循证医学在慢性充血性心力衰竭药物治疗中的应用

循证医学(evidence-based medicine,EBM)是近年来国际临床医学领域迅速发展起来的新学科,强调"为每位病人作出医疗决定时,应明确而仔细地使用现有的最好证据"。本文利用循证医学的方法,参照若干著名的大规模多中心的随机对照试验(ran- domized controlled trial,RCT)来评估目前几类临床常用药物在治疗慢性充血性心力衰竭中的作用,试图找出针对不同NYHA等级患者的最佳治疗建议。     

循证医学理念对麻醉科医生的启迪

循证医学(EBM)是近年来迅速兴起的一门临床医学,其理论和方法已渗透到医疗决策和临床实践的各个方面.本文分析了麻醉领域运用EBM的必要性,每个麻醉医生必须具备EBM知识.EBM以令人信服的临床证据,带来了麻醉学实践革命性的改变.麻醉医生不仅要有丰富的临床经验和技能,同时要利用最佳的证据来指导麻醉实践,并充分尊重患者的意愿和价值观.     

循证医学在急诊住院医师培训中的应用

循证医学（Evidense—based medicine,EBM）是一门新兴临床学科,著名流行病学专家David Sackett教授将循证医学定义为：慎重、准确和明智地应用能获得的最好研究依据来确定患者的治疗措施。其实质就是医生诊治患者的一个过程,是精益求精地认识疾病的本质,从而去寻求最佳证据,并联系的实际情况,取得最佳治疗效果。循征医学的3个基本要素是临床医生的个人专业技能、最好的科学证据、患者的价值和愿望。     

循证护理在抗蝮蛇毒血清所致血清病的应用

循证护理是循证医学在护理学领域的应用,是一种科学有效的提高护理实践的方法,即以有价值的、可信的科学研究结果为证据,提出问题,寻找实证,运用实证,对病人实施最佳的护理。血清病指注射动物免疫血清后所并发的一种过敏性疾病,是一种典型的Ⅲ型变态反应。     

神经修复学临床细胞治疗进展

细胞治疗作为21世纪新的临床医疗技术已成为当今研究热点,本刊4年前发文《神经修复临床细胞治疗现状与展望》,重点介绍神经修复治疗的细胞分类、概念梳理和误用纠正、临床应用探索和法律法规;旨在推动神经修复临床细胞治疗健康、有序和规范发展。近年这一领域又完成了不少临床研究,尤其是多中心、双盲(或观察者盲)、安慰剂和随机临床试验。遗憾的是,曾报道有效的细胞治疗(包括干细胞衍生细胞)多数不能被高循证医学证据水平临床试验证实,这一残酷现实结果与学术界、患者、政府管理层和企业投资者预期值相差甚远。因此并非所有细胞对任何神经系统疾病及不同时间窗都有临床治疗价值,实践是检验真理的唯一标准,作为新的临床医疗技术需要随机双盲高循证医学证据证实。本文重点介绍高等级循证医学证据结果,分析临床试验失败原因。已被高循证医学证据证实有效的神经修复细胞治疗是现阶段这一领域重要成果,应深化探索和加快其临床转化,使其真正成为现代医学临床医疗技术,满足人类神经退变、损伤和修复及延年益寿期望。本刊秉承“实事求是”的原则,坚守“开放、客观、公正”的立场,鼓励各位专家学者以客观数据和资料为依据,总结甄别已完成的相关研究治疗结果,调整并确保本领域创新能沿着正确路线探索,以更好更快地促进细胞治疗成为临床落地实用技术,为人类提供更多的健康服务。     

循证医学对提高干部医疗保健水平的意义和作用

循证医学在近20年得到了迅速发展。应用循证医学的理念和方法,指导干部医疗保健工作,有利于医务人员在疾病诊断、治疗方面作出最佳选择,有利于医务人员水平提高,有利于医患之间沟通,有助于提高干部医疗保健的医疗质量及卫生资源利用。干部保健管理部门也可以进行循证决策,制定合适的体检项目、符合干部保健特点的诊疗规范,对保健人群进行循证管理。     

转化医学信息

转化医学作为医学研究的一个分支,从其概念的提出到现在十多年间发展迅速,引起了世界各国学者的广泛关注和重视。转化医学的核心是将医学生物学基础研究成果迅速有效地转化为可在临床实践中应用的理论、技术、方法和药物,并在实验室与病房之间架起一条快速通道,实现基础研究与临床研究的双向转化,是沟通基础医学与临床医学的桥梁,也是当前医学研究的热门话题。鉴于此,本刊推出"转化医学信息"栏目,对该领域相关报道内容进行介绍,希望对相关科研和医疗工作者有所启发。     

循证医学应用于急诊临床教学的价值

被誉为“21世纪临床医学新思维”的循证医学（Evideneedbased medicine,EBM）日益引起广大包括急诊医师在内的临床医学工作者的关注。EBM的出现为现代医学教育提供了新的教学模式．在急诊医学临床实习教学中应用EBM．对促进循证医学的发展。培养高素质的急诊医学人才,提高医疗质量将产生重大的影响。     

“带状疱疹优秀病例征文”病例征集通知

<正>带状疱疹是一种急性病毒性感染性皮肤病,并可导致严重的神经痛等各种并发症。如何凭借最佳治疗策略达到缩短病程,预防感染、降低并发症等目的,需要临床医师不断积累临床经验并优化治疗方法。因此,《中国真菌学杂志》计划于2015~2016年在全国范围内开展"带状疱疹优秀病例征文"。项目以真实病例为蓝本,通过病例征集为临床医师制定个体化治疗方案提供借鉴,为优化治疗方案提供循证医学证据。促进和推动我国临床医生在该领域的学术水平和诊疗水平。     

“带状疱疹优秀病例征文”病例征集通知

<正>带状疱疹是一种急性病毒性感染性皮肤病,并可导致严重的神经痛等各种并发症。如何凭借最佳治疗策略达到缩短病程,预防感染、降低并发症等目的,需要临床医师不断积累临床经验并优化治疗方法。因此,《中国真菌学杂志》计划于2015~2016年在全国范围内开展"带状疱疹优秀病例征文"。项目以真实病例为蓝本,通过病例征集为临床医师制定个体化治疗方案提供借鉴,为优化治疗方案提供循证医学证据。促进和推动我国临床医生在该领域的学术水平和诊疗水平。     

Evidence-Based Medicine,Clinical Practice Guidelines,and Common Sense in the Management of Osteoporosis

ObjectiveTo evaluate the benefits and limitations of randomized controlled trials (RCTs), clinical practice guidelines (CPGs), and clinical judgment in the management of osteoporosis.MethodsA review was conducted of the English-language literature on the origins and applications of RCTs, CPGs, evidence-based medicine, and clinical judgment in the management of osteoporosis.ResultsEvidence-based medicine is use of the currently available best evidence in making clinical decisions for individual patients. CPGs are recommendations for making clinical decisions based on research evidence, sometimes with consideration of expert opinion, health care policy, and costs of care. The highest levels of medical evidence are usually thought to be RCTs and meta-analyses of high-quality RCTs. Although it is desirable and appropriate for clinicians to consider research evidence from RCTs and recommendations presented in CPGs in making clinical decisions, other factors—such as patient preference, comorbidities, affordability, and availability of care—are important for the actual implementation of evidence-based medicine.ConclusionDecisions about who to treat, which drug to use, how best to monitor, and how long to treat require clinical skills in addition to knowledge of medical research. The necessity of integrating common sense and clinical judgment is highlighted by the fact that many patients treated for osteoporosis in clinical practice would not qualify for participation in the pivotal clinical trials that demonstrated efficacy and safety of the drugs used to treat them. (Endocr Pract. 2009;15:573-579)     

医院科研管理与创新对转化医学实施的推动作用

转化医学是近年来国际医学界推崇的一个重要医学理念,正日益成为生命科学和医学研究关注的热点。转化医学已不仅强 调临床医学与基础医学的结合,而且涉及多个学科之间的融会贯通。因此,医院科研管理的支持和重视程度转化医学实施的主要 动力,而科研项目的创新性、可行性是决定转化医学研究立项的关键。我院自2010 年成立转化医学研究中心以来,已将多项成果 成功转化并应用于临床实践,为生命科学研究领域中人类健康计划的发展提供了借鉴。本文结合我院实际,分析科研管理对转化 医学成果实施的促进作用,为医疗机构的科研管理人员提供参考。     

Evidence-based medicine,opinion-based medicine,and real-world medicine

The freedom of a doctor to treat an individual patient in the way he believes best has been markedly limited by the concept of evidence-based medicine. Clearly all would wish to practice according to the best available evidence, but it has become accepted that "evidence-based" means that which is derived from randomized, and preferably double-blind, clinical trials. The history of clinical trial development, which can be traced to the use of oranges and lemons for the treatment of scurvy in 1747, has reflected a progressive need to establish whether smaller and smaller effects of treatment are real. It has led to difficult concepts such as "equivalence" and aberrations such as "meta-analysis." An examination of evidence-based practice shows that it has usually been filtered through the opinions of experts and journal editors, and "opinion-based medicine" would be a more appropriate term. In the real world of individual patients with multiple diseases who are receiving a number of different drugs, the practice of evidence-based (or even opinion-based) medicine is extremely difficult. For each patient a judgment has to be made by the clinician of the likely balance of risks and benefits of any therapy. Good practice still requires clinical freedom for doctors.     

Dissemination of evidence-based standards of care

Standards of care pertain to crafting and implementing patient-centered treatment interventions. Standards of care must take into consideration the patient's gender, ethnicity, medical and dental history, insurance coverage (or socioeconomic level, if a private patient), and the timeliness of the targeted scientific evidence. This resolves into a process by which clinical decision-making about the optimal patient-centered treatment relies on the best available research evidence, and all other necessary inputs and factors to provide the best possible treatment. Standards of care must be evidence-based, and not merely based on the evidence - the dichotomy being critical in contemporary health services research and practice. Evidence-based standards of care must rest on the best available evidence that emerges from a concerted hypothesis-driven process of research synthesis and meta-analysis. Health information technology needs to become an every-day reality in health services research and practice to ensure evidence-based standards of care. Current trends indicate that user-friendly methodologies, for the dissemination of evidence-based standards of care, must be developed, tested and distributed. They should include approaches for the quantification and analysis of the textual content of systematic reviews and of their summaries in the form of critical reviews and lay-language summaries.     

三氧化二砷对视网膜色素上皮细胞增殖的影响

视网膜色素上皮细胞(retinal pigment epithelial cell,RPE)在维护视网膜正常生理功能方面具有极其重要的作用。研究发现,视网膜色素上皮细胞是增殖性玻璃体视网膜疾病(proliferative vitreous retinopathy,PVR)发生发展的主要细胞,而其增殖与细胞内调控信息失调密切相关。多项研究成果表明,三氧化二砷(As2O3)已经被用于医药几千年。其在白血病治疗的使用早在一个世纪以前就有所描述。As2O3在医学上的作用有着悠久的历史。然而,在最近的几个世纪它几乎被遗忘在西方医学。三氧化二砷在白血病、肿瘤的基础研究与临床治疗中已取得较大进展,引起广泛关注,但在眼科领域的研究才刚刚起步.增殖性视网膜疾病的发病日趋严重,已经成为全球性的重大负担,此病所导致的眼部并发症严重影响患者视功能及生活质量,因此,有必要就三氧化二砷对视网膜色素上皮细胞增殖的作用进行综述,以期为眼科疾病的防治研工作提供新的思路和策略。     

The Spatialisation of Disease: Foucualt and Evidence-based Medicine (EBM)

In this paper I draw on the French philosopher Michel Foucault for a viewpoint on aspects of EBM. This means that I develop his idea of the spaces occupied by disease. I give much of the paper to only one of these spaces, the space of perception of disease, in order to major on the medical gaze, one of Foucault’s best-known contributions to the philosophy of medicine. As I explain what I mean by each of the spaces of disease, I configure EBM into this space. The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based clinical practice requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources. EBM can be considered a subcategory of evidence-based healthcare, which also includes other branches of health-care practice such as evidence-based nursing or evidence-based physiotherapy. EBM subcategories include evidence-based surgery and evidence-based cardiology (Guyatt et al. 2008, 783).     

The vanishing mother: Cesarean section and "evidence-based obstetrics"

The philosophy of "evidence-based medicine"--basing medical decisions on evidence from randomized controlled trials and other forms of aggregate data rather than on clinical experience or expert opinion--has swept U.S. medical practice in recent years. Obstetricians justify recent increases in the use of cesarean section, and dramatic decreases in vaginal birth following previous cesarean, as evidence-based obstetrical practice. Analysis of pivotal "evidence" supporting cesarean demonstrates that the data are a product of its social milieu: The mother's body disappears from analytical view; images of fetal safety are marketing tools; technology magically wards off the unpredictability and danger of birth. These changes in practice have profound implications for maternal and child health. A feminist project within obstetrics is both feasible and urgently needed as one locus of resistance.     

粪菌移植通过微生物-肠-脑轴改善抑郁症的研究进展

人类粪菌移植(fecal microbiota transplantation,FMT)早在19世纪50年代的西方医学中便有临床应用。FMT已被证明可以很好地缓解艰难梭菌感染(aostridium difficile infection,CDI)的胃肠道疾病,在调节微生物-肠-脑轴(microbiota-gut-brain axis,MGBA)从而改善抑郁症方面也有一定的应用和疗效。为了探讨粪菌移植通过调节微生物-肠-脑轴改善抑郁症的可能性,为抑郁症的改善提供新的思路和方法,本文参考了近5年的相关文献,梳理了抑郁症发生的微生物-肠-脑轴相关机制,主要有自主神经系统异常、下丘脑-垂体-肾上腺(hopothalamic-pituitary-adrenal,HPA)轴异常、肠神经系统异常、循环系统异常和"肠漏"假说等,就微生物-肠-脑轴与抑郁症的关系、FMT改善抑郁症的动物实验、临床试验、现状分析和未来展望等方面作一综述。目前粪菌移植在改善抑郁症上展现了很大的潜能,但仍需要更多的实验研究。     

儿科抗癫痫药物应用研究进展

儿童癫痫为小儿神经科的常见疾病,临床表现以抽搐为主。近年来,随着医疗技术的发展,以及人们对儿童癫痫的重视,国内外文献对儿科癫痫的治疗报道越来越多,目前,药物治疗仍然是抗癫痫的首选方法,除了运用新型抗癫痫药物外,也有采用中药治疗癫痫的报道,现就近年来儿童癫痫的药物治疗研究作一综述。     

Evidence-based alternative medicine?

The validity of evidence-based medicine (EBM) is the subject of ongoing controversy. The EBM movement has proposed a "hierarchy of evidence," according to which randomized controlled trials (RCTs) and meta-analyses of RCTs provide the most reliable evidence concerning the efficacy of medical interventions. The evaluation of alternative medicine therapies highlights problems with the EBM hierarchy. Alternative medical researchers-like those in mainstream medicine-wish to evaluate their therapies using methods that are rigorous and that are consistent with their philosophies of medicine and healing. These investigators have three ways to relate their work to EBM. They can accept the EBM hierarchy and carry out RCTs when possible; they can accept the EBM standards but argue that the special characteristics of alternative medicine warrant the acceptance of "lower" forms of evidence; or they can challenge the EBM approach and work to develop new research designs and new standards of evidence that reflect their approach to medical care. For several reasons, this last option is preferable. First, it will best meet the needs of alternative medicine practitioners. Moreover, because similar problems beset the evaluation of mainstream medical therapies, reevaluation of standards of evidence will benefit everyone in the medical community--including, most importantly, patients.