[Influence of medical outliers in patients with femoral neck fracture]. / Influencia del ingreso hospitalario ectópico en pacientes con fractura del cuello femoral.

OBJECTIVES: The objective is to describe and analyze how outlier admission influences hospital stay and the appearance of complications in patients with a femoral neck fracture treated with arthroplasty. MATERIAL AND METHOD: A historical cohort study was carried out in which the group of patients with a displaced fracture of the femoral neck who had an outlier admission was defined as an exposed cohort, that is, they were admitted to a hospitalization area not belonging to the Orthopedic Surgery and Traumatology department, unlike the unexposed cohort, that included patients admitted to a hospitalization area assigned to the Orthopedic Surgery and Traumatology department. RESULTS: Outlier admission was a risk factor for requiring a postoperative transfusion (RR 1.52, 95% CI 1.05-2.21; P=.035), to have a postoperative stay longer than 5 days (RR 1.35, 95% CI 1.04-1.74; P=.038) and to suffer general postoperative complications (RR 1.35, 95% CI 1.02-1.78; P=.048). CONCLUSIONS: Outlier admission is a threat to the quality and safety of health care. In patients over 80 years of age, medical outliers is a risk factor for postoperative transfusion and systemic postoperative complications.

[Cost effective medicine and evidence based medicine: impact on clinical decision making]. / Medicina coste-efectiva y medicina basada en la evidencia: su impacto en el proceso de decisiones clínicas.

The following paper analyses the relationship between cost-effective medicine and evidence-based medicine and their complementary aspects. Clear concepts and methods are pointed out. Useful examples of both approaches for daily clinical practice are given. Individual and social perspectives are presented including their impact on clinical decision making.

[Benign prostatic hyperplasia and evidence based medicine: its approach in clinical practice]. / Hiperplasia prostática benigna y medicina basada en la evidencia: su aproximación a la práctica clínica.

The contribution of evidence based medicine (EBM) methodology to the clinical practice of symptomatic benign prostatic hyperplasia (BPH) patients may be very helpful. Otherwise its development is incipient. BPH is still a high prevalent and far-reaching clinicopathologic entity. In the last few years, new drug and surgical therapies have emerged that have significantly changed BPH clinical management. In this article, the elements that make feasible the application of EBM to the clinical management of BPH patients are reviewed, with the aim of making this relation part of the vast extension of EBM in the different medical specialties. This objective is an answer to the double interest, on one hand, in defining the importance of this new concept of medical practice and, on the other hand, in making clinical practice suitable for solving the queries of a disease with such a variable influence in patient's welfare and quality of life. We therefore conclude that application of EBM methodology to BPH management is relevant and necessary.

[The phenomenon of "evidence-based medicine"]. / El fenómeno de la "medicina basada en la evidencia".

Evidence-based medicine originates in 1992 when the proliferation of medical publications and other clinically relevant information was neither organized nor efficiently employed, aggravating concerns on the ethical duty of its incorporation to clinical decision making. Development of clinical research and its methods have changed the nature of medical knowledge, "changing the paradigm" leading to need for changing both practice organization and the contents of continuous education. This is the "objective basis" of evidence-based medicine. Since evidence-based medicine emphasizes the clinician's judgement and asses the knowledge basis of his practice, reinforces professional autonomy compared to other considerations, thus having political and ethical implications. Evidence-based medicine redefines in its own terms professional excellence.

[Evidence-based health care]. / Asistencia sanitaria basada en la evidencia.

Health care evidence based is a 90's trend of health professionals interested in the scientific development of effectiveness and efficiency research into the health management and introducing scientific evidence into the health decision-making process. The development of health services research, outcome management and evidence based medicine, makes possible the new orientation of heath systems toward health care evidence based. That means health services provided with the maximum quality, effectiveness, appropriateness and taking into account the informed patients preferences. If we want to see health care evidence based fully working among managers and clinicians, we need the development of information systems directed to the measurement of clinical outcomes in terms of effectiveness and efficiency, as well as specific plus tailored training programs and, pushing focused research areas into the improvement of health services provided at hospital and primary care levels.