Therapeutic evaluation on complex interventions of integrative medicine and the potential role of data mining

It is a common view that the integration of Chinese medicine （CM） and modern Western medicine is an efficient way to facilitate the development of CM. Integrative medicine is a kind of complex interventions. Scientific therapeutic evaluation plays a crucial role in making integrative medicine universally acknowledged. However, the modern method of clinical study, which is based on the concept of evidence-based medicine, mostly focuses on the population characteristics and single interventional factor. As a result, it is difficult for this method to totally adapt to the clinical features of CM and integrative medicine as complex interventions. One possible way to solve this issue is to improve and integrate with the existing method and to utilize the evaluation model on complex interventions from abroad. As an interdisciplinary technique, data mining involves database technology, artificial intelligence, machine learning, statistics, neural network and some other latest technologies, and has been widely used in the field of CM. Therefore, the application of data mining in the therapeutic evaluation of integrative medicine has broad prospects.     

Appraisal of Clinical Practice Guidelines for Ischemic Stroke Management in Chinese Medicine with Appraisal of Guidelines for Research and Evaluation Instrument: A Systematic Review

Objective: To systematically review the clinical practice guidelines (CPGs) for ischemic stroke in Chinese medicine (CM) with the Appraisal of Guidelines for Research and Evaluation (AGREE Ⅱ) instrument. Methods: CM CPGs for ischemic stroke were searched in 5 online databases and hand-searches in CPG-related handbooks published from January 1990 to December 2012. The CPGs were categorized into evidence based (EB) guideline, consensus based with no explicit consideration of evidence based (CB-EB) guideline and consensus based (CB) guideline according to the development method. Three reviewers independently appraised the CPGs based on AGREE Ⅱ instrument, and compared the CPGs'' recommendations on CM pattern classification and treatment. Results: Five CM CPGs for ischemic stroke were identified and included. Among them, one CPG was EB guideline, two were CB guidelines and two were CB-EB guidelines. The quality score of the EB guideline was higher than those of the CB-EB and CB guidelines. Five CM patterns in the CPGs were recommended in the EB CPG. The comprehensive protocol of integrative Chinese and Western medicine recommended in the EB CPG was mostly recommended for ischemic stroke in the CPGs. The recommendations varied based on the CM patterns. Conclusion: The quality of EB CPG was higher than those of CB and CB-EB CPGs in CM for ischemic stroke and integrative approaches were included in CPGs as major interventions.     

中医和中西医结合临床指南制定的现状与问题

随着临床循证指南的广泛应用及中医药规范化工作的开展,各类中医或中西医临床指南也在逐渐增多。借助指南质量评估工具对2008年10月前公开发表的11个中医和中西医结合临床指南进行初步评价,大部分指南未描述证据收集和综合证据的方法,仅1篇说明推荐意见的证据分级标准,存在指南制作不够规范,编写人员专业背景单一,缺乏高级别的证据等问题。建议成立多学科组成的指南制定小组,注重证据并严格遵循循证指南制订的原则和流程,建立符合中医文献自身特点的证据评价和分级方法,注重中医指南的适用性与指导性,并加强对指南质量的评估。     

中医和中西医结合临床治疗指南存在的问题与对策

目前参与中医、中西医结合指南制订的成员构成并没有严格要求，制订指南最大的问题是证据不足，没有根据证据的可信度注明推荐意见。建立指南应根据临床治疗指南开发的原则，首先要筛选好人员，成立指南开发小组，对证据进行合理的分类处理，对临床治疗指南进行分级说明推荐理由，以利于临床实际应用。严格遵循指南制订的原则和流程，才能制订出符合我国国情的中医药及中西医结合治疗疾病的临床医疗指南。     

制定中西医结合临床指南应注意的问题

一部好的中西医结合临床指南的制定，应由多学科专家，包括中西医结合临床专家、中医临床专家、西医临床专家、不同层次医疗保健机构的医务人员、有关临床科研人员、基础医学研究者、统计学家、临床流行病学家、临床经济学家和医学决策与管理专家共同参与；遵循以下程序：中西医结合学会和（或）各专科分会确定指南题目，组成专题指南制定小组（或以研究项目的形式确定），系统文献评价，草拟初稿，同行咨询及评议，向学术界公开内容，收集反馈意见与建议并进行分析，对指南进行修改，发表与发行，各地应用，反馈审计与评价．再修订完善；在循证医学基础上强调科学证据与证据更新，不断补充和完善原定的指南版本；坚持病证结合，以病统证，规范证型标准，合理设置证型数量，在典型证型基础上，设置加减治疗的标准与方法；注意原则性与灵活性相结合，强调指南只能作为临床医生的诊疗参考，实际应用应灵活处理，不能机械照搬；注重指南的实用性，使使用者看后很容易使用与操作，同时指南制定组织有义务对医务人员进行培训，以推进临床指南的实施。只有这样，才能确保所制定的中西医结合临床指南具有一定的科学性、权威性、规范性与适用性，达到制定指南的目的。     

Clinical Practice Guideline of Integrative Chinese and Western Medicine for Acute Myocardial Infarction

With increasing morbidity and mortality, acute myocardial infarction (AMI) has become one of the major causes of human death, leading to heavy burdens to individuals, families and society. Previous researches have found that though large amount of resources and great effort were devoted, no significant improvements were achieved in reducing the in-hospital mortality of AMI patients. Meanwhile, extensive studies about Chinese medicine (CM) have found that CM has special advantages in treating AMI patients. However, there is no standardized and unified clinical practice guideline (CPG) of CM for AMI. Therefore, a CPG with strict standard and generally acknowledgement is urgent to be established. This guideline was developed following the methodological process established by the World Health Organization Handbook for Guideline Development. Extensive search on clinical evidences including systematic review (SR), randomized controlled trial (RCT), observational study and case reports was launched, covering evidence of CM for AMI on several aspects, such as diagnosis, CM patterns, CM interventions on AMI and complications, cardiac rehabilitation and clinical pathway management. Besides, the application of Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach enabled the evaluation of evidence and formulation of grade of recommendation (GOR) and level of evidence (LOE). With the help of GOR and LOE, this CPG recommends the integrative CM and WM treatment method in AMI patients and provides useful information on medical decision for clinical physicians.     

从脑卒中的防治探讨中西医结合切入点

寻求中西医学的结合点是目前临床医学研究的热点.以中西医结合防治脑卒中及卒中单元的构建为例,可以从中医视角(中医体质、中医证型),用现代医学方法探究脑卒中的发病和发展规律;借鉴西医治疗指南的制定形成中医药治疗脑卒中的规范化方案,可以辨病、辨证、辨体质相结合,并且将中西医结合从干预方法的结合进步为管理上的结合;将中医体质理...     

特发性膜性肾病中医临床实践指南（2021）

特发性膜性肾病占我国肾小球疾病的24.9%，已跃居第二位且比例有逐年增高趋势。中医药治疗已广泛应用于特发性膜性肾病的临床实践中，然而目前尚无中医治疗膜性肾病的循证实践指南。本指南按照国际指南制订方法与步骤，证据质量及推荐意见强度使用GRADE方法，通过访谈国医大师以及广东省名中医，确定指南范围、形成临床问题提纲；基于访谈结果和现有中西医肾病指南、权威教材以及临床研究文献的系统梳理和回顾的结果拟定临床问题、膜性肾病临床疗效评价指标以及中医证型的调查清单，在全国范围内进行专家调查；然后针对临床问题检索到的证据进行质量评价，并举行专家共识会议，最终形成关于中医治疗特发性膜性肾病的10条推荐意见。本指南聚焦于中医治疗特发性膜性肾病的临床实践，适用于各级中医/中西医结合医疗机构以及开展中医药服务的医疗机构及医务工作者。     

研制肿瘤患者生活质量量表中医版的意义及必要性

现行以生存期及病灶缓解率为主要观察指标的肿瘤临床疗效评价标准,已无法全面而准确地反映中医治疗肿瘤的临床疗效。生活质量因其概念及所覆盖范围与中医基础理论和临床辨证论治及疗效评价体系的一致性,已开始进入中医及中西医结合治疗肿瘤临床疗效评价体系,但尚缺乏已成为生活质量测定规范化测定工具的、能准确反映中医和中西医结合治疗肿瘤临床疗效的生活质量量表。本文从现行临床疗效评价体系的不足、中医辨证论治体系与生活质量的关系等方面论述了研制由中医临床及研究人员参与、能全面而准确反映中医治疗肿瘤临床疗效的肿瘤患者生活质量量表的意义及必要性。     

“急性心肌梗死中西医结合临床路径研究”研究方案

背景：急性心肌梗死（acute myocardial infarction,AMI）是严重危害人类健康的心血管疾病。临床路径（clinical pathway,CP）可以按病种设计最佳的医疗和护理方案,根据病情合理安排住院时间和费用。本研究通过构建AMI的中西医结合临床路径,进行路径的有效性和安全性评价,为AMI的中西医结合治疗提供优化诊治方案。方法与设计：通过AMI中医证候演变规律研究、文献调研和专家咨询,构建AMI中西医结合临床路径;通过多中心（2010年1月~2010年10月入住广东省中医院及各分中心医院的ST段抬高型心肌梗死患者）的非随机、历史对照（2008年1月~2009年12月入住广东省中医院及各分中心医院的ST段抬高型心肌梗死患者）研究,观察临床路径实施前后患者住院时间、费用和住院期间主要心血管事件发生率的变化,对临床路径的有效性和安全性进行评价。讨论：本研究在全国中医院中率先开展中西医结合临床路径的研究工作,建立AMI中西医结合临床路径制定的方法和关键技术,具有方法学指导和行业示范作用,为探索医疗体制改革下的单病种管理模式的改革提供借鉴。临床试验注册号：ChiCTR-TNRC-10000753。     

把提高病人的整体生活质量和满意度作为医学追求的两个主要价值——陈可冀院士访谈录

循证医学、中西医结合医学、转化医学、临床路径,都可以从价值医学、医学伦理学方面得到诠释。所有这些都是为了提高病人的整体生活质量,提高病人的满意度和幸福感,这应该是医学的两个主要价值追求。     

普通型手足口病3种治疗方案的临床研究

目的比较3种治疗方案对普通型手足口病的临床疗效。方法将200例普通型手足口病患儿分成中医组75例、西医组50例、中西医结合组75例,观察患儿的皮疹消退时间、热退时间及咳嗽、纳差、恶寒等症状消失时间。结果皮疹消退时间,中医组和中西医结合组显著少于西医组(P<0.05);咳嗽、纳差、恶寒等症状消失时间,中医组和中西医结合组显著少于西医组(P<0.05);在体温恢复正常方面,中西医结合组和西医组无显著性差异(P>0.05)。结论中医药治疗手足口病在改善临床症状和减少并发症方面有一定优势。     

循证医学时代的中西医结合诊疗模式

循证医学时代对中西医结合的理念、模式、方法提出了新的要求,强调干预措施疗效的客观评价,中西医相结合的模式从两者的互补最终朝向跨学科、以病人为中心、以调动病人自愈能力的整体医疗模式方向发展。中国循证医学的研究领域包括循证医学教育、系统评价、随机对照临床试验文献质量评价等。大多数中西医结合医疗干预措施需要进行科学的评价,针对中西医治疗手段需要有关疗效、安全性、成本-效果的高质量证据,实现证据的全球化和决策的本土化。真正的中西医结合医学最终将创造一种全新的医学示范,体现安全、有效、可支付、可获得的医疗服务。     

整合医学理念在口腔黏膜病教学中的应用

口腔黏膜病病因复杂、形态各异,且与各临床医学学科关系密切。在口腔医学中,口腔黏膜病学是与全身性疾病联系最紧密的学科之一。这些特点增加了口腔医学生学习难度,也是口腔医学教学的难点。整合医学理念将多学科理论、多技术体系进行充分融合,形成集临床医学理论、分子医学前沿与身心治疗模式于一体的理论体系。探索整合医学理念在口腔黏膜病教学中的应用,意义在于加深对口腔黏膜病原理和本质的理解,培养学生的医学网状思维,提高其分析、整合解决问题的能力。     

Clinical observation on treatment of post-craniocerebral traumatic mental disorder by integrative medicine

Objective： To observe the clinical efficacy of integrative medical therapy in treating post-craniocerebral traumatic mental disorder （PCT-MD）. Methods： Sixty patients with confirmed diagnosis of PCT-MD were randomly assigned to the treated group and the control group equally. All were treated by conventional comprehensive Western medicine, but to patients in the treated group, modified Xufu Zhuyu Decoction （血府逐瘀汤, XFZY） was additionally given and the therapeutic course for both groups was 20 days. Changes in mental symptoms were observed and recorded on the 10th and 20th day and clinical efficacy as well as cranial CT image was estimated after termination of the treatment. Results： The clinical effective rate in the treated group and the control group was 96.67% and 83.30% respectively. Comparison between them showed significant difference （P〈0.05）. Significant differences were also shown in the comparisons between the two groups in improving mental symptoms, either on the 10th or on the 20th day （P〈0.05 and P〈0.01 respectively）, and in post-treatment cranial CT image （P〈0.05）. Conclusion： Better efficacy could be obtained by integrative medical therapy in treating PCT-MD.     

Current status and prospect of prevention and treatment of oral diseases by integrative medicine

To carry out integrative medical prevention and treatment of oral diseases, based on the inheritance and development of traditional medicine as well as the application of modern scientific, technique and medical theory, is of great significance in oral health maintenance. Certain achievements of the integrative traditional Chinese and Western medicine （TCM-WM） have been obtained in the recent several years in clinical and experimental studies and theoretic exploration of oral diseases, which are introduced briefly as follows.     

小儿支气管肺炎的临床诊治新进展

小儿支气管肺炎的治疗是目前儿科临床中的重点和难点。如何安全有效地达到理想的治疗效果是儿科临床一直追求的目标。文章针对目前中医中药、西医西药及中西医结合治疗小儿支气管肺炎的情况,对其临床诊治新进展进行了综述。     

Quality Assessment of Clinical Practice Guidelines for Integrative Medicine in China: A Systematic Review

Objective: To assess the quality of integrative medicine clinical practice guidelines(CPGs) published before 2014. Methods: A systematic search of the scientific literature published before 2014 was conducted to select integrative medicine CPGs. Four major Chinese integrated databases and one guideline database were searched: the Chinese Biomedical Literature Database(CBM), the China National Knowledge Infrastructure(CNKI), China Science and Technology Journal Database(VIP), Wanfang Data, and the China Guideline Clearinghouse(CGC). Four reviewers independently assessed the quality of the included guidelines using the Appraisal of Guidelines for Research and Evaluation(AGREE) Ⅱ Instrument. Overall consensus among the reviewers was assessed using the intra-class correlation coefficient(ICC). Results: A total of 41 guidelines published from 2003 to 2014 were included. The overall consensus among the reviewers was good [ICC: 0.928; 95% confidence interval(CI): 0.920 to 0.935]. The scores on the 6 AGREE domains were: 17% for scope and purpose(range: 6% to 32%), 11% for stakeholder involvement(range: 0 to 24%), 10% for rigor of development(range: 3% to 22%), 39% for clarity and presentation(range: 25% to 64%), 11% for applicability(range: 4% to 24%), and 1% for editorial independence(range: 0 to 15%). Conclusions: The quality of integrative medicine CPGs was low, the development of integrative medicine CPGs should be guided by systematic methodology. More emphasis should be placed on multi-disciplinary guideline development groups, quality of evidence, management of funding and conflicts of interest, and guideline updates in the process of developing integrative medicine CPGs in China.     

全科医学与整合医学的现状与展望

全科医学、整合医学强调以人为本,通过有机整合达到最优化的服务,前者面向社区与家庭,整合临床医学、预防医学、康复医学以及人文社会学科相关内容于一体,后者从人的整体出发,将医学各领域最先进的知识理论和临床各专科最有效的实践经验分别加以有机整合。本文主要介绍全科医学与整合医学的学科历史,阐述两者的服务理念、范围,分析临床和教学现状,在此基础上探讨两者的发展方向。