Making literature searches easier: a rapid and sensitive search filter for retrieving randomized controlled trials from PubMed.

AIMS: To develop and test the sensitivity and precision of a rapid and simple search filter (RSSF), suitable for busy clinicians wanting to find randomised controlled trials (RCTs) in PubMed. Ideally it should retrieve all the RCTs, but as few irrelevant studies as possible, and be easy to use. METHODS: The RSSF consisted of the search term 'Randomized Controlled Trial' limited to the Publication Type field. Journals that published the highest numbers of diabetes RCTs between 2000 and 2005 were identified, and then handsearched in order define a set of known RCTs. The sensitivity of the RSSF was tested by measuring the proportion of the known RCTs retrieved, and the precision by checking the proportion of the retrieved studies which were RCTs. The RSSF was compared to a highly sensitive search strategy (HSSS) developed for PubMed. Embase was checked for trials not in PubMed. RESULTS: Sixteen journals were found to contain half of all published RCTs in diabetes. 820 diabetes RCTs were identified by handsearching. Measured against these, the RSSF gave a sensitivity of 96.0% (95% CI, 94.8% to 97.1%), and a precision of 93.6% (95% CI 91.7% to 95.0%). Compared to the HSSS, the RSSF reduced the filtering required by 87%. An Embase search for diabetes RCTs found 36 (2.1%) not in PubMed. CONCLUSIONS: A rapid simple search filter for PubMed can find almost all diabetes RCTs, while excluding most studies not required, thereby greatly reducing the time cost of searching and filtering results, and of searching other databases.     

肛旁脓肿行Ⅰ期根治性手术疗效的探讨

目的：探讨肛旁脓肿行Ⅰ期根治性手术的疗效。方法：对78例肛旁脓肿患者交叉设计分成两组。分别行Ⅰ期根治性手术（RS）和单纯脓肿切开引流（ID），比较术后疗效。结果：RS组病人术后形成肛瘘的发生率远低于ID组。而并发症却无升高趋势，且明显缩短了伤口愈合时间。结论：Ⅰ期根治性手术治疗肛旁脓肿疗效满意，临床使用价值高，值得推广。     

小切口治疗后交叉韧带胫骨起点撕脱骨折

膝关节炎(osteoarthritis,OA)是膝关节的慢性退行性疾病,多发于中老年患者,主要病变位置在膝关节承重区的软骨,当软骨发生磨损、破坏时,作为基质主要成分的蛋白多糖(protoglycan,PG)大量分散于关节液中,与人体代谢相关[1],成为可以定量分析关节软骨破坏程度的有效灵敏指标[2]。我院对膝骨关节炎患者采用内服补肝益肾、活血通络中药及关节腔内玻璃酸钠注射,同时以单纯的玻璃酸钠注射作为对照,分别在治疗前后抽取关节液,行PG定量检查,对两组的PG变化趋势进行观察,现将结果报告如下。1资料和方法1·1一般资料将2006年12月至2007年3月的60例…     

增白牙膏去除牙面外源性色素临床实验

目的测试一种增白牙膏用于减少牙面外源性色素的效果. 方法 研究对象121例,年龄21～57岁.实验组60例,对照组61例,两组年龄和性别分布差异无显著性.采用双盲法两组平行设计,根据Lobene色斑指数(LSI)和性别均衡分为两组,随机分配使用实验牙膏或对照牙膏.实验组牙膏含3 %植酸钠和1.3 %焦磷酸钠,对照组牙膏不含相应成分.临床检查分别在基线、3周和6周后进行,由同一人测定LSI.问卷询问刷牙情况. 结果 基线检查、实验3周和6周后实验组LSI分别为3.00、2.16和1.47, 对照组分别为3.10、3.08和2.18.基线检查两组LSI差别无显著性意义, 实验3周和6周后两组LSI比较差异均有显著性意义. 实验组LSI在3周和6周后分别比基线时降低28 %和51 %. 结论含3 %植酸钠和1.3 %焦磷酸钠牙膏能有效减少牙面色素,效果随使用时间而增强.     

Supporting insensitive mothers: the Vilnius randomized control trial of video-feedback intervention to promote maternal sensitivity and infant attachment security

Objective   This randomized control trial examined the effects of a short-term, interaction-focused and attachment-based video-feedback intervention (VIPP: video-feedback intervention to promote positive parenting).
Design   VIPP effect on mothers' sensitive responsiveness and infant–mother attachment security was evaluated in a sample ( n  = 54) of low sensitive, non-clinical, middle class Lithuanian mothers.
Methods   Maternal sensitivity was assessed in a free play session with the Ainsworth's sensitivity scale, and attachment security was observed using the Attachment Q sort for home observations.
Results   We found that the intervention mothers indeed significantly improved their sensitive responsiveness through participation in our VIPP. The effect size was large according to Cohen's criteria, d  = 0.78. VIPP enhanced maternal sensitive responsiveness even when maternal age, educational level, depression, daily hassles, efficacy, infant gender, and infant negative and positive affect were controlled for. However, attachment security in the VIPP infants was not enhanced after the intervention, compared with the control infants, and the infants did not seem to be differentially susceptible to the increase in maternal sensitivity dependent on their temperamental reactivity.
Conclusion   We suggest that a relatively brief and low-cost programme can provide effective support for mothers who lack sensitivity in the interactions with their infants.     

ANGIOTENSIN-CONVERTING ENZYME INHIBITION AS FIRST-LINE TREATMENT FOR HYPERTENSION

1. Perindopril (4 mg) was compared with atenolol (50 mg), captopril (25 mg b. d.) or a diuretic (hydrochlorothiazide 50 mg and amiloride 5 mg) in three studies involving a total of 503 hypertensive patients with a diastolic blood pressure (DBP) of 95–125 mmHg.
2. A 4 week single-blind placebo period preceded 12 weeks of active treatment. Dose titration was at weeks 4 and 8 if supine DBP >90 mmHg. The dose was doubled and if necessary a diuretic was added in the atenolol or captopril comparisons, and atenolol was added in the diuretic study.
3. The fall in supine blood pressure (BP) was 27/17 mmHg with perindopril and 21/16 mmHg for atenolol. Monotherapy controlled 55% of patients on perindopril and 48% on atenolol, increasing to 78% and 58% with the addition of hydrochlorothiazide, respectively. Captopril caused a BP fall of 19/12 mmHg compared with 27/18 mmHg for perindopril, with 49% of both groups being controlled on monotherapy.
4. Diuretic addition produced a greater antihypertensive effect with perindopril (75%) compared with 57% for captopril in achieving control. Perindopril caused a comparable fall in supine BP to the diuretic combination 27/19 mmHg and 31/18 mmHg, but the fall in erect systolic BP was significantly greater for the diuretic. At 3 months, 85% of the diuretic group and 78% of the perindopril group achieved the target BP.
5. A multicentre trial of 856 patients treated with perindopril (690 patients treated for 1 year or more) has shown that BP control is maintained in the long term with a low incidence of side-effects (7.9%) causing withdrawal from treatment. These studies demonstrate that perindopril compares favourably with standard first-line therapy for mild to moderate hypertension.     

A placebo controlled trial of remoxipride in the prevention of relapse in chronic schizophrenia

Sixty-two DSM III chronic schizophrenic inpatients were selected for a double-blind, placebo controlled, multi-centre, relapse prevention study of remoxipride, a selective dopamine (D₂)-receptor antagonist. After a 1 month placebo washout, 23 patients had relapsed and were withdrawn. Of the remaining patients 19 were randomised to remoxipride (150–300 mg daily) and 20 to placebo. Their median age was 58 years, 26 were male, and the median duration of illness was 33 years. After 24 weeks a further total of 8 remoxipride and 17 placebo patients had been withdrawn. Excluding three patients withdrawn for reasons other than relapse, the comparative relapse rates were 37% and 75%, respectively (P=0.015). Efficacy analyses using clinical global impression (P=0.04) and change in BPRS scores (P=0.016) were in favour of remoxipride. Extrapyramidal symptoms were minimal in both groups. Treatment emergent adverse events were similar in the two groups. Remoxipride is therefore of potential value as a safe drug which is both effective and well tolerated in the long term management of chronic schizophrenic patients.     

The effectiveness of 'nursing beds': a review of the literature

A literature search was conducted to identify 'nursing led in-patient units' where the nurse is the designated leader of the clinical team. The review concentrates on studies which have attempted to measure the impact of nursing-led in-patient units and reviews both the methodology and outcomes. Three major bodies of work were identified. Lydia Hall's evaluation of the Loeb Center for Nursing and Rehabilitation (USA) is reviewed in some detail. This work was the model for 'nursing beds' at the two Oxfordshire Nursing Development Units (UK) in the 1980s. Studies evaluating these centres are reviewed and reports of similar UK units discussed. A third body of work evaluates a nurse-managed critical care environment. Common features include a case mix based on nursing need with nurses having authority to admit and discharge patients. While results are generally favourable, with improved patient independence, fewer readmissions, lower mortality and cost savings reported in some or all of the studies, all studies reviewed demonstrate the difficulties of applying an experimental model to real life clinical services. Methodological limitations render firm conclusions difficult. Techniques adopted from studies in field settings, the so-called 'quasi-experiment', are advocated as a remedy, as is further study of the process of care in investigating this model of care delivery.     

大学生心理障碍干预实验研究

目的　探索有效的心理障碍治疗方法 ,降低大学生心理障碍发病率。方法　以经SCL - 90测试分析筛检出≥ 2项因子分在 2 3以上的心理障碍者 2 0 5人为研究对象 ,采取心理治疗、中药治疗、中药与心理疗法结合治疗 3种干预模式对实验组心理障碍者进行为期半年治疗 ,对实验组与空白对照组测试情况比较、各实验组组间比较 ,干预前、后测试结果比较 ,对干预效果进行评价。结果　 3个干预实验组与对照组相比 ,SCL - 90测试结果均低于对照组 ;干预前后SCL - 90测试总分、总均分、各因子分差异有显著性意义 (P <0 0 0 1)。结论　 3种干预方式对心理障碍均有不同程度的疗效 ,以中药与心理疗法结合治疗效果最佳。