主题:【原创】在医学上什么是证据?送给无知的人们 -- 虽远必诛
1,现在Cochrane reviews 的出的结论是没有药物可以治愈感冒。某些药物可以缓解症状。
你能分清楚治愈cure 和治疗 treat,症状控制,systematic management 之间的区别吗?
不能!
看看这里。链接出处
所以你说治愈同无效之间有很多级别,就是连基本概念都不懂。
现在在探讨:中药能否治好普通感冒。结论是无法治好。
2,
你对cochrane reviews 太不熟悉了,不适合于看医学文献。
这个是review,回顾别人的实验,不是自己做实验。
是说目前进入回顾的文章,缺乏偏见控制bias,没有用安慰剂对照,或者没有用其他药物对照。
比如说简单的给汤药,然后得出正性的结果,当然不令人信服,这个是EBM的关键,要有安慰剂,或者其他药物对比,否则人家说不吃,或者吃其他药物更好,你无法回答。
这就是目前可以查到的中药治疗感冒的文献的通病。
这下你明白了吗?
3,既然细究结论,不如都贴出来,看看全文不是更好
希望你能看得懂。
一共116页,有兴趣的可以打印出来。
这个是关于偏见控制的
We assessed the risk of bias of each trial in terms of generation
of allocation sequence, allocation concealment, blinding, uncompleted
data and selective reporting; and classified themas ’lowrisk’,
’moderate risk’, or ’high risk’ according to the guidelines of the
Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 (
Higgins 2008) and as described in Wu 2007a. There was no disagreement
in this process.
Sequence generation
An adequate approach for generating allocation sequence with a
low risk of selection bias should be by using a random numbers table
or computer software, or other simple randomisationmethods,
for example, coin tossing or card shuffling. We considered a trial
which only mentions ’random’ but does not include a description
of the approach used as a moderate risk of selection bias.
讲的很清楚,自己好好看。
Low risk of selection bias: adequate measures to conceal allocation
sequence is defined as the person who generates an allocation
sequence not recruiting the participants, for example, by central
randomisation. Examples of concealing allocation sequences are
using sealed opaque envelopes or storing allocation sequences in
a locked computer.
Moderate risk of selection bias: where concealment of the allocation
sequence is mentioned but the approach used is not reported.
High risk of selection bias: allocation concealment is reported
inadequately, or is not performed at all.
关于盲的控制
Masking of both the participants and results assessor was considered
as a low risk of performance or/and detection bias.
Single blinding of the results assessor was considered as amoderate
risk of performance or/and detection bias. If single blinding was
performed on the participants but not the results assessor, it was
considered as a high risk of detection bias.
Non-blinding for detection of outcomes includes quality of life
(QoL); adverse events were considered as a high risk of detection
bias. Blinding was not considered necessary for reporting mortality.
结果的评价
We analysed the data using Review Manager 5 (RevMan 2008).
We compared outcome measures for binary data using risk ratios.
For continuous data, we used the mean difference.We conducted
a pooled analysis for two trials only (Chang 2002; Yu 2005).
入选实验的介绍
All 17 included trials used a parallel group design. Four trials (
Chang 2007; Li 1999a; Wang 2008a; Zhang 2008) were multicentre
trials.
A total of 3212 participants were included in the 17 trials, with
numbers of participants in each trial varying from58 to 463. Only
three trials (Chang 2005; Chang 2007; Wang 2008a) mentioned
that the sample size was calculated according to the SFDA’s regulation
about sample size of non-inferiority test studies (that a total
number of 200 participants be included); extra participants were
also included in these trials to avoid possible attrition bias.
Nine trials included children aged from six months to 14 years (
Chen 2004; Li 1998; Liu 2002;Ma 2000; Pan 2000; Song 2004a;
Wang 1998; Yang 2000; Yu 1997). Eight trials included adultsaged from 18 to 65 or 72 years old (Chang 2002; Chang 2005;
Chang 2007; Li 1999a;Wang 2004;Wang 2008a; Yu 2005;Zhang
2008).
Eleven trials included participants according to TCM signs. Nine
trials (Chang 2005; Chang 2007; Chen 2004; Li 1998; Li 1999a;
Ma 2000; Wang 2008a; Yang 2000; Zhang 2008) included patients
with “fever cold”. One trial (Yu 1997) included both “fever
cold” and “chills cold” patients. Three trials (Chang 2002; Wang
2004; Yu 2005) included “chills cold”.Two trials (Pan 2000;Wang
1998) did not sort the patients by TCM signs.
Two trials (Chang 2002; Yu 2005) compared the Chinese herbs
Sanhan Jiere Koufuye and (Fenghan) Biaoshi Ganmao Chongji.
Other trials used different interventions and comparators. These
are listed below:
Yu 1997 comparedCaichenQinreWeixinGuanchangji
with virazole and acetaminophen.
Li 1998 compared Qinwen Keli granule with Kangbingdu
Koufuye.
Wang 1998 compared JianerQinjie YewithQinre Jiedu
Koufuye.
Li 1999a compared Qinkailing injection with Lincomycine.
Ma 2000 compared Shuanghua Penhuji with
Shuanghuanglian Qiwuji.
Pan 2000 compared Xiaoer Reganning with Vitamin C
Yinqiao Chongji.
Yang 2000 compared Huanghu Jiere Daipaoji with
Shiqi Ganmao Daipaoji.
Liu 2002 compared Kangbingdupian with Banlangen
Chongji.
Chen 2004 comparedGegenCenlianweiWanwith Yinqiao
Jiedupian.
Song 2004a compared self-prepared TCM cream with
penicillin or lincomycin.
Wang 2004 compared Sufeng Ganmao Koufuye with
Ganmao Qinre Koufuye.
Chang 2005 compared Jinlian Qinre capsules with Jinlian
Qinre granules; that is the same ingredients in two
different forms. The principle of selecting the control
drug was that its “effect was commonly recognised”. A
double-dummy placebo was used in both arms.
Chang 2007 compared ChaigeQingre granule with Fufang
Shuanghua granule.
Wang 2008a used a double-dummy placebo in both
arms, and compared Yiqing Shuangjie granule and
Chaihuang tablet placebo with Chaihuang tablet, and
compared Yiqing Shuangjie tablet and Caihuang tablet
placebo with Chaihuang tablet.
Zhang 2008 comparedQingyin injectionwithQinkailing
injection
Recovery (expressed as a dichotomous event)was used as a primary
outcome in all trials, except for Pan 2000 and Zhang 2008. Inefficacy
was reported in 15 trials. Fever clearance time was reported in
six trials (Chang 2002; Chang 2005; Li 1998;Wang 1998;Wang
2008a; Yu 1997). The time point at which the temperature started
to abate was reported in four trials (Chang 2005; Li 1998; Wang
1998; Wang 2008a). Six trials (Chang 2002; Chang 2005; Chen
2004; Li 1999a;Wang 2008a; Yu 1997) compared the prevalence
of viral respiratory tract infection by a throat swab culture. Five
trials reported that liver and kidney function tests were carried
out to look for side effects or adverse events (Chang 2002; Chang
2005; Chang 2007; Wang 2008a; Zhang 2008).
Eight trials (Chang 2002; Chang 2005; Chang 2007; Chen
2004; Song 2004a;Wang 2004;Wang 2008a; Yu 2005) evaluated
changes of TCM signs, which included “e feng han” (fear of wind
and cold); “fa re” (fever); “bi sai liu ti” (snuffles and runny nose);
examination of the colour and surface of the tongue; and “mai
xiang” (examining the pulse).
Risk of bias in included studies
Randomisation
Three trials (Chang 2002; Song 2004a; Yang 2000) mentioned
that a random numbers table was used to generate the allocation
sequence. Three trials (Chang 2005; Chang 2007; Wang 2008a)
mentioned that SAS software was used to generate the sequences.
The other 11 trials mentioned “random allocation”, but no description
about which methods were used. After telephoning the
trial authors, we learned that a random numbers table was used
in seven trials (Chen 2004; Li 1998; Liu 2002; Ma 2000; Song
2004a; Yu 1997; Yu 2005). Five trials used computer software (Li
1999a; Pan 2000;Wang 2004; Zhang 2001; Zhang 2008) and one
trial (Wang 1998) used the method of “mo jiu” (drawing straws).
作者结论
Implications for practice
We could not find a well-designed trial to provide strong evidence
to support
the use of any Chinese traditional herbal medicines for
the treatment of the common cold.
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🙂虽然得不出治愈的结论,但改善症状是可以做出的结论 1 紫色月亮 字42 2009-12-18 01:55:55
🙂现在是探讨,治愈还是不治愈的问题 虽远必诛 字34 2009-12-18 01:57:37
🙂大夫,你这样就有点不地道啦。 6 大脚丫 字2678 2009-12-17 07:41:11
🙂看来你不但是英文有问题,逻辑也有问题,看文献,太难为你了
🙂review質疑的是trail本身,并不是質疑中藥本身 2 柠檬籽儿 字336 2009-12-17 21:51:50
🙂可悲,可怜。 虽远必诛 字0 2009-12-18 04:00:30
🙂not a scientific sense... 柠檬籽儿 字110 2009-12-18 19:36:41
🙂if the research design has 1 虽远必诛 字257 2009-12-18 19:56:47