Use Of Evidence-based Medicine Research Articles

New horizons of osteopathy (letter to the Editor-in-Chief)

An analysis of the stages in the development of scientific research on the use of evidence-based medicine in osteopathy is presented. A search was conducted for scientific publications in the entire Medline database of the US National Center for Biotechnology Information (NCBI), starting in 1984. The main directions aimed at improving the quality and reliability of scientific research in osteopathy are described. As a discussion, it is proposed to use an assessment method that allows you to record three types of body reactions to the treatment — immediate, fast and delayed.

Clinical Validation of Digitally Acquired Clinical Data and Machine Learning Models for Remote Measurement of Psoriasis and Psoriatic Arthritis: A Proof-of-Concept Study.

Psoriatic disease remains underdiagnosed and undertreated. We developed and validated a suite of novel, sensor-based smartphone assessments (Psorcast app) that can be self-administered to measure cutaneous and musculoskeletal signs and symptoms of psoriatic disease. Participants with psoriasis (PsO) or psoriatic arthritis (PsA) and healthy controls were recruited between June 5, 2019, and November 10, 2021, at 2 academic medical centers. Concordance and accuracy of digital measures and image-based machine learning models were compared to their analogous clinical measures from trained rheumatologists and dermatologists. Of 104 study participants, 51 (49%) were female and 53 (51%) were male, with a mean age of 42.3 years (SD 12.6). Seventy-nine (76%) participants had PsA, 16 (15.4%) had PsO, and 9 (8.7%) were healthy controls. Digital patient assessment of percent body surface area (BSA) affected with PsO demonstrated very strong concordance (Lin concordance correlation coefficient [CCC] 0.94 [95% CI 0.91-0.96]) with physician-assessed BSA. The in-clinic and remote target plaque physician global assessments showed fair-to-moderate concordance (CCCerythema 0.72 [0.59-0.85]; CCCinduration 0.72 [0.62-0.82]; CCCscaling 0.60 [0.48-0.72]). Machine learning models of hand photos taken by patients accurately identified clinically diagnosed nail PsO with an accuracy of 0.76. The Digital Jar Open assessment categorized physician-assessed upper extremity involvement, considering joint tenderness or enthesitis (AUROC 0.68 [0.47-0.85]). The Psorcast digital assessments achieved significant clinical validity, although they require further validation in larger cohorts before use in evidence-based medicine or clinical trial settings. The smartphone software and analysis pipelines from the Psorcast suite are open source and freely available.

Challenges of the Presence and Absence of Clinical Librarians in the Use of Evidence-Based Medicine in Clinical Departments

Due to the rapid growth of information technology and medical information resources, medical personnel need to search and retrieve valid and updated information. However, with limited time to access these resources, there is a need for clinical librarians to connect medical staff to evidence-based medicine (EBM). The present study was conducted to identify the challenges in the absence and the benefits of the presence of clinical librarians in the application of EBM in clinical departments. Ten clinical physicians working at Children’s Medical Center Hospital in Tehran, Iran were interviewed for this qualitative study. Most of the hospital-based physicians did not make any systematic use of EBM and seven were not familiar with the term “clinical librarian.” In their opinion, the clinical librarians’ activities included training the clinical and research teams, providing them with the required information, and providing an EBM-oriented approach to morning report and educational rounds. Therefore, the services delivered by clinical librarians in various hospital departments might positively influence the hospital-based physicians’ information-seeking behavior.

Identifying the effective factors in using medical evidence in clinical medicine: A qualitative study in the emergency department

Introduction: Evidence-based medicine can increase the clinical performance of physicians. This qualitative study was conducted with the aim of examining the effective factors for using new evidence by emergency medicine residents in Rasoul Akram and Haftam Tir Hospitals in Tehran, Iran.
 Methods: The present descriptive-analytical study was conducted in the year 2016 in two hospitals In Tehran. In order to conduct this qualitative study, residents were selected by purposive sampling. The data was collected during 18 in-depth individual interviews and the categories and themes of the effective factors in the use of new evidence were extracted using conventional content analysis.
 Results: Participants were introduced to medical evidence through text books, attending workshops, faculty classes, attending conferences, or through friends. Evidence-based medicine consists of factors such as: physician incentive factors, patient incentive factors, factors in favor of scientific facts, environmental-cultural incentives and moral incentives, and among the inhibitory factors discouraging the use of evidence based medicine are factors that influence physician and patient, environmental-cultural inhibitors and social inhibitors.
 Conclusion: There seems to be a positive attitude among residents towards the use of evidence-based medicine, but there are still several obstacles to its implementation in society. Structural and individual factors and policy-making are the most important determining factors in its implementation in Iran.

Current state and prospects of forensic-medical diagnosis of drowning: A review of the literature

The article describes the current possibilities of forensic medicine in the diagnosis of death by drowning, as well as reflects the different views of the authors and the evolution of approaches to this issue. Despite the constant interest of scientists in the topic of drowning and extensive research on this issue, there are still many white spots. Researchers are trying to identify more specific changes characteristic of drowning and possible methods to detect them. The main evidence based method of diagnosing drowning at present is the detection of diatomic plankton in the tissues of isolated kidneys by light optical microscopy. However, microscopic examination and identification of diatomic plankton require a lot of time and accurate taxonomic examination. Also, a disadvantage of this method is that the methods of processing the material sent for research, as a result of the use of concentrated acids for the destruction of organs, greatly complicates and sometimes eliminates the possibility of detection of diatomic plankton. In some cases, the presence of diatoms during drowning is so small that it is impossible to detect them by microscopy. In such cases, the presence of phytoplankton DNA detected by PCR in tissues during drowning is almost the only method for diagnosing drowning. Nowadays there has been a lack of research in the field of forensic medicine related to the use of evidence-based medicine, especially in the field of drowning.

3rd Annual International Pharmacoeconomic Forum Highlights.

3rd Annual International Pharmacoeconomic Forum Highlights.

Hostage to history - questioning the duration of systemic antimicrobial therapy for the treatment of canine superficial bacterial folliculitis.

Current guidelines for the use of systemic antimicrobials for the treatment of superficial bacterial folliculitis in dogs include the recommendation that the disease be treated for a minimum of 3 weeks and for at least 1 week beyond clinical resolution. With increasing antimicrobial resistance being noted for bacteria involved in this condition, as well as the increased use of evidence-based medicine, this dogma needs to be reevaluated.

Association of HLA gene polymorphism with susceptibility, severity, and mortality of COVID-19: A systematic review.

HLA is crucial for appropriate immune responses in several viral infections, as well as in severe acute respiratory syndrome coronavirus-2 (SARS CoV-2). The unpredictable nature of Coronavirus Disease 19 (COVID-19), observed in both inter-individual and inter-population level, raises the question, to what extent the HLA, as part of host genetic factors, contribute to disease susceptibility and prognosis. We aimed to identify significant HLAs, those were investigated till now, for their association with COVID-19. Three databases were searched (PubMed, Cochrane library, and Web of Science) and articles published between January 2020 and May 2021 were included for in-depth analysis. Two separate teams including four observers independently extracted the summary data, with discrepancies resolved by consensus. This study is registered with PROSPERO (CRD42021251670). Of 1278 studies identified, 36 articles were included consisting of 794,571 participants. Countries from the European region appeared in the highest number of studies and vice versa for countries from South East Asia. Among 117 significantly altered alleles, 85 (72.65%) were found to have a positive correlation with COVID-19 and 33 (27.35%) alleles were observed having a negative correlation. HLA A*02 is the most investigated allele (n=18) and showed contradictory results. Non-classical HLA E was explored by only one study and it showed that E*01:01 is associated with severity. Both in silico and wet lab data were considered and contrasting results were found from two approaches. Although several HLAs depicted significant association, nothing conclusive could be drawn because of heterogeneity in study designs, HLA typing methods, and so forth. This systematic review shows that, though HLAs play role in COVID-19 susceptibility, severity, and mortality, more uniformly designed, interrelated studies with the inclusion of global data, for use in evidence-based medicine are needed.

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.

Perspective of Evidence-Based Medicine among Egyptian Family Physicians in Egypt

Objective: To assess family practitioners’ attitudes toward and awareness of evidence-based medicine in Egypt. Introduction: Evidence based medicine (EBM) is a systematic approach to medicine in which health care professionals use the best available scientific evidence to help make decisions about the care of individual patients. The use of evidence-based medicine may help plan the best treatment and improve quality of care and patient outcomes. Methodology: This is a cross-sectional study conducted on 135 family physicians from Rural and urban family medicine centres throughout Egypt that are affiliated with Ministry of Health and the private sector by using self- administered Evidence-Based Medicine Questionnaire distributed between October and November 2020. Results: With a 100% response rate most of the participants were females 91 (68.9%), aged between 30-39 (73.3 %), and worked in mixed urban and rural settings (53.3%). Most physicians welcomed or strongly welcomed the use of EBM (54.1% and 38.2% respectively). Moreover, 97% of the respondents agreed that EBM is useful or extremely useful.The majority (98.5% ) agreed that EBM improves patient care. . About 71% of the participants thought that the adoption of EBM will add more load on the family medicine practitioners Conclusion: Egyptian family physicians generally have a good attitude towards EBM, however their general knowledge about it is still insufficient. Keywords: Guidelines, Standards, Care pathways, Africa, Quality of health care

Self-reported knowledge, attitudes, practices and barriers in use of evidence-based medicine among resident physicians in Kenya: a mixed methods study

BackgroundEvidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide safe and most cost-effective care. Postgraduate doctors are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine but very few studies have been done in Sub Saharan Africa. This study explored the self-reported knowledge, attitudes, practices and barriers of evidence-based practice among resident physicians in a tertiary teaching hospital.MethodsA mixed methods cross-sectional study that used convergent parallel design was conducted. The quantitative arm was conducted among all residents enrolled in the Master of Medicine programme at Aga Khan University Hospital Nairobi (AKUHN). It included an online survey exploring self-reported knowledge, attitudes, practices and barriers of EBM among all residents. Simultaneously, semi-structured In-Depth Interviews were carried out among 18 purposefully selected residents in order to explore the same themes in more depth.ResultsOne hundred and one residents (99%) responded to the survey. The mean scores for self-reported knowledge, attitude and practice of EBM among residents were 73.88, 66.96 and 63.19% respectively, which were generally higher than in comparable studies. There was a significant association between year of residency and practice of EBM. The most common barriers faced by residents were lack of time, lack of EBM skills and patients’ unawareness about EBM.From the qualitative study, residents demonstrated good knowledge and support of EBM but practice remained relatively poor. Barriers to EBM were characterized by lack of motivation, time, skills and resources, patient overload and fear of challenging consultants.ConclusionThere was good understanding and support of EBM among residents at AKUHN, though challenges were experienced in regards to practice of EBM because of lack of time and skills. Therefore resources should be allocated towards integrating EBM into undergraduate medical curricula to cultivate critical thinking skills at an early stage before transition into residency.

The Usage of Evidence-Based Dentistry among Postgraduate Student of Isfahan University of Medical Sciences

Introduction: Our current era is the age of information exploration and innovation that has given us a good opportunity to use evidence-based information, so this study aimed to evaluate the use of Evidence-Based Dentistry in Isfahan Dental School in 2018. Materials & Methods: The sampling method of this study was census and, the number of faculty assistants was 50. The method of collecting this information was through a questionnaire Regarding fulfillment of ethical manners in this study, participants were not required to mention their names and personal characteristics, and only if they consented participate in the study, a questionnaire was provided to them. Man withny analysis and Spear man correlation were used to evaluate the relation between EBD (Evidence Based Dentistry) according to their gender. Results: In the current evaluation, it was observed that 19 dentists (36.5%) were female and 33 (63.5%) were male. Most residents (63.5%) sometimes use evidence-based dentistry, 11 cases (21.2%) rarely and 8 cases (15.3%) using this technique always. About the frequency distribution of resources used by residents to answer questions in dealing with patients, the highest frequency (65.4%) was related to “textbooks or questions from clinical teachers” as well as “translated reference books” and the least Frequency (13.5%) was related to “Search other databases”. Conclusion: Based on the findings in this section, the use of evidence-based medicine among residents is low.

Cultural health capital and the stratification of reproduction in Czech and Spanish egg donation markets.

This article explores the ways that fertility clinics in the Czech Republic and Spain attract international fertility clients for fertility treatment involving egg donation. I draw upon a content analysis of 18 fertility clinics' advertising materials and 31 in-depth interviews with fertility professionals in the Czech Republic and Spain, and Canadian fertility travellers to show how clinics use cultural health capital (CHC) to persist as popular destination sites for fertility travellers. I argue that the use of evidence-based medicine and patient-centred care combined with bioracial discourses are strategies by which clinics create a culture of fertility care that is legible to white, middle-class, hetero travellers. My interviews with fertility patients who travelled to these sites show the ways in which CHC is interactional-I document how fertility travellers desire these specific practices that are both created for and marketed to them. By expanding the definition of CHC to show how fertility clinics market and fertility travellers expect a particular culture of fertility medicine, I elucidate the interactions between clinics and professionals that reinforce ideals of white motherhood and the stratification of reproduction.

Untargeted metabolomics approach to discriminate mistletoe commercial products

Mistletoe (Viscum album L.) is used in German-speaking European countries in the field of integrative oncology linking conventional and complementary medicine therapies to improve quality of life. Various companies sell extracts, fermented or not, for injection by subcutaneous or intra-tumoral route with a regulatory status of anthroposophic medicinal products (European Medicinal Agency (EMA) assessment status). These companies as well as anthroposophical physicians argue that complex matrices composed of many molecules in mixture are necessary for activity and that the host tree of the mistletoe parasitic plant is the main determining factor for this matrix composition. The critical point is that parenteral devices of European mistletoe extracts do not have a standard chemical composition regulated by EMA quality guidelines, because they are not drugs, regulatory speaking. However, the mechanism of mistletoe’s anticancer activity and its effectiveness in treating and supporting cancer patients are not fully understood. Because of this lack of transparency and knowledge regarding the matrix chemical composition, we undertook an untargeted metabolomics study of several mistletoe extracts to explore and compare their fingerprints by LC-(HR)MS(/MS) and 1H-NMR. Unexpectedly, we showed that the composition was primarily driven by the manufacturer/preparation method rather than the different host trees. This differential composition may cause differences in immunostimulating and anti-cancer activities of the different commercially available mistletoe extracts as illustrated by structure–activity relationships based on LC–MS/MS and 1H-NMR identifications completed by docking experiments. In conclusion, in order to move towards an evidence-based medicine use of mistletoe, it is a priority to bring rigor and quality, chemically speaking.

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.

Family care for persons with severe mental illness: experiences and perspectives of caregivers in Uganda

BackgroundIn low-income settings with limited social protection supports, by necessity, families are a key resource for care and support. Paradoxically, the quality of family care for people living with Severe Mental Illness (PLSMI) has been linked to support for recovery, hospital overstay and preventable hospital readmissions. This study explored the care experiences of family members of PLSMI with patients at the national mental hospital in Kampala, Uganda, a low income country. This study was undertaken to inform the development of YouBelongHome (YBH), a community mental health intervention implemented by YouBelong Uganda (YBU), a registered NGO in Uganda.MethodsQualitative data was analysed from 10 focus groups with carers of ready to discharge patients on convalescent wards in Butabika National Referral Mental Hospital (BNRMH), Kampala. This is a subset of data from a mixed methods baseline study for YouBelong Uganda, undertaken in 2017 to explore hospital readmissions and community supports for PLSMI from the Wakiso and Kampala districts, Uganda.ResultsThree interrelated themes emerge in the qualitative analysis: a range of direct, practical care provided by the caregiver of the PLSMI, emotional family dynamics, and the social and cultural context of care. The family care giving role is multidimensional, challenging, and changing. It includes protection of the PLSMI from harm and abuse, in the context of stigma and discrimination, and challenging behaviours that may result from poor access to and use of evidence-based medicines. There is reliance on traditional healers and faith healers reflecting alternative belief systems and health seeking behaviour rather than medicalised care. Transport to attend health facilities impedes access to help outside the family care system. Underpinning these experiences is the impact of low economic resources.ConclusionsFamily support can be a key resource and an active agent in mental health recovery for PLSMI in Uganda. Implementing practical family-oriented mental health interventions necessitates a culturally aware practice. This should be based in understandings of dynamic family relationships, cultural understanding of severe mental illness that places it in a spiritual context, different family forms, caregiving practices and challenges as well as community attitudes. In the Ugandan context, limited (mental) health system infrastructure and access to medications and service access impediments, such as economic and transport barriers, accentuate these complexities.

Assessing for Practice-Based Learning and Improvement: Distinguishing Evidence-Based Practice From Reflective Learning.

Assessing for Practice-Based Learning and Improvement: Distinguishing Evidence-Based Practice From Reflective Learning.

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.

Barriers and Strategies: A Review of Access to Affordable Multi-Drug Resistant Tuberculosis Medication in China.

This study analyzed the barriers of patient access to affordable MDR-TB medication in China and the reasons behind, and proposed strategies towards removing the barriers based on literature review and key informant interviews. Reasons behind the high financial burden of MDR-TB patients in China are the lack of a coordinated and multi-sourced financing model to secure patients’ access to the expensive novel medicines, and the absence of the safety-net for the patients with low ability to pay the costs. Appropriate health insurance benefit packages and provider payment mechanisms, supportive legal framework, coordinated policies as well as incentives for off-label use of evidence-based repurposed medicines are missing. The observations identified key intervention areas including continued efforts to make the novel effective medicines affordable and to strengthen the legislative protection for off-label use of evidence-based medicines; increase incentives for pharmaceutical companies to expand indications of established medicines based on the evidence; implement public initiatives to support the use of repurposed medicines for diseases with major public health significance, and scale up good practices from local pilots to create a coordinated multi-sourced financing model. A comprehensive approach to address the barriers in the full treatment course of MDR-TB and a safety-net for low-ability-to-pay patients are also critical to secure universal access to affordable MDR-TB medication.

Mitigating Biases in a Cohort Study: A Critical Examination of the Silicone Arthroplasty in Rheumatoid Arthritis Study.

Research bias, or the systematic errors of a study, can arise before, during, or after a trial ends. These biases hinder the internal validity of the study, which is the accuracy of a study's conclusions regarding the effects of an intervention on a given group of subjects. With the growing use of evidence-based medicine, there is a demand for high-quality evidence from the research community. Systematic reviews and meta-analyses of randomized controlled trials are considered the highest level of evidence, followed by individual randomized controlled trials. However, most surgical trials cannot be conducted as randomized controlled trials because of factors such as patient preferences and lack of equipoise among surgeons. Therefore, surgical trials may lack features that are held as important standards for high-quality evidence, such as randomization and blinding. To demonstrate the biases that surgical trials may encounter, the authors examined a prospective cohort study, the Silicone Arthroplasty in Rheumatoid Arthritis study. The authors focus on the challenges that arise during a surgical trial, including the design, implementation, and methods used to report the clinical evidence. By recognizing and addressing obstacles that exist in research, investigators will provide health care providers with high-quality evidence needed to make well-informed, evidence-based clinical decisions.