Evidence-based treatment for acute spinal cord injury

OBJECTIVE： To formulate an evidence-based treatment for one patient with acute spinal cord injury and summarize evidence for evaluating acute spinal cord injury treatment. METHODS： Studies related to the treatment for acute spinal cord injury were identified via a search of National Guideline Clearinghouse （NGC, 2000 11）, the Cochrane Library （Issue 1,2011）, TRIP Database （2000 11）, and PubMed （1966-2011）. Treatment strategies were formulated according to three basic principles： best evidence, doctor＇s professional experience, and wishes of the patient. RESULTS： A total of 34 articles were selected, including 1 NGC guideline, 22 systematic reviews, and 11 randomized controlled trials. Based on our review, we arrived at the following recommendations： no clinical evidence exists definitively to recommend the use of any of neuroprotective pharmaceuticals; surgery should be undertaken early; mechanical compression devices and low-molecular weight heparin should be employed to prevent thrombosis; respiratory muscle training is beneficial for pulmonary function and quality of life; and functional electrical stimulation and acupuncture can promote functional recovery. The patient accordingly underwent surgery 6 hours after trauma without receiving any neuroprotective pharmaceuticals; low-molecular weight heparin and intermittent pneumatic compression were applied to prevent thrombosis. He also underwent respiratory muscle training daily for 8 weeks and received functional electrical stimulation for 15 minutes and acupuncture for 30 minutes every day. After follow-up for 3 months, the above therapeutic regimen was confirmed efficacious for acute spinal cord injury. CONCLUSION： Evidence-based medicine provides an individualized treatment protocol for acute spinal cord injury, which can significantly improve the therapeutic effect and prognosis.

Evidence-Based Medicine Research on Prescriptions in Synopsis of the Golden Chamber in the Treatment of Pelvic Inflammatory Disease

Purpose: Based on the National Natural Science Foundation of China, we collect and sort out the literature published in approximately the last 30 years, which use prescriptions in Synopsis of the Golden Chamber to treat pelvic inflammatory disease (PID). This study provides theoretical basis for the treatment of PID;we recommend this achievement to colleagues. Method: Firstly, we searched and collected the literatures from last three decades in CNKI, Wanfang and VIP databases, which are about classical prescriptions treating endometriosis. Then, by screening all the literatures, we obtained the clinical research literatures and individual case reports. Finally, we went through the internal quality of the two categories of literatures to get the dominant prescriptions. Using a retrospective study of evidence-based medicine research, we comprehensively collect literature, standardize the disease spectrum, classify the evidence, and then evaluate the internal quality. Results: We refine 4 prescriptions which commonly are used in the treatment of PID;in other words, they are also the clinical symptoms of PID: Gui Zhi Fu Ling Wan symptom, which manifests blood stasis and cold-damp stagnancy;Dang Gui Shao Yao San symptom, which manifests disharmony of liver and spleen, qi-blood stasis and damp obstruction;Da Huang Mu Dan Tang symptom, which manifests the gathering toxic heat and qi-blood stasis;Yi Yi Fu Zi Bai Jiang San symptom, which manifests the internal toxic heat and qi-blood injury. Conclusion: This study is gospel for the patients with recurrent episodes of PID who can’t often use antibiotics. At the same time, it is also a green therapeutics which Chinese ancients dedicated to human medicine.

An Evidence-Based Management Approach to HIV/AIDS in Nigeria

Objectives: This paper seeks to examine the history of HIV/AIDS in Nigeria while presenting a clear picture of some of the issues that exist in service delivery. Lastly, this paper explores how an evidence-based management approach offers an effective set of tools to HIV/AIDS organizations. Methods: Content analysis and a qualitative desk review of the literature. Results: Findings from this paper reveal that through the use of evidence-based management, preconceived notions can be challenged so as to yield a diversity of thought and a more people-centered approach to public health delivery. This paper also shows that in the Nigerian setting, an evidence-based management framework can be a transformative tool in ensuring that key populations can receive critical care and treatment in the long run despite the uncertainty that might exist when it comes to funding and resources. Conclusions: Evidence-based management is a rigorous framework that can be used for understanding how a multitude of factors can position an organization to achieve its theory of change, which in turn can lead to sustainable impact in the long run. Incorporating the use of evidence in everyday organizational behavior involves not only looking at the manner in which data is aggregated, but also how it is disseminated. In order to ensure that the evidence is not manipulated, nonprofit organizations are often viewed as being best suited for collecting evidence since they are not heavily plagued by systemic corruption and political tides, compared to their government counterparts.

A decade in gastric cancer curative surgery:Evidence of progress(1999-2009)

To investigate the progress in evidence-based surgical treatment of non-metastatic gastric cancer,we re- viewed the last ten years'literature.The data used in this review were identified by searches made on MED-LINE,Current Contents,PubMed,and other references taken from relevant original articles(on prospective and retrospective studies)concerning gastric cancer surgery.Only papers published in English between January 1999 and December 2009 were selected.Data from ongoing studies were obtained in December 2009, from the trials registry of the United States National Institutes of Health(http://www.clinicaltrial.gov).The citations list was presented according to evidence based relevance(i.e.,randomized controlled trials,pro- spective studies,retrospective series).In the last ten years,many challenges have been faced relating to the extension of gastric resection and nodal dissection as well as surgical timing,but we found only limited evidence,regardless of latitude of study.The ongoing phase-Ⅲ trials may provide answers that will be valid for the coming decades,and which may bring definitive answers for the currently unresolved questions.

基于《黄帝内经》病证结合思想探讨疾病循证病机-证治体系研究模式

深度挖掘《黄帝内经》病证结合思想,《黄帝内经》首开辨病论治之先河,在此基础上,又将辨病与脏腑辨证、病因辨证、经络辨证及六经辨证有机结合,开启了病证结合思想的萌芽,为后世病机、证候、治则治法理论的发展奠定了坚实的理论基础。基于病机、证候、治法、方药之间的内在联系性与统一性,提出病证结合是循证病机-证治体系的立论基础,循证病机-证治体系以疾病为研究基础,以病机为核心要素,以临床疗效为评价标准,“基于疗效,评价病机”是构建疾病循证病机-证治体系的关键。在疾病循证病机-证治体系的构建过程中,借鉴循证医学系统评价的方法,通过“以方测证、验证病机”的方式,为循证病机-证治体系的构建提供思路。

Evidence-Based Therapies of Chinese Medicine for Chronic Urticaria:Where Do We Stand and Where Are We Going?

Chronic urticaria（CU）is characterized by repeated occurrence of wheals or itching for more than 6 weeks.When urticaria symptoms repeatedly occur despite taking Western medicines such as antihistamines,Chinese medicine（CM）has been shown to relieve symptoms and prevent recurrence.However,the lack of robust evidence from the evidence-based medicine perspective is hindering acceptance of CM by the Western medicine community.In recent years,more and more evidence-based studies of CU treatment by CM were report in English literatures,including acupuncture,herbs,and food,although some of evidence is still with low quality.These progress in CM treatment of CU will inspire high quality evidences via randomized,controlled trials assessing efficacy and safety of CM treatment of CU.

临床指南和个体化治疗辩证应用--以肺癌筛查及综合治疗方案选择为例

肺癌筛查的方法,以外科为主的综合治疗方案(化疗、靶向治疗、放疗、免疫治疗等序贯或联合)的选择差异及患者的真实世界,都直接影响患者预后。另外,现实世界中临床医生多采取自己擅长的方法去治疗,有时忽略了对患者最有益的方案。建议在循证医学的指导下,以临床指南为基石,结合患者个体化病情,胸外科、肿瘤科、放疗科、中医科及呼吸与危重症医学科等多学科会诊讨论后,给予精准诊断和治疗。同时,将医患共同决策的模式与个体化指南相结合,最大可能使患者获益。

《Ⅰ-Ⅲ期结直肠癌西医常规治疗后中医干预指南》解读及病例分享

《Ⅰ-Ⅲ期结直肠癌西医常规治疗后中医干预指南》于2020年3月9日在中华中医药学会立项,由来自全国各地12家单位组成的18名专家起草,2022年7月正式在中华中医药学会发布。本指南通过德尔菲法确定了5个临床问题并通过循证医学进行了解答。结直肠癌是常见的恶性肿瘤之一,其较高的发病率与不良生活方式、饮食结构和环境的改变有关。中医药对于Ⅰ~Ⅲ期结直肠癌的治疗积累了大量临床经验,具有独特疗效,已有大量研究表明中医可作为结直肠癌西医常规治疗后的补充和替代治疗,为进一步规范Ⅰ~Ⅲ期结直肠癌西医常规治疗后的中医诊疗,提高中医诊治Ⅰ~Ⅲ期结直肠癌的水平,使其具有良好的科学性及适用性,中国中医科学院西苑医院联合全国多家单位共同制定了本指南。为了提高本指南的适用性,方便临床医生应用,现对发病机制、诊断、辨证分型、治疗及临床问题等内容进行解读,并通过1例典型病例解读指南的临床问题产生过程。由本指南制定相关专家及参与工作的医学生组成的研究团队对该指南进行解读。参与指南解读的人员不存在与原指南相关的学术或商业利益冲突。

Therapeutic effects and safety of olcegepant and telcagepant for migraine A meta-analysis

OBJECTIVE： To evaluate the therapeutic effects and adverse reactions of olcegepant and telcagepant for the treatment of migraine. DATA RETRIEVAL： We identified studies using Medline （1966-01/2012-06）, PubMed （1966-01/2012-06）, Scopus （1980-01/2012-06）, Cochrane Central Register of Controlled Trials （1980-01/2012-06） and China National Knowledge Infrastructure （1980-01/2012-06）. SELECTION CRITERIA： The included studies were double-blind, randomized and placebo-controlled trials of olcegepant or telcagepant for the treatment of single acute migraine in patients with or without aura. Adverse reaction data were also included. Two independent investigators performed quality evaluation and data extraction using Jadad scoring. Meta-analyses were undertaken using RevMan 5.0.25 software. MAIN OUTCOME MEASURES： Pain relief rate, pain-free rate, and incidence of adverse reactions were measured in patients 2 and 24 hours after injection of olcegepant and oral teicagepant. RESULTS： Six randomized, controlled trials were included. Meta-analysis demonstrated that compared with placebo, the pain relief rate （odds ratio, OR = 5.21, 95% confidence interval, CI： 1.91-14.2, P 〈 0.01） and pain-free rate （OR = 31.11, 95% Ch 3.80-254.98, P 〈 0.01） significantly increased 2 hours after 2.5 mg/d olcegepant treatment. Pain relief rate and pain-free rate 2 and 24 hours after treatment with telcagepant 150 mg/d and 300 mg/d were superior to placebo （P 〈 0.01）. Moreover, the remission rate of unrelenting headache was higher after 24 hours of 300 mg/d telcagepant treatment compared with 150 mg/d （OR = 0.78, 95% Ch 0.62-0.97, P 〈 0.05）. The incidence of adverse reactions with olcegepant was not significantly greater than placebo （P = 0.28） but within 48 hours of administration of telcagepant 300 mg/d, the incidence of adverse reactions was higher than placebo （OR = 1.21,95% Ch 1.04-1.42, P 〈 0.01）. Few studies have compared the therapeutic effects of olcegepant and telcagepant. CONCLUSION： The calcitonin-gene-related peptide receptor antagonists olcegepant and telcagepant have shown good therapeutic effects in the treatment of migraine. Moreover, the incidence of adverse reactions compares favorably with placebo, although liver transaminases may become elevated after long-term use.

An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.

部分嵌套式设计在中医药“同病异治”疗效评价中的应用及方法学探索

目的本研究针对中医学同病异治、辨证论治的特征,引入部分嵌套式设计。方法部分嵌套式设计以复杂干预对照标准化治疗,中医组按“证型-治法-方药”分割为多个子集(存在嵌套结构),对照组采用标准化西医治疗(无嵌套结构);并以一项溃疡性结肠炎“同病异治”数据为例,套用该设计类型并采用多水平模型分析。结果部分嵌套式设计符合“同病异治”诊疗特征并满足循证评价的设计要求,通过多水平模型可实现类似数据结构的分析。结论利用部分嵌套式设计能实现对“同病异治”整体效果的评价,可为中医药临床疗效评价提供方法学参考。

膝骨关节炎非手术治疗患者运动干预的最佳证据总结

目的总结膝骨关节炎非手术治疗患者运动干预的最佳证据,为临床膝骨关节炎非手术治疗患者的运动康复提供参考。方法确定循证问题,依照“6S”证据模型,计算机检索JBI循证卫生保健中心数据库、BMJ、英国国家卫生与临床优化研究所指南网等国内外数据库中关于膝骨关节炎非手术治疗患者运动干预的所有证据,包括指南、系统评价、证据总结、专家共识、临床决策、随机对照试验,检索时限为2018年2月10日至2023年2月10日。由2名研究者独立完成文献质量评价、证据提取和总结。结果共纳入12篇文献,其中指南6篇,系统评价2篇,专家共识2篇以及随机对照试验2篇。从运动原则、运动评估、运动类型、运动强度、运动频率和时间、运动监测6个方面共汇总27条最佳证据。结论膝骨关节炎患者运动方案的制定应遵循运动频率、强度、时间和类型原则,医护人员在临床应结合患者自身状况意愿、证据应用情境等因素选择证据,个体化制定患者的运动干预计划。

2型糖尿病中西医结合诊疗指南

2型糖尿病(T2DM)是全球性的公共卫生问题,目前我国患病总人数已超过1亿。为指导2型糖尿病规范化中西医诊疗,中国中西医结合学会联合中华中医药学会、中华医学会共同开展中西医结合诊疗方案制订工作,本指南组织国内22位内分泌及相关领域中西医专家,通过前期调研、专家访谈、共识会议,结合循证医学证据,最终形成了2型糖尿病中西医结合诊疗指南。主要内容包括2型糖尿病的诊断标准、高危人群筛查、中医证候分型、治疗原则和方法。治疗方案涵盖健康教育与管理、营养与药膳、运动与功法、心理调节与情志疗法,以及中药辨证论治、中成药、中医外治法等中医疗法与西药的联合干预。强调以患者为中心,注重个体化治疗,旨在改善血糖控制,减少并发症,提高生活质量。本指南适用于中医、中西医结合医疗机构的临床医师及相关护理人员,也可供西医临床医师和健康管理相关专业人员参考。

中西医结合治疗膀胱癌的研究进展

膀胱癌(bladder cancer,BC)是一种在全球影响广泛的常见且危险的疾病。西医和中医各自对膀胱癌有其独特的理解、诊断方法和治疗方法。概述西医和中医对膀胱癌的流行病学、统计学、诊断和治疗方面的认识。此外,还探讨了中西医结合治疗膀胱癌的方法,包括中医在手术治疗、化疗、放疗、靶向治疗、免疫治疗以及其他西医治疗中的应用。最后,讨论了中医对膀胱癌的循证和临床研究,包括单一化合物、提取物、方剂和专利药物的应用。

以循证理论为指导的急救护理路径在急性脑梗死患者中的应用效果

目的:探讨以循证理论为指导的急救护理路径在急性脑梗死(ACI)患者中的应用效果。方法:回顾性分析2020年4月—2022年3月福建中医药大学附属第二人民医院急诊科收治的96例ACI患者的临床资料,按照救护方法的不同分为两组,各48例。对照组实施常规急诊救护,观察组实施以循证理论为指导的急救护理路径,两组均持续随访3个月。对比两组救治效率、神经功能、日常生活能力及护理满意度。结果:观察组院前救治时间、入院至医嘱下达时间、检查用时、入院至开始静脉溶栓时间分别为(4.11±0.42)min、(4.33±1.02)min、(8.46±1.43)min、(48.71±9.44)min,均短于对照组的(5.51±0.44)min、(5.56±1.33)min、(10.65±2.23)min、(55.96±10.63)min,差异有统计学意义(P<0.05)。观察组救护后美国国家卫生研究院卒中量表(NIHSS)评分为(15.48±3.10)分,低于对照组的(20.06±3.41)分,日常生活能力指数量表(ADL)评分为(76.35±6.95)分,高于对照组的(68.78±6.44)分,差异有统计学意义(P<0.05)。观察组护理满意度为95.83%,高于对照组的83.33%,差异有统计学意义(P<0.05)。结论:以循证理论为指导的急救护理路径在急性脑梗死患者中具有较好的救治效率,可改善神经功能及日常生活能力,提升护理满意度。

2期压力性损伤创面处理策略最佳证据总结

目的:检索并总结2期压力性损伤创面处理相关证据,形成科学、实用的创面处理策略,为临床医务人员实践提供规范指引。方法:系统检索国内外指南网\相关组织机构官方网站及数据库中2期压力性损伤创面处理相关证据,进行方法学质量评价后对证据进行提取、汇总和主题归纳。结果:最终纳入文献8篇,其中指南3篇、系统评价1篇、证据总结3篇及RCT研究1篇,提炼出6个维度(伤口评估、疼痛管理、周围及组织清洁、创面处理、伤口记录及质量管理),共21条证据主题。结论:临床护士,特别是非伤口专科护士可遵循最佳证据为2期压力性损伤患者实施标准化创面处理策略,促进创面愈合,改善患者健康结局。

老年皮肤瘙痒症患者非药物管理的最佳证据总结

目的 系统检索、评价并综合老年皮肤瘙痒症患者非药物治疗的最佳证据,为临床护理实践提供参考。方法 以“6S”证据金字塔为模型进行证据检索,系统检索计算机决策支持系统、指南网站、专业学会网站和数据库中关于老年皮肤瘙痒症非药物治疗的临床决策、指南、证据总结、系统评价、专家共识,检索时限为建库至2023年7月30日。由2名具有循证知识的研究者对纳入的文献进行质量评价,根据主题对证据进行提取、总结。结果 最终纳入指南4篇、临床决策3篇、系统评价4篇、专家共识2篇,形成原则、评估、物理治疗、中医治疗、心理治疗、健康宣教6个主题,共22条最佳证据。结论 该研究总结了老年皮肤瘙痒症患者非药物治疗的最佳证据,为临床护理实践提供了依据。护理人员可结合临床实际情境进行证据应用,加强对老年皮肤瘙痒症患者的科学管理。

基于ClinicalTrials.gov的全球数字疗法临床试验注册现状研究

目的研究全球数字疗法临床试验注册现状,为数字疗法的临床研究及应用提供参考。方法在ClinicalTrials.gov中检索数字疗法相关临床试验,运用文献计量学方法,分析全球数字疗法临床试验的注册数量和年度变化趋势、国家/地区分布及合作情况、申办者类型及构成情况、研究类型及试验分期、适应证分类和特征。结果全球数字疗法相关临床试验共2960项,其中美国最为活跃,远超其他国家/地区,与德国同处国际合作的中心,申办者中64.79%是高校/医院,美国高校/医院表现突出。85.44%是干预性研究,大多数属于设备和行为干预,适应证集中于精神疾病、慢性病和神经系统疾病领域,包括焦虑症(109项)、抑郁症(103项)和肥胖(101项)。截至检索日期,我国数字疗法相关临床试验为143项,与美国存在较大差距。结论全球数字疗法临床试验呈现逐年增长趋势,受COVID-19大流行影响,2020年后增长显著。我国数字疗法尚处于起步阶段,全面推广及应用尚需时间。

《CSCO非小细胞肺癌诊疗指南2024》更新解读

2024年4月,中国临床肿瘤学会(CSCO)正式发布《CSCO非小细胞肺癌诊疗指南2024》(以下简称《2024版CSCO非小细胞肺癌(NSCLC)指南》)。该指南在2023年版的基础上,继续秉承循证医学证据、立足诊疗药物可及性,兼顾地区发展差异和药物经济学成本,汇总专家意见,对非小细胞肺癌的诊疗进展进行及时更新。该文旨在对《2024版CSCO NSCLC指南》更新部分进行梳理和剖析,重点解析免疫治疗及靶向治疗的更新要点及其相应的循证医学证据。

口腔黏膜下纤维性变治疗的循证医学研究

口腔黏膜下纤维性变(oralsubmucousfibrosis,OSF)是一种与咀嚼槟榔等因素密切相关的口腔黏膜潜在恶性疾患。OSF的致病机制不明确,无根治方法,目前临床上治疗方法较多,如类固醇、己酮可可碱、番茄红素、姜黄、丹参、芦荟等药物及激光和手术等治疗方法,为了评价这些治疗方法改善OSF最大张口度、灼痛感、舌灵活度等症状的有效性及安全性,近十年学者们已完成了多项循证医学研究。本文对近十年(2014年7月至2024年6月)PubMed、Embase、WebofScience、TheCochraneLibrary、中国知网、万方、维普七大数据库治疗OSF的系统性评价或Meta分析进行归纳总结,为OSF的临床治疗和研究提供参考。当前的循证医学研究表明,己酮可可碱、透明质酸酶联合类固醇、番茄红素、姜黄素、丹参联合类固醇、芦荟等药物可有效改善OSF患者的最大张口度和烧灼感,且安全性好。透明质酸酶联合类固醇、番茄红素、姜黄素、丹参联合类固醇、芦荟证据等级均为A级,己酮可可碱证据等级为B级。番茄红素比其他药物,改善患者最大张口度的效果更好。芦荟在治疗早期比其他药物,改善烧灼感效果更好。此外,抗氧化剂改善OSF的症状效果佳,应用前景好。激光可改善OSF最大张口度、疼痛等症状,但成本较高,证据等级为C级;手术改善OSF最大张口度效果明显,但创伤大,证据等级为C级。目前循证证据纳入的临床研究数量和样本量较少,未来需更多设计良好、随访期长、结局指标标准化的治疗OSF多中心大样本的随机对照临床试验,再进行循证评价。