How doctors practice evidence-based medicine.

RATIONALE AND AIMS: Evidence-based medicine (EBM) has gained worldwide attention. Many studies have used questionnaires to discuss factors obstructing the practice of EBM. However, no large-scale data analysis has focused on who has practised EBM and when they practised it. This retrospective study aims to fill the research gap by applying nationally representative data to analyse EBM practice after the provision of new evidence regarding the prescription of rosiglitazone which has been shown to increase the risk of myocardial infarction. METHODS: We used the National Health Insurance Database in Taiwan to analyse the variations in rosiglitazone prescription among physicians. The study period was from the second quarter of 2007 to the fourth quarter of 2008. A total of 2536 physicians who prescribed rosiglitazone at least once were included in this study. We applied multivariate logistic analyses to predict the probability of physicians ceasing to prescribe rosiglitazone. RESULTS: We observed a significant improvement in EBM practice among specialists and experienced physicians. Endocrinologists were four times more likely to change rosiglitazone prescription habits than other specialists (odds ratio 4.129, 95% confidence interval 2.484-6.863). Doctors with more than 10 years of specialist experience performed better in EBM practice. Moreover, a prominent time lag with more than 6 months between EBM emergence and EBM practice was noticed. CONCLUSIONS: Our study suggested that EBM was still not well practised, using rosiglitazone prescription as a study case. Further education and encouragement to strengthen physicians' EBM practice remain urgently needed within the medical community.

Interleukin-1 receptor antagonist gene polymorphism in patients with multidrug-resistant Acinetobacter baumannii-associated pneumonia.

OBJECTIVE: Multidrug-resistant Acinetobacter baumannii (MDRAB)-associated pneumonia has been a common disease and a therapeutic problem in hospitals. Interleukin-1 receptor antagonist (IL-1ra) has been considered a required role for host immune defense in pneumonia disease. The aim of this study was to investigate whether the variable nucleotide tandem repeat polymorphism of the IL-1ra gene was associated with MDRAB-related pneumonia. METHODS: Sixty-six pneumonia patients were enrolled in the study: 36 subjects had MDRAB-related pneumonia and 30 controls had non-MDRAB pneumonia. Polymerase chain reaction, restriction fragment length polymorphism, and agarose gel electrophoresis techniques were used to determine the IL-1ra genotype. RESULTS: The frequencies of the IL-1ra genotype in the MDRAB-related pneumonia cases were A1/A1, 0.889 and A1/A2, 0.111; the frequencies of the IL-1ra genotype in the controls were A1/A1, 0.333 and A1/A2, 0.667. A statistically significant difference was determined (P < 0.05). We also observed an increase in the frequency of IL-1ra A1 allele in the MDRAB-related pneumonia group. A statistically significant difference was determined (P<0.05). CONCLUSIONS: We suggested that IL-1ra polymorphism was associated with the risk of MDRAB-related pneumonia.