Objective To systematically assess the clinical efficacy and safety of cilostazol for preventing ischemic stroke recurrence. Methods Such databases as PubMed, The Cochrane Library, EMbase, CNKI, CBM, and VIP were searched for randomized controlled trials (RCTs) on the use of cilostazol to prevent ischemic stroke recurrence (up to November, 2010). Two researchers selected studies and extracted data independently using a designed extraction form. The quality of included trials was evaluated and RevMan 5.0 software was used for meta-analyses. Results Four RCTs involving 3 916 patients were included. The results of meta-analyses showed that there were significant differences between cilostazol and aspirin in terms of hemorrhagic stroke occurrence (RR=0.39, 95%CI 0.24 to 0.61, Plt;0.000 1), headache occurrence (RR=1.99, 95%CI 1.16 to 3.43, P=0.01) and dizziness occurrence (RR=1.43, 95%CI 1.13 to 1.79, P=0.002). Whereas, no significant difference was found between the two groups in terms of ischemic stroke recurrence (RR=0.80, 95%CI 0.61 to 1.04, P=0.10) and transient ischemic attack occurrence (RR=0.93, 95%CI 0.45 to 1.92, P=0.85). Conclusion The current evidence indicates that cilostazol is as effective as aspirin in preventing ischemic stroke recurrence, but with less incidence of hemorrhagic stroke.
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.
Objectives To evaluate the clinical efficacy and safety of coronary artery drug injection for slow flow/no-reflow phenomenon after coronary stent implantation. Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2009), PubMed, EMbase, CBM, CNKI, VIP, and WanFang databases from their inception to April 2009. Two reviewers independently evaluated the quality of the included studies and extracted the data. Meta-analyses were performed by RevMan 5.0 software. Results Eight randomized controlled trials (RCTs) involving 593 patients were included. The results of meta-analyses showed that urokinase, adenosine, and anisodamine could significantly improve the thrombolysis in myocardial infartion (TIMI) flow. In addition, anisodamine could improve the coronary blood pressure. Urokinase significantly reduced the incidence of malignant ventricular arrhythmias and non-fatal of heart failure during hospitalization, but it could not change the mortality and the incidence of unstable angina, recurrence of myocardial infarction, and ischemic target revascularization. Conclusion Evidence shows that anisodamine, urokinase, urapidil and adenosine can improve TIMI flow and improve myocardial perfusion on the no-reflow patients post coronary stent implantation and urokinase can significantly reduce the incidence of main adverse cardiovascular events. Their clinical application is worthy to be advocated.
OBJECTIVE: To comprehend the progress of tissue engineering research and speculate its developmental trends. METHODS: MEDLINE search was conducted to retrieve the papers published between 1987 to 1999 under the main headings of tissue engineering. Years, nationalities, languages, journals, authors and heading frequencies of 314 papers were analyzed by bibliometrics. RESULTS: Since 1990, the number of tissue engineering research literatures had doubled, and papers between 1998 and 1999 made up 57.96% of the total papers. All papers came from 15 nations, in 6 languages and 140 journals; 64.97% came from United States and 25.79% from England, Netherlands and Germany; 93.95% was in English; 42.04% was published on 15 journals. Vacanti JP and 19 other authors presented 5 to 24 papers. Heading frequencies were cytology 22.89%, transplantation 13.30%, scaffolds and extracellular matrixes 11.72%, implanting 10.60%, polymers 8.91%, potential applications 8.91%, artificial substitutes 6.88%, tissue culture 6.70% and biogenetics 4.96%. CONCLUSION: Tissue engineering literatures mainly come from United States, England, Netherlands and Germany. English is the major language. J Biomed Mater Res and 14 other journals are important journals about tissue engineering research. Vacanti JP and 19 other authors are prolific authors. Cytology, transplantation, scaffolds and extracellular matrixes and implanting are hot topics and key points on tissue engineering research.
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 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 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.
ObjectiveTo analyze the trend of disease burden of tracheal and bronchial lung cancer in China from 1990 to 2021 and predict its future changes. MethodsData was extracted from the Global Burden of Disease Database 2021 to analyze the disease burden of tracheal and bronchial lung cancer in China from 1990 to 2021. The Joinpoint regression model was used to analyze the temporal trends. The BAPC model was employed to predict the future disease burden of tracheal and bronchial lung cancer in China. ResultsIn 2021, the standardized incidence rate, standardized prevalence, standardized mortality rate, and standardized DALYs rate of tracheal and bronchial lung cancer in China were 44.01/100 000, 57.95/100 000, 38.98/100 000, and 878.25/100 000, all of which showed an upward trend compared to 1990, with the standardized prevalence increasing the fastest at 71.75%, followed by the standardized incidence rate, which increased by 32.93%. BAPC prediction results indicated that the standardized incidence and prevalence rates of tracheal and bronchial lung cancer in the Chinese population will show an upward trend, while the standardized mortality rate will show a downward trend, and the standardized DALYs rate will remain relatively stable from 2022 to 2035. The standardized incidence rate is expected to rise from 46.18/100 000 in 2022 to 50.32/100 000 in 2035, the standardized prevalence rate is expected to rise from 60.47/100 000 in 2022 to 73.49/100 000 in 2035, the standardized mortality rate is expected to decrease from 39.75/100 000 in 2022 to 36.53/100 000 in 2035, and the standardized DALYs rate is expected to rise from 903.25/100 000 in 2022 to 916.38/100 000 in 2035. ConclusionFrom 1990 to 2021, the disease burden of tracheal and bronchial lung cancer in China showed an upward trend. Although the disease burden among the elderly and males is more prominent, the rate of increase among females in the past decade has been rapid and shows a trend towards younger ages. Comprehensive prevention and control measures should be taken. It is predicted that the situation of tracheal and bronchial lung cancer incidence and prevalence in China will remain very serious from 2022 to 2035.
Objective To systematically evaluate the clinical effectiveness and safety of capecitabine plus docetaxel in the treatment of patients with metastatic breast cancer where anthracycline has failed as a treatment. Methods We electronically searched PubMed, EMBASE, the Cochrane Library (2008, issue 4), and CBM to Sept. 2008. Randomized controlled trials (RCTs) and quasi-RCTs about capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with metastatic breast cancer were identified. Study selection and analyses were undertaken according to the Cochrane Handbook, and RevMan 5.0 was applied for statistical analyses. The following was studied: total survival time, the development time of disease, reaction rate, the mid-survival time, adverse events and quality of life. Results Three RCTs involving 672 patients with metastatic breast cancer were included. The results of meta-analyses showed that the overall survival (MD=3.00, 95%CI 1.64 to 4.36), disease time to progression (MD=1.85, 95%CI 1.15 to 2.55), and the response rate (RR=1.29, 95%CI 1.09 to 1.52) were superior in the combination arm to the docetaxel alone arm. Conclusion The current evidence available shows that the combination of capecitabine and docetaxel may significantly improve the short-term efficacy comparing with docetaxel alone. However, adverse events and long-term efficacy are not clear; more high-quality RCTs should be conducted.
Decision-making is often a complex and hard-to-routinize process. Based on the decision-making experience of fighting COVID-19, policymakers have gradually realized that climate action, quality education, and other societal challenges, as well as the sustainable development goals (SDGs) need to be addressed with the best available evidence using an evidence-informed decision-making (EIDM) approach. The Global Commission on Evidence was established in 2021. In addition, the Evidence Commission issued reports in 2022 and 2023. A systematic methodology to address societal challenges with EIDM has been constructed in the report. Five types of domestic evidence (data analytics, evaluation, modeling, qualitative insights, and behavioural/implementation research) and four steps in decision-making process (understanding a problem and its causes, selecting an option for addressing the problem, identifying implementation considerations, and monitoring implementation and evaluating impacts) were used to support four types of decision-makers (government policymakers, organizational leaders, professionals and citizens) in EIDM, as demonstrated by the reports. To further disseminate the concept and methodology of EIDM globally, the secretariat works with 25 Evidence Commissioners to write the report, and continues to cooperate with Country Leads Group from 12 countries to conduct rapid evidence-support system assessments (RESSAs), and collaborates with Evidence Commission Implementation Council to accelerate the implementation of 24 recommendations. The main history, core methodology, and latest developments of the Global Committee on Evidence were systematically reviewed in this paper. We aimed to show decision-makers a new version of how to scientifically address the societal challenges of EIDM.