Objective To evaluate the diagnostic value of MR imaging for anterior cruciate ligament. Methods We searched PubMed, EMBASE, CBM, CSJD and CJFD to find all diagnostic tests about MR imaging in anterior cruciate ligament. QUADAS items were used to evaluate the quality of the included studies. We used Meta-disc software for data collection, and sensitivity, specificity and SROC curves were calculated to assess the diagnostic value of individual diagnostic tests. Results Twenty-nine studies met the eligibility criteria and were included. Compared with arthroscope, the summary values of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and SROC curve of MR imaging were 93%, 93%, 9.85, 126.39, and 0.971 4, respectively. Conclusion MR imaging can be regarded as an effective and feasible method for ACL tears diagnosis and screening clinically, based on the results of this systematic review.
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.
Objectives To evaluate the effect of metrinidazole treatment after conventional hemorrhoidectomy pain in patients with third and fourth degree hemorrhoids. Methods We searched the Cochrane Library (Issue 1 2009), PubMed (1966 to March 2009), EMbase (1974 to March 2009), SCI (1974 to March 2009), CBM (1978 to March 2009), CNKI (1994 to March 2009), and VIP (1989 to March 2009) to identify randomized controlled trials or quasi- randomize controlled trials of metronidazole versus placebo for treating post hemorrhoidectomy pain. We evaluated the quality of the included studies by using the Handbook 4.2.6 recommend standards and analyzed data using the Cochrane Collaboration’s RevMan 4.2.10. Results We included seven randomized controlled trials or quais-randomized controlled trials (n=553). Meta-analyses showed that there were statistical differences between metronidazole and placebo in pain after hemorrhoidectomy and the use of an additional dose of analgesia. Conclusions The current evidence shows that metronidazole relieves the pain after conventional hemorrhoidectomy and reduces the additional used of analgesics. Further high quality, large sample randomized controlled trials should be carried out.
Objective To evaluate the effect of clinical pathway (CP) teaching methods versus traditional methods in nursing clinical teaching. Methods The following electronic databases as PubMed, EMBASE, The Cochrane Library, CBM and CNKI were retrieved on computer from their establishment to April 2011 to search for randomized controlled trials (RCTs) of comparing CP with traditional methods in nursing clinical teaching. The methodological quality of the included RCTs was assessed by two reviewers independently according to the scale of criteria for methodological quality developed by Smits PB, and the meta-analysis was conducted by using the Cochrane Collaboration’s RevMan5.1 software. Results A total of 12 RCTs involving 1 269 participants were included, and nine of them were of high quality. The meta-analyses showed that compared with the traditional teaching method, the CP teaching tended to be superior (Plt;0.05) in improving nursing students’ objective knowledge, nursing operating skills, professional ability and satisfaction with teaching methods, and in improving patients’ satisfaction as well. Conclusion The clinical pathway teaching method is a scientific teaching model in nursing clinical teaching; it standardizes the teaching procedure, promotes students’ active learning and further enhances the teaching effect. But it is necessary to unify the method of assessment with more researches. In addition, researchers should pay more attention to improving the comprehensive quality of nursing students.
Objective Investigate the effectiveness of problem-based learning (PBL) in teaching of evidence-based medicine for undergraduates.Methods Participating students from four of eight classes with major of clinical medicine in Grade 2006 were assigned to the lecture-lased learning (LBL) group (50 students) and the PBL group (46 students), and each group had two classes. The examination scores, questionnaire, and seminars were used in combination to evaluate the teaching effectiveness. SPSS 11.5 software was used for statistical analyses. Results The baseline characteristics were balanced between the two groups because no difference was found in aspects of taking part in literature or information retrieval training, research project, undergraduate starting an undertaking plan and social survey, as well as getting known of evidence-based medicine, clinical epidemiology and PBL. The evaluation results of teaching effectiveness showed that, a) About the examination score, there was a significant difference between the two groups (Plt;0.05); the score of the PBL group was higher than that of the LBL group in aspects of fundamental knowledge, issuing question, retrieving evidence, evaluating evidence, applying evidence and total score; and b) About the attitude towards LML, there was a significant difference between the two groups about whether the LBL was beneficial or not to improve positive study, study interest, participation willingness, aggregate analysis ability, speech ability, self-study ability, information acquisition ability, information analyses and utilization ability, problem analyses and solving ability, combination of theory and clinic, communication between teachers and students, team cooperation and so on; but there was no significant difference between the two groups (Pgt;0.05) in aspects of improving learning efficiency, better understanding theory leader from class, improving writing ability and practicing ability; 97.83% of the students in the PBL group thought that PBL was suitable for themselves which should be introduced into other course teaching; 48.00% of the students in the LBL group thought that the current LBL teaching mode was not suitable for undergraduate, while 28.00% of the students in the LBL group thought that the current teaching mode should get reformed. Conclusion The PBL teaching mode is beneficial for undergraduates to better training clinical thinking, improve the ability of problem construction, aggregate analyses, literature retrieval, language express and exploratory innovation, and fully improve the quality of evidence-based medicine teaching. The PBL teaching method is suitable for teaching of evidence-based medicine for undergraduate medical students.
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.
Objective To evaluate the effect of standardized patient (SP) used in nursing fundamental. Methods Randomized controlled trials (RCTs) or quasi randomized controlled trials (q-RCTs) about comparing standardized patients with traditional teaching method in nursing fundamental were searched from the following electronic databases: PubMed, EMbase, The Cochrane Library, CNKI, CBM, VIP and so on. The methodological quality of the included RCTs was assessed according to the quality assessment scale developed by Smits PB, and the valid data were extracted and meta-analyzed with the Cochrane Collaboration’s RevMan 5.0.17 software. Results Five RCTs and one q-RCT involving 585 participants were included. The results of quality evaluation showed that the scores of five studies were more than or equaled 30. Descriptive analyses were only used because there was clinical heterogeneity between different studies. Comparing with traditional teaching method, SP teaching method in nursing fundamental improved the nursing procedure skills, the communication ability with patients and the ability of clinical judgment for nursing students. Conclusion The standardized patient teaching method is a prospective teaching mode. Because of the lack of RCTs about SP used in nursing fundamental, and the big difference of the teaching method and examine criteria in different studies, it is necessary to be verified in future by unified assessment methods and more researches with high quality.
Objective To assess the effects of combining intravenous immunoglobulin for systemic lupus erythematosus (SLE) by analyzing the randomized controlled trials (RCT). Methods The electronic databases such as PubMed (1966 to Aug. 2010), EMbase (1974 to Aug. 2010), The Cochrane Library (Issue 2, 2010), CNKI (1994 to Aug. 2010), VIP (1989 to Aug. 2010), CBM (1978 to Aug. 2010) and Chinese Medical Association Digital Periodicals (1998 to Aug. 2010) were searched to collect RCTs of intravenous immunoglobulin for the patients with SLE. The methodology quality of the included studies was evaluated in accordance with RCTs quality evaluation standard of the Cochrane Handbook 4.2.6, and meta-analyses were performed by using RevMan 5.0 software. Results Four RCTs involving 154 participants were included. The results of meta-analyses showed that compared with cyclophosphamide pulse therapy, the combining intravenous immunoglobulin markedly reduced the SLE disease activity index (MD= –3.09, 95%CI –4.21 to –1.97), the incidence of infection (OR=0.24, 95%CI 0.11 to 0.54), the proteinuria (MD= –1.09, 95%CI –2.11 to –0.06), and the relapse of SLE (OR=0.07, 95%CI 0.01 to 0.37). But there was no significant difference in elevating of complement between two groups. Conclusion According to the results of meta-analyses, compared with cyclophosphamide pulse therapy, cyclophosphamide combining intravenous immunoglobulin may be more efficient in improving clinical symptoms, decreasing incidence rate of infectious diseases, and reducing relapse for SLE 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.
Objective To systematically evaluate the clinical effectiveness and safety of raltitrexed plus cisplatin in the treatment of malignant pleural mesothelioma (MPM) when compared with other chemotherapy regimens. Methods We electronically searched PubMed, Embase, The Cochrane Library and Chinese Biomedicine Database to March, 2007. Randomized controlled trials (RCTs) and quasi-RCTs were identified, and Revman 4.2.10 was applied for statistical analyses. Results One RCT involving 250 patients was included, which compared raltitrexed plus cisplatin versus cisplatin alone in the treatment of MPM. In the intention-to-treat population, the median survival time was statistically longer in the raltitrexed plus cisplatin group as compared to cisplatin alone group. (11.4 versus 8.8 months, P=0.048). The incidence of grade 3/4 toxicities was similar between the two groups. Conclusion The current evidence available showed that, the combination of raltitrexed and cisplatin may prolong the survival time for MPM patients, with a low incidence of grade 3/4 toxicities. However, more high-quality RCTs are required to further define its clinical effectiveness.