Evidence-based Medicine In Clinical Practice Research Articles

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.

Knowledge, Attitude, and Practice towards Evidence-Based Medicine among Northern Saudi Primary Care Physicians: A Cross-Sectional Study.

The evidence-based practice of primary care physicians is essential because they are the first line of contact with the local community, and they cater to most of their communities' health needs. In the current study, in which we used a cross-sectional survey in northern Saudi Arabia, we assessed primary care physicians' knowledge, attitude, practice, and barriers regarding evidence-based medicine (EBM). Of the 300 physicians who participated, less than half had high knowledge (43.7%) and attitude (47.7%) toward EBM. The chi-square test revealed that the knowledge categories were significantly associated with the age group (p = 0.002) and EBM training received in the past five years (p < 0.001), and the attitude categories were significantly associated with nationality (p = 0.008). Of the respondents, 155 (51.7%) used EBM in their daily clinical practice. Through logistic regression analysis, we found that the identified predictors of including EBM in clinical practice were the 31-45-year-old age group (adjusted odds ratio (AOR) = 2.11, 95% confidence interval (CI) = 1.65-2.73) and EBM training received during last 5 years (AOR = 2.12, 95% CI = 1.35-2.94). We recommend enhancing primary care physicians' knowledge of EBM and its importance in clinical practice through appropriate training programs. A multi-centric mixed-method survey is warranted in other provinces of the KSA to recognize region-specific training demand.

Dialogue between bioethics and evidence- based medicine, a narrative ethics perspective

Evidence-Based Medicine (EBM) is the methodological paradigm of Western medicine today. EBM is expected to reduce the use of intuition and to promote the use of scientific evidence, in the clinical decision-making process. Benefits of EBM in clinical practice are thoroughly documented, however, there are also critics. Among other issues, EBM is thought to contribute to an excessive reductionism, to neglect context variables and individual attributes involved in the physician-patient relationship. All the above could lead to several bioethical conflicts. This work consists in a literature review that examines the interaction between EBM and Bioethics in a reciprocity frame, in order to approach possible ethical conflicts that emerge with the use of EBM, and later analyze them from the perspective of the Narrative Ethics model, proposed by the philosopher Paul Ricoeur.

USE OF EVIDENCE-BASED MEDICINE BY DENTISTS.

The aim: To investigate how dentists use evidence-based medicine in clinical practice. Objectives: to determine how dentists understand the role of evidence-based medicine to ensure the quality of dental care; what sources of evidence are used; what are the barriers to the use of evidence and the possibility of removing it. Materials and methods: Methods of semi-structured in-depth interview, thematic analysis, graphic, generalization were used. Materials: records of respondents' answers. Results: Dentists have identified the benefits of evidence: a positive treatment outcome; protection against doctor's mistakes; safety of dental interventions, maintaining the level of professional knowledge. Dentists use online evidence resources, training materials, advertising of medical devices and filling materials. Barriers to the use of evidence-based medicine are the lack of sectoral clinical protocols, lack of personal time and low English proficiency, according to dentists. Not all evidence-based medicines and medical devices are approved for use in Ukraine. Removing barriers will ensure more active use of evidence in dental practice. Conclusions: Dentists are aware of the role of evidence-based medicine in ensuring the quality of dental care, know the sources of evidence. Barriers are the lack of national clinical protocols, their incomplete provision of resources, the lack of dentists' own time and the low level of English language proficiency. The results of the study can be used in the formation of sectoral and local policies for the standardization of health care and continuing education of dentists.

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.

Advances in Experimental and Clinical Research of the Gouty Arthritis Treatment with Traditional Chinese Medicine.

Gouty arthritis (GA) is a multifactorial disease whose pathogenesis is utterly complex, and the current clinical treatment methods cannot wholly prevent GA development. Western medicine is the primary treatment strategy for gouty arthritis, but it owns an unfavorable prognosis. Therefore, the prevention and treatment of GA are essential. In China, traditional Chinese medicine (TCM) has been adopted for GA prevention and treatment for thousands of years. Gout patients are usually treated with TCM according to their different conditions, and long-term results can be achieved by improving their physical condition. And TCM has been proved to be an effective method to treat gout in modern China. Nevertheless, the pharmacological mechanism of TCM for gout is still unclear, which limits its spread. The theory of prevention and treatment of gout with TCM is more well acknowledged in China than in abroad. In this article, Chinese herbs and ancient formula for gout were summarized first. A total of more than 570 studies published from 2004 to June 2021 in PubMed, Medline, CNKI, VIP, Web of Science databases and Chinese Pharmacopoeia and traditional Chinese books were searched; the current status of TCM in the treatment of GA was summarized from the following aspects: articular chondrocyte apoptosis inhibition, antioxidative stress response, inflammatory cytokine levels regulation, uric acid excretion promotion, immune function regulation, uric acid reduction, and intestinal flora improvement in subjects with gout. The literature review concluded that TCM has a specific curative effect on the prevention and treatment of GA, particularly when combined with modern medical approaches. However, lacking a uniform definition of GA syndrome differentiation and the support of evidence-based medicine in clinical practice have provoked considerable concern in previous studies, which needs to be addressed in future research.

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.

The long road to learn the meaning of p-value in medical schools: challenges for a research methodology training in medical schools

The movement towards evidence-based medicine has been highly successful (Fregni, 2019). Clinicians understand the need to practice based on solid and unbiased evidence. However, the pathway towards full use of evidence-based medicine (EBM) has not been completed. There is still a long way to go. One of the main obstacles to the better use of EBM in clinical practice is the lack of research methodology training. It is clear that there is not enough time in the curriculum of medical students to cover the complex field of research methodology (Fregni, 2019). Also, the current methods of teaching have been far from optimal, and therefore, students usually tend to dislike statistics and epidemiology early on, which provides them fewer tools to use EBM in their clinical profession effectively. In this editorial, we convened a group of clinicians and educators (from the Teaching, Learning and Innovation Initiative) from several countries to briefly discuss some of the main challenges we see in medical students' current education that applies to EBM teaching.

Increasing general practitioner use of evidence-based medicine in teaching and clinical practice through evidence-based journal clubs

Learning evidence-based medicine (EBM) skills is now integral to university medical education. GPs who trained before the introduction of EBM in the late 1990s have identified a lack of training in this area. Evidence-based journal clubs (EBJCs) aim to promote the application of research evidence to clinical decision making. GPs meet regularly to develop EBM skills and apply these to questions arising in their clinical practice. Over 4 years, 47 GP clinical supervisors of medical students participated in a series of EBJCs offered by a university medical school. This article presents a qualitative exploration of their views and experiences. GPs noted that participating in EBJCs improved their use of EBM in clinical practice by making them more independent learners, facilitating consistent management approaches in group practices and aligning their skills in EBM with those of current students. Barriers such as time constraints and limited access to EBM resources were also noted, and GPs discussed strategies for managing these. Opportunities for GPs who act as clinical supervisors to increase their skills in EBM are important, particularly for those GPs transitioning from a traditional medical education model to an EBM model, as they role model highest-quality patient care to students, including the need for ongoing learning.

25. WHAT'S THE EVIDENCE? EVALUATING THE IMPACT OF A RESIDENT EVIDENCE-BASED MEDICINE CURRICULUM

Background The ability to incorporate evidence-based medicine (EBM) into clinical practice is an ACGME competency, yet many pediatric residents have limited knowledge, comfort, and skill in this area. In addition, there is a lack of data regarding how residents apply EBM curricula to clinical practice. Objective: Describe the effect of an EBM curriculum on resident attitudes and clinical use of EBM. Methods We implemented a twice-weekly EBM curriculum to review key literature and guidelines. In this IRB-exempt mixed methods study, we surveyed residents, fellows, and faculty about use of EBM at baseline and 6 months later. Results were compared using Mann-Whitney U tests. We surveyed faculty twice weekly 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. Results Residents (N=61 pre- and 41 post-curriculum) reported increased: satisfaction with conferences (p=0.0037), importance of EBM (p = 0.0041), comfort generating a search question (p= 0.0001), and citation of evidence on rounds (p Conclusion As a result of this EBM curriculum, trainees described increased use of EBM in clinical practice and better understanding of research methodology. Additionally, resident use of EBM reinforced plans, taught faculty, and at times, changed management. Ongoing work is needed to create a culture that promotes EBM.

Understanding perioperative bowel preparation for colorectal surgery

Bowel preparation is an important perioperative measure in elective colorectal surgery. The goal is to empty the contents of the intestine and reduce the number of bacteria in the intestine, so as to reduce the risk of surgical-related infections, ensure the safety of the surgery and facilitate a smooth postoperative recovery. Compared with the upper abdominal surgery, colorectal surgery is usually associated with a higher risk of postoperative infection, including incision and abdominal infections, anastomotic leakage and infection-related intestinal obstruction, and of infections of distant organs, such as pneumonia and urinary tract infections. With the application of evidence-based medicine in clinical practice, especially the popularization of enhanced recovery after surgery (ERAS), the unfavorable factors of bowel preparation, such as physical discomfort, interference with normal physiology, and increased care burden, have received increasing attention. Relevant clinical trials and meta-analyses continue to emerge, and the clinical significance of bowel preparation in preventing postoperative infection has been questioned.

Evidence-Based Medicine (EBM) is properly perceived but its application is still limited in the orthopedic clinical practice: an online survey among the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members.

To evaluate the knowledge and awareness of Evidence-Based Medicine (EBM) among members of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). A questionnaire was developed that explored the following areas: (i) respondents' attitudes to EBM; (ii) their motivation to implement EBM in daily practice; (iii) their educational background, knowledge and skills related to accessing and interpreting information; (iv) their level of attention to, and use of, scientific literature; (v) access to and availability of evidence; (vi) perceived barriers in using EBM in clinical practice. The resulting data were analyzed using descriptive statistics, and the correlation between age, educational background and country was further investigated. Two-hundred and eighty-eight ESSKA members (11% of the total population) compiled the questionnaire. The participants covered all the five continents and an expected prevalence of European professionals (77%) was observed. The vast majority of participants were medical doctors (91%), mainly specialized in knee surgery with minimal involvement in research. 97% of the participants declared having some knowledge of EBM, acquired mainly during their professional education, with some geographical differences. The youngest clinicians and those from Eastern Europe reported the greatest difficulty in using EBM in daily practice. The application of EBM in clinical practice is positively affected by the time dedicated to research and negatively correlates with the time dedicated to patient care. The results of this survey highlight the need for further investigation into the main reasons behind the limited diffusion of the EBM approach, despite the medical community's knowledge and interest in the concept. A wider application of EMB would upgrade clinical practice, linking medical knowledge and scientific evidence to patients' needs which would result of benefit to patients, but also more in general to the health system.

Knowledge of Cochrane, evidence-based medicine and the Cochrane Library at Defence Force Medical Services: a baseline cross-sectional survey among military health personnel in Zambia

Objectives: Evidence-based medicine (EBM) is a core competency for all healthcare professions including military healthcare personnel. We surveyed military health personnel knowledge and experience with Cochrane, EBM and the Cochrane Library at Defence Force Medical Services in Zambia.
 Materials and Methods: During May 2013 and March 2014, we used a pretested self-administered survey to collect data from the study participants. Categorical associations was tested by Chi-squared or Fisher's exact test. The strength of association between categorical variables was expressed using odds ratio (OR) with 95% confidence interval (CI).
 Results: The overall participation rate was 92% (57/62). The sample consisted of doctors, nurses, clinical officers, medical licentiates and other professions. Nearly 44% worked in military clinics, 28% hospitals, 23% head office and 5% in training schools. Most (79%) of respondents have heard of EBM, but 84% had low knowledge and 88% lacked EBM training. Nearly 77% agreed that EBM was useful in clinical practice, 98% showed interest in EBM training and 46% declared workplace EBM promotion. Awareness about Cochrane was 53% and only two recognized Cochrane South Africa as their reference centre. Awareness and usage of the Cochrane Library was generally very poor and only one knew the database. Medical doctors were roughly five times more likely to cite organizational barriers to the Cochrane Library compared to nurses and clinical officers (Adjusted OR=5.19, 95% CI, 1.15–23.52, P=0.03).
 Conclusions: Military medical personnel encounter considerable barriers to adopt EBM in clinical practice. Addressing their multifaceted barriers would facilitate the delivery of evidence-based healthcare and improve patient outcomes.

Because Life Is Open Book: An Open Internet Family Medicine Clerkship Exam.

A core principle of family medicine is information mastery, or application of principles of evidence-based medicine in clinical practice. While information mastery teaching and assessment are beginning to permeate postgraduate family medicine training programs, and while exciting literature on new open resource assessment methods is emerging, there are no prior descriptions of examinations that specifically assess medical students' information mastery competency. To test information mastery competency, a novel final exam for the family medicine clerkship was developed, implemented, and evaluated. During the timed exam, the competency-based information mastery assessment (IMA) requires students to look up evidence-based information using web resources to answer case-based questions. Exam feasibility was tested with pilot examinees whose reactions were gauged. Student performance on the traditional closed book knowledge assessment (KA) was compared with performance on the open internet IMA. Exam performance was compared with preceptor ratings of students' clinical performance. Low performers were further analyzed for preceptors' ratings of specific student skills in information mastery and self-directed learning. An open internet IMA testing knowledge application and information mastery skills is not only feasible but can also be educational. Student performance scores on the open internet IMA do not differ from scores on the closed book KA. Students describe many positive features of this open internet IMA. Student performance on the competency-based IMA correlates with clinical ratings by preceptors and with preceptors' judgment of information mastery skills. A novel approach to assessment in family medicine clerkships may be used to assess student competency in information mastery. Further research is needed for enhanced exam validation.

Evidence-based medicine: A survey among perioperative health care professionals in India.

Background and Aims:Evidence-based medicine (EBM) is defined as the use of scientifically proven evidence for delivering best possible health care to patients. Despite growing emphasis on the need for EBM-based practice, acceptability, and perceptions toward EBM might differ among health professionals. The objective of this study was to assess the attitude, knowledge, and current practices of EBM among perioperative care health professionals in India.Material and Methods:This was a single point paper-based questionnaire survey carried out in February 2014 among delegates registered for an EBM conference on “perioperative care” held at a Tertiary referral Cancer Centre in India. Participation was voluntary and respondents were given the option of remaining anonymous.Results:Out of 190 questionnaires, 123 (65%) were returned. Most respondents (98%) agreed that practicing EBM improved patient care. The need to follow departmental protocols (22%) worries about the cost of implementing new treatments (20%) and inadequate skills to critically appraise articles (16%) accounted for major barriers in implementing EBM in clinical practice, with only 15% of respondents stating reluctance to change set practice. “Randomized controlled trial” and “number needed to treat” were the best and least understood EBM terms. Regarding awareness of 10 commonly used EBM-based guidelines in perioperative medicine, the percentage of correct responses ranged from 20% to 88%.Conclusion:Although most respondents agreed that practicing EBM improved patient care, many of them showed a low level of awareness regarding fundamental aspects of EBM. In addition to encouraging implementation of EBM, there should be increased focus on training in EBM methods.

Role of evidence-based medicine in the cultivation of clinical medicine undergraduates' scientific research ability

The paper described the concept of evidence-based medicine and its guiding role in clinical practice and scientific research. It emphasized the importance of teaching evidence-based medicine in clinical medicine teaching of medical college students, and put forward some suggestions on how to carry out evidence-based medicine teaching among undergraduate students. In the course of undergraduate study, students should have preliminary grasp of how to apply the theory of clinical epidemiology to evaluate the evidence of clinical research so that they could evaluate the authenticity, importance and applicability of the research evidence. Besides, they could correctly understand and apply the evidence of evidence-based medicine in clinical practice in the future, and at the same time cultivate their scientific research thinking and innovative ability. Key words: Evidence-based medicine; Postgraduates; Clinical medicine teaching; The evaluation of research evidence

Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges.

Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative.

Knowledge and attitudes of students of College of Medicine towards evidence-based medicine and barriers to its use in clinical practice in Erbil city, Iraq

Background and objective: Evidence-based medicine, by guiding medical care towards meaningful outcomes to patients, has a significant worldwide impact on medical care and education. It is important that medical students, whom are the future physicians, keep themselves updated with recent advancement in medical knowledge and health care. The aim of this cross-sectional study was to determine the attitude, knowledge and barriers among students towards evidence-based medicine and making them familiar with the concept and advantage of evidence based medicine. Methods: A cross-sectional study was conducted on 163 sixth year students of the College of Medicine at Hawler Medical University during the period from October 2012 to May 2013. The response rate was 86.5%. Knowledge towards evidence-based medicine, accessing and interpreting evidence and perceived barriers to practice evidence-based medicine among participants were the main outcome measures. Results: Of 141 of participants that filled the questionnaire, only 69.5% had heard about evidence-based medicine. Around 82% stated that they had known evidence-based medicine and only 23.5% had known steps of evidence-based medicine. Around 65% of respondents welcomed the promotion of evidence-based medicine and 74.4% agreed with that finding from the current study in which it would be helpful in daily management of patients. Furthermore, 31.6% of students reported that standard textbook as a frequent source used for medical knowledge. Around 91% of students did not know the strongest evidence in the hierarchy of evidence and only small proportion of students reported that they understand the common epidemiological concepts that are used in evidence-based medicine. Conclusion: Evidence-based medicine is relatively a new concept among students at the College of Medicine in Erbil. Although the students appeared interested in learning and implementing evidence-based medicine in clinical practice, they need more guidance and training to ensure the correct use of evidence-based medicine ideals.

Prevenção quaternária como diretriz para a equipe editorial de uma revista de medicina baseada em evidência

O presente artigo tem como objetivo analisar as atividades de redação da revista Minerva, periódico belga de medicina baseada em evidência (MBE), de acordo com as diretrizes da prevenção quaternária. A partir da produção editorial da revista Minerva foi realizada uma análise narrativa de suas atividades de redação em relação ao questionamento clínico, à pesquisa, à crítica e à interpretação de informações clínicas relevantes à prática profissional. São detalhados os limites da MBE e as ferramentas e linhas de reflexão emitidas pela equipe de redação da revista a fim de favorecer a implementação da MBE na prática clínica. Dessa forma, se pretende prevenir o intervencionismo médico desnecessário, ao se fortalecer a prevenção quaternária como uma competência fundamental dos trabalhadores da saúde ao longo de sua vida profissional a serviço dos pacientes, o que pode ser reforçado pelo trabalho da equipe editorial de uma revista de MBE.

Making reasonable decisions: a qualitative study of medical decision making in the care of patients with a clinically significant haemoglobin disorder.

Therapies utilized in patients with clinically significant haemoglobin disorders appear to vary between clinicians and units. This study aimed to investigate the processes of evidence implementation and medical decision making in the care of such patients in NSW, Australia. Using semi-structured interviews, 11 haematologists discussed their medical decision-making processes with particular attention paid to the use of published evidence. Transcripts were thematically analysed by a single investigator on a line-by-line basis. Decision making surrounding the care of patients with significant haemoglobin disorders varied and was deeply contextual. Three main determinants of clinical decision making were identified - factors relating to the patient and to their illness, factors specific to the clinician and the institution in which they were practising and factors related to the notion of evidence and to utility and role of evidence-based medicine in clinical practice. Clinicians pay considerable attention to medical decision making and evidence incorporation and attempt to tailor these to particular patient contexts. However, the patient context is often inferred and when discordant with the clinician's own contexture can lead to discomfort with decision recommendations. Clinicians strive to improve comfort through the use of experience and trustworthy evidence.