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79-447: The Guidelines International Network ( GIN ) is an international scientific association of organisations and individuals interested and involved in development and application of evidence-based guidelines and health care information. The network supports evidence-based health care and improved health outcomes by reducing inappropriate variation throughout the world. The Network's membership consists of 115 organisations working in

158-907: A National Guideline Clearinghouse that followed the principles of evidence-based policies was created by AHRQ, the AMA, and the American Association of Health Plans (now America's Health Insurance Plans). In 1999, the National Institute for Clinical Excellence (NICE) was created in the UK. In the area of medical education, medical schools in Canada, the US, the UK, Australia, and other countries now offer programs that teach evidence-based medicine. A 2009 study of UK programs found that more than half of UK medical schools offered some training in evidence-based medicine, although

237-402: A 6-monthly periodical that provided brief summaries of the current state of evidence about important clinical questions for clinicians. By 2000, use of the term evidence-based had extended to other levels of the health care system. An example is evidence-based health services, which seek to increase the competence of health service decision makers and the practice of evidence-based medicine at

316-753: A career with the British navy. His cousin was James Lind (1736–1812) . James rose to the rank of post-captain , and was notable for his role in the Battle of Vizagapatam in the Bay of Bengal in 1804, for which he was knighted. Lind died at Gosport in Hampshire in 1794. He was buried in St Mary's Parish Churchyard in Portchester . Lind's is one of twenty-three names on the Frieze of

395-658: A definition that emphasized quantitative methods: "the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation or management of individual patients." The two original definitions highlight important differences in how evidence-based medicine is applied to populations versus individuals. When designing guidelines applied to large groups of people in settings with relatively little opportunity for modification by individual physicians, evidence-based policymaking emphasizes that good evidence should exist to document

474-431: A generation of physicians to retire or die and be replaced by physicians who were trained with more recent evidence. Physicians may also reject evidence that conflicts with their anecdotal experience or because of cognitive biases – for example, a vivid memory of a rare but shocking outcome (the availability heuristic ), such as a patient dying after refusing treatment. They may overtreat to "do something" or to address

553-567: A half litres ). As the beer had been boiled in the brewing process, it was reasonably free from bacteria and lasted for months, unlike water. In the Mediterranean , wine was also issued, often fortified with brandy . A frigate with 240 men, with stores for four months, carried more than one hundred tons of drinkable liquid. Water quality depended on its source, the condition of casks and for how long it had been kept. In normal times, sailors were not allowed to take any water away. When water

632-644: A major part of the evaluation of particular treatments. The Cochrane Collaboration is one of the best-known organisations that conducts systematic reviews. Like other producers of systematic reviews, it requires authors to provide a detailed study protocol as well as a reproducible plan of their literature search and evaluations of the evidence. After the best evidence is assessed, treatment is categorized as (1) likely to be beneficial, (2) likely to be harmful, or (3) without evidence to support either benefit or harm. A 2007 analysis of 1,016 systematic reviews from all 50 Cochrane Collaboration Review Groups found that 44% of

711-422: A number of limitations and criticisms of evidence-based medicine. Two widely cited categorization schemes for the various published critiques of EBM include the three-fold division of Straus and McAlister ("limitations universal to the practice of medicine, limitations unique to evidence-based medicine and misperceptions of evidence-based-medicine") and the five-point categorization of Cohen, Stavri and Hersh (EBM

790-472: A patient's emotional needs. They may worry about malpractice charges based on a discrepancy between what the patient expects and what the evidence recommends. They may also overtreat or provide ineffective treatments because the treatment feels biologically plausible. It is the responsibility of those developing clinical guidelines to include an implementation plan to facilitate uptake. The implementation process will include an implementation plan, analysis of

869-618: A positive impact on evidence-based knowledge, skills, attitude and behavior. As a form of e-learning, some medical school students engage in editing Misplaced Pages to increase their EBM skills, and some students construct EBM materials to develop their skills in communicating medical knowledge. James Lind Lind argued for the health benefits of better ventilation aboard naval ships, the improved cleanliness of sailors' bodies, clothing and bedding, and below-deck fumigation with sulphur and arsenic . He also proposed that fresh water could be obtained by distilling sea water . His work advanced

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948-473: A series of 28 published in JAMA between 1990 and 1997 on formal methods for designing population-level guidelines and policies. The term 'evidence-based medicine' was introduced slightly later, in the context of medical education. In the autumn of 1990, Gordon Guyatt used it in an unpublished description of a program at McMaster University for prospective or new medical students. Guyatt and others first published

1027-401: A single solution. He believed that scurvy had multiple causes which therefore required multiple remedies. The medical establishment ashore continued to believe that scurvy was a disease of putrefaction, curable by the administration of elixir of vitriol, infusions of wort and other remedies designed to 'ginger up' the system. It could not account for the effect of citrus fruits and so dismissed

1106-492: A systematic review, to consider the impact of different factors on their confidence in the results. Authors of GRADE tables assign one of four levels to evaluate the quality of evidence, on the basis of their confidence that the observed effect (a numeric value) is close to the true effect. The confidence value is based on judgments assigned in five different domains in a structured manner. The GRADE working group defines 'quality of evidence' and 'strength of recommendations' based on

1185-541: A test's or treatment's effectiveness. In the setting of individual decision-making, practitioners can be given greater latitude in how they interpret research and combine it with their clinical judgment. In 2005, Eddy offered an umbrella definition for the two branches of EBM: "Evidence-based medicine is a set of principles and methods intended to ensure that to the greatest extent possible, medical decisions, guidelines, and other types of policies are based on and consistent with good evidence of effectiveness and benefit." In

1264-464: A treatment is either not safe or not effective, it may take many years for other treatments to be adopted. There are many factors that contribute to lack of uptake or implementation of evidence-based recommendations. These include lack of awareness at the individual clinician or patient (micro) level, lack of institutional support at the organisation level (meso) level or higher at the policy (macro) level. In other cases, significant change can require

1343-526: A wide range of biases and constraints, from trials only being able to study a small set of questions amenable to randomisation and generally only being able to assess the average treatment effect of a sample, to limitations in extrapolating results to another context, among many others outlined in the study. Despite the emphasis on evidence-based medicine, unsafe or ineffective medical practices continue to be applied, because of patient demand for tests or treatments, because of failure to access information about

1422-419: Is a poor philosophic basis for medicine, defines evidence too narrowly, is not evidence-based, is limited in usefulness when applied to individual patients, or reduces the autonomy of the doctor/patient relationship). In no particular order, some published objections include: A 2018 study, "Why all randomised controlled trials produce biased results", assessed the 10 most cited RCTs and argued that trials face

1501-399: Is a tool that helps in visualizing the hierarchy of evidence in medicine, from least authoritative, like expert opinions, to most authoritative, like systematic reviews. Medicine has a long history of scientific inquiry about the prevention, diagnosis, and treatment of human disease. In the 11th century AD, Avicenna , a Persian physician and philosopher, developed an approach to EBM that

1580-444: Is an expert (however, some critics have argued that expert opinion "does not belong in the rankings of the quality of empirical evidence because it does not represent a form of empirical evidence" and continue that "expert opinion would seem to be a separate, complex type of knowledge that would not fit into hierarchies otherwise limited to empirical evidence alone."). Several organizations have developed grading systems for assessing

1659-437: Is provided by systematic review of randomized , well-blinded, placebo-controlled trials with allocation concealment and complete follow-up involving a homogeneous patient population and medical condition. In contrast, patient testimonials, case reports , and even expert opinion have little value as proof because of the placebo effect, the biases inherent in observation and reporting of cases, and difficulties in ascertaining who

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1738-403: The Bay of Biscay . Lind divided the sailors participating in his experiment into six groups, so that the effects of various treatments could be fairly compared. Lind found improvement in symptoms and signs of scurvy among the group of men treated with lemons or oranges. He published a treatise describing the results of this experiment in 1753. An early critique of statistical methods in medicine

1817-569: The London School of Hygiene and Tropical Medicine building in Keppel Street , London. Names were selected by a committee of unknown constitution who deemed them to be pioneers in public health and tropical medicine. At University of Edinburgh Medical School there is the James Lind commemorative plaque unveiled in 1953, funded by citrus growers of California and Arizona. The James Lind Alliance

1896-603: The American College of Physicians, and voluntary health organizations such as the American Heart Association, wrote many evidence-based guidelines. In 1991, Kaiser Permanente , a managed care organization in the US, began an evidence-based guidelines program. In 1991, Richard Smith wrote an editorial in the British Medical Journal and introduced the ideas of evidence-based policies in the UK. In 1993,

1975-587: The British fleets than French and Spanish arms. Since antiquity in some parts of the world, and since the 17th century in England, it had been known that citrus fruit had an antiscorbutic effect. John Woodall (1570–1643), an English military surgeon of the British East India Company recommended them but their use did not become widespread. John Fryer (1650–1733) too noted in 1698 the value of citrus fruits in curing sailors of scurvy. Although Lind

2054-582: The British navy a significant advantage over the French. In the 18th century ships took along water, cordial and milk in casks. According to the Regulations and Instructions relating to His Majesty's Service at Sea , which had been published in 1733 by the Admiralty, sailors were entitled to a gallon of weak beer daily (5/6 of a British gallon, equivalent to the modern American gallon or slightly more than three and

2133-578: The Cochrane Collaboration created a network of 13 countries to produce systematic reviews and guidelines. In 1997, the US Agency for Healthcare Research and Quality (AHRQ, then known as the Agency for Health Care Policy and Research, or AHCPR) established Evidence-based Practice Centers (EPCs) to produce evidence reports and technology assessments to support the development of guidelines. In the same year,

2212-556: The Evidence-Based Medicine Working Group at McMaster University published the methods to a broad physician audience in a series of 25 "Users' Guides to the Medical Literature" in JAMA . In 1995 Rosenberg and Donald defined individual-level, evidence-based medicine as "the process of finding, appraising, and using contemporaneous research findings as the basis for medical decisions." In 2010, Greenhalgh used

2291-701: The Navy as a surgeon's mate, serving in the Mediterranean , off the coast of West Africa and in the West Indies. By 1747 he had become surgeon of HMS  Salisbury in the Channel Fleet , and conducted his experiment on scurvy while that ship was patrolling the Bay of Biscay. Just after that patrol he left the Navy, wrote his MD thesis on venereal diseases and earned his degree from the University of Edinburgh Medical School , and

2370-399: The annual GIN Conference around the globe: 2003 Edinburgh (UK), 2004 Wellington (NZ), 2005 Lyon (FR), 2007 Toronto (CA), 2008 Helsinki (FI), 2009 Lisbon (PT), 2010 Chicago (US), 2011 Seoul (KR), 2012 Berlin (DE), 2013 San Francisco (US), 2014 Melbourne (AU), 2015 Amsterdam (NL), 2016 Philadelphia (US), 2018 Manchester (UK) and 2019 Adelaide. In 2017, GIN was one of five organising partners of

2449-617: The area of evidence-based guidelines and policies, the explicit insistence on evidence of effectiveness was introduced by the American Cancer Society in 1980. The U.S. Preventive Services Task Force (USPSTF) began issuing guidelines for preventive interventions based on evidence-based principles in 1984. In 1985, the Blue Cross Blue Shield Association applied strict evidence-based criteria for covering new technologies. Beginning in 1987, specialty societies such as

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2528-399: The basis for governmentality in health care, and consequently play a central role in the governance of contemporary health care systems. The steps for designing explicit, evidence-based guidelines were described in the late 1980s: formulate the question (population, intervention, comparison intervention, outcomes, time horizon, setting); search the literature to identify studies that inform

2607-449: The best available external clinical evidence from systematic research." The aim of EBM is to integrate the experience of the clinician, the values of the patient , and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. The EBM Pyramid

2686-563: The best available external clinical evidence from systematic research." This branch of evidence-based medicine aims to make individual decision making more structured and objective by better reflecting the evidence from research. Population-based data are applied to the care of an individual patient, while respecting the fact that practitioners have clinical expertise reflected in effective and efficient diagnosis and thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences. Between 1993 and 2000,

2765-611: The context, identifying barriers and facilitators and designing the strategies to address them. Training in evidence based medicine is offered across the continuum of medical education. Educational competencies have been created for the education of health care professionals. The Berlin questionnaire and the Fresno Test are validated instruments for assessing the effectiveness of education in evidence-based medicine. These questionnaires have been used in diverse settings. A Campbell systematic review that included 24 trials examined

2844-403: The effectiveness of e-learning in improving evidence-based health care knowledge and practice. It was found that e-learning, compared to no learning, improves evidence-based health care knowledge and skills but not attitudes and behaviour. No difference in outcomes is present when comparing e-learning with face-to-face learning. Combining e-learning and face-to-face learning (blended learning) has

2923-465: The end of the 1980s, a group at RAND showed that large proportions of procedures performed by physicians were considered inappropriate even by the standards of their own experts. David M. Eddy first began to use the term 'evidence-based' in 1987 in workshops and a manual commissioned by the Council of Medical Specialty Societies to teach formal methods for designing clinical practice guidelines. The manual

3002-510: The evidence of them as unproven and anecdotal. In the Navy however, experience had convinced many officers and surgeons that citrus juices provided the answer to scurvy, even if the reason was unknown. On the insistence of senior officers, led by Rear Admiral Alan Gardner in 1794, lemon juice was issued on board the Suffolk on a twenty-three-week, non-stop voyage to India. The daily ration of two-thirds of an ounce mixed in grog contained just about

3081-416: The evidence, or because of the rapid pace of change in the scientific evidence. For example, between 2003 and 2017, the evidence shifted on hundreds of medical practices, including whether hormone replacement therapy was safe, whether babies should be given certain vitamins, and whether antidepressant drugs are effective in people with Alzheimer's disease . Even when the evidence unequivocally shows that

3160-436: The experiment. This began after two months at sea when the ship was afflicted with scurvy. He divided twelve scorbutic sailors into six groups of two. They all received the same diet, but in addition group one was given a quart of cider daily, group two twenty-five drops of elixir of vitriol (sulfuric acid), group three six spoonfuls of vinegar , group four half a pint of seawater, group five two oranges and one lemon , and

3239-521: The extent to which it is feasible to incorporate individual-level information in decisions. Thus, evidence-based guidelines and policies may not readily "hybridise" with experience-based practices orientated towards ethical clinical judgement, and can lead to contradictions, contest, and unintended crises. The most effective "knowledge leaders" (managers and clinical leaders) use a broad range of management knowledge in their decision making, rather than just formal evidence. Evidence-based guidelines may provide

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3318-524: The field of medical guidelines and other types of healthcare guidance as well as of around 130 individual experts (March 2021). The members represent about 47 countries from all continents. The list of members is available on the GIN website Being constituted as a Scottish Guarantee Company under Company Number SC243691, the Network is recognised as a Scottish Charity under Scottish Charity Number SC034047. Based upon

3397-410: The first Global Evidence Summit. GIN Projects are developed in several working groups focussing on the following topics, amongst many others: Evidence-based medicine Evidence-based medicine ( EBM ) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with

3476-497: The following system: GRADE guideline panelists may make strong or weak recommendations on the basis of further criteria. Some of the important criteria are the balance between desirable and undesirable effects (not considering cost), the quality of the evidence, values and preferences and costs (resource utilization). Despite the differences between systems, the purposes are the same: to guide users of clinical research information on which studies are likely to be most valid. However,

3555-474: The guideline development, adaptation and implementation community. GIN's main aims are: GIN has an International Guideline Library and registry, one of the world's largest guideline libraries, containing regularly updated guidelines and publications of the GIN membership, as well as other guideline developers. The registry is open for all guideline developers to register their guidelines. As of April 2021 around 3000 documents were available. The network organises

3634-431: The individual studies still require careful critical appraisal. Evidence-based medicine attempts to express clinical benefits of tests and treatments using mathematical methods. Tools used by practitioners of evidence-based medicine include: Evidence-based medicine attempts to objectively evaluate the quality of clinical research by critically assessing techniques reported by researchers in their publications. There are

3713-537: The lack of controlled trials supporting many practices that had previously been assumed to be effective. In 1973, John Wennberg began to document wide variations in how physicians practiced. Through the 1980s, David M. Eddy described errors in clinical reasoning and gaps in evidence. In the mid-1980s, Alvin Feinstein, David Sackett and others published textbooks on clinical epidemiology , which translated epidemiological methods to physician decision-making. Toward

3792-430: The last group a spicy paste plus a drink of barley water . The treatment of group five stopped after six days when they ran out of fruit, but by that time one sailor was fit for duty while the other had almost recovered. Apart from that, only group one showed any effect from its treatment. Shortly after this experiment, Lind retired from the Navy and practised privately as a physician. In 1753, he published A treatise of

3871-417: The medical policy documents of major US private payers were informed by Cochrane systematic reviews, there was still scope to encourage the further use. Evidence-based medicine categorizes different types of clinical evidence and rates or grades them according to the strength of their freedom from the various biases that beset medical research. For example, the strongest evidence for therapeutic interventions

3950-466: The medical profession, believed that scurvy came from ill-digested and putrefying food within the body, bad water, excessive work, and living in a damp atmosphere that prevented healthful perspiration. Thus, while he recognised the benefits of citrus fruit (although he weakened the effect by switching to a boiled concentrate or "rob", in which the boiling process destroys vitamin C), he never advocated citrus juice as

4029-424: The methods and content varied considerably, and EBM teaching was restricted by lack of curriculum time, trained tutors and teaching materials. Many programs have been developed to help individual physicians gain better access to evidence. For example, UpToDate was created in the early 1990s. The Cochrane Collaboration began publishing evidence reviews in 1993. In 1995, BMJ Publishing Group launched Clinical Evidence,

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4108-503: The minimum daily intake of 10 mg vitamin C. There was no serious outbreak of scurvy. This resulted in widespread demand for lemon juice, backed by the Sick and Hurt Board whose numbers had recently been augmented by two practical naval surgeons who knew of Lind's experiments with citrus. The following year, the Admiralty accepted the Board's recommendation that lemon juice be issued routinely to

4187-682: The organizational or institutional level. The multiple tributaries of evidence-based medicine share an emphasis on the importance of incorporating evidence from formal research in medical policies and decisions. However, because they differ on the extent to which they require good evidence of effectiveness before promoting a guideline or payment policy, a distinction is sometimes made between evidence-based medicine and science-based medicine, which also takes into account factors such as prior plausibility and compatibility with established science (as when medical organizations promote controversial treatments such as acupuncture ). Differences also exist regarding

4266-424: The others to yours; I will cure them without blood-letting and sensible evacuation; but you do, as ye know ... we shall see how many Funerals both of us shall have... The first published report describing the conduct and results of a controlled clinical trial was by James Lind , a Scottish naval surgeon who conducted research on scurvy during his time aboard HMS Salisbury in the Channel Fleet , while patrolling

4345-399: The policy to evidence instead of standard-of-care practices or the beliefs of experts. The pertinent evidence must be identified, described, and analyzed. The policymakers must determine whether the policy is justified by the evidence. A rationale must be written." He discussed evidence-based policies in several other papers published in JAMA in the spring of 1990. Those papers were part of

4424-683: The practice of preventive medicine and improved nutrition . Lind was born in Edinburgh , Scotland, in 1716 into a family of merchants, then headed by his father, James Lind. He had an elder sister. He was educated at the Royal High School, Edinburgh . In 1731 he began his medical studies as an apprentice of George Langlands, a fellow of the Incorporation of Surgeons which preceded the Royal College of Surgeons of Edinburgh . In 1739, he entered

4503-467: The previous steps; implement the guideline. For the purposes of medical education and individual-level decision making, five steps of EBM in practice were described in 1992 and the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers was summarized into five steps and published in 2005. This five-step process can broadly be categorized as follows: Systematic reviews of published research studies are

4582-546: The process of finding evidence feasible and its results explicit. In 2011, an international team redesigned the Oxford CEBM Levels to make them more understandable and to take into account recent developments in evidence ranking schemes. The Oxford CEBM Levels of Evidence have been used by patients and clinicians, as well as by experts to develop clinical guidelines, such as recommendations for the optimal use of phototherapy and topical therapy in psoriasis and guidelines for

4661-403: The quality as two different concepts that are commonly confused with each other. Systematic reviews may include randomized controlled trials that have low risk of bias, or observational studies that have high risk of bias. In the case of randomized controlled trials, the quality of evidence is high but can be downgraded in five different domains. In the case of observational studies per GRADE,

4740-422: The quality of evidence starts off lower and may be upgraded in three domains in addition to being subject to downgrading. Meaning of the levels of quality of evidence as per GRADE: In guidelines and other publications, recommendation for a clinical service is classified by the balance of risk versus benefit and the level of evidence on which this information is based. The U.S. Preventive Services Task Force uses

4819-671: The quality of evidence. For example, in 1989 the U.S. Preventive Services Task Force (USPSTF) put forth the following system: Another example are the Oxford CEBM Levels of Evidence published by the Centre for Evidence-Based Medicine . First released in September 2000, the Levels of Evidence provide a way to rank evidence for claims about prognosis, diagnosis, treatment benefits, treatment harms, and screening, which most grading schemes do not address. The original CEBM Levels were Evidence-Based On Call to make

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4898-411: The question; interpret each study to determine precisely what it says about the question; if several studies address the question, synthesize their results ( meta-analysis ); summarize the evidence in evidence tables; compare the benefits, harms and costs in a balance sheet; draw a conclusion about the preferred practice; write the guideline; write the rationale for the guideline; have others review each of

4977-524: The results of the trials on wort were published. In 1762 Lind's Essay on the most effectual means of preserving the health of seamen appeared. In it he recommended growing salad—i.e. watercress (43 mg vitamin C per 100 g) —on wet blankets. This was put into practice, and in the winter of 1775 the British Army in North America was supplied with mustard and cress seeds. However Lind, like most of

5056-399: The reviews concluded that the intervention was likely to be beneficial, 7% concluded that the intervention was likely to be harmful, and 49% concluded that evidence did not support either benefit or harm. 96% recommended further research. In 2017, a study assessed the role of systematic reviews produced by Cochrane Collaboration to inform US private payers' policymaking; it showed that although

5135-481: The scurvy , that was mostly ignored. In 1758, he was appointed chief physician of the Royal Naval Hospital Haslar at Gosport . When James Cook went on his first voyage he carried wort (0.1 mg vitamin C per 100 g), sauerkraut (10–15 mg per 100 g) and a syrup, or "rob", of oranges and lemons (the juice contains 40–60 mg of vitamin C per 100 g) as antiscorbutics, but only

5214-513: The supply increase so that, at the insistence of Admiral Lord St Vincent , it began to be issued generally. Lind noticed that typhus disappeared from the top floor of his hospital, where patients were bathed and given clean clothes and bedding. However, incidence was very high on the lower floors where such measures were not in place. Lind recommended that sailors be stripped, shaved, scrubbed, and issued clean clothes and bedding regularly. Thereafter, British seamen did not suffer from typhus, giving

5293-403: The term two years later (1992) to describe a new approach to teaching the practice of medicine. In 1996, David Sackett and colleagues clarified the definition of this tributary of evidence-based medicine as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with

5372-526: The use of the BCLC staging system for diagnosing and monitoring hepatocellular carcinoma in Canada. In 2000, a system was developed by the Grading of Recommendations Assessment, Development and Evaluation ( GRADE ) working group. The GRADE system takes into account more dimensions than just the quality of medical research. It requires users who are performing an assessment of the quality of evidence, usually as part of

5451-560: The whole fleet. Another Scot, Archibald Menzies , brought citrus plants to Kealakekua Bay in Hawaii on the Vancouver Expedition , to help the Navy re-supply in the Pacific. This was not the end of scurvy in the Navy, as lemon juice was at first in such short supply that it could only be used in home waters under the direction of surgeons, rather than as a preventative. Only after 1800 did

5530-471: The work of the international AGREE Collaboration for the quality of clinical practice guidelines, an organised network for organisations and experts working in the field of evidence-based guidelines was proposed in early 2002 at the first international guideline conference in Berlin, Germany. Guideline experts called for international standardized guideline methods, and information exchange in this field. The proposal

5609-648: Was endorsed by health care agencies from all parts of the world such as AHRQ (USA), CBO (NL) German Agency for Quality in Medicine , NICE (UK), SIGN (UK), and NZGG (NZ). Against this background the Guidelines International Network GIN was founded in November 2002 in Paris with Günter Ollenschläger as founding chairman. The goal of the network is to lead, strengthen and support collaboration and work within

5688-626: Was eventually published by the American College of Physicians . Eddy first published the term 'evidence-based' in March 1990, in an article in the Journal of the American Medical Association ( JAMA ) that laid out the principles of evidence-based guidelines and population-level policies, which Eddy described as "explicitly describing the available evidence that pertains to a policy and tying

5767-602: Was granted a licence to practise in Edinburgh. Scurvy is a disease caused by a vitamin C deficiency, but in Lind's day, the concept of vitamins was unknown. Vitamin C is necessary for healthy connective tissue . In 1740 the catastrophic result of then-Commodore George Anson 's circumnavigation attracted much attention in Europe; out of 1900 men, 1400 died, most of them allegedly from scurvy. According to Lind, scurvy caused more deaths in

5846-597: Was mostly similar to current ideas and practises. The concept of a controlled clinical trial was first described in 1662 by Jan Baptist van Helmont in reference to the practice of bloodletting . Wrote Van Helmont: Let us take out of the Hospitals, out of the Camps, or from elsewhere, 200, or 500 poor People, that have fevers or Pleuritis. Let us divide them in Halfes, let us cast lots, that one halfe of them may fall to my share, and

5925-411: Was not the first to suggest citrus as a cure for scurvy, he was the first to study its effect by a systematic experiment in 1747. It was one of the first reported, controlled, clinical experiments in history, particularly because of its use of control groups . Lind thought that scurvy was due to putrefaction of the body that could be helped by acids , so he included an acidic dietary supplement in

6004-574: Was production of fresh water by distillation possible on a useful scale. Lind's final work was published in 1768; the Essay on Diseases Incidental to Europeans in Hot Climates, with the Method of Preventing their fatal Consequences. It was a work on the symptoms and treatments of tropical disease, but was not specific to naval medicine and served more as a general text for doctors and British emigrants. The Essay

6083-523: Was published in 1835, in Comtes Rendus de l’Académie des Sciences, Paris, by a man referred to as "Mr Civiale". The term 'evidence-based medicine' was introduced in 1990 by Gordon Guyatt of McMaster University . Alvan Feinstein 's publication of Clinical Judgment in 1967 focused attention on the role of clinical reasoning and identified biases that can affect it. In 1972, Archie Cochrane published Effectiveness and Efficiency , which described

6162-408: Was scarce, it was rationed and rain collected with spread sails. Fresh water was also obtained when possible en voyage , but watering places were often marshy, and in the tropics infested with malaria . In 1759, Lind discovered that steam from heated salt water was fresh. He proposed to use solar energy for the distillation of water. But only when a new type of cooking stove was introduced in 1810

6241-570: Was used as a medical text in Britain for fifty years following publication. Seven editions were printed, including two after Lind's death. Lind married Isabella Dickie and had two sons, John and James. In 1773 he was living on Princes Street in a brand-new house facing Edinburgh Castle . John FRSE (1751–1794), his elder son, studied medicine at St Andrews University and graduated in 1777, then succeeded his father as chief physician at Haslar Hospital in 1783. James (1765–1823), also embarked on

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