Evidence-based Medicine Toolkit

Applying the evidence 75NNT (for your patient) =1(PEER × RRR)We assume that the same relative benefit would apply to patientsat different levels of risk.Is the intervention realistic in your setting?You need to consider whether the treatment, test, prognostic factoror causative described in the study would be comparable inyour setting, and to what extent any differences would affect yourjudgement. Amongst the factors you should consider are:• Did the study take place in a different country, with differentdemographics?• Did it take place in a different clinical setting (in-patient, districtgeneral, teaching hospital, emergency department, out-patient,general practice)?• Some interventions, especially diagnostic tests, may be unavailableor slow to come back.• Will you be able to provide a comparable level of monitoring?• How you present the treatment options to the patient will bedifferent from the trial; this might significantly affect patientcompliance.Does the comparison intervention reflect yourcurrent practice?If the study compares the benefits of new intervention A with controlintervention B, does B match up with what you currently do?If not, you need to think about how your current practice wouldcompare and whether this would affect the extent of any benefit.Translating an intervention to your practice setting may openup a whole gamut of issues, which we can only touch upon here.However, it is worth asking whether you can adapt your setting.For instance:• Can your practice nurse develop specialist clinics?• Can one of your GPs develop a specialist interest?• Can you introduce protocols which are evidence-based whichcan be followed by a number of staff, irrespective of seniority?• Can your guidelines be transferable between different wards orsettings?