Increasing the duration of dual amoxicillin plus omeprazole Helicobacter pylori eradication to 6 weeks: a pilot study

Background and Aim: Helicobacter pylori infections have become increasingly difficult to treat as antimicrobial resistance has increased. The aim of this study was to test the hypothesis that a 6‐week dual regimen of amoxicillin 1 gm and omeprazole 20 gm therapy b.i.d. would cure at least 90% of treatment‐naïve H. pylori infections. Methods: This was an open‐label prospective pilot study in which treatment‐naïve subjects with active H. pylori infection (positive by two tests) received dual amoxicillin 1 g and omeprazole 20 mg, b.i.d. daily for 6 weeks. Success was accessed by urea breath test 4–6 weeks later. A tentatively effective therapy was defined as a per‐protocol treatment success of 90% or greater; treatment success of 80% or less was prespecified as unacceptable. Results: Sixteen patients were included in the study (14 men, two women) with an average age of 49 years. At 16 patients, the prespecified stopping rule of six treatment failures was achieved (i.e. the 95% confidence interval excluded achieving the required 90% success rate even if 50 patients were entered). As per protocol, enrollment was stopped. Per‐protocol and intention‐to‐treat treatment success were both 62.5% (95% confidence interval, 35–84%). Compliance was greater than 99%. Five patients (31%) reported side‐effects, all of which were mild and none interrupted therapy. Conclusion: Despite the theory and pre‐existing data from Japan, in the USA, prolonging the duration of dual amoxicillin‐PPI therapy did not improve treatment outcome in 90% or more of our patients.     

Stroke management: updated recommendations for treatment along the care continuum

The Australian Clinical Guidelines for Stroke Management 2010 represents an update of the Clinical Guidelines for Stroke Rehabilitation and Recovery (2005) and the Clinical Guidelines for Acute Stroke Management (2007). For the first time, they cover the whole spectrum of stroke, from public awareness and prehospital response to stroke unit and stroke management strategies, acute treatment, secondary prevention, rehabilitation and community care. The guidelines also include recommendations on transient ischaemic attack. The most significant changes to previous guideline recommendations include the extension of the stroke thrombolysis window from 3 to 4.5 h and the change from positive to negative recommendations for the use of thigh-length antithrombotic stockings for deep venous thrombosis prevention and the routine use of prolonged positioning for contracture management.     

Addressing different biases in analysing drug use on cancer risk in diabetes in non‐clinical trial settings—what,why and how?

Motivated by recent reports on associations between diabetes and cancer, many researchers have used administrative databases to examine risk association of cancer with drug use in patients with diabetes. Many of these studies suffered from major biases in study design and data analysis, which can lead to erroneous conclusions if these biases are not adjusted. This article discusses the sources and impacts of these biases and methods for correction of these biases. To avoid erroneous results, this article suggests performing sensitivity and specificity analysis as well as using a drug with a known effect on an outcome to ascertain the validity of the proposed methods. Using the Hong Kong Diabetes Registry, we illustrated the impacts of biases of drug use indication and prevalent user by examining the effects of statins on cardiovascular disease. We further showed that 'immortal time bias' may have a neutral impact on the estimated drug effect if the hazard is assumed to be constant over time. On the contrary, adjustment for 'immortal time bias' using time-dependent models may lead to misleading results biased towards against the treatment. However, artificial inclusion of immortal time in non-drug users to correct for immortal time bias may bias the result in favour of the therapy. In conclusion, drug use indication bias and prevalent user bias but not immortal time bias are major biases in the design and analysis of drug use effects among patients with diabetes in non-clinical trial settings.     

PICC置管前评估的临床实践指南构建及AGREE评价

目的构建以证据为基础的经外周穿刺中心静脉导管(PICC)置管前评估的临床实践指南并进行AGREE评价。方法通过现况调查,制作PICC置管前评估的系统评价,对PICC置管前评估相关临床实践指南进行文献内容分析,构建指南草案并通过德尔菲法对指南相关附件进行修订,使用AGREE评估系统进行评价。结果指南形成包含置管护士、环境与设备、患者评估、导管选择、穿刺技术与穿刺部位、知情同意6个方面共31项推荐意见。AGREE评价的标准化总分分别为98%、93%、95%、92%、89%、100%,6名PICC护理专家均给予"强烈推荐"评价。结论该指南是基于我国临床现状、循证证据、患者意愿和偏好、专业人员判断的循证性临床实践指南,可作为PICC置管前评估的依据。     

集束化护理的误区分析与正确应用

分析我国护理人员在构建和实施集束化护理方案过程中,忽略集束化护理方案基于证据的实质、对各集束措施之间的关联性理解不够及认为集束化护理中的措施一成不变等误用情况;阐述了集束化护理的正确应用、集束化护理实施过程中的挑战与应对策略.旨在促使护理人员正确认识和应用集束化护理,以促进护理质量的持续改进.     

成体干细胞在男性不育领域的应用及展望

干细胞是目前生物医学研究领域的热点,并由基础医学研究扩展到了临床应用。根据干细胞所处发育阶段和分化性质,通常可分为胚胎干细胞、诱导性多能干细胞(iPS)和成体干细胞。其中成体干细胞在诸多系统疾病中已经开展临床应用。目前,对成体干细胞范畴内的精原干细胞、间充质干细胞的基础研究走在生殖男科治疗研究的前列,应用于临床尚需时日。本文综述成体干细胞在男性不育领域的应用前景。