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The Quality of Practice Committee of the RCPCH
  1. N McIntosh1,
  2. J H Baumer2
  1. 1University of Edinburgh, UK
  2. 2Derriford Hospital, Plymouth, UK
  1. Correspondence to:
    Prof. N McIntosh
    Department of Child Life and Health, University of Edinburgh, 20 Sylvan Place, Edinburgh EH9 1UW, UK; neil.mcintoshed.ac.uk

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Update on the clinical effectiveness programme

Failure by doctors to incorporate strong research evidence into their clinical practice delays improvement in mortality and morbidity. The logo of the Cochrane collaboration1 (fig 1) shows the clear evidence of benefit from the randomised controlled trials of antenatal steroids in preterm labour available in 1982 if studies had been subject to meta-analysis.2 Antenatal steroids took over a decade after this point to be widely incorporated into obstetric practice despite the clear evidence that neonatal mortality and subsequent neurodevelopmental morbidity were reduced.3 Similarly suboptimal management was shown in a proportion of children with Kawasaki disease in the UK in 1990.4,5 Only 60% received intravenous gammaglobulin, some in an inadequate dose, despite clear evidence of benefit from randomised controlled trials. A further example might be professional advice on the sleeping position for babies and the risk of cot death.6

Figure 1

 Logo of the Cochrane collaboration.

There are a number of reasons for this. First, unless doctors are practising in a very narrow field there are just too many peer reviewed journals to read. In addition it is only by careful critical appraisal that the research evidence can be set in context of what is already known. This is a time consuming task, and requires a skill that not all doctors yet possess. There is also a genuine lack of knowledge in many medical areas, and one of the important functions of a guideline is to highlight research gaps. Advances in medical knowledge from additional research are also important in improving clinical management.

Clinical practice guidelines are “systematically developed statements to assist both practitioner and patient in decisions about appropriate health care for specific clinical circumstances”.7 It is only through the systematic search for and appraisal of research evidence …

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Footnotes

  • Competing interests: none declared