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The concept of »evidence-based medicine« (EBM) is actually a very good proposal to keep a sufficient overview with respect to the abundance of research literature – also in the field of psychotherapy – and thus to be able to make better decisions for the benefit of patients. It is shown that this good concept is now predominantly misused. Instead of taking into account the breadth of relevant information on an issue, EBM in Germany has been substantially converted into an instrument for selection and regulation. Only studies that follow the logic of pharmaceutical trials – RCTs – are taken into account, although this approach is inadequate for a wide range of psychotherapy. Moreover, these results are then summarized by means of »effect sizes« using the methods of meta-analysis – although »effect size« does not (only) measure treatment success. [ABSTRACT FROM AUTHOR]

Objectives: Decision aids (DAs) are promising tools to foster evidence‐based shared decision‐making between practitioners and service users. Nevertheless, it is still obscure how an evidence‐based DA for people with severe mental illness, especially psychosis, should look in an inpatient treatment setting to be useful and feasible. Therefore, we conducted focus groups with psychiatrists and service users to collect and assess their expectations and wishes regarding an evidence‐based DA. From these findings, we derived immediate recommendations for the future development of DAs. Methods: We held two group interviews with service users (n = 8) and three group interviews with psychiatrists (n = 10). We used an open, large‐scale topic guide. First, we presented data from a current meta‐analysis on antipsychotics to the interviewees and, in a second step, asked for their expectations and wishes towards a DA that integrates these data. Results: Our thematic analysis revealed six key themes addressed by the respondents: (1) general considerations on the importance and usefulness of such a DA, (2) critical comments on psychiatry and psychopharmacotherapy, (3) communicative prerequisites for the use of a DA, (4) form and content of the DA, (5) data input, data processing and output as well as (6) application of the DA and possible obstacles. Conclusions: Participants identified several important features for the development of DAs for selecting antipsychotics in inpatient psychiatric treatment. The digital format was met with the greatest approval. Especially the adaptability to different needs, users and psychopathologies and the possibility to outsource information dissemination via app seemed to be a decisive convincing argument. Further research is required to test specific features of DAs to be developed in clinical settings. Patient or Public Contribution: The entire project is supported by an advisory board, including also experienced users. The members are regularly updated about the process and give important feedback. [ABSTRACT FROM AUTHOR]

Aim: We investigated public opinion on therapeutic benefit, costs, and evidence-based medicine (EBM) as possible prioritization criteria and probed for associations between respondents' preferences and their personal health and their disease experience. Subjects and methods: In computer-assisted personal interviews with a representative sample of the German population, participants were asked for their opinions regarding various priority criteria: (1) therapeutic benefit, measured in terms of response rate and survival time; (2) costs of a medical treatment, in both general and specific scenarios; (3) EBM, in general and exceptions under specific conditions. Questions to the participants' health (SF-8) and to their relatives/friends' health were included. Data were evaluated using contingency analysis, regression analysis, and nonparametric tests (Kruskal-Wallis and Kolmogorov-Smirnov) for frequency distributions. Results: The survey included 2,031 participants (response rate 57 %). Factors related to quality of life (QoL) were considered to be more important than life prolongation. Therapeutic benefits of treatments (response rate of treatments, survival time of patients) should be very high to be financed by the health insurance. Cost was only accepted as a prioritization criterion when the prolongation of life was very short and the costs were very high. Exceptions to EBM were accepted in the case of life-threatening diseases or a recommendation by a physician. Evidence of self-serving biases were not be observed. Conclusion: Under certain circumstances, the general public seems to accept therapeutic benefit, costs, and EBM as possible prioritization and seems to be guided by general responsibility rather than self-interest. [ABSTRACT FROM AUTHOR]

The Standing Committee on Vaccination (STIKO) is a voluntary body whose 18 experts are appointed by the Federal Ministry of Health. The scientific work of STIKO is supported by a scientific secretariat at the Robert Koch Institute. The STIKO develops independent vaccination recommendations for Germany using the methodology of evidence-based medicine (EBM).During the COVID-19 pandemic, STIKO faced major challenges. Several COVID-19 vaccines based on new technologies were approved within a very short time. The benefit-risk assessment had to be carried out according to the current state of knowledge. The vaccination recommendations had to be continuously adapted to the constantly changing epidemiology of SARS-CoV‑2, increasing vaccine availability, new approvals, extensions of indications, and safety signals of vaccines. STIKO has adapted its way of working to the situation; the experts showed an impressive commitment during the pandemic. Even under time pressure, STIKO adhered to the principles of EBM and developed evidence-based vaccination recommendations. Before the final decision was made, STIKO submitted every vaccination recommendation to a commenting procedure with the stakeholders (e.g., medical societies and health authorities). Despite the short deadlines, the stakeholders made extensive and constructive comments and gave STIKO the opportunity to discuss and adapt their recommendations, consider the feedback, and thus build on a broad consensus.The past few months have shown that it is possible and rational to developing vaccination recommendations based on the principles of EBM even during a pandemic. Sufficient human resources in the STIKO office are essential., (© 2022. The Author(s).)

The aim of the article is to describe the development of the principles of medicine based on the evidence (EBM) based on postulates of Robert Koch, Nobel prize winner, protagonist of the "Golden Age" medical bacteriology, founder of a concept of modern microbiology and infectology. Kochs work led to the discovery of a causal relationship between exposure to a specific pathogen and disease on the example of identifying the cause of anthrax - Bacillus anthracis, a disease whose symptoms vary depending on the mode of transmission (gastrointestinal ingestion, cutaneous form on contact and pulmonary manifestations when inhaled). Tuberculosis caused by Kochs bacillus, Mycobacterium tuberculosis, yet still affecting 1.7 billion people (about 25 % of the world's population), in 95 % of cases in developing countries, where poverty and high prevalence of HIV are part of everyday life. Koch also discovered Vibrio cholerae, the pathogen responsible for seven recorded pandemics, and hitherto sporadic epidemics in recent years. The main contribution of the Kochs four postulates formulation was the principle, which helped to reveal the causal relationship between the pathogenic microbe to protrude infectious disease and obtain reliable evidence in improving credibility of diagnosis of infectious diseases. Other stages in the development of EBM were formulated by Bradford Hill in his nine principles, which are valid as well for noncommunicable diseases. The subjects of discussion are limitations and restrictions of present EBM and its essentials and the use in rational preventive, diagnostic and treatment strategies.

With its "Münsteraner Memorandum on Alternative Practitioners" the author collective "Münsteraner Kreis" has recently criticized current German double standards for physicians versus alternative practitioners with regard to minimal competency and to quality assurance. The authors' main goal was to attract attention to the problem and to provide systematic arguments in favor of a healthcare system that is serving patients' needs more appropriately. Reactions to the Memorandum were numerous, divergent in their evaluations, often constructive, and frequently emotionally heated. Here, we collect, analyse and evaluate only the critical voices in order to sharpen the positions presented in the Memorandum, upgrade them if necessary, and identify areas in need of further research. For greater clarity, we standardize the objections, sort them into categories, subject them to theoretical and empirical plausibility analysis, and discuss their significance for the positions we have adopted., (Copyright © 2018. Published by Elsevier GmbH.)

Purpose: Computer-assisted learning (CAL) programs are becoming more widely used in medical and dental training. However, the combination of CAL programs and evidence-based education in dentistry has not been described previously. The aim was to determine the acceptance and user-friendliness of a CAL program combined with evidence-based training., Methods: The didactic concept of the module includes the case-oriented, problem-based embedding of a total of 32 EbM learning assignments, which can be completed interactively and self-determinedly in an interdisciplinary context using focus patients with different diseases. The present study was conducted at the Dental School of the Goethe University in Frankfurt/Main. Data on acceptance and user-friendliness were collected from three consecutive cohorts of 114 dental students attending their first clinical semester. They used the "Toothache Walk-in Clinic: FOCUS" CAL, which can be downloaded via the Internet. The instrument consisted of 64 statements. The first part addressed general information about the user. The second part contained 43 specific statements on the CAL program. These included factors A (handling and technical aspects), B (content and functional range), and C (didactics and suitability for education). Possible responses ranged from 0 to 3 (0 = strongly disagree, 3 = strongly agree)., Results: All of the 114 questionnaires distributed were returned (response rate 100%). Most users (90.1%) considered the topics of evidence-based dentistry important for their training. They rated the program by using German school grades, and the overall rating was 2.26 (SD = 0.64). Most students (88.6%) considered the program useful for their clinical training in the treatment of patients. The mean scores for the 43 specific items amounted to 1.90 (factor A, SD = 0.63), 1.55 (factor B, SD = 1.93), and 2.23 (factor C, SD = 0.79)., Conclusions: The CAL program with dental medicine vignettes and learning elements for evidence-based medicine received a primarily positive assessment. Students welcome that EbM contents are offered as part of their dental studies curriculum., (Copyright © 2017. Published by Elsevier GmbH.)