Application Of Evidence-based Medicine Research Articles

Evidence-Based Concept Mapping for the Athletic Training Student

Context A concept map is a graphical and cognitive tool that enables learners to link together interrelated concepts using propositions or statements that answer a posed problem. As an assessment tool, concept mapping reveals a learner's research skill proficiency and cognitive processing. Background The identification and organization of the relationships between concepts are the hallmark of concept mapping that build knowledge acquisition and clinical reasoning skill. Concept mapping does not emphasize linear relationships but the complexity of reciprocal relationships, linking new knowledge to prior knowledge. The brain works by making analogical links between past and current information and utilizes these links to create new mental models to solve a current or future problem. Students engage in a search of the literature and synthesize and critique the findings for integration into an approach to address a clinical question or problem. Objectives Provide health profession educators with an understanding of how concept mapping can be utilized to assess and build students' clinical reasoning as well as promote transfer of learning from the classroom to the clinical setting. Description An overview of the concept mapping process as well as rationale for its use to build clinical reasoning and decision-making skill is provided. Suggestions are also provided for its use as a competency instruction and assessment tool. Clinical Advantages Concept mapping reveals the gaps in a student's clinical reasoning and decision-making process, assists in filling these gaps and builds student understanding and application of evidence-based medicine to inform appropriate clinical decisions. Conclusions Through examination of concepts, their associated problems and how best to solve them based on evidence, concept mapping complements the instruction and assessment of educational competencies. The concept mapping process facilitates a student-centered learning approach, which can be peer or instructor evaluated.

Using Tablet Computers to Teach Evidence-Based Medicine to Pediatrics Residents: A Prospective Study

ObjectiveWe sought to determine if tablet computers—supported by a laboratory experience focused upon skill-development—would improve not only evidence-based medicine (EBM) knowledge but also skills and behavior. MethodsWe conducted a prospective cohort study where we provided tablet computers to our pediatric residents and then held a series of laboratory sessions focused on speed and efficiency in performing EBM at the bedside. We evaluated the intervention with pre- and postintervention tests and surveys based on a validated tool available for use on MedEdPORTAL. The attending pediatric hospitalists also completed surveys regarding their observations of the residents' behavior. ResultsAll 38 pediatric residents completed the preintervention test and the pre- and postintervention surveys. All but one completed the posttest. All 7 attending pediatric hospitalists completed their surveys. The testing, targeted to assess EBM knowledge, revealed a median increase of 16 points out of a possible 60 points (P < .0001). We found substantial increases in individual resident's test scores across all 3 years of residency. Resident responses demonstrated statistically significant improvements in self-reported comfort with 6 out of 6 EBM skills and statistically significant increases in self-reported frequencies for 4 out of 7 EBM behaviors. Attending pediatric hospitalists reported improvements in 5 of 7 resident behaviors. ConclusionsThis novel approach for teaching EBM to pediatric residents improved knowledge, skills, and behavior through the introduction of a tablet computer and laboratory sessions designed to teach the quick and efficient application of EBM at the bedside.

Is evidence based medicine (EBM) applicable in our real life?

Abstract Applying evidence based medicine (EBM) in our daily practice and health settings is a great challenge for residents due to the lack of time and experience. The following case scenario is an example of real life application of EBM.

Using PICO to align medical evidence with MDs decision making models.

Modern medicine is characterized by an "explosion" in clinical research information making practical application of Evidence-Based Medicine (EBM), problematic for many clinicians. We have developed a PICO-(evidence based search strategy focusing on Patient/Population, Intervention, Comparison and Outcome)-based framework for (indexing and retrieving medical evidence and we posit that the use of PICO allows for organizing evidence that is aligned with an MD's decision making model. We describe a study where medical students evaluated our PICO-based approach and results show that students are eager to apply EBM but are hindered by a lack of specialist skills. Students reported that the PICO-based framework for organizing evidence provided an intuitive way of accessing and evaluating evidence and would be useful for their clinical tasks.

Application of evidence-based medicine combined with case based learning in pediatric residency training

Objective To explore the effect of evidence-based medicine combined withcase based learning(CBL) in pediatric residency training.Methods Totally 52 residents were equally divided into two groups:experiment group and control group.Method of CBL combined with the evidencebased medicine (Taking two residents as one group,firstly teacher posed the questions and then residents searched for references when off duty and made evidence-based case presentation at fixed time when doing teaching ward around,after wards all personnel in the department made case discussion,finally teacher made the summary) was used in experimental group while traditional teaching method (teacher guided the residents to analyze the case by clinical experiences,residents took notes and sometimes asked questions,teacher directly gave the answers)was used in control group.The teaching effect is evaluated by questionnaire,theory test and clinical skills assessment.Statistical analysis was carried out on appraisal results with SPSS 16.0 software,test results and appraisal results were expressed as ((x-) ±s) and t test was performed,P ＜ 0.05 was taken as statistically significant.Results Residents in experimental group had more advantages in self-study ability,literature retrieval ability,physician teamwork spirit,clinical thinking,PowerPoint making and language expression after receiving CBL combined with evidence-based medicine.Theory examination showed that average score of experimental group was better than that of control group (75.46 ± 6.646) vs.(71.38 ±4.758),with statistically significantly differences (P =0.014),especially in subjective items.Clinical skills assessment showed that experimental group was better than control group in writing medical records and doing clinical thinking.Conclusions Teaching method of evidence-based medicine combined with CBL is significantly better than traditional indoctrination teaching in improving the abilities of self-study,cultivating clinical thinking,literature retrieval,language performance and other skills.This teaching method is more suitable for pediatric residency training. Key words: Case-based learning; Evidence-based medicine; Residency training

The teaching of critical appraisal skills in urology residency: What is the evidence?

The manuscript by Roth and Siemens1 is a topical one that deals with attitudes towards and knowledge of evidence-based medicine (EBM) among graduating urology residents. The authors also discuss the prevalence and structure of EBM curricula in Canadian urology training programs. The findings from this self-reported survey of 29 chief residents are concerning but not surprising. Formal teaching of EBM in residency was reported by less than a third of respondents and only slightly more than half received instruction during medical school. Most urology resident exposure to EBM occurs in a journal club format and most respondents were not aware of 8 commonly used web-based EBM resources available to practitioners. Knowledge of the fundamentals of EBM terminology was correspondingly limited, but there was strong support for developing formal instruction and evaluation of these important concepts. A lack of time during residency and a lack of faculty with the requisite expertise were cited as the most common reasons for the limited exposure to EBM. These are similar to barriers reported in other specialty training programs as outlined in a recent systematic review of this topic.2 In general, limited time, competing responsibilities and resident lack of knowledge and skills were cited as the most common barriers to the application of EBM in the published literature. Interestingly, in one Canadian study included in this review, several surgical residents reported a fear of repercussion from staff surgeons when confronting them with new evidence.3 (There were no urology residents in this study!) As new faculty with advanced education in EBM come on board, our training of urology residents in this area may self-correct as long as the teachers are enabled to apportion the necessary time in urology curricula to this important facet of postgraduate education. This is easier said than done. There is considerable curriculum compression in residency training programs today with requirements for teaching of all the CanMEDS core competencies to maintain Royal College accreditation. Evidence-based medicine falls under the scholar rubric of CanMEDS. Item 6.2 of the Royal College general standards of accreditation states that “The program must ensure that there are effective teaching programs in the critical appraisal of medical literature using knowledge of research methodology and biostatistics.”4 Hosting journal clubs as the sole method of teaching critical appraisal is not likely to be deemed sufficient to receive a passing grade by an external reviewer of our residency programs. Under the old apprenticeship model of training, scholarship involved honing our clinical skills in concert with the incorporation of expert opinion into one’s personal database. In the hierarchy of EBM, expert opinion is the lowest level of evidence and therefore a lower value is placed on authority than did previous traditional medical paradigms.5,6 Urologists need to continue to climb the pyramidal levels of evidence if we are to remain a scholarly specialty. That said, not all urologists (me included) need to be the principal investigator of a randomized controlled trial, be capable of conducting a meta-analysis, or wax eloquent about the difference between an odds ratio, a risk ratio, and a hazard ratio. However, we should all be aware of what these tools entail, whether they are in existence for questions that arise in our clinical practices, and where to access them if they do exist.

NASPGHAN Guidelines for Training in Pediatric Gastroenterology

G.G.C. has received com M.C. has served on th served on the board o and Enteral Nutrition; her institution has rec collaborative and Prov pensation from Child L.A.G. has received c received compensatio employment, expert t stocks/stock options; LLC, consulted to No received or has grants Institutes of Health, th holds equity interest in has received compens Fibrosis Foundation; M Abbott Laboratories, Foundation, the Natio Diseases/National Ins ticals; E.A.R. has rece sionalism & Ethical institution has receive as the medical editor has received compen Pharmaceuticals, and Nutrition; J.T. has rec Pediatrics, Prometheu conflicts of interest. Copyright # 2012 by E Hepatology, and Nut Gastroenterology, He DOI: 10.1097/MPG.0b01

A study of resident′s attitude, knowledge and barriers towards the use of evidence based medicine

Objectives: To survey the attitudes, awareness, and practice of evidence based medicine (EBM), and to determine the barriers that influence application of EBM in therapeutic process among clinical residents in Iran. Materials and Methods: A cross sectional survey was conducted during September to December 2012 at the teaching hospitals of Tehran University of Medical Sciences among 79 clinical residents from different medical specialties. A valid and reliable questionnaire consisted of five sections and 27 statements were used in this research. Most respondents (90%) completed the questionnaires voluntarily and anonymously. We inserted the data into Microsoft Excel 2007. Data were analyzed using Statistical Package for Social Sciences (SPSS) 16.0 software. We applied Spearman and Mann-Whitney test for correlation between variables. Results: Knowledge of residents about EBM is low and their attitude towards EBM was positive, but their knowledge and skills in regard with the evidence based medical information resources were mostly limited to Google Scholar. Lack of enough time to practice EBM and unperfect access to data bases were the main barriers. There was no significant correlation between residency grade and familiarity and use of electronic EBM resources (Spearman, P = 0.138). Conclusions: It is essential to improve their knowledge, skills, and capabilities to practice EBM. They can conduct EBM that should reduce medical errors and faulty diagnoses. Integration of training approaches like journal clubs or workshops with clinical practice is suggested.

„Wir machen doch eigentlich alle EbM!“ – Vorstellungen und Haltungen deutscher Hausärzte zu Evidenzbasierter Medizin und Leitlinien im Praxisalltag: Eine qualitative Studie

Implementation of guidelines in general practice is difficult. Do general practitioners (GPs) reject evidence-based medicine (EBM) in general? Which attitudes do GPs have towards EBM and guidelines, and which value do they attach to EBM in daily routine? We conducted a qualitative study using five focus groups with 53 GPs. The study was set in the German federal states of Bavaria, Saxony, North Rhine-Westphalia, Hesse and Hamburg. Participants were selected according to area (rural/urban), region (North/South, East/West) and grade of professionalisation. Focus groups were digitally recorded and fully transcribed. Data were analysed in a multidisciplinary team using qualitative content analysis. Most participants felt positive towards EBM. Lack of feasibility was explicitly mentioned: the participants distinguished between "practised" and "true" EBM. Guidelines are often considered unsuitable for general practice. The GPs felt confident that their treatment of patients was evidence-based. Compared to older studies, German GPs have an increasingly favourable opinion about EBM. In order to enhance the practical application of EBM and guidelines the attitudes of GPs need to be considered.

1014 Higher Specialist Training in Ireland. Learning from the Graduates 2005–2011

Background and AimsThe Higher Specialist Training (HST) program in General Paediatrics was initiated in 1999. The first graduates to complete the full program received their CSCST in 2005. There are...

Reasoning and Evidence-Based Medicine

It is impossible to answer every potential clinical question through randomized controlled trials. Hence, assumptions, rational thinking, logic, and reasoning are used in making recommendations; however, these methods may interfere with the judicious application of evidence-based medicine and, as discussed in this article, may result in logical fallacies. We also explain how we may incorporate recommendations based on assumptions and rational thinking in patient care. Extrapolations of study content and confusing association with causation are common pitfalls in the application of the evidence-based medicine process. Personal bias can be another barrier in the adoption of evidence-based medicine. It can be difficult to modify personal bias despite the evidence; keeping up with the medical literature in a busy practice can be daunting.

Evidence-Based Medicine

The concept of evidence-based medicine (EBM), defined as the integration of best research evidence with clinical expertise and patient values, is essential to the review, understanding, and application of clinical principles into the practice of medicine. Critical appraisal includes recognizing and evaluating various study designs and their ranking in order of priority, judging relevance to the question at hand, identifying potential sources of bias, and determining whether the data presentation, statistical analysis, and conclusions are appropriate. The focus of this article is on the quality of the evidence and how each step in critical appraisal is important to the overall concept and application of EBM.

Application of evidence-based medicine to recurrence of Hansen’s type I intervertebral disc disease in dogs: A justification for continuation of study into percutaneous laser disc ablation?

AbstractTo review and evaluate the literature reporting results of prophylactic surgical procedures for Hansen’s type I intervertebral disc disease.Systematic literature review.Online bibliographic searches of abstracts through PubMed and the Veterinary Information Network (VIN) were performed using the searchable term “canine intervertebral disc disease and recurrence”. The resources were evaluated in regard to the ability of the retrieved references to directly address the clinical question as follows: which prophylactic technique when considered with or without surgery will consistently reduce or eliminate the recurrence of clinical signs associated with Hansen’s type I intervertebral disc disease. All studies were compared and evaluated with regard to study design, technique utilized, short and long-term outcome, and evidence classification.An online bibliographical search was performed in PubMed using the full search term of “canine intervertebral disc disease and recurrence” resulted in 20 total sources, and of those sources 13 contained information pertaining to the clinical question. The same search term when used in the VIN search engine under the classification of journal abstracts resulted in 43 total results with 18 applicable resources. In review of both searches, 13 resources were listed in both searches. Of the 18 obtained by the VIN search 14 were available in the English language. No resources were included in class I level of evidence, and only one was considered as class II level of evidence. As for the remaining studies, three results were classified as class III studies, and the remaining reports were classified as class IV level of evidence.Although direct extrapolation of the evidence provided by the search to the clinical scenario is not possible, this review will hopefully provide the basis for development of a randomized controlled study to provide for a clear need in evidence for prevention of intervertebral disc extrusion in dogs.

Evidence-Based Medicine: Opportunities and Challenges in a Diverse Society

In this article we explore the discourse and practice of evidence-based medicine (EBM) in the context of social and cultural diversity. The article consists of 2 parts. First, we begin by defining EBM, describing its historical development and current ascendance in medical practice. We then note its importance in contemporary psychiatry, comparing dynamics between the United States and Canada. Secondly, we offer a constructive critique of the application of EBM and evidence-based practices in the context of ethnocultural diversity, as one consistent reflection on the EBM literature is that it is does not adequately address issues of diversity. In doing so, we use the situation here in Canada as an extended case study, though our observations will likely be applicable in other diverse nations, such as the United States, the United Kingdom, and Australia. We critically examine the following 6 issues related to the practice of EBM in a diverse society: generalizability and transferability of evidence-based interventions; diversifying standards of evidence in EBM; strategies to address diversity in EBM research; cultural adaptations of evidence-based interventions; integrating idiographic knowledge; and, training and health service delivery. Concurrent with our critique, we offer research and practice suggestions that may address outstanding challenges vis-à-vis the practice of EBM in a diverse society. These include a need for more effectiveness research, more openness to diverse sources of knowledge, better integration of idiographic and nomothetic knowledge, and a critical approach to extrapolation and transfer of knowledge.

Integrating evidence in disability evaluation by social insurance physicians

The aim of this study was to explore applying the method of evidence-based medicine (EBM) to resolve common questions in the field of disability evaluation. We used three clinical questions corresponding to problems encountered by insurance physicians in daily practice to explore opportunities for and barriers to the application of EBM. The questions fell under two topics: the prognosis of work ability and the effectiveness of interventions to enhance work participation. We used the four-step EBM strategy: (i) formulation of a clinical question, (ii) searching the literature, (iii) appraisal of the evidence, and (iv) implementation of the findings into clinical practice. We restricted the searches to PubMed (Medline). For rheumatoid arthritis, we found evidence on the prognosis of work disability over a long-term period. For remaining sciatica after lumbar discectomy, we found evidence for the stability of the limitations at this stage. For depression with co-morbid alcoholism, we found evidence that treatment of both conditions would enhance work participation. The searches were effective and efficient. The interpretation of the findings was hampered by a lack of consensus in the literature about outcomes such as the concept of a poor prognosis of work ability. The EBM strategy and methods can be used by social insurance physicians to find and apply evidence for common questions in disability evaluation. The World Health Organization's International Classification of Functioning, Disability, and Health (ICF) model is instrumental in this, although more consensus on central outcome measures is needed. Further research is needed on the translation of evidence into practice. Development of valid specific search strategies for physicians in disability evaluation would improve the implementation of EBM.

The challenge of integrating new online education packages into existing curricula: A new model

Background: In 2009, The National Institute for Health and Clinical Excellence (NICE) developed an undergraduate online learning package on the practical application of evidence-based medicine with the intention that it would be integrated into existing medical curricula.Methods: Complementary methodologies were used to yield a diversity of quantitative and qualitative data on how the online learning package was integrated.Results: The modules of the online learning package received an overall positive reaction from the users but uptake of the modules was lower than expected. Even though some curriculum integration occurred, several students were unaware that the package existed, some lacked the time to use the package and others would have preferred to have had the package earlier in their course.Conclusions: A new model for the effective integration of online education packages into existing undergraduate medical curricula is proposed, especially when developed by external organisations. This new model should enable educationalists to better reveal and overcome the contextual and process challenges, barriers and solutions to implementing effective flexible learning approaches. When introducing new learning resources into a curriculum, many factors are important, especially the learners’ perceived needs and how these vary at different stages of their course.

Interpreting systematic reviews: are we ready to make our own conclusions? A cross-sectional study

BackgroundIndependent evaluation of clinical evidence is advocated in evidence-based medicine (EBM). However, authors' conclusions are often appealing for readers who look for quick messages. We assessed how well a group of Malaysian hospital practitioners and medical students derived their own conclusions from systematic reviews (SRs) and to what extent these were influenced by their prior beliefs and the direction of the study results.MethodsWe conducted two cross-sectional studies: one with hospital practitioners (n = 150) attending an EBM course in June 2008 in a tertiary hospital and one with final-year medical students (n = 35) in November 2008. We showed our participants four Cochrane SR abstracts without the authors' conclusions. For each article, the participants chose a conclusion from among six options comprising different combinations of the direction of effect and the strength of the evidence. We predetermined the single option that best reflected the actual authors' conclusions and labelled this as our best conclusion. We compared the participants' choices with our predetermined best conclusions. Two chosen reviews demonstrated that the intervention was beneficial ("positive"), and two others did not ("negative"). We also asked the participants their prior beliefs about the intervention.ResultsOverall, 60.3% correctly identified the direction of effect, and 30.1% chose the best conclusions, having identified both the direction of effect and the strength of evidence. More students (48.2%) than practitioners (22.2%) chose the best conclusions (P < 0.001). Fewer than one-half (47%) correctly identified the direction of effect against their prior beliefs. "Positive" SRs were more likely than "negative" SRs to change the participants' beliefs about the effect of the intervention (relative risk (RR) 1.8, 95% confidence interval 1.3 to 2.6) and "convert" those who were previously unsure by making them choose the appropriate direction of effect (RR 1.9, 95% confidence interval 1.3 to 2.8).ConclusionsThe majority of our participants could not generate appropriate conclusions from SRs independently. Judicious direction from the authors' conclusions still appears crucial to guiding our health care practitioners in identifying appropriate messages from research. Authors, editors and reviewers should ensure that the conclusions of a paper accurately reflect the results. Similar studies should be conducted in other settings where awareness and application of EBM are different.Please see Commentary: http://www.biomedcentral.com/1741-7015/9/31/.

Evidence-Based Medicine in Aesthetic Surgery

Two years ago this month, when I began my tenure as Editor-in-Chief following the official indexing of Aesthetic Surgery Journal (ASJ) in Medline/PubMed, I wrote about my goals for the Journal and my commitment to you, ASJ ’s readers.1 At that time, I reaffirmed my belief that the Journal was “well-positioned to stay at the forefront of clinical, scientific, and technological advances and to bring you the information you need to stay ahead of the curve.” It remains my desire, as it was then, that ASJ be “the Journal to which you consistently turn for information that has real value to your aesthetic surgery practice.” In keeping with that mission, it is with great excitement and pride that we begin a dialogue with you about integrating evidence-based medicine (EBM) into the pages of ASJ and into our daily clinical practices. In August 2010, I was privileged to participate in a two-day EBM Summit in Colorado Springs, during which leaders in the aesthetic surgery field, representatives from our sister specialties, and experts in the application of EBM came together to discuss how we might begin incorporating EBM principles to our clinical practices. A full summary of this meeting appears in this month’s issue as a Special Topic in on page 137; it will also appear in the pages of Plastic and Reconstructive Surgery . This demonstrates our cooperative efforts in ensuring that professional societies and scholarly Journals are speaking with one voice, working together to support you in your efforts to continually improve patient outcomes and satisfaction—which I know is of the utmost importance to all of us as practicing physicians. I hope the background information on the EBM Summit will be as helpful, exciting, and encouraging to you as …

Melanoma histopathology report: proposal for a standardized terminology

Dear Editor, Pathology diagnosis is the end result of a complicated and highly sophisticated process, which, through interpretation of morphological alterations, generates data required for patient management. It is largely based on the macroscopic and microscopic features, but also considers any other issue, from clinical history and physical examination, through laboratory and radiological findings, to pathobiological and therapeutic implications. However, the correct diagnosis at the microscope is not the final step. Pathologists still need to transfer the final diagnosis to the clinicians and to provide information on the nature of the disease and diagnosis consequences, i.e., to release a final pathology report. Often, the report has the form of a narrative text, which largely reflects the personality and attitudes of the reporting pathologist. Thus, identical or similar cases may be diagnosed with significant variations in the content of their reports. This may generate unwonted diversities in the clinical evaluation and therapy. Another drawback of a free text report is the omission of critical information required for the clinical outcome and research purposes. Current medical practice is governed by an evidence-based medicine (EBM) approach. The use of standardized pathology reports, based on checklist compilation, is proposed as a major application of EBM to pathology. Such reports provide the basis for consistent reporting. We have recently surveyed the reporting of melanomas by European pathologists and assessed their current practice and opinions on the information required for the final report, via a web-based questionnaire that was diffused through the members of the Dermatopathology Working Group of the European Society of Pathology. The results of the study indicate that pathology reports for primary cutaneous melanoma vary remarkably among laboratories across Europe [1]. Although the most important prognostic features were reported, some key information which may have an influence on prognosis and treatment were often omitted, while other parameters were inadequately standardized. The objects of the current letter are to present Europewide guidelines for the optimization of the pathology report of skin melanoma and to describe the process that has generated the document through the survey evaluation. A preliminary draft of the proposed melanoma report presented during the business meeting of the Dermatopathology Working Group, which was held in Florence, in September 2009 (22nd European Congress of Pathology). Debates focused on the need for a clear-cut distinction between essential (mandatory to be reported) and desirable (optional to be reported) information and on the terminolA. Batistatou (*) Department of Pathology, University of Ioannina, Medical School, University Campus, 1186, 45110 Ioannina, Greece e-mail: abatista@cc.uoi.gr

Application of evidence-based medicine in the infection control in neonatal intensive care unit

Objective To establish infection management process by applying evidence-based medicine in neonatal intensive care unit (NICU). Methods To find out the problems about infection management in NICU by investigating correlative materials, collect and evaluate the literatures searched by medical databases (Medline) and related web site, establish the infection management process of NICU scientifically and systematically. Results To compare control group and observation group, difference of eligible rate of disinfectant of feeding bottle nipple, air, surface, incubator humidifier water monitoring and hand washing compliance in two groups were statistically significant (P ＜ 0. 05 or P ＜ 0. 01). Conclusions NICU infection management process based on scientific evidence-based medicine is a scientific and effective method. Key words: Evidence-based medicine; Neonatal intensive care unit; Infection management process