Objective To investigate the current status of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) on pressure sore in China. Methods We searched Chinese Journal of Nursing, Chinese Journal of Practical Nursing and Journal of Nurses Training in CNKI and VIP (January 2000 to December 2005) for Chinese articles on pressure sore, using "pressure sore", "bed sore", "nursing", "treatment", "prevention", "evaluation" and "management" as search terms. The retrieved articles were summarized. Results We identified 16 reports (10 RCTs and 6 CCTs). The studies were judged to be of low quality.There was one study on the evaluation, two on the prevention, and 13 on the treatment of pressure sores. Conclusion The current studies on pressure sore in China are focusing on treatment. Randomized controlled trials of large sample size of pressure sore are needed to improve nursing quality.
①抗抑郁药 我们没有找到研究抗抑郁药治疗绝经期症状疗效的随机对照试验(RCT). ②可乐定 1个RCT发现,疗程8周的经皮可乐定较安慰剂能明显减少发生潮热的妇女人数,增加潮热发生频率减少的妇女人数. ③雌激素 1篇系统评价和2个随后的RCT发现,雌激素较安慰剂能明显改善血管舒缩症状.两篇系统评价和3个随后的RCT发现,雌激素能预防尿路感染,改善泌尿生殖系统症状.1篇系统评价发现,雌激素能减轻抑郁情绪.4个RCT发现,雌激素在短期内能改善生活质量.重要的不良反应包括静脉血栓性疾病、乳腺癌和子宫内膜癌. ④植物雌激素 1个RCT发现,治疗6周时,大豆蛋白与非植物雌激素相比能减轻血管舒缩症状的严重程度,但不能减少其发生频率.1个RCT发现,治疗12周后,黄酮和安慰剂在改善血管舒缩症状方面无显著差异.另1个RCT发现,疗程gt;12周,异黄酮与安慰剂相比能减轻血管舒缩症状.1个RCT发现,治疗12周后,大豆粉与安慰剂相比能明显减少每周潮热的平均发生次数.但另1个RCT发现,大豆蛋白和安慰剂相比在改善血管舒缩症状方面无显著差异.1个RCT发现,疗程gt;12周,大豆粉和小麦粉在改善血管舒缩症状方面无显著差异.1个RCT(94例妇女)发现,治疗3个月时,大豆蛋白和安慰剂在缓解心理、肌肉关节、泌尿生殖系统症状方面无显著差异. ⑤孕激素 1篇系统评价和另6个RCT发现,孕激素能减轻血管舒缩症状.对于其它结局(包括生活质量),我们没有发现高质量的证据. ⑥睾酮 1个RCT比较了甲基睾酮 + 雌激素与单独使用雌激素,结果 发现甲基睾酮能明显减轻潮热症状;但另1个RCT发现,治疗6个月后两者没有明显差异.1个交叉设计的RCT发现,有限的证据显示睾酮能提高性快感和性欲,但另1个RCT发现治疗6个月时两组间没有明显差异.我们未找到单用甲基睾酮在改善更年期其他常见症状方面的RCT. ⑦替勃龙 1个RCT发现,替勃龙与安慰剂比较能明显改善血管舒缩症状.第2个RCT发现,替勃龙改善血管舒缩症状效果不如雌、孕激素替代治疗.第3个RCT发现,在改善血管舒缩症状方面,替勃龙和雌激素替代治疗无明显差异.1个RCT发现,治疗48周后,在改善阴道干燥症状方面,替勃龙和持续性激素替代治疗无明显差异,但前者能明显改善性满足感.1个RCT发现,与安慰剂比较,治疗3个月后,替勃龙能明显降低性唤起阈和提高性高潮.1个RCT发现,替勃龙与结合雌激素相比能明显提高性欲和增加性交频率.
①关于药物引起的卵巢抑制:1篇系统评价发现,使用卵巢抑制药治疗子宫内膜异位症与安慰剂或达那唑相比,妊娠率无明显差异.该评价还发现,卵巢抑制药引起的不良反应包括体重增加、潮热和骨质疏松症,达那唑可能引起剂量相关的体重增加和雄激素样作用. ②宫腔内人工授精+促性腺激素:1个RCT发现,宫腔内人工授精+促性腺激素治疗与不治疗相比,可明显提高活产率.第2个RCT发现,期待疗法与宫腔内人工授精+垂体降调节+促性腺激素治疗后的分娩率无明显差异.第3个RCT发现,宫腔内人工授精+促性腺激素治疗与单用宫腔内人工授精相比,仅明显提高妊娠率. ③体外受精:我们没有找到关于子宫内膜异位症引起不孕妇女接受受精体外治疗的RCT. ④手术治疗:两个比较腹腔镜手术与诊断性腹腔镜的RCT发现,在妊娠率和活产率方面结论不一.
Objective To find the most effective treatment for a patient with difficult selective biliary cannulation (DSBC) during endoscopic retrograde cholangiopancreatography (ERCP) by EBM practice. Methods Evidence was retrieved from The Cochrane Library (Issue 1, 2010), ACP online, NGC (1998 to June 2010), PubMed (1950 to June 2010), and CBM (1994 to June 2010). The collected evidence was then graded. Results After preliminary research, we identified 18 relevant articles. The evidence showed that pre-cutting technique could increase cannulation success rates in DSBC and was safe, effective, and time-saving for an experienced endoscopist. Pancreatic duct occupation was easier to perform than pre-cutting technique and could also increase selective cannulation success rates in DSBC. According to the evidence, together with endoscopist’s experience and the preference of the patient and his family, needle-knife precut papillotomy was performed. Successful selective biliary cannulation was accomplished after pre-cutting. Conclusion The current evidence suggests that pre-cutting technique and pancreatic duct occupation could increase selective cannulation success rates in DSBC. Patients’ condition and endoscopist’s experience should be considered properly before the operation.
Objective To give an individualized treatment to a young woman with primary dysmenorrhea. Methods According to the basic principle and methods of evidence-base medicine, we searched The Cochrane Library (Issue 1, 2009), MEDLINE (PubMed, January 1950 to May 2009), ACP Journal Club (OVID, January 1991 to May 2007) for systematic reviews and randomized controlled trials (RCTs) to acquire the best clinical evidence on the treatment of primary dysmenorrhea. Results A total of 11 systematic reviews and 1 RCT were identified. A reasonable treatment plan was made through combining the patient’s will with her family members’. Conclusion The treatment effect on primary dysmenorrhea of the young woman is improved by an individualized treatment plan based on an evidence-based method.
现有预防非妊娠期妇女膀胱炎复发的临床证据如下:①连续预防性使用抗生素:一系列随机对照试验研究表明,连续预防性使用抗生素(甲氧苄氨嘧啶、复方磺胺甲噁唑、呋喃妥英、头孢克洛或一种喹啉)6～12个月可以减少复发性膀胱炎的发生率,但各种不同用药方案间未发现感染率有差异.一个比较持续性每日使用抗生素与性交后使用抗生素的随机对照试验表明,1年后尿培养阳性率差异无统计学意义.②性交后预防性使用抗生素(复方磺胺甲噁唑、呋喃妥英或一种喹啉):4个随机对照试验研究表明,性交后2 h内使用复方磺胺甲噁唑、呋喃妥英或喹啉较安慰剂能显著降低膀胱炎发生率.一个关于性交后预防性使用抗生素和每日连续使用抗生素的随机对照试验发现,1年后二者的膀胱炎发生率的差异无统计学意义.③一次性使用复方磺胺甲噁唑:一个小样本随机对照试验发现,连续每日预防性使用复方磺胺甲噁唑与在膀胱炎症状出现后一次性使用复方磺胺甲噁唑相比,前者能显著降低膀胱炎发生率.但由于证据太有限,不能得出肯定结论.④酸果蔓汁(cranberry juice)和酸果蔓制品:一个系统评价发现,酸果蔓汁及其制品能预防复发性膀胱炎的证据不足.⑤用马尿酸乌洛托品预防:缺乏研究马尿酸乌洛托品的可靠的随机对照试验.
Evidence-based dentistry has been established for more than a decade, and described as ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients＇. However, Orthodontic clinicians in China still tend to base their treatment protocols on the ‘it works in my hands＇evidence provided by their peers, mainly due to their weak experience in searching and applying clinical evidences. In this article, authors are willing to share their experience with their Chinese peers, and to promote the dissemination and application of evidence-based orthodontics in clinical practice.
Until Issue 2 in 2008, the Cochrane Database of Systematic Reviews had included 23 systematic reviews concerning colorectal tumors by the colorectal cancer group. These reviews involved prevention, diagnosis, treatment, prognosis and follow-up. The preventive ability of non-steroid anti-inflammatory drugs, accuracy of chromoscopy, shortterm outcomes of laparoscopic colorectal resection and outcomes of laparoscopic total mesorectal excision were confirmed. Meanwhile, the effect of dietary fibre in prevention, mechanical preoperative preparation, and prophylactic anastomotic drainage was questioned. Because of the low quality of trials, no firm conclusions were revealed in some reviews, such as traditional Chinese medicine in chemotherapy. Through the study of Cochrane systematic reviews, medical practitioners and researchers can obtain high-quality evidence, and identify future research direction in the field of colorectal cancer.
We searched The Cochrane Library（Issue 3, 2005）, MEDLINE（1996-2005） ,CMCC（1996-2005）, VIP（1996-2005） ,CNKI（1996-2005） to summarize the available evidence of topiramate for an intractable epilepsy. After scanning all these articles, we identified 11 articles including meta-analysis, randomised controlled trials and systematic reviews to evaluate. Topiramate offered an alternative in the treament for intractable epilepsy, especially for partial epilepsy, and its efficacy was proven. Patients had good tolerance. And no intercross effects with the traditional anti-epileptic drugs were found. So topiramate had broad clinical value. The primary dosage of topiramate was 200mg/d. The sustaining dosage was 400-600mg/d. And we didn＇t recommend the dosage of more than 600mg/d.