应用R软件dosresmeta程序包和mvmeta程序包实现剂量-反应关系Meta分析

剂量-反应关系Meta分析在探讨潜在风险因素暴露水平与对应疾病发生风险方面具有重要作用,且应用日益广泛。随着各种函数模型的不断优化,剂量-反应关系函数模型的建立逐渐成熟,已由单纯的线性关系发展成集线性及非线性关系于一体的函数模型,由单纯的一次回归函数发展为多次回归函数。基于R软件实现这一分析的软件程序也逐渐研发出来,本文介绍了如何使用R软件mvmeta及dosresmeta进行剂量-反应关系Meta分析。     

Disparities in Receipt of Breast and Cervical Cancer Screening for Rural Women Age 18 to 64 with Disabilities

BackgroundPrevious research has found breast and cervical cancer screening disparities between women with and without disabilities, and between women living in rural versus urban areas. Living in a rural area may add to the barriers women with disabilities experience when attempting to obtain screening for breast and cervical cancer. The purpose of this study was to examine the combination of disability status and rurality in association with receipt of breast and cervical cancer screening among women age 18 to 64 in the United States.MethodsWe conducted cross-sectional analyses of data from the Medical Expenditure Panel Survey, using pooled annual data files from 2002 through 2008. We compared recent receipt of breast and cervical cancer screening among four groups: 1) urban women without disabilities, 2) urban women with disabilities, 3) rural women without disabilities, and 4) rural women with disabilities.FindingsOverall, women with disabilities were less likely to be up to date with mammograms and Pap tests compared with women with no disabilities. Similarly, women in rural areas were less likely to have received breast or cervical cancer screening within recommended timeframes. Women who both had a disability and lived in a rural area were the least likely to be current with screening.ConclusionsOur findings suggest that living in rural regions compounds disparities in receipt of cancer screening among women with disabilities. Increased attention is needed to improve receipt of cancer screening among rural women with disabilities.     

The Metabolic Effects of Oats Intake in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

The present study aimed to comprehensively assess if oats intake is beneficial for diabetic patients. The literature search was conducted in PubMed database up to 23 August 2015. Fourteen controlled trials and two uncontrolled observational studies were included. Compared with the controls, oats intake significantly reduced the concentrations of glycosylated hemoglobin A1c (HbA1c) (MD, −0.42%; 95% CI, −0.61% to −0.23%), fasting blood glucose (FBG) (MD, −0.39 mmol/L; 95% CI, −0.58 to −0.19 mmol/L), total cholesterol (TC) (MD, −0.49 mmol/L; 95% CI, −0.86 to −0.12 mmol/L), low-density lipoprotein cholesterol (LDL-C) (MD, −0.29 mmol/L; 95% CI, −0.48 to −0.09 mmol/L). Oatmeal significantly reduced the acute postprandial glucose and insulin responses compared with the control meal. The present study has revealed a beneficial effect of oats intake on glucose control and lipid profiles in type 2 diabetic patients. Further investigations of oats intake in patients with type 1 diabetes and the safety of oats consumption are required.     

旋覆夏麻芎芍草汤加减治疗慢性咳嗽临床观察

目的:观察旋覆夏麻芎芍草汤加减治疗慢性咳嗽的临床疗效。方法:纳入60例慢性咳嗽(风寒犯肺证)患者,采用随机数字表分为治疗组和对照组,每组30例。对照组患者给予镇咳、化痰等西医常规治疗,治疗组患者给予旋覆夏麻芎芍草汤加减治疗,治疗周期均为3周。评价两组患者的临床疗效,比较两组患者的日间和夜间咳嗽症状评分,采用莱切斯特咳嗽问卷(LCQ)评价患者的生活质量,检测所有患者的用力肺活量(FVC)、第1秒用力呼气容积(FEV_1)占预计值百分比(FEV_1%)、最大呼气流量(PEF)。结果:①治疗后,治疗组患者的临床总有效率为90.0%,对照组为76.7%,治疗组的疗效优于对照组(P0.05)。②治疗后,两组患者的日间和夜间咳嗽症状评分较治疗前均明显降低(P0.01),且治疗组患者的日间和夜间咳嗽症状评分低于对照组(P0.05)。③治疗后,两组患者的LCQ生理、心理、社会维度评分及总分较治疗前均升高(P0.05),且治疗组患者的LCQ生理、心理、社会维度评分及总分高于对照组(P0.05)。④治疗后,两组患者的FVC、FEV_1%、PEF水平较治疗前均显著升高(P0.05),且治疗组患者的FVC、FEV_1%、PEF水平高于对照组(P0.05)。结论:旋覆夏麻芎芍草汤加减治疗慢性咳嗽具有较好的临床疗效,能够有效改善患者的咳嗽症状和肺功能,提高患者的生活质量。     

药物临床试验安全性报告的规范

从药物临床试验的定义及各分期对安全性的要求强调安全性报告的重要性。简单介绍药物临床试验安全性报告的现状,并对CONSORT声明扩展版中针对药物有害性临床试验报告的标准及条目进行解释。     

Bleeding in patients with atrial fibrillation treated with dabigatran,rivaroxaban or warfarin: A retrospective population-based cohort study

BackgoundRandomized controlled trials (RCTs) have shown that dabigatran, rivaroxaban and warfarin cause similar bleeding rates.MethodsWe performed a retrospective population-based cohort study to determine the incidence of bleeding in patients with atrial fibrillation (AF) beginning dabigatran, rivaroxaban or warfarin. Consecutive patients initiating anticoagulation for AF during a 3 year period were identified using a computerized database. Patients who bled and required hospitalization underwent chart review. Bleeding incidences were calculated per 100 patient-years of treatment.Results18,249 patients were included: 9564 (52.4%) received warfarin, 5976 (32.7%) dabigatran, and 2709 (14.8%) rivaroxaban. Bleeding incidences were 3.9 (95% CI, 3.6–4.4) in warfarin-treated patients, 4.2 (95% CI, 3.7–4.7) in dabigatran patients, and 4.1 (95% CI, 3.0–5.3) in rivaroxaban patients. Intracranial hemorrhage (ICH) rates were 0.71 (95% CI, 0.56–0.90) for warfarin, 0.4 (95% CI, 0.18–0.87) for dabigatran, and 0.27 (95%CI, 0.10–0.80) for rivaroxaban. GI hemorrhage rates were 1.88 (95%CI, 1.62–2.20) for warfarin, 2.98 (95% CI, 2.4–3.5) for dabigatran and 2.39 (95%CI, 1.6–3.5) for rivaroxaban.ConclusionsWe demonstrate similar bleeding rates with both dabigatran 150 mg and 110 mg and rivaroxaban compared to warfarin.     

江西省新型冠状病毒肺炎中医药实施与效果分析

目的:调查中医药在江西省新型冠状病毒肺炎患者救治过程中的实施情况与治疗效果。方法:采取问卷形式,从江西省定点医院收集新型冠状病毒肺炎患者病历信息,以患者姓名和医院名称对接转院前后病历,获取患者从首次入院至治愈出院的完整信息。统计中医药应用患者数,计算中医药实施度:中医药应用患者数/患者总数×100%,以反映中医药实施情况。比较分析中西医结合治疗与纯西医治疗患者间平均住院时长、平均病毒核酸转阴时长和发热时长中位数。结果:本次研究共从50家定点医院收集了784例新型冠状病毒肺炎患者的完整住院信息,占江西省内总患者数的83.7%。江西省首批确诊患者即开始采用中西医结合治疗,共有739例进行了中医药干预,中医药总实施度为94.3%,且中医药实施度在轻型、普通型、重型、危重型4类患者中依次递增。普通型患者中,连花清瘟颗粒(胶囊)结合西医、清肺排毒汤结合西医或口服中成药结合西医等3种中西医结合治疗的效果均显著优于纯西医治疗。结论:中医药在江西省新型冠状病毒肺炎救治过程中实施较早,实施度高;结合西医治疗,清肺排毒汤、连花清瘟颗粒(胶囊)或口服中成药能有效促进普通型患者康复。故在突发公共卫生事件应对中,应坚持中西医结合政策方针,以最大程度挽救患者生命。