Evidence-based practice challenges

The philosophy of evidence-based practice is widely accepted, although operational and implementation issues represent major barriers. One of the significant barriers is a shortage of evidence reports on topics of critical interest, and the lack of a national infrastructure to prepare such reports. In response to this need, AHRQ has funded 12 Evidence-based Practice Centers to conduct systematic, comprehensive analyses and syntheses of the scientific literature to develop evidence reports and technology assessments on clinical topics that are common, expensive, and present challenges to decision makers. Since December 1998, 11 evidence reports have been released on topics that include sleep apnea, traumatic brain injury, alcohol dependence, cervical cytology, urinary tract infection, depression, dysphasia, sinusitis, stable angina, testosterone suppression, and attention deficit hyperactivity disorder. 

Hill, K., 2006. Augmentative and alternative communication (AAC) research and development The challenge of evidence-based practice. International Journal of Computer Processingof OrientalLanguages,... 

Identification of optimal care for the patient with STEMI is challenging because of the dynamic nature of the evidence base on which clinical decisions are made. The introduction of new agents and devices and refinement of treatment strategies rapidly make prior studies less relevant to contemporary practice. An example of this concept is the prior proscription against routine catheterization and intervention within the first 24 hours after fibrinolysis (78-80). Such an admonition, correct... 

A care bundle is the term used for a group of evidence based clinical practices that, when used on their own, are shown to improve care, but when applied together they result in substantially greater improvements. The challenge for healthcare is to apply these best practices reliably on every patient who needs them, every day, measuring comphance and monitoring the outcome. 

Our advice to clinicians is to make the best decision that they can, based on the evidence, while opting for agents with the best side effect profiles and that are supported, when possible, with other appropriate therapies. Because of the experimental nature of pharmacotherapy in this population, practitioners should endeavor to confirm the utility of treatment with hard data. Where possible, periodic drug holidays are recommended to determine if continued therapy is needed. Until far more drug research is available on young people with MR, this will continue to be one of the more challenging populations in which to practice psychopharmacology. 

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