目的:系统评价单用蜂针或蜂针联合其他方法治疗类风湿性关节炎的效果。方法:检索中国生物医学文献数据库(CBM)、万方数据资源系统(Wan Fang Data)、中国知网(CNKI)、中文科技期刊数据库(VIP)截至2016年3月29日的文献,用Cohrane协作网系统综述手册5.0标准评价文献质量,用Rev Man 5.2软件进行Meta分析。结果:纳入文献11篇,共738例;单用蜂针的总有效率高于布洛芬+中药制剂(P<0.05);单用蜂针与甲氨蝶呤、单用蜂针与甲氨蝶呤+塞来昔布的总有效率比较无显著差异(P>0.05);蜂针+甲氨蝶呤与甲氨蝶呤、蜂针+甲氨蝶呤+柳氮磺吡啶+美洛昔康与甲氨蝶呤+柳氮磺吡啶+美洛昔康、蜂针+中药熏洗+芬必得+来氟米特+甲氨蝶呤与芬必得+来氟米特+甲氨蝶呤、蜂针+中药外敷+青霉素+双氯芬酸钠与青霉素+双氯芬酸钠的总有效率均是前者高于后者(P<0.05或P<0.01);蜂针+养血通痹汤与非甾体类消炎镇痛药+激素、蜂针+雷公藤与雷公藤的总有效率比较无显著差异(P>0.05)。结论:单用蜂针或联合蜂针能提高类风湿关节炎的疗效,但需更多高质量、大样本的随机对照试验证实。
Objective:Acupuncture is an efficient treatment modality for many different training,but the technique can be challenging to master.Identification of the different acupuncture points can now be practiced in a standardized and patient-safe simulation-based environment.We aim to gather additional evidence regarding simulation-based training of acupuncture skills and hope that the simulation-based test developed and will be used for simulation-based mastery learning in future develop.Methods:The aim of this study was to develop a test of acupuncture skills using the TCM(Traditional Chinese Medicine) Meridians & Acupoints Anatomy Teaching Platform and gather validity evidence using Messick’s framework.Novice medical students without prior experience in acupuncture(n=43),intermediate medical students who had finished the mandatory acupuncture course(n=24),and skilled acupuncture doctors(n=17) were included in the study.One-hundred and seven acupuncture points were presented to the participants in identical randomized order and they were asked to identify each point by touching the correct anatomical location on the simulator.The simulator automatically registered the accuracy of participants’ answers.Results:The reliability of the final test(66 acupuncture points) was at a high level with a Cronbach’s alpha of 0.98 and only 16 acupuncture points were needed to ensure a reliability of 0.90.The test could discriminate significantly between all three groups and a credible pass/fail-score of 34 points was determined which resulted in eight out of 43(19%) novices passing the test and only two out of 17(12%)experienced failing the test.These consequences were statistically significant(P <0.001).Conclusion:Based on Messick’s framework we demonstrated strong validity evidence for a newly developed simulation-based test of acupuncture points localization skills.The test can be used as an aid to decide when trainees are ready to progress to more advanced training and clinical practice.Compared with the traditional point
