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991.
J.L.H. Evers 《Reproductive biomedicine online》2013,26(6):742-746
In assisted reproduction, there is strong evidence for some things done, but no or only very weak evidence for others. There are several reasons for this. Most assisted reproduction procedures have small signal-to-noise ratios. This means that their treatment effect is sometimes only little better than the spontaneous conception rate, or the conception rate with traditional treatment. Hence, large trials are required. These demand complex multicentre logistics. The latter require substantial funding and funding for reproductive medicine in most countries is notoriously difficult to obtain (as opposed, for example, to oncology research or cardiovascular research). Apart from these funding issues, the creation of embryos specifically for research is only allowed in a limited number of European countries, thus tempting clinicians to skip preclinical studies altogether and go directly for clinical application in their patients, raising an ethical issue. Introducing new treatments into the clinic without proper evidence, however, is perhaps even more of an ethical issue. Subfertile couples are very vulnerable and should not be exploited.In assisted reproduction, we have strong evidence for some things we do, but no or only very weak evidence for others. There are several reasons for this. Most assisted reproduction procedures have small signal-to-noise ratios. Which means that their treatment effect is sometimes only little better than the spontaneous conception rate, or the conception rate with traditional treatment. Hence large trials are required. These demand complex multicentre logistics. The latter require substantial funding and funding for reproductive medicine in most countries is notoriously difficult to obtain (as opposed to, for example, oncology research or cardiovascular research). Apart from these funding issues, the creation of embryos specifically for research is only allowed in a limited number of European countries, thus tempting clinicians to skip preclinical studies altogether and go directly for clinical application in their patients, an ethical issue. Introducing new treatments into the clinic without proper evidence, however, is perhaps even more of an ethical issue. Subfertility couples are very vulnerable, they should not be exploited.VIDEO LINK: http://sms.cam.ac.uk/media/1401622 相似文献
992.
Yan Ma PhD Garrett G. Sullivan MD Elizabeth Schrick RN In-Young Choi PhD Zhuoya He PhD JoAnn Lierman RN PhD 《Journal of the American College of Nutrition》2013,32(3):187-193
Objective: A simple method of using fingerstick blood glucose (FSBG) monitors to estimate blood ascorbate values after high-dose intravenous (IV) ascorbate infusion is evaluated as a substitution for high-performance liquid chromatography (HPLC) measurement. Methods: In 33 participants, readings from FSBG monitors were taken before and after IV ascorbate infusions at various time points, with the postinfusion FSBG readings subtracted from the baseline glucose readings. The results of the subtractions (AAFSBG) were correlated with ascorbate concentrations detected by HPLC (AAHPLC). Results: A linear regression was found between ascorbate concentrations detected by the fingerstick method (AAFSBG) and by HPLC (AAHPLC). The linear correlations were identical in healthy subjects, diabetic subjects, and cancer patients. Analysis of variance obtained an AAFSBG/AAHPLC ratio of 0.90, with a 90% confidence interval of (0.69, 1.20). The corrections of AAFSBG improved similarity to AAHPLC but did not significantly differ from the uncorrected values. Conclusion: The FSBG method can be used as an approximate estimation of high blood ascorbate concentration after IV ascorbate (>50 mg/dL, or 2.8 mM) without correction. However, this measurement is not accurate in detecting lower or baseline blood ascorbate. It is also important to highlight that in regard to glucose monitoring, FSBG readings will be erroneously elevated following IV ascorbate use and insulin should not be administered to patients based on these readings. 相似文献
993.
目的 开展更全面的中成药临床应用资料收集,并对非定量化资料进行定性处理。方法 运用专家深度访谈的方法,以某中成药的临床应用为例,对临床上使用过该中成药的专家进行半结构式访谈,记录并整理访谈资料,引入扎根理论方法进行访谈资料分析。结果 本研究共访谈了10位专家,经扎根理论分析编码,将该中成药的临床应用编码为该药的背景、有效性、安全性、经济便宜性、依从性、临床定位6个主范畴,最终提炼出一个核心类属,并围绕这几个方面的具体信息进行详细分析。结论 通过收集、整理和分析专家经验性信息,丰富了中成药上市后再评价的临床证据集,明确了已上市中成药的临床应用范围,可为后续的临床和科研研究提供证据支持,同时,专家深度访谈和扎根理论分析是对专家经验的挖掘和利用,还可应用于中医经验传承、医者诊疗思维研究等领域。本研究进行了方法探讨和实例验证,以期为后续更高阶的研究奠定基础。 相似文献
994.
995.
ObjectiveThe combination of phenomic data from electronic health records (EHR) and clinical data repositories with dense biological data has enabled genomic and pharmacogenomic discovery, a first step toward precision medicine. Computational methods for the identification of clinical phenotypes from EHR data will advance our understanding of disease risk and drug response, and support the practice of precision medicine on a national scale.MethodsBased on our experience within three national research networks, we summarize the broad approaches to clinical phenotyping and highlight the important role of these networks in the progression of high-throughput phenotyping and precision medicine. We provide supporting literature in the form of a non-systematic review.ResultsThe practice of clinical phenotyping is evolving to meet the growing demand for scalable, portable, and data driven methods and tools. The resources required for traditional phenotyping algorithms from expert defined rules are significant. In contrast, machine learning approaches that rely on data patterns will require fewer clinical domain experts and resources.ConclusionsMachine learning approaches that generate phenotype definitions from patient features and clinical profiles will result in truly computational phenotypes, derived from data rather than experts. Research networks and phenotype developers should cooperate to develop methods, collaboration platforms, and data standards that will enable computational phenotyping and truly modernize biomedical research and precision medicine. 相似文献
996.
997.
Hisako Kakai 《Explore (New York, N.Y.)》2013,9(6):365-371
ObjectiveA whole systems research approach was used to explore the psychosocial functions attributed to an Integrative Medicine oncology program. Field research was conducted at a cancer clinic to answer the following questions: (1) what meanings do the participants attribute to the Integrative Medicine oncology program; (2) what contributes to sustaining the Integrative Medicine program; and (3) what role does the Integrative Medicine program play in the lives of the participants.MethodsParticipant observation and in-depth interviews were conducted at a community-based cancer clinic that offers various complementary modalities along with conventional cancer treatments.ParticipantsThe data were obtained from a total of 23 participants including cancer patients/survivors, caregivers, volunteers who provided the complementary therapies, and healthcare professionals at the clinic.ResultsResults indicated that the Integrative Medicine program had three major psychosocial functions for those involved. Participants viewed the Integrative Medicine program as a place (1) to exchange health/medical information and learn from others' experiences and expertise, (2) to give and receive emotional support, and (3) for the individual to act on his/her transformed new identity and new life goals through serving others.ConclusionsThe results illustrate the positive psychosocial impacts an Integrative Medicine program may bring to individuals involved in it and suggest the value of using a whole systems research (WSR) approach to Integrative Medicine research. 相似文献
998.
目的通过有效的评价实现促进社区卫生服务健康发展的目的。方法按照江苏省财政厅有关统计方法对苏州市城区社区卫生服务进行投入与产出绩效综合评估。结果 2008年得分80.21分,全省排位第4,2009年得分90.76分。评价显示,苏州市在投入和社会满意度方面相对于其他地区具有较大优势,但在绩效产出方面优势不足。优势不足的原因被认为是服务绝对量加大造成相对量的减少,这是机构与医护人员结构没有适应外来流动人员在苏州市发展的趋势。2009年,各级卫生行政部门在人力资源和社区服务上加强了管理,使相应的指标得到了显著提高,综合评价呈现良好的发展态势。结论为了进一步提升社区卫生服务效率水平,苏州市仍需要进行调整和完善规划,进一步强化各项监管制度。 相似文献
999.
1000.
目的:探究中药熏蒸联合人工泪液治疗干眼症的临床疗效,分析其对患者视觉相关生命质量的影响。方法:选取2014年11月至2016年12月北京市健宫医院收治的干眼症患者72例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组36例(72只患眼),对照组给予人工泪液治疗,观察组在对照组的基础上联合中药熏蒸治疗,2周为1个疗程,2组均连续治疗2个疗程。统计2组临床疗效;比较2组患者治疗前后主要中医症状积分、泪液分泌量、泪膜破裂时间;采用美国国家眼科研究所视觉相关生命质量量表(NEI-VFQ-25)评价并比较2组患者治疗前后视觉相关生命质量。结果:治疗后观察组总有效率为90. 28%,较对照组的63. 89%显著升高(P 0. 01);与治疗前比较,治疗后2组患者患眼疲劳感、干涩感、异物感及烧灼感等症状积分均显著降低,且观察组显著低于对照组(P 0. 01);与治疗前比较,治疗2周后至治疗4周后2组泪液分泌量呈逐渐升高趋势(P 0. 01),泪膜破裂时间呈逐渐延长趋势(P 0. 05),且治疗后2组间差异有统计学意义(P 0. 05或P 0. 01);与治疗前比较,治疗后2组患眼一般健康状况、活动障碍及视力障碍评分均显著升高(P 0. 01),且观察组显著高于对照组(P 0. 01)。结论:中药熏蒸联合人工泪液治疗干眼症可有效缓解患眼临床症状,促进患眼泪液分泌并增强泪膜稳定性,同时还可显著改善患眼视觉相关生命质量,疗效显著优于人工泪液单用。 相似文献