Are case reports valuable?Exploring their role in evidence based medicine and patient care

Case reports,often overlooked in evidence-based medicine(EBM),play a pivotal role in healthcare research.They provide unique insights into rare conditions,novel treatments,and adverse effects,serving as valuable educational tools and generating new hypothesis.Despite their limitations in generalizability,case reports contribute significantly to evidence-based practice by offering detailed clinical information and fostering critical thinking among healthcare professionals.By acknowledging their limitations and adhering to reporting guidelines,case reports can contribute significantly to medical knowledge and patient care within the evolving landscape of EBM.This editorial explores the intrinsic value of case reports in EBM and patient care.

Preceptors'experiences in guiding nursing students to use research findings and to implement evidence-based practice

Objective:Evidence-based practices(EBPs)have been taught to students by identifying the best evidence/evidence from research results.However,the experiences of Indonesian nurse preceptors in helping students implement research findings have not been explored thoroughly.This study aimed to explore Indonesian nurse preceptors in guiding nursing students to use research findings.Methods:This study used interpretive phenomenology analysis that involves 9 nurse preceptors from hospitals in West Kalimantan,Indonesia.Semi-structured in-depth interviews were recorded and then transcribed verbatim.Results:Three themes were generated during the analysis:“types of student supervision,”“issues during supervision,”and“the need for research literacy and supervision.”Conclusions:Nurse preceptors need support to supervise the nursing students to use research findings.In addition to upgrading nursing skills,nurse preceptors must receive training in research and its utilization.Developing an appropriate strategy to assist students in using research findings will enhance the promotion of evidence-based nursing practices on a daily basis.

Evidence-Based Nursing Practice of Reducing Immune-Related Skin Toxicity of Tumor Patients Guided by Sensitive Indicators

Purpose research on nursing sensitive indicators in tumor Patients application effect in immune-related skin toxicity management. Method select our hospital April to June, 202360 cases patients with immune therapy settings as the control group. August-October, 2023 60 cases the patients treated with immune therapy were the experimental group. The control group adopted regular nursing methods, while the experimental group sensitive Indicators, evidence-based give preventive care. The social situation, psychological state, physical function, quality of life score, incidence of skin toxicity caused by immune checkpoint inhibitors, moderate and above of the two groups of patients were compared. Incidence of skin toxicity. Result: experience group SAS score, SDS score higher than the control group, the difference was statistically significant (P < 0.05);The incidence of skin toxic reactions caused by immune checkpoint inhibitors and the incidence of moderate and above skin toxic reactions in the experimental group are lower than those in the control group, and the difference is statistically significant (P < 0.05). Conclusion: sensitive indicator guidance evidence-based preventive care can reduce the degree of immune-related skin toxicity, improve the psychological state and quality of life of tumor patients treated with immune therapy and reduce the incidence of adverse reactions, improve nursing quality and patient satisfaction.

Clinical Practice of Evidence-Based PDCA Cycle Management Model in Accelerated Recovery of Lung Cancer Patients

Objective: To explore the nursing effect of evidence-based PDCA cycle management mode in accelerated rehabilitation of patients undergoing thoracoscopic lung cancer radical surgery. Methods: 104 patients who underwent thoracoscopic lung cancer radical surgery in our hospital from June 2022 to February 2023 were randomly divided into control group and intervention group, with 52 cases in each group. The control group implemented evidence-based ERAS clinical pathway management, while the intervention group implemented evidence-based PDCA cycle quality management. The postoperative recovery of the two groups of patients was compared. Results: The postoperative recovery of the intervention group was significantly better than that of the control group. The first time to get out of bed, the first time to eat, the duration of chest drainage tube placement, and the length of hospital stay were significantly shorter than those of the control group. The incidence of postoperative chest complications and hospitalization costs were significantly lower than those of the control group, and patient satisfaction was significantly higher than that of the control group (P Conclusion: Evidence-based PDCA cycle quality management mode can effectively improve the implementation quality of accelerated rehabilitation nursing for patients undergoing thoracoscopic lung cancer radical surgery, and it is worthy of clinical promotion.

Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

循证医学(Evidence-based Medicine)——临床研究与实践的新时代

80年代以来的大规模、随机、双盲、多中心、安慰剂对照临床试验证明,以经验和推论,如以一些临床化验指标为依据的传统临床试验不能反映病人的长期预后。为了对新药和已上市药物作出恰当的评价,应当从所谓“众说纷坛”转向注重和评价病人预后,包括总死亡率、重要心脑血管事件、生活质量、卫生经济学等的“循证医学”。反过来,“循证医学”和临床治疗指南的发展将对新药的研究与开发、医生的临床实践、药物经济学、医疗保健服务决策等带来积极和正面的影响。

Evidence-Based Medicine Research on Prescriptions in Synopsis of the Golden Chamber in the Treatment of Pelvic Inflammatory Disease

Purpose: Based on the National Natural Science Foundation of China, we collect and sort out the literature published in approximately the last 30 years, which use prescriptions in Synopsis of the Golden Chamber to treat pelvic inflammatory disease (PID). This study provides theoretical basis for the treatment of PID;we recommend this achievement to colleagues. Method: Firstly, we searched and collected the literatures from last three decades in CNKI, Wanfang and VIP databases, which are about classical prescriptions treating endometriosis. Then, by screening all the literatures, we obtained the clinical research literatures and individual case reports. Finally, we went through the internal quality of the two categories of literatures to get the dominant prescriptions. Using a retrospective study of evidence-based medicine research, we comprehensively collect literature, standardize the disease spectrum, classify the evidence, and then evaluate the internal quality. Results: We refine 4 prescriptions which commonly are used in the treatment of PID;in other words, they are also the clinical symptoms of PID: Gui Zhi Fu Ling Wan symptom, which manifests blood stasis and cold-damp stagnancy;Dang Gui Shao Yao San symptom, which manifests disharmony of liver and spleen, qi-blood stasis and damp obstruction;Da Huang Mu Dan Tang symptom, which manifests the gathering toxic heat and qi-blood stasis;Yi Yi Fu Zi Bai Jiang San symptom, which manifests the internal toxic heat and qi-blood injury. Conclusion: This study is gospel for the patients with recurrent episodes of PID who can’t often use antibiotics. At the same time, it is also a green therapeutics which Chinese ancients dedicated to human medicine.

Traditional Chinese Medicine as a Treatment for Rheumatoid Arthritis:From Empirical Practice to Evidence-Based Therapy

Rheumatoid arthritis(RA)is a common autoimmune condition with an elusive etiology.Conventional and biological disease-modifying drugs sometimes fail or produce only partial responses.Traditional Chinese medicine(TCM)has long been used in China as a treatment for RA and is achieving everincreasing acceptance worldwide.TCM treatments are traditionally guided by the theory of treatment based on TCM syndrome differentiation;however,they remain a matter of empirical practice relying on TCM theories and doctors’own experience,which places severe restrictions on worldwide TCM application.Nevertheless,TCM is a treasure trove for drug discovery,particularly as a treatment for complicated human conditions.The discoveries of artemisinin as a treatment for malaria and of TCM–arsenic trioxide(As2O3)combination therapy as a treatment for acute promyelocytic leukemia(APL)are excellent examples of the great value of TCM.Regarding RA treatments,many Chinese medicinal herbs and their formulas,extracts,ingredients,and even single compounds have been used in clinical applications.Several Chinese proprietary medicines(CPMs)derived from TCM formulas or herbal bioactive components,such as the controlled-release ZhengQingFengTongNing(ZQFTN)Tablets,Tripterygium Glycoside Tablets,and Total Glucosides of Peony(TGP)Capsules,have been included in the National Health Insurance Directory of China,and show comparable therapeutic efficacies to those of western chemical drugs with fewer side effects.As TCM research has advanced,particularly in the use of multidisciplinary technologies,the scientific foundations and characteristics of the use of TCM to treat RA have been revealed,and the quality of TCM treatments have been increasingly enhanced.However,TCM generally lacks sufficient clinical and laboratory data to be consistent with international standards for quality,safety,and efficacy in order to support its application worldwide.Therefore,intensive basic and clinical studies on TCM are required.In particular,investigations that use cutting-edge technologies in analytical chemistry,biology,and biomedical sciences,and the development of randomized clinical trials(RCTs)and personalized pragmatic randomized controlled trials(PPRCTs)are necessary.Researchers should also collaborate to advance TCM from empirical practice to evidence-based therapy,thus consistently promoting TCM development and globalization in a vital,beneficial,and contributable manner.

Methodological exploration on the construction of a traditional Chinese medicine nursing expert consensus based on evidence--taking stroke as an example

Objective: To explore the methodology of the evidence-based expert consensus formulation process of traditional Chinese medicine(TCM) nursing taking stroke as an example.Methods: First, preliminary and comprehensive presentation of all stroke-related symptoms and corresponding TCM nursing techniques involved were revealed through bibliometric analysis. Then, selection of stroke symptoms and TCM nursing techniques for inclusion in the consensus was performed using an expert consultation method. Next, we determined the search strategy for a precise evidence search;conducted an evaluation of evidence quality and the grade of the evidence;and completed evidence extraction, evidence analysis, and evidence synthesis based on the included symptoms and TCM nursing techniques. The Delphi method was then applied to determine the strength of each recommendation and the choice of nursing care points by referring to the Grading of Recommendations, Assessment, Development, and Evaluations grid. Finally, we conducted an external expert validation of the Delphi results to form an expert consensus guideline.Results: Through the bibliometric analysis, 22 stroke symptoms and 18 TCM nursing techniques were identified in the literature. Then, after expert consultation, 22 symptoms and 111 pairs of symptoms combined with TCM nursing techniques were selected for the evidence search. Evidence integration yielded 10 stroke symptoms corresponding to 29 bodies of evidence;these 10 symptoms were retained through the Delphi consultation, and recommendation strength results for 26 recommendations were obtained. A total of 9 symptoms were further retained for expert external validation to form 24 recommendations, with a recommendation process score range of 7.64-9.99 points and a more scientific and standardized recommendation-formation process.Conclusion: Owing to the current limited conditions of evidence-based resources for TCM nursing, the present consensus-building process represents only a preliminary exploration of an evidence-based expert consensus for TCM nursing to provide a reference for a more scientific and standardized methodology.

Homogenization Construction of Three-Level Teaching Bases for General Practice Medicine Under the Internet+Model

With the continuous expansion of medical student enrollment,the number of clinical teaching bases is gradually increasing.However,there are significant differences in clinical teaching management models and teaching levels among different bases.Most clinical teaching bases have incomplete teaching management systems,inadequate teaching management institutions,insufficient teaching personnel,and inadequate implementation of teaching rules and regulations.This article combines the construction practice of three-level clinical teaching base of the General Medicine College and the First Affiliated Hospital of Xi’an Medical University.We establish a standardized management system for the three-level clinical teaching base;implement a teaching supervision system and strengthen the monitoring of teaching quality;adopt multiple evaluations to test the effectiveness of clinical teaching implementation;explore the path of homogenization construction of teaching bases in terms of unified teacher training,promoting the development of teacher teaching abilities with equal quality and excellence,and providing a reference for improving the quality of medical talent training.

Calling into Question the Efficacy of Evidence-Based Medicine: Is It Always the Best Approach? Is That Really the Placebo Effect?

The techniques of evidence-based medicine (EBM) are being frequently used recently. The generally accepted theory is that if a medicine is not absorbed by the body, it will have no effect. However, the author has noticed that even when substances, including medicines, are not absorbed by the body, they can have a marked effect. In some cases, just bringing the substance close to the body can have an effect;in such cases, the efficacy of EBM for estimating the therapeutic value of medicines may be debatable. Therefore, a more accurate evaluation method should be devised. The author proposes that another group be introduced into trials. This group would include subjects who were exposed to but did not have an opportunity to absorb the medicine being tested.

EVIDENCE-BASED MEDICINE AND THE CLINICAL STUDY ON ACUPUNCTURE AND MOXIBUSTION

In this article, the authors hold that the evidence based medicine(EBM) is a new medical action produced at the historic moment in clinical practice, which is promoting development of the medicine and even the whole life science in a fully new train of thought and method. Further the briefly introduced contents are the effect of EBM, the difficulty of utilizing in the acupuncture clinical practice and how to resolve them. It is highly recommended that the doctors of the acupuncture science field should study EBM and its effect and difficulties in practice as earlier as possible, insistently assimilate new knowledge and keep abreast of the times’ progress to facilitate the further development of acupunctology.

Evidence based medicine:clinical trials that guide the management of ST-elevation myocardial infarction of elderly patients

Cardiovascular disease is the most frequent diagnosis in elderly people and is the leading cause of death in both men and women older than 65 years. Every year in the United States more than 700,000 patients arrive at the emergency room with ST-segment elevation myocardial infarction(STEMI). About 60 percent of hospital admissions for AMI are of people older than 65 years. Their in-hospital, 1-month,and 1-year mortality is high. 1 In this article, we will provide a review on clinical trials that guide the management of STelevation myocardial infarction of the elderly patients.……

COVID-19: Off-label therapies based on mechanism of action while waiting for evidence-based medicine recommendations

The world pandemic due to coronavirus disease 2019,known as COVID-19,embodies a high rate of disease transmission that causes a critical hospitalization overload.As of May 15,2020,the disease has been the cause of more than 4 million infections and more than 280000 deaths all over the world.At the beginning,we underestimated the disease;now,we have sufficient information and it is clear that it is not just a respiratory disease.In fact,if a prompt treatment is not initiated,the disease may evolve towards an abnormal immune response and cytokine storm with an important thrombophilic pattern.Therefore,we think that while waiting for certainties to be established by evidence-based medicine,it is not ethical to not try off-label therapies for some of the well-known drugs,as they could have some efficacy based on their mechanisms of action.

Research in spinal surgery: Evaluation and practice of evidence-based medicine

Evidence-based medicine(EBM) is a common concept among medical practitioners, yet unique challenges arise when EBM is applied to spinal surgery. Due to the relative rarity of certain spinal disorders, and a lack of management equipoise, randomized controlled trials may be difficult to execute. Despite this, responsibility rests with spinal surgeons to design high quality studies in order to justify certain treatment modalities. The authors therefore review the tenets of implementing evidencebased research, through the lens of spinal disorders. The process of EBM begins with asking the correct question.An appropriate study is then designed based on the research question. Understanding study designs allows the spinal surgeon to assess the level of evidence provided.Validated outcome measurements allow clinicians to communicate the success of treatment strategies, and will increase the quality of a given study design. Importantly,one must recognize that the randomized controlled trial is not always the optimal study design for a given research question. Rather, prospective observational cohort studies may be more appropriate in certain circumstances, and would provide superior generalizability. Despite the challenges involved with EBM, it is the future of medicine. These issues surrounding EBM are important for spinal surgeons, as well as health policy makers and editorial boards, to have familiarity.

The Downsides of Evidence-Based Medicine

There exist problems in the actual evidence-based in the practice of medicine relating to the time available and the stringent algorithms employed by the attending physicians. The mistakes are often serious. Illustrating clinical examples are given as to how things can go wrong under the pressure baring on clinicians by the factors given.

Palliative radiotherapy for bone metastases from lung cancer: Evidence-based medicine?

To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy(EBRT) for bone metastases(BM) from lung cancer were sought via literature search(2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter(range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impendingpathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.

Evidence-Based Medicine Research on Shanghan Zabing Lun Prescriptions in the Treatment of Endometriosis

Objective: Adopting the methods of Evidence-based Medicine research to acquire the dominant prescriptions of Shanghan Zabing Lun in the treatment of Endometriosis, meanwhile to fully dig the value of classical prescriptions. Method: Firstly, we searched and collected the literatures from last three decades in CNKI, Wanfang and VIP databases, which are about classical prescriptions treating endometriosis. Then, by screening all the literatures, we obtained the clinical research literatures and individual case reports. Finally, we went through the internal quality of the two categories of literatures to get the dominant prescriptions. Results: 22 Shanghan Zabing Lun prescriptions have been used in the treatment of endometriosis. According to the clinical research and case literatures, Guizhi Fuling Wan is the prime prescription to treat endometriosis with high quality and high frequency. Conclusions: Through evidence-based medical research and evaluation of evidence, it can be seen that treatment of endometriosis presents a certain tendency that Guizhi Fuling Wan, Wenjing Decoction and Dahuang Zhechong Wan have good clinical effect treating endometriosis and their syndromes are well matched with the symptoms of endometriosis in the present clinical environment.