Co‐occurring medical conditions in adults with Down syndrome: A systematic review toward the development of health care guidelines. Part II

Adults with Down syndrome (DS) represent a unique population who are in need of clinical guidelines to address their medical care. Many of these conditions are of public health importance with the potential to develop screening recommendations to improve clinical care for this population. Our workgroup previously identified and prioritized co‐occurring medical conditions in adults with DS. In this study, we again performed detailed literature searches on an additional six medical conditions of clinical importance. A series of key questions (KQ) were formulated a priori to guide the literature search strategy. Our KQs focused on disease prevalence, severity, risk‐factors, methodologies for screening/evaluation, impact on morbidity, and potential costs/benefits. The available evidence was extracted, evaluated and graded on quality. The number of participants and the design of clinical studies varied by condition and were often inadequate for answering most of the KQ. Based upon our review, we provide a summary of the findings on hip dysplasia, menopause, acquired cardiac valve disease, type 2 diabetes mellitus, hematologic disorders, and dysphagia. Minimal evidence demonstrates significant gaps in our clinical knowledge that compromises clinical decision‐making and management of these medically complex individuals. The creation of evidence‐based clinical guidance for this population will not be possible until these gaps are addressed.     

多参数信息融合实现非脑电的睡眠结构分期

目前临床睡眠分析的主要手段是多导睡眠图（Polysomnograph,PSG）,用仪器记录被测者整晚的脑电、眼动电和颏肌电等生理参数,计算机进行自动睡眠分期,再由技术人员依据国际标准进行校正.几十年来PSG保持着睡眠分期金标准的地位.提出在不使用脑电的条件下,利用较易获得的心动周期、呼吸、体动等基本生理参数,提取其中与睡眠过程及其变化有关的规律和信息,建立知识规则库,采用不确定推理的证据理论进行多参数睡眠信息融合计算,实现睡眠结构分期.50余例与PSG对照试验结果表明：醒睡的平均符合率达90%以上,基本睡眠结构的平均符合率达75%以上,证明该技术达到了应用的要求.     

治疗儿童呼吸系统疾病中成药的临床研究证据的概况性综述

目的：该研究使用概况性综述的方法,对治疗儿童呼吸系统疾病的中成药说明书信息及临床研究证据进行全面分析总结并报告。方法：通过检索2021年版《国家基本医疗保险、工商保险和生育保险药品目录》、2018年版《国家基本药物目录》、2020年版《中华人民共和国药典》（一部）,三大药品目录,获得治疗儿童呼吸系统疾病中成药;再检索中英文数据库获得相关文献,最后进行数据统计与可视化分析。结果：经筛选分析后,共纳入中成药52种。涉及9种剂型;主要组成为黄芩、苦杏仁、连翘等;功效以清热解表、止咳化痰等为主;主要治疗小儿风热感冒、咳嗽等;药物不良反应与禁忌证均只有19.23%(10/52)的中成药给与说明,其余均为尚不明确。纳入文献279篇,其中中文核心期刊文献277篇,英文科学引文索引扩展版（SCIE）2篇,包括随机对照研究253篇（含剂型/剂量比较6篇）、基于医院管理信息系统（HIS）数据的回顾性分析11篇、病例系列1篇、系统评价与Meta分析13篇（含网状Meta分析2篇）、经济学评价1篇。72.76%(203/279)的研究发表在中国科技核心期刊上;文献只涉及33种中成药,关于小儿肺热咳喘口服液的研...     

循证医学对心血管病研究的影响

循证医学的出现使现有的医学观念从理论知识加个人经验的医学模式转变到科学证据为基础的医学模式。随着临床流行病学的深入开展及临床科研方法的重大发展,循证医学正在逐渐深入医学的各个角落,在心血管领域也是如此。文章将主要阐述循证医学在心血管病临床医疗实践、科研、卫生决策和医学教育方面产笺重要影响;客观分析循证医学在此领域的发展史及现状;同时也概括了我国心血管研究在循证医学方面的成果与不足。从而进一步揭示,科学的证据正有利地促进着医学的全方位发展,以问题为基础的循证医学是当今临床医学发展的必然趋势。     

What is the Level of Evidence Substantiating Commercial Payers’ Coverage Policies for Total Joint Arthroplasty?

BackgroundThe prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States.MethodsThe references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease.Results282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA.ConclusionMost of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.     

Challenges and Opportunities for Real-World Evidence in Metastatic Luminal Breast Cancer

BackgroundThe therapeutic armamentarium for patients with metastatic breast cancer is becoming more and more specific. Recommendations from clinical trials are not available for all treatment situations and patient subgroups, and it is therefore important to collect real-world data.SummaryTo develop recommendations for up-to-date treatments and participation in clinical trials for patients with metastatic breast cancer, the Prospective Academic Translational Research PRAEGNANT Network was established to optimize the quality of oncological care in the advanced therapeutic setting. The main aim of PRAEGNANT is to systematically record medical care for patients with metastatic breast cancer in the real-life setting, including the outcome and side effects of different treatment strategies, to monitor quality-of-life changes during therapy, to identify patients eligible for participation in clinical studies, and to allow targeted therapies based on the molecular structures of breast carcinomas.Key MessagesThis article describes the PRAEGNANT network and sheds light on the question of whether the various end points from clinical trials can be transferred to the real-world treatment situation.     

Good practices in health promotion for older people – Significance for evidence in health policy

This article is devoted to convincing policy makers to use good practices in encouraging older people to pursue adequate and effective health policies. Long-term scientific research focused on the effects of health promotion programmes is rarely undertaken, although its scope is still expanding. At the same time, it is strongly desirable to form health policy based on scientific evidence. In this situation, an indication of good practices characterised by precisely defined features and their systematic evaluation could be an alternative to an insufficient number of empirical studies. The first step of the methodology was a literature review on health promotion for older people, aimed at defining good practices and criteria used for their selection. The authors searched the following databases: PubMED, Embase and Cochrane Library, as well as international databases dedicated to health promotion programmes for older people (e.g. Age-friendly World ( https://extranet.who.int/agefriendlyworld/age-friendly-practice-database-launched ); HealthProElderly ( www.healthproelderly.com/database/index.php?id=16 ); JA-CHRODIS ( www.chrodis.eu ); EuroHealthNet ( www.eurohealthnet.eu ) and ProFouND; ( www.profound.eu.com ). As relevant health policy information is usually available in national languages, the authors then approached national experts in 10 European countries, who filled in a dedicated survey on health promotion programmes for older people and indicated examples of good practices from their countries. Practical evidence, based on real implemented programmes, is valuable as inspiration for health promotion programmes, their planning and management. Selecting good practices from among implemented and evaluated actions makes it possible to establish their value. The significance of good practices in health promotion is to deliver real benefits and health effects for a target group, which, in the case of evident benefits, renders the practices credible and worthy of further dissemination. The EU already successfully shares good practices in migrant health and environmental protection. Creating databases on good practices helps policy makers promote the sustainability of already implemented activities and enhances their applicability by other organisations and in different settings.     

应用循证医学观点对脑梗死急性期药物治疗的评价

目的 :以循证医学观点对脑梗死急性期各种药物治疗的临床应用进行评价。方法 :采用国内外文献综述方法。结果与结论 :对于脑梗死急性期应用尿激酶、rtPA静脉溶栓、尿激酶原动脉溶栓、阿司匹林等均有效。肝素、低分子肝素抗凝治疗对心源性脑栓塞、凝血性疾病、症状性脑动脉狭窄、症状性颅外段夹层动脉瘤及静脉血栓形成有效。降纤酶、甘油、神经节苷脂和常规应用甘露醇等尚未得出结论。而血液稀释疗法、皮质类固醇激素、氨茶碱和钙通道阻滞剂等均为阴性结果     

循证医学与中医学关系及设想初探

循证医学主要研究内容是提供证据和应用证据，其与中医相同之处是重视证据，重视整体观。中医辩证是通过四诊收集证据，将诊查结果作为辩证、立法、用药的依据。循证医学的核心思想是寻求证据，应用证据。前者用于诊断、后者注重对诊断和治疗结果的分析评价。中医重视整体观，重视从局部与整体有机的联系上分析疾病的病机变化。治疗上重视人体整体 功能状态的调整和改善。而循证医学也具有整体观，突破以往以疾病为中心的模式，倡导临床措施和医疗决策以病人为中心。为促进循证中医药学的发展，建议制作中医药的系统评价；进行循证中医药学在临床实践中的应用研究；组织评价方法研究小组；建立中医临床评价研究资料库。     

Outcome from Complex Neurosurgery: An Evidence Based Approach

Summary ? Background. The aim of this study was to determine outcome, including quality of life, after surgery for petroclival meningioma using a standard skull base approach and to carry out an evidence based appraisal of the relevant literature.  Method. Pre- and post-operative data including adverse events were prospectively recorded in 19 patients (15 females, age range 29–63) undergoing a transpetrous approach for a petroclival meningioma. Patients were assessed using the GOS and SF-36 post operatively.  Findings. 24 operations were done. 6 patients developed a new permanent neurological deficit and 10 experienced a temporary deficit or exacerbation of existing deficits. At 1 year 15 patients had made a good/moderate recovery, 3 were severely disabled and 1 died – in keeping with other studies. By contrast the SF-36 showed that in all 8 categories of the SF-36 between 39–72% of surviving patients were functioning below the accepted norms.  Interpretation. After transpetrous excision of a petroclival meningioma the quality of life for the patient is worse than that indicated in surgeons' reported results. This paper represents an attempt to address the issue of evidence-based medicine and finds that such an approach is not apparent in the medical literature on this pathology. While we argue that methods for measuring outcome should be refined and carers input recognised it does raise certain philosophical considerations. It is the counsel of perfection and if achieved may lead to surgeons operating on fewer patients, more petroclival cases being viewed as inoperable because of the higher morbidity, despite there being an inescapable pathway to surgical intervention.