Centre for decision analysis and support (CeDAS)

Our CeDAS consults on and executes research programs that integrate evidence based medicine (EBM) and medicine based evidence( MBE) in order to track clinical decision making. The output often results in large educational programs.

Evidence Based Medicine

EBM is commonly accepted as the guiding principle in clinical practice. Although EBM has been described as a way of "....integrating individual clinical expertise with the best available external clinical evidence from systematic research", the focus in the medical literature and guideline development is on the use of external evidence. However, the application of the results of clinical studies to individual patient care is often hampered by the fact that the evidence is insufficient or not detailed enough to apply to the wide range of patients seen in everyday practice.

Although the evidence from randomised controlled clinical trials is substantial, their limited scope, rigorous inclusion and exclusion criteria, and different designs often restrict a tailored application to the wide range of patients seen in daily practice. For a substantial proportion of decisions made in clinical practice, sound scientific evidence is lacking.

Medicine Based Evidence

Despite the lack of clear and precise indications for many diagnostic and therapeutic procedures, doctors have to make decisions every day about their application in particular patients. Decision making in daily practice can be considered as a complex and continuous learning process in which information from clinical studies is triangulated with personal insights, opinions of colleagues and clinical experience with own patients. It has been postulated that the "sum of clinical wisdom" stemming from that process may constitute valuable information to refine and adapt the evidence from clinical studies.

An integrated approach is needed to combine the best of two worlds into patient-specific recommendations.