The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China

<b><i>Introduction:</i></b> Very preterm infants are at high risk of early death or severe brain injury, with potential for impaired long-term neurodevelopmental function and physical health. There are evidence-based healthcare practices that can reduce the incidence. <b><i>Materials and Methods:</i></b> Infants born at 24–31⁶ weeks gestational age and admitted within 24 h to NICUs participating in the Chinese Neonatal Network in 2019 were included. We examined the association between 4 evidence-based practices: inborn (born in a tertiary hospital in the Chinese Neonatal Network), ACS (any antenatal corticosteroid), MgSO₄ (prenatal magnesium sulfate), and NT (normothermic temperature [36.0–37.5°C] at admission) and early death and/or severe brain injury in the study population. <b><i>Results:</i></b> Of 6,035 eligible infants, the incidence of early death and/or severe brain injury was 10.6%. Exposure to ACS only was associated with significant lower incidence of death and/or severe brain injury than none (aOR, 0.71; 95% CI: 0.57–0.88), but not MgSO₄ only (aOR, 0.97; 95% CI: 0.81–1.17), NT only (aOR, 0.91; 95% CI: 0.76–1.08), or inborn only (aOR, 0.91; 95% CI: 0.72–1.15). The association between number of practices and incidence of early death and/or severe brain injury is as follows: none = 23% (31/138), any 1 = 14% (84/592), any 2 = 12% (185/1,538), any 3 = 9% (202/2,285), and all 4 = 9% (140/1,482). <b><i>Discussion/Conclusion:</i></b> More comprehensive use of evidence-based practices was associated with improved survival without severe brain injury among very preterm infants born at &#x3c;32 weeks gestational age.

The Organic Turn: Coping With Pandemic and Non-pandemic Challenges by Integrating Evidence-, Theory-, Experience-, and Context-Based Knowledge in Advising Health Policy

The COVID-19 pandemic has posed an extraordinary challenge for public health and health policy. Questions have arisen concerning the main strategies to cope with this situation and the lessons to be learned from the pandemic. This conceptual paper aims to clarify these questions via sociological concepts. Regarding coping strategies used during the pandemic, there is a strong tendency for health policymakers to rely on expert knowledge rather than on evidence-based knowledge. This has caused the evidence-based healthcare community to respond to urgent demands for advice by rapidly processing new knowledge. Nonetheless, health policymakers still mainly rely on experts in making policy decisions. Our sociological analysis of this situation identified three lessons for coping with pandemic and non-pandemic health challenges: (1) the phenomenon of accelerating knowledge processing could be interpreted from the organizational innovation perspective as a shift from traditional mechanistic knowledge processing to more organic forms of knowledge processing. This can be described as an “organic turn.” (2) The return of experts is part of this organic turn and shows that experts provide both evidence-based knowledge as well as theoretical, experiential, and contextual knowledge. (3) Experts can use theory to expeditiously provide advice at times when there is limited evidence available and to provide complexity-reducing orientation for decisionmakers at times where knowledge production leads to an overload of knowledge; thus, evidence-based knowledge should be complemented by theory-based knowledge in a structured two-way interaction to obtain the most comprehensive and valid recommendations for health policy.

Six Honest Serving Matters, Teaching Us all We Need to Know About Context in Knowledge Implementation?; Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-Country Analysis"

While context is a vital factor in any attempt to study knowledge translation or implement evidence in healthcare, there is a need to better understand the attributes and relations that constitute context. A recent study by J. Squires et al. investigates such attributes and definitions, based on 39 stakeholder interviews across Australia, Canada, the UK, and the USA. Sixteen attributes, comprising 30 elements suggested as new findings, are proposed as the basis for a framework. This commentary argues for the need to incorporate more perspectives but also suggests an initial taxonomy rather than a framework, comprising a wider range of stakeholders and an enhanced understanding of how context elements are related at different levels and how this affects implementation processes. Aligning with person-centred care, this must include not only professionals but also patients and their next of kin, as partners in shaping more evidence-based healthcare.

A Study of a Gain Based Approach for Query Aspects in Recall Oriented Tasks

Evidence-based healthcare integrates the best research evidence with clinical expertise in order to make decisions based on the best practices available. In this context, the task of collecting all the relevant information, a recall oriented task, in order to take the right decision within a reasonable time frame has become an important issue. In this paper, we investigate the problem of building effective Consumer Health Search (CHS) systems that use query variations to achieve high recall and fulfill the information needs of health consumers. In particular, we study an intent-aware gain metric used to estimate the amount of missing information and make a prediction about the achievable recall for each query reformulation during a search session. We evaluate and propose alternative formulations of this metric using standard test collections of the CLEF 2018 eHealth Evaluation Lab CHS.

Barriers and facilitators to promoting evidence uptake in Chinese medicine: a qualitative study in Hong Kong

Background In response to the World Health Organization’s recommendation, policy makers have been adopting evidence-based healthcare approach to promote the development of traditional, complementary and integrative medicine (TCIM) into Hong Kong’s health system. Disseminating synopses of clinical evidence from systematic reviews or randomized trials is regarded as a potentially effective strategy to promote evidence uptake. The study aimed to identify barriers and facilitators to implementing this strategy among Hong Kong Chinese medicine practitioners (CMPs). Methods Twenty-five CMPs aged under 45 years and trained in Hong Kong after reunification with China in 1997 were interviewed individually. Four clinical evidence synopses of randomized trials and systematic reviews on Chinese medicine interventions were presented, and CMPs were asked to comment on their applicability in routine practice. The Consolidated Framework for Implementation Research (CFIR) was applied to guide interview and analysis. Results The barriers included: i) CMPs’ perceived difficulties in applying complex evidence in decision-making and ii) inadequate training and limited consultation time. The facilitators were i) availability of publicly accessible and user-friendly synopses, ii) formation of community of evidence-based practice among CMPs with input from key opinion leaders, iii) opportunity for interprofessional collaborations with conventional healthcare providers, and iv) patients’ demand for evidence-based clinical advice. Besides, i) CMPs’ knowledge and beliefs in evidence-based healthcare approach, ii) presentations of evidence-based information in the synopses, and iii) clinical decision making as influenced by quality of evidence reported acted as both barriers and facilitators. Conclusions This CFIR-based qualitative study investigated how the World Health Organization recommendation of promoting evidence use in routine practice was perceived by CMPs trained in Hong Kong after reunification with China in 1997. Key barriers and facilitators to applying evidence were identified. Such results will inform tailoring of implementation strategies for promoting evidence uptake, in the context of a well-developed health system dominated by conventional medicine.