基于循证指南和精准医学时代背景下肝癌诊疗的思考与总结

正信息时代,瞬息万变,新的医学理念和技术层出不穷,不断更新着人们对于疾病的认知模式。近些年来,诸多国家和地区遵循循证医学,筛选出最可靠并具有一定的临床运用价值的研究成果,更新发表了各种专家共识或临床指南,指导世界各地医师的诊疗[1]。肝癌的诊治作为全球性的难     

中医药治疗经间期出血的Meta分析

目的：系统评价中医药治疗经间期出血的疗效。方法：检索近8年中医药干预经间期出血的随机对照临床试验，并对文献结果进行Meta分析。结果：最终15篇临床研究文献入选，研究结果异质性检验：x2＝14.93，P＝0.38。故采用固定效应模型进行统计分析，合并后OR值为5.21，95%，可信区间为3.54～7.66，菱形位于中间线的右侧，经Z检验，Z＝8.39，P〈0.00001，中医药治疗效果显著。“漏斗图”图形显示存在发表偏倚。结论：①中医药治疗经间期出血与西药治疗疗效相当，且可发挥其副作用少、安全性高的优势；②在有力证据方面，中医药（尤其针灸）治疗经间期出血需要更多高质量的研究文献，现阶段文献资料欠严谨。     

Building immunization decision-making capacity within the World Health Organization European Region

A National Immunization Technical Advisory Group (NITAG) is a multi-disciplinary body of national experts that provides evidence-based recommendations to policy-makers, assisting them in making sound immunization policy and programme decisions. The World Health Organization (WHO) Regional Office for Europe is working to strengthen the capacity of newly-established NITAGs and has targeted efforts on low- and middle-income countries. The Regional Office, in collaboration with WHO Headquarters and USA Centers for Disease Control and Prevention (CDC), developed a new training strategy and held training workshops to improve NITAGs’ functioning and ability to make evidence-based recommendations. Feedback from countries that participated in trainings indicated that the updated training materials and interactive approach with follow-up technical support enabled them to align their NITAG charters and processes with WHO recommendations. To ensure continued progress, global and regional partners such as WHO and CDC should continue providing technical support to recently established NITAGs.     

How do deaf speakers talk about time?

The grammatical and lexical aspects of temporal reference in the expressive language of prelingually deaf speakers in comparison with normally hearing age-matched speakers were examined. Significant differences emerged between groups in the grammaticalization of time. The deaf subjects used fewer verb inflections to mark time and made many errors with inflections. In addition, a significant triple interaction was found between group × verb typology × verb inflection, which suggested that the deaf were using the verb inflections to code the aspectual features of completion and duration inherent in verbs. Lexical aspects of time reference were found to be similar for both groups. The results are discussed with reference to the normal development of linguistic expressions of time in children acquiring language, and the implications for language therapy with the deaf are considered.     

Mode of action analysis for liver tumors from oral 1,4-dioxane exposures and evidence-based dose response assessment

1,4-Dioxane is found in consumer products and is used as a solvent in manufacturing. Studies in rodents show liver tumors to be consistently reported after chronic oral exposure. However, there were differences in the reporting of non-neoplastic lesions in the livers of rats and mice. In order to clarify these differences, a reread of mouse liver slides from the 1978 NCI bioassay on 1,4-dioxane in drinking water was conducted. This reread clearly identified dose-related non-neoplastic changes in the liver; specifically, a dose-related increase in the hypertrophic response of hepatocytes, followed by necrosis, inflammation and hyperplastic hepatocellular foci. 1,4-Dioxane does not cause point mutations, DNA repair, or initiation. However, it appears to promote tumors and stimulate DNA synthesis. Using EPA Guidelines (2005), the weight of the evidence suggests that 1,4-dioxane causes liver tumors in rats and mice through cytotoxicity followed by regenerative hyperplasia. Specific key events in this mode of action are identified. A Reference Dose (RfD) of 0.05 mg/kg day is proposed to protect against regenerative liver hyperplasia based on a benchmark dose (BMD) approach. Based on this RfD, a maximum contaminant level goal of 350 μg/L is proposed using a default relative source contribution for water of 20%.     

Dual-Energy CT of the Abdomen and Pelvis: Radiation Dose Considerations

Dual-energy CT offers several new applications and opportunities for routine clinical practice. Increasing utilization in the context of both routine practice and clinical research raises questions about expected radiation dose when compared with conventional single-energy exams. Despite initial concerns, advanced iterative reconstruction techniques and creation of virtual unenhanced images in multiphase acquisitions offer methods for dose reduction. Although dose varies across patients and scanners, modern dual-energy exams allow for comparable and potentially decreased radiation dose when compared with single-energy CT. In this review, we examine dual-energy radiation dose considerations with discussion of accepted ACR diagnostic reference levels.     

Science-based practice and the speech-language pathologist

Evidence-based practice (EBP) is a well established concept in the field of speech-language pathology. However, evidence from research may not be the primary information that practitioners use to guide their treatment selection from the many potential options. There are various alternative therapy procedures that are strongly promoted, so clinicians must become skilled at identifying pseudoscience from science in order to determine if a treatment is legitimate or actually quackery. In order to advance the use of EBP, clinicians can gather practice-based evidence (PBE) by using the scientific method. By adhering to the principles of science, speech-language pathologists can incorporate science-based practice (SBP) into all aspects of their clinical work.     

Evaluating training methods for transporting contingency management to therapists

The effects of three increasingly intensive training methods on therapist use, knowledge, and implementation adherence of contingency management (CM) with substance abusing adolescents were evaluated. Ten public sector substance abuse or mental health provider organizations were randomized to one of three training conditions: workshop and resources (WS +), WS + and computer assisted training (WS +/CAT), or WS +/CAT and supervisory support (WS +/CAT/SS). Across conditions, 161 therapists participated in the training experiences, and measures were obtained at baseline and 2-month intervals for 12 months following workshop participation. Across training conditions, therapists reported increased CM use, knowledge, and implementation adherence through the 12-month follow-up. The findings show that community-based practitioners are amenable to the adoption of evidence-based treatments when provided access to useful resources. Moreover, high quality workshops in combination with resource access can increase knowledge of the evidence-based treatment and might enhance intervention adherence to a level needed to improve youth outcomes.