Journal of evaluation in clinical practice
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There is mounting evidence of a gap between Evidence-based Medicine (EBM) and physician clinical practice, in part because EBM is averaged global evidence gathered from exogenous populations which may not be relevant to local circumstances. Local endogenous evidence, collected in particular and 'real world' patient populations may be more relevant, convincing and timely for clinical practice. Evidence Farming (EF) is a concept to provide such local evidence through the systematic collection of clinical experience to guide more effective practice. ⋯ Clinical experience is relatively neglected by the EBM movement, but if that experience were systematically gathered through an approach such as EF, it would meet a need left unfulfilled by EBM.
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To measure knowledge of Israeli low back pain (LBP) clinical practice guidelines among different subgroups of primary care doctors, prior to designing an intervention programme to enhance guideline adherence in practice. ⋯ Striking differences exist between subgroups of primary care doctors regarding their knowledge of LBP guidelines. These differences will require the design of multiple interventions tailored to each subgroup.
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Knowledge in evidence-based medicine (EBM) is increasingly becoming a core competence in medical education. We evaluated the trainee doctors' attitudes and knowledge of EBM to obtain the basis required for developing appropriate teaching and learning opportunities. ⋯ The present study demonstrates that the majority of trainee physicians at a Tehran University hospital lack adequate knowledge about basic concepts of EBM. Furthermore, most of them continue to use traditional sources of knowledge rather than evidence-based sources. On the positive side, there was an overall positive attitude towards EBM and the majority had a positive tendency to take part in EBM training courses.
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Evidence-based medicine is being applied to decisions in a range of contexts beyond one-to-one patient care. Yet considerable disagreement persists regarding the defining components of evidence-based decision-making, particularly in institutional and public health contexts. ⋯ Asking critical questions about the purposes and context of a specific decision, basic principles of evidence-based reasoning can be appropriately applied beyond the bedside.
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Urinary incontinence is a common problem, affecting quality of life and leading to high costs. There is doubt about the use of clinical practice guidelines on urinary incontinence in primary care. ⋯ Dutch GPs follow the guideline only partially: compliance with diagnostic advices is fairly good; compliance with treatment advices is low. Further research should focus on solutions how to support GPs to tackle major barriers to facilitate the adherence to guidelines (substitution of tasks to specialized nurses, reducing the threshold for referral and concentrating expertise in integrated continence care services).