The study on the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of nerve root sciatica: A protocol for systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Nerve root sciatica (NRS) is a common orthopedic disease, which usually occurs between 20 and 40 years of age, and the incidence rate is increasing year by year and is being younger. The disease has no special effect of treatment, clinically generally taking the symptomatic treatment, such as taking short-term glucocorticoids, sedatives, analgesics, and so on. Long-term use of drugs will adversely affect the patient's gastrointestinal tract, liver, and kidney function. The surgical treatment has a high risk of surgery, high cost, side effects, and other problems, so the choice of treatment method has always been a difficult problem in clinical and scientific research. The study shows that 90% of patients with sciatica can be cured by non-surgical treatment, so conservative therapy is often used in the treatment of sciatica, traditional Chinese medicine treatment methods in the treatment of NRS has been widely used, which has achieved good results, but there is no evidence of evidence-based medicine. Therefore, this study uses systematic evaluation to conduct the scientific evaluation of the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS, and provide evidence-based medical evidence support for the treatment of NRS. METHODS: Using the computer to retrieve the PubMed, ScienceDirect, Web of Science, Embase, Cochrane Library, CNKI, VIP, WANFANG Database, and CBM. Using the subject words and terminology words to retrieve the Chinese-English database and retrieve a randomized controlled study on the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS, and the range of search time is January 1990 to January 2021. The searched literature is screened and evaluated by two researchers respectively according to the inclusion and exclusion criteria. If there is disagreement, discussing it with the third researcher to determine the final inclusion of the literature. Using the RevMan 5.3 software to conduct the meta-analysis. RESULTS: This study will compare the effectiveness and safety of traditional Chinese medicine acupoint catgut embedding guided by musculoskeletal ultrasound in the treatment of NRS. CONCLUSION: The results of this study will be published in internationally influential academic journals to provide evidence-based medical evidence for the clinical effectiveness and safety of traditional Chinese medicine acupoint catgut embedding in the treatment of NRS. ETHICS AND DISSEMINATION: This study does not involve specific patients, and all research data comes from publicly available professional literature, so an ethics committee is not required to conduct an ethical review and approval of the study. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/Q492E.

Disease diagnostic coding to facilitate evidence-based medicine: current and future perspectives.

Technologic advances in information management have rapidly changed laboratory testing and the practice of veterinary medicine. Timely and strategic sampling, same-day assays, and 24-h access to laboratory results allow for rapid implementation of intervention and treatment protocols. Although agent detection and monitoring systems have progressed, and wider tracking of diseases across veterinary diagnostic laboratories exists, such as by the National Animal Health Laboratory Network (NAHLN), the distinction between detection of agent and manifestation of disease is critical to improved disease management. The implementation of a consistent, intuitive, and useful disease diagnosis coding system, specific for veterinary medicine and applicable to multiple animal species within and between veterinary diagnostic laboratories, is the first phase of disease data aggregation. Feedback loops for continuous improvement that could aggregate existing clinical and laboratory databases to improve the value and applications of diagnostic processes and clinical interventions, with interactive capabilities between clinicians and diagnosticians, and that differentiate disease causation from mere agent detection, remain incomplete. Creating an interface that allows aggregation of existing data from clinicians, including final diagnosis, interventions, or treatments applied, and measures of outcomes, is the second phase. Prototypes for stakeholder cooperation, collaboration, and beta testing of this vision are in development and becoming a reality. We focus here on how such a system is being developed and utilized at the Iowa State University Veterinary Diagnostic Laboratory to facilitate evidence-based medicine and utilize diagnostic coding for continuous improvement of animal health and welfare.

Management of Acute and Traumatic Wounds With Negative-Pressure Wound Therapy With Instillation and Dwell Time.

BACKGROUND: A promising and useful development of negative-pressure wound therapy (NPWT) is the addition of instillation and dwell time of topical wound solutions (NPWTi-d). Uses of NPWTi-d include acute and traumatic wounds, whereby wound closure may be facilitated via wound cleansing and promotion of granulation tissue formation. This systematic review summarizes publications on NPWTi-d in the treatment of acute and traumatic wounds. METHODS: A systematic review was performed analyzing articles from major clinical databases. Only clinical studies ≥10 patients reporting on the application of NPWTi-d in acute and traumatic wounds were included. RESULTS: One hundred ninety-two articles were retrieved, of which 10 articles met inclusion criteria. Of those, 2 were lesser-quality randomized controlled trials, comparative studies or prospective cohorts, 2 were retrospective studies, and 6 retrospective cohort studies. In total, included publications reported 109 patients with acute and traumatic wounds treated with NPWTi-d. Data from these studies indicated the potential for reduction in bacterial bioburden through wound cleansing and promotion of granulation tissue formation, thereby facilitating wound closure, reduced length of therapy and hospital time. However, for most publications, different wound causes and subsequently no isolated results for acute and traumatic wounds were reported. CONCLUSION: NPWTi-d has promise to be effective in facilitating wound closure and reducing the time for wound closure. The present systematic review demonstrates a relatively low level of evidence available to objectively support this effect. To underline these positive results, large prospective, randomized controlled trials are necessary to manifest the role of NPWTi-d in the daily clinical routine for this wound category.

Chronic mesenteric ischemia: Clinical practice guidelines from the Society for Vascular Surgery.

BACKGROUND: Chronic mesenteric ischemia (CMI) results from the inability to achieve adequate postprandial intestinal blood flow, usually from atherosclerotic occlusive disease at the origins of the mesenteric vessels. Patients typically present with postprandial pain, food fear, and weight loss, although they can present with acute mesenteric ischemia and bowel infarction. The diagnosis requires a combination of the appropriate clinical symptoms and significant mesenteric artery occlusive disease, although it is often delayed given the spectrum of gastrointestinal disorders associated with abdominal pain and weight loss. The treatment goals include relieving the presenting symptoms, preventing progression to acute mesenteric ischemia, and improving overall quality of life. These practice guidelines were developed to provide the best possible evidence for the diagnosis and treatment of patients with CMI from atherosclerosis. METHODS: The Society for Vascular Surgery established a committee composed of vascular surgeons and individuals experienced with evidence-based reviews. The committee focused on six specific areas, including the diagnostic evaluation, indications for treatment, choice of treatment, perioperative evaluation, endovascular/open revascularization, and surveillance/remediation. A formal systematic review was performed by the evidence team to identify the optimal technique for revascularization. Specific practice recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation system based on review of literature, the strength of the data, and consensus. RESULTS: Patients with symptoms consistent with CMI should undergo an expedited workup, including a computed tomography arteriogram, to exclude other potential causes. The diagnosis is supported by significant arterial occlusive disease in the mesenteric vessels, particularly the superior mesenteric artery. Treatment requires revascularization with the primary target being the superior mesenteric artery. Endovascular revascularization with a balloon-expandable covered intraluminal stent is the recommended initial treatment with open repair reserved for select younger patients and those who are not endovascular candidates. Long-term follow-up and surveillance are recommended after revascularization and for asymptomatic patients with severe mesenteric occlusive disease. Patient with recurrent symptoms after revascularization owing to recurrent stenoses should be treated with an endovascular-first approach, similar to the de novo lesion. CONCLUSIONS: These practice guidelines were developed based on the best available evidence. They should help to optimize the care of patients with CMI. Multiple areas for future research were identified.

Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods.

OBJECTIVE: Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider's perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial. METHODS: Using a convergent mixed methods design, the authors had PCPs complete a post-trial survey and participate in interviews about using the CET for managing patients' skin problems. Data from both methods were integrated. RESULTS: PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact. CONCLUSION: PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management.

Artificial intelligence and automation of systematic reviews in women's health.

PURPOSE OF REVIEW: Evidence-based women's healthcare is underpinned by systematic reviews and guidelines. Generating an evidence synthesis to support guidance for clinical practice is a time-consuming and labour-intensive activity that delays transfer of research into practice. Artificial intelligence has the potential to rapidly collate, combine, and update high-quality medical evidence with accuracy and precision, and without bias. RECENT FINDINGS: This article describes the main fields of artificial intelligence with examples of its application to systematic reviews. These include the capabilities of processing natural language texts, retrieving information, reasoning, and learning. The complementarity and interconnection of the various artificial intelligence techniques can be harnessed to solve difficult problems in automation of reviews. Computer science can advance evidence-based medicine through development, testing, and refinement of artificial intelligence tools to deploy automation, creating 'living' evidence syntheses. SUMMARY: Groundbreaking, high-quality, and impactful artificial intelligence will accelerate the transfer of individual research studies seamlessly into evidence syntheses for contemporaneously improving the quality of healthcare.

Cosmetic treatment in patients with autoimmune connective tissue diseases: Best practices for patients with lupus erythematosus.

The cutaneous manifestations of lupus, especially chronic cutaneous lupus erythematosus, are a source of significant morbidity and can negatively impact patient quality of life. While the active inflammatory component of the disease may be adequately treated, patients are frequently left with residual skin damage and disfiguring aesthetic deficits. Dermatologists lack guidelines regarding the use and safety of various reconstructive and cosmetic interventions in this patient population. Laser treatments are largely avoided in the lupus population because of the possible photodamaging effects of ultraviolet and visible light. Similarly, given the autoimmune nature of this disease, some physicians avoid injectable treatment and grafts because of the concern for disease reactivation via antigenic stimulation. In the second article in this continuing medical education series we compile available data on this topic with the goal of providing evidence-based guidance on the cosmetic treatment of patients with lupus erythematosus with a focus on chronic cutaneous lupus erythematosus.

Survey of Infection Control Precautions for Patients with Severe Combined Immune Deficiency.

Severe combined immune deficiency (SCID) is caused by an array of genetic disorders resulting in a diminished adaptive immune system due to impaired T lymphocytes. In these patients, active infection at the time of hematopoietic transplantation has been shown to increase morbidity and mortality. To prevent transmission of infections in SCID patients, standardized infection control precautions should be implemented. An online survey regarding SCID-specific protocols was distributed through several immunodeficiency organizations. Seventy-three responses were obtained, with the majority (55%) of responses from the USA, 15% from Canada, and the remainder from 12 other countries. Only 50% of respondents had a SCID-specific infection control protocol at their center, and while a majority of these centers had training for physicians, a small minority had training for other healthcare workers such as nursing and housekeeping staff. Significant variability of infection control practices, such as in-patient precautions, required personal protective equipment (PPE), diet restrictions, visitor precautions and discharge criteria, was found between different treatment centers. There is a paucity of evidence-based data regarding the safest environment to prevent infection in SCID patients. Institutional protocols may have significant impact on infection risk, survival, family well-being, child development and cost of care. From these results, it is evident that further multi-center research is required to determine the safest and healthiest environment for these children, so that evidence-based infection control protocols for patients with SCID can be developed.

Smart Trauma: Improving the Delivery of Evidence-Based Trauma Care.

BACKGROUND: Mobile technology can aid in healthcare decision-making at the point of care. We created a Web-based trauma-specific smartphone application containing links to local protocols and national organization guidelines for trauma providers. We hypothesized that smartphone access to these guidelines would facilitate application of knowledge in a timely fashion. MATERIALS AND METHODS: Trauma providers were randomized to have or not have access to their smartphone during a timed, 10-question examination of trauma scenarios based on Eastern Association for the Surgery of Trauma, Western Trauma Association, and local protocols. Participants were then surveyed regarding their experience with the application. Groups were compared based on time with completion and percentage of correct answers. Subgroup analyses were completed to assess the utility of the application. RESULTS: Of 30 participants, 16 were randomized to smartphone use. Smartphone users took longer to complete the examination than nonusers (9:18 versus 6:36, P = 0.007) but answered a greater proportion of questions correctly (50% versus 40%, P = 0.159). Smartphone users had a higher percentage correct for Eastern Association for the Surgery of Trauma and Western Trauma Association protocol-based questions (78% versus 52%, P = 0.027; 70% versus 39%, P = 0.011), but no difference for local protocol-based questions (29% versus 37%, P = 0.48). Smartphone users who reported recent application use had the longest time to completion (11:44, P = 0.023) but the highest percentage correct (60%, P = 0.03). CONCLUSIONS: Smartphone use among those familiar with our trauma application resulted in the highest percentage correct but increased times to completion. The application interface should be streamlined, and providers educated to improve usage and reduce time to access information.

Swedish Society of Rheumatology 2018 guidelines for investigation, treatment, and follow-up of giant cell arteritis

To develop evidence-based guidelines for the management of giant cell arteritis (GCA) as a complement to guidelines in other areas of rheumatology, issued by the Swedish Society of Rheumatology. A working group selected key areas for recommendations, reviewed the available evidence, and wrote draft guidelines. These were discussed and revised according to standard procedures within the Swedish Society of Rheumatology, including a one-day meeting open to all members. For key recommendations, the quality of evidence was assessed according to GRADE. The final guidelines were approved by the Society board in March 2018.

AVATAR®: an electronic evidence-based medicine friendly tool for vascular access planning.

In today's demanding healthcare setting, many patients who are referred to hospital for treatment require some form of intravascular access device to administer required therapies and medications. It is estimated that most of admissions have an intravascular device placed on arrival to any given facility. Often these treatment prerequisites, combined with a wide range of available devices, based upon a combination of patient assessments, necessitated treatment regimens, and the use of a decision algorithm to choose the most appropriate device that provides all the patient's needs, requires a logical and methodical approach during the decision-making process. Several criteria should always remain in high regard for patient and device considerations, such as overall need for a device, the type of drugs or medications being infused, duration of therapy, patient disease states and comorbidities, as well as vessel health, patient age, previous intravascular device history, patient preference, potential site(s) of implantation, and finally, the resources available for ongoing device management. We have developed a tool, called AVATAR, aimed to make easier the implementation of a vascular access planning. It is a newly-designed tool, developed for the clinicians that must decide which type of venous access device is the ideal one in each single patient. It utilizes existing information that may not necessarily be only used by experts, but mainly by any clinician who may be looking for assistance in determining patient requirements. It requires clinical knowledge and it is not designed to be used for determining vascular access choices in emergency situations.

Analysing the opinions of UK veterinarians on practice-based research using corpus linguistic and mathematical methods.

The use of corpus linguistic techniques and other related mathematical analyses have rarely, if ever, been applied to qualitative data collected from the veterinary field. The aim of this study was to explore the use of a combination of corpus linguistic analyses and mathematical methods to investigate a free-text questionnaire dataset collected from 3796 UK veterinarians on evidence-based veterinary medicine, specifically, attitudes towards practice-based research (PBR) and improving the veterinary knowledge base. The corpus methods of key word, concordance and collocate analyses were used to identify patterns of meanings within the free text responses. Key words were determined by comparing the questionnaire data with a wordlist from the British National Corpus (representing general English text) using cross-tabs and log-likelihood comparisons to identify words that occur significantly more frequently in the questionnaire data. Concordance and collocation analyses were used to account for the contextual patterns in which such key words occurred, involving qualitative analysis and Mutual Information Analysis (MI3). Additionally, a mathematical topic modelling approach was used as a comparative analysis; words within the free text responses were grouped into topics based on their weight or importance within each response to find starting points for analysis of textual patterns. Results generated from using both qualitative and quantitative techniques identified that the perceived advantages of taking part in PBR centred on the themes of improving knowledge of both individuals and of the veterinary profession as a whole (illustrated by patterns around the words learning, improving, contributing). Time constraints (lack of time, time issues, time commitments) were the main concern of respondents in relation to taking part in PBR. Opinions of what vets could do to improve the veterinary knowledge base focussed on the collecting and sharing of information (record, report), particularly recording and discussing clinical cases (interesting cases), and undertaking relevant continuing professional development activities. The approach employed here demonstrated how corpus linguistics and mathematical methods can help to both identify and contextualise relevant linguistic patterns in the questionnaire responses. The results of the study inform those seeking to coordinate PBR initiatives about the motivators of veterinarians to participate in such initiatives and what concerns need to be addressed. The approach used in this study demonstrates a novel way of analysing textual data in veterinary research.

Evidence-based adequacy criteria for instrumented urine cytology using cytospin preparations.

Cytospin preparations of instrumented urine cytology specimens with less than 10 urothelial cells or more than 50 urothelial cells/10 hpfs are both associated with significantly increased false negative rates compared to cases with 10-49 urothelial cells/10 hpfs.

Síntese de recomendações: um recurso para subsidiar o processo de adaptação de guia de prática clínica para o tratamento farmacológico da depressão / Summary of recommendations: a resource to support the process of adaptation of the clinical practice guidelines for the pharmacological treatment of depression

A depressão é um dos maiores problemas de saúde pública do século XXI. Guias de prática clínica (GPCs) estão disponíveis para o tratamento da depressão e têm como objetivo fornecer a melhor e mais recente evidência disponível para os cuidados dos pacientes. Visando reduzir a duplicação de esforços e realizar a adequação de GPC ao contexto local o objetivo desta pesquisa é sintetizar as recomendações de GPCs de alta qualidade sobre o tratamento farmacológico da depressão em adultos na atenção primária. Foram realizadas as etapas busca sistemática dos GPCs, avaliação e seleção dos GPCs de melhor qualidade, e elaboração da síntese de recomendações de acordo com o preconizado no método ADAPTE. Foram considerados os GPCs com recomendações para o tratamento farmacológico da depressão em adultos em atenção primária, em língua inglesa, portuguesa ou espanhola, publicados a partir de 2011. Para a avaliação da qualidade dos GPCs, foi utilizado o Appraisal of Guidelines for Research & Evaluation II (AGREE II) sendo considerados de alta qualidade os GPCs com 80% ou mais no domínio "rigor metodológico". As características associadas à alta qualidade dos GPCs foram analisadas por meio do teste estatístico de Fisher. A extração das recomendações foi realizada de modo independente por dois avaliadores e estas foram organizadas em tópicos. Dos 28 GPC avaliados apenas cinco (18%) foram considerados de alta qualidade. A realização de revisão sistemática e da revisão externa e a aplicação de consenso formal foram características associadas à alta qualidade. Na síntese, além dos GPCs de alta qualidade, foram incluídos 2 GPCs muito empregados na prática clínica. Constatou-se que a maioria dos GPCs traz recomendações concordantes e complementares. Quase todos os GPCs recomendam o uso de inibidores seletivos de recaptação de serotonina como primeira escolha de tratamento. Uma das principais divergências é a recomendação de agomelatina, milnaciprano e mianserina por um dos GPCs como opção de primeira linha de tratamento. A pesquisa demonstra que a qualidade dos GPCs está aquém do desejável, tal qual evidenciado em outros estudos. A elaboração da síntese de recomendações permitiu evidenciar que há um GPC que se destacou por recomendar o uso de medicamentos considerados pouco eficazes na depressão. Considerando que a maioria das recomendações eram concordantes e os GPCs complementavam-se, essa síntese pode contribuir para que sejam realizadas discussões e adaptações locais, favorecendo a elaboração de novos GPCs que possam atender às necessidades de distintos grupos de usuários e demandas regionais

Depression is one of the most significant public health problems of the 21st century. Clinical practice guidelines (CPGs) are available for treating depression and are used for providing the best and latest evidence available for patient care. To avoid the duplication of effort and allow the adequacy of CPGs to regional healthcare networks, the objective of this study is to summarise the recommendations of high-quality CPGs on the pharmacological treatment of depression in adults in the primary healthcare network. The stages of this study were the systematic search of CPGs, analysis and selection of high-quality CPGs, and summarisation of the recommendations according to the ADAPTE guidelines. The CPGs published in English, Portuguese, and Spanish since 2011 with recommendations for the pharmacological treatment of depression in adults in the primary healthcare network were considered. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) was used to evaluate the quality of CPGs. CPGs with a score of >=80% in the domain 'methodological rigour' were considered high-quality. The factors associated with high quality were analysed using Fisher's exact test. The recommendations were extracted independently by two evaluators and organised into topics. Of the 28 evaluated CPGs, five (18%) were considered high-quality. The inclusion of systematic reviews and external reviews and the application of formal consensus were associated with high quality. In addition to high-quality CPGs, two CPGs commonly used in clinical practice were included in the summary. The recommendations provided by most CPGs were consistent and complementary. Almost all CPGs recommended using selective serotonin reuptake inhibitors as the first choice of treatment. One of the main divergences was the recommendation of agomelatine, milnacipran, and mianserin by one CPG as a first-line treatment option. The quality of CPGs was below desirable, and this result was corroborated by other studies. The analysis of the recommendations indicated that one CPG advised using medications with low efficacy in treating depression. Provided that most suggestions were concordant and the CPGs were complementary, this summary may contribute to local discussions and adaptations and promote the development of new CPGs that meet the needs of different user groups and regional demands

Cómo interpretar guías de práctica clínica elaboradas con metodología GRADE / Clinical guidelines using the GRADE system (Grading of Recommendations Assessment, Development and Evaluation)

The Ministry of Health of Chile, aiming to improve the quality of clinical practice guidelines, gradually incorporated the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) to develop evidence based recommendations. This system summarizes and evaluates the certainty of the available evidence. It moves from evidence to decision in a systematic and transparent manner, based on four main dimensions: balance between benefits and harms, certainty of evidence, patient's values and preferences and use of resources. The GRADE system produces strong and conditional recommendations. Strong recommendations provide confidence that the favorable consequences of an intervention clearly outweigh the adverse consequences, or vice versa. These recommendations apply to a broad range of patients and circumstances. Conditional recommendations, however, indicate that there is a close balance between favorable and unfavorable consequences of the intervention, there is uncertainty in the magnitude of benefits or adverse effects, there is uncertainty or variability in values and preferences of individuals or costs are not justified. These recommendations apply to many patients, but not all of them: ideally they should be discussed with each person. To achieve a better implementation of the recommendations made with GRADE methodology, health professionals should know the meaning of strong and conditional recommendations and they should be able to critically assess of them.

Use of Convexity in Ostomy Care: Results of an International Consensus Meeting.

Ostomy skin barriers that incorporate a convexity feature have been available in the marketplace for decades, but limited resources are available to guide clinicians in selection and use of convex products. Given the widespread use of convexity, and the need to provide practical guidelines for appropriate use of pouching systems with convex features, an international consensus panel was convened to provide consensus-based guidance for this aspect of ostomy practice. Panelists were provided with a summary of relevant literature in advance of the meeting; these articles were used to generate and reach consensus on 26 statements during a 1-day meeting. Consensus was achieved when 80% of panelists agreed on a statement using an anonymous electronic response system. The 26 statements provide guidance for convex product characteristics, patient assessment, convexity use, and outcomes.