To err is human. Clinical practice guidelines （CPGs） are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barrier...To err is human. Clinical practice guidelines （CPGs） are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time, a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation （EBI） strategies.展开更多
Ⅰ、DIAGNOSTIC UNCERTAINTY We always face diagnostic uncertainty.Decision making,by means of diagnostic tests,is a major task to clinicians,especially in critical patients.Take an example.A man comes with chest pain a...Ⅰ、DIAGNOSTIC UNCERTAINTY We always face diagnostic uncertainty.Decision making,by means of diagnostic tests,is a major task to clinicians,especially in critical patients.Take an example.A man comes with chest pain at 2 am.The gold standard of cardiac catheterization to see if there is any occlusion of coronary arteries,remains the best option.However it is invasive.Cardiologists and laboratory support may not be available.But minutes count.We may want to have a reliable diagnostic test to rule in or rule out myocardial infarct.展开更多
I . Narrative review vs. Systematic review Narrative review is a non-systematic review of a topic, after a comprehensive, critical and objective analysis of current literature. It is not required to list the types of ...I . Narrative review vs. Systematic review Narrative review is a non-systematic review of a topic, after a comprehensive, critical and objective analysis of current literature. It is not required to list the types of databases and methodological approaches used, nor the evaluation criteria for inclusion of retrieved articles during databases search. These review articles use a qualitative approach. After full understanding of the topic viewed, you may then identify any knowledge gaps or inconsistencies. This will lead to a research question (PICO) that justifies conducting further study.展开更多
Introduction Randomized control trial (RCT)is one of the most well developed branches in evidence-based medicine.High standard journals adopt a standardized checklist (CONSORT statement,Consolidated Standards of Repor...Introduction Randomized control trial (RCT)is one of the most well developed branches in evidence-based medicine.High standard journals adopt a standardized checklist (CONSORT statement,Consolidated Standards of Reporting Trials),to guarantee the quality of reporting randomized control trials (RCTs)(See http://www.consort-statement,org/).展开更多
Before you start your own clinical trial,you should empower yourselves the literature appraisal tool.Below is the first chapter of a whole series of evidencebased teaching manual.After reading the manual,you will be a...Before you start your own clinical trial,you should empower yourselves the literature appraisal tool.Below is the first chapter of a whole series of evidencebased teaching manual.After reading the manual,you will be able to appraise other authors"articles with confidence.Chapter one deals with simple statistics for clinicians.Normal distribution and probability of "1 in 20"are fundamental to statistical testing.Central limit theorem suggests sample size of at least 30.Forest plot,point estimate and confidence intervals are explained,together with the difference between staffs- tical significance and clinical significance.Student t test is used in parametric testing while chi square test is used in Non-parametric test.展开更多
Introduction Doing clinical research is easy when you understand. Before conducting a clinical trial,you first need to know how to appraise a study. For different study types,you deliberately look out for bias,and tha...Introduction Doing clinical research is easy when you understand. Before conducting a clinical trial,you first need to know how to appraise a study. For different study types,you deliberately look out for bias,and that is,systematic errors affecting the truth. We call this process "Validity ". Practice makes perfect. After practicing appraisal works on different types of studies,展开更多
Harm and PrognosisⅠ、Harm articles aim at investigating any relationship of a harmful exposure and an adverse outcome.Case-control study only shows us an association.A well-designed cohort may demonstrate cause-effec...Harm and PrognosisⅠ、Harm articles aim at investigating any relationship of a harmful exposure and an adverse outcome.Case-control study only shows us an association.A well-designed cohort may demonstrate cause-effect relationship.Suppose we want to know whether smoking causes lung cancer.What will be our study design?We cannot do a RCT to study harm.It will be unethical to randomize subjects into 2 groups:one group must smoke and another does not.We can do a cohort study or case-control,instead.Cohort study can be prospective or retrospective.展开更多
What is Non-inferiority trial(NI)?NI is designed to see whether a new test agent is Not Unacceptably less efficacious than a standard treatment with well-established historical data.With continuous updates in primary ...What is Non-inferiority trial(NI)?NI is designed to see whether a new test agent is Not Unacceptably less efficacious than a standard treatment with well-established historical data.With continuous updates in primary studies and clinical uses,incremental benefits of newly developed treatments may be marginal over current treatments.To design another 3-arms RCT of new test agent to a standard treatment,as well as,placebo group may be unethical and a waste of resources.In such circumstances,there has been increasing use of NIs.NIs are more complex to design,conduct,and interpret than traditional superiority trials.Lefs illustrate with a 3-arms diagram below.展开更多
Ⅰ Why do we need to conduct a study?·To fill in knowledge gap·To identify the good and the bad management·To find out new diagnostic methods·To prevent adverse outcome·To improve patient care...Ⅰ Why do we need to conduct a study?·To fill in knowledge gap·To identify the good and the bad management·To find out new diagnostic methods·To prevent adverse outcome·To improve patient care FINER is the key concept when we start to think about to conduct a study.展开更多
文摘To err is human. Clinical practice guidelines （CPGs） are often not followed and lead to adverse outcomes. The issue on implementation of CPG is complex. A review of CPG implementation is done to identify the barriers and enablers. For the first time, a fishbone diagram is used to delineate the root-causes. And Haddon matrix is applied to help understand the complexity of evidence-based implementation （EBI） strategies.
文摘Ⅰ、DIAGNOSTIC UNCERTAINTY We always face diagnostic uncertainty.Decision making,by means of diagnostic tests,is a major task to clinicians,especially in critical patients.Take an example.A man comes with chest pain at 2 am.The gold standard of cardiac catheterization to see if there is any occlusion of coronary arteries,remains the best option.However it is invasive.Cardiologists and laboratory support may not be available.But minutes count.We may want to have a reliable diagnostic test to rule in or rule out myocardial infarct.
文摘I . Narrative review vs. Systematic review Narrative review is a non-systematic review of a topic, after a comprehensive, critical and objective analysis of current literature. It is not required to list the types of databases and methodological approaches used, nor the evaluation criteria for inclusion of retrieved articles during databases search. These review articles use a qualitative approach. After full understanding of the topic viewed, you may then identify any knowledge gaps or inconsistencies. This will lead to a research question (PICO) that justifies conducting further study.
文摘Introduction Randomized control trial (RCT)is one of the most well developed branches in evidence-based medicine.High standard journals adopt a standardized checklist (CONSORT statement,Consolidated Standards of Reporting Trials),to guarantee the quality of reporting randomized control trials (RCTs)(See http://www.consort-statement,org/).
文摘Before you start your own clinical trial,you should empower yourselves the literature appraisal tool.Below is the first chapter of a whole series of evidencebased teaching manual.After reading the manual,you will be able to appraise other authors"articles with confidence.Chapter one deals with simple statistics for clinicians.Normal distribution and probability of "1 in 20"are fundamental to statistical testing.Central limit theorem suggests sample size of at least 30.Forest plot,point estimate and confidence intervals are explained,together with the difference between staffs- tical significance and clinical significance.Student t test is used in parametric testing while chi square test is used in Non-parametric test.
文摘Introduction Doing clinical research is easy when you understand. Before conducting a clinical trial,you first need to know how to appraise a study. For different study types,you deliberately look out for bias,and that is,systematic errors affecting the truth. We call this process "Validity ". Practice makes perfect. After practicing appraisal works on different types of studies,
文摘Harm and PrognosisⅠ、Harm articles aim at investigating any relationship of a harmful exposure and an adverse outcome.Case-control study only shows us an association.A well-designed cohort may demonstrate cause-effect relationship.Suppose we want to know whether smoking causes lung cancer.What will be our study design?We cannot do a RCT to study harm.It will be unethical to randomize subjects into 2 groups:one group must smoke and another does not.We can do a cohort study or case-control,instead.Cohort study can be prospective or retrospective.
文摘What is Non-inferiority trial(NI)?NI is designed to see whether a new test agent is Not Unacceptably less efficacious than a standard treatment with well-established historical data.With continuous updates in primary studies and clinical uses,incremental benefits of newly developed treatments may be marginal over current treatments.To design another 3-arms RCT of new test agent to a standard treatment,as well as,placebo group may be unethical and a waste of resources.In such circumstances,there has been increasing use of NIs.NIs are more complex to design,conduct,and interpret than traditional superiority trials.Lefs illustrate with a 3-arms diagram below.
文摘Ⅰ Why do we need to conduct a study?·To fill in knowledge gap·To identify the good and the bad management·To find out new diagnostic methods·To prevent adverse outcome·To improve patient care FINER is the key concept when we start to think about to conduct a study.
