Evidence-based Medical Information Research Articles

Physicians' characteristics in the usage of online database: A representative nationwide survey of regional hospitals in Taiwan

Physicians have to deal with a broad range of medical problems in clinical practice, thus making the timely acquisition of relevant information is a critical skill for physicians to improve care quality. The current national study investigates how physicians search for medical information and analyses how they use online medical databases. A structured questionnaire survey was conducted, with 457 valid returns collected. Internet-based resources (Web portals, online databases, and electronic journals) were more often accessed by physicians to look for medical information than personal or paper ones. Almost universally, physicians have accessed online databases. MEDLINE was the most frequently accessed database. Furthermore, physicians under 50 years old tended to access online databases more often than their elder colleagues (OR = 5.27, 95% CI = 1.96–14.14 for age <35; OR = 4.68, 95% CI = 2.07–10.60 for ages 35–50). In addition, physicians with faculty position were more often accessing online databases (OR = 3.32; 95% CI = 1.75–6.30). Other factors — including clinical experience, administrative position, gender, academic degree, and professional specialty — carried no significant differences. These data may assist in determining how to promote the use of online evidence-based medical information for clinical services.

Physicians' User Experiences of Mobile Pharmacopoeias and Evidence-Based Medical Guidelines

This article studies physicians’ mobile user experiences with evidence-based medical guidelines and drug information databases through the concept of webflow. Data was collected among the 352 users of a mobile medical application. The response rate was 66.5% (n=234). The results demonstrate that rather than usefulness and ease of use it is the orientation and navigation within the system in par with perceived challenges, focused attention, and learning that lead to positive user experience. Finding relevant pieces of information becomes essential in system utilization. The results also support the claim that mobile applications are not only beneficial for patient safety but they may also improve the physicians’ computer and professional skills. Frequent use was noted to improve physicians’ computer skills, the feeling of being in control of the system, and their perception of the system’s ease of use. Moreover, learning may play a greater role for knowledge work than often suggested.

Complementary and alternative medicine in patients with chronic lymphocytic leukemia

Despite the widespread use of complementary and alternative medicine (CAM) in the general population for the treatment of chronic diseases, only few data have been published for patients with leukemia. The aim of this survey was to study systematically the use of CAM in patients with chronic lymphocytic leukemia (CLL). A structured questionnaire was sent to 247 CLL patients of all clinical stages and disease durations, treated and untreated. The questionnaire was returned anonymously by 87 patients (35%). Thirty-nine patients (44%) had used alternative treatments. No correlation was seen with educational level, gender, or previous or current chemotherapy. The most common alternative or complementary treatment modality was vitamin supplementation (26%), followed by mineral (18%), homeopathic (14%), and mistletoe therapy (9.2%). Some 21% of patients considered their alternative treatment as being successful. Most patients reported that they decided to use CAM after conducting a personal investigation and based on the information they found, without outside recommendations (59%). The majority of the patients used patient brochures about CLL as an important source of information (54%), followed by specific lectures (34%) or the internet (32%). Our data show that patients with CLL use a wide range of CAM, among them potentially harmful methods. Rational, evidence-based medical information about the effects and risks of CAM use should be made available through patient brochures distributed by patient organizations, through information events with lectures, or via the internet.

Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management, Part I: Introduction and General Considerations

Evidence-based medicine, systematic reviews, and guidelines are part of modern interventional pain management. As in other specialties in the United States, evidence-based medicine appears to motivate the search for answers to numerous questions related to costs and quality of health care as well as access to care. Scientific, relevant evidence is essential in clinical care, policy-making, dispute resolution, and law. Consequently, evidence based practice brings together pertinent, trustworthy information by systematically acquiring, analyzing, and transferring research findings into clinical, management, and policy arenas. In the United States, researchers, clinicians, professional organizations, and government are looking for a sensible approach to health care with practical evidence-based medicine. All modes of evidence-based practice, either in the form of evidence-based medicine, systematic reviews, meta-analysis, or guidelines, evolve through a methodological, rational accumulation, analysis, and understanding of the evidentiary knowledge that can be applied in clinical settings. Historically, evidence-based medicine is traceable to the 1700s, even though it was not explicitly defined and advanced until the late 1970s and early 1980s. Evidence-based medicine was initially called "critical appraisal" to describe the application of basic rules of evidence as they evolve into application in daily practices. Evidence-based medicine is defined as a conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based practice is defined based on 4 basic and important contingencies, which include recognition of the patient's problem and construction of a structured clinical question, thorough search of medical literature to retrieve the best available evidence to answer the question, critical appraisal of all available evidence, and integration of the evidence with all aspects and contexts of the clinical circumstances. Systematic reviews provide the application of scientific strategies that limit bias by the systematic assembly, critical appraisal, and synthesis of all relevant studies on a specific topic. While systematic reviews are close to meta-analysis, they are vastly different from narrative reviews and health technology assessments. Clinical practice guidelines are systematically developed statements that aim to help physicians and patients reach the best health care decisions. Appropriately developed guidelines incorporate validity, reliability, reproducibility, clinical applicability and flexibility, clarity, development through a multidisciplinary process, scheduled reviews, and documentation. Thus, evidence-based clinical practice guidelines represent statements developed to improve the quality of care, patient access, treatment outcomes, appropriateness of care, efficiency and effectiveness and achieve cost containment by improving the cost benefit ratio. Part 1 of this series in evidence-based medicine, systematic reviews, and guidelines in interventional pain management provides an introduction and general considerations of these 3 aspects in interventional pain management.

Eine Befragung von Schwangeren zu Erwartungen an die Geburtsklinik für klinikinterne Maßnahmen zur Qualitätsförderung

Transparent and effective quality management is an essential marketing tool for maternity clinics. Procedures for quality assurance in maternity clinics differ from those in other medical professions. Apart from evidence-based health care the pregnant woman's choice of maternity services providers is increasingly influenced by a number of other factors as well, such as, for example, the response to individual needs or the staff. Hence, the facilities need to present their services and quality of care according to the needs of the target group. In order to identify these needs, a survey was performed among 152 pregnant women during the "Baby Fair", which took place in Berlin in 2006. The objective of the survey was to find out about the preferences and expectations of pregnant women towards the maternity clinic and breastfeeding and their current criteria for the choice of a maternity clinic. The questionnaire contained questions about expectations towards the maternity clinic staff, traditional medicine and alternative medicine, premises, courses offered, rooming-in and expectations towards breastfeeding. The findings from the survey show that the pregnant women's ratings for personal contact, expertise and kindness of the staff were twice as high as for premises, comfort and service. The provision of traditional versus alternative medicine was rated equally. More than 90% of the respondents do see a demand for specific public relations campaigns by maternity clinics concerning information about the particular institution, its range of activities and the impact and process of rooming-in. Only 20% of the respondents felt sufficiently informed about breastfeeding. Besides medical and technical factors, staff factors play a key role in the assessment of maternity clinics. In addition to evidence-based medical information communication strategies should also include information on the staff employed. In particular, information is lacking on rooming-in and breastfeeding, which emphasises the necessity for the timely provision of scientifically based information to pregnant women.

The Women's Health Track of the Kaiser Permanente National Primary Care Conference

Twice a year the Kaiser Permanente National Primary Care Conference (PCC) brings together expert clinician-presenters from all over the Kaiser Permanente Regions. The Women's conference format five years ago and has continued to grow in participation and popularity. Besides offering the latest evidence-based medical information, the conference is always held in a relaxing atmosphere and allows quality time to renew and invigorate the spirit. The PCC faculty is invited to attend a Faculty Development Workshop to improve presentation style and skills. The workshop includes on-camera and group critiquing and is a great opportunity even for experienced presenters. … Kaiser Permanente National Primary Care Conference (PCC) brings together expert clinician-presenters from all over the Kaiser Permanente Regions. Most recently, the meeting took place in Las Ve-gas, Nevada (October 2004). The overall attendance for the conference was approximately 350–including physicians, nurse practitioners, registered nurses, and other allied health professionals from all over the country. The Women's Health Track was the largest ever with 96 registered attendees. Some of the Women's Health topics featured in Las Vegas included: Musculoskeletal Problems in Active and Athletic Women—Presented by Robert Sallis, MD, Southern California HPV and New Cervical Cancer Screening Guidelines and Gy-necologic Cancer Update—Presented by Walter Kinney, MD, Northern California Women's Respiratory Health: Gender and Sex Differences—Presented by Reginald Mason, MD, KP Georgia The Epidemic of Chlamydia—Presented by Charles Wibbelsman, MD, Northern California; Victoria Mancuso, MD, Northern California; and Lee Jacobs, MD, Georgia Evidence-Based Approach to Complementary and Alternative Medicine: Chiropractic, Acupuncture, and Herbs—Moderated by Lee Jacobs, MD, Geor-gia; Panelists: Kirk Pappas, MD, Northern California; Stanford Shoor, MD, Northern California; and Tierona Low Dog, MD, guest presenter. The Spring 2005 National Primary Care Conference promises to be equally interesting and relevant. Please look for the announcement for the next conference in Maui (page 107) to be held from March 20-25, 2005 or go to: www.kpprimarycareconference.org. Some of the Women's Health Topics planned for the spring include: Cosmetic Dermatology and Plastic Surgery Polycystic Ovarian Syndrome and Metabolic Syndrome—What's the relationship? Lactation—Physiology, Medications, and the Impact on Primary Care Sexuality—Physiology and Implications for Women with Chronic Diseases Evidence-Based Approach to Complementary and Alternative Medicine: Spiritual Healing, Prayer, and Meditation Management of Obesity HPV and New Cervical Cancer Screening Guidelines and Gynecologic Cancer Update I look forward to seeing you in Maui!

Evidence-based patient information about treatment of multiple sclerosis—A phase one study on comprehension and emotional responses

Objective This study analysis the comprehension and emotional responses of people suffering from multiple sclerosis when provided with an evidence-based information module. It is a core module of a comprehensive decision aid about immunotherapy. The core module is designed to enable patients to process scientific uncertainty without adverse effects. It considers existing standards for risk communication and presentation of data. Methods Using a mailing approach we investigated 169 patients with differing courses of disease in a before–after design. Items addressed the competence in processing relative and absolute risk information and patients’ emotional response to the tool, comprising grade of familiarity with the information, understanding, relevance, emotional arousal, and certainty. Results Overall, numeracy improved ( p < 0.001), although 99 of 169 patients did not complete the numeracy task correctly. Understanding depended on the relevance related to the course of disease. A moderate level of uncertainty was induced. No adverse emotional responses could be shown, neither in those who did comprehend the information, nor in those who did not develop numeracy skills. Conclusion In conclusion, the tool supports people suffering from multiple sclerosis to process evidence-based medical information and scientific uncertainty without burdening them emotionally. Practice implications This study is an example for the documentation of an important step in the development process of a complex intervention.

A Novel Data Mining Approach to the Identification of Effective Drugs or Combinations for Targeted Endpoints?Application to Chronic Heart Failure as a New Form of Evidence-based Medicine

Data mining is a technique for discovering useful information hidden in a database, which has recently been used by the chemical, financial, pharmaceutical, and insurance industries. It may enable us to detect the interesting and hidden data on useful drugs especially in the field of cardiovascular disease. We evaluated the current treatments for chronic heart failure (CHF) in our institute using a decision tree method of data mining and compared the results with those of large-scale clinical trials. We enrolled 1,100 patients with CHF (NYHA classes II-IV and EF < 40%) who were hospitalized at the National Cardiovascular Center during the past 31 months. Drugs prescribed at discharge were extracted from the clinical database. Both echocardiograms and plasma BNP level at 6-12 months after discharge were determined prospectively. It was found that beta-blockers, angiotensin converting enzyme inhibitors, and angiotensin II receptor antagonists independently improve both the plasma BNP level and %fractional shortening (FS), while oral inotropic agents increased the plasma BNP level and decreased %FS. These findings agree with evidence accumulated from several large-scale trials. Interestingly, statins, histamine receptor blockers, and alpha-glucosidase inhibitors also attenuated the severity of CHF, suggesting the possibility of new treatment of CHF. Clinical data mining using Japanese CHF patients yielded almost identical data to the results of large-scale trials, and also suggested novel and unexpected candidates for CHF therapy. Further validation of the data mining approved in the cardiovascular field is warranted.

The MATCH Study Results in the Context of Secondary Stroke Prevention

The performance of randomized clinical trials provides evidence-based medical information to clinicians and impacts on day-to-day treatment decisions. Many secondary stroke prevention trials over the past 4 decades have provided much useful information concerning the efficacy or lack thereof of different therapies for reducing recurrent stroke risk. For platelet antiaggregants, placebo-controlled trials are no longer justified and comparator trials evaluating drug combinations in comparison to monotherapy are appropriate. The MATCH trial evaluated the efficacy and safety of combined clopidogrel–aspirin therapy to clopidogrel alone in high-risk patients with completed stroke or transient ischemic attack who also had 1 or more of 5 additional risk factors. The combined endpoint of ischemic stroke, myocardial infarction, vascular death, or recurrent hospitalization for an ischemic …

Information therapy: health education one person at a time.

Targeted and timely health information is a key part of helping patients achieve their behavior change and disease management goals. However, most health professionals rely on inefficient systems (office hours only) and outmoded technologies (mouth to ear) to transfer information to patients. Often, patients are left on their own to track down health information relevant to them. Information therapy, the prescription of specific evidence-based medical information to specific patients at just the right time to help them make specific health decisions or behavior changes, will ensure patients and providers overcome these obstacles. Embedding evidence-based information within the process of care further ensures patients and their families become more knowledgeable and involved in their care. This article outlines what constitutes prescription-strength information, three critical elements needed to deliver information prescriptions, opportunities for information prescriptions within the continuum of care, and the impact information therapy could have on the health education profession.

Clinical Evidence at the Point of Care in Acute Medicine: A Handheld Usability Case Study

The need to design medical information device interfaces for clinical use has been well documented in medical journals. In this study we apply well known usability techniques such as user requirement elicitation and prototype design and evaluation to design an evidence-based medical information retrieval system intended for a wireless environment. Our immediate goal is to make the daily practice of evidence-based medicine (EBM) for frontline clinicians easier by providing relevant, timely information at the point of care (using a wireless PDA device), delivered in a format that is usable and liked by the target group. Our objective is to use this evidence-based information delivery tool as an educational device and to encourage clinicians to consult, as appropriate, the latest best evidence available to support their clinical decision in hopes of improving clinical outcomes. The development of a handheld user interface for clinicians is described, along with results obtained from usability testing with a sample set of scenarios.

THE VALUE COMPONENT OF EVIDENCE-BASED MEDICINE

THE VALUE COMPONENT OF EVIDENCE-BASED MEDICINE

Refusal of treatment.

Patients' thoughts, feelings and desires are communicated in a variety of ways, and require sympathetic, critical interpretation. Patients need clear, evidence-based medical information so that they can make their own decisions about whether to consent to or refuse medical treatment. Treatment refusal may provide an opportunity to introduce patients to advance care planning. Unconscious motivations in doctors may obstruct good clinical decision-making. Although respect for the patient's responsibility to make healthcare decisions should be a condition of the clinical relationship, healthcare decision-making is a collaborative process.

Supporting Knowledge Management in an Online Community of Healthcare Professionals - The Evimed Project

A major problem for healthcare professionals is to do the daily routine in practice and to keep up with scientific advances simultaneously. Issues they have to deal with include an overload with highly specialized information from biomedical research and a lack of clinically relevant information prepared according to the needs of the consultation-hour. This 'information paradox' together with the demand for reliable information has a catalyzing effect on the emergence of a novel medical discipline, the evidence-based medicine. Evidence-based medicine is the conscious, explicit, and judicious application of the currently best evidence in making medical care decisions in favor of an individual patient. Evidence-based medical information services on the Internet have the potential to significantly contribute to the management of knowledge in online communities of healthcare professionals. This study presents such a service – the Evimed project. It particularly considers the aspect of community support which ...