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1999) Clearly, Modern Practice Is Dependent On A Strong Evidence Base On ...

1999)

Clearly, modern practice is dependent on a strong evidence base on which to justify treatment choices. This statement underlines the need for a critical appraisal of all research papers read and assimilated, as it is only by this method that it is possible to ascertain the level of reliability of the information contained therein. (Haynes RB 2005)

Classification of evidence levels
Ia
Evidence obtained from meta-analysis of randomised controlled trials.

Ib
Evidence obtained from at least one randomised controlled trial.

IIa
Evidence obtained from at least one well-designed controlled study without randomisation.

IIb
Evidence obtained from at least one other type of well-designed quasi-experimental study.

III
Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.

IV
Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.


(Berwick D 2005)
Clinical effectiveness.
To a large extent, clinical effectiveness is inextricably linked to the issues of clinical evidence base. The issue itself is however, much wider in concept as clinical effectiveness is dependent of a great many other, possibly more nebulous factors. (Green J et al. 1998)

Some authorities suggest that effectiveness is a direct result of the ability to arrive at the correct diagnosis since clearly a wrong diagnosis will most probably result in inappropriate and ineffective treatment. Other aspects of clinical effectiveness involve issues such as one's ability to communicate (in the true sense of the word) with the patient. To be able to fully understand the implications of what is said ( and sometimes what is not said), to be able to assimilate all of the information given and then to communicate effectively with the patient so that patient compliance is achieved are other hallmarks of clinical effectiveness. ( EHC 1999)

Interprofessional working/collaboration.
This is a concept that arose as a direct result of the initiatives outlined in the NHS Plan 2000 (NHS 2000). It directly links with the concepts of the seamless interface of healthcare and multidisciplinary team working. The NHS of a few decades ago was hallmarked by working practices that appeared to be largely insular and profession specific. Communication within medical, surgical and nursing teams, for example was largely vertical and not horizontal (Carter S P et al. 2003). Professional directives form virtually all of the medically related professional bodies now call for facilitation of interprofessional working. (Penson R T et al. 2006).


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