Evidence-based Clinical Chinese Medicine:What Has Changed Over the Past 20 Years

Chinese medicine has been used for centuries to treat a range of health conditions.This history has produced a wealth of classical literature,case studies and clinical research data detailing its use and effectiveness.However,high-quality and conclusive evidence that meets modern requirements for clinical decision support is lacking.This evidence gap limits the integration of Chinese medicine with contemporary medicine,which in turn limits global access and acceptance of Chinese medicine as a form of safe and effective health care.Over the past 20 years,researchers and organisations around the world,including the World Health Organization(WHO)and United Nations,have worked to support the integration of traditional medicines,such as Chinese medicine,with conventional medicines to improve global health care.This paper provides an overview of Chinese medicine studies published in the top four general medical journals(BMJ,JAMA,Lancet and New England Journal of Medicine)from February 2005 to February 2024 in the past 20 years to highlight the progress in the development of this evidence base.It also highlights key actions taken to promote evidence-based clinical Chinese medicine,including product and practitioner regulation,formalising education standards,and international collaborations.Research conducted at the China-Australia International Research Centre for Chinese Medicine demonstrates the benefits of such a collaboration.Through development of its unique and inclusive‘whole-evidence’approach,plus clinical studies and systematic reviews,the Centre has significantly contributed to the evidence base for clinical Chinese medicine.In addition,its high-impact papers and groundbreaking monographs have been cited in international conventional medicine guidelines.While progress has certainly been made during the past 20 years to build a stronger evidence base for clinical Chinese medicine,there is still a considerable gap that limits its integration with conventional medicine.Future funding and research are needed to continue this work and achieve to safe,effective and accessible traditional medicine as part of the WHO’s Universal Health Coverage strategy.

Secondary cardiovascular prevention in older adults： an evidence based review

1 BackgroundIn the United States, life expectancy is rising, particularly among the older population （〉 65 years）, with projected estimates approaching 20% by year 2050. Despite improved survival estimates, cardiovascular diseases remain the leading cause of morbidity and mortality resulting in substantial increase in health care cost. For younger adults, the evidence for secondary cardiovascular prevention is well established and corroborated by robust data. However, the application of risk reduction strategies in older populations remains an area of active debate. Many assume that vulnerability to chronic cardiovascular diseases is an inexorable part of aging such that the risks attributable to prevention outweigh potential benefits.

Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

Objective:The aim of this article was to discuss the theory of doctor-patient co-operated evidence-based medical record and set up the preliminary frame of the doctor-patient co-operated evidence-based medical record following the concept of narrative evidence-based medicine.Methods:The information was searched from Pubmed,Embase,CBMdisc,CNKI.A preliminary agreement was reached by referring to the principles of narrative medicine and advises given by experts of digestive system and evidence-based medicine in both Traditional Chinese Medicine and Western Medicine.Result:This research is a useful attempt to discuss the establishment of doctor-patient co-operated evidence-based medical record guided by the direction of narrative evidence-based medicine.Reflection and outlook:Doctor-patient co-operated medical record can be a key factor of the curative effect evaluation methodology system of integrated therapy of Tradition Chinese Medicine and Western Medicine on spleen and stomach diseases.

The concept of narrative evidence-based medicine and shared decision-making in traditional Chinese medical practice

For the explosive development of emerging diagnostic and therapeutic technologies brought by the advancement of precision medicine strategy, shared decision-making could improve the quality of clinical decision-making and promote the transformation of clinical research evidence in TCM. Paying attention to patients＇ narrative needs and strengthening medical humanistic concerns could improve clinical outcome and patient satisfaction. We described the origins and development of evidence-based medicine, narrative medicine and shared decision-making, and analyzed the existing problems in TCM clinical decision-making. Further, we put forward the model of shared decision-making between clinicians and patients under the guidance of narrative evidence-based medicine concepts and methods.

A review on the International Patient Decision Aid Standards （IPDAS）： history, development and application

A Patient Decision Aid （PtDA） is an important means in TCM practice to promote shared decision-making between doctor and patient, which is developed based on evidence-based and narrative medicine concepts. It is also an important tool for individualized diagnosis and treatment in the context of precision medical care. With the rapid increase of interest on the PtDA, it is important to establish a unified quality evaluation standard and standardize the development process. This article aims to introduce the main content, development history and application of International Patient Decision Aid Standards （IPDAS）, and provide reference for the application of the evaluation standard in China.

Current situation on the reporting quality of randomized controlled trials in 5 leading Chinese medical journals

Objective:The Consolidated Standards for Reporting of Trials(CONSORT) statement has already proved to be an efficient standard for reporting quality of randomized controlled trials(RCTs).However,most of the Chinese medical journals have not endorsed the CONSORT statement.The current situation about the reporting quality of RCTs in Chinese medical journals is still unclear.The purpose of the study was to evaluate the reporting quality of RCTs on papers published in 5 leading Chinese medical journals.Methods:We evaluated 232 original RCT papers using a reporting quality scale based on CONSORT statement from 2001 to 2006 in 5 Chinese medical journals(Journal type 1) without adoption of CONSORT and Chinese Journal of Evidence-based Medicine(Journal type 2) which adopted CONSORT in 2004.We measured the inclusion of 26 items for the reporting quality scale and 6 core items of each RCT report,gave score to each item and calculated the total score obtained in each report and the proportion of reports including individual items.The reporting quality of RCT trials from 2001 to 2003(pre-adoption period) was compared with that from 2004 to 2006(post-adoption period).Results:The average reporting quality of RCTs was moderate(mean score,15.18),and the mean score of the 6 core items was low(mean score,1.09) in 5 leading journals.The difference in the total score and the score of the 6 core items between pre-adoption period(2001-2003) and post-adoption period(2004-2006) was statistically significant(P=0.003;P=0.000).Interaction between journal type and period was not significant(F=0.76;P=0.383).We concluded that the change tendency of reporting quality between Journal type 1 and 2 was not different.But as to the core items of sequence concealment and intention-to-treat analysis,the increases were greater for Journal type 2 when evaluated against Journal type 1(P=0.038;P=0.016).Conclusion:The reporting quality of RCT trials in 5 leading Chinese medical journals is improving.However,the lack of important items in RCT trials remains a serious problem.We recommend the endorsement of the Consolidated Standards for Reporting of Trials statement in Chinese medical journals and the continuing education on evidence-based medicine in China.

Patient decision aids for cardiovascular disease： the status-quo and prospects

This article introduced the development and application of patient decision aid （PtDA） for cardiovascular disease. There are many risk factors for cardiovascular disease, and the mortality rate is high. Therefore, continuous management in symptoms, risk factors and lifestyle behaviors is needed for a good prognosis. PtDA can improve the patient＇s understanding of cardiovascular disease and the potential risk of perception of cardiovascular disease, as well as improve the communication between doctors and patients. The emergence of narrative evidence-based medicine provided a new opportunity for the further development of PtDA. At present, there were demands for domestic cardiovascular decision aids, but the researches were extremely limited.

Systemic therapy of non-colorectal gastrointestinal malignancies in the elderly

In the coming years life expectancy is expected to increase and with this the percentage of the population above age 65 will grow. Patients above 65 make up more than two thirds of those currently diagnosed with gastrointestinal malignancies. Available evidence based medicine does not focus on the average patient, above the age 70, encountered in every day practice. Most guidelines and clinical trials are not designed to take into account the special considerations needed when treating the elderly such as functional status, comorbidities, polypharmacy, life expectancy, and social support. The majority of available data is based on retrospective reviews or subset analyses of larger studies where the elderly represent a fraction of the studied population. This review focuses on the toxicities and tolerability of current standard therapies for noncolorectal gastrointestinal malignancies, including gastroesophageal, pancreatic, bile duct and hepatocellular cancers in the elderly. With careful patient selection and geriatric assessment the elderly can safely benefit from standard therapies offered to younger patients.

Reality of evidence-based practice in palliative care

There has been a paradigm shift in medicine away from tradition, anecdote and theoretical reasoning from the basic sciences towards evidence-based medicine(EBM). In palliative care however, statistically significant benefits may be marginal and may not be related to clinical meaningfulness. The typical treatment vs. placebo comparison necessitated by ‘gold standard' randomised controlled trials(RCTs) is not necessarily applicable. The complex multimorbidity of end of life care involves considerations of the patient's physical, psychological, social and spiritual needs. In addition, the field of palliative care covers a heterogeneous group of chronic and incurable diseases no longer limited to cancer. Adequate sample sizes can be difficult to achieve, reducing the power of studies and high attrition rates can result in inadequate follow up periods. This review uses examples of the management of cancer-related fatigue and death rattle(noisy breathing) to demonstrate the current state of EBM in palliative care. The future of EBM in palliative care needs to be as diverse as the patients who ultimately derive benefit. Non-RCT methodologies of equivalent quality, validity and size conducted by collaborative research networks using a ‘mixed methods approach' are likely to pose the correct clinical questions and derive evidencebased yet clinically relevant outcomes.

Issuing the Antibiotics for Children with and without Prescription in Pharmacies in Republic of Macedonia

The use of medicines for infants and children is presenting one unique set of challenges, because children are the most vulnerable population in any society. In this study, we set out to present the characteristics and classification of antibiotics recommended for children according to WHO, EMA and EBM. Also, the aim of this study was to analyze the most prescribed pediatric antibiotics in 2013 in Republic of Macedonia compared with standard treatments. Presented data was collected according to the number of prescribed recipes of pediatric dosage forms covered by the Fund of Republic of Macedonia. The obtained results showed that the most prescribed pediatric antibiotic is amoxicillin with clavulanic acid （875mg ＋ 125mg） in form of tablet, with 280 863 prescribed recipes which corresponds to the recommendations of EBM.

Modulation by anti-oketsu formulations in Kampo medicine of human arterial stiffness

Objective:In traditional herbal medicine(Kampo medicine in Japan),'sho'is diagnosed by the traditional assessments of clinical conditions.Among a variety of the shos,there is an'oketsu'syndrome,which is a stagnation and disturbance of microcirculation.The prompt effects of four anti-oketsu formulations in Kampo medicine on cardiovascular functions were compared in oketsu and non-oketsu persons.Methods:The arterial pulse wave from radial artery is formed by the combination with ejection and reflection pulses.An augmentation index(AI),a ration of the ejection and reflection pulses,indicates a degree of arteriosclerosis.For both seventy-six students with oketsu and thirty-seven students with non-oketsu,Kampo formulations overcoming oketsu of Tokishakuyakusan(TS,Dang-Gui-Shao-Yao-San),Kamishoyosan(KS,Jia-Wei-Xiao-Yao-San),Keisibukuryogan(KB,Gui-Zhi-Fu-Ling-Wan)and Tokakujokito(TJ,Tao-He-Cheng-Qi-Tang)were taken once,and then,the cardiovascular functions including blood pressure,heart rate,central arterial blood pressure(CBP)and AI were examined for 60 min.Results:At 40-60 min after an intake,these formulations decreased the AI almost by 6-18%(n=76),by 18.3±3.1%(P<0.01,n=15)with TJ.Simultaneously,the CBP was reduced by 9.0±1.8%(P<0.05,n=23)with KS and by 9.1±2.0%(P<0.05,n=15)with TJ.On the other hands,non-oketsu group had less or no effect by any kinds of the formulations.Conclusion:The anti-oketsu formulations can exert the ameliorative action for oketsu persons via decreasing AI and CBP.

Meta analysis on ischemic stroke treated with scalp acupuncture

Objective To evaluate the efficacy and safety of scalp acupuncture in the treatment of ischemic stroke. Methods The method recommended in the Cochrane Collaboration was used for the systematic evaluation of the randomized controlled trials （RCTs） of scalp acupuncture in the treatment of ischemic stroke. Results One thousand three hundred and ninety-five cases from 13 papers in Chinese version were in compliance with the inclusive criteria and all of them were the low-quality trials. The results of the included 5 trials in Meta analysis indicated that the efficacy of scalp acupuncture was superior to medication in the treatment of ischemic stroke （RR=1.27, 95% CI 1.06, 1.51）. The results of 3 trials in Meta analysis suggested that the recovery in the nerve function defect of the patients with ischemic stroke treated with scalp acupuncture was apparent as compared with medication （WMD = -2.96, 95% C1-4.00, -1.92）. The results of 5 trials in Meta analysis showed that the efficacy of scalp acupuncture on ischemic stroke was potentially superior to body acupuncture （RR=I.10, 95% CI 0.93, 1.28）. Conclusion It is seen in the Meta analysis results of the included 13 RCTs that scalp acupuncture achieves the definite efficacy on ischemic stroke. Due to the limitation of the inclusive numbers and quality of the research, especially the lack of long-term indices, the conclusion reliability of this research is relatively low. Hence, it is required much more evidences for a further confirmation from the large scale and multiple central RCTs with high quality and intrinsic authenticity.

Clinical efficacy observation of thalamic pain treated with acupuncture under the guidance of evidence-based medicine

Objective To study the feasibility of the crossover trial design and the minimal imbalance index random distribution method in the clinical small-sample-size randomized controlled trial（RCT） research of thalamic pain treated with acupuncture under the guidance of evidence-based medicine（EBM）.Methods The crossover trial design was adopted.Eleven cases with the definite diagnosis were randomized into a program-I group（6 cases,treated with acupuncture before western medicine） and a program-II group（5 cases,treated with western medicine before acupuncture） according to the minimal imbalance index method.In the statistical analysis,the groups were named as an acupuncture group and a western medicine group separately,11 cases in each one.Acupuncture was applied to Xìmén（郄门 PC 4）,Yīnxì（阴郄 HT 6）,Xuèhǎi（血海 SP 10）,etc.In the control treatment,Carbamazepine was prescribed for oral administration.Either the duration of treatment or the wash-out period was 10 days.The visual analogue scale（VAS） was adopted for the efficacy assessment.Results The total effective was 100.0%（11/11） after treatment in either group.The remarkably effective rates were 63.6%（7/11） and 36.4%（4/11） in the acupuncture group and the western medicine group separately,without statistically significant difference in comparison.Conclusion The crossover trial design and the minimal imbalance index distribution method can accomplish RCT of the clinical acupuncture and moxibustion research with the small sample size involved.They can provide the high-quality evidences for clinical acupuncture research.Acupuncture therapy can achieve the same therapeutic effect as Carbamazepine,the common western medicine,and the efficacy of it is potentially superior to that of western medicine.

Evidence-based clinical practice guidelines for acupuncture-moxibustion treatment of scapulohumeral periarthritis

The aim of this study was to establish clinical practice guidelines for acupuncture-moxibustion by retrieving relevant literature and adopting the best current national and international evidence, according to experts＇ experience and patients＇ values. This was achieved using the Grade of Recommendations Assessment, Development and Evaluation（GRADE） system combined with a wide range of national experts＇ consensus, in order to provide reliable evidence for acupuncture-moxibustion treatment of scapulohumeral periarthritis, and to ensure the safety and effectiveness of the treatment.

Overview of the acupuncture parts in the Cochrane Database of systematic reviews and the Cochrane Collaboration

Background The clinical efficacy of acupuncture is a topic that has received worldwide attention. In recent years, the rise of evidence-based medicine has led to calls for the clinical curative effects of acupuncture to be tested through objective, standardized, systematic evaluation. The results of systematic reviews for clinical trials on the efficacy of acupuncture directly affect the development of acupuncture medicine. Because of its rigorous methods and its capability to provide the very latest results, the Cochrane Database of Systematic Reviews（CDSR） is recognized worldwide as one of the most reliable sources for scientific evidence. Objective Assess the current system evaluation related to acupuncture in CDSR and the Cochrane Collaboration. Methods Based on the protocols described in the Cochrane library review and the Cochrane Collaboration, and considering the registered titles in the data base, the following key terms were selected： acupuncture, transcutaneous electrical nerve stimulation, electroacupuncture, needle and acupressure. Results The 275 articles were retrieved. According to inclusion and exclusion criteria, 139 articles were eventually chosen for inclusion. We found a growing number of acupuncture related CDSR annual reviews and protocols on the overall Before 2014. The published acupuncture related reviews, protocols and registered titles concerning the subject involve 34 Cochrane Review Groups. Through analyzing the 84 reviews related to acupuncture, we concluded that these studies show a rather low rate of efficacy overall for acupuncture. Of the 84, 19（22.62%） concluded that there is evidence for the efficacy of acupuncture,2（2.38%） showed acupuncture treatment were not more effective than controls and the remaining 63（75.00%） showed that the efficacy of acupuncture were uncertain. Conclusions By analyzing and summarizing the acupuncture reviews published in the CDSR before 2014, we found that current research shows acupuncture treatment is most effective for treating pain and related symptoms（57.89%）. However, studies showing lack of efficacy or uncertain results far outweighed the studies with positive results. We discuss the possible reasons for this and beleive it is related to the overall quality of research, poorly designed sham acupuncture, lack of standard procedures for locating points and needling, and lack of attention to individual differences.

Integrating acupuncture:are there positive health outcomes for women?

The key health issues for women tend to be primarily associated with the female reproductive system. There are also other gender priorities and consequences associated with ageing, which require effective interventions. Acupuncture is used worldwide and its evidence base is increasing on both mechanisms of action and its effectiveness in clinical care. Although acupuncture may be a valuable addition to healthcare for some conditions, it is rarely fully integrated into mainstream Western medicine clinical practice. Inadequate design and poor reporting of clinical trials have been barriers. Additionally systematic reviews and meta-analyses have tended to be equivocal and have reported that there is insufficient evidence for its recommendation. Future research should focus on ensuring good trial design including cost effectiveness and qualitative data and using a more pragmatic stance which reflects acupuncture in clinical practice. Undoubtedly, effective interventions are always needed to ensure the best health outcomes and address preventable deaths, morbidities, and disabilities among women but integration will be compromised unless underpinned by good evidence.

Nonlinear vibration of an elastically restrained tapered beam

This paper presents the analytical simulation of an elastically restrained tapered cantilever beam using the energy balance method(EBM) and the iteration perturbation method(IPM).To assess the accuracy of solutions,we compare the results with the harmonic balance method(HBM).The obtained results from EBM and IPM are in excellent agreement with HBM results.The results show that both methods can be easily extended to other nonlinear oscillations and it can be predicted that both methods can be found widely applicable in engineering and physics.

Research Advance and Prospects of Evidence-Based Acupuncture Science in China

Acupuncture is a traditional empirical medicine, and evidence-based medicine（EBM） is a new medical method and development of the empirical medicine. Since 1990s, Chinese acupuncture workers began to absorb and use the methods and principles of EBM to guide acupuncture clinical research and practice. Now more and more domestic acupuncture clinicians use and follow the methods and principles of EBM. On the systemic review of acupuncture-associated articles in Cochrane library, previously effective acupuncture therapy lacks adequate evidences, which may be related to the low quality of randomized controlled trials（RCTs）. In the future, only developing specialized team of acupuncture clinical research and clinical research center can radically elevate the levels of acupuncture clinical research and evaluation. Meanwhile, developing China＇s evidence-based acupuncture should base itself on the characteristics of acupuncture, such as emphasis on original research in ancient books, high-quality single RCTs and systemic review of non-randomized researches.

Acupuncture Skills and Its Evidence-based Assessment

Acupuncture originated in China several thousand years ago, and this therapeutic approach has been shown to be an effective treatment of many diseases and the maintenance of health in China and other countries all over the world. However, there is little study into how the important skills of acupuncture should optimally be taught and how competence at this skill should be evaluated. The current competency assessment of acupuncture skills is primarily based on evaluations by experts, which can be subjective with large variations and potentially inaccurate. Developing evidence-based assessment standards for acupuncture skills is required to move the assessment of the clinical practice of acupuncture forward, and this performance evaluation could be based on standardized expert evaluation, computer-based measurements such as motion analysis , and high-fidelity simulators or standardized patients.