To help better understanding on evidence-based medicine, five frequently asked questions relevant to evidence-based clinical practice were commented on. The questions included: 1. Dose evidence-based medicine only emphasize evidence and ignore clinical experiences? 2. Dose evidence only include randomized controlled trials and systematic reviews? 3. How to face the quality of evidence? 4. Is randomized evidence suitable for treating individual patient? 5. Is evidence-based medicine useless since there is no adequate evidence for many clinical questions?
Gordon Henry Guyatt(1953-)is a professor of Department of Clinical Epidemiology amp; Biostatistics and Department of Medicine in McMaster University. He has engaged in evidence-based clinical research and practice for about 20 years. In 1992, he first proposed the term “evidence-based medicine” in one of his articles published in JAMA. He is dedicated to bringing the wonderful idea of evidence-based medicine to bedside and systematically training clinicians from all over the world to acquire the basic skills for evidence-based clinical practice. His great contribution to evidence-based medicine is introduced in this article through demonstrating the development of evidence-based clinical practice.
The number of clinical practice guidelines for traditional Chinese patent medicine has been increasing recently. However, the quality of guidelines was still low compared to international guidelines. Considering the characteristics of traditional Chinese patent medicine, we suggested the following items should be taken into account when developing traditional Chinese patent medicine guidelines: ensuring the standardized guidelines of traditional Chinese patent medicine research problem is scientific based on reliable evidence; identifying the common questions according to these research problems; understanding the strength of evidence and how to recommend correctly; inviting some experts in other fields to take part in the development of guidelines; paying more attention on the changes of disease burden and the impact of new methods and technologies when developing the guideline; paying more attention to the non-consensus opinions and evidence supporting these opinions; insisting on quality is the priority, while speed is secondary.
This article introduces development methods and notices about evidence-based clinical practice guidelines of ventilator-associated pneumonia (VAP) and discuss the similarities and differences between GRADE system and the methodological studies of other clinical guidelines, focusing on the analysis of literature retrieval, quality of evidence, formation of recommendation strength, and detailed measures on how to ensure correct understanding and rationally using the GRADE system. Applying the GRADE system to develop evidence-based clinical practice guidelines of VAP could clearly present the quality of evidence and make recommendations.
Based on peer-reviewed systematic reviews and randomized controlled trials published between January 2000 and June 2019 with regards to the management of glenohumeral joint osteoarthritis (GJO), the American Academy of Orthopaedic Surgeons (AAOS) established the clinical practice guidelines for the treatment of GJO. The guidelines provided practice recommendations including risk factors, non-surgical treatment, surgical treatment, prosthesis selection, and perioperative management for GJO. The recommendations were graded according to different evidence strength. This paper interprets the guidline in order to provide reference for domestic medical workers.
Objective By means of evidence-based clinical practice, to find more effective treatment for a hepatitis B related nephritis patient with renal failure. Methods The following databases as Up to Date (May 2011), The Cochrane Library (Issue 5, 2011), PubMed (1978 to 2011) and CNKI (1978 to 2011) were searched to identify systematic reviews and randomized controlled trials (RCTs) of treating hepatitis B related nephritis with glucocorticoid, immunosuppressor or antiviral therapies, and the quality of collected clinical evidence was evaluated by using GRADEpro software. Results The glucocorticoid or combined immunosuppressors was not recommended for existing adverse effects and not acting on the remission of hepatitis B related nephritis and reduction of proteinuria. However, the antiviral therapy used alone was recommended for acting on the remission of hepatitis B related nephritis and the reduction of proteinuria. In view of adverse effects and expensive price of interferon, the nucleoside analogue antiviral agent was suggested. Considering the renal toxicity of adefovir and tenofovir, and possible drug-resistance of lamivudine, the entecavir (0.5 mg qd) was finally selected with patient’s agreement, and the supporting therapies such as lowering blood pressure, and protecting the kidney and liver were adopted continually. After one month treatment, 24-hour urinary protein got reduced, serum albumin got increased, kidney function got stable, and hepatitis B virus DNA quantity got reduced. Conclusion For treating hepatitis B related nephritis with kidney failure, entacavir can reduce 24-hour urinary protein, raise serum albumin, stabilize kidney function and reduce hepatitis B virus DNA in a short term, but its long-term efficacy still requires further studies.
Clinical practice guidelines need to be based on evidence, but traditional Chinese medicine, especially integration of traditional Chinese and Western medicine guidelines, inevitably need to combine clinical research evidence, ancient literature, and expert experience and consensus. In the process of formulating, there are deviations in understanding and application of the expert consensus method and expert experience, resulting in opaque of the recommendations, unclear of the details of the diagnosis and treatment strategy, less prominent of the advantages and value of traditional Chinese medicine, which affects the scientificity, transparency, applicability, promotion and application of the guidelines of traditional Chinese medicine or integration of traditional Chinese and Western medicine. This study discusses the guiding principle of "evidence as a core, consensus as a supplement, and experience as a reference" that was generally followed and puts forward detailed methodological suggestions to the formulation of guidelines for traditional Chinese medicine and integration of traditional Chinese and Western medicine.
Objective Through studying a diabetic patient accompanied with pancreatic cancer by means of evidence-based clinical practice, to find out the relationship between diabetes mellitus and cancer and whether the long-acting insulin glargine increases the risk of cancer or not, which is regarded as a disputable hot issue at present. Methods Such databases as The Cochrane Library (Issue 3, 2010), OVID-EBM Reviews (1991 to Sept. 2010), MEDLINE (1950 to Sept. 2010) and CNKI (2000 to Sept. 2010) were retrieved to collect high quality clinical evidence, and the best therapy was formulated in accordance with the willingness of patients themselves. Results Eight randomized controlled trials (RCTs), four meta-analyses and one RCT meta-analysis were included. The evidence indicated that: a) Diabetes mellitus was kind of related to the occurrence of malignancies; b) There was no evidence at present showing the relationship between long-acting insulin glargine and cancer; c) Strictly controlling of blood sugar did not increase the risk of tumorigenesis, but hyperglycemia causing cancer was proofless; and d) Whether the diabetic patient with cancer should stop taking long-acting insulin glargine or not should require suggestions from specialists rather than patients themselves. Conclusion No evidence at present shows that tumorigenesis is related to diabetes mellitus, long-acting insulin glargine and strict controlling of blood sugar. It is necessary to require more evidence to decide whether the therapy should be adjusted or not for the diabetic patient with cancer who is in the process of glargine therapy.
Precision medicine is a medical paradigm founded on individual genetic information amalgamated with extensive clinical data to offer patients precise diagnoses and treatments. Genetic testing forms the cornerstone of accurate diagnosis, and skilled professionals in fields like clinical medicine, molecular biology, and bioinformatics play a crucial role in realizing the potential of precision medicine. This paper presents reference suggestions for the continuing education approach for relevant technical personnel. The main emphasis is on conducting routine face-to-face and hands-on training to enhance theoretical knowledge and professional skills. Secondly, there is a need to modify the training approach by reinforcing molecular biology, bioinformatics, and other courses, enhancing assessment methods, gradually implementing specialized training in precision medicine subspecialties, and ensuring effective clinical practice and management of precision medicine.
Mechanoresponsive microRNAs are a type of miRNAs which are sensitive or responsive to mechanical strain applied to them, their expression levels were changed after mechanical loading, thus affecting the expression levels of mRNA and proteins they regulated. Up to now, some mechanoresponsive miRNAs have been discovered in physiological or pathological tissues or organs. However, these discoveries are usually limited, and they are not able to guide clinical practice well. According to this situation, this paper summarizes research findings of mechanoresponsive miRNAs, and provides directions for clinical practice and further researches.