Evidence-based medicine is a modern term for the application of clinical epidemiology to the care of patients (Fletcher & Fletcher, 2005).
It involves many crucial steps in the development of effective measures that can be used in the treatment of disease. It begins with a clinical question, the use of research evidence to answer the question, deciding whether the evidence is worthy enough to allow for decisions to be based and finally allowing conclusions to reach the care of patients (Fletcher & Fletcher, 2005).
The use of the clinical study is one step in the process. A patient in our pulmonary rehabilitation program is currently a participant in a clinical study which could change her life as well as others in the future if the device being tested proves to be effective. The study is based on the question of whether or not the use of implanted coils in the lungs of those patients suffering with emphysema will improve their quality of life (Medland, 2012). At this point, she has received the implanted coils and is doing very well which has included her welcome return to work as an elementary school teacher.
The concept of cause as discussed by (Fletcher & Fletcher, 2005), in the development of the disease of COPD is another I encounter in my everyday work. In the majority of cases a significant smoking history can be identified. Still, there are many who do not develop COPD including many variations in the severity of its presentation. Many times a family history of lung disease or an added exposure to an environmental lung irritant can be present. This relationship of cause in the development of COPD is a topic of research both at conferences and in respiratory journals. As mentioned by (Fletcher & Fletcher, 2005), “many factors act together to cause disease”.
Ethics must also impact professional work. Epidemiologists have ethical and professional obligations to maximize the potential benefits of studies to research participants and to society and to minimize potential harms and risks (Coughlin, 2006).
In the clinical trial mentioned above, Northwestern University researchers would have the duty of presenting the risks and benefits to those wishing to participate in their clinical trial. I also felt the responsibility to present to my patients in the best way I could this clinical study of which I learned of at a COPD conference, which greatly impacted the life of a patient that I know well.
Beneficence, nonmaleficence, autonomy, and justice are ethical principles that must be upheld in the obtaining of research with the protection of patients as the ultimate goal (Coughlin, 2006).
Evidence-based knowledge should continue to grow. The advice to stay current and also the fact that this can prove daunting is prudent. The pace of change in medical knowledge has accelerated, and expectations for being up to date have increased (Fletcher & Fletcher, 2005).
General ways to keep current and continue to grow in evidence-based knowledge can be through reading journals and attending seminars or conferences in areas of practice. The guidance of viewing journal articles beginning with the abstract, then conclusion, and lastly the methods section is beneficial to obtaining the most relevant information in the quickest manner (Fletcher & Fletcher, 2005).
Databases are another way to keep current. The National Guidelines Clearinghouse available online. is an excellent source of information. Guidelines are as such a place to start in clinical care and can be influenced by clinical judgment (Fletcher & Fletcher, 2005). I have dealt with Medicare guidelines in the running of a pulmonary rehabilitation program that meets those guidelines both to ensure Medicare reimbursement and the best interest of patients.
Another database is the Cochrane Database of Systematic Reviews also available online. It provides a source of information on the effects of clinical practices. A publication with similar assistance is from the British Medical Journal called Clinical Evidence available in print and on CD-ROM (Fletcher & Fletcher, 2005.
Finally, yet one more database is MEDLINE which may prove to be the most helpful to the nurse practitioner in daily treatment of clients and is available (Fletcher & Fletcher, 2005).
By: Joann Ciszczon BS,RN,RRT
Coughlin, S. (2006). Ethical issues in epidemiologic research and public health practice. Emerging Themes in Epidemiology. 3(16), 1-10.
Fletcher, R. H. & Fletcher, S. W. (2005). Clinical epidemiology: The essentials. (4th ed.)
New York: Lippincott Williams & Wilkins.
Medland, T. (2012). New, Minimally invasive procedure may improve quality of life for patients with emphysema. Retrieved from http://www.nmh.org/nm/minimally-invasive-procedure-for-patients-with-emphysema