中医药学循证医学文献阅读.ppt

1、中医药学循证医学文献阅读,Systematic Review系统评价Ginkgo 银杏,记忆医学术语方法之一,No Chineseas simple as one word复杂学名记住中文即可,Glossary,Ginkgo 5iNkEu,maidenhair 掌叶铁线蕨 (少女秀发蕨),意向治疗分析,neurotransmitter 7njuErEtrAns5mitE,神经递质,Prejudice,偏见 BiasbaiEs,Sadness,抑郁 Depressiondi5preFEn,Ringing in the ears,耳鸣Tinnitusti5naitEs,State of being

2、 thick,粘性 viscosityvis5kCsiti,记忆公共英语单词方法之一,No Chineseas simple as one wordPlain English （简朴英语）,Glossary,robust rE5bQst strong 精力充沛的substantive 5sQbstEntiv large 大量的cognitive 5kCnitiv get to know 认知的 modification 7mCdifi5keiFEn make change 修正Unconfounded kEn5faundid not confuse 不糊涂的inconsistent7inkEn

3、5sistEnt contradictory 不一致,Strong,精力充沛的 RobustrE5bQst,Not confuse,不糊涂的 UnconfoundedkEn5faundid糊涂的 confoundedkEn5faundid,Contradictory,不一致 inconsistent shape7inkEn5sistEnt,Glossary,Ginkgo Biloba 白果 (中文即可)Maidenhair 掌叶铁线蕨 (中文即可)Cognitive get to know Substantive large,Amendment improveDepression sadnes

4、s Tinnitus ringing in the ears Viscosity state of being thick,医学英语新教程,第30章 - p234 阅读16句子Ginkgo 银杏,医学英语新教程,第30章 - p234 阅读16句子Cochrane Library系统综述文摘,Learning Objectives of Systematic Review,To masterTitleAuthorStructure of SRResult Conclusion,To know aboutIntroductionBackgroundObjectiveSearch strategy

5、,掌握,标题 (十分简洁),Ginkgo Biloba for cognitive impairment and dementia白果治疗认知损害与痴呆症（Cochrane系统综述）,掌握,标题 (十分简洁),Ginkgo Biloba for cognitive impairment and dementia白果治疗认知损害与痴呆症（Cochrane系统综述）,掌握,标题固定句式:中心词 for 短语,掌握,当代(科技)医学英语特点,Controlled language,作者（2）,Birks JGrimley Evans J,掌握,（Cochrane 综述文摘）,Cochrane Rev

6、iewSystematic Review Abstract,Structure of Cochrane Reveiw,IntroductionBackgroundObjectiveSearch strategySelection criteriaData collection and analysisMain resultsReviews conclusion,掌握,Structure of Cochrane Reveiw,Introduction 引言BackgroundObjectiveSearch strategy 检索策略Selection criteria 选择标准Data coll

7、ection and analysis 数据收集与分析Main results 主要结果Reviews conclusion 综述者结论,掌握,引言 (修订,截至,被动),A substantive amendment to this systematic review was last made on 26 August 2002.此系统综述的实质性修改截止2002年8月26日。,Background,origin 起源 current status 现况 mechanism 机制,掌握,Background origin,Extracts of the leaves of the maid

8、enhair tree, Ginkgo biloba, have long been used in China as a traditional medicine for various disorders of health.在中国，从掌叶铁钱蕨白果树叶精华作为传统药物，长期用于治疗各种疾病。,掌握,Background status,A standardized extract is widely prescribed in Germany and France for the treatment of a range of conditions including memory and

9、 concentration problems, confusion, depression, anxiety, dizziness, tinnitus and headache.,掌握,背景 现况,一种广泛用于德国与法国的标准萃取物可治疗多种疾病，包括记忆与思想集中病症、意识模糊、抑郁、焦虑、头晕、耳鸣与头痛。,掌握,Background- mechanism,The mechanisms of action are thought to reflect the action of several components of the extract and include increasin

10、g blood supply by dilating blood vessels, reducing blood viscosity, modification of neurotransmitter systems, and reducing the density of oxygen free radicals.,掌握,背景 机制,有人认为，若干成分的作用机制是扩张血管、降低血液粘滞度、改善神经递质系统，以及减少氧游离基密度而增加血供,掌握,3.Objective - explicit 鲜明,The aim of the review is to assess the efficacy a

11、nd safety of Ginkgo biloba for the treatment of patients with dementia or cognitive decline.本综述目标是评估白果治疗痴呆症或认知功能减退的有效性与安全性。,掌握,Search strategy 3T,TimeTypesTerms,Strategy Time & Types,Trial were identified on 26 June 2002 through a search of the CDCIG,synonym 同义词 & asterisk *,The search terms used we

12、reginkgo*,tanakan,EGB-761,EGB761 andEGB 761.,所用检索术语为ginkgo*、tanakan、EGB-761、EGB761与“EGB 761”。,Selection criteria - phrase+ clause,All relevant, unconfounded, randomized, double-blind controlled studies, in which extracts of Ginkgo biloba at any strength and over any period were compared with placebo

13、 for their effects on people with acquired cognitive impairment, including dementia, of any degree of severity.,收录标准,收录所有与白果萃取物（任何浓度与任何疗程）治疗获得性认知损害（包括任何类型的痴呆症）相关的正规随机双盲安慰剂对照研究文献。,collection & analysis - meta,Data for the meta-analyses are based on reported summary statistics for each study.供荟粹分析分析的资

14、料取自每个研究的发表总结性统计。,Main results 先总后分,General: 1-4Division (benefit): 5-7 (the same sentence pattern)Summary (adverse): 8-9,掌握,Main results 先总 概括,Overall, there are no significant differences between Ginkgo and placebo in the proportion of participants experiencing adverse events. 在总体上，接受白果与安慰剂受试者的不良反应

15、事件无显著差异。,掌握,Main results 先总 - meta,There are benefits (主语) associated with Ginkgo (dose less than 200mg/day) compared with placebo at less than 12 weeks (54/63 showed improvement compared with 20/63, OR 15.32, 95% CI 5.90 to 39.80, P=200mg/日）相关效益（56/43 比20/63，优势比15.32，95%可信区间5.90至39.80，P=0.0001）。,掌握

16、,Main results 3 division,Cognition shows (different data.)Activities show / .Measures of mood show / .,Division 后分(疗效),掌握,Main results division -meta,There are benefits (主语) associated with Ginkgo (dose less than 200mg/day) compared with placebo at less than 12 weeks (54/63 showed improvement compar

17、ed with 20/63, OR 15.32, 95% CI 5.90 to 39.80, P=0.0001).,掌握,same pattern with different subjects and data,Cognition shows benefit for Ginkgo (dose less than 200mg/day) compared with placebo at 12 weeks (SMD -0.57, 95% CI -1.09, -0.05, P=0.03, random effects model).,掌握,same pattern with different su

18、bjects and data,Activities shows benefit for Ginkgo (dose less than 200mg/day) compared with placebo at 12 weeks (SMD -0.57, 95% CI -1.09, -0.05, P=0.03, random effects model).,掌握,same pattern with different subjects and data,Measures of mood shows benefit for Ginkgo (dose less than 200mg/day) compa

19、red with placebo at 12 weeks (SMD -0.57, 95% CI -1.09, -0.05, P=0.03, random effects model).,掌握,当代(科技)医学英语特点,Controlled language,Reviewers conclusions,Merits Imperfect Prospect,掌握,Reviewers conclusions 优点,Ginkgo biloba appears to be safe in use with no excess side effects compared with placebo.应用白果相

20、对安慰剂无过度副作用，显得(似乎)安全。,掌握,Reviewers conclusions 说明,Many of the early trials used unsatisfactory methods, were small, and we cannot exclude publication bias.许多早期试验应用效果不满意者多为小型研究,综述者不能排除论文偏倚。,掌握,Reviewers conclusions -优点,Overall there is promising evidence of improvement in cognition and function associ

21、ated with Ginkgo.总体上讲，白果改善认知与功能依据前景良好。,掌握,Reviewers conclusions 不足,However, the three more modern trials show inconsistent results.然而，有个以上当代临床试验的结果不一致。,掌握,Reviewers conclusions 展望,There is need for a large trial using modern methodology and permitting an intention-to-treat analysis to provide robust

22、 estimates of the size and mechanism of any treatment effects.尚需应用现代的方法学与“意向治疗分析”大型临床试验，以提供任何治疗效应大小的有力依据与机制。,掌握,Summary key points,Title: 干预 + for + 病症Author : 2, independently Structure of SR: 8 sectionsConclusion: merits; imperfect; prospect,掌握,结构式文摘与系统综述文摘比较,系统综述文摘-洋八股,Result: Sentence Pattern,There are benefits (主语) associated with A (dose 剂量) compared with B at (weeks 时间) (+/all showed improvement compared with +/all, OR ?, 95% CI ? to ?, P ?).,掌握,To save or cancel TCM?,张功耀,何祚庥院士,鲁迅？梁启超？,反驳无一提到循证医学依据,Significance,国外循证医学依据证明客观评定中医,Thank You,杨明山 制作,