Clinical Practice Guidelines

The physician in evidence-based clinical practice "takes the best available evidence, in cooperation with the person, to choose the alternative that best matches that patient" [12]. It brings findings from population research to individual care, demonstrating a direct correlation to epidemiology [13]. The main difference between these ideas seems to be whether or not the patient is involved in making decisions about therapy.

In 1990, the Institute of Medicine (IOM) of the National Academy of Sciences defined Clinical Practice Guidelines (CPGs) as "systematically developed recommendations to help clinicians and patients make important decisions about patient care for certain clinical conditions" [14, 15]. The IOM guidelines advisory panels created clear standards for appraising the appropriateness of practice guidelines. Validity was seen as one of the most important qualities, and it was described in terms of 1: health and cost outcomes and 2: the degree to which clinical advice and the scientific evidence used to make the guidelines match up.

As such, CPGs serve as a foundation for 1: increasing knowledge by making practitioners conscious of suggestions; 2: adjusting mindsets toward quality care; 3: shifting procedures; and, 4: positive patient safety. They could become an effective way for doctors, especially generalists, to keep up with discoveries if the recommendations are written with the most up-to-date information and are assessed and updated regularly. Clinical Practice Guidelines can also be used to inform healthcare managers and commissioning bodies about which health initiatives are acceptable and which are not. People also think that practice recommendations are useful when it comes to the law, making patients and the public more aware, and deciding what research needs to be done first [16, 17].

EBM Practice Guidelines

For generations, practice guidelines—official pronouncements from organizations and agencies about the acceptable use of procedures and treatments—have weighed these issues in informal ways. A panel of specialists gathers around a conference table and is requested to submit suggestions based on their knowledge of the evidence and their personal opinions. There is no formal approach toexamining evidence or reaching a consensus. Whatever methodologies and reasoning are employed are rarely included in the final draft. Even though formal consensus-building processes have been used, most notably at the National Institutes of Health Consensus Development Conferences and the Rand appropriateness panels, the panelists still make decisions based on their own opinions [18, 19].

Many organizations have shifted to EBM for the formulation of guidelines. Evidence-based practice guidelines have a clear method, a thorough look at the evidence that supports them, graded suggestions that link back to the evidence that backs them up, and they make it clear when advice is based on opinion.

Generally, evidence-based practice guidelines come from six processes that, depending on the issue, are carried out with various intensities and in various patterns Figure 2.

Subject Matter and Methodology: An evidence model can often assist in clarifying the connections in the explanatory framework for which evidence is needed [20]. The very first stage is to define the review's emphasis, including the target disease, the interventions to be evaluated, critical clinical demographics and medical settings, and significant treatment outcomes. The search's parameters, such as library databases and exclusion criteria, are also established.

Critical and Systemic Evaluation: Evidence is reviewed according to protocols that have become more standardized in recent decades [21]. The first of three basic procedures is to conduct a systematic literature survey, utilizing explicitly stated search queries and other strategies to ensure that the required information has been acquired for reviewers and readers. Second, critical evaluation of individual research, including the use of clear analytic methods to assess internal and external validity, as well as the documentation of data in abstracted formats and evidence tables. Finally, there is also the integration of results, which involves describing the findings in narrative prose, evidence charts, or balance sheets. In the last step, evidence can be combined quantitatively in meta-analyses to measure the size of the overall effect.

Internal validity is measured by looking at a set of things, such as the sample population, how people are put into groups, interventions, outcome measures, dropout rates, and statistical measurements [22]. External validity is found by thinking about how the sample population, interventions, and environment are representative of the whole.

Expert Consultation: In all practical recommendations, expert input is considered. Even when evidence is provided, personal conclusions could be drawn when evaluating the evidence's strength or generalization, as well as when balancing the advantages and harms. When there is a dearth of evidence, groups differ in their willingness to offer suggestions based on personal opinions. When perspective is used in EBM, it is important to be clear about it so that people can understand why the recommendations were made and decide for themselves if they are correct.

Considerations in Public Policy: Policymakers must often evaluate the cost-effectiveness or cost-utilization of treatments in an era with constrained medical resources. Accessibility to care, availability of skilled personnel and innovation, insurance plans, and medicolegal consequences are all taken into account to varying degrees based on the subject and panel ideology. Potential conflicts among panelists become particularly difficult in this situation [23]. Some groups never make suggestions based on their own opinions. Instead, they say that there isn't enough information to make a suggestion.

Document Preparation: In practice, guidelines and the language of recommendations are given a lot of thought because even minor differences in terminology can have important policy implications and alter the quality of patient treatment. The utilization of letter codes or suggestion classifications to signify how vigorously the intervention is suggested is a feature of evidence-based guidelines. Almost always, the quality of supporting evidence is reflected in this grading structure. The optimum alternative for interventions with complicated tradeoffs or ambiguous data may be determined by the values patients attach to prospective benefits and hazards. Guidelines for these kinds of things are moving away from giving general advice and instead telling clinicians to help patients assess and weigh their preferences as part of a joint decision-making process [24]. This approach entails discussing with individuals the possible advantages and risks of interventions, as well as their likelihood; assisting them in identifying how firmly they feel about possible outcomes, and deciding which choice is best based on this knowledge.

Evaluation by Peers: Evidence-based guidelines are frequently shared in written format with content experts to gain comment on the comprehensiveness of the review and the accuracy of the critical assessment, much like any other academic paper. The draft is also sent to stakeholders for responses, such as applicable professional groups and advocacy groups.

Evidence-based Medicine's Challenges

Evidence-based medicine has grown swiftly into a vibrant intellectual community dedicated to improving clinical practice by rendering it more scientifically and empirically oriented, resulting in healthier, more reliable, and cost-effective care [25]. Evidence-based medicine has had a lot of success over the last two decades, thanks to a lot of investment and enthusiasm. Notwithstanding numerous achievements, there is still a lot of variance in how evidence-based practice is implemented. The task of learning more about the foundations of our health in more depth can be daunting, and there are numerous potential dangers. With personalized medicine, you should be careful not to oversell and make sure that any claims you hear are backed up by evidence.

No other health sector has ever developed at such a breakneck pace. As a result, this has repercussions that will undoubtedly affect many parts of the medical field. Because of the overall ideals and warm appreciation for EBM proponents, but concern about its existing procedures, based on what is performed according to what is promised. And it may be necessary to revisit and modify educational programs regularly to reflect the current, but ever-changing, state-of-the-art of targeted therapy. Given the probable future involving citizens in self-management of healthcare as a component of targeted therapy, it's also critical to devote sufficient time and resources to promoting awareness of individual health and keeping people informed about the state of the field and how to best profit from it. Keeping the public sector up to date on the latest developments is a huge but vital task. The public needs to be an active part of this process of change, not just a passive observer.

The issues that the EBM faces are listed below.

Originality

The discrepancy seen between the contents of EBM and the application of EBM in medical care has been a primary cause of confusion. The materials are similar to a medical textbook, whereas the practice is just what happens when doctors make and follow patient-care procedures. Evidence-based medications, according to many professionals, are"hardly anything original." The originality lies in the substance of what is effectively a new form of clinical medicine textbook, rather than in the proposed practice of EBM. This uniqueness is hinted at by the fact that EBM uses "the best possible external medical evidence from systematic research" [26]. When the details of this clue are fleshed out, it's clear that it points to a narrow focus.

The Evidence's Composition

Despite the large amount of data that can be used in EBM, the evidence for EBM is nearly entirely based on randomized clinical trials and the meta-analyses that are conducted using those studies. Since meta-analyses may gather and evaluate data but not modify it, RCTs have now become the primary source to analyze data integrity and spectrum, as well as the extent of topics included in EBM collections.

Data Accuracy and Scope

Randomized clinical trials have focused on gathering "hard" statistics about mortality, sickness, and demographic trends to gain "trustworthy" knowledge. Before treatment, the patient's baseline status is routinely assessed using "reliable" data such as age, gender, ethnicity, MRI, endoscopy, histology, cytology, and laboratory investigations. When it's relevant, the outcome of therapy is written as "death" or as a global rating for typical symptoms that don't need to be described in more detail because "double-blind" observations should help avoid bias.

The failure resulted from the evidence collected in randomized controlled trials (RCTs). It is frequently inserted into meta-analyses without even being quality-checked first. Aside from omitting serious symptoms and other therapeutic factors that help distinguish these groupings, randomized-trial data frequently omits clinical subtleties that are critical for several other clinical options. The trial's conception and execution may also be overlooked at times [27, 28]. Many RCTs that have been intellectually inadequate notwithstanding their "gold standard" designation have been noted by practitioners of meta-analysis. Although strict criteria might be used to select only the truly "golden" RCTs [29, 30].

Misrepresented Evidence-Based Brand

The issue is that entrenched interests have stolen and twisted the evidence-based "quality mark." The pharmaceutical and healthcare businesses, in particular, are increasingly dictating research priorities. They specify what constitutes "risk states" for disease and disease. Evidence-based therapy may not be able to find the subtle biases that are becoming more common in sector investigations by using validity assessments and risk of bias methods [31].

An Enormous Amount of Evidence

The huge amount of evidence accessible is the next facet of the evidence-based medicine issue. The number of treatment guidelines, in particular, is currently unmanageable and illogical.

Co-Morbidity

As the population is aging and the occurrence of severe degenerative diseases rises, the individual with a single diagnosis that maps easily to a particular evidence-based recommendation is becoming increasingly rare. Even when relevant studies are planned to cover people with a variety of illnesses, adapting the results to patients with specific comorbidities is difficult. Comorbidity affects each individual differently and appears to defy attempts to create or apply objective ratings, metrics, treatments, or guidelines [32]. Care that is based on evidence for one illness or dangerous condition is causing or making another worse. This is especially true for the dangers of polypharmacy in the elderly.

Progress in the Status of Evidence-Based Medicine

The fundamental principles of EBM have been widely shared: an increasingly complex pyramid of evidence, the necessity for methodical descriptions of the strongest evidence to assist care; and the necessity for taking patient values into account when making important clinical choices. Several similar activities have benefited from, and possibly been spawned by, EBM. These measures have included an emphasis on comparative research on the effectiveness [33] over or under assessment and treatment [34]. quality-of-care measurements [35], enhancing publication standards [36], guaranteeing that all investigations are registered [37, 38], and minimizing waste in research production, such as the discontinuation of misdirected initiatives, which have become standard practice. These tasks can be accomplished under the broad scope of the EBM motion, which has enlarged to include fields of study such as midwifery, dental care, health policy, and public health, and there is a need for evidence-based scientific research to ensure that clinics, healthcare facilities, and medical institutions function optimally [39].

Evidence-based medication's commitments to the medical field and related areas in terms of establishing a platform for integrating research findings into the provision of health care [40] and boosting awareness of the importance of considering individual patient preferences and values will be long-lasting.

Evidence-Based Medicine's Special Relationship with South Asian Countries

South Asian countries, despite their differences in geography, linguistics, and political institutions, suffer from similar health concerns. Most people are dealing with a triple burden: persistent communicable diseases, worsening chronic disorders, and a rising number of accidents. HIV/AIDS, rapid urbanization that wasn't planned for, and several other factors that affect health make the situation worse [41]. Another common feature is that national medical figures conceal significant differences between countries [42, 43]. The health statistics in Asia's southern areas are among the worst worldwide. It has the highest rate of malnutrition and high blood sugar in the world. It also has 40% of the world's tuberculosis cases, a high rate of heart disease, and one of the worst measures of reproductive health [44]. Resource constraints, poor infrastructure, no universal healthcare plans, and a high illness load define health systems throughout the territory. Medical systems all around the region are also dealing with issues like a shortage of evidence-based policies and an absence of community responsibility. People incur hefty out-of-pocket expenses on top of other socioeconomic implications of ill health since there are no or inadequate national health care plans and private enterprise plays such a large role [45]. Overall, South Asia's financial investment in medical services is low relative to many other regions of the world, with the Maldives and Sri Lanka being the exception. Citizens of South Asia have more in common than they do distinctions, and inhabitants here must strive to maintain stability and utilize resources to enhance the region's wellness.

There is no centralized medical system in South Asia. Several qualified doctors operate in private organizations or clinics that provide care that is comparable to Western standards, while the bulk of the community is forced to rely on substandard or nonexistent medical treatment. There seems to be no expert assistance in many remote places, excluding the infrequent medical officer. People must travel large distances, delaying even suboptimal care [46]. In the world we live in now, it's important to use rational therapy based on strong experimental findings, especially in poor countries where resources are limited and public health care is either not available or not good enough [47]. Such countries cannot afford to waste resources on ineffective treatments [48]. The amount of money and time that an individual spends on their health treatment is also significant. With scarce resources, EBM may be a viable option for delivering appropriate health care.

South Asian countries are diverse in terms of culture as well as medical practice, ranging from huge super-specialty clinics with clinicians skilled in the most up-to-date techniques to quacks who treat patients only based on experience or practice. Ironically, these enormous, well-equipped clinics can only serve a limited, affluent segment of the population, and the bulk of sufferers are managed by doctors who are minimally trained or unskilled. As per research, this region has poor knowledge regarding EBM. According to multiple survey data, EBM has been implemented in some parts of South Asia, while it is still unknown in others. Due to resource restrictions among most healthcare institutions in South Asia, the whole cycle of EBM can only be applied to a small number of conditions. The majority of issues must be resolved at the intuitive end of the intellectual continuum. Evidence-based medications undoubtedly necessitate the training and acquisition of new skills (literature browsing and systematic review), which most practitioners regard as burdensome [49].

Need for Technology in Evidence-Based Medicine to Facilitate Healthcare and Deliver Care Remotely

With the emergence of fast and accessible operating systems in the early years of the twenty-first century, we have seen incredible technological advancement. Concurrently, a worldwide connection enabled by internet and satellite techniques has caused a spike in the number of "network participants' for information exchange. The temporal convergence of various concurrent events has led to the advent of new mobile health (mHealth) innovations. The human urge to deliver and receive high-quality, inexpensive medical treatment promptly has accelerated the progress of medicine. In today's hyper-connected society, mobile technology seems to have become a vital component. Modern medicine is transforming the manner in which it promotes and delivers treatment. Innovations in this technology and telehealth have made a big impact on this. While a wave of freely accessible technologies has captured the interest of the medical world and enhanced access to medication, especially in distant locations, there must be a concern about telemedicine approaches' security, dependability, consistency, and precision. The use of mobile technologies to deliver basic health care is becoming more common. Mobile devices have the potential to revolutionize the way health interventions are delivered. Mobile technology could make health programs better and give more people access to medicine [50]. Masses of rural residents now have access to adequate communication and information transfer technologies thanks to the spectacular expansion and profound usage of smartphone communications. The increasing use of mobile phones heralds the potential of using mobile technologies to deliver mobile medical solutions. One of the benefits of telephones in continuous patient care is that they can help clients and healthcare providers talk to each other in more than one way. This makes the connection between them more dynamic [51]. In today's hyper-connected society, mobile technology has become a crucial element. However, despite the hurdles that older folks encounter when it comes to the use of mobile technology when they do, new technology becomes an important part of their everyday lives since it helps them to maintain contact with family [52]. Even now, research shows that mobile technology can be a kind of personal and situational support for older adults who don't know enough about their health, making it easier for patients and providers to work together for self-management [53]. To promote social help and avoid relapse, technology could be used in a variety of ways. Via internet support organizations and associations, it can allow individuals in treatment to communicate with each other and assist one another. It may provide a range of easy options to contact people like clinicians or significant others (e.g., texts and emails, telephone conversations). Telemedicine and mobile technology will become a fundamental element of medical practice shortly, thanks to technological advancements and the low cost of handheld equipment. The practice of medicine that is aided by portable diagnostic equipment is referred to as mHealth. The use of these devices at the point of care is changing the way healthcare is given from being led by the healthcare system to being led by the patient [54, 55]. The confluence of these elements offers an unrivaled opportunity to promote patient involvement, save medical costs, and improve results [56]. The rising usage of communications technology platform services in the medical industry has resulted inthe aim to enhance and ensure improved medical services. Online communication is gaining popularity in the medical field as a means of tracking disease outbreaks, assessing patient care, diagnosing clients, training patients, and gathering and disseminating data using simple cell phones. Several studies have shown that smartphones can be used to share information about patient safety and manage people's attendance at certain health events [57]. Medical professionals can rapidly update and access patient information using mobile technologies from anywhere within a telecommunications network's range. This assures that patients' health records are updated regularly. Physicians who have access to the most recent data are better able to make medication judgments. The use of mobile technology-based applications may remove needless paperwork, leading to more efficient and successful patient care. Many initiatives have used short messaging service (SMS) systems to ensure patient adherence, such as the Mobile Med Alert, a cellular health warning system that delivers patients SMS reminding patients to consume their medications. The HeartSaver is a special cell phone for health care that can monitor a patient's electrocardiogram (ECG) in real-time and automatically find many heart diseases [58]. The AarogyaSetu and Cowin smartphone applications were a huge hit in India during the COVID outbreak. At the same time, Cowin did its job of making vaccines easy to get and safe to schedule, and AarogyaSetu worked on keeping track of the local COVID infection record.

Medical practice in reality is complicated, and it poses crucial challenges regarding how we might create clinically useful electronic health data. Clinicians are starting to wonder if having more gadgets means having more information but if any of that information is redundant or even useless.

Mobile Devices in Healthcare: Applications and Benefits

The need for better communication and information tools at the point of service has been a big reason why healthcare professionals use mobile devices so much [59]. In a clinical context, healthcare practitioners should have access to a variety of resources as described in Table 1 [60].