Evidence-based Cardiology (Evidence-Based Medicine)

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Similarly, the significant time inherent in designing, funding and conducting clinical trials means that secular shifts in underlying patient populations and treatment patterns may render the insights from these trials less germane to contemporary practice.

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Finally, as the cardiac population ages, many patients will be affected by multiple co-morbidities. Most clinical research excludes patients with significant co-morbidity, and therefore cannot provide insight into significant portions of current cardiac populations. Understanding the relevance of clinical research to clinical practice can be accomplished by assessing research insights in the context of contemporary cardiac patients and treatment patterns.

This context can be provided by large, comprehensive clinical registries.

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The goal for these analyses is to assist front-line cardiovascular clinicians in applying clinical research insights to their individual patients. Furthermore, these analyses can identify relevant questions in contemporary practice that are unanswered by current clinical research data, and thus inform clinical researchers of important questions for future investigation.

The R2P initiative was founded in by Thomas M. Under the oversight of the R2P committee, chaired by Robert W. Yeh MD, FACC , eight recent cardiovascular clinical studies or evidence covering the spectrum of cardiovascular disease were identified and analyzed using their relevant NCDR clinical registry. B The York Database of Abstracts of Reviews of Effects DARE : complementing the data contained in the database of systematic revisions, DARE includes detailed critical analyses of two hundred revisions and summaries of publications of international health technology publications.

Evidence-Based Cardiology | Annals of Internal Medicine | American College of Physicians

It can be accessed free of charge at www. In Brazil it is currently possible to access the Cochrane Library free of charge by registering through Bireme at www. Health technology assessment is currently an essential part of the organization of health services and a clinical decision-making support tool. Various websites feature systematic revision on the subject, including aspects of economic evaluation in healthcare, especially cost-effectiveness studies.

Following are some of the major sites. Guidelines are systematic clinical positions established by official societies or organizations with a view to providing health professionals with updated information regarding the handling of diverse clinical problems.

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Ideally, such resources should be set up to respond objectively to specific clinical questions based on systematic reviews and randomized clinical tests. The guidelines do feature potential limitations such as the fact that many of their recommendations are based solely on the opinion of specialists and not on consistent evidence.

In addition, some of these positions are sponsored by the pharmaceutical industry and thus entail conflict of interests. The main guideline search sites are the National Guidelines Clearinghouse www. SumSearch www. In addition, as is the case with PubMed, users can specify the clinical-epidemiological focus of interest in their search for evidence.

OVID www. This database includes some of the most important sources of evidence such as Best Evidence and Clinical Evidence. The downside is that this site is not free of charge. There are textbooks currently available that include chapters dealing with EBM concepts.

Interventional cardiology’s golden age of contributions to evidence-based medicine

In the case of therapeutic interventions, one of the most complete and of highest quality is Clinical Evidence www. This is a compendium, updated every six months, that discusses the benefits and risks of various medical interventions based on systematic reviews and randomized clinical tests.

Its focus is basically preventive-therapeutic, and its chapters are organized based on clinical questions such as "What is the risk associated to the use of thrombolytics in the treatment of ischemic stroke? Clinical Evidence has the added advantage of featuring evidence search and evaluation methods in its text. It includes topics on various different fields of medicine such as cardiology, psychiatry, gynecology, gastroenterology, pulmonology, pediatrics, and others.

A recent release was Clinical Evidence Cardiovascular Disorders www. The book entitled Evidence Based Cardiology, edited by Yusuf et al and published by the BMJ, is a textbook that covers the main clinical themes on cardiovascular diseases and includes EBM concepts explicitly in its chapters, which makes it an excellent reference source.

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This book also has the advantage of providing updating on its website www. Another textbook - also entitled Evidence Based Cardiology but published by Shane and Cannono - features a collection of key references on broad themes in cardiology. Given its format as a manual, it has the advantage of being quick and easy to consult in day-to-day clinical practice. The website addresses listed below provide educational material on EBM such as electronic calculators, critical analysis cards on articles, course schedules, workshops and links to other that may be of interest.

  1. Cardiac/Vascular Intervention;
  2. Suffering and Healing in America: an American Doctors View from Outside!
  3. Cardiology Clinical Practice Guidelines Summaries.
  4. Guideline Summaries.
  5. ISBN 13: 9780727916990.

Also useful are sites that provide updated material about critical appraisal cards on articles such as the Centre for Health Evidence at www. Websites that provide training for searches in medical literature are also available. Pertinent information is also to be found at websites such as that of the periodical Bandolier at www.

On certain occasions, such as daily clinical practice, there is a need to find evidence more quickly.

At other times, such as in drawing up a research project, a more comprehensive search is needed. Thus, to optimize EBM practice, it is essential to determine the function of the various sources of evidence.

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Table I shows some of the main sources of evidence discussed in this text and an evaluation of their utility. Evidence based medicine: what it is and what it isn't. BMJ ; Evidence-based medicine working group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA ; The need for evidence-based medicine. J R Med ; Rosemberg W, Donald A.

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Evidence-based medicine: an approach to clinical-problem-solving. Evidence-based medicine. London; Churchill Livingstone; Hersh W.