背景 基层医师在基层医疗卫生服务中发挥重要作用，临床实践指南是指导临床实践的重要工具，了解基层医师对指南的知悉程度与使用现状，可为基层指南推广与培训、提高基层医疗质量提供新思路。目的 调查、了解基层医师对糖尿病中医类指南的知悉程度与参考使用现状，并探讨其影响因素。方法 2021-09-22—10-29，通过线上调查方式向中华中医药学会糖尿病基层防治专家指导委员会发放电子问卷，并采用滚雪球抽样的方法 扩散至更多医师。问卷包括3部分：基本信息、医师使用中医药防治糖尿病现状与需求、医师对糖尿病指南认知现状与需求调查。采用有序多分类Logistic回归分析探讨基层医师对糖尿病中医类指南知悉程度与使用现状的影响因素。结果 共回收基层医师填写的有效问卷382份。35.34%(135/382)的医师对糖尿病中医类指南非常熟悉或比较熟悉，28.80%(110/382)的医师经常参考使用糖尿病中医类指南。单因素分析结果显示，不同性别、专业方向、所在科室、每周诊疗糖尿病患者数量、对中医药治疗糖尿病疗效评价、医师所在单位是否可以购买指南推荐的中药饮片或中成药、对指南知悉程度的基层医师对糖尿病中医指南参考情况比较，差异有统计学意义（P<0.05）。有序多分类Logistic回归分析结果显示，基层医师对糖尿病中医类指南知悉程度的影响因素为对中医药疗效评价为“非常有效”（OR=5.783,95%CI=1.283～26.102），医师所在单位可以购买指南推荐的中药饮片或中成药（OR=2.399,95%CI=1.548～3.717），既往接受过糖尿病防治指南的专题培训（OR=1.751,95%CI=1.149～2.667）3个因素；基层医师对糖尿病中医类指南参考情况的影响因素为医师对指南的知悉程度[非常或比较熟悉（OR=15.721,95%CI=7.584～32.557）、一般熟悉（OR=5.392,95%CI=2.841～10.237）]，工作年限≤5年（OR=14.083,95%CI=1.390～142.594），不同专业[中医专业（OR=6.869,95%CI=1.483～31.849）、中西医结合专业（OR=6.613,95%CI=1.551～28.219）]，不同地理区域[东北部（OR=2.962,95%CI=1.064～8.240）、东南部（OR=2.686,95%CI=1.004～7.178）]4个因素。结论 基层医师对糖尿病中医类指南的知悉程度和参考使用情况尚需提高。对指南的知悉程度、工作年限、专业方向、地理区域是影响医师参考使用指南的重要因素。今后应加强对基层医师的培训力度，尤其是对西北部和西南部地区、具有中医专业背景 的基层医师应加强中医防治糖尿病相关指南的培训。

OBJECTIVE:This study aims to investigate physicians' familiarity and awareness of four diabetes guidelines and their practice of the recommendations outlined in these guidelines.DESIGN:A cross-sectional study.SETTING:An online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians.PARTICIPANTS:1150 physicians from 192 cities across 30 provinces in China provided complete data.RESULTS:Tertiary care hospital physicians (TCPs) exhibited the highest familiarity with the Guideline for the Prevention and Treatment of Type 2 Diabetes Mellitus in China (91.3%), followed by the National Guidelines for the Prevention and Control of Diabetes in Primary Care (76.8%), the Standards of Medical Care in Diabetes (72.2%) and the Guidelines for Prevention and Treatment of Diabetes in Chinese Medicine (63.8%). Primary care practitioners (PCPs) exhibited familiarity with these four guidelines at about 50% or less. Self-reported reference to modern diabetes guidelines by physicians is more frequent than traditional Chinese medicine (TCM) diabetes guidelines, with rates at 73.2% and 33.8%, respectively. Approximately 90% of physicians provided instructions on self-monitoring of blood glucose to their patients with diabetes. Less than one-third of physicians referred patients to a specialised nutritionist. In terms of health education management, TCPs reported having a diabetes health management team at the rate of 75.7%, followed by secondary care hospital physicians at 57.0% and PCPs at 27.5%. Furthermore, approximately 40% of physicians did not fully grasp hypoglycaemia characteristics.CONCLUSIONS:Familiarity and awareness of the screening guidelines varied among physicians in different hospital settings. Importantly, significant discrepancies were observed between physicians' awareness and their self-reported reference to modern medicine guidelines and TCM guidelines. It is essential to consistently provide education and training on diabetes management for all physicians, particularly PCPs.

《国家糖尿病基层中医防治管理指南（2022）》是我国首部基层糖尿病中医指南。指南制订过程严格遵循循证临床实践指南的制订方法和步骤，重视中医理论的指导，吸纳了近年来中医药治疗糖尿病的最新研究证据。通过对全国1 150名医师进行调研、31名医师进行访谈，了解基层医疗现状，从而构建了指南的临床问题，力求该指南在基层具有实用性和可操作性。指南编撰过程中，召开多轮专家会议，来自全国50多所医院的80多名中西医专家参与了讨论。指南充分发挥中医“治未病”的优势，强调早筛查、早评估、早干预，倡导针刺、耳穴、穴位贴敷、穴位按摩、穴位埋线等中医非药物疗法，并将代茶饮、传统锻炼功法融入防治体系，从重点解决患者常见症状入手提升患者的生命质量，强调综合管理模式，尤其对内分泌糖尿病专科医师、中医师、健康管理师共同参与的“三师共管”团队诊疗模式进行了推荐。为便于医务人员深入理解及更好地应用本指南，现对指南的制订背景和方法学要点进行概述，并对指南关键内容进行解读。

美国糖尿病学会（ADA）在历年更新的《糖尿病医学诊疗标准》中一直强调“以患者为中心”理念的重要性，践行该理念有利于提高医疗服务效率和患者满意度、减少患者并发症发生、提升患者生命质量、降低患者医疗成本等。中医学素有“以人为本”的诊疗思想及丰富的个性化治疗手段，与ADA指南中“以患者为中心”的理念相契合。故该文基于ADA指南“以患者为中心”的理念，结合我国糖尿病防治现状，探讨我国糖尿病综合诊疗的发展思路，以期为我国糖尿病综合诊疗的完善和推广提供参考和可借鉴的经验。

"中西医并重"是我国糖尿病防治的重要策略和方针.为规范基层糖尿病诊疗,2022年3月中华医学会糖尿病学分会,国家基层糖尿病防治管理办公室共同发布了《国家基层糖尿病防治管理指南(2022)》,此次更新首次增加了糖尿病的中医药防治内容.笔者结合《中国2型糖尿病防治指南(2020)》,对指南中医药纳入背景和要点进行解读和对比分析,为临床应用提供参考.

[目的]探索中医体质与行为生活方式研究的现状、热点和趋势.[方法]检索中国知网建库至2020年12月收录的中医体质与行为生活方式研究文献,运用CiteSpace软件进行知识图谱可视化分析并开展计量学研究.[结果]共纳入563篇文献.发文量整体呈上升趋势;刊载文献量≥5篇的20本期刊中核心期刊13本,占65.00％;学位论文来源于32所高校,中医药大学有18所;该研究领域有6位核心作者,其发文总量为60篇(10.66％);222篇研究标注基金资助,占期刊论文总数的55.22％;热点关键词为中医体质、体质辨识、痰湿质、生活方式、气虚质等;关键词聚类得到前6位聚类标签依次为痰湿质、中医体质、体质辨识、药膳、相关性、危险因素;关键词突现分析显示睡眠质量、饮食调护、健康管理分别于2017、2018、2019年开始突现、突现强度较强且延续至今.[结论]中医体质与行为生活方式研究的发文量整体呈上升趋势,但核心作者群的形成有待加强,睡眠质量、饮食调护、健康管理是该领域的最新热点和前沿.

OBJECTIVE:To systematically evaluate the effect and safety of compound Kushen injection (CKI) as an add-on treatment on the treatment for breast cancer.METHODS:We searched eight major electronic databases from their inception to November 1, 2021, for randomized clinical trials (RCTs) comparing CKI plus chemotherapy with chemotherapy alone. Primary outcomes included objective response rate (ORR) and disease control rate (DCR), health-related quality of life (HRQoL), progression-free survival (PFS), and overall survival (OS). Secondary outcomes included adverse drug reactions (ADRs) and tumor marker level. We used Cochrane's RevMan 5.3 for data analysis. The GRADEpro was used to appraise the certainty of evidence. Trial sequential analysis (TSA) was applied to estimate the required sample size in a meta-analysis and test the robustness of the current results.RESULTS:Thirty RCTs with 2556 participants were totally included. CKI plus chemotherapy showed significant effects in increasing ORR (RR 1.30, 95%CI [1.18, 1.43], I 2  = 27%, n = 1694), increasing DCR (RR 1.21, 95%CI [1.15, 1.28], I 2  = 16%, n = 1627), increasing HRQol as measured by Karnofsky Performance Scale (KPS) score improvement rate (RR 1.42, 95% CI [1.26, 1.61], I 2  = 37%, n = 1172), increasing the PFS (MD 2.24 months, 95%CI [1.26, 3.22], n = 94) and the OS (MD 2.24 months, 95%CI [1.45, 3.43], n = 94), compared to chemotherapy alone. The results showed that CKI plus chemotherapy had a lower risk of ADRs than that of chemotherapy alone group. The certainty of evidence of the included trials was generally low to very low. TSA for ORR and KPS score improvement rate demonstrated that the current results reached a sufficient power regarding both numbers of trials and participants.CONCLUSIONS:Low certainty of evidence suggested that the combination of CKI and conventional chemotherapy appeared to improve ORR, DCR, and KPS score in breast cancer patients. Conclusions about PFS and OS could not be drawn due to lack of evidence. Additionally, CKI appeared to relieve the risk of ADRs in patients with breast cancer receiving chemotherapies. However, due to weak evidence, the findings should be further confirmed in large and rigorous trials.

INTRODUCTION:It is unclear whether changes in beverage price and sales after beverage tax implementation can be sustained long term. This study aims to quantify the changes in beverage prices and sales in large retailers 2 years after the implementation of the 1.5 cents per ounce Philadelphia beverage tax. METHODS:Data on price and volume sales of beverages and potential food substitutes were collected from 109 supermarkets, 45 mass merchandizers, and 350 pharmacies in Philadelphia, Baltimore (control), and Pennsylvania ZIP codes bordering Philadelphia (to investigate potential cross-border shopping for tax avoidance). Difference-in-differences analyses compared beverage prices and volume sales in the year before tax implementation (2016) to 2 years after (2018). Data were analyzed in 2020-2021. RESULTS:Difference-in-differences analyses found that after tax implementation, taxed beverage prices in Philadelphia increased by 1.02 cents per ounce (95% CI=0.94, 1.11; 68% pass through), and taxed beverage volume sales in stores decreased by 50% (95% CI=36%, 61%). After accounting for cross-border shopping, taxed beverage volume sales decreased in Philadelphia by 35% in 2018. Volume sales of nontaxed beverages did not change after tax implementation (difference-in-differences=4%, 95% CI= -3%, 12%). Volume sales of nontaxed beverage concentrates increased on average by 34% (95% CI=19%, 51%), but there was no evidence of substitution to high-calorie foods. CONCLUSIONS:There was a large reduction in taxed beverage volume sales 2 years after Philadelphia tax implementation, even after accounting for cross-border shopping. Increases in nontaxed beverage concentrate sales likely partially offset this decline, but there was no evidence of post-tax food substitution.

Research ObjectiveThe VA computes the Care Assessment Needs (CAN) score weekly for over 5 million Veterans to predict risk of one‐year mortality and to improve resource allocation to high‐risk Veterans. Motivated by evidence of unfair predictive algorithms in other settings, our objective was to examined the CAN score for racial unfairness.Study DesignWe constructed a cross‐sectional cohort of Veterans who were alive and had at least one outpatient primary care encounter during 2016, based on a VA national repository of administrative claims and electronic health data containing inpatient, outpatient, laboratory, procedure, and pharmacy encounters. We used the last score of the CAN 2.5 model (current CAN version) in 2016 for all analyses. First, we descriptively compared distributions of the last CAN scores in 2016 for self‐identified White and Black Veterans. Second, we assessed CAN fairness by calculating the false‐negative rate (FNR) as our primary fairness metric, defining a “positive” prediction at or above the 80th percentile for Black and White Veterans. Deaths were confirmed using 2017 mortality data. Third, to investigate contributors to unfairness, we compared pooled mortality within strata of Black and White Veterans based on exact matches of the most influential variables in the CAN model: age and Elixhauser comorbidities. To account for class imbalance (lower representation of Black Veterans) we re‐assessed fairness after re‐training the CAN model by upweighting the Black cohort.Population StudiedOur population consisted of 791,438 (18.3%) Blacks and 540,877 (81.7%) Whites.Principal FindingsBlack Veterans were younger (median age 59 vs. 67) and more likely to suffer from PTSD (30.9% vs. 22.4%) and be unmarried (58.8% vs. 42.9%). CAN scores were lower for Blacks than Whites (mean [SD] 41.8 [28.2] vs 52.2 [28.1]) and appeared more unfair for Blacks than Whites (FNR 35.3% vs. 26.5%, meaning CAN under‐predicted death for Blacks versus Whites). When matching on comorbidities, the pooled mortality rate was lower for Blacks (2.1% vs. 3.6%), largely because younger Blacks had similar comorbidities to older White Veterans. This discrepancy was mitigated after additionally matching on age (pooled mortality 2.9% vs. 3.0%). Accounting for class imbalance marginally reduced unfairness for Blacks vs. Whites (FNR 34.1% vs. 25.4%).ConclusionsThe CAN score, a widely‐used VA risk model, underestimates mortality risk for Black relative to White Veterans. Differences in the age distributions strongly suggest statistical unfairness driven by confounded social factors. Addressing class imbalance only marginally improves fairness.Implications for Policy or PracticeThis is the first study to show systematic racial unfairness in a VA algorithm due to a relatively young and sick Black population, a mechanism of unfairness that could apply to other care management algorithms. Mitigating algorithmic unfairness may require data on social determinants of health and should be a priority to improve VA healthcare equity.Primary Funding SourceDepartment of Veterans Affairs.

Objective: To evaluate the efficacy and safety of Rupi Sanjie (RPSJ) capsule plus the conventional surgical operation for treatment of hyperplasia nodule of mammary gland. Methods: A meta-analysis was conducted on randomized controlled trials (RCT) related to RPSJ capsule plus surgical operation in the treatment of hyperplasia nodule of mammary gland. The methodological quality of eligible RCTs was assessed according to the criteria from the Cochrane Handbook for Systematic Reviews of Interventions. RevMan5.3 and Stata14.0 were used for data analyses. Trial sequential analysis was performed to estimate the sample size of systematic review base on TSA software v0.9. Results: Twenty-two RCTs were totally included in this study, involving 2135 patients. The result showed the clinical recurrence rate of RPSJ capsule plus surgical treatment group was significantly lower than surgical treatment alone group (RR: 0.25, 95％CI [0.17, 0.37], P<0.01). The clinical cure rate and total effective rate were higher in RPSJ capsule plus surgical treatment group than the conventional surgical treatment group (RR: 1.63, 95％CI [1.46, 1.82], P<0.01); (RR: 1.29, 95％CI [1.22, 1.37], P<0.01). Application of RPSJ capsule decreased the occurrence of adverse events including nausea, vomiting, irregular menstruation, constipation, dizziness, and headache etc. (RR: 0.90, 95％CI [0.54, 1.49], P=0.68). The results of trial sequential analysis demonstrated that the current available data did not reach the expected value. Conclusion: RPSJ capsule plus the conventional surgical treatment was more effective in reducing the clinical recurrence rate, and improving the total clinical effective rate and clinical cure rate, with a decrease in the occurrence of adverse events.

Objectives. To test whether fruit drink countermarketing messages alone or combined with water promotion messages reduce Latinx parents' purchases of fruit drinks for children aged 0 to 5 years. Methods. We performed a 3-arm randomized controlled online trial enrolling 1628 Latinx parents in the United States during October and November 2019. We assessed the effect of culturally tailored fruit drink countermarketing messages (fruit drink-only group), countermarketing and water promotion messages combined (combination group), or car-seat safety messages (control) delivered via Facebook groups for 6 weeks on parental beverage choices from a simulated online store. Results. The proportion of parents choosing fruit drinks decreased by 13.7 percentage points in the fruit drink-only group (95% confidence interval [CI] = -20.0, -7.4; P<.001) and by 19.2 percentage points in the combination group (95% CI = -25.0, 213.4; P<.001) relative to control. Water selection increased in both groups. Conclusions. Fruit drink countermarketing messages, alone or combined with water promotion messages, significantly decreased parental selection of fruit drinks and increased water selection for their children. Public Health Implications. Countermarketing social media messages may be an effective and low-cost intervention for reducing parents' fruit drink purchases for their children.

Background Identifying individuals at risk for future hospitalization or death has been a major priority of population health management strategies. High-risk individuals are a heterogeneous group, and existing studies describing heterogeneity in high-risk individuals have been limited by data focused on clinical comorbidities and not socioeconomic or behavioral factors. We used machine learning clustering methods and linked comorbidity-based, sociodemographic, and psychobehavioral data to identify subgroups of high-risk Veterans and study long-term outcomes, hypothesizing that factors other than comorbidities would characterize several subgroups. Methods and findings In this cross-sectional study, we used data from the VA Corporate Data Warehouse, a national repository of VA administrative claims and electronic health data. To identify high-risk Veterans, we used the Care Assessment Needs (CAN) score, a routinely-used VA model that predicts a patient’s percentile risk of hospitalization or death at one year. Our study population consisted of 110,000 Veterans who were randomly sampled from 1,920,436 Veterans with a CAN score≥75 th percentile in 2014. We categorized patient-level data into 119 independent variables based on demographics, comorbidities, pharmacy, vital signs, laboratories, and prior utilization. We used a previously validated density-based clustering algorithm to identify 30 subgroups of high-risk Veterans ranging in size from 50 to 2,446 patients. Mean CAN score ranged from 72.4 to 90.3 among subgroups. Two-year mortality ranged from 0.9% to 45.6% and was highest in the home-based care and metastatic cancer subgroups. Mean inpatient days ranged from 1.4 to 30.5 and were highest in the post-surgery and blood loss anemia subgroups. Mean emergency room visits ranged from 1.0 to 4.3 and were highest in the chronic sedative use and polysubstance use with amphetamine predominance subgroups. Five subgroups were distinguished by psychobehavioral factors and four subgroups were distinguished by sociodemographic factors. Conclusions High-risk Veterans are a heterogeneous population consisting of multiple distinct subgroups–many of which are not defined by clinical comorbidities–with distinct utilization and outcome patterns. To our knowledge, this represents the largest application of ML clustering methods to subgroup a high-risk population. Further study is needed to determine whether distinct subgroups may benefit from individualized interventions.

IMPORTANCE Financial incentives may improve health by rewarding patients for focusing on present actions-such as medication regimen adherence-that provide longer-term health benefits. OBJECTIVE To identify barriers to improving statin therapy adherence and control of cholesterol levels with financial incentives and insights for the design of future interventions. DESIGN, SETTING, AND PARTICIPANTS This qualitative study involved retrospective interviews with participants in a preplanned secondary analysis of a randomized clinical trial of financial incentives for statin therapy adherence. A total of 636 trial participants from several US insurer or employer populations and an academic health system were rank ordered by change in low-density lipoprotein cholesterol (LDLC) levels. Participants with the most LDLC level improvement (high-improvement group) and those with LDLC levels that did not improve (nonimprovement group) were purposively targeted, stratified across all trial groups, for semistructured telephone interviews that were performed from April 1 to June 30, 2018. Interviews were coded using a team-based, iterative approach. Data were analyzed from July 1, 2018, to October 31, 2020. MAIN OUTCOMES AND MEASURES The primary outcome was mean change in LDLC level from baseline to 12 months; the secondary outcome, statin therapy adherence during the first 6 months. RESULTS A total of 54 patients were interviewed, divided equally between high-improvement and nonimprovement groups, with a mean (SD) age of 43.5 (10.3) years; 36 (66.7%) were women, 28 (51.9%) had diabetes, and 18 (33.3%) had cardiovascular disease. Compared with the high-improvement group, the nonimprovement group had fewer interviewees with an annual income of greater than $50 000 (11 [40.7%] vs 22 [81.5%]), worse self-reported health (fair to poor, 13 [48.1%] vs 3 [11.1%]), more Black interviewees (16 [59.3%] vs 4 [14.8%]), and lower baseline LDLC levels (>160 mg/dL, 2 [7.4%] vs 25 [92.6%]). Participants in the nonimprovement group had a greater burden of chronic illness (>= 2 chronic conditions, 13 [48.1%] vs 6 [22.2%]) and were less frequently employed (full-time, 6 [22.2%] vs 12 [44.4%]). In interviews, the nonimprovement group was less focused on risks of high LDLC levels, described less engagement in LDLC level management, articulated fewer specific nutritional choices for optimizing health, and recounted greater difficulty obtaining healthy food. Participants in both groups had difficulty describing the structure of the financial incentives but did recall features of the electronic pill containers used to track adherence and how those containers affected medication routines. CONCLUSIONS AND RELEVANCE Participants in a statin adherence trial whose LDLC levels did not improve found it more difficult to create medication routines and respond to financial incentives in the context of complex living conditions and a high burden of chronic illness. These findings suggest that future studies should be more attentive to socioeconomic circumstances of trial participants.

IMPORTANCE Financial incentives may improve health behaviors. It is unknown whether incentives are more effective if they target a key process (eg, medication adherence), an outcome (eg, low-density lipoprotein cholesterol [LDL-C] levels), or both. OBJECTIVE To determine whether financial incentives awarded daily for process (adherence to statins), awarded quarterly for outcomes (personalized LDL-C level targets), or awarded for process plus outcomes induce reductions in LDL-C levels compared with control. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial was conducted from February 12, 2015, to October 3, 2018; data analysis was performed from October 4, 2018, toMay 27, 2021, at the University of Pennsylvania Health System, Philadelphia. Participants included 764 adults with an active statin prescription, elevated risk of atherosclerotic cardiovascular disease, suboptimal LDL-C level, and evidence of imperfect adherence to statin medication. INTERVENTIONS Interventions lasted 12 months. All participants received a smart pill bottle to measure adherence and underwent LDL-C measurement every 3 months. In the process group, daily financial incentiveswere awarded for statin adherence. In the outcomes group, participants received incentives for achieving or sustaining at least a quarterly 10-mg/dL LDL-C level reduction. The process plus outcomes group participants were eligible for incentives split between statin adherence and quarterly LDL-C level targets. MAIN OUTCOMES AND MEASURES Change in LDL-C level from baseline to 12 months, determined using intention-to-treat analysis. RESULTS Of the 764 participants, 390 were women (51.2%); mean (SD) age was 62.4 (10.0) years, 310 (40.6%) had diabetes, 298 (39.0%) had hypertension, and mean (SD) baseline LDL-C level was 138.8 (37.6) mg/dL. Mean LDL-C level reductions from baseline to 12 monthswere -36.9mg/dL (95% CI, -42.0 to -31.9mg/dL) among control participants, -40.0mg/dL (95% CI, -44.7 to -35.4mg/dL) among process participants, -41.6 mg/dL (95% CI, -46.3 to -37.0 mg/dL) among outcomes participants, and -42.8mg/dL (95% CI, -47.4 to -38.1mg/dL) among process plus outcomes participants. In exploratory analysis among participants with diabetes and hypertension, no spillover effects of incentives were detected compared with the control group on hemoglobin A1c level and blood pressure over 12 months. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, process-, outcomes-, or process plus outcomes-based financial incentives did not improve LDL-C levels vs control.

Background: Breast pain is one of the most common breast disorders, affecting 41%-69% women in the clinical populations. Chinese herbal medicine (Rupi Sanjie, RPSJ) capsule has been recommended to be commonly used for breast pain in China. This review aimed to systematically collect latest evidence and critically evaluate the eff;ectiveness and safety of RPSJ capsule for breast pain. Methods: We searched 6 databases from their inception to June 1, 2020 for randomized clinical trials (RCTs) comparing RPSJ capsule with conventional drug therapies, placebo or no treatment. Primary outcomes were breast pain relief, reduction of breast mass and clinical cure rate. Results: Seventeen RCTs were included in total, involving 2899 participants with breast pain. RPSJ capsule showed a significant effects in shortening duration of the breast pain (MD-6.51 days, 95%CI [-8.57, -4.45], n = 82, 1 trial), shortening the duration of breast mass (MD-5.17 days, 95%CI [-7.56, -2.78], n = 82, 1 trial), improving clinical cure rate (RR 1.55, 95% CI [1.21, 2.00], I2 = 64%, n = 1398, 10 trials) and total effective rate (RR 1.08, 95% CI [1.03, 1.14], I-2 = 71%, n = 2170, 14 trials) compared to Tamoxifen (TAM). The meta-analysis showed that the incidence of total adverse events was higher in TAM group than the RPSJ capsule group (RR 0.30, 95%CI [0.21, 0.42], I-2 = 49%, n = 2122, 13 trials). Conclusions: RPSJ capsule appears to be a potentially effective in treating breast pain and seems generally safe for clinical application. However, this potential benefit is inconclusive due to generally weak evidence, and the findings should be further confirmed in large and rigorous trials. (C) 2020 Korea Institute of Oriental Medicine. Publishing services by Elsevier B.V.

目的 分析中成药治疗乳腺增生症随机对照试验(randomized controlled trials,RCTs)的对照措施设置现状及存在的问题,为提高中成药RCTs的证据质量提供参考和建议.方法 检索中国知网、中国科技期刊数据库(维普)、万方学位及会议论文数据库、中国生物医学文献数据库(SinoMed)、美国国立医学图书馆(PubMed)、Cochrane图书馆及Embase等数据库,检索从建库至2018年12月所有相关中成药治疗乳腺增生症的RCTs.参考临床流行病学对照设置原则和方法对纳入文献对照措施设置情况进行分析.结果 纳入239项RCTs,均为中文发表,发表在1997—2018年间.纳入文献中对照药物文献数量最多的是西药三苯氧胺和中成药类,结果分别有102项(40.48％)和99项(39.29％),两类对照各个时段累计文献数量占总文献量的比例总体呈现增长趋势.安慰剂对照使用率偏低(2.78％),描述为其他对照措施的文献数量近年呈现递增趋势,文献中相关对照措施的选择比较混乱.结论 三苯氧胺在乳腺增生症临床研究中被作为阳性对照药的合理性值得进一步思考;与部分疗效缺乏证据支持的中成药或其他疗法互为对照,其对照措施设置提供的疗效证据存在不合理性,建议今后研究在明确研究目的的基础上采用肯定有效或无效的对照措施.

目的 调查新型冠状病毒肺炎(COVID-19)暴发期间肝移植受者服药依从性及生命质量,为今后突发公共卫生事件发生时对肝移植受者的健康管理提供依据.方法 2020年2月17日至2月21日对长期随诊于上海交通大学医学院附属仁济医院的183例成人肝移植受者进行问卷调查.问卷由一般资料、免疫抑制剂治疗依从性Basel评估量表(BAASIS)及肝移植后生活质量调查问卷(pLTQ)组成.经数据分析获得疫情期间肝移植受者服药依从性及生命质量情况,并通过多元线性回归分析探讨二者的影响因素.结果 180例样本纳入分析.肝移植受者服药依从性得分为(5.25±2.26)分,57.22％(103/180)受者依从性好;生命质量得分为(146.51±29.73)分.患者服药依从性的影响因素为术后未能正常工作(b'=-0.192,P=0.008)、术后时间长(b'=0.188,P=0.009)、少数民族(b'=0.186,P=0.010).患者生命质量的影响因素为睡眠质量差(b'=-0.252,P<0.01)、家庭人均月收入高(b'=0.212,P=0.003)、术后时间长(b'=0.177,P=0.009)、术后未能正常工作(b'=-0.150,P=0.036).结论 疫情期间肝移植受者的服药依从性较好、生命质量未受到明显影响.但术后正常工作、术后时间长和少数民族对服药依从性的负向影响,睡眠质量差、收入低、术后时间短、术后未能正常工作对生命质量的负向影响,临床中应引起充分重视.

目的 分析乳房保健对乳头凹陷孕妇产后乳腺炎发生率的影响.方法 系统检索PubMed、SinoMed、中国知网、万方及维普数据库中关于孕期乳房保健对乳头凹陷孕妇产后乳腺炎发生率影响的相关文献,检索时间为各库建库至2020年6月1日,资料提取和文献质量评价由2名研究者独立进行.效应量的表示和区间范围为相对危险度(RR)和95％CI,采用RevMan 5.3分析数据.采用TSAv 0.9软件对乳腺炎发生率结果进行试验序贯分析,估算Meta分析样本量和效应值强度.结果 共纳入20篇文献,患者2 091例.与不干预组和孕期常规健康教育组比较,乳房保健组乳头凹陷孕妇产后乳腺炎、乳头皲裂发生率更低(均P＜0.05).结论 在孕期实施乳房保健可降低乳头凹陷孕妇产后乳腺炎发生率.

Key Points Question What barriers to statin therapy adherence and control of cholesterol levels are revealed through qualitative interviews with participants in a randomized trial of financial incentives for adherence? Findings In this qualitative study of 54 participants, individuals whose cholesterol levels did not improve described a greater burden of chronic illness, were less frequently employed, were less focused on the risks of high cholesterol levels, appeared to have lower health literacy, were less engaged in their cholesterol level management, made fewer specific nutritional choices for optimizing health, and had greater difficulty obtaining healthy food compared with participants with marked improvement of cholesterol levels. Meaning These findings suggest that future interventions should consider addressing socioeconomic circumstances in combination with adherence interventions among patients needing to reduce cholesterol levels.