This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (69)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Patient Safety/ Medical Error  • Alert me on articles by topic

XIV. How to Decide on the Applicability of Clinical Trial Results to Your Patient

Antonio L. Dans, MD; Leonila F. Dans, MD; Gordon H. Guyatt, MD, MSc; Scott Richardson, MD; for the Evidence-Based Medicine Working Group

JAMA. 1998;279:545-549.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

CLINICAL SCENARIO

You are the attending physician on duty when a poor, 45-year-old man presents to the emergency department of a general hospital in the Philippines. He has severe chest pain for 2 hours, associated with clammy perspiration. Physical examination reveals a blood pressure of 110/70 mm Hg, a pulse rate of 92 beats per minute, a normal first heart sound, and clear lungs. An electrocardiogram discloses 3-mm ST-segment elevation in the inferior leads. As intravenous lines are placed, and the patient is prepared for admission to the coronary care department, you consider whether you should offer this patient a thrombolytic agent. Though your response is that the impecunious patient cannot afford the treatment, you ponder the right course of action in a richer patient. As your duty ends that . . . [Full Text of this Article]

THE SEARCH

THE GUIDES—BIOLOGIC ISSUES

Are There Pathophysiologic Differences in the Illness Under Study That May Lead to a Diminished Treatment Response?

Sources of Evidence

Are There Patient Differences That May Diminish the Treatment Response?

Sources of Evidence

SOCIAL AND ECONOMIC ISSUES

Are There Important Differences in Patient Compliance That May Diminish the Treatment Response?

Sources of Evidence

Are There Important Differences in Provider Compliance That Might Diminish the Safety and Efficacy of the Treatment?

Sources of Evidence

EPIDEMIOLOGIC ISSUES

Do My Patients Have Comorbid Conditions That Significantly Alter the Potential Benefits and Risks of the Treatment?

Sources of Evidence

Are There Important Differences in Untreated Patients' Risk of Adverse Outcomes That Might Alter the Efficiency of Treatment?

Sources of Evidence

COMMENT

RESOLUTION OF THE SCENARIO

From the Departments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario (Dr Guyatt); the Departments of Internal Medicine (Dr A. L. Dans) and Pediatrics (Dr L. F. Dans), University of the Philippines College of Medicine, Manila; and the Department of Medicine, University of Texas Health Sciences Center, San Antonio (Dr Richardson).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Evidence-based Medicine: Critical Appraisal of the Literature (Critical Appraisal Tools)
Raslich and Onady
Pediatr. Rev. 2007;28:132-138.
FULL TEXT  

Searching for Evidence-Based Medicine in the Literature Part 3: Assessment
Bartkowiak
Clin Med Res 2005;3:113-115.
FULL TEXT  

Prior convictions: bayesian approaches to the analysis and interpretation of clinical megatrials
Diamond and Kaul
J Am Coll Cardiol 2004;43:1929-1939.
ABSTRACT | FULL TEXT  

Practical Clinical Trials: Increasing the Value of Clinical Research for Decision Making in Clinical and Health Policy
Tunis et al.
JAMA 2003;290:1624-1632.
ABSTRACT | FULL TEXT  

Applying Trial Evidence Back to the Patient
Williams
Arch Dermatol 2003;139:1195-1200.
FULL TEXT  

Best evidence and the clinical decision making process
Pirmohamed
Postgrad. Med. J. 2002;78:316-316.
FULL TEXT  

Evidence-based Radiology: A New Approach to the Practice of Radiology
The Evidence-Based Radiology Working Group
Radiology 2001;220:566-575.
ABSTRACT | FULL TEXT  

Applying the results of trials and systematic reviews to our individual patients
Straus and McAlister
Evid. Based Ment. Health 2001;4:6-7.
FULL TEXT  

Erythropoietin: A Paradigm for the Development of Practice Guidelines
Rizzo et al.
ASH Education Book 2001;2001:10-30.
ABSTRACT | FULL TEXT  

GENERAL CARDIOLOGY: Evaluation of large scale clinical trials and their application to usual practice
Tonkin
Heart 2000;84:679-684.
FULL TEXT  

Evidence-based medicine: a commentary on common criticisms
Straus and McAlister
CMAJ 2000;163:837-841.
ABSTRACT | FULL TEXT  

Users' Guides to the Medical Literature: XXV. Evidence-Based Medicine: Principles for Applying the Users' Guides to Patient Care
Guyatt et al.
JAMA 2000;284:1290-1296.
ABSTRACT | FULL TEXT  

The need and means for evidence-based medicine in developing countries
Dans and Dans
Evid. Based Med. 2000;5:100-101.
FULL TEXT  

Users' Guides to the Medical Literature: XX. Integrating Research Evidence With the Care of the Individual Patient
McAlister et al.
JAMA 2000;283:2829-2836.
ABSTRACT | FULL TEXT  

Users' Guides to the Medical Literature: XIX. Applying Clinical Trial Results; B. Guidelines for Determining Whether a Drug Is Exerting (More Than) a Class Effect
McAlister et al.
JAMA 1999;282:1371-1377.
FULL TEXT  

Users' Guides to the Medical Literature: XIX. Applying Clinical Trial Results; A. How to Use an Article Measuring the Effect of an Intervention on Surrogate End Points
Bucher et al.
JAMA 1999;282:771-778.
FULL TEXT  

A 75-Year-Old Man With Congestive Heart Failure
Guyatt
JAMA 1999;281:2321-2328.
FULL TEXT  

Users' Guides to the Medical Literature: XV. How to Use an Article About Disease Probability for Differential Diagnosis
Richardson et al.
JAMA 1999;281:1214-1219.
FULL TEXT  

Applicability of Clinical Trial Results to Primary Care
Sonis et al.
JAMA 1998;280:1746-1746.
FULL TEXT  

The unpredictability paradox: review of empirical comparisons of randomised and non-randomised clinical trials
Kunz and Oxman
BMJ 1998;317:1185-1190.
ABSTRACT | FULL TEXT