The number of clinical guidelines developed and published in different countries is increasing worldwide. Too many guidelines do not remain in regular use, even though the aim is to implement them in clinical practice. The scientific validity and reliability of the guidelines need to be reviewed. Here is a case presented to show how to optimally use the evidence-based guideline to improve clinical decision making.
The core idea of comparative effectiveness research (CER) refers to "study in the real-world" which can be considered as the extension of evidence-based medicine. So far CER has arouse wide concern. CER includes many intervention trials and observational studies, including systematic reviews/meta-analyses, effectiveness randomized controlled trials, and registry trials. Database is an important platform for CER. CER has better feasibility and can provide useful evidence for "real-world" decision-making. However, it also has limitations such as difficult control of confounding factors. It still needs to be further studied due to its immature methodological base. CER has been already applied in some neurological fields, with internationally-recommended research priorities for CER in neurology.
Helicobacter pylori (HP) infection is closely associated with the occurrence of such common upper gastrointestinal diseases as chronic gastritis, peptic ulcer and gastric cancer. However, even with the currently most effective treatment regimens, approximately 10% to 20% of patients still fail to obtain eradication of the infection and remain HP positive. So the eradication of HP infection remains one of the major challenges in the medical field. This article aims to introduce the evidence for the choice of the second-line regimens after the failure of the first therapy. And the evidence includes the quadruple therapy proposed by the Maastricht III Consensus and the triple regimens with different antibiotics in all kinds of randomized clinical trials.
Objective To formulate an evidence-based treatment plan for a patient with type 2 diabetes and microalbuminuria. Methods According to the patient’s clinical conditions, we put forward 5 clinical problems. We searched the Cochrane Library (Issue 4, 2005), ACP Journal Club (1991 to 2005), and MEDLINE (1991 to 2005) databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of diabetic nephropathy were included. The treatment plan was developed accordingly. Results Thirteen eligible studies were included. Evidence indicated that an intensive intervention aimed at the multiple potential risk factors could be applied to delay or prevent the progression of diabetic nephropathy, which included intensive blood glucose control, tight blood-pressure control, lipid modulation, restriction of protein intake and smoking cessation. The individualized treatment plan was based on the high quality evidence as well as the patient’s specific condition. The patient is still being followed-up. Conclusion Interventions for risk factors of type 2 diabetes like changing living style, decreasing serum glucose, blood pressure, and level of blood fat help to release the clinical symptom and better the long-term living quality of patients.
Objective To analyze the research status and development trend of evidence-based social sciences, and to explore the synergistic relationship among branches of various fields. Methods A comprehensive search for research related to evidence-based social sciences published between the establishment of the database and September 2022 was conducted on the Web of Science, China Science Citation Database (CSCD), and Chinese Social Sciences Citation Index (CSSCI). The VOSviewer software was used to analyze the author and keywords and to perform the visualization. Results A total of 6 969 papers were included, 195 of which were in Chinese. The first paper, published in 1995, was on evidence-based management. The number of papers published on evidence-based social science research presented a trend of increasing continuously. The country with the most papers published was the United States; the institution outside China with the most papers published was McMaster University; and the institution in China with the most papers published was Sichuan University. The analysis of keywords showed that evidence-based policy, evidence-based practice, evidence-based management, and evidence-based decision-making appeared more frequently; research questions focused on evidence-based health policy development, application of big data in the context of COVID-19, evidence of climate change-induced disease, and real world research. Conclusion All the fields of evidence-based social sciences are closely related to each other in terms of research content and methods, and it presents a multi-level and multi-field crossover with evidence-based medicine. However, evidence-based social sciences in China are still in their infancy. Therefore, it is necessary to improve the methodological system of evidence-based social sciences, enrich the research content of social sciences, speed up the filling of evidence gaps in various fields, and promote the improvement and sustainable development of evidence-based social sciences.
This is the second paper in the evidence-based medicine glossary series. It provides information on the principles for evidence-based medicine through definitions, criteria for inclusion and screening, regular flow-sheet, reporting format and the establishment of databases.
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.
Clinical efficacy evaluation is important for the development of traditional Chinese medicine (TCM). In view of the existing accumulation and current situation of the TCM clinical efficacy evaluation, based on the international perspective, and taking the rational and objective evaluation of TCM clinical efficacy and safety as the foundation, in order to enhance TCM evidence level to support clinical decision-making and promote TCM industry and TCM internationalization development, the State Administration of TCM entrusted China Academy of Chinese Medical Sciences to establish China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM). CCEBTCM is expected to optimize the allocation of evidence-based research resources in TCM field to further integrate advantages of evidence-based TCM research teams, promote consensus on evidence-based TCM standards, share evidence-based TCM data or information and lead cultural exchanges between Chinese and overseas. In this way, the status and influence of TCM in the world will be enhanced so that it can better serve global health.
Objective To make an individulized treatment plan for a patient with locally advanced non-small cell lung cancer (NSCLC). Methods After clinical problems were put forward, evidence was collected from http://www. nccn.org. The Cochrane Library (Issue 4, 2008), Medline (PubMed 1990. 1-2008.11) and CHKD periodical database were searched. Results A total of 21 RCTs, 5 systematic reviews and 13 CT phase Ⅲ trials were identified. A rational treatment plan was made upon a serious evaluation of the data. After nine monthes of follow-up, the plan was proved optimal. Conclusion For locally advanced NSCLC patients, an individulized treatment plan made by evidence-based methods not only can inprove the treatment efficacy but also can lead both of doctors and patients to assume the indeterminateness of medicine.
Archibald Leman Cochrane（1909 to 1988）was a physician and clinical epidemiologist from the UK. The basic theroy of evidence-based medicine was established because of his influential book, Effectiveness and Efficiency: Random Reflections on Health Services published in 1972. The randomized controlled trial and systematic review promoted by Archie has become the key stone of evidence-based medicine. He was known as one of the forefathers of evidence-based medicine because of his outstanding contribution. In commemoration of Arichie Cochrane, The Cochrane Collaboration was named after him. His legendary life story and the early stages of the development of evidence-based medicine are introduced in this article.