Key Technology Research To Dengue In TCM Clinical Practice Guidelines

ObjectiveDengue fever and dengue hemorrhagic fever are re-emerging diseases that are endemic in the Tropics. The global prevalence of dengue cases has increased in South-East Asia, Africa, the Western Pacific, and the Americas. The increasingly widespread distribution and the rising incidence of dengue virus infections are related to increased distribution of Aedes aegypti, an increasingly urban population, and increasing air travel. Literature research and preliminary preparation, as well as analysis and evaluation of consistency are the two key technologies of dengue in TCM clinical practice guidelines. The aim of this study is to discuss this two key technologies to provide guidance and revision advice for dengue in TCM clinical practice guidelines.Methods1. Firstly, we searched a large number of literature concerning danger in Pubmed, Embase, Cochrane Library, Clinical Trial, CNKI, WanFang Database, VIP, CBM, Chinese Medical Classics and Guangdong Provincial TCM Hospital Library. And then, materials about prevention and treatment of dengue were screened according to the Inclusion and Exclusion Criteria, which was set by the specialists and experts. Data were extracted using Excel. The evidence qualities were classified by the Evidence-based Classification System of Clinical Research proposed by professor Liu Jianping, and the recommendations were formed using the Classification Criteria recommended by American Institute of Clinical Guidelines.2. Retrospective analysis of 200 dengue cases obtained from Guangdong Provincial Hospital of TCM including Dade Road institute, Fangcun branch, Ershadao branch, Daxuecheng barnch in October 2014, to access the consistency and analyze the difference between the guideline and clinical practice, providing further amending advice for dengue in TCM clinical practice guidelines.Results1.We had completed the work of literature research and preliminary preparation(1)The retrieval situation of Dengue literature:We chose 19 modern literature key searching words and 16 TCM classical key searching words. And we formed the corresponding retrieval strategy according to the characteristics of each database.(2)Literature retrieval and inclusion:In total,78 literature,3 guidelines,10 monographs and 11 ancient articles were included in our study. (3)Classification of evidence and the formation of recommendations: A total of 19 recommendations were formed according to the Classification criteria recommended by American Institute of clinical guidelines.2. We had fulfilled the analysis and evaluation of consistencyResults of consistency evaluation:(1)Diagnosis:the concordance rate of traditional Chinese medicine diagnosis between clinical and the guideline was 100%. the concordance rate of western medicine diagnosis between clinical and the guideline was 100%. The concordance rates of TCM syndrome classification and diagnosis between clinical and the guideline were 66% and 89%, respectively.(2)Treatment:the concordance rates of therapeutical principle, prescription and main traditional Chinese medicine between clinical and the guideline were 64%,58% and 58%, respectively. There are totally 62 kinds of traditional Chinese medicinal preparations. The concordance rates of Tanreqing injection, Qingkailing Injection, Reduning injection, Xuebijing injection between clinical and the guideline were 8%、4%、26%、2%, the total consistency was 40%.The summary for inconsistent reasons between guide and clinical trial: There are three aspects causes of inconsistent reasons summary in guide to clinical trial.First of all, some traditional Chinese medicine preparations widely used in clinic, such as Xiyanping injection, Lingyangjiao pills, Antiviral Oral-Liquid, Xinxue Tablets, Cold particles, Diyushengbai tablets, were not included in the guideline. the usage rates of them were 29.5%、15.5%、13.5%、 9.5%、 9%、9%, respectively. Secondly, the doctors were unfamiliar with the contents of guideline, and some of them had a poor compliance, for example, in clinical, the name of the syndrome is not standardized, and the doctors in different hospitals are different in practice. Thirdly, some patients have basic disease, much to induced and aggravated the basic disease, and then only have or accompanied with the symptoms of the underlying disease. Those patients need to be treatmentd using comprehensive method; Chinese medicine adopts the individualized treatment plan, the same card type, because patients usually health and disease clip different, drug selection will have differences; the willingness of patients. Patients complicated with, who need comprehensive treatment had an effect on treatment according to the guidelines.We should supplement and perfect Chinese medicine preparation.Conclusion1. Literature research and preparation, in accordance with the Chinese medicine treatment of dengue fever clinical practice, reflects the characteristics of Chinese medicine, with practical and scientific. But at the present stage, the quantity of literatures about dengue is low, and the quality is low, which leads to the low level of evidence. We hoped to carry out more prospective, multi-center clinical study, and cultivate talents who not only had knowledge of traditional Chinese medicine, but also had knowledge of modern scientific research literacy, causing a new level of Chinese medicine diagnosis and treatment of dengue, formulating to be the cornerstone of Chinese medicine research and guide in the foundation of virus infection for other insect-borne diseases such as malaria, Zika virus;2. There were conformable to the guideline and practice, in TCM diagnostics(TCM disease diagnosis, diagnosis of Chinese medicine basis), and diagnosis of western medicine(Western medicine disease diagnosis, western medicine disease diagnosis basis). There were a good agreement between the guideline and practice, in syndrome differentiation and treatment principle (basis of syndrome classification and syndrome diagnosis). The consistency is general between the guideline and practice, in drug composition and Chinese patent medicine. The working group of guideline still need to modify the contents, and increase the intensity of the guide to promote the user to improve the compliance.