Inzitari D, Carlucci G
Department of Neurological and Psychiatric Sciences, University of Florence, III Neurology Clinic-Stroke Unit, Italy.
Neurol Sci. 2006 Jun;27 Suppl 3:S225-7. doi: 10.1007/s10072-006-0622-y.
Evidence-based medicine's aims are to retrieve, screen and compound the best external evidence with the experience of the physician, and to best respond to the specific medical need of each individual patient. Clinical questions are better answered when good systematic reviews of randomised trials or good randomised clinical trials are available. On the other hand, in a clinical scenario, difficulties in applying the evidence may be amplified due to variability of disease conditions, feasibility of intervention and patient's preferences. Guidelines are recommendations, based as much as possible on evidence, aimed at supporting clinical judgement/diagnostic skills/treatment decisions in everyday practice. Guidelines may improve the quality of care received by the patient and may contribute towards better consistency of care in a definite geographical area. However, guidelines risk reducing physician skills to critically appraising the evidence. In a clinical scenario, guidelines do not always provide substantial help, especially when no conclusive evidence supports them. The Italian Stroke Guidelines (SPREAD) have contributed towards more evidence-based and better harmonised stroke care in Italy. However, the number of high grade recommendations in SPREAD is still limited. Professionals should not forget that clinical decisions often reflect several issues, not only scientific ones, including personal experience, applicability of intervention and patient's preferences.
循证医学的目标是检索、筛选并整合最佳外部证据与医生的经验，以最好地满足每个患者的具体医疗需求。当有高质量的随机试验系统评价或高质量的随机临床试验时，临床问题能得到更好的解答。另一方面，在临床情境中，由于疾病状况的变异性、干预的可行性和患者的偏好，应用证据时的困难可能会加剧。指南是尽可能基于证据的建议，旨在支持日常临床实践中的临床判断/诊断技能/治疗决策。指南可能会提高患者接受的护理质量，并有助于在特定地理区域内实现更好的护理一致性。然而，指南有降低医生批判性评估证据能力的风险。在临床情境中，指南并不总是能提供实质性帮助，尤其是在没有确凿证据支持时。意大利卒中指南（SPREAD）为意大利更基于证据且更协调一致的卒中护理做出了贡献。然而，SPREAD中高级别推荐的数量仍然有限。专业人员不应忘记，临床决策往往反映多个问题，不仅是科学问题，还包括个人经验、干预的适用性和患者的偏好。
