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Where do developing world clinicians obtain evidence for practice: a case study on pneumonia

Page, John; Heller, Richard F; Kinlay, Scott; Lim, Lynette; Qian, Wang; Suping, Zheng; Kongpatanakul, Supornchai; Akhtar, Murtaza; Khedr, Salah; Macharia, William

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There are few data on the practice of evidence based medicine in the developing world, nor on the actual sources of evidence that clinicians use in practice. To test the hypothesis that there was variation between and within developing countries in the proposed management of a patient with hospital acquired pneumonia, and that part of the variation can be explained by the sources of evidence used. Questionnaire responses to hypothetical case history. Investigators from 6 centres within the...[Show more]

dc.contributor.authorPage, John
dc.contributor.authorHeller, Richard F
dc.contributor.authorKinlay, Scott
dc.contributor.authorLim, Lynette
dc.contributor.authorQian, Wang
dc.contributor.authorSuping, Zheng
dc.contributor.authorKongpatanakul, Supornchai
dc.contributor.authorAkhtar, Murtaza
dc.contributor.authorKhedr, Salah
dc.contributor.authorMacharia, William
dc.date.accessioned2015-12-13T23:16:31Z
dc.identifier.issn0895-4356
dc.identifier.urihttp://hdl.handle.net/1885/89454
dc.description.abstractThere are few data on the practice of evidence based medicine in the developing world, nor on the actual sources of evidence that clinicians use in practice. To test the hypothesis that there was variation between and within developing countries in the proposed management of a patient with hospital acquired pneumonia, and that part of the variation can be explained by the sources of evidence used. Questionnaire responses to hypothetical case history. Investigators from 6 centres within the International Clinical Epidemiology Network (INCLEN) in China, Thailand, India, Egypt, and Kenya. Doctors chosen to represent primary and secondary hospital practice in the regions of the study centres. Investigations and initial treatments which would be ordered for a hypothetical 60-year-old woman who develops pneumonia 5 days after hospital admission, whether local data on antibiotic sensitivities are available and where information would be obtained to guide management. Chest x-ray and sputum gram stain/culture were consistently the most commonly ordered investigations, there being much greater variation in the initial treatment choices with either penicillin, a third-generation cephalosporin or aminoglycoside being the most popular choice. Textbooks were the commonest form of information source, and access to a library, textbooks and journals were statistically significantly associated with appropriate choice of investigations, but not treatment. Access to local antibiotic sensitivities was associated with appropriate initial treatment choice. Improving access to information in the literature and to local data may increase the practice of evidence-based medicine in the developing world.
dc.publisherPergamon-Elsevier Ltd
dc.sourceJournal of Clinical Epidemiology
dc.subjectKeywords: article; clinical research; controlled study; developing country; evidence based medicine; human; medical practice; physician; pneumonia; practice guideline; priority journal; questionnaire; Cross Infection; Developing Countries; Evidence-Based Medicine; Clinical research; Developing countries; Evidence based medicine; Physician's practice pattern; Pneumonia; Questionnaires
dc.titleWhere do developing world clinicians obtain evidence for practice: a case study on pneumonia
dc.typeJournal article
local.description.notesImported from ARIES
local.description.refereedYes
local.identifier.citationvolume53
dc.date.issued2000
local.identifier.absfor010104 - Combinatorics and Discrete Mathematics (excl. Physical Combinatorics)
local.identifier.ariespublicationMigratedxPub19487
local.type.statusPublished Version
local.contributor.affiliationPage, John, University of Newcastle
local.contributor.affiliationHeller, Richard F, University of Newcastle
local.contributor.affiliationKinlay, Scott, University of Newcastle
local.contributor.affiliationLim, Lynette, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationQian, Wang, Shanghai Medical University
local.contributor.affiliationSuping, Zheng, West China University of Medical Sciences
local.contributor.affiliationKongpatanakul, Supornchai, Mahidol University
local.contributor.affiliationAkhtar, Murtaza, Government Medical College, India
local.contributor.affiliationKhedr, Salah, Suez Canal University
local.contributor.affiliationMacharia, William, University of Nairobi
local.description.embargo2037-12-31
local.bibliographicCitation.startpage669
local.bibliographicCitation.lastpage675
local.identifier.doi10.1016/S0895-4356(99)00231-0
dc.date.updated2015-12-12T08:48:35Z
local.identifier.scopusID2-s2.0-0033855745
CollectionsANU Research Publications

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