Применение теории доказательств в медицине
Evidence based medicine (EBM) is a bridge between the science and the medical practice. Today there is a range of terms in use, and there is a discussion on their application. IN this text authors discuss the essense of the EBM, specifically - the process of proving the statement.
The development of the rational medicine, based on scientific evidence (evidence based medicine, EBM) in the late 21 century lead to the opening of the Pandora box of doubt in the evidence base of medicine. Paradoxically part of the specialists and the public, who are inconvenient with the critical assessment of the evidence, start to criticize the EBM for the corrupted evidence base. In the real world the only way out from the situation with the weak evidence base is the work to support the free access to the research evidence and hard work to improve the quality of evidence
Objective — to make a systematic search and an analysis of evidence for the long-term population-based efficiency of screenings and other measures implemented in the framework of Stage 1 screening during periodical health check in the Russian Federation according to the Order №36ан dated 2015. Material and methods. A systematic search was carried out independently by two authors in four databases: Scientific Electronic Library, Cochrane Library, Medline/PubMed, and USPSTF. Systematic reviews are an investigated publications type. The criteria for the efficacy of screening were overall and specific mortality and disability. The methodological quality of systematic reviews was assessed by two authors by the procedure using the international AMSTAR questionnaire. Results. Only a fecal occult blood test and abdominal aorta ultrasonography have a scientific justification as screening methods in certain age and gender populations by the criterion for reducing the specific mortality, while the methodological quality of systematic reviews is high and medium/high. The efficiency of mammography in women has not been proven in high methodological quality studies.
In the internal medicine wide spectrum the gastroenterology is one of the chapters, less enlightened by the scientific evidence. It does not mean that the practice of the grasntroenterology may ot be improved by the systematic use of the approaches of the evidence based medicine
Institutions affect investment decisions, including investments in human capital. Hence institutions are relevant for the allocation of talent. Good market-supporting institutions attract talent to productive value-creating activities, whereas poor ones raise the appeal of rent-seeking. We propose a theoretical model that predicts that more talented individuals are particularly sensitive in their career choices to the quality of institutions, and test these predictions on a sample of around 95 countries of the world. We find a strong positive association between the quality of institutions and graduation of college and university students in science, and an even stronger negative correlation with graduation in law. Our findings are robust to various specifications of empirical models, including smaller samples of former colonies and transition countries. The quality of human capital makes the distinction between educational choices under strong and weak institutions particularly sharp. We show that the allocation of talent is an important link between institutions and growth.