Objective Based on the acquirable and optimized evidences at present, to explore the challenge and countermeasures for the development of nursing discipline in China, and to provide suggestions for promoting the construction of nursing discipline, platform, and talent team. Methods The study materials were searched in the following electronic databases including PubMed, EMbase, Web of Science, CNKI, VIP and CBM, as well as in the official websites of World Health Organization (WHO), International Council of Nurses (ICN), World Bank, the Ministry of Health (MOH) and the Ministry of Education (MOE) of China, and the domestic universities, colleges or technical secondary schools. Then the statistical analysis was conducted using SPSS 13.0 and Microsoft Excel software. Results a) By 2012, there were 855 nursing schools, 38 212 nursing undergraduates enrolled in universities, and 130 837 nursing students enrolled in junior colleges and senior vocational schools; b) The doctor-to-nurse ratio was 1 to 0.9 in 2010. The actual demand for doctors was 2.6 million, and there were still lack of 346 000 nurses; c) The age of nurses younger than 35 years old accounted for 50%. Those with primary professional title accounted for 64% to 69%, while less than 2.5% with advanced professional title; d) The training cost for a doctor and nurse/midwife in China only accounted for 2/5 of that in India and 1/5 to 1/4 in the sub-Sahara Africa; and e) To date, only 30.1% of disaster nursing studies in China provided research data, 30.6% were clinical experience and 38.3% were review. Conclusion Education and health systems need to be extensively reformed. It is necessary to train nursing students with core competencies using transformative learning. It is necessary to update textbooks and teaching methods, and funding should be appropriately increased. Nursing should cooperate with other disciplines, and apply evidence-based nursing methods to improve the quality of healthcare services and patient satisfaction.
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.
The health status, health needs and demands as well as the concept of health itself have changes dramatically in the last one hundred years, the organizational and institutional evolutions of health system took place accordingly. To adapt the changes of health system, medical education has experienced three generations of major reform in the last century: the science-based curricula, problem-based instruction, system-based and competence-oriented education. At the same time the organization of medical education evolved from academic medicine to academic health center to academic health system. This article briefly describes the process of this evolution and presents author’s personal views on academic health system.
Objective To compare the survey results of the 8-year program students of clinical medicine discipline before and after the implementation of system-based integrated course reform, to provide feedback for system-based integrated course reform. Methods The questionnaire survey was continuously conducted for 2 years among the 8-year program students in grade of 2005 and 2006, so as to investigate their attitudes towards the integrated clinical courses, then relevant improvement of teaching measures were performed according to their feedback, and the difference of teaching effects between those 2 years was finally compared. Results A total of 79 students in grade 2005 and 78 students in grade 2006 were investigated. The baseline data were matched between the 2 grades. The results of statistical analysis showed that, the overall cognition (χ2=32.924, Plt;0.000 1) and assessment (t=−2.900, P=0.004) of integrated courses among students in grade 2006 got more improved in comparison with the students in grade 2005, and more students tended to select integrated courses, but there was no statistical difference. Conclusion Although system-based integrated clinical course as a new thing has its limitations, the reform idea and direction are still approved by students, so it is worth popularizing.
Objective To study and analyze both merits and demerits of 4 famous foreign evidence-based medicine databases, so as to provide references for the development of Chinese evidence-based medicine databases. Methods By means of document analysis and web search, the databases including UpToDate, MD Consult, Clinical Evidence and DynaMed were comprehensively analyzed from the following aspects: management ideas, editing process, personalized services and so on. Results a) Time of foundation: UpToDate founded in 1992 is the earliest-established evidence-based medicine database; b) Management ideas: All 4 databases aim to integrate all the high quality evidences about some clinical topics and help doctors to make the most reasonable decisions at present; c) Editing process: The inclusive criteria of Clinical Evidence is more strict than other databases, for the evidence needs to go through 18 steps before it is included; and d) Update rate: DynaMed updates every day as the fastest than other databases. Conclusion A mature evidence-based medicine database needs a powerful methodology team, b financial support and a large number of literature services. Besides learning good foreign experiences, it is also very important to assemble a methodology team, and particularly to integrate domestic characteristics for the establishment of domestic evidence-based medicine database.
General practice is a new discipline, and it is in common with evidence-based medicine for the features of “patient-centered” and “evidence-based”. Evidence-based medicine has spread in all fields of clinical practice, and it has been applied to different extents in many medical health and medical education fields including general practice. This paper aims to discuss and analyze the significance, modes and attentions of evidence-based general practice, so as to provide further references for promoting the practice of evidence-based general practice in China.
Objective To collect and analyze the data of emergency medicine supply for both Wenchuan and Lushan earthquakes victims in the West China Hospital, so as to provide evidence for scientifically and efficiently carrying out the logistical support for emergency rescue medicines supply, and improving the coping capacity for those similar public health emergencies. Methods Both medicine constituent ratios and DDDs were taken as evaluation indexes, and the data were input by Excel software. Then the following items were analyzed: the use and cost of emergency medicine for victims admitted in the hospital from one day to one month after earthquake, as well as, the acceptance, allocation and use of the donation medicines for both Wenchuan and Lusan earthquakes. Results During the first month after Lushan earthquake, the victims used 26 categories of medicines involving 455 drug specifications in the West China Hospital. The dosage and DDDs of therapeutic medicines were higher than those of ancillary medicines. The donation medicines for Lushan earthquake accepted by the hospital were in 8 categories involving 16 drug specifications, and they were all used to rescue the victims in the hospital. Based on the hospital emergency medicine supply system oriented by the information of victim’s medicine use, the drug specification and total drug cost of the donation medicines for Lushan earthquake decreased by 90.91% and 89.73%, respectively, indicating a more accurate and efficient system compared with those for Wenchuan earthquake. Conclusion The implementation of the hospital emergency medicine supply system oriented by the information of victim’s medicine use is helpful to improve the time efficiency and pertinence of earthquake medical rescue.
Objective To evaluate the quality of Chinese clinical practice guidelines published in domestic medical journals in 2011. Methods The following 4 Chinese databases including WanFang Data, VIP, CNKI and CBM were searched from January 2011 to December 2011. The quality of included guidelines was assessed by using AGREE II. Results A total of 75 guidelines published in 2011 were included. Among them, 10 guidelines (13%) stated the conflict of interest, 10 guidelines (13%) mentioned evidence-based developing, 5 guidelines (7%) performed evidence grading system, 8 guidelines (11%) performed recommendation strength grading system, and 4 guidelines (5%) performed both evidence and recommendation strength grading systems. The ratio of the 6 domains’ scores of AGREEⅡ were as follows: scope and purpose (18%), stakeholder involvement (11%), rigour of development (8%), clarity of presentation (34%), applicability (5%), and editorial independence (14%). Conclusion Compared with the guidelines published before, the guidelines of 2011 have a higher quality and some of them are progressively standardized in developing methodology.
Objective To review published literature on telemedicine in China using qualitative analysis. Methods Such databases as CBM, VIP, CNKI, and CSSCI were electronically and comprehensively searched for clinical studies related to telemedicine from inception to March 2013. References of the included studies were also retrieved. Two reviewers independently identified the literature according to inclusion and exclusion criteria, extracted data, and assessed the quality of the included studies. Then, qualitative analysis was performed in aspects of the application fields, range, and effects of the included studies. Result Finally, 19 studies were eligible for the analysis, including 16 quasi-randomized controlled trials and 3 observational studies. According to methodological evaluation standards (JBI, 2005), among 16 quasi-randomized controlled trials, 12 were of medium quality and four were of low quality; and 3 observational studies were all of low quality. The results of qualitative analysis showed that, literature on telemedicine had increased by year since 1995. However, the literature on relevant research of telemedicine had been published since 2002. The number of literature increased evenly and sporadically in journals. According to the classification of the application fields of telemedicine, 15 (80%) related to remote monitoring, especially related to remote fetal monitoring, 4 (21%) were remote consultation, and 3 (16%) were remote treatment. The results of 19 studies showed that, telemedicine had better effects than traditional medicine. Conclusion In China, literature related to telemedicine increases by year but the quality of them are low. High quality studies are further needed. The distribution of the application fields of telemedicine is uneven, most of which focuses on remote monitoring. The quality of research is low and need high-quality research in future. The therapeutic effects of telemedicine are better with accurate monitoring data and convenience to patients..
Objective To investigate the effects of evidence-based medicine (EBM) course on clinical medical students and to propose teaching advice. Methods Using a predesigned questionnaire, we conducted an investigation on the literature retrieval, knowledge of EBM terms, and subject attitude of clinical 5-year and 7-year medical students before and after EBM course, and then an interview was performed to collect the opinions of the students. Data was statistically analyzed. Results After the course, average reading time and frequency of literature retrieval increased significantly compared to the situation before EBM course (Plt;0.05). Knowledge levels of main EBM terms related to practice increased significantly (Plt;0.05). 5-year medical students’ ability of literature appraisal also increased (Plt;0.05). In this interview, these students suggested that course time of literature retrieval and screening should increase and medical statistics should be reviewed. Conclusion Through the study of EBM course, both knowledge and attitude of students changed a lot, and combining case teaching with EBM course has a better teaching effect. Learning the concepts and techniques of EBM for clinical medical students can help them apply medical research evidence correctly in clinical practice, and train their self-learning ability.