Advertisement

Evidence-based medicine as a strategy for improving the quality of clinical decision making for dialysis patients

  • David N. Churchill
Part of the Developments in Nephrology book series (DINE, volume 39)

Abstract

Traditional clinical decision making has been based on information provided by clinical experts, usually during undergraduate and post graduate training, and then supplemented by formal continuing medical education and informally through consultations. There is an implicit assumption that the need for scientific information is satisfied by this process. However, there is convincing evidence that this assumption is incorrect [1]. The opinion of experts is often inconsistent with scientific evidence [2]. In response to this unsatisfactory situation, the concept of evidence-based medicine has evolved [3].

Keywords

Medical Literature Clinical Practice Guideline National Kidney Foundation Post Graduate Training Individual Article 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Williamson JW, German PS, Weiss R, Skinner EA and Bowes F. Health science information management and continuing education of physicians: a survey of US primary dare physicians and their opinion leaders. Ann Intern Med 1989; 110:151–60PubMedGoogle Scholar
  2. 2.
    Antman EM, Lao J, Kupelnick B, Mosteller F and Chalmers TC. A comparison of results of meta-analysies of randomized control trials and recommendations of clinical experts; treatments for myocardial infarction. JAMA 1992; 268:240–8PubMedCrossRefGoogle Scholar
  3. 3.
    Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA 1992; 268:2420–5.CrossRefGoogle Scholar
  4. 4.
    Kuhn TS. The structure of scientific revolutions. Chicago, Ill: University of Chicago Press; 1970.Google Scholar
  5. 5.
    Carruthers SG, Larochelle P, Haynes RB, Petrasovits A and Schiffrin EL. Report of the Canadian hypertension society concensus conference: 1. Introduction. Can Med Asoc J 1993; 149:289–93Google Scholar
  6. 6.
    Oxman AD, Sackett DL, Guyatt GH for the Evidence-Based Medicine Working Group.Users guides to the medical literature. 1. How to get started. JAMA 1993; 270:2093–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Haynes RB, McKibbon K.A, Fitzgerald D, Guyatt GH, Walker CJ and Sackett DL. How to keep up with the medical literature, V access by personal computer to the medical literature. Ann Intern Med 1990; 112:78–84.PubMedGoogle Scholar
  8. 8.
    Guyatt GH, Sackett DL, Cook DJ for the Evidence-Based Medicine Working Group. Users guides to the medical literature. II How to use an article about therapy or prevention. A. Are the results of the study valid? JAMA 1993; 270: 2598–601.PubMedCrossRefGoogle Scholar
  9. 9.
    Guyatt GH, Sackett DL, Cook DL for the Evidence-Based Medicine Working Group. Users guides to the medical literature. II How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? JAMA 1994; 271:59–63.PubMedCrossRefGoogle Scholar
  10. 10.
    Chalmers TC, Celano P, Sacks HS and Smith H Jr. Bias in treatment assignments in controlled clinical trials. N Engl J Med 1983; 309:1358–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Colditz GA, Miller JN and Mosteller F. How study design affects outcomes in comparisons of therapy, I. Medical. Stat Med 1989; 8:441–54.CrossRefGoogle Scholar
  12. 12.
    Haynes RB, Mukherjee J, Sackett DL, Taylor DW, Barnett HJM and Peerless SJ. Functional status changes following medical or surgical treatment for cerebral ischemia: results in the EC/IC Bypass Study. JAMA 1987; 257:2043–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Oxman AD and Guyatt GH. A consumer’s guide to subgroup analysis. Ann Intern Med 1992; 116: 78–84.PubMedGoogle Scholar
  14. 14.
    Oxman AD, Cook DJ, Guyatt GH for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature. VI. How to use an overview. JAMA 1994; 272:1367–71.PubMedCrossRefGoogle Scholar
  15. 15.
    Chalmers TC, Berrier J, Sacks HS et al: Meta-analysis of clinical trials as a scientific discipline, II: replicate variability and comparison of studies that agree and disagree. Stat Med 1987; 6: 733–44.PubMedCrossRefGoogle Scholar
  16. 16.
    Klahr S, Levey AD, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, Striker G for the Modification of Diet in Renal Disease Study Group. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med 1994; 330: 877–44PubMedCrossRefGoogle Scholar
  17. 17.
    Mehta R, McDonald B, Gabbi F, Pahl M, Farkas A, Pascual M, Fowler W for the ARF Collaborative Study Group. Continuous versus intermittent dialysis for acute renal failure in the ICU. J Am Soc Nephrol 1996; 7:1457 (abstract).Google Scholar
  18. 18.
    Levey AS, Adler S, Caggiula AW, England BK, Greene T, Hunsicker LG et al. Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease Study. Am J Kidney Dis 1996; 27:652–63.PubMedGoogle Scholar
  19. 19.
    Pedrini MT, Levey AS, Lau J, Chalmers TC and Wang PH. The effect of dietary protein restriction on the progression of diabetic and non-diabetic renal diseases: a meta-analysis. Ann Intern Med 1996; 124:627–32.PubMedGoogle Scholar
  20. 20.
    Browman GP, Levine MN, Mohide EA, Hayward RS, Pritchard KJ, Gafni A et al: The practice guidelines developement cycle: a conceptual tool for practice guidelines development and implementation. J Clin Oncol 1995; 13:502–12PubMedGoogle Scholar
  21. 21.
    Davis DA and Taylor-Vaisey A. Translating guidelines into practice: a systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. Can Med Assoc J 1997; 157:408–16.Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • David N. Churchill

There are no affiliations available

Personalised recommendations