Objective To evaluate the published case-reports of evidence-based practice(EBP) over three years,and to improve the quality of the papers and provide a recommended writing model. Methods Collecting the published 20 case-report of EBP and assessing their writing quality in 5 aspects according to the steps of EBP. Results Many Abstracts did not reflect entire context, and convey the overall information to readers, a formative structured Abstract should be taken. Most case-reports only involved with therapy,few diagnostic,harm and prognostic case-reports were republished,few EBP of surgery and other specialties, such as ENT,ophthalmology were mentioned.Searching strategies were not sufficiently described.Most authors only search The Cochrane Library and PubMed,while predigested sources were seldom used.Critical appraisal of evidence was difficult to each author,most papers were lack of appraisal or simply evaluated the validity of used evidence,and applicability of evidence was not clearly explained.All the papers did not conduct post evaluation.Conclusions Much needs to be done in improving the quality of published case-reporters of EBP,a standardized writing model should be recommended.
This paper is to reveal how the traditional practice is being challenged by evidence-based medicine and it also indicates where does the best evidence come from, how to find and classify them. This paper will also show the clinicians how to practice evidence-based medicine, especially in the treatment of respiratory disease in a step by step fashion. Finally this paper will guide the Chinese physicians how to solve the commonly confronting problems in practicing evidence-based medicine.
Objective To search and review the best clinical evidence to direct the use of ultrasound. Methods After developing clinical questions, we searched the following databases for evidence: PROQUEST (1984 to 2004), SUMSEARCH (1980 to 2004) and The Cochrane Library (Issue 4, 2004). The key words were “repeated ultrasound exposure and children development (outcome)”. Results We found 3 systematic reviews, 3 randomized controlled trials, 1 cohort study and 1 case-control study. Most of the trials concluded that the effects of ultrasound to fetus were to be identified, some of the trials showed that ultrasound exposure could have an effect on fetus growth and language ability after delivery. Conclusions The pregnant women should avoid ultrasound as much as possible.
To assess the efficacy and safety of thrombolytic therapy. Electronic search was applied to the Cochrane Airways Group register (MEDLINE, EMBASE, CINAHL standardized searches) with the date up to 2003 April. Hand searched respiratory journals and meeting abstracts. All randomized controlled trials comparing thrombolytic therapy with heparin alone or surgical intervention (eg. embolectomy) met the inclusion criteria. Two reviewers independently selected trials, assessed trial quality and extracted the data.
Through searching and evaluating the evidence on advanced prostate cancer, we found that different types of androgen deprivation had similar effect, and immediate androgen deprivation had survival benefit. For the patient with hormone-refractory prostate cancer, therapies including mitoxantrone, prednisone, docetaxel and surmine were more effective. Strontium-89 provided more effective pain relief than external beam radiation. And bisphophonate had no effect. Antiandrogen withdrawal suggested prostate specific antigen would decline, but the clinical outcome wasn’t reported.
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.