BACKGROUND Endoscopic colon polypectomy is a common procedure used to remove polyps that may develop into colorectal cancer if left untreated.Despite these advantages,patients frequently experience anxiety and other a...BACKGROUND Endoscopic colon polypectomy is a common procedure used to remove polyps that may develop into colorectal cancer if left untreated.Despite these advantages,patients frequently experience anxiety and other adverse reactions.Standardized evidence-based nursing practices are essential for enhancing patient care by addressing both physical and psychological health issues.AIM To analyze the impact of standardized evidence-based nursing on psychological status and adverse reactions of patients undergoing endoscopic colonic polypectomy.METHODS Data from 200 patients who underwent endoscopic colonic polypectomy at the authors’hospital between January and June 2024 were randomly assigned to two groups:Control[received routine nursing care(n=100)]and study[received standardized evidence-based nursing intervention(s)(n=100)].Psychological status,visual analog scale,and Short-Form 36 Health Survey scores,adverse events,and satisfaction with nursing were compared between the two groups.RESULTS After the interventions,the study group exhibited significantly lower scores on the Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale,along with a reduced incidence of adverse events compared with the control group(P<0.05).Short-Form 36 Health Survey scores and overall satisfaction with nursing care were also significantly higher in the intervention group(P<0.05).CONCLUSION Standardized evidence-based nursing interventions effectively reduced negative patient emotions and enhanced quality of life and satisfaction,demonstrating high safety.展开更多
Objectives To investigate the barriers and facilitators influencing the sustainable implementation of evidence-based practice(EBP)for Peristomal Irritant Contact Dermatitis(PICD)based on the Consolidated Framework for...Objectives To investigate the barriers and facilitators influencing the sustainable implementation of evidence-based practice(EBP)for Peristomal Irritant Contact Dermatitis(PICD)based on the Consolidated Framework for Implementation Research(CFIR).Methods The sample consisted of 17 nurses from three urology wards at a tertiary hospital in Beijing,China,who had participated in the EBP.Guided by the CFIR,we identified constructs influencing the sustainability of implementation by conducting a directed content analysis of the 17 individual in-depth interviews.By rating,the valence and magnitude of each construct were determined.Results This study identified 19 factors across the five domains of the CFIR.Among these determinants,16 were identified as barriers,while three were recognized as facilitators.Common barriers across different contexts were identified,such as delayed evidence updating,the complexity of intervention components and steps,and incompatibility between the implementation process and clinical practices.In contrast,facilitators of intervention implementation were regular communication and feedback,support and drive from principals and a positive cultural atmosphere.In addition,we identified“regular evidence updating”as an independent construct outside of the CFIR,a finding that will provide key information for updating the CFIR framework.Conclusions Regular evidence updating is crucial for the sustainability of EBP implementation.Researchers should receive consistent feedback from practitioners and adjust or modify the EBP as necessary.Additionally,researchers must consider the compatibility or adaptability of the EBP’s content with clinical practice in formulating it rather than adding additional complexity to the original workflow.展开更多
Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge tran...Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge translation model to guide evidence-based practice in nutrition management, and compare the nutritional status, cardiac function status, quality of life, and quality review indicators of chronic heart failure patients before and after the application of evidence. Results: After the application of evidence, the nutritional status indicators (MNA-SF score, albumin, hemoglobin) of two groups of heart failure patients significantly increased compared to before the application of evidence, with statistically significant differences (p Conclusion: The KTA knowledge translation model provides methodological guidance for the implementation of evidence-based practice for heart failure patients. This evidence-based practice project is beneficial for improving the outcomes of malnutrition in chronic heart failure patients and is conducive to standardizing nursing pathways, thereby promoting the improvement of nursing quality.展开更多
Based on the educational evaluation reform,this study explores the construction of an evidence-based value-added evaluation system based on data-driven,aiming to solve the limitations of traditional evaluation methods...Based on the educational evaluation reform,this study explores the construction of an evidence-based value-added evaluation system based on data-driven,aiming to solve the limitations of traditional evaluation methods.The research adopts the method of combining theoretical analysis and practical application,and designs the evidence-based value-added evaluation framework,which includes the core elements of a multi-source heterogeneous data acquisition and processing system,a value-added evaluation agent based on a large model,and an evaluation implementation and application mechanism.Through empirical research verification,the evaluation system has remarkable effects in improving learning participation,promoting ability development,and supporting teaching decision-making,and provides a theoretical reference and practical path for educational evaluation reform in the new era.The research shows that the evidence-based value-added evaluation system based on data-driven can reflect students’actual progress more fairly and objectively by accurately measuring the difference in starting point and development range of students,and provide strong support for the realization of high-quality education development.展开更多
Objective:To construct an evidence-based practice plan for perioperative nutritional optimization in esophageal cancer patients.Methods:By systematically searching relevant guidelines at home and abroad,two experts in...Objective:To construct an evidence-based practice plan for perioperative nutritional optimization in esophageal cancer patients.Methods:By systematically searching relevant guidelines at home and abroad,two experts independently assessed the quality of the guidelines,extracted valuable evidence and recommendations,and initially formed a draft nursing program.Subsequently,an expert panel was organized to conduct a detailed discussion to review the practicality and effectiveness of the recommendations one by one,and the program was finally revised and improved.Results:The protocol covered four stages of patients’admission,preoperative,postoperative,and discharge,involving specific contents such as nutritional assessment,risk screening,dysphagia assessment,nutritional therapy,enteral and parenteral nutritional support,symptom management,and health education.The program included a total of 61 entries,with 33 class A recommendations and 28 class B recommendations.Conclusion:The constructed perioperative nutritional care program for esophageal cancer patients is scientific and practical,and can provide practical guidance for clinical care.展开更多
Sustainable travel behavior intervention is an essential strategy to promote the development of urban transportation.The interventions offer personalized strategies based on certain scenario and participants to promot...Sustainable travel behavior intervention is an essential strategy to promote the development of urban transportation.The interventions offer personalized strategies based on certain scenario and participants to promote its effectiveness over hard travel restrictions.However,personalized strategies may also bring about difficulties to identify the actual effect of the measures.Furthermore,based on current practice,to make full use of travel behavior interventions,it is necessary to construct a unified methodological evidencebased framework to assess the reliability and effectiveness of travel behavior intervention studies.In response to these issues,we applied evidence-based knowledge graph to the field of sustainable travel behavior interventions to help decision supporters design sustainable travel behavior interventions wisely and in turn avoid excessive use of hard travel restrictions.We introduced concept of evidence-based practice to conduct a systematic analysis concerning reliability and validity of current full volume empirical studies by dimensions of scenarios,types of interventions and targets.In addition,we took advantage of high extensivity and integrability of knowledge graph to organize evidence-based related elements.Result of the systematic analysis shows that in terms of reliability of evidence,school intervention is the best scenario,knowledge incentive is the best intervention type and promoting public transit and walking proportion are the best targets.Oppositely,the reliability of interventions in workplace,belonging to reward and threat along with aiming at changing travel patterns generally and lowering travel carbon emission need to be enhanced.From the study,various research prospects are raised to promote evidence quality in the field of travel behavior intervention implementation.As a pioneer study,our research contributes to the field of urban transportation in introducing concepts of evidence-based practice and enabling optimization and extension of our achievement via the usage of knowledge graph,enhancing reliability and objectivity in urban transportation decision-making.展开更多
Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires improvement.The purpose of this study was to ...Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires improvement.The purpose of this study was to determine the effect of using tailored,multifaceted strategies to improve evidence-based post-stroke dysphagia identification and management practice in a community hospital.Methods Guided by the Knowledge to Action framework,the tailored,multifaceted strategies were developed and implemented for 5 months in a community hospital using a before-and-after study design.These strategies consisted of training intervention,policy intervention,and audit and feedback intervention.Nurses’level of knowledge and adherence,were collected in March 2019 and again in January 2020.Patients’quality of life and satisfaction were evaluated during the pre-intervention period(between February 2019 and April 2019)and the post-intervention period(between November 2019 and January 2020).Results A total of 55 patients with post-stroke dysphagia(28 in the pre-intervention period and 27 in the post-intervention period)and 17 registered nurses were recruited.Following implementation,there were statistically significant improvements in patients’outcomes(quality of life and satisfaction)and nurses’outcomes(level of knowledge and adherence).Conclusions This study assists in closing the research-practice gap by using tailored,multifaceted strategies to increase the use of evidence-based nursing care for dysphagia identification and management practices.展开更多
Objective To identify the status of knowledge,attitude,and behaviour toward evidence-based practice(EBP)among Chinese psychiatric nurses,and to examine the influencing factors of EBP behaviour.Methods We utilised a cr...Objective To identify the status of knowledge,attitude,and behaviour toward evidence-based practice(EBP)among Chinese psychiatric nurses,and to examine the influencing factors of EBP behaviour.Methods We utilised a cross-sectional design.A total of 923 psychiatric nurses from 168 hospitals in 27 provinces in the mainland of China participated in our survey.The EBP questionnaire,the barriers to research utilisation scale and the facilitators to research utilisation scale were used for data collection via WeChat group from July 2018 to April 2019.Multiple regression analysis was used to analyse the influencing factors of psychiatric nurses’evidence-based practice behaviour.Results The score of Chinese psychiatric nurses’EBP attitude,behaviour and knowledge were 4.81±1.34,4.11±1.36 and 3.53±1.29,respectively.Multiple regression analysis showed that nurses’EBP behaviour was mainly determined by knowledge and attitude,which together explained 61.8%of the variance.The two top barriers were the dimensions of presentation and research.Facilitators include managerial support,employing nurses with research skills as models and providing advanced education on evidence-based nursing.Conclusion Psychiatric nurses have positive attitudes toward EBP,but their level of knowledge and behaviour is insufficient.Heavy workload,insufficient time,and a lack of knowledge and skills is the main barrier.Managerial support,employing nurses with research skills as models and providing advanced education are the main facilitators.展开更多
Objectives Evidence-based healthcare contributes to the improvement of healthcare quality and informs healthcare decision-making.The provision of timely high-quality evidence is always required to fulfil the ever-chan...Objectives Evidence-based healthcare contributes to the improvement of healthcare quality and informs healthcare decision-making.The provision of timely high-quality evidence is always required to fulfil the ever-changing needs and expectations of healthcare personnel.This study aimed to assess the needs and expectations of healthcare personnel regarding evidence-based healthcare in China.Methods We conducted a cross-sectional online survey from December 8,2020 to January 15,2021 involving 901 participants across China.Healthcare providers,policy makers,researchers and educators,and full-time postgraduate medical and nursing students working/living in China were eligible to participate.A self-developed questionnaire was used.Results Participants generally agreed that health-related research evidence was beneficial.Evidence-based resources,such as Cochrane resources,were only known or used by about half of the respondents due to difficulties related to availability and accessibility.Various types of resources,topics of evidence,and themes of workshops were of particular interest to most of the participants.Conclusions The dissemination and translation of evidence,provision of more support in evidence availability,offering evidence-based training,and determining the most in-demand research areas have been identified as priority areas of work which could fulfil the needs and expectations of healthcare personnel in China.展开更多
Objective: To assess the quality of the first batch of Chinese evidence-based clinical practice guidelines (CPGs) in Traditional Chinese Medicine (TCM) using the Appraisal of Guidelines for Research and Evaluation (AG...Objective: To assess the quality of the first batch of Chinese evidence-based clinical practice guidelines (CPGs) in Traditional Chinese Medicine (TCM) using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Methods: Evidence-based CPGs in TCM supported by the World Health Organization Western Pacific Regional Office (WHO/WPRO) and whose development was organized by the China Academy of Chinese Medical Sciences were identified and manually retrieved. CPGs were assessed using the AGREE instrument, and the data in each CPG were analyzed in terms of the six domains in the AGREE instrument: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Results: Twenty-eight CPGs were identified, of which 26 were included in the study. The AGREE instrument rated the 26 CPGs in terms of the six domains. The assessment results showed the following average scores: for editorial independence, 84.16%; for rigor of development, 80.95%; for scope and purpose, 79.96%; for clarity and presentation, 70.88%; for stakeholder involvement, 61.28%; for applicability, the average score was only 27.09%. In summary, nine CPGs were rated as "strongly recommended", six as "recommended with provision or alternation", and 11 as "unsure". Conclusion: Most of the first batch of Chinese evidence-based CPGs in TCM had significant shortcomings in applicability. It is suggested that special attention be paid to enhancing the quality of applicability when developing evidence-based CPGs in TCM.展开更多
Background: Making changes in the existing curriculum aims, objectives, course contents learning outcomes and assessment strategies have become a fact of life for nurse educators. Purpose: To enhance the existing Bach...Background: Making changes in the existing curriculum aims, objectives, course contents learning outcomes and assessment strategies have become a fact of life for nurse educators. Purpose: To enhance the existing Bachelor of Science (BSc) in nursing curriculum through integration of evidence-based practice (EBP) and teaching of critical thinking skills. Materials and Methods: A needs analysis was conducted using a five-phased approach to review the BSc in nursing Curriculum. Kern’s six-step model was adapted and introduced through a series of workshop exercises that highlighted the application of each step: 1) Desk review of the BSc curriculum offered globally;2) Administration of the needs assessment questionnaire to key informants;3) Strengths, weakness, opportunities and threat analysis;4) Consultative meeting with major stakeholders;5) Curriculum review. Results: The five-phased approach established some gaps in existing curricula, and identified critical core competences and best practices in integrating EPB and critical thinking in the BSc undergraduate curriculum and some “A” level content that was not in tandem with the practice of nurses. New courses were developed to support students in academic writing and enhance professionalism and duration of training was reduced from 5 to 4 years. Conclusion: The process demonstrated that BSc curriculum review, in fact, should be thoroughly scrutinized to encourage positive changes to the curriculum, provide opportunities for team building and the development of leadership skills and a whole-of course perspective on the curriculum.展开更多
Hepatocellular carcinoma(HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide,...Hepatocellular carcinoma(HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide, HCC is a leading cause of cancerrelated deaths, as it is the fifth most common cancer and the third most important cause of cancer related death in men. Among various risk factors the two are prevailing: viral hepatitis, namely chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of obesity and the metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the BarcelonaClinic Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized-based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the disease(chronic liver disease and the cancer) and due to the large number of potentially efficient therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative(surgical treatment and tumor ablation) or palliative(transarterial therapy, radioembolization and medical treatment, i.e., sorafenib) is mandatory to achieve the best treatment outcome.展开更多
Rheumatoid arthritis(RA)is a common autoimmune condition with an elusive etiology.Conventional and biological disease-modifying drugs sometimes fail or produce only partial responses.Traditional Chinese medicine(TCM)h...Rheumatoid arthritis(RA)is a common autoimmune condition with an elusive etiology.Conventional and biological disease-modifying drugs sometimes fail or produce only partial responses.Traditional Chinese medicine(TCM)has long been used in China as a treatment for RA and is achieving everincreasing acceptance worldwide.TCM treatments are traditionally guided by the theory of treatment based on TCM syndrome differentiation;however,they remain a matter of empirical practice relying on TCM theories and doctors’own experience,which places severe restrictions on worldwide TCM application.Nevertheless,TCM is a treasure trove for drug discovery,particularly as a treatment for complicated human conditions.The discoveries of artemisinin as a treatment for malaria and of TCM–arsenic trioxide(As2O3)combination therapy as a treatment for acute promyelocytic leukemia(APL)are excellent examples of the great value of TCM.Regarding RA treatments,many Chinese medicinal herbs and their formulas,extracts,ingredients,and even single compounds have been used in clinical applications.Several Chinese proprietary medicines(CPMs)derived from TCM formulas or herbal bioactive components,such as the controlled-release ZhengQingFengTongNing(ZQFTN)Tablets,Tripterygium Glycoside Tablets,and Total Glucosides of Peony(TGP)Capsules,have been included in the National Health Insurance Directory of China,and show comparable therapeutic efficacies to those of western chemical drugs with fewer side effects.As TCM research has advanced,particularly in the use of multidisciplinary technologies,the scientific foundations and characteristics of the use of TCM to treat RA have been revealed,and the quality of TCM treatments have been increasingly enhanced.However,TCM generally lacks sufficient clinical and laboratory data to be consistent with international standards for quality,safety,and efficacy in order to support its application worldwide.Therefore,intensive basic and clinical studies on TCM are required.In particular,investigations that use cutting-edge technologies in analytical chemistry,biology,and biomedical sciences,and the development of randomized clinical trials(RCTs)and personalized pragmatic randomized controlled trials(PPRCTs)are necessary.Researchers should also collaborate to advance TCM from empirical practice to evidence-based therapy,thus consistently promoting TCM development and globalization in a vital,beneficial,and contributable manner.展开更多
BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing...BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.展开更多
The aim of this study was to establish clinical practice guidelines for acupuncture-moxibustion by retrieving relevant literature and adopting the best current national and international evidence, according to experts...The aim of this study was to establish clinical practice guidelines for acupuncture-moxibustion by retrieving relevant literature and adopting the best current national and international evidence, according to experts＇ experience and patients＇ values. This was achieved using the Grade of Recommendations Assessment, Development and Evaluation（GRADE） system combined with a wide range of national experts＇ consensus, in order to provide reliable evidence for acupuncture-moxibustion treatment of scapulohumeral periarthritis, and to ensure the safety and effectiveness of the treatment.展开更多
AIM: To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease (NAFLD) in clinical practice.
Objectives:To examine Chinese nurses'practice of reading and understanding scientific literature and elucidate the motivating and deterring factors.Methods:This is a cross-sectional study conducted between March a...Objectives:To examine Chinese nurses'practice of reading and understanding scientific literature and elucidate the motivating and deterring factors.Methods:This is a cross-sectional study conducted between March and June 2015.A random sample of 853 full-time registered nurses from three tertiary and two secondary hospitals in China filled out a set of self-administered questionnaires,including literature habit questionnaire(41 items),the situational motivation scale and the socio-demographic and professional characteristics questionnaire(15 items).Results:Significant majority(89.2%)of the respondents reported perception of barriers to keeping up to date with literature.The language barrier was the most prominent,followed by poor presentation and readability of articles.Using simpler language when writing articles,improving ones'foreign language proficiency and getting education or training on nursing research were raised as the top facilitators.Additionally,reading and understanding literature was significantly associated with the nurses'educational background,motivation,genders and work settings.Conclusions:The survey of the current status of literature education among Chinese nurses suggests that providing protected time,training for critical thinking,and incentive mechanisms will help improve nurses'engagement in literature and create a culture of academic inquiry.展开更多
The concept of evidence-based practice has persisted over several years and remains a cornerstone in clinical practice,representing the gold standard for optimal patient care.However,despite widespread recognition of ...The concept of evidence-based practice has persisted over several years and remains a cornerstone in clinical practice,representing the gold standard for optimal patient care.However,despite widespread recognition of its significance,practical application faces various challenges and barriers,including a lack of skills in interpreting studies,limited resources,time constraints,linguistic competencies,and more.Recently,we have witnessed the emergence of a groundbreaking technological revolution known as artificial intelligence.Although artificial intelligence has become increasingly integrated into our daily lives,some reluctance persists among certain segments of the public.This article explores the potential of artificial intelligence as a solution to some of the main barriers encountered in the application of evidence-based practice.It highlights how artificial intelligence can assist in staying updated with the latest evidence,enhancing clinical decision-making,addressing patient misinformation,and mitigating time constraints in clinical practice.The integration of artificial intelligence into evidence-based practice has the potential to revolutionize healthcare,leading to more precise diagnoses,personalized treatment plans,and improved doctor-patient interactions.This proposed synergy between evidencebased practice and artificial intelligence may necessitate adjustments to its core concept,heralding a new era in healthcare.展开更多
Dysmenorrhea refers to periodic abdominal pain,or radiating to lumbosacral region.For the severe case,it is intolerable,combined with nausea and vomiting sometimes.This disease is commonly seen in unmarried young wome...Dysmenorrhea refers to periodic abdominal pain,or radiating to lumbosacral region.For the severe case,it is intolerable,combined with nausea and vomiting sometimes.This disease is commonly seen in unmarried young women.Epidemiological studies have shown that dysmenorrhea is the most common gynecological disease,especially in young women[1].Acupuncture and moxibustion have a long history in the treatm ent of primary dysmenorrhea(hereinafter referred to as PD),and compared with medication,the advantages are presented in the treatment.Entrusted by the Standardization Working Committee of China Association for Acupuncture and Moxibustion(CAAM),Department of Acupuncture and Moxibustion,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine has undertaken the drafting of Evidence-Based Clinical Practice Guideline of Acupuncture and Moxibustion:Primary Dysmenorrhea(hereinafter referred to as the Guideline).The Guideline was issued in 2014 by CAAM.It summarizes the research achievements in acupuncture-moxibustion treatm ent for dysmenorrhea in recent decades and is intended to standardize the clinical regimen of treatm ent with acupuncture and moxibustion so as to improve the clinical effect.展开更多
For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making...For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.展开更多
文摘BACKGROUND Endoscopic colon polypectomy is a common procedure used to remove polyps that may develop into colorectal cancer if left untreated.Despite these advantages,patients frequently experience anxiety and other adverse reactions.Standardized evidence-based nursing practices are essential for enhancing patient care by addressing both physical and psychological health issues.AIM To analyze the impact of standardized evidence-based nursing on psychological status and adverse reactions of patients undergoing endoscopic colonic polypectomy.METHODS Data from 200 patients who underwent endoscopic colonic polypectomy at the authors’hospital between January and June 2024 were randomly assigned to two groups:Control[received routine nursing care(n=100)]and study[received standardized evidence-based nursing intervention(s)(n=100)].Psychological status,visual analog scale,and Short-Form 36 Health Survey scores,adverse events,and satisfaction with nursing were compared between the two groups.RESULTS After the interventions,the study group exhibited significantly lower scores on the Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale,along with a reduced incidence of adverse events compared with the control group(P<0.05).Short-Form 36 Health Survey scores and overall satisfaction with nursing care were also significantly higher in the intervention group(P<0.05).CONCLUSION Standardized evidence-based nursing interventions effectively reduced negative patient emotions and enhanced quality of life and satisfaction,demonstrating high safety.
基金supported by the Peking University Nursing Discipline Research Development Fund(No.TYZH2023001)。
文摘Objectives To investigate the barriers and facilitators influencing the sustainable implementation of evidence-based practice(EBP)for Peristomal Irritant Contact Dermatitis(PICD)based on the Consolidated Framework for Implementation Research(CFIR).Methods The sample consisted of 17 nurses from three urology wards at a tertiary hospital in Beijing,China,who had participated in the EBP.Guided by the CFIR,we identified constructs influencing the sustainability of implementation by conducting a directed content analysis of the 17 individual in-depth interviews.By rating,the valence and magnitude of each construct were determined.Results This study identified 19 factors across the five domains of the CFIR.Among these determinants,16 were identified as barriers,while three were recognized as facilitators.Common barriers across different contexts were identified,such as delayed evidence updating,the complexity of intervention components and steps,and incompatibility between the implementation process and clinical practices.In contrast,facilitators of intervention implementation were regular communication and feedback,support and drive from principals and a positive cultural atmosphere.In addition,we identified“regular evidence updating”as an independent construct outside of the CFIR,a finding that will provide key information for updating the CFIR framework.Conclusions Regular evidence updating is crucial for the sustainability of EBP implementation.Researchers should receive consistent feedback from practitioners and adjust or modify the EBP as necessary.Additionally,researchers must consider the compatibility or adaptability of the EBP’s content with clinical practice in formulating it rather than adding additional complexity to the original workflow.
文摘Objective: To develop a best-evidence-based optimal nutrition management plan for patients with chronic heart failure, apply it in clinical practice, and evaluate its effectiveness. Methods: Use the KTA knowledge translation model to guide evidence-based practice in nutrition management, and compare the nutritional status, cardiac function status, quality of life, and quality review indicators of chronic heart failure patients before and after the application of evidence. Results: After the application of evidence, the nutritional status indicators (MNA-SF score, albumin, hemoglobin) of two groups of heart failure patients significantly increased compared to before the application of evidence, with statistically significant differences (p Conclusion: The KTA knowledge translation model provides methodological guidance for the implementation of evidence-based practice for heart failure patients. This evidence-based practice project is beneficial for improving the outcomes of malnutrition in chronic heart failure patients and is conducive to standardizing nursing pathways, thereby promoting the improvement of nursing quality.
基金This paper is the research result of“Research on Innovation of Evidence-Based Teaching Paradigm in Vocational Education under the Background of New Quality Productivity”(2024JXQ176)the Shandong Province Artificial Intelligence Education Research Project(SDDJ202501035),which explores the application of artificial intelligence big models in student value-added evaluation from an evidence-based perspective。
文摘Based on the educational evaluation reform,this study explores the construction of an evidence-based value-added evaluation system based on data-driven,aiming to solve the limitations of traditional evaluation methods.The research adopts the method of combining theoretical analysis and practical application,and designs the evidence-based value-added evaluation framework,which includes the core elements of a multi-source heterogeneous data acquisition and processing system,a value-added evaluation agent based on a large model,and an evaluation implementation and application mechanism.Through empirical research verification,the evaluation system has remarkable effects in improving learning participation,promoting ability development,and supporting teaching decision-making,and provides a theoretical reference and practical path for educational evaluation reform in the new era.The research shows that the evidence-based value-added evaluation system based on data-driven can reflect students’actual progress more fairly and objectively by accurately measuring the difference in starting point and development range of students,and provide strong support for the realization of high-quality education development.
文摘Objective:To construct an evidence-based practice plan for perioperative nutritional optimization in esophageal cancer patients.Methods:By systematically searching relevant guidelines at home and abroad,two experts independently assessed the quality of the guidelines,extracted valuable evidence and recommendations,and initially formed a draft nursing program.Subsequently,an expert panel was organized to conduct a detailed discussion to review the practicality and effectiveness of the recommendations one by one,and the program was finally revised and improved.Results:The protocol covered four stages of patients’admission,preoperative,postoperative,and discharge,involving specific contents such as nutritional assessment,risk screening,dysphagia assessment,nutritional therapy,enteral and parenteral nutritional support,symptom management,and health education.The program included a total of 61 entries,with 33 class A recommendations and 28 class B recommendations.Conclusion:The constructed perioperative nutritional care program for esophageal cancer patients is scientific and practical,and can provide practical guidance for clinical care.
基金supported by the Science and Technology Commission of Shanghai Municipal under Grant 22511104200the Fundamental Research Funds for the Central Universities under No.2022-5-YB-02.
文摘Sustainable travel behavior intervention is an essential strategy to promote the development of urban transportation.The interventions offer personalized strategies based on certain scenario and participants to promote its effectiveness over hard travel restrictions.However,personalized strategies may also bring about difficulties to identify the actual effect of the measures.Furthermore,based on current practice,to make full use of travel behavior interventions,it is necessary to construct a unified methodological evidencebased framework to assess the reliability and effectiveness of travel behavior intervention studies.In response to these issues,we applied evidence-based knowledge graph to the field of sustainable travel behavior interventions to help decision supporters design sustainable travel behavior interventions wisely and in turn avoid excessive use of hard travel restrictions.We introduced concept of evidence-based practice to conduct a systematic analysis concerning reliability and validity of current full volume empirical studies by dimensions of scenarios,types of interventions and targets.In addition,we took advantage of high extensivity and integrability of knowledge graph to organize evidence-based related elements.Result of the systematic analysis shows that in terms of reliability of evidence,school intervention is the best scenario,knowledge incentive is the best intervention type and promoting public transit and walking proportion are the best targets.Oppositely,the reliability of interventions in workplace,belonging to reward and threat along with aiming at changing travel patterns generally and lowering travel carbon emission need to be enhanced.From the study,various research prospects are raised to promote evidence quality in the field of travel behavior intervention implementation.As a pioneer study,our research contributes to the field of urban transportation in introducing concepts of evidence-based practice and enabling optimization and extension of our achievement via the usage of knowledge graph,enhancing reliability and objectivity in urban transportation decision-making.
基金This work was supported by the Postgraduate Independent Project of Beijing University of Chinese Medicine(No.2017-JYB-XS-085).
文摘Objectives Even though guidelines are available to guide dysphagia identification and management practice,there is still a gap between evidence and practice,which requires improvement.The purpose of this study was to determine the effect of using tailored,multifaceted strategies to improve evidence-based post-stroke dysphagia identification and management practice in a community hospital.Methods Guided by the Knowledge to Action framework,the tailored,multifaceted strategies were developed and implemented for 5 months in a community hospital using a before-and-after study design.These strategies consisted of training intervention,policy intervention,and audit and feedback intervention.Nurses’level of knowledge and adherence,were collected in March 2019 and again in January 2020.Patients’quality of life and satisfaction were evaluated during the pre-intervention period(between February 2019 and April 2019)and the post-intervention period(between November 2019 and January 2020).Results A total of 55 patients with post-stroke dysphagia(28 in the pre-intervention period and 27 in the post-intervention period)and 17 registered nurses were recruited.Following implementation,there were statistically significant improvements in patients’outcomes(quality of life and satisfaction)and nurses’outcomes(level of knowledge and adherence).Conclusions This study assists in closing the research-practice gap by using tailored,multifaceted strategies to increase the use of evidence-based nursing care for dysphagia identification and management practices.
基金This study was supported by Chinese nursing management scientific research fund(CNM-2017-09).
文摘Objective To identify the status of knowledge,attitude,and behaviour toward evidence-based practice(EBP)among Chinese psychiatric nurses,and to examine the influencing factors of EBP behaviour.Methods We utilised a cross-sectional design.A total of 923 psychiatric nurses from 168 hospitals in 27 provinces in the mainland of China participated in our survey.The EBP questionnaire,the barriers to research utilisation scale and the facilitators to research utilisation scale were used for data collection via WeChat group from July 2018 to April 2019.Multiple regression analysis was used to analyse the influencing factors of psychiatric nurses’evidence-based practice behaviour.Results The score of Chinese psychiatric nurses’EBP attitude,behaviour and knowledge were 4.81±1.34,4.11±1.36 and 3.53±1.29,respectively.Multiple regression analysis showed that nurses’EBP behaviour was mainly determined by knowledge and attitude,which together explained 61.8%of the variance.The two top barriers were the dimensions of presentation and research.Facilitators include managerial support,employing nurses with research skills as models and providing advanced education on evidence-based nursing.Conclusion Psychiatric nurses have positive attitudes toward EBP,but their level of knowledge and behaviour is insufficient.Heavy workload,insufficient time,and a lack of knowledge and skills is the main barrier.Managerial support,employing nurses with research skills as models and providing advanced education are the main facilitators.
文摘Objectives Evidence-based healthcare contributes to the improvement of healthcare quality and informs healthcare decision-making.The provision of timely high-quality evidence is always required to fulfil the ever-changing needs and expectations of healthcare personnel.This study aimed to assess the needs and expectations of healthcare personnel regarding evidence-based healthcare in China.Methods We conducted a cross-sectional online survey from December 8,2020 to January 15,2021 involving 901 participants across China.Healthcare providers,policy makers,researchers and educators,and full-time postgraduate medical and nursing students working/living in China were eligible to participate.A self-developed questionnaire was used.Results Participants generally agreed that health-related research evidence was beneficial.Evidence-based resources,such as Cochrane resources,were only known or used by about half of the respondents due to difficulties related to availability and accessibility.Various types of resources,topics of evidence,and themes of workshops were of particular interest to most of the participants.Conclusions The dissemination and translation of evidence,provision of more support in evidence availability,offering evidence-based training,and determining the most in-demand research areas have been identified as priority areas of work which could fulfil the needs and expectations of healthcare personnel in China.
基金supported by projects from the China Academy of Chinese Medical Sciences (No.Z0135)the State Administration of Traditional Chinese Medicine (No. ZYYS-2008)the National Science Foundation of China (No. 30825047)
文摘Objective: To assess the quality of the first batch of Chinese evidence-based clinical practice guidelines (CPGs) in Traditional Chinese Medicine (TCM) using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Methods: Evidence-based CPGs in TCM supported by the World Health Organization Western Pacific Regional Office (WHO/WPRO) and whose development was organized by the China Academy of Chinese Medical Sciences were identified and manually retrieved. CPGs were assessed using the AGREE instrument, and the data in each CPG were analyzed in terms of the six domains in the AGREE instrument: scope and purpose, stakeholder involvement, rigor of development, clarity and presentation, applicability, and editorial independence. Results: Twenty-eight CPGs were identified, of which 26 were included in the study. The AGREE instrument rated the 26 CPGs in terms of the six domains. The assessment results showed the following average scores: for editorial independence, 84.16%; for rigor of development, 80.95%; for scope and purpose, 79.96%; for clarity and presentation, 70.88%; for stakeholder involvement, 61.28%; for applicability, the average score was only 27.09%. In summary, nine CPGs were rated as "strongly recommended", six as "recommended with provision or alternation", and 11 as "unsure". Conclusion: Most of the first batch of Chinese evidence-based CPGs in TCM had significant shortcomings in applicability. It is suggested that special attention be paid to enhancing the quality of applicability when developing evidence-based CPGs in TCM.
文摘Background: Making changes in the existing curriculum aims, objectives, course contents learning outcomes and assessment strategies have become a fact of life for nurse educators. Purpose: To enhance the existing Bachelor of Science (BSc) in nursing curriculum through integration of evidence-based practice (EBP) and teaching of critical thinking skills. Materials and Methods: A needs analysis was conducted using a five-phased approach to review the BSc in nursing Curriculum. Kern’s six-step model was adapted and introduced through a series of workshop exercises that highlighted the application of each step: 1) Desk review of the BSc curriculum offered globally;2) Administration of the needs assessment questionnaire to key informants;3) Strengths, weakness, opportunities and threat analysis;4) Consultative meeting with major stakeholders;5) Curriculum review. Results: The five-phased approach established some gaps in existing curricula, and identified critical core competences and best practices in integrating EPB and critical thinking in the BSc undergraduate curriculum and some “A” level content that was not in tandem with the practice of nurses. New courses were developed to support students in academic writing and enhance professionalism and duration of training was reduced from 5 to 4 years. Conclusion: The process demonstrated that BSc curriculum review, in fact, should be thoroughly scrutinized to encourage positive changes to the curriculum, provide opportunities for team building and the development of leadership skills and a whole-of course perspective on the curriculum.
文摘Hepatocellular carcinoma(HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide, HCC is a leading cause of cancerrelated deaths, as it is the fifth most common cancer and the third most important cause of cancer related death in men. Among various risk factors the two are prevailing: viral hepatitis, namely chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of obesity and the metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the BarcelonaClinic Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized-based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the disease(chronic liver disease and the cancer) and due to the large number of potentially efficient therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative(surgical treatment and tumor ablation) or palliative(transarterial therapy, radioembolization and medical treatment, i.e., sorafenib) is mandatory to achieve the best treatment outcome.
文摘Rheumatoid arthritis(RA)is a common autoimmune condition with an elusive etiology.Conventional and biological disease-modifying drugs sometimes fail or produce only partial responses.Traditional Chinese medicine(TCM)has long been used in China as a treatment for RA and is achieving everincreasing acceptance worldwide.TCM treatments are traditionally guided by the theory of treatment based on TCM syndrome differentiation;however,they remain a matter of empirical practice relying on TCM theories and doctors’own experience,which places severe restrictions on worldwide TCM application.Nevertheless,TCM is a treasure trove for drug discovery,particularly as a treatment for complicated human conditions.The discoveries of artemisinin as a treatment for malaria and of TCM–arsenic trioxide(As2O3)combination therapy as a treatment for acute promyelocytic leukemia(APL)are excellent examples of the great value of TCM.Regarding RA treatments,many Chinese medicinal herbs and their formulas,extracts,ingredients,and even single compounds have been used in clinical applications.Several Chinese proprietary medicines(CPMs)derived from TCM formulas or herbal bioactive components,such as the controlled-release ZhengQingFengTongNing(ZQFTN)Tablets,Tripterygium Glycoside Tablets,and Total Glucosides of Peony(TGP)Capsules,have been included in the National Health Insurance Directory of China,and show comparable therapeutic efficacies to those of western chemical drugs with fewer side effects.As TCM research has advanced,particularly in the use of multidisciplinary technologies,the scientific foundations and characteristics of the use of TCM to treat RA have been revealed,and the quality of TCM treatments have been increasingly enhanced.However,TCM generally lacks sufficient clinical and laboratory data to be consistent with international standards for quality,safety,and efficacy in order to support its application worldwide.Therefore,intensive basic and clinical studies on TCM are required.In particular,investigations that use cutting-edge technologies in analytical chemistry,biology,and biomedical sciences,and the development of randomized clinical trials(RCTs)and personalized pragmatic randomized controlled trials(PPRCTs)are necessary.Researchers should also collaborate to advance TCM from empirical practice to evidence-based therapy,thus consistently promoting TCM development and globalization in a vital,beneficial,and contributable manner.
文摘BACKGROUND Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery(ERAS)provide recommendations for ERAS in gastrointestinal surgery,the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the com-plex factors contributing to patient stress responses.Moreover,stress responses are more severe in older adult patients.Therefore,precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.and demonstrate nursing benefits through clinical practice.METHODS This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response.Next,392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based(study group)or conventional(control group)ERAS nursing models,respectively.Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.RESULTS Among 64 domestic and international studies,the stress responses of older adult patients mainly included emotional anxiety,sleep disorders,gastrointestinal discomfort,physical weakness,pain,and swelling.The appropriate nursing interventions included comprehensive psychological counseling,pre-and postoperative nutritional support,temperature control,pain management,and rehabilitation training.Compared with the control group,the study group showed lower heart rate,mean arterial pressure,blood glucose level,and adrenaline level;shorter duration of drainage tube placement,time to first flatus,time to first ambulation,and postoperative hospital stay;lower anxiety scores on postoperative day 3;and lower incidences of postoperative infection,obstruction,poor wound healing,and gastrointestinal reactions were lower in the study group(all P<0.05).CONCLUSION The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery,promoted postoperative recovery,and reduced the incidence of complications.
基金Supported by standardization of traditional Chinese medicine,State Administration of Traditional Chinese Medicine of the People’s Republic of China:ZYYS-2009-0009-8special project of construction of TCM Master CHENG Xin-nong’s Inheritance Studio,State Administration of Traditional Chinese Medicine of the People’s Republic of China
文摘The aim of this study was to establish clinical practice guidelines for acupuncture-moxibustion by retrieving relevant literature and adopting the best current national and international evidence, according to experts＇ experience and patients＇ values. This was achieved using the Grade of Recommendations Assessment, Development and Evaluation（GRADE） system combined with a wide range of national experts＇ consensus, in order to provide reliable evidence for acupuncture-moxibustion treatment of scapulohumeral periarthritis, and to ensure the safety and effectiveness of the treatment.
基金Supported by(in part)Chilean Society of GastroenterologyGrants from the Fondo Nacional De Ciencia y Tecnología de Chile,FONDECYT 1110455 to Arrese M and 1120652 to Riquelme Athe Comisión Nacional de Investigación,Ciencia y Tecnología,CONICYT,basal project CARE Chile UC
文摘AIM: To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease (NAFLD) in clinical practice.
文摘Objectives:To examine Chinese nurses'practice of reading and understanding scientific literature and elucidate the motivating and deterring factors.Methods:This is a cross-sectional study conducted between March and June 2015.A random sample of 853 full-time registered nurses from three tertiary and two secondary hospitals in China filled out a set of self-administered questionnaires,including literature habit questionnaire(41 items),the situational motivation scale and the socio-demographic and professional characteristics questionnaire(15 items).Results:Significant majority(89.2%)of the respondents reported perception of barriers to keeping up to date with literature.The language barrier was the most prominent,followed by poor presentation and readability of articles.Using simpler language when writing articles,improving ones'foreign language proficiency and getting education or training on nursing research were raised as the top facilitators.Additionally,reading and understanding literature was significantly associated with the nurses'educational background,motivation,genders and work settings.Conclusions:The survey of the current status of literature education among Chinese nurses suggests that providing protected time,training for critical thinking,and incentive mechanisms will help improve nurses'engagement in literature and create a culture of academic inquiry.
文摘The concept of evidence-based practice has persisted over several years and remains a cornerstone in clinical practice,representing the gold standard for optimal patient care.However,despite widespread recognition of its significance,practical application faces various challenges and barriers,including a lack of skills in interpreting studies,limited resources,time constraints,linguistic competencies,and more.Recently,we have witnessed the emergence of a groundbreaking technological revolution known as artificial intelligence.Although artificial intelligence has become increasingly integrated into our daily lives,some reluctance persists among certain segments of the public.This article explores the potential of artificial intelligence as a solution to some of the main barriers encountered in the application of evidence-based practice.It highlights how artificial intelligence can assist in staying updated with the latest evidence,enhancing clinical decision-making,addressing patient misinformation,and mitigating time constraints in clinical practice.The integration of artificial intelligence into evidence-based practice has the potential to revolutionize healthcare,leading to more precise diagnoses,personalized treatment plans,and improved doctor-patient interactions.This proposed synergy between evidencebased practice and artificial intelligence may necessitate adjustments to its core concept,heralding a new era in healthcare.
基金State Administration of Traditional Chinese Medicine(Department of Policy,Regulation and Supervision)“Evidence-based clinical practice guideline of acupuncture and moxibustion:primary dysmenorrhea”:No.ZYYS-2009-0009-4Scientific Specific Project of China Base Business Construction for Clinical Research of Traditional Chinese Medicine,State Administration of Traditional Chinese Medicine:No.JDZX2015063
文摘Dysmenorrhea refers to periodic abdominal pain,or radiating to lumbosacral region.For the severe case,it is intolerable,combined with nausea and vomiting sometimes.This disease is commonly seen in unmarried young women.Epidemiological studies have shown that dysmenorrhea is the most common gynecological disease,especially in young women[1].Acupuncture and moxibustion have a long history in the treatm ent of primary dysmenorrhea(hereinafter referred to as PD),and compared with medication,the advantages are presented in the treatment.Entrusted by the Standardization Working Committee of China Association for Acupuncture and Moxibustion(CAAM),Department of Acupuncture and Moxibustion,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine has undertaken the drafting of Evidence-Based Clinical Practice Guideline of Acupuncture and Moxibustion:Primary Dysmenorrhea(hereinafter referred to as the Guideline).The Guideline was issued in 2014 by CAAM.It summarizes the research achievements in acupuncture-moxibustion treatm ent for dysmenorrhea in recent decades and is intended to standardize the clinical regimen of treatm ent with acupuncture and moxibustion so as to improve the clinical effect.
文摘For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.
