《护士进修杂志》随机对照临床试验文献评价

目的 了解《护士进修杂志》从1986年创刊以来刊登的临床护理论文中的随机对照试验（RCTs)和半随机对照试验（CCTs)论文的数量和质量，向中国Cochrane中心输送基线资料，同时了解护理工作者临床科研设计和论文撰写能力的现状，方法 按Cochrane中心手检指南对该杂志15卷180期的护理论文进行手检结果：共检出临床护理论文5297篇，其中属RCTs121篇，占2.3%，CCTs121篇，占2.3%。结果 RCTs论文从90年代开始逐年增加，尤以近五年递增明显，临床护理论文的数量也呈逐年增加趋势，说明广大护理工作者参与护理研究的意识增强，撰写论文的积极性在提高，RCTs121篇论文中，仅5篇阐明有具体随机方法（随机数字表），占4.1%,在CCTs121篇论文中，采用半随机分配法有22篇，占18.1%，其余论文采用非随机分组者占81.9%，结论 说明在RCTs和CCTs中有许多不足，有待改进。     

《中国疼痛学杂志》随机对照临床试验文献评价

目的：了解我国疼痛治疗临床科研状况。方法：手检1995（创刊）～1999年中国疼痛学杂志,对中国疼痛学杂志中的临床研究论文进行分类及评价。结果：5卷17期共载临床研究论文220篇,其中随机对照试验83篇（37.7%）。结论：疼痛治疗领域临床研究数量较少,RCT质量仍有待进一步提高。     

欢迎订阅2008年《中国中西医结合急救杂志》

《中国中西医结合急救杂志》系中国中西医结合学会主办、天津市天和医院承办的全国性科技期刊（为中国中西医结合学会系列杂志之一，由《中西医结合实用临床急救》杂志更名），是我国中西医结合急救医学界权威性学术期刊，已进入国内外多家权威性检索系统。本刊为双月刊，64页，国际通用16开大版本，80克双胶纸印刷。欢迎广大读者到当地邮局办理2008年的订阅手续，邮发代号；6-93，定价：每期7．6元，全年45．6元。     

《中国急救医学》随机对照临床试验文献评价-循证方法在急救医学中的应用

目的通过评价<中国急救医学>临床治疗试验中随机对照试验(RCT)的论文数量,了解急诊医学中科研设计的方法学现状,并向中国Cochrane中心输送基线资料.方法对<中国急救医学>1981～2000年中发表的临床研究文献进行逐期逐页手工检索,并根据"国际Cochrane协作网工作手册1997"对RCT和临床对照试验(CCT)的定义,严格鉴定RCT和CCT.结果在20卷158期中共刊登临床试验论文3951篇,其中RCTs 90篇(1.90%),CCTs 26篇(0.53%),RCT论文呈逐年增加趋势,1996年以后,尤以1998年以后为甚.结论 <中国急救医学>刊登RCT论文呈逐年增加,说明急诊医学已经逐渐从经验医学向循证医学转变.     

欢迎订阅2006年《中国中西医结合急救杂志》

《中国中西医结合急救杂志》系中国中西医结合学会主办、天津市天和医院承办的全国性科技期刊（为中国中西医结合学会系列杂志之一，由《中西医结合实用临床急救》杂志更名），是我国中西医结合急救医学界权威性学术期刊，已进入国内外多家权威性检索系统。本刊为双月刊，64页，国际通用16开大版本，80克双胶纸印刷。     

《中国临床药理学杂志》随机对照临床试验文献方法学评价

目的：评价《中国临床药理学杂志》临床治疗随机对照试验论文的设计和撰写现状。方法：逐期逐页人工检索《中国临床药理学杂志》1985（创刊）－2000年中发表的临床治疗试验，根据Cochrane中心手检指南对其中的RCT和CCT进行严格鉴定。结果：16卷68期共刊登临床研究论文166篇，其中RCT34篇，占20．5％，CCT95篇,57．2％。结论：《中国临床药理学杂志》临床治疗随机对照试验论文数呈逐年增加，但也存在一些问题，其质量仍有待提高。     

《中国中西医结合急救杂志》稿约

1《中国中西医结合急救杂志》是由中国中西医结合学会主办的全国性学术期刊，是目前我国中西医结合急救医学界权威性刊物，为中文核心期刊和中国科技核心期刊。本刊以备科、各种疾病的中西医结合实验研究、临床研究、急救经验和成果为报道内容。     

告读者：《中国中西医结合急救杂志》英文摘要写作要求

投《中国中西医结合急救杂志》文章的作者写作英文摘要时请按照如下要求：     

《中国中西医结合急救杂志》对作者署名的一般要求

同时具备以下3项条件者方可署名为作者：①参与选题和设计,或参与资料的分析与解释者;②起草或修改论文中关键性理论或其他主要内容者;⑧能对编辑部的修改意见进行核修,在学术上进行答辩,并最终同意该文发表者。     

《中国实用眼科杂志》随机对照临床治疗试验文献方法学评价

目的：了解《中国实用眼科杂志》从1983年至2000年间随机对照临床治疗试验论文的设计和撰写现状。方法：逐期逐页手工检索《中国实用眼科杂志》1983－2000年中发表的对照试验论文，按Cochrane协作网RCT、CCT资料库中的判定标准进行严格鉴定。结果：在18卷194期中共刊登临床对照试验166篇（其中RC178篇，CCT8篇）。结论：《中国实用眼科杂志》刊登的临床随机对照试验论文逐年增多，但仍存在较多问题：没有做到真正的随机，试验组和对照组基线资料缺乏可比性，样本量太少，纳入、排除标准不明确，没有恰当的统计学分析。临床治疗试验的设计多采用RCT和盲法，并做到真正的随机。     

我国耳鼻咽喉科疾病防治性研究随机对照试验现况的初步分析

目的评价我国医学文献中耳鼻咽喉疾病防治性研究随机对照试验(randomized controlled trials,RCT)的质量,了解其是否能为临床实践提供可靠的决策证据,为改进和提高临床治疗试验的水平提供依据.方法对我国可能刊登上述RCT的5种耳鼻咽喉科学期刊进行人工检索并根据国际循证医学标准对其中的RCT报告进行分析.结果查阅杂志287期,共含论著10 471篇,检索出RCT报告81篇,并从研究对象的选择、样本含量、随机方法、组间可比性、试验措施、对照措施、盲法、疗效评价指标、干预措施临床效果的报道、随访及失访问题等几个方面进行分析.结论我国耳鼻喉科疾病防治性研究RCT数量不足,质量距循证医学标准还有较大距离,尚不能满足临床实践的需要.更多开展高质量RCT研究对于提高耳鼻咽喉科疾病的防治水平具有特别重要的意义.     

我国慢性胃炎治疗性研究的现状分析

目的：了解我国慢性胃炎治疗性研究的一般状况，特别是RCT／CCT的现状，以及能否为临床提供可靠的研究依据。方法：按中国循证医学中心及Cochrane手册标准对8种消化专业或与消化专业有关的临床中杂志逐篇人工查阅，登记所有慢性胃炎的临床治疗性研究，分析其中的RCT／CCT。结果：共查阅113卷823期，包括临床治疗性章214篇，并分析了RCT／CCT共81篇。结论：目前我国发表的慢性胃炎的防治性研究RCT／CCT的数量较少，质量差别大，还不能满足临床实践的需要，西药类药物防治性研究献RCT／CCT比例高于中医与中西医结合类药物。     

对常用消化系统药物资料的质量分析

目的了解目前临床上常用的消化系统药物资料的随机对照试验(RCT)的现状,及能否为临床用药提供可靠的依据.方法对近2年我科收集的各类消化系统药物资料逐个进行人工手检,并按临床流行病学标准对其中的防治性RCTs文章进行分析评价.结果共收集由三类企业提供的消化系统药物资料60种,包含文章252篇.其中RCTs文章75篇,占文章总数的29.8%.进口类药物RCTs文章45篇,RCTs比例为29%;合资类药物RCTs文章12篇,RCTs比例为46%;国产类药物RCTs文章18篇,RCTs比例为25%.结论合资类药物的临床试验资料RCTs文章的比例大于国产和进口类药物(P＜0.05).目前临床上常用消化系统药物资料的质量差别较大,药物临床试验的质量和数量均有待提高.     

Odds ratio vs risk ratio in randomized controlled trials

Objective. Use of odds ratio (OR) in randomized controlled trials (RCTs) has been criticized because it overestimates the effect size, if incorrectly interpreted as risk ratio (RR). To what extent does this make a difference in the context of clinical research is unclear. We, therefore, aimed to address this issue considering its importance in evidence-based practice of medicine. Methods. We reviewed 580 RCTs published in the New England Journal of Medicine between January 2004 and June 2014 and identified 107 RCTs that reported unadjusted RR (n = 76) or OR (n = 31) for the primary outcome. For studies reporting ORs, we calculated RRs, and vice versa, using Stata software. The percentage of divergence between the reported and calculated effect size estimates was analyzed. Results. None of the RCTs showed a statistically significant result becoming insignificant or vice versa depending on the effect size estimate. OR exaggerated the RR in 62% of the RCTs. The percentage of overestimation was > 50% in 28 RCTs and > 100% in 13 RCTs. The degree of overestimation was positively correlated with the prevalence of outcomes (spearman’s rho = 0.84 and 0.66, p < 0.001). Conclusion. Use of OR instead of RR in RCTs does not change the qualitative inference of results. However, the use of OR can markedly exaggerate the effect size in RCTs if misinterpreted as RR and, hence, has the potential to mislead clinicians.     

Moving beyond randomized controlled trials in the evaluation of compulsory community treatment

Compulsory community treatment for people with severe mental illness remains controversial due to conflicting research evidence. Recently, there have been challenges to the conventional view that trial‐based evidence should take precedence. This paper adds to these challenges in three ways. First, it emphasizes the need for critiques of trials to engage with conceptual and not just technical issues. Second, it develops a critique of trials centred on both how we can have knowledge and what it is we can have knowledge of. Third, it uses this critique to develop a research strategy that capitalizes on the information in large‐scale datasets.     

Cluster randomized controlled trials

Cluster randomized controlled trial (RCT), in which groups or clusters of individuals rather than individuals themselves are randomized, are increasingly common. Indeed, for the evaluation of certain types of intervention (such as those used in health promotion and educational interventions) a cluster randomized trial is virtually the only valid approach. However, cluster trials are generally more difficult to design and execute than individually randomized studies, and some design features of a cluster trial may make it particularly vulnerable to a range of threats that can introduce bias. In this paper we discuss the issues that can lead to bias in cluster randomized trials and conclude with some suggestions for avoiding these problems.     

Systematic reviews of randomized controlled trials: the need for complete data

If the relative effectiveness of different treatments that might be used in clinical practice is to be evaluated reliably, it is very important that the evaluation is carried out in an appropriate manner. This is especially true where the differences between treatments are expected to be moderate, and so easily obscured by the play of chance or systematic bias. Although such differences are often of considerable clinical importance, they can be difficult to assess and require a large amount of randomized evidence. This evidence can be obtained through prospective randomized controlled trials, meta-analysis of results from past randomized trials, or ideally a combination of the two, with prospective trials contributing to future meta-analyses. Whichever technique is adopted, all possible biases must be minimized through the collection of as much randomized evidence as possible. In meta-analyses, this is best achieved by ensuring that all relevant trials, and all randomized participants in these trials, are included in the analysis. The gold standard for this might be a meta-analysis of individual patient data, in which details for each participant in every trial are collected and analysed centrally. This approach requires considerable time and effort. However, it will add to the analyses that can be performed and will remove many of the problems associated with a reliance on published data alone and some of the problems that can arise from the use of aggregate data. This paper sets out some of the reasons for this and some of the techniques used for individual patient data-based meta-analysis.     

基于评判视角研读随机对照试验研究文献

目前护理随机对照试验（RCT）研究文献发表数量逐年上升,其研究结果对护士和护生的临床知识、护理行为以及开展科研均会产生潜在影响,采取评判的态度和系统的方法正确阐释RCT研究结果,是将研究结果转化为临床实践的关键一步。因此本文基于此理念,从以下3个方面来评价一项RCT研究的结果及临床意义：1可信度：学会判断RCT研究结果的信度和效度;2结果的阐释：学会从样本量和精度看临床统计结果 ;3适用性：学会研读外在效度和干预措施的副作用,判断新方法的适用对象。从而促进研究成果的临床转化,提升我国护理质量。     

提高国内随机对照试验Meta-分析的质量

高质量的随机对照试验(RCT)的Meta-分析结果与国际公认的大样本RCT结果一起被各国列为最高等级的证据,可为临床实践和卫生决策提供更真实的科学依据,引导临床医师在实践中做出正确的决策。但质量差的Meta-分析反而可能导致错误的结论。国外Meta-分析方法的应用已趋于成熟和规范。然而目前国内由于应用时间不长,且缺乏统一规范的实施标准,文献质量参差不齐,很多方面还存在着较为严重的缺陷。探讨如何提高国内RCTMeta-分析的质量,尽快与国际接轨,以便为循证医学、药学提供更科学真实的证据。以进行RCTMeta-分析的步骤为线索,对国内Meta-分析存在的问题和解决的办法进行了综述。具体内容包括:提出一个好问题(研究目的),全面收集相关的RCT,制定严格的纳入/排除标准,正确提取数据资料,对符合纳入标准的RCT进行质量评价,应用正确的统计方法,必须进行敏感性分析,根据结果做出正确、全面的结论。一篇理想的RCTMeta-分析应当纳入当前所有的高质量的同质研究,无发表偏倚,使用正确的模型和统计学方法,并对结果做出全面的论述。也就是说只有尽量满足进行Meta-分析每一步所需的条件,才能逐步提高Meta-分析的质量,使得其结论更加科学,可靠。     

Acupuncture for recurrent headaches: a systematic review of randomized controlled trials

Objective : To assess whether there is evidence that acupuncture is effective in the treatment of recurrent headaches. Design :Systematic review. Study selection :Randomized or quasi-randomized clinical trials comparing acupuncture with any type of control intervention for the treatment of recurrent headaches. Data sources : Electronic databases (Medline, Embase, Cochrane Field for Complementary Medicine, Cochrane Controlled Trials Register), personal communications and bibliographies. Data collection and analysis : Information on patients, interventions, methods, and results were extracted by at least two independent reviewers using a pretested form. A pooled estimate of the responder rate ratio (responder rate in treatment group/responder rate in control group) was calculated as a crude indicator of trial results as meta-analysis of more specific outcome data was impossible due to heterogeneity and insufficient reporting. Results :Twenty-two trials, including a total of 1042 patients (median 36, range 10–150), met the inclusion criteria. Fifteen trials were in migraine patients, six in tension-headache patients, and in one trial patients with various headaches were included. The majority of the 14 trials comparing true and sham acupuncture showed at least a trend in favor of true acupuncture. The pooled responder rate ratio was 1.53 (95% confidence interval 1.11 to 2.11). The eight trials comparing acupuncture and other treatment forms had contradictory results. Conclusions :Overall, the existing evidence suggests that acupuncture has a role in the treatment of recurrent headaches. However, the quality and amount of evidence is not fully convincing. There is urgent need for well-planned, large-scale studies to assess effectiveness and efficiency of acupuncture under real life conditions.