Primary endocrine therapy as a treatment for older women with operable breast cancer – A comparison of randomised controlled trial and cohort study findings

Introduction: One third of all breast cancers occur in women over the age of 70. Primary endocrine therapy (PET) is used in some women to minimise morbidity in a population with higher rates of comorbidity and frailty. In the UK up to 40% of women over 70 are treated with PET although there is a high rate of variability of practice between centres reflecting a lack of guidance about case selection.     

Inflammatory mediators in human epilepsy: A systematic review and meta-analysis

BackgroundAccumulating evidence suggests a role for inflammation in the pathophysiology of epilepsy.MethodsWe performed a systematic review and meta-analysis of studies that investigated inflammatory mediators in human epilepsy. Studies reporting on inflammatory mediators in serum, cerebrospinal fluid or brain tissue of epilepsy patients were included. Studies comparing patients to controls were included in a meta-analysis.Results66 articles reporting on 1934 patients were included. IL-1ra, IL-1β, IL-6, IL-10, IFN-γ and TNF-α were the most extensively investigated proteins. Elevated levels for IL-1ra, IL-1β, IL-6 and CXCL8/IL-8 were reported in several different epilepsy etiologies and media, while other proteins were specifically increased for one etiology. IL-1α, IL-7 and IL-13, as well as the chemokines CCL2-5, −19 and −22, were increased exclusively in brain tissue. In an aggregate meta-analysis, we found significantly different protein levels for serum IL-6, IL-17 and CSF IL-1β and IL-10.ConclusionInflammatory pathways are involved in epilepsy. Future studies may further clarify their role, and prove potential of targeted anti-inflammatory treatment.     

利用人事档案开发医院人力资源信息管理系统

在医院发展技术化和国际化的大背景下,人力资源管理显得越来越重要。搭建起标准化、规范化、网络化的人力资源管理信息化工作平台,其前提是确定人力资源管理提升规划方案,重点是人力资源管理系统化。在医疗改革中,必须坚持以人为本,利用好人事档案开发出人力资源管理信息系统。     

Amphotericin B for treatment of visceral leishmaniasis: systematic review and meta-analysis of prospective comparative clinical studies including dose-ranging studies

ObjectivesTo evaluate the evidence for use of different formulations of amphotericin B (AmB), minimum effective dose for each formulation and its comparative efficacy against other drugs in achieving definitive cure of visceral leishmaniasis.MethodsThis systematic review and meta-analysis included following data sources: PubMed, Embase, Scopus, Web of Science and CINAHL. Controlled prospective clinical trials (randomized or nonrandomized, including dose-ranging studies) conducted between 1996 and 2017 with at least one treatment group receiving AmB were included (published data only). The primary outcome was definitive cure at 6 months. Adverse events and mortality were assessed as secondary outcomes. The PROSPERO registration number for this review is CRD42017067488.ResultsThirty-one studies (26 from India) that enrolled 6903 patients into 84 study groups met the selection criteria. In India, liposomal AmB was not inferior to AmB deoxycholate (relative risk 1.00, 95% confidence interval (CI) 0.96–1.03, two randomized controlled trials (RCTs), 514 participants, high-quality evidence), and a single dose of the earlier formulation as low as 3.75 mg/kg achieved a cure rate of over 89% (95% CI 70.6–97.2). AmB deoxycholate was as effective as miltefosine (relative risk 0.99, 95% CI 0.95–1.03, two trials, 523 participants, high-quality evidence) and may be better than paromomycin (relative risk 1.04, 95% CI 1.02–1.07, one trial, 667 participants, low-quality evidence) in achieving definitive cure.ConclusionsAmB is an efficacious drug in the Indian subcontinent. Further evidence is needed from prospective clinical trials in other endemic geographical regions.     

Global economic evaluations of rotavirus vaccines: A systematic review

Introduction: World Health Organization (WHO) recommends Rotavirus vaccines to prevent and control rotavirus infections. Economic evaluations (EE) have been considered to support decision making of national policy. Summarizing global experience of the economic value of rotavirus vaccines is crucial in order to encourage global WHO recommendations for vaccine uptake. Therefore, a systematic review of economic evaluations of rotavirus vaccine was conducted.Methods: We searched Medline, Embase, NHS EED, EconLit, CEA Registry, SciELO, LILACS, CABI-Global Health Database, Popline, World Bank - e-Library, and WHOLIS. Full economic evaluations studies, published from inception to November 2015, evaluating Rotavirus vaccines preventing Rotavirus infections were included. The methods, assumptions, results and conclusions of the included studies were extracted and appraised using WHO guide for standardization of EE of immunization programs.Results: 104 relevant studies were included. The majority of studies were conducted in high-income countries. Cost-utility analysis was mostly reported in many studies using incremental cost-effectiveness ratio per DALY averted or QALY gained. Incremental cost per QALY gained was used in many studies from high-income countries. Mass routine vaccination against rotavirus provided the ICERs ranging from cost-saving to highly cost-effective in comparison to no vaccination among low-income countries. Among middle-income countries, vaccination offered the ICERs ranging from cost-saving to cost-effective. Due to low- or no subsidized price of rotavirus vaccines from external funders, being not cost-effective was reported in some high-income settings.Conclusion: Mass vaccination against rotavirus was generally found to be cost-effective, particularly in low- and middle-income settings according to the external subsidization of vaccine price. On the other hand, it may not be a cost-effective intervention at market price in some high-income settings. This systematic review provides supporting information to health policy-makers and health professionals when considering rotavirus vaccination as a national program.     

我国人群细胞因子水平与抑郁症的相关性研究的系统评价

目的:系统评价我国人群细胞因子水平与抑郁症的相关性。方法:计算机检索PubMed、中国生物医学文献数据库、维普中文数据库、中国期刊全文数据库和万方数据库,收集研究国内细胞因子与抑郁症相关性的病例对照研究,由两名研究者按照纳入与排除标准筛选文献、提取资料和评价质量后,采用Rev Man 5.1.5统计软件进行Meta分析。结果:共纳入7项研究,合计577例患者,其中试验组331例,健康对照组246例。Meta分析结果显示,试验组患者白细胞介素(IL)-6浓度[WMD=13.71,95%CI(6.91,20.51),P<0.000]和IL-1β浓度[SMD=2.15,95%CI(1.04,3.26),P<0.000]均高于健康对照组,两组比较差异有统计学意义;而抑郁组患者IL-2浓度亦高于健康对照组,但两组比较差异无统计学意义。结论:我国人群患抑郁症与IL-6、IL-1β水平升高存在一定的相关性。由于本研究的局限性,IL-6、IL-1β浓度与抑郁症的发作性质、严重程度的定量关系等内容尚需开展更多高质量、大样本的研究。     

The efficacy of supplementation with the novel medical food,Souvenaid, in patients with Alzheimer's disease: A systematic review and meta-analysis of randomized clinical trials

Background and rationale: Certain nutritional supplements are being marketed for the management of Alzheimer's disease (AD), but the evidence for their effectiveness is not established. The objective of this review was to evaluate the evidence from randomized clinical trial (RCTs) examining the effect of Souvenaid in patients with AD.

Methods: We conducted electronic searches in Medline, Embase, PsychINFO, CINAHL, and The Cochrane Library. The reporting quality of the included studies was determined using the Cochrane collaboration tool for assessing the risk of bias. Two reviewers independently determined eligibility, assessed the reporting quality of included studies and extracted data.

Results: Three studies with a total of 1011 participants were included. All were of good reporting quality. Meta-analyses revealed non-significant differences in cognition (ADAS-cog scores MD: 0.08, 95% CI: ?0.71 to 0.88) and function (ADCS-ADL scores MD: 0.36, 95% CI: ?0.54 to 1.25) between Souvenaid and placebo. One study showed significant increase in neuropsychological test battery composite z-score with Souvenaid compared with placebo, and another reported significant improvement in delayed verbal recall for a subgroup of patients with very mild AD. There was no significant effect on global clinical function. No serious adverse events were observed.

Conclusions: The evidence from published clinical trials does not show that supplementation with Souvenaid has beneficial effects on functional ability, behaviour, or global clinical change. Souvenaid may cause improvements in verbal recall in patients at early stages of AD. Few RCTs examining the effect of Souvenaid have been conducted, and they are all funded by same manufacturer. Future research should include using unified tools to measure cognition, function, and behaviour in AD.