Antibiotic prophylaxis of infective endocarditis during digestive endoscopy: over- and underuse in Switzerland despite professed adherence to guidelines

Agreement between reported use of interventions for liver diseases and research evidence in Cochrane systematic reviews

BACKGROUND/AIMS

This study evaluates the agreement between reported use of interventions for patients with liver diseases and research evidence in Cochrane systematic reviews.

METHODS

In July 2002, the Cochrane Hepato-Biliary Group had completed 28 systematic reviews on 36 interventions that were available in Denmark. Based on the reviews, three interventions (n-acetylcysteine for paracetamol overdose, terlipressin for bleeding oesophageal varices, and antibiotics for patients with cirrhosis and gastrointestinal bleeding) with significant beneficial effects on clinical outcomes were classified as 'evidence-based', whereas 19 were classified as 'possibly evidence-based', and 14 as 'not evidence-based'. Questionnaires on reported use and perceived intervention effects were mailed to 108 physicians practising in Danish hospitals. Sixty-six returned their questionnaire.

RESULTS

The proportion of physicians who reported that they never used the three evidence-based interventions varied considerably (2, 62, and 57%, respectively). The perceived intervention effect, duration of clinical experience, employment as head of department, and university hospital employment were significant predictors of more frequent use of evidence-based interventions. Physicians also reported that they used the interventions that were not evidence-based more often if they were employed at a university hospital.

CONCLUSIONS

Considerable disagreements between reported use and research evidence were identified. Additional research on methods to introduce evidence-based medicine in practice seems warranted.

Guidelines and Evaluation: Improving the Quality of Consultation-Liaison Psychiatry

Previous research has shown that residents in the consultation-liaison unit of Geneva University Hospital did not meet proposed guidelines on three counts: quickness of response to emergency situations, reporting cases to supervisors, and consulting with supervisors on major issues. The introduction of daily meetings between residents and supervisors improved the level of compliance with guidelines, from 69.2% to 82.6% for quickness of response, from 57.6% to 97.3% for reporting cases to supervisors, and from 25.0% to 98.0% for consulting with supervisors on major issues. Periodical evaluation would thus appear to enhance performance.

Clinical guidelines: the blind leading the deaf?

Clinical guidelines are developed by most specialist societies but the available data suggest that their impact on physician behavior is limited. National guidelines may need modification at the local level to account for local conditions and need regular updates to ensure that they continue to be based on the best available evidence. Measures to involve community practitioners in guideline development may enhance their uptake in the community.