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Evidenzbasierte Medizin und die Cochrane Collaboration— Bedeutung für die Schlafmedizin

The concept of “evidence-based medicine” and the cochrane collaboration— implications for sleep medicine

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Zusammenfassung

In einer Zeit einschneidender Reformen des Gesundheitswesens erlangt die aus dem angloamerikanischen Sprachraum stammende „Evidence-based Medicine” zunehmende Bedeutung. Evidenzbasierte Medizin bedeutet die Möglichkeit, medizinische Entscheidungen auf der Basis der besten zur Zeit verfügbaren externen Evidenz in Verbindung mit der individuellen klinischen Erfahrung zu treffen.

Dieser Artikel untersucht anhand empirischer Beispiele die Bedeutung dieses Konzepts für den einzelnen Schlafmediziner und für die Schlafmedizin als naturwissenschaftliche medizinische Disziplin.

Am Beispiel der Behandlung primärer Insomnien und der Diskussion um die nasale CPAP-Behandlung des obstruktiven Schlafapnoe-Syndroms werden Notwendigkeit, Möglichkeiten und Grenzen der Anwendung einer Evidence-based Medicine in der Praxis der Schlafmedizin dargestellt. Der Beitrag der Cochrane Collaboration zur Aufbereitung und Bereitstellung der Evidenz in Form von Datenbanken und systematischen Übersichtsarbeiten wir aufgezeigt. Die Wertigkeit verschiedener Datenbanken für die Literaturrecherche in der Schlafmedizin und die bisherige schlafmedizinische Repräsentanz in der Cochrane Collaboration wird aufgezeigt. Schließlich werden auch Gefahren der Evidenzbewertung hinsichtlich Kostenentscheidungen in der Gesundheitspolitik diskutiert.

Das Konzept der Evidence-based medicine ist von hoher Relevanz für die Schlafmedizin. Schlafmedizinische Themen sind im Moment in der Cochrane Collaboration unterrepräsentiert. Evidence-based Medicine bietet ein hohes Missbrauchspotential.

Summary

There is an ongoing world-wide process of restructuring the health care systems. The concept of Evidence-based Medicine (EMB) aims to bridge the gap between clinical research and clinical decision making by vigorously integrating the best available external evidence with the individual clinical expertise.

In this article we examine empirically the perspectives of the new paradigm for practitioners and scientists in the field of sleep medicine.

The two examples of the treatment of primary insomnia as well as the ongoing discussion regarding nasal CPAP treatment for obstructive sleep apnea illustrate implications, chances and limitations of the application of EBM for clinical practice. We evaluate the contribution of the world-wide network of the Cochrane Collaboration in preparing and maintaining systematic reviews of the effects of health care. Empirical data shows the relevance of different databases for searching literature in sleep medicine and the representation of sleep medicine within the Cochrane Collaboration. The risk of uncritically applying this evidence concerning cost-decisions in the health care system are considered.

The concept of EBM is of high relevance for sleep medicine. To date topics of sleep medicine are generally underrepresented within the Cochrane Collaboration network. There is a high potential of abuse for this new paradigm.

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Authors and Affiliations

  1. Abt. Psychiatrie und Psychotherapie, Klinik um der Albert-Ludwigs-Universität, Hauptstr. 5, D-79104, Freiburg

    Michael M. Berner, Mathias Berger & Dieter Riemann

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  1. Michael M. Berner
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  2. Mathias Berger
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  3. Dieter Riemann
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Correspondence to Michael M. Berner.

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Berner, M.M., Berger, M. & Riemann, D. Evidenzbasierte Medizin und die Cochrane Collaboration— Bedeutung für die Schlafmedizin. Somnologie 5, 81–90 (2001). https://doi.org/10.1046/j.1439-054X.2001.01143.x

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