Informed-evidence decision-making (IEDM) has emerged as the predominant principle of providing guidance for policy-making and practice, however, the best available evidences requisite of performing successfully IEDM. Different forms of evidence and different kinds of review questions call for the development of new approaches that are designed to more effectively and rigorously identify and synthesize the evidence. Fourteen methods of reviewing literature have been recently used to identify and synthesize evidence, of which scoping reviews is increasing popular. This article introduces aspects such as background, purpose and methodological frame work and explains the process of it with an example so that facilitating the dissemination and utilization of scoping review in China.
ObjectiveTo investigate the influence of misplaced subclavian vein (SCV) catheter into the ipsilateral internal jugular vein (IJV) on transpulmonary thermodilution (TPTD) measurements and explore the possible mechanisms preliminarily.MethodsIn this prospective study, 408 patients in whom an SCV catheterization was indicated for TPTD monitoring were enrolled. A first set of TPTD measurements was collected at baseline in all patients (group 1, SCV catheters were correctly placed; group 2, SCV catheters were misplaced into the ipsilateral IJV). The parameters included mean transit time (MTt), downslope time (DSt), cardiac index (CI), global end-diastolic volume index (GEDVI) and extra-vascular lung water index (EVLWI). A second set of TPTD measurements was performed only in those with catheter misplacement immediately after the misplaced SCV catheters being corrected (Group 3). The differences in MTt, DSt, GEDVI and EVLWI between group 2 and 3 were recorded as ΔMTt, ΔDSt, ΔGEDVI and ΔEVLWI, respectively.ResultsGEDVI and EVLWI were significantly higher (all P<0.001) in group 2 than those in group 1, while CI was not significantly different (P>0.05) between these two groups. Multivariate logistic regression identified PaO2/FiO2 [adjusted odds ratio (OR) 1.492/10 mm Hg; 95% confidence interval (CI), 1.180 - 1.884; P<0.001], GEDVI (OR=1.307/10 mL/m2, 95% CI 1.131 - 1.511; P<0.001) and EVLWI (OR=3.05; 95%CI 1.593 - 5.840; P<0.001) as the 3 independent factors associated with the misplacement of SCV catheter into the ipsilateral IJV. In group 2, GEDVI [(1041±122)mL/m2 vs. (790±102)mL/m2, P<0.001], EVLWI [(20.3±4.0)mL/kg vs. (10.3±2.3)mL/kg, P<0.001], CI [(3.6±1.2)L·min–1·m–2 vs. (2.9±1.0)L·min–1·m–2, P<0.001], MTt [(38.2±13.3)s vs. (30.8±9.4)s, P<0.001] and DSt [(18.9±7.2)s vs. (13.2±4.9)s, P<0.001)] were significantly higher than those in Group 3. Multiple regression analysis demonstrated that ΔEVLWI (R2=0.86, P<0.001) was negatively correlated with ΔMTt (coefficient±SE, –0.52±0.12; P<0.001) and positively correlated with ΔDSt (coefficient±SE, 1.45±0.17; P<0.001).ConclusionsDuring TPTD measurements, indicator injection through an SCV catheter misplaced into the ipsilateral IJV results in an overestimation of CI, GEDVI and EVLWI. The increase in DSt might be a key factor in explaining the overestimation of EVLWI in patients with misplaced SCV catheters. Given that the accurate measurements of GEDVI and EVLWI are of utmost importance for guiding resuscitation and decision-making regarding fluids administration, immediate repositioning is required if a misplacement is suspected and confirmed by the chest X-ray.
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.
ObjectiveTo evaluate the effects of multi-disciplinary diagnosis and treatment model based on doctor-patient shared decision making on treatment outcomes, quality of life and postoperative complications of breast cancer patients. MethodsA total of 100 breast cancer patients were included in this study through a prospective randomized controlled design, and were randomly divided into control group and intervention group, with 50 patients in each group. The control group received traditional treatment mode, while the intervention group implemented a multidisciplinary treatment mode based on doctor-patient sharing decision making. The results of treatment, quality of life and postoperative complication rate were compared between the two groups. ResultsThe completion rate of adjuvant radiotherapy and chemotherapy in the intervention group was 94.0%, which was higher than that in the control group (80.0%), and the difference was statistically significant (P=0.037). The satisfaction rate of postoperative breast appearance in the intervention group was 90.0%, which was higher than that in the control group (60.0%), with statistical significance (P<0.001). There was no significant difference in grade Ⅲ/Ⅳ toxicity between the two groups (P>0.05). After treatment, the scores of patients’ quality of life in the intervention group were higher than those in the control group, and the difference was statistically significant (P<0.05). The incidence of postoperative complications in the intervention group was 6.0%, which was lower than that in the control group (22.0%), and the difference was statistically (P=0.021). ConclusionsThe application of multidisciplinary diagnosis and treatment model based on doctor-patient sharing decision-making in the treatment of breast cancer patients has significantly improved the treatment effect and quality of life, and effectively reduced the rate of postoperative complications. This model provides a new approach to the treatment of breast cancer that is more personalized, comprehensive and efficient.
The outline of the "Healthy China 2030" states that medical institutions should serve as the primary purchasing agents for medicines and medical consumables, and joints purchasing should be encouraged. Since its establishment, the National Healthcare Security Administration has conducted five batches of national centralized procurement of high-value medical consumables, forming a nationwide collaborative framework involving national, provincial (including inter-provincial alliances), and local municipalities (including local municipal alliances). This study explains the current development status of the centralized procurement of medical consumables in representative countries, and explores the role of research evidence, such as health technology assessment (HTA), in the centralized procurement of medical consumables in China. Looking ahead, various forms of research evidence, such as HTA, will contribute to the dynamic adjustment of the catalogue for the collection and procurement of medical consumables, and the construction of a comprehensive evaluation index system for the clinical use of medical consumables, as well as the integration of evidence-based and artificial intelligence technology for the whole life-cycle management of medical consumables, will inject new impetus into the management of collection and procurement and innovation.
In recent years, the concept of population medicine has emerged as a research field that has important implications for healthcare practice and policy decision-making. It specifically aims to improve overall health of patient populations and safety, quality and efficiency of healthcare system. This paper descried the background, definition and characteristics of population medicine, discussed relationship between population medicine and population health and evidence-based medicine. It also introduced Department of Population Medicine at Harvard Medical School as a world-class model in the field of population medicine, discussed the needs and potential strategies for developing population medicine research in China, and briefly outlined the current development of population medicine in China.
ObjectiveTo systematically review the influencing factors of breast cancer patients in treatment decision-making. MethodsWeb of Science, PubMed, EMbase, The Cochrane Library, JBI Evidence Synthesis, CINAHL, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect qualitative studies about the influencing factors of breast cancer patients in treatment decision-making from inception to October 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Then, the results were combined using integrating methods. ResultsA total of 13 studies were included. Sixty-seven results were extracted, with 22 results retained after incorporation and removal of duplications. The 22 results were grouped according to their similarities to form 6 categories. These categories resulted in two synthesized findings: influencing factors of patient participation in treatment decision-making and integration results and influencing factors of patients' treatment options. ConclusionBreast cancer patient participation in treatment decisions is influenced not only by internal factors, but also by family and external situational factors. When patients choose treatment, they consider not only their personal values and preferences, but also the impact of treatment on their families and their expectations. The choice is also influenced by social and cultural aspects.
This article explores the application and research progress of shared decision-making (SDM) tools in ultra-early vascular recanalization therapy for ischemic stroke, focusing on analyzing the functional characteristics and advantages and disadvantages of various tools. Based on functional goals, SDM tools can be divided into four categories: brief decision aids, risk communication tools, patient information tools, and prognosis assessment tools. These tools can assist patients and doctors in making informed treatment decisions quickly in time-sensitive situations, providing a reference for optimizing stroke revascularization treatment. Additionally, SDM tools can facilitate communication between doctors and patients, enabling patients to better understand the risks and benefits of treatment options, leading to choices more aligned with personal preferences and values. Through an in-depth study of these SDM tools, it is expected to improve the diagnostic and treatment efficiency for stroke patients, reduce decision conflicts, promote collaboration between doctors and patients, and provide new ideas and methods for stroke treatment and management.