日本汉方医学领域循证医学研究现状及其启示

目的 对日本汉方医学的循证医学研究现状进行总结。 方法 系统评价日本东洋医学会（JSOM）循证医学工作组对日本汉方医学的循证医学评价和总结报告。 结果 JSOM 的循证医学特别委员会成立较早,并在全日本范围内进行了三次汉方治疗的系统总结与评价,其制剂质量规范可靠。2009 版汉方诊疗指南对日本汉方临床的诊疗可望有较好的推动作用。 结论 为促进我国中医药循证医学的发展,我们需要借鉴JSOM 的循证医学研究计划,重视研究数据的真实性、重视非随机试验的科学分析和报告;根据中医学的特点,由简到繁、系统地开展循证医学研究。     

Use of traditional,complementary and alternative medicine in nine countries: A cross-sectional multinational survey

ObjectivesTraditional, complementary, and alternative medicine (TC&AM) play an exceptional role in health care around the world as many patients has sought a holistic approach.SettingIn this study, a multinational survey was developed and administered to obtain experience, attitude, and promotion information with regard to the international use of TC&AM among nine countries: Germany, United States, Japan, China, Malaysia, Vietnam, Russia, Kazakhstan, and United Arab Emirates (UAE). The survey was administered via online to members of SurveyMonkey Audience, a proprietary panel of respondents who were recruited from a diverse population worldwide.ResultsA total of 1071 participants has completed the survey. The participants were in favor of the treatments and therapies as well as expressed positive attitudes and also have used herbal medicine treatment more than acupuncture therapy and also used the modalities to promote metabolism rather than treating musculoskeletal diseases. Moreover, participants mentioned that TC&AM should be applied for treating and managing infectious diseases, such as COVID-19. Additionally, participants recommended using Facebook channel to promote its treatments and therapies.ConclusionBased on the results, this study provides initial insights on TC&AM that may influence the non-users globally and perhaps inspire a need for further research including more countries in different continents.     

循证检验医学

在当今倡导证据指导下的医疗行为及医疗决策的时代，分析检验医学存在的问题，讨论将循证医学的理念引入检验医学的必要性及可行性，探索循证检验医学实践的途径，以使检验医学跟上临床医学的最新发展步伐，提供以病人为中心的最佳实验医学技术及实验医学服务。     

我国和WHO基本药物目录2009年版比较分析

目的比较2009年版我国和世界卫生组织（WHO）基本药物目录的异同,为今后我国基本药物目录遴选、调整与实施推广提供建议和参考。方法采用描述性分析方法,比较2009版我国与WHO基本药物目录在药物遴选与使用措施、收录西药种类、数量和规格等方面的差异。结果我国2009版基本药物目录遴选原则、更新程序以WHO目录为依据,但未公开遴选过程、方法及药物有效性、安全性、经济性和适用性评价的证据。WHO目录按解剖–治疗–化学代码分类法（ATC法）分类,我国目录按临床药理学作用分类。两目录一级分类重合21类,一、二级分类有交叉;WHO目录独有8个一级分类,我国独有3个分类。WHO与我国目录分别收录药物358和255种（含注释内药物）,重合133种,两目录还各特有药物206、108种。我国目录中抗感染药物51种,仅为WHO目录的一半,重合40种,我国和WHO目录各特有药物11、60种;其中我国和WHO目录分别含22和31种抗菌药,重合17种;抗真菌、抗结核、抗病毒药物我国目录均少于WHO目录。我国目录中的呼吸、消化、神经系统药物和激素类药物与WHO目录重合数量少,分别为1、7、9和17种;特有药物数量较多,分别为6、12、7和14种,但大多缺乏有效性及安全性证据;心血管系统药物我国和WHO目录分别收录19和29种,重合14种,其中抗高血压和抗心律失常药物收录了部分相同机制药物和WHO目录剔除的药物。结论我国2009年版基本药物目录纳入的基本药物与我国疾病负担基本相符;药物总数与WHO目录相近,但重合比例不高;遴选过程和遴选证据未见公开;部分纳入的特有药物缺乏高质量证据。建议加强与其他部门联系与分工协作,统一遴选标准;加强基本药物目录证据生产,公布我国基本药物遴选具体过程和证据;制定配套基本药物技术支持文件;加大宣传和监测评估,推进基本药物使用。     

Can the critically ill consent to participation in commercial television programmes? An Australian prehospital and emergency medicine perspective

The fly‐on‐the‐wall medical documentary is a popular television phenomenon. When patients can give appropriate consent to filming, the final product can be both educational for the public and rewarding for its subjects. However, in the dynamic world of emergency and prehospital medicine, consenting critically ill patients before filming is a significant challenge. The main barriers to gaining valid consent in the field and in the ED are limited time to inform the patient and the diminished capacity of the sick patient. Although there is an argument that involvement in a commercial film might be beneficial to several parties, including the patient, these benefits do not amount to therapeutic necessity if prior consent is not obtainable. Despite this, we still see acutely incapacitated patients featured in some television programmes. In these cases, the conventional process of consent might be being sidestepped in order to obtain permission for broadcast retrospectively. This alternative process fails to recognise that incapacitated patients require protection from an invasion of privacy that occurs when a crew is filming their resuscitations. This harm has already occurred by the time consent is sought. Ultimate responsibility for defending the patients' interests during their medical treatment rests with the medical practitioner. We argue that filming a patient without prior consent in both the prehospital and emergency environment is ethically unsound: it threatens trust in the healthcare relationship and might compromise the patient's dignity and privacy. Robust guidelines should be developed for all healthcare professionals who engage with commercial film crews.     

Ten Years Evidence-based High-Tech Acupuncture-A Short Review of Centrally Measured Effects (Part II)

The assessment of acupuncture-induced effects on brain function is crucial. Ultrasound-assisted brain function monitoring and bioelectrical methods as well as near infrared spectroscopic procedures and functional magnetic resonance investigations form the basis for the latest scientific examination methods for acupuncture research. The laserneedle acupuncture, which was examined scientifically for the first time in Graz, represents a new painless and non-invasive acupuncture method. In this way, individual combinations of acupuncture points can be stimulated simultaneously according to traditional Chinese medicine. In the context of double-blind studies, effects in the brain could be demonstrated in a reproducible manner for the first time. This second part of the short review article summarizes some of the centrally measured effects of acupuncture obtained at the Medical University of Graz within the last 10 years.     

Combined development of traditional Chinese medicine and interventional medicine

The combination of Traditional Chinese Medicine and Interventional Radiology has an excellent clinical effect. This paper reviews the principles and methods of the combined application of Traditional Chinese Medicine and Interventional Radiology, aiming to promote the complementary and coordinated development of Traditional Chinese Medicine and Interventional Radiology.     

Ayurveda and traditional Chinese medicine: a comparative overview

Ayurveda, the traditional Indian medicine (TIM) and traditionalChinese medicine (TCM) remain the most ancient yet living traditions.There has been increased global interest in traditional medicine.Efforts to monitor and regulate herbal drugs and traditionalmedicine are underway. China has been successful in promotingits therapies with more research and science-based approach,while Ayurveda still needs more extensive scientific researchand evidence base. This review gives an overview of basic principlesand commonalities of TIM and TCM and discusses key determinantsof success, which these great traditions need to address tocompete in global markets.     

Ten Years Evidence-based High-Tech Acupuncture--A Short Review of Peripherally Measured Effects

Since 1997, the Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine of Graz Medical University has been dealing with the demystification of acupuncture and examining, using non-invasive methods, how different stimulation modalities (manual needle acupuncture, laserneedle acupuncture and electro acupuncture) affect peripheral and central functions. Laser is also an important instrument for acupuncture. One only needs to mention the treatment of children or of patients with needle phobia. The laserneedle acupuncture, which was examined scientifically for the first time in Graz, represents a new painless acupuncture method for which up to ten laserneedles are glued to the skin, but not stuck into it. This first part of the short review article summarizes some of the peripherally measured effects of acupuncture obtained at the Medical University of Graz within the last 10 years.     

The Japanese Association for Acute Medicine (JAAM)

The Japanese Association for Acute Medicine (JAAM) is an academic association and a suborganization of Japan Medical Association. In Japan, emergency medicine specialists who treat critical patients exclusively were the byproducts of the advent of tertiary emergency centers. Acute medicine naturally covers a wide range disciplines, from basic sciences and clinical medicine to sociomedical considerations. These facts, as well as the presence of JAAM, have contributed to the creation of the new multidisciplinary clinical science of "pantraumatology." Despite the progress in acute medicine over the last several years in Japan, important future tasks include the support and dissemination of emergency medical research, improved organization in the emergency care system, and standards for general clinical competency of emergency specialists at all levels.     

Demographic and clinical characteristics of patients admitted to medical departments

INTRODUCTION: The significant changes, which have affected departments of medicine over the last two decades, have been much editorialized. Surprisingly few data have been published that document these changes. We describe the demographic and clinical characteristics of patients admitted to one hospital's departments of internal medicine. METHODS: During a 3 months prospective study, 1039 patients (46% of all 2277 new admissions to the departments of medicine, consisting of +/- 175 beds) were randomized for inclusion. Information was extracted from the medical records regarding demography; functional capacity; clinical data and outcome. RESULTS: The mean age of the patients was 72 +/- 16 years (mean +/- SD); 51% were male, 56% were married, and 83% lived at home. Although 293 patients (28%) were defined as dependent, the majority lived at home (170, 58%). Cognition was normal in only 74%. The four most common disease categories leading to admission were infections (383 patients, 37%), cardiovascular disorders (372, 36%), respiratory conditions (284, 27%) and genito-urinary problems (90, 9%). Overall, 98 persons died (9%). Independent risk factors for death were: mechanical ventilation; a 'do not resuscitate' order; a high APACHE-II score; a low serum albumin level; higher age; and not being married (P < 0.01). CONCLUSIONS: Geriatric patients occupy a central position in our medical wards. These data are relevant for allocation of special resources for departments with high proportions of geriatric patients; for the design of employment conditions that ascertains continuing job satisfaction; as well as for the planning of teaching opportunities for residents and students.     

Observation Medicine in Emergency Medicine Residency Programs

OBJECTIVE: To evaluate observation unit (OU) prevalence, emergency medicine (EM) resident exposure in observation medicine (OM), EM faculty/residency director (RD) OM training, and RD attitudes toward OM. METHODS: Information was obtained from residency programs by telephone during a four-month period. RESULTS: Survey respondents indicated that 36.1% have OUs and 44.9% plan to have an OU. Observation medicine resources include textbooks 32.0%, articles 45.9%, lectures 36.9%, fellowships 2.5%, and research 26.2%. Observation medicine patient care occurs: 1) during residency: 25.4% of RDs, 11.3% of entire faculty; 2) as an attending: 45.1% of RDs. CONCLUSIONS: Nearly two-thirds of EM programs have or are planning an OU. Resources are lagging behind. This survey describes current OM education strategies to teach OM.     

Evolution of Academic Emergency Medicine over a Decade (1991-2001)

OBJECTIVE: To test the hypothesis that emergency medicine (EM) has made significant, quantifiable progress within U.S. academic medicine over the past ten years, 1991-2001. METHODS: Baseline (7/1/1991) and comparison (7/1/2001) data sets contained all Liaison Committee on Medical Education (LCME)-accredited schools, Association of Academic Chairs of Emergency Medicine (AACEM)-recognized academic departments of EM, Residency Review Committee (RRC)-accredited EM residencies, and Association of American Medical Colleges (AAMC)-designated academic medical centers. The increase over ten years in the two primary variables of academic departmental status, and EM residencies located at academic medical centers, was examined in the aggregate, then stratified by medical schools grouped by academic rank. Differences over time are expressed as simple proportions, bounded by 95% confidence intervals (95% CIs). RESULTS: Between 1991 and 2001, the proportion of academic departments of EM at medical schools increased from 18% to 48% (95% CI for difference of 30% = 19% to 41%). The proportion of EM residencies at academic medical centers increased from 42% to 66% (95% CI for a difference of 24% = 11% to 36%). The largest increment of 37% (95% CI = 22% to 52%) in academic departments of EM, and of 36% (95% CI = 20% to 52%) in EM residencies located at academic medical centers, occurred within medical schools whose academic rank was above the median. CONCLUSIONS: A quantitatively and statistically significant increase in academic departments of EM within medical schools and EM residency programs at academic medical centers has occurred over the past decade. Half of all medical schools now have academic departments of EM, and two-thirds of academic medical centers house EM residency programs. This has taken place largely within institutions whose academic ranking places them among the top half of all U.S. medical schools.     

Ideas and ideals in medicine: fruits of reason or props of power?

Editors of medical journals play a central role in the promotion – or suppression – of ideas and ideals in medicine. Recently eminent among these have been the advocacies of the Evidence-based Medicine (EBM) movement and colleagues concerned with evidence and guidelines for health care. With regard to these topics, it still remains for editors of journals either to advance or to retard even the consolidation of the associated core concepts, most notably those of evidence in medicine, scientific medicine, and rational medicine. I present, first, a case study on the conduct of the editors of three medical journals, specifically their assumption of the role of authority on the scholarly fundamentals of evidence in medicine and their responding to propositions on the topic with commentaries well below the intellectual standards that should prevail in the journals of a learned profession. Then, following a brief review of the Flexnerian and EBM ideas and ideals on the practice of medicine, supplemented by observations drawn from medical sociology and the precepts of the philosophy of science, I posit a way of understanding such behaviour by editors of medical journals. They can have a temptation, and apparently some propensity, to play a regressive role in the development of the fundamentals of medicine. This is prone to occur whenever reason constitutes a threat to power, whether solely to the editors' own or to that of the profession at large. A full realization of the dream of reason in medicine requires an immense integrity of its journal editors and of its other intellectual leaders.     

Metabolomics: The Stethoscope for the Twenty-First Century

Metabolomics encompasses the systematic identification and quantification of all metabolic products in the human body. This field could provide clinicians with novel sets of diagnostic biomarkers for disease states in addition to quantifying treatment response to medications at an individualized level. This literature review aims to highlight the technology underpinning metabolic profiling, identify potential applications of metabolomics in clinical practice, and discuss the translational challenges that the field faces. We searched PubMed, MEDLINE, and EMBASE for primary and secondary research articles regarding clinical applications of metabolomics. Metabolic profiling can be performed using mass spectrometry and nuclear magnetic resonance-based techniques using a variety of biological samples. This is carried out in vivo or in vitro following careful sample collection, preparation, and analysis. The potential clinical applications constitute disruptive innovations in their respective specialities, particularly oncology and metabolic medicine. Outstanding issues currently preventing widespread clinical use are scalability of data interpretation, standardization of sample handling practice, and e-infrastructure. Routine utilization of metabolomics at a patient and population level will constitute an integral part of future healthcare provision.