[On the history of the evolution of Evidence-based medicine and its revelation].

The notions of Evidence-based medicine developed through two phases, which successively looked into the doctor-patient relationship and decision-making background. One of the new trends in evidence-based medicine deals with how to make theory into practice. Applying the practical model from post-SSK to interpret how the notions of evidence-based medicine changed, it is found that evidence-based medicine is an indivisible practical network integrating many natural and social factors as well as material and cultural factors which interconnect through "translation". Therefore, the involvement of various factors such as natural matter, social relations, regional factors, resources of traditional culture and scientific instruments leads up to the ultimate theory becoming the result of multiple factors in a continuous process of seeking the best way in scientific practice. In this motile process, the borderline between nature and society, material and human, natural science and social science vanishes and a new stage called humanistic medicine appears.

[Analysis on the background of arising of Evidence-based medicine].

Science is coming from the background of social culture. Evidence-based medicine (EBM) was generated at the early 90's of 20th Century, and there were some landmark things before its appearance. The background of EBM included: (1) risk control of medical techniques at the 70s of 20th Century; (2) ethical ideas of Protestant, including secularism, rationalism and utilitarianism; (3) British positivism and its tradition.

[The basic concept of patient safety and its evolution].

Patient safety has become a hot topic and a big challenge for healthcare services globally during the past ten years. Patient safety is not a new concept but has its explicit cultural root. There were some related elaborations early in the collected works of Hippocrates. Reviewing the origin and developmental process of the concept of patient safety can benefit acquiring a deeper recognition of the basic concept of patient safety. "Medical risk is everywhere" has become the consensus of healthcare professions globally. Patient safety is a perpetual task of the medical area as well as the most basic starting point and final destination in healthcare service.

[Effect and safety of the therapies for acute myocardial infarction patients with failed thrombolytic therapy: a systematic review].

OBJECTIVE: To assess the effect and safety of therapies in common use for acute myocardial infarction (AMI) patients with failed thrombolytic therapy. METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 2, 2006), MEDLINE (1966 to July 2006), EMBASE (1984 to July 2006), China National Knowledge Infrastructure (CNKI, 1994 to July 2006), China Biomedicine Database disc (CBMdisc, 1980 to July 2006). We also searched several key Chinese journals in the field of cardiovascular diseases. The language was limited to Chinese and English. We included all the randomized controlled trials (RCTs) for acute myocardial infarction patients with failed thrombolytic therapy. Two authors independently assessed the methodological quality of the included studies, the data were analyzed by RevMan 4.2.8 from the Cochrane Collaboration. RESULTS: Nine RCTs met the inclusion criteria. A significant difference was found between the rescue percutaneous coronary intervention (PCI) group and conventional treatment group in the mortality rate at the end of the follow-up [RR=0.64, 95%CI (0.41, 0.98)]. Thromboembolic stroke and bleeding in rescue PCI group were significantly higher than that in conventional treatment group [RR=4.39, 95%CI (1.14, 16.87), and RR=2.79, 95%CI (1.55, 5.02), respectively]. Compared with conventional therapy, rescue thrombolytic treatment was associated with a significantly higher reperfusion rate [RR=2.92, 95%CI (1.75, 4.85)]. Comparison between rescue PCI with rescue thrombolytic treatment revealed that the revascularization rate in rescue PCI group was significantly lower than that in rescue thrombolytic group [RR=0.57, 95%CI (0.34, 0.95)], and the incidence of bleeding was significantly higher in rescue PCI group [RR=2.15, 95%CI (1.27, 3.63)]. Comparison of glycoprotein (GP)IIb/IIIa receptor antagonists with standard treatment showed no significant difference between them in the mortality rate and bleeding rate at the end of the follow-up. CONCLUSION: Current evidence does not confirm the effect or safety of the therapies for AMI patients with failed thrombolytic therapy, nor support the routine use of these therapies in clinical practice except for rescue PCI that reduces mortality compared with traditional treatment. Further high-quality randomized controlled trials are needed to provide reliable evidence for the treatments of AMI patients with failed thrombolytic therapy.