Can Evidence‐Based Guidelines and Clinical Trials Tell us How to Treat Patients?
Can Evidence‐Based Guidelines and Clinical Trials Tell us How to Treat Patients?
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DOI：
10.1111/j.1528-1167.2007.01123.x
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发表时间：
2007-07
期刊：
影响因子：
5.6
通讯作者：
J. French
中科院分区：
文献类型：
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作者：
J. French
25年前，临床医生通常能够根据个人对可用治疗药物的经验来护理他或她的患者。由于几个原因，这种治疗方法在最近已经成为一项更加艰巨的任务。首先，可用的治疗方式的数量激增。这是非常困难的个人从业者跟上与所有这些可能的替代品使用的细微差别。其次，与这些疗法相关的文献数量也有所增加。虽然总的来说这是一件好事，但不幸的是，文献质量参差不齐。即使医生只关注研究，他或她也可能无法从表面上确定这些研究是否适合回答特定的临床问题。当然，期望所有从业者都是临床试验方法学专家是太过分了。出于所有这些原因，困惑的从业者已经将循证指南视为日常实践中急需的帮助。想到一群知识渊博的专家已经筛选了文献中所有可用的研究，提供了将导致最佳实践的“真理”核心，这是多么令人欣慰。难怪循证指南变得非常受欢迎，并且通常代表高影响力期刊中引用最多的文章，以及专业学会网站上下载最多的文件。所有这些对循证指南的兴奋导致了这样的印象，即它们实际上可以取代医生的经验，并提供一个路线图，
Twenty-five years ago, a clinician was usually able to render care to his or her patients based on personal experience with the therapeutic agents available. This approach to therapeutics has become a much more daunting task in recent times for several reasons. Firstly, the number of available therapeutic modalities has skyrocketed. It is very difficult for an individual practitioner to keep up with the nuances of use related to all of these possible alternatives. Secondly, the amount of literature relating to these therapies has also increased. While in general this is a positive thing, unfortunately the literature is of varying quality. Even if a practitioner pays attention only to research studies, he or she might be unable to determine on face value whether the studies are appropriate for answering a particular clinical question. It is certainly too much to expect that all practitioners will be experts on clinical trial methodology. For all of these reasons, the bewildered practitioner has looked to evidence-based guidelines as much needed assistance on daily practice. How reassuring to think that a group of knowledgeable experts has sifted through all available studies in the literature, to provide the kernel of “truth” that will lead to best practice. It is no wonder that evidence-based guidelines have become extremely popular, and usually represent the most cited articles in high impact journals, and the most downloaded files from specialty Society websites. All of this excitement about evidence-based guidelines has led to the impression that they can, in fact, replace physician experience, and provide a roadmap by which a