Sudlow C M, Rodgers H, Kenny R A, Thomson R G
Department of Medicine, Medical School, University of Newcastle upon Tyne.
BMJ. 1995 Aug 26;311(7004):558-60. doi: 10.1136/bmj.311.7004.558.
Several large trials have shown that the risk of stroke in patients with non-valvar atrial fibrillation is reduced by treatment with warfarin. Implementing this research evidence requires not only an understanding of the trials' results and of the changes that they imply for clinicians' treatment decisions but also an appreciation of the organisation, quantity, and quality of services required to support these changes. Understanding of these implications is crucial for developing services that allow changes in practice to produce reductions in stroke incidence while minimising the risks of treatment. This article considers the developments in service provision that will probably be required to support the changes in clinical practice suggested by the trials' results. These services will be provided largely by doctors, and their development has implications for doctors in both primary and secondary care.
多项大型试验表明，使用华法林治疗可降低非瓣膜性心房颤动患者的中风风险。要将这一研究证据付诸实践，不仅需要理解试验结果以及这些结果对临床医生治疗决策所意味着的变化，还需要认识到支持这些变化所需服务的组织、数量和质量。理解这些影响对于开发服务至关重要，这些服务要能使实践中的变化降低中风发病率，同时将治疗风险降至最低。本文探讨了可能需要的服务提供方面的发展，以支持试验结果所建议的临床实践变化。这些服务将主要由医生提供，其发展对初级保健和二级保健中的医生都有影响。
