| Background:In the recent20years in clinical medical practice, Evidence-based medicine is developed a new clinical methodology, the research principle and method of the increasingly attention by people,and widely used in clinical medical research. In recent years the evidence-based medical practice has changed many modern medical treatment of diseases medicine principle and methods, make treatment more scientific and more rigorous, the development of modern medicine has had a huge impact. Traditional Chinese medicine (TCM) is the outstanding civilization achievements of the Chinese nation, the theory and practice has its unique advantages and distinct characteristics, Evidence-based medicine method is used in traditional Chinese medicine (TCM) research in recent years is the hot spot of the care, using the principle of evidence-based medicine and methods guide future Chinese medicine clinical research, improve research methods, improve Chinese medicine clinical research。At present, mature chronic hepatitis B evidence-based medical work platform is lack for clinical research of widely used specially for the traditional Chinese medicine, in order to improve the prevention and control of traditional Chinese medicine,it is very necessary and urgent to construct chronic hepatitis b evidence-based medicine platform for Chinese medicine control and research.Purpose:Through the establishment and application of Chinese medicine control chronic hepatitis B evidence-based medicine platform,which provide clinical-the effective integration of scientific research tools for Chinese medicine control of chronic hepatitis B (evaluate and seek for existing medical evidence), clinical decision making (guide the clinical for using evidence-based medical evidence) and clinical research (provide new evidence-based medical evidence).Method:In the basic theory of TCM and evidence-based medicine guidance, combined with mathematical statistics method, the comprehensive application of computer technology, through the multidisciplinary integrated, constructing the evidence-based medicine work platform, a comprehensive collection of chronic hepatitis B clinical diagnosis data, and standardization of information collection, constructing the chronic hepatitis B patient card information database, provide the basis data for related clinical research. It also provides evidence-based medical evidence material and research tools for clinical diagnosis and treatment of chronic hepatitis B, and help to complete clinical observation literature quality evaluation for chronic hepatitis B. The establishment of evidence-based medicine work platform, to track long-term follow-up of patients with chronic hepatitis B disease and syndrome information, periodic testing and comprehensive evaluation to assess the possibility of the development of chronic hepatitis B the risk of serious clinical outcomes such as cirrhosis, liver cancer,the establishment of chronic hepatitis B monitoring system.First, the platform building and programing must have an accurate understanding and analysis of user needs. The needs analysis is the basis of the whole building process, which is the most difficult and time-consuming step. As the "foundation",whether the needs analysis is done fully and accurately or not,determines the speed and quality for "the buildings". Analysis requirements, includ requirements gathering and requirements analysis phase, requirements gathering can be clinical attendant, someone asked, design questionnaire for clinicians to fill a variety of ways, and as the basic principles, needs analysis to meet the clinical needs and the highlight of Traditional Chinese Medicine clinic features. In order to protect the platform to build the feasibility of the program, we take the overall design principle, meanwhile step by step. The first step is to build the information collection system of the clinical syndromes of chronic hepatitis B, the stability of the system commissioning, considered for inclusion in a large sample, multi-center case; The second step is the TCM liver disease literature management system, in the collection of Chinese medicine treatment of liver disease literature,based on the analysis of open-source framework library for a full-text search engine lucene; the third step is the preparation of the clinical decision support systems, to build the chronic hepatitis B data warehouse of clinical diagnosis and treatment. Due to the complexity of Chinese medicine clinical research, and the difficulty of information systems and information processing technology requirements, therefore, taking the first step is difficult. The basis of the data source to the pre-related topics, chronic hepatitis B patients with clinical disease card database is constructed as a breakthrough, effective way to explore TCM clinical data processing, and accumulated experience, and ultimately meet the clinical needs of Chinese medicine, the integration of scientific research information to Chinese medicine clinical processing goals.Result:disease syndrome acquisition system for Chronic hepatitis B provide a uniform standard for TCM clinical information acquisition and storage, which is conducive to the effective use of this information, and provides a useful tool to improve the efficiency and reliability of TCM clinical research, and also provide reliable data sources as an effective platform for future large sample, multi-center clinical study.it also builds the massive Chinese medicine clinical syndromes information Warehouse. The establishment of the Document Management System in TCM liver disease, screening, filtering and sorting through the massive literature information, access to valuable literature information for the clinician to provide an efficient, professional query tools, combined with the ideas and methods of evidence-based medicine to the Chinese medicine treatment a systematic review of the clinical efficacy of chronic liver disease, efficacy evaluation for Chinese medicine to provide a high level of evidence based medicine. Retrieve the inclusion criteria and exclusion criteria developed under this study, a total of281Chinese medicine treatment of chronic hepatitis B clinical research literature to meet the requirements, evaluation criteria based on evidence-based medicine, Chinese medicine treatment of RCT literature number increased every year. But the overall quality of research need to improve, the attention should be paid to the design of clinical research studies. In this study, it is difficult to establish the effective evaluation system, the lack of a large number of high-quality clinical research can be incorporated into the evaluation of evidence-based medicine. In this study, the final24met the inclusion criteria of the literature with meta-analysis to compare the combination therapy group with a simple Western therapy group, there is the simple difference in efficacy of Chinese medicine treatment. Integrative Medicine certainly has some advantages for improving liver function, slowing the progression of the disease.But the literature number is less than normal, and some literatures have low quality,it is urgent to follow the further studyAccording to Logistic regression analysis, this study screened out some independent risk factors of serious clinical outcomes occurrence of C H B, including age, gender ALP, GGT, TBIL, and HBV-DNA etc. According to Cox regression analysis, age, gender,ALB, TBIL, HBV-DNA, for chronic hepatitis B cirrhosis, liver cancer and other serious clinical outcomes, show independent influencing factors. At the same time,age, gender, HBV-DNA and TBIL, all enter the two factor analysis models,they show that the longer the age, male gender, the higher HBV-DNA and TBIL levels, cause the higher risk of cirrhosis, liver cancer and other serious clinical outcomes accordingly. According to discriminant analysis results, combined with the practicality and feasibility of clinical application, selecting age, sex, total bilirubin, TBIL and GGT of HBV-DNA,build the assessment model of the clinical prognosis of chronic hepatitis B between0and41points. The higher the score is, the higher the risk of serious clinical outcomes. The result shows, age>50(years), GGT>55(u/1), TBIL>18(umol/1), HBV-DNA viral load>105(copies/1), and female gender,are possibly at the high risk of the occurrence of serious clinical outcomes,such as cirrhosis and liver cancer.The establishment of syndrome information database for chronic hepatitis B, through a distributed network of case data entry,Achieve structured management of chronic hepatitis B data cases, greatly improve the clinical research efficiency.It also help to discover the occurrence of disease progression of factors. an accurate understanding of the diseasethe development process will also play an active role in the progression of chronic hepatitis B in-depth study of the law, for the establishment of late-stage clinical monitoring system to provide true, reliable data sources. syndrome information database collected262cases of mild to moderate chronic hepatitis B patients including age, sex, TBIL, GGT and HBV-DNA, the indicators focus on monitoring, assessment of the level of risk of cirrhosis, liver cancer and other serious clinical outcomes, and build long-term follow up in clinical monitoring system.Conclusion:The establishment and application of this Evidence-based medicine work platform for clinical and research workers provide a working platform to carry out the clinical treatment and research of chronic hepatitis B with high efficiency, good quality information.this standardized platform can significantly improve Chinese medicine clinical treatment and research ability and level for chronic hepatitis B. |
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