中文发表的乳腺癌随机对照试验摘要报告质量调查

目的 评价中文发表的乳腺癌随机对照试验(RCT)摘要报告质量。 方法 运用计算机检索主要中文数据库,纳入中文发表的乳腺癌RCT,采用“摘要CONSORT”标准评价纳入RCT摘要的报告质量,使用Meta-Analyst软件进行统计分析。 结果 最终纳入符合标准的RCT 965篇,评价结果显示:乳腺癌RCT摘要中存在严重报告质量缺陷,尤其体现在“标题中判定为随机研究”(1.1%,95%CI:0.6%～2.0%)、“随机化”(3.8%,95%CI:2.8%～5.2%)、“盲法”(1.0%,95%CI:0.6%～1.9%)、“统计方法”(11.5%,95%CI:9.6%～13.7%)、“随机分组的例数”(7.5%,95%CI:6.0%～9.3%)、“招募对象”(12.2%,95%CI:10.3%～14.4%)、“试验注册信息”(13.1%,95%CI:11.1%～15.3%)和“资助来源”(8.1%,95%CI:6.5%～10.0%)8个方面。“摘要CONSORT”发布以后,可以显著提高“研究对象”“干预”“统计方法”“结局”和“结论”的报告率。比较非中国科学引文数据库(CSCD),CSCD收录RCT的摘要在“标题识别随机”“随机化”“招募对象”和“资助来源”的报告上差异有统计学意义。 结论 中文发表乳腺癌RCT摘要存在严重报告缺陷,应当引起期刊编辑和研究员的重视。      

Systematic review of randomized controlled trials of traditional Chinese medicine treatment of non-acute bronchial asthma complicated by gastroesophageal reflux

OBJECTIVE:To assess the effectiveness and safety of Traditional Chinese Medicine(TCM) treatment of non-acute bronchial asthma complicated by gastroesophageal reflux.METHODS:We searched databases from MEDLINE,Cochrane Library,CNKI,VIP,CBM,Wanfang Data,and TCM Database Systems.All randomized,controlled trials(RTCs) of TCM treatment of non-acute asthma complicated by gastroesophageal reflux were included.Data were independently collected by two reviewers.The standards for assessing quality described in the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate articles.Meta-analyses were conducted using RevMan 5.0.17 software.Heterogeneity was assessed,and a corresponding effects model was used to merge and analyze results.Indexes used to evalu-ate curative effects were:clinical efficacy,symptom scores,pulmonary function values,and adverse incidents.Effectiveness was indicated using risk ratio(RR) or mean difference(MD),and 95% confidence intervals(CIs) were calculated.RESULTS:Six RCTs were included,involving 304 patients with non-acute asthma complicated by gastroesophageal reflux.The treatment groups received Chinese drugs alone or TCM combined with standard Western medical treatment,and the control groups received standard Western medical treatment alone.Standard Western medical treatment included anti-inflammatory drugs and bronchodilators for asthma,and drugs to promote gastric peristalsis and inhibit gastric acid production for gastroesophageal reflux.Methodological quality was low in all six RCTs.Two RCTs showed that clinical efficacy was higher in the treatment group than in the control group(RR:1.43,95%CI:1.10 to 1.87 vs RR:1.51,95% CI:1.09 to 2.08).One RCT showed that the asthma score was lowered more effectively in the treatment group than in the control group(MD:-1.10,95% CI:-2.04 to-0.16).Two RCTs showed that the gastroesophageal reflux score was reduced more effectively in the treatment group than in the control group(RR:-3.70,95% CI:-4.30 to 3.10 vs RR:-5.30,95% CI:-6.32 to-4.28).One RCT showed that some pulmonary function values were improved more effectively in the treatment group than in the control group(P< 0.05).No differences were seen in the various indexes between groups in the other RCTs.No adverse reactions,dropout rates,or follow-up rates were reported in any of the RCTs.CONCLUSIONS:The clinical symptoms ofnon-acute asthma complicated by gastroesophageal reflux can be improved by some Chinese drugs.Curative effects can be increased by combining the use of TCM with Western medicine.Because of the small quantity and low quality of research reported to date,it is necessary to conduct further RCTs to confirm these results.The results of this systematic review indicate that the quality of future clinical trials should be improved by including larger patient numbers,correctly randomizing patients into study groups,using blinding methods to measure and assess outcomes,and using accepted indexes to evaluate curative effects.     

End-of-life care content in 50 textbooks from multiple specialties

CONTEXT: Prior reviews of small numbers of medical textbooks suggest that end-of-life care is not well covered in textbooks. No broad study of end-of-life care content analysis has been performed on textbooks across a wide range of medical, pediatric, psychiatric, and surgical specialties. OBJECTIVE: To determine the quantity and rate the adequacy of information on end-of-life care in textbooks from multiple medical disciplines. DESIGN AND SOURCES: A 1998 review of 50 top-selling textbooks from multiple specialties (cardiology, emergency medicine, family and primary care medicine, geriatrics, infectious disease and acquired immunodeficiency syndrome [AIDS], internal medicine, neurology, oncology and hematology, pediatrics, psychiatry, pulmonary medicine, and surgery) for the presence and adequacy of content in 13 end-of-life care domains. MAIN OUTCOME MEASURES: Chapters on diseases commonly causing death and those devoted to end-of-life care were identified, read, rated, and compared by textbook specialty, chapter, and domain for the presence of helpful information in the 13 domains. Content for each domain was rated as absent, minimally present, or helpful. Textbook indexes were analyzed for the number of pages relevant to end-of-life care. RESULTS: Overall, helpful information was provided in 24.1% (range, 8.7%-44.2%) of the expected end-of-life content domains; in 19.1% (range, 6.2%-38.5%), expected content received minimal attention; and in 56.9% (range, 23.1 %-77.9%), expected content was absent. As a group, the textbooks with the highest percentages of absent content were in surgery (71.8%), infectious diseases and AIDS (70%), and oncology and hematology (61.9%). Textbooks with the highest percentage of helpful end-of-life care content were in family medicine (34.4%), geriatrics (34.4%), and psychiatry (29.6%). In internal medicine textbooks, the content domains with the greatest amount of helpful information were epidemiology and natural history. Content domains covered least well were social, spiritual, ethical, and family issues, as well as physician after-death responsibilities. On average, textbook indexes cited 2% of their total pages as pertinent to end-of-life care. CONCLUSION: Top-selling textbooks generally offered little helpful information on caring for patients at the end of life. Most disease-oriented chapters had no or minimal end-of-life care content. Specialty textbooks with information about particular diseases often did not contain helpful information on caring for patients dying from those diseases.     

Vegetable and Fruit Consumption among Chinese Adults and Associated Factors: A Nationally Representative Study of 170,847 Adults

Objective This study examined vegetable and fruit (VF) consumption rate and its associated factors among Chinese adults. Methods Nationally representative data from the 2013 China Chronic Disease Surveillance survey were used. Dietary intake data, including VF consumption during the last 12 months, were collected. All analyses were weighted to obtain nationally representative estimates. Associations between VF consumption and other factors (e.g., meal frequency and physical activity) were examined through logistic regression analysis. Results The average fruit consumption was 102.3 g/day (95% CI: 97.0-107.6) and the average vegetable consumption was 350.6 g/day (95% CI: 339.3-361.8). Over half (53.2%, 95% CI: 50.9-55.4) of Chinese adults met the VF consumption of 400 g/day recommended by the World Health Organization (WHO). Rural residents had a higher prevalence of low VF consumption rate than urban residents [49.20% (95% CI: 46.2%-52.2%) vs. 44.0% (95% CI: 41.7%-46.3%) P lt; 0.01]. Old age (OR = 1.01, 95% CI: 1.00-1.01), low educational level, low income, minority ethnicity (OR = 1.41, 95% CI: 1.15-1.74), underweight (OR = 1.17, 95% CI: 1.03-1.33), single marital status (OR = 1.20, 95% CI: 1.08-1.33), low health literacy, irregular breakfast (OR = 1.20, 95% CI: 1.04-1.38) or lunch (OR = 1.58, 95% CI: 1.26-1.99) habits, and no leisure-time physical activity were associated with low VF consumption. Conclusion Only half of Chinese adults met the VF consumption recommended by the WHO. Low socio-economic status, irregular diet, and poor health literacy were likely associated with low VF consumption. National efforts and programs are needed to promote VF consumption.     

Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation

CONTEXT: The Consolidated Standards for Reporting of Trials (CONSORT) statement was developed to help improve the quality of reports of randomized controlled trials (RCTs). To date, a paucity of data exists regarding whether it has achieved this goal. OBJECTIVE: To determine whether use of the CONSORT statement is associated with improvement in the quality of reports of RCTs. DESIGN AND SETTING: Comparative before-and-after evaluation in which reports of RCTs published in 1994 (pre-CONSORT) were compared with RCT reports from the same journals published in 1998 (post-CONSORT). We included 211 reports from BMJ, JAMA, and The Lancet (journals that adopted CONSORT) as well as The New England Journal of Medicine (a journal that did not adopt CONSORT and was used as a comparator). MAIN OUTCOME MEASURES: Number of CONSORT items included in a report, frequency of unclear reporting of allocation concealment, and overall trial quality score based on the Jadad scale, a 5-point quality assessment instrument. RESULTS: Compared with 1994, the number of CONSORT checklist items in reports of RCTs increased in all 4 journals in 1998, and this increase was statistically significant for the 3 adopter journals (pre-CONSORT, 23.4; mean change, 3.7; 95% confidence interval [CI], 2.1-5.3). The frequency of unclear reporting of allocation concealment decreased for each of the 4 journals, and this change was statistically significant for adopters (pre-CONSORT, 61%; mean change, -22%; 95% CI, -38% to -6%). Similarly, 3 of the 4 journals showed an improvement in the quality score for reports of RCTs, and this increase was statistically significant for adopter journals overall (pre-CONSORT, 2.7; mean change, 0.4; 95% CI, 0.1-0.8). CONCLUSION: Use of the CONSORT statement is associated with improvements in the quality of reports of RCTs.     

Patient-important outcomes in registered diabetes trials

Gunjan Y. Gandhi, MD, MSc; M. Hassan Murad, MD, MPH; Akira Fujiyoshi, MD, MPH; Rebecca J. Mullan, MS; David N. Flynn, BS; Mohamed B. Elamin, MBBS; Brian A. Swiglo, MD; William L. Isley, MD; Gordon H. Guyatt, MD, MSc; Victor M. Montori, MD, MSc

JAMA. 2008;299(21):2543-2549.

Context  Concerns about the safety and efficacy of diabetes interventions persist, in part because randomized clinical trials (RCTs) have not measured their effect on patient-important outcomes, ie, death and quality of life (morbidity, pain, function).

Objective  To systematically determine the extent to which ongoing and future RCTs in diabetes will ascertain patient-important outcomes.

Data Sources  On November 10, 2007, we searched primary RCT registries ClinicalTrials.gov (http://www.clinicaltrials.gov), International Standard Randomized Controlled Trial Number Register (http://isrctn.org), and Australian New Zealand Clinical Trials Registry (http://www.anzctr.org.au).

Study Selection  We identified phase 2 through 4 RCTs enrolling patients with diabetes. Of 2019 RCTs, 1054 proved eligible. We randomly sampled 50% of the eligible RCTs (527 of 1054) and selected 436 registered since registration became mandatory (2004).

Data Extraction  Pairs of reviewers working independently collected study characteristics and determined the outcomes measured and their type (physiological outcomes, surrogate outcomes thought to reflect an increased risk for patient-important outcomes, and patient-important outcomes).

Results  Of the 436 registered RCTs included in this analysis, 24 (6%) had not started enrollment, 109 (25%) were actively enrolling, and 303 (69%) had completed enrollment. Primary outcomes were patient-important outcomes in only 78 of 436 RCTs (18%; 95% confidence interval [CI], 14%-22%), physiological and laboratory outcomes in 69 of 436 (16%; 95% CI, 13%-20%), and surrogate outcomes in 268 of 436 (61%; 95% CI, 57%-66%). Patient-important outcomes were reported as primary or secondary outcomes in 201 of 436 (46%; 95% CI, 41%-51%). In multivariate analysis, large trials (odds ratio [OR], 1.10; 95% CI, 1.02-1.19 for every additional 100 patients) and trials of longer duration (OR, 1.03; 95% CI, 1.01-1.06 for every additional 30 days) were more likely while parallel design RCTs (OR, 0.15; 95% CI, 0.05-0.44) and type 2 diabetes trials (OR, 0.23; 95% CI, 0.09-0.61) were less likely to assess patient-important outcomes as a primary outcome.

Conclusion  In this sample of registered ongoing RCTs in diabetes, only 18% included patient-important outcomes as primary outcomes.

     

Preoperative radiotherapy for resectable rectal cancer: A meta-analysis

CONTEXT: The benefit of adjuvant radiotherapy for resectable rectal cancer has been extensively studied, but data on survival are still equivocal despite a reduction in the rate of local recurrence. OBJECTIVE: To assess the effectiveness of preoperative radiotherapy followed by surgery in the reduction of overall and cancer-related mortality and in the prevention of local recurrence and distant metastases. DATA SOURCES: Computerized bibliographic searches of MEDLINE and CANCERLIT (1970 to December 1999), including non-English sources, were supplemented with hand searches of reference lists. The medical subject headings used were rectal cancer, radiotherapy, surgery, RCT, randomized, and clinical trial. STUDY SELECTION: Studies were included if they were randomized controlled trials (RCTs) comparing preoperative radiotherapy plus surgery with surgery alone and if they included patients with resectable histologically proven rectal adenocarcinoma, without metastatic disease. Fourteen RCTs were analyzed. DATA EXTRACTION: Data on population, intervention, and outcomes were extracted from each RCT according to the intention-to-treat method by 3 independent observers and combined using the DerSimonian and Laird method. DATA SYNTHESIS: Radiotherapy plus surgery compared with surgery alone significantly reduced the 5-year overall mortality rate (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.72-0.98; P =.03), cancer-related mortality rate (OR, 0.71; 95% CI, 0.61-0.82; P<.001), and local recurrence rate (OR, 0.49; 95% CI, 0.38-0.62; P<.001). No reduction was observed in the occurrence of distant metastases (OR, 0.93; 95% CI, 0.73-1.18; P =.54). CONCLUSIONS: In patients with resectable rectal cancer, preoperative radiotherapy significantly improved overall and cancer-specific survival compared with surgery alone. The magnitude of the benefit is relatively small and criteria are needed to identify patients most likely to benefit from adjuvant radiotherapy. JAMA. 2000;284:1008-1015     

中国2004—2010艾滋病母婴传播率及母婴阻断药物应用状况的系统评价

目的:了解我国2004-2010年艾滋病母婴传播及母婴阻断药物应用状况。方法：全面检索CBM和Pubmed等中英文数据库,检索时间均从建库到2013年5月。对纳入的文献采用参照AHRQ横断面研究评价标准和STROBE声明拟定的四条标准进行质量评价。并将样本量、监测地点和监测年份作为主要异质性来源进行meta回归分析。采用Comprehensive Meta-Analysis V2.0 software 进行meta分析。结果：共检索到文献2356篇,最终纳入51篇进行分析。2004-2010年我国艾滋病母婴传播率依次分别为12.90%（95% CI: 7.48 %- 21.36%）,16.35%（95% CI: 10.41%- 24.73%）,6.45%（95% CI: 3.73 %- 10.93%）,6.25%（95% CI: 2.39%- 15.36%）,5.56%（95% CI: 2.79 %- 10.76%）,3.10%（95% CI: 1.59 %- 5.97%）,2.29%（95% CI: 1.36 %- 3.83%）。2004-2010年,我国艾滋病孕产妇中阻断药物应用率依次分别为70.39%（95% CI: 24.42%-94.59%）,71.99%（95% CI: 61.49%-80.54%）,78.79%（95% CI: 70.19%-85.43%）,86.84%（95% CI: 79.24%-91.94%）,82.71%（95% CI: 76.62%-87.48%）,81.85%（95% CI: 75.55%-86.80%）,86.16%（95% CI: 53.20%-97.15%）。2005-2010年婴儿阻断药物应用率依次分别为80.72%（95%CI: 72.89%-86.70%）,81.84%（95% CI:71.55%-88.98%）,85.43%（95% CI:80.99%-88.97%）,89.75%（95% CI: 81.82%-94.45%）,92.39%（95% CI: 84.97%-96.31%）,90.34%（95% CI: 85.50%-93.68%）。 结论：近年来我国艾滋病母婴传播率呈下降趋势,孕产妇及婴儿阻断药物应用率都有所升高。     

Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal

OBJECTIVE: To analyse the evidence for the efficacy and potential harmful effects of benzodiazepines compared with other therapies in the treatment of acute alcohol withdrawal. DATA SOURCES: MEDLINE and the Cochrane Controlled Trials Registry were searched for English-language articles published from 1966 to December 1997 that described randomized controlled trials (RCTs) of benzodiazepines in the treatment of acute alcohol withdrawal. Key words included "benzodiazepines" (exploded) and "randomized controlled trial." Bibliographies of relevant articles were reviewed for additional RCTs, and manufacturers of benzodiazepines were asked to submit additional RCT reports not in the literature. STUDY SELECTION: Articles were considered for the meta-analysis if they were RCTs involving patients experiencing acute alcohol withdrawal and comparing a benzodiazepine available in Canada with placebo or an active control drug. Of the original 23 trials identified, 11 met these criteria, representing a total of 1286 patients. DATA EXTRACTION: Data were extracted regarding the participants, the setting, details of the intervention, the outcomes (including adverse effects) and the methodologic quality of the studies. DATA SYNTHESIS: The meta-analysis of benefit (therapeutic success within 2 days) showed that benzodiazepines were superior to placebo (common odds ratio [OR] 3.28, 95% confidence interval [CI] 1.30-8.28). Data on comparisons between benzodiazepines and other drugs, including beta-blockers, carbamazepine and clonidine, could not be pooled, but none of the alternative drugs was found to be clearly more beneficial than the benzodiazepines. The meta-analysis of harm revealed no significant difference between benzodiazepines and alternative drugs in terms of adverse events (common OR 0.67, 95% CI 0.34-1.32) or dropout rates (common OR 0.68, 95% CI 0.47-0.97). INTERPRETATION: Benzodiazepines should remain the drugs of choice for the treatment of acute alcohol withdrawal.     

All in a day's work: an observational study to quantify how and with whom doctors on hospital wards spend their time

OBJECTIVE: To quantify time doctors in hospital wards spend on specific work tasks, and with health professionals and patients. DESIGN: Observational time and motion study. SETTING: 400-bed teaching hospital in Sydney. PARTICIPANTS: 19 doctors (seven registrars, five residents, seven interns) in four wards were observed between 08:30 and 19:00 for a total of 151 hours between July and December 2006. MAIN OUTCOME MEASURES: Proportions of time in categories of work; proportions of tasks performed with health professionals and patients; proportions of tasks using specific information tools; rates of multitasking and interruptions. RESULTS: The greatest proportions of doctors' time were in professional communication (33%; 95% CI, 29%-38%); social activities, such as non-work communication and meal breaks (17%; 95% CI, 13%-21%), and indirect care, such as planning care (17%; 95% CI, 15%-19%). Multitasking involved 20% of time, and on average, doctors were interrupted every 21 minutes. Most tasks were completed with another doctor (56%; 95% CI, 55%-57%), while 24% (95% CI, 23%-25%) were undertaken alone and 15% (95% CI, 15%-16%) with a patient. Interns spent more time completing documentation and administrative tasks, and less time in direct care than residents and registrars. The time interns spent documenting (22%) was almost double the time they were engaged in direct patient care. CONCLUSIONS: Two-thirds of doctors' time was consumed by three work categories: professional communication, social activities and indirect care. Doctors on wards are interrupted at considerably lower rates than those in emergency and intensive care units. The results confirm interns' previously reported dissatisfaction with their level of administrative work and documentation.     

Effectiveness and safety of heat-sensitive moxibustion on bronchial asthma: a Meta-analysis of randomized control trials

ObjectiveTo systematically evaluate the effectiveness and safety of heat-sensitive moxibustion (HSM) on asthma.MethodsLarge databases in China and overseas were searched by electronic and manual means to collect information on randomized controlled trials (RCTs). Two evaluators independently extracted data and evaluated the quality of RCTs according to Cochrane Review Handbook v5.0. RevMan v5.0.20 was used for statistical analyses.ResultsFourteen RCTs involving 637 patients were collected. Thirteen RCTs compared the effects of HSM and Western Medicine. After 3-month treatment and after 6-month follow-up, there was no significant difference in effective rate [relative risk (RR) =1.01, 95% CI (0.92, 1.12), and 1.12, (0.93, 1.36), respectively], in the asthma control test score of asthma symptoms [weighted mean difference (WMD) = − 1.54, 95% CI (− 3.54, 0.47), and 1.41, (− 0.48, 3.29), respectively] and in the forced expiratory volume in 1 second (FEV₁) and peak expiratory flow (PEF). One RCT compared the effect of HSM with warm-suspended moxibustion. After 6-month follow-up, there was a significant difference in FEV₁ and PEF [WMD=0.51, 95% CI (0.10, 0.92), and 1.78, (1.06, 2.50), respectively]. After 3-month treatment, there was no significant difference between the two groups. One RCT compared the effect of HSM with acupoint application. After 3-month treatment, there was no significant difference in the effective rate [RR=0.68, 95% CI (0.42, 1.12)].ConclusionsHSM did not show superiority to conventional Western Medicine and acupoint application in terms of curative effects, and may be superior to warm-suspended moxibustion with regard to long-term curative effects. Because of low quality of the included RCTs, this conclusion must be bolstered with higher-quality RCTs.     

比较复方丹参滴丸与地奥心血康胶囊治疗心绞痛随机对照临床试验的系统评价和meta分析

背景：复方丹参滴丸与地奥心血康胶囊是治疗冠心病心绞痛的常用中成药,已有临床试验比较它们的疗效,但尚未发现比较两者治疗心绞痛疗效的系统评价报告。目的：基于复方丹参滴丸和地奥心血康胶囊治疗心绞痛的临床随机对照试验（radominzed controlled trial,RCT）,通过meta分析系统评价两者治疗心绞痛的疗效。检索策略：检索发表于1994年至2011年的复方丹参滴丸和地奥心血康胶囊治疗心绞痛的RCT报告。检索的中文数据库包括中国博士学位论文全文数据库、中国期刊全文数据库、中国优秀硕士学位论文全文数据库和万方数据库;检索的外文数据库为Cochrane图书馆、荷兰医学文摘、ScienceDirect、MEDLINE（EBSCOhost）和PubMed。最后检索日期为2011年4月7日。纳入标准：报告描述为RCT,不限定发表语言;干预措施为使用药物治疗心绞痛;治疗组和对照组分别采用复方丹参滴丸和地奥心血康胶囊;治疗结局指标包括总体疗效和心电图改善;试验参与者需为冠心病心绞痛患者;疗程至少为28d。资料提取与分析：提取的数据项如下：发表年份;作者姓名;试验日期;试验组与对照组参与者的基线可比性;总样本量;疗效指标,包括总体疗效和心电图改善;疗程;每天给药剂量;复方丹参滴丸和地奥心血康胶囊的不良反应;总体疗效和心电图改善的有关数据。通过纳入和排除标准筛选检索到的RCT,利用Jadad评分量表和Cochrane偏倚风险评估量表进行质量评分。采用优势比（odds ratio,OR）和95%可信区间（confidence interval,CI）衡量总体疗效和心电图改善的效应值。根据纳入RCT的基本特征,进行亚组分析和敏感性分析。结果：最终纳入9篇RCT报告,包括926名试验参与者。9篇RCT中8篇的Jadad得分为2,另外1篇得分为4。复方丹参滴丸对地奥心血康胶囊的总体疗效的优势比为2.06（95%CI：1.03～4.12;P总效应=0.04）。6篇报告心电图疗效的RCT中复方丹参滴丸对地奥心血康胶囊的优势比为1.92（95%CI：1.23～3.00;P心电图疗效=0.004）。亚组分析及敏感性分析未发现可以显著影响结果稳定性的因素。结论：研究结果表明复方丹参滴丸治疗冠心病心绞痛的疗效优于地奥心血康,但尚需要更多高质量的RCT以确定疗效的差异程度。     

猪肺磷脂注射液和氨溴索治疗新生儿呼吸窘迫综合征疗效对比的Meta分析

目的 系统评价猪肺磷脂注射液和氨溴索治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效及安全性.方法 计算机检索国内外比较猪肺磷脂注射液和氨溴索治疗NRDS的临床疗效及安全性的随机对照试验(RCT)文献.根据改良后的JADAD量表进行文献质量评价,采用Rev Man 5.3.1软件进行分析.结果 共纳入24个RCT.Meta分析结果显示,相较于氨溴索治疗NRDS,猪肺磷脂注射液更能明显升高pH值(MD=-0.02,95%CI:-0.03~-0.01,P<0.01)、PaO2值(MD=-2.92,95%CI:-4.59~-1.26,P<0.01)、PaO2/FiO2值(MD=-7.62,95%CI:-10.87~-4.37,P<0.01),降低PaCO2值(MD=0.95,95%CI:0.12~1.77,P=0.02)、FiO2值(MD=0.03,95%CI:0.01~0.05,P<0.01)、近期并发症(RR=1.67,95%CI:1.31~2.12,P<0.01)和远期并发症发生率(RR=2.85,95%CI:1.14~7.07,P=0.02),减少平均住院时间(MD=3.03,95%CI:0.94~5.11,P<0.01)及病死率(RR=1.96,95%CI:1.15~3.34,P=0.01).两组患者持续气道正压通气(CPAP)时间、给氧时间、临床症状转归时间、N RDS发病率、治疗总有效率差异无统计学意义(P>0.05).结论 猪肺磷脂注射液治疗N RDS临床疗效优于氨溴索,但鉴于该Meta分析纳入文献数量有限且质量中等,结论尚需规范的大规模、多中心RCT论证.     

General practitioners' perceptions of medicolegal risk. Using case scenarios to assess the potential impact of prostate cancer screening guidelines

OBJECTIVE: To ascertain general practitioners' perceptions of medicolegal risk when screening for prostate cancer, and explore the potential impact of three national guidelines on perceptions and clinical practice. DESIGN: Postal survey in August 1997. PARTICIPANTS: 219 randomly selected GPs in New South Wales (65% response rate). MAIN OUTCOME MEASURES: Response to case scenarios; perceptions of medicolegal risk and protection afforded by national guidelines before and after reading extracts of three national guidelines; ratings of current and potential strategies to increase GPs' sense of medicolegal protection. RESULTS: 90% (95% CI, 86.5%-94.3%) would screen an asymptomatic male patient and 61% (95% CI, 54.2%-67.2%) indicated GPs would be at risk if they did not screen. Although significant changes in responses were found after respondents had read guideline extracts, 46% (95% CI, 39.5%-52.7%) continued to perceive medicolegal risk if screening was not performed. About two-thirds (65%; 95% CI, 59.9%-72.5%) supported a clear statement about the legal status of guidelines in a court of law to increase their sense of medicolegal protection. CONCLUSIONS: Even when made aware of national evidence-based guidelines against prostate cancer screening, GPs in our survey perceived limited hypothetical medicolegal protection.     

普拉格雷和氯吡格雷对冠心病患者疗效和安全性的Meta分析

目的比较普拉格雷(prasugrel)与氯吡格雷(clopidogrel)治疗冠心病的疗效和安全性。方法计算机检索Pub Med、Medline、Cochrane Central Register of Controlled Trials、CNKI全文数据库,收集2006年1月~2014年6月公开发表的有关普拉格雷和氯吡格雷疗效比较的随机对照试验(RCT),手检已获文献的参考文献、会议摘要及相关网站。对文献质量进行严格评价后,对符合要求的RCTs进行资料提取并采用Rev Man5.0软件进行Meta分析。结果共纳入5项RCTs,Meta分析显示,普拉格雷组与氯吡格雷组之间全因病死率(OR=0.94,95%CI:0.86~1.16,P=0.32)、心肌梗死(MI)发生率(OR=0.82,95%CI:0.68~1.00,P=0.05)、脑卒中发生率(OR=0.96,95%CI:0.75~1.22,P=0.72)均无统计学意义;普拉格雷组主要不良心脏事件(MACE)发生率(OR=0.45,95%CI:0.34~0.59,P=0.000)、支架内血栓发生率(OR=0.79,95%CI:0.63~0.98,P=0.04)均低于氯吡格雷组,但大出血发生率(OR=1.26,95%CI:1.03~1.55,P=0.02)高于氯吡格雷组。结论在冠心病双重抗血小板治疗中,第2代P2Y12二磷酸腺苷受体拮抗剂普拉格雷能更显著降低MACE发生率、支架内血栓发生率,在全因病死率、MI发生率、脑卒中发生率与氯吡格雷相似,但能增加大出血的风险。     

质子泵抑制剂和左氧氟沙星为基础的三联疗法作为一线方案根除幽门螺杆菌的荟萃分析

目的 评价质子泵抑制剂(PPI)和左氧氟沙星为基础的三联疗法作为一线方案根除幽门螺杆菌的疗效与安全性.方法 在Medline、Embase、OVID、Cochrane Library、Clinical evidenceonline、Socolar检索平台和CNKI中国期刊全文数据库(1994至2008年)中检索2008年5月17日之前已发表的关于PPI和左氧氟沙星为基础的三联疗法作为一线方案根除幽门螺杆菌的随机对照临床试验.应用Jedad评分对纳入的研究进行质量评价.利用Stata 9.0软件进行数据分析,根据异质性检验结果 ,选择相应的效应模型进行荟萃分析.并通过Egger回归和剪切-添补的方法 评定是否存在发表偏倚,利用剪切.添补的方法 对未发表的研究结果进行估计.结果按入选标准,共纳入11个随机对照临床试验,共1926例幽门螺菌感染者纳入荟萃分析.荟萃分析表明:作为一线方案,PPI和左氧氟沙星为基础的三联疗法与标准三联疗法比较,其根除率高,比值比(OR)值为1.56[95%可信区间(CI)为1.25～1.94,P=0.000],不良反应发生低,OR值为0.57(95%CI为0.44～0.74,P=0.000),依从性差异无统计学意义,OR值为0.72(95%CI为0.34～1.49,P=0.374).结论 PPI和左氧氟沙星为基础的三联疗法可以有效地根除幽门螺杆菌,可以作为根除幽门螺杆菌的一线方案.     

含莫西沙星三联方案根除幽门螺杆菌的疗效观察

目的 观察9 d疗程的含莫西沙星三联方案对初治和复治幽门螺杆菌(Hp)感染患者的根除效果.方法 纳入313例Hp感染初治患者、51例第2次治疗患者、32例第3次治疗患者,均给予莫西沙星400 mg 1次/d,埃索美拉唑20 mg 2次/d,替硝唑400 mg 2次/d,疗程9 d.疗程结束4周以后复查呼气试验,阴性者为根除成功,按照意向治疗(ITT)和按符合方案(PP)分析计算Hp根除率及95%可信区间(CI),并观察药物的不良反应和患者的依从性.结果 按ITT分析:首次治疗组、第2次治疗组、第3次治疗组的Hp根除率分别是89.8%(86.7%～93.0%)、81.2%(75.3%～90.9%)、81.2%(66.1%～92.6%),差异无统计学意义(χ~2=4.339,P＞0.05);按PP分析:3组Hp根除率分别是93.9%(90.9%～96.4%)、84.8%(79.1%～93.6%)、81.2%(66.1%～92.6%),差异有统计学意义(χ~2=9.294,P＜0.01),第2次治疗组、第3次治疗组的根除率均低于首次治疗组(χ~2=4.885、P＜0.05,χ~2=7.023、P＜0.01).在首次治疗组中,不管按ITT还是PP分析,活动期溃疡病和慢性胃炎患者的Hp根除率差异均无统计学意义(χ~2=1.670、0.030,均P＞0.05).按ITT分析,3组慢性胃炎患者的Hp根除率差异无统计学意义(χ~2=2.950,P＞0.10),而按PP分析则差异有统计学意义(χ~2=8.551,P＜0.05),其中第3次治疗的慢性胃炎患者Hp根除率低于首次治疗(χ~2=8.076,P＜0.01).比较常见的不良事件是大便次数增多、腹部不适和头晕,多出现在服药的前3 d内,一般可以忍受,仅1例(0.3%)因头晕而停药,治疗的依从性为96.0%.结论 9 d疗程的莫西沙星+埃索美拉唑+替硝唑方案对于初治和复治Hp感染患者都有比较高的根除率,依从性高,不良事件相对较少,可以作为一线甚至二线补救治疗的选择方案.     

Efficacy of non-penetrating trabecular surgery for open angle glaucoma: a meta-analysis

Background Non-penetrating trabecular surgery is a new filtrating surgery without opening in ternal trabecular structures. This study was to estimate the overall efficacy of non-penetrating trabecular surgery for open angle glaucoma. Methods The published articles selected for this study were obtained by a computerised Medline and China Biological Medicine Disk search of the literature and a manual search of the bibliographies of relevant articles. Articles meeting the inclusion criteria were reviewed systematically, and the reported data were aggregated using the statistical techniques of mete-analysis. Results A total of 37 articles were included in the mete-analysis. The pooled complete success rates of non-penetrating trabecular surgery with different techniques were: deep sclerectomy single, 69.7%(95% CI.58.5%-81.0%); deep sclerectomy with collagen implant, 59.4% (95% CI: 47.0%-71.8%); deep sclerectomy with reticulated hyaluronic acid implant, 71.1% (95% CI: 56.8%-85.3%); and viscocanalostomy, 72.0% (95% CI: 57.6%-86.4%). The overall weighted complete success rate of non-penetrating trabecular surgery was 67.8% (95% CI:61.4%-74.3%). Conclusions Non-penetrating trabecular surgery is the best available therapy method for medically uncontrolled open angle glaucoma with a complete success rate of over 60%. But the different techniques cannot belie the complete success rate of non-penetrating trabecular surgery.