| Users' guides to the medical literature: XX. Integrating research evidence with the care of the individual patient. Evidence-Based Medicine Working Group. | |
| | |
MedLine Citation:
|
PMID: 10838653 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Clinicians can use research results to determine optimal care for an individual patient by using a patient's baseline risk estimate, clinical prediction guidelines that quantitate an individual patient's potential for benefit, and published articles. We propose that when clinicians are determining the likelihood that treatment will prevent the target event (at the expense of adverse events) in a patient that they also incorporate the patient's values. The 3 main elements to joint clinical decision making are disclosure of information about the risks and benefits of therapeutic alternatives, exploration of the patient's values about both the therapy and potential outcomes, and the actual decision. In addressing the patient's risk of adverse events without treatment and risk of harm with therapy, clinicians must recognize that patients are rarely identical to the average study patient. Differences between study participants and patients in real-world practice tend to be quantitative (differences in degree of risk of the outcome or responsiveness to therapy) rather than qualitative (no risk or adverse response to therapy). The number needed to treat and number needed to harm can be used to generate patient-specific estimates relative to the risk of the outcome event. Clinicians must consider a patient's risk of adverse events from any intervention and incorporate the patient's values in clinical decision making by using information about the risks and benefits of therapeutic alternatives. JAMA. 2000;283:2829-2836 |
| | |
Authors:
|
F A McAlister; S E Straus; G H Guyatt; R B Haynes |
Related Documents
:
|
16251173 - Disseminated intravascular coagulation in pediatric patients: clinical and laboratory f... 11011353 - Considerations for the use of antidepressants in patients with cardiovascular disease. 12353853 - Colonic tuberculosis. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: JAMA : the journal of the American Medical Association Volume: 283 ISSN: 0098-7484 ISO Abbreviation: JAMA Publication Date: 2000 Jun |
Date Detail:
|
Created Date: 2000-07-07 Completed Date: 2000-07-07 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 7501160 Medline TA: JAMA Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 2829-36 Citation Subset: AIM; IM |
Affiliation:
|
Mount Sinai Hospital, Suite 431, 600 University Ave, Toronto, Ontario, Canada, M5G 1X5 sstraus@mtsinai.on.ca |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Decision Making Evidence-Based Medicine* Humans Patient Care* Periodicals as Topic* Research* Risk |
| Comments/Corrections | |
Comment In:
|
JAMA. 2000 Nov 22-29;284(20):2594; author reply 2595
[PMID:
11086361
]
JAMA. 2000 Nov 22-29;284(20):2595 [PMID: 11086362 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Effectiveness of automatic shoulder belt systems in motor vehicle crashes.
Next Document: Public health law in a new century: part I: law as a tool to advance the community's health.