摘要:

Evidence-based medicine is the process of finding and applying the best available clinical research evidence to the management of individual patients. This first requires posing an appropriate answerable clinical question about diagnostic possibilities, prognosis, risks, diagnostic tests or treatment. We then need to rapidly and efficiently identify the best clinical research evidence to answer these questions. This may involve using either ‘predigested’ sources of evidence, such as systematic reviews or evidence-based guidelines, or, when these are not available, finding the primary evidence ourselves. Finally, this research evidence needs to be weighed, appraised and integrated with our clinical expertise to apply it to the individual patient problem.Recent studies have suggested that 82% of treatment decisions in a general medical ward and 69% of decisions in ambulatory care can be based on convincing evidence, more than half of which comes from randomised controlled trials. The key problem then is finding and integrating such evidence into routine practice. The recently established Cochrane Collaboration is beginning to provide a systematic summary of randomised trial evidence of the effects of treatment, but will take 5 to 10 years to provide comprehensive coverage. However, a number of other summary sources, together with skills in using ‘Medline’ efficiently and effectively, will provide practitioners with ready access to the best evidence. We illustrate these methods with several cases from ambulatory practice.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

The time has come for the development of standards to ensure quality and cost-effective care for the treatment of people with schizophrenia. Advances in understanding the efficacy of treatments for schizophrenia, the promise of new treatment advances derived from a rapidly evolving neuroscience, pressures to contain healthcare costs while maintaining or increasing quality, and the growth of advocacy on behalf of persons with schizophrenia are driving this need.The evidence for the efficacy of pharmacotherapies, psychological interventions, family interventions, vocational rehabilitation, and case management and assertive community treatment is summarised. This article presents the implications of the evidence for instituting disease management programmes for schizophrenia. Such disease management programmes must ensure that efficacious treatments are available, that both effectiveness and costs are considered in the allocation of resources, and that evaluative systems are in place to promote ongoing learning about how to provide the best care.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

International guidelines for the management of asthma are now available. These include the US National Heart, Lung, and Blood Institute (NHLBI) International Consensus for the Diagnosis and Treatment of Asthma and the NHLBI/World Health Organization Global Initiative for Asthma (GINA).The main purpose of such guidelines is to improve the quality of care for patients with asthma. This can only be accomplished, however, if these documents are effectively utilised. Effective utilisation will require the preparation of guidelines that can be readily adapted to requirements of local healthcare providers. To do this, consideration must be given to socioeconomic and practice differences within and between countries.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

The HIV/AIDS pandemic remains volatile and has become immensely complex. It is now a mosaic composed of a multitude of epidemics, which can be distinguished on the basis of: time of introduction of HIV; predominant modes of transmission; geography; age, sex, socioeconomic or behavioural characteristics of the populations most affected; rapidity of or potential for HIV spread; and availability of resources for prevention and care.From a global perspective, the pandemic disproportionately affects the developing world. HIV continues to spread at a diminished rate in the industrialised world and an increased rate in most parts of the resource-poor world. HIV increasingly affects people who, for reasons of race, sex, behaviour or social and economic status, are marginalised and have lesser access to preventive and healthcare services. As HIV epidemics spread and mature, their social, economic and demographic effects, particularly in the developing world, will continue to create great burdens on individuals, communities and countries, and may challenge the stability of entire regions.Current evidence of the effectiveness of HIV prevention and recent progress achieved in the development of new therapies provide the scientific basis on which an expanded response to growing prevention and care needs can be built. Even as prevention and treatment options improve, the human and economic costs of the pandemic will continue to be felt by individuals, families and loved ones, communities, countries and regions throughout the world.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS