It has been 36 years since the first version of essential medicine list (EML) was released by WHO in 1977,when 18 versions of WHO-EML and four versions of children essential medicine list have been released. In 1982, the first version of national essential medicine list (NEML) was released in China. Till 2012, there were eight versions of NEML in total. This paper introduces WHO-EML in aspects of origin, idea, definition, design, and innovation of selection methodology,principle, and workflow; compares the evolution, design, selection methodology between WHO-EML and Chinese NEML; and points out the challenges of evaluation and decision making of Chinese NEML.
The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) has been widely accepted in the assessment of diagnostic accuracy and quality. However, it is not suitable for assessing risk of bias in studies comparing diagnostic accuracy. The current common practice in systematic reviews is to derive comparative accuracy from non-comparative diagnostic accuracy studies, which is inherently biased. The QUADAS group developed the QUADAS-Compare (QUADAS-C) tool for assessing the risk of bias in comparative diagnostic accuracy studies. It was officially launched in October 2021. QUADAS-C retains the same 4-domain structure as QUADAS-2: patient selection, index test, reference standard, and flow and timing. It also includes an additional 14 signaling questions and 4 risk of bias questions. This allows researchers to identify high-quality research evidence and avoid bias in research design and conduct. This article interpreted the basic situation, evaluation items, evaluation standards, and usage methods and procedures associated with QUADAS-C to provide references for domestic users.
目的 通过关键词共现分析和作者共现分析的方式，研究国内外循证医学教育领域的研究热点、学科分支和发展趋势。 方法 通过检索中国学术期刊数据库（CNKI）和Medline数据库，分别收集相关研究文献，并提取关键词词频、作者发文数、核心期刊和核心研究单位，对核心关键词和核心发文作者建立共现矩阵，使用Ucinet绘制可视化网络图。 结果 成功得到核心关键词和核心作者可视化网络。中文可视化网络包括“循证医学”、“护理”、“教育”、“教学”4个方面，英文可视化网络包括“evidence-based medicine”、“nursing”、“education”、“organization amp; administration”4个方面，国内外该学科发展趋势相似。国内循证医学教育以四川大学为核心，合作网络较大。同时国内核心期刊与国外侧重点不同。 结论 国内循证医学教育研究领域总体发展趋势良好，在医学教育中起着极为重要的作用。Objective To built visualized networks of evidence-based medical education in and out of China by using co-occurrence analysis of key words and authors. Methods We searched the China National Knowledge Infrastructure (CNKI) database in Chinese and Medline database in English, collecting the related articles, and took out the core key words, core authors and core administrations. Then we built the matrix of key words and authors, and finally finished visualized network by Ucinet. Results We successfully obtained the visualization of this subject. Chinese network contained four parts: “evidence-based medicine”, “nursing”, “education” and “teaching”; while English network also contained four parts: “evidence-based medicine”, “nursing”, “education”, “organization” and “administration”. In China, Sichuan University located in the center of the network of authors, and also leading in the administrations. The network of authors in China showed a larger cooperation than overseas. And the core-periodicals had different emphases. Conclusion The evidence-based medical education develops well in China, and plays an important role in the medical education.
【摘要】 目的 通过关键词共现分析和作者共现分析的方式，研究国内外循证心血管领域的研究热点、学科分支和发展趋势。 方法 通过检索中国生物医学数据库和Medline数据库，分别收集相关研究文献，并提取关键词词频、作者发文数和核心研究单位，对核心关键词和核心发文作者建立共现矩阵，使用Ucinet绘制可视化网络图。 结果 成功得到核心关键词和核心作者可视化网络。中文可视化网络包括循证医学、治疗和护理3个方面，英文可视化网络包括evidence-based medicine、therapy和treatment outcome 3个方面。而在作者合作可视化网络中，国内作者合作关系较为松散，合作团体较小，国外作者合作关系较为紧密，合作团体较大。国内核心研究机构分布于循证研究重点高校，国外则以发达国家为主。 结论 国内循证心血管研究领域总体发展趋势较好，但较国外相比仍存在一些不足，需要进一步加强重点研究，调整研究规划。【Abstract】 Objective To research on the hot issues, branch system and development trend of evidence-based cardiovascular medicine in and out of china by using co-word analysis of keywords and authors. Methods By Searching the CBM database in Chinese and Medline database in English, we collected the related articles and picked out the frequency of keywords, authors and core administrations, and built the matrix of keywords and authors. Finally we completed the visualized network by Ucinet. Results We successfully obtained the visualization of this subject. Chinese network contained three parts: evidence-based medicine, therapy and nursing, while English network also contained three parts: evidence-based medicine, therapy and treatment outcome. In the authors′ visualized network, Chinese authors had less cooperation and looser relationship compared with their counterparts overseas. The core administrations in china located in outstanding universities, and developed countries had the dominated roles in the world. Conclusions The development trend of evidence-based cardiovascular medicine in china is good, but still has some limitations compared with overseas studies. More emphasis should be put on strengthening core-area researching and research plan adjustment.
Hospital-based health technology assessment (HB-HTA) is an indispensable method and measure to improve the level of fine management and establish a value-based medical service system. This paper introduces the differences between HB-HTA and HTA, four organizational management models, assessment process, assessment steps and HB-HTA reporting standardization, which provides a reference for evaluating organizations.
ObjectiveTo analyze publications of the application of artificial intelligence related methods in medicine.MethodsPubMed and EMbase databases were electronically searched. Pathfinder Networks (PFNETs) algorithm, co-word network analysis and visualization technology were applied to analyze the time trend, journal distribution, and co-word structure of high-frequency medical keywords in key journals.ResultsThe amount of literature published on the application of artificial intelligence related methods in the medical field had been increasing annually. Nowadays, the number of studies published in the United States was the largest, and that in China, it was the sixth (first in developing countries). The number of the first author from the United States or China were among the top two, which were significantly more than any other regions. In 2012, IEEE Trans Neural Netw Learn Syst in the computer field became one of the major contributing journals. In recent years, the methods and applications proposed in the medical field were closely related to natural language processing, neural networks, and support vector machines.ConclusionsAt present, the United States is in a leading position in terms of artificial intelligence in medicine, and China has also abundant research strength. The number of medical literature published in interdisciplinary journals is increasing gradually, showing that the research and application of artificial intelligence related methods in medicine have become a research hotspot in recent years.
The QUADAS-2, QUIPS, and PROBAST tools are not specific for prognostic accuracy studies and the use of these tools to assess the risk of bias in prognostic accuracy studies is prone to bias. Therefore, QUAPAS, a risk of bias assessment tool for prognostic accuracy studies, has recently been developed. The tool combines QUADAS-2, QUIPS, and PROBAST, and consists of 5 domains, 18 signaling questions, 5 risk of bias questions, and 4 applicability questions. This paper will introduce the content and usage of QUAPAS to provide inspiration and references for domestic researchers.
Currently, the medical imaging methods based on artificial intelligence are developing rapidly, and the related literature reports are increasing year by year. However, there is no special reporting standard, and the reporting of the results is not standardized. In order to improve the report quality of this kind of research and help readers and evaluators evaluate the quality of this kind of research more scientifically, a checklist for artificial intelligence in medical imaging (CLAIM) was put forward abroad. This paper introduces the content of CLAIM and explains its items.
Objective To evaluate and select essential medicine for acute cholecystitis using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Three guidelines were included (two foreign guidelines, one domestic guideline; two based on evidence, one based on expert consensus). (2) Results of two RCTs (n=200, low quality) and two CCTs (n=230, low quality) indicated efficiencies of ampicillin/sulbactam, piperacillin/tazobactam, ciprofloxacin combined with metronidazole, and ceftazidime combined with metronidazole were 92.5%, 92.6%, 92.5% and 91.3%. A result of three RCTs (n=661, low quality) indicated that lavofloxacin had efficiencies of 82.2% to 95.8% which were 84.4% to 94.7% when combined with metronidazole. A result of three RCTs (n=553, low quality) indicated that for acute cholecystitis, ceftriaxone had an efficiency of 90.0%, cefuroxime 73.7% and cefoperazone/sulbactam 95.6% (Efficiency: ceftriaxone 93.3%, cefuroxime 82.5% and cefoperazone/sulbactam 92.3%, when combined with metronidazole). A result of one RCT (n=72, low quality) indicated that cephazoline had an efficiency of 70.9% with bacteria resistance rates of 70% for G+ and 87% for G. Conclusion (1) We offer a b recommendation for piperacillin/tazobactam and cefoperazone/sulbactam used in the treatment of acute cholecystitis (mild, moderate and severe). We offer a b recommendation for meropenem, imipenem/cilastatin and metronidazole as alternatives for severe acute cholecystitis. (2) We offer a weak recommendation for ceftazidime and cefepime used in the treatment of severe acute cholecystitis and a weak recommendation for cefotiam, ampicillin/sulbactam and cefuroxime used in the treatment of acute cholecystitis (mild and moderate). We offer a weak recommendation for lavofloxacin and ciprofloxacin used in the treatment of acute cholecystitis (mild and severe) and a weak recommendation for ceftriaxone used in the treatment of acute cholecystitis (mild, moderate and severe). (3) We make a recommendation against cephazoline as routine use. (4) More large-scale, multi-center, double-blinded RCTs are needed in clinical and pharmacoeconomic studies of acute cholecystitis and outcome indicator should be improved in order to produce high-quality local evidence.
Objective To evaluate and select essential medicine for the treatment of cerebral circulation insufficiency by means of evidence-based approaches based on the burden of disease for township health centers located in the eastern, central and western regions of China. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Five clinical guidelines on transient ischaemic attack/ischaemic stroke were included, all of which were evidence-based clinical guidelines. (2) In total, there were 13 medicines (of five classes) listed in these guidelines. (3) We offer a b recommendation for aspirin as essential medicine for cerebral circulation insufficiency and a weak recommendation for warfarin, clopidogrel, heparin, paracetamol, insulin, normal saline and glucose/dextrose. We made a recommendation against tPA, GPⅡb/Ⅲa and antibiotics according to WHOEML (2011), NEML (2009), CNF (2010), other guidelines and the quantity and quality of evidence. (4) Recommended medicines have been marketed in China and their prices were affordable except Clopidogrel’s. (5) Some results of domestic low-quality studies indicated that recommend medicines were safe and effective, which had significant differences compared to high-quality evidence from foreign studies. Further studies were needed to be confirmed. Conclusion (1) We offer a b recommendation for aspirin and a weak recommendation for warfarin, clopidogrel, heparin, paracetamol, insulin, normal saline and glucose/dextrose. We make a recommendation against tPA, GPⅡb/Ⅲa and antibiotics. (2) There is lack of high-quality evidence from relevant domestic studies, especially on long-term safety and pharmacoeconomic evidence. (3) We propose that more studies should be carried out on the safety, special efficacy and pharmacoeconomic of Chinese medicine, Chinese medicinals and medicine with special efficacy. Besides, we also compare recommended medicine with those of the same class and construct Level 1 to 2 systems of preventing and treating cerebral vascular diseases.