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Evidence Based Practice

APPLY

After considering all your evidence, ask yourself the following questions to apply the results to your patient.

Were the study patients similar to my population of interest? 

  • Does your population match the study inclusion criteria?
  • If not, are there compelling reasons why the results should not apply to your population?

Were all clinically important outcomes considered? 

  • What were the primary and secondary endpoints studied?
  • Were surrogate endpoints used?

Are the likely treatment benefits worth the potential harm and costs?

  • What is the number needed to treat (NNT) to prevent one adverse outcome or produce one positive outcome?
  • Is the reduction of clinical endpoints worth the potential harms of the surgery or the cost of surgery? 
Mingrone and colleagues measured surrogate markers for clinical outcomes. 2 years seems sufficient to detect effects on glycemic control and diabetes remission. Given the progressive nature of type 2 diabetes, longer follow-up could help characterize with greater precision the extent to which these benefits are sustained over time. Further ascertainment of the nature and frequency of surgical complications associated with different procedures, surgical experience and volume levels, and patient characteristics would be helpful in decision making. Longer, larger multicenter studies measuring such patient-important outcomes as mortality, morbidity, end-organ damage, functional capacity, and quality of life are needed. The findings of Mingrone and colleagues add to the body of evidence favoring bariatric surgery but, alone, should not result in a rush to do more surgeries.  (ACP Journal Club. 2012 Jul 17;157:JC1-12.)

Take this information back to your patient and discuss the issues to help him decide on a plan of action.

Source: Guyatt, G. Rennie, D. Meade, MO, Cook, DJ. Users' Guide to Medical Literature: A Manual for Evidence-Based Clinical Practice, 2nd Edition, 2008.