①供体授精:我们发现,在供体授精的效果方面,尚缺乏高质量证据.②胞浆内精子注射+体外授精:1篇系统评价发现,尚无足够的证据说明胞浆内精子注射+体外授精与单独使用体外授精何者效果更好.③宫腔内人工授精:两篇系统评价发现,宫腔内人工授精较宫颈内授精或自然性交,能明显增加每个周期的妊娠率.④体外授精与配子输卵管内移植:1个RCT显示,尚无足够证据证明体外授精与配子输卵管内移植何者效果更好.
ObjectiveThis article aims to comprehensively retrieve and summarize the best evidence for the self-management of epilepsy in adolescents, so as to provide a reference for clinical medical staff and relevant decision makers. MethodsWe systematically searched Cochrane, Global Guidelines Collaboration (GIN), Scottish Interhospital Guidelines Network (SIGN), Joanna Briggs Institute (JBI), NICE, RANO (Nurses' Association of Ontario, Canada), UpToDate, BMJ, Medical Maitong, PubMed, International League Against Epilepsy, China National Knowledge Infrastructure, Wanfang Database and other databases and websites. All kinds of literature related to the self-management of epilepsy in adolescents were collected from the establishment of the database to April 18, 2023, including clinical decision-making, clinical guidelines,. Evidence summary, expert consensus, systematic review, etc. Four researchers were invited to evaluate the quality of the retrieved guidelines, and two researchers independently screened and evaluated the quality of the remaining literature. According to the opinions of professionals, data extraction and analysis were performed on the literature that met the inclusion criteria. ResultsA total of 9 articles were included, including 3 clinical guidelines, 3 expert consensus and 3 systematic reviews. We summarized the evidence in the literature in the following 8 aspects: Self-management initiation timing, monitoring management, psychological management, innovative self-management mode, information and support, medication management, daily life management and follow-up management. We identified 34 best pieces of evidence. ConclusionsThis article provides health care providers with the best evidence for the self-management of adolescents with epilepsy, guiding them to provide self-management education and counseling for adolescents with epilepsy through evidence-based methods, helping them to improve self-management ability, reduce seizures, reduce health services and healthcare costs, and improve quality of life.
Objective To summarize the best evidence of preoperative prehabilitation for patients undergoing total joint replacement/total knee replacement (THA/TKA), and to provide reference for clinical work in the context of enhanced recovery after surgery (ERAS), in order to speed up the postoperative rehabilitation process of patients undergoing THA/TKA. Methods Up To Date, BMJ Practice, National Institute for Health and Care Excellence, Cochrane Library, JBI Evidence-Based Health Care Center Database, Guidelines International Network, www.guide.medlive.cn, PubMed, China National Knowledge Infrastructure, VIPdata, and WanFang Data were searched by computer for literature about preoperative prehabilitation of THA/TKA patients. The retrieval time was from the establishment of the databases to May 31, 2022. The quality of the included literature was evaluated by 2 researchers with evidence-based training. Results A total of 11 publications were included, including 1 guideline, 3 expert consensuses, 3 systematic reviews, and 4 randomized controlled trials, covering 6 aspects of multidisciplinary team, patient education, drug management, nutritional guidance, index control, and exercise intervention. A total of 16 best evidences of preoperative prehabilitation in patients with THA/TKA were extracted, including 9 A-level recommendations and 7 B-level recommendations. Conclusions THA/TKA prehabilitation includes various comprehensive interventions. With the development of ERAS in orthopaedics, the best evidence extracted can be used by clinical staff for THA/TKA. Evidence-based evidence is provided for patients to formulate prehabilitation programs.
Evidence-based Chinese medicine is a relatively new discipline which applies the concepts and methods of evidence-based medicine (EBM) to the clinical research and practice of Chinese medicine. It is not only a branch of EBM but also a natural product of the development of Chinese medicine. This paper introduces the theoretical concepts of evidence-based Chinese medicine and reviews the process of its development. It then elucidates the main characteristics of evidence-based Chinese medicine, emphasizes its holistic approach, prescription-syndrome relationship, and its human-centered approach. Research contents and status quo are also summarized to point out the challenges of the production and application of evidence. Finally, we innovatively indicate further research directions on combining individual-based research with population-based research and developing narrative EBM.
In the formulation of the clinical question of traditional Chinese medicine clinical practice guidelines, even if the intervention elements (intervention or control) have an appropriate scope, guideline developers are still faced with a variety of interventions. By analyzing the difficulty and necessity of priority selection of intervention interventions, we propose the approach of extending expert evidence to the process of priority selection of intervention interventions, and further provide the methodology of expert evidence data collection table design, application, data presentation and expert decision-making method to provide references and guidance for guideline developers.
Objective To summarize the best evidence for prevention and management of joint dislocation after total hip arthroplasty (THA) and provide evidence-based support for reducing the occurrence of joint dislocation after THA. Methods The databases and websites related to prevention and management of joint dislocation after THA were searched, mainly including clinical decisions, guidelines, expert consensuses, evidence summaries, systematic reviews. The search period was from January 1, 2020 to April 30, 2025. Results Finally, 12 articles were included, including 2 guidelines, 4 systematic reviews, 4 clinical decisions, and 2 evidence summaries. The 5 dimensions of evaluation, preventive measures, early dislocation identification, daily activity recommendations, and health education were summarized and organized into 25 pieces of evidence. Conclusions The overall quality of the evidence related to the prevention and management of joint dislocation after THA summarized in this study is good. Medical staff should selectively apply the evidence based on clinical situations to develop safe, scientific, and personalized anti-dislocation plans for patients, in order to reduce the occurrence of joint dislocation and improve patient prognosis.
This article reviews the progress, problems and future development of evidence-based neurology; introduces sources of clinical evidence and evidence-based recommendations on some common neurological disorders from the Quality Standards Subcommittee of the American Academy of Neurology. It promotes high quality clinical research to provide good evidence and the use of current best evidence in patient care.
Objective To retrieve and summarize the best evidence for fall prevention after total hip arthroplasty in elderly patients. Methods BMJ Best Practice, UpToDate, JBI evidence-based healthcare center database, National Institute for Health and Clinical Excellence, Scottish Intercollegiate Guidelines Network, Cochrane Library, PubMed, Web of Science, EBSCO, International Collaboration of Orthopaedic Nurisng website, American Academy of Orthopaedic Surgeons website, European Society for Trauma and Emergency Surgery website, Medlive, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were systematically searched. The retrieval time was from the establishment of the databases to June 30, 2024. The quality of literature was evaluated, and evidence was extracted, evaluated, and summarized. Results A total of 12 articles were included, including 4 guidelines, 2 randomized controlled trials, 2 cohort studies, and 4 expert consensus studies. A total of 18 pieces of evidence were extracted, including 13 A-level recommendations and 5 B-level recommendations. The evidence covers six major themes of risk factors, assessment, multidisciplinary team support, health education, medication management, safety environment, and assistive devices. Conclusions The fall prevention after total hip arthroplasty in elderly patients involves multiple factors, and the fall prevention should be based on multidisciplinary team cooperation, achieving linkage between the hospital and the family to jointly ensure patient safety. In the future, it is recommended to combine individual patient differences with actual clinical scenarios when applying evidence.
As an important policy tool, real-world evidence is the basis for health insurance catalogue adjustment, and relevant policies and regulations have been issued in foreign countries to guide the use of real-world research for health insurance access, but the field of traditional Chinese medicine in China in particular is still in the exploratory stage. Since TCM protocols are widely used in clinical practice and have significant clinical value, this paper takes TCM protocols as an example and systematically constructs a technical pathway based on real-world research to support health insurance access, including clinical needs assessment, basic requirements of protocols, key points for conducting real-world research and evaluating real-world evidence, the process of access, the strategy of access, and the dynamic monitoring of access, with the aim of providing guidance for the application of real-world research in China's health insurance catalogue adjustment. Access to real-world research to provide reference for the application of real-world research in China's health insurance.
High-quality randomized controlled trials (RCTs) are regarded as the gold standard for assessing the efficiency and safety of drugs. However, conducting RCTs is expensive and time consumed, and providing timely evidence by RCTs for regulatory agencies and medical decision-makers can be challenging, particularly for new or emerging serious diseases. Additionally, the strict design of RCTs often results in a weakly external validity, making it difficult to provide the evidence of the clinical efficacy and safety of drugs in a broader population. In contrast, large simple clinical trials (LSTs) can expedite the research process and provide better extrapolation and reliable evidence at a lower cost. This article presents the development, features, and distinctions between LSTs and RCTs, as well as special considerations when conducting LSTs, in accordance with literature and guidance principles from regulatory agencies both from China and other countries. Furthermore, this paper assesses the potential of real-world data to bolster the development of LSTs, offering relevant researchers’ insight and guidance on how to conduct LSTs.