EVIDENCE-BASED MEDICINE, OPHTHALMOLOGY, CLINICAL MEDICINE

Clinical practice guidelines (CPGs) have become ubiquitous in every field of medicine today but there has been limited success in implementation and improvement in health outcomes. Guidelines are largely based on the results of traditional randomised controlled trials (RCTs) which adopt a highly selective process to maximise the intervention's chance of demonstrating efficacy thus having high internal validity but lacking external validity. Therefore, guidelines based on these RCTs often suffer from a gap between trial efficacy and real world effectiveness and is one of the common reasons contributing to poor guideline adherence by physicians. "Real World Evidence" (RWE) can complement RCTs in CPG development. RWE-in the form of data from integrated electronic health records-represents the vast and varied collective experience of frontline doctors and patients. RWE has the potential to fill the gap in current guidelines by balancing information about whether a test or treatment works (efficacy) with data on how it works in real world practice (effectiveness). RWE can also advance the agenda of precision medicine in everyday practice by engaging frontline stakeholders in pragmatic biomarker studies. This will enable guideline developers to more precisely determine not only whether a clinical test or treatment is recommended, but for whom and when. Singapore is well positioned to ride the big data and RWE wave as we have the advantages of high digital interconnectivity, an integrated National Electronic Health Record (NEHR), and governmental support in the form of the Smart Nation initiative.
Big Data ; Electronic Health Records ; Evidence-Based Medicine ; Guideline Adherence ; Humans ; Practice Guidelines as Topic ; Practice Patterns, Physicians' ; Pragmatic Clinical Trials as Topic ; Precision Medicine ; Singapore

Evidence-based medicine (EBM) has been defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. EBM could be a meme in medicine that is transferred from one clinical filed to another. The knowledge base that informs clinical decision has been growing with a very rapid pace making it a difficult challenge for the busy clinician to keep up with this growing and high volume of research findings. To keep up to date with the best research evidence, clinicians need a set of strategies. EBM may be the solution of this challenge. The term, Evidence-Based Psychiatry (EBP) was introduced by Elliot Goldner and Dan Bilsker in 1995. The purposes of this review are to introduce EBP and to find the best way to adopt the evidence-based approach to the practice of psychiatry in Korea. For these purposes, we reviewed the practice of EBM and discussed the application of EBP in Korean psychiatric field of medicine.
Clinical Medicine ; Evidence-Based Medicine ; Humans ; Knowledge Bases ; Korea

BACKGROUND: As evidence-based medicine is getting popular recently, the importance of randomized controlled trial as a research methodology is also getting highlighted. This study was conducted in order to identify the status quo of randomized controlled trial research in major domestic journals and to provide baseline data for constructing Korean clinical trial database such CCTR (Cochrane Clinical Trial Registry). METHODS: Five journals issued by domestic publication industry were selected, out of which 127,560 original articles, equal to 253 volumes, were investigated. The author extracted the articles, which performed prospective clinical trial, targeting human beings. The selected papers were analyzed with experts to single out randomized controlled trial among them. Furthermore, the quality of the re-selected ones were assessed according to Jadad Quaility Assessment Scale. RESULTS: After analysis, it turned out that the number of papers adopting prospective clinical trial were 406 volumes (3.2%) of 12,760 and that they increased from 157 in 1980s to 224 in 1990s. However, the percentage of prospective clinical trial monographs, introduced during 1980s and 1990s, remained 2.0 to 4.0. The number of randomized controlled trial-based papers were 115, accounting for 0.9% of total articles. The number of RCT increased to approximately two fold from 1980s to 1990s. Quality analysis showed that among a total of 115 RCT papers, those of scoring 1 and 3 were 16 (13.9%), 82 articles obtained score 2 (72.2%). There was no papers, which won the marks of 4 and 5. CONCLUSION: It was found that domestic randomized controlled trial research was weak both in number and quality. Therefore, it is necessary to activate clinical medicine study with good quality to upgrade the amount and quality of monographs.
Clinical Medicine ; Evidence-Based Medicine ; Humans ; Publications ; Research Design

BACKGROUND: Despite the development of medical knowledge and technology, it has long been pointed out that the treatment guidelines are not sufficiently based on evidence. It has not been yet studied how evidence based medicine is implemented when physicians make their therapeutic decision. The purpose of this study was to determine the degree of evidence based interventions in a university based family medicine outpatient clinic. METHODS: The degree of evidence based practice was evaluated using Ellis and Gills' method developed by the Evidence - Based Medicine Center in Oxford. The Patients' records of an outpatient clinic of a university hospital were reviewed on the primary diagnosis - intervention. The evidence based guidelines were defined as traditional textbooks and the results of randomized controlled trials found on databases such as Medicine, Clinical evidence, Best evidence, and Cochrane. ln case where there were no guidelines, consultation with the specialists was done. The degree of the evidence based therapeutic interventions was assessed by three levels. RESULTS: There were 179 primary diagnosis - intervention pairs, among them, 125 pairs (69.8%) of interventions were based on randomized controlled trial evidence and 19 pairs (10.6%) based on convincing non-experimental evidence. No evidence was found for 35 pairs (19.6%) . As a result, 80.4% of the total 144 pairs were regarded as evidence - based medicine. CONCLUSIONS: The result showed that considerable portion of the total cases were evaluated as based on clinical evidence, which is similar to the conclusions of the previous studies in other countries. We hope that future similar studies will be conducted in other institutions as well as in other specialities.
Ambulatory Care Facilities* ; Clinical Medicine ; Diagnosis ; Evidence-Based Medicine ; Evidence-Based Practice ; Hope ; Humans ; Outpatients* ; Specialization

The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.
Breast Neoplasms ; Consultants ; Decision Support Systems, Clinical ; Humans ; Precision Medicine

The research aims to propose the approaches to the clinical trial of acupuncture and moxibustion and provide the methodological guide for the research in this field in terms of the inadequate systematic collection, lack of the specific characteristics of acupuncture-moxibustion treatment and insufficient persuasion in clinical evidences of acupuncture-moxibustion research. Through a systematic review of the registration of acupuncture-moxibustion clinical trials at home and abroad, the distribution of diseases with the recommendation of acupuncture and moxibustion in Cochrane Library database, combined with the evidence grade of the evidence-based medicine and the individual characteristics of clinical practice with acupuncture and moxibustion, some research ideas and framework are proposed for the clinical trial of acupuncture and moxibustion. To take the curative effect as the forerumer, the dominant disease and therapeutic methods of acupuncture and moxibustion should be initially generalized by the case experiences and clinical observation at the first. In view of the potential function of acupuncture and moxibustion in treatment, the rigorous and standardized clinical trial should be carried out to verify their therapeutic effect. Finally, the experimental research is adopted to explore the mechanism of acupuncture and moxibustion. Through the combination of quantitative and qualitative methods, all of the evidences are integrated to form an integrative evidence chain. It is anticipated that the construction of the integrative evidence chain in clinical trial of acupuncture and moxibustion may enhance the promotion of clinical practice with acupuncture and moxibustion and increase the influence of acupuncture-moxibusiton discipline.
Acupuncture Therapy ; Clinical Trials as Topic ; Evidence-Based Medicine ; Medicine, Chinese Traditional ; Moxibustion

The first three industrial revolutions that took place in history provided people with opportunities to live rich lives, along with cultural benefits. However, with regards to the fourth industrial revolution, which is expected to be completed in the next 10 to 20 years, deep fears are present in the midst of coexisting expectations and worries. Unemployment and the polarization of wealth are problems that the fourth industrial revolution is expected to bring about, and the medical world will also face considerable and fundamental difficulties due to the emergence of artificial intelligence. Based on a review of several arguments and predictive theories that have been presented thus far, the author would like to make the following proposals. The fact that the emergence of artificial intelligence will revolutionize the foundations of the medical world should be clearly recognized. With regards to medical treatment using artificial intelligence, we should be very concerned about whether doctors will be the masters or the slaves of artificial intelligence, and if we are to become the main agents of the age of artificial intelligence, now is the time to engage in careful introspection about what we should do. Medicine will be transformed into predictive medicine in the future thanks to the fusion of information and communications technology with precision medicine, supported by the development of genomics, proteomics, and cytomics. As we enter the age of the fourth industrial revolution, doctors should recognize the fact that only emotionally sensitive approaches to treating patients and interdisciplinary collaboration will protect us.
Artificial Intelligence ; Clinical Medicine ; Cooperative Behavior ; Education, Medical ; Foundations ; Genomics ; Humans ; Precision Medicine ; Proteomics ; Slaves ; Unemployment

Recent advances in deep learning have impacted various scientific and industrial fields. Due to the rapid application of deep learning in biomedical data, molecular imaging has also started to adopt this technique. In this regard, it is expected that deep learning will potentially affect the roles of molecular imaging experts as well as clinical decision making. This review firstly offers a basic overview of deep learning particularly for image data analysis to give knowledge to nuclear medicine physicians and researchers. Because of the unique characteristics and distinctive aims of various types of molecular imaging, deep learning applications can be different from other fields. In this context, the review deals with current perspectives of deep learning in molecular imaging particularly in terms of development of biomarkers. Finally, future challenges of deep learning application for molecular imaging and future roles of experts in molecular imaging will be discussed.
Biomarkers ; Clinical Decision-Making ; Learning ; Machine Learning ; Molecular Imaging ; Nuclear Medicine ; Precision Medicine ; Statistics as Topic

No abstract available.
Evidence-Based Medicine ; Humans ; Precision Medicine