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 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.
Objective To formulate an individualized evidence-based treatment for a first-diagnosed patient with coronary artery-pulmonary artery fistula. Methods Aiming at the issue of whether interventional operation was necessary for first-diagnosed coronary artery-pulmonary artery fistula or not, the computer retrieval was conducted in the US National Guideline Clearinghouse, The Cochrane Library, PubMed and MEDLINE from 1990 to 2011, to collect and assess the best evidence of relevant systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines, in order to be applied in clinical treatment. Results There were 1 clinical guideline for treating coronary artery fistula and 3 different high-quality evidence studies were retrieved. The results showed percutaneous coronary intervention was the best treatment currently. According to the obtained evidence and patient’s willingness, the relevant examinations were taken, and the preoperative preparation for percutaneous coronary intervention was done actively after the patient was admitted. Three days after hospitalization, the selective coronary angiography showed right coronary artery-pulmonary artery fistula and left coronary circumflexus artery-left atrial multiple fistulae, then the percutaneous coronary intervention spring coil embolization was successfully conducted for right coronary artery-pulmonary artery fistula. After operation, bayasprin enteric-coated tablets 0.1 g/d was taken for anti-platelet aggregation and preventing thrombotic diseases. The observation during operation and postoperative 5-day hospitalization showed no relevant complications. Conclusion Percutaneous coronary intervention is safe and effective for the symptomatic patients with coronary artery-pulmonary artery fistula.
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.
Objective To study and analyze both merits and demerits of 4 famous foreign evidence-based medicine databases, so as to provide references for the development of Chinese evidence-based medicine databases. Methods By means of document analysis and web search, the databases including UpToDate, MD Consult, Clinical Evidence and DynaMed were comprehensively analyzed from the following aspects: management ideas, editing process, personalized services and so on. Results a) Time of foundation: UpToDate founded in 1992 is the earliest-established evidence-based medicine database; b) Management ideas: All 4 databases aim to integrate all the high quality evidences about some clinical topics and help doctors to make the most reasonable decisions at present; c) Editing process: The inclusive criteria of Clinical Evidence is more strict than other databases, for the evidence needs to go through 18 steps before it is included; and d) Update rate: DynaMed updates every day as the fastest than other databases. Conclusion A mature evidence-based medicine database needs a powerful methodology team, b financial support and a large number of literature services. Besides learning good foreign experiences, it is also very important to assemble a methodology team, and particularly to integrate domestic characteristics for the establishment of domestic evidence-based medicine database.
General practice is a new discipline, and it is in common with evidence-based medicine for the features of “patient-centered” and “evidence-based”. Evidence-based medicine has spread in all fields of clinical practice, and it has been applied to different extents in many medical health and medical education fields including general practice. This paper aims to discuss and analyze the significance, modes and attentions of evidence-based general practice, so as to provide further references for promoting the practice of evidence-based general practice in China.
Objective To formulate an evidence-based nursing strategy of turning over for a patient with the risk of pressure ulcer. Methods The personalized clinical questions were put forward based on the PICO and patient’s condition, and the following databases such as NGC, The Cochrane Library of DARE, CDSR, CCTR, MEDLINE, PubMed and CBM were searched to collect the best clinical evidences of turning over for preventing pressure ulcer. Results One clinical guideline, one systematic review and three randomized controlled trials were included finally. According to the retrieval outcomes, patient’s clinical condition, and patients and their family members’ willingness, a reasonable nursing plan of turning over was formulated: lie on the visco-elastic foam decompression bed, turn over every 4 hours, and combine supine position with alternation of left-oblique 30° position and right-oblique 30° position. During hospitalization, the grade-I pressure ulcer in size of 4×6 cm2 on patient’s sacrococcygeal region was clear, dry and not broken, and the other part of body with pigmentation had no occurrence of pressure ulcer. Conclusion Evidence-based approaches are helpful to provide patient with a nursing plan that meets the needs of both scientificalness and individualization.
Objective To establish the evidence-based treatment strategy for an advanced lung cancer case with spinal metastasis, regarding the patient’s condition and treatment expectations. Methods According to PICO principles, questions in the patient’s treatment were converted into a search strategy. The literature searching was performed in several databases. In accordance with the five evidence grading standards in evidence-based medicine, the best clinical evidence was interpreted to guide the treatment decisions. Results A total of 148 papers were detected and screened, of which 4 systematic reviews or meta-analyses were included finally. Four issues that patients concerned, including restoring spinal cord function (walking and sphincter function), local pain control, long-term survival, and treatment complications, were all supported by grade-1 evidence. The patient finally chose surgical decompression, which was of a higher complication risk, but better possibility of restoring nerve function, significant pain relief, and improved long-term survival. The patient obtained fully recovery and regained walking function after surgery. Conclusion The evidence-based treatment is able to provide reasonable treatment options for lung cancer patients with spinal metastasis. Decompression surgery for patients with walking dysfunction should be carried out as soon as possible, in order to early restore spinal marrow function, relieve pain and improve long-term survival. But both doctors and patients should fully acquaint themselves with the higher risk of surgical complications.
Objective To investigate the effects of evidence-based medicine (EBM) course on clinical medical students and to propose teaching advice. Methods Using a predesigned questionnaire, we conducted an investigation on the literature retrieval, knowledge of EBM terms, and subject attitude of clinical 5-year and 7-year medical students before and after EBM course, and then an interview was performed to collect the opinions of the students. Data was statistically analyzed. Results After the course, average reading time and frequency of literature retrieval increased significantly compared to the situation before EBM course (Plt;0.05). Knowledge levels of main EBM terms related to practice increased significantly (Plt;0.05). 5-year medical students’ ability of literature appraisal also increased (Plt;0.05). In this interview, these students suggested that course time of literature retrieval and screening should increase and medical statistics should be reviewed. Conclusion Through the study of EBM course, both knowledge and attitude of students changed a lot, and combining case teaching with EBM course has a better teaching effect. Learning the concepts and techniques of EBM for clinical medical students can help them apply medical research evidence correctly in clinical practice, and train their self-learning ability.
Objective To analyze the methodological quality of clinical practice guideline mentioned “evidence-based” in China. Methods We selected clinical guidelines developed based on evidence issued by the Chinese Medical Association in 2010-2012, and meanwhile, we conducted additional search for guidelines on clinical major diseases. Then, we selected literature according to the inclusion and exclusion criteria and evaluated the included guidelines according to 8 items relevant to methodological rigor which were selected from the Appraisal of Guidelines for Research and Evaluation (AGREE II). If the guidelines comply with the item, we recorded 1 point, otherwise 0 point. Results a) Among twenty-two included guidelines, 13 were originated and 9 were updated once every 3 to 5 years. b) Diseases covered stroke, diabetes, chronic hepatitis B, hypertension, pediatric nutrition, etc. c) The number of guideline references were 10 to 218, of which, nine guidelines cited 24 Cochrane systematic reviews (CDSRs), accounted for 2.62% (24/916). Among them, the acute ischemic stroke guideline cited the most (7 CDSRs). d) The number of experts involved in guidelines development was 2 to 95 and guidelines pages were 4 to 150. e) The guidelines’ quality generally scored 4 to 7, most of which described the process of guidelines development. The grades of recommendation were consistent with the levels of evidence. But most of the included guidelines did not clearly described literature research methods, peer reviewer, and update procedures. Conclusion There is a growing trend that clinical guidelines are developed based on evidence in China. However, the quality of reporting and the methodological rigor of guidelines need further improvement. The citation rates of Cochrane systematic reviews in these guidelines were relatively low. We suggest that guideline recommendations should be consistent with the levels of evidence and adapt to local conditions, and relevant support policies for guideline implementation in practice. In future, attention should be paid to the aspects of guideline development methods, reporting standard, guideline accessibility, and standard training for relevant personnel.