The paths from research to improved health outcomes.
The paths from research to improved health outcomes.
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DOI：
10.1136/ebn.8.2.36
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发表时间：
2005-04-01
影响因子：
--
通讯作者：
Haynes, Brian
中科院分区：
文献类型：
--
作者：
Glasziou, Paul;Haynes, Brian
循证医学旨在根据现有最好的研究证据，为临床医生和患者提供关于最有效护理的选择。对于患者来说，这是一种自然的预期。对于临床医生来说，这是一个几乎不可能实现的梦想。这份弥合质量鸿沟的美国报告记录了我们所知道的和我们所做的之间的差距，并引起了人们的注意。1该报告确定了3种类型的质量问题-过度使用、使用不足和误用。报告指出：“我们所有医疗质量问题的集体影响所传递的伤害负担是惊人的。”虽然人们的注意力集中在滥用(或错误)上，但更大比例的可预防负担可能是使用不足和过度使用的证据-实践差距。多年来，应该改变实践的研究往往被忽视--例如，休克时使用晶体(而不是胶体)，腰椎穿刺术后2个仰卧位，任何医疗条件下3个卧床休息，3在房颤患者中适当使用抗凝剂和阿司匹林。4 Antman等人记录了心血管试验结果与教科书建议之间的重大延迟。5然而，即使最佳做法众所周知，它们往往执行不力：国家调查显示，大多数高血压患者未被发现、未得到治疗或控制不充分，6这导致了目前对知识转化的兴趣。7在证据过剩的情况下预防饥荒8循证医学在弥合研究-实践差距方面发挥了什么作用？对临床医生的调查表明，使用当前研究证据的一个主要障碍是在大量研究中获取正确信息所需的时间、精力和技能。9，即使对于一个
Evidence-based medicine aims to provide clinicians and patients with choices about the most effective care based on the best available research evidence. To patients this is a natural expectation. To clinicians this is a near impossible dream. The US report Bridging the quality chasm has documented and drawn attention to the gap between what we know and what we do. 1 The report identified 3 types of quality problems—overuse, underuse, and misuse. It suggested:‘‘The burden of harm conveyed by the collective impact of all of our health care quality problems is staggering.’’While attention has focused on misuse (or error), a larger portion of the preventable burden is likely to be the evidence-practice gaps of underuse and overuse. Research that should change practice is often ignored for years—for example, crystalloid (rather than colloid) for shock, 2 supine position after lumbar puncture, 3 bed rest for any medical condition, 3 and appropriate use of anticoagulants and aspirin among patients with atrial fibrillation. 4 Antman et al documented the substantial delays between cardiovascular trial results and textbook recommendations. 5 However, even when best practices are well known they are often poorly implemented: national surveys show that the majority of hypertensive patients are undetected, untreated, or inadequately controlled, 6 which has led to the current interest in knowledge translation. 7PRACTICE FAMINE AMIDST THE EVIDENCE GLUT What role does evidence-based medicine8 have in bridging the research-practice gap? Surveys of clinicians suggest that a major barrier to using current research evidence is the time, effort, and skills needed to access the right information among the massive volumes of research. 9 Even for a