中晚期子宫内膜癌术后放疗效果的系统评价

目的系统评价术后放疗在中晚期子宫内膜癌的治疗效果、安全性及成本效果。方法电子检索Cochrane图书馆、The Cochrane Central Register of Controlled Trials（CENTRAL）、The National Research Register、Health technology assessment database（HTA）、MEDLINE、EMbase、CancerLit、CBMdisc、VIP、万方学位论文数据库、CNKI并辅以手工检索。检索时间截至2007年3月，收集子宫内膜癌（EC）术后放疗与术后非放疗比较的随机对照试验（RCT）。由两名研究者按Cochrane系统评价方法，独立选择试验，提取资料、评价纳入研究的方法学质量，提取有效数据进行Meta分析。结果共纳入符合标准的RCT3个，患者1126例，3个RCT均是术后盆腔放疗与术后化疗的比较，其中2个RCT为放疗与CAP化疗方案比较，包括730例患者；1个RCT为放疗与AP化疗方案比较，包括396例患者。Meta分析结果显示：对子宫内膜癌Ⅰc、Ⅱ、Ⅲ期患者，其5、7年总体生存率、疾病无进展存活率及5年局部复发率、远处复发率、总复发率，在放疗组与化疗组的差异无统计学意义；对子宫内膜癌Ⅲ、Ⅳ期患者，其5年总体生存率、疾病无进展存活率，化疗组优于放疗组；在3／4级消化系统及泌尿生殖系毒性反应方面，化疗组与放疗组的差异无统计学意义；而3／4级血液学毒性反应方面，化疗组高于放疗组。结论对子宫内膜癌Ⅰc、Ⅱ、Ⅲ期患者，术后盆腔放疗的效果和化疗相似；但对子宫内膜癌Ⅲ、Ⅳ期患者，放疗的效果比化疗差；放疗的骨髓抑制作用比化疗小，在胃肠道和泌尿生殖系3／4级毒性反应，两者差异无统计学意义。     

系统评价方法：汇总分析及其在流行病学研究中的应用

在进行具体评价时, 所选择的评价因素应该是在各研究中存在的差异, 且是能够影响总效应量大小的那些因素。质量评价贯穿PA的始终, 几乎在每个步骤均可应用到, 可作为选择分析所纳入研究的标准,在计算总效应量时作为协变量纳入方程, 减少异质性的作用, 也可以从评分的高低确定异质性来源等。     

急性脑血管病多学科一体化治疗模式对照研究

目的研究ACVD多学科一体化治疗模式对ACVD患者的疗效观察。方法建立完善的多学科一体化治疗的组织网络体系,共入选ACVD患者7202例,其中,将2000年6月至2005年6月在脑血管病治疗中心住院的ACVD患者共4089例作为治疗组(多学科一体化治疗),1995年5月至2000年5月住院的ACVD患者共3113例作为对照组(以往常规治疗法)。观察指标是神经功能缺损评分(NI HSS)、生活能力评分(BI)、牛津残障评价(OHS)、住院时间、病死率及合并症和出院后6个月残障评价。经SPSS Windows10.0统计学方法,进行分析。结果治疗组NI HSS-4.59±4.68、BI29.53±24.40、OHS-1.29±0.95对照组NI HSS-1.97±2.17、BI6.94±21.41、OHS-0.84±1.09两组比较有极显著意义(P<0.001),临床治愈率提高31.92%,平均住院日缩短8.8天,病死率降低了12.27%,并发症降低了12.52%,致残率降低了31.92%。结论多学科一体化治疗模式能提高治愈率、减少并发症、降低病死率和致残率、提高了患者的生活质量,是适合我国的ACVD的治疗模式。     

Filiform needle acupuncture for allergic rhinitis: A systematic review and meta-analysis

Background: Filiform needle acupuncture(FNA), the most classical and widely applied acupuncture method based on traditional Chinese medicine theory, has shown a promising effect in the treatment of allergic rhinitis(AR).Objective: To evaluate the efficacy, safety, cost-effectiveness, and patient preference of FNA in the treatment of AR by comparing FNA with sham acupuncture, no treatment, and conventional medication.Search strategy: Eight electronic databases were systematically searched from in...     

Motivations and barriers to pursue cancer genomic testing: A systematic review

ObjectivesSingle-gene testing is associated with psycho-social challenges for cancer patients. Genomic testing may amplify these. The aim of this study was to understand patients’ motivations and barriers to pursue cancer genomic testing, to enable healthcare providers to support their patients throughout the testing process and interpretation of test results.MethodsFive databases were searched for original peer reviewed research articles published between January 2001 and September 2018 addressing motivation for genomic cancer testing. QualSyst was used to assess quality.Results182 studies were identified and 17 were included for review. Studies were heterogenous. Both somatic and germline testing were included, and 14 studies used hypothetical scenarios. 3249 participants were analyzed, aged 18 to 94. Most were female and white. The most common diagnoses were breast, ovarian, lung and colorectal cancer. Interest in testing was high. Motivations included ability to predict cancer risk, inform disease management, benefit families, and understand cancer. Barriers included concerns about cost, privacy/confidentiality, clinical utility, and psychological harm.ConclusionsDespite concerns, consumers are interested in cancer genomic testing if it can provide actionable results for themselves and their families.Practice ImplicationsProviders must manage understanding and expectations of testing and translate genetic information into health-promoting behaviours.     

Age at menopause in India: A systematic review

Background and aimsMenopause is a physiological process in nature and hence, variations in the age of menopause are not expected. Hence, the study was conducted with an objective to calculate the reliable estimates of age at menopause for India, and understand the differentials in women’s age at menopause throughout the country.MethodsA total of 202 studies of age at menopause, covering the period 2009–2020, were accessed from PubMed database and Google. Of these only ten studies met the selection criteria for this paper, which is that the data for these studies must be collected from house-to-house surveys.ResultsThe average age at menopause in India, with minimal publication bias, is 46.6 years (95% CI: 44.83, 48.44). In one study slightly above 1.96 Standard Deviation, was observed, as ascertained by Funnel Plot and Egger’s test. The mean age ranged from a minimum of 44.69 years (95% CI: 35.01, 54.37) to a maximum of 48.95 (95% CI: 42.29, 55.61) years. Furthermore, the age at menopause did not exhibit any significant variation by age at menarche, although the association was positive.ConclusionsThe age at menopause showed positive association with age at menarche. In India, during the period 2009–2020, it was 46.6 years, which significantly lower than the age in some developed countries. The differences may be methodological since no information was found regarding the distribution of age at menopause in the studies that were considered for meta-analysis.     

Prognostic models for mortality after cardiac surgery in patients with infective endocarditis: a systematic review and aggregation of prediction models

BackgroundThere are several prognostic models to estimate the risk of mortality after surgery for active infective endocarditis (IE). However, these models incorporate different predictors and their performance is uncertain.ObjectiveWe systematically reviewed and critically appraised all available prediction models of postoperative mortality in patients undergoing surgery for IE, and aggregated them into a meta-model.Data sourcesWe searched Medline and EMBASE databases from inception to June 2020.Study eligibility criteriaWe included studies that developed or updated a prognostic model of postoperative mortality in patient with IE.MethodsWe assessed the risk of bias of the models using PROBAST (Prediction model Risk Of Bias ASsessment Tool) and we aggregated them into an aggregate meta-model based on stacked regressions and optimized it for a nationwide registry of IE patients. The meta-model performance was assessed using bootstrap validation methods and adjusted for optimism.ResultsWe identified 11 prognostic models for postoperative mortality. Eight models had a high risk of bias. The meta-model included weighted predictors from the remaining three models (EndoSCORE, specific ES-I and specific ES-II), which were not rated as high risk of bias and provided full model equations. Additionally, two variables (age and infectious agent) that had been modelled differently across studies, were estimated based on the nationwide registry. The performance of the meta-model was better than the original three models, with the corresponding performance measures: C-statistics 0.79 (95% CI 0.76–0.82), calibration slope 0.98 (95% CI 0.86–1.13) and calibration-in-the-large –0.05 (95% CI –0.20 to 0.11).ConclusionsThe meta-model outperformed published models and showed a robust predictive capacity for predicting the individualized risk of postoperative mortality in patients with IE.Protocol registrationPROSPERO (registration number CRD42020192602).     

Novel point-of-care biomarker combination tests to differentiate acute bacterial from viral respiratory tract infections to guide antibiotic prescribing: a systematic review

BackgroundAcute respiratory tract infections (RTIs) are the most common reason to seek medical care, with many patients receiving inappropriate antibiotics. Novel testing approaches to identify aetiology at the point-of-care are required to accurately guide antibiotic treatment.ObjectiveTo assess the diagnostic accuracy of biomarker combinations to rapidly differentiate between acute bacterial or viral RTI aetiology.Data sourcesMEDLINE, Embase and Web of Science databases were searched to February 2021.Study eligibility criteriaDiagnostic accuracy studies comparing accuracy of point-of-care and rapid diagnostic tests in primary or secondary care, consisting of biomarker combinations, to identify bacterial or viral aetiology of RTI.MethodsRisk of bias was assessed using the QUADAS-2 tool. Sensitivity and specificity of tests reported by more than one study were meta-analysed using a random effects model.ResultsTwenty observational studies (3514 patients) were identified. Eighteen were judged at high risk of bias. For bacterial aetiologies, sensitivity ranged from 61% to 100% and specificity from 18% to 96%. For viral aetiologies, sensitivity ranged from 59% to 97% and specificity from 74% to 100%. Studies evaluating two commercial tests were meta-analysed. For ImmunoXpert, the summary sensitivity and specificity were 85% (95% CI 75%–91%, k = 4) and 86% (95% CI 73%–93%, k = 4) for bacterial infections, and 90% (95% CI 79%–96%, k = 3) and 92% (95% CI 83%–96%, k = 3) for viral infections, respectively. FebriDx had pooled sensitivity and specificity of 84% (95% CI 75%–90%, k = 4) and 93% (95% CI 90%–95%, k = 4) for bacterial infections, and 87% (95% CI 72%–95%; k = 4) and 82% (95% CI 66%–86%, k = 4) for viral infections, respectively.ConclusionCombinations of biomarkers show potential clinical utility in discriminating the aetiology of RTIs. However, the limitations in the evidence base, due to a high proportion of studies with high risk of bias, preclude firm conclusions. Future research should be in primary care and evaluate patient outcomes and cost-effectiveness with experimental study designs.Clinical trialPROSPERO registration number: CRD42020178973.     

酮替芬治疗感冒后咳嗽的系统评价

目的评价酮替芬治疗感冒后咳嗽临床疗效与安全性。方法检索主要中英文数据库从建库至2015年12月20日酮替芬治疗感冒后咳嗽随机对照试验研究,筛选合格研究。Cochrane评价员手册、Jadad评分法分别进行偏倚风险评价及质量评价。应用Rev Man5.3软件进行Meta分析。结果符合纳入标准的文献共3篇。Meta分析结果显示,酮替芬治疗感冒后咳嗽治疗组与对照组相比,临床疗效总有效率比值比(odds ratio,OR)为9.44,95%可信区间(confidence interval,CI)(2.81,31.70),差异有统计学意义(P=0.0003);不良反应OR为1.94,95%CI(0.40,9.54),差异无统计学意义(P=0.41)。结论酮替芬治疗感冒后咳嗽有显著临床疗效,但仍需更多高质量、大样本的临床研究来进一步验证。     

三大核事故应急人员心理健康后果的系统综述

目的:系统性评价三哩岛、切尔诺贝利、福岛三大核事故对应急人员心理健康状况的影响。方法:采用主题词与自由词组合检索的方式,检索PubMed、Web of Science、APA PsycINFO数据库中关于三哩岛、切尔诺贝利、福岛三大核事故应急人员心理健康后果研究的相关文献,进行系统综述。结果:共纳入37项研究。核事故后应急人员普遍存在一般心理困扰、抑郁、焦虑、创伤后应激障碍等心理问题。切尔诺贝利核事故的心理影响最为严重,引起清理人员器质性精神障碍、人格障碍等严重精神障碍。不同核事故应急人员的心理健康状况与灾难相关的应急处置工作经历、核事故伴发的社会因素相关。结论:核事故后应急人员普遍存在一般心理困扰、焦虑、抑郁、创伤后应激障碍、严重精神障碍等长期心理健康问题,应急人员的基线心理健康状况和心理干预措施有待进一步研究。