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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).

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