Anticoagulación en pacientes con fibrilación auricular crónica: ¿cuándo indicarla? / Anticoagulants for patients with chronic auricular fibrillation: when are they indicated?

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[A global perspective on evidence-based medicine]. / Una perspectiva global sobre la medicina basada en la evidencia.

Evidence-based Medicine (EBM) has aroused considerable interest in Spain as a concept. Its original announcement in 1992 proposed a change in the paradigm in both the practice of medicine and how to teach it. That caused some controversy. The progressive improvement of both the quality of literature presentation and common understanding about the internal validity of studies can be attributed to its diffusion. EBM has also helped to disseminate new concepts like the NNT, more intuitive for the clinician. It has also fostered a variety of educational initiatives for the critical appraisal of the literature. Several initiatives for the compilation of sources screened for quality and oriented for application the practitioners' are ongoing, notably the Cochrane Collaboration, often using the features offered by the new technology. EBM has also contributed in some countries to formalize explicit policies to encourage directed clinical research.

[The phenomenon of "evidence-based medicine"]. / El fenómeno de la "medicina basada en la evidencia".

Evidence-based medicine originates in 1992 when the proliferation of medical publications and other clinically relevant information was neither organized nor efficiently employed, aggravating concerns on the ethical duty of its incorporation to clinical decision making. Development of clinical research and its methods have changed the nature of medical knowledge, "changing the paradigm" leading to need for changing both practice organization and the contents of continuous education. This is the "objective basis" of evidence-based medicine. Since evidence-based medicine emphasizes the clinician's judgement and asses the knowledge basis of his practice, reinforces professional autonomy compared to other considerations, thus having political and ethical implications. Evidence-based medicine redefines in its own terms professional excellence.