The Study On Quality Evaluation To TCM Treatment Literature And Model Application

1 Research backgroundWith the rapid development of TCM clinic,TCM clinical literature publication increased very quickly,and the universal application of computer and network technology make massive medical literature easily brought to every reader.So how to fully grasp useful information in the limited time available become the key issues which constrain the level and depth of researches,and knowledge services get more necessary than traditional information services.The rapid development of evidence-based medicine urges clinical medicine to undergo tremendous changes that is transforming from experience medicine to evidence-based medicine.Therefore,in all areas of clinical medicine a large-scale evaluation of medical literature is taken,aiming at give the literature a fair and scientific evaluation in order to use scientific,reliable and valuable medical literature in clinic,education,researches and health program decision.In this regard,the progress of TCM Informatics need to adapt to this change,actively meet the new needs of evidence-based TCM information services.At present,the evaluation of clinical literature is at the initial stage of drawing lessons from EBM and clinical epidemiology,not taking TCM special nature into account,which is not entirely suited to the needs of TCM clinical practice.Therefore, the most important issue in using clinical evidence to support clinical decision-making is the establishment of TCM's own hierarchy of evidence.In addition,TCM treatment is also different from the western medicine treatment, which is based on syndrome differentiation,and formula is an important method of treatment,whose feature is the combination use of herbs,which is very influential to evaluation result.From the groups,the formula is neither the same completely,nor different completely,just changing in addition and subtraction around a few common herb combinations,which is the rudiment of fundamental formula embodying internal changes rules in the formula groups,which can be taken advantages in TCM treatment evaluation. 2 Research contentsBased on the above analysis,my research aims at the evaluation and utilization of the literature of TCM treatment,for which established TCM treatment literature evidence hierarchy and formula tree analysis algorithm,on the basis of both set up a set of standardized methods of formula data utilization and a assistant platform of clinical decision-making in order to promote evidence usage,finally take example of the TCM literature of viral myocarditis to practice evidence evaluation and utilization,to verify the methodology established in this study.3 TCM evidence hierarchy of treatment literature3.1 The current hierarchy of clinical evidence and issuesAt present,the current clinical evidence hierarchy widely accepted,are Australian National Health and Medical Research Council evidence levels,national guideline clearinghouse evidence levels,Oxford -Center for Evidence-Based Medicine evidence levels.The problems of current clinical evidence hierarchy used in the evaluation of TCM treatment are:The clinical practice of TCM is non-group,but is individual,special,incidental treatment by syndromes.TCM practice not only need to consider the common pathogenesis of disease,but also need to adjust according to the differences of time,places and constitutions.The evaluation standard suitable for groups cannot be directly applied to the evaluation of TCM individualized practice without any adjustment.The existing evidence hierarchy does not reflect the core of TCM syndrome differentiation and treatment,thus the evidence got from them will actually be hard to apply to the real clinical practices of TCM.Expertise and case studies are closer to the individual essence of TCM syndrome differentiation and treatment,which should be upgraded in the evidence hierarchy.3.2 Classification principles and methods of TCM treatment literatureAccording to the above analysis,TCM treatment literature can be classified from three levels.First of all,syndrome differentiation and treatment,as the most essential feature of TCM,is taken as the first element of the grading.Secondly,clinical research type is taken as the second element.Finally,the quality of design and complement is taken as the third element.4 The basic formula and formula tree analysis algorithm4.1 The basic formula theoryThe establishment of TCM treatment literature evidence hierarchy makes high-quality evidences distinguished out,which accord with the theory and practice of TCM.But these formulas in high-quality evidences are not of consistency,differences existing more or less,which case great difficulties to classification and analysis of homogeneous formula.However,in spite of a great many changes in prescriptions, there are some laws named as basic formula we can find,that is,a number of herbs is the core makeup of a formula group changes and they can form many other formula in the addition and subtraction of herbs.4.2 Formula tree analytic algorithmsMy study,in accordance with the construction characteristics of TCM formula, using data mining theory related(association analysis),design a formula tree analytic algorithm in order to solve the problem of TCM basic formula calculation.4.2.1 Mathematical Model Encode formula and drug with variable m and n,and set up a variable a_m,n, meaning that if some drug contained in some formula,a_m,n equal to 1,if not contained, a_m,n equal to 0.By this way,establish a two-dimensional matrix.4.2.2 Basic rules of formula tree analytic algorithmRule 1:Prescription tree generated by the bottom.The herb contained in all the prescriptions is the root,but the root does not necessarily exist.Rule 2:If there is no root node,the herb of highest frequency appeared is the main node.Formulas with main nodes live in the main trunk,forming a collection of main nodes;formulas without main nodes live in the branch trunks,forming a collection of branches nodes.Rule 3:take loop computing by rule 2,nodes do not produce until there are no repeated herbs in rested formulas.Rule 4:If several herbs have the same frequencies,select the one spreading most other nodes as the node of this level.Rule 5:If a formula participate in a lower-level node producing but not a higher level node,this formula separate from other formulas and form a leaf between the lower-level node and the higher-level node4.2.3 The natures of formula treeNature 1:the frequency of herb is inversely proportional to its level,that is,the higher the frequency is,the lower the level is.Nature 2:the number of levels is in a positive correlation with the credibility of the basic formula,the similarity coefficient of some formulas above some a node is positively correlated with the feasibility of the basic formula under the node.Nature 3:the basic formula can be obtained from the tree trunk according to a certain degree of support and fitness.5 Evaluation and utilize of viral myocarditis literature with TCM treatment5.1 Obtain evidenceSearch in China Traditional Chinese Medicine Database Retrieval System from 1994 to 2003,with subject 'myocarditis',except for infectious,rheumatic and other non-viral myocarditis literature and acupuncture,massage,nursing,pharmacology and other types of literature,finally paper included totally.In accordance with the model of disease,syndrome,formula,herb,protocol regimen is taken out from literature data,finally 1155 records got.5.2 Evaluate evidenceAccording to TCM treatment literature evidence hierarchy,records is divided into grades as following.5.3 Use evidenceApplying the methods of formula data synthesis utilization to most 10 syndromes, calculate basic formulas and recommended formulas as following.Basic formula Recommended formula 5 Summary and innovationBased on TCM treatment literature evidence hierarchy and formula tree analysis algorithm,my study establishes the method of formula data synthesis utilization in order to give an identified and standardized flow of the evaluation.For transform from information services to knowledge services,my study built a assistant platform of clinical decision-making,a composite dynamic web exhibition of clinical relevant information,which is the extraction,aggregation and summary of high-quality clinical literature and provide original text downloading and recommended therapeutic regimen based on strictly evaluated evidences,supporting assistance to clinical decision-making.My study' innovation is:Bring forward TCM treatment literature evidence hierarchy,which suitable for TCM reality and EBM theory,based on TDS,considering impact factors with more perspective.Put forward to formula tree analysis algorithm,exhibiting graphical combination of prescription creatively,calculating the core of combination objectively and repeatedly,which is a try of TCM to explore its own data mining.6 ProspectsEvaluation of TCM clinical treatment cause a world-wide attention but not yet carried out deeply,my study is exploratory hoping useful for later study.Owing to time constraints,there are still parts of this study not completed during doctorial peoried,such as the verification of proof evaluation criteria,software development and so on.With the increasing of TCM clinical information,further research in data mining methods of this field,will improve the use efficiency of TCM data,information services to the traditional model to a knowledge services,will spur the transform from information services to knowledge services for clinical and scientific decision-making, will make TCM informatics play a greater role in the development of TCM.