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Critical appraisal of medical literature : Introductory guidelines

Goh LG

Family Physician, 1997;10:4-9.

Matched MeSH terms: Evidence-Based Medicine
Critical appraisal skills and the family physician

Krishnan R

Family Physician, 1997;10:1-1.

Matched MeSH terms: Evidence-Based Medicine
Knowledge and attitudes of Malaysian private medical practitioners toward guidelines-based medicine

Lian PC, Marnoch G

J Manag Med, 1999;13(2-3):178-89.
PMID: 10747449

This paper describes a study of the knowledge and attitudes of a sample of private medical practitioners in Malaysia in relation to questions posed on guidelines-based medicine. The study was conducted through a postal questionnaire sent to a sample of 2,000 private practitioners. Placing the research in context, a description of Malaysia and its health-care system is provided. Issues surrounding guidelines-based medicine in the Malaysian context are discussed. An analysis of the sample population's personal and professional characteristics is presented. Key research findings include identifying a substantial knowledge deficit--less than half of the respondents claimed to understand "guidelines". A majority of doctors (64 per cent) think guidelines are useful. Only 29 per cent of respondents knew where to find guidelines, with 22 per cent claiming to have used guidelines. The paper concludes with a discussion of issues in the implementation of guidelines-based medicine in Malaysia based on the study's findings.

Matched MeSH terms: Evidence-Based Medicine/statistics & numerical data*
Fulltext Current trends in the management of chronic obstructive pulmonary disease

Liam CK

Med J Malaysia, 2000 Jun;55(2):285-92; quiz 293.
PMID: 19839165
Matched MeSH terms: Evidence-Based Medicine*
Antibiotic prophylaxis in elective colorectal surgery

Gul YA, Lian LH, Jabar FM, Moissinac K

ANZ J Surg, 2002 Apr;72(4):275-8.
PMID: 11982514

Antibiotics are often administered in elective colorectal surgery to prevent wound infection. The tendency for surgeons to prolong the administration of prophylactic antibiotic therapy in the postoperative period is a well-known fact. The aim of this study was to elucidate the pattern of prophylactic antibiotic utilization in elective colorectal surgery and to determine if evidence-based medicine is employed in relation to this practice.

Matched MeSH terms: Evidence-Based Medicine
Teaching of evidence-based medicine to medical undergraduates

Atiya AS

Med J Malaysia, 2002 Dec;57 Suppl E:105-8.
PMID: 12733204

Medical practice is changing, and the foundations of the paradigm shift lie in the development in research over the last four decades. Today, it is no longer adequate to treat a patient purely on clinical experience alone without a clear demonstration of evidence based on research, particularly the use of randomised controlled clinical trials. What is thought to be an effective mode of treatment currently may not necessarily hold true by the time medical students begin his/her medical practice. As a consequence, many medical schools worldwide are increasingly promoting evidence-based medicine (EBM) teaching in their medical curriculum along with problem-based learning (PBL). Teaching of EBM requires a paradigm shift in itself, as students must possess additional skills that are not traditionally part of medical training. These include the ability to acquire the skills in 'means of answering questions' than just 'knowing the answer to questions'. This paper aims to describe what EBM is and to highlight the formative experience of the teaching of EBM at the medical undergraduate level in the University of Malaya. Challenges and opportunities towards successful adoption of evidence-based practice are discussed.

Matched MeSH terms: Evidence-Based Medicine/education*
Fulltext Upper respiratory tract infections: to what extent is the management evidence-based?

Teng CL, Nurjahan MI, Hashim NA, Punithambigai P, Leong KC, Mihat O

Med J Malaysia, 2003 Jun;58(2):159-66.
PMID: 14569735 MyJurnal

Over a 2-week period, the management of upper respiratory tract infection by 24 medical officers and medical assistants in Seremban District was studied. Each practitioner recorded clinical data and prescription for twenty consecutive patients using a structured questionnaire. The extent to which the practitioners used "predictive features" (fever, absence of cough, cervical adenopathy, enlarged tonsils and exudates on tonsils) in clinical decision-making was analysed. The mean antibiotic prescription rate was 28.7% (95% CI: 24.6%, 33.0%). The antibiotic prescription rate of medical officers and medical assistants were similar. Five features were independently associated with antibiotic prescription (phlegm, fever, cervical adenopathy, red throat and tonsillar exudates). Antibiotics were prescribed for 22.1% of patients with 0-1 predictive features. High prescribers were 5 times more likely to prescribe antibiotics in this group of patients than low prescribers. To a large extent the clinical decision-making of practitioners in this study was evidence based. However, they were unduly influenced by purulent manifestation (phlegm) and redness of throat. The antibiotic prescription rate in these government health clinics is potentially reducible by means of educational intervention.

Matched MeSH terms: Evidence-Based Medicine
Fulltext Are doctors in the university-based primary care clinic more evidence-based?

Khoo EM, Teng CL, Wong KC

Med J Malaysia, 2004 Mar;59(1):129.
PMID: 15535352
Matched MeSH terms: Evidence-Based Medicine
Fulltext Primary care doctors' perceptions towards evidence-based medicine in Melaka State: a questionnaire study

Chan GC, Teng CL

Med J Malaysia, 2005 Jun;60(2):130-3.
PMID: 16114151

A cross sectional study using a self-administered questionnaire to determine the perceptions of primary care doctors towards evidence-based medicine (EBM) was conclucted in Melaka state. About 78% of the primary care doctors were aware of EBM and agreed it could improve patient care. Only 6.7% of them had ever conducted a Medline literature search. They had a low level of awareness of review publications and databases relevant to EBM; only about 33% of them were aware of the Cochrane Database of Systemic Reviews. Over half of the respondents had at least some understanding of the technical terms used in EBM. Ninety percent of the respondents had Internet access and the majority of them used it at home. The main barriers to practicing EBM were lack of personal time and lack of Internet access in the primary care clinics.

Matched MeSH terms: Evidence-Based Medicine*
Evidence-based practical management of vulvovaginal candidiasis in primary care

Loh KY, Sivalingam N

Family Physician, 2005;13:20-21.

Matched MeSH terms: Evidence-Based Medicine
Fulltext Managing congestive heart failure in a general hospital in Malaysia. Are we keeping pace with evidence?

Chin SP, Sapari S, How SH, Sim KH

Med J Malaysia, 2006 Aug;61(3):278-83.
PMID: 17240575 MyJurnal

Evidence-based heart failure management now includes beta-blockers and spironolactone in addition to diuretics and angiotensin-converting enzyme inhibitors. We aim to determine if these recommendations had been applied in practice for acute and chronic stable heart failure, and what difficulties there might be. Data from 80 consecutive patients hospitalized for decompensated heart failure ('acute') between May and July 2003 were analyzed at admission, upon discharge and at 12 weeks follow-up; along with 74 cardiology clinic out-patients with stable congestive heart failure ('chronic'- no decompensation or admission in previous six months). Less than half of study patients with prior left ventricular dysfunction were on ACE-inhibitors (47%), diuretics (39%), ATII antagonists, spironolactone or digoxin (5% each). All 'acute' patients were commenced on diuretics and ACE-inhibitors in hospital. Six patients died or transferred to another center. Compliance with clinic appointment at 12 weeks was 85% despite telephone reminders. Drug prescription at 12 weeks was significantly lower for diuretics and ACE-inhibitors compared to prescription at discharge (all p < 0.05) but higher compared to patients with chronic HF. Diuretics and ACE inhibitors remain under-utilized for patients with recurrent heart failure. Use of spironolactone and beta-blocker is slow due to limited medical experience and funding. Clinic non-attendance is significant and due to patient factors.

Matched MeSH terms: Evidence-Based Medicine
Fulltext The product of outcome-based undergraduate medical education: competencies and readiness for internship

Lai NM, Ramesh JC

Singapore Med J, 2006 Dec;47(12):1053-62.
PMID: 17139402

INTRODUCTION: Outcome-based curriculum is adopted at the International Medical University (IMU), Malaysia, where specific learning objectives are laid out progressively under eight major outcomes. We present an outcome-guided, self-reported competency profile of our undergraduate students near the end of their training, focusing on elements that are considered most immediately relevant for their internship.
METHODS: Anonymous surveys were conducted on two cohorts of medical students in their final semester at IMU. The surveys covered a range of competencies, including practical skills, ward routines, generic attributes and evidence-based medicine, grouped under the exit outcomes as defined by the university.
RESULTS: A total of 92 students were assessed. In general, the students were confident of their ability on common practical skills and ward routines. They were comfortable with the level of professionalism and personal attributes required for internship, with the prospect of handling unexpected additional tasks and working away from home perceived as the main difficulties. Most students referred to at least three sources of clinical information to answer their clinical queries. However, they referred more to single journals than databases or collections. The majority could critically appraise journal articles to a variable extent, but nearly half took 30 minutes or longer to trace an abstract of interest.
CONCLUSION: This report demonstrates the strength of outcome-based curriculum in its ability to produce competent students that are well prepared for their internship. Assessing students using this educational approach provides a clear picture of their strengths and weaknesses, and identifies stages in their training where additional inputs are required.

Matched MeSH terms: Evidence-Based Medicine
Fulltext Impact of various continuing medical education activities on clinical practice - a survey of Malaysian doctors on its perceived importance

Loh LC, Ong HT, Quah SH

Ann Acad Med Singap, 2007 Apr;36(4):281-4.
PMID: 17483859

INTRODUCTION: Medical talks, newsletter circulars, scientific meetings and conferences, and interaction with members of the pharmaceutical industry, have become convenient means of carrying out continuing medical education (CME) for many busy doctors.

MATERIALS AND METHODS: To study the perceived importance of these various CME activities, a self-completed posted questionnaire survey was conducted among registered practitioners of a densely populated urban state in Malaysia.

RESULTS: Of the 172 respondents [male, 77%; hospital-based, 37%; general practitioner (GP), 55%; private practice, 70%; respondent rate of 19.5%], most preferred local conferences and endorsements by local experts to their foreign counterparts. Meetings or conferences sponsored by the pharmaceutical industry were ranked similarly with those without such links, while the reputation of the pharmaceutical firms was of foremost importance. Among GPs (n = 95) and non-GPs (n = 77), medical society newsletters were rated significantly higher by GPs while overseas conferences were rated higher by non-GPs.

CONCLUSION: Our findings provide an important first look at this under-explored area among Malaysian doctors and described a high degree of acceptance for the involvement of the pharmaceutical industry in CME activities.

Matched MeSH terms: Evidence-Based Medicine/education*
The process of evidence-based medicine and the search for meaning

Biswas R, Umakanth S, Strumberg J, Martin CM, Hande M, Nagra JS

J Eval Clin Pract, 2007 Aug;13(4):529-32.
PMID: 17683292 DOI: 10.1111/j.1365-2753.2007.00837.x

BACKGROUND AND RATIONALE: Evidence based medicine is the present backbone of rational and objective, modern medical problem solving and is a meeting ground for quantitative and qualitative researchers alike as it culminates into applying the fruits of clinical research to the individual patient. A systematic enquiry into the evolving paradigms in EBM is a need of the hour.
AIMS AND METHODS: A qualitative enquiry examining the impact of different methodologies in EBM and their role in generating meaning interpretable at individual levels.
RESULTS: Present day outcome based research deals less with patients as individuals than as populations. Evidence based medicine struggles to apply the fruits of population based research to individuals who are often not as predictable as linear quantitative research would like them to be. The present EBM literature neglects a lot of events it doesn't believe to be statistically significant and perhaps here is an area that needs to be improved on - it assumes that because associations are demonstrated between interventions and outcomes in RCTs/meta-analysis, these associations are linear and causal in the real world. While they may be demonstrated repeatedly in highly controlled environments, in the real 'uncontrolled' world of clinical practice with real people, their validity breaks down.
CONCLUSIONS: One needs to make the EBM standard model patient-individual (a projection of collective patient event data) resemble the real human individual patient so that optimal EBM individual data that matches our query can be easily and quickly spotted from the dense jungle of information that has grown over the years. This hints at rethinking our entire research methodology and modifying it to suit the needs of the individual patient.

Matched MeSH terms: Evidence-Based Medicine/methods*
Changes in the process of care and outcome over a 10-year period in a neonatal nursery in a developing country

Ho JJ, Chang AS

J Trop Pediatr, 2007 Aug;53(4):232-7.
PMID: 17578848

Over a 10-year period there was increasing involvement by clinicians in the generation and implementation of evidence-based practices in the neonatal intensive care unit (NICU). For two cohorts of very low birth weight (VLBW) babies admitted 10 years apart to a developing country, NICU were compared and changes occurring in process of care that might have contributed to any change in outcome were documented.

Matched MeSH terms: Evidence-Based Medicine
What we really need to do to reduce cardiovascular events in hypertensive patients

Ong HT

J Fam Pract, 2007 Sep;56(9):727-34.
PMID: 17764644
Matched MeSH terms: Evidence-Based Medicine
Evidence of divergence with duration of residence in circulatory disease mortality in migrants to Australia

Gray L, Harding S, Reid A

Eur J Public Health, 2007 Dec;17(6):550-4.
PMID: 17353202

BACKGROUND: Very little is known about how acculturation affects health in different societal settings. Using duration of residence, this study investigates acculturation and circulatory disease mortality among migrants in Australia.
METHODS: Data from death records, 1998-2002, and from 2001 Census data were extracted for seven migrant groups [New Zealand; United Kingdom (UK)/Ireland; Germany; Greece; Italy; China/Singapore/Malaysia/Vietnam (East Asia); and India/Sri Lanka (South Asia)] aged 45-64 years. Poisson regression models were fitted to estimate the duration of residence effect (categorized in 5-year bands and also as having arrived 2-16, 17-31 and 32 years ago or more), adjusted for sex, 5-year age group and year of death, then additionally for occupational class and marital status (SES) on relative risks (RR) of CVD mortality.
RESULTS: Compared with the Australia-born population, CVD mortality was generally lower in each migrant group. Decreasing mortality with increasing duration of residence was observed for migrants from New Zealand (RR 0.95, 95% Confidence Interval 0.92-0.98, P<0.01, per 5-year increase), Greece (0.90, 0.86-0.94, P<0.01), Italy (0.94, 0.91-0.97, P<0.01) and South Asia (0.95, 0.91-0.99, P<0.01), mainly in older age groups. Trends remained after SES adjustment and also when broader categories of duration of residence were used. CVD mortality among migrants from the UK/Ireland appeared to converge towards those of the Australian-born.
CONCLUSIONS: These results show divergence in CVD mortality compared with the Australian rate for New Zealanders, Greeks, Italians and South Asians. Sustained cardio-protective behavioural practices in the Australian setting is a potential explanation.

Matched MeSH terms: Evidence-Based Medicine*
Fulltext Optimising reproductive and child health outcomes by building evidence-based research and practice in South East Asia (SEA-ORCHID): study protocol

Henderson-Smart DJ, Lumbiganon P, Festin MR, Ho JJ, Mohammad H, McDonald SJ, et al.

BMC Med Res Methodol, 2007;7:43.
PMID: 17892586

Disorders related to pregnancy and childbirth are a major health issue in South East Asia. They represent one of the biggest health risk differentials between the developed and developing world. Our broad research question is: Can the health of mothers and babies in Thailand, Indonesia, the Philippines and Malaysia be improved by increasing the local capacity for the synthesis of research, implementation of effective interventions, and identification of gaps in knowledge needing further research?

Matched MeSH terms: Evidence-Based Medicine*
Fulltext Use of evidence-based practices in pregnancy and childbirth: South East Asia Optimising Reproductive and Child Health in Developing Countries project

SEA-ORCHID Study Group, Laopaiboon M, Lumbiganon P, McDonald SJ, Henderson-Smart DJ, Green S, et al.

PLoS One, 2008 Jul 09;3(7):e2646.
PMID: 18612381 DOI: 10.1371/journal.pone.0002646

BACKGROUND: The burden of mortality and morbidity related to pregnancy and childbirth remains concentrated in developing countries. SEA-ORCHID (South East Asia Optimising Reproductive and Child Health In Developing countries) is evaluating whether a multifaceted intervention to strengthen capacity for research synthesis, evidence-based care and knowledge implementation improves adoption of best clinical practice recommendations leading to better health for mothers and babies. In this study we assessed current practices in perinatal health care in four South East Asian countries and determined whether they were aligned with best practice recommendations.
METHODOLOGY/PRINCIPAL FINDINGS: We completed an audit of 9550 medical records of women and their 9665 infants at nine hospitals; two in each of Indonesia, Malaysia and The Philippines, and three in Thailand between January-December 2005. We compared actual clinical practices with best practice recommendations selected from the Cochrane Library and the World Health Organization Reproductive Health Library. Evidence-based components of the active management of the third stage of labour and appropriately treating eclampsia with magnesium sulphate were universally practiced in all hospitals. Appropriate antibiotic prophylaxis for caesarean section, a beneficial form of care, was practiced in less than 5% of cases in most hospitals. Use of the unnecessary practices of enema in labour ranged from 1% to 61% and rates of episiotomy for vaginal birth ranged from 31% to 95%. Other appropriate practices were commonly performed to varying degrees between countries and also between hospitals within the same country.
CONCLUSIONS/SIGNIFICANCE: Whilst some perinatal health care practices audited were consistent with best available evidence, several were not. We conclude that recording of clinical practices should be an essential step to improve quality of care. Based on these findings, the SEA-ORCHID project team has been developing and implementing interventions aimed at increasing compliance with evidence-based clinical practice recommendations to improve perinatal practice in South East Asia.

Matched MeSH terms: Evidence-Based Medicine*
The 2nd International Conference on East-West Perspectives on Functional Foods: Science, Innovations and Claims

Florentino RF

Asia Pac J Clin Nutr, 2008;17(3):540-3.
PMID: 18818176

The 2nd International Conference on East-West Perspective on Functional Foods held in Kuala Lumpur, Malaysia, on November, 2007, discussed the current work on some traditional Asian foods and new technologies that offer both challenges and opportunities for functional foods. The highlight of the conference was on the current regulatory status of nutrition and health claims related to functional foods and the experiences in some countries on the substantiation of claims. Attention was also given to strategies for effective communication of functional foods to consumers. The conference concluded with recommendations to strengthen R and D efforts and harmonization of protocols and methodologies on functional foods within the region.

Matched MeSH terms: Evidence-Based Medicine

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