Methods Of Evidence-based Medicine Research Articles

OP140 Adult Patient Access To Electronic Health Records

IntroductionIn order to facilitate patient information, patient involvement, and to support patient-centered care, healthcare organizations are increasingly offering access to patient data that are stored in the institution-specific electronic health record (EHR). Patients can access these data, read, and print them, or download and integrate them into any type of patient-held record. This EHR access is typically web-based and called “patient portal” allowing the independent access via the Internet from everywhere. A patient portal may also offer additional features such as prescription requests, appointment booking, messaging, personal health-related reminders, individual therapeutic recommendations, personal diaries, and social networking with other patients. In a Cochrane review, we assessed the effects of providing access to EHR for adult patients on patient empowerment and health-related outcomes compared to usual care.MethodsAccording to the methods of evidence-based medicine, we developed a protocol for a Cochrane review, which is published in the Cochrane database.ResultsWe identified ten randomized controlled trials (RCTs) including 6,668 randomized participants. Seven RCTs took place in the USA, two in Canada, and one in Japan. Additional functionalities of interventions and disease conditions were heterogeneous. Three studies (n = 601) reported on patient empowerment. The risk differences reported were neither statistically significant nor clinically relevant. Eight studies (n = 2,070) reported on nine different risk factors (blood pressure, blood glucose, poor asthma control, 10-year Framingham risk score, cholesterol, body mass index, composite score of eight variables, intraocular pressure, composite score of three variables). The results were heterogeneous. Mostly there were no statistically significant risk differences between study groups.ConclusionsOverall, there is no evidence for a clear positive effect of patient portals on patient empowerment and health related outcomes (mainly risk factors). However, we identified only a small number of studies. The usage of portals was often low and several studies were older.

A Meta-analysis on Acupuncture and Moxibustion Treatment of Schizophrenia

To evaluate the clinical efficacy and security of acupuncture therapy combined with conventional antipsychotics in the treatment of schizophrenia. We first comprehensively retrieved papers about acupuncture or moxibustion treatment of schizophrenia published from the time of establishment of the database to April of 2017 in Chinese databases such as Chinese National Knowledge Infrastructure(CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang, and Chinese BioMedical Literature (CBM) by using keywords "acupuncture""moxibustion""acupuncture ＋moxibustion""acupuncture ＋medication""electroacupuncture""filiform needle""scalp-acupuncture""auricular acupuncture"， etc. Then, according to the principles and methods of evidence-based medicine, papers conformed to the included standards were enrolled to Meta-analysis by using Review Manager 5.3 software. A total of 618 studies were identified, with only 17 articles (containing 1 542 patients) conformed to our included standards and analyzed finally. In regard to the total effective rate of acupuncture or moxibustion for schizophrenia, the combined OR＝3.09, 95% CI (2.31, 4.13), the diamond was on the right side of the vertical line (suggesting being effective), OR checked by Z test (Z＝7.61, P<0.000 01). In regard to the untoward effect, the combined OR＝0.34, 95% CI (0.16, 0.75), the diamond was on the left side of the vertical line (suggesting less adverse effects), OR checked by Z test (Z＝2.67，P＝0.008). Sensitivity analysis: the combined standardized mean difference (SMD)＝－0.61, 95% CI(－0.88, －0.34), the diamond was on the left side of the vertical line (suggesting having more profits than simple medication), SMD checked by Z test (Z＝4.39, P<0.000 1)．. Acupuncture and moxibustion combined with conventional antipsychotics is significantly better than that of antipsychotics alone in the treatment of schizophrenia and has less side effects. But, high quality clinical studies with rigorous experimental design and large sample size are needed to provide more reliable evidence.

The Diagnosis and Therapy of Degenerative Knee Joint Disease: Expert Consensus from the Chinese Pain Medicine Panel.

At present, there are many constantly updated guidelines and consensuses on the diagnosis and treatment of osteoarthritis both at home and abroad. The recommendations established using methods of evidence-based medicine has experienced strict research on controlling bias and promoting reproduction rate. As a result, the previous evidence was reevaluated, and a lot of changes were provoked in the diagnosis and treatment concept of osteoarthritis. However, several methods not recommended by foreign guidelines are still in use in the current clinical practice in China. On the one hand, Chinese experts have not reached extensive consensus on whether it is necessary to make changes according to foreign guidelines. On the other hand, almost all the current relevant guidelines are on osteoarthritis, but the lesions around knee joints which, as a whole, bear the largest weight in human body, cannot be ignored. For this purpose, Chinese Association for the Study of Pain (CASP) organized some leading experts to formulate this Chinese Pain Specialist Consensus on the diagnosis and treatment of degenerative knee osteoarthritis (DKOA) in combination with the guidelines in foreign countries and the expert experience of clinical practice in China. The consensus, which includes the definition, pathophysiology, epidemiology, clinical manifestation, diagnostic criteria, and treatments of DKOA, is intended to be used by first-line doctors, including pain physicians to manage patients with DKOA.

Evidence based practice for the application of feeding management after spinal operation

Objective To analyze the effect of evidence based practice on feeding after spinal operation. Methods To formulate an answerable question, find the best available evidence, appraise the evidence and formulate the recommendations by using the method of evidence-based medicine. A total of 60 postoperative patients who received spinal operation were divided into observation group and control group (30 cases in each group). Those patients in control group received the routine diet guidance and the guidelines for the standardization of intake and consumption after spinal cord surgery were used for patients in observation group. The outcomes were evaluated by postoperative recovery and complications of patients after spinal operation. Results There were no significant difference in the incidence of nausea, vomiting, bloating and celialgia in the 5 hours after surgery and 2 hours after feeding between the two groups (P>0.05). The incidence of thirst and hunger in the 5 hours after surgery in observation group were 3.33%(1/30) and 13.33%(4/30).The incidence of thirst and hunger in the 5 hours after surgery in control group were 80.00%(24/30) and 83.33%(25/30). There were statistically significant in the incidence of thirst and hunger in the 5 hours after surgery between the two groups (χ2=36.27, 24.09, P 0.05). Conclusions Evidence-based practice in the use of guidelines for the standardization of intake and consumption after spinal cord surgery can guide clinical practice. Key words: Post spinal operation; Postoperation feeding; Evidence-based medicine

Evidence base of randomized controlled trials and guideline recommendations of patent Traditional Chinese Medicines for uncomplicated acute lower respiratory tract infections in adults

OBJECTIVETo compare clinical practice guideline recommendations on the use of oral patent Traditional Chinese Medicines (PTCMs) for uncomplicated acute lower respiratory tract infections (ALRTIs) in adults with the existing evidence using results of a systematic review of randomized controlled trials (RCTs). METHODSA systematic review on RCTs and a systematic review of current guidelines on orally taken PTCMs for uncomplicated ALRTIs were performed. PubMed, Cochrane Library, EMBASE and four Chinese databases were searched from inception to September 2016 for RCTs testing orally taken PTCMs for uncomplicated ALRTIs (excluding pneumonia). Two reviewers independently screened each study, extracted study data, and assessed risk of bias. Disagreements were resolved through discussion or by consultation with a third reviewer. Clinical practice guidelines for uncomplicated ALRTIs containing PTCM recommendations were identified and quality appraised. The quality of pooled evidence of the RCTs and the guidelines was assessed with GRADE and AGREE II respectively. The consistency of the evidence base in RCTs and the guideline recommendations were then compared. RESULTSFor the systematic review of RCTs, 4810 papers were identified, among which 29 RCTs (5093 patients) were included in the review. PTCMs compared to placebo increased the effective treatment rate of cough (3 trials, 949 patients, risk ratio (RR) 2.50, 1.16 to 5.43; low certainty); improved assessment of global health (3 trials, 948 patients, RR 1.70, 1.44 to 2.01; low certainty); and increased the effective rate of specific symptom relief (1 trial, 478 patients, RR 4.01, 2.76 to 5.81; moderate certainty). 21 trials (3432 patients) compared effects of different PTCMs. For the guideline evaluation, 29 PTCMs were recommended for the use of uncomplicated ALRTIs, of which27 had no supportive evidence from RCTs. CONCLUSIONThe evidence base of PTCMs for uncomplicated ALRTIs is weak and the guideline recommendations were based on almost no clinical trial evidence. Rigorous clinical research is urgently needed to inform the clinical use of these herbal medicines. Further training in evidence-based medicine methods for Traditional Chinese Medicine guideline developers is essential.

Передчасні пологи (Клінічна лекція)

The article presents modern views on the pathogenesis of preterm labor, their relevance and classification. From the perspective of evidence-based medicine methods of prevention are considered. A comparison of the main tocolytic agents, their advantages and disadvantages is presented. Key words: premature birth, perinatal and infantile mortality, tocolysis, magnesium sulfate, gestational age.

ADJUVANT CRYOTHERAPY IN THE SURGICAL TREATMENT OF GIANT CELL BONE TUMOR

Recurrence of a giant cell tumor or a malignization of the bone (osteoclastoma) is a common complication after surgical treatment. Increased surgical radicality in such pathology is an acute issue. Ablastic procedure can be performed by exposure to ultralow temperatures.Purpose — to improve the surgical treatment efficiency of osteoclastoma by uncontrolled cryodestruction of the visual cells and tissue elements in the resection of the tumor-affected bone.Material and methods. Experimental studies on tumor fragments in vitro. Pathological tumor tissue was three times treated with liquid nitrogen (boiling point −195.8°C). The time of each freeze-defrost cycle was up to three minutes. In the clinical practice, the same cooling agent instillation of the bone defect after resection and mechanical removal of the tumor was used in 67 patients (52 cryosurgical interventions and 15 traditional resections).Results. In the study the authors used the methods of evidence-based medicine. After instillation of liquid nitrogen on giant cell tumor the temperature of −154°C was noted. In the area of cryotreatment 80% of necrotic tumor tissue was identified morphometrically. The study of 67 operated patients demonstrated that positive results were obtained in 40 cases among patients exposed to cryogenic treatment and recurrent was observed in 8 cases. Good outcomes after conventional surgery were observed in 7 patients and recurrence of tumor was reported in 5 cases.Conclusion. Positive experience of cryosurgical procedures allows to restrict indications for articular and extensive segmental resections in favor of intrafocal and marginal resections with cryodestruction and bone defect grafting. The method allows to expand a preservation trend in orthopedic oncology.

Chronic Heart Failure.

Chronic heart failure (CHF) is the most common reason for hospital admissions in Germany. For the National Disease Management Guideline (NDMG) on CHF, a multidisciplinary expert panel revised the chapters on drug therapy, invasive therapy, and care coordination, following the methods of evidence-based medicine. Recommendations are based on international guideline adaptations or systematic literature search. They were developed by a multidisciplinary expert panel, approved in a formal consensus procedure, and tested in open consultation, as specified by the requirements for S3 guidelines. The pharmacological treatment is based on ACE inhibitors, beta-blockers and mineralocorticoid receptor antagonists as well as diuretics to treat fluid retention, if present. Sacubitril/Valsartan and ivabradine showed positive effects on mortality in large but methodologically limited RCT. They are recommended if established combination therapy is not sufficient for symptom control, or if drugs are not tolerated/contraindicated. The indications for pacemakers or defibrillators have been confined to patient subgroups in which clinical trials have shown a clear benefit. Moreover, the goals of treatment and the patient's expectations should be aligned with each other. Structured care programs, specialized nurses, remote, or telephone monitoring showed moderate effects on patient related outcomes in RCT. All patients with heart failure are suggested to be enrolled in a structured program (e.g., a disease management program) including coordinated multidisciplinary care and continuous educational interventions. In patients with a poor prognosis, more intensive care is recommended, e.g. specialized nurses, or telephone support.

Evidence-based practice on the application of sanyrene in one case of sodium aescinate drug extravasation

Objective To explore sodium aescinate drug extravasation treatment method with method of evidence-based medicine. Methods According to the clinical symptoms of a patient who suffered the extravasation of sodium aescinate, electronic databases were searched to collect relevant materials of preventing extravasation of sodium aescinate. The evidence was applied to the patient after evaluating the reality, feasibility of these evidences mentioned in the literatures. Results Eventually, six random trials, five clinical experience, and two literature reviews were included. The collected evidences supported that sanyrene was safe and effective in treating the extravasation of sodium aescinate. The color and function the patient′s hand returned to normal after using sanyrene in three days, meanwhile, irreversible complication was avoided. Conclusions Sanyrene applied to sodium aescinate extravasation, easy to operate, the effect is obvious, it is worth promoting. Key words: Evidence-based nursing; Sanyrene; Sodium aescinate; Drug extravasation

SURGICAL TREATMENT AND POSTOPERATIVE MANAGEMENT OF PATIENTS WITH BROAD FOREFOOT

The article considers the problem of broad forefoot, which is one of the most frequent deformities of the musculoskeletal system. Aim - to improve the results of treatment of patients with transverse platypodia by the use of new methods of surgical interventions, and to improve the tactics of postoperative management of such patients. Material and methods. The study involved analysis of the results of treatment of 375 patients. For evaluating the long-term outcomes of treatment, methods of evidence-based medicine were used, reflecting a reduction in the relative risk of interventions and an increase in their relative benefit. Results. The study of the long-term results of treatment showed that there were good and satisfactory outcomes in 92.7% cases (267 patients) and only 7.3% of unsatisfactory results (21 patients) in the main group; in comparison group - 74.7% (65 patients) and 25.3% (22 patients) respectively. The evaluation of the adequacy of anesthesia on the first day after the operation revealed good and satisfactory quality of anesthesia in the first group in 89.9% patients (259), in the second - only in 55.2% patients (48). Conclusion. The use of the above mentioned methods of surgical treatment and enhancement of tactics of postoperative management improve outcomes of patients with transverse flatfoot, and, consequently, are recommended for widespread use in clinical practice.

Evidence-based medicine - A critical review

Evidence-based medicine is a method to establish best practice recommendations based on graded recommendations for diagnostic and therapeutic issues in health care. In mental healthcare, evidence-based medicine has shown that the therapeutic procedures are efficient and can help to not only ameliorate the symptoms of mental disorders, but also to improve the quality of life of those affected by mental disorders. Evidence-based medicine is not, however, cookbook medicine. While evidence is mostly generated in larger group trials and should be applicable to the majority of cases, aspects of the personal situation, social support systems and legal boundaries all affect mental healthcare and may modulate the interpretation of the findings of evidence-based medicine. A human-based psychiatry will therefore need to use the methods of evidence-based medicine as a basis for diagnostic and therapeutic recommendations, but will also need to extend into the acknowledgements of personal accounts, traditions and the cultural framework, in which mental healthcare is provided. This presentation will highlight some of the issues associated with the questions of the roles of evidence-based medicine in mental healthcare, and in a human-based approach towards mental healthcare.Disclosure of interestUnterstützung bei Symposien/Symposia Support.Janssen-Cilag GmbH, Neuss.Aristo Pharma GmbH, Berlin.Lilly Deutschland GmbH, Bad Homburg.Servier Deutschland GmbH, München.Fakultätsmitglied/Faculty Member.Lundbeck International Neuroscience Foundation (LINF), Dänemark.

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.

Digital radiography in the diagnosis of coronary calcinosis: capabilitites and perspectives

Aim. To study the capabilities of digital radiography in the diagnosis of coronary calcifications and to perform a comparative analysis of the received results with the results of multidetector computed tomography. &#x0D; Methods. We analyzed in a comparative aspect the results of examination of 90 patients who underwent both types of diagnostic procedures. Among the patients, 46 were males, 34 were females, the average age was 59±4.3 years, and the age of male patients was significantly higher than that of female patients. Statistical analysis was performed using variational, discriminant, correlation methods, evidence-based medicine methods and ROC-analysis. &#x0D; Results. A comparative analysis of the results showed that the reason, why coronary calcifications visualized in all arteries at multidetector computed tomography are not visible on digital X-ray, is their decreased firmness, so these calcifications were soft enough. Visualization of calcifications on digital chest X-ray is limited to certain calcium score values, which for anterior interventricular branch of left coronary artery is 355, for circumflex branch of the left coronary artery - 385, for right coronary artery - 367, for left main coronary artery - 393, for aortic arch - 396. Coronary calcifications with similar and higher calcium score values can be detected with digital radiography, which allows integrating this method in screening for cardiovascular diseases risk. The sensitivity, specificity and overall value of digital radiography for the detection of coronary calcifications were 59.5±3.3, 85.5±2.9 and 70.0±2.4, respectively. &#x0D; Conclusion. Detection of coronary calcifications in digital radiography is limited to certain calcium score values; in all coronary arteries at multidetector computed tomography, as the calcium score of coronary calcifications increases, the sensitivity and spesifity of their visualization in digital X-ray examination increase as well.

Evidence-Based Assessment of ADHD in Youth Using a Receiver Operating Characteristic Approach

Guidelines exist for the assessment of attention deficit/hyperactivity disorder (ADHD), but they are often unclear as to how a clinician should consider multiple informants, methods, and co-occurring symptoms to reach an overall diagnostic probability for an individual patient. The current study used receiver operating characteristic analyses and evidence-based medicine methods to evaluate the Achenbach System of Empirically Based Assessment measures and the Conners’ Continuous Performance Test for ADHD diagnosis in youth. Children (n = 379) and their parent(s) presented at an outpatient clinic for a psychoeducational assessment. Analyses examined the diagnostic efficiency and utility of study measures for predicting a best-estimate ADHD diagnosis. The Child Behavior Checklist Attention Problems construct, Teacher Report Form Attention Problems construct, and Hit Reaction Time Standard Error showed adequate diagnostic efficiency and unique contributions to the prediction of ADHD, Combined Type diagnosis. None of these measures showed good diagnostic efficiency or utility for the prediction of ADHD, Predominantly Inattentive Type. Child anxiety did not moderate the relations between predictors and ADHD diagnosis. Both the Child Behavior Checklist and Teacher Report Form Attention Problems constructs can discriminate youth with ADHD, Combined Type from other clinic-referred youth. Although Hit Reaction Time Standard Error also showed diagnostic utility, the decision to include a computerized measure should consider time and expense and be utilized in cases where diagnostic probability is unclear. Finally, anxiety may be associated with elevated attention problems, but it does not appear that anxiety affects diagnostic cutoffs for ADHD.

PS 08-36 ANTIHYPERTENSIVE DRUG RECOMMENDATIONS FOR CKD PATIENTS

Objective: Chronic kidney disease (CKD) is a key challenge for public health worldwide, and hypertension is one of the most prevalent cardiovascular risk factors for CKD. Traditionally, drug recommendations have been provided using methods of evidence-based medicine. The aim of our study is to recommend influential antihypertensive drugs for patients with CKD by mining the MEDLINE literature database. Design and Method: A graph-based ranking algorithm was used to calculate the most influential antihypertensive drugs for CKD. Results: Over an exhaustive study on all research literatures published in MEDLINE, Irbesartan is ranked as the most influential antihypertensive drug for patients with CKD in our study. The status of loop diuretics has lessened over time, and the importance of angiotensin receptor blockers has increased rapidly. The recommended antihypertensive drug categories determined by MedRank appeared prior to the release of hypertension guidelines. The concordance between physician rankings collected via questionnaires and our system output rankings was not high (average overlap, 0.53 ± 0.20); however, the concordance increased with increasing position of physicians (P < 0.05). Conclusions: In conclusion, among patients with CKD, irbesartan was considered as the most influential antihypertensive drug by MedRank, which is a crucial method for determining antihypertensive drug recommendations for patients with CKD. This approach is a potential method for medical literature discovery, decision support, and guideline development.

PS 18-04 MATHEMATICAL MODEL FOR THE OPTIMIZATION OF REGULATORY POLICY ON THE UKRAINIAN MARKET OF ANTIHYPERTENSIVE DRUGS

Objective: Over the years cardiovascular disease is the leading cause of mortality in different countries including Ukraine. Since 2012 Ukraine has been implementing the project of state price regulation of pharmaceutical products for the treatment of patients with hypertension, but expected effectiveness and consequences of this project are still questionable. Design and Method: Methods of evidence-based medicine, economic and market analysis and mathematical modeling of economic systems were used in this study. Results: It was developed mathematical model in the form of integrated criterion, as a tool for estimation the change in life expectancy for patients with hypertension depending on the reimbursement budget (Fig., formula 1). With the limited budget maximum reimbursement effect of regulatory policy is determined, solving the problem of maximizing the cumulative change in life expectancy among patients with hypertension (Fig., formula 3). New and reference price can be determined for the next period of time via analysis of the results of possible extension of the project (Fig., formula 4). Regulatory policy can determine the optimal amount of funding for the next period, changing the rate of reimbursement and distribution of funds among the different groups of patients and increasing the life expectancy of patients (Fig., formula 5 and 6). Conclusions: The developed mathematical model can be used for the choice of optimal distribution of reimbursement budget between the various groups of hypertensive patients, determining the impact of regulatory policy as life expectancy increase and minimization of the amount of necessary funds.

Evidence and Evidence Gaps - an Introduction

Treating patients requires the inclusion of existing evidence in any health care decision, to be able to choose the best diagnosis or treatment measure or to make valid prognosis statements for a particular patient in consideration of the physician's own expertise.The basis are clinical trials, the results of which are ideally gathered in systematic reviews, rated, summarized and published. In addition to the GCP (Good Clinical Practice)-compliant planning, conducting and analysis of clinical studies it is essential, that all study results are made publicly available, in order to avoid publication bias. This includes the public registration of planned and discontinued trials. In the last 25 years, the evidence-based medicine (EbM) has increasingly found its way into clinical practice and research. Here EbM is closely associated with the names Archibald Cochrane and David Sackett. In Germany, both the German Cochrane Centre (DCZ) and the network of evidence-based medicine (DNEbM) were established approximately 15 years ago. In the international Cochrane Collaboration clinicians and other scientists like statisticians interdisciplinary work side by side to develop the methods of evidence-based medicine and to address the topics of evidence generation and processing as well as the transfer of knowledge. Challenge: Existing evidence primarily serves doctors to support their decision-making, but is also the basis for providing scientific proof for a health care intervention's benefit to patients and ultimately payers/health insurances. The closure of existing evidence gaps requires substantial human and financial resources, a complex organizational structure and can only succeed with the involvement of clinical and methodological expertise and specific knowledge in the field of clinical research. In addition, the knowledge must be transferred into practice, using journals, guidelines, conferences, databases, information portals with processed evidence and not least the medical education of students.One problem is the wealth of information, so that in clinical practice there may be gaps in knowledge of actual evidence. Usually it still takes several years until new knowledge is fully implemented in daily practice. The German Society of Otolaryngology, Head and Neck Surgery (DGHNOKHC) and the German professional association of otolaryngologists (BVHNO) have a vested interest in supporting their members in the generation, processing and dissemination of evidence, and to foster the transfer of knowledge into practice. This includes the areas of diagnosis, treatment, prognosis and prevention as well as drug therapies or the application of medical devices or surgical procedures. Crucial is the regular determination of existing evidence gaps, including in the area of already established procedures, which must be followed by a prioritization of research questions and subsequent conduct of clinical research. Only with combined efforts even large trials can be performed, to test therapies and diagnostics for example, also after approval under everyday conditions. Methods, Results and Vision: The executive committees of DGHNOKHC and BVHNO have together founded the German Clinical Trials Unit for Ear, Nose and Throat medicine, Head and Neck Surgery (DSZ-HNO) to assist their members in the identification of evidence gaps and the planning and conduct of systematic reviews and clinical trials. The first projects have been started, including a BMBF(German Ministry for education and research)-funded clinical trial for the treatment of sudden hearing loss and a survey to detect evidence gaps in Otolaryngology. It seems both reasonable and feasible to provide a structure such as a jointly-run study center for doctors in hospitals and medical practices to assist in clinical research and to anchor the principles of evidence-based medicine in daily life.

A Program to Increase Research Productivity Among Hospital Pharmacists

Objective: To describe the development, implementation, and outcomes of a structured research training program that aimed to increase the research productivity among hospital pharmacists. Methods: The program was conducted in a step-wise approach and started with educational sessions on evidence-based medicine and research methods. After about a year, pharmacists were trained and mentored on how to conduct and publish a research project. We evaluated the number of research projects and publications for the pharmacy department before and after the implementation of the program. Results: In the 5 years prior to implementing the program, there were a total of 4 institutional review board (IRB) proposals, 4 abstracts, and 2 manuscripts, which had pharmacists as primary investigators. After 5 years of running the program, there were 24 pharmacist-initiated research proposals submitted to the IRB, 29 abstracts, and 11 published manuscripts. The major challenges were the lack of sufficient time and the extensive training and mentorship required. Conclusion: Implementing a structured pharmacy research program at a hospital setting was feasible and was associated with an increase in the pharmacist-led research and publications. The success of such a program requires training and mentorship, strong commitment, and administrative support.

Inheritance of the Zhiqiang spirit to inaugurate a new era of precision biliary surgery

With inheritance of scientific spirit of Huang Zhiqiang, depending on the modern science and technology of evidence-based medicine methods, digital surgical technique, molecular imaging technique, minimally invasive technology, genomics and proteomics technology and Big Data analytics, giving full play to the characteristics of precision surgery, which include evidence-base, quantification, visualization and controllability, a new era of biliary surgery in China is inaugurated. Key words: Biliary tract diseases; Biliary surgery; Precision surgery; Digital surgery; Genomics

Improved quality and more attractive work by applying EBM in disability evaluations: a qualitative survey.

BackgroundThe uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The aim of this study was to explore perceptions and experiences of physicians doing disability evaluations regarding motivators and preconditions for the implementation of EBM in daily practice.MethodsThis qualitative study was nested in a cluster randomized controlled trial (Trial registration NTR1767; 20-apr-2009) evaluating the effects of training in EBM. The 45 physicians that participated received a comprehensive 6-months training program in EBM of which the last course day included audio-recorded interviews in groups. During these interviews participating physicians discussed perceptions and experiences regarding EBM application in daily practice. In an iterative process we searched for common motivators or preconditions for the implementation of EBM.ResultsThree main concepts or themes emerged after analyzing the transcriptions of the discussions: 1) improved quality of physicians’ actions, such as clients benefiting from the application of EBM; 2) improved work attractiveness of physicians; and 3) preconditions that have to be met in order to work in an evidence-based manner including professional competence, facilitating material conditions and organizational support and demands.ConclusionsPhysicians trained in EBM are motivated to use EBM because they perceive it as a factor improving the quality of their work and making their work more attractive. In addition to personal investments and gains, organizational support should further facilitate the uptake of evidence in practice.