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【社会人文】《柳叶刀》——临床研究在中国的
In western countries since the 19th century, clinical research has contributed greatly to the accumulation of knowledge regarding prevention, diagnosis, and treatment of disease and disability.[size=0.8em]1[/size] However, in general, it has been assumed that there has been a lower level of academic achievement in clinical research in China than that in the west. There are only very few Chinese publications in the first-class western journals, such as The Lancet and New England Journal of Medicine, and rarely are these Chinese reports influential.[size=0.8em]2[/size] Since only a few studies have examined the clinical research situation in China, our aim was to address the issue, and to offer advice for policy reform in clinical research and medical education.
We did a study in one comprehensive and national key university in China to investigate three aspects: the extent to which Chinese work is published in western journals; the extent of research activity and knowledge in practising hospital doctors; and the amount of research training received by medical students.
First, we did a computer literature search with PubMed for clinical research articles (2000—09) both in China and worldwide. Publications on clinical research, basic medical science, and randomised controlled trial (RCT) research were extracted. These were indexed under the “MESH” or “Publication type” fields using one or more specific headings.
We then did a cross-sectional survey in six affiliated hospitals of Peking University, Beijing, in 2007, to ascertain the extent of doctors' experience and involvement in research. Information was obtained from a self-completed questionnaire, which consisted of three main parts and a total of 43 questions. The first part was for demographic characteristics. The second was about practices and attitudes towards clinical research. The third comprised seven items (translated into Chinese) abstracted from the Fresno test—a simple, valid tool for assessing knowledge and skill in all the usual domains of evidence-based medicine.[size=0.8em]3[/size]
Further, we collected training information on undergraduate andgraduate courses for medical students. Three aspects were included: teaching content, credit hours, and assessment patterns, and information was obtained from the Department of Education in the University.
The literature search found that published articles related to basic medical science and clinical research from China increased on average by 31·2% and 22·0%, respectively, each year between 2000 and 2009 (figure). The basic medical science to clinical research ratio was on average 1·3:1 (range from 0·7:1 to 1·5:1). The number of RCTs done in China increased from 85 in 2000 to 743 in 2009, and constituted nearly a third of the total clinical research publications in China (3321 [31·9%]). China accounted for 1·5% and 1·7% of the total of the worldwide clinical research and RCT publications, respectively.
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Number and ratio of Chinese publications on basic science and clinical research, 2000—09
In total, 2005 doctors who were registered employees of the six hospitals were involved in the survey on doctors' experience and involvement in research. About 20% of the participants had led clinical research in the past 5 years, and 43% reported that they had done research under a leading researcher. The mean time spent on clinical treatment of patients was 8·4 units (half day/person/week), and 1·5 units for clinical research. Most responders (96·5%) believed that it was necessary to do clinical research and 97·1% of them had the intention of doing clinical research. However, only 54·8% put the ideas into action. The reasons for inaction included: insufficient research funding (67·6%), no available time (66·5%), and an unsupportive research environment (35·7%).
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作者:admin@医学,生命科学 2011-01-08 00:42
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