Objective The objective of this study is to find individualized, evidence-based treatment for a patientwith extensive small cell lung cancer, malignant pleural effusion, and liver metastasis.Methods According to the PICO (patient intervention comparison outcome) principle, evidence was collected and critically assessed. The patient’s preference was also taken into consideration in the decision making process. Results We included 10 randomized controlled trials, 13 systematic reviews and meta-analyses, and three clinical guidelines. The evidence indicated that chemotherapeutic treatment prolongs survival in patients with extensive small cell lung cancer and AiDi injections could relieve adverse effects caused by chemotherapy or radiotherapy. Cisplatin and etoposide are considered major standard cytotoxic drugs for small cell lung cancer. We drained the pleural cavity and infused Bleomycin into the pleural cavity. We also used an EP regimen of chemotherapy after the patient’s condition had improved. This patient survived longer than the average survival time for small cell lung cancer patients and has enjoyed a higher quality of life. Conclusion Chemotherapy is the main medical treatment for patients with extensive small cell lung cancer, backed up by symptomatic treatment and supportive care. Prophylactic cranial irradiation decreases brain metastases incidence and improves survival in complete response small cell lung cancer patients.
Objective To retrospectively compare short-term outcomes and health economics of PHS versus UHS for inguinal hernia repair. Methods We included 105 patients suffering from reducible inguinal hernia hospitalized in the First Affiliated Hospital of Lanzhou University from September, 2007 and September, 2012. The referred hernia types involved direct and indirect hernia (unilateral and bilateral). Based on different repair materials, the patients were divided into two groups, PHS group (n=53) and UHS group (n=52). Outcome parameters for comparison included incidences of seroma and scrotum edema, hospital duration, costs, etc. Results There were no differences in age, sex, hernia type, incidences of seroma and scrotum edema after surgery, hospital duration and costs between the two groups. However, the patients in the PHS group spent less money than those in the UHS group regarding the costs of materials and hospitalization, with significant differences. Conclusion For inguinal hernia repair, PHS and UHS are alike in reducing short-term complications, but PHS can significantly reduce patients’ economic burden due to less costs.
Fleming proposed the concept of evidence-based pathology (EBP) in 1996. In recent years, there have been a lot of evidence-based studies on the diagnosis and prognosis of diseases. However, there are still limitations and challenges in the development, and the growth in application of evidence-based medicine in the pathology is still slow. This study introduced the history of evidence-based pathology, summarized the primary application areas and the latest research progress, analyzed current opportunities and challenges of evidence-based pathology, and provided some suggestions.
Objective To assess the affect of problem-based learning (PBL) versus literature based learning(LBL) in clinical medicine students. Methods Computer retrieval was conducted to search for controlled studies comparing PBL with LBL. The quality of included studies was critically evaluated and data was analyzed by using The Cochrane Collaboration’s RevMan 5.0 software. Results Finally 11 articles were included in the review, but most of them were of low quality.There are clinical heterogeneity between different studis which cause descriptive results. The PBL tended to be superior to LBL in the analysis-skill, self-directed learning skill, data-searching skill, and original skill.Conclusion PBL tends to be associated with better learning results among clinical medicine students compared withLBL methods. We need large-scale, randomized controlled trials of higher quality to confirm this.
Objective To evaluate the efficacy and safety of mifepristone for perimenopause dysfunctional uterine bleeding (PDUB). Methods Such databases as VIP, CNKI, Wanfang and CBM were retrieved for collecting randomized controlled trials (RCTs) on mifepristone for PDUB. The quality of included studies was evaluated and Meta-analysis was performed according to the Cochrane methods. Results Forty RCTs involving 3 850 PDUB patients were included. The control group was divided into two sub-groups according to the features of intervention drugs: the sub-group of diagnostic curettage plus progestational hormone, and the sub-group of diagnostic curettage plus antiestrogenic drugs. The Meta-analysis indicated that compared with the sub-group of diagnostic curettage plus progestational hormone, the diagnostic curettage plus mifepristone group was more effective to increase the total effective rate, such as improving symptoms and signs of PDUB (RR=1.11, 95%CI 1.06 to 1.16, Plt;0.000 01), and to reduce recurrence (RR=0.44, 95%CI 0.36 to 0.52, Plt;0.000 01). But no differences were found between the two groups in the change of endometrial thickness, contents of hemoglobin, and serum level of FSH, LH, E2 and P hormone. Both the intervention and control groups appeared mild adverse reactions, such as rashes, tidal fever, nausea, anorexia, vomiting and breast distending, but with no liver and kidney damages. The long-term safety failed to be evaluated due to short follow-up time. Conclusion Based on this review, diagnostic curettage plus mifepristone shows certain advantage in the treatment of PDUB including the total effective rate and reducing recurrence. But there is no difference in regulating sex hormone level, inhibiting endometrial proliferation and improving anemia compared with the group of diagnostic curettage plus progestational hormone. However, this evidence is not b enough due to the low quality of included trials, possible bias risk, and failure of evaluating its long-term safety.
Objective To provide a reference for the best evidence-based medicine (EBM) education modelby retrospective analysis and summary the EBM education model of the EBM center of Lanzhou University for medicalpostgraduates. Methods To utilize students’ spare time we changed the traditional teaching method, and instead used problem based learning and academic discussions to teach postgraduates how to design and apply research. Results Sixtytwo postgraduates were trained and completed 73 research papers and registered 33 Cochrane systematic reviews. Twentythree papers were published in foreign journals (SCI) as first authors, 34 papers were published in domestic journals. Five students received awards in the academic conference of Lanzhou University. Conclusion Medical students will benefit from taking part in EBM research. This education model will help them not only understand the methods of clinical research and EBM and improve the quality of their research and their cooperative skills, but also master related clinical knowledge.
Objectives To assess the efficacy and safety of metformin plus rosiglitazone in treating type 2 diabetes mellitus. Methods Based on the principles and methods of Cochrane systematic reviews, we searched the CochraneLibrary (2008, 4 issue), PubMed (1966 to October 19, 2008), Embase (1974 to October 19, 2008), China BiomedicalLiterature Database (1978 to October 12, 2008), China Journal Fulltext Database (1994 to October 12, 2008), ChineseScientific Journals Full text Database (1989 to October 12, 2008). Randomized controlled trials (RCTs) of Metforminplus roziglitazone versus metformin for type 2 diabetes were included. We assessed the quality of the included RCTsaccording to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1. The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results Twelve RCTs totaling 3020 patients were included. Metaanalysis showed that Glycosylated hemoglobin levels [WMD= – 0.48%, 95%CI (– 0.74, – 0.22), P=0.000 3], fasting plasma glucose levels [WMD= – 1.03mmol/L, 95%CI (– 1.85, – 0.75), Plt;0.000 01], insulin sensitivity, and β-cell function improved significantly with metformin plus rosiglitazone therapy. Compared with the metformin monotherapy group, patients treated with metformin plus rosiglitazone had more edema events [RR= 3.27, 95%CI (1.80, 5.91), Plt;0.000 1] and lower gastro-intestinal events [RR= 0.82, 95%CI (0.71, 0.94), P=0.004]. We found no statistically significant effect on body weight, the percentage of patients with at least one adverse event, and hypoglycemia events. Conclusions Current evidence demonstrates that combination treatment with metformin plus rosiglitazone improves glycemic control, insulin sensitivity, and cells function more effectively than with metformin monotherapy. Side effects of two types of therapy have differences in performance.
Objective To assess the clinical effectiveness of vacuum-formed versus Hawley retainers in the period of retention. Methods PubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP, and WanFang Data were searched from the date of their establishment to December 31, 2011, to collect the randomized controlled trials (RCTs) about the clinical effectiveness of vacuum-formed versus Hawley retainers. The quality of the included studies was evaluated by two reviewers independently, and meta-analysis was performed by using RevMan 5.1.4 software. Results Six RCTs including 935 patients were identified. The results of meta-analyses showed significantly fewer changes in irregularity of the maxillary incisors (MD=0.13, 95%CI 0.04 to 0.21) and mandibular incisors (MD=0.29, 95%CI 0.24 to 0.33) in the vacuum-formed group than in the Hawley group. There were no significant differences between the two groups in maxillary intercanine width (MD=?–0.01, 95%CI –0.03 to 0.01), mandibular intercanine width (MD=0.04, 95%CI –0.02 to 0.10), maxillary intermolar width (MD=?–0.01, 95%CI –0.03 to 0.00) and mandibular intermolar width (MD=?–0.02, 95%CI –0.08 to 0.04). The results of qualitative analysis were consistent with the results of meta-analysis and there were no significant differences in overjet and overbite. Conclusion Vacuum-formed retainers are more effective than Hawley retainers at maintaining position of incisors in the period of retention. In other aspects, they are similar. In consideration of the factors such as the limited quality and incomplete measure index of primary studies, RCTs of higher methodological quality are needed.
Objective To assess the efficacy and safety of low-dose urokinase plus conventional treatment versus conventional treatment alone in patients with unstable angina. Methods We searched the database PubMed, EMBASE, The Cochrane Library, SCI, CBM, CNK, VIP and Wanfang database on line by computer, and handsearched relevant professional journals by two independent screening and extract information. The quality of the included documents was evaluated by the criterion of Cochrane handbook 4.2.6. The cochrane collaboration’s Revman 4.2.10 software was used for data analyses. Results A total of 19 randomized controlled trials were included (2 273 patients) Meta-analyses showed that the low-dose urokinase group was better than the conventional treatment group in efficiency [OR= 4.18, 95%CI (3.24, 5.41)] and ECG [OR= 2.81, 95%CI (2.04, 3.88)], and there were no differences between the two groups in cardiovascular outcomes [OR= 0.74, 95%CI (0.44,1.24)], mucocutaneous bleeding [OR= 1.43, 95%CI (0.90, 2.28)], gums bleeding [OR= 1.88, 95%Cl (0.46, 7.70)] and microscopic hematuria [OR= 3.82, 95%CI (0.77, 18.92)]. Conclusion The low dose urokinase group is higher efficient than the conventional treatment group. As the samples of the included studies are small and their quality is low, more randomized, double-blind, high-quality and big- sample trials are required.
Objective To assess the effectiveness and safety of laryngeal mask airway (LMA) and endotracheal tube (ETT) for airway management in pediatric general anesthesia. Methods Randomized controlled trials were collected through electronic searches of the PubMed, The Cochrane Library, EMbase, CBM, WanFang Data, VIP, CNKI from the date of establishment to November 2010. All the related data that matched the standards were abstracted by two reviewers independently. The quality of the included trials was evaluated according to the Cochrane Handbook 5.0. RevMan 5.0 software was used for meta-analysis of the complications, success of insertion on the first attempt and hemodynamic changes. Results A total of 39 trials involving 2 612 patients were included. The results of meta-analyses showed that LMA was superior to ETT in terms of less cough (RR=0.21, 95%CI 0.15 to 0.28, Plt;0.000 01), laryngospasm or bronchospasm (RR=0.37, 95%CI 0.18 to 0.77, P=0.008) and agitation (RR=0.14, 95%CI 0.09 to 0.22, Plt;0.000 01) during emergency. The incidence of postoperative sore throat (RR=0.32, 95%CI 0.19 to 0.55, Plt;0.000 1), hoarse voice (RR=0.09, 95%CI 0.03 to 0.27, Plt;0.000 1), nausea and vomiting (RR=0.46, 95%CI 0.26 to 0.80, P=0.006) was significantly lower in the LMA group. The hemodynamic changes during insertion and extraction of LMA were more stable than ETT, such as the heart rate changes in insertion, extraction and post-extraction period (SMD= –1.18, 95%CI –1.59 to –0.77, Plt;0.000 01; SMD= –1.29 95%CI –1.72 to –0.86, Plt;0.000 01; and SMD= –1.51 95%CI –2.15 to –0.87, Plt;0.000 01, respectively) and the MAP changes in insertion, extraction and post-extraction period (SMD= –1.21, 95%CI –1.39 to –1.02, Plt;0.000 01; SMD= –1.31, 95%CI –1.77 to –0.85, Plt;0.000 01; and SMD= –0.85, 95%CI –1.24 to –0.46, Plt;0.000 1, respectively); but no significant differences in postoperative regurgitation and aspiration (RR=3.00, 95%CI 0.62 to 14.61, P=0.17) and successful insertion on the first attempt (RR=0.99, 95%CI 0.94 to 1.05, P=0.84) were found between the LMA and ETT groups. Conclusion Current evidence indicates that the laryngeal mask airway is superior to endotracheal tube in terms of fewer complications during emergency and after operation as well as stable hemodynamic changes. So, it is a selective, safe and effective airway management for children.