Objective To make an individualized therapeutic regimen for a patient with stage III relapsed ovarian cancer guided by evidence-based medicine.Methods According to the clinical problems this patient showed and the PICO (patient, intervention, comparison and outcome) principle, the best clinical evidence associated with relapsed ovarian cancer was retrieved and evaluated. Results The current evidence showed that the relapsed ovarian cancer with platinum resistance tended to be treated by pharmacotherapy. Consequently, on the basis of combining the recommended guidelines, randomized controlled trials (RCTs), systematic reviews or meta-analyses on RCTs, clinical experience from doctors and willingness of patient, the regimen of Irinotecan plus Pegylated Liposomal Doxorubicin for interventional chemotherapy was recommended for this patient. After three courses of the treatment, the disease got some relieved; the medical team would like to keep conducting the same regimen for another six to eight courses, and the follow-up visit was undergoing. Conclusion For patients with relapsed ovarian cancer with platinum resistance, an individualized therapeutic regimen under the guidance of evidence-based methods can not only improve the therapeutic efficacy but also guide both doctors and patients to take the indeterminate risk of medicine.
ObjectivesTo evaluate the characteristics, main contents, key elements and techniques of global drug value assessment tools, especially for those developed for antineoplastic agents, and to provide reference for the establishment of the first value assessment tool for antineoplastic agents in China.MethodsDatabases including MEDLINE, EMbase, CBM, CNKI, VIP, WanFang Data and 19 relevant websites of institutions and societies were searched from inception to October 31st, 2018 to identify all the drug value assessment tools worldwide. Two independent reviewers screened the literatures, extracted the data and cross-checked them according to the inclusion and exclusion criteria. A qualitative analysis was conducted to describe the characteristics of these drug value assessment tools, including the publishing organization, year of publication, country, applicable type of disease and drug category, result display, and etc. Key elements and techniques in terms of evaluation dimensions, sources and levels of evidence, methods and procedures to form the tool were compared.ResultsA total of 12 English drug value assessment tools were included, which were published in 2010 to 2018 exclusively from Europe and North America. The applicable types of diseases and drug categories are not identical. The target users and stakeholders of each tool were slightly different. Evaluation dimensions, sources and levels of evidence, methods and procedures to form the tool were vital issues in value evaluation for drugs.ConclusionsThe structures of existing drug value assessment tools were almost the identical. However, there is no consensus on value definitions, evaluation dimensions, sources of evidence and result display. Methods and procedures to form the tool are not well described. It is urgent to explore and develop a value-oriented, focused and feasible drug assessment tool for antineoplastic agents in order to satisfy the strategic requirements of value-based post-marketing drug reevaluation.
【摘要】 目的 分析手術治療垂體瘤患者長期臨床恢復以及生活質量改善情況。 方法 回顧性分析2007年12月-2008年9月手術治療的103例垂體瘤患者術前以及術后長期隨訪資料，使用SF-36量表對術前、術后患者生活質量進行評估，分析手術治療前后患者癥狀、激素水平恢復情況以及生活質量改善情況，并進一步分析腫瘤大小、侵襲程度對術后生活質量的影響。 結果 術后頭痛癥狀消失52例，視力改善76例，其他癥狀具有不同程度改善；術后SF-36生活質量評估結果顯示，患者除精神健康外的7個維度（生理機能、生理職能、軀體疼痛、一般健康狀況、精力、社會功能、情感職能）均有明顯改善（P＜0.05），不同腫瘤大小及侵襲程度的患者術后生活質量評分均無統計學意義（P＞0.05），垂體功能完全恢復者生活質量評分高于垂體功能低下者（P＜0.05）。 結論 顯微手術治療垂體瘤患者可明顯改善患者的一般癥狀、提高患者的生活質量，單純腫瘤的大小和侵襲程度對術后生活質量的影響程度較小，術后垂體功能的恢復程度明顯影響患者的生活質量，垂體瘤術后患者的激素長期替代治療尚需進一步加強。【Abstract】 Objective To analyze the long-term clinical recovery and quality of life (QoL) in patients with pituitary adenoma treated by microneurosurgery. Methods The clinical data of 103 patients undergoing microneurosurgery from December 2007 to September 2008 were retrospectively analyzed, health-related questionnairs (SF-36) were used to assess the QoL. The post-surgery recovery of symptoms, endocrine function, and QoL were compared with those of pre-surgery, then the correlation between tumor size, invasive behavior, and QoL were analyzed. Results Headache disappeared in 52 patients. Visual symptoms improved in 76 patients. Other symptoms were also improved. Seven concepts (physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotioning) were improved after surgery (Plt;0.05). The eight health concepts of SF-36 showed no significant difference between patients with different tumor size and invasive behavior (Pgt;0.05). Differences were considered statistically significant between normal and abnormal pituitary function groups after surgery(Plt;0.05) in all concepts. Conclusion Microneurosurgical treatment can improve the general symptoms and the QoL. The tumor size and invasion have little influence on the QoL after surgery, but the improvement of hormone deficiency has influence on the QoL significantly. More attention should be given to the long-term hormone replacement therapy after the pituitary adenoma surgery.
Objective To systematically review venous thromboembolism (VTE) risk assessment tools. Methods The Embase, PubMed, CNKI, CBM, WanFang Data, VIP databases and 22 relevant institutions and associations were searched to identify all VTE assessment tools from inception to December 31, 2022. Two researchers independently screened the literature, extracted data, and cross-checked the data. A qualitative analysis was used to describe the country's essential characteristics, publishing organization, year, applicable disease type, applicable population, tool formation method, etc. Key elements and techniques were compared in terms of evaluation dimension, methods, and procedures to form the tool, risk stratification ability, and whether to verify. Results A total of 42 VTE risk assessment tools were included, of which 16 were in the United States, and only 4 were in China. They were released between 1996 and 2021, and the applicable disease types and populations differ. Nineteen tools were constructed based on case-control or retrospective cohort studies, 16 were conducted using prospective cohort studies, and 5 were based on cross-sectional and RCT studies; Additionally, 20 tools were built based on logistic regression models; The evaluation dimensions of each tool differed, and the most common frequency of occurrences were VTE history, age, BMI value, and confirmed tumor, accounting for 64.29%, 54.76%, 54.76%, and 47.62%, respectively. Thirty-three tools were stratified for risk, and 30 tools were presented in the form of risk scores; Some tools lacked clinical validation data, and only 12 tools were analyzed for specificity, sensitivity, NPV, PPV, and AUC. Conclusion The evaluation dimensions and evidence sources of existing VTE risk assessment tools are not completely consistent, the implementation methods and results presentation forms of the tools are not completely the same, and the scope of application is different; Some tool construction methods and processes are not clear enough, and there is a lack of validation research on external validity, which has certain limitations in promoting clinical practice in China.
【摘要】 目的 了解四川省基層醫療衛生機構基本醫療功能開展情況，以便有針對性地采取措施，提高基層醫療衛生機構的服務能力。 方法 2008年8月采用自填式問卷調查的方法，對基層醫療衛生機構開展的基本醫療功能情況進行調查。 結果 基層醫療衛生機構提供的三類基本醫療功能（基本檢查項目、常見病診療、家庭診療及轉診）總體情況不甚理想，基本檢查項目開展情況社區衛生服務中心好于鄉鎮/街道衛生院。一級項目中除社區衛生服務中心轉出服務開展比例達100%外，大部分醫療衛生機構一級、二級項目開展不全，社區衛生服務中心與鄉鎮/街道衛生院X線檢查開展比例均在50%左右，常見病診療部分一級項目開展機構的比例不到30%。家庭診療及轉診二級項目兩類機構開展比例均較低。 結論 基層醫療衛生機構提供的基本醫療功能特別是常見病診療項目有待加強。【Abstract】 Objective To understand the situation of basic medical services in primary medical institutions of Sichuan province so as to take related measures to improve the medical services in primary medical institutions. Methods We used self-administered questionnaires to investigate the basic medical services in primary medical institutions in August, 2008. Results The general situation of the three types of basic medical services (basic examination items, common disease diagnosis and treatment, family diagnosis and treatment and referrals) was not very good, but the development of basic examination items in the community health service center was better than that in villages and town hospitals or street service center. Among all kinds of first-grade medical health services, except for that the referral service in community health service center accounted for 100%, most of the first and second-grade medical health services were not fully developed. The proportion of X ray detection in community health service center and villages and town hospitals or street service center was about 50%, and the development of common disease diagnosis and treatment among the first grade medical health services accounted for only 30%. The proportion of family diagnosis and treatment and referrals was low. Conclusion The basic medial services in primary medical institutions should be strengthened, especially for the common disease diagnosis and treatment.