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.

A Study on the Application of Evidence-Based Nursing in The Care of Patients with Severe Acute Pancreatitis

Objective: To explore the application research of evidence-based nursing in the care of patients with severe acute pancreatitis. Methods: This study focuses on evidence-based nursing care of severe acute pancreatitis. Patients with severe acute pancreatitis who received treatment in our hospital were selected, from which 80 cases were chosen for detailed analysis. The patients were randomly grouped into a control group (conventional nursing care) and a study group (evidence-based nursing care), with 40 patients each. Relevant research data were recorded during the nursing process, analyzed, and used as research indicators. Results: The hospitalization time and morbidity and mortality rate of the research group were shorter than those of the control group, and the recovery rate was higher than that of the control group (P < 0.05). Patient satisfaction with nursing care in the observation group was higher than in the control group (P < 0.05). Conclusion: For patients with severe acute pancreatitis, the use of evidence-based nursing methods effectively reduced the patient’s mortality rate, improved its curative effect, and also shortened the patient’s hospitalization time.

Nurses’ and midwives’ participation and utilization of health-related research in Kenya: Implications for evidence-based practice

Objective To assess the level of participation of nurses and midwives in health-related research,determine the status of utilization of research to inform nursing and midwifery practice in Kenya,and explore perspectives of nurses and midwives about strategies to empower nurses/midwives to engage in health research in Kenya.Methods Data were extracted from online survey responses of 156 nurse and midwife educators,practitioners,and managers/administrators.SPSS version 26 was used to analyze quantitative data;qualitative data were analyzed using Excel to organize data into categories.Results Over one-third of participants reported ever publishing research(37.2%,58/156).Participants reported using knowledge gained in nursing school to guide practice most frequently(n=148).Utilization of research findings to guide practice was reported by 80.3%(110/137)of participants.Strategies to enhance participation in the research included research training,research forums,policy reforms,and emphasis on research in curricula.Conclusions There is need to intensify and prioritize proposed strategies to empower nurses/midwives to engage in health research.

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.

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.

Optimization of evidence-based research in the prevention and treatment of coronary heart disease with traditional Chinese medicine:A comprehensive review

Coronary heart disease(CHD) has severely impacted the lives and health of patients for ages. Although the modern methods used for the prevention and treatment of CHD have been increasingly perfected,clinical problems remain that require solutions. In the prevention and treatment of CHD with traditional Chinese medicine(TCM), great therapeutic advantages have been demonstrated. However, the expression of its advantages relies on scientific evidence-based research and evaluation, which require further optimization and improvement. Therefore, this review aims to comprehensively emphasize our understanding of the current deficiencies in TCM evidence-based studies and the necessity of adopting scientific evidence-based optimization methods for use in research. In this process, evidence should be produced in a standard manner, and the advantages of TCM patterns should be accurately stated because these factors contribute to efficient transformation and proper verification of the obtained evidence.Additionally, focusing on patient-oriented medicine and doctor-patient relationships is also essential.These methods are of great significance to prove the clinical efficacy of TCM and promote its development.

The artificial intelligence evidence-based medicine pyramid

Several studies exist in the literature regarding the exploitation of artificial intelligence in intensive care.However,an important gap between clinical research and daily clinical practice still exists that can only be bridged by robust validation studies carried out by multidisciplinary teams.

Research in spinal surgery: Evaluation and practice of evidence-based medicine

Evidence-based medicine(EBM) is a common concept among medical practitioners, yet unique challenges arise when EBM is applied to spinal surgery. Due to the relative rarity of certain spinal disorders, and a lack of management equipoise, randomized controlled trials may be difficult to execute. Despite this, responsibility rests with spinal surgeons to design high quality studies in order to justify certain treatment modalities. The authors therefore review the tenets of implementing evidencebased research, through the lens of spinal disorders. The process of EBM begins with asking the correct question.An appropriate study is then designed based on the research question. Understanding study designs allows the spinal surgeon to assess the level of evidence provided.Validated outcome measurements allow clinicians to communicate the success of treatment strategies, and will increase the quality of a given study design. Importantly,one must recognize that the randomized controlled trial is not always the optimal study design for a given research question. Rather, prospective observational cohort studies may be more appropriate in certain circumstances, and would provide superior generalizability. Despite the challenges involved with EBM, it is the future of medicine. These issues surrounding EBM are important for spinal surgeons, as well as health policy makers and editorial boards, to have familiarity.

Use of Evidence-Based Research Approach in RCTs of Acupuncture-Related Therapies for Primary Dysmenorrhea: A Meta-Research

Objective To assess the use of evidence-based research(EBR)approach in randomized controlled trials(RCTs)of acupuncture-related therapies for primary dysmenorrhea(PD).Methods PubMed,EMBASE,Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,Chinese Biomedical Database,and China Science and Technology Journal Database were searched from January 2013 to December 2022 for RCTs of acupuncture on PD.The full text and references of each RCT were read to assess whether systematic reviews(SRs)or other types of studies with similar research questions and end-users’perspectives were cited to justify and design the trial.In addition,the discussion section were analyzed to evaluate whether trials placed the new result in the existing SRs to draw a conclusion.Multivariable logistic regression was used to find variables that associated with 3 aspects of EBR approach:(1)citing clinical studies for justification,(2)citing relevant studies that obtain the perspectives of end users,and(3)citing clinical studies for results discussion.Results Of 473 RCTs included,45.67%(216)of the trials cited relevant similar studies,21.56%(102)referenced to the studies that collected end-users’perspectives,and 10.99%(52)placed result in the context of the previous research.Few RCTs appropriately applied EBR approach.Among all the included studies,3.17%(15)of the trials used SRs to inform study questions but none of them used updated SRs with acceptable quality;1.05%(5)of the trials cited SRs of end-user’s perspectives in the justification and design of the study,and only 1 trial added results in existing SR to draw a conclusion.Year of publication,language,funding,registration,ethical approval and number of sites were significantly associated with 1 of the 3 aspects of EBR approach.Conclusions Few RCTs in acupuncture-related therapies for PD used the EBR approach to minimize research redundancy.Researchers,research institutes,funding agencies,ethics committees,journals and peer reviewers in acupuncture should make efforts to use and promote the EBR approach to ensure the value of new trials.

Integration of Decision-Support and Knowledge-Based Techniques in a Problem-Solving Strategy for Selection Problems

The limitations of traditional approaches to selection problems are examined. A problemsolving strategy is presented in which decision-support and knowledge-based techniques play complementary roles. An approach to the representation of knowledge to support the problem-solving strategy is presented which avoids commitment to a specific programming language or implementation environment. The problem of choosing a home is used to illustrate the representation of knowledge in a specific problem domain. Techniques for implementation of the problem-solving strategy are described. Knowledge elicitation techniques and their implementation in a development shell for application of the problem-solving strategy to any selection problem are also described.

A Web Based Decision Support System for Intermodal Port and Dry Port Facilities

This paper presents a Web-based Decision Support System (Web-DSS) that was designed and developed to support and provide suggestions on the procedures taking place between a port and a dry port, which have to collaborate, work concurrently and optimize their joint operation. The system operates at the highest hierarchical level supervising a number of different components dealing with three different time scale horizons so as to provide assistance at operational, tactical and strategic level. The Web-based DSS coordinates and integrates the subsystems operating at lower levels and it interfaces with all the involved actors: customers, suppliers, relevant authorities so as to receive all the necessary information to come up with “optimal” suggestions and decisions. In this paper, the overall architecture is presented and the individual modules are described.

Empirical study on the evidence-based medicine in court of China

Evidence-based medicine(EBM)is recognized as one of the highest-quality scientific approaches in the medical community around the globe.It calls for doctors to use the best available scientific evidence in clinical decision-making.This paper used an empirical study on 44 EBM related judicial cases in China,the result shows the EBM is commonly used as a supplement to the expert opinion in actual judicial review,it is deemed to illuminate the causation in the case fact rather than as the standards of care,which has the similar characteristics as"documentary evidence",and over the years the Chinese judicial practice formed a"three-stage"judicial review rule on EBM:(1)the first stage is whether the evidence itself can meet the standards of EBM;(2)the second stage is when determining the evidence presented by parties is sufficient to meet the legal standards of EBM,and whether it can be applied in a court case would depend upon comprehensive consideration of adaptability and maturity of EBM;(3)the third stage is whether to treat EBM as the only basis in causation analysis.

高校决策咨询类科研成果认定与奖励制度的调查分析——以30所高校为例

[目的/意义]深入了解新时代高校决策咨询类成果评价制度改革进展、存在的问题,为持续深化改革提供素材。[方法/过程]采用网络调查法、政策文本分析法、理论分析法,对30所本科高校相应政策文本进行系统整理分析,掌握改革实践进展状况。[结果/结论]调查发现,存在6个突出问题,即评价客体不统一、评价主体构成单一、评价方法单一、评价标准体系不健全、署名要求过于僵化以及结果应用范围偏窄。针对调研高校制度存在的问题,本文对应提出了6个方面的改进对策,即适度扩大决策咨询类科研成果认定范围、健全成果评价用户为主组织制度、根据评价目的完善评价方法、完善以质量创新和实际贡献为导向的评价标准体系、对高级别特殊决策咨询类科研成果取消“第一”署名限制以及适度扩展认定成果的应用范围。

基于回收质量差异的双渠道物流供应链决策

旨在研究回收质量差异对双渠道供应链决策的影响,构建由制造商、零售商以及第三方组成的双渠道销售和混合回收供应链决策模型。运用Stackelberg博弈论对模型进行求解分析,并进一步分析回收渠道竞争度、消费者对销售价敏感度和回收质量差异对成员决策的影响,最后通过数值仿真分析验证模型的正确性和结论的准确性。结果表明,回收价、回购价、回收量、直销量、分销量和成员利润与产品质量等级呈正相关,直销价、批发价和分销价与质量等级呈负相关;回收量和成员利润与回收渠道竞争度呈负相关;消费者对价格差越敏感,直销量和制造商利润越高,分销价和销售商利润越低。

中文医学术语集在真实世界临床研究中的应用

目的:通过分析国内外医学术语集的应用进展,拓展中文临床术语集在中文电子病历环境下的科研应用场景及范围。方法:检索四川大学数字图书馆出版物,通过文献回顾进行分析归纳。结果:中文医学术语集对电子病历概念识别和数据挖掘具有重要作用,有助于语义互操作。基于语义网及语义知识库,可以更深入地进行多种风险预测模型、语义相似度计算和推理性决策支持系统的研究。结论:中文医学术语集是基础性的信息化标准,可支撑多种临床智慧应用构建,建议纳入医学教育。

高校循证治理的价值意涵、现实困境与突破路径

高校循证治理是指在大数据时代,治理主体以证据为核心,将主观经验、研究证据及利益相关者的价值相融合,科学、精准、协同、高效地治理高等学校的过程。推进高校循证治理是高校治理体现民主与科学精神的必然要求,是大数据时代高校治理现代化的现实需要,是搭建高等教育理论与实践之间桥梁的必然选择。当前,我国高校循证治理面临着如下三种现实困境:一是治理主体循证素养不足;二是证据开发力度不够;三是循证治理机制不畅。推进高校循证治理需要从以下三个方面进行突破:一是重视循证人才培养,提升治理主体的循证素养;二是重视循证证据,建立高校循证数据库;三是重视高校循证决策机制的建立和完善。

用审计结果促进企业财务管理及会计核算的策略研究

在现代商业环境中,企业的财务管理和会计核算是确保企业稳定运营、可持续发展的重要组成部分。然而,由于信息不对称、内部控制不完善等原因,企业的财务报表可能存在错误和不准确的情况,给企业决策带来不确定性。审计作为一种独立的评估机制,通过对企业财务报表的审查和验证,揭示了财务报表的真实性和准确性,为企业提供了可靠的决策依据。

案例研究方法在院校研究中的应用特征及规范

以中国院校研究案例辑及四大核心期刊上的案例研究论文为研究对象,从案例研究的特征及规范性两个维度构建分析框架,评估案例研究方法的应用现状,结果发现:案例研究方法的应用,体现了院校研究自我研究和管理研究的基本特征,案例研究主题分布不均匀、整体规范性不足,当前案例研究的规模与质量尚不足以形成系统的研究专题及院校研究理论。院校研究主体价值取向的二元矛盾、案例研究方法的复杂性以及院校研究共同体内部缺乏案例研究的统一标准及系统规划,是问题产生的主要原因。

肿瘤患儿照护者对选择长期静脉导管置管决策体验的质性研究

目的探讨肿瘤患儿照护者对选择中心静脉置管的决策体验,为制定决策辅助策略提供依据。方法采用现象学质性研究方法,以目的抽样法选取肿瘤患儿照护者17人进行半结构式访谈,采用Colaizzi资料分析法对访谈资料进行分析。结果共提炼出3个主题和6个亚主题,分别为决策前积极准备与消极应对共存(迷茫无助、积极应对)、决策中医生主导与共享决策共存(医生主导决策、共享决策)、决策后获益庆幸与反思后悔共存(获益庆幸、后悔担心)。结论肿瘤患儿照护者在选择静脉导管置入时的决策体验复杂、决策参与度不高;医护人员应关注其参与共享决策意愿及影响因素,并予以针对性干预,提升其共享决策参与意愿。

急性白血病病人替代决策者的化疗决策困境的质性研究

目的:了解急性白血病(AL)病人替代决策者的化疗决策困境,为医护人员开发决策辅助工具提供参考。方法:采用目的抽样法,选取15例AL病人的替代决策者进行半结构式访谈,采用Colaizzi 7步法对访谈资料进行分析。结果:AL病人的替代决策者在化疗决策中主要有决策能力困境(低健康素养导致决策能力不足、价值观不明确导致的不确定感)、医患沟通困境(无法理解医学专业术语、医患沟通时间不足)及心理困境(健康信念缺乏导致决策态度消极、决策压力大导致负性情绪、实际治疗效果与期望不符导致心理落差)三大困境。结论:血液科医护人员应提高AL病人替代决策者的健康素养、积极推广预立医疗照护计划(ACP)、加强决策支持、提高自身沟通能力并开展心理干预,提高替代决策者的决策意识和能力,改善其化疗决策困境。