Evidence-based medicine, medical decision analysis, and pathology

Recent advances in molecular pathology and other technologies such as proteomics present pathologists with the challenge of integrating the new information generated with high-throughput methods with current diagnostic models based mostly on histopathology and clinicopathologic correlations. Parallel developments in the field of medical informatics and bioinformatics provide the technical and mathematical methods to approach these problems in a rational manner. However, it remains unclear whether pathologists or other medical specialists will become primarily responsible for the development and maintenance of these multivariate and multidisciplinary diagnostic and prognostic models that are hoped to provide more accurate, individualized patient-based information. Evidence-based medicine (EBM) and medical decision analysis (MDA) are relatively new disciplines that use quantitative methods to assess the value of information, differentiate fact from myth, and integrate so-called best evidence into multivariate models for the assessment of prognosis, response to therapy, selection of laboratory tests, and other complex problems that influence individual patient care. We review from an epistemological viewpoint the current approach to information in pathology and describe some of the concepts developed by the practitioners of EBM and MDA.     

教育心理学和教学效益相关性的研究

本研究在罗马尼亚Oradea大学医药学院进行，始于1998年，结束于2003年。研究的出发点为该学院的学生们提出不少的教师，包括一些国内外知名的学者和医生，因缺乏教育心理学知识，不能很好地理解学生，组织教学和传授知识。因此，本研究设置了问卷调查，学院向教员开设了教育心理学课程(1998年10月～1999年7月)，与学生和教师座谈，统计并比较学生的考试成绩，特别地跟踪研究全国年度(1999年～2003年)医学证书汇考结果。研究结果客观地证实了教育心理学能够提高学习(工作)效益和成果，因为教育心理学知识使得教师(和医师)更好地与学生(或病人)沟通、理解和组织、合作。     

Designs for Instruction, Designs for Change: Distributing Knowledge of Evidence-Based Practice

We comment on the target article by Weingardt (this issue), which discusses recent advances in instructional design and technology (IDT) and their implications for dissemination of evidence-based practices. These arguments are extended to the topic of psychological intervention design, and possibilities for new intervention structures are briefly explored. Finally, comments are offered on maintaining a careful balance between technological and social processes in the effort to promote the dissemination of innovative and evidence-based psychological procedures.     

Commentary: Organizational Culture and Practice Epistemologies

Hemmelgarn, Glisson, and James (2006) provide an excellent review of the impact of organizational culture and climate for the implementation of evidence-based practice (EBP) models within social and mental health services systems. As their article makes clear, the implementation process should address the organizational context, and effectiveness and services research should consider organizational factors in outcome and EBP transport research. This commentary extends discussion of one aspect of organizational culture—the extent to which organizations are driven by an empirical scientific epistemology—and how this may contribute to establishing a context for EBP design, selection, implementation, and sustained evolution in field settings.     

Relational continuity of care in community pharmacy: A systematic review

Relational continuity of care (COC) is becoming an important concept related to improving healthcare quality, reducing medical costs and increasing patient satisfaction with primary care. While community pharmacy (CP) has a considerable role in primary care, there are few reports dedicated to the role of relational COC in CP. This study reviewed the existing evidence of relational COC in CP and its effect on patients. PubMed, Embase, CINAHL, Cochrane Library CENTRAL and Google Scholar were used to search for relevant studies from the date of database inception through to January 2021, which were appraised according to eligibility criteria. There were no limitations on the primary outcome or language. Case reports and studies without control groups were excluded. The Newcastle–Ottawa quality assessment scale was used to assess the quality of the studies. Database searches identified 13 records. Relational COC measures in the included studies were grouped in three kinds; pharmacy-visiting pattern, Continuity of Care Index and loyalty. The assessed outcomes were medication adherence behaviour (e.g., the proportion of days covered, medication possession ratio), adverse drug reactions, potentially inappropriate drug prescribing and clinical outcomes. The odds of patients adhering to their medication regimen were about 1.1~2.5 times higher among those who consistently visited a single pharmacy compared to patients visiting multiple pharmacies. Additionally, the care provision with a high level of relational continuity could lower inappropriate drug use by 21~32 per cent and the use of other costly services by 12~29 per cent. This study suggests that a high degree of relational COC in CP could improve safe use of medications among patients. Future research is needed to employ more rigorous methods to reduce heterogeneity and to measure effects on clinical outcomes.     

静脉用药调配中心干预不合理医嘱的效益分析

目的对静脉用药调配中心(pharmacy intravenous admixture services,PIVAS)干预临床不合理用药产生的经济效益、社会效益、人力资源效益进行分析,促进临床合理、安全、经济用药。方法采用回顾性分析方法,调取2018年10月1-31日山东大学齐鲁医院PIVAS接收的全部静脉用药医嘱及对不合理用药医嘱的干预结果,分析PIVAS干预不合理用药医嘱产生的药品资源、人力资源节约情况。结果2018年10月1-31日PIVAS药师共审核用药医嘱412782组,其中不合理医嘱1967组,占0.417%,包括不规范、不适宜及超常医嘱等类型。通过PIVAS药师干预不合理用药医嘱,及时纠正医师用药医嘱错误,节约了药品资源及护理工时。结论PIVAS进行用药医嘱审核对于保障患者临床合理用药具有积极意义,有利于节约医疗资源。     

Examining community pharmacists’ intention to provide pharmacist-driven vaccination services: A structural equation modelling

BackgroundThe evidence of pharmacists' current involvement in vaccination services in low- and middle-income countries (LMICs) is uncertain. This study would be a first step to develop vaccination services by investigating community pharmacists’ intention to be involved in PDV services not just during COVID-19 pandemic but also during standard service provision in Turkey which can be taken as an example across LMICs.ObjectiveConsidering the efforts to empower community pharmacists in service provision, the goal of the present study was to develop a structural equation model to explain the “Pharmacist-Driven Vaccination Service Intention Model (PDV-SIM)” by using the theory of planned behavior (TPB).MethodsBased on the constructs of TPB, a measurement tool was developed. Sub-factors of PDV service intention was determined by conducting exploratory factor analysis (EFA). In the second step, confirmatory factor analysis (CFA) was conducted to prove the theoretical structure of the tool. Finally, a model explaining the relationship between observed variables, latent constructs from TPB was developed by SEM analysis.ResultsIn the proposed PDV-SIM, patient related attitude toward PDV services, attitude toward negative consequences of PDV services, and subjective norm about PDV services had an impact on the behavioral intention of community pharmacists. Nevertheless, professional development attitude toward PDV services and perceived behavioral control were not evaluated as determinants of the behavioral intention.ConclusionResults of this study revealed that TPB is appropriate for modelling PDV service intention of community pharmacists. This model can be utilized as a guide to potential pharmacy regulatory bodies and policy makers in their efforts to enable community pharmacists as vaccinators across LMICs.     

基层医院如何开展临床药学工作

临床药学是现代药学的重要组成部分,临床药学工作在各级医院开展极不平衡,特别是基层医院开展较差。本文论述了在基层医院应从人才的选择入手开展临床药学工作。     

‘Hello,my name is Gabriel,I am the house officer,may I examine you?’ or The Objective Santa Christmas Examination (OSCE)

OBJECTIVE: To design a clinical examination of high content validity suitable for use as a formative assessment tool with pre-registration house officers (PRHO'S) towards the end of their first house officer post. DESIGN: A multicentre collaboration between four UK medical schools who offer undergraduate curricula which are problem-based, systems-based, patient-orientated, student-centred, jargon-laden and utterly staff-bewildering. MAIN OUTCOME: An objective structured clinical examination (OSCE) which is suitable for use with graduates of UK medical schools. It assesses the knowledge, skills and attitudes essential for future careers in a hierarchical system where protecting the senior staff from all forms of irritation is paramount. RESULTS: PRHO'S who excel in this examination get better references. CONCLUSION: The OSCE format can be used to provide 'real-life' scenarios appropriate to the season.