جستجوی مقالات مرتبط با کلیدواژه « پزشکی مبتنی بر شواهد » در نشریات گروه « پزشکی »

Correct clinical decision-making has a significant impact on the treatment process, achieving the expected clinical outcome and increasing patient satisfaction, and identifying the factors affecting it is essential for evidence-based medical education. This study aimed to determine the relationship between evidence-based medicine with academic self-efficacy and research self-efficacy of medical students.

This descriptive analytical study conducted from October 2022 to October 2023 on 45 medical students at Abadan University of Medical Sciences. After obtaining consent from the students and registering demographic and educational information, data collection was performed using evidence-based medicine, academic self-efficacy, and research self-efficacy questionnaires. Then data analyzed by descriptive statistics, Pearson correlation coefficient, Spearman correlation coefficient, and regression model in SPSS.

The findings of our study showed that research self-efficacy in students who had research experience (189.03) was significantly higher than students who did not have research experience (140.76).  In addition, the average score of academic and research self-efficacy and evidence-based medicine in students who had a history of membership in the student research committee was significantly higher than students who did not have a history of membership. Finally, it was found that evidence-based medicine had a direct and significant relationship with research self-efficacy (r=0.361, P<0.05) and academic self-efficacy (r=0.457, P<0.001). In examining the relationship between academic self-efficacy and research self-efficacy, it was also found that these two variables have a direct and significant relationship with each other (r=0.714, P<0.001). As well as, there was no significant relationship between academic self-efficacy, research self-efficacy, and understanding the characteristics of evidence-based practice with any of the variables of age, gender and entry year (P>0.05).

 According to the obtained results, it can be concluded that academic self-efficacy and research self-efficacy have an effect on evidence-based medicine, and all of the above can be improved by teaching  medical students to participate in student research committees and doing research work. In this way, it improves the quality of treatment in doctors.

Clinical practice guidelines (CPGs) are currently the optimal way to transfer information to healthcare professionals to ensure that their clinical actions are evidence-based. However, the process of developing and implementing these CPGs faces challenges. Artificial Intelligence (AI), particularly machine learning, natural language processing, and decision support systems, can be employed as effective solutions to transform the development and implementation process of CPGs and address the challenges in this field. This study aimed to investigate the role of AI in the development and implementation of CPGs.

In this review study, PubMed and Google Scholar databases were searched using selected keywords, including clinical practice guidelines, artificial intelligence, machine learning, and clinical decision support systems, and their English equivalents, from 2013 to 2023.

AI has the potential to revolutionize the development and implementation process of CPGs. The reviewed studies demonstrated that AI can be used in data analysis, evidence synthesis, decision support, customization, continuous updating, and quality assurance of CPGs. Challenges and ethical considerations in this field, such as data quality, transparency and interpretability, accountability, inclusiveness, ethical considerations, legal and regulatory frameworks, also need to be addressed.

AI has the potential to improve the traditional approach of CPGs development and implementation. Advanced research and collaboration between AI experts, healthcare professionals, and policymakers are necessary to refine and optimize the role of AI in clinical guidelines. This collaborative effort will ensure that AI remains a valuable tool in improving patient outcomes, promoting evidence-based decision-making, and shaping the future of health and treatment.

Evidence-based medicine can increase the clinical performance of physicians. This qualitative study was conducted with the aim of examining the effective factors for using new evidence by emergency medicine residents in Rasoul Akram and Haftam Tir Hospitals in Tehran, Iran.

The present descriptive-analytical study was conducted in the year 2016 in two hospitals In Tehran. In order to conduct this qualitative study, residents were selected by purposive sampling. The data was collected during 18 in-depth individual interviews and the categories and themes of the effective factors in the use of new evidence were extracted using conventional content analysis.

Participants were introduced to medical evidence through text books, attending workshops, faculty classes, attending conferences, or through friends. Evidence-based medicine consists of factors such as: physician incentive factors, patient incentive factors, factors in favor of scientific facts, environmental-cultural incentives and moral incentives, and among the inhibitory factors discouraging the use of evidence based medicine are factors that influence physician and patient, environmental-cultural inhibitors and social inhibitors.

There seems to be a positive attitude among residents towards the use of evidence-based medicine, but there are still several obstacles to its implementation in society. Structural and individual factors and policy-making are the most important determining factors in its implementation in Iran.

Health care systems need reforms in the process of education to performance. Reforms with a targeted educational and medical perspective that will permeate all effective health care systems and evidence-based medicine is considered a practical method in the development of health care and treatment in the world. This approach will be effective during its lifetime in the education of medical sciences, on the quality of education, on the quality of education, from the beginning of the education of health and medical sciences until the lifetime of the educators.
The present study is a systematic review by searching in Iranian databases such as: SID, Iranmedex, Magiran, foreign databases such as: Uptodate, Pubmed, Scopous during the years 2019 to 2022 with keywords; Evidence-based medicine, evidence-based education, evidence-based practice, evidence-based learning, evidence-based care, educational quality, medical science education are searched.
Evidence-based medicine in line with its longevity in medical sciences still needs a fundamental review in healthcare and treatment, many studies have stated the lack of use of evidence-based medicine and obstacles to its implementation in their results. However, the growing trend of using evidence-based medicine is not significant and requires inductive impulses to implement, apply and use and evaluate its effects.
Evidence-based medical education and its effects have been clearly studied, but micro and macro policies in its implementation and application require a fundamental review so that the process of education, learning, performance and care is the most favorable process of growth and development in the body. Go through the educational and research system of medical sciences.

Continuing medical education is a continuing process to teach clinicians and provide patients with up-to-date, evidence-based care. The current study is a review type that through searching in databases; Google Scholar, PubMed, Elsevier and ProQuest Scopus, has been done in the range of 2019-2022. Articles were searched based on the keywords of continuing medical education, virtual education, electronic education and corona-virus and the English equivalent of Continuing Medical Education, Virtual Teaching, E-Learning, Corona-Virus. In the initial review, a number of 476 articles and documents were searched, after removing 86 duplicates, and then they were reviewed in terms of the inclusion criteria, and the articles that met the inclusion criteria after a complete review, finally, 28 articles that met the inclusion criteria were included in the study for final analysis. The results indicate the effective methods in education in medical sciences and electronic learning are mentioned as a common and effective method. The findings showed that the use of electronic learning, mobile learning, online training, simulator learning environment and blended learning can be effective in improving the skills and adequacy of continuous training. The use of electronic education has led to an increase in the motivation of participants due to saving time for studying and learning educational materials. The results of the challenges and opportunities observed from the texts examined in this research show that, considering the challenges and opportunities of virtual education for providers and learners, the necessity of assessing the needs of practitioners and experts regarding the required training and evolution in virtual education planning, the awareness and familiarity of virtual education planners and managers with these challenges and opportunities as a basic introduction to respond to existing problems and establish an efficient educational system. The development of virtual education requires the strengthening of the supporting role and support of the continuous medical education office of the university in providing infrastructure and financial resources and more independence to universities in planning and implementing the development of virtual education.

To be up-to-date, the medical community must have the ability to communicate in the electronic environment and search for information resources. The present study aims to develop a questionnaire to assess the attitudes of Iranian medical students towards searching for information resources by formulating clinical questions and evaluate its validly and reliability.

This is a descriptive cross-sectional study. Participants were 190 interns from two educational hospitals in Tehran, Iran who were randomly selected. Exploratory factor analysis was used for assessing construct validity of the questionnaire in SPSS software, version 22.

The face validity and content validity of the 18-item questionnaire were assessed and confirmed by five experts. Based on the results of exploratory factor analysis, four factors of self-learning, learning motivation, information proficiency, and analysis were identified. The results of confirmatory factor analysis confirmed the four-factor model. The total reliability and the reliability for all factors were calculated using Cronbach’s alpha coefficient which were reported above 60%. The Kaiser-Meyer-Olkin coefficient and Bartlett test coefficient were 0.822 and 0.934, respectively (P=0.000).

The questionnaire has acceptable validity and reliability to be used by medical community in Iran and in future studies.

Evidence-based medicine (EBM) integrates the best available evidence from authentic studies with clinical expertise and patients' values, helping pharmacists to have access to the best available evidence to respond to clinical questions. The present study aimed to assess the level of awareness and attitude of pharmacists as the initial step to improve these practices.

The instrument used in this cross-sectional study was a questionnaire of awareness and attitudes towards EBM and its related terms (Abofarha et al., 2014). After localization, the questionnaire was provided to the pharmacists working in the pharmacies of Zanjan province and pharmacy students in the last two years of university, and the results were assessed.

The participation rate was 75%, and 66.8% of subjects were familiar with the concept of EBM. The participants who did not have sufficient knowledge had higher mean age scores in comparison with those who did not (P=0.001). Moreover, 74.1% of students and 60% of graduates in this study showed sufficient knowledge and the difference between the two groups was significant (P= 0.023). In addition, 84.1% of the participants had a positive attitude towards EBM. Students and graduates did not significantly differ in terms of attitude.

As evidenced by the results of this study, pharmacists and pharmacy students in Zanjan province had a good knowledge of EBM terms. Moreover, it was found that participants with more work experience were less knowledgeable in this regard. The majority of them had positive attitudes towards EBM, and it is suggested to include EBM in the pharmacy curriculum to increase students' knowledge in this regard.

Introduction

In the late 20th century, scientists sought concrete evidence to apply in diagnosing and treating diseases and surgical interventions. Therefore, Evidence-Based Medicine (EBM) was proposed as a way to search, critically evaluate, and use research results in medical practice. Evidence-based medicine means the conscious, explicit, and wise use of the best evidence in the decision-making process to provide patient care services. Although evidence-based medicine seems to be the standard gold and its use is growing, in reality, it is still not widely used. In this regard, developed countries have been trying to close the gap between research and medical practice by using evidence-based medicine for years. For example, the American Institute of Medicine stated that many medical errors are due to practitioners' lack of knowledge about the best medical methods. It can be reduced to a large extent if they use a systematic search method to get the best evidence. In addition, recent studies have been done in Iran showed that evidence-based practice had received attention in various fields of medicine. Despite this, medical practitioners' awareness, attitude, and performance of evidence-based medicine were low resulted from a lack of facilities, time, and proficiency in English. However, since resident physicians play an essential role in teaching medical students and are crucial clinical decision-makers in teaching hospitals, their ability to use the evidence-based medicine has effectively reduced medical errors and improved clinical decisions. Therefore, the present study was designed to assess residents' attitudes and perceptions of using evidence-based medicine through self-declaration.

This research was an applied and descriptive-cross-sectional study. The study population consisted of all medical and dental residents studying at Ahvaz Jundishapur University of Medical Sciences in 2020. Two hundred and nine residents participated in the study by completing the questionnaire. Then data were collected through the census method, and sampling was not done. However, the unavailable residents were excluded from the study due to the outbreak of Covid-19 during data collection. The research instrument was a questionnaire with validity and reliability of 0.79 and 0.7, respectively. The questionnaire consisted of 4 parts, the first part of which included 13 questions regarding the level of familiarity of the residents with evidence-based medicine, the level of access to the Internet, and the resources used to update information. In the second and third parts of the questionnaire, questions were asked for self-assessment of the attitude and skill toward evidence-based medicine. In addition, the Likert scale was used to measure the responses. The questionnaires were distributed among the participants in face-to-face contact. A deadline of 7 days was considered to respond to the questionnaire. The participants' identification data were not collected due to protect privacy. Also, the obtained data were analyzed in SPSS version 21 using descriptive analysis, including frequency tables, mean and standard deviation, and analytic statistics.

The results showed that 54.5% of the respondents were male, and 45.5% were female, and the average age was 32.31 ± 4.246, with an alpha of 0.05. In addition, 42.1% of the participants passed at least a course in evidence-based medicine, and 65.5% were familiar with it. Also, most of them knew the PubMed database (89%), and their familiarity with the Bandolier (3.3%), Dare, and DOAJ (zero percent) databases were minimal. Moreover, the participants used printed books as the first and most important source of information (41.5%). According to 40% of the participants, lack of knowledge of using the sites was the most important reason for not using Internet-based information sources. Furthermore, 54.8% of the participants agreed that evidence-based medicine is a feasible method for the daily care of patients, and 52.9% of them stated that its everyday use could be helpful. Also, the results of the study indicated that the participants' attitude regarding their performance in evidence-based medicine about their skill in evaluating the quality of a clinical trial study with 7.7% was at the highest level.On the other hand, the lowest level of their skill was related to the best article selected from among several articles, with 3.3%. Even though evidence-based medicine is taught in many major universities around the world and is used in medical practices, the results of this study, which were in agreement with other studies, showed that only about half of the residents were familiar with it, or they passed a training related course. Besides, the results of this study showed that although evidence-based medicine was valuable and important from the participants' point of view, they were not using evidence-based databases as the primary source to get information. In this regard, several studies have also reported similar findings. A limitation of this study was the impossibility of participation all the residents due to the outbreak of COVID-19. Therefore, the researchers had to involve as many residents as were available. However, a positive point of this research was the study on residents from various medical and dental fields.

In general, the results showed moderate knowledge and skills in using evidence-based medicine databases among residents. Also, PubMed was a popular database among the residents. As related studies have suggested, although evidence-based medicine is part of the academic curriculum, to increase residents' knowledge and skill, therefore, it seems necessary to plan an educational program or workshop.

Background and Purpose:

A paradigmatic reading of medical history results in comprehending the evolution of main concepts based on different paradigms after provoked crises and scientific revolutions in the history of medicine. Basic concepts may fundamentally change in scientific revolutions, i.e., the routine image of phenomena changes in a Gestalt manner. According to modern medicine in the recent century, basic concepts, including causation and explanation, body and physicality, and disease and health have fundamentally changed in the history of medicine. The current study aimed to present and discuss a philosophical image of conceptual incommensurability in the causality concept for emphasizing examples of defining health and disease in different medical paradigms and some models in the scientific revolution of medicine. 

A philosophical analysis was applied to examine the philosophical foundations of medical paradigms. Searching in medical history helps perceive examples of understanding causation and its function. Moreover, both paradigms are discussed in more detail based on a comparative approach with examples.

According to the incommensurability concepts in the science paradigms, simultaneous understanding of the causality concept is considered impossible in traditional-Iranian and modern medicine, i.e., evidence-based medicine.

This study emphasizes the independence of theoretical aspects and practical dimensions of medical paradigms and also deems dialogue and even methodical comparison between paradigms possible, and even necessary; however, this comparison is not a simultaneous communication between both paradigms and demands avoiding methodological confusion.

Our current era is the age of information exploration and innovation that has given us a good opportunity to use evidence - based information, so this study aimed to evaluate the use of Evidence - Based Dentistry in Isfahan Dental School in 2018.

The sampling method of this study was census and, the number of faculty assistants was 50. The m ethod of collecting this information was through a questionnaire Regarding fulfillment of ethical manners in this study, participants were not required to mention their names and personal characteristics, and only if they consented participate in the study , a questionnaire was provided to them. Man withny analysis and Spear man correlation were used to evaluate the relation between EBD (Evidence Based Dentistry) according to their gender.

In the current evaluation, it was observed that 19 dentists (36.5%) were female and 33 (63.5%) were male. Most residents (63.5%) sometimes use evidence - based dentistry, 11 cases (21.2%) rarely and 8 cases (15.3%) using this technique always. About the frequency distribution of resources used by residents to answer questions in dealing with patients, the highest frequency (65.4%) was related to "textbooks or questions from clinical teachers" as well as "translated reference books" and the least Frequency (13.5%) was related to "Search other databases".

Based on the findings in this section, the use of evidence - based medicine among residents is low.

Journal Club is a novel, effective and essential educational method which is commonly used in medical education and is one of the most important components of the evidence-based education. Considering its simple implementation, cost-effectiveness and no need for special equipment, it is widely acknowledged as one of the most favorite educational programs. Despite its importance application in clinical education, there is a few research on how this can affect clinical practice in Iran. According to recent evidence, meetings quality is inadequate and were not as powerful as expected to be presented as an effective and productive movement in evidence-based education. Holding journal clubs would be most beneficial and serve as turning point in research and education, when statistics and epidemiology specialists are properly employed. This can raise new challenges and provide a proper background for creativity and productivity. What makes this educational method to be crucial and valuable, is that it can present up-to-date worldwide researches with high quality and evidence-based approach. Nowadays, clinical science is facing a major gap between research and clinical aspect which may reduce the power of both areas. Any measure taken to hold a structural evidence-based journal club is as essential as clinical interventions on human. Thus, this educational method could be a constructive tool to reduce the so-called gap.

Suicide attempt is self-destructive, Consciously and purposefully is increasing among women. This study aims Comparison of the effectiveness of two therapeutic approaches Integrative and Commitment and acceptance psychotherapy on Cognitive fusion was performed on women.

The current research is a quasi-experimental with pre-experimental-post-experimental study with a follow up design. The statistical population of the present study included all women with suicide attempts in north Khorasan who were hospitalized in 2020. The sample of the study included 16 subjects who selected through random sampling as well as inclusion criteria and assigned randomly into two experimental groups (8 people in each group). Acceptance and commitment therapy package and integrated treatment protocol accomplished in eight 90-minutes sessions individually every week. The research tool was questionnaire of cognitive fusion by Gillanders and colleague (2010). Data were collected in three stages before the intervention, at the end of the intervention and after two months. Data were analyzed using of multivariate covariance and tests using SPSS-26.

The results showed that both treatments effect on cognitive fusion but there isn’t significant difference between the two treatments (F=1.578, P<0.230, eta=0.101).

Education Integrated treatment and acceptance and commitment therapy an effect on the cognitive fusion of women who attempted suicide. Reduces cognitive fusion and increased cognitive deficits in women. Therefore Such training can prevent and reduce suicide attempts in women.

The importance of evidence-based strategic decision making in hospitals has led to the aim of this study to develop and implement evidence-based strategic decision-making in hospitals in Tehran.

The present study was a mixed exploratory research conducted in the field. The qualitative community included academic experts. Also, the quantitative community includes the managers of selected hospitals of Tehran University of Medical Sciences. The research tools included interviews and questionnaires. The statistical method used in this study was structural equations with partial least squares method.

The results showed that eight factors (knowledge, judgment, experience, context, managerial preferences and values, stakeholder preferences and values, ethical considerations, and organization plans) were used as proponents of strategic decision-making development. The evidence was identified in Tehran hospitals. The results of the present model showed that all factors influence the development of evidence-based strategic decision making in hospitals in Tehran, with the most influential context being 0.224. Also the results of model fit indices showed that the model presented in the present study has a good fit.

According to the results of the present study, the causative agent was identified as the most important factor in the development of evidence-based strategic decision making in hospitals in Tehran, which indicates the importance of paying attention to these factors in hospitals.

The purpose of this study is to identify patterns of information sharing in the field of evidence-based medicine to determine the main areas of evidence dissemination, including co-authorship patterns and citation networks, and to provide a scientific horizon for improving evidence-based medical research in Iran. Accordingly, evidence-based medicine related research at the Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences is suggested.

This study is a bibliographic study using scientometric methods. In this regard, the network of co-authorship and analysis of scientific articles indexed with the subject of evidence-based medicine in the Scopus database from 2004 to 2019 were analyzed.

The status of scientific production of evidence-based medicine of Endocrinology and Metabolism research Institute has been increasing in recent years. The Journal of Diabetes and Metabolic Disorders contains a great collection of information about evidence-based medicine in this field and its contents have been widely cited in many Iranian journals. In lexical analysis, the most widespread evidence was osteoporosis.

The results indicated that evidence-based medical research topics are widely focused on other medical fields such as osteoporosis and obesity and have shifted from evidence-based clinical practice to evidence-based clinical management.

Today, the main basis of diagnosis and treatment in medicine is the obtained evidence from the research. One of the movements that have attempted to establish this basis is evidence-based medicine (EBM). The present review dealt with the philosophical assessment of this subject.

In this study, EBM-related data from books and articles were reviewed. 

According to the obtained results of this study, the advocates of EBM have two assumptions. The first one is that medicine as practiced today is not scientific and should become scientific using evidence. The second assumption is that clinical decision-making should be based on the data derived from clinical trials the most reliable of which are systematic reviews.

The results of similar EBM-related studies usually lead to the development of guidelines for medical practice. Therefore, the assessments and challenges of EBM should be considered, even if it has been the only way to date.

The utilization of the medical research results is one of the most important indicators in the development of this profession, which provides effective care to patients and improves the quality of care. However, performing based on the evidence-based results has been unsuccessful in some cases. This study aimed to investigated and prioritize the factors affecting evidence-based medicine among physicians affiliated to Iranian Health insurance. This descriptive cross-sectional study was conducted on 150 physicians affiliated to Iranian Health insurance in Tehran city in 2018. The simple random sampling method was used to collect the data. The data collection tool was a questionnaire containing of three parts: demographic questionnaire, Fonk (1995) evidence-based medical barriers questionnaire that included four domains and 25 questions, as well as a researcher-made questionnaire that prioritized the factors influencing evidence-based medicine implementation. Data were analyzed by SPSS version 21 and Expert Choice software using hierarchical analysis method. Most physicians were male (53.3%) and worked as an official employee. Among four dimensions, the highest mean and standard deviation was related to organizational impact, while the lowest was related to the quality of research and possible outcomes. Regarding the factors of organizational impacts, the highest weight or priority was attributed to the feeling of insufficient independence to change care methods with a weight of 0.259. Among the factors related to the research quality, the highest weight and priority was related to the factor of methodological defects in the research with a weight of 0.192. Considering the factors related to the skills of conducting research, the highest priority and weight was attributed to the lack of documentary evidence for the performance change with a weight of 0.320. Moreover, regarding the factors related to communication and access to the findings of the research, the highest weight and priority was in the factor of unavailability of actual articles (0.475). The findings of this study showed that physicians considered problems and barriers related to organization, individual, and quality of research studies. Therefore, facilities should be created for using research findings as well as the conditions for updating physicians' knowledge, skills, and attitudes to use the research results.

Evidence-based medicine is the systematic process of assessing the most reliable evidence from clinical research for decision making in clinical care. The variety of assessment criteria and confusion in selecting the reliable scientific resources has challenged users. Therefore, the current study was conducted with the aim to rank evidence-based medical databases using Ovid's assessment criteria through hierarchical analysis method.
The current study is an applied descriptive-survey research conducted using field and cross-sectional studies in the first six months of 2017 in libraries of Tehran city medical universities (Tehran, Shahid Beheshti, Iran, and Baqiyatallah). Data were provided through systematic review based on Ovid assessment criterion, and collected in the form of paired comparison questionnaire by 20 expert's opinions. After that, data were analyzed using hierarchical analysis technique and Expert Choice 11 software. This criterion includes 6 main measures and 48 sub-measures.
According to the obtained results of the study, a search criterion with the weight of 0.247, guides criterion with the weight of 0.172, services criterion with the weight of 0.166, display criterion with the weight of 0.156, link criterion with the weight of 0.151, and performance criterion with the weight of 0.109 were put in the first, second, third, fourth, fifth, and the last or sixth priority with inconsistency rate of 0.10, respectively. The Cochrane database with the coefficient of 0.491 and Up to Date database with the coefficient of 0.224, assigned the highest and the lowest priority to themselves amongst the databases.
In order to develop and improve the activities of medical evidence-based databases, authorities should pay attention to the user's desired criteria and apply their recommendations. Moreover, the users must be taught how to use databases

Studies conducted have shown that the rate of awareness and use of evidence-based medicine (EBM) is low. The current study aimed is a systematic review to identify barriers of using EBM.
All indexed article in national and international valid databases were reviewed by standard and sensible keywords. Articles were selected based on inclusion criteria and after quality assessment entered to the process of systematic review. In total, 9930 articles extracted and amongst them 97 were included.
Findings indicate that the most important barriers for physicians and residents in order of importance were: time limits, limited knowledge and skills, limitations of the evidence, lack of facilities, attitudinal barriers, educational barriers and barriers related to the patients.
According to the barriers and difficulties in the effective use of the resources there for the physicians, that first step in improving and removing barriers for its implementation seemed to be the awareness about EBM application status. On the other hand, clinical librarians play important role in practical application of EBM in practice.