EVIDENCE-BASED PEDIATRIC PULMONARY MEDICINE - HOW CAN IT HELP

Evidence-based medicine aims to identify, critically appraise, and app ly the best available evidence in making decisions about the care of p atients. These aims are similar to those conscientious clinicians have always sought to achieve, but an evidence-based approach applies a sy stematic and rigorous methodology to this process to ensure that the e vidence applied is relevant and of high quality. Because of the volume of potentially relevant information that needs to be accessed from th e medical literature, many clinicians rely on reviews of the evidence. Systematic reviews provide summaries of the results of evidence-based healthcare, which can be made available to clinicians, healthcare adm inistrators, and patients. The use of explicit, systematic methods in reviews limits bias (systematic errors) and reduces random errors (sim ple mistakes), thus providing reliable results on which to draw conclu sions and make decisions. Meta-analysis is the use of statistical meth ods to summarize the results of independent studies. When used appropr iately, meta-analysis can provide more precise estimates of the effect s of healthcare than those derived from the individual studies include d in a review. Childhood respiratory diseases can be a challenging are a in which to undertake clinical research. These challenges include di agnostic uncertainty, lack of objective endpoints, and aspects of gene ralizability of randomized controlled trials. Despite these difficulti es, there are now many examples of systematic reviews and evidence-bas ed approaches in pediatric pulmonology. if applied appropriately, they can ensure that management of patients is based on clinically useful diagnostic tests and treatments that have been shown to be effective a nd not harmful. (C) 1998 Wiley-Liss, Inc.