From the Departments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario (Dr Guyatt); the Departments of Internal Medicine (Dr A. L. Dans) and Pediatrics (Dr L. F. Dans), University of the Philippines College of Medicine, Manila; and the Department of Medicine, University of Texas Health Sciences Center, San Antonio (Dr Richardson).
Users' Guides to the Medical Literature section editor: Drummond Rennie,
MD, Deputy Editor (West), JAMA .
You are the attending physician on duty when a poor, 45-year-old man
presents to the emergency department of a general hospital in the Philippines.
He has severe chest pain for 2 hours, associated with clammy perspiration.
Physical examination reveals a blood pressure of 110/70 mm Hg, a pulse rate
of 92 beats per minute, a normal first heart sound, and clear lungs. An electrocardiogram
discloses 3-mm ST-segment elevation in the inferior leads. As intravenous
lines are placed, and the patient is prepared for admission to the coronary
care department, you consider whether you should offer this patient a thrombolytic
agent. Though your response is that the impecunious patient cannot afford
the treatment, you ponder the right course of action in a richer patient.
As your duty ends that night, you resolve to prepare for the next patient
admitted for an acute myocardial infarction (MI) by retrieving the best evidence
on the use of thrombolytics.
Dans AL, Dans LF, Guyatt GH, Richardson S, for the Evidence-Based Medicine Working Group . Users' Guides to the Medical LiteratureXIV. How to Decide on the Applicability of Clinical Trial Results to Your Patient. JAMA. 1998;279(7):545–549. doi:10.1001/jama.279.7.545