Objective To investigate the use of evidence-based medicine (EBM) and barriers to applying EBM in clinical practice in medical postgraduates. Methods Three hundred and sixty-five first and second-year medical postgraduates selecting the EBM courses were included. All the students were surveyed by questionnaires. Result The response rate to the survey was 100%. About half of the students read 1~5 professional articles per month before postgraduate study. Fifty-six percent of the students used professional literature and research findings when making clinical decisions. Fifty-seven point three percent used electronic databases to search for practice-relevant literature before postgraduate study. Sixty-one point four percent found it difficult to obtain relevant clinical guidelines and 68.5% never applied relevant clinical guidelines in clinical decision-making. The barriers to using EBM in clinical practice included difficulties in searching and accessing full text of potentially relevant articles, lack of EBM knowledge, influences from clinical experience and authorities, uncertainties about the quality of evidence and time-consuming. Conclusion EBM clinical practice and EBM medical education has transformed from dissemination and popularization stage to skill acquisition stage.
With clinical medicine science transforming from traditional medicine to evidence-based medicine, how to practice evidence-based medicine has become a new challenge to clinical doctors. Therapy studies play an important part in clinical studies and how to practice evidence-based medicine in the therapy of diseases is an important question that doctors are concerned. This paper will introduce as on how to practice evidence-based medicine in the therapy of diseases.
Objective To evaluate the effectiveness of teaching evidence-based medicine (EBM). Methods 1. Introducing EBM teaching material in Chinese. 2. Offering EBM course in medical college of Sichuan University. 3. Problem-based,self-directed teaching methods. 4. A variety of test method. Results 36 Cochrane systematic review titles were registered, 17 Cochrane systematic review protocols were published in Cochrane Library, 6 Cochrane systematic reviews were published in Cochrane Library. 62 EBM research papers were published on Chinese Journal of EBM. Feedback of teaching EBM from postgraduates: 77.6%, 22.4% postgraduates consider this EBM course is very helpful and helpful for them respectively; 14.3%, 80% postgraduates achieve completely the goal and achieve the goal in greater part by this EBM course respectively; the reason of not achieving the goal is a lack of time to read and attend the course. 61.2%-80% and 16.3%-32.7% postgraduates consider the teaching contents is very good and good respectively; 61.2%-75.5% and 12.3%-28.6% postgraduates consider this teaching model is very good and good respectively; 44.9% postgraduates hope to increase hours of EBM course, increase discusses, increase EBM practice in future; 10.2% postgraduates consider the questions of test are hard to solve. Conclusion This EBM course is effective.
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.
Objective To explore the method of teach evidence-based medicine (EBM) for medical postgraduates through by analyzing EBM examination paper in 2003 and 2004.Methods Participants: Two hundred and twenty one second year medical postgraduates who selected EBM course in 2003 and 2004 were included. Examination: Two parts were included in 2003: A test of EBM knowledge with open book in class (80 points) and an evidence-based case report on five steps of evidence-based practice (15 points). In 2004, the students were required to present an evidence-based case report on five steps of evidence-based practice (80 points). Evaluation: Based on the principle of EBM and five steps of evidence-based practice, we worked out an unified criteria and independently evaluated all examination papers. All scores were converted into the hundred percentage point system. Results The distribution of the mean score in 2003 was nearly normal and in 2004 was skewed. The mean score (standard deviation) was 75.5 (6.5) points in 2003 and 69.8(11.8) points in 2004. The passing grade rate was 97.4% in 2003 and 95.3% in 2004. The comparison between basic knowledge of EBM and skills of EBM in 2003: The mean score (standard deviation) was 62 (6.4) in basic knowledge of EBM and 55.1(16.7) in skills of EBM. Feedback from students: About 80% students thought EBM course was very helpful; about 95% students mostly achieved their expected goals.Conclusions We should teach and lead students to the method of self-directed learning and help them develop skills to use EBM in clinical practice.
Objective To find the best teaching method of summer EBM course to help students understand and apply EBM principles in research. Methods Training medical students to participate in an international team of clinical research for best evidence. We used a step-by-step method to teach how to write Cochrane systematic review and apply its method to other researches. Results Since our training program was launched three years ago, 38 medical students have taken part in the training. Five Cochrane systematic reviews and 19 protocols were published in The Cochrane L ibrary. Three medical students were the principal investigators and played an important role in another 2 studies. Seven articles were published in Chinese medical key journals, and 1 was indexed by SCI. Eleven students were funded to participate in the international academic conferences.Conclusions Medical students will benefit from taking part in the EBM research. This activity will help them not only understand method of clinical research and EBM , improve the quality of research and their cooperative skills but also master related clinical knowledge.
Lung four dimensional computed tomography (4D-CT) can lead to accurate radiotherapy. However, for the safety of patients, the scan spacing of 4D-CT cannot be too small so that the inter-slice resolution of lung 4D-CT is low, and thus the coronal and sagittal images need to be interpolated to obtain high-resolution images. This paper presents a super-resolution reconstruction technique based on multi-model Gaussian process regression. We use the high-resolution transversal images and the corresponding low-resolution images as the training sets. The high-resolution pixels of the coronal and sagittal images can be predicted by constructing multiple Gaussian process regression models. The experimental results show that our method is superior to bicubic algorithm, projections onto convex sets, sparse coding, multi-phase similarity based method and Gaussian process regression method based on self-learning block in terms of the edge and detail recovery. The results demonstrate that the proposed method can effectively improve the quality of lung 4D-CT images, and potentially be applied to better image-guided radiation therapy of lung cancer.
Evidence-based education (EBE) is the integration of professional wisdom and the best available experimental evidence to make educational guiding decisions. EBE aims to improve the scientificity and effectiveness of educational policies, decisions and practices through the combination of evidence-based research and personal professional experience, so as to improve the quality of education and teaching. This paper focuses on the definition, connotation, characteristics, implementation principles and the background of EBE.
ObjectiveTo evaluate the predictive value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with multislice computed tomography (MSCT) in the evaluation of neoadjuvant chemotherapy (NACT) for breast cancer. MethodsThe clinical, imaging, and pathological data of breast cancer patients who received NACT in the Affiliated Hospital of Southwest Medical University from February 2019 to August 2021 were retrospectively collected. Based on the results of postoperative pathological examination, the patients were assigned into significant remission (Miller-Payne grade Ⅰ–Ⅲ) and non-significant remission (Miller-Payne grade Ⅳ–Ⅴ). The variables with statistical significance by univariate analysis or factors with clinical significance judged based on professional knowledge were included to conduct the logistic regression multivariate analysis to screen the risk factors affecting the degree of pathological remission after NACT. Then, the screened risk factors were used to establish a prediction model for the degree of pathological remission of breast cancer after NACT, and the efficacy of this model was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) curve. ResultsAccording to the inclusion and exclusion criteria, a total of 211 breast cancer patients who received NACT were collected, including 116 patients with significant remission and 95 patients with non-significant remission. Logistic regression multivariate analysis results showed that the human epidermal growth factor receptor 2 positive, lower early enhancement rate after NACT, lower arterial stage net increment after NACT, and lower CT value of arterial phase of lesions would increase the probability of significant remission in patients with breast cancer after NACT (P<0.05). The area under the ROC curve of the model for predicting the degree of pathological remission of breast cancer after NACT was 0.984, the specificity was 93.7%, and the sensitivity was 95.7%. The calibration curve showed that the model result fit well with the actual result, and the DCA result showed that it had a high clinical net benefit value. ConclusionFrom the results of this study, DCE-MRI combined with MSCT enhanced scanning has a good predictive value for pathological remission degree after NACT for breast cancer, which can provide clinical guidance for further treatment.