Evidence-based practice (EBP) is a concept that was popularized in the early 1990’s by several physicians who recognized that medical practice should be based on the best and most current available evidence. Although this concept seems self-evident, much of medical practice was based on outdated textbooks and oral tradition passed down in medical school. Currently, exercise science is in a similar situation. Due to a lack of regulation within the exercise community, the discipline of exercise science is particularly prone to bias and misinformation, as evidenced by the plethora of available programs whose efficacy is supported by anecdote alone. In this manuscript, we provide a description of the five steps in EBP: 1) develop a question, 2) find evidence, 3) evaluate the evidence, 4) incorporate evidence into practice, and 5) re-evaluate the evidence. Although objections have been raised to the EBP process, we believe that its incorporation into exercise science will improve the credibility of our discipline and will keep exercise practitioners and academics on the cutting edge of the most current research findings.
The principal conclusions of the fourth report of the Joint Cardiology Committee are: 1 Cardiovascular disease remains a major cause of death and morbidity in the population and of utilisation of medical services. 2 Reduction in the risk of cardiovascular disease is feasible, and better co-ordination is required of strategies most likely to be effective. 3 Pre-hospital care of cardiac emergencies, in particular the provision of facilities for defibrillation, should continue to be developed. 4 There remains a large shortfall in provision of cardiological services with almost one in five district hospitals in England and Wales having no physician with the appropriate training. Few of the larger districts have two cardiologists to meet the recommendation for populations of over 250,000. One hundred and fifty extra consultant posts (in both district and regional centres) together with adequate supporting staff and facilities are urgently needed to provide modest cover for existing requirements. 5 The provision of coronary bypass grafting has expanded since 1985, but few regions have fulfilled the unambitious objectives stated in the Third Joint Cardiology Report. 6 The development of coronary angioplasty has been slow and haphazard. All regional centres should have at least two cardiologists trained in coronary angioplasty and there should be a designated budget. Surgical cover is still required for most procedures and is best provided on site. 7 Advances in the management of arrhythmias, including the use of specialised pacemakers, implantable defibrillators, and percutaneous or surgical ablation of parts of the cardiac conducting system have resulted in great benefit to patients. Planned development of the emerging sub-specialty of arrhythmology is required. 8 Strategies must be developed to limit the increased exposure of cardiologists to ionising radiation which will result from the expansion and increasing complexity of interventional procedures. 9 Supra-regional funding for infant cardiac surgery and transplantation has been successful and should be continued. 10 Despite advances in non-invasive diagnosis of congenital heart disease the amount of cardiac catheterisation of children has risen due to the increase in number of interventional procedures. Vacant consultant posts in paediatric cardiology and the need for an increase in the number of such posts cannot be filled from existing senior registrar posts. All paediatric cardiac units should have a senior registrar and in the meantime it may be necessary to make proleptic appointments to consultant posts with arrangements for the appointees to complete their training. 11 Provision of care for the increasing number of adolescent and adult survivors of complex congenital heart disease is urgently required. The management of these patients is specialised, and the committee recommends that it should ultimately be undertaken by either adult or pediatric cardiologists with appropriate additional training working in supra-regionally funded centers alongside specially trained surgeons. 12 Cardiac rehabilitation should be available to all patients in the United Kingdom. 13 New recommendations for training in cardiology are for a total of at least five years in the specialty after general professional training, plus a year as senior registrar in general medicine. An additional year may be required for those wishing to work in interventional cardiology and adequate provision must be made for those with an academic interest. 14 It is essential that both basic and clinical research is carried out in cardiac centres but these activities are becoming increasingly limited by the lack of properly funded posts in the basic sciences and restriction in the number of honorary posts for clinical research workers. 15 A joint audit committee of the Royal College of Physicians and the British Cardiac Society has been established to coordinate audit in the specialty. All district and regional cardiac centres should cooperate with the work of the committee, in addition to their participation in local audit activities.
We are in the era of "evidence based medicine" in which our knowledge is stratified from top to bottom in a hierarchy of evidence. Many in the medical and dental communities highly value randomized clinical trials as the gold standard of care and undervalue clinical reports. The aim of this editorial is to emphasize the benefits of case reports in dental and oral medicine, and encourage those of us who write and read them.
On November 23rd 2011, the Aspirin Foundation held a meeting at the Royal Society of Medicine in London to review current thinking on the potential role of aspirin in preventing cardiovascular disease and reducing the risk of cancer in older people. The meeting was supported by Bayer Pharma AG and Novacyl.
The liver section of the British Society of Gastroenterology and the research unit of the Royal College of Physicians collaborated to set up a nationwide audit to investigate the practice of percutaneous liver biopsy in England and Wales. Each of 189 health districts in England and Wales was approached to provide a list of 10 consecutive percutaneous biopsies performed during 1991, and details of demographic data, indications, suspected diagnosis, investigations, biopsy technique, outcome, and influence on patient management were collected. Data were retrieved on 1500 (79%). The age distribution showed 6% of biopsies were done in those over 80 years of age and as many over 90 as under 10 years of age. Suspected malignancy and chronic liver disease each contributed one third of the indications. In 34% the procedure was carried out by radiologists under ultrasound image control. The remainder were done by general physicians and gastroenterologists, with the operator in the second group being more senior and experienced. The Trucut biopsy needle accounted for two thirds of biopsies, the remainder being the Menghini type. For both needles the samples were recorded as excellent or satisfactory in 83% and inadequate in only 5%. Bleeding complicated 26 procedures (1.7%), requiring transfusion in 11, and was commoner when clotting was impaired or serum bilirubin raised. There were two definite and three possible procedure related, given an overall mortality of 0.13-0.33%. The diagnosis made before biopsy was confirmed in 63% of patients, and the clinician found the biopsy helpful in treatment in 75%. Day case biopsy and techniques to reduce the risk of bleeding were surprisingly rare in this series, which has given a unique opportunity to examine everyday practice across a wide range of hospitals.
A comprehensive appraisal was undertaken on behalf of the British Cardiac Society and the Royal College of Physicians of London to assess the use of clopidogrel in acute coronary syndromes. The appraisal was submitted to the National Institute for Clinical Excellence (NICE) in August 2003 and contributed to the development of the recently published guidelines for the use of clopidogrel in acute coronary syndromes. The submission to NICE and more recent publications evaluating the use of clopidogrel are reviewed.
acute coronary syndrome; clopidogrel; non-ST elevation myocardial infarction
Preface to The Molecular basis of signal transduction in plants. A Discussion Meeting held at the Royal Society of London on 18 and 19 February 1998. Organized and edited by N.-H. Chua, A. Hetherington, R. Hooley and R. F. Irvine.
Introduction to Brain mechanisms of selective perception and action. Proceedings of a Discussion Meeting held at the Royal Society of London on 19 and 20 November 1997. Organized and edited by G. W. Humphreys, J. Duncan and A. Treisman.
Preface to Epithelial cell growth and differentiation.The proceedings of a Discussion Meeting held at the Royal Society of London on 22 and 23 October 1997. Organized and edited by M. J. Crompton, T. M. Dexter and N. A. Wright.
This article examines the career and reform agenda of Christopher Merrett as a means of evaluating the changing conditions of medical knowledge production in late seventeenth-century London. This period was characterised by increasing competition between medical practitioners, resulting from the growing consumer demand for medical commodities and services, the reduced ability of elite physicians to control medical practice, and the appearance of alternative methods of producing medical knowledge – particularly experimental methods. This competition resulted in heated exchanges between physicians, apothecaries, and virtuosi, in which Merrett played an active part. As a prominent member of both the Royal Society and the Royal College of Physicians, Merrett sought to mediate between the two institutions by introducing professional reforms designed to alleviate competition and improve medical knowledge.These reforms entailed sweeping changes to medical regulation and education that integrated the traditional reliance on Galenic principles with knowledge derived from experiment and artisanal practices. The emphasis Merrett placed on the trades suggests the important role artisanal knowledge played in his efforts to reorganise medicine and improve knowledge of bodily processes.
Christopher Merrett; Artisanal Knowledge; Natural History; Natural Philosophy; Galenism; Royal Society; Royal College of Physicians; Physicians; Virtuosi; Apothecaries; Chemical Physicians; Professional Reform; Medical Marketplace; Competition; Pamphlet War
Upper gastrointestinal endoscopy is a valuable diagnostic tool, but for an endoscopy service to be effective it is essential that it is not overloaded with inappropriately referred patients. A joint working party in Britain has considered the available literature on indications for endoscopy, assessed standard practice through a questionnaire, and audited randomly selected cases using an independent panel of experts and an American database system. They used these data to produce guidelines on the appropriate and inappropriate indications for referral for endoscopy, although they emphasise that under certain circumstances there may be reasons to deviate from the advice given. The need for endoscopy is most difficult to judge in patients with dyspepsia, and this aspect is discussed in detail. Early endoscopy will often prove more cost effective than delaying until the indications are clearer.
This paper examines a succession of incidents at a critical juncture in the life of Professor Horace Lamb FRS, a highly regarded classical fluid mechanicist, who, over a period of some 35 years at Manchester, made notable contributions in research, in education and in wise administration at both national and university levels. Drawing on archived documents from the universities of Manchester and Adelaide, the article presents the unusual sequence of events that led to his removing from Adelaide, South Australia, where he had served for nine years as the Elder Professor of Mathematics, to Manchester. In 1885 he was initially appointed to the vacant Chair of Pure Mathematics at Owens College and then, in 1888, as an outcome of his proposal for rearranging professorial responsibilities, to the Beyer Professorship of Pure and Applied Mathematics.
Horace Lamb; Owens College; University of Adelaide; Henry Taylor
Urinary lithiasis and gout were uncommonly prevalent in the eighteenth century. This essay considers the history of both afflictions and especially tells of the last illnesses of Sir Robert Walpole, who died from complications of stone, and his son, Horace, who throughout his life was a sufferer of gout.