Working group for Evidence-Based Medicine in dermatology

Evidence-based medicine (EBM) is a medicine that is not based on intuition, unsystematic individual experience or, at best, outdated textbooks, but tries to make medical decisions based on scientific evidence.

EBM has become increasingly important in recent years and is being used in both guideline development and clinical practice. On the one hand, this is due to the ever-increasing volume of results from medical research, which can no longer be overcome in the tight reading time of the individual. On the other hand, the evidence-based assessment of medical literature is an important contribution to quality improvement and quality assurance in clinical practice and in health care. The work of the Cochrane Collaboration (CC) in the context of EBM is an important contribution to obtaining sound scientific answers to questions of clinical practice with high validity or minimal bias. The center of evidence-based medicine is the individual patient for whom the best possible diagnosis or therapy is to be selected. Building on the concept of D.L. Sackett follows a standardized approach: first and foremost is the formulation of an answerable clinical question, the further steps indicate the largely standardized process of decision-making. The decision-making is based on the critical evaluation of the found literature, which mostly uses the resources of the Cochrane Collaboration. At the end the decision made is reviewed.

This standardized approach can be illustrated by the evidence-based case reports. Evidence-based case reports were first initiated by F. Godlee in 1998 in the British Medical Journal. The aim of these reports is to show the attending physician ways to, for example, base a therapy decision on an individual patient on an evidence-based basis.

Structure of an evidence-based case report

• Question: How do I best treat this condition?
• Search strategy: On which basis can I make the decision?
• Critical evaluation of the works found: How good are these basics (for example, the quality of the studies)?
• Therapy decision: I choose this treatment for this patient.
• Rationale and discussion: Why did I make that decision and did I really follow evidence-based thinking?

However, evidence-based medicine is not only reflective, but also has an innovative aspect. Structured systematic reviews such as those of the Cochrane Collaboration serve to summarize existing knowledge and identify research deficits. These form the basis for future clinically controlled trials. Epidemiology and biomathematics provide the methodological basis for conducting these studies. Within epidemiological research, it is also possible to conduct studies aimed at reviewing the methods used in clinical trials (e.g., the targets used, such as clinical scores).