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Table of Contents
EDITORIAL
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 1-2

Generating evidence


1 Professor & HOD, Department of Medicine, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
2 Associate Professor, Department of Medicine, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India

Date of Web Publication7-Aug-2018

Correspondence Address:
J D Lakhani
Professor & HOD, Department of Medicine, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.238788

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How to cite this article:
Lakhani J D, Muley A. Generating evidence. J Integr Health Sci 2014;2:1-2

How to cite this URL:
Lakhani J D, Muley A. Generating evidence. J Integr Health Sci [serial online] 2014 [cited 2021 Nov 30];2:1-2. Available from: https://www.jihs.in/text.asp?2014/2/1/1/238788



The term Evidence based medicine (EBM) started gaining momentum in 90s, and has been accepted, revered and appreciated as a means of better care for patients in the form of evidence based healthcare. All over the world now, hospital administrators, academicians, and clinicians consider this as a high order of need for medical practice. The whole concept of EBM is based on evidence. One way by which evidence is put forth is by gathering evidence that has already been produced. EBM experts consider systematic reviews and meta-analyses as the highest level of evidence followed by Randomised controlled trials (RCTs). But, many RCTs are sponsored by pharmaceutical companies to seek approval for marketing from regulatory authorities making results questionable.

Systematic reviews and meta-analyses are tools used to churn the studies done on a similar query in the past and gather evidence for an answer. One big advantage of systematic review and meta-analysis is that it brings most of the studies done on a particular topic on one platform and gives a clear picture of all the research that has been done in the past. Sometimes it may give direction and insight for generating better evidence or motivate researchers to plan RCTs which can give a conclusive answer to the query. However, searching for all the studies published on a similar topic poses many problems; free full text might not be available or it may not be in most understood language that is English. Studies may have heterogeneity in the form of multiple variations even if they address a similar question, e.g.; the studies dealing with effect of medicine on heart failure might have used different medicines in different doses for different duration making pooling of results difficult. In such cases finding a common inference may not be easy.

Negative results may not get published as it may not be rewarding to researchers, sponsoring bodies and scientific journals. Publication bias and non-publication of negative result trial may be due to academic and non-academic reasons and lead to misleading evidence. It may result into consideration a ‘fact’ or ‘treatment guideline’ which is based on an ‘expert opinion’ rather than on evidence. One big hurdle is that the evidence that already exists might not answer all queries or may not be suitable to be applied at a local level.

To generate evidence for simple health care measures which may not have commercial interest and has subjectivity criteria for intervention as well as outcome, may be challenging. This may be because unlike surgical or drug intervention, therapies like diet therapy, counseling, physiotherapy are of long duration, outcome is gradual continuous and not one time spontaneous. Lots of effort and motivation may be required to generate evidence in such fields. Formulation of PICO based study design and choosing right comparator may be perplexing in such interventions.

Thus generation of right evidence on which EBM foundation is laid has to be given importance otherwise frustrating experience of “not getting enough and appropriate evidences” may baffle well intended healthcare therapist who wants to practice EBM. Evidence generation in areas which are important for community and rural areas, which can be adapted at primary healthcare level has become the need of the day. For this purpose, evidence needs to be generated by doing small studies at local level after identifying the local problems. This is especially important in case of community based problems as only proper evidence can bridge the gap between knowledge and practice. However, this may be time consuming, need a lot of effort and finance, enough political will, economical support and internal strength. Efforts are also needed to percolate the understanding of terminology like CI, NNT, forest plot, publication bias, and critical appraisal to every healthcare student and this makes evidence based medical education prudent.

Sumandeep Vidyapeeth has been working in this area through implementation of Evidence based education system which aims to impart the wisdom of evidence right from the beginning in all students of medical as well as paramedical streams. The institute has also taken a step forward through the programme EviGenCHIP. The programme aims to identify a problem, form a method to answer the problem and generate data from local population as basic data which can be used as evidence and can be applied directly to the community. It has been done with the help of trained faculty and students as a community based project.

However, there is a lot left to be done, there is long ways to go….to generate evidence which needs all of us to come together and integrate all health sciences for a better cause.





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