A search for the evidence supporting community paediatric practice

Abstract

Aim-Controversy exists regarding the evidence base of medicine. Estimates range from 20% to 80% in various specialties, but there have been no studies in paediatrics. The aim of this study was to ascertain the evidence base for community paediatrics. Methods-Twelve community paediatricians working in clinics and schools in Yorkshire, Manchester, Teesside, and Cheshire carried out a prospective review of consecutive clinical contacts. Evidence for diagnostic processes, prescribing, referrals, counselling/advice, and child health promotion was found by searching electronic databases. This information was critically appraised and a consensus was obtained regarding quality and whether it supported actions taken. Results-Two hundred and forty seven consultations and 1149 clinical actions were performed. Good evidence was found from a randomised controlled trial or other appropriate study for 39.9% of the 629 actions studied; convincing nonexperimental evidence for 7%; inconclusive evidence for 25.4%; evidence of ineVectiveness for 0.2%; and no evidence for 27.5%. Prescribing and child health promotion activities had the highest levels of quality evidence, and counselling/ advice had the lowest. Conclusions-An encouraging amount of evidence was found to support much of community paediatric practice. This study improved on previous research in other specialties because actions other than medications and surgery were included. (Arch Dis Child 1999;80:257-261)

Parental attitudes towards and perceptions of their children's participation in clinical research: a developing-country perspective

“…Whereas publication of adult randomised clinical trials (RCTs) increased by 4.71/year between 1985 and 2004, publication of paediatric RCTs increased by 0.4/year 2. In one study of community paediatric practice, only 40% of clinical decisions involving children were found to be evidence-based or supported by good-quality trials 3. Moreover, most paediatric studies were found to suffer from small sample sizes, which make them less likely to detect important treatment effects 1…”

Parents’ Perspectives on Research Involving Children

“…evidence-based medicine. Only a subgroup of children receives treatments approved for pediatric use (1)(2)(3). Prevalence of adverse drug reactions to off-label medication are high (4), because doses are estimated by body weight (5)(6)(7) under the assumption that children are small adults.…”

Paediatric patient family engagement with clinical research at a tertiary care paediatric hospital

“…Predictably, these difficulties may deter researchers and funding bodies and may have contributed to the dearth of high-quality paediatric research (4,5). As a result, <40% of paediatric medical decisions are supported by sufficient evidence (6), and most of these decisions are based on the results of research conducted with adult populations or no research whatsoever (7)(8)(9)(10).…”