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Evidence Based Medicine
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Medicine

See drugs, medication, and pharmacology for substances that treat patients. This article is about medical practice.

Medicine is a branch of health science concerned with restoring and maintaining health and wellness. Broadly, it is the practical science of preventing and curing diseases. However, medicine often refers more specifically to matters dealt with by physicians and surgeons.

Medicine is both an area of knowledge (a science), and the application of that knowledge (the medical profession). The various specialized branches of the science of medicine correspond to equally specialized medical professions dealing with particular organs or diseases. The science of medicine is the body of knowledge about body systems and diseases, while the profession of medicine refers to the social structure of the group of people formally trained to apply that knowledge to treat disease.

There are traditional and schools of healing which are usually not considered to be part of (Western) medicine in a strict sense (see health science for an overview). The most highly developed systems of medicine outside of the Western or Hippocratic tradition are the Ayurvedic school (of India) and traditional Chinese medicine. The remainder of this article focuses on modern (Western) medicine.

Table of contents
1 History of medicine
2 Medical sciences and health professions
3 Interdisciplinary medical fields
4 Settings where medical care is delivered
5 Teaching of medicine
6 Legal restrictions
7 Criticism
8 See also
9 External links

History of medicine

See the main articles History of medicine and Timeline of medicine and medical technology

Medicine as it is practiced now is rooted in various traditions, but developed mainly in the late 18th and early 19th century in Germany (Rudolf Virchow) and France (Jean-Martin Charcot and others). The new, "scientific" medicine replaced more traditional views based on the "Four humours". The development of clinical medicine shifted to the United Kingdom and the USA during the early 1900s (Sir William Osler, Harvey Cushing).

Evidence-based medicine is the recent movement to link the practice and the science of medicine more closely through the use of the scientific method and modern information science.

Genomics is already having a large influence on medical practice, as most monogenic genetic disorders have now been linked to causative genes, and molecular biological techniques are influencing medical decision-making.

Medical sciences and health professions

The delivery of modern health care depends, not just on medical practitioners, but on an expanding group of highly trained professionals coming together as an interdisciplinary team. A full list is given on the health profession page. Some examples include: nurses, laboratory scientists, pharmacists, physiotherapists, speech therapists, occupational therapists, dieteticians and bioengineers.

The scope and sciences underpinning human medicine overlap many other fields. Dentistry and psychology, while separate disciplines from medicine, are sometimes also considered medical fields. Physician assistants, nurse practitioners and midwives treat patients and prescribe medication in many legal jurisdictions. Veterinary medicine applies similar techniques to the care of animals.

Medical doctors have many specializations and subspecializations which are listed below.

Basic, supplementary, and related sciences

  • Anatomy is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology are concerned with microscopic structures.
  • Biochemistry is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
  • Bioethics is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology.
  • Biostatistics is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental to epidemiology and evidence-based medicine.
  • Cytology is the microscopic study of individual cells.
  • Embryology is the study of the early development of organisms.
  • Epidemiology is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
  • Genetics is the study of genes, and their role in biological inheritance.
  • Histology is the study of the structures of biological tissues by light microscopy, electron microscopy and histochemistry.
  • Immunology is the study of the immune system, which includes the innate and adaptive immune system in human, for example.
  • Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
  • Neuroscience is a comprehensive term for those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain.
  • Pathology is the study of disease - the causes, course, progression and resolution thereof.
  • Pharmacology is the study of drugs and their actions.
  • Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
  • Toxicology is the study of hazardous effects of drugs and poisons.

Diagnostic and imaging specialties

Disciplines of clinical medicine

  • Anesthesiology (AE), Anaesthesia (BE), is the clinical discipline concerned with providing anesthesia. Pain medicine is often practiced by specialised anesthesiologists.
  • Dermatology is concerned with the skin and its diseases.
  • Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
  • General practice or family medicine or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems. Family doctors are usually able to treat over 90% of all complaints without referring to specialists.
  • Intensive care medicine is concerned with the therapy of patients with serious and life-threatening disease or injury. Intensive care medicine employs invasive diagnostic techniques and (temporary) replacement of organ functions by technical means.
  • Internal medicine is concerned with diseases of inner organs and systemic dieseases of adults, i.e. such that affect the body as a whole. There are several subdisciplines of internal medicine:
    • Cardiology is concerned with the heart and cardiovascular system and their diseases.
    • Clinical pharmacology is concerned with how systems of therapeutics interact with patients.
    • Gastroenterology is concerned with the organs of digestion.
    • Endocrinology is concerned with the endocrine system, i.e. endocrine glands and hormones.
    • Hematology (or haematology) is concerned with the blood and its diseases.
    • Infectious diseases is concerned with the study, diagnosis and treatment of diseases caused by biological agents.
    • Nephrology is concerned with diseases of the kidneys.
    • Oncology is devoted to the study, diagnosis and treatment of cancer and other malignant diseases.
    • Pulmonology (or chest medicine, respiratory medicine or lung medicine) is concerned with diseases of the lungs and the respiratory system.
    • Rheumatology is devoted to the diagnosis and treatment of inflammatory diseases of the joints and other organ systems.
  • Neurology is concerned with the diagnosis and treatment of nervous system diseases.
  • Obstetrics and gynecology are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine is generally practiced by gynecological specialists.
  • Palliative care is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal disease (cancer, heart failure).
  • Pediatrics (or paediatrics) is devoted to the care of children, and adolescents. Like internal medicine, there are many pediatric supspecialities for specific age ranges, organ systems, disease classes and sites of care delivery. Most subspecialities of adult medicine have a pediatric equivalent such as pediatric cardiology, pediatric endocrinology, pediatric gastroenterology, pediatric hematology, and pediatric oncology.
  • Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital abnormality.
  • Preventive medicine
  • Psychiatry is a branch of medicine that studies and treats mental disorders. Related non-medical fields are psychotherapy and clinical psychology.
  • Radiation therapy is concerned with the therapeutic use of ionizing radiation and high energy elementary particle beams in patient treatment.
  • Surgical specialties - there are many medical disciplines that employ operative treatment. Some of these are highly specialized and are often not considered subdisciplines of surgery, although their naming might suggest so.
    • General surgery is the specialty of surgery of the skin, locomotor system, and abdominal organs. In the past, it was deemed the pre-requisite training prior to progression to other sub-specialty training, but lately has evolved into its own sub-specialty.
    • Cardiovascular surgery is the surgical specialty that is concerned with the heart and major blood vessels of the chest.
    • Neurosurgery is concerned with the operative treatment of diseases of the nervous system.
    • Oromaxillofacial surgery (technically a subspeciality of dentistry)
    • Ophthalmology deals with the diseases of the eye and their treatment.
    • Orthopedic surgery, surgery of the locomotor system, is generally practiced together with trauma surgery and/or traumatology.
    • Otolaryngology (or otorhinolaryngology or ENT/ear-nose-throat) is concerned with treatment of ear, nose and throat disorders.
    • Pediatric surgery
    • Plastic surgery includes aesthetic surgery (operations that are done for other than medical purposes) as well as reconstructive surgery (operations to restore function and/or appearance after traumatic or operative mutilation).
    • Surgical Oncology is concerned with ablative and palliative surgical approaches to cancer treatment
    • Urology focuses on the urinary tracts of males and females, and on the male reproductive system. It is often practiced together with andrology ("men's health").
    • Vascular surgery is surgery of the blood vessels, usually outside of the chest.

Interdisciplinary medical fields

Interdisciplinary sub-specialties of medicine are:

Settings where medical care is delivered

See also clinic,
hospital, and hospice

Medicine is a diverse field and the provision of medical care is therefore provided in a variety of locations. In addition to inpatient hospital settings, medical services are often provided in locations such as emergency departements, endoscopy departments, outpatients department, operating theaters, and birth suites. Modern medical care also depends on information still delivered in many health care settings on paper records, but with increasing frequency by electronic means.

Teaching of medicine

See also the main articles Medical doctor (BE) and Physician (AE)

Medical training is involves several years of university study followed by several more years of residential practice at a hospital. Entry to a medical degree in some countries (such as the United States) requires the completion of another degree first, while in other countries (such as the Source | Copyright


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Evidence-Based Medicine
Collection of resources and techniques by the University of Hertfordshire.
http://www.herts.ac.uk/lis/subjects/health/ebm.htm

CEBM - Centre for Evidence Based Medicine
Information, resources and techniques composed by CEBM of Warneford Hospital, Headington, Oxford.
http://www.cebm.net/

The Unit for Evidence-Based Practice and Policy
Compilation of resources, techniques and links put together by the University College London.
http://www.ucl.ac.uk/openlearning/uebpp/uebpp.htm

TripDatabase
Searchable medical database with emphasis on evidence based medicine, including Cochrane and Bandolier reviews, clinical guidelines, peer reviewed journals, and patient information.
http://www.tripdatabase.com/

Evidence-based Medicine Resource Center
Provides references, bibliographies, tutorials, glossaries, online databases, and practice tools in evidence-based medicine, from the New York Academy of Medicine.
http://www.ebmny.org/

BestBETs
Designed to provide rapid evidence-based answers to real-life clinical questions, using a systematic literature review. Emergency medicine focus, from Emergency Department of Manchester Royal Infirmary.
http://www.bestbets.org/

Evidence Based Medicine Resources & Links
Up-to-date and extensive collection of resources in EBM (Evidence-based Medicine), from i-medicine.info, compiled by Stuart Bennett and Dr. Michael Hughes.
http://www.miart.co.uk/i-medicine.info/evidencebasedmed.asp

PrimeAnswers: Best Evidence at the Point of Care
Knowledge base of critically appraised topics (CATs) to assist primary care providers in using the best available evidence for patient management. From University of Washington.
http://www.primeanswers.org/primeanswers/

NHMRC Clinical Practice Guidelines
Large collection of guidelines of high methodological quality for both healthcare professionals, especially the general practitioner, and consumers, with some documents on EBM practice and methods. From National Health and Medical Research Council (NHMRC), Australia.
http://www.health.gov.au/nhmrc/publications/cphome.htm#top

Scottish Intercollegiate Guidelines Network (SIGN)
High quality evidence-based practice guidelines aimed at primary care physicians.
http://www.show.scot.nhs.uk/sign/index.html

Centre for Clinical Effectiveness (CCE)
Repository of almost 200 evidence-based critical appraisals of original articles and systematic reviews, of high methodological quality and targeted to healthcare providers. With a free (pdf) download of Work Book 2004 on conducting evidence-based research. From Monash University, Australia.
http://www.med.monash.edu.au/healthservices/cce/

Clinical Evidence
A international standard, compiles best available evidence, based on systematic reviews and randomized clinical trials (RCTs), to answer clinical questions for some 200 medical conditions. Aimed at healthcare professionals, by subscription (some free samples), from British Medical Journal (BMJ).
http://www.clinicalevidence.com/ceweb/conditions/index.jsp

HSTAT: Health Services/Technology Assessment Text
Large database of full-text evidence-based clinical practice guidelines, technology assessments and health information (produced mainly by the AHRQ, NIH and AHCPR agencies). Searchable by the Search HSTAT tool, from NLM National Library of Medicine).
http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat

ICSI Healthcare Guidelines
Large collection of evidence-graded practical guidelines with online summaries, full text as pdf. From Minnesota-based Institute for Clinical Systems Integration (ICSI).
http://www.icsi.org/knowledge/browse_bydate.asp?catID=29

DARE (Database of Abstracts of Reviews of Effects)
DARE, which is one of the databases included within the Cochrane Library, provides summaries of systematic reviews which meet the strictest quality criteria of evidence-based medicine, along with critical commentaries on the quality of the reviews. Updated monthly, the online version of DARE contains more information than available in the Cochrane Library. From the Centre for Reviews and Dissemination (CRD), University of York.
http://www.york.ac.uk/inst/crd/darehp.htm

NeLH: Hitting the Headlines
Assesses the reliability and quality of health stories reported in the news media and of the underlying research. A project of NHS Centre for Reviews and Dissemination (CRD) at the University of York, which also produces the DARE database, and commissioned by NeLH (National electronic Library for Health).
http://www.nelh.nhs.uk/hth/archive.asp

GAC Clinical Practice Guidelines
The Guidelines Advisory Committee (GAC) provides highly rigorous systematic critical appraisals of clinical practice guidelines using evidence-based methodology (about 60 are currently recommended). GAC is a joint body of the Ontario Medical Association and the Ontario Ministry of Health and Long-Term Care.
http://www.gacguidelines.ca/

HTA: Health Technology Assessment
Evidence-based systematic assessments of health technology, including interventions, drugs and methods, with over 200 documents plus executive summaries. A program of NHS (National Health Service), based at the University of Southampton.
http://www.hta.nhsweb.nhs.uk/

PEBC: Program in Evidence-based Care
Publishes evidence-based systematic reviews in cancer care and research, with evidence summaries (systematic overviews of best evidence available on the clinical topic ), for both healthcare providers and the public. High methodological quality, based at McMaster University (Canada).
http://www.cancercare.on.ca/access_PEBC.htm

EBOC: Evidence-Based On-Call
Collection of evidence-based critical appraisals and clinical guidelines. High methodological quality, from the Oxford Centre for Evidence-based Medicine.
http://www.eboncall.org/

CFP: Canadian Family Practice
Monthly publication, with a high-quality critical appraisal section in each issue on family medicine (internal medicine, psychiatry, obstetrics, mental health). From the College of Family Physicians of Canada.
http://www.cfpc.ca/cfp

CAHTA Health Technology Assessment Reports
Evidence-based practice guidelines and systematic reviews, from the Catalan Agency for Health Technology Assessment and Research (CAHTA. In English, Spanish and Catalan.
http://www.aatrm.net/cgi-bin/frame.pl/ang/pu.html

Just the Berries
Large collection of evidence-based commentaries and reviews of family practice topics by clinical experts. "The berries" = the critical points of a given topic. From St. Martha's Regional Hospital, Antigonish, Nova Scotia.
http://www.theberries.ns.ca/

Attract
A database of categorized clinical questions, with responses using evidence-based techniques, based in Gwent (South Wales) UK.
http://www.attract.wales.nhs.uk/

Bandolier Home Page
Journal on evidence-based health care with online edition.
http://www.jr2.ox.ac.uk/bandolier/

Effective Health Care bulletins
A bi-monthly bulletin which examines the effectiveness of a variety of health care interventions. Based on systematic review. Full text available online.
http://www.york.ac.uk/inst/crd/ehcb.htm

Effectiveness Matters
A bulletin providing updates on the effectiveness of health interventions. Subscribe to the paper version(free) or view the full text published articles online.
http://www.york.ac.uk/inst/crd/em.htm

Health Evidence Bulletins - Wales
Collection of evidence based information on prevention, diagnosis and treatment of a number of common serious health problems.
http://hebw.uwcm.ac.uk/

Netting The Evidence
A ScHARR (School of Health and Related Research) introduction to Evidence Based Practice on the internet. Support and access to helpful organisations and useful learning resources, such as an evidence-based virtual library, software and journals.
http://www.sheffield.ac.uk/~scharr/ir/netting/

Cochrane Collaboration
Preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care. General information, help for newcomers and guidelines, manuals and software.
http://www.cochrane.org/

Update Software
Electronic publishing and software development in health care, with the emphasis on Evidence Based Medicine and Cochrane productions.
http://www.update-software.com/

The Cochrane Library
Online version of this big and current collection of reviews and meta-analyses in Healthcare. The Cochrane Library is available on a subscription basis.
http://www.update-software.com/cochrane/

UNC Critically Appraised Topics
University of North Carolina Medical School assembled this collection.
http://www.med.unc.edu/medicine/edursrc/!catlist.htm

Health Information Research Unit - Evidence-Based Health Informatics
HIRU at McMaster University conducts research in the field of health information science and is dedicated to the generation of new knowledge about the nature of health and clinical information problems, the development of new information resources to support evidence-based health care, and the evaluation of various innovations in overcoming health care information problems.
http://hiru.mcmaster.ca/

InfoPOEMs
Delivers daily Patient-Oriented Evidence that Matters (DailyPOEMs) by email and produces the InfoRetriever database system of filtered, synopsized, evidence-based information next to a regular print newsletter "Evidence-Based Practice".
http://www.infopoems.com/

Golden Hour - Medical Information center
Israel based tool for Evidence Based Medicine information retrieval. Free medical databases; medical software; consulting services.
http://www.goldenhour.co.il/

ACP Journal Club
Evidence Based Medicine for better patient care from the American College of Physicians. Limited access. Members of the ACP and subscribers have full access.
http://www.acpjc.org/

Evidence-Based Medicine Group of The Scottish Intensive Care Society
An evidence-based resource for critical care.
http://www.sicsebm.org.uk/

Evidencewatch
Portal with links to evidence-based resources in current medicine and complimentary and alternative medicine therapies, some original material in the form of commentaries. Compiled by Constantine Kaniklidis, medical researcher.
http://www.evidencewatch.com/

Informed Health Online
Updated evidence-based health information for consumers and clinicians, as well as education about health research and evidence.
http://www.informedhealthonline.org/

Critical Appraisal Skills Programme
Evidence-based approach in health and social care. CASP aims to enable individuals to develop the skills to find and make sense of research evidence, helping them to put knowledge into practice.
http://www.phru.nhs.uk/~casp/casp.htm

Dr Cave's Black Book
Written by a General Practitioner with evidence based information covering a number of common and less common problems with links to original research whenever possible.
http://black.book.users.btopenworld.com/

Therapeutics Initiative: Evidence Based Drug Therapy
Provides up-to-date, evidence based, practical information and clinical recommendations on drug therapy, in the form of a bi-monthly Therapeutics Letter, from the University of British Columbia.
http://www.ti.ubc.ca/

New Zealand Guidelines Group
Dedicated to New Zealand and international evidence-based best practice initiatives, publishes respected guidelines and the bi-monthly New Zealand Evidence-based Health Care Bulletin.
http://www.nzgg.org.nz/

Evidence-Based Medicine (EBM Online)
Bi-monthly publication in which practicing clinicians assess the clinical relevance, quality and validity of the best studies from wide range of international medical journals. From BMJ (British Medical Journal).
http://ebm.bmjjournals.com/

EPC Evidence Reports
Evidence-based practice reports, from the Evidence-based Practice Center of the U.S.-based AHRQ (Agency for Healthcare Research and Quality).
http://www.ahcpr.gov/clinic/epcindex.htm

National Guideline Clearinghouse
Comprehensive database of evidence-based clinical practice guidelines, with both full-text and structured abstracts, unique guideline syntheses, PDA downloads, and a guidelines comparison tool.
http://www.guideline.gov/



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