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Traditional Chinese Medicine as a Treatment for Rheumatoid Arthritis:From Empirical Practice to Evidence-based Therapy

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Engineering 2019年第5期5卷 895-906页

作者： Hu-Dan Pan Yao Xiao Wan-Ying Wang Ru-Tong Ren Elaine Lai-Han Leung Liang Liu State Key Laboratory of Quality Research in Chinese Medicine Macao Institute for Applied Research in Medicine and HealthMacao University of Science and TechnologyMacaoChina State Key Laboratory of Respiratory Disease Guangzhou Institute of Respiratory HealthThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou 510120China Department of Respiratory and Critical Care Medicine Affiliated Taihe Hospital of Hubei University of MedicineHubei 442000China

Rheumatoid arthritis(RA)is a common autoimmune condition with an elusive etiology.Conventional and biological disease-modifying drugs sometimes fail or produce only partial responses.Traditional Chinese medicine(TCM)has long been used in China as a treatment for RA and is achieving everincreasing acceptance worldwide.TCM treatments are traditionally guided by the theory of treatment based on TCM syndrome differentiation;however,they remain a matter of empirical practice relying on TCM theories and doctors’own experience,which places severe restrictions on worldwide TCM application.Nevertheless,TCM is a treasure trove for drug discovery,particularly as a treatment for complicated human conditions.The discoveries of artemisinin as a treatment for malaria and of TCM–arsenic trioxide(As2O3)combination therapy as a treatment for acute promyelocytic leukemia(APL)are excellent examples of the great value of TCM.Regarding RA treatments,many Chinese medicinal herbs and their formulas,extracts,ingredients,and even single compounds have been used in clinical applications.Several Chinese proprietary medicines(CPMs)derived from TCM formulas or herbal bioactive components,such as the controlled-release ZhengQingFengTongNing(ZQFTN)Tablets,Tripterygium Glycoside Tablets,and Total Glucosides of Peony(TGP)Capsules,have been included in the National Health Insurance Directory of China,and show comparable therapeutic efficacies to those of western chemical drugs with fewer side effects.As TCM research has advanced,particularly in the use of multidisciplinary technologies,the scientific foundations and characteristics of the use of TCM to treat RA have been revealed,and the quality of TCM treatments have been increasingly enhanced.However,TCM generally lacks sufficient clinical and laboratory data to be consistent with international standards for quality,safety,and efficacy in order to support its application worldwide.Therefore,intensive basic and clinical studies on TCM are required.In particular,investigations that use cutting-edg

关键词： Traditional Chinese medicine Rheumatoid arthritis Evidence-based therapy Perspective

Evidence-based Education:The(Not So Simple)Case of French-Speaking Belgium

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ECNU Review of Education 2021年第1期4卷 164-189页

作者： Dylan Dachet Ariane Baye University of Liege

Purpose:Taking the case of educational reform in French-speaking Belgium(the Pact for Educational Excellence),this article aims to describe the process of integrating Evidence-based education(EBE)into an educational reform within a country where the influence of qualitative research is important.Design/Approach/Methods:A narrative case study was conducted to analyze and understand the stages of the ongoing educational reform process and the successive involvements of our research center in the work of this reform.Inspired by the paradigm of EBE,we initiated both the consultation processes intended to set the direction of educational decisions and programs.Findings:According to Slavin(2017,2019),providing educator-friendly reviews,making available a broad range of proven education programs,and providing resources to help schools to implement proven programs are levers for implementing Evidence-based reform within an educational system.This article shows that one of the three levers is fully met.For the other two,work being done on EBE in the U.S.and the UK in particular can save us time.Originality/Value:This article highlights concrete actions that will ensure the gradual establishment and acceptance by political and educational actors of an Evidence-based reform.

关键词： Belgium education system reform Evidence-based

Hepatocellular carcinoma: From clinical practice to Evidence-based treatment protocols

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World Journal of Hepatology 2015年第20期7卷 2274-2291页

作者： Danijel Galun Dragan Basaric Marinko Zuvela Predrag Bulajic Aleksandar Bogdanovic Nemanja Bidzic Miroslav Milicevic Clinic of Digestive Surgery University Clinical Center of Serbia Medical School University of Belgrade

Hepatocellular carcinoma(HCC) is one of the major malignant diseases in many healthcare systems. The growing number of new cases diagnosed each year is nearly equal to the number of deaths from this cancer. Worldwide, HCC is a leading cause of cancerrelated deaths, as it is the fifth most common cancer and the third most important cause of cancer related death in men. Among various risk factors the two are prevailing: viral hepatitis, namely chronic hepatitis C virus is a well-established risk factor contributing to the rising incidence of HCC. The epidemic of obesity and the metabolic syndrome, not only in the United States but also in Asia, tend to become the leading cause of the long-term rise in the HCC incidence. Today, the diagnosis of HCC is established within the national surveillance programs in developed countries while the diagnosis of symptomatic, advanced stage disease still remains the characteristic of underdeveloped countries. Although many different staging systems have been developed and evaluated the BarcelonaClinic Liver Cancer staging system has emerged as the most useful to guide HCC treatment. Treatment allocation should be decided by a multidisciplinary board involving hepatologists, pathologists, radiologists, liver surgeons and oncologists guided by personalized-based medicine. This approach is important not only to balance between different oncologic treatments strategies but also due to the complexity of the disease(chronic liver disease and the cancer) and due to the large number of potentially efficient therapies. Careful patient selection and a tailored treatment modality for every patient, either potentially curative(surgical treatment and tumor ablation) or palliative(transarterial therapy, radioembolization and medical treatment, i.e., sorafenib) is mandatory to achieve the best treatment outcome.

关键词： Hepatocellular carcinoma Evidence-based Management

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

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World Journal of Orthopedics 2014年第2期5卷 89-93页

作者： Mark E Oppenlander Christopher M Maulucci George M Ghobrial James S Harrop Department of Neurological Surgery Thomas Jefferson University Hospital Philadelphia PA19107 United States Division of Neurological Surgery Barrow Neurological Institute St. Joseph Hospital and Medical CenterPhoenix AZ 85003 United States

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.

关键词： Evidence-based medicine Spinal surgery Trial design Research Methodology

Evidence-based medicine in China

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Chronic Diseases and Translational Medicine 2019年第1期5卷 1-5页

作者： Wang Ji-Yao Jin Xue-Juan Department of Internal Medicine Zhong Shan Hospital Fudan University Shanghai 200032 China Center of Evidence-based Medicine Fudan University Shanghai 200032 China Cardiovascular Diseases Institute Zhong Shan Hospital Fudan University Shanghai 200032 China

Evidence-based medicine (EBM) has been promoted in China for the past 2 decades and has had a great in-fluence on the field of medicine. Medical students, practitioners, and policy makers have employed evidence from well-designed and well-conducted studies to optimize decision-making. This article summarizes the recent progress in EBM in China. Development of EBM in remote areas of China Ten years ago, many remote areas, such as Tibet, Xinjiang, the western edge of Yunnan Province, the northeast edge of Guizhou Province, and Western Sichuan Plateau, suffered from deep medical and social problems. There was a wide disparity in access to physicians practicing EBM between rural areas and big cities at that time.

关键词： Evidence-based medicine Trends China

Evidence-based interventions of threatened miscarriage

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World Journal of Traditional Chinese Medicine 2017年第1期3卷 32-34页

作者： Juan Li Jing-shu Gao Chi Chiu Wang Ernest HY Ng Xiao-ke Wu Department of Traditional Chinese Medicine The First Affiliated Hospital of Guangzhou Medical University Department of Obstetrics & Gynaecology National Key Discipline and Clinical Base Heilongjiang University of Chinese Medicine Department of Obstetrics & Gynaecology The Chinese University of Hong Kong Hong Kong Special Administrative Region Department of Obstetrics & Gynaecology The University of Hong Kong Hong Kong Special Administrative Region

Threatened miscarriage is the commonest complication of early pregnancy and affects about 20% of pregnancies. It presents with vaginal bleeding with or without abdominal cramps. Increasing age of women, smoking, obesity or polycystic ovary syndrome(PCOS) and a previous history of miscarriage are risk factors for threatened miscarriage. The pathophysiology has been associated with changes in levels of cytokines or maternal immune dysfunction. Clinical history and examination, maternal serum biochemistry and ultrasound findings are important to determine the treatment options and provide valuable information for the prognosis. Bed rest is the commonest advice, but there is little evidence of its value. Other options include progesterone, human chorionic gonadotropin(HCG) and muscle relaxants. The complementary and alternative medicine(CAM) therapies such as acupuncture and Chinese herbs have also been tried. There is some evidence from clinical studies indicating that CAM therapies may reduce the rate of miscarriage, but the quality of studies is poor. Thus, further double-blind,randomized-controlled trials are necessary to confirm its effectiveness, especially acupuncture and Chinese herbs.

关键词： Threatened miscarriage Evidence-based Intervention Complementary and alternative medicine

循证医学教学模式在研究生神经病理性疼痛教学中的应用研究

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中国疼痛医学杂志 2015年第6期21卷 427-429,433页

作者：张颜波赵同张敬军王海涛李思颉牛敬忠泰山医学院附属医院神经内科泰安271000 首都医科大学宣武医院低氧医学研究所北京100053

目的:探讨循证医学教学模式在研究生神经病理性疼痛教学中的可行性和效果分析。方法:选取神经内科实习的研究生40名,随机分为对照组和实验组(每组各20名)。分别采取传统医学教学模式和循证医学教学模式。通过调查问卷和临床技能考核方... 详细信息

目的:探讨循证医学教学模式在研究生神经病理性疼痛教学中的可行性和效果分析。方法:选取神经内科实习的研究生40名,随机分为对照组和实验组(每组各20名)。分别采取传统医学教学模式和循证医学教学模式。通过调查问卷和临床技能考核方法探讨循证医学教学模式的可行性和教学效果。结果:(1)对照组和实验组入科时对神经病理性疼痛感兴趣百分比分别为35%和40%;出科时实验组与对照组相比兴趣增加(P<0.05);实验组出科时比入科时兴趣也明显提高(P<0.05)。(2)对照组入科时认为循证医学教学模式有利于临床实践和就业的占30%,实验组占35%;出科时实验组与对照组相比重要性认识上提高(P<0.05);实验组出科时比入科时相比重要性认识上同样提高(P<0.05)。(3)实验组与对照组相比,在病史采集、体格检查、病历书写、基本操作和病例分析方面均有提高(P<0.05),尤其在病历书写和病例分析方面明显提高(P<0.01)。结论:开展研究生神经病理性疼痛循证医学教学模式具有可行性和必要性。

关键词：循证医学神经病理性疼痛研究生教学模式 Evidence-based medicine (EBM)

Individualized music for dementia:Evolution and application of Evidence-based protocol

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World Journal of Psychiatry 2012年第2期2卷 26-32页

作者： Linda A Gerdner Stanford Geriatric Education Center Center for Education in Family and Community Medicine Stanford University School of Medicine

The theory-based intervention of individualized music has been evaluated clinically and empirically leading to advancement and refinement of an Evidence-based protocol, currently in its 5th edition. An expanded version of the protocol was written for professional health care providers with a consumer version tailored for family caregivers. The underlying mid-range theory is presented along with a seminal study that was followed by further research in the United States, Canada, Great Britain, France, Sweden, Norway, Japan and Taiwan. Key studies are summarized. Given its efficacy when implemented by research staff, studies have advanced to testing the intervention under real-life conditions when implemented and evaluated by trained nursing assistants in long-term care facilities and visiting family members. In addition, one study evaluated the implementation of music by family members in the home setting. Initial research focused on agitation as the dependent variable with subsequent research indicating a more holistic response such as positive affect, expressed satisfaction, and meaningful interaction with others. The article advances by describing on-line programs designed to train health care professionals in the assessment, implementation and evaluation of individualized music. In addition, Gerdner has written a story for apicture book intended for children and their families(in press). The story models principles of individualized music to elicit positive memories, reduce anxiety and agitation, and promote communication. The article concludes with implications for future research.

关键词： Individualized music Dementia Alzheimer’s disease Agitation Evidence-based protocol

Effect of early warning and Evidence-based intervention combined with drug therapy on the infection process in children with mycoplasma pneumonia

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Journal of Hainan Medical University 2018年第13期24卷 58-61页

作者： Yu-Hua Gong Wen-Jun Song Pediatrics Department Zigong Third People's Hospital in Sichuan ProvinceZigongSichuan Province643020China

Objective:To study the effect of early warning and Evidence-based intervention combined with drug therapy on the infection process in children with mycoplasma pneumonia.Methods:Children who were treated and clearly diagnosed with mycoplasma pneumonia in Zigong Third People's Hospital between May 2014 and October 2017 were chosen and randomly divided into two groups, experimental group accepted early warning and Evidence-based intervention combined with drug therapy, and control group accepted routine drug therapy. The levels of inflammatory cytokines and oxidative stress response indicators in serum as well as the expression of inflammation and oxidative stress signal molecules in peripheral blood were measured before treatment and 3 d after treatment.Results:Compared with those of same group before treatment, serum TNF-α, CysLTs, sTREM1, sP-selectin, sICAM1, MDA, SF and COR levels as well as peripheral blood TLR4, NF-κB, COX2, NOX4, MPO and iNOS expression intensity of both groups of patients significantly decreased whereas SOD and IgA levels significantly increased after treatment. Moreover, serum TNF-α, CysLTs, sTREM1, sP-selectin, sICAM1, MDA, SF and COR levels as well as peripheral blood TLR4, NF-κB, COX2, NOX4, MPO and iNOS expression intensity of experimental group were lower than those of control group whereas SOD and IgA levels were higher than those of control group. Conclusion: Early warning and Evidence-based intervention combined with drug therapy can reduce the inflammatory response and oxidative stress response in the infection process of children with mycoplasma pneumonia.

关键词： Mycoplasma pneumonia Early warning and Evidence-based intervention Inflammatory response Oxidative stress response