To help better understanding on evidence-based medicine, five frequently asked questions relevant to evidence-based clinical practice were commented on. The questions included: 1. Dose evidence-based medicine only emphasize evidence and ignore clinical experiences? 2. Dose evidence only include randomized controlled trials and systematic reviews? 3. How to face the quality of evidence? 4. Is randomized evidence suitable for treating individual patient? 5. Is evidence-based medicine useless since there is no adequate evidence for many clinical questions?
To improve proper application of evidence in clinical practice．six relevant problems were reviewed．The problems included：① How to evaluate and use evidence from systenaatic reviews of randomized controlled trials?② How to evaluate and use evidence from randomized controlled trials?③ How to evaluate and use evidence from non—randomized controled trials?④ How to evaluate and use evidence from case series?⑤ How to evaluate and use expert opinions?⑥ How to evaluate and use chnical practice guidelines?
This article reviews the progress, problems and future development of evidence-based neurology; introduces sources of clinical evidence and evidence-based recommendations on some common neurological disorders from the Quality Standards Subcommittee of the American Academy of Neurology. It promotes high quality clinical research to provide good evidence and the use of current best evidence in patient care.
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.
To evaluate the effectiveness and safety of anticoagulants in ischaemic stroke primary or secondary prevention and treatment, we searched The Cochrane Library and MEDLINE to find high quality evidence and summarized the available evidence. The results showed that routine immediate anticoagulant therapy in patients with acute ischaemic stroke should not be recommended because it increased the risk of hemorrhage with ineffective reduction to the risk of death or disability. For the high risk group with cardiogenic embolism, anticoagulant therapy could safely and effectively reduce the incidence of stroke or other vascular events. However, for non-cardiogenic embolism group, anticoagulant therapy was hard to balance the benefits and harms.
Objective To explore whether there is enough clinical evidence to confirm that stereotactic aspiration does more good than harm in patients with cerebral hemorrhage. Method A systematic review of all relevant clinical studies on stereotactic aspiration in the treatment of cerebral hemorrhage. Results Eight randomized controlled trials (RCTs) including 757 patients and 17 nonrandomized controlled studies including 1 766 patients, as well as 20 uncontrolled studies including 1 244 patients were identified . All studies reported positive results regarding the effects. However, the quality of the included studies were generally poor. The main problem was that most trials reported them as a RCT, but no description of the method of randomization. Conclusions Stereotactic aspiration in the treatment of cerebral hemorrhage is promising based on present evidence. However, at present, we can not draw definite conclusion whether the treatment does more good than harm compared with noninvasive medical treatment because of the poor quality of included studies. Therefore, more high quality RCTs are required.
Hot flashes are a common syndrome in postmenopausal women. The treatment is complex and different for specific patients. A clinical case and hormonal replacement therapy selection are provided to show evidence-based practice in this field.
The application of dopamine agonists in Parkinson’s disease has been a hot topic in recent years. Can dopamine receptor agonists serve as the initial drugs for Parkinson’s disease? Does it improve the natural history of patients? Has it neuroprotective role? When and how to use dopamine receptor agonists? This article provides evidence on the pros and cons of dopamine receptor agonists in the treatment of Parkinson’s disease for helping clinical decision making.
In 2007, the findings from clinical trials on stroke treatment have been both encouraging and disappointing. In order to interpret the challenges and opportunity in evidence-based stroke practice, we reviewed several major clinical trials in stroke that were published last year. It revealed that we should strengthen the evidence base for acute stroke care by conducting more high-quality randomized controlled trials and by increasing the energy, resources and manpower available for these trials.
Objective To study the clinical characteristics of myotonic dystrophy. Method Patient records in West China Hospital, Sichuan University and China Biological Medicine Database (CBM-disc 1980-1999) were searched. Demographic data, clinical manifestations, laboratory findings of patients with myotonic dystrophy were analyzed. Results Of the total 97 patients, 64 cases were male, and 33 were female. Mean age was 28.5 years old. Ninety percent of patients had a family history. The frequency of symptoms in turn was myotonia (99%), muscle weakness (97%), muscle atrophy (85%), cataract (63%), hair losing or bald (57%) and gonadal atrophy (37%), sexuality disfunction (33%), heart damage (11%), intelligence impairment (11%), hypothyroid or disfunction of adrenal gland (8%), mental state disorders (8%). Conclusions In this group of patients, myotonia, muscle weakness and muscle atrophy were most common symptoms. In addition, some other systemic symptoms were common, such as cataract, hair losing, bald and gonadal atrophy. The clinical manifestations of myotonic dystrophy were complex.