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Objective We aimed to evaluate and compare the efficacy of the bicaval and the biatrial standard techniques in orthotopic heart transplantation. Methods A systematic review with meta-analysis was performed. As data sources, we used the electronic databases EMBASE and Medline (1966–August 2006), hand searching in 4 journals, expert consultation, and reference lists of reviews. Observational and randomized and prospective and retrospective controlled trials that reported outcomes on the 2 techniques of heart transplantation were considered. Results A total of 23 retrospective and 18 prospective studies were included. Meta-analyses of prospective trials including between 228 and 472 patients revealed significant superiority of the bicaval technique in comparison with the biatrial procedure for early atrial pressure (weighted mean difference, −3.95; 95% confidence interval, −6.50 to −1.40), perioperative mortality (odds ratio, 0.41; 95% confidence interval, 0.17 to 0.98), tricuspid valve regurgitation (odds ratio, 0.23; 95% confidence interval, 0.15 to 0.36), and sinus rhythm (odds ratio, 7.01; 95% confidence interval, 2.57 to 19.13). The latter also showed a significant difference in the analysis of retrospective studies (odds ratio, 2.69; 95% confidence interval, 1.55 to 4.66). Conclusion In summary, this systematic review and meta-analysis provides evidence of clinically relevant beneficial effects of the bicaval technique in comparison with those of the standard technique. Nevertheless, the longer-term beneficial effects of the bicaval technique remain to be evaluated.

Information derived from Health Technology Assessment (HTA) reports is increasingly used for decision-making in healthcare. The production of HTA reports requires well-qualified interdisciplinarily working specialists who are not yet available in sufficient number. The German HTA Society and the German Network for Evidence Based Medicine have now developed an HTA curriculum which may serve as a basis for training courses for users of HTA information as well as HTA authors. Structure and content of the curriculum were inspired by internationally established training courses. However, the specific aspects of technology regulation and decision-making in the healthcare systems of German-speaking countries are emphasised. The curriculum is subdivided into a total of 11 modules. These include principles of HTA, status and regulation of technologies, priority setting, management of knowledge and information, methods of conducting HTA reports and project management. In the next step, the application of the curriculum into an Internet-based training course is planned.

Evidence-based medicine is not self-explaining. But due to the use of methodological, technical and statistical terms beginners might find it difficult to get access to EbM. To overcome this hurdle, a working group of practising physicians and methodologists have developed a glossary for the German Network Evidence-based Medicine covering the most important terms and providing explanations by giving practical examples. Access is also possible through www.ebm-netzwerk.de/glossar.htm. The present glossary is just a start, though. Over the coming years more terms will have to be added according to the needs and suggestions of our readership. We thus call on active participation of its users.

In 2002 the German "Curriculum Evidence-based Medicine" was made available by the Agency for Quality in Medicine and the German Network for Evidence-based Medicine. Its primary aim was to train practising medical doctors. We adapted the curriculum for participants of a postgraduate Master of Public Health course and a course for medical students. The two groups differ from the main target group regarding both their baseline knowledge and the objectives of their respective training courses. Here we report how the curriculum was adapted. The curriculum was adjusted in several ways: The postgraduate course focused on case studies with public health relevance. Beyond the obligatory modules, the focus was on training skills in searching and assessing secondary and tertiary evidence like systematic reviews or health technology assessments. In addition, the health policy context for evidence based medicine in Germany was analysed. In the course that aimed at medical students we included the module "Critical Appraisal of a Survey". At the beginning of each case study, the frequency and relevance of the health problems were elaborated. Apart from case studies on therapeutic interventions we also presented studies on diagnosis, prognosis and screening to demonstrate that evidence-based clinical decision making is feasible for the whole spectrum of questions arising from patient care. The curriculum proved to be adaptive to the needs of heterogeneous groups of participants. In this article we provide a detailed list of practical recommendations for courses for students of Public Health and Medicine.

Background Adherence to current monomorbidity-focused, mono-disciplinary guidelines may result in undesirable effects for persons with several comorbidities, in adverse interactions between drugs and diseases, conflicting management strategies, and polypharmacy. As yet no satisfactory approaches exist to address multimorbidity (MM) in clinical guidelines since this patient group is too heterogeneous as to be met by guideline recommendations. Objectives to develop a set of case-based (N = 1) guidelines for common disease combinations identified through epidemiological research and expert (GP) consultations. Methods We followed a new 5-step, mixed methods approach comprising: (1) review of epidemiological data on MM patterns; (2) interdisciplinary focus groups developed case vignettes according to both internal evidence and the results of step 1; (3) development of case-based recommendations according to case vignettes (N of one guidelines); (4) informal consensus of recommendations; (5) formal consensus. Results Step one revealed three different approaches for the selection criteria of case vignettes: first, cases addressing MM disease patterns from epidemiological studies (MM clusters); second, cases addressing triads of the 6 most prevalent chronic conditions; third, cases according to a problem-oriented prioritisation of focus group participants. All in all 10 N-of-one guidelines according to 10 cases could be developed according to the new 5-step-process. Discussion We present a new approach in order to capture the complex and heterogeneous problems of MM through evidence-based and case-based recommendations. This set of N-of-one-guidelines may serve as a framework of evidence-based recommendations for MM patients as the base for the development of meta-tools for both guideline developers and clinicians.