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”
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.
Objectives To evaluate pulmonary physicians’knowledge level about prevention and treatment of chronic obstructive pulmonary disease( COPD) in some urban areas in China. Methods A total of 258 pulmonary physicians were interviewed face-to-face in 24 hospitals from July to October in 2006. The questionnaire included the knowledge of COPD, prescriptions at initial visit and follow-up, pulmonary function test monitoring, assessment and intervention in stable COPD, knowledge and evaluation of the commonly used medicines, the effects of smoking cessation and adopted measures, as well as the knowledge of treatment prospects and patients’ education. Results Eighty-eight percent of pulmonary physicians considered themselves knowledgeable on COPD, and 95% were familiar with the severity classification. Most of them knew about GOLD and Chinese Guideline of Prevention and Treatment to COPD, and paid attention to chest X-ray and pulmonary function test during diagnosis. The standards in evaluation of stable COPD patients were not well understood, and 92% of physicians claimed for pulmonary function test in stable stage. Seventy-nine percent of physicians actively suggested the patients quit smoking. The prescription for COPD patients at iniative and maintenance therapy met the guideline on the whole, but the mucolytic agents were appreciated too much and used too frequently. Thirty-three percent of physicians took it necessary to treat stable COPD,and 69% believed that pharmacotherapy for stable COPD could rersult in satisfactory quality of life.Conclusions In some big cities in China, the pulmonary physicians have good knowledge about COPD. But long-term prevention and intervention, especially in pharmacotherapy, are still unsatisfactory.
ObjectiveTo investigate primary healthcare workers' knowledge, attitude and behaviour, and explore the way of guidelines' popularization, application and surveillance mechanism in primary healthcare institutions. MethodsHealthcare workers in seven township hospitals in Gaolan county, Gansu province were given a questionnaire to test their knowledge, attitudes and behaviour regarding Clinical practice guidelines. ResultsAmong the 143 distributed questionnaires, 143 valid were retrieved. The results showed that 80% of respondents knew the guidelines and 51% had used guidelines in treatment, 32% obtained guidelines mainly through distribution by affiliations. The most popular type of guidelines was self-developed by native departments. Respondents (37%) considered difficult availability of guidelines major barriers to popularization, 74% failed to receive training about guidelines, 88% looked forward to special organizations in charge of disseminating guidelines and conducting related training on how to apply guidelines. ConclusionPrimary healthcare workers report low awareness of, attention to and compliance with clinical practice guidelines. The greatest challenge for guidelines' popularization in township hospitals is difficult availability and it is of vital importance for primary institutions to enhance guidelines' implementation and strengthen learning and conduct training.
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 knowledge related to evidence-based medicine (EBM) in the medical students of Hubei University of Medicine using a cross-sectional survey approach. MethodsWe conducted an investigation on 600 medical students (extracted by stratified random sampling) from different majors and different grades who were at school using a pre-designed questionnaire from May 10th to May 12th, 2013. The data were analyzed with Microsoft Excel 2007. ResultsA total of 545 valid questionnaires were recovered with an effective recovery rate of 90.8%. The results showed that 58.5% of the participants heard of EBM for the first time or once heard of it but knew nothing; 38.2% had learnt some knowledge about EBM. However, only 3.3% were familiar with it; all the participants suggested EBM teaching should be performed. ConclusionThe knowledge related to EBM in the medical students of Hubei University of Medicine is low. However, their study attitude towards EBM is pretty good. The level of EBM teaching needs to be improved.
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 identify patterns in information sharing between a series of Chinese evidence based medicine (EBM) journals and the Cochrane Database of Systematic Reviews, to determine key evidence dissemination areas for EBM and to provide a scientific basis for improving the dissemination of EBM research. Method Data were collected on citing and cited from the Chinese Journal of Evidence-Based Medicine (CJEBM), Journal of Evidence-Based Medicine (JEBMc), Chinese Journal of Evidence Based Pediatrics (CJEBP), and the Cochrane Database of Systematic Reviews (CDSR). Relationships between citations were visualized. High-frequency key words from these sources were identified, to build a word co-occurrence matrix and to map research subjects. Result CDSR contains a large collection of information of relevance to EBM and its contents are widely cited across many journals, suggesting a well-developed citation environment. The content and citation of the Chinese journals have been increasing in recent years. However, their citation environments are much less developed, and there is a wide variation in the breadth and strength of their knowledge communication, with the ranking from highest to lowest being CJEBM, JEBMc and CJEBP. The content of CDSR is almost exclusively Cochrane intervention reviews examining the effects of healthcare interventions, so it’s contribution to EBM is mostly in disease control and treatment. On the other hand, the Chinese journals on evidence-based medicine and practice focused more on areas such as education and research, design and quality of clinical trials, evidence based policymaking, evidence based clinical practice, tumor treatment, and pediatrics. Conclusion Knowledge and findings of EBM are widely communicated and disseminated. However, citation environments and range of knowledge communication differ greatly between the journals examined in this study. This finds that Chinese EBM has focused mainly on clinical medicine, Traditional Chinese Medicine, pediatrics, tumor treatment, nursing, health economic and management, and medical education. Internationally, EBM research topics have begun to shift, from drug treatment to surgery or other non-pharmacological treatments; from therapy to diagnosis, rehabilitation, and prevention; from evidence based clinical practice to evidence based management and policymaking. The philosophy and method of EBM, evidence production and translation are also shifting from well resourced settings to low- and middle-income countries, especially those in which English is not a major language.
In order to meet the rapid development of in-vitro diagnostic reagent (IVD) market and the development needs of laboratory medicine, and ensure efficient management and cost control in IVD purchasing, it is necessary to build the purchasing management standard, improve the purchasing quality of IVD, reduce the overall hospital costs, and ensure the accuracy and reliability of clinical test results. Through three aspects: the preparation before business negotiation, business negotiation, and execution after business negotiation, this article clarifies the self-bidding procurement process of IVD, and emphasizes the importance of knowledge in IVD procurement management, so as to provide references and suggestions for novice buyers to get familiar with the business quickly and improve their negotiation ability.
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.