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 an...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.展开更多
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...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.展开更多
Psoriasis and diabetes shared common underlying pathophysiological mechanisms.Emerging data suggested that antidiabetic medications may improve the psoriasis severity in patients with diabetes mellitus.Several hypogly...Psoriasis and diabetes shared common underlying pathophysiological mechanisms.Emerging data suggested that antidiabetic medications may improve the psoriasis severity in patients with diabetes mellitus.Several hypoglycemic agents including thiazolidinediones,glucagon-like peptide-1 receptor agonists,dipeptidyl peptidase-4 inhibitors,and biguanides have been reported to make a remarkable reduction in the Psoriasis Area and Severity Index score from baseline.This antipsoriatic effect could be mediated not only by the glucoselowering action of these agents but also via inhibition of keratinocyte over proliferation,increase expression of differentiation markers,suppression the immune inflammatory pathway,and blocking the calcium channels and mitogen-activated protein kinase signaling pathways.On the other hand,there was no significant increase in adverse reactions associated with the treatment of pioglitazone or metformin.However,previous studies often had the relatively short duration of the trials,and did not have enough power to assess recurrence of psoriasis.Potential bias in the study and missing data could undermine the reliability of the results.Therefore,the appropriately randomized controlled studies with large sample sizes and long-term durations in various psoriasis patients are warranted for further support.展开更多
One definition of futility is any treatment that merely preserves permanent unconsciousness or fails to end total dependence of a patient on intensive medical care However, no agreement has ever been reached on what ...One definition of futility is any treatment that merely preserves permanent unconsciousness or fails to end total dependence of a patient on intensive medical care However, no agreement has ever been reached on what the exact defmition of futility is, as it is not only based on temporary values but also evolves into different subtypes, making it harder to define. The difficulty in dealing with futility problem is how doctors evaluate the futile situation, which is further complicated by lack of standards for specific diseases and experience-based prognosis, leading to subjectivity in evaluation for futility.展开更多
Introduction:Considering the importance of evidence-based medicine(EBM)and the emphasis of Persian medicine(PM)experts on its use,this study was designed;to investigate the practice of PM specialists,the obstacles,cha...Introduction:Considering the importance of evidence-based medicine(EBM)and the emphasis of Persian medicine(PM)experts on its use,this study was designed;to investigate the practice of PM specialists,the obstacles,challenges,and solutions of developing and using EBM in PM were also the aims of the present study.Method:In the present study,98 PM specialists,who work in Iran completed the electronic Persian version of the evidence-based medicine.The effective factors in the practice of specialists were assessed by Spearman correlation and Mann-Whitney U tests.Results:The mean±standard deviation of age,graduation time,and clinical experience were 44.52±6.45,3.26±2.28,and 6.76±5.27 years,respectively.Evaluating the data showed,that 52 participants(53.1%)had not passed any EBM training courses.Social media,general and medical databases,textbooks,colleagues,and journal articles were used frequently in clinical practices,but the specific EBM-specific resources were neglected.Conclusions:More attention must be paid to produce scientific evidence,improving the infrastructures and health policies,and empowering PM specialists to apply EBM in their clinical practices.展开更多
Objective: Adopting the methods of Evidence-based Medicine research to acquire the dominant prescriptions of Shanghan Zabing Lun in the treatment of Endometriosis, meanwhile to fully dig the value of classical prescri...Objective: Adopting the methods of Evidence-based Medicine research to acquire the dominant prescriptions of Shanghan Zabing Lun in the treatment of Endometriosis, meanwhile to fully dig the value of classical prescriptions. 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. Results: 22 Shanghan Zabing Lun prescriptions have been used in the treatment of endometriosis. According to the clinical research and case literatures, Guizhi Fuling Wan is the prime prescription to treat endometriosis with high quality and high frequency. Conclusions: Through evidence-based medical research and evaluation of evidence, it can be seen that treatment of endometriosis presents a certain tendency that Guizhi Fuling Wan, Wenjing Decoction and Dahuang Zhechong Wan have good clinical effect treating endometriosis and their syndromes are well matched with the symptoms of endometriosis in the present clinical environment.展开更多
There exist problems in the actual evidence-based in the practice of medicine relating to the time available and the stringent algorithms employed by the attending physicians. The mistakes are often serious. Illustrat...There exist problems in the actual evidence-based in the practice of medicine relating to the time available and the stringent algorithms employed by the attending physicians. The mistakes are often serious. Illustrating clinical examples are given as to how things can go wrong under the pressure baring on clinicians by the factors given.展开更多
The COVID-19 pandemic has been very challenging for the human race.This review aims to discuss the shaping of modern evidence-based medicine in India and address the emerging ethical issues.This review talks about tes...The COVID-19 pandemic has been very challenging for the human race.This review aims to discuss the shaping of modern evidence-based medicine in India and address the emerging ethical issues.This review talks about testing strategies,management strategies,supportive and preventive strategies employed,and analysis of the evolving guidelines in relation to evidence-based medicine.The ethical issues addressed in this review are long-term side effects of vaccines,ethical issues related to Electronic Health Record,telemedicine,discharge policy,and prescription of unavailable/costly drugs.There appear to be many unidentified variables in decision-making and as a result,making guidelines based on low certainty evidence is a challenging task.Though there may be dissimilitude in various available evidence,one thing is quite clear that evidence-based medicine is the leading force in developing and formulating better health care practices.展开更多
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 de...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.展开更多
The techniques of evidence-based medicine (EBM) are being frequently used recently. The generally accepted theory is that if a medicine is not absorbed by the body, it will have no effect. However, the author has noti...The techniques of evidence-based medicine (EBM) are being frequently used recently. The generally accepted theory is that if a medicine is not absorbed by the body, it will have no effect. However, the author has noticed that even when substances, including medicines, are not absorbed by the body, they can have a marked effect. In some cases, just bringing the substance close to the body can have an effect;in such cases, the efficacy of EBM for estimating the therapeutic value of medicines may be debatable. Therefore, a more accurate evaluation method should be devised. The author proposes that another group be introduced into trials. This group would include subjects who were exposed to but did not have an opportunity to absorb the medicine being tested.展开更多
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 tre...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.展开更多
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 ma...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.展开更多
To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications re...To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy(EBRT) for bone metastases(BM) from lung cancer were sought via literature search(2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter(range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impendingpathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.展开更多
Irritable bowel syndrome(IBS)is a chronic and debilitating functional gastrointestinal disorder that affects9%-23%of the population across the world.The percentage of patients seeking health care related to IBS approa...Irritable bowel syndrome(IBS)is a chronic and debilitating functional gastrointestinal disorder that affects9%-23%of the population across the world.The percentage of patients seeking health care related to IBS approaches 12%in primary care practices and is by far the largest subgroup seen in gastroenterology clinics.It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis.The pathophysiology of IBS is not clear.Many theories have been put forward,but the exact cause of IBS is still uncertain.According to the updated ROMEⅢcriteria,IBS is a clinical diagnosis and presents as one of the three predominant subtypes:(1)IBS with constipation(IBS-C);(2)IBS with diarrhea(IBS-D);and(3)mixed IBS(IBS-M);former ROME definitions refer to IBS-M as alternating IBS(IBS-A).Across the IBS subtypes,the presentation of symptoms may vary among patients and change over time.Patients report the most distressing symptoms to be abdominal pain,straining,myalgias,urgency,bloating and feelings of serious illness.The complexity and diversity of IBS presentation makes treatment difficult.Although there are reviews and guidelines for treating IBS,they focus on the efficacy of medications for IBS symptoms usinghigh-priority endpoints,leaving those of lower priority largely unreported.Therefore,the aim of this review is to provide a comprehensive evidence-based review of the diagnosis,pathogenesis and treatment to guide clinicians diagnosing and treating their patients.展开更多
The world pandemic due to coronavirus disease 2019,known as COVID-19,embodies a high rate of disease transmission that causes a critical hospitalization overload.As of May 15,2020,the disease has been the cause of mor...The world pandemic due to coronavirus disease 2019,known as COVID-19,embodies a high rate of disease transmission that causes a critical hospitalization overload.As of May 15,2020,the disease has been the cause of more than 4 million infections and more than 280000 deaths all over the world.At the beginning,we underestimated the disease;now,we have sufficient information and it is clear that it is not just a respiratory disease.In fact,if a prompt treatment is not initiated,the disease may evolve towards an abnormal immune response and cytokine storm with an important thrombophilic pattern.Therefore,we think that while waiting for certainties to be established by evidence-based medicine,it is not ethical to not try off-label therapies for some of the well-known drugs,as they could have some efficacy based on their mechanisms of action.展开更多
In this article, the authors hold that the evidence based medicine(EBM) is a new medical action produced at the historic moment in clinical practice, which is promoting development of the medicine and even the whole l...In this article, the authors hold that the evidence based medicine(EBM) is a new medical action produced at the historic moment in clinical practice, which is promoting development of the medicine and even the whole life science in a fully new train of thought and method. Further the briefly introduced contents are the effect of EBM, the difficulty of utilizing in the acupuncture clinical practice and how to resolve them. It is highly recommended that the doctors of the acupuncture science field should study EBM and its effect and difficulties in practice as earlier as possible, insistently assimilate new knowledge and keep abreast of the times’ progress to facilitate the further development of acupunctology.展开更多
基金This study was supported by the Key Project of the National Natural Science Foundation of China(81830115).
文摘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.
文摘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.
文摘Psoriasis and diabetes shared common underlying pathophysiological mechanisms.Emerging data suggested that antidiabetic medications may improve the psoriasis severity in patients with diabetes mellitus.Several hypoglycemic agents including thiazolidinediones,glucagon-like peptide-1 receptor agonists,dipeptidyl peptidase-4 inhibitors,and biguanides have been reported to make a remarkable reduction in the Psoriasis Area and Severity Index score from baseline.This antipsoriatic effect could be mediated not only by the glucoselowering action of these agents but also via inhibition of keratinocyte over proliferation,increase expression of differentiation markers,suppression the immune inflammatory pathway,and blocking the calcium channels and mitogen-activated protein kinase signaling pathways.On the other hand,there was no significant increase in adverse reactions associated with the treatment of pioglitazone or metformin.However,previous studies often had the relatively short duration of the trials,and did not have enough power to assess recurrence of psoriasis.Potential bias in the study and missing data could undermine the reliability of the results.Therefore,the appropriately randomized controlled studies with large sample sizes and long-term durations in various psoriasis patients are warranted for further support.
文摘One definition of futility is any treatment that merely preserves permanent unconsciousness or fails to end total dependence of a patient on intensive medical care However, no agreement has ever been reached on what the exact defmition of futility is, as it is not only based on temporary values but also evolves into different subtypes, making it harder to define. The difficulty in dealing with futility problem is how doctors evaluate the futile situation, which is further complicated by lack of standards for specific diseases and experience-based prognosis, leading to subjectivity in evaluation for futility.
文摘Introduction:Considering the importance of evidence-based medicine(EBM)and the emphasis of Persian medicine(PM)experts on its use,this study was designed;to investigate the practice of PM specialists,the obstacles,challenges,and solutions of developing and using EBM in PM were also the aims of the present study.Method:In the present study,98 PM specialists,who work in Iran completed the electronic Persian version of the evidence-based medicine.The effective factors in the practice of specialists were assessed by Spearman correlation and Mann-Whitney U tests.Results:The mean±standard deviation of age,graduation time,and clinical experience were 44.52±6.45,3.26±2.28,and 6.76±5.27 years,respectively.Evaluating the data showed,that 52 participants(53.1%)had not passed any EBM training courses.Social media,general and medical databases,textbooks,colleagues,and journal articles were used frequently in clinical practices,but the specific EBM-specific resources were neglected.Conclusions:More attention must be paid to produce scientific evidence,improving the infrastructures and health policies,and empowering PM specialists to apply EBM in their clinical practices.
文摘Objective: Adopting the methods of Evidence-based Medicine research to acquire the dominant prescriptions of Shanghan Zabing Lun in the treatment of Endometriosis, meanwhile to fully dig the value of classical prescriptions. 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. Results: 22 Shanghan Zabing Lun prescriptions have been used in the treatment of endometriosis. According to the clinical research and case literatures, Guizhi Fuling Wan is the prime prescription to treat endometriosis with high quality and high frequency. Conclusions: Through evidence-based medical research and evaluation of evidence, it can be seen that treatment of endometriosis presents a certain tendency that Guizhi Fuling Wan, Wenjing Decoction and Dahuang Zhechong Wan have good clinical effect treating endometriosis and their syndromes are well matched with the symptoms of endometriosis in the present clinical environment.
文摘There exist problems in the actual evidence-based in the practice of medicine relating to the time available and the stringent algorithms employed by the attending physicians. The mistakes are often serious. Illustrating clinical examples are given as to how things can go wrong under the pressure baring on clinicians by the factors given.
文摘The COVID-19 pandemic has been very challenging for the human race.This review aims to discuss the shaping of modern evidence-based medicine in India and address the emerging ethical issues.This review talks about testing strategies,management strategies,supportive and preventive strategies employed,and analysis of the evolving guidelines in relation to evidence-based medicine.The ethical issues addressed in this review are long-term side effects of vaccines,ethical issues related to Electronic Health Record,telemedicine,discharge policy,and prescription of unavailable/costly drugs.There appear to be many unidentified variables in decision-making and as a result,making guidelines based on low certainty evidence is a challenging task.Though there may be dissimilitude in various available evidence,one thing is quite clear that evidence-based medicine is the leading force in developing and formulating better health care practices.
基金This research was funded by Sichuan Medical Health Legal Research Center Project(grant number:YF21-Q06)Anhui Law and Social Security Research Center Project(grant number:fzsh2021cx-17)National Social Science Foundation Project“Comparative Study on Public Health Legislation”(grant number:20CFX016).
文摘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.
文摘The techniques of evidence-based medicine (EBM) are being frequently used recently. The generally accepted theory is that if a medicine is not absorbed by the body, it will have no effect. However, the author has noticed that even when substances, including medicines, are not absorbed by the body, they can have a marked effect. In some cases, just bringing the substance close to the body can have an effect;in such cases, the efficacy of EBM for estimating the therapeutic value of medicines may be debatable. Therefore, a more accurate evaluation method should be devised. The author proposes that another group be introduced into trials. This group would include subjects who were exposed to but did not have an opportunity to absorb the medicine being tested.
文摘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.
文摘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.
文摘To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy(EBRT) for bone metastases(BM) from lung cancer were sought via literature search(2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter(range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impendingpathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.
文摘Irritable bowel syndrome(IBS)is a chronic and debilitating functional gastrointestinal disorder that affects9%-23%of the population across the world.The percentage of patients seeking health care related to IBS approaches 12%in primary care practices and is by far the largest subgroup seen in gastroenterology clinics.It has been well documented that these patients exhibit a poorer quality of life and utilize the health care system to a greater degree than patients without this diagnosis.The pathophysiology of IBS is not clear.Many theories have been put forward,but the exact cause of IBS is still uncertain.According to the updated ROMEⅢcriteria,IBS is a clinical diagnosis and presents as one of the three predominant subtypes:(1)IBS with constipation(IBS-C);(2)IBS with diarrhea(IBS-D);and(3)mixed IBS(IBS-M);former ROME definitions refer to IBS-M as alternating IBS(IBS-A).Across the IBS subtypes,the presentation of symptoms may vary among patients and change over time.Patients report the most distressing symptoms to be abdominal pain,straining,myalgias,urgency,bloating and feelings of serious illness.The complexity and diversity of IBS presentation makes treatment difficult.Although there are reviews and guidelines for treating IBS,they focus on the efficacy of medications for IBS symptoms usinghigh-priority endpoints,leaving those of lower priority largely unreported.Therefore,the aim of this review is to provide a comprehensive evidence-based review of the diagnosis,pathogenesis and treatment to guide clinicians diagnosing and treating their patients.
文摘The world pandemic due to coronavirus disease 2019,known as COVID-19,embodies a high rate of disease transmission that causes a critical hospitalization overload.As of May 15,2020,the disease has been the cause of more than 4 million infections and more than 280000 deaths all over the world.At the beginning,we underestimated the disease;now,we have sufficient information and it is clear that it is not just a respiratory disease.In fact,if a prompt treatment is not initiated,the disease may evolve towards an abnormal immune response and cytokine storm with an important thrombophilic pattern.Therefore,we think that while waiting for certainties to be established by evidence-based medicine,it is not ethical to not try off-label therapies for some of the well-known drugs,as they could have some efficacy based on their mechanisms of action.
文摘In this article, the authors hold that the evidence based medicine(EBM) is a new medical action produced at the historic moment in clinical practice, which is promoting development of the medicine and even the whole life science in a fully new train of thought and method. Further the briefly introduced contents are the effect of EBM, the difficulty of utilizing in the acupuncture clinical practice and how to resolve them. It is highly recommended that the doctors of the acupuncture science field should study EBM and its effect and difficulties in practice as earlier as possible, insistently assimilate new knowledge and keep abreast of the times’ progress to facilitate the further development of acupunctology.