Bhatt R, Sandramouli S
Wolverhampton and Midland Counties Eye Infirmary, Wolverhampton, UK.
Eye (Lond). 2007 Jul;21(7):976-83. doi: 10.1038/sj.eye.6702374. Epub 2006 Apr 28.
To study the overall level of evidence-based practice in an accident and emergency eye unit in the UK and evaluate the extent of evidence-based practice by ophthalmologists and nurse practitioners (NPs).
The case notes of all new patients attending our accident and emergency department for a period of 1 week were reviewed prospectively. For each case, the diagnosis at presentation and its intervention was ascertained. A literature search using Medline and Cochrane library was performed to assess the level of evidence provided for each diagnosis-intervention pair. Each diagnosis-intervention pair was evaluated and graded to assess the best level of evidence provided.
A total of 474 new patients attended the eye casualty during the study period. No diagnosis was made in 27 cases and they were excluded from the analysis. Out of 447 patients, 308 (68.9%) cases were managed by NPs and 139 (31.1%) by doctors. A total of 294 (65.8%) patient interventions were based on evidence from systematic reviews, meta-analysis and randomised-controlled trials, of which 223 were managed by NPs and 71 by ophthalmologists. This difference was statistically significant with P<0.001. One hundred and seven (23.9%) interventions were supported by evidence from prospective and retrospective trials.
This study demonstrated that two-thirds of interventions were based on the highest level of evidence and was comparable to studies performed in other specialities. It also highlights the advanced role of trained NPs in acute ophthalmology.
研究英国一家急诊眼科单位循证实践的总体水平，并评估眼科医生和执业护士（NPs）循证实践的程度。
前瞻性地回顾了在我们急诊科就诊的所有新患者连续1周的病历。对于每个病例，确定就诊时的诊断及其干预措施。使用Medline和Cochrane图书馆进行文献检索，以评估每个诊断-干预对所提供的证据水平。对每个诊断-干预对进行评估和分级，以评估所提供的最佳证据水平。
在研究期间，共有474名新患者到眼科急诊就诊。27例未做出诊断，被排除在分析之外。在447例患者中，308例（68.9%）由NPs管理，139例（31.1%）由医生管理。共有294例（65.8%）患者的干预措施基于系统评价、荟萃分析和随机对照试验的证据，其中223例由NPs管理，71例由眼科医生管理。这种差异具有统计学意义，P<0.001。107例（23.9%）干预措施得到前瞻性和回顾性试验证据的支持。
本研究表明，三分之二的干预措施基于最高水平的证据，这与其他专科的研究结果相当。它还突出了训练有素的NPs在急性眼科中的先进作用。
