A cross-sectional study evaluating the knowledge, attitude, and practice of evidence-based medicine among resident doctors of a health-care Institution of National Importance in India.

Background and Objectives: Evidence-based medicine (EBM) promotes the integration of updated- best evidence with patient preferences and medical expertise for clinical decision-making. Despite the availability of high-quality evidence such as systematic review and meta-analysis, some clinicians manage their patients based on past experiences and expert opinion. Thus, this study was proposed to assess the knowledge, attitude, and practice of EBM among resident doctors at a tertiary care hospital in India. Participants and Methods: This cross-sectional questionnaire-based study was conducted among senior residents and final-year postgraduates (PGs) who were independently involved in clinical decision-making. By convenience sampling method, the participants were recruited, and the validated EBM Questionnaire (EBMQ) was distributed online for assessing the knowledge, attitude, and practice of EBM. Descriptive statistics were represented as frequency and proportions. Results: A total of 102 resident doctors participated with male preponderance (74.5%). Nearly, 96 (94.1%) participants were already practicing EBM and 21.6% had undergone EBM training. Textbooks (50%) were the most often referred sources for EBM information. Specific EBM databases such as MEDLINE and Cochrane were also utilized by 37.3% of participants. More than 70% of participants understood the terms such as a randomized controlled trial, case-control study, and P value. A higher proportion (80.4%) of participants showed a positive attitude about patient care improved by EBM. Conclusions: The majority of the resident doctors exhibited good knowledge and a positive attitude toward applying EBM in clinical decision-making. Periodic training through workshops or courses and integration of EBM with the PG curriculum would potentially enhance the EBM practice.

Efficacy and safety of lobeglitazone, a new Thiazolidinedione, as compared to the standard of care in type 2 diabetes mellitus: A systematic review and meta-analysis.

AIM: This systematic review and meta-analysis was conducted to evaluate the efficacy and safety of lobeglitazone as compared to the standard of care (SOC) in patients with type 2 diabetes mellitus (T2DM). METHODS: Databases were searched for relevant randomized controlled trials. The primary outcome was the comparison of the glycated hemoglobin (HbA1C) level after 24 weeks. Pooled mean differences and odds ratios were calculated using random-effects models. RESULTS: Of 267 studies that were screened, four were included. Treatment with adjunct lobeglitazone showed a reduction in the HbA1C level [mean difference: -0.23% (95% CI: -0.62 to 0.16); p = 0.24; i2: 87%; moderate GRADE (Grading of Recommendations Assessment, Development and. Evaluation) of evidence], fasting blood glucose level [mean difference: -7.12 mg/dl (95% CI: -20.09 to 5.85); p = 0.28; i2: 87%; moderate GRADE of evidence], and lipid profile as compared to those following treatment with the SOC; however, the changes were not statistically significant. The risk of hypoglycemia was significantly lower [odds ratio: 0.24 (95% CI: 0.08 to 0.70); p < 0.05; i2: 0%; moderate GRADE of evidence] without any significant difference in the risk of drug-related adverse events [odds ratio: 1.59 (95% CI: 0.87 to 2.93); p = 0.13; i2: 0%; moderate GRADE of evidence] following treatment with lobeglitazone as compared to those following treatment with the SOC. CONCLUSION: Treatment with adjunct lobeglitazone showed changes in the blood glycemic status and lipid profile similar to SOC in patients with T2DM, and the results were not statistically significant. Lobeglitazone was well tolerated; its safety profile was comparable to SOC.

An Audit of the Quality of Reporting and Bias of Studies on Yoga in Epilepsy.

Background: Yoga is increasingly being used as a complementary mode of treatment for epilepsy along with pharmacotherapy; however, the quality of reporting and bias of studies on yoga in epilepsy is uncertain. Objective: This study was performed to systematically evaluate the reporting quality and bias of the published studies on yoga in epilepsy. Materials and methods: PubMed and Cochrane databases were searched for studies investigating the efficacy of yoga in epilepsy or describing the patients' or caregivers' knowledge, attitude, influence, and practice of yoga in epilepsy. The reporting qualities of the studies were appraised by standard reporting checklists (CONSORT, STROBE, COREQ, and modified CONSORT) and the risks of bias were assessed using standard tools (Cochrane Collaboration's risk of bias tool, Newcastle-Ottawa scale, and ROBINS-I tool) according to the study designs. Results: Fifteen studies (four randomized control trials, seven observational studies, three non-randomized interventional studies, and one was a mixed-method study) were included. The reporting qualities of the studies which evaluated the role of yoga in epilepsy were comparatively poor from the methodological perspective and the risks of bias were comparatively high than those which described the knowledge, attitude, influence, and practice of yoga in epilepsy. Conclusion: The reporting qualities of studies in relation to yoga and epilepsy were not satisfactory and the risks of bias were high. Hence, it is imperative to be cautious before widely recommending yoga in epilepsy.

Indo-Swiss symposium on advances in pharmacogenomic strategies for implementation of personalized medicine.

The Indo-Swiss symposium on advances in pharmacogenomic strategies for implementation of personalized medicine was conducted as a part of the JIPMER Integrated Pharmacogenomics Program (JIPP), held in Puducherry, India on 23 November 2019. The symposium focused on the growing contribution of pharmacogenomic information in designing treatment strategies and promoting better approaches to personalized medicine. The primary objective of this symposium was to bridge gaps in understanding the basics and recent advances in the field of pharmacogenomics. This symposium sought to promote interaction between the Indian and Swiss researchers to initiate future collaborative research projects. This symposium also served as a platform for young researchers to present their research findings as posters to the audience.

Calculation of the fragility index of randomized controlled trials in epilepsy published in twelve major journals.

OBJECTIVE: Fragility index is the minimum number of participants in a trial whose status has to be changed from an 'event' to a 'non-event' for a dichotomous primary outcome to turn the P-value (calculated by Fischer's exact test) statistically non-significant (P > 0.05). This study was performed to evaluate the fragility index of randomized controlled trials (RCTs) in epilepsy published in 12 major journals. METHODS: We identified the relevant RCTs published in six major epilepsy-related and six Neurology journals from January 2015 to September 2019 and determined the fragility index of those RCTs which reported statistically significant results of dichotomous primary outcomes. We also calculated the Spearman correlation coefficients between the fragility index and the sample size, the event rate, and the reported P-value. RESULTS: A total of 1395 RCTs were screened and finally ten were eligible for the analysis. The median (IQR) fragility index was only 1.5 (11). There was no significant correlation between the fragility index and the sample size (r = 0.620, P = 0.056), the event rate (r = < 0.0001, P = 1.0), and the reported P-value (r = - 0.315, P = 0.447). CONCLUSION: The median fragility index of the included RCTs on epilepsy was very low. The addition of only two alternate events to an arm of the average trial would have rejected the statistical significance. Fragility index should be used while reporting the results of dichotomous primary outcomes of RCTs.