The Evidence Assessment And Evidence-based Practice On Chinese Herb Medicine For The Treatment Of Vascular Dementia

ObjectiveCompare the efficacy of prescriptions between physicians in Guangdong hospital of Chinese Medicine and retrieved Randomize controlled trials(RCTs)on Vascular Dementia(VD),to explore the ideas and methods on improving evidence-based clinical practice on Vascular Dementia(VD).Methods(1)Search VD patients from 2002 to 2017 in the Hospital information System(HIS).Collect information on patients characteristics and treatment,included the cases which symptoms has been improved afte taking Chinese herb medicine.(2)Retrieve RCTs on Chinese herb medicine for VD patients.(3)For the included cases,SPSS 17.0 software is used to analyze the frequency of primary diseases,Traditional Chinese Medicine Inheritance Support Platform System(TCMIS)is adopted to summarize herb medicine.Prescriptions both collect from HIS and RCTs are analyzed with Prescription Identification Assistant software.(4)On account of the fact that the subjective outcomes rather than objective outcomes are used in the HIS,the common basic formula come from retrieved literature will be conducted on systematic review and meta analysis by Revman 5.2.Use GRADE system to assess the overall quality and make clinical recommendations.ResultTotally 138 patients were collected from HIS,107 patients had completely treatment information who changed for better,the overall age is 74.00±7.82,74 men and 33 women,all of them described courses and basic diseases except one,the courses range from 5 days to 16 years.Twenty-six kinds of basic diseases were found,the highest was sequelae of cerebral infarction,then was the hypertension,following with the diabetes.As to the syndromes,deficiency and phlegm stasis blocking was the most.All the patients were treated with primary treatment.It was found by the TCMIS that the top three frequently used herbs were Shichangpu,Fuling,Banbxia.The Prescription Recognition Assistant showed that the most common prescription used by the doctors and literature was modified Dihuangyinzi.Systematic review showed that the quality of included studies was low,while meta-analysis indicated that modified Dihuangyinzi may play a role in improving HDS,MMSE and FAQ,however,the heterogenicity was high among studies,the GRADE assessment showed a low evidence quality and low recommendation.Conclusions1.Dihuangyinzi,Huanshaodan,Yiqihuatanfang were the three frequently used prescriptions,while Shichangpu,Fuling,Banxia were the three frequently used herbs;2.Subjective outcome indexes showed an positive effect in included cases.Besides,meta-analysis showed that as to improve HDS,MMSE and FAQ scales,CHM performed better;3.The results of case study was consistent with meta-analysis;4.The evidence quality was too low to make a recommendation,probably because of the small samples and different ingredients of prescription.Physicians should be cautious in clinical practice when make use of it.More multi-center trials with large samples and rigorous design should be conducted in the future.