Abstract
BackgroundClinical practice guidelines and Risk Assessment Models (RAMs) are some useful tools to bring medical evidences into our daily clinical practice. Despite the improvement over the time, they still have some shortcomings.DiscussionOne of these shortcomings is the arbitrary cutoffs used in these tools to facilitate the decision making process. This problem is to some extent due to the "Black or White" approach of modern medicine in making the decisions, whilst in the real world and our daily practice we used mostly an uncertain approach, which is called recently as "Fuzzy" thinking approach.SummaryThe authors of this article believe that the fuzzy type of thinking may resolve the above mentioned shortcomings of clinical practice guideline or risk assessment models and they tried to discuss about this using an example about Venous Thromboembolism related guidelines and RAMs.
Highlights
Clinical practice guidelines and Risk Assessment Models (RAMs) are some useful tools to bring medical evidences into our daily clinical practice
An example for an important health system problem which experiences a gap between medical evidences and clinical practice is venous thromboembolism (VTE) [2]
What is the real difference between 59 and 61 years old, which 1 was assigned for one of them and 2 was assigned for the other? This problem is due to mentioned arbitrary cutoff points which were addressed in the 8th American College of Chest Physicians (ACCP) practice guideline too
Summary
We (the authors) do not confine this shortcoming of RAMs (i.e arbitrary cutoffs) only to age or the duration of surgery as noted by the ACCP guideline. By merging and concurrent use of these two approaches (EBM and Fuzzy logic) in the process of decision-making, fuzzy logic can yield its suitable place in the field of medicine, considering the rapidly progression of evidence-based medicine in this field It seems that lack of adequate validity studies, limited number of thromboprophylaxic options, or the complexity of using these risk assessment models for physicians is not enough to burying risk assessment models, and advocating for the simple approach (risk of each patient group) used by ACCP guideline. List of Abbreviations RAM: Risk Assessment Model; ACCP: American College of Chest Physicians; VTE: Venous Thromboembolism; EBM: Evidence-Based Medicine; BMI: Body Mass Index; TIA: Transient Ischemic Attack; CABG: Coronary Artery Bypass Graft
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