The integration of evidence based medicine and personal care in family practice

Abstract

Evidence based medicine is seductive in its simplicity and few would argue with the philosophical concept. The reality of its application in primary care is rather different. It is difficult to find evidence supporting many clinical management decisions, it may be difficult to interpret evidence when it is available, and it may be difficult to apply this evidence in the consultation. Clinical decisions may be influenced at many levels through health policy, audit, protocols, and guidelines, but the individual doctor patient relationship remains at the core of general practice. Developing a culture of evidence based medicine in general practice must integrate quantitative and qualitative research, epidemiology and psychology and the skills of public health and family medicine.

General practitioners' perceptions of the route to evidence based medicine: a questionnaire survey

“…Views on major barriers to practising evidence based medicine —The barriers described in this study are more pragmatic than some of those identified in other papers 7 17. Lack of personal time was the main perceived barrier.…”

“…The case notes may not have been representative of typical consultations, as only recorded consultations with a primary diagnosis and intervention were used and in general practice patients rarely enter the consulting room with a discrete, one dimensional problem 15 16. Other reviews have suggested that evidence based medicine is less relevant to general practice than other specialties because it mainly addresses the biomedical perspective of diagnosis from a doctor centred paradigm7 and does not integrate quantitative and qualitative research, epidemiology, and psychology and the skills of public health and family medicine 17…”

Elucidating the Nature of theStreptomyces plicatusβ-Hexosaminidase-Bound Intermediate Using ab initio Molecular Dynamics Simulations

“…Recent studies of the conformation of thiazoline 3 and derivatives in solution suggest that the observed conformation (as adjudged by vicinal proton coupling constants) is solvent-dependent; 50 further studies show that, in aqueous solutions, the 3 J 1 H NMR coupling constants found for the hexopyranose ring of thiazoline 3 are pH-sensitive. 51 While thiazoline 3 and its N-acyl derivatives orient their aliphatic side chains in the hydrophobic binding pocket of GH-84 enzymes in a manner consistent with that found during a reactive pathway, 49 no experimental evidence directly linking the hexopyranose conformation of bound thiazolines 3 to the enzymes' conformational itinerary is available. Furthermore, we expect that the pK a of the thiazolinium ion of 3 will be significantly lower than that of the associated oxazolinium ion 2 and the predominant protonation state of the enzyme-bound thiazoline need not necessarily match that of the enzyme-bound oxazoline.…”

Knowledge and Attitudes of Physicians Towards Evidence Based Medicine in Ilam, Iran

“…Physicians are being encouraged to apply EBM to improve their clinical care worldwide(7). EBM offers a systematic and structured approach of medical education (8). It sensitizes physicians for necessity of updating advances in their practicing field (9, 10) so it helps physicians during the process of decision making for an optimal treatment.…”