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Comparative Effectiveness of Paclitaxel-Containing Regimens for Treatment of Triple-Negative Breast Cancer: A Network Meta-Analysis 含紫杉醇方案治疗三阴性乳腺癌的比较疗效:网络荟萃分析
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-06-04 DOI: 10.1111/jebm.70037
Junqiang Niu, Xuan Tuo, Xu Hui, Man Li, Suyi Liu, Zhichun Zhang, Jianming Tang, Yongbin Lu, Kehu Yang

Objective

To evaluate the efficacy and safety of paclitaxel-based regimens, including traditional Chinese medicine (TCM) combinations, for the treatment of triple-negative BC (TNBC) using a network meta-analysis.

Methods

PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, CBM, VIP, WanFang database were searched comprehensively from inception to February 27, 2025. Eligible studies included adult TNBC patients treated with paclitaxel alone or in combination with other therapies. Outcomes included objective response rate (ORR), overall survival (OS), progression-free survival, pathologic complete response, disease-free survival, and adverse events (AEs). Statistical analyses were performed using the frequentist contrast-based method and random effects model. The Grading of Recommendations, Assessment, Development, and Evaluation approach using CINeMA application and a modified Cochrane Risk of Bias Tool were used to assess the certainty of evidence and methodological quality.

Results

93 randomized controlled trials (108 publications) involving 19,016 patients were included. Paclitaxel-based quadruple and quintuple therapies significantly improved ORR (relative risk (RR) = 1.74, 95% confidence interval (CI) [1.39–2.71], low certainty of evidence) and OS duration (weighted mean difference (WMD) = 59.16 weeks, 95% CI [28.81–89.51], low) compared to monotherapy. Paclitaxel-based monotherapy and double therapy had the least potential to cause neutropenia. Regimens incorporating TCM showed superior ORR compared to non-TCM combinations and monotherapy (18 randomized controlled trials, 1570 patients; RR = 1.29. 95% CI [1.17–1.41], moderate; RR = 1.55, 95% CI [1.37–1.75], moderate).

Conclusions

Combination therapies, especially those incorporating targeted agents or platinum-based regimens, may exhibit superior efficacy while maintaining acceptable safety profiles. Additionally, TCM may be associated with a higher ORR and a reduced risk of AEs. Further large-scale, high-quality studies are warranted to investigate the efficacy and safety of combining paclitaxel with targeted agents, platinum-based therapies, or TCM in the treatment of TNBC.

目的通过网络荟萃分析,评价以紫杉醇为基础,包括中药联合用药治疗三阴性BC (TNBC)的疗效和安全性。方法综合检索PubMed、EMBASE、Cochrane Library、Web of Science、CNKI、CBM、VIP、万方数据库,检索时间为建库至2025年2月27日。符合条件的研究包括单独使用紫杉醇或与其他疗法联合治疗的成年TNBC患者。结果包括客观缓解率(ORR)、总生存期(OS)、无进展生存期、病理完全缓解期、无病生存期和不良事件(ae)。采用基于频率对比的方法和随机效应模型进行统计分析。采用推荐分级、评估、发展和评价方法,使用CINeMA应用程序和改进的Cochrane偏倚风险工具来评估证据的确定性和方法质量。结果纳入93项随机对照试验(108篇出版物),19016例患者。与单药治疗相比,紫杉醇为基础的四联和五联治疗显著改善了ORR(相对风险(RR) = 1.74, 95%可信区间(CI)[1.39-2.71],证据确定性低)和OS持续时间(加权平均差(WMD) = 59.16周,95% CI[28.81-89.51],低)。紫杉醇为基础的单药治疗和双药治疗引起中性粒细胞减少的可能性最小。与非中药联合或单药治疗相比,中药联合方案的ORR更高(18项随机对照试验,1570例患者;Rr = 1.29。95% CI[1.17-1.41],中度;RR = 1.55, 95% CI[1.37 ~ 1.75],中度)。结论:联合治疗,特别是那些结合靶向药物或铂类药物的方案,可能在保持可接受的安全性的同时表现出更好的疗效。此外,中医可能与较高的ORR和较低的ae风险相关。需要进一步开展大规模、高质量的研究,以调查紫杉醇联合靶向药物、铂类药物或中药治疗TNBC的疗效和安全性。
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引用次数: 0
Current Situation on Application of Evidence-Based Pharmacy in National Drug Policy 循证药学在国家药品政策中的应用现状
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-06-03 DOI: 10.1111/jebm.70033
Linan Zeng, Dan Liu, Lingli Zhang, Wei Xiao, Zhe Chen, Hailong Li, Sha Diao, Kun Zou, Qiusha Yi
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引用次数: 0
Knowledge and Awareness of Generative Artificial Intelligence Use in Medicine Among International Stakeholders: A Cross-Sectional Study 国际利益相关者对生成式人工智能在医学中的应用的知识和意识:一项横断面研究
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-06-02 DOI: 10.1111/jebm.70034
Xufei Luo, Bingyi Wang, Yule Li, Shuang Liu, Haodong Li, Yaxuan Ren, Wah Yang, Kyle Lam, Stephen R Ali, Gemma Sharp, Fabio Ynoe Moraes, Ye Wang, Di Zhu, Zhenhua Yang, Daher Mohammad, Robert Fruscio, Maged N. Kamel Boulos, Zhicheng Lin, Kazuki Ide, Xuping Song, Lu Zhang, Yih Chung Tham, Hui Liu, Long Ge, Yaolong Chen, Zhaoxiang Bian, the GAMER working group and ADVANCED working group

Objective

To assess the knowledge, attitudes, and practices (KAP) of medical stakeholders regarding the use of generative artificial intelligence (GAI) tools.

Methods

A cross-sectional survey was conducted among stakeholders in medicine. Participants included researchers, clinicians, and medical journal editors with varying degrees of familiarity with GAI tools. The survey questionnaire comprised 40 questions covering four main dimensions: basic information, knowledge, attitudes, and practices related to GAI tools. Descriptive analysis, Pearson's correlation, and multivariable regression were used to analyze the data.

Results

The overall awareness rate of GAI tools was 93.3%. Participants demonstrated moderate knowledge (mean score 17.71 ± 5.56), positive attitudes (mean score 73.32 ± 15.83), and reasonable practices (mean score 40.70 ± 12.86). Factors influencing knowledge included education level, geographic region, and attitudes (p < 0.05). Attitudes were influenced by work experience and knowledge (p < 0.05), while practices were driven by both knowledge and attitudes (p < 0.001). Participants from outside China scored higher in all dimensions compared to those from China (p < 0.001). Additionally, 74.0% of participants emphasized the importance of reporting GAI usage in research, and 73.9% advocated for naming the specific tool used.

Conclusion

The findings highlight a growing awareness and generally positive attitude toward GAI tools among medical stakeholders, alongside the recognition of their ethical implications and the necessity for standardized reporting practices. Targeted training and the development of clear reporting guidelines are recommended to enhance the effective use of GAI tools in medical research and practice.

目的评估医疗利益相关者对使用生成式人工智能(GAI)工具的知识、态度和实践(KAP)。方法采用横断面调查法对医学相关人员进行调查。参与者包括对GAI工具熟悉程度不同的研究人员、临床医生和医学期刊编辑。调查问卷包括40个问题,涵盖四个主要方面:与GAI工具相关的基本信息、知识、态度和实践。采用描述性分析、Pearson相关分析和多变量回归分析。结果GAI工具的总体知晓率为93.3%。参与者知识水平中等(平均得分17.71±5.56),态度积极(平均得分73.32±15.83),行为合理(平均得分40.70±12.86)。影响知识的因素包括教育程度、地理区域和态度(p <;0.05)。工作经验和知识对态度有影响(p <;0.05),而实践受知识和态度的驱动(p <;0.001)。中国以外的参与者在所有方面的得分都高于中国的参与者(p <;0.001)。此外,74.0%的参与者强调报告GAI在研究中的使用的重要性,73.9%的参与者主张命名所使用的特定工具。研究结果强调了医疗利益相关者对GAI工具的认识和普遍积极的态度,以及对其伦理影响和标准化报告实践的必要性的认识。建议进行有针对性的培训和制定明确的报告准则,以加强在医学研究和实践中有效利用GAI工具。
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引用次数: 0
Associations of Combined Socioeconomic Status and Healthy Lifestyle With Incidence of Chronic Respiratory Diseases: A Prospective Cohort Study 综合社会经济地位和健康生活方式与慢性呼吸系统疾病发病率的关联:一项前瞻性队列研究
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-06-01 DOI: 10.1111/jebm.70035
Jin Yang, Jilong Huang, Jian Gao, Wenfang Zhong, Peiliang Chen, Qingmei Huang, Yixin Zhang, Fangfei You, Huan Chen, Chuan Li, Weiqi Song, Dong Shen, Jiaojiao Ren, Dan Liu, Zhihao Li, Chen Mao

Objectives

To evaluate the relationship between socioeconomic status (SES), lifestyle factors, and their combined impact on chronic respiratory diseases (CRDs).

Methods

Participants were from the UK Biobank and were categorized into SES groups using latent class analysis based on family income, education, and employment status. Lifestyle factors were assessed via 24-hour dietary recalls and structured questionnaires. Each criterion scored 1 (healthy) or 0 (unhealthy), creating a total score from 0 to 4. Multivariable Cox proportional hazards models, interaction analyses, and mediation analyses were conducted.

Results

Among 296,731 participants, 12,128 (4.1%) participants were diagnosed with CRDs. Among low SES groups, healthy lifestyle groups with scores 2, 1, and 0 showed significantly increased hazard ratios of 1.32 (95% CI: 1.21–1.44), 1.77 (95% CI: 1.63–1.93) and 2.36 (95% CI: 2.15–2.60) compared with the healthy lifestyle scores ≥3. The combined effect of SES and healthy lifestyle increased the risk of CRDs by 15% over the risk expected from simply adding their respective effects. The proportion of SES on CRDs incidence mediated by healthy lifestyle factors was statistically significant (p < 0.001), accounting for about 2%.

Conclusions

The risk of incident CRDs in the low SES population with an unhealthy lifestyle increased by 32%–136%. Unhealthy lifestyles significantly affect the incidence of CRDs in different SES subgroups. About 2% of the risk between SES and incident CRDs was mediated by lifestyle factors. These findings highlight the importance of addressing socioeconomic disparities and unhealthy lifestyle behaviors in public health strategies aimed at preventing CRDs.

目的探讨社会经济地位(SES)、生活方式因素及其对慢性呼吸系统疾病(CRDs)的综合影响。方法研究对象来自英国生物银行,根据家庭收入、教育程度和就业状况,采用潜类分析将其分为社会经济地位组。生活方式因素通过24小时饮食回顾和结构化问卷进行评估。每个标准得分为1(健康)或0(不健康),总分从0到4。进行了多变量Cox比例风险模型、相互作用分析和中介分析。结果在296731名参与者中,12128名(4.1%)参与者被诊断为CRDs。在低SES组中,评分为2、1和0分的健康生活方式组与评分≥3分的健康生活方式组相比,风险比分别为1.32 (95% CI: 1.21-1.44)、1.77 (95% CI: 1.63-1.93)和2.36 (95% CI: 2.15-2.60)显著增加。SES和健康生活方式的综合影响使CRDs的风险比简单地增加它们各自的影响所预期的风险高出15%。SES对健康生活方式因素介导的CRDs发病率的影响有统计学意义(p <;0.001),约占2%。结论生活方式不健康的低社会经济地位人群发生冠心病的风险增加32% ~ 136%。不健康的生活方式显著影响不同社会地位亚组的CRDs发病率。SES和突发CRDs之间约2%的风险由生活方式因素介导。这些发现强调了在旨在预防慢性阻塞性肺病的公共卫生战略中解决社会经济差异和不健康生活方式行为的重要性。
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引用次数: 0
Calculation of the Overlap in Umbrella Reviews Based on the Sample Size of Primary Studies 基于初级研究样本量的伞形评价重叠度计算
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-05-29 DOI: 10.1111/jebm.70038
Hamidreza Ashayeri, Hanieh Salehi-Pourmehr, Ali Jafarizadeh
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引用次数: 0
The Indirect Impact of COVID-19 Pandemic on Mortality, Complications, and Healthcare Utilization Among Patients With Chronic Respiratory Diseases in Hong Kong: An Interrupted Time Series Analysis COVID-19大流行对香港慢性呼吸系统疾病患者死亡率、并发症和医疗保健利用的间接影响:中断时间序列分析
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-05-29 DOI: 10.1111/jebm.70039
Qi Kang, Yuk Kam Yau, Zhuoran Hu, Jianchao Quan, David Chi Leung Lam, Ivy Lynn Mak, Ian Chi Kei Wong, David Vai Kiong Chao, Welchie Wai Kit Ko, Chak Sing Lau, Cindy Lo Kuen Lam, Eric Yuk Fai Wan

Purpose

This study aimed to investigate COVID-19's indirect influence on chronic respiratory disease (CRD) patients for two years since the COVID-19 pandemic began.

Methods

Using population-based data in Hong Kong, we included CRD patients diagnosed from January 2011 to December 2021. Interrupted Time Series Analysis were applied to assess mortality, complications, and healthcare utilization rates during the “pre-COVID-19 pandemic” (January 2012–January 2020), “initial COVID-19 pandemic” (February 2020–February 2021), and “post-initial COVID-19 pandemic” (March 2021–December 2021) periods.

Results

Among 587,049 patients with CRD, all-cause mortality had an increasing trend during the post-initial COVID-19 pandemic period (incidence rate ratio (95% CI): 1.019 (1.005, 1.034); p = 0.007), compared with pre-COVID-19 pandemic period. Nonrespiratory mortality had an increasing trend in the initial COVID-19 pandemic period (1.020 (1.006, 1.033); p = 0.004) and was higher than the pre-pandemic level in the post-initial COVID-19 pandemic. We observed abrupt declines in the incidence rates of asthma exacerbation, acute exacerbation of chronic obstructive pulmonary disease, pneumonia, and acute respiratory failure in the first month of initial COVID-19 pandemic period, remaining below pre-COVID-19 pandemic levels throughout the initial pandemic period.

Conclusion

The disruption of usual healthcare impacts mortality rates among patients with CRD without COVID-19, particularly nonrespiratory mortality. Contingency plans on continuing follow-up and monitoring of CRD patients are needed, for example, teleconsultations, shared primary care, and tele-reminders on red-flag symptoms for patients with CRD, when healthcare services may be disrupted during public health crises.

目的探讨自COVID-19大流行开始两年来COVID-19对慢性呼吸系统疾病(CRD)患者的间接影响。方法使用基于人群的香港数据,我们纳入了2011年1月至2021年12月诊断的CRD患者。采用中断时间序列分析来评估“COVID-19大流行前”(2012年1月至2020年1月)、“COVID-19大流行初期”(2020年2月至2021年2月)和“COVID-19大流行初期后”(2021年3月至2021年12月)期间的死亡率、并发症和医疗保健利用率。结果587049例CRD患者中,全因死亡率在COVID-19大流行初期呈上升趋势(95% CI: 1.019 (1.005, 1.034);p = 0.007),与covid -19大流行前相比。在COVID-19大流行初期,非呼吸系统死亡率呈上升趋势(1.020 (1.006,1.033);p = 0.004),高于COVID-19大流行初期的流行前水平。我们观察到,在COVID-19大流行初期的第一个月,哮喘加重、慢性阻塞性肺疾病急性加重、肺炎和急性呼吸衰竭的发病率突然下降,在整个大流行初期仍低于COVID-19大流行前的水平。结论常规医疗服务的中断影响无COVID-19的CRD患者的死亡率,尤其是非呼吸系统死亡率。需要制定持续跟踪和监测慢性肾病患者的应急计划,例如,在公共卫生危机期间卫生保健服务可能中断时,远程会诊、共享初级保健和远程提醒慢性肾病患者的危险症状。
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引用次数: 0
Meta-Epidemiology: A Combination of Epidemiology and Meta-Analysis in Response to the Challenges of Systematic Reviews and Meta-Analysis 元流行病学:流行病学与元分析的结合,应对系统评价与元分析的挑战
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-05-26 DOI: 10.1111/jebm.70036
Masoud Mohammadi
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引用次数: 0
Large Language Models in Integrative Medicine: Progress, Challenges, and Opportunities 结合医学中的大型语言模型:进展、挑战和机遇
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-05-19 DOI: 10.1111/jebm.70031
Hiu Fung Yip, Zeming Li, Lu Zhang, Aiping Lyu

Integrating Traditional Chinese Medicine (TCM) and Modern Medicine faces significant barriers, including the absence of unified frameworks and standardized diagnostic criteria. While Large Language Models (LLMs) in Medicine hold transformative potential to bridge these gaps, their application in integrative medicine remains underexplored and methodologically fragmented. This review systematically examines LLMs' development, deployment, and challenges in harmonizing Modern and TCM practices while identifying actionable strategies to advance this emerging field. This review aimed to provide insight into the following aspects. First, it summarized the existing LLMs in the General Domain, Modern Medicine, and TCM from the perspective of their model structures, number of parameters and domain-specific training data. We highlighted the limitations of existing LLMs in integrative medicine tasks through benchmark experiments and the unique applications of LLMs in Integrative Medicine. We discussed the challenges during the development and proposed possible solutions to mitigate them. This review synthesizes technical insights with practical clinical considerations, providing a roadmap for leveraging LLMs to bridge TCM's empirical wisdom with modern medical systems. These AI-driven synergies could redefine personalized care, optimize therapeutic outcomes, and establish new standards for holistic healthcare innovation.

中医与现代医学的融合面临着很大的障碍,包括缺乏统一的框架和标准化的诊断标准。虽然医学中的大型语言模型(llm)具有弥合这些差距的变革潜力,但它们在中西医结合中的应用仍未得到充分探索,方法上也不完整。这篇综述系统地考察了法学硕士在协调现代和中医实践方面的发展、部署和挑战,同时确定了推进这一新兴领域的可行战略。本综述旨在提供以下方面的见解。首先,从模型结构、参数数量和特定领域训练数据等方面对通用领域、现代医学领域和中医领域现有法学硕士进行了总结。通过基准实验和llm在中西医结合中的独特应用,我们强调了现有llm在中西医结合任务中的局限性。我们讨论了开发过程中的挑战,并提出了可能的解决方案来缓解这些挑战。这篇综述综合了技术见解和实际的临床考虑,为利用法学硕士将中医的经验智慧与现代医疗系统联系起来提供了路线图。这些人工智能驱动的协同效应可以重新定义个性化护理,优化治疗结果,并为整体医疗保健创新建立新的标准。
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引用次数: 0
Limited Evidence to Fully Determine the Implementation of Evidence-Based Practice by Healthcare Providers in Africa: A Systematic Review and Meta-Analysis 有限的证据,以充分确定实施循证实践的医疗保健提供者在非洲:系统评价和荟萃分析
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-05-15 DOI: 10.1111/jebm.70032
Feleke H. Astawesegn, Kedir Y. Ahmed, Subash Thapa, Shakeel Mahmood, Anayochukwu Anyasodor, M. Mamun Huda, Setognal B. Aychilihum, Utpal K. Modal, Allen G. Ross
<div> <section> <h3> Aim</h3> <p>Implementing evidence-based practice (EBP) is a complex process requiring healthcare providers to integrate evidence-based medicine (EBM) into clinical practice, ultimately improving clinical outcomes. This systematic review examined the sources of information for EBP, analyzed the extent of EBP implementation by healthcare providers, and explored the factors influencing EBP in Africa.</p> </section> <section> <h3> Methods</h3> <p>We identified articles published between January 1992 and March 2024 by searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMbase, PubMed, and Scopus databases. The pooled effect sizes for the prevalence of EBP and odds ratios (ORs) were estimated using random- and fixed-effects models as appropriate. For the qualitative component of the study, we performed a thematic analysis and subsequently integrated and interpreted findings from both the quantitative and qualitative analyses.</p> </section> <section> <h3> Results</h3> <p>Thirty-three studies were included in this review, involving 9722 healthcare providers: 60.3% nurses, 15.9% physicians, and 15.4% midwives. Our findings revealed a lack of detailed information on how healthcare providers utilized different forms of EBM to inform EBP and clinical outcomes in Africa. Self-reported EBP was 57.3% among nurses and 37.3% among physicians. Nigeria had the highest self-reported EBP (75.2%), whereas Egypt had the lowest (18.9%). Common sources of information reported for EBP were PubMed, UpToDate, the Cochrane Library, clinical guidelines, and training programs. Factors associated with EBP included knowledge of EBP (OR = 2.13, 95% confidence interval [CI]: 1.83–2.47), positive attitude toward EBP (OR = 1.95, 95% CI: 1.76–2.15), and having EBM training (OR = 3.08, 95% CI: 2.08–4.57), and a managerial role (OR = 2.16, 95% CI: 1.37–3.41). The availability of guidelines (OR = 1.88, 95% CI: 1.5–2.37) and internet access (OR = 1.90, 95% CI: 1.54–2.34) were also found to increase EBP. Our qualitative analysis identified common barriers to EBP, including a lack of support, resistance to change, poor communication, and failure to integrate EBP courses into the continuing education curricula.</p> </section> <section> <h3> Conclusion</h3> <p>This systematic review found limited information on the sources of EBM, how it was delivered, and its frequency of use in clinical practice. Thus, the correlation between EBM, EBP, and clinical outcomes was not fully transparent. Further studies are required to examine the medical conditions
实施循证实践(EBP)是一个复杂的过程,要求医疗保健提供者将循证医学(EBM)整合到临床实践中,最终改善临床结果。本系统综述检查了EBP的信息来源,分析了医疗保健提供者实施EBP的程度,并探讨了影响非洲EBP的因素。方法通过检索护理与相关健康文献累积索引(CINAHL)、EMbase、PubMed和Scopus数据库,筛选出1992年1月至2024年3月间发表的文章。采用随机效应和固定效应模型对EBP患病率和优势比(or)的合并效应大小进行估计。对于研究的定性部分,我们进行了专题分析,随后整合和解释了定量和定性分析的结果。结果本综述纳入33项研究,涉及9722名医疗服务提供者:护士60.3%,医生15.9%,助产士15.4%。我们的研究结果显示,缺乏关于医疗保健提供者如何利用不同形式的循证医学来告知非洲的循证bp和临床结果的详细信息。自我报告的EBP在护士中占57.3%,在医生中占37.3%。尼日利亚自我报告的EBP最高(75.2%),而埃及最低(18.9%)。EBP报告的常见信息来源是PubMed、UpToDate、Cochrane图书馆、临床指南和培训计划。与EBP相关的因素包括EBP知识(OR = 2.13, 95%可信区间[CI]: 1.83-2.47)、对EBP的积极态度(OR = 1.95, 95% CI: 1.76-2.15)、接受过EBM培训(OR = 3.08, 95% CI: 2.08-4.57)和管理角色(OR = 2.16, 95% CI: 1.37-3.41)。获得指南(OR = 1.88, 95% CI: 1.5-2.37)和上网(OR = 1.90, 95% CI: 1.54-2.34)也会增加EBP。我们的定性分析确定了EBP的常见障碍,包括缺乏支持、抗拒变革、沟通不良以及未能将EBP课程整合到继续教育课程中。结论本系统综述发现关于循证医学的来源、传播方式和临床应用频率的信息有限。因此,EBM、EBP与临床结果之间的相关性并不完全透明。需要进一步的研究来检查在提供者的业务范围内处理的医疗状况、所使用的证据类型、实施EBP的频率和一致性,以及它对提高患者预后的影响。
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引用次数: 0
Clinical Application Guideline of Combination With Traditional Chinese Medicine and Western Medicine in the Prevention and Treatment of Chronic Obstructive Pulmonary Disease (2024) 中西医结合防治慢性阻塞性肺疾病临床应用指南(2024)
IF 3.6 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-04-29 DOI: 10.1111/jebm.70024
Di Wu, Wei Liu, Jianxin Wang, Wei Chen, Mengyao Shi, Lu Zhang, Hui Wang, Huanzhang Ding, Xiao Ma, Yating Gao, Zengtao Sun, Jiangtao Lin, Hongchun Zhang, Suyun Li, Zhuying Li, Zhenhui Lu, Fuqiang Wen, Zegeng Li

Aim

Chronic Obstructive Pulmonary Disease (COPD) is a common chronic airway disease that can lead to decreased lung function in patients. It places a heavy economic burden on patients and society. Traditional Chinese medicine (TCM) and Western medicine have played important roles in managing COPD. We aimed to develop an evidence-based guideline for treating COPD with Chinese and Western Medicine.

Methods

We formed a guideline panel of multidisciplinary experts. The clinical questions were identified based on two rounds of issue solicitation and expert demonstration. We searched the literature for direct evidence on the management of COPD and assessed its certainty-generated evidence using the grading of recommendations, assessment, development, and evaluation (GRADE) approach. The recommendations and their strengths were formulated using the Delphi method.

Results

Our guideline covers aspects of the diagnosis and treatment of COPD such as principles and commonly used medications for both traditional Chinese medicine and Western medicine, complications, and the high-risk populations. 9 clinical questions and 35 recommendations were identified, which covered the combinations of YuPingFeng granule, Buzhong Yiqi decoction, Gushen Dingchuan Pill, Bufei Huoxue Capsules, Runfei cream, Bailing Capsule, Tanyin Pills, etc., and nonpharmacological therapy of TCM such as combined acupoint application, electroacupuncture, and Chinese exercise techniques (Tai Chi, Baduanjin), etc. Recommendations were either high or low or in the form of ungraded consensus-based statements.

Conclusions

This is a comprehensive and systematic evidence-based guideline and we hope it can systematically and effectively guide clinicians in managing COPD and improve overall medical care.

目的慢性阻塞性肺疾病(COPD)是一种常见的慢性气道疾病,可导致患者肺功能下降。它给患者和社会带来了沉重的经济负担。中医和西医在慢性阻塞性肺病的治疗中发挥了重要作用。我们的目的是制定一个循证的中西医结合治疗COPD的指南。方法由多学科专家组成指导小组。通过两轮问题征集和专家论证确定临床问题。我们检索了有关COPD治疗的直接证据文献,并使用分级推荐、评估、发展和评价(GRADE)方法评估其确定性证据。采用德尔菲法制定建议及其优势。结果本指南涵盖了慢性阻塞性肺病的诊治原则、中西医结合的常用药物、并发症、高危人群等方面。发现临床问题9个,建议35条,涉及玉屏风颗粒、补中益气汤、固肾定喘丸、补肺活血胶囊、润肺乳膏、百灵胶囊、坦阴丸等联合用药,以及联合穴位贴敷、电针、中医运动技术(太极拳、八段锦)等非药物治疗。建议或高或低,或以未分级的协商一致意见声明的形式提出。结论本指南是一份全面系统的循证指南,希望能系统有效地指导临床医生管理COPD,提高整体医疗服务水平。
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Journal of Evidence‐Based Medicine
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