Testing Treatments is a book to help the public understand how to validate the efficacy of testing treatments and the possible bias and error in clinical trial, as well as to call for help to promote good study thus to improve the quality of health care. No matter for the first or the second edition, this book is very popular around the world, and its second edition has been translated into more than ten languages. To help the readers understand the content of the book, we established a website (www.testingtreatments.org) and other sibling sites in different languages. The website not only provided the full-texts to download, but also collected various popular science resources (videos, audios and cartoons) to help the readers assimilate more knowledge. The editors of all the different language websites have established an TTi Editorial Alliance to share experience and provide each other with mutual support, thus to promote health professionals, patients and public around the world to use reliable research to inform their health decisions.
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”
In combination with the national health informatization construction in UK during the past ten years, this article introduced the resource construction of decision making knowledge library like British Electronic Medicine Library Clinical Pathway Database and NHS Evidence, as well as the function and application of clinical decision support system (CDSS) like PRODIGY, medical knowledge map and so on, discussed the development characteristics and construction experiences of British health decision support system (HDSS). And aiming directly at Chinese specific circumstances, this article offered some suggestions on promoting China HDSS development, for instance, dynamically integrating CDSS with patients’ diagnosis and treatment procedure through the electronic medical record system, strengthening the resources construction of knowledge library, establishing localized clinical pathway, and so on.
ObjectiveTo investigate the status of knowledge, attitude, and practice of patient identification in nurses, and provide a basis for clinical managers to carry out targeted training.MethodsA total of 3 696 nurses of tertiary, secondary, and primary hospitals in Guizhou Province were recruited and investigated for the status of knowledge, attitude, and practice of patient identification with a questionnaire by using convenient sampling in May 2019.ResultsThe scores of identification knowledge, attitude, and practice of the 3 696 nurses were 47.87±6.10, 27.39±3.15, and 57.19±4.86, respectively. Logistic regression analysis showed that the higher the educational level was, the higher the score of nurses’ knowledge of patient identification was [odds ratio (OR)=1.592, 95% confidence interval (CI) (1.084, 2.338), P=0.018]; the higher the personal monthly income was, the more positive the nurses’ attitude towards patient identification was [OR=1.570, 95%CI (1.005, 2.453), P=0.048].ConclusionsThe general situation of patient identification in nurses is good, but there are still differences among nurses with different characteristics. It is suggested that managers should pay special attention to the training of nurses with low educational level and low income, make them master the knowledge of patient identification, at the same time, improve their enthusiasm and standardize their behavior, so as to ensure the safety of patients.
Objective To learn the impact of health education on schistosomiasis among high school students in Wanzhou area of Three Gorges Reservoir, and to evaluate its effects. Methods The stratified multi-level cluster randomized sampling was used to survey 566 high school students in Wanzhou and Yunyang areas, and the questionnaire was used to investigate their recognition of schistosomiasis. Results After one-year health education on schistosomiasis, the passing rate of the knowledge about schistosomiasis prevention among high school students in demonstration area raised from 9.43% to 98.87% (χ2=463.46, P=0.000), which was higher than that of the inside and outside control areas (χ2=312.92, P=0.000); the passing rate of the attitude and belief of schistosomiasis prevention were 98.12%, which was higher than that of the inside and outside control areas (χ2=109.49, P=0.000); 56.02% of high school students in demonstration area had no susceptible behavior of schistosomiasis, which was higher than that of the inside and outside control areas (χ2=237.53, P=0.000). Conclusion Health education on schistosomiasis can efficiently improve the awareness of schistosomiasis prevention among high school students, and has important meanings for controlling potential epidemics and spread of schistosomiasis in Wanzhou area of Three Gorges Reservoir.
Glaucoma is one of blind causing diseases. The cup-to-disc ratio is the main basis for glaucoma screening. Therefore, it is of great significance to precisely segment the optic cup and disc. In this article, an optic cup and disc segmentation model based on the linear attention and dual attention is proposed. Firstly, the region of interest is located and cropped according to the characteristics of the optic disc. Secondly, linear attention residual network-34 (ResNet-34) is introduced as a feature extraction network. Finally, channel and spatial dual attention weights are generated by the linear attention output features, which are used to calibrate feature map in the decoder to obtain the optic cup and disc segmentation image. Experimental results show that the intersection over union of the optic disc and cup in Retinal Image Dataset for Optic Nerve Head Segmentation (DRISHTI-GS) dataset are 0.962 3 and 0.856 4, respectively, and the intersection over union of the optic disc and cup in retinal image database for optic nerve evaluation (RIM-ONE-V3) are 0.956 3 and 0.784 4, respectively. The proposed model is better than the comparison algorithm and has certain medical value in the early screening of glaucoma. In addition, this article uses knowledge distillation technology to generate two smaller models, which is beneficial to apply the models to embedded device.
Objective To learn and analyse the current clinicians’ knowledge and attitudes towards patient safety, and to provide relevant evidence for future medical education. Method We conducted a survey on clinicians mainly in West China Hospital of Sichuan University with group random sampling method. We analysed the data on the clinicians’ knowledge and attitudes with SPSS softerware. Result Totally 300 questionnaires were distributed, of which 258 were completed adequately. The results showed the clinicians’ knowledge on patient safety was poor, however, the respcnse from the clinicians in Outpatient Department were better than those in Inpatient Department. The majority of the clinicians (above 95.00%) were willing to learn the knowledge of patient safety. Conclusion As the clinicians are willing to learn the knowledge of patient safety positively, it is necessary to integrate patient safety education into the current medical education curriculum.
Objective To learn and evaluate the effect of health education of schistosomiasis in the Three Gorges Reservoir Area, so as to provide scientific basis for establishing the comprehensive prevention and control model in potential epidemic area of schistosomiasis. Methods Through adopting the multi-stage stratified cluster sampling method, the questionnaires were distributed to residents selected randomly from the demonstration, inside and outside control areas. The survey data were input with EpiData 3.0 software by two reviewers, and the differences among groups were analyzed by using SPSS 18.0 software to further evaluate the effect of health education of schistosomiasis. Results All the questionnaires distributed to 1 420 residents were retrieved (100%). The results of analysis showed that for the residents in the demonstration area, the average score of being aware of schistosomiasis prevention was (7.51±2.89), which was markedly higher than those in the inside (2.52±2.97) and the outside (3.13±3.51) control areas, with significant differences (Plt;0.05); and the passing rates were 78.15%, which was also obviously higher than those in the inside (17.26%) and the outside control areas (32.16%), with significant differences (Plt;0.05). Conclusion The health education of schistosomiasis can improve residents’ knowledge about schistosomiasis prevention, and it is very important to prevent and control the potential prevalence of schistosomiasis in the Three Gorges Area.
Objective To evaluate the control status and knowledge level about disease in asthmatic patients in hospitals of different grades in Gansu province, and provide a basis for proposing a work plan forprevention and treatment of asthma in Gansu province.Methods We performed a questionnaire investigation in a face-to-face manner in asthmatic patients from hospitals of three different grades, which included a grade 3A hospital, a grade 3B hospital, and a grade 2A hospital.Results A total of 542 asthmatic patients were investigated. The percentage of complete controlled, well controlled and uncontrolled were 3. 5% , 16. 9% and 79. 5% respectively. The rate of complete controlled was low in three hospitals without significant difference ( 3. 6% , 3. 4% , and 3. 3% , respectively) . The rate of well controlled in the grade 3A and 3B hospitals was higher than that in the grade 2A hospital ( 20. 4% and 18. 3% vs. 8. 2% ,P lt;0. 05) . 41. 4% of the respondents had been hospitalized for exacerbation in the past one year, and the rate was higher in the grade 2A hospital than that in the grade 3A and 3B hospitals ( 58. 2% vs. 31. 8% and 42. 9%, P lt;0. 01) . 46. 9% of the patients had visited the emergency department, and the rate was higher in the grade 2A hospital than that in the grade 3A and 3B hospitals ( 63. 9% vs. 41. 6% and 42. 3% , P lt;0. 01) . 23. 6% of the respondents had underwent lung function test follow-up during the past one year, andthe rate in the grade 3A hospital was higher than that in the grade 3B and 2A hospitals( 79. 2% vs. 44% and 40. 2%, P lt;0. 01) . Only 2. 8% of the patients in the grade 3A hospital had used peak flowmeter regularly.There were 19. 7% of the patients received a long-term treatment plan by specialists, and the rate in the grade 3A and 3B hospitals was higher than that in the grade 2A hospital ( 22. 4% and 21. 7% vs. 11. 5% ,P lt;0. 05) . 30. 6% of the respondents insisted on using inhaled corticosteroid ( ICS) or combination of ICS and long acting β2 -agonist ( ICS/LABA) , and the rate was higher in the grade 3A and 3B hospitals than that in the grade 2A hospital ( 33. 9% and 32. 6% vs. 21. 3% , P lt;0. 05) . 27. 7% of the patients had used the theophylline drugs regularly, and there were no significant differences in three hospitals. 30. 3% of the patients did not used the drugs regularly, and most of these patients were from the grade 2A and 3B hospitals ( 54. 1% and 32. 9% respectively) . 11. 4% of the patients has used antibiotics, herbal medicine or other drugs. And most of these patients were from the grade 2A and 3B hospitals ( 50% and 30. 6% respectively) . 26. 2% of the patients believed that asthma is an inflammatory disease. 51. 3% of the patients selected ICS ( or ICS/LABA) as the first line medicine, and the rate in the grade 3A hospital was higher than that in the grade 3B and 2A hospitals ( P lt;0. 05) . Only13. 1% -14. 7% of the patients attended the lecture about asthma in hospitals in the past one year, and the rate in the grade 3A hospital was thehighest, but the difference was not significant. Conclusions The lack of the awareness, the poor control, and the non-standardized treatment and management of the disease are the main obstacles in the control of asthma in Gansu province, especially in township hospitals.
Objective To evaluate the control status and knowledge level about disease in asthmatic patients in region level cities of Shaanxi province for effect appraisal of patient education. Methods Eight hospitals were selected from six region level cities, where questionnaire survey was completed in out-patients with asthma ( ≥14 years old) . Results A total of 523 patients completed the questionnaire with a ratio of male to female of 1∶1. 14, and an average age of ( 44. 3 ±15. 5) years old. The percentage of controlled,partly controlled and uncontrolled by self-evaluation was respectively 26. 4% , 52. 4% and 11. 1% . 48% insisted on using inhaled corticosteroids ( ICS) . The average score was 17. 88 ±4. 43 by asthma control test ( ACT) . The first three medicines used daily were ICS ( 26. 6% ) , sustained-release theophyline ( 25. 2% )and combination ICS/ long-acting β2 -agonists ( 21. 8% ) . 12. 6% had no medicine and 5. 2% used nonorthodox medicines. 68. 6% patients had omen before exacerbation, and those were sneezing, chest distress and cough. 73. 6% knew asthma is a disease of airway inflammation, and 33. 3% selected ICS as the leader medicine. Only 32. 1% attended the lecture about asthma in hospitals and 85. 0% longed for such education. Conclusions The control status and knowledge level about disease in asthmatic patients in cities still need to be improved in Shaanxi province, and too much work need to be done in order to realize the total control in all patients.