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[Objective]To explore the application and effect of traditional Chinese medicine(TCM)clinical decision-making system in the treatment of moderate or severe intrauterine adhesion(IUA).[Methods]A prospective randomized controlled trial was conducted.Patients with moderate or severe IUA who underwent hysteroscopic uterine adhesiolysis in a tertiary hospital of TCM in Hangzhou from January 2022 to December 2022 were selected.The patients were divided into control group(51 cases),decision system group(53 cases)and clinician group(54 cases)according to whether they were treated by TCM dominant disease clinical decision-making system.The improvement of menstrual volume,American Fertility Society(AFS)score,endometrial thickness,endometrial blood flow parameters and the efficacy of TCM accompanying symptoms were compared among the three groups before and after treatment.[Results]Compared with control group,the menstrual volume of decision system group and clinician group were significantly improved(P＜0.05),but there was no significant difference between decision system group and clinician group(P＞0.05).Compared with control group,the AFS scores of uterine cavity in decision system group and clinician group were significantly decreased(P＜0.01),and there was no significant difference between decision system group and clinician group(P＞0.05).The endometrial thickness was significantly increased and the endometrial blood flow parameters were significantly decreased in the three groups after treatment,and the differences were statistically significant(P＜0.01),but there was no significant difference among the three groups before and after treatment(P＞0.05).Compared with control group and decision system group,the clinical physician group had significantly improved efficacy of TCM accompanying symptoms(P＜0.05),and there was no significant difference between control group and decision system group(P＞0.05).[Conclusion]TCM clinical decision system for IUA can significantly improve the menstrual volume of patients with moderate or severe IUA,reduce postoperative AFS score and prevent the recurrence of adhesion.
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With the progress of dose individualization theory and research, decision-making systems have increasingly emerged in recent years. In this paper, common individualized dosing computer program, web platform and application on mobile devices are identified and summarized by searching literatures and internet, and compared with each other in terms of general characteristics and professional characteristics. Twenty-five systems are included in total. These systems, which estimate parameters mostly by Bayesian algorithm, cover anti-bacterial drugs and antiviral drugs, immunosuppressants, anti-tumor drugs, nervous system drugs, cardiovascular system drugs, respiratory system drugs and so on. MwPharm++, a commercial computer program, has the best comprehensive performance among all these. Besides, highlighted advantages are showed in commercial computer program Precise PK, APK, free computer program JPKD, BestDose and web platform SmartDose. Along with the development of internet and the high performance computing tools, mobile apps are booming. It is expected that the decision-making systems to be developed and promoted continuously in the future and could provide more options and references for clinical individualized dosing.
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Objective To discuss some problems about current learning objectives for the speciality of clinical medicine in China,including the concepts,the decision-making systems and value-orientation,and to provide the reference for stipulating the learning objectives in future. Methods The objectives of some Chinese medical universities were collected from their websites.Some medical educators were consulted about their feelings about these learning objectives,and also were asked to identify their own objectives. Results Medical educators failed to distinguish their own objectives,and there were four main problems in current learning objectives: generalization,similarity and lack of individuality,difficulty in guide the curricula and teaching,and setting up too high object. Conclusion The learning objectives in clinical medicine should reflect both specialty characteristic and university individuality,so they should be drawn up by teachers,students and educatirnal administrators,moreover their value orientation should be eligible standard,not excellence.