Introducing “Evidence for clinical practice”

Combining alternative medicine and conventional medicine approaches into an integral whole is called integrative medicine [1]. Combining the best research evidence with clinical expertise and patient values into an integral whole is called evidence-based medicine [2]. Evidence-based medicine (EBM) is neither alternative medicine nor conventional medicine (though the expectation for evidence-based medicine is increasingly conventional). Both integrative medicine and evidence-based medicine are closely aligned if not just different views to providing holistic care. Finding the best research evidence at the moment you need it is a challenge for clinicians, regardless of domain of practice. To address this challenge, DynaMed was created with a mission to provide the most useful information to health care professionals at the point of care. It is a point-of-care database systematically derived from and presenting the best available evidence across medicine, is used globally, and contains more than 200,000 citations after twenty years of systematic literature surveillance. In the last few years, the systematic effort to identify, critically appraise, synthesize and report evidence has been expanded to include guidance, and DynaMed Plus now provides systematicallyderived recommendations for more than 1000 broad topics across medicine. Independent evaluations consistently find this to be the most current clinical reference with the highest-quality evidence summarized using explicit, transparent methods [3–8]. The DynaMed mission is so intertwined with integrative medicine and evidence-based medicine that it presents a unique opportunity to view developments in integrative medicine through the lens of those making it interpretable and usable for practicing clinicians. This approach to providing guidance for clinical practice is to convey what we know regarding the desirable and undesirable consequences for different clinical actions and how well we know (or do not know) the likelihood of these consequences. Clinical decision-making is rarely straightforward – it varies with the values and preferences of the clinicians and, most importantly, the patients. So the best evidence and guidance is summarized with attention to context for facilitating shared decision-making rather than as prescriptive (and proscriptive) protocols expected to be the same for all patients. DynaMed Plus’s systematically derived recommendations can involve synthesizing inconsistent or uncertain research evidence and guidelines. For example, two large, methodologically sound randomized trials have concluded that acupuncture reduces chronic low back pain compared to no acupuncture or conventional treatment but is no more effective than minimal (sham) acupuncture [9,10]. From this evidence, one might conclude that