Is Our Clinical Decision Making Based on the Best Research Evidence?

Document Type : Original Article (s)

Authors

1 Pharmacologist, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

2 Epidemiologist, Department of Epidemiology & Biostatics, School of Public Health, Tehran University of Medical Sciences, Tehran and Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

3 Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

4 General Practitioner, Isfahan, Iran.

5 Resident of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

6 PhD Student, School of Management and Medical Information Science, Tehran University of Medical Sciences, Tehran and Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Introduction: Evidence based practice is an approach to clinical practice which emphasizes the use of best clinical researches as a component of clinical decision making. The aim of this study was to determine the percentage of current clinical decision making and disease management which is based and supported by high-level evidence in an educational hospital located in Isfahan, Iran.Methods: A cross-sectional study was carried on 103 patients who were admitted during one month to seven Internal medicine wards in Alzahra hospital. For each patient, the primary diagnosis and primary treatment were recorded. Evidence based resources were then searched for randomized controlled trials (RCT’s), systematic reviews and clinical practice guidelines to find the best research evidence that the treatments were effective. The main outcome measure was the level of evidence which supports the primary intervention for the primary diagnosis of each patient.Finding: Level I evidence (at least one randomized trial) supported the primary intervention used in 68.9% of internal admissions and level II evidence (convincing non-experimental evidence) supported the primary intervention in 31.1% of admissions. None of patients received intervention with level III supporting evidence.Conclusion: Most patients had received high level supported interventions. It seems that we should repeat this study in other wards. Also it may be recommended to design some educational evidence based practice for non academic physicians.

Keywords

References

  1. Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problem-solving. BMJ 1995; 310: 1122-6.
  2. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992; 268(17): 2420-5.
  3. Davies J, Freemantle N, Grimshaw J, Hurwitz B, Long A, Russell IT, et al. Implementing clinical practice guidelines: Can guidelines be used to improve clinical practice? Effective Health Care Bulletin 1994; 1: 1-12.
  4. Mant J, Hicks N. Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating acute myocardial infarction. BMJ 1995; 311: 793-6.
  5. White KL. Evidence-based medicine. Lancet 1995; 346: 837-8.
  6. Smith R. Where is the wisdom? The poverty of medical evidence.BMJ 1991; 303: 798-9.
  7. Office of Technology Assessment of the Congress of the United States. Assessing the efficacy and safety of medical technologies. Washington, DC: US Government Printing Office; September 1978. [cited: Des 2003]. Available from: http: www.wws.princeton.edu/cgi-bin/byteserv.prl/~ota. Html.
  8. Office of Technology Assessment of the Congress of the United States. The impact of randomized clinical trials on health policy and medical practice. Washington, DC: US Government Printing Office; August 1983. [cited: Des 2003] Available from: www.wws.princeton.edu/cgi-bin/byteserv.prl/~ota.html.
  9. Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient general medicine is evidence based. A-Team, Nuffield Department of Clinical Medicine. Lancet 1995; 346: 407-10.
  10. Moyer VA, Gist AK, Elliott EJ. Is the practice of paediatric inpatient medicine evidence-based? J Paediatr Child Health 2002; 38(4): 347-51.
  11. Rudolf MC, Lyth N, Bundle A, Rowland G, Kelly A, Bosson S et al. A search for the evidence supporting community paediatric practice. Arch Dis Child 1999; 80(3):257-261.
  12. Baraldini V, Spitz L, Pierro A. Evidence-based operations in paediatric surgery. Pediatr Surg Int 1998; 13(5-6): 331-5.
  13. Kenny SE, Shankar KR, Rintala R, Lamont GL, Lloyd DA. Evidence-based surgery: interventions in a regional paediatric surgical unit. Arch Dis Child 1997; 76(1): 50-3.
  14. Khan AT, Mehr MN, Gaynor AM, Bowcock M, Khan KS. Is general inpatient obstetrics and gynaecology evidence-based? A survey of practice with critical review of methodological issues. BMC Womens Health 2006; 6: 5.
  15. Howes N, Chagla L, Thorpe M, McCulloch P. Surgical practice is evidence based. Br J Surg 1997; 84(9): 1220-3.
  16. Lee JS, Urschel DM, Urschel JD. Is general thoracic surgical practice evidence based? Ann Thorac Surg 2000; 70(2): 429-31.
  17. Lai TY, Wong VW, Leung GM. Is ophthalmology evidence based? A clinical audit of the emergency unit of a regional eye hospital. Br J Ophthalmol 2003; 87(4): 385-90.
  18. Carreazo NY, Bada CA, Chalco JP, Huicho L. Audit of therapeutic interventions in inpatient children using two scores: are they evidence-based in developing countries? BMC Health Serv Res 2004; 4(1): 40.
  19. Finnish Medical Society Duodecim. Deep vein thrombosis. EBM Guidelines. Evidence-Based Medicine. Helsinki: John Wiley & Sons; 2006.
  20. Finnish Medical Society Duodecim. Acute coronary syndromes: unstable angina pectoris and non-ST segment elevation myocardial infarction (NSTEMI). In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2007 Nov 28
  21. Scottish Intercollegiate Guidelines Network (SIGN): Clinical Guidelines. Management of acute upper and lower gastrointestinal bleeding. [Online]. Available from: http: www.sign.ac.uk/guidelines/index.html.
  22. Pfister R, Schneider CA. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: application of natriuretic peptides. Eur Heart J 2009; 30(3): 382-3.
  23. Singapore Ministry of Health. Management of asthma. Singapore: Singapore Ministry of Health; 2008.
  24. Scottish Intercollegiate Guidelines Network (SIGN): Clinical Guidelines. Management of early rheumatoid arthritis. [Online]Available from: http:
  25. www.sign.ac.uk/guidelines/index.html.
  26. National Collaborating Centre for Chronic Conditions. Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care. Thorax 2004; 59(1): 1-232.
  27. Flanc RS, Roberts MA, Strippoli GFM, Chadban SJ, Kerr PG, Atkins RC. Treatment for lupus nephritis. Cochrane Database of Systematic Reviews 2004; (1).
  28. Michael M, Elliott EJ, Craig JC, Ridley G, Hodson EM. Interventions for hemolytic uremic syndrome and thrombotic thrombocytopenic purpura: a systematic review of randomized controlled trials. Am J Kidney Dis 2009; 53(2): 259-72.
  29. Finnish Medical Society Duodecim. Myocardial infarction. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2006 Apr 26
  30. Paul M, Borok S, Fraser A, Vidal L, Leibovici L. Empirical antibiotics against Gram-positive infections for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 2005; 55(4): 436-44.
  31. Ozkaynak MF, Krailo M, Chen Z, Feusner J. Randomized comparison of antibiotics with and without granulocyte colony-stimulating factor in children with chemotherapy-induced febrile neutropenia: a report from the Children's Oncology Group. Pediatr Blood Cancer 2005; 45(3):
  32. -80.
  33. Runyon BA. Management of adult patients with ascites due to cirrhosis. Hepatology 2004; 39(3): 841-56.
  34. Lichtenstein GR, Abreu MT, Cohen R, Tremaine W. American Gastroenterological Association Institute medical position statement on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology 2006; 130(3): 935-9.
Journal of Isfahan Medical School
Volume 28, Issue 121 - Serial Number 121
November and December 2011
Pages 1598-1605

Files

History

  • Receive Date: 27 December 2010
  • Revise Date: 02 November 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics