Diabetes im Alter

Zusammenfassung In Deutschland leiden 25% der über 70-Jährigen unter einem Diabetes mellitus. Biologisch ältere, multimorbide und in ihren Funktionen beeinträchtigte geriatrische Patienten benötigen spezielle Vorgehensweisen bei Zielplanung, Allgemeinmaßnahmen und Pharmakotherapie. Auf der Basis der vorhandenen Leitlinien werden gesicherte Erkenntnisse dargestellt und Empfehlungen zu den Besonderheiten der Therapie des geriatrischen Diabetespatienten gegeben. Besonderes Augenmerk liegt dabei auf der Interaktion von geriatrischen Syndromen und Diabetes sowie der Verbesserung der Lebensqualität.     

文拉法辛与三环类抗抑郁药治疗抑郁症痊愈率的循证医学研究

目的　比较文拉法辛与三环抗抑郁药治疗抑郁症临床痊愈率的差异。方法　应用循证医学的Me-ta分析,采用固定效应模型(fixed effects model,FEM)法对符合标准的16项对照研究文献进行评价。结果　文拉法辛与三环抗抑郁药治疗抑郁症的临床痊愈率不同,差异有显著性(χ2=4.773,df=1,P<0.05);综合的ORs=1.36,95%CI为1.04~1.78。提示文拉法辛治疗抑郁症的临床痊愈率是三环抗抑郁药的 1.36倍。结论　治疗抑郁症,文拉法辛比三环抗抑郁药有更可靠的临床痊愈率。     

循证医学对心血管病研究的影响

循证医学的出现使现有的医学观念从理论知识加个人经验的医学模式转变到科学证据为基础的医学模式。随着临床流行病学的深入开展及临床科研方法的重大发展,循证医学正在逐渐深入医学的各个角落,在心血管领域也是如此。文章将主要阐述循证医学在心血管病临床医疗实践、科研、卫生决策和医学教育方面产笺重要影响;客观分析循证医学在此领域的发展史及现状;同时也概括了我国心血管研究在循证医学方面的成果与不足。从而进一步揭示,科学的证据正有利地促进着医学的全方位发展,以问题为基础的循证医学是当今临床医学发展的必然趋势。     

Impact of an Evidence-Based Medicine Curriculum on Resident Use of Electronic Resources: A Randomized Controlled Study

Background  Evidence-based medicine (EBM) is widely taught in residency, but evidence for effectiveness of EBM teaching on changing residents’ behavior is limited. Objective  To investigate the impact of an EBM curriculum on residents’ use of evidence-based resources in a simulated clinical experience. Design/Participants  Fifty medicine residents randomized to an EBM teaching or control group. Measurements  A validated test of EBM knowledge (Fresno test) was administered before and after intervention. Post intervention, residents twice completed a Web-based, multiple-choice instrument (15 items) comprised of clinical vignettes, first without then with access to electronic resources. Use of electronic resources was tracked using ProxyPlus software. Within group pre–post differences and between group post-test differences were examined. Results  There was more improvement in EBM knowledge (100-point scale) for the intervention group compared to the control group (mean score increase 22 vs. 12, p = 0.012). In the simulated clinical experience, the most commonly accessed resources were Ovid (71% of residents accessed) and InfoPOEMs (62%) for the EBM group and UptoDate (67%) and MDConsult (58%) for the control group. Residents in the EBM group were more likely to use evidence-based resources than the control group. Performance on clinical vignettes was similar between the groups both at baseline (p = 0.19) and with access to information resources (p = 0.89). Conclusions  EBM teaching improved EBM knowledge and increased use of evidence-based resources by residents, but did not improve performance on Web-based clinical vignettes. Future studies will need to examine impact of EBM teaching on clinical outcomes.     

Outpatient treatment of symptomatic pulmonary embolism: A systematic review and meta-analysis

Background

Patients with acute deep vein thrombus (DVT) can safely be treated as outpatients. However the role of outpatient treatment in patients diagnosed with a pulmonary embolism (PE) is controversial. We sought to determine the safety of outpatient management of patients with acute symptomatic PE.

Materials and Methods

A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Pooled proportions for the different outcomes were calculated.

Results

A total of 1258 patients were included in the systematic review. The rate of recurrent venous thromboembolism (VTE) in patients with PE managed as outpatients was 1.47% (95% CI: 0.47 to 3.0%; I²: 65.4%) during the 3 month follow-up period. The rate of fatal PE was 0.47% (95% CI: 0.16 to 1.0%; I²: 0%). The rates of major bleeding and fatal intracranial hemorrhage were 0.81% (95% CI: 0.37 to 1.42%; I²: 0%) and 0.29% (95% CI: 0.06 to 0.68%; I²: 0%), respectively. The overall 3 month mortality rate was 1.58% (95% CI: 0.71 to 2.80%; I²: 45%). The event rates were similar if employing risk stratification models versus using clinical gestalt to select appropriate patients for outpatient management.

Conclusions

Independent of the risk stratification methods used, the rate of adverse events associated with outpatient PE treatment seems low. Based on our systematic review and pooled meta-analysis, low-risk patients with acute PE can safely be treated as outpatients if home circumstances are adequate.     

Acceptance of evidence based medicine (EBM) databases by Iranian medical residents using unified theory of acceptance and use of technology (UTAUT)

Objective

Physicians often need uptodate, reliable and with easy access information for clinical decisions evidence based medicine (EBM) databases can be a suitable approach to meet this need. The aim of this study was to assess the knowledge, use and factors affecting the acceptance of EBM and its databases by Iranian medical residents using UTAUT model.

2000~2019年国家自然科学基金资助循证医学相关项目情况分析

目的分析2000~2019年国家自然科学基金(国自然)对循证医学相关项目的资助情况。方法计算机检索国家自然基金数据库、科学基金系统和丁香通、梅斯医学等网站获取国自然项目信息,同时检索CNKI、VIP、CBM、WanFang Data和Web of Science获取项目成果信息后,采用Excel 2016软件对检索结果进行统计分析。结果国自然从2000年开始资助循证医学项目。20年间国家自然科学基金资助各类循证医学相关项目共94项,资助金额总计4476.3万元;北京、上海、广东、四川等地区立项数、资助单位数及资助金额排名均靠前;面上项目和青年项目是国自然资助循证医学项目的主体;中医药学研究新技术和新方法、卫生管理与政策、中西医结合临床基础等学科分类的资助比例较大;面上项目的论文成果产出总量最多,但国家杰出青年科学基金的单位成果产出最高;中国循证医学中心有3篇成果文献发表在BMJ上并获高被引。结论国家自然科学基金对循证医学相关项目资助力度逐年增加,但对比自然基金平均项目相对较弱。同时资助地域、单位不均衡;研究方向及内容逐年变化,呈学科聚集趋势。     

Evidence-based Medicine

Summary:  Evidence-based medicine (EBM) has become a watchword for "the new" medical practice in the new century. Whether it represents a paradigm shift or simply a codification of the scientific method in medicine will be debated for years to come. Regardless of the place of EBM in medicine, this "movement" has served an important role in moving physician practice into the realm of becoming more scientific (albeit empirical) and transparent. There are still many problems to be addressed in the global application of the best evidence for medical practice. These include low-quality studies, delays in implementation of clear-cut improvements, outright fraud and deceit, and wariness on the part of physicians to change their practice. By working to understand the underpinnings of EBM (basic statistical concepts and critical thinking) we can advance the practice of medicine along the moral high road of science.