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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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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To establish the effectiveness of clinical guideline implementation strategies. Data sources/study setting Systematic reviews in full text, English language, 1987-2007, reporting any measure of clinical process change or cost-benefit analysis. ⋯ Successful guideline implementation strategies should be multifaceted, and actively engage clinicians throughout the process.
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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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Randomized Controlled Trial
Improved guideline adherence to pharmacotherapy of chronic systolic heart failure in general practice--results from a cluster-randomized controlled trial of implementation of a clinical practice guideline.
Clinical practice guidelines (CPG) reflect the evidence of effective pharmacotherapy of chronic (systolic) heart failure (CHF) which needs to be implemented. This study aimed to evaluate the effect of a new, multifaceted intervention (educational train-the-trainer course plus pharmacotherapy feedback = TTT) compared with standard education on guideline adherence (GA) in general practice. ⋯ Despite of pre-existing high GA in both groups and an active control group, the multifaceted intervention was effective in quality of care measured by GA. Further research is needed on the choice of interventions in different provider populations.