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The Evidence-based Medicine Paradigm: Where are We 20 Years Later? Part 2

  • Shashi S. Seshia (a1) and G. Bryan Young (a2)

In Part 2, we discuss the challenges of keeping up with the ‘literature,’ evidence-based medicine (EBM) in emerging economies and the Neurosciences, and two recent approaches to classifying evidence. We conclude by summarizing information from Parts 1 and 2 which suggest the need to critically re-appraise core elements of the EBM paradigm: (1) the hierarchical ranking of evidence, (2) randomized controlled trials or systematic reviews as the gold standard for all clinical questions or situations, (3) the statistical tests that have become integral to the ‘measurements’ for analyzing evidence, and (4) re-incorporating a role for evidence from basic sciences and pathophysiology. An understanding of how cognitive processes influence clinical decisions is also necessary to improve evidence-based practice. Emerging economies may have to modify the design and conduct of clinical research to their settings. Like all paradigms, EBM must keep improving with input from the grassroots to remain beneficial.

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Corresponding author
Department of Pediatrics, Division of Pediatric Neurology, University of Saskatchewan, Royal University Hospital, 108 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada. Email:
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Canadian Journal of Neurological Sciences
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