Evidence-based Medicine Tools Research Articles

Validity and reliability of the Japanese version of the ACE tool for assessing evidence-based medicine competencies in medical practitioners and students: An evaluation in an online setting.

Introduction Evidence-based medicine (EBM) competency is crucial for healthcare professionals; however, validated tools to assess EBM skills in Japanese are scarce. This study aimed to develop and validate a Japanese version of the Assessing Competency in EBM (ACE) tool. Methods We translated the ACE tool into Japanese, following international standards, and distributed it online to 99 healthcare professionals and students. The participants completed demographic questions and the Japanese version of the ACE tool. A subset also completed the retest and Fresno test. Internal consistency was assessed using Cronbach's alpha, test-retest reliability using the intraclass correlation coefficient (ICC), and construct validity using a confirmatory factor analysis and correlation with the Fresno test. Results The Japanese version of the ACE tool showed a low internal consistency (Cronbach's alpha = 0.31, 95% CI: 0.09-0.49), but an acceptable test-retest reliability (ICC = 0.64, 95% CI: 0.40-0.81). A confirmatory factor analysis provided moderate support for the structure of the tool (SRMR = 0.092, RMSEA = 0.048, CFI = 0.852). The tool demonstrated a moderate correlation with the Fresno test (r = 0.35). The median completion time was 847 s (IQR, 577-1,249 s). Conclusion Although the Japanese version of the ACE tool showed some promising aspects, including a quick administration and partial validity, its low internal consistency suggests that refinement is needed before it can be confidently used in Japanese medical education settings. Future studies should focus on improving the tool's reliability, potentially through in-person administration, to develop a robust EBM assessment tool in the Japanese healthcare context.

Review article: Primer for clinical researchers on innovative trial designs for emergency medicine.

Randomised trials have long been recognised as the gold standard research tool for evidence-based medicine. The past decade has seen the emergence of several innovative trial designs that are revolutionising how trials are conducted. These innovative designs enable more efficient, pragmatic trials that can address complex research questions which were previously not possible. In this paper, we provide an overview of the key innovative designs that are likely to be useful in the emergency medicine context, namely cluster crossover and stepped wedge designs, sequential multiple assignment randomised trial (SMART) designs, and platform trials. We describe the main features of each design, outline their pros and cons, and describe when they may or may not be useful. We also provide examples of these innovative designs in contexts that are relevant to emergency medicine.

The Use of Generative AI for Scientific Literature Searches for Systematic Reviews: ChatGPT and Microsoft Bing AI Performance Evaluation.

A large language model is a type of artificial intelligence (AI) model that opens up great possibilities for health care practice, research, and education, although scholars have emphasized the need to proactively address the issue of unvalidated and inaccurate information regarding its use. One of the best-known large language models is ChatGPT (OpenAI). It is believed to be of great help to medical research, as it facilitates more efficient data set analysis, code generation, and literature review, allowing researchers to focus on experimental design as well as drug discovery and development. This study aims to explore the potential of ChatGPT as a real-time literature search tool for systematic reviews and clinical decision support systems, to enhance their efficiency and accuracy in health care settings. The search results of a published systematic review by human experts on the treatment of Peyronie disease were selected as a benchmark, and the literature search formula of the study was applied to ChatGPT and Microsoft Bing AI as a comparison to human researchers. Peyronie disease typically presents with discomfort, curvature, or deformity of the penis in association with palpable plaques and erectile dysfunction. To evaluate the quality of individual studies derived from AI answers, we created a structured rating system based on bibliographic information related to the publications. We classified its answers into 4 grades if the title existed: A, B, C, and F. No grade was given for a fake title or no answer. From ChatGPT, 7 (0.5%) out of 1287 identified studies were directly relevant, whereas Bing AI resulted in 19 (40%) relevant studies out of 48, compared to the human benchmark of 24 studies. In the qualitative evaluation, ChatGPT had 7 grade A, 18 grade B, 167 grade C, and 211 grade F studies, and Bing AI had 19 grade A and 28 grade C studies. This is the first study to compare AI and conventional human systematic review methods as a real-time literature collection tool for evidence-based medicine. The results suggest that the use of ChatGPT as a tool for real-time evidence generation is not yet accurate and feasible. Therefore, researchers should be cautious about using such AI. The limitations of this study using the generative pre-trained transformer model are that the search for research topics was not diverse and that it did not prevent the hallucination of generative AI. However, this study will serve as a standard for future studies by providing an index to verify the reliability and consistency of generative AI from a user's point of view. If the reliability and consistency of AI literature search services are verified, then the use of these technologies will help medical research greatly.

Systematic review and meta-analysis as tools for evidence-based medicine

Systematic review and meta-analysis as tools for evidence-based medicine

Clinical Physician Assistant Students’ Perceptions of Evidence-Based Medicine Resources: A Cross-Sectional Examination

Evidence-based medicine (EBM) instruction is required for physician assistant (PA) students. As a follow-up to an initial didactic year survey, this study seeks to understand which attributes of EBM resources clinical PA students find most and least useful, their self-efficacy utilizing medical literature, and their usage of EBM tools in the clinic. Results indicate that students preferred UpToDate and PubMed. PA students valued ease of use, which can inform instructors and librarians. Respondents utilized EBM tools daily or a few days a week, underscoring the importance of EBM tools in real-world scenarios. After their clinical year, students felt moderately confident utilizing the medical literature, emphasizing EBM training.

What information sources do Dutch medical specialists use in medical decision-making: a qualitative interview study

ObjectiveTo explore what information sources medical specialists currently use to inform their medical decision-making.DesignQualitative, semistructured interviews.Setting and participantsA total of 20 semistructured interviews were conducted with 10 surgeons and 10...

Oxidant and antioxidant status among tobacco users: A cross-sectional study.

Smokeless and smoking tobacco use results in increased oxidative stress and lipid peroxidation, which play a major role in the causation of cancer in tobacco habituates. Malondialdehyde (MDA) is a product of lipid peroxidation, and glutathione peroxidase (GPx) and superoxide dismutase (SOD), the main enzymes in the antioxidant defense system, are assessed among tobacco users. This study gave insight into the relationship between tobacco use, oxidative stress, and antioxidant enzyme activity. This study aimed to estimate the levels of lipid peroxidation product MDA and antioxidant enzymes SOD and GPx among tobacco users and compare them with controls. A case-control study comprising 30 smokeless tobacco users, 30 smokers, and 30 controls was enrolled for the study. Serum MDA was assayed by the thiobarbituric acid method; serum SOD and GPx were assayed using Ransel antioxidant kits. The results were statistically analyzed using descriptive and inferential statistical analysis. Serum MDA levels, which indicate oxidative stress, were increased among all tobacco users and significantly increased among smokeless tobacco users as compared to smokers. Serum SOD and GPx levels were decreased among both forms of tobacco users compared with controls. With an increase in duration and frequency of tobacco use, there was a significant increase in serum MDA levels among both smokers and chewers and a decrease in serum SOD and GPx levels. In the present day, the tobacco epidemic has attained enormous proportions with the tobacco habit starting as early as 13-14 years and leading to serious conditions with high morbidity and mortality. These biochemical parameters such as MDA, SOD, and GPx, which act as marker of oxidant and antioxidant system, can constitute important tools for evidence-based medicine for educating patients and motivating interventions in tobacco cessation therapy.

Evidence-Based Medicine and Pharmacotherapy Content Alignment

ObjectiveWhen effectively executed, content alignment can aid student performance in associated courses. Limited research exists for content alignment of evidence-based medicine (EBM) and pharmacotherapy courses. This study assesses the impact of EBM and pharmacotherapy course alignment on student performance. MethodsContent alignment included assignment of 6 landmark trials in EBM coursework. The articles were identified by pharmacotherapy instructors as “landmark” to management of associated diseases in the aligned pharmacotherapy semester. Articles were the basis for quizzes over skills taught in the EBM course and were referenced during pharmacotherapy lectures. ResultsDuring the alignment semester, students were more likely to cite specific guidelines and/or primary literature to rationalize pharmacotherapeutic plans on examinations compared with the prealignment period (54% vs 34%). Overall, pharmacotherapy case performance and plan rationale scores were significantly higher in the alignment semester compared with prealignment. Student performance on the Assessing Competency in Evidence-Based Medicine tool improved from the start of the semester (8.64, SD 1.66) to the end (9.5, SD 1.49; mean score +0.86). Comfort in applying EBM analysis to primary literature increased significantly between the first and final assignments, with 6.7% and 71.7% of students self-reporting a high degree of confidence, respectively. Students (73%) reported an enhanced understanding of pharmacotherapy due to alignment compared with a previous semester of pharmacotherapy without alignment. ConclusionThe use of landmark trial assignments to align EBM and pharmacotherapy coursework demonstrated a positive impact on student rationale for clinical decision-making and student confidence in evaluating primary literature.

APPRAISE-RS: Automated, updated, participatory, and personalized treatment recommender systems based on GRADE methodology

PurposeClinical practice guidelines (CPGs) have become fundamental tools for evidence-based medicine (EBM). However, CPG suffer from several limitations, including obsolescence, lack of applicability to many patients, and limited patient participation. This paper presents APPRAISE-RS, which is a methodology that we developed to overcome these limitations by automating, extending, and iterating the methodology that is most commonly used for building CPGs: the GRADE methodology. MethodAPPRAISE-RS relies on updated information from clinical studies and adapts and automates the GRADE methodology to generate treatment recommendations. APPRAISE-RS provides personalized recommendations because they are based on the patient's individual characteristics. Moreover, both patients and clinicians express their personal preferences for treatment outcomes which are considered when making the recommendation (participatory). Rule-based system approaches are used to manage heuristic knowledge. ResultsAPPRAISE-RS has been implemented for attention deficit hyperactivity disorder (ADHD) and tested experimentally on 28 simulated patients. The resulting recommender system (APPRAISE-RS/TDApp) shows a higher degree of treatment personalization and patient participation than CPGs, while recommending the most frequent interventions in the largest body of evidence in the literature (EBM). Moreover, a comparison of the results with four blinded psychiatrist prescriptions supports the validation of the proposal. ConclusionsAPPRAISE-RS is a valid methodology to build recommender systems that manage updated, personalized and participatory recommendations, which, in the case of ADHD includes at least one intervention that is identical or very similar to other drugs prescribed by psychiatrists.

Introduction: Historical Development and Progression of Clinical Research on Ageing.

Research on ageing has developed since Greek times. It had a very slow advance during the Middle Ages and a big increase in the Renaissance. Darwin contributed somehow to the understanding of the ageing process and initiated a cumulus of ageing explications under the name of Evolutionary Theories. Subsequently, science discovered a great number of genes, molecules, and cell processes that intervened in ageing. This led to the beginning of trials in animals to retard or avoid the ageing process. Alongside this, improvements, geriatric clinical investigations (with the evidence-based medicine tools) started to consolidate as a discipline and commenced to show the challenges and deficiencies of actual clinical trials in ageing; the COVID-19 outbreak revealed some of them. The history of clinical research in ageing has already begun and is essential to affront the challenges that the world will face with the increasing ageing population.

Didactic Physician Assistant Students’ Perceptions of Evidence-Based Medicine Resources: A Preliminary Investigation

Evidence-Based Medicine (EBM) instruction is required for physician Assistant (PA) students. This pilot study surveyed didactic PA students at three geographically diverse PA programs at the end of their didactic EBM course to understand which attributes of EBM resources they find most and least useful, and their self-efficacy in searching and appraising medical literature. Thematic analysis identified the most important student-reported attributes of a resource. PA students in this sample preferred UpToDate and PubMed as their top EBM tools based on attribute ratings. However, each database included in this pilot study received positive feedback, despite a low usage rate across institutions. The most important attributes were ease of use/search, information presentation, and conclusion/critical appraisal skill. After one EBM course, on average, students rated their self-efficacy searching the literature and appraising the literature as “moderately confident.” This suggests that instructors and librarians have an opportunity to expose students to more tools as well as encourage “the right tool for the right job.”

Prophetic Medicine: Building an Epistemological Framework to Overcome the Conflict between Religion and Evidence-Based Medicine

Prophetic medicine (PM) is the body of medical advice given by the Prophet Muhammad (the Prophet of Islam). Although various theories have been advanced to explain the articulation of PM in Islamic history, the most coherent theory is that PM was articulated by Islamic scholars to reconcile the Prophet’s medical advice with Greek medicine. In a similar fashion, faced with the current-era domination of the medical scene by Evidence-Based Medicine (EBM), some Muslim researchers have hastened to attempt combining EBM with PM by using EBM tools to validate PM. A literature review revealed four features shared by most of the current PM studies. First, they were conducted in Islamic countries. Second, their main purpose was to confirm the validity of PM. Third, they lacked a consistent epistemological framework. Fourth, they used deductive reasoning that treated PM as absolute truth in their introductory sections, restricting their purpose to proving the validity of PM and leaving no room for refutation. To draw more effectively on the PM heritage without contradicting current scientific method, it is instructive to extract and adapt the methods used by earlier Islamic scholars to combine PM with Greek medicine. After an extensive textual analysis of the books of the Prophet’s sayings (Hadiths) and scholars’ commentaries, the methods by which scholars combined PM and Greek medicine were extracted. The study concludes by proposing several models that combine PM with EBM. The closest model found to acknowledge the holiness of the Prophet’s Hadiths without contradicting the scientific nature of EBM is to limit the divine validity of the Prophet’s medical Hadiths to those to whom the Prophet prescribed the medicine, without including those who came after them in later times. This approach opens the door to benefiting from these Hadiths as indicating possible directions for modern scientific research without calling the Prophet’s prophecies or the validity of his words into question.

Face-to-face versus online clinically integrated EBM teaching in an undergraduate medical school: a pilot study

ObjectivesThe aim of this study was to test the feasibility and effectiveness of two models (face-to-face vs online teaching) of clinically integrating evidence-based medicine (EBM) teaching in an undergraduate medical...

Professor Solomon P. Wasser and Medicinal Mushroom Science, with Special Attention to the Problems of Mycotherapy in Oncology.

This article is dedicated to the 75th anniversary of Solomon P. Wasser and discusses the challenges within the research direction he founded with Professors T. Mizuno, S.T. Chang, and other colleagues, known as medicinal mushroom science. This research organically grows out of taxonomic studies, since understanding of the classification system leads to greater ability to make forecasts and predictions in the practical field as well as to increase knowledge of close relationships between organisms, allowing greater eeconomic organization within the search and screening for new practically significant organisms. Through the efforts of Professors Wasser, Mizuno, and Chang, the International Journal of Medicinal Mushrooms (IJMM) was created, combining the efforts of physicians using mushroom raw materials as an auxiliary tool and specialists in fungal biotechnology. In this work, the basic prerequisites for cancer mycotherapy are described, based on data on the mechanism of action of fungal metabolites on cancer targets. A large section of this report is devoted to a review of evidence-based medicine tools and an overview of their use among teams of Chinese researchers. It has been shown that the main recipients of mycotherapy, as well as other types of immunotherapies, are patients with stage 3 cancer who have undergone surgery to remove the primary tumor node and are undergoing chemotherapy; for these patients, their immune status must be increased, and the immune system requires a periodic rebooting. In this respect, Dectin stimulation using fungal glucans is comparable to cytokine therapy and can be characterized as an "endogenous cytokine therapy." The results of the combined treatment at this stage are to be quantified using evidence-based medicine tools, for which we recommend including the consumption of mushroom extracts in the patient questionnaire. This article also discusses challenges in the pharmacokinetics of β-glucans and triterpenoids.

Basics of meta-analysis.

Meta-analysis is an approach to formally, systematically and quantitatively analyze multiple existing research studies and to synthesize new research findings based upon the existing data. Until the late 1970s, meta-analyses were not regularly reported in the medical literature, but since then there has been an exponential growth of meta-analyses and they are now among the most frequently cited form of research. A properly performed systematic review and meta-analysis is a very important tool in evidence-based medicine and a good understanding of the steps involved in doing a systematic review and meta-analysis is important to yield meaningful results. The purpose of this review article is to provide a brief overview about systematic reviews and meta-analyses and the underlying principles for conducting this type of research. Methodological approaches for conducting a meticulous meta-analysis are described and the important steps involved in the interpretation and presentation of meta-analysis are outlined and discussed. The key objective of this paper is to outline a step-by-step approach that is useful to all researchers, who would like to conduct their first meta-analysis. This paper also provides clinicians and researchers with the information to interpret systematic reviews and meta-analyses.

Patient-Reported Outcomes of Metal and Acrylic Resin Removable Partial Dentures: A Systematic Review and Meta-Analysis.

Metal removable partial dentures (RPDs) are often considered long-term treatment options for partially edentulous patients, while acrylic resin RPDs are considered interim treatments. The aim of this review was to compare metal and acrylic resin RPDs regarding patient-reported outcomes for partially edentulous individuals. Four databases (MEDLINE, EMBASE, CENTRAL, and Web of Science) were systematically searched for observational studies and randomized controlled trials comparing patient-reported outcomes between metal and acrylic resin RPDs. The primary outcome was patient satisfaction. Included studies were assessed for risk of bias using the Cochrane risk of bias in nonrandomized studies of interventions tool (ROBINS-I) and the Cochrane Collaboration Risk of Bias Tool for Randomized Controlled Trials. The level of evidence was evaluated using Oxford Center for Evidence-based Medicine tool. A random-effects model was used to analyze the data. A total of 15 studies were included in the systematic review; 10 in the meta-analysis. The pooled effect size for patient satisfaction and oral health-related quality of life showed no statistical significant difference between metal and acrylic resin dentures (0.22, 95% confidence interval -0.01, 0.45, p = 0.06; 1.45, 95% confidence interval -2.43, 5.33, p = 0.46, respectively). Compliance with using RPDs was significantly higher in patients with metal compared to patients with acrylic resin dentures (pooled odds ratio = 0.57, 95% confidence interval 0.45, 0.73, p < 0.001). Most studies had critical to serious risk of bias and low level of evidence. The reviewed studies showed that there was no significant difference between metal and acrylic resin RPDs in patient satisfaction and oral health-related quality of life. Metal dentures were associated with higher patient compliance rates and were preferred more by patients compared to acrylic resin dentures. However, the reviewed studies had low levels of evidence and therefore, high-quality randomized controlled trials are needed to conclusively address the question of this review.

A systematic review of respiratory infection due to air pollution during natural disasters

BACKGROUND Wildfire and volcano eruption occurred in Indonesia due to its geographical location, climate change, global warming, and human behavior. Various substances produced an increased risk of experiencing health problems, including respiratory infection. Evidence about the effect of pulmonary infection during natural disasters is still limited. This study was aimed to review and elaborate on previous studies to determine the effect of air pollution exposure during natural disasters and respiratory infection.&#x0D; METHODS Literature searches were conducted on PubMed, EBSCOhost, and Google Scholar, and was limited to the 10 last years, human studies, and the English language. Inclusion criteria were articles with representation for clinical questions, review articles, population studies, and the full-text article was available. Exclusion criteria were articles that only discussed the exposure to and not the association with the effect of the respiratory infection. The Oxford Center for Evidence-Based Medicine tools appraised six relevant articles.&#x0D; RESULTS Air pollution during a natural disaster enhances particulate matter to 10–70 μg/m3 and more than 5 times the aerosol optical depth measurement compared with the tolerated air concentration. The air level was consistently related to acute respiratory infection, pneumonia, bronchitis, and bronchiolitis admissions in wildfire smoke and volcanic eruption in this review. Nevertheless, there was a diverse result for upper respiratory infection cases.&#x0D; CONCLUSIONS Natural disasters increased the level of ambient air pollution that exceeded the levels recommended by the World Health Organization air quality guideline. Air pollution may play an important role in respiratory tract infection, especially among population with high exposure.

Daily versus weekly evidence reports for orthopaedic surgeons in India: A mixed-methods study.

Background:There is a dearth of research regarding the impact of evidence-based medicine (EBM) tools, such as evidence summaries, in developing countries. The goals of this study were to: investigate accessibility, use, and impact of an online EBM knowledge dissemination portal in orthopaedic surgery in India; explore whether receiving daily targeted evidence summaries results in more frequent use of an EBM tool compared with receiving general weekly reports; and identify and explain the barriers and benefits of an online EBM resource in the Indian context.Methods:Forty-four orthopaedic surgeons in Pune, India, were provided free access to OrthoEvidence (OE), a for-profit, online EBM knowledge dissemination portal. Participants were subsequently randomized into 2 groups—1 group received daily targeted evidence summaries while the other received general weekly summaries. This study employed an explanatory sequential mixed methods design that incorporated 2 questionnaires, OE usage data, and semi-structured interviews to gain insight into the surgeons’ usage, perceptions, and impact of OE.Results:There were no observable differences in OE usage between groups. OE was deemed to be comprehensive, practical, useful, and applicable to clinical practice by the majority of surgeons. The exit survey data revealed no differences between groups’ perceptions of the OE tool. semi-structured interviews revealed barriers to keeping up with evidence that included limited access to relevant medical literature and limited incentive to keep up with current evidence.Conclusions:Neither frequency of delivery (daily versus weekly) nor targeted versus general content affected the use of evidence summaries. Facilitating uptake of current evidence into clinical practice among Indian orthopedic surgeons may require additional components beyond dissemination of evidence summaries.

Agreement between results of meta-analyses from case reports and clinical studies, regarding efficacy and safety of idursulfase therapy in patients with mucopolysaccharidosis type II (MPS-II). A new tool for evidence-based medicine in rare diseases

BackgroundA preliminary exploratory study shows solid agreement between the results of case reports and clinical study meta-analyses in mucopolysaccharidosis Type I (MPS-I) adult patients. The aim of the present study is to confirm previous results in another patient population, suffering from mucopolysaccharidosis Type II (MPS-II).MethodsA systematic review and meta-analysis of case reports published by April 2018 was conducted for MPS-II patients treated with enzyme replacement therapy (ERT). The study is reported in accordance with PRISMA and MOOSE guidelines (PROSPERO database code CRD42018093408). The assessed population and outcomes were the same as previously analyzed in a meta-analysis of MPS-II clinical studies. The primary endpoint was the percent of clinical cases showing improvement in efficacy outcome, or no harm in safety outcome after ERT initiation. A restrictive procedure to aggregate case reports, by selecting standardized and well-defined outcomes, was proposed. Different sensitivity analyses were able to evaluate the robustness of results.ResultsEvery outcome classified as “acceptable evidence group” in our case report meta-analysis had been graded as “moderate strength of evidence” in the aforementioned meta-analysis of clinical studies. Sensitivity, specificity, and positive-negative predictive values for results of both meta-analyses reached 100%, and were deemed equivalent.ConclusionsAggregating case reports quantitatively, rather than analyzing them qualitatively, may improve conclusions in rare diseases and personalized medicine. Additionally, we propose some methods to evaluate publication bias and heterogeneity of the included studies in a meta-analysis of case reports.

THE EVIDENCE-BASED MEDICINE PICO STRATEGY APPLIED TO DENTISTRY USING MESH, EMTREE AND DECS

Introduction: the PICO mnemonic is an evidence-based medicine tool that helps formulate the research questions needed to conduct the right search for scientific information. To properly classify this information, controlled languages or thesauruses are used for information retrieval. The aim was to identify whether the PICO search strategy in evidence-based medicine using the MeSH, Emtree and DeCS thesauruses answers a research question in the field of dentistry. Methods: to carry out the PICO strategy, a research question was formulated, identifying the natural language terms for each component of the PICO acronym, which were normalized into the three thesauruses to create the search equations. Results: 43 results were foundon Medline through PubMed, 5 on Embase, and 0 on LILACS. There were 4 original articles that answer the research question, proving to be an effective strategy for finding clinical evidence. Conclusion: this study shows that the strategy helps obtain results to answer the question posed. It should be noted that, in order to successfully search and retrieve information, researchers should use the PICO strategy and get familiar with the thesauruses that help structure search equations in the various bibliographic databases.