Inaugurele rede Universiteit van Amsterdam. / Uitg. onder auspiciën van de Universiteit van Amsterdam. - Op omslag: AMC. Description based on print version record. Includes bibliographical references (p. 21-22). Met lit. opg.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

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Thesis (M. Med. Sc.)--University of Hong Kong, 2005. / Also available in print.

Thesis (Ed. D.)--West Virginia University, 2009. / Title from document title page. Document formatted into pages; contains x, 152 p. : ill. Vita. Includes abstract. Includes bibliographical references (p. 94-99).

Thesis (M. Med. Sc.)--University of Hong Kong, 2005.

Background: The gap between evidence and practice is an important problem that may, in part, be exacerbated by language barriers. Methods: We surveyed members of the Japanese Society for Fracture Repair regarding their self-perceived familiarity with evidence-based medicine, and barriers to keeping up with evidence relevant to their practice. We subsequently enrolled these same orthopedic surgeons in a randomized trial to explore the impact of providing 20 electronic links to English or Japanese OrthoEvidence summaries on whether surgeons accessed the link. Results: A total of 106 participants were enrolled in the study, and 105 completed the pre-trial survey. Fifty-seven participants acknowledged barriers to adopting EBM; the three most prominent reasons were lack of time (77%), lack of training in critical appraisal (100%), and language barriers (95%). The mean EBM familiarity score on a 4-point scale, higher scores indicating greater familiarity, was 2.59 (standard deviation [SD] 0.38, 95% confidence interval [CI] 2.52 to 2.66). Our randomized trial found no significant difference in the number of evidence summaries that were accessed whether they were provided in Japanese (median 9, interquartile range[IQR] 5 to 15; n = 52) or English (median 3, IQR 2 to 15; n = 53) (p=0.06). Conclusion: Although most Japanese orthopaedic surgeons acknowledge barriers in adopting EBM into clinical practice, and highlighted language as a key barrier, providing evidence summaries in Japanese did not significantly increase the number that were accessed. / Thesis / Master of Science (MSc) / Evidence-based medicine (EBM) incorporates current best evidence into clinical decision-making. The volume of new publications presents a challenge to staying on top of research findings in practice. Further, as most research is published in English, language barriers may hinder adoption into practice by non-English clinicians. We administered a survey to Japanese orthopedic surgeons to assess their familiarity with EBM, and perceived barriers to incorporating EBM into clinical practice. We subsequently conducted a randomized trial to explore the effect of providing electronic links to Japanese or English research summaries to Japanese orthopedic surgeons on whether or not they accessed summaries. Participants endorsed several barriers to incorporating EBM into practice, including lack of time, lack of training in critical appraisal, and language barriers; however, there was no difference in the number of evidence summaries accessed in our trial whether research reports were provided in English or Japanese.

Since its addition to the medical lexicon in 1992, the concept of ‘evidence-based medicine’ (EBM) has captured the imagination of the medical world, attracting both passionate advocates and ardent opponents. EBM is defined clinically as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Yet, its boldest claim is an ethical one: that EBM, rather than any other method, is the most effective way to fulfill our moral duty to help patients achieve better health. Academic debate on this point has been deeply polarized, from those who assert that ethical practice is evidence-based practice to those who argue that evidence-based practice impoverishes practice and robs it of ethical substance. Mainstream psychiatrists have endorsed EBM which holds out the promise of greater ethical legitimacy for psychiatric disorders and treatments through improved scientific substantiation. Evidence-based psychiatry arises through the straightforward application of EBM to the practice of psychiatry and thus shares the same ethical goal of EBM, to improve patients’ health. Given the ethical debates that have framed psychiatry since its inception as a medical specialty, and the particular nature of mental disorders and their treatments, it is unclear if EBM can be applied to psychiatry, and therefore, whether it can deliver on its ethical promises. This thesis project involved two phases. The first, a conceptual phase, included an analysis of EBM’s ethical commitments as they are represented in its two authoritative textbooks (‘literal’ EBM). This provisional analysis was then extended by a qualitative analysis of the views of three groups of participants concerning the ethics of EBM: 1) EBM developers; 2) mental health practitioners; and 3) philosophers or bioethicists. Combining the analyses from both phases, a more complete depiction of the ethics of EBM was developed in order to address the main thesis question. Evidence-based psychiatric practice cannot be ethical practice by itself. Instead, it can play a small ethical role in clinical practice, only if it is situated within the larger value structure of contemporary medicine and psychiatry.

Since its addition to the medical lexicon in 1992, the concept of ‘evidence-based medicine’ (EBM) has captured the imagination of the medical world, attracting both passionate advocates and ardent opponents. EBM is defined clinically as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” Yet, its boldest claim is an ethical one: that EBM, rather than any other method, is the most effective way to fulfill our moral duty to help patients achieve better health. Academic debate on this point has been deeply polarized, from those who assert that ethical practice is evidence-based practice to those who argue that evidence-based practice impoverishes practice and robs it of ethical substance. Mainstream psychiatrists have endorsed EBM which holds out the promise of greater ethical legitimacy for psychiatric disorders and treatments through improved scientific substantiation. Evidence-based psychiatry arises through the straightforward application of EBM to the practice of psychiatry and thus shares the same ethical goal of EBM, to improve patients’ health. Given the ethical debates that have framed psychiatry since its inception as a medical specialty, and the particular nature of mental disorders and their treatments, it is unclear if EBM can be applied to psychiatry, and therefore, whether it can deliver on its ethical promises. This thesis project involved two phases. The first, a conceptual phase, included an analysis of EBM’s ethical commitments as they are represented in its two authoritative textbooks (‘literal’ EBM). This provisional analysis was then extended by a qualitative analysis of the views of three groups of participants concerning the ethics of EBM: 1) EBM developers; 2) mental health practitioners; and 3) philosophers or bioethicists. Combining the analyses from both phases, a more complete depiction of the ethics of EBM was developed in order to address the main thesis question. Evidence-based psychiatric practice cannot be ethical practice by itself. Instead, it can play a small ethical role in clinical practice, only if it is situated within the larger value structure of contemporary medicine and psychiatry.

The purposes of this study were to understand emergency physicians¡¦ perception, attitude and application of evidence-based medicine(EBM). This cross-sectional study employed quantitative methods. Regarding the quantitative method, the study population included emergency physicians in southern Taiwan of 32 participating hospitals. Structured questionnaires were sent to emergency physicians, a total of 214 questionnaires were distributed with 189 questionnaires being returned. The response rate was 88.32%. Descriptive statistics was used in data analysis. The major findings were: 1. Emergency physician¡¦s perception of EBM: The average score in Physicians¡¦ understanding EBM terminologies were from 1.88 to 2.79(score ranged from 1 to 4, 1 represented fully understand). 2. Emergency physician¡¦s attitude of EBM: a. There were over a half (57.7%) emergency physicians had taken EBM training courses, while 93.1% expressed their willingness to attend EBM activities in the future. b. Most emergency physicians(86.7%) agreed that application of EBM was useful in clinical practice. c. The major barriers of emergency physicians to apply EBM were lack of time(57.1%), lack of EBM knowledge(50.3%), lack of research methodology knowledge(45.5%) and hardness of critical appraisal(40.7%). d. In general, emergency physicians hold positive attitudes toward EBM, the average score was from 1.79 to 3.09 (score ranged from 1 to 5, 1 represented the most agree). 3. Emergency physician¡¦s application of EBM: a. The average proportion of EBM application in emergency physicians¡¦ clinical practice was 54.42% . b. Emergency physician¡¦s choice of clinical problem-treating was diverse, only little clinical problem may have uniform opinions.