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.
Objective To assess the methodological quality of systematic reviews or meta-analyses of intervention published in the Chinese Journal of Evidence-Based Medicine, so as to provide evidence for improving the domestic methodological quality. Methods The systematic reviews or meta-analyses of intervention published from 2001 to 2011 were identified by searching the Chinese Journal of Evidence-Based Medicine. The methodological quality of included studies was assessed by AMSTAR scale. The Excel software was used to input data, and Mata-Analyst software was used to conduct statistical analysis. Results A total of 379 studies were included. The average score of AMSTAR was 6.15±1.35 (1.5-9.5 point). Just some items of AMSTAR scale were influenced by the following features of included studies: publication date, funded or not, number of author, author’s unit, and number of author’s unit. The total AMSTAR score of studies published after 2008 was higher than those published before 2008 (P=0.02), but the improvement of methodological quality was limited. While the total AMSTAR score of studies published by 3 or more than 3 authors were higher than those published by 2 or less than 2 authors (P=0.04). Conclusion The methodological quality of the included studies published in the Chinese Journal of Evidence-Based Pediatrics is uneven. Although the methodological quality improves somewhat after the publication of AMSTAR scale, there is no big progress, so it still needs to be further improved.
Trial Sequential Analysis (TSA), one kind of cumulative meta-analysis, is a method which introduces sequential analysis into traditional meta-analysis to avoid random errors (false positive or false negative outcomes) that occurred during repeated updates when traditional meta-analysis is performing. It is also applied to calculate required information size (RIS) of a firm conclusion. This study aims to summarize the proposal, fundamental theory, application software, and current limitation of TSA, and to clarify the advantages of TSA on the basis of detailed examples, in order to attract more attention of researchers and promote the methodological development of meta-analysis in China.
Traditional Chinese medicine (TCM) has some unique advantages in the prevention and treatment of cancer. Due to different ideas and mechanism of between TCM and biomedicine in the prevention and treatment of cancer, the clinial effect evaluation approches of biomedicine could not be used as a beneficial method to scientifically evaluate the effects of TCM. From three angles, this article analyzes the key issues regardsing the evaluation methods of TCM as an adjuvant therapy of cancer. It draws lessons from the idea of quality-adjusted survival (QAS), proposes Two-in-One (TIO) method to evaluate the effects of TCM as adjuvant therapy of cancer, which reflects the combined value of the individual patient dynamic information and provides methodological support for the effect evaluation of TCM.
Objective To evaluate the effect of standardized patient (SP) used in nursing fundamental. Methods Randomized controlled trials (RCTs) or quasi randomized controlled trials (q-RCTs) about comparing standardized patients with traditional teaching method in nursing fundamental were searched from the following electronic databases: PubMed, EMbase, The Cochrane Library, CNKI, CBM, VIP and so on. The methodological quality of the included RCTs was assessed according to the quality assessment scale developed by Smits PB, and the valid data were extracted and meta-analyzed with the Cochrane Collaboration’s RevMan 5.0.17 software. Results Five RCTs and one q-RCT involving 585 participants were included. The results of quality evaluation showed that the scores of five studies were more than or equaled 30. Descriptive analyses were only used because there was clinical heterogeneity between different studies. Comparing with traditional teaching method, SP teaching method in nursing fundamental improved the nursing procedure skills, the communication ability with patients and the ability of clinical judgment for nursing students. Conclusion The standardized patient teaching method is a prospective teaching mode. Because of the lack of RCTs about SP used in nursing fundamental, and the big difference of the teaching method and examine criteria in different studies, it is necessary to be verified in future by unified assessment methods and more researches with high quality.
Objective To explore teaching effects of case-based learning (CBL) in abdominal physical examination in diagnostics. Methods Among 83 undergraduates in grade 2007 and in major of 8-year clinical medicine were randomly divided into two groups. Under the same conditions, 41 in the CBL group were taught with CBL method, while the other 42 in the control group were taught with traditional teaching method. Their scores in standard patient (SP) practice assessment of abdominal physical examination, examination of abnormal abdominal signs, ability to analyze and write medical records, and right answers to abdominal examination in final exam were compared. Meanwhile, questionnaire surveys were distributed to them after class. Results There was no significant difference between the two groups in the scores of SP practice assessment or medical record writing and analyzing, but the CBL group was obviously superior to the control group in the tests of abnormal abdominal signs and the right answers to abdominal examination in final exam (Plt;0.05). The questionnaire surveys revealed that the CBL group obviously scored higher in the following 3 items: increase the learning interest and commitment, strengthen the ability to analyze and solve problems, and improve the ability to combine theory and practice (Plt;0.05). Conclusion CBL method has an obvious advantage to improve the teaching quality in abdominal physical examination in diagnostics.
Objective Investigate the effectiveness of problem-based learning (PBL) in teaching of evidence-based medicine for undergraduates.Methods Participating students from four of eight classes with major of clinical medicine in Grade 2006 were assigned to the lecture-lased learning (LBL) group (50 students) and the PBL group (46 students), and each group had two classes. The examination scores, questionnaire, and seminars were used in combination to evaluate the teaching effectiveness. SPSS 11.5 software was used for statistical analyses. Results The baseline characteristics were balanced between the two groups because no difference was found in aspects of taking part in literature or information retrieval training, research project, undergraduate starting an undertaking plan and social survey, as well as getting known of evidence-based medicine, clinical epidemiology and PBL. The evaluation results of teaching effectiveness showed that, a) About the examination score, there was a significant difference between the two groups (Plt;0.05); the score of the PBL group was higher than that of the LBL group in aspects of fundamental knowledge, issuing question, retrieving evidence, evaluating evidence, applying evidence and total score; and b) About the attitude towards LML, there was a significant difference between the two groups about whether the LBL was beneficial or not to improve positive study, study interest, participation willingness, aggregate analysis ability, speech ability, self-study ability, information acquisition ability, information analyses and utilization ability, problem analyses and solving ability, combination of theory and clinic, communication between teachers and students, team cooperation and so on; but there was no significant difference between the two groups (Pgt;0.05) in aspects of improving learning efficiency, better understanding theory leader from class, improving writing ability and practicing ability; 97.83% of the students in the PBL group thought that PBL was suitable for themselves which should be introduced into other course teaching; 48.00% of the students in the LBL group thought that the current LBL teaching mode was not suitable for undergraduate, while 28.00% of the students in the LBL group thought that the current teaching mode should get reformed. Conclusion The PBL teaching mode is beneficial for undergraduates to better training clinical thinking, improve the ability of problem construction, aggregate analyses, literature retrieval, language express and exploratory innovation, and fully improve the quality of evidence-based medicine teaching. The PBL teaching method is suitable for teaching of evidence-based medicine for undergraduate medical students.
Objective To analyze the status of applying diagnostic test in imaging scientific study internationally and domestically, and to compare the application of the image diagnostic studies of our country with that of abroad. Method We hand-searched the diagnosis tests published in the "Chinese Journal of Radiology", the most influential in China, and in "Radiology’’, the most influential abroad, from 1998 to 1999 respectively. Then we evaluated each of the diagnosis tests according to the international standards. Results We searched 408 original articles in "Chinese Journal of Radiology" in which the diagnostic test articles were 12%, and 796 original articles in "Radiology" with the diagnostic test articles 23% from 1998 to 1999 respectively. In these diagnosis tests, by comparing the "Chinese journal of radiology" with the "Radiology", it was found that 19% applied blind comparison with Gold Standard, 28% calculated sensitivity, specificity and accuracy, 9% both calculated negative predictive value and positive predictive value and none calculated likelihood ratios in the former versus 64%, 57%, 33% and 26% and 3% respectivdy in the latter. Conclusions Compared with the international level, both the quality and the quantity of the diagnosis tests applied in the specialty of imaging scientific study in China are much lower and far from meeting the clinical requirement. Improving the methods of scientific study and carrying on more diagnosis tests with high qualities are of important significance in improving the diagnostic level of imaging.
Systematic reviews provide information about the effectiveness of interventions by identifying, appraising, and summarizing the results of otherwise unmanageable quantities of primary research in an effort to provide valid, reliable evidence for health decision-making and clinical practice. They differ from traditional reviews produced by "content experts" in that they use a replicable, scientific and explicit approach that seeks to minimize bias. They are particularly useful when there is uncertainty regarding the potential benefits or harm of an intervention and when there are variations in practice. Poor quality systematic reviews may mislead policy-makers and clinicians. This paper will introduce the basic methods of Cochrane systematic reviews in order to help those who are interested in conducting systematic review.
In the absence of large trials, it is important for us to discuss whether a well-conducted meta-analysis of smaller randomized controlled trial (RCT) can replace large trials or not. We have evaluated the quality of original literature and methodological quality. The difference between meta-analysis of smaller RCT and the largest randomized trials have also discussed.