iindaba

Isiphumo se-placebo sibhekisa kwimvakalelo yokuphucuka kwempilo kumzimba womntu ngenxa yolindelo oluhle xa ufumana unyango olungasebenziyo, ngelixa isiphumo esihambelanayo se-anti placebo kukuhla kokusebenza okubangelwa kulindelo olubi xa ufumana amachiza asebenzayo, okanye ukwenzeka kweziphumo ebezingalindelekanga ngenxa yolindelo olubi xa ufumana i-placebo, enokukhokelela ekuwohlokeni kwemeko. Ngokuqhelekileyo zikhona kunyango lwezonyango kunye nophando, kwaye zinokuchaphazela ukusebenza kwesigulane kunye neziphumo.

Isiphumo se-placebo kunye ne-anti-placebo effect ziziphumo eziveliswa kukulindela okulungileyo nokubi kwezigulane kwimeko yazo yezempilo, ngokulandelelanayo. Ezi ziphumo zinokuthi zenzeke kwiindawo ezahlukeneyo zeklinikhi, kubandakanywa nokusetyenziswa kweziyobisi ezisebenzayo okanye i-placebo yonyango kwimisebenzi yeklinikhi okanye izilingo, ukufumana imvume enolwazi, ukubonelela ngolwazi olunxulumene nonyango, kunye nokuqhuba imisebenzi yokukhuthaza impilo yoluntu. Isiphumo se-placebo sikhokelela kwiziphumo ezithandekayo, ngelixa i-anti-placebo effect ikhokelela kwiziphumo eziyingozi neziyingozi.

Umahluko kwimpendulo yonyango kunye neempawu zokubonisa phakathi kwezigulane ezahlukeneyo zingabalelwa ngokuyinxenye kwi-placebo kunye nemiphumo echasene ne-placebo. Kwinkqubo yonyango, ukuphindaphinda kunye nokuqina kweziphumo ze-placebo kunzima ukumisela, ngelixa phantsi kweemeko zovavanyo, ukuphindaphinda kunye nobukhulu beziphumo ze-placebo zibanzi. Ngokomzekelo, kwiimvavanyo ezininzi zeklinikhi eziphindwe kabini zokunyanga iintlungu okanye ukugula kwengqondo, impendulo kwi-placebo ifana naleyo yamachiza asebenzayo, kwaye ukuya kuthi ga kwi-19% yabantu abadala kunye ne-26% yabathathi-nxaxheba abalupheleyo abafumana i-placebo babike iziphumo zecala. Ukongeza, kulingo lwezonyango, ukuya kuthi ga kwi-1/4 yezigulane ezifumene indawo ye-placebo ziye zayeka ukusela iyeza ngenxa yeziphumo ebezingalindelekanga, icebisa ukuba isiphumo esichasene ne-placebo sinokukhokelela ekuyekisweni kwechiza okusebenzayo okanye ukungathotyelwa kakuhle.

Iinkqubo ze-neurobiological ze-placebo kunye ne-anti placebo effects
Impembelelo ye-placebo ibonakaliswe ukuba inxulunyaniswa nokukhutshwa kwezinto ezininzi, ezifana ne-opioids engapheliyo, i-cannabinoids, i-dopamine, i-oxytocin, kunye ne-vasopressin. Isenzo sento nganye sijolise kwinkqubo ekujoliswe kuyo (okt intlungu, intshukumo, okanye inkqubo yomzimba yokuzikhusela) kunye nezifo (ezifana nesifo samathambo okanye isifo sikaParkinson). Ngokomzekelo, ukukhutshwa kwe-dopamine kubandakanyeka kwimpembelelo ye-placebo kunyango lwe-Parkinson's disease, kodwa kungekhona kwimpembelelo ye-placebo kunyango lweentlungu ezingapheliyo okanye ezibuhlungu.

Ukwandiswa kweentlungu ezibangelwa yingcebiso yomlomo kwilingo (i-anti placebo effect) ibonakaliswe ukuba ixutywe yi-cholecystokinin ye-neuropeptide kwaye inokuvinjelwa yi-proglutamide (oluhlobo lwe-A kunye nohlobo lwe-B receptor antagonist ye-cholecystokinin). Kubantu abasempilweni, olu lwimi lubangela ukuba i-hyperalgesia idityaniswe nomsebenzi owandisiweyo we-hypothalamic pituitary adrenal axis. Ichiza le-benzodiazepine i-diazepam linokuchasa i-hyperalgesia kunye nokungasebenzi kakuhle kwe-hypothalamic pituitary adrenal axis, iphakamisa ukuba ixhala liyabandakanyeka kwezi ziphumo zokulwa ne-placebo. Nangona kunjalo, i-alanine inokuthintela i-hyperalgesia, kodwa ayikwazi ukuthintela ukugqithisa kwe-hypothalamic pituitary adrenal axis, ebonisa ukuba inkqubo ye-cholecystokinin ibandakanyeka kwi-hyperalgesia inxalenye ye-anti-placebo effect, kodwa kungekhona kwindawo yokuxhalabisa. Impembelelo yofuzo kwi-placebo kunye ne-anti-placebo iziphumo inxulumene ne-haplotypes ye-nucleotide polymorphisms enye kwi-dopamine, i-opioid, kunye ne-endogenous cannabinoid genes.

Inqanaba lomthathi-nxaxheba lwe-meta-analysis of 20 functional neuroimaging studies ezibandakanya abathathi-nxaxheba be-603 abaphilileyo babonise ukuba umphumo we-placebo ohambelana nentlungu unempembelelo encinci kwiimpawu ze-imaging ezisebenzayo ezinxulumene nentlungu (ezibizwa ngokuba zisayinwe zentlungu ye-neurogenic). Isiphumo se-placebo sinokudlala indima kumanqanaba amaninzi othungelwano lobuchopho, olukhuthaza iimvakalelo kunye nefuthe lazo kumava eentlungu ezininzi. Ingqondo kunye ne-spinal cord imaging ibonisa ukuba i-anti-placebo effect ikhokelela ekwandeni kokudluliselwa komqondiso weentlungu ukusuka kwintambo yomgogodla ukuya kwingqondo. Kuvavanyo lokuvavanya impendulo yabathathi-nxaxheba kwiikhrimu ze-placebo, la makhrimu achazwa njengebangela intlungu kwaye abhalwe njengexabiso eliphezulu okanye eliphantsi. Iziphumo zibonise ukuba imimandla yokuhanjiswa kweentlungu kwingqondo kunye nentambo yomgogodla yasebenza xa abantu belindeleke ukuba bafumane intlungu enzima emva kokufumana unyango ngamakhrimu amaxabiso aphezulu. Ngokufanayo, ezinye iimvavanyo ziye zavavanya iintlungu ezibangelwa bubushushu obunokukhululwa ngeyeza elinamandla le-opioid remifentanil; Phakathi kwabathathi-nxaxheba abakholelwa ukuba i-remifentanil iyekisiwe, i-hippocampus yasebenza, kwaye i-anti placebo effect yavala ukusebenza kwechiza, iphakamisa ukuba uxinzelelo kunye nememori zibandakanyeka kule mpembelelo.

Okulindelweyo, iingcebiso zoLwimi, kunye neziphumo zeNkqubo-sikhokelo
Iziganeko zemolekyuli kunye nothungelwano lwe-neural utshintsho olusisiseko se-placebo kunye neziphumo ezichasene ne-placebo zilawulwa ziziphumo zabo ezilindelekileyo okanye ezibonwayo kwixesha elizayo. Ukuba ulindelo lunokufezekiswa, lubizwa ngokuba lulindelo; Ulindelo lunokulinganiswa kwaye luphenjelelwe lutshintsho kwimbono kunye nokuqonda. Ukulindela kunokuveliswa ngeendlela ezahlukeneyo, kubandakanywa namava angaphambili emiphumo yeziyobisi kunye nemiphumo emibi (njengeempembelelo ze-analgesic emva kweyeza), imiyalelo yomlomo (njengokwaziswa ukuba iyeza elithile linokunciphisa intlungu), okanye ukuqwalaselwa kwentlalo (njengokuqwalasela ngokuthe ngqo ukukhululeka kweempawu kwabanye emva kokuthatha iyeza elifanayo). Nangona kunjalo, ezinye izinto ezilindelweyo kunye ne-placebo kunye ne-anti-placebo iziphumo azinakwenzeka. Ngokomzekelo, sinokwenza ngokwemiqathango iimpendulo ze-immunosuppressive kwizigulana ezenza utyando lwezintso. Indlela yobungqina kukusebenzisa i-stimuli engathathi hlangothi ngaphambili idityaniswe ne-immunosuppressants kwizigulane. Ukusetyenziswa kwe-neutral stimulation yodwa kwakhona kunciphisa ukwanda kweeseli ze-T.

Kwiimeko zeklinikhi, ukulindela kuphenjelelwa yindlela echazwe ngayo iziyobisi okanye "isakhelo" esisetyenzisiweyo. Emva kotyando, xa kuthelekiswa nolawulo lwesigqubuthelo apho isigulane singayazi ixesha lokulawula, ukuba unyango oluya kufumana ngelixa ulawula i-morphine lubonisa ukuba lunokunciphisa ngempumelelo intlungu, kuya kuzisa inzuzo ebalulekileyo. Iziyalezo ezithe ngqo zeziphumo ebezingalindelekanga zinokuzanelisa. Uphononongo lwalubandakanya izigulane eziphathwe nge-beta blocker atenolol ngenxa yesifo senhliziyo kunye noxinzelelo lwegazi, kwaye iziphumo zibonise ukuba iziganeko zecala lezesondo kunye ne-erectile dysfunction yayiyi-31% kwizigulane ezaziziswe ngamabomu ngemiphumo enokubakho, ngelixa isiganeko sasiyi-16% kuphela kwizigulane ezingazange zichazwe ngemiphumo emibi. Ngokufanayo, phakathi kwezigulane ezithatha i-finasteride ngenxa yokwandiswa kwe-prostate ene-benign, i-43% yezigulane ezichazwe ngokucacileyo ngemiphumo yecala yezesondo zafumana iziphumo ezibi, ngelixa phakathi kwezigulane ezingazange zichazwe ngemiphumo emibi yesondo, le nxalenye yayiyi-15%. Uphononongo lubandakanya izigulana zombefu ezaphefumlela i-nebulize saline kwaye zaziswe ukuba ziphefumla izinto ezingafuniyo. Iziphumo zibonise ukuba malunga nesiqingatha sezigulana ziye zafumana ubunzima bokuphefumla, ukunyuka kokumelana nomoya, kunye nokuncipha kwemiphunga. Phakathi kwabaguli abanesifo sombefu abaphefumle iibronchoconstrictors, abo baye baxelelwa ngeebronchoconstrictors baba noxinzelelo olukhulu lokuphefumla kunye nokunganyangeki komoya kunabo baxelelwa ngeebronchodilators.

Ukongeza, ulindelo olubangelwa lulwimi lunokubangela iimpawu ezithile ezinjengeentlungu, ukurhawuzelelwa, kunye nesicaphucaphu. Emva kwesiphakamiso solwimi, i-stimuli ehambelana nentlungu ephantsi ingabonwa njengentlungu ephakamileyo, ngelixa i-tactile stimuli ingabonwa njengentlungu. Ukongeza kokunyanzelwa okanye ukwandisa iimpawu, ukulindela okungalunganga kunokunciphisa ukusebenza kwamachiza asebenzayo. Ukuba ulwazi lobuxoki lokuba iyeza liza kwandisa kunokuba linciphise intlungu idluliselwe kwizigulane, umphumo we-analgesics wendawo unokuvalelwa. Ukuba i-5-hydroxytryptamine receptor agonist rizitriptan ibhalwe ngephutha njenge-placebo, inokunciphisa ukusebenza kwayo ekuphatheni ukuhlaselwa kwemigraine; Ngokufanayo, ulindelo olubi lunokunciphisa umphumo we-analgesic wamachiza e-opioid kwiintlungu ezibangelwa uvavanyo.

Iindlela zokufunda kwi-placebo kunye neziphumo ezichasene ne-placebo
Zombini ukufunda kunye nemeko yeklasiki zibandakanyeka kwi-placebo kunye neziphumo ezichasene ne-placebo. Kwiimeko ezininzi zeklinikhi, ukuvuselela okungathathi hlangothi ngaphambili okudityaniswa nemiphumo enenzuzo okanye eyingozi yamachiza ngokusebenzisa i-classical conditioning inokuvelisa izibonelelo okanye iziphumo ebezingalindelekanga ngaphandle kokusetyenziswa kweziyobisi ezisebenzayo kwixesha elizayo.

Umzekelo, ukuba iimpawu zokusingqongileyo okanye incasa zidityaniswe ngokuphindaphindiweyo ne-morphine, iimpawu ezifanayo ezisetyenziswa ne-placebo endaweni ye-morphine zisengavelisa iziphumo zokuthomalalisa iintlungu. Kwizigulana ze-psoriasis ezifumene ukusetyenziswa kwekhefu ledosi encitshisiweyo ye-glucocorticoids kunye ne-placebo (ebizwa ngokuba yi-dose yokwandisa indawo ye-placebo), izinga lokuphinda kwe-psoriasis lalifana nelo lezigulane ezifumana unyango olupheleleyo lwe-glucocorticoid. Kwiqela lokulawula izigulane ezifumene i-regimen yokunciphisa i-corticosteroid efanayo kodwa ayizange ifumane indawo ye-placebo ngamaxesha, izinga lokuphindaphinda laliphezulu ngokuphindwe kathathu kweqela le-placebo lokuqhubeka kwedosi. Iziphumo ezifanayo zokulungiswa kwemeko ziye zaxelwa kunyango lokuphuthelwa okungapheliyo kunye nokusetyenziswa kwe-amphetamines kubantwana abanengxaki yokungakhathali.

Amava onyango lwangaphambili kunye neendlela zokufunda zikwaqhuba impembelelo ye-anti placebo. Phakathi kwabasetyhini abafumana i-chemotherapy ngenxa yomhlaza webele, i-30% yabo iya kulindela isicaphucaphu emva kokuvezwa kwezinto ezisingqongileyo (ezifana nokuza esibhedlele, ukudibana nabasebenzi bezonyango, okanye ukungena kwigumbi elifana negumbi lokungena) ababengathathi hlangothi ngaphambi kokuba bavezwe kodwa babedibene nokuxiliswa. Abantwana abasandul 'ukuzalwa abaye bafumana i-venipuncture ephindaphindiweyo ngokukhawuleza babonisa ukukhala kunye neentlungu ngexesha lokucocwa kotywala eluswini lwabo ngaphambi kokuba babulawe. Ukubonisa i-allergies kwizikhongozeli ezitywiniweyo kwizigulana ze-asthma kunokubangela uhlaselo lwe-asthma. Ukuba ulwelo olunevumba elithile kodwa ngaphandle kweziphumo eziluncedo zebhayoloji ludityaniswe nechiza elisebenzayo elineziphumo ebezingalindelekanga ezibalulekileyo (ezifana ne-tricyclic antidepressants) ngaphambili, ukusetyenziswa kolwelo nge-placebo nako kunokubangela iziphumo ebezingalindelekanga. Ukuba iimpawu ezibonakalayo (ezifana nokukhanya kunye nemifanekiso) zaye zadibaniswa ngaphambili kunye neentlungu ezibangelwa uvavanyo, ngoko ukusebenzisa ezi mpawu ezibonakalayo zodwa kunokubangela intlungu kwixesha elizayo.

Ukwazi amava abanye nako kunokukhokelela kwi-placebo kunye neziphumo ezichasene ne-placebo. Ukubona ukuthomalaliswa kweentlungu kwabanye kunokubangela isiphumo se-placebo analgesic, esifana nobukhulu kwisiphumo se-analgesic esifunyenwe nguwe phambi kokuba unyango. Kukho ubungqina bokulinga ukucebisa ukuba indawo yentlalo kunye nokubonakaliswa kunokubangela iziphumo ebezingalindelekanga. Ngokomzekelo, ukuba abathathi-nxaxheba bafaka ubungqina kwabanye abachaza iziphumo zecala le-placebo, baxela intlungu emva kokusebenzisa i-ointment engasebenziyo, okanye ukukhupha umoya wangaphakathi ochazwe ngokuthi "unokuthi ube netyhefu," kunokukhokelela kwimiphumo emibi kubathathi-nxaxheba abavezwe kwi-placebo efanayo, i-ointment engasebenzi, okanye umoya wangaphakathi.

Imithombo yeendaba ezininzi kunye neengxelo zeendaba ezingezizo ezobuchwephesha, ulwazi olufunyenwe kwi-Intanethi, kunye nokunxibelelana ngokuthe ngqo nabanye abantu abaneempawu zonke zinokukhuthaza ukusabela okuchasene ne-placebo. Umzekelo, izinga lokunika ingxelo leempembelelo ezingalunganga kwi-statins linxulunyaniswa nobunzulu bengxelo engeyiyo malunga neestatins. Kukho umzekelo ocacileyo ngakumbi apho inani leziganeko ezimbi ezixeliweyo zanda ngamaxesha e-2000 emva kweengxelo zeendaba ezimbi kunye neethelevishini zibonise utshintsho oluyingozi kwifomula yeyeza le-thyroid, kwaye zibandakanya kuphela iimpawu ezithile ezikhankanywe kwiingxelo ezimbi. Ngokunjalo, emva kokunyuswa koluntu kukhokelela abahlali basekuhlaleni ukuba bakholelwe ngempazamo ukuba bachanabeke kwizinto eziyityhefu okanye inkunkuma eyingozi, izehlo zeempawu zibalelwa kubhengezo olucingelwayo lonyuka.

Impembelelo ye-placebo kunye ne-anti-placebo iziphumo kuphando kunye nokusebenza kweklinikhi
Kunokuba luncedo ukumisela ukuba ngubani otyekele kwi-placebo kunye neziphumo ezichasene ne-placebo ekuqaleni konyango. Ezinye iimpawu ezinxulumene nezi mpendulo ziyaziwa ngoku, kodwa uphando lwexesha elizayo lunokubonelela ngobungqina obungcono bokusebenza kwezi mpawu. Ukuba nethemba kunye nokuba sesichengeni kwingcebiso akubonakali ngathi kusondelelene nempendulo kwi-placebo. Kukho ubungqina obubonisa ukuba impembelelo ye-anti placebo inokwenzeka kakhulu kwizigulane ezixhalabileyo, eziye zafumana iimpawu zezizathu zonyango ezingaziwayo, okanye ezinokukhathazeka okukhulu kwengqondo phakathi kwabo bathatha amachiza asebenzayo. Okwangoku akukho bungqina bucacileyo malunga nendima yesini kwi-placebo okanye kwimiphumo echasene ne-placebo. Ukwenza umfanekiso, umngcipheko wemfuza emininzi, izifundo zonxulumano olubanzi lwe-genome, kunye nezifundo ezingamawele zinokunceda ukucacisa ukuba iindlela zobuchopho kunye nemfuzo zikhokelela njani kutshintsho lwebhayoloji olusebenza njengesiseko se-placebo kunye neziphumo ezichasene ne-placebo.

Ukusebenzisana phakathi kwezigulane kunye noogqirha beklinikhi kunokuchaphazela amathuba okuba nemiphumo ye-placebo kunye nemiphumo emibi echazwe emva kokufumana i-placebo kunye neziyobisi ezisebenzayo. Ukuthembela kwezigulane koogqirha bezonyango kunye nobudlelwane babo obuhle, kunye nokunxibelelana ngokunyanisekileyo phakathi kwezigulane kunye noogqirha, kubonakaliswe ukunciphisa iimpawu. Ngoko ke, abaguli abakholelwa ukuba oogqirha banovelwano baze bachaze iimpawu zomkhuhlane oqhelekileyo bathamba yaye bafutshane ixesha kunabo bakholelwa ukuba oogqirha abanaluvelwano; Izigulane ezikholelwa ukuba oogqirha banovelwano nabo bafumana ukuhla kwezikhombisi zenjongo zokuvutha, ezifana ne-interleukin-8 kunye ne-neutrophil count. Ukulindela okulungileyo koogqirha beklinikhi nabo badlala indima kwimpembelelo ye-placebo. Uphononongo oluncinci oluthelekisa i-anesthetic analgesics kunye nonyango lwe-placebo emva kokutsalwa kwezinyo lubonise ukuba oogqirha babeyazi ukuba izigulane ezifumana i-analgesics zidibene nokunciphisa intlungu enkulu.

Ukuba sifuna ukusebenzisa isiphumo se-placebo ukuphucula iziphumo zonyango ngaphandle kokwamkela indlela yobuzali, enye indlela kukuchaza unyango ngendlela eyiyo kodwa eyakhayo. Ukuphakamisa ukulindela kweenzuzo zonyango kuye kwaboniswa ukuphucula impendulo yesigulane kwi-morphine, i-diazepam, ukuvuselela ingqondo enzulu, ukulawulwa kwe-intravenous ye-remifentanil, ulawulo lwendawo ye-lidocaine, unyango oluncedisayo kunye noludibeneyo (njenge-acupuncture), kunye nokuhlinzwa.

Ukuphanda ulindelo lwesigulane linyathelo lokuqala lokubandakanya oku kulindelekileyo kwimisebenzi yeklinikhi. Xa uvavanya iziphumo ezilindelekileyo zeklinikhi, izigulane zingacelwa ukuba zisebenzise isikali se-0 (akukho nzuzo) kwi-100 (inzuzo enkulu enokucingelwa) ukuvavanya izibonelelo zabo zonyango ezilindelekileyo. Ukunceda izigulane ziqonde ukulindela kwabo utyando olukhethiweyo lwentliziyo kunciphisa iziphumo zokukhubazeka kwiinyanga ze-6 emva kokuhlinzwa; Ukubonelela ngesikhokelo malunga nezicwangciso zokuhlangabezana nezigulane ngaphambi kokuhlinzwa kwe-intra-abdominal kunciphisa kakhulu intlungu emva kokuhlinzwa kunye ne-anesthesia yeyeza (nge-50%). Iindlela zokusebenzisa ezi ziphumo zesakhelo azibandakanyi kuphela ukucacisa ukufaneleka kwonyango kwizigulane, kodwa nokucacisa umlinganiselo wezigulane ezixhamla kuyo. Ngokomzekelo, ukubethelela ukusebenza kakuhle kwamayeza kwizigulana kunokunciphisa imfuneko yokuthomalalisa iintlungu emva kotyando ezinokuthi izigulana zizilawule ngokwazo.

Kwinkqubo yonyango, kunokubakho ezinye iindlela ezisesikweni zokusebenzisa impembelelo ye-placebo. Olunye uphononongo luxhasa ukusebenza kwenkqubo “yeleyibhile evulekileyo ye-placebo”, ebandakanya ukunika i-placebo kunye nechiza elisebenzayo kunye nokwazisa ngokunyanisekileyo izigulane ukuba ukongeza i-placebo kungqiniwe ukuba kuphuculwe iziphumo eziluncedo zechiza elisebenzayo, ngaloo ndlela liphucula ukusebenza kwalo. Ukongeza, kunokwenzeka ukugcina ukusebenza kwechiza elisebenzayo ngokulungisa imeko ngelixa unciphisa kancinci umthamo. Indlela yokusebenza ethile kukudibanisa ichiza kunye neempawu zoluvo, oluluncedo ngakumbi kwiziyobisi eziyityhefu okanye ezikhobokisayo.

Ngokuchasene noko, ulwazi oluxhalabisayo, iinkolelo eziphosakeleyo, izinto ezilindelekileyo, amava amabi adlulileyo, ulwazi lwentlalo, kunye nemeko yonyango kunokukhokelela kwiziphumo ebezingalindelekanga kunye nokunciphisa izibonelelo zonyango lweempawu kunye nokuthomalalisa. Iziphumo ebezingalindelekanga ezingezizo ezithile zamachiza asebenzayo (ezikhawulekileyo, ezingafaniyo, ezizimeleyo, kunye nokuphindaphindeka okungathembekanga) zixhaphakile. Ezi ziphumo zecala zingakhokelela ekubambeni kakubi kwezigulane kwisicwangciso sonyango (okanye isicwangciso sokuyeka) esichazwe ngugqirha, sifuna ukuba batshintshele kwelinye iyeza okanye bongeze amanye amayeza ukunyanga le miphumo emibi. Nangona sifuna uphando olongezelelweyo ukumisela unxulumano olucacileyo phakathi kwezi zibini, ezi ziphumo bezingalindelekanga zingabangwa yimpembelelo ye-anti placebo.

Kusenokuba luncedo ukuchaza imiphumo engathandekiyo kwisigulana ngelixa ubalaselisa iinzuzo. Kwakhona kunokuba luncedo ukuchaza iziphumo ebezingalindelekanga ngendlela exhasayo kunendlela ekhohlisayo. Ngokomzekelo, ukuchazela izigulane umlinganiselo wezigulane ngaphandle kwemiphumo emibi, kunokuba umlinganiselo wezigulane ezinemiphumo emibi, unokunciphisa iziganeko zale miphumo.

Oogqirha banesibophelelo sokufumana imvume echanekileyo yolwazi kwizigulane ngaphambi kokuphumeza unyango. Njengenxalenye yenkqubo yemvume enolwazi, oogqirha kufuneka banike ulwazi olupheleleyo ukuze bancede izigulane ekwenzeni izigqibo ezinolwazi. Oogqirha kufuneka bachaze ngokucacileyo nangokuchanekileyo zonke iziphumo ezinokuthi zibe yingozi kunye neklinikhi ebalulekileyo, kwaye zazise izigulane ukuba zonke iziphumo ezibi kufuneka zixelwe. Nangona kunjalo, ukudwelisa iziphumo ebezingalindelekanga ezinobungozi nezingangcaluliyo nezingafuni nyango nganye nganye kwandisa amathuba okuba zenzeke, nto leyo ebeka ingxaki koogqirha. Esinye isisombululo esinokubakho kukwazisa isiphumo esichasene ne-placebo kwizigulane kwaye emva koko ubuze ukuba bazimisele na ukufunda malunga neziphumo ezibi, ezingangqalanga zonyango emva kokuqaphela le meko. Le ndlela ibizwa ngokuba yi "contextualized information consent" kunye "noqwalaselo olugunyazisiweyo".

Ukuphonononga le miba kunye nezigulana kunokuba luncedo njengeenkolelo ezigwenxa, ulindelo oluxhalabisayo, kunye namava angalunganga ngamayeza angaphambili kunokukhokelela kwisiphumo esichasene ne-placebo. Zeziphi iziphumo ebezingalindelekanga ezicaphukisayo okanye eziyingozi abakhe baba nazo ngaphambili? Zeziphi iziphumo ebezingalindelekanga abaxhalabileyo? Ukuba ngoku baphethwe ziziphumo ebezingalindelekanga ezinobungozi, ingaba bacinga ukuba ezi ziphumo bezingalindelekanga zingakanani? Ngaba balindele ukuba iziphumo ebezingalindelekanga zibe mandundu ekuhambeni kwexesha? Iimpendulo ezinikelwa ngabaguli zisenokunceda oogqirha bathomalalise inkxalabo yabo ngemiphumo engathandekiyo, nto leyo eyenza ukuba unyango lunyamezeleke ngakumbi. Oogqirha banokuqinisekisa izigulana ukuba nangona iziphumo ebezingalindelekanga zinokuba yinkathazo, eneneni aziyongozi kwaye aziyongozi kwezonyango, nto leyo enokuthomalalisa ukuxhalaba okubangela iziphumo ebezingalindelekanga. Ngokuchasene noko, ukuba intsebenziswano phakathi kwezigulane kunye noogqirha beklinikhi abanako ukunciphisa uxhalaba lwabo, okanye bayenze ibe nzima, iya kwandisa imiphumo emibi. Uphononongo olusemgangathweni lwezifundo zovavanyo kunye nekliniki lubonisa ukuba ukuziphatha kakubi okungahambiyo kunye neendlela zokunxibelelana ezingenamdla (ezifana nentetho enovelwano, ukungabikho kwamehlo kunye nezigulane, intetho ephazamisayo, kunye nokungabikho koncumo ebusweni) kunokukhuthaza umphumo we-placebo, ukunciphisa ukunyamezela isigulane kwiintlungu, kunye nokunciphisa umphumo we-placebo. Iziphumo ebezingalindelekanga ebezicingelwa zikholisa ukuba ziimpawu ebezikade zingahoywa okanye zingahoywanga, kodwa ngoku zibalelwa kumayeza. Ukulungisa olu luvo lugwenxa kunokwenza ichiza linyamezeleke ngakumbi.

Iziphumo ebezingalindelekanga ezixelwe zizigulana zinokubonakaliswa ngendlela engathethiyo nefihlakeleyo, ebonisa amathandabuzo, ugcino, okanye ixhala malunga neyeza, isicwangciso sonyango, okanye ubuchule bobuchule bogqirha. Xa kuthelekiswa nokubonisa amathandabuzo ngokuthe ngqo koogqirha beklinikhi, iziphumo ebezingalindelekanga azihlazisi kangako kwaye azinakwamkeleka ngokulula isizathu sokuyeka amayeza. Kwezi meko, ukucacisa nokuxoxa ngokuphandle ngezinto ezixhalabisa isigulana kunokunceda ukuphepha iimeko zokuyeka ukuqhubeka okanye ukungathotyelwa kakuhle.

Uphando malunga ne-placebo kunye ne-anti-placebo iziphumo zinentsingiselo ekuyilweni nasekuphunyezweni kwezilingo zeklinikhi, kunye nokuchazwa kweziphumo. Okokuqala, apho kunokwenzeka, ulingo lwezonyango kufuneka lubandakanye ungenelelo lwamaqela ongenelelo lwasimahla ukucacisa izinto ezibhidayo ezinxulumene ne-placebo kunye neziphumo ezichasene ne-placebo, ezifana nokuncipha kweempawu kuthetha. Okwesibini, i-longitudinal design yovavanyo iya kuchaphazela iziganeko zokuphendula kwi-placebo, ngokukodwa kwi-design ye-crossover, njengoko kubathathi-nxaxheba abafumene ichiza elisebenzayo kuqala, amava angaphambili afanelekileyo aya kuzisa ukulindela, ngelixa abathathi-nxaxheba abafumana i-placebo kuqala abazange. Ekubeni ukwazisa izigulane ngezibonelelo ezithile kunye nemiphumo emibi yonyango kunokunyusa iziganeko zezi nzuzo kunye nemiphumo emibi, kungcono ukugcina ukuhambelana kwiinzuzo kunye nolwazi oluchaphazelekayo olunikezwa ngexesha lenkqubo yemvume enolwazi kuzo zonke iimvavanyo ezifunda ichiza elithile. Kwi-meta-analysis apho ulwazi luhluleka ukufikelela ukuhambelana, iziphumo kufuneka zitolikwe ngokuqaphela. Kungcono kubaphandi abaqokelela idatha kwimiphumo emibi ukuba bangazi zombini iqela lonyango kunye nemeko yemiphumo emibi. Xa uqokelela idatha yempembelelo yecala, uluhlu lweempawu ezicwangcisiweyo lungcono kunophando oluvulekileyo.