回望剛剛過去的2011年，持續動蕩的經濟形勢和各種政治、民生、災害、氣候問題……記錄著2011年全球的艱難。保民生、調結構、促改革、求發展，穩中求變的實踐和業績，交出了2011年中國不遺憾的答卷。需求驅動、證據支持、立足于用、持續改進，《中國循證醫學雜志》盡量用證據記錄著這些重大的變革和進步： 整個世界對日本大地震及其引發的福島核危機的醫學反思，使“證據救援”成為全球共識。全球頻發的戰爭、騷亂與經濟危機勾勒出的有限資源與無限需求的巨大裂痕，使循證決策對合理利用有限衛生資源的作用日益突顯。 以Gordon Guyatt為首的頂級Cochrane方法學家在對證據從質量到使用潛心研究十余年后，以中、英文推出GRADE 2011系列工具，首次將試驗性研究和觀察性研究的質量體系置于同一坐標系下，并將質量評價結果與應用推薦結合起來，循證指導決策、實踐與轉化。 由CONSORT、STROBE、PRISMA、GRADE、STP等工具構建的循證醫學方法學體系基本形成，MEDLINE、EMBase、CNKI等國內外重要數據庫相繼增設循證醫學板塊，更便捷、實用、智能的循證決策輔助支持系統正呼之欲出。 國家醫改在“保基本、強基層、建機制”的方針指導下初見成效，循證醫學的原理、方法和證據被更多用于國家醫改、教改和衛生政策的制定、實施和評估，“循證醫學”也成為熱門詞匯，通過大眾媒體更廣為人知。 我們憾失第20屆Cochrane年會的承辦機會，但中國Cochrane/ 循證醫學中心及其分中心團隊在馬德里年會上的精彩答辯和展示，又使我們為在極限條件下交出這份并不遺憾的答卷而倍感自豪，并對中國循證醫學事業的未來充滿信心。 由美國中華醫學基金會（CMB）資助建設的“西部衛生政策循證研究中心網站和數據庫平臺”初步建成，《中國循證醫學雜志》首次躋身中國精品科技期刊300強，循證醫學發展的支撐平臺得以加強和延伸…… 展望剛剛開始的2011年，全球共識的世紀目標，共享的有限資源，共同面臨的公平性、合理性、科學性、透明化的挑戰，比任何時候更呼喚質量、方法、轉化、創新、合作、共贏： 我們將在世界衛生組織（WHO）“追求全球衛生覆蓋（Towards Universal Health Coverage）”目標的指引下，乘國家“十二五”良好開局和新醫改初見成效的東風，破冰經典循證醫學方法向循證決策方法轉化及他山之石的本土化問題，為中國衛生決策的問題凝練、政策制定、實施和后效評價提供方法學和高質量證據支撐。 我們將參考WHO國際臨床試驗注冊平臺（WHO-ICTRP）注冊全球臨床試驗的成功經驗和模式，跟進WHO西太區辦公室（WHOPRO）對西太區國家衛生研究注冊和數據共享平臺（National Health Research Registry and Data Sharing）的規劃，建設中國的循證衛生政策研究注冊系統，拓展醫學研究注冊的范圍和理念，通過規范發表行為和出版倫理，從入口到出口對醫學研究進行全程質量控制，不斷提高研究質量和透明化。 我們將抓住在新疆舉辦第7屆亞太地區循證醫學研討會的契機，在中國最廣袤的西部地區推廣循證理念、培育循證文化，搭建國際交流平臺，提升這一地區循證實踐與研究的視野和水平，并實現循證醫學教育部網上合作研究中心的第四次擴容。 我們還將適時召開《中國循證醫學雜志》和《Journal of Evidence-Based Medicine》新一屆編委會，為雜志的發展注入新鮮血液，集思廣益、規劃未來。我們將以雜志為平臺，以學科為依托，頂層設計，統籌規劃，帶動全國的高質量證據生產、傳播、轉化和評價，服務醫改、服務教改、服務社會、服務人民。 讓我們攜手并肩，作者、編者、讀者互動，共同譜寫2012年中國循證醫學的新篇章！ 李幼平，代表 中國Cochrane/ 循證醫學中心 循證醫學教育部網上合作研究中心 中國臨床試驗注冊中心 中國循證醫學雜志 Journal of Evidence-Based Medicine
In the large-scale strata up to thousands of kilometers in dimension acrossing China or even the whole Asian region, an integrated floating may take place in an instant which can release tremendous energy to cause a huge earthquake, revealed by Prof. XU Shao-xie, Academician of Chinese Academy of Engineering. The Wenchuan earthquake that happened at 14:28 on May 12, 2008 measuring 8.0 on the Richter scale was located at an intersection point of several earthquake belts along different directions, which may account for such a large-scale earthquake. The disastrous earthquake that hit Sichuan, a major high-dense province in west China, has resulted in the largest disaster-affected area, the highest casualties and death toll as well as the most rarely-seen population of the seriously wounded throughout the Chinese earthquake history, posing a tough challenge to the discipline level of Disaster Medicine in China or even the whole world and the capabilities for regional medical rescue. Immediately after the quake, “saving lives” as the first priority, the Chinese government began real-time video/audio broadcasting, organized relevant units, teams and experts to take prompt action for rescue, and made a wise decision to accept assistance from the international professional medical rescue teams. Many miracles have been created which smashed several records in the history of earthquake medical rescue . A new column of “Wenchuan Earthquake Medical Rescue” is being initiated from this issue. Based on the overall perspective and evidence-oriented characteristics of evidence-based medicine, this column publishes a series of original articles, review articles, articles on management research, policy research, economics research and practice and communication related to the medical rescue after the Wenchuan earthquake. Also, photos are presented with concise texts, which may contribute to the scientific record of the great leap forward from a big disaster to grand development. Manuscripts, research contributions, discussions and communications from relevant administrators, researchers, medical rescuers, volunteers, journalists, logistic servers, or even the wounded and their family members are all welcomed. We really hope that this initiative will promote the establishment of the discipline of modern Disaster Medicine, regional medical rescue centers and multi-disciplinary rescue teams, and improve the efficiency, quality and cost-effectiveness of such medical rescue.
Randomized double-blind controlled trials (RCTs) conduct researches in carefully selected populations to ensure results of RCTs are unaffected by external disturbances and provide evidence of safety and efficacy. Real-world researches further help to understand the real world effects of new technologies in different medical environments after-market authorization. RCTs are the evidence foundation of real-world researches, and real-world researches provide valuable complement to RCTs. Medical insurance database is one of the most important database in real-world researches. Now, China's national medical insurance is entering a new era and transits from passive payment and compensation into a value-based strategic purchase mechanism for its insured population to buy the most cost-effective services. It is necessary to establish a mature, well-organized and value-based mechanism. The core of such mechanism is values, which is the price/performance ratio of innovative medicines and technologies rather than looking at the price solely. Demonstrating innovative drug value is an essential part of health care assessment. The authors argue that the assessment of the overall value of innovative technologies or medicines should include and based on the following four dimensions: clinical value, economic value, patient value and society value.
H7N9, a novel avian influenza A virus that causes human infections emerged in February, 2013 in Anhui and Shanghai, China. The epidemic quickly spread to Zhejiang, Jiangsu and other neighbor provinces. As of May 30th, 2013, WHO had reported 132 cases, 37 (28%) of which died. Aiming at such serious outbreak of epidemic, we retrospectively analyzed its etiology, epidemiology, clinical characteristics, treatment, prevention and control based on data and evidence. Experience and evidence of the risk surveillance and management of such a novel anthropozoonosis lacks in China, or even lacks around the world. Quick and accurate identification of the rules and of the variation and transmission of avian influenza virus becomes a key to prevention, control and treatment. According to current best available evidence around the world, Chinese medicine and biomedicine should be put in to parallel use. Only realizing evidence-based decision making can we effectively prevent and control the epidemic, treat patients, and reduce the loss.
The selection of summary statistics to use in a meta-analysis is very important for the interpretation and application of its results. This paper introduces some basic concepts of summary statistics in meta-analysis. The selection of a summary statistic for a meta-analysis depends on the following factors: design of the studies being combined, type of data, consistency among the included studies, mathematical properties and ease of interpretation. For continuous data, the weighted mean difference (WMD) is recommended when all trials use the same scale to report their outcomes, while standardized mean difference (SMD) is more appropriate when trials use different scales to report their outcomes, or the means of their outcomes differ greatly. For dichotomous data, rate ratio or relative risk (RR) is bly recommended to be the summary statistics for meta-analyses of randomized trials. The use of odds ratio (OR) as the summary statistic is similar to that of RR, if the event being studied in both the intervention (exposure) and the control group is rare. There is no single measurement that is uniformly best for all meta-analyses.
Earthquake emergency medical rescue evidence-based decision-making is a typical case of real-world evidence deriving from real-world data, conducting real-world research, and producing real-world evidence for solving real-world problems. This article focuses on the use of evidence-based science in the real-world through a problem-oriented, evidence-based decision making way, as well as transferring of results to practice and continuing outcome evaluation.
It has been 36 years since the first version of essential medicine list (EML) was released by WHO in 1977,when 18 versions of WHO-EML and four versions of children essential medicine list have been released. In 1982, the first version of national essential medicine list (NEML) was released in China. Till 2012, there were eight versions of NEML in total. This paper introduces WHO-EML in aspects of origin, idea, definition, design, and innovation of selection methodology,principle, and workflow; compares the evolution, design, selection methodology between WHO-EML and Chinese NEML; and points out the challenges of evaluation and decision making of Chinese NEML.
The purpose of evidence-based healthcare management is to prevent the overuse, underuse or misuse of some management measures, and to eliminate the gap between research and practice or the difference between best practices and conventional practices. Evidence-based healthcare management is still in an early stage of development. It also faces many challenges, which have aroused some criticism and even suspicion. This is closely related to the complexity of the management field itself and the lack of empirical research in the field. Considering the scarcity of high-quality health and medical resources in China, in order to improve the scientificalness of healthcare decision-making, we strongly appeal that promoting evidence-based healthcare management requires government-led, universal education, intensified research, scientific evaluation, technological innovation and integration.