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Evidence-based medicine and patient-centred medicine: the need to harmonize

机译：循证医学和以患者为中心的医学：需要协调

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Randomized controlled trials are internationallynagreed to represent the highest test of an interventionnin medical research, the gold standard, and thenfundamental basis of evidence-based medicine (EBM).nThey are also the basis of numerous clinical guidelines.nWhy then are articles that challenge EBM and guidelinesnnow appearing?1,2 The answer is patient-centrednmedicine (PCM), care focused on the three dimensionsnof personal care: physical, psychological and social.3nThis involves integrating the patient’s culture,nsocio-economic circumstances, past history, values andnpreferences.nLimitations of randomized trials in medicalnresearchnThere are four issues limiting the use of evidence fromnrandomized trials by clinicians:nu0001 relevance of the population studiednu0001 clinical monitoring of the patients studiednu0001 assessment of adverse effectsnu0001 duration of the research.nResearch on the use of warfarin for atrial fibrillation,na therapy included in governmental guidance in thenUK, illustrates these four concerns.nFirst, in the SPAF Study,4 97% of 18,376 eligiblenpatients were excluded, i.e. almost all patients innclinical practice. Second, the monitoring of patients innthe AFASAK study5 included three full medicalnexaminations in the first year and repeated echocardiography.nHow much did this protect patients? Hownreplicable is it in routine practice? Third, the BATAFnStudy6 classified the adverse effect of bleeding (requiringnblood transfusion of three units) as minor. Donpatients and their doctors agree? And, fourth, none ofnthe studies lasted more than 2.5 years and two lastednless than 18 months despite previous research havingnfound that the adverse effects of warfarin increase withnlong-term use.7,8 How secure is advice for lifelongntreatment? Naturally, some general practitioners havenquestioned the applicability of these randomized trialsnto routine primary care.9
机译：随机对照试验在国际上被认为是医学研究，金标准，然后是循证医学（EBM）的基础的最高标准。n它们也是众多临床指南的基础。 1,2答案是以患者为中心的药物（PCM），护理重点是个人护理的三个维度：身体，心理和社会。3n这涉及整合患者的文化，社会经济状况，既往历史，价值观和偏好。n临床研究中的随机试验的存在n限制临床医生使用随机试验的证据有四个问题：nu0001所研究人群的相关性nu0001对所研究患者的临床监测nu0001不良反应的评估nu0001研究持续时间.n使用华法林治疗房颤的研究，n政府指南中包含的疗法nUK说明了这四个问题。n首先，在SPAF研究中，4 18,376名合格的患者中有97％被排除在外，即几乎所有患者都缺乏临床实践。其次，在AFASAK研究5中对患者进行的监测包括在第一年进行了三次完全的医学检查和重复的超声心动图检查。这对患者有多少保护？在日常实践中这有多难懂？第三，BATAFnStudy6将出血的不良反应（要求输血三个单位）归为轻微。病人和他们的医生同意吗？而且，第四，尽管先前的研究发现华法林的不良作用会随着长期使用而增加，但没有一项研究能持续超过2.5年，而两项研究都持续不到18个月。7,8终身治疗建议的安全性如何？自然地，一些全科医生对这些随机试验在常规初级保健中的适用性提出质疑。9

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