The first Global Evidence Summit (GES) was held in Cape Town in South Africa from September 13th to November 16th, 2017. This paper interprets the construction of digital and trustworthy evidence ecosystem which was proposed to be established by the GES.
As a new discipline, the cardiac surgery has a great development in the modern age, but still faces many problems and disputes. The emergence of the evidence-based medicine(EBM),which emphasizes the best evidence, and combines the doctor’s clinical experience to make the best judgment, gives the development of the cardiac surgery a new thinking . Four systematic reviews published in The Cochrane Library (Issue 3, 2004) have interprated the importance of EBM on how to resolve the actual problems in different field of the cardiac surgery.
Evidence-based medicine emphasizes that treatment must be based on the following elements ： the latest and best evidence, clinicians＇ expertise and patients＇ preference. Evidence-based medicine embodies the ethos both to explore medical science and to respect patients＇ values. Evidence-based medicine is an integration of the scientific and the humanistic spirit.
With the transformation of bio-psycho-social medical mode and the development of evidence-based medicine, people gradually realize that the new concept, patient-centered, can improve health awareness, promote harmonious doctor-patient trust and improve the satisfaction of patients. In this context, decision-aided system for patient appeared. It aims to encourage individuals to make specific choices according to their personal values and preferences after grasping relevant information of healthcare options. In addition, to facilitate the shared decision making, the decision aid can also upgrade the quality of care and improve doctor-patient relationship. This article gives an overview of the development of decision-aided system for patient, what it contains, how to develop and assess it, and the way to use it.
Interpretation of the complete scientific connotation of functional foods accurately prior to approval and registration based on animal tests and small sample size human food tests is challenging. Further technical evaluation after market introduction should be carried out on safety, health function and other aspects of those widely used commercial scale production products. According to the analysis report on the consumption situation of post-marketing population submitted when applying for product registration extension since the implementation of the functional food registration and filing management measures more than 3 years ago, the post-marketing evaluation report of functional food still lacks systematic and perfect evidence support. Based on the successful experience of evidence-based medicine and post-marketing evaluation evidence, this paper analyzes the post-marketing evaluation content, evidence source construction, evidence classification and classification of functional food, and puts forward the preliminary idea of constructing post-marketing evaluation evidence body of functional food safety and health function technology from multiple view points, so as to provide insights into evidence system research in this field in the future.
Objectives To establish a course evaluation model for overseas medical students in West China Medical School of Sichuan University, to identify problems in teaching and to solve problems based on evidence so as to futher improve the quality of teaching. Methods We conducted a preliminary course evaluation to determine the limitations of our evaluation methods and to convey our intention to related stakeholders. Firstly, we identified problems in teaching according to the feedback from our students using a questionnaire. Secondly, we proposed an initial list of possible solutions to these problems based on evidence from literature searching and discussion within the Department of Teaching Affairs. We submitted the initial list to the administrative departments, teaching departments (teachers) and students to identify applicable solutions through two rounds of formal consensus. Their attitudes to this procedure of evaluation and decision-making were collected. Finally, incentives were given out by administrative departments and teaching departments to facilitate the implementation of applicable solutions. Results Teachers’ English ability and the didactic teaching methods were the most concerned problems. In addition, some semesters and courses were not well arranged and there was not enough practice time. An initial list of 14 items was submitted to teaching departments and students. They all agreed with the procedure of evaluation and decision-making. We also found that some aspects of the evaluation methods and styles need to be improved. An additional paper would report further results. Conclusion This preliminary evaluation was helpful for improving teaching and formal evaluation in the future. We need to strengthen the English language skills of younger faculty and gradually adopt a model of student-centered and enquiry-based teaching. This process of evaluation and improvement should be applied as a long-term policy and an evidence-based research group should be established to work together with our quality assurance unit.
Objective To evaluate and select essential medicine for middle-aged and elderly women with primary osteoporosis using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) 18 guidelines were included, 14 of which were evidence-based or based on expert consensus. Recommended medicines included bisphosphonates, calcitonin, estrogen, parathyroid hormone, selective estrogen receptor modulator, strontium and Chinese patent drug. (2) A result of one quasi-RCT (very low quality) indicated that caltrate D had a better effect on elderly women with primary osteoporosis than calcium gluconate in improving bone mineral density (BMD) (MD=0.04, 95%CI 0.02 to 0.06) and ameliorating bone ache ( RR=2.64, 95%CI 1.40 to 4.96). A few cases treated by caltrate D presented with adverse reaction such as gastrointestinal discomfort, poor appetite, constipation and nausea which disappeared later. Caltrate D (calcium carbonate D3) with good applicability cost 1.00 yuan daily. (3) A result of one RCT (low quality) indicated that alendronate had a better effect than caltrate D in improving L2-L4 BMD (MD=0.06, 95%CI 0.017 to 0.10) and ameliorating bone ache (RR=1.8, 95%CI 1.40 to 2.52). A result of two RCTs (moderate quality) indicated that alendronate plus calcium carbonate plus vitamin D6 had a better effect than calcium carbonate plus vitamin D in improving L2-L4 BMD (MD=0.05, 95%CI 0.02 to 0.08) and reducing blood alkaline phosphatase (MD=–31.9, 95%CI –54.99 to –8.81). There were slight adverse effects mainly including gastrointestinal reaction. Alendronate with fairly poor applicability cost 2.67 yuan daily. (4) A result of one RCT (moderate quality) indicated that after a 3-month treatment, Xian Ling Gu Bao Jiao Nang (name of a Chinese patent drug, abbreviated as XLGB) plus calcium preparation had a better effect than calcium preparation alone (MD=10, 95%CI 0.05 to 0.15). A result of one RCT (moderate quality) indicated that given for 3 to 6 months, XLGB plus calcium preparation was superior to calcium preparation alone in increasing the density of Ward’s triangle and the great femoral trochanter. A result of one RCT (low quality) indicated that XLGB plus calcitriol had a better effect than calcitriol alone in pain relief (RR=1.26, 95%CI 1.04 to 1.52). There were slight adverse effects mainly including reaction in the digestive system, the circulatory system and the skin. XLGB with good applicability cost 4.58 yuan daily. Conclusion We offer a weak recommendation for alendronate applied to middle-aged and elderly women with primary osteoporosis and pain and fracture caused by primary osteoporosis. We also offer a b recommendation for caltrate D and XLGB applied to middle-aged and elderly women with primary osteoporosis and pain and fracture caused by primary osteoporosis. In addition, we propose that the census on elder people with osteoporosis in rural areas should be carried out. More clinical and pharmacoeconomic studies of large-sample, high-quality on alendronate and its calcium preparation for adult osteoporosis are needed in China.
