Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese medicine and Western medicine

Integrated traditional Chinese medicine(TCM)and Western medicine(WM)is a new medical science grounded in the knowledge bases of both TCM and WM,which then forms a unique modern medical system in China.Integrated TCM and WM has a long history in China,and has made important achievements in the process of clinical diagnosis and treatment.However,the methodological defects in currently published clinical practice guidelines(CPGs)limit its development.The organic integration of TCM and WM is a deeper integration of TCM and WM.To realize the progression of"integration"to"organic integration",a targeted and standardized guideline development methodology is needed.Therefore,the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

Teaching Research and Effect Observation on the Integration of Clinical Medicine Integrated Course and Ideological and Political Elements from the Perspective of“Sanquan Education”

Purpose:To analyze the application path of the integration of clinical medicine integrated courses with the elements of ideology and politics under the theory of“Sanquan Education,”and to provide references for the promotion of educational reform in medical schools.Methods:60 clinical medicine undergraduates at Jiamusi University in 2018 and 2019 were randomly selected as research subjects.On the basis of the analysis of students’characteristics and pre-study content,the students were divided into the integration group and the traditional group,each with 30 students.Students in the integration group carried out clinical medicine integrated class with the integration of ideological and political elements.Students in the traditional group carried out the traditional clinical medicine integrated class.Classroom evaluation scales,anonymous questionnaires,and interviews were used to conduct research,collect data,and compare and observe the application effects.Results:After carrying out different modes of clinical medicine integrated courses,the undergraduates of the Excellent Physician Class in the integration group were higher than those in the traditional group in terms of teaching satisfaction,comprehensive quality,basic knowledge test,and case analysis scores through questionnaire analysis(P<0.05).In the evaluation of the effect of ideological education,the undergraduates of the Excellent Physician Class of the integration group were higher than the traditional group in terms of the acceptance of doctor-patient communication,the correct rate of mastering the history of the discipline,and the correct rate of mastering the frontiers and policies(P<0.05).Conclusion:Through the integration of clinical medicine integrated course and ideological and political elements,we can help students establish correct values while teaching them professional knowledge,improve the implementation of moral education in medical schools,cultivate excellent medical workers with high morality and firm beliefs for the society,and realize the fundamental educational task of establishing morality and educating people in medical schools in the context of“Sanquan Education.”

Progress in clinical research on the integration of Chinese and Western medicines for treating primary liver cancer

Primary liver cancer(PLC) is one of the most common malignant tumors in China. PLC is characterized by insidious onset, rapid progress, poor quality of life, and short survival time. Notably, current treatment strategies remain unsatisfactory. Traditional Chinese medicines(TCM) have been used to treat a variety of diseases, including liver diseases, for more than 2000 years. In this study, we performed a review of the use frequency and clinical efficacy of TCM in treating PLC. Relevant literature from January 1, 2009, to January 1, 2021 was retrieved from network databases of China National Knowledge Infrastructure(CNKI), Chongqing VIP, Wanfang, PubMed, and SinoMed. The most frequently used TCM and their efficacy in PLC treatment were summarized. Based on the inclusion and exclusion criteria, 33 articles were selected. Overall, the efficacy of the combination of TCM and Western medicines in the treatment of PLC was higher than that in the control groups(i.e. treatment with Western medicines alone)(65.11% vs.44.31%, P <.05). Among the 33 selected articles, 11 were investigated for TCM preparation(marketed drugs) and 22 for TCM formulas. In total, 102 types of TCM(single herbs) were used to treat PLC. The top five most frequently used TCM were Poria(14.71%), Astragali radix(13.73%), Atractylodis Macrocephalae Rhizoma(12.75%), Bupleuri radix(12.75%), and Glycyrrhizae radix et Rhizoma(11.76%). Of the 102 types of TCM, tonics were the most frequently used categories, followed by heat-clearing medicines, blood-invigorating medicines, and stasis-resolving medicines. Of 207 papers, 174(84.06%) could not be subjected to statistical analysis due to research quality. Further high-quality research on herb sources, formula components and dosage, toxicology, and ethics of TCM is necessary. In conclusion, TCM play a promising role in the treatment and management of PLC, although further investigations are warranted.

Therapeutic Evaluation on Advanced Pancreatic Cancer Treated by Integrative Chinese and Western Medicine──Clinical Analysis of 56 Cases

Objective: In comparison with chemotherapy, to evaluate therapeutic effects on advanced pancreatic cancer treated by integrative Chinese and western medicine (ICWM) therapies. Methods: Based on the retrospective study of 56 patients with advanced pancreatic cancer, life table was applied to the analysis of patients' survival rate and Xz test to the comparison of therapeutic response between ICWM and chemotherapy groups. Results: The results showed that 1-year survival rate in the ICWM group was 55. 37%±3.24%; 2-year survival rate 34. 61%±16. 31%; 3-year survival rate 25. 96%±24. 64%; 5-year survival rate 25. 96%±24.64%; and median survival period 16. 3 months. However 1-year survival rate in the chemotherapy group was 21. 95%±27. 54% ; 2-year survival rate 7. 31%±27. 54% ; 3-year survival rate 0 % ; and median survival period 7. 5 months. The therapeutic effects between two groups were significantly different (P=0. 004). Further analysis suggested that the reduction of cancer mass in the ICWM group was more than that in chemotherapy group (P=0.049) and the improvement of advanced pancreatic cancer related-symptoms better than that of chemotherapy group (P = 0. 002). Conclusion: The ICWM comprehensive therapy is of important value in the treatment of advanced pancreatic cancer.

Clinical Controlled Study of Integrative Chinese and Western Medicine in Treating 49 Cases of SARS

Objective: To evaluate the efficacy of integrative Chinese and western medicine (ICWM) in treating severe acute respiratory syndrome (SARS) patients. Methods: Through parallel control design, 49 SARS patients were observed. Used as control, there were in the western medicine (WM) group 29 patients, who were treated with Ribavirin, Levofloxacin, Thymopentin, Azithromycin, methylprednisolone, etc. , on the basis of 'Recommended Protocol for Infectious Atypical Pneumonia' (abbreviated as 'Recommended Protocol') issueed by Ministry of Health. As the treated group, there were in the ICWM 20 cases. The protocol for treatment of SARS in 'Special Science and Technological Action to Prevent and Treat SARS' (abbreviated as 'Special S-T Action'), issued by Ministry of Science and Technology, together with the same WM as those for the control group. Results: (1) Time from the disease onset to the symptom improvement were 5.10±2. 83 days and 7. 62±2. 27 days in ICWM and WM group respectively, P<0.05; (2) As to corticosteroid (CS) amount and days before reducing dosage, 2 groups showed no significant difference, P>0. 05;(3) There was no significant difference in the time from disease onset to the body temperature normalization and the total amount of CS and the duration of using CS before reducing it to 80 mg between the ICWM group and the WM group; (4) The days and amounts for use CS after reducing between the ICWM group and the WM group were significantly different (P<0. 05). Conclusion: There were obvious advantages in ICWM to treat SARS, compared with that of WM alone, especially in improving the clinical symptoms, promoting the recovery of immune function, promoting the absorption of pulmonary inflammation and reducing the dosage and duration of CS treatment.

Organic Integration of Traditional Chinese and Western Medicines—Future of Clinical Practice Guidelines of Integrated Traditional Chinese and Western Medicines

The transformation and implementation of clinical practice guidelines for integrated traditional Chinese medicine(TCM)and Western medicine(WM)is crucial to the adoption of medical science and technological findings and is an important way for TCM to be made available to the world.First,clinical practice guidelines(CPGs)of TCM and WM integration in recent years was analyzed to clarify the current situation and problems in the existing guidelines according to the following four perspectives:(1)perspective of TCM and WM integration in guidelines,(2)diagnosis Using integrated TCM and WM,(3)integration of TCM and WM treatment,(4)promoting TCM and WM integration.Secondly,the information and quality evaluation of CPGs for integrated Chinese and Western medicine in 2020–2022 were analyzed to explore the degree and methods of integration of Chinese and Western medicine guidelines.And last this study aimed to lay a foundation for the further establishment of Chinese characteristic,repeatable,and calculable clinical practice guidelines of TCM and WM integration.

China Association of Chinese Medicine Paper notice for seminar on clinical application of new technology of integrated Chinese and western medicine in treating sequelae of cerebrovascular diseases

Hosted by ChinaAssociation of Chinese Medicine,and organized by World Journal of Integrated traditional and western Medicine,seminar on clinical application of new technology of integrated Chinese and western medicine in treating sequelae of cerebrovascular diseases is planned to be held in Nanning,Guangxi in August.

Pushing the frontiers of military medical excellence:updates,progress and future needs

Since its establishment in 2014,Military Medical Research has come a long way in becoming a premier journal for scientific articles from various different specialties,with a special emphasis on topics with military relevance.The field of military medicine may be obscure,and may not be readily encountered by the typical clinician on a day-today basis.This journal aims not only to pursue excellence in military research,but also to keep current with the latest advancements on general medical topics from each and every specialty.This editorial serves to recap and synthesize the existing progress,updates and future needs of military medical excellence,discussing foremostly the unique traits of literature published in this journal,and subsequently presenting the discourse regarding wartime and peacetime medicine,the role of the military in a public health emergency,as well as wound healing and organ regeneration.Special attention has been devoted to military topics to shed light on the effects of Chemical,Biological,Radiological and Explosive warfare,environmental medicine and military psychiatry,topics which rarely have a chance to be discussed elsewhere.The interconnectedness between military combat and soldier physical and mental well-being is intricate,and has been distorted by pandemics such as coronavirus disease 2019(COVID-19).This journal has come a long way since its first article was published,steadily contributing to the existing knowledge pool on general medical topics with a military slant.Only with continuous research and sharing,can we build upon the work of the scientific community,with hopes for the betterment of patient care.

Clinical trial with traditional Chinese medicine intervention ''tonifying the kidney to promote liver regeneration and repair by affecting stem cells and their microenvironment'' for chronic hepatitis B-associated liver failure

AIM:To study the clinical efficacy of traditional Chinese medicine(TCM)intervention"tonifying the kidney to promote liver regeneration and repair by affecting stem cells and their microenvironment"("TTK")for treating liver failure due to chronic hepatitis B.METHODS:We designed the study as a randomized controlled clinical trial.Registration number of Chinese Clinical Trial Registry is Chi CTR-TRC-12002961.A total of 144 patients with liver failure due to infection with chronic hepatitis B virus were enrolled in this randomized controlled clinical study.Participants were randomly assigned to the following three groups:(1)a modern medicine control group(MMC group,36patients);(2)a"tonifying qi and detoxification"("TQD")group(72 patients);and(3)a"tonifying the kidney to promote liver regeneration and repair by affecting stem cells and their microenvironment"("TTK")group(36patients).Patients in the MMC group received general internal medicine treatment;patients in the"TQD"group were given a TCM formula"tonifying qi and detoxification"and general internal medicine treatment;patients in the"TTK"group were given a TCM formula of"TTK"and general internal medicine treatment.All participants were treated for 8 wk and then followed at 48 wk following their final treatment.The primaryefficacy end point was the patient fatality rate in each group.Measurements of various virological and biochemical indicators served as secondary endpoints.The one-way analysis of variance and the t-test were used to compare patient outcomes in the different treatment groups.RESULTS:At the 48-wk post-treatment time point,the patient fatality rates in the MMC,"TQD",and"TTK"groups were 51.61%,35.38%,and 16.67%,respectively,and the differences between groups were statistically significant(P<0.05).However,there were no significant differences in the levels of hepatitis B virus DNA or prothrombin activity among the three groups(P>0.05).Patients in the"TTK"group had significantly higher levels of serum total bilirubin compared to MMC subjects(339.40μmol/L±270.09μmol/L vs 176.13μmol/L±185.70μmol/L,P=0.014).Serum albumin levels were significantly increased in both the"TQD"group and"TTK"group as compared with the MMC group(31.30 g/L±4.77g/L,30.72 g/L±2.89 g/L vs 28.57 g/L±4.56 g/L,P<0.05).There were no significant differences in levels of alanine transaminase among the three groups(P>0.05).Safety data showed that there was one case of stomachache in the"TQD"group and one case of gastrointestinal side effect in the"TTK"group.CONCLUSION:Treatment with"TTK"improved the survival rates of patients with liver failure due to chronic hepatitis B.Additionally,liver tissue was regenerated and liver function was restored.

Application of evidence-based medicine methods in integrative oncology research

To present the advances of evidence-based medicine and clinical research methodology in integrative oncology,we conducted a literature review of real-world studies of traditional Chinese medicine(TCM)in cancer care and summarized the available evidence.Pragmatic randomized controlled trials(pRCTs)and clinical registry studies are becoming more popular as they could compensate for the limitations of RCTs.Many RCTs of TCM for cancer treatment as well as systematic reviews have been published.The most investigated therapies are based on acupuncture,Chinese herbal compounds,and Chinese patent medicines.Acupuncture has a significant advantage in relieving cancer-related symptoms.Published studies focus more on improving clinical symptoms and laboratory indicators.However,the patient's quality of life deserves more attention.

Multi-centric Study on Clinical Epidemiology Is the Key Link in Treating Hypertension with Integrative Chinese and Western Medicine

General survey ofhypertension has beencarried out in our coun—try for three times.Thelast time was in 1999,with the result showingthat in our country theincidence of hyperten-sion among people over15 years old was11.26％.The incidencehas been raised by 25％

Meta-analysis of Integrated Traditional Chinese and Western Medicine in Treating H Type Hypertension

Objective: The aim of this study was to compare the clinical emcacy of integration of traditional Chinese medicine (TCM) and we stern medicine, and the western medicine therapy for H type hypertension. Methods: The randomized contmlled trials were collected via searching the internet. The literatures were screened according to inclusion and exclusion criteria. All the assignments were performed by two researchers. If there was disagreement between the two researchers, we would ask evidence based medicine expert for advice, to get an optimal result. The database included the ChianInfo (1978—2015), the Superstar database (1955—2017), the CBM(1985—2017), CNKI(1984—2017), PubMed(1966—2017). Accordingto Meta analysis, the RevMan 5.2 software was used to recover and analyze the literatures, and make the assessment of the integration of TCM and westem medicine in treating H Type Hypertension. Results: In the study, 12 trials were included. The total number of cases is 1139. The Meta analysis results showed that: Compared with western medicine the integration of TCM and western medicine would improve the antihypertensive efficacy [OR=0.39, 95%CI (0.25, 0.59), Z=4.38(P< 0.0001)],lower Hcy levels [WMD=-1.93, 95%CI (-2.27, 0.21), Z=4.38 (P< 0.0001)]. Conclusion: The combination therapy can effectively reduce Hcy levels, control blood pressure, better than Western medicine.

Irritable bowel syndrome and functional constipation management with integrative medicine: A systematic review

BACKGROUND Irritable bowel syndrome(IBS)and functional constipation(FC)are two commonly encountered functional gastrointestinal disorders in clinical practice and are usually managed with Western medicines in cooperation with traditional Chinese medicine(TCM)interventions.Although clinical practice guidelines(CPGs)have been developed to assist clinicians with their decisions,there are still gaps in management with regard to integrative medicine(IM)recommendations.AIM To comprehensively review the currently available CPGs and to provide a reference for addressing the gaps in IBS and FC management.METHODS We searched mainstream English and Chinese databases and collected data from January 1990 to January 2019.The search was additionally enriched by manual searches and the use of publicly available resources.Based on the development method,the guidelines were classified into evidence-based(EB)guidelines,consensus-based(CB)guidelines,and consensus-based guidelines with no comprehensive consideration of the EB(CB-EB)guidelines.With regard to the recommendations,the strength of the interventions was uniformly converted to a 4-point grading scale.RESULTS Thirty CPGs met the inclusion criteria and were captured as data extraction sources.Most Western medicine(WM)CPGs were developed as EB guidelines.All TCM CPGs and most IM CPGs were identified as CB guidelines.Only the 2011 IBS and IM CPG was a CB-EB set of guidelines.Antispasmodics and peppermint oil for pain,loperamide for diarrhea,and linaclotide for constipation polyethylene glycol and lactulose as osmotic laxatives,bisacodyl and sodium picosulfate as stimulant laxatives,lubiprostone and linaclotide as prosecretory agents,and prucalopride were strongly recommended or recommended in FC.TCM interventions were suggested based on pattern differentiation,while the recommendation level was considered to be weak or insufficient.CONCLUSION WM CPGs generally provide a comprehensive management algorithm,although there are still some gaps that could be addressed with TCM.Specific high-quality trials are needed to enrich the evidence.

Diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia and acute exacerbation of chronic obstructive pulmonary disease in Gansu Province:A case report

BACKGROUND In December 2019,the first patient with 2019-novel coronavirus(2019-nCoV)was reported in Wuhan,China,and the disease spread rapidly across the country and surrounding countries within 2 mo.As of February 29,2020,a total of 91 confirmed cases had been reported in Gansu Province.This case report of the diagnosis and treatment of an elderly patient with 2019-nCoV pneumonia complicated by acute exacerbation of chronic obstructive pulmonary disease in Gansu Province aims to provide a better reference for the treatment of patients in the future.CASE SUMMARY The patient,a 94-year-old female,lived in Maiji District of Tianshui,Gansu Province,China.On January 30,2020,she was admitted to the Fourth People’s Hospital of Tianshui after 9 d of close contact with a patient with 2019-nCoV pneumonia.She was subsequently admitted to Gansu Provincial Hospital of Traditional Chinese Medicine for isolation and transferred to Tianshui Gansu Provincial Hospital of Infectious Diseases on February 3,2020 for treatment.Upon initial examination,her body temperature was 36.7°C,pulse was 80,breathing was 20,and blood pressure was 130/80 mmHg.She was conscious with normal development and normal nutrition.The pharynx was not red,and bilateral tonsils were not red and swollen.The lungs sounded slightly coarse with no dry or wet rales.The first symptoms were cough and fatigue on 2 February.The patient was hospitalized for 12 d.After active treatment,she was discharged on February 14 with a good prognosis.CONCLUSION A history of exposure to the affected area or patient is a major cause of 2019-nCoV infection,and population clustering is a high risk factor for transmission.Patients may not necessarily have respiratory system symptoms as the only clinical manifestation but may also have concomitant or first onset digestive symptoms.Attention should be paid to the prevention and treatment of multiple organ dysfunction syndrome.Nucleic acid testing is extremely important and needs to be repeated several times.Laboratory and auxiliary examination indicators during the first week of admission are extremely important.It is feasible to carry out dynamic and continuous index monitoring,which can predict and guide the prevention and treatment of multiple organ dysfunction and the prognosis of the disease.

新医科背景下基础与临床融合式教学的研究与实践

为探索新医科背景下医学人才培养新模式,中南大学湘雅医学院积极推动临床五年制教育教学改革,在基础医学学科和临床学科协同开展系统性研究,从教育理念、教学内容、教学模式、教学资源、评价体系等方面进行改革实践,构建以知识整合为抓手的基础-临床融合式教学模式,建设优质共享资源,多学科整合与渗透、多种教学方法并用,为培养卓越医学人才综合素质提供了新思路。

医学基础与临床融合发展教学团队建设现状分析与初步实践

全面加强医学类师资队伍建设对提升医学人才培养质量具有重要意义,也是推动医学基础与临床融合发展的关键路径。分析目前医学类师资队伍建设过程中面临的困境与挑战,以地方院校医学师资队伍建设为切入点,聚焦基础与临床融合发展的教学团队建设,探讨加强基础与临床融合发展教学团队建设的实现路径,总结加强基础与临床融合发展教学团队建设的实践经验,以期通过教学团队建设,为持续提升医学专业人才培养质量提供经验与支持。

校院联合、医教一体开展专科护理人才培养的探索

在国家政策的支持和引导下,我国专科护士培养取得长足进步。但总体来说,仍存在专科护士教育体系不完善、培训内容不规范、师资力量薄弱、缺乏统一的资格认证、培养形式单一等问题。文章在分析我国专科护士培养的现状和存在问题的基础上,提出了高职院校联合临床教学基地“医教一体”开展专科护士人才培养的新路径。从专科护士“医教一体”培养合作模式与运行机制的建立、培养对象的选择和专科护理“医教一体”人才培养模式的创新、课程结构的重塑、临床教学基地的建设和专科护理师资队伍的建设等方面开展积极探索与实践,取得较好的成效,相关探索与实践是对专科护理人才培养新机制、新途径的有益探索,有利于充分发挥学校教育和高质量医疗资源两方面的优势,共同促进我国专科护士人才的培养,也为完善专科护士学历教育体系提供实践参考。

“动物病人”在内科学临床基础技能培训中的实践探索

目的探讨“动物病人”在内科学临床基础技能培训中的应用价值。方法选取2019年1—12月于广州医科大学附属第二医院已完成诊断学临床基础技能培训并进入临床实践的46名医学生作为研究对象,采用新西兰兔构建“动物病人”,每4名医学生为一组,分为12组,每组1名“动物病人”,采用互动式病例讨论等方式完成病例介绍,进行相关体格检查,并开展后续“动物病人”培训。采用问卷调查医学生对临床基础技能实践机会评价、医学生对“动物病人”培训必要性的评价。结果医学生对内科学临床操作技能培训满意占比37.0%、基本满意占比34.7%、不满意占比28.3%、非常不满意占比0.00%;影响内科学临床操作技能培训效果的主要原因自身专业不足占比10.9%、带教教师水平不足占比6.5%、带教师资不重视占比15.2%、临床实践机会不足占比56.5%、其他占比10.9%。医学生普遍对临床基础技能实践机会不足或严重不足,其中腹腔穿刺术、胸腔穿刺术、腰椎穿刺、动脉穿刺取血及导尿术实践机会不足、严重不足的比例均>55%。医学生对“动物病人”培训的总体满意度为95.6%、对教师满意度为95.7%;针对是否有必要在临床实际操作前采用“动物病人”培训,在腹腔穿刺术、血糖检测、动脉取血和导尿术四项技能中,选择有必要占比分别为91.3%、78.3%、93.5%和82.6%;全部医学生均表示能从“动物病人”临床技能培训中获益。在最大获益方面,41.3%选择有助于发现操作中的问题,39.1%选择有助于熟练操作,其他人员依次选择有助于培训临床思维和树立操作信心。培训设施不完善和学生参与程度不足是医学生认为本次培训的主要不足之处。结论“动物病人”培训作为现有技能培训与真实临床实践的桥梁,为医学生提供分层递进式技能操作培训,有利于提高医学生的实际临床技能操作水平,推动内科学临床基础技能教学改革,具有研究和推广价值。

孙桂芝病证结合辨证在肿瘤治疗中的应用

病证结合是孙桂芝教授治疗肿瘤病学术思想的重要组成部分,把辨证与辨病有机地结合起来,进行综合诊治,既照顾到整体,又注意到局部;辨证为先还是辨病为先在临床诊疗中要根据实际情况而定,二者互补。特别是现代科学技术的发展弥补了中医诊疗方面的不足,辨病治疗成为中医治疗学的重要部分。孙桂芝教授临证始终强调辨证与辨病紧密相连,中西手段并用,诊断疾病现代仪器和中医四诊联合,治疗上病证相参结合,攻补兼施,标本兼治,既要兼顾全局,也要重视细节。

基础医学整合式创新实验教学课程体系构建与实践

基础医学实验课程是实现医学生素质教育和创新人才培养目标的重要实践环节。河北医科大学以学生为中心,以岗位胜任力为导向,以临床问题或生命健康为主线,以实现素质教育和培养创新人才为目标,按照基本技能训练为基础、综合性实验为核心、设计性实验为创新的思路,构建基础医学整合式创新实验教学课程体系,为推动医学教育创新发展,提升医学人才培养质量提供重要的支撑和保障。