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Promoting evidence-based medicine.

The decision to embark on a particular course of management because “that’s how we did it in my residency” or because “it worked the last time we tried it” is neither reasonable nor justifiable. Clinical decisions should, as much as possible, be evidence based. Evidence-based medicine is defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”1 This statement requires that care providers be familiar with all the latest publications, be able to judge the quality of the data being presented (randomized, double-blind, placebo-controlled clinical trials, for example, hold more validity than case reports or expert opinion), and be able to balance the risks and potential benefits of various treatment options. 
 
In practice, evidence-based medicine requires expertise in retrieving, interpreting, and applying the results of scientific studies and in communicating the risks and benefits of different courses of action to patients. This daunting task is compounded by the fact that the volume of medical literature is expanding at a rate of greater than 7% per annum, doubling every 10 to 15 years. Even within the relatively narrow field of obstetrics and gynecology (ob-gyn), there are more than 5 major publications each month containing an excess of 100 original articles and 35 editorials. How then does a busy ob-gyn practitioner maintain a solid foundation of up-to-date knowledge within the scope of his or her practice? 
 
New and evolving information can be gleaned from a variety of sources: from the advice of colleagues and consultants, textbooks, pharmaceutical literature and advertising, lectures and continuing medical education (CME) courses, non-peer-reviewed “throw away” journals, peer-reviewed medical journals with original research articles and reviews, and from published clinical guidelines and consensus statements. Moreover, the Internet has created a paradigm shift by allowing instant access to the medical literature, thereby removing the reliance on clinical experience and expert opinion alone. Because no single source can be regarded as authoritative, we offer the following suggestions to busy ob-gyn practitioners: 
 
 
When faced with an unfamiliar clinical situation, in addition to seeking advice from your colleagues or securing a formal consultation from a medical subspecialist, use an Internet search engine or database (such as MEDLINE, PubMed, or OMIM®-Online Mendelian Inheritance in Man®) to search for relevant original research and review articles. 
 
 
Be familiar with The American College of Obstetricians and Gynecologists Practice Bulletins and Committee Opinions published each month in Obstetrics & Gynecology. 
 
 
Where possible, use the Cochrane Library (http://www.cochrane.org), an online resource that aims to improve health care decision making through systematic reviews of the effects of health care interventions. 
 
 
Consider registering with an online evidence-based, peer-reviewed information resource (such as http://www.UptoDate.com). 
 
 
Take advantage of CME courses and conferences, especially those recommended by your colleagues. 
 
 
 
It is with this dilemma in mind that we launched Reviews in Obstetrics & Gynecology. It is the sincere hope of the editorial staff that the reader will find the review articles in this free quarterly journal valuable as they strive to follow evidence-based medical principles while maintaining a busy clinical practice.