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.
Stroke is the leading cause of mortality and disability in China. Chinese medicine integrated with conventional medicine is current widely used in the prevention and treatment of stroke. A clinical practice guideline for application of integrative medicine in stroke was urgently required. This guideline was developed according to the World Health Organisation Handbook for Guideline Development and the Guideline Development Handbook for Diagnosis and Therapy of Integrative Medicine. The systematic reviews were conducted following the Cochrane handbook. The quality of evidence and strength of recommendations were evaluated using the GRADE approach. The reporting of guideline followed the RIGHT statement. A multi-disciplinary working team was established. Eleven research questions from 15 clinical questions were identified by questionnaire surveys, face-to-face meetings, and analysis by the working team. Fourteen recommendations regarding integrative medicine for ischaemic stroke, haemorrhagic stroke, and complications of stroke were formulated from systematic reviews of the benefits, harms, cost-effectiveness, quality of evidence, the values and preferences of patients and their family members, feedback on proposed recommendations from medical practitioners from a variety of disciplines, and a face-to-face consensus meeting. This guideline focuses on clinical treatments that are specific to integrative medicine for stroke and can be used by medical practitioners at all levels in medical institutions and rehabilitation facilities.
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.
ObjectiveTo provide the best evidence for an old diabetic patient who combined with frailty syndrome with the goal of glycemic control, treatment strategy and their prognosis.
MethodsPubMed, MEDLINE (Ovid), EMbase, The Cochrane Library (Issue 11, 2015) and CNKI were searched from their inception to Nov. 2015, to collect evidence about the management of glycemic control. Evidences were analyzed by the way of evidenced-based criterions.
ResultsOne clinical guideline, one meta-analysis, three RCTs, seven cohort studies and four case-control studies were included. Evidence showed that compared with patient uncombined with frailty, old diabetic patients with frailty had a higher prevalence of dementia, cardiovascular diseases and death; Aggressive glycemic control could not reduce the prevalence of cardiovascular events and the risk of death, while it could increase the risk of falling. Glycemic control was more comprehensive which would be taken frailty into consideration. Diet rich in protein (especially leucine), resistance exercise and reasonable medications based on comprehensive geriatric assessment were proved benefit for the old diabetic patient.
ConclusionThe incidence of cardiovascular events, hypoglycemia and mortality are increased in this old diabetic patient who combined with frailty. Maintaining HbA1c around 7.5% is reasonable and diet with enough calorie and rich in protein (especially leucine), resistance exercises should be recommended for the person.
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.
ObjectiveThe purpose of this study was to translate the U-CEP scale into Chinese, and evaluate the reliability and validity of the Chinese version of the U-CEP, in order to provide a measurement and evaluation tool for clinical epidemiology education and research. MethodsThe U-CEP scale was translated and adapted using the Brislin translation model. A nationwide survey of clinicians was conducted using the Chinese version of the U-CEP. Item analysis, reliability analysis, and validity analysis were performed using SPSS 26.0 software. ResultsThe discriminant validity analysis showed that except for item 4, the critical value (CR) of the other twenty-four items differed significantly between high and low groups (P<0.01), with CR values ranging from 2.902 to 14.609. The ITCs of the 25 items were all positive, with 5 items having an ITC<0.15(20%), 2 items having ITC≥0.15~0.20 (8%), 6 items having ITC≥0.20~0.40 (24%) and 12 items having ITC≥0.40 (48%). In terms of reliability, the overall Cronbach’s α coefficient of the Chinese version of the U-CEP was 0.80, with Cronbach’s α coefficient ranging from 0.752 to 0.805 when deleting each item one by one. The test-retest reliability was 0.848 (P<0.001). The alternative-form reliability was 0.838 (P<0.001). In terms of validity, expert analysis showed that the content validity of the Chinese version of the U-CEP was good. The construct validity analysis showed that the cumulative contribution rate of the 25 items was 57.50%. No respondent scored full marks or zero marks, indicating that no ceiling or floor effects were found. There were statistically significant differences in the total scores among clinicians with different educational backgrounds or with or without systematic learning of relevant knowledge (P<0.05). ConclusionThe Chinese version of the U-CEP has good reliability and validity, as well as good cultural adaptability. It can effectively assess a physician's knowledge of clinical epidemiology.
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.
ObjectiveIn order to summarize the best evidence, evaluate the efficacy and safety of interventions for the treatment of COVID-19, and provide practical guidance for medical workers, public health workers, and COVID-19 patients, we formulated the evidence-based practice points. MethodsWe followed the "Evidence-based practice points: methods and processes of development", with comprehensively considering the pros and cons of evidence, quality of evidence, public and patient preferences and values, cost of interventions, acceptability, and feasibility based on systematic reviews. Practice points Finally, 12 practice points were formed for non-severe, severe and critical COVID-19 patients. Non-severe: ① Consider Hanshiyi formula or Gegenqinlian pills for patients with nausea, vomiting and diarrhea; ② Consider Huashibaidu granules (decoration), Jinyinhua oral liquid, Jinhuaqinggan granules, Xuanfeibaidu granules (decoration), Lianhuaqingwen capsules (granules), or Reyanning mixture for patients with sore throat, fever, muscle aches or cough; ③ Consider Qingfeipaidu granules (decoration) for patients with nasal congestion, runny nose, cough, low-grade fever, aversion to wind and cold, and fatigue; ④ Consider Toujiequwen granules for patients with fever, chills, itchy throat, cough, dry mouth and throat, and constipation; ⑤ Consider Reduning injection or Xiyanping injection for patients with high fever, mild aversion to wind and cold, headache and body pain, cough, and yellow phlegm; ⑥ Consider molnupiravir, nirmatrelvir–ritonavir (Paxlovid), remdesivir or VV116 for patients within 5 to 7 days of the onset of symptoms and at high risk for progressing to severe disease. Severe: ① Consider Shenhuang granules or Xuebijing injection for patients with high fever, irritability, and thirst; ② Consider remdesivir used as soon as possible for patients with severe symptoms. Critical severe: Consider corticosteroids, IL-6 receptor inhibitors, and baricitinib for patients 7 days after the onset of symptoms.
