Evidence-based dentistry has been established for more than a decade, and described as ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients＇. However, Orthodontic clinicians in China still tend to base their treatment protocols on the ‘it works in my hands＇evidence provided by their peers, mainly due to their weak experience in searching and applying clinical evidences. In this article, authors are willing to share their experience with their Chinese peers, and to promote the dissemination and application of evidence-based orthodontics in clinical practice.
Perineal care is a classic topic for obstetrics. After thousands of years of practice, we have accumulated some experience and meanwhile, we are also taking some attempts. The effectiveness and reliability of these methods need evaluation. Nowadays, the best evidence comes from randomized controlled trials (RCT) and systematic reviews (SR). We searched The Cochrane Library (Issue 3, 2007), MEDLINE (Jan. 1980 to May 2007) databases and CBM-disc (Jan. 1980 to May 2007) to obtain current best evidence for perineal care.
Objective To retrieve and summarize the best evidence for fall prevention after total hip arthroplasty in elderly patients. Methods BMJ Best Practice, UpToDate, JBI evidence-based healthcare center database, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, Cochrane Library, PubMed, Web of Science, EBSCO, International Collaboration of Orthopaedic Nurisng website, American Academy of Orthopaedic Surgeons website, European Society for Trauma and Emergency Surgery website, Medlive, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were systematically searched. The retrieval time was from the establishment of the databases to June 30, 2024. The quality of literature was evaluated, and evidence was extracted, evaluated, and summarized. Results A total of 12 articles were included, including 4 guidelines, 2 randomized controlled trials, 2 cohort studies, and 4 expert consensus studies. A total of 18 pieces of evidence were extracted, including 13 A-level recommendations and 5 B-level recommendations. The evidence covers six major themes of risk factors, assessment, multidisciplinary team support, health education, medication management, safety environment, and assistive devices. Conclusions The fall prevention after total hip arthroplasty in elderly patients involves multiple factors, and the fall prevention should be based on multidisciplinary team cooperation, achieving linkage between the hospital and the family to jointly ensure patient safety. In the future, it is recommended to combine individual patient differences with actual clinical scenarios when applying evidence.
Network meta-analysis (NMA) is a statistical technique that integrates data from multiple clinical studies and compares the efficacy and safety of multiple interventions, which can provide pro and con ranking results for all intervention options in the evidence network and provide direct evidence support for clinical decision-making. At present, NMA is usually based on the aggregation of the same type of data set, and there are still methodological and software difficulties in achieving cross-study design and cross-data format data set merging. The crossnma package of R programming language is based on Bayesian framework and Markov chain Monte Carlo algorithm, extending the three-level hierarchical model to the standard NMA data model to achieve differential merging of varied data types. The crossnma package fully considers the impact of risk bias caused by the combination of different types of data on the results by introducing model variables. In addition, the package provides functions such as result output and easy graphing, which makes it possible to combine NMA across study designs and evidence across data formats. In this study, the model based on crossnma package method and software operation will be demonstrated and explained through the examples of four individual participant datasets and two aggregate datasets.
Objective To give an individualized treatment to a young woman with primary dysmenorrhea. Methods According to the basic principle and methods of evidence-base medicine, we searched The Cochrane Library (Issue 1, 2009), MEDLINE (PubMed, January 1950 to May 2009), ACP Journal Club (OVID, January 1991 to May 2007) for systematic reviews and randomized controlled trials (RCTs) to acquire the best clinical evidence on the treatment of primary dysmenorrhea. Results A total of 11 systematic reviews and 1 RCT were identified. A reasonable treatment plan was made through combining the patient’s will with her family members’. Conclusion The treatment effect on primary dysmenorrhea of the young woman is improved by an individualized treatment plan based on an evidence-based method.
To explain how to treat common gastric diseases like chronic gastritis, peptic ulcer, functional dyspepsia and gastric oesophageal reflux disease (GORD) based on evidence-based medicine. Through this paper, we try to help readers find and use clinical evidence to solve clinical problems.
Objectives About 12.9-50% patients of SARS (Severe Acute Respiratory Syndrome), require brief mechanical ventilation (MV) to save life. All the reported principles and guidelines for therapy SARS were based on experiences from clinical treatments and facts of inadequacy. Neither prospective randomized controlled trials (RCT) nor other high quality evidences were in dealing with SARS. Our objective is to seek safe and rational non-drugs interventions for patients with severe SARS by retrospectively reviewing clinical studies about MV all over the world, which include clinical guidelines, systematic reviews (SR), Meta-analysis, economic researches and adverse events. Methods To search MEDLINE and Cochrane Library with computer. According to the standards of inclucion or exclusion, the quality of the article which as assessed, and relevant data which were extracted double checked. The Meta-analysis was conducted if the studies had no heterogeneity. Results 14 papers were eligible. Due to the significant heterogeneity between these studies, further Meta-analysis could not be conducted, and the authors’ conclusions were described only. Conclusions The outcome of PPV is better than that of VPV. Patients who underwent PPV had a significantly lower mortality than that of VPV. Of course, the volutrauma should be watched. With low tidal volume and proper PEEP, or decreased FiO2, even permissive hypercapnia, the mortality and length of stay were cut down. Non-invasive mechanical ventilation (NIMV) was effective in treating haemodynamical stable patients, minimizing complications and reducing medical staff infection. Patients with serious dyspnea with PaO2/FiO2lt;200, no profit of NIMV, or couldn’t tolerance hypoxaemia were unlikely to benefit from this technique and needed ventilation with endotracheal intubation. Prone position could improve PaO2/FiO2, NO maybe increased pulmonary perfusion, improved V/Q, and raised oxygenation. Furthermore, Inhaled NO sequentially (SQA) was better than Inhaled NO continuouly (CTA). Some studies implied that practice of protocol-directed weaning from mechanical ventilation implemented by nurses excelled that of traditional physician-directed weaning.
Having searched The Cochrane Library (Issue 4, 2005), we found: fluoride can reduce the occurrence and severity of white spot lesions; removal of premature contacts of the primary teeth can prevent posterior crossbite; expanding the top teeth can decrease the risk of a posterior crossbite; CSF may help retaining teeth; clear overlay retainer may settle teeth quicker than Hawley retainer; adhesives for fixed orthodontic brackets is still in dispute.
Objective To summarize the optimal evidence for improving the management of chronic wounds exudate, so as to provide evidence-based references for medical professionals, therapists, patients, and their caregivers. Methods PubMed, Wanfang, CNKI, Medlive, UpToDate, etc., were searched by computer for literature about chronic trauma exudate management. The retrieval time limit was from 1998 to 2023. Two researchers trained in evidence-based practice evaluated the quality of the included literature and finally extracted evidence from the literature that met the quality evaluation criteria. Results A total of 11 articles were included, including 2 expert consensuses, 7 systematic reviews, 1 randomized controlled trial, and 1 guideline, covering 7 aspects of the assessment of the nature of chronic wounds exudate, selection of exudate assessment tools, management of antimicrobial concerns, selection and application of wound dressings, negative pressure wound drainage therapy, wound drainage bags, and affected limb elevation or compression therapy for patients with venous leg ulcers. A total of 13 best evidences were extracted. Conclusions When applying evidence, medical professionals should fully evaluate and combine the individual circumstances of the patient, make full use of existing resources, new treatment concepts and technologies, and carry out comprehensive integrated management. This can optimize the management of chronic wounds exudate and improve the quality of life of patients.
Objective To investigate the current status of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) on pressure sore in China. Methods We searched Chinese Journal of Nursing, Chinese Journal of Practical Nursing and Journal of Nurses Training in CNKI and VIP (January 2000 to December 2005) for Chinese articles on pressure sore, using "pressure sore", "bed sore", "nursing", "treatment", "prevention", "evaluation" and "management" as search terms. The retrieved articles were summarized. Results We identified 16 reports (10 RCTs and 6 CCTs). The studies were judged to be of low quality.There was one study on the evaluation, two on the prevention, and 13 on the treatment of pressure sores. Conclusion The current studies on pressure sore in China are focusing on treatment. Randomized controlled trials of large sample size of pressure sore are needed to improve nursing quality.