[Real clinical medicine and evidence-based medicine: evaluative clinical research]

The clinical view is essential in the application of a new paradigm on "evidence based medicine". Also, we hardly haven't studies that had been made with patients in real time and place. We analyzed the rate of evidence that found our clinical praxis.

A randomized observational epidemiological study was made over 689 clinical decisions in relation with 167 pathological processes, considered in 36 patients. Age (65.9, SD 2.1), sex (23 F, 13 M), comorbidity (4.6, SD 2.1), poly-pharmacy (8.8, SD 3.3). Case-mix of GRDs (infections--even HIV-, chronic respiratory affections, neurologic, cardiovascular diseases, diabetes and its complications ..., in decreased order. We used the D.L. Sackett's criterium (evidence level one "experimental", level two "no experimental but convincing-rational", level three "without any scientific base". A progressive internal control was used in order to adjust the "arbitrariness in the assignation".

60% of the decisions provided elevated care evidence level; 24.5% in level number two, and 15.5% without any foundation. The proceedings reasonably founded were 84.5%. The pharmacological treatment had more evidence. The diagnosticum was more empiric. The primary illness and its treatment concentrated more evidence that the enclosed conditions (65% level one and 50% respectively). The prediction is still unknown (null evidence).

More than a half of the patients were benefited of a clinical praxis, tested in effectiveness and safety. 15.5% of the decisions had an uncertain effect (favourable, newer or damaging). Nowadays, the complex clinical praxis, despite of exceeding the paradigm of "evidence based medicine", should tend toward scientific foundation as much as possible.