Evidence-based decision-making

循证决策
  • 文章类型: Letter
    “致编辑的信”标题为“用于大骨瓣减压术的头皮切口技术:反向问号与已发表病例的替代耳后和Kempe切口技术的比较系统评价和荟萃分析”,详细分析了大骨瓣减压术中的不同头皮切口技术。虽然其系统的方法和宝贵的见解值得称赞,这封信有几个限制,包括搜索策略缺乏透明度,未能解决潜在的偏见来源,以及狭隘地关注技术方面,而不考虑更广泛的结果领域和实际考虑。尽管有这些限制,这封信强调了循证决策在神经外科实践中的重要性,并呼吁进一步研究以弥补这些差距.
    The \"Letter to the Editor\" titled \"Scalp incision technique for decompressive hemicraniectomy: comparative systematic review and meta-analysis of the reverse question mark versus alternative retroauricular and Kempe incision techniques of published cases\" provides a detailed analysis of different scalp incision techniques in decompressive hemicraniectomy procedures. While commendable for its systematic approach and valuable insights, the letter has several limitations, including a lack of transparency in the search strategy, failure to address potential sources of bias, and a narrow focus on technical aspects without considering broader outcome domains and practical considerations. Despite these limitations, the letter underscores the importance of evidence-based decision-making in neurosurgical practice and calls for further research to address these gaps.
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  • 文章类型: Journal Article
    人们通常依靠科学发现来帮助他们做出决定——然而,未能报告影响幅度可能会导致潜在的偏见,假设发现实际上是重要的。在两项在线研究中(多产;N=800),我们测量了美国成年人对媒体报道中描述的昂贵干预措施的认可,这些干预措施导致的影响很小,大,或组间未报告的量级。与那些认为干预措施效果较小的参与者相比,那些认为干预措施效果未报告的参与者更有可能认可干预措施,并且与那些认为干预措施效果较大的参与者一样可能认可干预措施。暗示了一种现实意义的偏见。当报告影响幅度时,参与者平均调整了他们的评价。然而,一些人,比如那些算术能力低的人,比其他人更有可能对小影响采取行动,即使明确提示首先考虑效果的意义。
    People often rely on scientific findings to help them make decisions-however, failing to report effect magnitudes might lead to a potential bias in assuming findings are practically significant. Across two online studies (Prolific; N = 800), we measured U.S. adults\' endorsements of expensive interventions described in media reports that led to effects that were small, large, or of unreported magnitude between groups. Participants who viewed interventions with unreported effect magnitudes were more likely to endorse interventions compared with those who viewed interventions with small effects and were just as likely to endorse interventions as those who viewed interventions with large effects, suggesting a practical significance bias. When effect magnitudes were reported, participants on average adjusted their evaluations accordingly. However, some individuals, such as those with low numeracy skills, were more likely than others to act on small effects, even when explicitly prompted to first consider the meaningfulness of the effect.
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  • 文章类型: Journal Article
    增加新的预防传染病的机会,有效的疫苗和全球免疫计划在整个生命过程中的扩展凸显了国家免疫技术咨询小组(NITAG)的循证决策(EIDM)的重要性和价值。美国疾病控制和预防中心(CDC)和全球卫生工作组(TFGH)已经开发并提供了新工具来支持EIDM中的NITAG。其中包括一个工具包,用于开展NITAG的便利培训,秘书处,或工作组使用证据建议(EtR)方法,就特定的疫苗政策向卫生部(MoH)提供建议,以及针对NITAG成员的EtR方法的在线学习模块,秘书处和其他机构。CDC和TFGH还支持NITAG成熟度评估工具(NMAT)的最终开发和实施,以评估七个功能域中NITAG能力的成熟度。迄今为止,与世界卫生组织(世卫组织)总部和区域办事处合作,通过参与30多个国家的讲习班,广泛推广了EtR工具包和电子学习,和世卫组织3个区域的大多数国家使用的NMAT评估工具(美洲,东地中海,African).在为多个国家规划和举办培训以及支持各国应用EtR方法完成疫苗建议的其他方法方面,已经吸取了重要的经验教训。未来工作的优先事项包括需要评估EtR培训和NMAT评估的影响,与合作伙伴合作,扩展和调整这些工具,以便更广泛地使用,与其他方法协同加强NITAG,并开发最佳方法来授权NITAG使用EtR方法。
    Increasing opportunities for prevention of infectious diseases by new, effective vaccines and the expansion of global immunization programs across the life course highlight the importance and value of evidence-informed decision-making (EIDM) by National Immunization Technical Advisory Groups (NITAGs). The U.S. Centers for Disease Control and Prevention (CDC) and Task Force for Global Health (TFGH) have developed and made available new tools to support NITAGs in EIDM. These include a toolkit for conducting facilitated training of NITAGs, Secretariats, or work groups on the use of the Evidence to Recommendations (EtR) approach to advise Ministries of Health (MoH) on specific vaccine policies, and an eLearning module on the EtR approach for NITAG members, Secretariat and others. The CDC and TFGH have also supported final development and implementation of the NITAG Maturity Assessment Tool (NMAT) for assessing maturity of NITAG capabilities in seven functional domains. The EtR toolkit and eLearning have been widely promoted in collaboration with the World Health Organization (WHO) Headquarters and Regional Offices through workshops engaging over 30 countries to date, and the NMAT assessment tool used in most countries in 3 WHO regions (Americas, Eastern Mediterranean, African). Important lessons have been learned regarding planning and conducting trainings for multiple countries and additional ways to support countries in applying the EtR approach to complete vaccine recommendations. Priorities for future work include the need to evaluate the impact of EtR training and NMAT assessments, working with partners to expand and adapt these tools for wider use, synergizing with other approaches for NITAG strengthening, and developing the best approaches to empower NITAGs to use the EtR approach.
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  • 文章类型: Journal Article
    背景:研究低患病率疾病,如多发性硬化症是具有挑战性的,因为受这种疾病影响的个体数量相当少,并且真实世界的数据分散在许多数据源中。这些障碍削弱了数据集成,标准化,和分析,这对重要有意义的临床证据的产生产生了负面影响。
    目的:本研究旨在提出一个全面的,研究问题-不可知论者,多利益相关者驱动的端到端数据分析管道,可容纳3种流行的数据共享流:个人数据共享,核心数据集共享,和联邦模型共享。
    方法:标准化采用需求驱动的方法,其次是3流的数据采集,数据质量增强过程,数据集成过程,和最后的分析阶段,以满足现实世界的数据共享要求。通过在COVID-19和多发性硬化症全球数据共享计划中的成功实施,证明了该管道的有效性。
    结果:全球数据共享计划产生了多种科学出版物,并为多发性硬化症社区提供了广泛的全球指导。该管道有助于从各种来源收集相关数据,容纳不同的共享流,并将它们同化为统一的数据集,用于后续的统计分析或安全的数据检查。这条管道促成了感染COVID-19的多发性硬化症患者的最大数据集的组装。
    结论:拟议的数据分析流程体现了全球利益相关者合作的潜力,并强调了基于证据的决策的重要性。它是数据共享计划如何推动医疗保健进步的范例,强调其适应性和应对各种研究查询的能力。
    BACKGROUND: Investigating low-prevalence diseases such as multiple sclerosis is challenging because of the rather small number of individuals affected by this disease and the scattering of real-world data across numerous data sources. These obstacles impair data integration, standardization, and analysis, which negatively impact the generation of significant meaningful clinical evidence.
    OBJECTIVE: This study aims to present a comprehensive, research question-agnostic, multistakeholder-driven end-to-end data analysis pipeline that accommodates 3 prevalent data-sharing streams: individual data sharing, core data set sharing, and federated model sharing.
    METHODS: A demand-driven methodology is employed for standardization, followed by 3 streams of data acquisition, a data quality enhancement process, a data integration procedure, and a concluding analysis stage to fulfill real-world data-sharing requirements. This pipeline\'s effectiveness was demonstrated through its successful implementation in the COVID-19 and multiple sclerosis global data sharing initiative.
    RESULTS: The global data sharing initiative yielded multiple scientific publications and provided extensive worldwide guidance for the community with multiple sclerosis. The pipeline facilitated gathering pertinent data from various sources, accommodating distinct sharing streams and assimilating them into a unified data set for subsequent statistical analysis or secure data examination. This pipeline contributed to the assembly of the largest data set of people with multiple sclerosis infected with COVID-19.
    CONCLUSIONS: The proposed data analysis pipeline exemplifies the potential of global stakeholder collaboration and underlines the significance of evidence-based decision-making. It serves as a paradigm for how data sharing initiatives can propel advancements in health care, emphasizing its adaptability and capacity to address diverse research inquiries.
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  • 文章类型: Journal Article
    背景:基于证据的决策是卫生信息系统的基础;然而,阿姆哈拉地区的决策者并不主要利用常规健康信息。因此,本研究旨在探讨机构和部门负责人对日常健康信息需求和使用决策的看法。
    方法:从2019年6月10日至2019年7月30日,在阿姆哈拉地区的八个地区进行了现象学定性研究。我们获得了书面知情同意书,并有目的地招募了22名关键线人。研究小组准备了一个码本,为想法分配代码,确定的显著模式,将类似的想法分组,并从数据中发展出主题。因此,数据使用OpenCode软件进行主题分析。
    结果:研究表明,卫生工作者收集了许多数据,但是很少有人要求和利用它来为决策提供信息。大多数受访者认为收集数据只是为了报告。缺乏数据管理技能,分析,解释,和使用是技术属性。个人属性包括员工积极性低,粗心大意,数据缺乏价值。数据访问不良,对健康信息系统的低支持,存档空间有限,资金不足与组织属性有关。背景(社会政治)因素也影响了eHealth应用程序的使用,以改善医疗保健提供者之间的数据需求和使用。
    结论:在这项研究中,卫生工作者收集常规健康数据仅用于报告,他们并没有要求和主要使用它来告知决策和解决问题。技术,个人,组织,和上下文属性是对常规健康数据的低需求和使用的原因。因此,我们建议建立卫生工作者的技术能力,引入激励机制并确保问责制度,以更好地使用数据。
    BACKGROUND: Evidence-based decision-making is a foundation of health information systems; however, routine health information is not mostly utilized by decision makers in the Amhara region. Therefore, this study aimed to explore the facility and department heads\' perceptions towards the demand for and use of routine health information for decision making.
    METHODS: A phenomenological qualitative study was done in eight districts of the Amhara region from June 10/2019 to July 30/2019. We obtained written informed consent and recruited 22 key informants purposively. The research team prepared a codebook, assigned codes to ideas, identified salient patterns, grouped similar ideas, and developed themes from the data. Thus, data were analyzed thematically using OpenCode software.
    RESULTS: The study revealed that health workers collected many data, but little was demanded and utilized to inform decisions. The majority of respondents perceived that data were collected merely for reporting. Lack of skills in data management, analysis, interpretation, and use were the technical attributes. Individual attributes included low staff motivation, carelessness, and lack of value for data. Poor access to data, low support for Health Information System, limited space for archiving, and inadequate finance were related to organizational attributes. The contextual (social-political) factors also influenced the use of eHealth applications for improved data demand and use among health care providers.
    CONCLUSIONS: In this study, health workers collect routine health data merely for reporting, and they did not demand and use it mostly to inform decisions and solve problems. Technical, individual, organizational, and contextual attributes were contributors to low demand and use of routine health data. Thus, we recommend building the technical capacity of health workers, introducing motivation mechanisms and ensuring accountability systems for better data use.
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  • 文章类型: Journal Article
    未经证实:2019年冠状病毒病(COVID-19)大流行导致有关严重急性呼吸道综合症冠状病毒2的文献迅速激增,以及大流行的更广泛影响。对COVID-19的研究以前所未有的速度进行,掌握最相关证据的能力是临床医生的首要任务,研究人员,公共卫生专业人员和政策制定者。本文介绍了加拿大公共卫生署开发和使用的知识综合方法,用于管理和维护文献监测系统,以识别,表征,每天分类和传播COVID-19证据。
    UNASSIGNED:COVID-19文献每日扫描项目包括一个系统过程,包括四个主要步骤:文献检索;相关性筛选;研究的分类和总结;以及传播每日报告。
    未经评估:截至2022年3月底,COVID-19数据库中大约有30万次COVID-19和与大流行相关的引用,其中50%-60%是初级研究。每一天,所有新的COVID-19引文的报告,文献亮点和更新的数据库的链接被生成并发送到超过200收件人的邮件列表,包括联邦,省和地方公共卫生机构和学术机构。
    UNASSIGNED:实时维护了COVID-19文献的中央资料库,以帮助加速证据综合活动,并在加拿大的大流行应对期间支持基于证据的决策。这个系统的过程可以应用于需要持续评估和传播证据的未来快速发展的公共卫生主题。
    UNASSIGNED: The coronavirus disease 2019 (COVID-19) pandemic has led to a rapid surge of literature on severe acute respiratory syndrome coronavirus 2 and the wider impacts of the pandemic. Research on COVID-19 has been produced at an unprecedented rate, and the ability to stay on top of the most relevant evidence is top priority for clinicians, researchers, public health professionals and policymakers. This article presents a knowledge synthesis methodology developed and used by the Public Health Agency of Canada for managing and maintaining a literature surveillance system to identify, characterize, categorize and disseminate COVID-19 evidence daily.
    UNASSIGNED: The Daily Scan of COVID-19 Literature project comprised a systematic process involving four main steps: literature search; screening for relevance; classification and summarization of studies; and disseminating a daily report.
    UNASSIGNED: As of the end of March 2022 there were approximately 300,000 COVID-19 and pandemic-related citations in the COVID-19 database, of which 50%-60% were primary research. Each day, a report of all new COVID-19 citations, literature highlights and a link to the updated database was generated and sent to a mailing list of over 200 recipients including federal, provincial and local public health agencies and academic institutions.
    UNASSIGNED: This central repository of COVID-19 literature was maintained in real time to aid in accelerated evidence synthesis activities and support evidence-based decision-making during the pandemic response in Canada. This systematic process can be applied to future rapidly evolving public health topics that require the continuous evaluation and dissemination of evidence.
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  • 文章类型: Journal Article
    国家免疫技术咨询委员会(NITAG)的任务是指导卫生部和国家免疫计划的政策制定过程。许多NITAG依赖于世界卫生组织(WHO)免疫战略专家组(SAGE)审查的证据,旨在使WHO的建议适应各自的情况。自从COVID-19大流行以来,这种关系变得格外重要,在此期间,面对供应限制和复杂的计划和交付物流,NITAG在制定关于人口优先次序和疫苗利用的适当政策方面表现出了显著的斗争。进行这项在线调查是为了评估SAGE指导文件对COVID-19疫苗政策的有用性,并研究NITAG面临的持续需求和挑战。结果证实,SAGE关于COVID-19疫苗的建议很容易获得,理解,和适应。在SAGE面临的数据和时间有限的情况下,发现它们是全面和及时的。全球NITAG网络(GNN)似乎是解决高收入国家问题的最受欢迎的工具,与支持世卫组织国家或区域办事处的低收入国家形成鲜明对比。NITAG非常重视与其他NITAG的互动,这需要便利,并可以从增加的机会中受益,尤其是在区域内。进一步注意到,一些NITAG不得不在大流行期间解决SAGE通常不考虑的问题,如供应链物流和疫苗需求。借鉴COVID-19的经验,通过制定更具体的程序和考虑更多不同类型的数据,为加强NITAG和大流行恢复工作提供了机会,包括实施有效性和吸收数据。世卫组织国家办事处人员也有机会越来越多地参与支持NITAG,同时确保各国的信息和证据需求在SAGE审议中得到充分反映。
    National Immunization Technical Advisory Committees (NITAGs) are tasked with the responsibility of guiding ministries of health and national immunization programmes in their policy development processes. Many NITAGs rely on evidence reviewed by the World Health Organization\'s (WHO) Strategic Group of Experts(SAGE) on immunization and aim to adapt WHO\'s recommendations to their respective contexts. This relationship took on exceptional importance since the onset of the COVID-19 pandemic, during which NITAGs have expressed a notable struggle to craft appropriate policies on population prioritization and vaccine utilization in the face of supply constraints and complex programmatic and delivery logistics. This online survey was conducted to assess the usefulness of the SAGE guidance documents for COVID-19 vaccine policies and to examine the persisting needs and challenges facing NITAGs. Results confirmed that SAGE recommendations concerning COVID-19 vaccines are easy to access, understand, and adapt. They have been found to be comprehensive and timely under the data and time constrained circumstances confronting SAGE. The Global NITAG Network (GNN) appears to be the most popular vehicle for addressing questions among high income countries, in contrast to lower income countries who favour WHO Country or Regional Offices. NITAGs place much value on interaction with other NITAGs, which requires facilitation and could benefit from increased opportunities, especially within regions. It is further noted that some NITAGs have had to tackle issues during the pandemic not typically considered by SAGE, such as supply chain logistics and vaccine demand. Learning from the COVID-19 experience offers opportunities to strengthen NITAGs and the pandemic recovery effort through the development of more concrete procedures and consideration of more varied types of data, including implementation effectiveness and uptake data. There is also an opportunity for an increasing involvement of Country Office WHO personnel to support NITAGs, while ensuring information and evidence needs of countries are adequately reflected in SAGE deliberations.
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  • 文章类型: Journal Article
    背景:培训培训师概念(TTT概念)以传授基于证据的实践能力,旨在促进基于证据的实践的实施。这项研究的目的是为卫生保健专业人员的学校教师开发和试点测试TTT培训计划。该计划基于德国循证医学网络(DNebM)建立的核心课程“循证决策”。
    方法:该研究是根据UKMRC框架进行的,用于复杂的干预措施,包括第1阶段(开发)和第2阶段(试点)。在第一阶段,干预是在系统文献检索的基础上进行建模的。在第二阶段,TTT概念在两所学校的教师中为医疗保健专业人员进行了试点。对于评估,在每个模块之后对参与者进行了简短的访谈;在培训期间进行了课堂观察,然后进行了焦点小组访谈。此外,在训练前收集基线特征并进行描述性评估.在课程之前和之后,使用关键健康能力测试(CHC测试)对关键健康能力进行了调查。问卷,根据Mayring的定性内容分析对访谈和课堂观察协议进行处理。计算人员参数±SD以确定能力水平。
    结果:试点于2018年9月和2019年9月至11月进行。来自两家培训机构的8名教师参加了培训。对焦点小组访谈和课堂观察协议的评估导致了一个由6个主要类别和17个子类别组成的类别系统。材料和方法的可行性可以在两个试点测试中证明。参与者确认了先前知识的重新激活和扩展。小组的规模受到赞赏;参与者在课程中积极参与,并受到刺激计划自己的课程。CHC测试的评估显示平均人参数为432±45(预测试,n=8)和512±65(后测,n=8)。
    结论:使用混合方法,结果表明了该课程的可行性。
    结论:需要在随机对照试验(RCT)中进一步评估以证明课程的有效性。
    BACKGROUND: Train-the-trainer concepts (TTT concepts) to impart evidence-based practice competences aim at promoting the implementation of evidence-based practice. The aim of this study was to develop and pilot-test a TTT training program for teachers at schools for health care professionals. The program is based on the core curriculum \"Evidence-based Decision-making\" set up by the German Network for Evidence-based Medicine e.V. (DNEbM).
    METHODS: The study was conducted according to the UKMRC framework for complex interventions and consisted of Phase 1 (Development) and Phase 2 (Piloting). In Phase 1, the intervention was modelled on the basis of a systematic literature search. In Phase 2, the TTT concept was piloted with teachers at two schools for health care professionals. For the evaluation, short interviews with the participants were carried out after each module; classroom observations took place during the training and were followed by a focus group interview. In addition, baseline characteristics were collected prior to the training and descriptively evaluated. Critical health competence was surveyed using the Critical Health Competence Test (CHC test) before and after the course. The questionnaires, interviews and classroom observation protocols were processed according to Mayring\'s qualitative content analysis. Person parameters ±SD were calculated to determine the level of competence.
    RESULTS: Piloting took place in September 2018 and from September to November 2019. Eight teachers from two training institutions participated. The evaluation of the focus group interviews and the classroom observation protocols resulted in a category system comprising 6 main and 17 subcategories. The feasibility of the materials and methods could be demonstrated in both pilot tests. Reactivation and extension of prior knowledge were confirmed by the participants. The small group size was appreciated; the participants took an active part during the lessons and were stimulated to plan their own lessons. The evaluation of the CHC test revealed average person parameters of 432 ± 45 (pretest, n=8) and 512 ± 65 (posttest, n=8).
    CONCLUSIONS: Using mixed methods, the results show the feasibility of the curriculum.
    CONCLUSIONS: Further evaluation in a randomized controlled trial (RCT) is needed to prove the efficacy of the curriculum.
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  • 文章类型: Journal Article
    学术卫生部门(AHD)是学术机构和政府卫生机构之间的合作伙伴关系。这些伙伴关系旨在提供互惠互利,包括学生现场实习和实习的机会。实践知情课程,和基于实践的研究。学术卫生部门一词的历史可以追溯到2000年,尽管在该日期之前有几个学术实践伙伴关系的例子。除了过去二十年来建立的AHD之外,其他形式的学术实践参与提供类似的互惠互利,如预防研究中心和公共卫生培训中心。当前对AHD的研究探讨了这些伙伴关系对产出的影响,结果,以及构成它们的单位的影响。这篇评论还考虑了关于AHD如何应对COVID-19大流行的最新观点,以及它们如何推进公共卫生应对结构性种族主义和促进卫生公平的努力。预计《公共卫生年度回顾》的最终在线发布日期,第44卷是2023年4月。请参阅http://www。annualreviews.org/page/journal/pubdates的订正估计数。
    The academic health department (AHD) is a partnership between an academic institution and a governmental health agency. These partnerships are meant to provide mutual benefits that include opportunities for student field placements and internships, practice-informed curriculum, and practice-based research. The term academic health department dates back only to 2000, although there are several examples of academic-practice partnerships prior to that date. In addition to AHDs that have been established over the past two decades, other forms of academic-practice engagement provide similar mutual benefits, such as prevention research centers and public health training centers. Current research on AHDs explores how these partnerships matter regarding the outputs, outcomes, and impacts of the units that comprise them. This review also considers the most recent perspectives on how AHDs have responded to the COVID-19 pandemic and how they might advance public health\'s efforts to address structural racism and promote health equity.
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  • 文章类型: English Abstract
    促进各国卫生技术评估(HTA)机制的制度化,世界卫生组织(世卫组织)出版了《卫生技术评估机制制度化:如何引入系统地将HTA机制制度化的五个步骤指南》,具体来说,建立任务;建立法律框架;审查或建立法律框架;建立机构和治理安排;评估和评价所需的程序和证据;以及监测和评价。中医药HTA可以为各级决策者合理选择中医药健康技术提供科学信息和决策依据,推动中医药医疗体系高质量发展。然而,中医HTA处于起步阶段,必须在全球标准文件的指导下开展相关工作,确保标准化,透明度,和公平。根据世卫组织的指导,本课题组提出了中医药HTA机制制度化的必要性和逻辑框架,有利于建立符合国情、适合中医药的HTA制度化机制,为中医HTA的研究提供科学指导,为中医医疗决策做出贡献。
    To promote the institutionalization of the health technology assessment(HTA) mechanism in various countries, World Health Organization(WHO) has published the Institutionalizing Health Technology Assessment Mechanisms: a How to Guide to introduce five steps of institutionalizing the HTA mechanism systematically, specifically, "establishing a mandate; establishing the legal framework; reviewing or establishing the legal framework; establishing institutional and governance arrangements; processes and evidence required for assessment and appraisal; and monitoring and evaluation". Traditional Chinese medicine(TCM) HTA can provide scientific information and decision-making evidence for decision-makers at all levels to select TCM health technology reasonably, and promote the high-quality development of the TCM healthcare system. However, TCM HTA is in its infancy, and it is imperative to carry out relevant work under the guidance of global standard documents to ensure standardization, transparency, and fairness. In light of the WHO guidance, this research group put forward the necessity and logical framework for the institutionalizing HTA mechanism of TCM, which is helpful to establish the institutionalizing HTA mechanism in line with national conditions and suitable for TCM, provide scientific guidance for the research of TCM HTA, and contribute to TCM healthcare decision-making.
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