With vigorous development of the Evidence-Based Practice (EBP), systematic review as a reliable basis for decision making is becoming more and more important, especially in emergent and significant situation under the influence of various interferences. But there are many misunderstandings and fallacies in systematic review beyond medical field, which block the spread and application of systematic review in health system decisions. This paper takes the evidences of health intervention practice as examples, explores the functions of systematic review in health system decisions, tries to clarify these misunderstandings and fallacies, and so as to promote the development of systematic review.
This paper is to reveal how the traditional practice is being challenged by evidence-based medicine and it also indicates where does the best evidence come from, how to find and classify them. This paper will also show the clinicians how to practice evidence-based medicine, especially in the treatment of respiratory disease in a step by step fashion. Finally this paper will guide the Chinese physicians how to solve the commonly confronting problems in practicing evidence-based medicine.
Researches in evidence-based medicine have provided important evidence for family planning doctors to guide their clinical practice. With examples of clinical researches, the practical methods of evidence-based medicine in family planning service are discussed in this paper.
Evidence-based orthodontics has developed rapidly in recent years, but the lack of a good quality, clinical evidence base is a problem for orthodontic practice. All orthodontists should keep the concept of evidence-based medicine in mind during patient-oriented practice. This would help us to improve our practice and to make the best clinical decisions.
Evidence-based psychotherapy is an idea and performance reform in the clinical practice of psychology which is influenced by evidence-based medicine. It proposes to integrate the best available evidence provided by researchers, the clinical expertise of practitioners, and the patient’s characteristics, cultures and preferences, so as to achieve the best treatment. The development of evidence-based psychotherapy can be divided into two stages: empirically supported treatments and evidence-based practice. This paper reviews existing problems as well as developing tendencies.
We searched randomized controlled trials, meta-analysis and systematic reviews from OVID-EBM Reviews which included ACP Journal Club, The Cochrane Library, and MEDLINE（1991 to 2005 ） to evaluate clinical effectiveness of pit and fissure sealants for caries. The resultsshowed that pit and fissure sealants were recommended to prevent caries of the occlusal surface. The effectiveness varied between the two types of sealants, in general, flowable resin composite had a more satisfactory retention than glass ionomer composite. Acid etch was helpful for less microleakage and more satisfactory retention. Mechanical air-abrasion with acid etch may have the best border seal, However, we were not sure of the effectiveness of Er：YAG laser, technique of dental drill preparation and splicing. More high quality clinical trials on pit and fissure sealants are still needed.
Objective To evaluate the published case-reports of evidence-based practice(EBP) over three years,and to improve the quality of the papers and provide a recommended writing model. Methods Collecting the published 20 case-report of EBP and assessing their writing quality in 5 aspects according to the steps of EBP. Results Many Abstracts did not reflect entire context, and convey the overall information to readers, a formative structured Abstract should be taken. Most case-reports only involved with therapy,few diagnostic,harm and prognostic case-reports were republished,few EBP of surgery and other specialties, such as ENT,ophthalmology were mentioned.Searching strategies were not sufficiently described.Most authors only search The Cochrane Library and PubMed,while predigested sources were seldom used.Critical appraisal of evidence was difficult to each author,most papers were lack of appraisal or simply evaluated the validity of used evidence,and applicability of evidence was not clearly explained.All the papers did not conduct post evaluation.Conclusions Much needs to be done in improving the quality of published case-reporters of EBP,a standardized writing model should be recommended.
The number of clinical guidelines developed and published in different countries is increasing worldwide. Too many guidelines do not remain in regular use, even though the aim is to implement them in clinical practice. The scientific validity and reliability of the guidelines need to be reviewed. Here is a case presented to show how to optimally use the evidence-based guideline to improve clinical decision making.