Which of the following is the best definition of evidence based medicine?

Which of the following is the best definition of evidence based medicine?

A. A summary of existing data from existing clinical trials with a critical methodological review and statistical analysis of summative data
B. A type of research that compares the results of one approach to treating a disease with another approach to treating the same disease
C. Clinical decision making support tools developed by professional organizations that include expert
opinions and data from clinical trials
D. Clinical decision making supported by data, preferably from randomized controlled clinical trials
E. One physician’s clinical experience in caring for multiple patients with a specific disorder over many years

Answer:
D. (Clinical decision making supported by data, preferably from randomized controlled clinical trials)

Discussion:Evidence-based medicine (EBM) is an important cornerstone to the effective and efficient practice of internal medicine. EBM refers to the concept that clinical decisions should be supported by data with the strongest evidence gleaned from randomized controlled clinical trials. Clearly, in some situations, it is impossible or unethical to perform randomized controlled trials, and data from observational studies such as cohort or case-control studies supply important information regarding disease associations.
Professional organizations and government agencies use EBM to develop clinical practice guidelines. These guidelines combine the best available evidence from clinical and observational studies with expert opinion to develop clinical-decision support tools (option C).
The purpose of clinical guidelines is to provide a framework for diagnosis and treatment of a specific clinical problem in a cost-effective and efficient manner. When multiple clinical trials have been published, accumulated data can be summarized in a systematic review (option A).
In a systematic review, the researchers carefully scrutinize the methods of published trials for inclusion into the review and use statistical analysis to attempt to provide additional strength to clinical findings.
A new branch of research called comparative effectiveness research (option B) attempts to compare different approaches to treating disease to determine effectiveness from both a clinical and cost effectiveness standpoint. A variety of methods can be used, and systematic reviews are an important tool in comparative effectiveness research.
The weakest type of evidence is anecdotal evidence (option E), which is one individual’s clinical experience in treating a disease and can be biased by prior experiences.