This is the sixth paper in the evidence-based medicine glossary series. In this paper, We mainly introduced the concept of research synthesis, systematic review and meta-analysis and review developing process of these glossary.
Objectives To analyze the effect of improved oven for defluorination in coal-burning endemic fluorosis areas in China, and to provide evidence for the prevention and control of fluorosis. Methods Electronic databases including CNKI, CBM, VIP and CDMD-D (1989 to 2005), were searched. We also checked the reference lists of relevant articles. We selected relevant articles according to the predefined inclusion and exclusion criteria. The methodological quality was assessed . Data on room heat preservation and the effect of improved oven for defluorination were collected in the surveillance spots of Three Gorges Reservoir. Correlation analyses were conducted between the improved oven and its effect parameters. Results Twelve articles of low quality met the selection criteria, of which 9 were graded C and 3 were graded D in terms of the methodological quality. A negative correlation was found between the decreasing rate of normal oven use and the decreasing rate of dental fluorosis as well as of urine fluorine (Pearson correlation coefficient r = – 0.87, – 0.63, Plt;0.01, lt;0.05, respectively). Analysis also revealed a positive correlation between room heat preservation and the decreasing rate of dental fluorosis as well as of normal oven use (the two Spearman correlation coefficients and P values were the same: r = –1.00, Plt;0.01). Conclusion High-quality studies on the effect of improved oven for defluorination in China are not available. Based on the current evidence, the improved oven for defluorination and the correct use, maintenance and house rebuilding for heat preservation may help to prevent fluorosis.
Based on the site visit on the current application and practice of evidence-based medicine in USA, we find the difference between China and USA so as to further promote and plan the development of evidence-based medicine in China.
Objective To investigate the effect of training courses of evidence-based medicine (EBM) on the knowledge, skill, attitude and behavior of medical postgraduates and to explore the barriers to evidence-based practice (EBP), so as to provide knowledge to improve further EBM teaching and EBP. Methods A total of 110 medical postgraduates of Sichuan University who selected EBM courses in the autumn semester of 2004 were given questionnaires that combined both open and closed questions. The KAB (knowledge, attitude and behavior) of EBM and barriers to EBP were compared before and after the training courses. Results Differences were observed in KAB of EBM and barriers to EBP after the training courses, compared to the assessments done before the courses. In “Knowledge”: there was a significant increase in the understanding of specific terms in EBM after the training courses (75% of the items showed a statistically significant improvement). This was especially marked for “absolute risk”, “systematic review”, “meta-analysis” and “publication bias” (Plt;0.01). We also found an improvement in familiarity with medical search engines (Plt;0.05). In “Attitude”: the mean scores for most items (55%) were relatively high both before and after the training courses (gt;4), and a significant improvement was observed in 2 items. These were “Strong evidence is lacking to support most of the interventions I use with my patients” and “EBP needs to take into account patient preferences” (Plt;0.01). The mean scores of 2 items were relatively low both before and after the training courses (lt;3). These were “the adoption of EBP places an reasonable demand on physical therapists” and “EBP does not take into account the limitations of my clinical setting”. Another 2 items had mean scores close to 5: “I need to increase the use of evidence in my daily practice” and “I am interested in learning or improving the skills necessary to incorporate EBP into my practice”. In terms of “Behavior”: the medical postgraduates continued not to think highly of the use of literature after the training courses. About 60% of the postgraduates did not read any literature related to their specialties at all. Although searching of MEDLINE and other electronic databases was relatively frequent (gt;6 times/month: 60.3% before training and 65.7% after training), using professional literature and research findings in the process of clinical decision-making was not equal (gt;6 times/month: 29% before training and 35.1% after training). No significant difference was observed in applying clinical practice guidelines before and after the training courses. As for “Barriers”: the postgraduates considered “poor ability to critically appraise literature” as the most important barrier both before and after the training courses. The second and third most important barriers were different compared to after the training courses. The barrier of “lack of research skills” was larger than that of “lack of information resources” before the training courses, but after that the course, the order of these was reversed. Conclusion The knowledge of medical postgraduates increased significantly after the current training courses of EBM. Some improvement was also found in attitude and behavior. The top three barriers to EBP were “Poor ability to critically appraise literature”, “Lack of information resources”, and “Lack of research skills”
Objective To assess the effectiveness of evidence-based medicine for improving core competencies of undergraduate medical students. Methods MEDLINE, ERIC, Academic Source Premier, Campbell Library databases and three Chinese Databases (CBM, CNKI, VIP) were searched from January 1992 to May 2009.We also used Google to searching related literature. The design is a systematic review of randomized, non-randomized, and before-after studies. Two reviewers did study selection, quality assessment, and data abstraction independently. Different opinions were resolved by consensus. We used an adaptation of the quality measure from Gemma Flores-Mateo et al to assess the quality of selected studies. And descriptive analysis was conducted. Results A total of 17 studies met the selection criteria, 2 of them were of high quality, the others were of moderate quality. Studies involved Competencies of Scientific Foundation of Medicine, Clinical Skills, and Management of Information. Conclusion Competencies of Scientific Foundation of Medicine, Clinical Skills, and Management of Information are improved by evidence-based medicine teaching. No study on professional values, attitudes, behavior and ethics, population health and health systems, management of information, critical thinking and research is available. It is impossible to assess the four domains above.
Objective To evaluate the effect of teaching evidence-based medicine (EBM) in postgraduates. Methods One hundred and thirteen postgraduates in the second year grade selecting an EBM course were included. The course lasted four weeks (twice a week, 3 hours each time and total 21 hours). The courses were delivered in combination with cases. The teaching effect was evaluated by requesting the students to present an evidence-based case report on the five steps of evidence-based practice. Each teacher assessed the reports independently. Results The mean score of 107 EBM case reports was 51.35±11.38. Distribution of the mean score was nearly normal. Score distribution of the items: the full mark rate was 97% for case depiction and 62% for evidence searching. Stratified analysis: ① Formulating answerable clinical questions: the full mark rate was 88% for clear statement of patient type, 89% for clear statement of intervention, 35% for control and 36% for outcome statement, respectively. ② Searching evidence: the full marks rate was 95% for selecting relevant database, 90% for searching term, 68% for searching strategy and 79% for searching result depiction, respectively. ③ Critical appraisal of evidence: the full mark rate of critical appraisal of the clinical importance and validity of evidence was very low (35% and 7%respectively). ④ Evidence applying: the full mark rate of intervention’s benefit and risk for individual patient and patient’s value was higher than that of applying evidence to patients and intervention feasibility (24% and 21%, 16% and 12%). ⑤ Evaluation: the full mark rate of clinical result evaluation was higher than that of performance of evidence-based practice (55% and 17%). Conclusions Teaching EBM for postgraduates was successful, we need to strengthen the practice of critical appraisal and applying evidence for patients in the future EBM course.
Different from modern medicine, traditional Chinese medicine (TCM) has its unique thought patterns and decision methods. In the process of developing TCM clinical practice guidelines, not only the modern clinical researches should be included, but also the TCM ancient books which had influenced TCM for thousands of years should be included. As an important carrier of TCM, the characteristics of researches in TCM ancient books are different from modern clinical researches. In this paper, we introduced the present situation of the TCM guidelines and how to use TCM ancient books for developing TCM clinical guideline with the guidance of evidence-based method. We used the example of developing of headache TCM guideline to explain how to use TCM ancient books as evidence source for guideline development and explored the application of evidence-based research of TCM ancient books to promote TCM clinical guidelines development.
We introduced the current doctor-patient relationship and analyzed its opposition and unification based on present medical practice. We suggested that evidence-based medicine should be an important in improving doctor-patient relationship in clinical practice. We urged health care professionals to learn and apply initiatively evidence-based medicine, so as to improve the patient-professional relationship.