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Centre for Evidence-
Based Medicine

Therapy: Clinical Scenario

You are a Health Operations Coordinator in one of the government hospitals in your locality. One of your responsibilities is to coordinate pharmacy services along with other hospital services. In your recent meeting with department heads, the chief of the Cardiovascular Section requested that the pharmacy should have stocks of streptokinase. He emphasized that patients who are admitted with symptoms of acute myocardial infarction should immediately be given thrombolytic therapy. He went on to discuss that large studies have already proven the beneficial effect of early administration of the drug. You listened to him in earnest and decided to look into the possibility of requesting streptokinase. However, you are faced with bigger problems should you even consider the request: 1) you have to determine if the evidence really points to longer survival, 2) you have to assess if the data is applicable to patients admitted in your hospital or if you can generalize the results to the local setting, 3) you have to evaluate the efficiency of treatment in the local setting and in the hospital environment and, to top it all, 4) you have to gather the above-mentioned information accurately and sufficiently in order to present it to the board with the purpose of convincing them.

You pose the question, 'in a patient with suspected MI, does treatment with streptokinase improve survival?' Your task then is to utilize the Section Chief as your first resource. You immediately ask his assistance on retrieving an article and he was able to give you a full text copy of ISIS-2: 10 year survival among patients with suspected acute myocardial infarction in randomized comparison of intravenous streptokinase, oral aspirin, both or neither . He showed you how he retrieved this by using the Cochrane Library utilizing the key words "Streptokinase [Mesh] AND Infarction [Mesh]".

Read the article and decide:

  1. Is the evidence from this randomized trial valid?
  2. If valid, is this evidence important?
  3. If valid and important, can you apply this evidence in caring for patients?

You can only accomplish this by applying certain guides which are summarized in the following table. You then assess the article according to these guides and decide if it is useful.

Continue to completed worksheet