Objective To investigate and analyze the past and on-going pro-poor programs related to health equity, and the relevant policies, documents, interventions measures, etc. to improve the China prisoners’ accessibility and utilization of tuberculosis (TB) control services in TB control programs, then evaluate their impacts and influences to provide evidences and suggestions for the further work of TB prevention and treatment. Methods Retrieve published documents about TB prevention and treatment of transient population dating from 1998 to 2008 from MEDLINE, PubMed, CNKI, CBMdisc CDDB and VIP with computers. Simultaneously, a series of interviews was conducted after we got the agreement of the interview people by using non-probability statistics methods. Results A total of 23 documents were retrieved, and they were consonant with the criteria, among which 8 were published and 5 were policy documents. The study on the second document showed the measures that presently applied on TB patients among prisoners in China: find patients through surveys, inspect every prisons and patients going to visit doctors with symptoms; concerning differences between various groups of prisoners, the measure of “classify and instruction, enroll together and treat” was applied; carry out health education in the prisons and so on. After the implement of various measures, the knowledge awareness, discovery rate, accomplishment ratio, cure rate and so on were all improved. The results of the qualitative interviews showed: the TB patients and the doubts among prisoners could be well gotten together and isolated to receive DOTS; doctors were able to receive trainings on TB treatment and take appointment with certificate. Conclusion According to the results of qualitative interviews, the published and the secondary documents, it could be seen that DOTS are well implemented with remarkable effects.
ObjectiveTo investigate the methodological and reporting quality of clinical trials involving Xiaoyao San for chronic fatigue syndrome. MethodsWe searched PubMed, CBM, CNKI, VIP and WanFang Data to identify randomized controlled trials (RCTs) about Xiaoyao San for chronic fatigue syndrome. The methodological and reporting quality of included RCTs was respectively evaluated according to the assessment tool of risk of bias of the Cochrane Handbook 5.1.0 and the CONSORT 2010 statement, combined with complementary assessment by the characteristic indicators of traditional Chinese medicine (TCM). The methodological and reporting quality of included case series study was respectively assessed by the methods recommended by the Britain's National Institute for Clinical Excellence (NICE) and the STROBE statement. ResultsA total of 27 clinical trials were included, involving 11 RCTs and 16 case series studies. According to the assessment tool of risk of bias of the Cochrane Handbook, 54.5% of the RCTs performed proper random method, 9.1% conducted allocation concealment and blinding, 72.7% selected intention-to-treat (ITT) analysis without the report of loss to follow-up, and no RCT existed selective reports. Corresponding to the characteristic indicators of TCM, 54.5% of the RCTs did not conduct TCM syndrome diagnosis, the curative effect standard of TCM syndrome was discrepant, and no RCT was multi-center study. The CONSORT 2010 statement indicated that no RCT explained sample size estimation, implementation details of randomization, flow diagram of participant, use of ITT and clinical trial registration. According to the items recommended by Britain's NICE, 6.25% of the case series studies were multi-center, 81.25% did not report clear inclusion and exclusion criteria, and no case series study performed continuous patient recruitment and stratification analysis of outcome. The STROBE statement indicated that no case series study reported research design, sample size, flow chart, bias, limitations and generalizability. ConclusionThe quality of clinical trials about Xiaoyao San for chronic fatigue syndrome is still low in methodological and reporting aspects. It is suggested that the future clinical trials should be conducted with references of CONSORT statement and STROBE statement, to propel the modernization and internationalization of TCM.
睡眠呼吸暂停低通气综合征( OSAHS) 是一种常见的全身性慢性疾病, 主要表现为呼吸暂停和低通气, 反复发生低氧血症、高碳酸血症和睡眠结构紊乱, 导致白天嗜睡、情绪异常、神经认知功能障碍、心脑血管疾病等。这些异常对患者的日常生活、社会功能、工作效率及认知功能等方面都有不同程度的损害, 使患者生活质量明显下降。多项研究提示 OSAHS患者生活质量与抑郁、白天嗜睡、社会支持等密切相关, OSAHS 相关的生活质量评估量表不仅能关注多导睡眠图( PSG) 无法反映的主观症状如嗜睡、困倦等, 而且反映OSAHS 导致的器官功能损害及其严重程度。本文主要就用于评价OSAHS患者生活质量主要的相关量表及其应用, 以及目前一些治疗措施对生活质量的影响作一综述。
ObjectivesTo investigate the current situation of clinical practice guidelines (CPGs) of gastric cancer in China, and to assess the quality of these CPGs, so as to provide reference for developing the CPGs of gastric cancer normatively in the future.MethodsCNKI, WanFang Data, CBM and VIP databases were electronically searched to collect the CPGs of gastric cancer in China from inception to January 31st, 2018. Four reviewers independently screened literature, extracted data and assessed the quality of these CPGs using the Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ).ResultsA total of 12 guidelines published from 2007 to 2017 were included. Only 1 guideline was evidence-based guideline. The average scores of guidelines in six domains of AGREE Ⅱ were 83.3%, 42.2%, 16.3%, 80.2%, 37.3% and 0% respectively.ConclusionsThe overall quality of included CPGs is insufficient. There is a lack of evidence-based guidelines in China. More attention should be paid to rigor of development and applicability during the development of CPGs in the future, and a timely upgrade is also required.
Objectives To assess the quality of clinical practice guidelines for primary hepatic carcinoma published in 2016 and 2017 in China. Methods CNKI, WanFang Data, CBM and VIP databases were searched for clinical practice guidelines for primary hepatic carcinoma in China. The search date was from Jan. 1st, 2016 to Jan. 1st, 2018. Four researchers independently selected literatures and extracted data according to the inclusion and exclusion criteria. The Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) was utilized to assess the methodological quality of the guidelines. Results A total of 7 guidelines were included. The average scores of six domains for these guidelines were: 65.1% for scope and purpose, 39.4% for stakeholders’ involvement, 64.3% for rigor of development, 55.6% for clarity of presentation, 61.8% for applicability and 6.1% for editorial independence. Conclusions The quality of clinical practice guidelines for primary hepatic carcinoma in China is relative high, of which the recommendations are of great value in clinical practice, yet still required to be improved in some ways.
ObjectivesTo evaluate the methodological quality of clinical practice guidelines (CPGs) of Chinese rehabilitation medicine.MethodsCBM, VIP, CNKI, WanFang Data and Medlive databases were electronically searched to collect CPGs of Chinese rehabilitation medicine from January 1979 to May 2018. Four reviewers evaluated the methodological quality of the CPGs by AGREE Ⅱ.ResultsA total of 11 CPGs were included, which involved 5 CPGs on nervous system rehabilitation, 1 CPG on bone and joint system rehabilitation, 1 CPG each on pediatric rehabilitation, internal medicine system rehabilitation, burn rehabilitation, earthquake rehabilitation and rehabilitation diagnosis and treatment criteria respectively. The results of AGREE Ⅱ score showed that the average scores on six domains were 65.3%, 28.0%, 9.3%, 42.1%, 6.3% and 4.0%. There were not any level A (recommended) guidelines. Two guidelines were level B (recommended after being revised). The other nine guidelines were level C (not recommended).ConclusionsThere are a few rehabilitation CPGs in China and the quality of methodology is low. AGREE's methods and concepts have not been fully used for formulation. The rigor of development, clarity of presentation, applicability and editorial independence of guidelines should be emphasized, so as to produce high level CPGs and improve clinical practice quality in rehabilitation medicine.
Objective To explore the quality of the reporting of randomized controlled trials (RCTs) published in the Chinese Journal of Integrated Traditional and Western Medicine from 1999 to 2004. Methods A manual search was performed and the 22 checklists of CONSORT statement and other self-established criteria were applied. Results Six volumes and 72 issues were checked. There were 1 874 clinical trials of which 1288 (68.73%) RCTs were identified in 2 765 articles. Randomization methods were described in 630 (48.92%) RCTs which showed there was more significant difference than the RCTs published in 1998 (Plt;0.001).In the 1288 RCTs, placebo control was reported only in 21 trials (1.63%) and endpoint measurements were reported in 114 trials (8.85%). Seven trials (0.55%) mentioned the estimation of sample size. None mentioned randomization concealment. Blinding was reported in 54 trials (4.2%) and P value was reported in 9 trials (0.70%).Flow chart was not mentioned in any trials. Compliance was reported in 2 trials (0.16%), and only one trial (0.08%) reported negative results. Ancillary analysis was used in 33 trials (2.57%). 10 trials are multi-centre RCTs. None of the trials reported the approval of ethics committee. Informed consent was reported in 3 trials (0.24%). Acknowledgements were mentioned in 3 trials (0.24%). Syndrome types defined by traditional Chinese medicine (TCM) were reported in 163 trials (12.66%). The criteria of intervention quality control was mentioned in 2 trials (0.15%). Double dummy was used in 8 trials (0.63%) and outcome measurement of TCM was reported in 258 trials (20.04%). All Items reported in RCTs were of low quality. Conclusions The quality of reporting of RCTs published in the Chinese Journal of Integrated Traditional and Western Medicine from 1999 to 2004 has been improved, but it does not meet the CONSORT statement.
ObjectiveTo evaluate the quality of pancreatic cancer guidelines using evidence-based methods based on the global burden of pancreatic cancer, so as to explore its status, region distribution, characteristics of coverage themes, and difference of therapies recommended by the guidelines of various quality, and to provide references for clinical decisionmaking. MethodsPubMed, The Cochrane Library (Issue 11, 2013), CBM, CNKI, and VIP, as well as the website of National Guidelines Clearinghouse (NGC), Guidelines International Network (GIN), and National Institute for Clinical Excellence (NICE) were systematically searched for pancreatic cancer treatment guidelines. The Appraisal of Guidelines for Research and Evaluation (AGREE Ⅲ) was applied to assess methodological quality of included guidelines. ResultsA total of 14 relevant guidelines (including five evidence-based guidelines) were included involving seven countries of four continents (Asia, Europe, North America and Oceania) and four international academic organizations. There were only two domains, namely "scope and purpose" and "clarity of presentations" which got high average scores (more than 60%) among all 14 guidelines. The mean AGREE domain scores in guidelines varied with areas, and the quality of five evidence-based guidelines was superior to that established by consensus. According to the outcomes of AGREE Ⅲ, 11 guidelines were weakly recommended, while 3 were not recommended due to poor methodological quality. The subjects of 14 guidelines covered six treatment categories, including chemotherapy, surgery, radiotherapy, support therapy, radiotherapy, and interventional therapy. ConclusionThe overall methodological quality of pancreatic cancer guidelines is not high among different countries or regions. The quality of evidence-based guidelines is superior to that established by consensus. Chemotherapy, surgery, radiotherapy and support therapy were reccommended as predominant choice by these guidelines.
Objective To explore the condition and quality of domestic clinical therapeutic studies on integrated traditional Chinese and western medicine for posthepatitic cirrhosis in recent 30 years. Methods Jadad scale was used to score 121 literatures selected from January 1980 to January 2010 in periodicals of domestic authoritative resources databases, such as CNKI, VIP, WanFang Data, and CBM. Systematic reviews were conducted to 39 randomized controlled trials (RCTs) literatures of treating posthepatitic cirrhosis with integrated traditional Chinese medicine and western medicine scored two or more points. Results In 30 years, the main problems existing in domestic posthepatitic cirrhosis clinical research of integrated traditional Chinese and western medicine were as follows: the design of clinical RCTs was not strict enough; there was deficiency in the use of blind method; the standardized and uniformed research standard were insufficiency; the sample content was low without specific estimation methods; there was lack of analyses in compliance with cases falling off or without follow-up; and the report of adverse reaction and the quality of life research was neglected. Conclusion Posthepatitic cirrhosis therapy of integrated traditional Chinese and western medical is of “personalized” and “diversified” characteristics. Its therapeutic effects are significantly better than those of pure western medicine and worthy to be popularized in the clinic. However, the quality and level of its clinical scientific research methods still need further improvement.
Objective To investigate the preparing procedures for the larger chemically acellular nerve allografts (CANA) and to establish an evaluation criteria and the preparation method.Methods The sciatic nerves ofthe dogs were exposed by a muscle-splitting incision and were isolated free of the underlying fascia. The 50-mm-long segments of the nerve were made. The proximal and distal ends of the nerve segments were labelled and stabilized by pinning the ends to a thin plastic support, and then they were treated according to the following decellularization processes: The nerve segments were rinsed with the distilled water for 9h, transferred in a 3% Triton-100 solution for 12 h, soaked in 7% sodium deoxycholate for 12 h, and washed in the distilled water for 6 h. All the decellularization steps were performed at room temperature. The nerve segments were divided into 5 subgroups. In Group Ⅰ, Group Ⅱ and Group Ⅲ, the nerve segments were decellularized for 2, 3 and 4 times, respectively. In Group Ⅳ and Group Ⅴ, the two ends of the nerve segments were ligated with a silk line and were decellularized for 2 and 3 times, respectively. Each nerve segment was subdivided into 5 portions from the proximal end to the distal end. The degrees of decellularization, activity of Laminin, degrees of demyelination, and integrity of the nerve fiber tube were observed under microscope and were assessed by a scoring system. Results In all the groups the activity of Laminin was present and the degrees of decellularization were complete. As for the demyelination of the nerve segments, the myelin sheath in Groups Ⅰ, Ⅱ and Ⅲ was partially preserved, but it completely disappeared in Groups Ⅳ and Ⅴ. The structure of the nerve fiber tube in Groups Ⅰ and Ⅳ was almost normal. The total score for the degrees of decellularization, demyelination, and structural integrity was the lowest in Group Ⅳ but the quality was the best. Conclusion The degrees of demyelination are not parallel to the times of decellularization processes. In the quality control of CANA, we should consider the following 4 factors: activity of Laminin, degrees of decellularization, demyelination, and structural integrity. For the larger CANA,ligation of the two ends of the nerve segments during the decellularization procedure may be a better method of ensuring the quality of the decellularization.