INTRODUCTION

Evidence-based medicine (EBM) integrates clinical expertise, research evidence, and patient preferences to improve care. Despite its significance, challenges in EBM practice persist, particularly in resource-limited settings. This study was done to assess the knowledge, attitudes, practices, and barriers to EBM among resident physicians at Southern Isabela Medical Center (SIMC).

A descriptive cross-sectional study was conducted among 66 resident physicians at SIMC using the validated Evidence-Based Medicine Questionnaire (EBMQ). By purposive sampling, EBMQ was distributed online. Data on demographics, EBM knowledge, attitudes, practices, and barriers were analyzed using frequency and proportions.

The majority demonstrated fair knowledge (50%) of EBM resources and terms, with EBM (from BMJ) being the most utilized EBM-specific resource, and “randomized controlled trials” being the most understood concept. Attitudes were predominantly positive, with 98.5% acknowledging EBM’s role in improving patient care. However, practical application was inconsistent; while 65.2% regularly searched literature, only 43.9% critically appraised evidence. Barriers included limited EBM training and awareness of resources, inadequate facility resources, and patient preferences.

Resident physicians at SIMC possess positive attitudes and fair knowledge of EBM but face challenges in its practical application. Institutional efforts to enhance training, resource access, and infrastructural support are essential to improve EBM practice.

With advances of drug design and preparation technology, the development of long-acting drugs has become an important research focus in precision medicine and chronic disease management. These drugs are designed to improve the patients' compliance and quality of life by achieving prolonged maintenance of an effective drug concentration in the body with a reduced dosing frequency. Small molecule drugs, monoclonal antibodies and nucleic acid drugs all have their own difficulties in achieving long actions, which can be especially challenging for the latter two because of their structural complexity. This review provides an overview of the strategies for designing long-acting small molecule drugs, monoclonal antibodies, and nucleic acid drugs.
Humans ; Drug Design ; Antibodies, Monoclonal/chemistry* ; Nucleic Acids ; Precision Medicine ; Delayed-Action Preparations

Biliary tract cancer (BTC) is a rare group of malignancies that develop from the epithelial lining of the biliary tree and have a poor prognosis. Although chemotherapy is the standard of care for patients with advanced BTC in China, its clinical benefits are moderate. In recent years, the approval of targeted therapies and immunotherapies has provided new avenues for the management of advanced BTC. Nonetheless, the increasing number of personalized medicine approaches has created a challenge for clinicians choosing individualized treatment strategies based on tumor characteristics. In this article, we discuss recent progress in implementing precision medicine approaches for advanced BTC in China and examine genomic profiling studies in Chinese patients with advanced BTC. We also discuss the challenges and opportunities of using precision medicine approaches, as well as the importance of considering population-specific factors and tailoring treatment approaches to improve outcomes for patients with BTC. In addition to providing a comprehensive overview of current and emerging precision medicine approaches for the management of advanced BTC in China, this review article will support clinicians outside of China by serving as a reference regarding the role of patient- and population-specific factors in clinical decision-making for patients with this rare malignancy.
Humans ; Precision Medicine/methods* ; Biliary Tract Neoplasms/genetics* ; China ; Molecular Targeted Therapy ; Immunotherapy/methods*

OBJECTIVE: To systematically search and integrate the best evidence for early rehabilitation of ICU-acquired swallowing dysfunction (ICU-ASD) using evidence-based medicine methods, providing high-quality evidence-based support for intensive care unit (ICU) healthcare professionals in implementing early rehabilitation assessment and intervention strategies for ICU-ASD. METHODS: The systematic search was conducted according to the "6S" pyramid evidence model. Multiple authoritative databases and resources were comprehensively searched, including: National Guideline Clearinghouse (NGC), National Institute for Health and Care Excellence (NICE), Canadian Medical Association Clinical Practice Guidelines Library (CMACPGL), New Zealand Guidelines Group (NZGG), Guidelines International Network (GIN), Registered Nurses' Association of Ontario (RNAO), Scottish Intercollegiate Guidelines Network (SIGN), PubMed/Medline, Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, JBI Evidence-Based Health Care Database, Physiotherapy Evidence Database (PEDro), Chinese Medical Pulse Guidelines Website, SinoMed, CNKI, Wanfang Data, UpToDate, BMJ Best Practice, and professional association websites. The search encompassed guidelines, expert consensus statements, original studies [including cohort studies, quasi-experimental studies, and randomized controlled trials (RCT)], systematic reviews, and evidence summaries related to the prevention and management of ICU-ASD. The search period was limited from the inception of each database to November 30, 2024. The best evidence for early rehabilitation of ICU-ASD was summarized. The quality assessment of the literature and the extraction and synthesis of evidence were independently performed by two researchers with expertise in evidence-based medicine methodology. RESULTS: A total of 16 articles were included, consisting of 1 clinical decision-making study, 1 cohort study, 2 guidelines, 2 RCTs, 6 systematic reviews, 1 evidence summary, 2 expert consensuses, and 1 expert opinion. Following quality assessment, all 16 articles were incorporated into the analysis. For the early rehabilitation of ICU-ASD, five major themes were ultimately identified and 25 best evidence items were summarized, focusing on: multidisciplinary collaboration, swallowing screening and assessment, rehabilitation interventions, dietary and nutritional management, and oral hygiene. CONCLUSIONS The evidence summary provides individualized rehabilitation strategies for ICU-ASD patients, but their implementation still needs to be adapted to China's clinical practice context and patient preferences.
Humans ; Deglutition Disorders/etiology* ; Intensive Care Units ; Evidence-Based Medicine

Progressive pulmonary fibrosis (PPF) is a progressive and lethal condition with few effective treatment options. Improvements in quality of life for patients with PPF remain limited even while receiving treatment with approved antifibrotic drugs. Traditional Chinese medicine (TCM) has the potential to improve cough, dyspnea and fatigue symptoms of patients with PPF. TCM treatments are typically diverse and individualized, requiring urgent development of efficient and precise design strategies to identify effective treatment options. We designed an innovative Bayesian adaptive two-stage trial, hoping to provide new ideas for the rapid evaluation of the effectiveness of TCM in PPF. An open-label, two-stage, adaptive Bayesian randomized controlled trial will be conducted in China. Based on Bayesian methods, the trial will employ response-adaptive randomization to allocate patients to study groups based on data collected over the course of the trial. The adaptive Bayesian trial design will employ a Bayesian hierarchical model with "stopping" and "continuation" criteria once a predetermined posterior probability of superiority or futility and a decision threshold are reached. The trial can be implemented more efficiently by sharing the master protocol and organizational management mechanisms of the sub-trial we have implemented. The primary patient-reported outcome is a change in the Leicester Cough Questionnaire score, reflecting an improvement in cough-specific quality of life. The adaptive Bayesian trial design may be a promising method to facilitate the rapid clinical evaluation of TCM effectiveness for PPF, and will provide an example for how to evaluate TCM effectiveness in rare and refractory diseases. However, due to the complexity of the trial implementation, sufficient simulation analysis by professional statistical analysts is required to construct a Bayesian response-adaptive randomization procedure for timely response. Moreover, detailed standard operating procedures need to be developed to ensure the feasibility of the trial implementation. Please cite this article as: Zhang C, Nie YS, Zhang CT, Yang HJ, Zhang HR, Xiao W, Cui GF, Li J, Li SJ, Huang QS, Yan SY. An adaptive Bayesian randomized controlled trial of traditional Chinese medicine in progressive pulmonary fibrosis: Rationale and study design. J Integr Med. 2025; 23(2): 138-145.
Female ; Humans ; Male ; Bayes Theorem ; Disease Progression ; Drugs, Chinese Herbal/therapeutic use* ; Medicine, Chinese Traditional/methods* ; Pulmonary Fibrosis/therapy* ; Quality of Life ; Randomized Controlled Trials as Topic ; Research Design ; Adaptive Clinical Trials as Topic

To improve the consistency of outcome documentation and address the potential for outcome reporting bias in clinical trials involving integrative Chinese and Western medicine (ICWM) for ulcerative colitis (UC), we aim to develop a customized core outcome set (COS) that incorporates input from various stakeholders. The study design of this COS has been informed by the Core Outcome Measures in Effectiveness Trials Initiative Handbook, with adherence to the guidelines from the Core Outcome Set-STAndards for Reporting statement and Core Outcome Set-STAndardised Protocol Items recommendations. Five groups of stakeholders will be invited to participate in the development of COS for clinical trials with ICWM for UC, including healthcare professionals, patients, COS developers, COS users, and methodologists. The process will involve five stages: (1) conducting a systematic review of outcomes reported in clinical trials and protocols to develop a list of potential outcome domains; (2) conducting semi-structured interviews to obtain important outcomes; (3) choosing the most important outcomes by conducting three-round Delphi surveys; (4) achieving a consensus in a face-to-face meeting to discuss the final COS; and (5) publication, dissemination and implementation of COS. Consequently, this specialized COS will be applicable to clinical trials involving both traditional Chinese medicine (TCM) and ICWM interventions. Please cite this article as: Zhang X, Zhang L, Wang J, Lau CT, Wang N, Zhang X, Wang P, Li J, Han F, Bian Z. A protocol for developing, disseminating and implementing a core outcome set for clinical trials of integrative Chinese and Western medicine for ulcerative colitis. J Integr Med. 2025; 23(6):654-659.
Colitis, Ulcerative/therapy* ; Humans ; Medicine, Chinese Traditional ; Clinical Trials as Topic ; Integrative Medicine ; Research Design ; Outcome Assessment, Health Care ; Delphi Technique

This perspective review explores the transformative potential of personalized herbal medicine, examines the integration of ancient herbal knowledge with modern personalized medicine, delves into the principles of personalized medicine particularly in the context of herbal treatments, and investigates the principles of personalized medicine and elucidates how they are being applied to herbal medicine. It emphasizes the individualized nature of this approach and how it is facilitated through genetic analysis and health profiling. This review also highlights key advancements in herbal medicine, such as deoxyribonucleic acid (DNA) analysis and bioinformatics, and their role in the development of precise and personalized herbal remedies. The outcomes of personalized herbal medicine reveal how genetic variations are being considered to tailor treatments, create target-specific therapies, and customize dosage regimens. Furthermore, this review illustrates the evolution of herbal medicine with technological advancements, particularly DNA analysis and bioinformatics, to enhance precision and personalization. The challenge associated with implementing personalized herbal medicine more broadly includes issues of accessibility, regulation, education and ethics. It underscores the transformative potential of personalized herbal medicine. It calls for continued exploration, research and collaboration in this burgeoning field. This emerging field encourages researchers, practitioners, and stakeholders to engage in advancing healthcare practices that are increasingly personalized, evidence-based, and centered on patient's needs. Please cite this article as: Aslam MS, Kim YJ. Herbal medicine in the modern age: The era of personalized precision. J Integr Med. 2025; 23(6):591-604.
Precision Medicine ; Humans ; Herbal Medicine/methods* ; Phytotherapy

Allergic asthma, a major phenotype of bronchial asthma, shares similarities and differences with non-allergic asthma in its pathogenesis, clinical manifestations, diagnostic approach and criteria, and intervention strategies. The "Chinese guidelines for the diagnosis and treatment of allergic asthma (2019, the first edition)" established a framework for standardizing clinical practice relating to this condition in China. Based on the first edition, this guideline combines recent research progress and novel clinical evidence to supplement and revise the epidemiology, pathogenesis, common allergens, clinical manifestations, diagnostic techniques and standards, treatment and prevention principles of allergic asthma. Key amendments were made to the definition and underlying mechanisms, allergen detection techniques, and endotype assessment. Based on the current landscape of allergic asthma management in China, the updated guidelines provide tailored diagnostic and therapeutic recommendations, especially for allergen-specific immunotherapy, biologic-targeted therapies, and tertiary prevention strategies. A total of 14 evidence-based recommendations are proposed, serving as a clinical reference (guiding document) for optimizing the diagnosis, treatment, and long-term management of allergic asthma in China.
Humans ; Asthma/therapy* ; China ; Allergens ; Practice Guidelines as Topic ; Evidence-Based Medicine

Hemoptysis is a serious medical emergency associated with high mortality rates. Notably, it poses significant therapeutic challenges owing to the complexities in rapidly identifying the bleeding site and underlying cause. In severe cases, it can lead to death by asphyxia, thus necessitating prompt intervention. Bronchoscopy-guided endobronchial balloon occlusion (EBBO) is a vital procedure for blocking the bleeding bronchus, allowing time for subsequent embolization of the responsible vessel and definitive treatment. While traditional techniques for EBBO are intricate and demanding, recent advancements in balloon technology, along with procedural refinements, have simplified the process, reduced operation times, and enhanced medical staff proficiency. Nevertheless, a lack of standardized protocols and technical guidelines has hindered the widespread adoption of this technique in China. Accordingly, the Internal Medicine of Chinese Medical Association convened a group of experts to develop the "Expert consensus on endobronchial balloon occlusion in the treatment of hemoptysis (2025 edition)" to standardize this procedure. This consensus, grounded in evidence-based medicine and clinical practice both domestically and internationally, covers seven essential elements: treatment strategies, equipment, indications and contraindications, preoperative preparation, technical procedures and specifications, integration with other therapeutic techniques, efficacy assessment, and follow-up. By offering comprehensive guidance, the consensus aims to standardize and promote the use of EBBO for hemoptysis management in China.
Humans ; Hemoptysis/therapy* ; Balloon Occlusion/methods* ; Bronchoscopy ; Consensus ; Evidence-Based Medicine

Artificial intelligence (AI) is rapidly advancing in periodontology, bringing new opportunities to clinical diagnosis, risk assessment, personalized treatment planning, and remote patient care. Leveraging core technologies such as deep learning, machine learning, and natural language processing, AI significantly enhances the sensitivity of early periodontal disease detection and provides precise quantification of alveolar bone loss and soft tissue damage. AI facilitates multimodal data integration by synthesizing medical history, lifestyle factors, and imaging data, thereby offering enhanced accurate risk prediction and personalized therapeutic recommendations. By integrating remote monitoring with tailored health counseling, AI helps patients maintain adherence to self-care protocols, significantly improving their oral health-related quality of life and treatment satisfaction. Moreover, AI demonstrates considerable potential in periodontal research and education, particularly in large-scale data mining, virtual clinical case simulations, and natural language processing-assisted literature management. Nevertheless, challenges remain concerning model generalizability, data quality, ethical concerns, and interpretability. The advancement of multi-center big-data platforms is expected to foster a profound integration of AI and periodontology, propelling precision medicine and digital healthcare, enabling holistic management from prevention to long-term care, and enhancing diagnostic efficiency and patient health outcomes.
Humans ; Artificial Intelligence ; Periodontics/methods* ; Periodontal Diseases/therapy* ; Deep Learning ; Precision Medicine ; Quality of Life