Patients with brain metastases are more prone to developing life-threatening neurological symptoms. Initial therapies include surgery, whole brain radiotherapy (WBRT), and stereotactic radiotherapy. With the progress of stereotactic radiotherapy, the indication of stereotactic radiosurgery (SRS) is gradually expanding, and the indications for surgery and WBRT gradually narrowed. The existing studies have shown that SRS can significantly benefit patients who are <50 years old with single brain metastasis, but the specific scope of the application with SRS is still controversial, and a large number of the phase Ⅲ randomized multicenter trials designed around the controversies are also developing. This review summarizes the results of clinical research and came to the conclusion. Firstly, postoperative adjuvant SRS in the treatment of brain metastases is superior to postoperative adjuvant WBRT. Secondly, using SRS in the elderly patients with multiple brain metastases are safe and effective. Thirdly, the use of targeted therapy in patients with brain metastases thereby delaying SRS may lead to poor prognosis. The focus of future research include selection of optimal timing for adjuvant targeted therapy after SRS and the appropriate patient population, as well as prevention of recurrence and metastasis after lacal treatment.
Mitral regurgitation (MR) is the most common type of valvular heart disease. Mitral valve repair/replacement can improve the prognosis of patients with severe MR, but a large proportion of patients cannot tolerate surgical procedures due to comorbidities and surgical risks. Transcatheter mitral valve replacement (TMVR) is a kind of treatment for mitral valve disease in which an artificial valve is delivered to the mitral valve annulus through a catheter and released into place, with the advantages of no thorax opening, less trauma and high safety. Early clinical studies of TMVR have shown good results, but still face many challenges. Strict indications are effective measures to reduce surgical risks and postoperative complications. This article explores the relevant indications of TMVR by analyzing several studies at home and abroad.
The social needs, disciplinary development and humanistic reflection has promoted the emergence and development of evidence-based medicine. Moreover, evidence-based medicine-problems oriented research, evidence based decision, transferring results to practice and outcome evaluation-continues to meet society demands, promote the development of discipline and show humanist concern. The application of evidence-based medicine has gradually extended from the field of clinical medicine to the public health, society, management, economy, policy research and education in the process of solving various problems. The high quality evidence has also been important to decision-making in these fields. Our study explored the emergence and development of evidence-based medicine from the perspective of social needs, disciplinary development and humanistic reflection for the first time.
Objective To explore the influencing factors of inhalation medication compliance in Chinese asthma patients, and to provide evidence for improving the compliance of patients with inhalation therapy. Methods PubMed, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were searched for literature on factors influencing inhalation medication compliance in Chinese asthma patients from the establishment of databases to December 2021. Meta-analysis was performed using RevMan 5.2 software. Results A total of 16 studies were included, with a sample size of 2 600 cases, 1 084 cases of good compliance with inhalation administration, 1 516 cases of poor compliance with inhalation administration, and good compliance with inhalation administration accounted for 41.69%. The literature quality evaluation scores were all ≥4 points, all of which were of medium quality and above. Meta-analysis showed that the factors affecting inhalation compliance of asthma patients included age [odds ratio (OR)=0.54, 95% confidence interval (CI) (0.32, 0.91), P=0.02], educational level [OR=0.57, 95%CI (0.36, 0.90), P=0.02], doctor-patient relationship [OR=0.42, 95%CI (0.19, 0.93), P=0.03], disease severity [OR=0.25, 95%CI (0.11, 0.58), P=0.001], degree of mastery of asthma knowledge [OR=2.51, 95%CI (1.11, 5.65), P=0.03], degree of mastery of inhalation technique [OR=8.66, 95%CI (3.20, 23.40), P<0.0001], adverse drug reaction [OR=0.23, 95%CI (0.13, 0.41), P<0.00001]. Conclusion The compliance of inhaled dosing in Chinese asthma patients needs to be improved urgently. Age, education level, doctor-patient relationship, disease severity, mastery of asthma knowledge, mastery of inhalation technology, and adverse drug reactions are the important influencing factors of inhaled medication compliance.
ObjectiveTo develop Knowledge attitude behavior and practice (KABP) health education path table, and to explore its application in health education of physician-nurse collaboration for children with epilepsy, and provide practical reference for health education of children with epilepsy.MethodsA convenient sampling method was used to select 94 family units of children with epilepsy and their main caregivers from the Department of Neurology in Hunan Children’s Hospital from September 2018 to March 2019. Divided into observation group and control group, 47 cases in each group. In the control group, the health care education was carried out by the conventional method of medical personnel’s one-way input of knowledge. The observation group conducted health education through interactive participation in the path of the health education path of KABP on the basis of regular health education. Then compared the effect of the health education between the two groups.ResultsAfter the intervention, the quality of life scores of the observation group were significantly higher than the control group (P<0.01). The relevant knowledge scores of main caregivers at 1 and 3 months after discharge were significant higher than those in the control group (P=0.008, P=0.001). The medication compliance scores of children with epilepsy at 1 and 3 months after discharge were significant higher than those in the control group (P=0.010, P=0.006).ConclusionsThe KABP health education pathway can improve the knowledge level of caregivers, as well as the medication compliance and quality of life of children with epilepsy.
Ultrasound guided percutaneous interventional therapy has been widely used in clinic. Aiming at the problem of soft tissue deformation caused by probe contact force in robot-assisted ultrasound-guided therapy, a real-time non-reference ultrasound image evaluation method considering soft tissue deformation is proposed. On the basis of ultrasound image brightness and sharpness, a multi-dimensional ultrasound image evaluation index was designed, which incorporated the aggregation characteristics of the organization. In order to verify the effectiveness of the proposed method, ultrasound images of four different models were collected for experiments, including prostate phantom, phantom with cyst, pig liver tissue, and pig liver tissue with cyst. In addition, the correlation between subjective and objective evaluations was analyzed based on Spearman’s rank correlation coefficient. Experimental results showed that the average evaluation time of a single image was 68.8 milliseconds. The evaluation time could satisfy real-time applications. The proposed method realizes the effective evaluation of real-time ultrasound image quality in robot-assisted therapy, and has good consistency with the evaluation of supervisors.
Science is a system of knowledge that reflects the essential connections and laws of the objective world. Classification of disciplines is a subsystem of science, which involves the development of human cognition which evolved from the scientific category to the department of higher education, and then formation of a complex management system. Nowadays with the rapid development of science and technology which triggering numerous complex social problems, an increasing trend of scientific integration calls for multidisciplinary and interdisciplinary research and education. In the 1990s, evidence-based medicine was emerged in the self-doubting of medical science, and extended to other fields of medicine, health policy and social sciences, forming an interdisciplinary evidence-based science system. Evidence-based science is an embodiment of scientific integration, and also the carrier and mechanism of cross-disciplinary convergence. It attempts to break through barriers of disciplines and management, and promotes interdisciplinary research, during which it has encountered many difficulties due to limitations of traditional disciplines. Evidence-based science does not provide an intrusion or transformation of thinking paradigm into other disciplines, but rather an equal dialogue to promote broader discipline collaboration and a new round of self-improvement, so as to constantly explore novel methods and theories to solve emerging problems, achieve continuous improvement, and pursue excellence.
Nasopharyngeal carcinoma (NPC) is rather common in Southeast Asia and Southern China. The standard treatment for NPC is intensity-modulated radiotherapy (IMRT). A large number of the NPC survivors benefit from the IMRT, while some suffer from the late toxicities which can be life-threatening or significantly erode the patients’ quality of life and functional status, especially in the locally advanced NPC. Nowadays the late radiotherapy-related toxicities have been the most important concern for the radiotherapists and patients, who look forward to the better long-term tumor local control and overall survival. Therefore, we carried out a review about the late radiotherapy-related toxicities of the vital organs at risk after IMRT for NPC patients.
Medicine bears the responsibility for human health. Technical competence, service standards, professional ethics and social accountability constitute the soul of this profession. The principles of nonmaleficence, beneficence, respect for autonomy and justice help to establish good doctor-patient relationship and regulate medical services, which has been fixed by international and domestic professional norms. Besides to ensure its truth, effectiveness and safety, medical research also should require certain rendering of subject's autonomy, minimizing risks and maintaining social justice. Some procedures have established for supporting it. Modern medical education furnishes suitable human resources for medical profession, which directly affects the accessibility and outcomes of health services. Its objectives, operations and assessments are increasingly taking shape. Faced with the current issues of healthcare equity, worsening doctor-patient relationship, scandals and ethical controversies in medical research, and the failing of medical education to fully match social needs, evidence-based medical methodology is extending to policy and social sciences for identifying and creating high-quality scientific evidence to improve the quality of decision-making.