[The role of epidemiological evidence in providing care for individual patients].
Evidence-based medicine is increasingly being viewed as a sine-qua-non for the modern and high-quality practice of medicine. 'Evidence' refers to the availability of epidemiological research. In this paper, we discuss a number of limitations of over-emphasis on epidemiological evidence. We focus on the availability, reliability and applicability of epidemiological evidence in the context of individualised medicine. We conclude that relying excessively on epidemiological evidence is a danger that we are insufficiently aware of. The implications of our conclusions for patient care and health policy are discussed. We propose that epidemiological evidence should be used for benchmarking average care provided by doctors working alone or in group practices, but not for benchmarking care provided to individual patients.
Available from: Dirk T Ubbink
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ABSTRACT: Evidence-based practice (EBP) is a generally accepted means to improve healthcare quality. However, not all healthcare professionals and managers apply EBP in daily practice. We investigated EBP attitudes, knowledge and the perceived barriers and facilitators to practising EBP , to define tailor-made interventions for improving evidence-based behaviour.
In this cross-sectional survey, doctors and nurses from five major specialities of a university hospital were invited to complete the McColl and Barriers questionnaires.
Response rates were 70% (305÷435) for doctors and 74% (396÷537) for nurses. They were welcoming towards EBP, but considered time constraints, knowledge gaps and poor availability of evidence as major barriers to implement EBP . They also mentioned contradicting results (75%) and flawed methodology (69%), while nurses frequently mentioned unawareness of (75%), or difficulty in reading and interpreting research papers (70%). Regarding EBP knowledge, 6/8 common EBP terms could be explained by 54% of doctors but by only 15% of nurses. Facilitating factors among doctors concerned the availability and accessibility of high-level evidence and communication of evidence during various clinical meetings and handovers for clinical decision making. Among nurses, promoting factors involved more teaching and instances to incorporate EBP in clinical practice. Both groups desired more managerial support in terms of motivation and opportunities.
Doctors and nurses have embraced the EBP paradigm as an important means to improve quality of clinical patient care, but its application is still cumbersome. This paper offers a tailored programme for implementation and managerial role-models.sustainment of EBP, corroborated by professional and managerial role-models.
The Netherlands Journal of Medicine 02/2011; 69(2):87-94. · 1.97 Impact Factor
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ABSTRACT: This article describes evidence-based practice (EBP) in the health professions and sciences in general and in the rehabilitation disciplines specifically. It discusses the following: what counts as evidence and how that has changed over the last 4 decades, trends in the short history of evidence-based medicine and EBP, the fallacious nature of most criticisms of EBP, (perceived) shortcomings of clinical research and the resulting evidence in rehabilitation, resources available to clinicians who want their practice to be evidence-based, and the barriers these clinicians face in keeping up with the evidence and applying it in practice. Lastly, it describes how the development of a new art and science, knowledge translation, may play a role in truly making EBP feasible in rehabilitation services.
Archives of physical medicine and rehabilitation 06/2012; 93(8 Suppl):S164-76. DOI:10.1016/j.apmr.2011.12.014 · 2.57 Impact Factor
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