To help better understanding on evidence-based medicine, five frequently asked questions relevant to evidence-based clinical practice were commented on. The questions included: 1. Dose evidence-based medicine only emphasize evidence and ignore clinical experiences? 2. Dose evidence only include randomized controlled trials and systematic reviews? 3. How to face the quality of evidence? 4. Is randomized evidence suitable for treating individual patient? 5. Is evidence-based medicine useless since there is no adequate evidence for many clinical questions?
In 2007, the findings from clinical trials on stroke treatment have been both encouraging and disappointing. In order to interpret the challenges and opportunity in evidence-based stroke practice, we reviewed several major clinical trials in stroke that were published last year. It revealed that we should strengthen the evidence base for acute stroke care by conducting more high-quality randomized controlled trials and by increasing the energy, resources and manpower available for these trials.
The core idea of comparative effectiveness research (CER) refers to "study in the real-world" which can be considered as the extension of evidence-based medicine. So far CER has arouse wide concern. CER includes many intervention trials and observational studies, including systematic reviews/meta-analyses, effectiveness randomized controlled trials, and registry trials. Database is an important platform for CER. CER has better feasibility and can provide useful evidence for "real-world" decision-making. However, it also has limitations such as difficult control of confounding factors. It still needs to be further studied due to its immature methodological base. CER has been already applied in some neurological fields, with internationally-recommended research priorities for CER in neurology.
Ischemic lesions, lacunar infarcts and leukoaraiosis on head CT or MRI are commonly detected in patients with non-specific symptoms such as dizziness and headache or people undergoing healthy physical examinations. Although these imaging findings are mostly related to vascular disease, especially cerebral small vessel disease, it does not mean that long-term use of antiplatelet drugs and statins are required. On the basis of literature review and clinical experiences, the article points out that the treatment methods for such manifestations include determining whether these lesions are vascular lesions, searching for risk factors or causes such as aging, hypertension, diabetes mellitus, vascular stenosis, and psychological factors, and taking strategies for the corresponding prevention and management, provides a reference for the appropriate diagnosis and treatment of these imaging manifestations in clinical practice.
Objective To investigate the current situation of clinical studies on puerarin for ischemic stroke and the reliability of these evidence. Methods By electronic searching and handsearching, we collected all the published clinical study reports on puerarin for ischemic stroke and assessed all the included reports according to clinical epidemiologic standard. Results 35 RCTs, 22 non-randomized controlled trials and 17 case serials studies were included and analysed. Conclusions Current quality of clinical studies of puerarin for ischemic stroke is not good enough to provide reliable evidence.
Objective To explore whether there is enough clinical evidence to confirm that stereotactic aspiration does more good than harm in patients with cerebral hemorrhage. Method A systematic review of all relevant clinical studies on stereotactic aspiration in the treatment of cerebral hemorrhage. Results Eight randomized controlled trials (RCTs) including 757 patients and 17 nonrandomized controlled studies including 1 766 patients, as well as 20 uncontrolled studies including 1 244 patients were identified . All studies reported positive results regarding the effects. However, the quality of the included studies were generally poor. The main problem was that most trials reported them as a RCT, but no description of the method of randomization. Conclusions Stereotactic aspiration in the treatment of cerebral hemorrhage is promising based on present evidence. However, at present, we can not draw definite conclusion whether the treatment does more good than harm compared with noninvasive medical treatment because of the poor quality of included studies. Therefore, more high quality RCTs are required.