A Nordin-Johansson | PubMed Health

PubMed2000

Randomized controlled trials and consensus as a basis for interventions in internal medicine.

OBJECTIVES: To estimate the proportion of routine clinical interventions in internal medicine that are supported by the results of randomized controlled trials or consensus amongst experienced internists. DESIGN: Retrospective review of case records allowed one or more major diagnosis-intervention combination(s) to be identified for each patient. The scientific literature was searched for metaanalyses and randomized controlled trials in electronic databases that supported the specific intervention used. When support from randomized trials was lacking, possible consensus on management was sought by asking national expert panels of experienced clinicians. SETTING: Department of Medicine at a Swedish teaching hospital. SUBJECTS: At total of 197 consecutively admitted medical inpatients. RESULTS: Fifty per cent of the diagnosis-intervention combinations (186/369) were supported by results from randomized controlled trial evidence and 34% (125/369) were supported by consensus amongst experienced clinicians. The proportion of interventions based on randomised controlled trials was highest in patients with cardiac (64%) and other circulatory diagnoses (73%). There were no important differences between sexes or between age groups. CONCLUSIONS: Half of the interventions used in routine clinical practice amongst medical inpatients are supported by results from randomized controlled trials. These results refute popular claims that only a small proportion of medical interventions are supported by scientific evidence.

Aged↗

PubMed1999

[Evidence-based health care in practice. The scientific basis of clinical management is better than reported].

In a series of 197 consecutive patients admitted to a department of medicine, the scientific basis of major interventions was evaluated by comparison with corresponding data in published reports of randomised controlled trials (RCTs) or, if no such data were available, according to the consensus of a panel of experienced consultants in internal medicine. Of the 369 major interventions (including expectant management) in the series, 50 per cent were judged according to RCTs and 34 per cent according to panel consensus, no authoritative support being available in the remaining 16 percent of cases. Intervention consistent with corresponding RCT data was somewhat more common in the under 70 than in the over 70-year-old age subgroup of patients, but there was no such difference between male and female subgroups. Among the various specialties and subspecialties, support from RCTs was available for the majority of interventions in cardiology, stroke/angiology and gastroenterology, where-as support from the panel was available for the majority of interventions in endocrinology, nephrology, haematology, and oncology. Regarding the management of patients presenting with symptoms only, without a specific diagnosis, no support was available from RCTs and little consensus among the panel.

Adult↗