An evident view of evidence-based practice in perinatal medicine: absence of evidence is not evidence of absence
Sola, A.; Dieppa, F.D.; Rogido, M.R.
Jornal de Pediatria 83(5): 395-414
2007
ISSN/ISBN: 0021-7557 PMID: 17940687 DOI: 10.2223/jped.1702Document Number: 198199
To provide valuable elements and some humor in this so-called era of "evidence-based practice" with the aim of helping clinicians make better choices in the care they deliver based on evidence, not simply or exclusively based on a randomized clinical trial (RCT) or meta-analysis (which may not be evidence). Books and peer-reviewed articles are quoted and listed in the bibliography. Evidence of life, learning from our own mistakes and many other evident facts that support this review are not quoted. 1) "Absence of evidence is not evidence of absence" and "lack of evidence of effect does not mean evidence of no effect." 2) RCTs with "negative" results and those with "positive" results, but without outcomes that matter, often cannot conclude what they conclude. 3) Non-randomized clinical trials and practical trials may be important. 4) Research to prove is different than research to improve. 5) Clinical choice must assess effects on outcomes that matter to patients and their parents. 6) Quantifying adverse outcomes, number needed to damage and to treat is not that simple. Significant challenges inherent to health service research must be correlated to possible clinical applications using tools to have a more "evident view of evidence-based practice" in perinatal medicine, recalling that absence of evidence is not evidence of absence.