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首页> 外文期刊>Archives of Internal Medicine >Translating evidence into practice: are we neglecting the neediest?
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Translating evidence into practice: are we neglecting the neediest?

机译：翻译证据付诸实践:我们忽视贫困?

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The rational and efficient application of effective treatment to those who derive the most benefit is an inherent attribute of high-quality health care. Yet how are physicians to accomplish this efficient and effective use of treatment within the frenetic pace of patient care? Accomplishing these aims requires adherence to a basic tenet of clinical epidemiology, that for an intervention with a given relative risk reduction, the absolute benefits are greatest in those with the greatest underlying risk. For example, if the use of statin therapy in patients with coronary artery disease results in a 30% relative risk reduction in death and the underlying risk of mortality is 20%, then the absolute risk reduction is 6 deaths for each 100 patients treated and the number of patients who need to be treated to save 1 life is 17. Conversely, if the underlying mortality rate is 2%, then the number of patients who need to be treated to save a life is 167. Obviously, much more aggressive treatment is warranted in higher-risk patients, since fewer need to be treated to save a life. Moreover, because all therapies are associated with some degree of risk, the benefits are more likely to outweigh those risks in the patients with the greatest underlying potential to benefit from treatment. Among the most established applications of this clinical logic is the use of bypass surgery, for which patients with the greatest risk for death (eg, those with left main coronary disease or triple-vessel disease with left ventricular dysfunction) are recommended for treatment. Consequently, outcomes researchers have developed numerous techniques for risk stratification to assist clinicians in identifying high-risk patients for whom more aggressive use of treatments can be considered.
机译：合理、高效的应用程序那些得到最有效的治疗好处是高质量的固有属性卫生保健。这种高效和有效治疗的使用在快节奏的病人护理?为了完成这些目标,我们需要坚持临床流行病学的基本原则,这对于一个干预与给定的相对风险减少,绝对的好处是最大的那些最伟大的潜在风险。例子中,如果在患者使用他汀类药物的治疗与冠状动脉疾病的30%相对风险降低和死亡潜在风险的死亡率是20%,那么绝对风险降低为每个100 6人死亡病人和病人的数量需要治疗以节省1生命是17。相反,如果底层的死亡率2%,那么患者需要的数量拯救生命是167。更积极的治疗是必要的高风险患者,因为更少的需要治疗,挽救一条生命。治疗与某种程度的相关联风险,更有可能大于好处这些风险最大的患者潜在的可能从治疗中获益。最成熟的应用临床逻辑是心脏搭桥手术的使用的患者的死亡风险最大(例如,那些左主干冠状动脉疾病与左心室triple-vessel疾病功能障碍)推荐的治疗。因此,研究人员已经开发出结果许多技术风险分层协助临床医生识别高风险患者来说,更积极的使用治疗可以考虑。

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