The document discusses the need for evidence-based medicine (EBM) in clinical practice and challenges incorporating EBM. It finds that: 1) A study of patients at a general medicine hospital found that 82% received evidence-based care, with treatments for 53% justified by randomized controlled trials or reviews and 29% by convincing non-experimental evidence. 2) Barriers to practicing EBM include lack of time and access to information at the point of care. Bringing a "cart" of medical evidence resources to patient rounds increased evidence-based searches and decisions. 3) National clinical guidelines need local adaptation to consider unique patient populations, resources, behaviors and costs. Local groups are best equipped to identify