Abstract：
:Evidence-based health care (EBHC), previously evidence-based medicine (EBM), is considered by many to have modernized health care and brought it from an authority-based past to a more rationalist, scientific grounding. But recent concerns and criticisms pose serious challenges and urge us to look at the fundamentals of a changing EBHC. In this paper, we present French philosopher Bruno Latour's vision on modernity as a framework to discuss current changes in the discourse on EBHC/EBM. Drawing on Latour's work, we argue that the early EBM movement had a strong modernist agenda with an aim to "purify" clinical reality into a dichotomy of objective "evidence" from nature and subjective "preferences" from human society and culture. However, we argue that this shift has proved impossible to achieve in reality. Several recent developments appear to point to a demise of purified evidence in the EBHC discourse and a growing recognition-albeit implicit and undertheorized-that evidence in clinical decision making is relentlessly situated and contextual. The unique, individual patient, not abstracted truths from distant research studies, must be the starting point for clinical practice. It follows that the EBHC community needs to reconsider the assumption that science should be abstracted from culture and acknowledge that knowledge from human culture and nature both need translation and interpretation. The implications for clinical reasoning are far reaching. We offer some preliminary principles for conceptualizing EBHC as a "situated practice" rather than as a sequence of research-driven abstract decisions.
journal_name
J Eval Clin Practjournal_title
Journal of evaluation in clinical practiceauthors
Wieringa S,Engebretsen E,Heggen K,Greenhalgh Tdoi
10.1111/jep.12752subject
Has Abstractpub_date
2017-10-01 00:00:00pages
964-970issue
5eissn
1356-1294issn
1365-2753journal_volume
23pub_type
杂志文章abstract：RATIONALE:The ADAPTE framework was established to enhance efficiency in guideline development and to facilitate adaptation of high-quality clinical practice guidelines for a local context. It offers guideline developers a systematic methodology for guideline adaptation; however, the feasibility and usability of the pro...
journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章,评审
doi：10.1046/j.1365-2753.1998.t01-1-00003.x
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journal_title：Journal of evaluation in clinical practice
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.1998.tb00098.x
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journal_title：Journal of evaluation in clinical practice
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doi：10.1111/j.1365-2753.2009.01189.x
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章,多中心研究
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2006.00768.x
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journal_title：Journal of evaluation in clinical practice
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journal_title：Journal of evaluation in clinical practice
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.12403
更新日期：2016-02-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
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doi：10.1046/j.1365-2753.1999.00188.x
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2008.01037.x
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章,评审
doi：10.1111/j.1365-2753.2007.00845.x
更新日期：2008-04-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.12131
更新日期：2014-08-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2006.00620.x
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.1998.tb00088.x
更新日期：1998-11-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
pub_type： 社论
doi：10.1111/jep.12831
更新日期：2017-10-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
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journal_title：Journal of evaluation in clinical practice
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journal_title：Journal of evaluation in clinical practice
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journal_title：Journal of evaluation in clinical practice
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更新日期：2006-12-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
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doi：10.1111/j.1365-2753.2011.01728.x
更新日期：2011-10-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
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doi：10.1111/j.1365-2753.2005.00582.x
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pub_type： 杂志文章
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更新日期：2016-10-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
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doi：10.1111/j.1365-2753.2008.01084.x
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/j.1365-2753.2010.01618.x
更新日期：2012-06-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
pub_type： 杂志文章
doi：10.1111/jep.13273
更新日期：2020-04-01 00:00:00
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journal_title：Journal of evaluation in clinical practice
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