Addressing modifiable risk factors for coronary heart disease in primary care: an evidence-base lost in translation.
Addressing modifiable risk factors for coronary heart disease in primary care: an evidence-base lost in translation.
复制标题
解决初级保健中冠心病的可改变危险因素：翻译中丢失的证据基础。
DOI：
10.1093/fampra/cmq025
复制
发表时间：
2010
期刊：
影响因子：
2.2
通讯作者：
S. de Lusignan
中科院分区：
文献类型：
--
作者：
Safia Debar;Pushpa Kumarapeli;J. Kaski;S. de Lusignan
背景
心血管疾病的风险因素可以在初级保健中修改。电子病历(EPR)系统包括嵌入式心血管风险因素计算器，应该会促进这一过程。
客观化
观察心血管风险评估和管理的证据基础在实践中是如何实施的。
方法
我们使用四个测试案例对初级保健中用于计算心血管风险的不同风险计算器进行了比较。我们观察了这些计算器是如何在初级保健EPR系统中实施的。我们通过一次研讨会探讨了全科医生认为哪些风险因素是重要的，并有动力将其作为临床护理的一部分加以解决。
结果
审查的风险计算器使用不同的风险因素集，对于相同的测试患者概况计算的风险级别差异高达100%。嵌入英国计算机系统的风险因素计算器都包括弗雷明翰方程，尽管界面、缺省值和患者组有所不同。全科医生对管理吸烟、血压、肥胖(体重指数)、糖尿病和胆固醇的重要性达成了共识，但也强调了提供个性化护理和锻炼专业判断的重要性。
结论
似乎在翻译过程中丢失了一个证据基础。不同的指南计算风险的方式不同，即使使用相同的指南，实施中的差异也会导致进一步的差异。教育和开发改进的风险计算器应使最适当的计算器能够用于个别患者；可通过使用一套标准的测试用例来实现实施的认证。
BACKGROUND
Risk factors for cardiovascular disease can be modified in primary care. Electronic patient record (EPR) systems include embedded cardiovascular risk factor calculators and should facilitate this process.
OBJECTIVE
To observe how the evidence base for assessing and managing cardiovascular risk is implemented in practice.
METHOD
We compared the different risk calculators promoted for calculating cardiovascular risk in primary care using four test cases. We looked to see how these calculators were implemented in primary care EPR systems. We explored through a workshop which risk factors GPs thought were important and felt motivated to address as part of clinical care.
RESULTS
The risk calculators reviewed use different sets of risk factors and the levels of risk calculated for the same test patient profiles vary by up to 100%. The risk factor calculators embedded within UK computer systems all include the Framingham equation though there is variation in interface, default values and patient groups included. GPs showed consensus around the importance of managing smoking, blood pressure, obesity (body mass index), diabetes and cholesterol but also stressed the importance of providing personalized care and exercising professional judgement.
CONCLUSIONS
There appears to be an evidence-base lost in translation. Different guidelines calculate risk differently, and even when the same guideline is used, variation in implementation leads to further variation. Education and development of improved risk calculators should enable the most appropriate calculator to be used for an individual patient; accreditation of implementation could be achieved through the use of a standard set of test cases.
影响因子：
105.7
作者：
Hippisley-Cox, Julia;Coupland, Carol;Brindle, Peter
通讯作者：
Brindle, Peter
DOI：
--
发表时间：
2001
期刊：
--
影响因子：
--
作者：
Kathryn Fitch;Steven J. Bernstein;Marfa D. Aguilar;Bernard Burnand;Juan R Lacalle
通讯作者：
Kathryn Fitch;Steven J. Bernstein;Marfa D. Aguilar;Bernard Burnand;Juan R Lacalle