| ObjectiveThrough to the released in 2008 of China association of Chinese medicine of traditional Chinese medicine guide:the clinical usage of the journal with Lupus Nephritis data collection analysis, objective evaluation of the clinical applicability of the guide.MethodsIn 2008, the release of China association of Chinese medicine of TCM guide "Lupus Nephritis" as the research target; In the first affiliated hospital of Guangdong province, Guangzhou university of Chinese medicine hospitals, Chinese medicine hospital in Hubei province, people’s hospital affiliated to Fujian university of traditional Chinese medicine, Chinese medicine hospital in Chongqing as the research object. By using questionnaire to collect the clinical doctors’ cognition to the guide application situation, clinical doctors to write report on the collection and analysis with lupus nephritis patients’clinical data, data processing adopts EPIDATAv3.1 input software, through the data summary analysis, to a certain extent, to evaluate the clinical applicability to the guide.Results1. Contents of Guidelines and research of structural applicability (N=50)Clinical doctors, who participate in the questionnaire survey, has reach to the total number of 50 people, including senior title of 19 people, intermediate title for 17 people, primary title for nine people and others for five people.1.1 The basic informationCognitive, content, utilization rate of guide name is 100%,76.0% and 48.0%;1.2 Qualities and standardsScope of application, terminology and utilization rate is 90.0%,80.0% and 78.0%. utilization rate, the key points of diagnosis, classification of syndrome differentiation utilization rate is 54.0%, the utilization rate of 72.0%, formula utilization rate is 58.0% 70%, medication use, other treatment utilization rate is 60.0%, cultivate and preventive use 0;1.3 The application circumstancesCoordination apply rate is 66.0%, sex of suitable rate is 66.0%, the content reasonable rate was 66.0%, the structure rationality for the rate of 92.0%, compared with this unit scheme applicable rate of 66.0%, compared with the solutions such as diagnosis and treatment level key disciplines applicable rate of 46.0%, compared with the latest scientific research level applicable rate of 28.0%, compared with expert diagnosis and treatment experience of applicable rate 62.0%, efficacy rate was 29.0%, security for rate 74.0%, economy applicable rate 64.0%, ease applicable rate 58.0%, and regulate medical management in the applicable rate of 62.0%;2. Guide clinical applicability study (N=246)2.1 Guide the clinical application of coincidenceDiagnosis coincidence rate:87.4% disease diagnosis of traditional Chinese medicine, western medicine diagnosis 95.9%; Dialectical coincidence rate 51.6%; Treatment coincidence rate:points of 42.7%, the agent 47.2 33.9%, other 33.9% treatment, cultivate prevention;2.2 Guidelines for clinical useCompletely using guide circumstances:diagnosis of traditional Chinese medicine, western medicine diagnosis and classification of syndrome, treatment, other treatments and prevention guide to cultivate adoption rate: 87.4%,95.9%,51.6%,42.7%,47.2%,10.9% and 47.2%; Part adopts guide case guide adoption rate:11%,3.3%,43.9%,56.1%,43.1%,38.7% and 43.1%; Without using guide adoption rate:0.8%,0.8%,4.5%,1.2%,9.7%,50.4% and 0;2.3 Origins of Clinical application solutionsChinese medicine source disease diagnosis rate:100% guidelines; Medicine source disease diagnosis rate:100% diagnostics guide; Source of syndrome classification rate:guidelines for 4.1% 7.0% 7.0%, expert experience and research achievements, the key specialty plan, hospital diagnosis and conventional 26.0%26.4%, other 8.0%; Certificate of source rate:guidelines for 0.3%,96.5% and 96.5%, expert experience and research achievements, the key specialty plan, hospital diagnosis and conventional 0.5%1.2%, other 0.5%; In the source rate the formulas:guidelines for 0.3%,95.4% and 95.4%, expert experience and research achievements, the key specialty plan, hospital diagnosis and conventional 0.8% and 0%, other 0.8%; Other source treatment rate:guidelines for 0%,95.4% and 95.4%, expert experience and research achievements, the key specialty plan, hospital diagnosis and conventional 0% 0.1%, other 2.3%; Cultivate source rate:prevention guidelines 0% 0% 0%, expert experience and research achievements, the key specialty plan, hospital diagnosis and conventional 70.0% and 0%, others are 10.7%2.4 Evaluations of therapeutic effectsCases which have been completely using the guide:cure rate 5.7%, show the efficiency of 46.3%, the recovery of 45.5%, total effective rate was 97.5%. Part adopts guide cases; cure rate 2.8%, efficiency is 44.2%, the recovery of 34.9%. The total effective rate is 89.1%. By not using guide of cases, the recovery rate is 1.0%, efficiency is 30.3%, the recovery of 28.9%. The total effective rate is 60.2%. Completely using guide of recovery rate and the significant efficiency is slightly higher than the part adopts guidelines and not using guide group, but there was no statistically significant difference (P>0.05). That Chinese medicine treatment with lupus nephritis is a must have advantages, also has certain guidance for clinical guiding significance, can improve the clinical curative effect. Considered part of the case because patients using and not using guide the guide type evidence, so use the other treatment, the formulas for the same is evidence-based medicine of traditional Chinese medicine, so also have good rate and more efficient.2.5 Evaluations of safetyCases which have been fully using the guide:safety rate is good, like 12.2%,70.7% and 13.4%. Safety ratio is 82.9%. Those parts, which adopt guide cases, safety rate is very good, almost 2.9%,8.2% and 60.7%, safety ratio is 68.9%. Not using guide cases, safety is very good,5.3% 41.0% good,37.3% commonly, safety ratio is 16.3%. Completely using guide safety ratio is higher than without using part adopts and guide groups, but there was no statistically significant difference (P>0.05). No matter whether to adopt guidelines, all is to use a comprehensive treatment of traditional Chinese medicine, its high proportion of the total safety, that Chinese medicine treatment with lupus nephritis is safe.2.6 Evaluations of EconomicsCases which have been fully using the guide:it’s good to economy accounted for 6.5%, accounted for 66.8%, better general accounted for 22.4%,4.8% difference. Economic ratio has reach 72.8%. Cost-effect ratio is 39.8%. Part adopts guidelines of cases, the economy is very good (5.9%), good (49.8%), generally accounted for 14.5%,29.8% difference. Economic ratio has achieved 55.7%. Cost-effect ratio is 55.6%. Not using guide of cases, the economy is very good (2.0%), good (49.0%), generally accounted for 25.0%,24.0% difference. Economic ratio has reach 51.0%. Cost-effect ratio is 23.9%. Completely using guide economic ratio slightly higher than the part of the group in use and not use guide; But there was no statistically significant difference (P>0.05). No matter whether to adopt guidelines, all is to use a comprehensive treatment of traditional Chinese medicine, its high proportion of the total economy, suggests that Chinese medicine treatment with lupus nephritis possesses the advantages of Jane, and cheap. Because some guide to use and not use cases, may also apply to other therapy, treatment method, cost is also relatively increase.ConclusionAfter gathering information and analysis of "Questionnaire survey of the applicability of traditional Chinese medicine clinical guidelines" and "Survey of the application cases of evaluation questionnaire of TCM clinical diagnosis and treatment guidelines", the Guide has gained a higher evaluation, including the technical level comprehensive score of 5.0, satisfaction of 4.8 and applicability of 4.8, which are in the medium level. In the main parts of Guide, such as the term, the key points of diagnosis and treatment based on syndrome differentiation are all have directive significance; but it still need to improve the guide in the clinical application of the technology level, improve the applicability and satisfaction. The above contents still have space to update and improve, which is the meaning of the subject. |
PDF Full Text Request