Rural Doctors’ Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study

Background

Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice.

Aim

This study aimed to explore the views and experiences of rural doctors’ about evidence-based medicine in their daily clinical practice in a rural primary care setting.

Methods

Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach.

Results

Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings.

Conclusion

The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.     

A Preliminary Study on Oxya fuscovittata (Marschall) as an Alternative Nutrient Supplement in the Diets of Poecillia sphenops (Valenciennes)

Growth of the ornamental fish industry is being hindered by the scarcity of low cost feed; hence alternative protein supplements should be explored. In this context the present study aims to evaluate whether the grasshopper Oxya fuscovittata could be used as a supplement for fish meal in the diets of Poecillia sphenops, which is one of the most common ornamental fishes worldwide. The present work is divided into three phases: In the first phase proximate composition of the grasshopper is obtained and five diets are prepared where fish meal is gradually replaced by Oxya meal and named as control, D1, D2, D3 and D4. All the diets are formulated on iso-nitrogenous basis where the protein percentage is fixed at 400 g/kg. The second phase deals with feeding trial and in the third phase all the data of the feeding trial are subjected to a linear model. The feeding trial shows that the control, D1 and D2 fed fishes have almost similar results. The linear model proves that the variation in the indices are mainly due to replacement of fish meal by Oxya meal, not due to the variations of rice husk and mustard oil cake that are also used to formulate the diets of the present study. From the results two Oxya supplemented diets, i.e. D1 and D2 are proved to be almost equivalent to the control diet. Hence it is concluded that Oxya meal is able to replace 25% to 50% of fish meal from the diets of P. sphenops.     

Assessment of consumption,utilisation and growth of Oedaleus abruptus (Thunberg) and Spathosternum prasiniferum prasiniferum (Walker) (Orthoptera: Acrididae) fed with various food plants in laboratory conditions

Summary. Grasshoppers are serious pests of crops worldwide. In the present era of changing agricultural practices and uncertainty regarding the impacts of global climate change, the need to understand the nutritional ecology of grasshoppers is urgent. In the present study newly hatched nymphs of two multivoltine acridids, Spathosternum prasiniferum prasiniferum and Oedaleus abruptus, were fed with four food plants of the family Poaceae: Cynodon dactylon, Triticum aestivum, Sorghum halepense and Oryza sativa. Then their growth, adult life span, food consumption and utilisation were recorded. Sorghum halepense was found to be the most suitable food plant for S. pr. prasiniferum whereas for O. abruptus it was Triticum aestivum followed by Sorghum halepense in most cases. The results from the present study may help forecasting modellers to simulate a predictive model that may speculate future outbreaks, forage loss and its possible effects on the economy more efficiently.     

Quantitative aspects of anin situ hybridization procedure for detecting mRNAs in cells using 96-well microplates

The universal quantitation of the DNA hybridization reaction has been a goal sought by many researchers. Part of this search has been the need to develop a rapid, sensitive, easy-to-perform, and quantitative method to measure the abundance of specific mRNAs directly within cells. Conventionally mRNA detection can be done by advanced quantitativein situ hybridization (ISH) using either image analysis or fluorescencein situ hybridization (FISH), or indirectly by extraction of mRNA from cells or tissue and using Northern blot or quantitative polymerase chain reaction (PCR). We examined the quantitative nature of probe binding to intracellular mRNA in a sensitive and easy-to-use nonisotopic method of ISH previously developed in our laboratories. The method is applicable to isolated primary cells or cells in culture. The procedural details are very simple, with cells being centrifuged into 96-well microplates, fixed with formalin, and pretreated with Triton X-100 and Nonidet P-40 before photobiotin-labeled cDNA probes are applied. Biotin from the hybridization of probe to target is detected using multiple applications of streptavidin and biotinylated alkaline phosphatase and visualized by thep-nitrophenyl phosphate conversion method. The quantitative parameters of the ISH procedure were determined by measuring the levels of expression of erythropoietin (EPO) mRNA and its translated protein in transfected COS-7 cells. There is a log-linear relationship between the levels of signal obtained in the ISH reaction in 96-well microplates and the EPO protein levels measured by enzyme-linked immunosorbent assay (ELISA). This demonstrated relationship is important in the standardization and use of these procedures to measure quantitatively mRNAs within cells.