Application Of Evidence-based Medicine Research Articles

Lessons from a geriatric clinical case from the 19th century: abridge to modern geriatric medicine.

Count Neipperg (1775-1829), the morganatic husband of Maria Luigia of Habsburg, Napoleon's former wife, presented with typical heart failure symptoms and died of bilateral bronchopneumonia. Neipperg's case is an example of the conflict in the medical field, which led to the birth of modern evidence-based medicine (EBM), and although Neipperg died almost 200 years ago, his case presents the same critical issues that more complex geriatric patients face today. First, the attending physicians provided divergent opinions without reaching an agreement. For example, Francesco Rossi correctly diagnosed heart disease by evaluating the patient's signs and symptoms, a clinical approach that is an early example of modern EBM. By contrast, Giacomo Tommasini made a misdiagnosis based on the philosophical principles of John Brown's vitalist theory, as reworded by Giovanni Rasori. Second, Tommasini's medical report also includes evidence of the Geriatric 5Ms for older patient care, such as multi-complexity, multimorbidity, medication, mobility, and the mind. Moreover, both physicians considered "what matters most" for the patient and his family. Third, the Count's status and political role were identified as the social and structural determinants of health (SSDoH) and used to justify the exceptional intensity of the health care provided. Subsequently, the ante litteram application of EBM and a clinical evaluation based on Geriatrics 5Ms principles anticipate current multidisciplinary management focused on the patient rather than a single disease. The systematic revision of past clinical cases not examined before could open new windows in the dissemination of the geriatric methodology and discipline.

Do we really apply evidence-based-recommendations to spine surgery? Results of an international survey

ObjectiveThis international survey investigated Evidence-Based Medicine (EBM) in spine surgery by measuring its acceptance among spine surgeons. It assessed their understanding of EBM and how they apply it in practice by analyzing responses to various clinical scenarios..Materials and methodsFollowing the CHERRIES guidelines, an e-survey was distributed to multiple social media forums for neurosurgeons and orthopedic surgeons on Facebook, LinkedIn, and Telegram and circulated further through email via the authors’ network. Three hundred participants from Africa, Asia, Europe, North America, and Oceania completed the survey.ResultsOur study revealed that 67.7% (n = 203) of respondents used EBM in their practice, and 97.3% (n = 292) believed training in research methodology and EBM was necessary for the practice of spine surgery. Despite this endorsement of using EBM in spine surgery, we observed varied responses to how EBM is applied in practice based on example scenarios. The responders who had additional training tended to obey EBM guidelines more than those who had no additional training. Most surgeons responded as always or sometimes prescribing methylprednisolone to patients with acute spinal cord injury. Other significant differences were identified between geographical regions, training, practice settings, and other factors.ConclusionsMost respondents used EBM in practice and believed training in research methodology and EBM is necessary for spine surgery; however, there were significant variations on how to use them per case. Thus, the appropriate application of EBM in clinical settings for spinal surgery must be further studied.

Improved Cardiac Rehabilitation Referral Rate Utilizing a Multidisciplinary Quality Improvement Team.

Introduction Cardiac rehabilitation (CR) is an underutilized resource in patients with ischemic heart disease, despite being a Class IA recommendation. In this study, a multidisciplinary quality improvement (QI) team aimed to improve CR referrals by standardizing the ordering process at our hospital system. Method By using a collaborative approach involving the electronic medical record (EMR), medical provider education, and hospital protocols, our two-hospital healthcare system was able to successfully identify barriers to CR referral rates and implement interventions for these barriers. All physicians and medical providers, including ancillary staff, were educated on the EMR order sets to improve compliance by using automated order sets in the EMR. The CR referral order in the EMR included a statement regarding the application of evidence-based medicine, and a computerized provider order entry was included as a reminder to the ordering provider. The use of EMR was monitored monthly by the QI committee. Chi-square test and odds ratios were obtained for statistical analysis. Results Through provider-EMR education and patient education on discharge, CR referral rates significantly improved from 51.2 to 87.1% (p = 0.0001) in a 12-month period. The study included 1,499 patients in total. The improvement was statistically significant regardless of patient gender, race, or insurance coverage. Additionally, subgroup analysis in this study found that prior to standardization of the ordering process, African American patients were significantly less likely to be referred to CR compared to Caucasian patients. (51.2% vs. 41.0%, p=0.01). There was no statistically significant difference in the likelihood of CR referral between Caucasian and African American patients following the intervention (84.0% vs. 78.0%, p = 0.166). Conclusion This study shows that CR is an underutilized resource and that effective QI initiatives may not only increase CR referral rates but also close the gap between racial inequities in referral rates. Future research with multi-center randomized control trials is needed to further enhance its external generalizability to other institutions.

Redefining the Role of Medical Affairs Professionals as Innovators and Leaders in Industry-Led Medical Education.

Medical affairs professionals are pivotal players at the intersection of medical innovation and practice in the pharmaceutical industry. They are uniquely positioned to translate complex medical knowledge into actionable insights for internal and external stakeholders. Industry-led continuing medical education (CME) programs, guided by these professionals, hold the potential to markedly improve clinicians' application of evidence-based medicine (EBM) in clinical settings, thereby elevating patient care outcomes. However, current CME techniques often overlook the integration of diverse disciplines such as educational theories, cognitive psychology, information mastery, and implementation science, which are important for effective real-time decision-making in patient care. This gap in integrating implementation science is vital, as it is key in ensuring that medical innovations are not just developed but also effectively implemented and efficiently utilized in clinical settings. In this opinion article, we aim to highlight the crucial yet often underrecognized role of medical affairs professionals in shaping robust and practical CME programs within the industry. We explore emerging trends and approaches in medical education and CME based on the principles of adult education. Additionally, we explore how medical affairs professionals can effectively drive the adoption of EBM in clinical practice. This exploration aims to provide insights into enhancing CME programs, with medical affairs professionals at the forefront of innovation and leadership in bridging gaps in clinical practice.

Barriers to Implementation and Application of Evidence-Based Medicine from the Viewpoints of Clinical Residents

Background: Nowadays, evidence-based medicine (EBM) is considered a rational framework for decision-making in medicine and its skill training. Thus, the present study aimed to determine the barriers to the execution and application of EBM. Methods: In this cross-sectional survey study, 99 clinical assistants of Hamadan University of Medical Sciences in Iran were randomly assigned to the study. Data were collected using a questionnaire, including background information and information related to barriers in 5 areas, and then analyzed by SPSS-22. Results: Overall, 66.7% of the clinical assistants identified spending a long time to justify the patient to implement EBM, and 61.6% identified the lack of trained people for evidence-based care, the absence of monitoring mechanisms, and the follow-up of EBM in education and treatment. In addition, 60.6% identified new evidence-based medical devices and the lack of knowledge of many doctors in this category as the most serious obstacles. The highest and lowest average barriers were obtained concerning the health system managers (76.30) and librarians and medical informants (64.27), respectively. Conclusion: Notwithstanding that the assistants consider EBM effective in treating patients; the lack of training in the skills associated with this category and the lack of attention of health system managers have prevented the utilization of EBM in practice. Accordingly, eliminating the barriers associated with managers can be the most important step in the development of EBM.

Improving Hypertension Control in Vulnerable Populations Around the World.

This review aims to describe recent literature, guidelines, and approaches to reveal and reduce hypertension burden in disadvantaged populations. Hypertension is a major global health issue and the most potent risk factor for cardiovascular disease, morbidity, and mortality. It disproportionally affects vulnerable populations, including low-, middle-, and high-income countries. Specifically, the burden of hypertension is higher in US Black adults, and addressing social determinants of health is crucial for reducing disparities among vulnerable populations worldwide. Multifactorial approaches, including lifestyle modifications and combination drug therapy, are essential in managing hypertension. Community-based interventions, team-based care, and telehealth strategies can also improve hypertension control. Additionally, renal nerve denervation is a potential treatment for resistant hypertension. Overall, to reduce the global hypertension burden among vulnerable populations, emphasis should be placed on equitable healthcare access and application of evidence-based medicine.

The Application of Evidence-Based Medicine in Individualized Medicine.

The fundamental aim of healthcare is to improve overall health of the population by providing state-of-the-art healthcare for individuals at an affordable cost. The foundation for this system is largely referred to as "evidence-based medicine". Too often, evidence-based medicine is based solely on so-called "best research evidence", collected through randomized controlled trials while disregarding clinical expertise and patient expectations. As healthcare gravitates towards personalized and individualized medicine, such external clinical (research) evidence can inform, but never replace, individual clinical expertise. This applies in particular to orphan diseases, for which clinical trials are methodologically particularly problematic, and evidence derived from them is often questionable. Evidence-based medicine constitutes a complex process to allow doctors and patients to select the best possible solutions for each individual based on rapidly developing new therapeutic directions. This requires a revisit of the foundations of evidence-based medicine. A proposition as to how to manage evidence-based data in individualized immune-oncology is presented here.

Challenges of the Presence and Absence of Clinical Librarians in the Use of Evidence-Based Medicine in Clinical Departments

Due to the rapid growth of information technology and medical information resources, medical personnel need to search and retrieve valid and updated information. However, with limited time to access these resources, there is a need for clinical librarians to connect medical staff to evidence-based medicine (EBM). The present study was conducted to identify the challenges in the absence and the benefits of the presence of clinical librarians in the application of EBM in clinical departments. Ten clinical physicians working at Children’s Medical Center Hospital in Tehran, Iran were interviewed for this qualitative study. Most of the hospital-based physicians did not make any systematic use of EBM and seven were not familiar with the term “clinical librarian.” In their opinion, the clinical librarians’ activities included training the clinical and research teams, providing them with the required information, and providing an EBM-oriented approach to morning report and educational rounds. Therefore, the services delivered by clinical librarians in various hospital departments might positively influence the hospital-based physicians’ information-seeking behavior.

Coronavirus Disease 2019 in Pediatric Emergency Room: The Dilemma of Cycle Threshold Value

Abstract Objective The havoc caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic could not have been predicted, with children being affected worldwide. Testing for SARS-CoV-2 infection helped to define the interventions against the spread of the disease. A polymerase chain reaction (PCR) test has been the mainstay of diagnostic testing. Cycle threshold (Ct) is a semiquantitative value that indicates approximately how much viral genetic material was in the sample. The aim of this study was to evaluate the impact of Ct values among children with SARS-CoV-2 infection. Methods Between May 3, 2020 and August 3, 2020, clinical laboratory input and the data of patients with positive SARS-CoV-2 PCR tests were retrospectively studied. Results There was no statistical significance between Ct values and the patient's status, symptoms other than fever, or other laboratory findings. However, the Ct value of patients who had symptoms at the time of admission to the hospital was significantly lower. Conclusion In this study, symptomatic patients had lower Ct than asymptomatic patients that reflected higher viral loads. In evidence-based medicine applications, it might be useful to correlate the clinical history with laboratory test results. Even symptomatic patients with high Ct value coinfections, or an alternative acute infection, should be considered.

Application of Evidence-based Medicine in Clinical Teaching of Ultrasound Medicine

Application of Evidence-based Medicine in Clinical Teaching of Ultrasound Medicine

Keeping up with the literature: A current practice survey and qualitative needs assessment among emergency physicians.

Physicians face the challenge of staying current with a rapidly growing body of evidence and applying it to their practice. How emergency physicians (EPs) do so is unknown. The authors sought to describe and assess needs around EP patterns of evidence-based medicine (EBM) and continuing medical education (CME) resource use. The authors conducted a multicenter, cross-sectional study in 2019 across 12 tertiary care, community, and suburban emergency department (ED) sites in the greater area of Edmonton. Information on EBM/CME resource use along with barriers and facilitators to staying current was gathered using a rigorously developed survey tool, distributed electronically and by mail. Responses were tabulated and subgroups analyzed using MANOVA and ANOVA tests. Thematic analysis of comments used a phenomenological lens. A total of 118 EPs (40.1%) completed the survey. Listening to podcasts, attending EM conferences, and subscription-based resources were preferred for staying current. Resource use differed by years in practice but not by age, sex, training background, or site type. EBM had an important impact on respondents' practice (average rating 3.8 out of 5, with 5 indicating "practice changing"). Time was an important barrier. Most (62.7%) felt that they did not spend enough time, despite spending a median of 4 to 5h monthly on EBM. Facilitators (including journal club summaries or lists of practice-relevant papers) had only moderate impacts. Thematic analysis found three themes (importance of EBM, implementation challenges, and dissemination of EBM) and 13subthemes. EPs preferentially chose podcasts, conferences, and subscription-based resources to stay current with EBM; time was the biggest barrier. These findings help ED leads and educators tailor CME to physician learning preferences to maximize application of EBM to clinical practice. The next steps include developing/curating resources and disseminating the survey on a larger scale to identify opportunities for shared virtual resources.

Kanıta Dayalı Tıp Ekseninde Akılcı Laboratuvar Uygulamasının Hastane İşlem Maliyetleri Üzerindeki Etkisi: Bir Üniversite Hastanesinde Vaka Çalışması

Objective: By integrating the rational laboratory system into hospital processes with evidencebased medicine applications, it is ensured that hospital resources are used more effectively and
 efficiently by preventing unnecessary test requests and reducing laboratory operation costs.
 Methods: The data in this qualitative study are the primary data and were obtained through
 document review and focus group (physician) interviews. The data in question were analyzed
 comparatively before the Rational Laboratory Application (RLA) (between 01.06.2018-
 31.12.2018) and after the RLA (between 01.06.2019-31.12.2019). The universe of the study
 consists of all the data in the laboratory of Düzce University Health Application and Research
 Center Hospital (DUHARCH). In this universe, the data evaluated for rational laboratory
 application constitute the sample of the research.
 Results: Before the RLA, a total of 446,300 test requests were made in the seven months (in
 2018) and the cost of these tests was determined to be 1,591,063 ₺ ($ 330,782.33). After the
 RLA, a total of 475,585 test requests were made in the seven months (in 2019), and the cost of
 these tests was determined to be 1,537,903 ₺ ($ 271,235.10). It was found that after RLA, there
 was a 6.56% increase in the number of examination requests compared to before RLA, but as an
 amount, costs fell by 3.34% on a ₺ basis and 22% on a $ basis. In the unit-based analysis, it was
 seen that successful units were surgical, and unsuccessful units were internal units that requested
 more tests.
 Conclusions: It was concluded that the rational laboratory system based on evidence-based
 medicine reduces hospital processing costs, provided that patient safety is protected, so this
 method can be a tool for more effective and efficient use of hospital resources.

Choices in hemodialysis therapies: variants, personalized therapy and application of evidence-based medicine.

ABSTRACTThe extent of removal of the uremic toxins in hemodialysis (HD) therapies depends primarily on the dialysis membrane characteristics and the solute transport mechanisms involved. While designation of ‘flux’ of membranes as well toxicity of compounds that need to be targeted for removal remain unresolved issues, the relative role, efficiency and utilization of solute removal principles to optimize HD treatment are better delineated. Through the combination and intensity of diffusive and convective removal forces, levels of concentrations of a broad spectrum of uremic toxins can be lowered significantly and successfully. Extended clinical experience as well as data from several clinical trials attest to the benefits of convection-based HD treatment modalities. However, the mode of delivery of HD can further enhance the effectiveness of therapies. Other than treatment time, frequency and location that offer clinical benefits and increase patient well-being, treatment- and patient-specific criteria may be tailored for the therapy delivered: electrolytic composition, dialysate buffer and concentration and choice of anticoagulating agent are crucial for dialysis tolerance and efficacy. Evidence-based medicine (EBM) relies on three tenets, i.e. clinical expertise (i.e. doctor), patient-centered values (i.e. patient) and relevant scientific evidence (i.e. science), that have deviated from their initial aim and summarized to scientific evidence, leading to tyranny of randomized controlled trials. One must recognize that practice patterns as shown by Dialysis Outcomes and Practice Patterns Study and personalization of HD care are the main driving force for improving outcomes. Based on a combination of the three pillars of EBM, and particularly on bedside patient–clinician interaction, we summarize what we have learned over the last 6 decades in terms of best practices to improve outcomes in HD patients. Management of initiation of dialysis, vascular access, preservation of kidney function, selection of biocompatible dialysers and use of dialysis fluids of high microbiological purity to restrict inflammation are just some of the approaches where clinical experience is vital in the absence of definitive scientific evidence. Further, HD adequacy needs to be considered as a broad and multitarget approach covering not just the dose of dialysis provided, but meeting individual patient needs (e.g. fluid volume, acid–base, blood pressure, bone disease metabolism control) through regular assessment—and adjustment—of a series of indicators of treatment efficiency. Finally, in whichever way new technologies (i.e. artificial intelligence, connected health) are embraced in the future to improve the delivery of dialysis, the human dimension of the patient–doctor interaction is irreplaceable. Kidney medicine should remain ‘an art’ and will never be just ‘a science’.

Using Self-Determination Theory to Drive an Evidence-Based Medicine Curriculum for Pediatric Residents: A Mixed Methods Study.

The ability to incorporate evidence-based medicine (EBM) into clinical practice is an Accreditation Council for Graduate Medical Education competency, yet many pediatric residents have limited knowledge in this area. The objective of this study is to describe the effect of an EBM curriculum on resident attitudes and clinical use of EBM. We implemented a longitudinal EBM curriculum to review key literature and guidelines and teach EBM principles. In this Institutional Review Board-exempt mixed methods study, we surveyed residents, fellows, and faculty about resident use of EBM at baseline, 6 months, and 12 months after the beginning of the intervention. We conducted point prevalence surveys of faculty about residents' EBM use on rounds. Residents participated in focus groups, which were audio-recorded, transcribed, and coded using conventional content analysis to develop themes. Residents (N=61 pre- and 70 post-curriculum) reported an increased appreciation for the importance of EBM and comfort generating a search question. Faculty reported that residents cited EBM on rounds, with an average of 2.4 citations/week. Cited evidence reinforced faculty's plans 79% of the time, taught faculty something new 57% of the time, and changed management 21% of the time. Focus groups with 22 trainees yielded 4 themes: 1) increased competence in understanding methodology and evidence quality; 2) greater autonomy in application of EBM; 3) a call for relatedness from faculty role models and a culture that promotes EBM; and 4) several barriers to successful use of EBM. After implementation of a longitudinal EBM curriculum, trainees described increased use of EBM in clinical practice.

Combining personalised medicine and patient-centered care in breast cancer: a systematic review

Abstract Background Breast Cancer (BC) is estimated to cause 2.3 million yearly new cases worldwide. Efforts towards standardized, quality assured and effective care have led to an increasing complexity and specialization of BC management. This systematic review's aim is to describe the state-of-the art of available literature investigating the enactment of personalised medicine and patient-centered care models in BC practice and build a framework towards personalised BC care within a patient-centered model. Methods Databases were searched to retrieve articles reporting on BC management, evaluated in terms of patient-centered and personalised medicine approaches, assessing success factors or limits, in English, from the inception to December 2020. The investigated dimensions for patient-centered care models were audits, communication, informative systems and multidisciplinarity. Concerning Personalised Medicine, investigations were related to molecular boards, genetic testing and shared-clinical decision-making. Results Out of 1885 records, 25 studies were included in the qualitative analysis. The main success factors are multi-professional collaborations with defined roles and responsibilities, training programs on genomic tools and adequate communication strategy (i.e universal genomic language) to involve patients in the decision-making process. Among detected barriers, delays in genetic testing use were linked to the lack of public reimbursement and of clarity in timing and appropriateness. Conclusions Both these models are complementary and needed to ensure effective changes in the path of BC patient management. Our framework aims to the transformation of standardized application of evidence-based medicine into a dynamic and personalised care pathway. Key messages The combination of the two care delivery approaches is scarcely investigated in literature. Our framework would allow to fill such gap and attributes a key role to sharing the decision-making process.

Letter to the Editor

Dr. Bharathy Kumaravel
 
 Journal of Medical Education Research
 University of Buckingham Press
 51 Gower Street
 London
 WC1E 6HJ
 
 9th June 2021
 
 Dear Editor,
 
 Evidence-based medicine (EBM) has become the gold standard for clinical decision-making and customary practice over the last few decades. As recently qualified junior NHS doctors, the COVID-19 pandemic has highlighted the practical relevance and importance of developing the skills of effective literature search and critical appraisal to be able to utilise it in our daily clinical practice.
 
 This letter is to bring to your kind attention our own reflection of training opportunities we had in relation to EBM and public health in our undergraduate curriculum. This training has helped us to survive our initial clinical years, made even more challenging by COVID-19 and ever-evolving medical knowledge. As per Meats, Heneghan, Crilly and Glasziou (2009) there is significant variation in EBM undergraduate teaching in medical schools in the UK and although core EBM topics are taught in theory, relatively few medical students gain the opportunity to practice or assess such skills. 
 
 As medical students at the University of Buckingham Medical School (UBMS), we formed a group called ‘UBMS public health crew’. We were able to go into community lunch clubs and conduct one-to-one interviews with the elderly ethnic minority communities to gain their perceptions and possible barriers they face regarding influenza vaccination uptake. We also had the annual EBM conference conducted by the medical school where we were able to submit our reports of concise and efficient implementation of EBM on clinical questions we formed during our clinical years. These were then showcased as posters, with the best examples also being presented with a prize of EBM champion for the best presentation. To our knowledge, student initiatives surrounding the clinical application of EBM is unique to University of Buckingham.
 
 The culmination of this training resulted in us continuing to incorporate EBM into our clinical practice and with the onset of the COVID-19 pandemic, it showed how EBM became almost a necessity in our clinical practice. During the initial wave, many junior doctors were redeployed to COVID specific wards. Clinicians caring for these patients were eager to learn more about the disease. As a result, at our hospital, a journal club was setup to critically analyse recent publications on COVID-19. A topic that was discussed was fluid administration in these patients. An initial management strategy had been to restrict fluid administration to these patients to avoid causing an acute respiratory distress syndrome. However, as more evidence emerged it became clear that this had potentially harmful effects. This led to the advocation of judicious fluid management. Our early exposure to the practical application of EBM has nurtured a dynamic approach to clinical medicine in a profession where what is best for the patient today is not necessarily the case tomorrow.
 
 In addition to our clinical application, we have also continued our research on EBM teaching for medical students. By presenting our research with posters and publications we are continuing to expand our research on this field with further opportunities.
 
 In conclusion, having formal modules on developing EBM skills as well as having interactive and real-time opportunities for medical students to expand on their EBM interests such as having community-based EBM projects and implementation of EBM in clinical practice are imperative to ensure future clinicians deliver scientifically sound clinical care that is in line with ever evolving medical research and to deal with unprecedented medical challenges.
 
 Sincerely,
 
 Dr. Fathima Rawther and Dr. Justin Collis
 Foundation Year 2 Doctors
 Royal Berkshire Hospital and Epsom & St Helier University Hospitals
 
 
 
 References
 Meats, E., Heneghan, C., Crilly, M. and Glasziou, P., 2009. Evidence-based medicine teaching in UK medical schools. Medical Teacher, 31(4), pp.332-337.

Factors Associated with Practicing Evidence-Based Medicine Among Medical Interns in Amhara Regional State Teaching Hospitals, Northwest Ethiopia: A Cross-Sectional Study.

BackgroundEvidence-based medicine (EBM) is an important component of modern medicine and is essential for the provision of high-quality health services. Little is known about the level of EBM use among Ethiopian medical students. This study aimed to assess the factors associated with EBM practice among medical interns in teaching hospitals in northwestern Ethiopia.MethodsA cross-sectional study was conducted using a random sample of medical interns in teaching hospitals of northwest Ethiopia. Binary logistic regression analysis was used to identify factors associated with EBM practice. The strength of the interaction between variables was calculated using the adjusted odds ratio (AOR) with a 95% confidence interval (CI).ResultsCompleted questionnaire was obtained from 403 (95.3%) of 423 medical interns. About 48.4% of respondents had a good EBM practice. EBM knowledge (AOR = 1.86, 95% CI = 1.220–2.835), attitude to EBM (AOR = 2.05, 95% CI = 1.318–3.193), ability to appraise evidence (AOR = 2.35, 95% CI = 1.570–3.517), and having sufficient time to search for evidence (AOR = 1.67, 95% CI = 1.065–2.627) were factors significantly associated to EBM practice.ConclusionThis study demonstrates that the main factors affecting medical intern’s practice of EBM were lack of critical appraisal skill, lack of knowledge needed to practice EBM, negative attitudes toward EBM, and insufficient time to search for evidence. Providing EBM training to the needs of medical interns would overcome the barriers identified in this study, as well as assist medical interns and other clinical staffs to ensure the correct application of EBM in to clinical practice.

Medical imaging clinical appropriateness:rational examination according to evidence-based medical imaging

The rational clinical examination is important. The authors raised the concept of "medical imaging clinical appropriateness (MICA) " to meet the medical need in clinic (for diagnosis or assessment of a kind of disease or syndrome), which means radiologists and clinicians work together to carefully evaluate the necessity and rationality of an examination according to evidence of evidence-based medicine, expertise, experience, and patient's willing.The necessity is prerequisite, the rationality is the core, the evaluation of evidence is the basis, the application of evidence-based medicine is the important method. This work will provide us a series of criteria in the format of guidelines, providing evidence of rational examination for clinicians. Based on hard working and cooperation between radiologists and clinicians, we will establish the system of MICA in China, standardizing medical process, promoting rationalization, optimizing medical resources allocation and usage.

Effectiveness of Modalities to Teach Evidence Based Medicine to Pediatric Clerkship Students: A Randomized Controlled Trial

ObjectiveTo evaluate the effectiveness of a traditional didactic session (TDS) as compared to a self-paced, interactive, multimedia module (SPM) on the application of evidence-based medicine (EBM) skills among medical students during their inpatient pediatric rotation.MethodsWe conducted a randomized controlled trial from June, 2017 to June, 2018 at a quaternary care children's hospital. Students were randomized to TDS or SPM during each 2-week block. All students completed a critical appraisal tool (CAT) of evidence related to a clinical question in a standardized appraisal form and self-reflected about the EBM process. The primary outcome was the numeric score of the CAT derived by using the validated Fresno tool. Secondary outcomes of knowledge, attitudes, confidence, and self-reported behaviors related to EBM were measured using validated surveys. Statistical analysis was performed using Student's t test for CAT scores and mixed-model procedure (PROC MIXED), with subject as random effect and time as repeated measure for the secondary outcomes.ResultsOne hundred twenty-seven clerkship students were included. Overall, there was no significant difference in mean CAT scores for TDS (n = 59) versus SPM (n = 66) groups (90.3 vs 92.0, P = .65). There were no significant differences between SPM and TDS groups for knowledge (P = .66), attitudes (P = .97), confidence (P = .55), and accessing evidence (P = .27). Both groups showed significant gains in knowledge, attitudes, confidence, and accessing evidence from baseline to postcourse. Improvements in knowledge and confidence were sustained at 3-months.ConclusionA SPM learning module is as effective as a TDS module for application of EBM concepts and knowledge to patient care.

Aceso: PICO-guided Evidence Summarization on Medical Literature.

Evidence-Based Medicine (EBM) aims to apply the best available evidence gained from scientific methods to clinical decision making. A generally accepted criterion to formulate evidence is to use the PICO framework, where PICO stands for Problem/Population, Intervention, Comparison, and Outcome. Automatic extraction of PICO-related sentences from medical literature is crucial to the success of many EBM applications. In this work, we present our Aceso system, which automatically generates PICO-based evidence summaries from medical literature. In Aceso 1, we adopt an active learning paradigm, which helps to minimize the cost of manual labeling and to optimize the quality of summarization with limited labeled data. An UMLS2Vec model is proposed to learn a vector representation of medical concepts in UMLS 2, and we fuse the embedding of medical knowledge with textual features in summarization. The evaluation shows that our approach is better on identifying PICO sentences against state-of-the-art studies and outperforms baseline methods on producing high-quality evidence summaries.