医院图书馆在开展循证医学中的应对方略

本文简述了循证医学的概念、国内发展现状及它对医院图书馆的要求,提出了医院图书馆在开展循证医学过程中的应对方略。     

Internal Crack Initiation and Growth Starting from Artificially Generated Defects in Additively Manufactured Ti6Al4V Specimen in the VHCF Regime

The aim of the present work was to investigate the ‘fine granular area’ (FGA) formation based on artificially generated internal defects in additively manufactured Ti6Al4V specimens in the early stage of fatigue crack growth in the ‘very high cycle fatigue’ (VHCF) regime. Fatigue tests were performed with constant amplitude at pure tension-compression loading (R = −1) using an ultrasonic fatigue testing setup. Failed specimens were investigated using optical microscopy, high-resolution ‘scanning electron microscopy’ (SEM), and ‘focused ion beam’ (FIB) techniques. Further, the paper introduces alternative proposals to identify the FGA layer beneath the fracture surfaces in terms of the ‘cross section polishing’ (CSP) technique and metallic grindings with special attention paid to the crack origin, the surrounding microstructure, and the expansion of the nanograin layer beneath the fracture surface. Different existing fracture mechanical approaches were applied to evaluate if an FGA formation is possible. Moreover, the results were discussed in comparison to the experimental findings.     

医学图书馆嵌入临床循证医学信息服务模式构建

以前的循证医学信息服务采用"主动参与参考咨询"模式,视角不够科学、内容不够系统。以临床医师循证决策需求为逻辑起点,引入"信息-知识-智能"转化律后,通过比较循证过程及"信息-知识-智能"转化过程,构建了循证医学信息服务新型模式,为临床医学馆员和临床医师思考"需要做什么"以及"如何科学地做"提供了统一理论,有效指导临床医学馆员开展循证医学信息服务工作,辅助临床医师科学地进行临床决策。     

Medical decision-making in membranous nephropathy: how to use limited clinical research evidence in patient management

Evidence-based medicine (EBM) originally referred to the use of a combination of clinical expertise and research evidence to make medical decisions, while carefully considering the patient's preference. In Japan, however, EBM has been misunderstood as the more abstract pursuit of acquiring research evidence and building medical guidelines. This review aims to summarize the available data regarding therapy for membranous nephropathy (MN), a field in which no consensus has been reached, and to discuss medical decision-making by using a decision tree in several model cases. In clinical practice, we have to consider both the risks and benefits of treatment. These are evaluated by their therapeutic effect (the rate of improvement, no change, or worsening) and by the patients' quality of life (QOL). This process is compatible with the essential concept of EBM.     

Translating evidence-based information into effective risk communication: current challenges and opportunities

Recent medical advances and the easy availability of evidence-based information at the point of care are believed to provide physicians with improved tools for risk communication. However, evidence indicates that physicians still display marked variability in ordering tests. Factors that determine a physician's test-ordering tendencies vary by specialization, practice, geographical location, defensive practice, and tolerance of uncertainty and are also modified by patient requests. Understanding of statistical terms on the part of both physicians and patients remains limited. Physicians may display limited ability to assess pretest and posttest probabilities, especially in low- and intermediate-risk patients, even after attending short courses in epidemiology, or may find the process impractical. Presentation of diagnostic-test results in a natural-frequency format might improve understanding. Both physicians and patients have difficulty grasping the term "number needed to treat" compared with "relative risk reduction" when comparing therapeutic options. Other patient-related factors that limit understanding include low literacy, individual risk tolerance, and framing patterns of the problem (potential gains vs losses). Despite numerous available modalities (quantitative and qualitative) of risk communication, consensus over the advantage of any single modality in translating evidence into risk communication is limited. It is essential that physicians remain patient-centered, generate trust, and build a partnership with the patient to achieve consensus for medical decision-making. Future studies are indicated to assess the effectiveness of novel risk-communication modalities based on patients' and physicians' characteristics and identify appropriate modality of translating evidence (quantitative or qualitative information).     

循证医学中常用统计指标的介绍

本文集中介绍了循证医学中的常用统计指标,如RRR(相对危险度减少率,relative risk reduetion)、ARR(绝对危险度减少率,absolute risk reduction)、NNT(需要处理的病人数,number needed to treat)等的意义和用途,以供循证医学研究者参考.     

骨质疏松症临床实践指南研究现状及方法学探讨

从撰写的程序、内容、方法等方面总结了国内外骨质疏松症临床实践指南撰写的现状以及差距,在此基础上对制定中医骨质疏松症临床实践指南的方法学进行了探索。认为应当借鉴循证医学的方法,根据中医学自身特点,制定中医骨质疏松症临床实践指南。