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.
The summary of finding (SoF) table for network meta-analysis (NMA) was developed by the GRADE working group to facilitate and consolidate understanding NMA findings and GRADE certainty of evidence. This paper introduces the development process, the structure of NMA-SoF and limitations. A NMA publication was presented as an example to comprehensively illustrate the application of the NMA-SoF table.
Retrospective chart review (RCR) is a type of research that answers specific research questions based on the existing patient medical records or related databases through a series of research processes including data extraction, data collation, statistical analysis, etc. Relying on the development of medical big data, as well as the relatively simple implementation process and low cost of information acquisition, RCR is increasingly used in the medical research field. In this paper, we conducted the visual analysis of high-quality RCR published in the past five years, and explored and summarized the current research status and hotspots by analyzing the characteristics of the number of publications, national/regional and institutional cooperation networks, author cooperation networks, keyword co-occurrence and clustering networks. We further systematically combed the methodological core of this kind of research from eight aspects: research question and hypothesis, applicability of chart, study design, data collecting, statistical analysis, interpretation of results, and reporting specification. By summarizing the shortcomings, unique advantages and application prospects of RCR, providing guidance and suggestions for the standardized application of RCR in the medical research field in the future.
Objective To review main obstacles to health care professionals' adherence to clinical practice guidelines (CPGs) by employing the scoping review method and a determinants framework, and to explore the effect of implementation strategies in intervention researches on guideline adherence. Methods The articles published from January 1, 2011 to June 10, 2023 were retrieved from the PubMed, CINAHL, MEDLINE, Embase, Scopus, Cochrane Library, SinoMed, CNKI, WanFang Data and VIP databases. The original literature on the CPGs implementation obstacles and strategies was included, and the primary and secondary screening of the literature were completed by four researchers according to the inclusion and exclusion criteria. The basic characteristics of the literature, the factors affecting the implementation of the CPGs, and the strategies used were extracted. The results were analyzed and summarized using qualitative and quantitative methods. Results A total of 61 articles were included in the scoping review. The factors affecting the implementation of CPGs could be divided into five categories: guidelines themselves, external factors, internal factors, individual factors, and implementation process. The most common implementation obstacles were insufficient knowledge or skills of professionals regarding guidelines (n=21, 34.4%), insufficient necessity of using guidelines according to doctors (n=17, 27.9%), and unreasonable factors within hospital (n=16, 26.2%). The factors that promoted the implementation of CPGs included guidelines based on high-quality evidence (n=5, 8.2%), good department or hospital culture (n=4, 6.6%), convenient accessibility of guideline knowledge and information (n=4, 6.6%), and doctors’ excellent professional ability (n=4, 6.6%). The overall effectiveness of the guideline implementation strategy was 50%. Clinical decision support system (CDSS) could improve the adherence of CPGs. Guideline education or training was one of the most commonly used methods, but the effect of improving guideline compliance was unstable. Conclusion The primary challenges in implementing guidelines include inadequate professional capacity and demand, suboptimal hospital infrastructure and limited resources. However, the obstacles are not absolute. It is recommended to use implementation strategies to improve the absorption and implementation of guidelines, among which CDSS is an effective measure for promoting guideline adherence.
Objective To be aware of the treatment status and economic burden of people with hemophilia (PWH) in mainland China, so as to seek the optimal therapy for them. Methods The relevant Chinese and English databases such as CBM, CNKI, VIP, WanFang Database, PubMed, EMbase and The Cochrane Library (Issue 6 of 12, June 2011) were searched in June, 2011. The economic analyses and studies on PWH treatment and economic burden published from 1980 to 2011 were collected. Results The diagnosis and treatment of PWH in mainland China lagged behind. More than 30% of PWH did not receive or occasionally received treatment, and less than 10% received prophylactic therapy. Lots of PWHs still used FFP or cryoglobulin which were easily to cause blood-borne viral diseases. More than half of PWH families could afford a little or completely could not afford the therapy. Low dose prophylactic therapy was cost-efficient than on-demand therapy. Based on the therapy status, it was estimated that approximately RMB 53 844 yuan per year per patient should be put into practice in order to have PWH received low-dose prophylactic therapy, and to prevent 80% of bleeding. Conclusion PWH in mainland China is poor in treatment status and heavy in economic burden, so it is an optimal way to adopt comprehensive care model and low-dose prophylactic therapy in mainland China.
近十年，在药品不良反应监测领域，基于医疗保健数据库的安全信号检测方法受到越来越多的关注，已成为弥补自发报告固有局限性的重要手段。目前数据挖掘方法主要基于比值失衡分析法（disproportionality analysis）、传统药物流行病学设计（如自身对照设计）、序列对称分析（sequence symmetry analysis，SSA）、序贯统计检验（sequential statistical testing）、时序关联规则（temporal association rules）、监督机器学习（supervised machine learning，SML）、树状扫描统计量方法（tree-based scan statistic）等。本文从应用场景和实用性角度对医疗保健数据库中安全信号检测方法及其性能进行介绍。
This paper introduced the preferred reporting items for journal and conference abstracts of systematic reviews and meta-analyses of diagnostic test accuracy studies (PRISMA-DTA for abstracts), which was published in BMJ in March 2021. This paper presented the 12 items of checklist, explanations, and examples of complete reporting, to help domestic researchers to report complete and informative abstracts of systematic reviews and meta-analyses of diagnostic test accuracy studies.
Oral H1-antihistamines are one of the most commonly prescribed drug categories in the treatment of allergic diseases in children. However, its rational application still lacks sufficient evidence and pharmaceutical guidance, making its clinical use risky. Based on the best available evidence, expert experience, and the willingness of patients' families, the guideline development panel developed this guideline, using the grading of recommendations assessment, development and evaluation (GRADE) approach. The guidelines developed 19 recommendations in 8 domains, covering the therapeutic status of oral H1-antihistamines in pediatric allergic diseases, age range, dose, duration of treatment, adjustment in the presence of hepatic and renal insufficiency, drug interactions, adverse effects and adherence. As a result, this guideline helped to standardize and guide the rational use of oral H1-antihistamines in pediatric allergic diseases.
Transparent reporting of randomized trials is essential to facilitate critical appraisal and interpretation of results. Factorial trials, in which two or more interventions are assessed in the same set of participants, have unique methodological considerations. However, reporting of factorial trials is suboptimal. A consensus-based extension to the consolidated standards of reporting trials (CONSORT) 2010 statement for factorial trials was developed based on the enhancing the quality and transparency of health research (EQUATOR) methodological framework. In the study, we introduced and interpreted the extension of the CONSORT 2010 statement for factorial design in which 16 items were modified and one new item was added and presented an example of a factorial trial in mental health to provide guidance on the reporting of factorial randomized trials.