Evidence-based medicine integrates clinical experience with the best available research information [ 12 ]. It categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research. One of the scales most used is the Scottish Intercollegiate Guidelines Network SIGN which use a code together the study type for decide the level of evidence [ 13 ]. High level of strength of recommendation is assigned to randomized control trials with a very low risk of bias and low levels of recommendation correspond to observational studies.
Hence, the called "pragmatic studies" or "real-life studies" might be qualified as low evidence. This would suppose a contradiction, the most effectiveness studies would be the lowest level of evidence.
Efficiency is the ratio of the output to the inputs of any system. An efficient system or person is one who achieves higher levels of performance outcome, output relative to the inputs resources, time, money consumed [ 14 ]. Historically, efficiency measurements come from engineering science where performance had to be measured.
The result has been typically displayed as physical units per resource used. Achieving efficiency, which is defined as maximizing the outputs achieved per unit of input invested [ 14 ] is naturally of great interest to national governments, international donors and other stakeholders in the health sector. As what type of product is being evaluated, we distinguish between two types of outputs: Health services visits, drugs, admissions and health outcomes by way of example: Preventable deaths, functional status, clinical outcomes such as blood pressure or blood sugar control.
Efficiency measures must also explicitly identify the inputs that are used or will be counted to produce the output of interest. Inputs can be measured as counts by type by way of example, nursing hours, bed days, days supply of drugs or they can be monetized real or standardized dollars assigned to each unit. We refer to these, respectively, as physical inputs or financial inputs [ 14 , 15 ]. As can be seen, there have developed a series of artificial meanings on the use of efficacy, effectiveness and efficiency that impede the comprehension of the topic.
Especially, in the field of the medicine there has spread the use of these words with a meaning different from that of the real language. Hereby, there is understood that effectiveness is an intervention or initiative intended to achieve the desired effect, under ordinary circumstances not controlled circumstances such as in a laboratory.
Similarly, efficacy is an objective achieved under controlled circumstances. As a consequence, this artificial use does that do not correspond to an intuitive meaning that we should know before the previously arbitrary definitions to be able to understand medical topic about which it treats. We are forced to know before these artificial meanings to understand the subject which is discussed.
In addition, the artful meaning that gives to the term's efficacy and effectiveness, corresponds to other perfectly catalogued terms.
That is, words we are looking for to denominated ideal circumstances or real circumstances are already invented: strategy and tactics [ 3 ]. The phrase "strategy and tactics" is military in origin. This way, the term strategy means a plan in ideal situation and not place in practices yet or, a plan of action designed to achieve a long-term or overall aim. Financial support: None. Potential competing interests : None. Pharmacoeconomic evaluation in the real world. Effectiveness versus efficacy studies.
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An idea that seems perfect under ideal conditions may not stand the test of chaos which real life inevitably brings about. When choosing between two solutions with similar levels of efficacy, it makes sense to go with the most effective one.
Once you have found an effective solution, you can then try to improve it by making it more efficient. The Oxford Dictionary offers several definitions of efficiency.
You could effectively get the right things done, but in an inefficient manner. Efficiency is about doing things in the most economical way, whether in terms of time, energy, or money.
Similarly, in project management or decision making, you could come up with a solution that achieves the right result effective , but is needlessly costly inefficient. In their history, Band-Aids have probably allowed millions of people to keep working or playing tennis or cooking or walking when they would otherwise have had to stop.
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