Clinical Epidemiology in China series. Paper 1: Evidence-based medicine in China: An oral history study.

OBJECTIVE: To describe and record the evolution of EBM in China. STUDY DESIGN AND SETTING: We conducted the study following the general methodology of oral history. The interviews were done at Lanzhou University, between 18th and 22nd April 2019 using pre-defined questions. All interviews were videorecorded. Two investigators extracted and analyzed the information from the interviews independently. RESULTS: One international expert and ten Chinese experts participated in the interviews. After the introduction of EBM in China in the mid-1990s, more than 20 EBM centres have been established. According to the interviewees, Gordon Guyatt, David Sackett and Iain Chalmers are the international experts who played the most important role in the development of EBM in China. China has contributed to EBM on the international level by conducting systematic reviews, developing reporting checklists, and introducing the principles of EBM into Traditional Medicine. The Chinese Cochrane Centre and the EBM Centre of Lanzhou University were ranked the top two EBM Centres in China by the interviewees. CONCLUSION: EBM has been developing in China for nearly a quarter of a century. Many achievements have been reached, however, EBM is still facing many challenges in China, including shortages of funding support and personnel, as well as limited local high-quality evidence.

Exploring Current Evidence on the Past, the Present, and the Future of the Heart Team: A Narrative Review.

INTRODUCTION: Including healthcare professionals dealing with cardiovascular diseases, Heart Team is a concept/structure designed for selecting diagnostic strategies, facilitating therapeutic decisions, and improving cardiovascular outcomes in patients with complex heart pathologies, requiring input from different subspecialties and the necessity of a multidisciplinary approach. The aim of this narrative review is to search for and to summarize current evidence regarding Heart Team and to underline the future directions for the development of this concept. METHODS: We searched the electronic database of PubMed, SCOPUS, and Cochrane CENTRAL for studies including Heart Team. Forty-eight studies were included, if reference was made to Heart Team structure and functionality. RESULTS: We depicted the structure and the timeline of Heart Team, along with actual evidence-based recommendations from European Guidelines. We underlined the importance of quality of knowledge-sharing and decision-making inside the Team, analyzing bad decisions which did not reflect members' true beliefs due to "uniformity pressure, closed mindedness, and illusion of invulnerability." The observation that Guidelines' indications regarding Heart Team carry a level C indication underlines the very future of this Team: randomized controlled trials proving solid benefits in an evidence-based world. CONCLUSIONS: Envisioned as a tool for optimizing the management of various complex cardiovascular pathologies, Heart Team should simplify and facilitate the activity in the cardiovascular ward. Finally, these facts should be translated into better cardiovascular outcomes and a lower psychological distress among Team participants. Despite all future changes, there must always be a constant part: the patient should remain at the very center of the Team.

Alternative and complementary approaches in psychiatry: beliefs versus evidence.

While the legitimacy of medical treatments is more and more questioned, one sees a paradoxical increase in nonconventional approaches, notably so in psychiatry. Over time, approaches that were considered valuable by the scientific community were found to be inefficacious, while other approaches, labelled as alternative or complementary, were finally discovered to be useful in a few indications. From this observation, we propose to classify therapies as orthodox (scientifically validated) or heterodox (scientifically not validated). To illustrate these two categories, we discuss the place, the role, the interest, and also the potential risks of nonconventional approaches in the present practice of psychiatry.

Si bien la legitimidad de los tratamientos médicos se cuestiona cada vez más, se observa un aumento paradójico en las aproximaciones no convencionales, especialmente en la psiquiatría. Con el tiempo, se descubrió que las aproximaciones que la comunidad científica consideraba valiosas eran ineficaces, mientras que otros enfoques, etiquetados como alternativos o complementarios, se descubrieron finalmente como útiles en algunas indicaciones. A partir de esta observación, se propone clasificar las terapias como ortodoxas (validadas científicamente) o heterodoxas (no validadas científicamente). Para ilustrar estas dos categorías, se discute el lugar, el papel, el interés y también los riesgos potenciales de las aproximaciones no convencionales en la práctica actual de la psiquiatría.

Tandis que la légitimité des traitements médicaux est de plus en plus mise en question, on constate une augmentation paradoxale des approches non conventionnelles, notamment en psychiatrie. Avec le temps, des approches qui étaient considérées de valeur par la communauté scientifique se sont révélées inefficaces, tandis que d'autres, étiquetées comme alternatives ou complémentaires, ont été décrites comme efficaces dans quelques indications. À partir de cette observation, nous proposons de classer les traitements soit comme orthodoxes (validés scientifiquement) soit comme hétérodoxes (non validés scientifiquement). Pour illustrer ces deux catégories, nous commentons la place, le rôle, l'intérêt et aussi les risques potentiels des approches non conventionnelles dans la pratique actuelle de la psychiatrie.

Teledermatology: A Review and Update.

Telemedicine is slowly transforming the way in which healthcare is delivered and has the potential to improve access to subspecialty expertise, reduce healthcare costs, and improve the overall quality of care. While many subspecialty fields within medicine today have either experimented with or begun to implement telemedicine platforms to enable remote consultation and care, dermatology is particularly suited for this care system as skin disorders are uniquely visible to the human eye. Through teledermatology, diagnostic images of skin disorders with accompanying clinical histories can be remotely reviewed by teledermatologists by any number of modalities, such as photographic clinical images or live video teleconferencing. Diagnoses and treatment recommendations can then be rendered and implemented remotely. The evidence to date supports both its diagnostic and treatment accuracy and its cost effectiveness. Administrative, regulatory, privacy, and reimbursement policies surrounding this dynamic field continue to evolve. In this review, we examine the history, evidence, and administrative landscape surrounding teledermatology and discuss current practice guidelines and ongoing controversies.

New approaches within the history and theory of medicine and their relevance for homeopathy.

Conventional sciences have brought forth a wealth of knowledge and benefits, but they have not always been clear and precise about their legitimate scope and methodological limitations. In contrast, new and critical approaches in modern sciences question and reflect their own presuppositions, dependencies, and constraints. Examples are quantum physics, theory and history of science, as well as theory and history of medicine, sociology, and economics. In this way, deprecative dogmatism and animosity amongst sciences ought to be lessened, while the field opens up for each science to redefine its appropriate place in society. This would appear to be a chance for homeopathy, as new approaches, especially within the social and economic sciences, suggest that being a follower of Samuel Hahnemann (1755-1843) may have advantages and privileges that conventional medicine seems to be lacking and whose relevance was overlooked during the rise of economic thinking in the last two centuries.

Quoting A.T. Still with rigor: an historical and academic review.

The statements of Andrew Taylor Still, MD, DO, abound within the osteopathic literature. However, Still is sometimes misquoted, and corresponding references to his quotations are occasionally incomplete or inaccurate. There are several reasons why these errors continue to occur, including confusion surrounding the copyright dates and multiple editions of his books. In addition, less reliable, secondary sources of Still's words are often used instead of primary sources. To help resolve these problems, the author proposes 3 solutions. A list of Still's known published books, including the correct copyright date of The Philosophy and Mechanical Principles of Osteopathy, is provided. The disadvantages associated with using the 2 most popular secondary sources of Still's work are described. Guidelines from the 10th edition of the AMA Manual of Style are reviewed to assist authors, educators, and students in accurately citing material from older sources, such as Still's writings.

Avicenna's doctrine and institutional review board in international bio-medical research.

Avicenna, an outstanding Persian physician and philosopher (980 AD-1037 AD), established a clinical treaty, or doctrine, without which medical experimentation would not have progressed. This doctrine emphasizes the ultimate divine power of God or a higher being over healing and mandates the patients' well-being as the crucial aspect in all medical care and experiments. The Institutional Review Board, as the ethical body that oversees clinical research, is in line with this doctrine. However, the lack of a homogenous and internationally recognized code of ethics, the decentralized work of ethics oversight committees, the improper implementation of established ethical standards and a shortage of scientific auditing capacities have raised concerns over the possible exploitation of vulnerable populations.

Evidence-based medicine: what it can and cannot do.

Evidence-based medicine (EBM) is not a old hat, a "cookbook" medicine perpetrated by arrogant to serve cost cutters to suppress clinical freedom, a mandatory, deterministic, totalitarian practice of medicine, a way to control cost and to ignore patient preferences, a limit to personal/ humanistic/individual medicine. EBM is a reference of excellence to guide clinical decisions, the integration of own expertise with others' expertise and patient preferences, a way to improve medical practice and limit the variability and errors created when there is not evidence to identify the gold standard and differentiate among alternatives available. But evidences need to be integrated with a new thinking based on Complexity Science. Health care systems operates as complex adaptative systems rather than rigid, linear or mechanical organizations and innovation is a critical outcome of Complexity Science. How does EBM impact drug innovation? New drug approvals are not keeping pace with rising Research and Development spending, clinical approval success rate for new chemical entities (NCEs) is progressively dropping and maybe, through these indicators, we are seeing the worst face of EBM: its limiting, blocking, and controlling side. If that is the case, EBM is the main ally to keep the economy of health systems under control and the great excuse to block the access of the innovation to patients. Certainly not the best way to maximize the benefits of EBM.

Legacy of Avicenna and evidence-based medicine.

Although the term 'evidence-based medicine' (EBM) is of recent origin, its roots are generally agreed to lie in earlier times. Several writers have suggested that the 11th century CE physician and philosopher Avicenna (Ibn Sina) formulated an approach to EBM that broadly resembles modern-day principles and practice. The aim of this paper is to explore the origins and influence of Avicenna's version of EBM. A survey of the literature suggests that two influences on Avicenna's thought were crucial: the doctrine of Ijma; and Stoic logic, perhaps transmitted via the writings of Galen. In turn, Avicenna is known to have been a major influence on both medical practice and the development of logic in medieval Europe. Through this route, Avicennian logic (notably its inductive aspect) inspired the new style of thought associated with the scientific revolution, which later came to be reflected in 'scientific medicine', and may therefore have been an indirect source of EBM today.

[On the history of the evolution of Evidence-based medicine and its revelation].

The notions of Evidence-based medicine developed through two phases, which successively looked into the doctor-patient relationship and decision-making background. One of the new trends in evidence-based medicine deals with how to make theory into practice. Applying the practical model from post-SSK to interpret how the notions of evidence-based medicine changed, it is found that evidence-based medicine is an indivisible practical network integrating many natural and social factors as well as material and cultural factors which interconnect through "translation". Therefore, the involvement of various factors such as natural matter, social relations, regional factors, resources of traditional culture and scientific instruments leads up to the ultimate theory becoming the result of multiple factors in a continuous process of seeking the best way in scientific practice. In this motile process, the borderline between nature and society, material and human, natural science and social science vanishes and a new stage called humanistic medicine appears.

[Analysis on the background of arising of Evidence-based medicine].

Science is coming from the background of social culture. Evidence-based medicine (EBM) was generated at the early 90's of 20th Century, and there were some landmark things before its appearance. The background of EBM included: (1) risk control of medical techniques at the 70s of 20th Century; (2) ethical ideas of Protestant, including secularism, rationalism and utilitarianism; (3) British positivism and its tradition.

Prenatal care: limitations and opportunities.

Prenatal care is a venerable tradition in the U.S. health care system and one that deserves critical examination. Inordinate amounts of public and personal resources are expended on a tradition of care that has not proven itself equal to current perinatal prevention challenges. In this article, the evolution of prenatal care is reviewed, its efficacy is critiqued, and efforts at restructuring the content and processes of care are examined. Three promising alternatives to the dominant medical model are described: the comprehensive prenatal care approach illustrated by many publicly funded prenatal clinics, the prenatal empowerment model as exemplified by midwifery care, and the prenatal group model as illustrated by CenteringPregnancy. Nurses are called upon to champion prenatal options for women.