Evidence-based practice: a critical appraisal by Liz Trinder, Shirley Reynolds

By Liz Trinder, Shirley Reynolds

Evidence-based perform is an idea whose time has come. Few strategies could have completed the prestige of unchallengeable logic in one of these brief house of time, and throughout this kind of extensive variety task. As but there were few possibilities to take inventory and think about the proof for evidence-based perform, or the consequences of its adoption. How powerful or possible is it in medication? Is it fairly diversified? What are the results of no longer basing perform on study? Can evidence-based perform be utilized in non-clinical settings, the place practitioners needs to care for the complexity of multi-problem members, households and corporations? this article introduces the major proposal of Evidence-Based perform and money owed for its emergence and quick growth inside of and past drugs. It then is going directly to describe how evidence-based perform is being translated in key parts (medicine, nursing, psychological healthiness schooling and social welfare) whereas significantly appraising the strengths and weaknesses of evidence-based perform because it applies in more than a few fields perform.

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It was assumed that the brightest students would enter a career in hospital medicine, and those who ‘fell off the ladder’, in Lord Moran’s phrase, would fall into general practice. These attitudes are far from extinct even today (Petchey et al. 1997). Traditionally, general practitioners learned medicine from and deferred to consultants, whose expertise and knowledge was regarded as authoritative. A good general practitioner was one who most thoroughly attended to the advice and superior knowledge of hospital specialists.

However, there are still only 36 professors of general practice or primary care in the UK, and 400 posts in general practice in universities in England and Wales out of a total of 7343 medical academic posts. In 1997 there were 18 600 hospital consultants and 27 100 unrestricted general practice principals in England (Department of Health 1998a and 199813). In 1995 there was one paid academic post per 124 GP principals in England and Wales, compared to 36 paid academic posts per 100 consultants (Royal College of General Practitioners 1997).

Qualitative methods were always appropriate to the primary care setting, although methodology has matured and become more sophisticated in recent years (Britten et al. 1995). 2). Different methods may be used to investigate aspects of the same topic. ’ (Fry 1959). Other studies might be very elaborate, involving complex statistical analysis to correct for confounding factors, in order to demonstrate that variation in referral rates is a genuine phenomenon (Cummins et aI. 1981), or use expert panels to assess the quality of referrals (Knottnerus et al.

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