Objective To investigate evidence retrieval, appraisal, and reevaluation during evidence-based clinical decision making in China. Also, to analyze the related factors, so as to find the problems in the course of evidence-based clinical decision making and put forward corresponding solutions. Methods We searched Chinese Biomedical Literature Disc (CBM) and China Journal Full-text Database (Medical sciences) of the China National Knowledge Infrastructure (CNKI) to collect clinical evidence-based case reports. Relevant information was extracted from these reports by a selfdesigned investigation form.Then statistical analyses were performed. Results The search tools used in the course of evidence-based clinical decision making varied. The most frequently used were MEDLINE/PubMed (82.08%) and The Cochrane Library (60.38%). 30.63% of evidence-based case reports described the search strategy in detail, and 9.01% described how they modified their search strategy. All doctors evaluated the association between evidence and disease, but few of them integrated patient factors and relevant external factors when evaluating evidence. The scientific nature and validity of the evidence was evaluated in 74 evidence-based case reports (66.67%), and such evaluation was mainly based on the criteria of evidence grading (50.00%). Reevaluation was mentioned in 85.59% of evidence-based case reports. Conclusion In China, the application of evidence-based decision making varied in different clinical departments. Problems existed in the course of evidence retrieval, appraisal, and reevaluation. This revealed the low information diathesis level of doctors and their lack of evidence-based medicine knowledge. It is suggested that information education and evidence-based medicine education should be strengthened to improve doctors’ ability to use evidence-based clinical decision making. It is also recommended that the search tools, relevant search strategy, the modification of search strategy, and reevaluation on practice results of each case should be mentioned in evidence-based case reports.
The analysis of big data in medical field cannot be isolated from the high quality clinical database, and the construction of first aid database in our country is still in the early stage of exploration. This paper introduces the idea and key technology of the construction of multi-parameter first aid database. By combining emergency business flow with information flow, an emergency data integration model was designed with reference to the architecture of the Medical Information Mart for Intensive Care III (MIMIC-III), created by Computational Physiology Laboratory of Massachusetts Institute of Technology (MIT), and a high-quality first-aid database was built. The database currently covers 22 941 medical records for 19 814 different patients from May 2015 to October 2017, including relatively complete information on physiology, biochemistry, treatment, examination, nursing, etc. And based on the database, the first First-Aid Big Data Datathon event, which 13 teams from all over the country participated in, was launched. The First-Aid database provides a reference for the construction and application of clinical database in China. And it could provide powerful data support for scientific research, clinical decision making and the improvement of medical quality, which will further promote secondary analysis of clinical data in our country.
Guideline implementation with decision support checklist (GUIDES) aims to assist the self-reflection of evidence-based clinical decision support system (CDSS) related professionals to enhance the process monitor and continuous improvement of evidence-based CDSS. This paper interpreted the development process, target user, and assessment method of GUIDES, analyzed the practical value of GUIDES through a typical example, and then reflected on the GUIDES and current studies on evidence-based CDSS in China. It is expected to provide references for future studies.
ObjectiveBased on the clinical data of patients with foot and ankle deformities in the QIN Sihe Orthopaedic Surgery Database, to analyze the characteristics and treatment strategies of foot and ankle deformities, and provide a basis for clinical decision-making. Methods A total of 22 062 patients with foot and ankle deformities who received orthopedic surgery between May 25, 1978 and December 31, 2020 were searched in the QIN Sihe Orthopedic Surgery Database. The gender, age at operation, regional distribution, etiology, type of deformity, operation method, postoperative fixation method, and other information were collected. Results Among the 22 062 patients, there were 13 046 males (59.13%) and 9 016 females (40.87%); the age at operation ranged from 1 to 77 years, with a median of 17 years, and 20 026 cases (90.77%) were aged 5 to 40 years. The patients came from 32 provinces, municipalities, and autonomous regions across the China and 5 countries including India and the United States, et al. The etiology and diseases type covered 154 kinds (of which sequelae of poliomyelitis, cerebral palsy, spina bifida and tethered spinal cord, congenital equinovarus foot, post-traumatic foot and ankle deformity, and Charcot-Marie-Tooth disease accounted for the highest proportion). The types of deformities included varus foot, equinus foot, valgus foot, talipes calcaneus, equinocavus, high arched foot, claw toe, and flail foot. Surgical methods included tendon lengthening, soft tissue release, tendon transposition, osteotomy orthopedics, and ankle arthrodesis. The 36 620 operations were performed, including 11 561 cases of hip, knee, and lower leg operations to correct the foot and ankle deformities. Postoperative fixation methods included Ilizarov external fixator in 2 709 cases (12.28%), combined external fixator in 3 966 cases (17.98%), and plaster or brace fixation in 15 387 cases (69.74%). ConclusionMale patients with foot and ankle deformities account for a large proportion, and the population distribution is mainly adolescents, with a wide distribution of regions, causes and diseases, and talipes equinovarus and varus foot are the main types of deformities. Foot and ankle deformities are often combined with deformities of other parts of the lower limb, which requires a holistic treatment concept. The application of foot soft tissue and bone surgery combined with Ilizarov external fixator and combined external fixators provides a guarantee for the correction of complex foot and ankle deformities.
Objective To summarize the classic and latest treatment techniques for localized knee cartilage lesions in clinical practice and create a new comprehensive clinical decision-making process. Methods The advantages and limitations of various treatment methods for localized knee cartilage lesions were summarized by extensive review of relevant literature at home and abroad in recent years. Results Currently, there are various surgical methods for treating localized knee cartilage injuries in clinical practice, each with its own pros and cons. For patients with cartilage injuries less than 2 cm2 and 2-4 cm2 with bone loss are recommended to undergo osteochondral autograft (OAT) and osteochondral allograft (OCA) surgeries. For patients with cartilage injuries less than 2 cm2 and 2-4 cm2 without bone loss had treatment options including bone marrow-based techniques (micro-fracture and ogous matrix induced chondrogenesis), autologous chondrocyte implantation (ACI)/matrix-induced ACI, particulated juvenile allograft cartilage (PJAC), OAT, and OCA. For patients with cartilage injuries larger than 4 cm2 with bone loss were recommended to undergo OCA. For patients with cartilage injuries larger than 4 cm2 without bone loss, treatment options included ACI/matrix-induced ACI, OAT, and PJAC. Conclusion There are many treatment techniques available for localized knee cartilage lesions. Treatment strategy selection should be based on the size and location of the lesion, the extent of involvement of the subchondral bone, and the level of evidence supporting each technique in the literature.
Objective To explore the use of ChatGPT (Chat Generative Pre-trained Transformer) in pediatric diagnosis, treatment and doctor-patient communication, evaluate the professionalism and accuracy of the medical advice provided, and assess its ability to provide psychological support. Methods The knowledge databases of ChatGPT 3.5 and 4.0 versions as of April 2023 were selected. A total of 30 diagnosis and treatment questions and 10 doctor-patient communication questions regarding the pediatric urinary system were submitted to ChatGPT versions 3.5 and 4.0, and the answers to ChatGPT were evaluated. Results The answers to the 40 questions answered by ChatGPT versions 3.5 and 4.0 all reached the qualified level. The answers to 30 diagnostic and treatment questions in ChatGPT 4.0 version were superior to those in ChatGPT 3.5 version (P=0.024). There was no statistically significant difference in the answers to the 10 doctor-patient communication questions answered by ChatGPT 3.5 and 4.0 versions (P=0.727). For prevention, single symptom, and disease diagnosis and treatment questions, ChatGPT’s answer scores were relatively high. For questions related to the diagnosis and treatment of complex medical conditions, ChatGPT’s answer scores were relatively low. Conclusion ChatGPT has certain value in assisting pediatric diagnosis, treatment and doctor-patient communication, but the medical advice provided by ChatGPT cannot completely replace the professional judgment and personal care of doctors.