偏倚风险评估系列:(三)交叉设计随机对照试验

针对交叉设计随机对照试验Cochrane偏倚评估工具2.0版本（RoB2.0）的主要内容进行详细介绍,主要阐述了与平行设计RoB2.0的不同之处,并举例说明交叉设计RoB2.0的使用方法和注意事项。交叉设计RoB2.0针对交叉设计的自身特点,设置了相应的信号问题,为交叉设计试验纳入系统综述进行证据整合提供偏倚风险信息。     

Women's perceptions of their treatment decision-making about breast cancer treatment

ObjectiveThere is limited understanding about what treatment decision making (TDM) means to patients. The study objective was to identify any processes or stages of TDM as perceived by women with early stage breast cancer (ESBC).MethodsInitial consultations with a surgeon or medical oncologist were videotaped. Subsequently, women viewed their consultation using a qualitative approach with video-stimulated recall (VSR) interviews. Interviews were taped, transcribed, and analyzed.ResultsThere were 6 surgical and 15 medical oncology (MO) consultations. Most women described TDM as beginning soon after diagnosis and involving several processes including gathering information from informal and formal networks and identifying preferred treatment options before the specialist consultation. Many women wanted more information from their surgeon so they could engage in subsequent TDM with their medical oncologist.ConclusionIn this study, women with ESBC began TDM soon after diagnosis and used several iterative processes to arrive at a decision about their cancer treatment. VSR interviews can be useful to investigate TDM occurring during the consultation.Practice implicationsWomen with ESBC rely on information provided by their surgeons and family physicians to make treatment decisions about surgery and also to prepare them for subsequent discussions with medical oncologists about chemotherapy.     

Patient influx and trauma types in a front-line hospital and a secondary referral hospital after the Wenchuan earthquake: a retrospectively comparative study

Purpose  

To better understand the differences of patient influx and types of trauma between front-line and referral hospitals after the Wenchuan earthquake, so as to improve the efficiency of injury management.     

老年人健康自评影响因素及人群归因危险度的系统评价

目的系统评价老年人健康自评的影响因素及其影响程度。方法计算机检索MEDLINE、EMbase、CBM、CNKI、VIP和WanFang Data,收集国内外1960年1月至2011年4月公开发表的关于老年人健康自评影响因素的研究文献。采用相对危险度(RR)或比值比(OR)作为相关性分析合并统计量,并应用相关性分析合并统计量(RR或OR)和总体人群暴露率估计某影响因素的人群归因危险度百分比。采用RevMan 5.1软件进行Meta分析。结果纳入12个研究,35 349例研究对象。其中10个研究在中国完成,其余2个研究分别来自于巴西和美国;11个为横断面研究,1个为队列研究。导致老年人健康自评差的主要因素及OR值(95%CI)为生活需要照料12.1(06.31,23.20)、糖尿病6.49(3.21,13.09)、冠心病5.60(1.07,29.42);而人群归因危险度排名前三位的因素依次为冠心病(53.91%)、半年前患病(52.56%)和慢性疾病(50.09%)。因符合纳入标准的研究较少,未能作亚组分析。结论现有证据显示,老年人健康自评差的主要影响因素为慢性疾病,但由于纳入研究数量有限,且主要为横断面研究,因果论证强度不足,故目前尚不能确定老年人健康自评的影响因素及其影响程度,期待更多前瞻性队列研究提供高质量证据。     

Referral delay in diagnosis of oro/oropharyngeal cancer in Israel

The delay, stage at diagnosis and referral pattern of 543 oro/oropharyngeal cancer patients in Israel were investigated. About two-thirds of the malignancies were diagnosed at early stages. In more than two-thirds there was a delay of at least 2 months from the onset of signs and symptoms up to diagnosis, with a non-significant relationship between stage and delay. A significant correlation (P= 0.002) was found between delay and malignancy site. A delay of more than 4 months was observed in 71% of the patients with lip cancer. Cancers of the lip, palate and buccal mucosa were more frequently diagnosed at early stages. A significant correlation (P= 0.001) was found between stage at diagnosis and referral source. Although 86% of the cancers were diagnosed by physicians, nearly half were already at an advanced stage; when the cancers were diagnosed by dentists, 81% of the remainder were at early stages. No significant relationship was found between the referral medical profession and site of diagnosis. No nasopharyngeal, oropharyngeal or laryngeal cancers were diagnosed by dentists.