Best evidence continuous medical education

Health care professionals need to approach their profession with a view to life long learning. They need to develop a strategy to meet their learning needs in a reflective and effective manner. Continuous medical educational (CME) is the traditional tool for learning and updating knowledge. Most of them are in the forms of courses, conferences, journal clubs and workshops. They are mostly didactic sessions and evidence suggests that they are not effective to improve the clinical skills and attitude. Systematic review of teaching evidence-based medicine shows that interactive and clinically integrated learning is the most effective form of learning. It enhances knowledge and skills. Professionals should view CME in a holistic manner in the context of continuous professional development (CPD) and even in the wider concept of knowledge translation, which encompasses both CME and CPD. e Learning is one of the most important forms of non-traditional CME. It provides an efficient and increasingly interactive delivery system that can handle complex and layered information. More work needs to be done to see its effectiveness for practising clinicians.     

Pharmacological approach to acute pancreatitis

The aim of the present review is to summarize the current knowledge regarding pharmacological prevention and treatment of acute pancreatitis （AP） based on experimental animal models and clinical trials. Somatostatin （SS） and octreotide inhibit the exocrine production of pancreatic enzymes and may be useful as prophylaxis against Post Endoscopic retrograde cholangiopancreatography Pancreatitis （PEP）. The protease inhibitor Gabexate mesilate （GM） is used routinely as treatment to AP in some countries, but randomized clinical trials and a meta-analysis do not support this practice. Nitroglycerin （NGL） is a nitrogen oxide （NO） donor, which relaxes the sphincter of Oddi. Studies show conflicting results when applied prior to ERCP and a large multicenter randomized study is warranted. Steroids administered as prophylaxis against PEP has been validated without effect in several randomized trials. The non-steroidal anti-inflammatory drugs （NSAID） indomethacin and diclofenac have in randomized studies showed potential as prophylaxis against PEP. Interleukin 10 （IL-10） is a cytokine with anti-inflammatory properties but two trials testing IL-10 as prophylaxis to PEP have returned conflicting results. Antibodies against tumor necrosis factor-alpha （TNF-α） have a potential as rescue therapy but no clinical trials are currently being conducted. The antibiotics beta- lactams and quinolones reduce mortality when necrosis is present in pancreas and may also reduce incidence of infected necrosis. Evidence based pharmacological treatment of AP is limited and studies on the effect of potent anti-inflammatory drugs are warranted.     

Evaluation of Cognitive Behavioral Interventions and Psychoeducation Implemented by Rehabilitation Specialists to Treat Fear-Avoidance Beliefs in Patients With Low Back Pain: A Systematic Review

Objectives

To systematically locate, critically appraise, and synthesize the available evidence regarding the effectiveness of cognitive behavioral therapies (CBTs) and psychoeducation that can be implemented by rehabilitation specialists to treat fear-avoidance beliefs in patients with acute, subacute, and chronic low back pain (LBP).

Effectiveness of Conservative,Surgical, and Postsurgical Interventions for Trigger Finger,Dupuytren Disease,and De Quervain Disease: A Systematic Review

Objectives

To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain disease.

老年人慢性疼痛管理的最佳证据总结

目的:总结老年人慢性疼痛管理的相关证据,为临床老年人疼痛管理的相关实践提供参考。方法:针对老年人慢性疼痛的问题,运用循证护理方法检索国内外数据库相关文献,检索时限为建库至2020年6月2日。由2名研究者采用JBI循证卫生保健中心的文献质量评价标准和证据推荐系统,对各类研究进行质量评价及证据推荐级别评定,纳入符合质量标准的文献,并提取证据。结果:共纳入文献20篇,包括指南8篇、系统评价3篇、专家共识3篇、最佳实践1篇、立场声明1篇、证据总结4篇。最终形成包括疼痛管理一般原则、疼痛评估、干预策略、自我管理、教育和培训5个方面的20条最佳证据。结论:本研究汇总了目前老年人慢性疼痛的文献,为临床老年人的慢性疼痛管理提供循证依据,临床人员应依据最佳临床证据并依据医院实际医疗情况进行证据的运用,以提高护理质量。     

中国儿童与老年健康证据转化平台的构建与应用

目的介绍并推广中国儿童与老年健康证据转化平台(Chinese Clearinghouse for Evidence Translation in Child & Aging Health,CCET)。方法分别成立儿童、老年健康顾问委员会,利用科学的评价量表评价筛选国内外相关的儿童、老年健康促进项目并由研究团队翻译转化。与兰州博阳软件工程有限公司合作,根据网站需呈现的内容与目标功能,共同规划设计网站框架与界面,初步建立站点。将转化的健康证据及其他信息资源（疾病基本情况、项目评价量表、研究报告标准等）上传使之在网站相应栏目中呈现,建立CCET网站,并通过微信和微博媒介定期传播儿童及老年健康最新进展、循证研究最新方法。结果CCET主要由儿童健康、老年健康、评价量表、报告标准、推广应用和老年抑郁症循证防治数据库6个版块组成。CCET儿童与老年健康促进项目由国内外专家采用科学的评价量表筛选和评价,转化的证据科学性强,目前已有相关研究机构和社区有意向参与CCET研究和应用转化项目。结论CCET致力于循证方法培训,建立国内健康干预项目的科学性和适用性评价系统,对国外证据转换后的后续干预项目培训,提升服务机构能力,以及综合干预课程研发。CCET信息全面、界面简单、用户友好,为促进我国儿童与老年健康提供证据支持。