Objective To investigate the use of evidence-based medicine (EBM) and barriers to applying EBM in clinical practice in medical postgraduates. Methods Three hundred and sixty-five first and second-year medical postgraduates selecting the EBM courses were included. All the students were surveyed by questionnaires. Result The response rate to the survey was 100%. About half of the students read 1~5 professional articles per month before postgraduate study. Fifty-six percent of the students used professional literature and research findings when making clinical decisions. Fifty-seven point three percent used electronic databases to search for practice-relevant literature before postgraduate study. Sixty-one point four percent found it difficult to obtain relevant clinical guidelines and 68.5% never applied relevant clinical guidelines in clinical decision-making. The barriers to using EBM in clinical practice included difficulties in searching and accessing full text of potentially relevant articles, lack of EBM knowledge, influences from clinical experience and authorities, uncertainties about the quality of evidence and time-consuming. Conclusion EBM clinical practice and EBM medical education has transformed from dissemination and popularization stage to skill acquisition stage.
Objective To provide basis to improve the ability of primary care services in Chengdu by comparatively analyzing inpatient medical service of primary medical institutions (community health service centers and township health centers). Methods From October to November 2016, the data of inpatient services in primary medical institutions in Chengdu, including 390 primary medical institutions in 22 districts (cities) and counties, were investigated by questionnaire. SPSS 19.0 was used for data collection and analysis, while the univariate logistic regression and multiple logistic regression were used to analyze the influencing factors. Results It was more common for rural primary medical institutions to carry out inpatient medical services than urban (96.18% vs. 53.84%). The coverage rate of insurance in urban areas was higher than rural areas (98.41% vs. 90.87%), while the rate of adopting clinical pathway of single disease was quite low both in urban areas (23.81%) and rural areas (18.25%). Primary medical institutions in urban areas launched more special projects of inpatient services than those in rural areas (14.29%–17.46% vs. 3.57%–7.54%). The total amount of inpatient medical services in 2015 in rural areas was larger than urban areas (529 611 vs. 103 912), the total number of inpatient services in rural was 5.09 times that in urban primary medical institutions, the average inpatient services in 2015 per one rural primary medical institution was 1.27 times that in urban, per 10 000 residents in rural areas consumed 3.01 times more inpatient medical services than those in urban areas in average, the median beds utilization efficiency in rural areas was better than in urban areas (74.47% vs. 22.47%); work intensity of inpatient medical service in rural areas was greater than in urban areas (234.57 vs. 81.74 cases per year per doctor). The number of inpatient services was positively related to population in service (when less than 100 000 residents), inpatient beds, the number of drugs, the number of medical staff. Conclusions For inpatient medical service, there are obvious differences between urban and rural areas in Chengdu. Therefore, above differences should be taken into full consideration in the allocation of resources in primary medical institutions. Thus more targeted management measures should be formulated.
【Abstract】 Objective To investigate the spectrum of CT and MR imaging and surgical operation findings in il iopsoasbursitis in patients with avascular necrosis of femoral head so as to enhance the diagnostic abil ity. Methods A total of 1 415 patients with avascular necrosis of the femoral head were analyzed retrospectively; of them, 15 patients were compl icated by il iopsoas bursitis surgically or aspiration of synovial fluid between May 2005 and May 2007. Fifteen cases were all necrosis of the bilateral femoral head and 17 hips were combined with il iopsoas bursitis. There were 14 males and 1 female, aging 29-58 years. The course of disease was 1 month to 3 years. All 15 patients had l imitation of abil ity of the hips and the “4” type sign was positive. The Harris score of hip’s function was 54-78 (mean 62.7). Five patients of them can be touched a palpable cystic mass and tenderness in the inguinal area, and 3 of them associated with femoral neuropathy and 2 patients presented sl ight atrophy of the thigh muscle in suffering side. All these cases were taken X-ray films of positive and frog-leg lateral position, hel ical CTscan with 5 mm thinness, and MRI was performed in 6 patients with T1WI, T2WI, T2WI and fat-saturated inversion recovery sequence. Results The radiographs were the primary basis evidences for diagnosis and degrees of the avascular necrosis of femoral head. According to the standards of Association Research Circulation Osseuse, there were 2 hips at stage II(II C 2), 6 hips at stage Ⅲ ( Ⅲ B 1, Ⅲ C 5 ) and 9 hips at stage IV. The X-ray films showed the bulging of the fat pad and soft tissue swell ing in 6 patients. CT analysis disclosed that the enlarged il iopsoas bursae appeared as hypodense, well-defined, thin-walled (lt; 2 mm) cystic structures. The content of the examined bursae was homogeneous with a CT density of ranging from 12.7 to 41.2 Hu, showing fluid collection. They were round or oval in shape medial to the il iopsoas, exhibiting inverted water-drop cystic shadow just inferior to the femoral head. Sl ight contrast enhancement of the bursal wall was seen after contrast agent administration in 3 cases. MRI demonstrated that the il iopsoas bursitis presented as low signal on T1WI and water-l ike highsignal on T2WI and markedly higher signal on STIR in 6 cases. The demonstration of the extent, size, mass effects and its relation and subsequent affection to surrounding anatomical structures were clearly shown by MRI, and by the communications between the il iopsoas bursa and the adjacent hip joint. Conclusion In the diagnosis of avascular necrosis of femoral head with imaging approaches, much attention should be paid to the abnormal ities around the articular capsule to early identify il iopsoas bursitis for further management.
Objective To compare the medical emergency rescue systems used during earthquakes in America, Japan, Russia and China; so as to provide reference material for the establishment and improvement of such a system in China. Methods We searched the official websites of China, America, Japan and Russia, WHO.int, CNKI, OVID, The Cochrane Library and other authoritative sources to collect information involving the medical emergency rescue systems used during earthquakes. The mechanism, legal management, preventive measures and performance of each country’s medical emergency rescue system were summarized and compared. Results Crisis management, integrated action and legal support were highly emphasized in America, Japan and Russia. America and Japan have performed well in implementing routine preventive measures. The organizational structure of the medical emergency rescue system in China was similar to that of the other countries, but its performance was not satisfactory due to insufficient financial support, poor management, inefficient operational mechanism and poor preventive measures. Conclusion There is an urgent need for China to reinforce its medical emergency rescue system. Different models should be taken into account because of the different regional situations in China.
Objective To investigate the effect of training courses of evidence-based medicine (EBM) on the knowledge, skill, attitude and behavior of medical postgraduates and to explore the barriers to evidence-based practice (EBP), so as to provide knowledge to improve further EBM teaching and EBP. Methods A total of 110 medical postgraduates of Sichuan University who selected EBM courses in the autumn semester of 2004 were given questionnaires that combined both open and closed questions. The KAB (knowledge, attitude and behavior) of EBM and barriers to EBP were compared before and after the training courses. Results Differences were observed in KAB of EBM and barriers to EBP after the training courses, compared to the assessments done before the courses. In “Knowledge”: there was a significant increase in the understanding of specific terms in EBM after the training courses (75% of the items showed a statistically significant improvement). This was especially marked for “absolute risk”, “systematic review”, “meta-analysis” and “publication bias” (Plt;0.01). We also found an improvement in familiarity with medical search engines (Plt;0.05). In “Attitude”: the mean scores for most items (55%) were relatively high both before and after the training courses (gt;4), and a significant improvement was observed in 2 items. These were “Strong evidence is lacking to support most of the interventions I use with my patients” and “EBP needs to take into account patient preferences” (Plt;0.01). The mean scores of 2 items were relatively low both before and after the training courses (lt;3). These were “the adoption of EBP places an reasonable demand on physical therapists” and “EBP does not take into account the limitations of my clinical setting”. Another 2 items had mean scores close to 5: “I need to increase the use of evidence in my daily practice” and “I am interested in learning or improving the skills necessary to incorporate EBP into my practice”. In terms of “Behavior”: the medical postgraduates continued not to think highly of the use of literature after the training courses. About 60% of the postgraduates did not read any literature related to their specialties at all. Although searching of MEDLINE and other electronic databases was relatively frequent (gt;6 times/month: 60.3% before training and 65.7% after training), using professional literature and research findings in the process of clinical decision-making was not equal (gt;6 times/month: 29% before training and 35.1% after training). No significant difference was observed in applying clinical practice guidelines before and after the training courses. As for “Barriers”: the postgraduates considered “poor ability to critically appraise literature” as the most important barrier both before and after the training courses. The second and third most important barriers were different compared to after the training courses. The barrier of “lack of research skills” was larger than that of “lack of information resources” before the training courses, but after that the course, the order of these was reversed. Conclusion The knowledge of medical postgraduates increased significantly after the current training courses of EBM. Some improvement was also found in attitude and behavior. The top three barriers to EBP were “Poor ability to critically appraise literature”, “Lack of information resources”, and “Lack of research skills”