Evidence-based Medical Practice Research Articles

Curing the pandemic of misinformation on COVID-19 mRNA vaccines through real evidence-based medicine - Part 2

BackgroundAuthorities and sections of the medical profession have supported unethical, coercive, and misinformed policies such as vaccine mandates and vaccine passports, undermining the principles of ethical evidence-based medical practice and informed consent. These regrettable actions are a symptom of the ‘medical information mess’: The tip of a mortality iceberg where prescribed medications are estimated to be the third most common cause of death globally after heart disease and cancer.AimTo identify the major root causes of these public health failures.MethodsA narrative review of both current and historical driving factors that underpin the pandemic of medical misinformation.ResultsUnderlying causes for this failure include regulatory capture – guardians that are supposed to protect the public are in fact funded by the corporations that stand to gain from the sale of those medications. A failure of public health messaging has also resulted in wanton waste of resources and a missed opportunity to help individuals lead healthier lives with relatively simple – and low cost – lifestyle changes.ConclusionThere is a strong scientific, ethical and moral case to be made that the current COVID vaccine administration must stop until all the raw data has been subjected to fully independent scrutiny. Looking to the future the medical and public health professions must recognise these failings and eschew the tainted dollar of the medical-industrial complex. It will take a lot of time and effort to rebuild trust in these institutions, but the health – of both humanity and the medical profession – depends on it.ContributionThis article highlights the importance of addressing metabolic health to reduce chronic disease and that insulin resistance is also a major risk factor for poor outcomes from COVID-19.

The Association of Attending Physicians' Publications and Patients' Readmission Rates: Evidence from Tertiary Hospitals in China Using a Retrospective Data Analysis.

Background: Physicians play a unique role in scientific and clinical research, which is the cornerstone of evidence-based medical practice. In China, tertiary public hospitals link promotions and bonuses with publications. However, the weight placed on research in the clinician’s evaluation process and its potential impact on clinical practice have come under controversy. Despite the heated debate about physicians’ role in research, there is little empirical evidence about the relationship between physicians’ publications and their clinical outcomes. Method: This paper examines the association of the quantity and quality of tertiary hospitals’ attending physicians’ publications and inpatient readmission rates in China. We analyzed a 20% random sample of inpatient data from the Urban Employee Basic Medical Health Insurance scheme in one of the largest cities in China from January 2018 through October 2019. We assessed the relationship between the quantity and impact factor of physicians’ publications and 30-day inpatient readmission rates using logistic regression. There were 111,965 hospitalizations treated by 5794 physicians in our sample. Results: Having any first-author publications was not associated with the rate of readmission. Among internists, having clinical studies published in journals with an average impact factor of 3 or above was associated with lower readmission rates (OR = 0.849; 95% CI (0.740, 0.975)), but having basic science studies published in journals with an average impact factor of 3 or above was not associated with the rate of readmission. Among surgeons, having clinical studies published in journals with an average impact factor of 3 or above was likewise associated with lower readmission rates (OR = 0.708 (0.531, 0.946)), but having basic science studies published in journals with an average impact factor of 3 or above was associated with higher readmission rates (OR = 1.230 (1.051, 1.439)).

DO INCREASED LEVELS OF TRIGLYCERIDES CONSIST AN INDEPENDENT RISK FACTOR DEFINING THE SEVERITY OF CARDIOMYOPATHY IN T2DM PATIENTS WITH KNOWN HYPERTENSION ?

Objective: The association of diabetes mellitus and heart disease is well established in evidence-based medical practice in our days. Diabetes Mellitus is also associated with various cardiovascular risk factors including hypertension and hypertriglyceridemia. Therefore, the severity of Cardiomyopathy in Diabetics is interdependent among these various risk factors. The aim of this study was to assess that hypertriglyceridemia is an independent risk factor of the severity of cardiomyopathy in T2DM patients with known Hypertension. Design and method: 451 (249male, 202 female) T2DM Hypertensive patients participated on this study. Age range of the patients was between 48–79 years of age. All patients were assessed for cardiac functioning with Echocardiography and Ventriculographies. Severity of Cardiomyopathy was estimated measuring LVEDP with a borderline > 15 mm Hg. TGC were measured in serum blood analysis of patients in SI units. Data were analyzed using ANOVA and logistic regression analysis. Hypertriglyceridemia was analyzed as an independent risk factor. Data is presented as mean ± standard deviation and level of significance was accepted when p < 0.05. Results: Data were analyzed on 451(249 male, 202 female) hypertensive T2DM patients, 91 (20.2%) presented with TGC level of 2.9 ± 0.8 mmol/L, and a LVEDP of 16.2 ± 0.8 mm Hg. 109 patients (24.1 %) with TGC level of 3.6 ± 0.7 mmol/L, and a LVEDP of 17.8 ± 0.9 mm Hg. 132 (29.3%) TGC level of 4.1 ± 0.3 mmol/L, and a LVEDP of 19.4 ± 0.8 mm Hg and 119 (26.4%)patients with TGC level of 4.7 ± 0.6 mmol/L, and a LVEDP of 21.1 ± 0.8 mm Hg. Data Analysis revealed that hypertriglyceridemia p = 0.019 is an independent risk factor of cardiomyopathy in T2DM hypertensive patients and leads in markedly increased Left Ventricular End Diastolic Pressures p = 0.022. Conclusions: Hypertriglyceridemia is an independent risk factor of Cardiomyopathy in Hypertensive T2DM patients.

Explainability and artificial intelligence in medicine

In recent years, improved artificial intelligence (AI) algorithms and access to training data have led to the possibility of AI augmenting or replacing some of the current functions of physicians.1 However, interest from various stakeholders in the use of AI in medicine has not translated to widespread adoption.2 As many experts have stated, one of the key reasons for this restricted uptake is the scarce transparency associated with specific AI algorithms, especially black-box algorithms.3 Clinical medicine, primarily evidence-based medical practice, relies on transparency in decision making.

Development of a Fast Fourier Transform-based Analytical Method for COVID-19 Diagnosis from Chest X-Ray Images Using GNU Octave.

Many artificial intelligence-based computational procedures are developed to diagnose COVID-19 infection from chest X-ray (CXR) images, as diagnosis by CXR imaging is less time consuming and economically cheap compared to other detection procedures. Due to unavailability of skilled computer professionals and high computer architectural resource, majority of the employed methods are difficult to implement in rural and poor economic settings. Majority of such reports are devoid of codes and ignores related diseases (pneumonia). The absence of codes makes limitation in applying them widely. Hence, validation testing followed by evidence-based medical practice is difficult. The present work was aimed to develop a simple method that requires a less computational expertise and minimal level of computer resource, but with statistical inference. A Fast Fourier Transform-based (FFT) method was developed with GNU Octave, a free and open-source platform. This was employed to the images of CXR for further analysis. For statistical inference, two variables, i.e., the highest peak and number of peaks in the FFT distribution plot were considered. The comparison of mean values among different groups (normal, COVID-19, viral, and bacterial pneumonia [BP]) showed statistical significance, especially when compared to normal, except between viral and BP groups. Parametric statistical inference from our result showed high level of significance (P < 0.001). This is comparable to the available artificial intelligence-based methods (where accuracy is about 94%). Developed method is easy, availability with codes, and requires a minimal level of computer resource and can be tested with a small sample size in different demography, and hence, be implemented in a poor socioeconomic setting.

SACI Protocol: Preliminary Guidelines for the Development of Digital Health Technologies for Clinical Trials in Brazil

In the last decade, evidence-based medical practice has been supported on a large scale by computerized decision support tools, aiming to reduce diagnostic and therapeutic uncertainty, complementing the actions of the health professional. With technological developments, it is now possible to consider these systems as part of clinical intervention, both for the diagnosis and treatment of diseases. The literature has described the implementation of e-health tools, that is, technological innovations in the health area such as software, applications, serious games, among others, as a strategy to improve the process and adherence to treatment. However, there is still no standardized instrument in Brazil that can be used to guide the development, from the research phase, and the implementation of these tools as a health intervention, also impacting patient outcomes. With the objective of investigating a new therapeutic and preventive form, based on intervention with a computerized system, this work proposes the creation of guidelines for the registration and implementation of e-health tools as a clinical intervention. The proposal aims to be able to assist in the reporting standardization from the development stage to the application of the e-health tool helping in the treatment of diseases, registering all the experience lived in the research and applying it in different contexts of health.

Feasibility of ERAS in Patients With Gastric Cancer Complicated by Diabetes Mellitus.

Enhanced Recovery After Surgery (ERAS) is the integration of multiple perioperative evidence-based medical practices into a single pathway aimed at eliminating surgical liabilities and improving treatment accuracy to enhance patients' postoperative outcomes. The ERAS Society has been developing guidelines that are widely applicable in the surgical field. ERAS pathways in selective and noncomplicated cases are extensively practiced. However, the ERAS literature excludes patients with comorbidities, such as gastric cancer complicated with diabetes mellitus (DM). Current ERAS guidelines exclude patients with DM in enhanced recovery programs because of insufficient evidence-based medicine on the molecular physiology of the patients in response to surgical insult. Therefore, it is important to implement accelerated rehabilitation surgery for patients with gastric cancer and DM. This review discusses the feasibility and necessity of applying ERAS guidelines to patients with gastric cancer complicated by DM. In addition, we documented the need to lay a logical foundation for enhanced recovery after surgery in patients with gastric cancer complicated by DM.

Evaluate the compliance of perioperative practices of the patients with the enhanced recovery after surgery protocols

The Enhanced Recovery after Surgery (ERAS) protocol is a multimodal and evidence-based medical practice developed to define the concept of perioperative interventions to improve postoperative outcomes. The protocol consists of a number of elements implemented in the pre-, intra - and post-operative periods. This study aimed to evaluate the compliance of perioperative practices with the ERAS protocols in patients undergoing surgical intervention. In this descriptive and prospective study, 405 patients who underwent surgery in the General Surgery Clinic of a University Hospital created a sample of the study. In the study, where no intervention was made to the patients included in the study, the compliance of routine perioperative practices in the clinic offered to patients undergoing surgery to the protocol was evaluated using the questionnaire prepared in this direction. Procedures such as, in the preoperative period, providing verbal information to all the patients and giving antibiotic prophylaxis to 98.5% of the patients, in the intraoperative period, preferring the smallest possible surgical incision, and, in the postoperative period, using the paracetamol (99.5%) as the first choice for analgesia were compatible with the ERAS protocols. Procedures such as, in the preoperative period, not providing oral carbohydrate to any of the patients and keeping the fasting period longer period (10.91 ± 4.79 hours), in the intraoperative period, preferring anesthetic agents that are effective for a long time, and not perform the necessary practices to ensure normothermia in any of the patients, and, in the postoperative period, not starting the oral nutrition early and using urinary catheterization for 87.7% of the patients were not compatible with the ERAS protocols. As a result of the research, it was determined that the routine perioperative applications in the clinic did not sufficiently comply with the ERAS protocol.

Hemolytic Disease of the Newborn: A Review of Current Trends and Prospects.

Hemolytic disease of the newborn (HDN), also known as Erythroblastosis fetalis, is a hemolytic condition that predominantly affects rhesus-positive fetuses and infants born to rhesus-negative mothers. The pathophysiology of HDN begins with maternal antibodies attacking fetal red blood cells following alloimmunization due to rhesus or ABO incompatibility between the maternal and fetal blood. Previously, HDN was known to cause fetal death in 1% of all pregnancies, but with the advent of immunoprophylactic therapies, the condition can be currently fairly well managed with fewer complications if diagnosed early. Diagnosis calls for extensive history taking, physical examination, serological studies, and imaging modalities such as pelvic ultrasound scans. To prevent the disease, earlier intravenous immunoglobulin (IVIG) should be given to pregnant Rh- women who have not been sensitized. It is also vital to understand prospective complications such as severe hyperbilirubinemia and develop appropriate remedies. Because of its great incidence and nature, HDN has been thoroughly explored, and more studies are being conducted each year, revealing new insights about the condition. This review covers the disorder’s etiology, diagnosis, and management, including the most current findings as of 2021, as well as trends and prospects, to help in future research and evidence-based medical practice.

Model of Social Support for Patients Treated for Cancer.

Simple SummaryThe experience of being diagnosed with a neoplastic disease and the associated cancer treatment, which is worrying and tough for the patient and their family, causes many difficult situations. Studying the multidimensional approach to social support in oncological patients has allowed for the development of a research model of social support using structural equations. Social support is an important variable in coping with cancer.Social support can be one of the main factors in better assessing the quality of life at any stage of the recovery process. It should meet the patient’s needs so that they can develop constructive methods of coping with the disease. In order to explain the factors influencing social support for cancer patients, a theoretical research model was formulated. It is presented in a graphic form in this article. In order to verify the model, the authors’ questionnaire and other standardised questionnaires were used. The experimental group consisted of 170 hospitalised oncological patients being treated for cancer. Personality structure, through its relationship with state of health (0.40) and attitude developed to the disease (0.64), influenced the support experienced by the treated patients (0.40). The surveyed patients, who were characterised by positive self-esteem and experience of life satisfaction despite various difficult situations, perceived to a greater degree the emotional and instrumental support provided to them. During cancer treatment, those patients who showed a need for help and did not experience negative emotions were characterised by an increased need for support. The research results can be introduced into evidence-based medical practice, which could significantly improve the quality of nursing and medical care for patients.

Factors associated with participation in Research by Very Early Career Doctors in a Lower Middle-Income Country in Africa: A Multi-Centre Study

Background: Research is beneficial for the professional growth of a doctor, and forms the bedrock of evidence-based medical practice. Very Early Career Doctors (VECDs) face peculiar personal, work and time constraints which have the potential to affect their research performance. This study described the research engagement of VECDs in Nigeria and investigated its potential associations.Methods: A descriptive cross-sectional study from the quantitative research arm of the Challenges Among Residency Training and Early Career Doctors in Nigeria (CHARTING) Study was conducted between May and December, 2019. Data on socio-demographics, work-related practices, research engagement and training were collected and summarised using frequencies and proportions (categorical variables) and means and standard deviations (for normally distributed continuous variables). Chi-square analysis was used in determining associations between variables and research engagement outcomes; and potential predictors investigated using logistic regression. A p-value &lt; 0.05 was considered significant.Results: A total of 476 VECDs from nine tertiary hospitals in Nigeria were recruited. They comprised of 305 (65.1%) males and 163 (34.9%) females with a mean age of 31.2 +/- 5.0 years. Three hundred and seventy-four (81.5%) and 187 (40.7%) respondents had participated in research and presented their research work, respectively. The proportion of respondents who received research grants, were first authors, and were involved in local &amp; international publications were 8 (1.7%), 32 (6.9%), 42 (9.2%) and 37 (8.0%) respectively.Age ≤ 40 years (P=0.038), graduating within the last 5 years (P=0.016), ≤ 4 years on current job (P=0.001), working in a university affiliated centre (P=0.011), previous undergraduate research methodology training (P&lt;0.0001), and agreeing with the statement that research will enhance their career (P=0.038); were significantly associated with ever having done any research work on bivariate chi-square analysis. Only having had a research methodology training significantly predicted ever participating in any research work (OR=4.49 (95% C.I 2.39-8.45); p&lt;0.0001).Conclusion: VECDs had a high research participation, but low research presentation in scholastic gathering, funding, authorship and publication rates. Research methodology training significantly predicted research participation.

Message of the Department Chair

Fifty years ago, the Department of Orthopaedics was founded and became the newest clinical department of the College of Medicine and Philippine General Hospital, University of the Philippines. This year 2021, we celebrate its Golden Anniversary. Even in its infancy, the department has given due emphasis on research as much as its commitment to training and service. It was one of the first if not the first clinical department to hold an Annual Research Forum and even a research unit was organized by its first Chair, Dr. Jose Silao. Much later, a small biomechanical testing unit was put up. Time and again, its staff and trainees have contributed to the continuing studies in Orthopaedics. These include a better understanding of essential surgical anatomy, validation of surgical procedures, new approaches to the treatment of many Orthopaedic pathologies, and innovations in implants and devices. The generation of new knowledge is a mandate for all university colleges and units and the Department of Orthopaedics takes this seriously. It takes pride in being recognized as a university-based training program. It hammers into the consciousness of its staff and trainees the importance of research. It uses research training for its residents as an important tool in inculcating in them the art of critical thinking, a must in our present-day evidence-based medical practice. This Orthopaedic issue of the Acta Medica Philippina is a fitting way of honoring the department’s long research tradition. The ease with which we gathered publishable researches for this issue just shows the vibrancy of research in the department and how much it has grown from its beginning in 1971. The founding fathers of the department will be proud to see that the department takes seriously the challenge to excel in Training, Service, and Research. I heartily congratulate and profusely thank the authors and editorial staff for coming out with this special Orthopaedic Issue of the Acta Medica Philippina.&#x0D; Juanito S. Javier, MD, MChOrth Chair Department of Orthopedics Philippine General HospitalUniversity of the Philippines Manila

Diagnostic and treatment algorithm for anaphylactic shock of the Self-regulatory organization of the “National board of phlebologists” Association

Many phlebologists today work in ambulatory settings, using both local anesthetics and sclerosants. Cases of anaphylactic shock are rare, but its consequences can be catastrophic. At the request of the self-regulatory organization of the “National College of Phlebologists” Association with the support of “Servier” company, the legal partner of the LLC “Faculty of Medical Law” board, together with leading anesthesiologists-resuscitators, has developed an easy-to-understand and easy-to-deliver information Algorithm for the diagnosis and treatment of anaphylactic shock. This algorithm will not only reduce the risks of adverse effects of anaphylaxis for the patient, but will also protect the physician in case of litigation, as it is prepared with references to current sources of evidence-based medical practice and regulations.

Diagnosis and management of epiploic appendagitis: a single-institution 10-year experience.

&lt;b&gt;Introduction&lt;/b&gt;: Epiploic appendagitis is known to be a benign and self-limiting process, yet optimal management is not well understood. Research focused on the efficacy of treatment in this rare condition may allow future patients diagnosed with epiploic appendagitis to be treated accordingly with the best evidence-based medical practice.&lt;br/&gt;&lt;b&gt;Aim&lt;/b&gt;: The aim of this study was to investigate the diagnosis, compare management options and follow up epiploic appendagitis. &lt;br&gt;&lt;b&gt;Materials and methods&lt;/b&gt;: This retrospective study included all patients over 18 years of age who were treated in a large tertiary hospital in the years 2009-2019 with a confirmed diagnosis of epiploic appendagitis and no coexisting acute intra-abdominal pathologies. Patients' health information was recorded and analysed.&lt;br/&gt;&lt;b&gt;Results&lt;/b&gt;: As many as 78 patients were diagnosed with epiploic appendagitis over a 10-year observation period. A minor male predominance (55%) and a broad range of ages at the moment of diagnosis (18-75) were found, with diabetes (n = 10) being the most common comorbidity in this condition . In the majority of cases, the disease was located in the sigmoid (41%) and descending colon (35%). Diagnosis was primarily based on imaging (computerised tomography 91%, ultrasonography 2.6%). Six percent of patients were diagnosed during surgery and these patients recovered with smaller rates of readmissions and recurrences (P &lt; 0.05). Patients given opioids on discharge were less likely to be readmitted to hospital (P &lt; 0.05), while those given antibiotics had a longer inpatient stay (P &lt; 0.05) with no change in readmission rates (P = 0.78) or recurrence rates (P = 0.48). &lt;br/&gt;&lt;b&gt;Discussion&lt;/b&gt;: Managing epiploic appendagitis with antibiotics is shown to have no effect on patient outcomes, while opioid use for pain control did not affect the length of hospital stay but it reduced the number of readmissions when compared to simple analgesics alone.

EVIDENCE-BASED MEDICINE IN THE TIMES OF COVID-19: A CROSS-SECTIONAL SURVEY TO UNDERSTAND THE INDIAN PERSPECTIVE

Introduction: During the COVID-19 pandemic, there is a tremendous amount of literature published regularly. In a country like India, historically, where there is a paternalistic approach to practicing medicine, there is a lot of hindrance to evidence-based medicine (EBM). Doctors have always weighed one's clinical experience superior over any other form of decision-making. This system of practice has made decision-making difficult for the physicians during this pandemic as COVID-19 is a reasonably new disease entity and the physicians lack enough 'prior experience' dealing with such a situation. Our survey tries to address the common barriers to evidence-based medical practices especially during the COVID-19 pandemic in India. We also try to explore the various source of information used by the doctors.&#x0D; Methods: It is a descriptive cross-sectional survey. The questions were provided in multiple-choice question format. An online survey comprising of 10 questions entitled “Hurdles faced by physicians to assimilate evidence-based guidelines on COVID-19” was made using Google Forms (Google Inc, California, US) and circulated through email to medical practitioners in the Ghatkopar (Mumbai, India) Medical Association's register from 17th June 2020 to 1st September 2020.&#x0D; Results: Our survey collected 213 responses, out of which 80.3% (n=171) of doctors were involved in care, counseling, or management of COVID-19 patients. The most opted primary sources for evidence-based information during this pandemic were teachings of/discussions with medical colleagues (71.4%, n=152), followed by online webinars (59.6%, n= 127) and social media (41.8%, n=89).&#x0D; When questioned about the main obstacles faced by them to obtain evidence-based information, the responses were as follows: Overload of medical literature (53.5%, n=114), limited access to quality resources (40.8%, n=87), unfamiliarity with the bio-statistics analysis (39%, n= 83), difficulty in locating relevant medical literature (38%, n=81), unfamiliarity with the research methodology (37.1%, n=79), lack of time (30%, n=64). &#x0D; Our respondents' perspective concerning EBM attributes: 57.3% (n=122) think evidence-based practice takes their clinical experience into account. 93.4% (n=199) of them have shown an interest in broadening their skills. There was no significant difference between doctors' attitudes with less than 10 years and more than 10 years of experience (chi-square value = 0.857, p = 0.65).&#x0D; Conclusion: Our survey results highlight the balance maintained between evidence-based medicine and experience-based medicine by Indian physicians. They identify the importance of EBM while acknowledging its shortcomings. They realize the significance of developing their repertoire to understand, appraise, and practice EBM.&#x0D; Keywords: EBM, COVID-19

Recent advances in understanding and managing Kallmann syndrome.

Many of the recent advances in our understanding of human reproductive biology and its genetic basis have arisen directly via the genetic investigation of patients with Kallmann syndrome and their families. The disease is characterised by the association of an isolated defect in the secretion (or, less commonly, action) of gonadotropin-releasing hormone (GnRH) and consequent infertility, with anosmia and potentially other associated non-reproductive features. GnRH-producing neurons are located in the hypothalamic brain region after a peculiar migration during embryonic life. To date, different genes affecting GnRH neuron development/migration have so far been implicated in Kallmann syndrome, but our knowledge of the genetic basis of the syndrome remains incomplete. From a clinical point of view, the disease has suffered from a lack of definitive diagnosis and treatment, and although progress has been made in terms of timely diagnosis and evidence-based treatment of patients, implementation remains inconsistent. These aspects will be discussed in this review, which examines new strategies for arriving at more evidence-based and patient-centred medical practice in Kallmann syndrome.

Clinical pharmacist participation in the treatment of a pregnancy complicated with Clostridium difficile infection

Objective To explore the clinical pharmacist participation in the treatment of pregnancy complicated with Clostridium difficile infection. Methods From the perspective of medications, clinical pharmacists followed evidence-based medical practice, combined pharmaceutical theory with clinical evidence and provided individualized pharmacy care in drug selection, dose adjustment, medication regime and liver protection treatment. Results Clinical pharmacists integrated into the treatment team to ensure the effectiveness and safety of medication in the patient with pregnancy. Conclusion The individualized pharmacy care improved the effectiveness of drug treatment.

Urgent Need of Continuing Medical Education: The Key for Patient Awareness of Labor Epidural Analgesia – A Survey of Chinese Perinatal Care Providers

Abstract Objective: This survey was designed to understand the misconceptions about labor epidurals. Methods: This voluntary and anonymous online survey on wenjuan.com was conducted from September 1st, 2015 to January 1st, 2016 via mainly WeChat groups dedicated to perinatal healthcare providers in China. The questionnaire included items inquiring the knowledge and opinions about labor epidural analgesia related to maternal complications, baby safety, and effect on laboring. Incomplete surveys were excluded from the data analysis. The data was presented as percentages and a Chi-square test or Fisher's exact test, as appreciate, was used to quantitatively compare the results. Results: A total of 1412 respondents completed surveys with 42.9% (606/1412) of them being anesthesiologists, 35.1% (495/1412) being obstetricians, 11.8% (167/1412) being midwives, 3.7% (52/1412) being labor and delivery nurses, and 6.5% (92/1412) being hospital administrators and unspecified. The study revealed a lack of knowledge in labor pain control. Although 82.4% (1164/1412) of respondents were familiar with labor epidural analgesia, 8.9% (126/1412) did not know how it works, and 1.1% (15/1412) never heard it in a multiple-choice question. The three main groups (anesthesiologists, obstetricians, and midwives/labor and delivery nurses) were chosen for comparisons. Opinions among these three groups concerning five questions in the three main concerns were evaluated using a statistical significance of P &lt; 0.05. Conclusion: The results in our survey indicated an urgent need of continuing medical education to multidisciplinary specialties to improve evidence-based medical practices as these misconceptions have existed for over 10 years in the medical professionals. Lack of public awareness fueled by misconceptions related to labor epidural analgesia may be associated with a lack of professional knowledge. Correct knowledge in professionals needs to be disseminated to the public in order to dispel possible misconceptions and rumors about labor epidural analgesia. This would not only enhance patient understanding of their care but also improve maternal, fetal, and neonatal outcomes.

Barriers to research productivity among gastroenterologists and hepatologists in Saudi Arabia.

Background:Clinical research is essential for the advancement of medical knowledge and evidence-based medical practice. In this study, we aimed to identify barriers that limit research productivity among gastroenterologists in Saudi Arabia.Methods:We conducted a national online survey targeting gastroenterologists in Saudi Arabia. Participants were asked about the patterns of their practice, their prior research activities, and potential barriers to research productivity. Univariate and multivariate analyses were performed to examine the association between different factors and research productivity.Results:A total of 85 gastroenterologists completed the survey. Respondents were predominantly male physicians (90.6%) and 40% of them belonged to the age group of 40-49 years. About 85.9% had at least one prior research participation of any type. Around 67.1% of the respondents had been a primary investigator at least once in the last 5 years, while only 23.5% had been a primary investigator at a minimum average rate of once a year. Multiple barriers to research productivity were identified: insufficient research time (78.8%), lack of funding and compensation (77.6%), lack of a statistician (68.2%), insufficient research training (64.7%), lack of connection (60%), lack of technical support (57.6%), and lack of interest (31%). On univariate analysis, insufficient research time and lack of funding and compensation were significantly associated with no research participation (P <0.01 and 0.03, respectively). On multivariate analysis, lack of funding and compensation was independently associated with no research participation (adjusted OR 15.32;95% C.I 2.66, 121.58, P < 0.01).Conclusions:Barriers to research productivity are highly prevalent among gastroenterologists in Saudi Arabia. Insufficient research time and lack of funding and compensation are the most common. Interventions are needed to promote research activities.

Stakeholder bias in best practice advisories: an ethical perspective.

Clinicians are increasingly being asked to heed and follow the guidance provided by “best practice advisories.” Such advisories, often in the form of electronic reminders or alerts, are meant to increase the efficiency and effectiveness of evidence-based medical practice. However, we argue that best practice advisories can sometimes be infused with stakeholder bias, even if inadvertently. We specifically argue that best practice advisory biases can occur when an advisory is not oriented to benefit patients at least as much or more than other stakeholders. To address this issue, we put forth the perspective that ethical consideration of biases is especially important in best practice advisory design and revision processes.