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|Springer: Berlin-Heidelberg 2005|
Evidenve-based Medicine and Clinical Guidelines in Cardiology.
Promoting Science, Practise, or Bureaucracy?
Page 45-60 from:
Evidence Based Practice in Medicine and Health Care. A discussion of the Ethical Issues
R. ter Meulen, N. Biller-Andorno, C. Lenk, R. Lie (Eds.)
(Eds.:) The contribution by Praetorius describes the role of clinical guidelines in cardiology, a clinical area that seems particularly amenable to the conduct of RCTs and the establishment of guidelines. The process of developing guidelines, however, is not always a transparent and evidence‑based one. In addition, there is an overwhelming flood of existing guidelines, which partly contradict each other. The chapter discusses a variety of preconditions for a more appropriate use of guidelines, among them the need for clarity and international harmonization, for methodological sophistication, and for a role of guidelines in individual decision‑making. The latter use acts to enhance rather than decrease the autonomy and sense of responsibility of the physician who applies them. Whether EBM can keep its promises is an open question: the effect of EBM on cardiology is in fact experimental and should itself be subject to investigation.
Correspondence and offprint requests to Dr. Frank Praetorius