Evidence-based Medicine In Daily Practice Research Articles

Social media marketing of pharmacies across the Republic of North Macedonia

Internet marketing or digital marketing, is the fastest growing type of promotion for brands and companies to connect with potential customers. There are as many specializations within digital marketing as there are ways of interacting using digital media. This study evaluates and describes the usage of social media marketing as most common type of digital marketing used for self-promotion of the pharmacy sector in the Republic of North Macedonia. Social media marketing is raising brand awareness by engaging people in discussion online. The most popular platforms for social media marketing are Facebook and Instagram. For the purpose of the analysis, data from social network profiles Facebook and Instagram and from the websites of the 1000 pharmacies is used. This data includes: profile content, frequency of posts of health related articles and products, presence of relevant information and links to sites from which the content is shared, frequency of posting offers and sales at the pharmacy. The conducted research shows that the use of Internet as a digital marketing tool in Republic of North Macedonia is not sufficiently developed, especially when websites are used as a marketing tool for promotion of the pharmacy business and their services. The results show that Facebook as social media is used most frequently for posting health advices, promotion of new products and answering customer’s questions. Promotion of the professional pharmaceutical services is lower than the promotion of products. This leads to insufficient data for the implementation of the principles of evidence-based medicine in daily practice. Keywords: Internet marketing, digital marketing, social media marketing, promotion, pharmacies, Facebook, Instagram, website

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 and use of evidence-based medicine in daily practice by health professionals: a cross-sectional survey

ObjectivesHealthcare professionals are expected to firmly ground their practice in sound evidence. That implies that they know and use evidence-based medicine (EBM). In this study, our aim was to know...

Knowledge, practices and attitudes of physicians towards evidencebased medicine in Egypt.

Evidence-based medicine help clinicians deal with information overload, to distribute healthcare resources more equitably, help reduce healthcare costs, and justify treatment choices to the public. This study aimed to assess evidence-based medicine (EBM) knowledge, practices and attitudes among physicians in Tanta University hospital, Tanta, Egypt. A cross-sectional study was used. Collection of data was by a self-administrated questionnaire distributed to 398 physicians in different specialties during 2017. Response rate was 93.6 %. More than half (61.3 %) of participants reported Pub Med as used in decision-making. Physicians with good knowledge of EBM represented 10.5 %, those with fair knowledge represented 54 %, and those with poor knowledge represented 35.5 %. Regarding attitudes towards EBM, 76.4 % of study participants welcomed the current promotion of EBM; 81.4 % thought that it useful to use research findings in daily management of patients; and 89.9 % thought that practicing EBM improved patient outcomes. More than half of participants (55.8 %) had attended courses related to EBM, but only 6.8 % had attended courses related to critical appraisal. The majority of participants (97 %) had access to the World Wide Web. Barriers reported by participants that interfere with EBM practice were patient overload (68.1 %), lack of time (60.1 %), colleagues' attitudes (47 %), lack of skills (46.7 %), and fear of criticism (44.5 %). Most participants in this study have a positive attitude towards EBM, have a fair knowledge of it, but poor practices. EBM should be integrated in the curriculum of both undergraduate and postgraduate studies, and EBM training courses provided to residents to ensure correct application of EBM in daily practice.

What Are the Barriers to Residentsʼ Practicing Evidence-Based Medicine? A Systematic Review

Insufficient time and lack of skills are important barriers to the practice of evidence-based medicine (EBM). Residents could have additional barriers because their practice can be strongly influenced by the educational system and clinical supervisors. The purpose of this study, therefore, was to systematically appraise and summarize the literature on the barriers that residents experience in the application of EBM in daily practice. The authors searched MEDLINE, EMBASE, the Cochrane Library, CINAHL, and ERIC for publications preceding January 2008. Additionally, they manually screened the abstracts of relevant conferences (Association for Medical Education in Europe, Society of General Internal Medicine, Society of Medical Decision Making, Ottawa, and Evidence-Based Health Care Teachers & Developers) from January 2001 until January 2008. The search was extended by contacting experts in the field. Original studies on barriers to applying EBM in daily practice were included. Methodological quality was assessed and results were extracted by two reviewers using prespecified forms. The search resulted in 511 titles, 84 abstracts, and 3 studies suggested by experts, of which 9 were included in this review. The quality of the included studies was high. The most frequently mentioned barriers for residents were limited available time (28%-85%), attitude, and knowledge and skills. In four studies, specific barriers related to the position of residents, such as influences from staff members, lack of experience in EBM, and low possibilities to change conditions, were described. Residents experience specific barriers to practice EBM. These barriers should be recognized and integrated into EBM training programs for residents.

Attitudes, Practice and Educational Preferences Towards Evidence-Based Medicine among Physicians in a Large Teaching Hospital

Evidence-based medicine (EBM) is an emerging must-know topic for today’s physicians. The present literature is inadequate in identifying the attitudes, practice, and educational needs and preferred interventions of EBM. The objectives of this survey were to identify a) the attitude toward and practice of EBM among physicians, b) perceived benefits of EBM in daily practice, c) barriers to EBM practice, and d) preferred educational interventions.Methods: This was a questionnaire-based cross-sectional survey of physicians in a single large teaching hospital.Results: Overall, 56% of the physician respondents described the attitude towards EBM in their institution as positive. A similar number of physicians also reported the attitude of their colleagues towards EBM as favourable. 67% of the physicians believed EBM was useful in daily management of patients. In contrast, only 45% of the physicians actually practiced EBM in their daily patient management. The factors that discouraged them from actual practice include a lack of time, lack of exposure to EBM during their undergraduate curriculum, lack of endorsement, and fear of criticism by seniors. Physicians preferred less time consuming and less rigorous educational interventions such as clinical practice guidelines, journal club, and case review and discussion for teaching and learning EBM.Interpretation: There are disconnects between belief and actual practice and between preferred and ideal educational interventions of EBM among physicians surveyed. Keywords: Evidence-Based Medicine, Faculty’s Perception, Singapore

MISSION!: Optimization of acute and chronic care for patients with acute myocardial infarction

Guideline implementation programs for patients with acute myocardial infarction (AMI) enhance adherence to evidence-based medicine (EBM) and improve clinical outcome. Although undertreatment of patients with AMI is well recognized in both acute and chronic phases of care, most implementation programs focus on acute and secondary prevention strategies during the index hospitalization phase only. Implementation of an all-phase integrated AMI care program maximizes EBM in daily practice and improves the care for patients with AMI. The objective of this study is to assess the effects of the MISSION! program on adherence to EBM for patients with AMI by the use of performance indicators. The MISSION! protocol is based on the most recent American College of Cardiology/American Heart Association and European Society of Cardiology guidelines for patients with AMI. It contains a prehospital, inhospital, and outpatient clinical framework for decision making and treatment, up to 1 year after the index event. MISSION! concentrates on rapid AMI diagnosis and early reperfusion, followed by active lifestyle improvement and structured medical therapy. Because MISSION! covers both acute and chronic AMI phase, this design implies an intensive multidisciplinary collaboration among all regional health care providers. Continuum of care for patients with AMI is warranted to take full advantage of EBM in day-to-day practice. This manuscript describes the rationale, design, and preliminary results of MISSION!, an all-phase integrated AMI care program.

Searching for evidence-based medicine in the literature. Part 3: Assessment.

After composing a pointed question for an evidence-based medicine (EBM) search and then selecting appropriate resources for its execution, the final step requires an assessment of the information gleaned: what is substantive material and what is not? Unless one is especially adept at statistics and/or EBM methodology, it may appear that one study is as good as another and, consequently, the researcher can feel muddled by the retrieval. Critical appraisal in EBM generally centers around three questions: 1) is it valid?, 2) what are the results?, and 3) is it applicable to the patient? One is trying to determine if the study’s evidence demonstrates enough rigor within its methodology to impact the course of a particular patient’s care. It may be tempting to view critical appraisal as an invitation to negate or castigate clinical study efforts but, in a real world, no study can be perfectly designed or executed. The main purpose of critical appraisal is to “assess not whether a paper is ‘rubbish’, but whether there is so much potential bias that the results are no longer valid”.1 While the determination of validity is not easy and relevance to patient care is sometimes obscured, two resources that can assist in the evaluation of good, better, and best EBM information can be accessed electronically. At the Critical Appraisal Skills Programme (CASP) section of the United Kingdom’s National Health Service web site (http://www.phru.nhs.uk/casp/appraisa.htm), a wealth of resources provides a rich repository. Especially useful are forms described as critical appraisal tools for various types of articles including systematic reviews, randomized controlled trials, cohort studies, case control studies, diagnostic test studies and economic evaluation studies. Each form consists of ten questions about each specific type of article, which are supplemented with prompts that assist in the assessment of each question topic. The questions derive from a notable series titled “Users’ Guides to the Medical Literature,” which appeared in the Journal of the American Medical Association (JAMA) from 1993 through 20002 – 34 and, as such, constitute a solid approach to evidence-based assessment. In terms of function, the forms demonstrate attention to clarity in font size, strong contrast in design, and an efficient screening section in each article type that determines whether one should proceed through all ten questions or stop. While the roomy, clear forms may be used only for an individual’s personal use, the web site also provides a method to obtaining copyright permission if one wanted to use them in a group practice or other setting. Another useful web site that offers a step-by-step approach to critical appraisal can be found at the Centre for Evidence-Based Medicine in Oxford, England (http://www.cebm.net/critical_appraisal.asp). Worksheets provided for the assessment of articles relating to diagnosis, harm, etiology, therapy and systematic reviews of therapy can be accessed separately or downloaded as a group. Each type of article evaluation requires a different approach to determination of validity; critical questions and demonstrations of specific calculations are customized for each worksheet set. The addition of statistics can be daunting, but the authors supply understandable sample calculations and then provide a practice section for the user’s skill development. The last section of the form consists of patient-related questions to focus the results of the inquiry and, as such, cinches the usefulness of the worksheets. The aim of the worksheet exercise is to determine the article’s relevance to an individual patient’s care, and these worksheets provide an effective and cogent methodology to do so. While there are many evidence-based medicine resources, it is more difficult to find those with an easy and efficient approach to a rather complex area. Without compromising quality or exhausting time, one can find respectable EBM web resources to compose a suitable question, execute a viable literature search, and then assess the trustworthiness of the materials gleaned. Certainly more time and resources are needed for extended systematic assessments, but the busy practitioner can use evidence-based medicine in daily practice and still feel comfortable about the results for specific patient care.