简介：Evidence-basedpointselectionmethodsmeanselectingacupuncturepointsonthebasisofevidenceofclinicalefficacy.Whilemostofthisevidencecurrentlyderivesfromhistoricalliterature,whichrepresentstheaccumulatedclinicalexperienceofovertwomillennia,thereisalsoagrowingbodyofevidencebeingestablishedthroughacupunctureresearch.

简介：Therehasbeenaparadigmshiftinmedicineawayfromtradition,anecdoteandtheoreticalreasoningfromthebasicsciencestowardsevidence-basedmedicine(EBM).Inpalliativecarehowever,statisticallysignificantbenefitsmaybemarginalandmaynotberelatedtoclinicalmeaningfulness.Thetypicaltreatmentvs.placebocomparisonnecessitatedby‘goldstandard'randomisedcontrolledtrials(RCTs)isnotnecessarilyapplicable.Thecomplexmultimorbidityofendoflifecareinvolvesconsiderationsofthepatient'sphysical,psychological,socialandspiritualneeds.Inaddition,thefieldofpalliativecarecoversaheterogeneousgroupofchronicandincurablediseasesnolongerlimitedtocancer.Adequatesamplesizescanbedifficulttoachieve,reducingthepowerofstudiesandhighattritionratescanresultininadequatefollowupperiods.Thisreviewusesexamplesofthemanagementofcancer-relatedfatigueanddeathrattle(noisybreathing)todemonstratethecurrentstateofEBMinpalliativecare.ThefutureofEBMinpalliativecareneedstobeasdiverseasthepatientswhoultimatelyderivebenefit.Non-RCTmethodologiesofequivalentquality,validityandsizeconductedbycollaborativeresearchnetworksusinga‘mixedmethodsapproach'arelikelytoposethecorrectclinicalquestionsandderiveevidencebasedyetclinicallyrelevantoutcomes.

简介：Purpose:Proctalgiafugax(PF)isabenignanorectalconditionwhichhasbeendescribedintheliteraturesincethenineteenthcenturycommonlypresentingtogeneralsurgeons.Thereislittlehighlevelevidenceonthesubjectanditstherapeuticmodalities.Weaimedthroughthissystematicliteraturereviewtooutlinethe

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简介：Inthisarticle,theauthorsholdthattheevidence-basedmedicine(EBM)isanewmedicalactionproducedatthehistoricmomentinclinicalpractice,whichispromotingdevelopmentofthemedicineandeventhewholelifescienceinafullynewtrainofthoughtendmethod.FurtherthebrieflyintroducedcontentsaretheeffectofEBM,thedifficultyofutilizingintheacupunctureclinicalpracticeandhowtoresolvethem.ItishighlyrecommendedthatthedoctorsoftheacupuncturesciencefieldshouldstudyEBManditseffectanddifficultiesinpracticeasearlieraspossible,insistentlyassimilatenewknowledgeandkeepabreastofthetimes'progresstofacilitatethefurtherdevelopmentofacupunctology.

简介：摘要After severe COVID-19 disease, many patients will experience a variety of problems with normal functioning and will require rehabilitation services to overcome these problems. The principles of and evidence on rehabilitation will allow an effective response. These include a simple screening process; use of a multidisciplinary expert team; four evidence-based classes of intervention (exercise, practice, psychosocial support, and education particularly about self-management); and a range of tailored interventions for other problems. The large number of COVID-19 patients needing rehabilitation coupled with the backlog remaining from the crisis will challenge existing services. The principles underpinning vital service reconfigurations needed are discussed.

简介：针灸学属于传统经验医学，循证医学是新兴的医学方法学，是经验医学的发展。自上个世纪90年代以来，中国从事针灸学研究的工作者已开始吸收和借鉴循证医学的方法和原理，用于指导针灸临床研究与医疗实践，现在国内已有越来越多的针灸临床工作者采用和遵循循证医学的原则和方法。从目前Cochrane图书馆发表的与针灸有关的系统评价来看，以往认为有效的针灸疗法却没有足够的证据表明有效，这与目前国内RCT质量不高直接有关。今后，发展并形成针灸临床研究专业化队伍和针灸临床研究中心，才能从根本上提高针灸临床研究和评价的水平。同时，发展中国循证针灸学，应结合中国针灸学的自身特点，如重视古籍中的原始研究证据，开展高质量的随机对照试验，重视非随机研究的系统评价等等。

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简介：AbstractBackground:The use of autologous free-tissue transfer is an increasingly utilized tool in the ladder of reconstructive options to preserve and restore function in patients with head and neck cancer. This article focuses on the evidence surrounding perioperative care that optimizes surgical outcomes and describes one tertiary center's approach to standardized free-flap care.Data Sources:This article examines English literature from PubMed and offers expert opinion on perioperative free-flap care for head and neck oncology.Conclusion:Free-flap reconstruction for head and neck cancer is a process that, while individualized for each patient, is best supported by a comprehensive and standardized care pathway. Surgical optimization begins in the preoperative phase and a thoughtful approach to intraprofessional communication and evidence-based practice is rewarded with improved outcomes.

简介：AbstractObjective:Nasopharyngeal carcinomas (NPC) are tumors arising from epithelium of the nasopharynx. The 5-year survival rate of primary NPC is 80% with significant risks of recurrence. The objective here is to provide an evidence-based systemic review of the diagnostic value of different modalities in detecting local, regional, and distal recurrent NPC, as well as the associated costs with these modalities.Methods:MEDLINE, EMBASE, and the Cochrane review database were queried. Two hundred and twenty-three abstracts were generated using the inclusion criteria: patients >18 years of age; histopathological reference standard; and modalities pertaining to imaging or microbiology.Results:Twenty-four manuscripts fulfilled the inclusion criteria and 5 surveillance tools identified: endoscopy, MR, FDG-PET, Tc-99m MIBI and 201TI SPECT, and EBV DNA.Conclusions:For local surveillance, endoscopy is the gold standard recommendation, with increased efficacy if Narrow Band Imaging or contact endoscopy are utilized. MRI and FDG-PET is also recommended to help with local to distal spread; however, Tc-99m MIBI and 201TI SPECT are options as well. EBV DNA is recommended as a cheap and accessible adjunct surveillance tool if an available as an option.

简介：AbstractBackground:China still suffers heavily from rabies, although reported human cases continue to decrease year over year. There are far fewer laboratory-confirmed human cases than clinically diagnosed cases, which is a big problem that needs to be addressed. In this report, we summarize analyses of all specimens from human cases tested in our laboratory over the past 15 years, in order to promote laboratory diagnosis of rabies.Methods:From 2005 to 2019, a total of 271 samples from 164 suspected rabies cases were collected from local hospitals by the local Centers for Disease Control and Prevention (CDCs) in China. Saliva, cerebrospinal fluid (CSF), serum (blood) and urine were collected for ante-mortem diagnosis, and brain tissue, neck skin tissue and cornea were collected for post-mortem diagnosis. All of the specimens were tested by reverse transcription-polymerase chain reaction (RT-PCR), and brain tissues were also tested using fluorescent antibody test (FAT). The number of positive test results obtained using different fluids or tissues, and at different stages of the disease, were compared using a chi-square test and a more effective sampling program is recommended.Results:As the national reference laboratory for rabies surveillance in China, our laboratory has tested 271 samples from 164 suspected rabies cases collected by local CDCs since 2005. We found that saliva gave the highest number of positive test results (32%), compared with CSF and other fluids. We also found that serum or blood specimens collected in the last 3 days of life can test positive by RT-PCR.Conclusions:Serum or blood samples collected in the last 3 days of a patient’s life can be used to measure viral RNA, which means that serum samples, as well as saliva and CSF, can be used to detect viral RNA for anti-mortem diagnosis of rabies. Because of our findings, we have modified our "National Surveillance Project for Human Rabies", by adding the collection and testing of serum samples from the end of the survival period. This will improve our national surveillance and laboratory diagnosis of human rabies.

简介：Olderadultfallsareasignificantpublichealthproblem,butonethatisamenabletopreventiveinterventions.1,2Despitetheprogressmadeinidentifyingriskfactors,developingefficacioushealth-relatedinterventions,andpromotingevidencebasedprogramsinthecommunity,muchworkremainsbeforethesestrategiesarebroadlyavailableandeffectivelyusedtoreducefall-relatedinjuries.3AsNewtonandScottFindlay4havepointedout,thetranslationofbasicscientificknowledgeintoclinicalstudies,andthetransformationofclinicalstudiesintoimprovementsinhealthservicesandpublichealthpractices,remainmajorobstaclestowidespreadadoption.

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简介：Osteoarthritis(OA)isthemostcommonformofarthritis.ThekneeandhipjointsarethemostcommonsitesforOA,andkneeOAismoreprevalentthanhipOA.1KneeOApatientsoftensufferpain,functionaldisability,articularcartilagewearandrelatedjointspacenarrowing.AmongU.S.adults,46.4millionhavephysician-diagnosedarthritisrepresenting

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简介：性健康或可勃起的机能障碍(编辑)现状指南提供常规药方或另外的著名外来的治疗的彻底的概述选择。在过去的10-15年，然而，国际研究人员的过多证实了单个、全面的生活方式变化能阻止并且潜在地改善我们考察的编辑应该等同分级A或为我们也考察的编辑铺平1个证据建议的生活方式证据为人参属人参的证据，一普通(OTC)有实验室调查，在约15年的多重积极使随机化的审判和几i的35年的历史的饮食的补充也许现在是至少在编辑指南讨论并且甚至强调生活方式和另外的非常规的干预以便病人们能探索的时间多种潜在地，与他们的医生和罐头一起的synergistic选择改进他们生活的质量和数量。例如，在编辑指南在生活方式修正上忽略一致、积极数据等于忽略食谱和生活方式变化减少风险或改善心血管的疾病。

简介：Inordertoachievetheinformationfusioninthetimedomainbasedontheevidencetheory,anevidencecombinationmethodinthetimedomainbasedonreliabilityandimportanceisproposedaccordingtotheideaofevidencediscount.Firstly,thedistortionofthetime-domainevidenceisjudgedbasedonsingleexponentialsmoothing.Thereal-timereliabilityoftheevidenceattheadjacenttimeisobtainedbythereal-timereliabilityassessmentmethodoftheevidencebasedonthecredibilitydecaymodel.Then,therelativeimportanceoftheevidenceattheadjacenttimeisobtainedbycomprehensivelyconsideringimprovedconflictdegreeanduncertainty.Finally,basedonthecriterionofevidencediscountandtheDempster’sruleofcombination,theevidencecombinationiscarriedouttoachievethesequentialcombinationoftime-domainevidence.Thenumericalsimulationandanalysisshowthatthismethodhasfullyembodiedthedynamiccharacteristicsoftime-domainevidencecombination,andithasstrongprocessingabilityforconflictinformationandanti-disturbingability.Theproposedmethodhasgoodapplicabilitytoinformationfusioninthetimedomain.

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