Principles of evidence-based management using stage I–II melanoma as a model

Authors

  • Tsu-Yi Chuang MD, MPH,

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  • Ryan Brashear MD,

    1. From the Departments of Dermatology, Surgery-Division of Plastic and Reconstructive Surgery and Pathology and Laboratory Medicine, Indiana University School of Medicine and Dermatology Section, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
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  • Jeffrey D. Wagner MD,

    1. From the Departments of Dermatology, Surgery-Division of Plastic and Reconstructive Surgery and Pathology and Laboratory Medicine, Indiana University School of Medicine and Dermatology Section, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
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  • Evan R. Farmer MD

    1. From the Departments of Dermatology, Surgery-Division of Plastic and Reconstructive Surgery and Pathology and Laboratory Medicine, Indiana University School of Medicine and Dermatology Section, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, USA
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Tsu-Vi Chuang, MD, MPH, Department of Dermatology, UH 3240, Indiana University Medical Center, 550 N. University Blvd., Indianapolis, IN 46202–5267, USA

Abstract

Evidence-Based Medicine (EBM) is the practice of integrating best research evidence with clinical expertise and patent values. 1 The term, Evidence-Based Medicine, was named in 1992 by a group led by Gordon Guyatt at McMaster University in Canada. The practice of EBM arose from the awareness of:

  • 1the daily need for valid information pertinent to clinical practice;
  • 2the inadequacy of traditional sources, like textbooks, for such information;
  • 3the disparity between clinical enhancing skills and declining up-to-date knowledge and eventually, clinical performance; and
  • 4the inability to spend more time in finding and assimilating evidence pertinent to clinical practice.

EBM simply emphasizes three As: Access, Appraisal and Application. Access requires refining a clinical question into a searchable term and an answerable question and using search engines to track down the information. Appraisal is using epidemiological principles and methods to critically review evidence for its validity and applicability. Application is integrating the critically appraised evidence with clinical expertise and each patient's unique situation. The outcomes following such practices are then assayed. The last step involves evaluating the effectiveness and efficiency in executing the first two As and seeking ways for improvement.

In this article, we describe the concept and steps of practising EBM and utilize melanoma as an example to illustrate how we integrate the best evidence to outline the management plan for stage I-II melanoma.

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