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La investigación cualitativa juega un papel crucial en las ciencias de la salud, centrándose en comprender profundamente fenómenos, experiencias, percepciones y comportamientos en sus contextos naturales. Este artículo aborda aspectos esenciales para llevar a cabo un estudio cualitativo, desde la formulación de preguntas de investigación hasta el análisis y reporte de los datos. Se resalta la reflexibilidad de la metodología cualitativa. Se presentan los principales diseños cualitativos: etnográfico, fenomenológico, teoría fundamentada y biográfico; las técnicas de muestreo: teórico, en cadena y por conveniencia, subrayando la importancia de alcanzar la saturación teórica. También se examinan métodos de producción de datos como la observación, entrevistas, grupos focales, grupos de discusión y técnicas documentales. El análisis de datos comienza con la transcripción íntegra de los audios y se continúa con la generación de códigos y agrupaciones de los mismos. El análisis puede ser tanto de contenido como del discurso, buscando interpretaciones profundas de la información recopilada. Este artículo es parte de una serie metodológica destinada a la formación de estudiantes en bioestadística y epidemiología clínica, destacando la colaboración entre instituciones de Chile y Argentina. El objetivo es ofrecer una guía completa para la implementación efectiva de investigaciones cualitativas en el ámbito de la salud, contribuyendo a una práctica clínica más humanizada y basada en la evidencia.

Qualitative research plays an essential role in health sciences, aiming to achieve a deep understanding of phenomena, experiences, perceptions, and behaviors in their natural contexts. In this article, we outline essential aspects to consider when conducting qualitative research, starting from formulating the research question to analyzing and reporting the obtained data. We present the main qualitative design methods and sampling techniques, emphasizing the importance of reaching data saturation and the data production methods. This article offers a roadmap for conducting qualitative research in health care, contributing to a more humanized and evidence-based clinical practice.

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Objective: The main objective of this study is to report on the implementation and results of the "Supporting Health-Related Judicial Decisions in Brazil" project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês through the "Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde", in Brazil. Methods: This study is an experience report of a project conducted at the Health Technology Assessment Center, Hospital Sírio-Libanês. Results: The activities of the project occurred in 2023 and included two online training courses on primary studies and systematic reviews, 11 one-day workshops with technical-scientific content for members of the Technical Support Centers for the Judiciary (NATJus), 40 online technical-scientific consultations for magistrates on a digital platform, 11 technical-scientific reports addressing the most legally claimed technologies in Brazil; two methodological tools, a national forum (hybrid event), 10 chat-based mentorships for NATJus members; and the maintenance of an open-access blog, by publishing news on relevant topics on law and health. Discussion and conclusion: This project has contributed to the improvement of the judicial decision-making process by providing a range of activities aimed at aiding the prioritization of health technologies that are clearly effective and safe over those that are ineffective, harmful, or have uncertain effects.

Objetivo: O objetivo principal deste estudo é relatar a implementação e os resultados do projeto "Apoio técnico-científico à tomada de decisão judicial em Saúde no Brasil" realizado no Hospital Sírio-Libanês por meio do "Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde". Métodos: Este estudo é um relato de experiência de um projeto realizado no Núcleo de Avaliação de Tecnologias em Saúde do Hospital Sírio-Libanês. Resultados: As atividades do projeto ocorreram em 2023 e incluíram dois cursos de formação online sobre estudos primários e revisões sistemáticas, 11 oficinas de um dia com conteúdo técnico-científico para membros dos Núcleos de Apoio Técnico ao Judiciário (NATJus), 40 consultas on-line técnico-científicas para magistrados em plataforma digital, 11 relatórios técnico-científicos abordando as tecnologias mais reivindicadas judicialmente no Brasil; duas ferramentas metodológicas, um fórum nacional (evento híbrido), 10 mentorias via chat para membros do NATJus; e a manutenção de um blog de acesso aberto, com publicação de notícias sobre temas relevantes de direito e saúde. Discussão e conclusão: Este projeto contribuiu para a melhoria do processo de tomada de decisão judicial, fornecendo uma série de atividades destinadas a ajudar na priorização de tecnologias de saúde que sejam claramente eficazes e seguras em detrimento daquelas que são ineficazes, prejudiciais ou têm efeitos incertos.

Objetivo: El objetivo principal de este estudio es informar sobre la implementación y los resultados del proyecto "Apoyo a las Decisiones Judiciales Relacionadas con la Salud en Brasil" realizado en el Centro de Tecnología en Salud del Hospital Sírio-Libanês a través del "Programa de Apoio ao Desenvolvimento Institucional do Sistema Único de Saúde", en Brasil. Métodos: Este estudio es un informe de experiencia de un proyecto realizado en el Centro de Tecnología en Salud del Hospital Sírio-Libanês. Resultados: Las actividades del proyecto ocurrieron en 2023 e incluyeron dos cursos de capacitación en línea sobre estudios primarios y revisiones sistemáticas, 11 talleres de un día de contenido técnico-científico para miembros de los Centros de Apoyo Técnico al Poder Judicial (NATJus), 40 consultas técnico-científicas en línea para magistrados en plataforma digital, 11 informes técnico-científicos que abordan las tecnologías más reclamadas legalmente en Brasil; dos herramientas metodológicas, un foro nacional (evento híbrido), 10 mentorías basadas en chat para miembros de NATJus; y el mantenimiento de un blog de acceso abierto, mediante la publicación de noticias sobre temas relevantes en derecho y salud. Discusión y conclusión: Este proyecto ha contribuido a mejorar el proceso de toma de decisiones judiciales proporcionando actividades para priorizar las tecnologías sanitarias claramente eficaces y seguras frente a aquellas que son ineficaces, nocivas o de efectos inciertos.

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La mayoría de las preguntas de investigación (PI), conducirán a un proyecto que apunta a generar nuevo conocimiento, sin embargo el escenario, la población a estudio y la metodología pueden ser muy diferentes, lo que determinará que los resultados obtenidos y por ende, el nivel de evidencia (NE) y el grado de recomendación (GR) puedan variar notablemente. El objetivo de este artículo fue proporcionar recomendaciones para formular una PI asociada al NE y respectivos GR que se pueden desprender a partir de los resultados generados. Este artículo entregará algunos conocimientos sobre la PI y su relación con los NE y GR de la evidencia generada a partir de resultados obtenidos por un proceso de investigación en diferentes escenarios de investigación.

SUMMARY: Most research questions (RQ) will lead to a project that aims to generate new knowledge. However, the setting, study population and methodology may be very different, which will determine the results obtained and therefore, the level of evidence (LOE) and the grade of recommendation (GOR) may vary significantly. The aim of this study was to provide recommendations to formulate a RQ associated with the LOE and respective GOR that can be derived from the generated results. This article will provide some knowledge about the RQ and its relationship with the LEO and GOR of the generated evidence from results obtained by a research process in different research scenarios.

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RESUMEN Introducción. El presente artículo resume la guía de práctica clínica (GPC) para el manejo de cáncer de colon en el Seguro Social del Perú (EsSalud). Objetivo. Proveer recomendaciones clínicas basadas en evidencia para el manejo de cáncer de colon en EsSalud. Métodos. Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos, el cual formuló preguntas clínicas. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y -cuando fue considerado pertinente- estudios primarios en PubMed durante el 2023. Se seleccionó la evidencia para responder cada una de las preguntas clínicas formuladas. Se evaluó la certeza de la evidencia usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buenas prácticas clínicas y los flujogramas. Finalmente, la GPC fue aprobada con Resolución N° 140-IETSI-ESSALUD-2023. Resultados. La GPC abordó 9 preguntas clínicas de manejo de cáncer de colon. En base a dichas preguntas se formularon 7 recomendaciones (todas ellas condicionales), 11 puntos de buena práctica clínica, y 1 flujograma. Conclusión. Se emitieron recomendaciones basadas en evidencia para el manejo de personas con cáncer de colon.

ABSTRACT Introduction. This article summarizes the clinical practice guide (CPG) for management of colon cancer in the Social Security of Peru (EsSalud). Objective. To provide evidence-based clinical recommendations for management of colon cancer in EsSalud. Methods. A guideline development group (GDG) was formed, which included specialist physicians and methodologists, who formulated clinical questions. Systematic searches of systematic reviews were conducted and - when deemed relevant - primary studies in PubMed during 2023. Evidence was selected to answer each of the proposed clinical questions. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic working meetings, the GDG used the GRADE methodology to review the evidence and formulate recommendations, points of good clinical practice, and flowcharts. Finally, the CPG was approved with Resolution No. 140-IETSI-ESSALUD-2023. Results. The CPG addressed 9 clinical questions regarding management. Based on these questions, 7 recommendations were formulated (all of which were conditional), 11 points of good clinical practice, and 1 flow chart. Conclusion. Evidence-based recommendations were statement for the management of patients with colon cancer.

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RESUMEN Introducción. Este artículo presenta un resumen de la guía de práctica clínica (GPC) para el tamizaje de cáncer de mama en el Seguro Social del Perú (EsSalud). Objetivo. Brindar recomendaciones clínicas fundamentadas en la evidencia para el tamizaje de cáncer de mama en EsSalud. Métodos. Se conformó un grupo elaborador de la guía (GEG) compuesto por especialistas médicos y metodólogos. El GEG formuló 5 preguntas clínicas a ser respondidas en esta GPC. Durante 2022, se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue necesario, de estudios primarios en PubMed y Cochrane CENTRAL. La evidencia fue seleccionada para responder cada una de las preguntas. La certeza de la evidencia fue evaluada mediante la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones periódicas, el GEG utilizó la metodología GRADE para revisar la evidencia y desarrollar las recomendaciones, puntos de buenas prácticas clínicas y el flujograma de tamizaje. La GPC fue aprobada mediante la Resolución N° 98-IETSI-ESSALUD-2022. Resultados. Esta GPC abordó 5 preguntas clínicas relacionadas con el examen físico y el uso de métodos de diagnóstico por imágenes para el tamizaje de cáncer de mama, resultando en la formulación de 8 recomendaciones (2 fuertes y 6 condicionales), 7 puntos de buenas prácticas clínicas, y un flujograma. Conclusión. Este artículo resume la metodología empleada y los hallazgos basados en evidencia de la GPC para el tamizaje de cáncer de mama en EsSalud.

ABSTRACT Introduction. This article provides an overview of the clinical practice guideline (CPG) for breast cancer screening in the Social Security of Peru (EsSalud). Objective. To offer evidence-based clinical recommendations for breast cancer screening within EsSalud. Methods. The CPG for breast cancer screening was developed by establishing a guideline development group (local GDG) consisting of medical specialists and methodologists. The local GDG formulated 5 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and, when it was considered pertinent, primary studies were conducted in Pubmed and Cochrane CENTRAL during 2022. The evidence to answer each of the posed clinical questions was selected. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and the flowchart of screening Finally, the CPG was approved with Resolution No. 68-IETSI-ESSALUD-2022. Results. The CPG examined 5 clinical questions related to physical examination and diagnostic imaging for breast cancer screening. This led to the development of 8 recommendations (2 strong and 6 conditional), 7 best practice points, and 1 flowchart. Conclusion. This article outlines the methodology and evidence-based findings of the CPG for breast cancer screening at EsSalud.

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RESUMEN Introducción. Este artículo sintetiza la guía de práctica clínica (GPC) para el diagnóstico y tratamiento de mujeres con endometriosis sintomática en el Seguro Social del Perú (EsSalud). Objetivo. Proporcionar recomendaciones clínicas fundamentadas en la evidencia para el diagnóstico y tratamiento de mujeres con endometriosis sintomática en EsSalud. Métodos. Se constituyó un grupo elaborador de la guía (GEG), compuesto por médicos especialistas y metodólogos. Este GEG formuló seis preguntas clínicas que la GPC debía responder. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y, cuando fue necesario, estudios primarios en las bases de datos PubMed y CENTRAL entre diciembre de 2021 y febrero de 2022. La evidencia relevante se seleccionó para responder a cada una de las preguntas clínicas planteadas. La certeza de la evidencia se evaluó utilizando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Durante reuniones regulares, el GEG empleó esta metodología para revisar la evidencia y desarrollar las recomendaciones, las buenas prácticas clínicas, y los flujogramas. La GPC fue finalmente aprobada mediante la Resolución N° 62-IETSI-ESSALUD-2022. Resultados. Esta GPC respondió a seis preguntas clínicas, distribuidas en dos áreas: diagnóstico y manejo de la endometriosis. A partir de estas preguntas, se elaboraron ocho recomendaciones (una fuerte y siete condicionales), 21 buenas prácticas clínicas, y dos flujogramas. Conclusión. Este artículo presenta un resumen de la metodología y las conclusiones basadas en la evidencia de la GPC para el diagnóstico y tratamiento de mujeres con endometriosis sintomática en EsSalud.

ABSTRACT Introduction. This article summarizes the clinical practice guideline (CPG) for the diagnosis and treatment of women with symptomatic endometriosis in the Social Security of Peru (EsSalud). Objective. The aim is to offer evidence-based clinical recommendations for diagnosing and managing women with symptomatic endometriosis in EsSalud. Methods. A guideline development group (GEG), consisting of medical specialists and methodologists, was established to create this CPG. The GEG formulated six clinical questions that guided the development of the CPG. Systematic searches of systematic reviews and -where applicable- primary studies were carried out in PubMed and CENTRAL between December 2021 and February 2022. Relevant evidence was selected to address each clinical question. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Throughout the CPG development process, the GEG held regular meetings to assess the evidence and formulate recommendations, establish points of good clinical practice, and develop flowcharts. The CPG was formally approved through Resolution No. 62-IETSI-ESSALUD-2022. Results. The CPG addressed six clinical questions, categorized into two primary areas: the diagnosis and management of endometriosis. Based on these questions, eight recommendations were developed, comprising one strong recommendation and seven conditional ones. Additionally, 21 good clinical practice points and two flowcharts were created. Conclusion. This article outlines the methodology and evidence-based conclusions of the CPG for the diagnosis and treatment of women with symptomatic endometriosis in EsSalud.

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Background: Evidence-based medicine (EBM) has proven useful in improving quality of health care and in controlling the health-care costs. Studies have shown that knowledge of information and communication technologies had an influence on EBM learning. Aims and Objectives: The present study was undertaken to correlate the computer literacy and EBM learning in 2nd year MBBS students. Materials and Methods: A validated questionnaire was given to students in Phase II MBBS at a teaching hospital in southern India. A total of 66 students responded to the questionnaire. Spearman’s rank correlation test was used to analyze the correlation between Student’s computer literacy and EBM learning. The Chi- square test was used to study the association between male and female responses. Results: Earlier computer training did not show any significant association with EBM learning, among female and male respondents. Browsing/searching the Internet more frequently had a significant male association between understanding the principles of EBM (?2 P = 0.03) when compared to females. The same was seen in case of acceptance (?2 P = 0.05) and interest (?2 P = 0.04) toward EBM learning. A strong positive correlation was found between the prior computer training and frequency of Internet usage with student EBM learning (Spearman correlation R = 0.99). Conclusion: The students should learn to address clinical questions based on current evidence to treat patients optimally. EBM helps to address this issue. Since computer skills are essential for integrating EBM into daily practice, efforts should be made to introduce EBM in medical curricula and improving computer skills among students.

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La investigación en salud es la base del conocimiento médico y de las recomendaciones en los sistemas de salud. Por ello, la elección de desenlaces apropiados en estudios de intervenciones terapéuticas es un paso fundamental en la producción de evidencia y, posteriormente, para la toma de decisiones. En este artículo proponemos tres factores clave para la elección de desenlaces: la inclusión de desenlaces reportados por pacientes, ya que ponen el foco del efecto de la intervención en la percepción que tienen los propios pacientes de su estado de salud y calidad de vida; la consideración de desenlaces clínicamente relevantes, los cuales son mediciones directas del estado de salud del paciente y, por ende serán determinantes en la toma de decisiones; y la utilización de herramienta que estandariza y permite la homogeneización en la medición e interpretación de desenlaces, facilitando la producción y posterior síntesis de evidencia apropiada para el ecosistema de evidencia. La correcta elección de los desenlaces permitirá que la evidencia generada de estos estudios ayude a los tomadores de decisiones en salud y los profesionales clínicos a entregar cuidados apropiados centrados en el paciente y a optimizar el uso de recursos en salud e investigación clínica.

Health research is the foundation of medical knowledge and healthcare system recommendations. Therefore, choosing appropriate outcomes in studies of therapeutic interventions is a fundamental step in producing evidence and, subsequently, for decision-making. In this article, we propose three key factors for the choice of outcomes: the inclusion of patient-reported outcomes, since they focus on the patient's perception of their health status and quality of life; the consideration of clinically relevant outcomes, which are direct measurements of the patient's health status and, therefore, will be decisive in decision-making; and the use of core outcome sets, a tool that standardizes the measurement and interpretation of outcomes, facilitating the production and synthesis of appropriate evidence for the evidence ecosystem. The correct choice of outcomes will help health decision-makers and clinicians deliver appropriate patient-centered care and optimize the use of resources in healthcare and clinical research.

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INTRODUCCIÓN: Varias guías de práctica clínica para el tratamiento de la COVID-19 se han desarrollado durante los dos últimos años de pandemia, sin embargo, su calidad metodológica es poco clara. OBJETIVO: Realizar una evaluación sistemática de la calidad de las guías de práctica clínica publicadas entre 2021 y octubre de 2022 para el tratamiento de la COVID-19, utilizando la herramienta AGREE II, e identificar las recomendaciones formuladas en dichas guías. JUSTIFICACIÓN: Durante la pandemia, surgieron múltiples guías, pero la claridad so-bre su calidad metodológica fue limitada. MÉTODOS: Se realizó una búsqueda sistemática de guías de práctica clínica sobre el tratamiento para la COVID-19 leve o moderada utilizando metabuscadores como Epistemonikos y Trip Database, y sitios web de organizaciones de sa-lud. Las guías seleccionadas fueron evaluadas con el instrumento AGREE II. RESULTADOS: Se evaluaron 11 GPC, presentando altas puntuaciones en los dominios de alcance y propósito (98,74 %), participación de los implicados (97,22 %), rigor en la elaboración (92 %), claridad de presentación (100 %), aplicabilidad (85,61 %), e independencia editorial (100 %). Aunque la ca-lidad general de las guías fue alta, se identificó la necesidad de mejorar en los aspectos de rigor en la elaboración y aplicabilidad de las recomendaciones. CONCLUSIONES: Encontramos que la calidad de las guías de práctica clínica evaluadas, en su mayoría es alta y, por lo tanto, son recomendables, aunque reconocemos la necesidad de mejorar la descripción de los dominios de rigor en la elaboración y aplicabilidad de las recomendaciones.

INTRODUCTION: Several clinical practice guidelines for the management of COVID-19 have been developed during the last two years of the pandemic, but their methodological quality is unclear. OBJECTIVE: To systematically assess the quality of clinical practice guidelines for the treatment of COVID-19 published between 2021 and October 2022 using the AGREE II tool, and to identify the recommendations made in these guidelines. JUSTIFICATION: During the pandemic, many guidelines were published, but clarity about their methodological quality was limited. METHODS: A systematic search for clinical practice guidelines on the management of mild-to-moderate COVID-19 was performed using meta-search engines such as Epistemoni-kos and Trip Database, as well as health organization websites. The selected guidelines were appraised using the AGREE II instrument. RESULTS: Eleven clinical practice guidelines (CPGs) were evaluated, showing high scores in the domains of scope and purpose (98.74%), stakehol-der involvement (97.22%), rigor of development (92%), clarity of presentation (100%), applica-bility (85.61%), and editorial independence (100%). Although the overall quality of the guidelines was high, there was identified a need for improvement in the areas of rigor of development and applicability of the recommendations. CONCLUSIONS: We found that the quality of the evalua-ted clinical practice guidelines is predominantly high, and therefore, they are recommendable. However, we recognize the need to improve the descriptions of the domains of rigor of develop-ment and applicability of the recommendations,

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Background: In oncology, overall survival (OS) and quality of life (QoL) are key indicators. The factors that affect OS and QoL include tumor-related characteristics (stage and grade), patient-related factors (performance status and comorbidities), and cancer-directed therapy (CDT)-related aspects. In addition, external factors such as governance or policy (e.g., inaccessibility to CDT, increased distance to service, poor socioeconomic status, lack of insurance), and hospital-related factors (e.g., facility volume and surgeon volume) can influence OS and QoL. Materials and Methods: The primary objective of this narrative review was to identify hospital-related factors that affect OS and QoL in patients receiving curative CDT. The authors defined extrinsic factors that can be modified at the hospital level as “hospital-related” factors. Only factors supported by randomized controlled trials (RCT), systematic reviews (SR) and/or meta-analyses (MA), and population database (PDB) analyses that address the relationship between OS and hospital factors were considered. Results: The literature review found that high hospital or oncologist volume, adherence to evidence-based medicine (EBM), optimal time-to-treatment initiation (TTI), and decreased overall treatment time (OTT) increase OS in patients undergoing curative CDT. The use of case management strategies was associated with better symptom management and treatment compliance, but had a mixed effect on QoL. The practice of enhanced recovery after surgery (ERAS) in cancer patients did not result in an increase in OS. There was insufficient evidence to support the impact of factors such as teaching or academic centers, hospital infrastructure, and treatment compliance on OS and QoL. Conclusion: The authors conclude that hospital policies should focus on increasing hospital and oncologist volume, adhering to EBM, optimizing TTI, and reducing OTT for cancer patients receiving curative treatment.

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Objective:To search, screen and summarize the best evidence of screening and management of patients with post-stroke fatigue, and to provide basis for early identification of clinical staff.Methods:According to the "6S" pyramid model, the system searches for relevant evidence on post stroke fatigue screening and management from UpToDate, BMJ Best Practice, International Guidelines Collaboration Network, New Zealand Guidelines Collaboration Group, Ontario Registered Nurses Association website, Scottish Interhospital Guidelines Network, Joanna Briggs Institute Evidence Based Health Care Center database, and Yimaitong, National Stroke Foundation, Stroke Association, National Stroke Center, Cochrane Library, PubMed, Embase, CINAHL, CNKI, WanFang Datebase, VIP and CBM from January 2013 to March 2023 regarding screening and management of post stroke fatigue patients. Researchers screen literature, evaluate quality, and summarize evidence.Results:Fifteen articles were selected, including 1 clinical decision, 3 guidelines, 3 expert consensus, 2 evidence summary, 5 systematic review and 1 randomized controlled trial. A total of 22 best evidence items were summarized from seven aspects of screening assessment, risk factors, psychosocial intervention, activity and rest, health education, complementary therapy, and follow-up.Conclusions:The study summarized the best evidence for the screening and management of patients with post-stroke fatigue, so as to provide a more scientific and systematic approach to the management of post-stroke fatigue and provide a reference for improving the long-term quality of life of stroke patients.

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OBJECTIVE:The rabbit model of steroid-induced osteonecrosis of femoral head is the most commonly used animal model of femoral head necrosis.The pathological changes of the femoral head are close to clinical practice,however,the conditions,methods and evaluation standards of animal models reported in and outside China are not uniform,which leads to the low scientific value of animal models and is difficult to popularize.This study aimed to clarify the influence of different mold-making conditions on the establishment of steroid-induced osteonecrosis of femoral head rabbit model and analyze the appropriate conditions for the successful model establishment. METHODS:We searched the CNKI,WanFang,VIP,CBM,WoS,PubMed and EMbsae databases for the literature on the modeling of steroid-induced osteonecrosis of femoral head rabbits up to April 1,2022,completed the screening of the literature according to the inclusion and exclusion criteria and literature quality evaluation,and extracted the outcome index data in the literature.RevMan Stata and ADDIS statistical software were used to conduct a meta-analysis of the included data. RESULTS:(1)A total of 82 articles with 1 366 rabbits were included in the study.The steroid-induced osteonecrosis of femoral head modeling methods were divided into three types:steroid-alone method,steroid combined lipopolysaccharide method and steroid combined serum method.Among these,33 articles used steroid-alone method;20 articles used steroid combined lipopolysaccharide method;29 articles used steroid combined serum method.(2)Meta-analysis results showed that the three modeling methods significantly increased the rate of empty bone lacunae in the femoral head of steroid-induced osteonecrosis of femoral head rabbits(P<0.001),and significantly decreased the ratio of the trabecular bone area in the femoral head of steroid-induced osteonecrosis of femoral head rabbits(P<0.001).The order of empty bone lacunae rate of each modeling method was:steroid combined with lipopolysaccharide method>steroid-alone method>steroid combined with serum method>normal group,and the order of trabecular bone area rate of each modeling method was:normal group>steroid combined with serum method>steroid-alone method>steroid combined with lipopolysaccharide method.(3)The results of subgroup analysis suggested that the rate of empty bone lacunae in the rabbit model induced by steroid alone might be related to the rabbit variety and the type of steroid used for modeling(difference between groups P<0.05),in which the combined effect amount of New Zealand white rabbits was higher than that of Chinese white rabbits(P<0.05)and Japanese white rabbits,and the combined effect amount of dexamethasone was higher than that of other steroids.The rate of empty bone lacunae induced by steroid combined with lipopolysaccharide was related to the administration mode of lipopolysaccharide and the type of steroid(P<0.05),among which the combined effect of methylprednisolone sodium succinate was significantly higher than that of other steroids(P<0.05),and the combined effect of prednisolone was significantly lower than that of other steroids(P<0.05).The combined effect of lipopolysaccharide 100 μg/kg×twice was significantly lower than 10 μg/kg×twice and 50 μg/kg×twice(P<0.05).The rate of empty bone lacunae in the model induced by steroid combined with serum was related to serum dose and steroid type(P<0.05),among which the combined effect amount of dexamethasone sodium phosphate was significantly higher than other steroid types(P<0.05),and the combined effect amount of dexamethasone was significantly lower than other steroid types(P<0.05);the combined effect amount of serum"10 mL/kg+6 mL/kg"combined dose was lower than other serum doses(P<0.05). CONCLUSION:(1)With the rate of empty bone lacunae and the ratio of trabecular bone area as the judgment standard for the successful establishment of the model,the three modeling methods can successfully construct the rabbit steroid-induced osteonecrosis of femoral head model,of which the steroid combined with lipopolysaccharide method is the best.(2)New Zealand white rabbits and dexamethasone are recommended when selecting the steroid-alone method.Methylprednisolone sodium succinate and low-dose lipopolysaccharide are recommended when selecting the steroid combined with lipopolysaccharide method.Dexamethasone sodium phosphate is recommended when selecting the steroid combined with serum modeling method.

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The online and offline hybrid teaching model of evidence-based medicine (EBM) is currently in the stage of development. Previous teaching focused on the teaching process in the classroom, and did not organically combine all the course contents before, during, and after class. The BOPPPS model can be used to establish coherence and integrity in the EBM teaching process. Considering the discipline characteristics and teaching objectives of EBM, this study initially explored and designed a BOPPPS-based online and offline hybrid teaching model. Taking the "diagnostic evidence" module as an example, the teaching implementation details were introduced. A pre-designed questionnaire was used to conduct baseline survey and follow-up survey on students before and after class to evaluate the teaching model and effect. The surveys showed that half of the students (77/154) preferred the new online and offline hybrid teaching model of EBM. The students found that all aspects of BOPPPS teaching were generally acceptable and satisfactory. Compared with before teaching, the students' proficiency in EBM was significantly improved after the teaching ( P<0.001), particularly in their ability to retrieve literature and evaluate the quality of evidence, which is of great significance for expanding their knowledge and clinical thinking.

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Myasthenia gravis (MG) is an autoimmune disorder mediated by autoantibodies that target the neuromuscular junction. The detection of pathogenic autoantibodies is crucial for the diagnosis and assessment of the disease. Commercial testing institutions and hospitals commonly use techniques such as radioimmunoprecipitation, enzyme-linked immunosorbent assay, or cell-based assay to test the serum of MG patients. However, these methods have limitations in terms of sensitivity and specificity, and there is a lack of direct comparative studies using high-level evidence-based medicine. The recent release of the SCREAM study using data from Chinese individuals confirms the advantages of cell-based assay, providing level Ⅰ evidence for the preferred recommendation of MG laboratory diagnosis and filling the gap in both domestic and international fields. However, the results obtained from the aforementioned testing methods are difficult to use for longitudinal comparison of patients and may not serve as the best biomarkers for disease monitoring. This article attempts to discuss this question by combining recent advances in understanding the pathogenic autoantibodies of MG and provides an outlook on future developments.

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Objective To introduce a partially nested design based on the characteristics of TCM in treating the same disease with different treatments and syndrome differentiation and treatment.Methods Partially nested design was used for standardized treatment of complex interventions.The TCM group was divided into multiple subsets according to"syndrome type-treatment method-prescription"(with nested structure),while the control group was treated with standardized Western medicine(without nested structure);taking a case study of"different treatments for the same disease"data for ulcerative colitis,this design type was applied and analyzed using a multi-level model.Results The partially nested design was consistent with the feature of TCM of"different treatments for the same disease"and met the methodological requirements for evidence-based evaluation.Multilevel models allowed analyses with this type of data.Conclusion The use of partially nested design enables the evaluation of the comprehensive effectiveness of"different treatments for the same disease",which can provide a methodological reference for the assessment of clinical effectiveness of TCM.

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ObjectiveTo systematically evaluate the distribution of traditional Chinese medicine（TCM） syndromes of primary osteoporosis（POP） in China by using evidence-based medicine methods， and to understand the distribution law of the syndromes. MethodChina National Knowledge Infrastructure（CNKI）， VIP Chinese Science and Technology Journal Database（VIP）， WanFang Data Knowledge Service Platform（WanFang） and China Biology Medicine（CBM） were searched to obtain representative literature， and each database was searched from the 1994 World Health Organization defined diagnostic criteria for osteoporosis until May 1， 2023. Two researchers independently screened literature according to the criteria， extracted data， and cross-checked them. Meta analysis was conducted using R4.1.3， and subgroup analysis was performed. ResultA total of 56 Chinese papers were included， involving 14 415 patients. After standardized classification of syndromes， 11 articles were excluded， and Meta analysis results of the ultimately included 45 Chinese articles showed that the distribution frequencies of liver-kidney Yin deficiency syndrome， spleen-kidney Yang deficiency syndrome and kidney deficiency and blood stasis syndrome in 12 723 patients were 27%［95% confidence interval（CI） 0.24-0.31］， 32%（95% CI 0.29-0.36）， 36%（95% CI 0.30-0.42）. Subgroup analysis showed that there was a statistically significant difference in the distribution of the three TCM syndromes in the north and south（P<0.05）. In addition， the incidence of TCM syndrome fractures in different types of POP was 15%（95% CI 0.09-0.24） for liver-kidney Yin deficiency syndrome， 20%（95% CI 0.12-0.30） for spleen-kidney Yang deficiency syndrome， and 31%（95% CI 0.25-0.39） for kidney deficiency and blood stasis syndrome. ConclusionThe distribution of syndromes in POP patients is mainly kidney deficiency， accompanied by liver and spleen dysfunction. Liver-kidney Yin deficiency syndrome， spleen-kidney Yang deficiency syndrome and kidney deficiency and blood stasis syndrome are all the main syndromes of POP and osteoporotic fractures， and kidney deficiency and blood stasis syndrome is most closely related to the development of osteoporotic fractures. The reference standards for syndrome determination among the included studies are inconsistent， and in the future， it is necessary to focus on their determination standards to obtain consensus research results， at the same time， conduct large-scale syndrome research to obtain representative research results， providing a basis for clinical practice and research.

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Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.

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Objective This study aims to summarize and evaluate clinical evidence of randomized controlled trial(RCT)of Chinese patent medicine published in 2021 and providing reasonable suggestions.Methods The collection literatures of Evidence Database System of TCM(EVDS)was main source,and CNKI,Wan Fang Data,VIP,SinoMed,Cochrane Library,PubMed,and EMbase databases were supplement.Obtaining the RCT of Chinese patent medicine published in 2021,and to analyze and evaluate their characteristics and methodological quality.Results 2215 RCTs of Chinese patent medicine(2206 in Chinese/9 in English)were included,which involving 237,379 patients,26 types of diseases,and 750 types of proprietary Chinese medicines(619 types of oral Chinese patent medicine,91 types of Chinese injections,and 40 types of topical Chinese patent medicine).The circulatory system diseases,respiratory system diseases and neurological diseases was highlight research area.The most number of diseases were ischemic Stroke,coronary heart disease,and angina pectoris.The sample size between 30 and 8,000 cases,and the case sources were mainly single-center.Methodologically,the implementation of allocation concealment and blinding remained unappreciated.Conclusion The number of RCTs publication increased in 2021 compared with 2020,more studies pay attention to neurological disease research,and quality control and standardized management during study design and implementation still need to be improved.