínicos: um retrocesso na prática da medicina baseada em evidências no BrasilLa vuelta de los anorexígenos de tipo anfetamínico: un paso atrás en la práctica de la medicina basada en la evidencia en Brasil
Afiliación
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil
Resumen en ingles
That clinical practice should always stand on the best available scientific evidence may seem obvious. Practitioners, however, often use their own clinical judgement or reasoning rather than the best available evidence to choose the therapy prescribed to their patients. Clinical judgement, the cognitive process by which physicians analyze data, derive diagnosis, decide on therapies, and evaluate the outcomes, is influenced by individual beliefs, prior experience, and education and values and, therefore, is amenable to error and biases that may lead to equivocal decisions regarding the most effective and safest treatment for the patient. In his landmark book Clinical Judgement (1967), Alvan Feinstein 1 critically appraised this process of thinking by which physicians reach a decision in clinical practice. Archibald Cochrane 2 in Effectiveness and Efficiency: Random Reflections on Health Services (1972) also described that many clinical practices and therapeutic interventions that physicians believed to be effective were in fact unsupported by randomized controlled trials (RCTs). Subsequent contributions by Sackett et al. 3 laid down the foundations of an evidence-based approach to guide decision-making in clinical practice, known as Evidence-Based Medicine (EBM), a term coined by Eddy in 1987. EBM was defined by Sackett et al. 3 (p. 71) as “(…) the conscientious, explicit and judicious use of current best evidence in making decisions about care of individual patients”, i.e., “(…) integrating the individual clinical expertise with the best available external clinical evidence from systematic research”.
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