Steven Doherty

History of evidence-based medicine. Oranges, chloride of lime and leeches: Barriers to teaching old dogs new tricks

Knowledge translation is the process of taking evidence from research and applying it in clinical practice. In this article I will cite some pivotal moments in the history of medicine to highlight the difficulties and delays associated with getting evidence into practice. These historical examples have much in common with modern medical trials and quality improvement processes. I will also review the reasons why evidence is not used and consider what factors facilitate the uptake of evidence. Understanding these concepts will make it easier for individual clinicians and institutions to change clinical behaviour and provide a starting point for those looking at implementing ‘new’ practices, new therapies and clinical guidelines. Finally, I will offer a list of criteria that clinicians might choose to consider when deciding on whether or not to adopt a new practice, treatment or concept.

Evidence-based implementation of adult asthma guidelines in the emergency department: A controlled trial

Objective:  To determine if an evidence‐based implementation (EBI) strategy could lead to the successful implementation of guidelines for the management of adult asthma in a large rural ED.

‘Evidence-based implementation’ of paediatric asthma guidelines in a rural emergency department

Aim:  To determine if an evidence‐based implementation (EBI) could lead to improved compliance with guidelines for acute asthma in children aged 1–15 years presenting to a large rural emergency department.

Evidence-based medicine: Arguments for and against

In this article I will discuss the various definitions of evidence‐based medicine (EBM), and summarize the application, criticisms and limitations of EBM. The spectrum of evidence, from pathophysiological inference to randomized controlled trials, will be presented as a mechanism for filtering bias with more rigorous evidence being required when bias is more likely. Although randomized controlled trials and meta‐analyses are at the top of the evidence hierarchy, they are not always necessary, might not be the most appropriate forms of evidence for some clinical questions, and have their own limitation that need to be understood. Best available evidence, applied to individual patients, is the corner stone of EBM. Although there are valid criticisms and limitations of EBM, if these are understood then the practice of EBM can provide guidance to the clinician and enhance patient care.

National project seeking to improve pain management in the emergency department setting: Findings from the NHMRC-NICS National Pain Management Initiative

The National Pain Management Initiative was established by the National Institute of Clinical Studies to improve analgesic practice across Australian EDs.

Pain management in Australian emergency departments: current practice, enablers, barriers and future directions.

Objective: To explore current pain management practice in Australian EDs and identify enablers and barriers for best‐practice pain management.

Factors influencing rural versus metropolitan work choices for emergency physicians

Objectives:  To survey Fellows of the Australasian College for Emergency Medicine (FACEM) on how a range of factors influenced their decision to accept their most recent position. To compare this information between rural and metropolitan FACEM.

Impact of pain location, organ system and treating speciality on timely delivery of analgesia in emergency departments

Objective: This retrospective, observational cohort study investigated whether the clinical features of a patients pain, including anatomical location, organ system and likely treating speciality, impact on the delivery of analgesia within 30 min in EDs.

Carbon monoxide poisoning

Editor,—I read with interest the article by Turner et al , providing an update on carbon monoxide poisoning.1 The authors correctly point out that hyperbaric therapy remains controversial, and that no controlled clinical trial had been conducted comparing hyperbaric oxygen (HBO) with normobaric oxygen (NBO). Since the date of acceptance of their paper a prospective, blinded, randomised trial comparing NBO with HBO has been published.2 This …

Prescribe systemic corticosteroids in acute asthma

Systemic corticosteroids reduce admission rates, relapse rates, and symptom duration and should be used for most acute exacerbations of acute asthma