Monash Women's, Monash Health, Clayton, Australia.
Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia.
J Obstet Gynaecol. 2021 Oct;41(7):1076-1079. doi: 10.1080/01443615.2020.1845635. Epub 2021 Feb 18.
Evidence-based medicine tries to support clinicians through research, integrated with clinical skill and patient values. This pilot study aimed to assess appropriateness and level of evidence of current clinical practices, through evaluating availability and quality of guidelines.A prospective observational study in a large tertiary hospital network was performed, sampling diagnostic and therapeutic interventions in obstetrics and gynaecology. Interventions performed were justified against knowledge in the published literature, and guideline recommended practice. We collected 58 patient observations, 40(69%) in obstetrics, 18(31%) in gynaecology. There were local guidelines relevant in 52%, national in 22%, and international guidelines in 12%. In 50 interventions with available guidelines, 54% provided strong and clear recommendations for practice, and were supported by research-based knowledge. Similarly, 66% of encounters were thought to be in concordance with research-based knowledge.There was good concordance between interventions and guideline recommendations. However, half of guidelines reviewed had limited or no knowledge to justify their recommendations.IMPACT STATEMENT Evidence based medicine should aim to improve patient outcomes. However, available trials assessing effectiveness of established practices suggest that they convey little to no benefit to patients. There remains a paucity of evidence for established practices in obstetrics and gynaecology This pilot study assesses the usefulness of interventions in obstetrics and gynaecology and confirms the feasibility of collecting and coding our interventions and clinical practices with a traffic light system. These findings demonstrate the feasibility of our traffic lights grading system within obstetrics and gynaecology. It demonstrates this method is useful to assess what knowledge base is guiding clinical practice, how well practice concords with guidelines and literature, as well as the presence and significance of any gaps in knowledge. These early findings will be used in an expanded study and have implications on the way healthcare effectiveness is evaluated, as well as reducing healthcare expenditure in obstetrics and gynaecology.
循证医学试图通过研究，结合临床技能和患者价值观为临床医生提供支持。本试点研究旨在通过评估指南的可用性和质量，评估当前临床实践的适宜性和证据水平。在一个大型三级医院网络中进行了前瞻性观察研究，对妇产科的诊断和治疗干预进行了抽样。干预措施是根据已发表文献中的知识和指南推荐的实践来证明其合理性。我们收集了 58 例患者观察结果，其中 40 例（69%）为产科，18 例（31%）为妇科。在 52%的情况下有相关的地方指南，22%有国家指南，12%有国际指南。在有可用指南的 50 项干预措施中，54%为实践提供了强有力和明确的建议，并得到了基于研究的知识的支持。同样，66%的就诊被认为与基于研究的知识相符。干预措施与指南建议之间存在良好的一致性。然而，审查的一半指南的建议只有有限或没有知识依据。
循证医学应该旨在改善患者的结果。然而，评估既定实践效果的现有试验表明，这些实践对患者没有带来多少益处。在妇产科中，仍然缺乏既定实践的证据。本试点研究评估了妇产科干预措施的有用性，并证实了使用红绿灯系统收集和编码我们的干预措施和临床实践的可行性。这些发现证明了我们的红绿灯分级系统在妇产科中的可行性。它表明该方法可用于评估哪些知识库指导临床实践，实践与指南和文献的一致性如何，以及知识差距的存在和意义。这些早期发现将在一项扩展研究中使用，并对医疗保健效果评估方式以及减少妇产科医疗保健支出产生影响。
