With the widespread promotion and application of the Enhanced Recovery After Surgery (ERAS) concept in the surgical fields, the implementation of the ERAS concept in the treatment of lower extremity deep venous thrombosis (DVT) was explored in the vascular surgery. The “Six-Step” comprehensive treatment protocol and the establishment of the ERAS system for lower extremity DVT developed by the Department of Vascular Surgery at the First Affiliated Hospital of Chongqing Medical University were elaborated. The protocol includes steps such as filter placement, thrombus clearance, relief of venous outflow obstruction, dissolution of residual thrombus, filter retrieval, and standardized post-discharge anticoagulation management, along with their respective advantages. Additionally, the training and dissemination efforts undertaken to promote the “Six-Step” comprehensive treatment protocol were described. A comparison was made between ERAS and traditional recovery surgery, highlighting the comprehensive clinical benefits of the former. The aim is to promote the standardized implementation of the ERAS system in lower extremity DVT treatment and to bring greater benefits to patients.
World Federation of Acupuncture-Moxibustion Societies (WFAS) standard Norms for Formulation and Evaluation of the Clinical Practice Guidelines of Acupuncture and Moxibustion (Hereinafter referred to as Norms) is the first methodological specification for the development of guidelines of acupuncture and moxibustion (Acup-Mox) issued by an international academic organization. The Norms stipulates the principles, procedures, review process and requirements of the development of WFAS guidelines of Acup-Mox. It also proposes the development method, evaluation method, and reporting standards of WFAS guidelines of Acup-Mox. This article introduces the development process of the Norms and provides an interpretation of the methodological supplementary requirements for key links such as "formulation of clinical questions", "evidence retrieval, evaluation and synthesis", and "consensus decision-making", as well as the "framework and contents of recommendation" to provide relevant references for users in learning and using the Guidelines.
ObjectiveTo systematically review the effects of nursing-implemented sedation protocol on outcomes of mechanical ventilation and sedation in mechanically ventilated ICU patients. MethodsWe searched EMbase (Ovid), The Joanna Briggs Institute EBP Database (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL, Ovid), MEDLINE (Ovid), Web of Knowledge, CINAHL, CBM, CNKI, WanFang Data and VIP to collect studies on nursing-implemented sedation protocol up to January 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 11 studies involving 2118 patients (1 037 were in the intervention group, and 1 081 were in the control group) were included. The results of meta-analysis showed that nursing-implemented sedation protocol could reduce the total dosage of midazolam (MD=-163.82, 95%CI -309.81 to -17.84, P=0.03), the daily dosage of midazolam (MD=-37.22, 95%CI -61.14 to -13.29, P<0.01), and the incidence rate of VAP (RR=0.53, 95%CI 0.34 to 0.81, P<0.01). However, nursing-implemented sedation protocol had no effects on the length of mechanical ventilation, the length of ICU stay, and self-extubation. ConclusionCompared with the usual sedation management, nursing-implemented sedation protocol can reduce the dosage of midazolam and the incidence rate of VAP. But no statistical significances are found in the length of mechanical ventilation, the length of ICU and the incidence rate of self-extubation.
The master protocol platform trial is a trial in which multiple treatments or different combinations of treatments are consistently evaluated in the context of a single disease, possibly within several sub-studies for different disease subtypes, allowing multiple treatments to enter or exit the trial platform based on a certain decision algorithm. Compared with the traditional clinical trial design, the master protocol platform trial as a scientific innovative model of clinical trial can accelerate drug evaluation to deal with the contradiction between the awaited evaluation of numerous drugs and lack of effective therapy for diseases. By using the large-scale randomized controlled clinical trial for COVID-19 inpatients (RECOVERY) led by the University of Oxford in the UK in 2020 as an illustration, this paper introduced the concept, design principle, and basic trial process of the master protocol platform trial to provide methodological references for clinical research of drugs.
As an important policy tool, real-world evidence is the basis for health insurance catalogue adjustment, and relevant policies and regulations have been issued in foreign countries to guide the use of real-world research for health insurance access, but the field of traditional Chinese medicine in China in particular is still in the exploratory stage. Since TCM protocols are widely used in clinical practice and have significant clinical value, this paper takes TCM protocols as an example and systematically constructs a technical pathway based on real-world research to support health insurance access, including clinical needs assessment, basic requirements of protocols, key points for conducting real-world research and evaluating real-world evidence, the process of access, the strategy of access, and the dynamic monitoring of access, with the aim of providing guidance for the application of real-world research in China's health insurance catalogue adjustment. Access to real-world research to provide reference for the application of real-world research in China's health insurance.
Background AIDS (acquired immune deficiency syndrome) has become the most devastating disease which humankind has ever encountered. Human immune-deficiency virus (HIV) is transmitted through blood, sexual behavior and mother-to-baby, with more efficient transmission through blood transfusion. HIV risk among blood transfusion was severe due to lack of effective and correctly applied screening method and rigorous management, especially in some developing countries. Since the first HIV screening reagent was approved by FDA to screen the blood in 1985, the fourth generation test has been produced till now. Initially, HIV test was primarily used to screen the blood supply, it also became an important aspect of HIV prevention, especially screening among people donating blood. Today, HIV testing is seen as an integral part of both the nation’s prevention and treatment efforts. Objective To assess the effectiveness of any intervention tests for HIV screening among people donating blood, and find appropriate tests for HIV screening to decrease the risk of HIV transmission by blood transfusion. Search strategy MEDLINE, Cochrane Controlled Trials Register (CENTRAL/CCTR), AIDSLINE, EMBASE, CBM were be searched with the terms: "HIV", "AIDS", "screening", "test", "blood donor", "blood bank" and the detailed screening method. The websites of WHO, UNAIDS, CDC, FDA, and their related links were searched. Letters were mailed to various agencies and experts in this field to acquire unpublished reports. Inclusion criteria RCT and CCT for screening HIV among blood. donors will be included. Observational studies such as cohort studies, cased-control studies, and historical controlled studies will be used for sensitivity analysis. Method of the review According to the principles of Cochrane Review, selection of trials for inclusion, quality assessment of studies, data extraction and syntheses were conducted by reviewers.
ObjectiveTo compare the clinical efficacy and complications of intra-arterial chemotherapy (IAC) and intravenous chemotherapy (IVC) for unilateral advanced retinoblastoma (RB). MethodsA retrospective clinical study. From January 2020 to January 2021, 40 patients (40 eyes) unilateral group cT2 RB patients diagnosed at Baoding Children’s Hospital and Beijing Children’s Hospital were recruited in this study. There were 22 males (22 eyes) and 18 females (18 eyes). All were monocular. All the patients were assigned to two groups according to different treatment modalities they received: IVC group and IAC group. There were 26 eyes and 14 eyes, respectively. When the tumor invades the optic nerve, choroid, sclera, anterior chamber and iris, enucleation was performed. The globe salvage rate, tumor extraocular metastasis rate, solid tumor control rate, treatment-related complications and pathological high-risk factors after enucleation were observed. The globe salvage rate and solid tumor control rate were compared between the groups by chi square test. ResultsThe globe salvage rate of IAC group and IVC group were 88.5% (23/26) and 50.0% (7/14), respectively. Solid tumor control of IAC group and IVC group were 84.6% (22/26) and 42.9% (6/14), respectively. There were statistically significant differences in globe salvage rate and solid tumor control between the two groups (χ2=7.18, 7.56; P＜0.05). Compared with IVC group, IAC group had less systemic complications, mild ocular and periocular side effects. Among 26 cases in IAC group and 14 cases in IVC group, 3 and 7 cases underwent enucleation respectively. The results of pathological examination showed that there were 2 cases and 3 cases with pathological high-risk factors in the two groups, respectively. During the follow-up period, 2 cases in IAC group had extraocular metastasis, there was no extraocular metastasis in IVC group. ConclusionCompared with IVC, IAC has the advantages of high tumor control rate, high globe salvage rate, less and mild complications, however, there is still tumor recurrence.
Precision medicine is an individualized clinical research model established according to gene, environment, lifestyle and other information. As an innovative method of clinical trials, the main scheme design breaks the barriers of traditional randomized controlled trials to the evaluation of targeted therapies in precision medicine and improves the efficiency of clinical research. This paper will systematically introduce the types, concepts and principles of the main scheme design of the new method of precision medicine clinical trial design, and summarize the advantages and limitations of the main scheme design combined with classic cases, aiming at providing scientific and rigorous methodological guidance and clinical practice experience for precision medicine scientific research design.
Emergency treatment of ocular trauma is a systematic and complicated work. Rapid and correct diagnosis and treatment are needed to maximize the recovery of ocular structure and function. In recent years, China has made remarkable progress in the emergency treatment of ocular trauma, including the development of Expert consensus on the norms of emergency treatment of ocular trauma in China (2019), the establishment of a national ocular trauma database, and the development of VisionGo Artificial Intelligence prediction system for ocular trauma. These measures improve the treatment level of ocular trauma and provide support for the prediction of postoperative visual acuity in severe traumatic eyes. However, with the development of economy and society, the characteristics of ocular trauma in our country have changed. For example, the majority of hospitalized patients were open ocular injuries, farmers and workers were the main occupational groups, and the proportion of eye injuries caused by traffic injuries increased year by year, and the proportion of women and minors increased. Although the annual loss of life of ocular trauma disability in China has decreased faster than the world average, the emergency treatment of ocular trauma still faces many challenges, such as regional differences, insufficient primary medical resources, lack of standardized training, and insufficient promotion of emergency treatment standards. In order to cope with these challenges, it is necessary to further strengthen the popularization of science and technology for the prevention and treatment of ocular trauma, standardize the emergency treatment process, strengthen the training of grass-roots medical personnel, strengthen the safety of emergency surgery, and pay special attention to the particularity of children's ocular trauma. In addition, relevant research has been actively carried out to establish a complete database of emergency patients with ocular trauma to promote the accurate prevention and treatment of ocular trauma.
Objective To investigate the consistency of regions of interest (ROI) volume among different radiological treatment planning systems (TPS) for the same group of patient data, and analyze the tendency and degree of differences caused by data transfer. Methods Between October 2010 and December 2013, the data of 10 nasopharyngeal carcinoma patients treated in West China Hospital were transferred from Monaco TPS into various other treatment planning systems. Based on different ROI volumes, they were divided into 8 groups. We counted the volume differences between these TPS and Monaco TPS, and carried out the statistical analysis. Results For small ROI volume, the calculated difference reached up to 65% in our study. As a general trend, differences became less and less with the increasing of volumes. But for single ROI, the volume difference was likely to vary randomly. The percentage of ROI volumes which were smaller than that of Monaco TPS was 70% for Raystation TPS, 38.75% for Pinnacle TPS, 88.75% for Eclipse TPS, 97.5% for Masterplan TPS, and 83.13% for iPlan TPS. Conclusions ROI volume differences exist generally among different treatment planning systems when ROIs are transferred among them by DICOM protocol. The volume variations may be affected by multiple factors. The volume consistency should be evaluated before any direct comparison of dose volu me histogram parameters which are done between different systems.