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.
Objective To provide evidence-based therapeutic schedule for an adult patient with Lumber Isthmic Spondylolisthesis grading II. Methods Based on fully assessing the patient’s conditions, the clinical problems were put forward according to PICO principles. Such database as The Cochrane Library (2005 to April 2011), DARE (April 2011), CENTRAL (April 2011), MEDLINE (April 2011), EMbase and CBM were searched to collect high quality clinical evidence, and then we told a patient information about treatment plans. The plan was chosen by the patient for she knew her conditions and the plans. Results We included 1 meta-analysis, 3 randomized controlled trials, 5 systematic reviews and 1 prospective study on the natural course of isthmic spondylolisthesis were included. Literature evidence indicated that the prognosis of isthmic spondylolisthesis was good. Surgery should be selected when there was neither no remission of symptom, nor progression of lumber olisthy with conservative treatment. The long-term effect of surgery may be good, but it cannot change the natural course of the disease. Based on literature evidence, the patient chose the conservative treatment. After one year’s treatment the patient recovered, her sciatica relieved, and CT showed no progression of lumber olisthy. Conclusion Patient with low grand isthmic spondylolisthesis chose conservative treatment may achieves good effects, whereas on the process of the treatment, regular follow-up to monitor the progression of lumber olisthy should be conducted.
This is the sixth paper in the evidence-based medicine glossary series. In this paper, We mainly introduced the concept of research synthesis, systematic review and meta-analysis and review developing process of these glossary.
While proposing evidence-based medical decision, we analyzed the existing problems in laboratory medicine, discussed the necessity and probability and explored the practicing way of evidence-based laboratory medicine, in order to follow the latest developing of clinical medicine and provide the best clinical laboratory technique and clinical laboratory service for good patient care.
Objective To investigate the accurateness and rapidity of information on SARS , and to provide evidence for decision-making in the construction of the public health information system of China, including information collection, identification and release. Method SARS related information was systematically collected, from ① databases including Medline, CBMdisc and Cochrane Library; ② official websites including WHO, MOH and CDC; ③ non-governmental websites including Sina, Sohu, Yahoo; ④ eleven Chinese Journals and ⑤ gray literatures, These evidence were graded based on their scientific sense, and were analyzed according to their rapidity of release. Results A total of 11 955 pieces of related information were collected. Non-governmental websites were the agents that released the largest number of information (46.7%). Regarding the scientific sense of evidence, hand searched journal was at the top of the evidence pyramid, and followed by Medline, gray literature, CBMdisc, official and non-governmental websites. Regarding the rapidity, official website achieved the most rapid information release, which was followed by nongovernmental website, journal, and database. 71.8 percent of information from official websites was in Chinese, while 65 percent was from database. Conclusions The SARS information from China has contributed enormously to the global information release. Although the amount and rapidity of the information were satisfied, management and deep processing of information should be improved.
Based on the site visit on the current application and practice of evidence-based medicine in USA, we find the difference between China and USA so as to further promote and plan the development of evidence-based medicine in China.
Objective To evaluate evidence from American medical risk monitoring and precaution system (AMRMPS) which may affect the construction of Chinese medical risk monitoring and precaution system (CMRMPS). Methods We searched relevant databases and Internet resources to identify literature on AMRMPS, medical errors, and patient safety. We used the quality evaluation system for medical risk management literature to extract and evaluate data. Results In 1999, a report from the Institute of Medicine (IOM) not only showed the severity and cause of medical errors in America but also gave the solution of it. In 2000, the Quality Interagency Coordination Task Force (QuIC) was appointed to assess the IOM report and take specific steps to improve AMRMPS. After 5 years, a well-developed medical risk management system was established with the improvement in the public awareness of medical errors, patient safety, performance criteria of medical safety, information technology and error reporting system. There was still some weakness of this system in risk precaution and prevention. Conclusion The experience from AMRMPS can be used to establish the CMRMPS. Firstly, we should disseminate and strengthen the awareness of medical risk and patient safety in public. Secondly, we should establish hospital audit system which includes auditing of medical staff and course of medical risk in continuing and academic education. Thirdly, we should develop regulations and guidelines on health care, medical purchase and drug supply which will benefit in management of regular work. Fourthly, we should develop computer information system for hospital which will regulate the management without the disturbance from human. Lastly, we should emphasize outcome evaluations and strive for perfection during the process.
Objective To provide evidence for establishing medical specialist training system in China by evidence-based evaluation on the comparison of medical specialists training programs in different countries in Europe, America and Asia. Methods The principle and method of evidence-based science were adopted. Pubmed, official website (such as Ministry of Health, and medical board), homepages of famous medical universities or teaching hospitals and most frequently used search engines were systematically searched till Mar. 31, 2004. Included literatures were evaluated according to pre-defined standards. Results A total of 878 studies (827 in English, 51 in other languages) were included. The main contents covered clinical courses (43.3%), training quality assessment (13.5%) and existing problems (12.7%). Based on these and information from official website, the process of doctor training could be divided into three stages: residency training, specialist training and continuing medical education, with the characteristics of critical standards and strict examination in each stage. Training programs for neurosurgeon and family practitioner were analyzed. Conclusions Medical specialists training is a systematic project, which needs comprechensive planning and taking all factors (such as requirement of medical care market, diseaseburden) into account . To establishing a connterpart in China, priority should be given to training quality, feasibility and improvability. At the same time, we should change our mind, face the reality, and deal with problems during the interim.
