Doctor-patient shared decision making is an expansion and extension of the patient-centered concept, which emphasizes communication and collaboration between doctors and patients in making decisions, focuses on patients, needs, enhances communication and exchange between doctors and patients, and improves the status of patients in medical decision making. This paper reviews the concept, domestic and international research overview, advantages, and application of doctor-patient shared decision making in hip and knee arthroplasty, and discusses the future research directions, in order to provide a reference for the application of shared decision making between doctors and patients in hip and knee arthroplasty in China.
The analysis of big data in medical field cannot be isolated from the high quality clinical database, and the construction of first aid database in our country is still in the early stage of exploration. This paper introduces the idea and key technology of the construction of multi-parameter first aid database. By combining emergency business flow with information flow, an emergency data integration model was designed with reference to the architecture of the Medical Information Mart for Intensive Care III (MIMIC-III), created by Computational Physiology Laboratory of Massachusetts Institute of Technology (MIT), and a high-quality first-aid database was built. The database currently covers 22 941 medical records for 19 814 different patients from May 2015 to October 2017, including relatively complete information on physiology, biochemistry, treatment, examination, nursing, etc. And based on the database, the first First-Aid Big Data Datathon event, which 13 teams from all over the country participated in, was launched. The First-Aid database provides a reference for the construction and application of clinical database in China. And it could provide powerful data support for scientific research, clinical decision making and the improvement of medical quality, which will further promote secondary analysis of clinical data in our country.
Objective To investigate the situation of supplemental drugs to the national essential medicines list (EML) in primary health care facilities. Methods Supplemental essential medicine lists published by provincial governments around our country were identified. Characteristics of categories, names and quantities of the supplemental drugs were extracted and compared. Results Supplemental lists issued by 13 provinces were included. The number of the supplemental drugs of four provinces including Jiangsu, Guangdong, Inner Mongolia and Shandong surpassed 200. All the included lists contained chemicals and traditional Chinese medicine, as well as nine categories mentioned in the EML. The frequency of 17 drugs in the supplemental lists was over 10. Specific paediatrics drugs and antitumor drugs were considered by several provinces. Conclusion At present, EML cannot meet the requirements of the primary healthcare. Selection and amendment of EML may refer to the supplemental lists which reflect the demands of essential drugs in every area in our country.
This paper introduced definition of right care, presented the evidences of overuse and underuse in the world and pointed out the importance of dissemination of evidence-based medicine to right care. Not only evidence production but also concepts of evidence-based practical are important. It is important to disseminate evidence-based medicine not only among academic societies but also among the public. These are critical for achieving right care and preventing overuse and underuse of medical care.
Objective To investigate the basic status of adult cleft lip and palate patients and the social perception of different populations towards cleft lip and palate diseases in the Chinese Mainland, and provide a scientific basis for further improving the public awareness of cleft lip and palate diseases. Methods A questionnaire survey on basic demographic information was conducted among cleft lip and palate patients who were aged 18 or above and received diagnosis and treatment in the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between January 2022 and October 2023. Simultaneously, another questionnaire survey was conducted among cleft lip and palate specialists, genetic and prenatal counsellors, ultrasound staff, general medical staff, families of cleft lip and palate patients, and the general population, to investigate their level of knowledge regarding prenatal diagnosis, treatment, and prognosis of cleft lip and palate, as well as their corresponding decision-making choices. Results A total of 489 copies of questionnaire were distributed to patients with cleft lip and palate who were 18 years old or above, and 440 valid copies were collected, with an effective response rate of 90.0%. Among the 440 patients, 90.0% were aged 18-30 years, 57.7% were males, 65.7% were residing within Sichuan Province, 53.8% had an associate degree, bachelor’s degree or above, 71.6% had no fixed occupation, 75.0% had siblings, and 86.8% had a monthly family income of ≤10000 yuan. In terms of the questionnaire on social perception of cleft lip and palate among different populations, a total of 1513 copies of questionnaire were collected, among which 1437 were valid copies, with an effective response rate of 95.0%. There was no statistically significant difference (P>0.05) in the understanding and perception among different populations regarding the questions “Does cleft lip and palate affect the quality of life and future development of affected children?” or “Do you think families of children with cleft lip and palate experience significant pressure?”, while there were statistically significant differences (P<0.05) in the understanding and perception of the remaining eight questions. Conclusions People with cleft lip and palate have certain difficulties in employment and need more attention and help from the society. There are differences in social perception related to cleft lip and palate among different groups of people.
Objective To investigate evidence retrieval, appraisal, and reevaluation during evidence-based clinical decision making in China. Also, to analyze the related factors, so as to find the problems in the course of evidence-based clinical decision making and put forward corresponding solutions. Methods We searched Chinese Biomedical Literature Disc (CBM) and China Journal Full-text Database (Medical sciences) of the China National Knowledge Infrastructure (CNKI) to collect clinical evidence-based case reports. Relevant information was extracted from these reports by a selfdesigned investigation form.Then statistical analyses were performed. Results The search tools used in the course of evidence-based clinical decision making varied. The most frequently used were MEDLINE/PubMed (82.08%) and The Cochrane Library (60.38%). 30.63% of evidence-based case reports described the search strategy in detail, and 9.01% described how they modified their search strategy. All doctors evaluated the association between evidence and disease, but few of them integrated patient factors and relevant external factors when evaluating evidence. The scientific nature and validity of the evidence was evaluated in 74 evidence-based case reports (66.67%), and such evaluation was mainly based on the criteria of evidence grading (50.00%). Reevaluation was mentioned in 85.59% of evidence-based case reports. Conclusion In China, the application of evidence-based decision making varied in different clinical departments. Problems existed in the course of evidence retrieval, appraisal, and reevaluation. This revealed the low information diathesis level of doctors and their lack of evidence-based medicine knowledge. It is suggested that information education and evidence-based medicine education should be strengthened to improve doctors’ ability to use evidence-based clinical decision making. It is also recommended that the search tools, relevant search strategy, the modification of search strategy, and reevaluation on practice results of each case should be mentioned in evidence-based case reports.
At present, upper limb motor rehabilitation relies on specific rehabilitation aids, ignoring the initiative of upper limb motor of patients in the middle and late stages of rehabilitation. This paper proposes a fuzzy evaluation method for active participation based on trajectory error and surface electromyography (sEMG) for patients who gradually have the ability to generate active force. First, the level of motor participation was evaluated using trajectory error signals represented by computer vision. Then, the level of physiological participation was quantified based on muscle activation (MA) characterized by sEMG. Finally, the motor performance and physiological response parameters were input into the fuzzy inference system (FIS). This system was then used to construct the fuzzy decision tree (FDT), which ultimately outputs the active participation level. A controlled experiment of upper limb flexion and extension exercise in 16 healthy subjects demonstrated that the method presented in this paper was effective in quantifying difference in the active participation level of the upper limb in different force-generating states. The calculation results of this method and the active participation assessment method based on sEMG during the task cycle showed that the active participation evaluation values of both methods peaked in the initial cycle: (82.34 ± 9.3) % for this paper’s method and (78.44 ± 7.31) % for the sEMG method. In the subsequent cycles, the values of both showed a dynamic change trend of rising first and then falling. Trend consistency verifies the effectiveness of the active participation assessment strategy in this paper, providing a new idea for quantifying the participation level of patients in middle and late stages of upper limb rehabilitation without special equipment mediation.
In 2019, the national government issued the document "Implementation Plan for Supporting the Construction of the Boao Lecheng International Medical Tourism Pilot Area", which allowed the use of innovative drugs and medical devices in medical institution of Boao Lecheng. These medical products had been designed to meet urgent clinical requirements and had been approved by regulatory authorities overseas. Through the use of these medical products, real-world data were generated in the routine clinical practice, based on which real-world evidence might be produced for regulatory decision-making by using scientific and rigorous methods. In March 2020, the first medical device product using domestic real-world data was approved, suggesting that the real-world data initiative in Boao Lecheng achieved initial success. This work also provided important experience for promoting the practice of medical device regulatory decision-making based on real-world evidence in China. Here, we shared the preliminary experiences from the study on the first approved medical device product and discussed the issues on developing a real-world data research framework in Boao Lecheng in attempt to offer insights for future studies.
The main task of Campbell Collaboration is to collaborate with Cochrane Collaboration so as to produce high quality evidence for the social welfare, education, justice and criminal, international development policy and other social sciences. This article systematically introduces Campbell Collaboration, its origins, achievements and development, with the purpose of allowing more scholars understand evidence-based ideas and methods of social science, providing evidence-based methodology basis for China's social policy.