In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a n...In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.展开更多
Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-23% of the population across the world. The percentage of patients seeking health care related to IBS a...Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-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 ROME III criteria, 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 using high-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
AIM: To follow the principles of evidence based medicine to reach the integrated results of these studies. METHODS: Twenty-one papers of case-control studies were selected, including 11 on gastric cancer,7 on precance...AIM: To follow the principles of evidence based medicine to reach the integrated results of these studies. METHODS: Twenty-one papers of case-control studies were selected, including 11 on gastric cancer,7 on precancerous lesion of stomach and 3 on lymphoma of stomach. Meta analysis was used to sum up the odds ratios (OR) of these studies. RESULTS: H. pylori vs gastric cancer (intestinal and diffuse type): the odds ratio from the fixed effect model is 3.0016 (95% CI: 2.4197-3.7234, P【0.001). H. pylori vs precancerous lesion of stomach: a random effect model was used to calculate the summary odds ratio and its value is 2.5635 (95% CI: 1.8477-3.5566, P【0.01). H. pylori vs lymphoma of stomach: though the quantity of literature is too small to make Meta analysis, the data of these 3 studies show that lymphoma of stomach is highly associated with H. pylori infections. CONCLUSION: Since it had been revealed that H. pylori infection pre-exists in gastric carcinoma and precancerous lesions, the results of Meta analysis present a strong evidence to support the conclusion that H. pylori infection is a risk factor for gastric carcinoma.展开更多
AIM:To investigate the efficacy of probiotics in irritable bowel syndrome(IBS) patients.METHODS:Pub Med,Cochrane library,Scopus,Google Scholar,and Clinicaltrial.gov databases were searched for literature published bet...AIM:To investigate the efficacy of probiotics in irritable bowel syndrome(IBS) patients.METHODS:Pub Med,Cochrane library,Scopus,Google Scholar,and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013.The applied Mesh terms were "probiotics," "irritable bowel syndrome," and "irritable bowel syndrome treatment." The collected data contained24 clinical trials,of which 15 were eligible for meta-analysis and nine were reviewed systematically.All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement.The Jadad score was used to assess the methodological quality of trials.The quality scale ranges from 0 to 5 points,with a score ≤ 2 indicating a low quality report,and a score of ≥3 indicating a high quality report.Relative risk(RR),standardized effect size,and 95%CI were calculated using the Der Simonian-Laird method.The Cochran Q test was used to test heterogeneity with P < 0.05.Funnel plots were constructed and Egger's and BeggMazumdar tests were performed to assess publication bias.RESULTS:A total of 1793 patients were included in the meta-analysis.The RR of responders to therapies based on abdominal pain score in IBS patients for two included trials comparing probiotics to placebo was 1.96(95%CI:1.14-3.36;P = 0.01).RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43(95%CI:1.13-5.21;P = 0.02).For adequate improvement of general symptoms in IBS patients,the RR of seven included trials(six studies) comparing probiotics with placebo was 2.14(95%CI:1.08-4.26;P = 0.03).Distension,bloating,and flatulence were evaluated using an IBS severity scoring system in three trials(two studies) to compare the effect of probiotic therapy in IBS patients with placebo,the standardized effect size of mean differences for probiotics therapy was-2.57(95%CI:-13.05--7.92).CONCLUSION:Probiotics reduce pain and sympt展开更多
近年来国内外关于孕激素在维持妊娠以及黄体支持领域的临床及基础研究十分活跃,不断有新的循证医学证据涌现。基于当前的最佳证据,本指南针对辅助生殖技术(assisted reproductive technology,ART)黄体支持、先兆流产、复发性流产以及早...近年来国内外关于孕激素在维持妊娠以及黄体支持领域的临床及基础研究十分活跃,不断有新的循证医学证据涌现。基于当前的最佳证据,本指南针对辅助生殖技术(assisted reproductive technology,ART)黄体支持、先兆流产、复发性流产以及早产中孕激素的应用方面,按照循证临床实践指南制订的方法和步骤,引入推荐意见分级的评估、制订及评价(grading of recommendations assessment,development and evaluation,GRADE)方法,结合临床医师的经验,考虑我国患者的偏好与价值观,平衡干预措施的利与弊,形成了15条推荐意见,以期为临床实践提供参考。展开更多
Building the clinical therapeutic evaluation system by combing the evaluation given by doctors and patients can form a more comprehensive and objective evaluation system.A literature search on the practice of evidence...Building the clinical therapeutic evaluation system by combing the evaluation given by doctors and patients can form a more comprehensive and objective evaluation system.A literature search on the practice of evidence-based evaluation was conducted in key biomedical databases,i.e.PubMed,Excerpt Medica Database,China Biology Medicine disc and China National Knowledge Infrastructure.However,no relevant study on the subjects of interest was identified.Therefore,drawing on the principles of narrative medicine and expert opinion from systems of Chinese medicine and Western medicine,we propose to develop and pilot-test a novel evidence-based medical record format that captures the perspectives of both patients and doctors in a clinical trial.Further,we seek to evaluate a strategic therapeutic approach that integrates the wisdom of Chinese medicine with the scientific basis of Western medicine in the treatment of digestive system disorders.Evaluation of therapeutic efficacy of remedies under the system of Chinese medicine is an imperative ongoing research.The present study intends to identify a novel approach to assess the synergistic benefits achievable from an integrated therapeutic approach combining Chinese and Western system of medicine to treat digestive system disorders.展开更多
The aim of this study was to establish clinical practice guidelines for acupuncture-moxibustion by retrieving relevant literature and adopting the best current national and international evidence, according to experts...The aim of this study was to establish clinical practice guidelines for acupuncture-moxibustion by retrieving relevant literature and adopting the best current national and international evidence, according to experts＇ experience and patients＇ values. This was achieved using the Grade of Recommendations Assessment, Development and Evaluation（GRADE） system combined with a wide range of national experts＇ consensus, in order to provide reliable evidence for acupuncture-moxibustion treatment of scapulohumeral periarthritis, and to ensure the safety and effectiveness of the treatment.展开更多
The basic concept of integrative medicine（IM） is that by combining mainstream（biomedicine） with complementary and alternative medicine（CAM）, synergistic therapeutic effects can be attained.When the methods of mi...The basic concept of integrative medicine（IM） is that by combining mainstream（biomedicine） with complementary and alternative medicine（CAM）, synergistic therapeutic effects can be attained.When the methods of mind/body medicine（MBM） are added to this combination,as in Western countries,a new concept emerges that drastically changes the approach toward illness. It is interesting to note that the joining of traditional Chinese medicine and Western medicine in the early days of the Peoples＇ Republic of China preceded the Western model of IM by almost 50 years.Several elements that make up the key components of IM as practiced today in the West were already present in the Chinese version of IM,and Chinese medicine has played and continues to play an important role in advancing IM.However,one of the major differences between the Chinese and the Western models of IM today,besides MBM and some other treatment options,is that Western integrative medicine（WIM） strictly requires its CAM methods to be supported by scientific evidence. The therapeutic methods of IM and their applications are many and varied.However,they are most frequently employed to treat chronic medical conditions,e.g.,bronchial asthma,rheumatic disease, chronic inflammatory bowel disorder and chronic pain.Other fields in which IM may be applied are internal medicine（inflammatory bowel diseases and cardiovascular diseases）,musculoskeletal disorders,oncology （chemotherapy-induced side effects）,obstetrics and gynecology（dysmenorrhea,endometriosis,infertility and menopausal complaints）,pediatrics,geriatrics,neurology（migraine and chronic headache）,and psychiatry （anxiety and depression）. The concept of WIM is discussed here in detail by reviewing its scope and implications for the practice of medicine and focusing on the role of Chinese medicine in WIM.展开更多
基金supported(in part)by the Entrusted Project of National Center for Medical Service Administration,National Health and Family Planning Commission China(No.[2019]099)the First Level Funding of the Second Medical Leading Talent Project in Hubei Provincethe Special Project for Emergency of the Ministry of Science and Technology(2020YFC0841300)。
文摘In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
文摘Irritable bowel syndrome (IBS) is a chronic and debilitating functional gastrointestinal disorder that affects 9%-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 ROME III criteria, 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 using high-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.
基金Supported by Funds for University Key Teachers by the Ministry of Education,No.2000-65
文摘AIM: To follow the principles of evidence based medicine to reach the integrated results of these studies. METHODS: Twenty-one papers of case-control studies were selected, including 11 on gastric cancer,7 on precancerous lesion of stomach and 3 on lymphoma of stomach. Meta analysis was used to sum up the odds ratios (OR) of these studies. RESULTS: H. pylori vs gastric cancer (intestinal and diffuse type): the odds ratio from the fixed effect model is 3.0016 (95% CI: 2.4197-3.7234, P【0.001). H. pylori vs precancerous lesion of stomach: a random effect model was used to calculate the summary odds ratio and its value is 2.5635 (95% CI: 1.8477-3.5566, P【0.01). H. pylori vs lymphoma of stomach: though the quantity of literature is too small to make Meta analysis, the data of these 3 studies show that lymphoma of stomach is highly associated with H. pylori infections. CONCLUSION: Since it had been revealed that H. pylori infection pre-exists in gastric carcinoma and precancerous lesions, the results of Meta analysis present a strong evidence to support the conclusion that H. pylori infection is a risk factor for gastric carcinoma.
文摘AIM:To investigate the efficacy of probiotics in irritable bowel syndrome(IBS) patients.METHODS:Pub Med,Cochrane library,Scopus,Google Scholar,and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013.The applied Mesh terms were "probiotics," "irritable bowel syndrome," and "irritable bowel syndrome treatment." The collected data contained24 clinical trials,of which 15 were eligible for meta-analysis and nine were reviewed systematically.All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement.The Jadad score was used to assess the methodological quality of trials.The quality scale ranges from 0 to 5 points,with a score ≤ 2 indicating a low quality report,and a score of ≥3 indicating a high quality report.Relative risk(RR),standardized effect size,and 95%CI were calculated using the Der Simonian-Laird method.The Cochran Q test was used to test heterogeneity with P < 0.05.Funnel plots were constructed and Egger's and BeggMazumdar tests were performed to assess publication bias.RESULTS:A total of 1793 patients were included in the meta-analysis.The RR of responders to therapies based on abdominal pain score in IBS patients for two included trials comparing probiotics to placebo was 1.96(95%CI:1.14-3.36;P = 0.01).RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43(95%CI:1.13-5.21;P = 0.02).For adequate improvement of general symptoms in IBS patients,the RR of seven included trials(six studies) comparing probiotics with placebo was 2.14(95%CI:1.08-4.26;P = 0.03).Distension,bloating,and flatulence were evaluated using an IBS severity scoring system in three trials(two studies) to compare the effect of probiotic therapy in IBS patients with placebo,the standardized effect size of mean differences for probiotics therapy was-2.57(95%CI:-13.05--7.92).CONCLUSION:Probiotics reduce pain and sympt
文摘近年来国内外关于孕激素在维持妊娠以及黄体支持领域的临床及基础研究十分活跃,不断有新的循证医学证据涌现。基于当前的最佳证据,本指南针对辅助生殖技术(assisted reproductive technology,ART)黄体支持、先兆流产、复发性流产以及早产中孕激素的应用方面,按照循证临床实践指南制订的方法和步骤,引入推荐意见分级的评估、制订及评价(grading of recommendations assessment,development and evaluation,GRADE)方法,结合临床医师的经验,考虑我国患者的偏好与价值观,平衡干预措施的利与弊,形成了15条推荐意见,以期为临床实践提供参考。
基金Supported by the National Natural Science Foundation of China(No.81303151)Beijing Nova Program(No.xxjh2015A093and No.Z1511000003150125)National Major Scientific and Technological Special Project for"Significant New Drugs Development"(No.2012ZX09303-010-002)
文摘Building the clinical therapeutic evaluation system by combing the evaluation given by doctors and patients can form a more comprehensive and objective evaluation system.A literature search on the practice of evidence-based evaluation was conducted in key biomedical databases,i.e.PubMed,Excerpt Medica Database,China Biology Medicine disc and China National Knowledge Infrastructure.However,no relevant study on the subjects of interest was identified.Therefore,drawing on the principles of narrative medicine and expert opinion from systems of Chinese medicine and Western medicine,we propose to develop and pilot-test a novel evidence-based medical record format that captures the perspectives of both patients and doctors in a clinical trial.Further,we seek to evaluate a strategic therapeutic approach that integrates the wisdom of Chinese medicine with the scientific basis of Western medicine in the treatment of digestive system disorders.Evaluation of therapeutic efficacy of remedies under the system of Chinese medicine is an imperative ongoing research.The present study intends to identify a novel approach to assess the synergistic benefits achievable from an integrated therapeutic approach combining Chinese and Western system of medicine to treat digestive system disorders.
基金Supported by standardization of traditional Chinese medicine,State Administration of Traditional Chinese Medicine of the People’s Republic of China:ZYYS-2009-0009-8special project of construction of TCM Master CHENG Xin-nong’s Inheritance Studio,State Administration of Traditional Chinese Medicine of the People’s Republic of China
文摘The aim of this study was to establish clinical practice guidelines for acupuncture-moxibustion by retrieving relevant literature and adopting the best current national and international evidence, according to experts＇ experience and patients＇ values. This was achieved using the Grade of Recommendations Assessment, Development and Evaluation（GRADE） system combined with a wide range of national experts＇ consensus, in order to provide reliable evidence for acupuncture-moxibustion treatment of scapulohumeral periarthritis, and to ensure the safety and effectiveness of the treatment.
文摘The basic concept of integrative medicine（IM） is that by combining mainstream（biomedicine） with complementary and alternative medicine（CAM）, synergistic therapeutic effects can be attained.When the methods of mind/body medicine（MBM） are added to this combination,as in Western countries,a new concept emerges that drastically changes the approach toward illness. It is interesting to note that the joining of traditional Chinese medicine and Western medicine in the early days of the Peoples＇ Republic of China preceded the Western model of IM by almost 50 years.Several elements that make up the key components of IM as practiced today in the West were already present in the Chinese version of IM,and Chinese medicine has played and continues to play an important role in advancing IM.However,one of the major differences between the Chinese and the Western models of IM today,besides MBM and some other treatment options,is that Western integrative medicine（WIM） strictly requires its CAM methods to be supported by scientific evidence. The therapeutic methods of IM and their applications are many and varied.However,they are most frequently employed to treat chronic medical conditions,e.g.,bronchial asthma,rheumatic disease, chronic inflammatory bowel disorder and chronic pain.Other fields in which IM may be applied are internal medicine（inflammatory bowel diseases and cardiovascular diseases）,musculoskeletal disorders,oncology （chemotherapy-induced side effects）,obstetrics and gynecology（dysmenorrhea,endometriosis,infertility and menopausal complaints）,pediatrics,geriatrics,neurology（migraine and chronic headache）,and psychiatry （anxiety and depression）. The concept of WIM is discussed here in detail by reviewing its scope and implications for the practice of medicine and focusing on the role of Chinese medicine in WIM.
