本文選題：兒童多動癥　切入點：循證醫(yī)學　出處：《南京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:文獻研究結合Delphi法對兒童多動癥的中醫(yī)兒科臨床指南進行修訂,以期對中醫(yī)藥治療兒童多動癥提供臨床指導。方法:在循證醫(yī)學的基礎上,采用文獻研究、Delphi法專家調查問卷、專家論證會、同行征求意見、方法質量學評價及臨床一致性評價相結合的方法修訂兒童多動癥的中醫(yī)診療指南。文獻研究:檢索相關期刊論文(CNKI)、萬方全文數(shù)據(jù)庫、中文科技期刊數(shù)據(jù)庫(維普)、中國優(yōu)秀博碩士學位論文全文數(shù)據(jù)庫、COCHRANE圖書館、Clinical Trial、NGC等,檢索年限從2000年1月到 2016年3月,選擇中醫(yī)治療及中西醫(yī)結合治療、預防類文獻,嚴格按照文獻的納入標準和排除標準,對文獻進行篩選評價,對隨機臨床試驗評價采用改良Jadad量表大于等于3分的文獻作為治療性建議的證據(jù),對非隨機臨床試驗的評價采用MINORS條目評分總分大于等于13分的文獻作為治療性建議證據(jù),對Meta分析的文獻,采用AMSTAR量表評分大于等于5分文獻為證據(jù),并對文獻進行分析、總結、尋找規(guī)律,建立Excel數(shù)據(jù)庫,并對各項指標進行頻數(shù)頻率的統(tǒng)計學分析,完成文獻研究總結,編寫專家調查問卷。Delphi法專家調查問卷:在前期文獻研究的基礎上,編寫專家調查問卷,基于Delphi法的原則,以電子郵件的方式向全國36位專家發(fā)放兩輪專家問卷調查表,主要從均數(shù)(x)、等級和(S)及不重要百分比(R)、變異系數(shù)(CV)等指標進行評價,對兩輪專家調查問卷的結果進行分析,匯總專家意見并結合文獻研究,確定指南初稿。專家論證會:邀請相關專業(yè)的24位專家召開了專家論證會,工作組按專家論證會意見結合兩輪專家調查問卷分析結果及文獻研究結果,修改指南初稿,形成了指南征求意見稿。同行征求意見、方法質量學評價、臨床一致性評價:項目工作組于2015年10月13～31日向36家單位的50位同行業(yè)專家發(fā)送征求意見稿,根據(jù)其提出的意見修改指南征求意見稿形成評價稿。兒科專家指導組于2015年12月13～30日組織中醫(yī)兒科學,中西醫(yī)結合兒科學、溫病學的4位專家進行指南方法學的質量評價(AGREEⅡ工具)。并于2015年12月10日-2016年3月30日邀請12個三級甲等醫(yī)院開展了 201例臨床一致性評價,并根據(jù)專家質量方法學評價和臨床一致性評價反饋的意見,對評價稿又作了全面的整理、修改,2016年4月形成了指南審核稿。結果:結合兩輪專家調查問卷、專家論證會、同行征求意見、方法質量學評價及臨床一致性評價,匯總專家意見對本次指南進行修訂,最終完成了科學規(guī)范的兒童多動癥的中醫(yī)臨床診療指南,對2012版的指南進行了完善與更新。結論:在循證醫(yī)學的基礎上,采用改良Jadad量表、MINORS條目、AMSTAR量表對臨床治療性文獻進行分析篩選評價,對兒童多動癥的標準化、規(guī)范化的循證實踐意義深遠。與2012年的指南相比較,在病名、適用范圍、診斷標準及辨證分型方面都進行了調整與更新,并且新增了預防和調護的內(nèi)容。在兒童多動癥的中藥復方用藥規(guī)律方面,發(fā)現(xiàn)中醫(yī)治療兒童多動癥以補虛、安神、清熱、平肝為主,兼以健脾為主要治法。
[Abstract]:Objective: to research the Delphi method combined with TCM pediatrics clinical guidelines of children with ADHD were revised, in order to provide clinical guidance for the treatment of children with ADHD medicine. Methods: Based on evidence-based medicine, using literature research method, Delphi expert questionnaire, expert on card, peer comments, guidelines for TCM diagnosis and treatment methods quality evaluation and clinical evaluation of the combination of the consistency of the revision of children with ADHD. Literature research: Chinese retrieval Journal Full-text Database (CNKI), Wanfang database, Chinese journal database (D & P), Chinese master theses full-text database, COCHRANE library, Clinical Trial, NGC and so on, the retrieval period from January 2000 to March 2016, selection of combined treatment of traditional Chinese medicine treatment and prevention of traditional Chinese medicine and Western medicine, literature, in strict accordance with the inclusion criteria and exclusion criteria, screening evaluation of literature The price of randomized clinical trials evaluated by modified Jadad scale is greater than or equal to 3 points for the treatment of literature suggests that the evidence, evaluation of non randomized clinical trials using MINORS entry score of greater than or equal to 13 of the literature for the treatment of evidence, analysis of the Meta document, the AMSTAR score of greater than or equal to 5 documents as evidence, and the literature analysis, summary, find the law, establish the Excel database, and the indicators for statistical analysis of frequency, complete the research and preparation of.Delphi expert questionnaire method expert questionnaire: Based on the previous literatures, written expert questionnaire, Delphi method based on the principle of two rounds of expert questionnaire issued to the 36 experts by e-mail, mainly from the mean level (x), and (S) and a significant percentage (R), the coefficient of variation (CV) and other indicators Evaluation of two rounds of expert questionnaire results of the analysis, summary of expert opinion and combined with literature research, determine the draft guide. Experts will invite 24 experts convened the relevant professional experts will work according to the group of experts will combined with two rounds of expert analysis results and the results of questionnaire, revised draft guidelines the guide, form draft. Peer comments, the evaluation methods of quality, clinical evaluation of consistency: the project working group 50 on 13~31 October 2015 36 units of the same industry experts send draft, according to the views of the revised draft guidelines form evaluation draft. Pediatric expert group in December 2015 13~30, organization of Pediatrics of traditional Chinese medicine, pediatrics of traditional Chinese and Western medicine, quality evaluation methodology guide 4 experts of seasonal febrile disease (AGREE II tool) and in 2015. In December 10th March 30th -2016 invited 12 three hospitals to carry out clinical evaluation of consistency in 201 cases, and according to the expert feedback methodology of quality evaluation and clinical evaluation of consistency of opinion, evaluation and release a comprehensive collation, modify, April 2016 formed the audit guidelines draft. Results: the combination of two rounds of expert questionnaire and experts will peer comments, and evaluate the consistency of quality evaluation methods, summary of expert opinions to revise the guidelines, the final completion of the clinical diagnosis and treatment of scientific and standardized ADHD refers to the south, the 2012 edition of the guide to the improvement and update. Conclusion: Based on evidence-based medicine by using the modified Jadad scale, AMSTAR scale, MINORS entry, analyzed the selection and evaluation of clinical literature, standardization of children with ADHD, standardized evidence-based practice in 2012 and have far-reaching significance. Compared with the guidelines, for in the name of disease, scope, diagnostic criteria and TCM syndrome classification have been adjusted and updated, and added the prophylaxis and nursing content. The regularity of Chinese compound prescription Chinese medicine treatment of children with ADHD, found that children with ADHD with tonic, sedative, heat, calming the liver and the spleen. As the main treatment.

【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R277.7

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