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PubMed1995

Inpatient general medicine is evidence based. A-Team, Nuffield Department of Clinical Medicine.

For many years clinicians have had to cope with the accusation that only 10-20% of the treatments they provide have any scientific foundation. Their interventions, in other words, are seldom "evidence based". Is the profession guilty as charged? In April, 1995, a general medical team at a university-affiliated district hospital in Oxford, UK, studied the treatments given to all 109 patients managed during that month on whom a diagnosis had been reached. Medical sources (including databases) were then searched for randomised controlled trial (RCT) evidence that the treatments were effective. The 109 primary treatments were then classified: 82% were evidence based (ie, there was RCT support [53%] or unanimity on the team about the existence of convincing non-experimental evidence [29%]). This study, which needs to be repeated in other clinical settings and for other disciplines, suggests that earlier pessimism over the extent to which evidence-based medicine is already practised is misplaced.

Clinical Medicine↗
PubMed1993

Osler's changing influence. Based on the Osler oration given at the Royal College of Physicians in 1990.

Over 20 years in North America William Osler transformed the pattern of medical education for both undergraduates and specialists. He wrote a textbook that not only was a stimulus to medical students and young doctors, but also inspired the railway baron J D Rockefeller to devote his wealth to the advancement of medical research and education. He encouraged the creation of medical associations and societies because he believed, rightly, that these enhanced not only the quality of medicine but also the relationship of the members of the profession, one with another. He provided a great library of medical history and medical biography which has been and will be an inspiration for years to come. In the 15 years Osler spent in England he created a school of medical science which has continued to burgeon and has formed a foundation for a great clinical and research medical school. He inspired the creation of the post-graduate centres associated with the general hospitals in every town throughout the country; he provided material for a biography which has inspired medical students and practitioners, who now realise that medicine is primarily about sick people, not disease; and he directed another great benefactor, Lord Nuffield, to devote his riches to many aspects of medicine.

Education, Medical↗