Objective To investigate the decision-making situation of doctors in the township hospitals in Gaolan, Gansu province, and to discuss its scientificity and rationality. Methods Self-designed questionnaire was adopted to investigate the clinical decision-making situation of 108 doctors from 7 township hospitals in Gaolan county. The investigation contained three parts as follows: basic information of respondents, general information of clinical decision-making evidence, and comparison between respondents’ decision-making situation and current best clinical evidence. Results Among the total 108 questionnaires distributed, 89 valid were retrieved. The feedback showed that 79% of the doctors diagnosed and treated patients in accordance with medical textbooks; 53% took curative effect into consideration in the first place; 33% failed to consider patients’ willingness properly when making clinical decisions; and 52% made clinical therapy regimen for common diseases based on the evidence which was different from that in BMJ published Clinical Evidence. Conclusion While making clinical decisions, doctors in the township hospitals do not adequately refer to the best clinical evidence as their decision-making basis, and fail to take patients’ value and willingness into consideration properly. It is necessary to promote the concept of evidence-based medicine and spread the best evidence in the township health departments.
Objective To apply the method of evidence-based medicine to identify the best therapy option for an emergency patient with upper gastrointestinal hemorrhage. Methods According to time and logical sequence of clinical events, a complete decision tree was built after the following steps to find the best treatment: clear decision-making, drawing decision tree graphics, listing the outcome probability, giving appropriate values to the final outcome, calculating and determining the best strategies. Results The performance of endoscopic therapy for the patient with upper gastrointestinal hemorrhage within the first six hours had little effect on the prognosis. Interventional therapy after the failure of endoscopic therapy had less mortality than direct surgical exploration. Conclusion Making clinical decision analyses via drawing the decision tree can help doctors clarify their ideas, get comprehensive views of clinical problems, and ultimately choose the best treatment strategy for patients.
Objective To investigate evidence retrieval, appraisal, and reevaluation during evidence-based clinical decision making in China. Also, to analyze the related factors, so as to find the problems in the course of evidence-based clinical decision making and put forward corresponding solutions. Methods We searched Chinese Biomedical Literature Disc (CBM) and China Journal Full-text Database (Medical sciences) of the China National Knowledge Infrastructure (CNKI) to collect clinical evidence-based case reports. Relevant information was extracted from these reports by a selfdesigned investigation form.Then statistical analyses were performed. Results The search tools used in the course of evidence-based clinical decision making varied. The most frequently used were MEDLINE/PubMed (82.08%) and The Cochrane Library (60.38%). 30.63% of evidence-based case reports described the search strategy in detail, and 9.01% described how they modified their search strategy. All doctors evaluated the association between evidence and disease, but few of them integrated patient factors and relevant external factors when evaluating evidence. The scientific nature and validity of the evidence was evaluated in 74 evidence-based case reports (66.67%), and such evaluation was mainly based on the criteria of evidence grading (50.00%). Reevaluation was mentioned in 85.59% of evidence-based case reports. Conclusion In China, the application of evidence-based decision making varied in different clinical departments. Problems existed in the course of evidence retrieval, appraisal, and reevaluation. This revealed the low information diathesis level of doctors and their lack of evidence-based medicine knowledge. It is suggested that information education and evidence-based medicine education should be strengthened to improve doctors’ ability to use evidence-based clinical decision making. It is also recommended that the search tools, relevant search strategy, the modification of search strategy, and reevaluation on practice results of each case should be mentioned in evidence-based case reports.
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.
1背景早在1987年英国爱丁堡皇家医院就开始着手研究快速的治疗流程分类系统给心肌梗塞的患者所带来的时间经济效益，就此对快速流程的研究正式拉开了序幕。到了20世纪90年代初，欧洲部分医院的急诊科首先从科室角度开始迅速推广快速流程； 同时涉及麻醉方面的流程效率改革和创新逐步兴起。20世纪90年代末麻醉专业从门诊麻醉模式、手术及麻醉前干预上，开始逐步提升快速流程的综合管理能力。正是在20世纪90年代末，快速流程的理念被正式提出，在当时它还有一个名称叫做多模式康复流程。这种理念随之在欧美国家流行起来，大量的临床实践不断在进行。1994年，美国Engelman等就提出了冠状动脉旁路“fast-track recovery”的概念，并建立了一套相应的快速康复程序，通过实践发现其的确能够加快患者的术后康复、缩短住院时间。至此快速流程作为一项高效的临床运作模式被正式纳入临床具体病种的应用中。从2001年至今，心脏外科及结直肠外科的快速流程已趋于成熟，并已成功地渗透到外科领域的多个环节……
３ 整体流程图……