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University of Minnesota
March 15, 2013
At the University of Minnesota, health care professionals learn how to incorporate scientific evidence into their practices.
The U brings scientific data to bear on health care practices
Post-menopausal women used to be given estrogen replacement therapy (ERT) on the assumption that it would benefit them.
But no scientifically valid studies had proven it.
"When one was finally done—the Women's Health Initiative in the early 2000s—it showed that ERT raised the risk of both breast cancer and heart disease," says Hanna Bloomfield, a professor of medicine at the University of Minnesota and acting associate chief of staff for research at the VA Medical Center.
Bloomfield, along with many colleagues in the medical, nursing, and other health professions, is active in the U's push to integrate scientific evidence into health care practices. It's called evidence-based medicine (EBM) or evidence-based practice (EBP), since it also informs care decisions by nurses and other non-M.D. practitioners.
"EBM hasn't been the norm because there has been a strong and ancient tradition within medicine that a physician's clinical experience and knowledge of the patient should be paramount," Bloomfield explains. "This made sense before there was any science on which to base clinical decision-making."
Putting evidence into practice
A few ways the U promotes EBM/EBP:
•A new module for first-year medical students introduces EBM principles
• A journal club for residents and students on the Medicine Service at the VA teaches critical evaluation of medical literature
• A recent workshop helped train faculty in the U's Academic Health Center (AHC) who teach EBM/EBP
• Two School of Nursing courses have students identify and synthesize evidence that may apply clinically
"The U of M is a leader because we cover the entire EBM spectrum from researching to practicing and teaching," notes Shannon Reidt.
But not now. That's not to say, though, that scientific results are or should be the whole story.
"EBM involves integrating clinical evidence and clinical judgment, and this integration is key," says Shannon Reidt, an assistant professor in the College of Pharmacy. "It's not just applying clinical evidence to patient care like a recipe from a cookbook."
Jonathan Koffel, a librarian at the Bio-Medical Library, did much to organize the workshop (see sidebar) and helps in numerous other ways, including attending patient rounds with the Department of Neurology.
"I'm in the hospital with physicians, going room to room [seeing] patients, and I try to find evidence to help with diagnosis, treatment, and follow-up," he says.
Tales from the front
"Medical students, or our own residents, may take up an EBM project," says Shailendra Prasad, an assistant professor of family medicine and community health. "If they see a patient and conclude that they should be doing some intervention, we give them tools such as how to do an effective literature search, the different sources of medical information, and how to weigh the quality of sources."
Weighing evidence runs from evaluating articles from a Google search to answering a patient who has read a news article or an "ask your doctor" ad, Prasad says.
"We have learned that the best evidence to apply in clinical situations is evidence that has been generated with [appropriate] patient population samples," says Ruth Lindquist, a professor in the School of Nursing. For example, evidence generated by studies of men may not apply directly or completely to women. "Women have often been excluded from studies due to potential risks related to pregnancy or the fetus, or potential complexities of hormonal cycles. Likewise, ethnic and cultural representation in studies is important [in translating findings] to the broad range of patients for whom we provide care."
Renee Crichlow sees EBM as a way to evaluate evidence and guard against, among other things, treating symptoms rather than patients. She points out a case that involved a drug to correct irregular heart rhythms that often occur in people who have had heart attacks. But a study showed "that people who received one particular anti-arhythmia medication had a higher rate of mortality," says Crichlow, an assistant professor of family medicine and community health. "The disease outcome was fewer arhythmias, but the patient outcome was more deaths. This was an early case where evidence started to shift practice."
Scientific evidence is invaluable to nurses doing patient care, says Lori Rhudy, a clinical assistant professor in the School of Nursing on the U's Rochester campus.
"For example, there's a lot of evidence around bedsore prevention and other things wholly in the domain of nursing that were discovered through research, like the frequency of repositioning patients and factors like friction and shear, which play a role in the development of the condition," she says.
All these issues drive U health care professionals to actively promote EBM/EBP.
"There are a lot of initiatives in AHC to engage students in different disciplines so they start EBP with their training," Rhudy says. "We have lots of investment in EBP and a culture that supports it."