Background The clinical efficacy of acupuncture is a topic that has received worldwide attention. In recent years, the rise of evidence-based medicine has led to calls for the clinical curative effects of acupuncture ...Background The clinical efficacy of acupuncture is a topic that has received worldwide attention. In recent years, the rise of evidence-based medicine has led to calls for the clinical curative effects of acupuncture to be tested through objective, standardized, systematic evaluation. The results of systematic reviews for clinical trials on the efficacy of acupuncture directly affect the development of acupuncture medicine. Because of its rigorous methods and its capability to provide the very latest results, the Cochrane Database of Systematic Reviews（CDSR） is recognized worldwide as one of the most reliable sources for scientific evidence. Objective Assess the current system evaluation related to acupuncture in CDSR and the Cochrane Collaboration. Methods Based on the protocols described in the Cochrane library review and the Cochrane Collaboration, and considering the registered titles in the data base, the following key terms were selected： acupuncture, transcutaneous electrical nerve stimulation, electroacupuncture, needle and acupressure. Results The 275 articles were retrieved. According to inclusion and exclusion criteria, 139 articles were eventually chosen for inclusion. We found a growing number of acupuncture related CDSR annual reviews and protocols on the overall Before 2014. The published acupuncture related reviews, protocols and registered titles concerning the subject involve 34 Cochrane Review Groups. Through analyzing the 84 reviews related to acupuncture, we concluded that these studies show a rather low rate of efficacy overall for acupuncture. Of the 84, 19（22.62%） concluded that there is evidence for the efficacy of acupuncture,2（2.38%） showed acupuncture treatment were not more effective than controls and the remaining 63（75.00%） showed that the efficacy of acupuncture were uncertain. Conclusions By analyzing and summarizing the acupuncture reviews published in the CDSR before 2014, we found that current research shows acupuncture treatment is most effective for treating pain and related symptoms（57.89%）. However, studies showing lack of efficacy or uncertain results far outweighed the studies with positive results. We discuss the possible reasons for this and beleive it is related to the overall quality of research, poorly designed sham acupuncture, lack of standard procedures for locating points and needling, and lack of attention to individual differences.展开更多
Over the past three decades, obsessive-compulsive disorder(OCD) has moved from an almost untreatable,life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children an...Over the past three decades, obsessive-compulsive disorder(OCD) has moved from an almost untreatable,life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments(which appears to be only a portion of the overall population) are not effectively treated.Suggestions for future avenues of research are also presented. These are primarily focused on(1) increased dissemination of effective therapies;(2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and(3) the impact of comorbid disorders on treatment outcome.展开更多
The systematic reviews(SRs) including a meta-analysis are considered as the top level of evidence.Although the existence of more than a hundred of low back pain(LBP)-related SRs seems very appealing and might therefor...The systematic reviews(SRs) including a meta-analysis are considered as the top level of evidence.Although the existence of more than a hundred of low back pain(LBP)-related SRs seems very appealing and might therefore suggest significant evidence on the topic,adeep analysis indicates that several of these SRs included only very few studies.Other SRs raise concerns because they included some randomized controlled trials which had a low methodological quality,or some studies which differed significantly regarding the studied populations and/or the experimental procedure.The sometimes controversial results of different SRs conducted on the same topic also highlight the significant influence of the inclusion/exclusion criteria used in the SRs to select the articles.To conclude,although meta-analysis is at the top of the evidence pyramid and have several strengths,the conclusions drawn from SRs should always be interpreted with caution because they can also have weaknesses.This is true,whether it be for LBP-related SRs including a meta-analysis,or any other.Therefore a critical analysis of any SR is always needed before integrating the results of the SR in its own clinical practice.Furthermore,clinical reasoning remains crucial,especially to consider the potential differences between one's patient and the patients included in the meta-analysis.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
基金Supported by National Natural Science Foundation of China:8140349481303025,reference number:2014CB543201
文摘Background The clinical efficacy of acupuncture is a topic that has received worldwide attention. In recent years, the rise of evidence-based medicine has led to calls for the clinical curative effects of acupuncture to be tested through objective, standardized, systematic evaluation. The results of systematic reviews for clinical trials on the efficacy of acupuncture directly affect the development of acupuncture medicine. Because of its rigorous methods and its capability to provide the very latest results, the Cochrane Database of Systematic Reviews（CDSR） is recognized worldwide as one of the most reliable sources for scientific evidence. Objective Assess the current system evaluation related to acupuncture in CDSR and the Cochrane Collaboration. Methods Based on the protocols described in the Cochrane library review and the Cochrane Collaboration, and considering the registered titles in the data base, the following key terms were selected： acupuncture, transcutaneous electrical nerve stimulation, electroacupuncture, needle and acupressure. Results The 275 articles were retrieved. According to inclusion and exclusion criteria, 139 articles were eventually chosen for inclusion. We found a growing number of acupuncture related CDSR annual reviews and protocols on the overall Before 2014. The published acupuncture related reviews, protocols and registered titles concerning the subject involve 34 Cochrane Review Groups. Through analyzing the 84 reviews related to acupuncture, we concluded that these studies show a rather low rate of efficacy overall for acupuncture. Of the 84, 19（22.62%） concluded that there is evidence for the efficacy of acupuncture,2（2.38%） showed acupuncture treatment were not more effective than controls and the remaining 63（75.00%） showed that the efficacy of acupuncture were uncertain. Conclusions By analyzing and summarizing the acupuncture reviews published in the CDSR before 2014, we found that current research shows acupuncture treatment is most effective for treating pain and related symptoms（57.89%）. However, studies showing lack of efficacy or uncertain results far outweighed the studies with positive results. We discuss the possible reasons for this and beleive it is related to the overall quality of research, poorly designed sham acupuncture, lack of standard procedures for locating points and needling, and lack of attention to individual differences.
文摘Over the past three decades, obsessive-compulsive disorder(OCD) has moved from an almost untreatable,life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments(which appears to be only a portion of the overall population) are not effectively treated.Suggestions for future avenues of research are also presented. These are primarily focused on(1) increased dissemination of effective therapies;(2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and(3) the impact of comorbid disorders on treatment outcome.
文摘The systematic reviews(SRs) including a meta-analysis are considered as the top level of evidence.Although the existence of more than a hundred of low back pain(LBP)-related SRs seems very appealing and might therefore suggest significant evidence on the topic,adeep analysis indicates that several of these SRs included only very few studies.Other SRs raise concerns because they included some randomized controlled trials which had a low methodological quality,or some studies which differed significantly regarding the studied populations and/or the experimental procedure.The sometimes controversial results of different SRs conducted on the same topic also highlight the significant influence of the inclusion/exclusion criteria used in the SRs to select the articles.To conclude,although meta-analysis is at the top of the evidence pyramid and have several strengths,the conclusions drawn from SRs should always be interpreted with caution because they can also have weaknesses.This is true,whether it be for LBP-related SRs including a meta-analysis,or any other.Therefore a critical analysis of any SR is always needed before integrating the results of the SR in its own clinical practice.Furthermore,clinical reasoning remains crucial,especially to consider the potential differences between one's patient and the patients included in the meta-analysis.
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.
