【正文】
ual clinical expertise. ? EBM is not costcutting medicine – when efficacy for the patient is paramount, costs may rise, not fall What EBM is Not ? EBM is not restricted to randomised trials – The randomised trial and systematic review are the “gold standard” for judging whether a treatment does more good than harm. – However, some questions about therapy do not require randomised trials or cannot wait for the trials to be conducted. – Sometimes the evidence we need will e from the basic sciences such as geics or immunology. – And if no randomised trial has been carried out for our patient’s predicament, we follow the trail to the next best external evidence and work from there. 。 Jarvik, Radiology 2022。 Cell or animal is equal to human Background ? Traditional practice Model – Clinicians are use convenient sources – Factors that influence decision making. ? Senior doctors ? Patient request ? Pharmaceutical representatives remendation ? Local expertbased CME Outdate! Background ? Longer life ? Chronic diseases ? More studies, more articles, much more information – 20,000 RCT’s published annually, 6000 articles enter Medline monthly – 1 study report published every 189。 ? 2022年 – 上海預(yù)防醫(yī)學(xué)研究院以 Ames試驗(yàn)和骨髓微核試驗(yàn) 作了研究,結(jié)果表明中華靈芝寶具有抗突變作用。課題,結(jié)論證實(shí)該藥物對 多種白血病和人體實(shí)體癌細(xì)胞 具有明顯的抑制作用,并呈現(xiàn)較好的量效關(guān)系。EvidenceBased Medicine 循證醫(yī)學(xué) 楊 學(xué) 寧 Xuening Yang, MD 廣東省人民醫(yī)院 Guangdong General Hospital 廣東省肺癌研究所 Guangdong Lung Cancer Research Institute 《 循證醫(yī)學(xué) 》 雜志 Journal of Evidencebased Medicine Background ? 1997年 – 上海醫(yī)科大學(xué)中西醫(yī)結(jié)合研究所完成的“中華靈芝寶” 動物實(shí)驗(yàn) 證實(shí):該藥物具有抑瘤作用、保護(hù)免疫功能和放化療減毒增效作用。 – 中國科學(xué)院上海藥物研究所完成“‘中華靈芝寶’對多種培養(yǎng)人癌細(xì)胞生長的作用”。 ? 1999年 – 中國科學(xué)院上海生物研究所丁健研究員等實(shí)驗(yàn)表明,中華靈芝寶(現(xiàn)名:雙靈固本散)能抑制拓?fù)洚悩?gòu)酶 I和拓?fù)洚悩?gòu)酶 II,造成癌細(xì)胞DNA單鏈或雙鏈斷裂,阻斷癌細(xì)胞的無限制繁殖,導(dǎo)致癌細(xì)胞破裂凋亡。 ? 2022年 – 國家藥品監(jiān)督管理局( SDA)批準(zhǔn)中華靈芝寶轉(zhuǎn)為“國藥準(zhǔn)字” B20220428,并更名為“雙靈固本散”。 ho