回望刚刚过去的2011年，持续动荡的经济形势和各种政治、民生、灾害、气候问题……记录着2011年全球的艰难。保民生、调结构、促改革、求发展，稳中求变的实践和业绩，交出了2011年中国不遗憾的答卷。需求驱动、证据支持、立足于用、持续改进，《中国循证医学杂志》尽量用证据记录着这些重大的变革和进步： 整个世界对日本大地震及其引发的福岛核危机的医学反思，使“证据救援”成为全球共识。全球频发的战争、骚乱与经济危机勾勒出的有限资源与无限需求的巨大裂痕，使循证决策对合理利用有限卫生资源的作用日益突显。 以Gordon Guyatt为首的顶级Cochrane方法学家在对证据从质量到使用潜心研究十余年后，以中、英文推出GRADE 2011系列工具，首次将试验性研究和观察性研究的质量体系置于同一坐标系下，并将质量评价结果与应用推荐结合起来，循证指导决策、实践与转化。 由CONSORT、STROBE、PRISMA、GRADE、STP等工具构建的循证医学方法学体系基本形成，MEDLINE、EMBase、CNKI等国内外重要数据库相继增设循证医学板块，更便捷、实用、智能的循证决策辅助支持系统正呼之欲出。 国家医改在“保基本、强基层、建机制”的方针指导下初见成效，循证医学的原理、方法和证据被更多用于国家医改、教改和卫生政策的制定、实施和评估，“循证医学”也成为热门词汇，通过大众媒体更广为人知。 我们憾失第20届Cochrane年会的承办机会，但中国Cochrane/ 循证医学中心及其分中心团队在马德里年会上的精彩答辩和展示，又使我们为在极限条件下交出这份并不遗憾的答卷而倍感自豪，并对中国循证医学事业的未来充满信心。 由美国中华医学基金会（CMB）资助建设的“西部卫生政策循证研究中心网站和数据库平台”初步建成，《中国循证医学杂志》首次跻身中国精品科技期刊300强，循证医学发展的支撑平台得以加强和延伸…… 展望刚刚开始的2011年，全球共识的世纪目标，共享的有限资源，共同面临的公平性、合理性、科学性、透明化的挑战，比任何时候更呼唤质量、方法、转化、创新、合作、共赢： 我们将在世界卫生组织（WHO）“追求全球卫生覆盖（Towards Universal Health Coverage）”目标的指引下，乘国家“十二五”良好开局和新医改初见成效的东风，破冰经典循证医学方法向循证决策方法转化及他山之石的本土化问题，为中国卫生决策的问题凝练、政策制定、实施和后效评价提供方法学和高质量证据支撑。 我们将参考WHO国际临床试验注册平台（WHO-ICTRP）注册全球临床试验的成功经验和模式，跟进WHO西太区办公室（WHOPRO）对西太区国家卫生研究注册和数据共享平台（National Health Research Registry and Data Sharing）的规划，建设中国的循证卫生政策研究注册系统，拓展医学研究注册的范围和理念，通过规范发表行为和出版伦理，从入口到出口对医学研究进行全程质量控制，不断提高研究质量和透明化。 我们将抓住在新疆举办第7届亚太地区循证医学研讨会的契机，在中国最广袤的西部地区推广循证理念、培育循证文化，搭建国际交流平台，提升这一地区循证实践与研究的视野和水平，并实现循证医学教育部网上合作研究中心的第四次扩容。 我们还将适时召开《中国循证医学杂志》和《Journal of Evidence-Based Medicine》新一届编委会，为杂志的发展注入新鲜血液，集思广益、规划未来。我们将以杂志为平台，以学科为依托，顶层设计，统筹规划，带动全国的高质量证据生产、传播、转化和评价，服务医改、服务教改、服务社会、服务人民。 让我们携手并肩，作者、编者、读者互动，共同谱写2012年中国循证医学的新篇章！ 李幼平，代表 中国Cochrane/ 循证医学中心 循证医学教育部网上合作研究中心 中国临床试验注册中心 中国循证医学杂志 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.
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.
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 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.
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.
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.
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.