Showing papers in "Journal of Evidence-based Medicine in 2008"

From randomized controlled trials to evidence grading schemes: current state of evidence-based practice in social sciences

Abstract: With the advance of web search and navigation technology, enormous amount of information, non-information, and misinformation may be obtained in milliseconds in response to questions about ‘what works’ in social sciences. Today, policy makers in non-medical public service arenas are under increasing pressure to make sound decisions based on scientific evidence. Some of these decisions are a matter of legal requirement. This paper shows how such movements are closely aligned with the evolution of organizations that develop and apply evidence standards and evidence grading schemes within the social science communities. The current state of evidence-based practice in social sciences is examined by reviewing the latest development of randomized trials and evidence grading schemes in the fields of education, criminal justice, and social welfare. Studies conducted under the auspices of the Campbell Collaboration and What Works Clearinghouse are used to illustrate ingredients of evidence grading schemes, graphic display of results of systematic reviews, and discrepancies of evidence derived from randomized trials and non-experimental trials. Furthermore, it is argued that the use of evidence on ‘what works’ depends on the potential users' awareness, understanding of the evidence, as well as their capacity and willingness to use it. Awareness and understanding depends on the world wide web and its augmentations, while capacity and willingness depends more on incentives to use good evidence and on political and ethical values. Implications for the future development of evidence grading organizations are discussed.

Analysis of 1856 inpatients and 33 deaths in the West China Hospital of Sichuan University from the Wenchuan earthquake

Abstract: Objective To describe the 1861 injured inpatients and deaths in the West China Hospital of Sichuan University after the Wenchuan earthquake, to provide evidence to help improve emergency plans for earthquake, and the establishment of state-level regional medical centers. Methods The analyses use, data provided by the Department of Information of the hospital up until 23 July 2008. Microsoft Excel for data input and SPSS 11.5 for statistical analysis were used. Results By 23 July, 2728 people from the disaster areas had been treated in the hospital, of whom 872 were admitted to the emergency department and 1856 to the inpatient department (974 men, median age 43 years; 882 women, median age 46 years). Most (82.4%) patients were sent to the hospital within the first two weeks after the earthquake, and the number of inpatients reached its peak on day 8 (976 cases). Most (60.2%) of the inpatients were discharged between day 9 and day 18. The injured patients came mainly from Deyang, Aba Prefecture and Dujiangyan. On admission, the diagnoses were mainly fracture (54.8%), craniocerebral injury (9.8%), and thoracoabdominal injury (7.5%). Thirty-three patients died, including five who were dead on arrival at the hospital, one death in the emergency department, and 27 inpatient deaths. Conclusion The development of an emergency plan for medical rescue after an earthquake disaster is an essential step to enhance emergency response capability, to improve the scientific process of field triage, transport and transfer, and to ensure the rational allocation and application of healthcare resources after large disasters in the future.

Evidence Aid – from the Asian tsunami to the Wenchuan earthquake

Abstract: Keywords: Cochrane Collaboration; earthquake; natural disaster; randomized trial; systematic review

Emergency response and medical rescue in the worst hit Mianyang areas after the Wenchuan earthquake.

Abstract: The 12 May 2008 earthquake caused damage to 88% of the health systems in the worst hit areas of Mianyang with 326 casualties and the direct economic loss of RMB 3124 billion. Within 30 minutes of the earthquake, the Mianyang headquarters for earthquake disaster relief and the Mianyang public health headquarters for medical rescue and treatment were organized. Five medical teams were sent to Beichuang County, the worst hit Mianyang area, four hours after the earthquake. A total of 22,947 wounded and sick people were delivered to local hospitals after simple triage and rapid treatment through three stations. By 30 June, the Mianyang medical organization had received 379,600 people and admitted 21,628 inpatients. These 2772 severely wounded (including 146 with limbs amputated and 846 who died in hospital). Since 17 May, 3381 wounded had been transferred to 14 provincial and city-level hospitals across China. On 20 June, the Mianyang Rehabilitation Center for wounded and sick people was established and received 156 rehabilitation inpatients. Together with the medical team for psychological intervention, they provided psychological support for over 70,000 people. Within two hours of the earthquake, the Mianyang Organization for Health and Epidemic Control and Prevention launched the emergency response plan for major natural disasters. The organization sent emergency teams for disease prevention and control and completed disinfection and burial of corpses and disposal of carcasses, monitoring of water quality and epidemics, disinfection of environmental ruins, epidemic control in resettled areas, precautions against secondary disasters caused by the earthquake, and large-scale health education. The emergency command system for medical rescue and disease control and prevention in the Mianyang areas integrated resources, carried out unified command, and responded rapidly. Furthermore, the headquarters of medical relief co-ordinated and united the governmental and nongovernmental organizations, achieving good performance for both medical relief and epidemic control. This experience of earthquake medical relief will benefit post-disaster reconstruction, as well as the establishment of national and regional emergency response systems.

Strategic supporting role of a regional state-level hospital during medical rescue after Wenchuan earthquake.

Abstract: Shortly after the Wenchuan earthquake, the administrative leaders of West China Hospital accurately defined the role of the hospital during the medical rescue work as the treatment center for seriously wounded people, the support center for local hospitals and clinics in the disaster areas in Sichuan Province, and the logistics support center for medical teams from other provinces. Integrated leadership of management and efficient multidepartment co-ordination and co-operation were emphasized. The hospital was immediately transformed from regular mode into a double-track emergency mode. Scientific allocation and dispatch of resources were ensured to meet the changing demand from all levels of rescue work. Three stages were defined based on the conditions of wounded people delivered to the hospital, with different main focuses for each stage. Because of the multidisciplinary co-operation and concerted efforts of a large number of experts from other provinces and countries, an effective and efficient medical rescue service was offered to all wounded people. Until 2 June 2008, 2618 injured people from the disaster area have been treated, of whom 1751 were admitted to the inpatient department, 1135 were seriously wounded, 127 were admitted into the intensive care unit, 1239 underwent surgery, and 77 were treated with haemodialysis. There was an inpatient mortality less than 0.7%. Moreover, even during such a period, routine medical service was offered to patients other than people wounded in the disaster.

Investigation and recommendations concerning prevention and treatment of infectious diseases and promotion of hygiene in earthquake-stricken areas.

Abstract: In order to identify all public hygiene problems in the Wenchuan quake-affected areas, and also to provide relevant recommendations to local governments, the quake areas were entered for field investigation and consultation. The current situation and hidden dangers and problems of epidemic surveillance, planned immunization, drinking water hygiene, nutrition and food hygiene, environmental hygiene are discussed in the article. Some suggestions are also provided for government public hygiene policy: (i) launch a patriotic health campaign among the population; (ii) study on green agricultural policy of changing dung into manure; (iii) start from quake-affected area to develop rural environmental hygiene work; (iv) prolong treatment of infectious diseases free of charge, and draw up a policy of free vaccination for earthquake victims; and (v) realize reform of the CDG funding system in the quake-affected area. At last, meaning and judgment criteria of ‘no big epidemic after a great disaster’ are interpreted. The observation period is divided into three phases: forthcoming summer and autumn phase, forthcoming winter and next spring phase, and comprehensive recovery phase.

Qualitative Method and Its Application Status in Healthcare

Abstract: Qualitative method originated from anthropology, sociology, psychology, folklore at the beginning of 20 century. Nowadays as a new m0ethod, medical qualitative method has been paid some attention by health care workers and researchers. This article introduces the qualitative research definition, advantages and disadvantages, the relation between qualitative and quantitative methods, techniques, application status, and significance used in Chinese medicine, etc. The author advocates that qualitative method will complement the effect appraisal content of Chinese medicine and explore the constitution of Chinese medicine complex intervention. However, qualitative research is inadequate in Chinese medicine, and we should conduct more high quality qualitative researches in Chinese medicine to enrich the clinical methods of Chinese medicine.

Stata in Assessing Heterogeneity in Meta-Analysis

Abstract: Assessment of the between-study heterogeneity is an essential component of meta-analysis. By using a published meta-analysis as an example, this paper explains many methods of Stata in assessing heterogeneity in meta-analysis and indicates that stata is a powerful tool in assessing the between-study heterogeneity.

Considerations on fundamental issues in establishing a universal coverage system for health in China

Abstract: This study discusses basic health services in China. In this study common sense and international experience in establishing a high-performing health system were introduced. Five components are identified: basic qualified human resources for health; basic infrastructure; essential medicines; essential technology and procedures; and basic service pathways. Recommendations were presented based upon the Chinese situation. They are: increase public financing and lower private out-of-pocket payment for services; revitalize the functions of public facilities; merge different health financing schemes; co-ordinate public fiscal and pricing policies; prioritize public financing to preventive and primary healthcare; establish and strengthen the partnership between public and private facilities and insurance schemes; and re-organize the administrative system in health-based upon the rules of simplicity, unity, and efficiency.

The Construction and Preliminary Screening of Item Pool on Chinese Menopause Rating Scale

Abstract: Objective To construct the item pool of Chinese Menopause Rating Scale(CMRS) and to screen the item pool preliminarily.Methods Under the direction of Chinese Medicine(CM) theory and the psychometrics methods and characteristics of menopausal syndrome(MS),the item pool were constructed.Then the item pool was screened through the combination of the focus group discussion,semi-open scale examination and expert interview.Results The item pool was composed of 137 items.After the preliminary screening,there were 61 items remained,which consisted of 34 items on the soma dimension,20 for psychology dimension and 7 for community dimension respectively.Conclusion The establishment and screening of CMRS was implemented through a variety of ways,the preliminary items completely cover the body function,psychological function and society function of patients with menopause syndrome and synthetically reflect the connotation of MS,and the popularity of language and cushy understanding of the CMRS contribute the well content-related validity of CMRS.

Discussing the Characteristics of Structure and Methodology in the Evidence-Based Guidelines of Acupuncture for Clinical Practice

Abstract: Objective To develop the high quality of methodology tool of evidence-based clinical practice guidelines for acupuncture. Methods Combining with the specialty of EBM, this article analyzes the similarities and differences between guidelines of Traditional Chinese Medicine and Western medicine. Results Summarizing the characteristics of structure and methodology of developing guidelines. Conclusion Abiding by the reasonable and optimized tool of guidelines development methods, we can develop high quality of evidence-based clinical practice guidelines for acupuncture.