Objective To identify an evidence-based treatment for a patient with aneurysmal subarachnoid hemorrhage (aSAH). Methods We first put forward clinical problems about how to prevent complications and how to treat ruptured aneurysm of aSAH, then searched The Cochrane Library (Issue 4, 2006), Ovid ACP Journal Club (1991 to 2006), Ovid MEDLINE (1966 to 2006), NGC (1998 to 2006) and CBM (1978 to 2006) to identify systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines. Results Eleven studies and five guidelines were included. Current evidence indicated that nimodipine was effective for prophylaxis of poor outcome after vasospasm, while tirilazad was not effective in female patients with good grades. The effectiveness of other treatments to prevent complications was not clear. Evidence on the use of antifibrinolytics for the prevention of re-bleeding was inconsistent. If a ruptured aneurysm was considered suitable for both surgical clipping and endovascular coiling, coiling was associated with a better outcome. According to the available evidence and guidelines, considering the patient’s conditions and preferences, nimodipine and antifibrinolytics were administered to prevent complications and her aneurysm was treated by early endovascular embolization. She did not experience vasospasm or re-bleeding during her hospital stay. Short-term follow-up showed a good outcome. Long-term prognostic benefits after endovascular therapy need to be confirmed by prolonged follow-up. Conclusions Therapies based on the best clinical evidence and guidelines should be given to prevent complications and improve outcome for patients after an aSAH.
Objective We searched and reviewed medical evidence to find the guide of treatment for local advanced nasopharyngeal carcinoma. Methods Firstly, we put forward clinical questions. Secondly, we searched medical evidence from Medline (1985-2002), Embase (1984-2000), Cochrane library (2002.1) and ACP. And then we reviewed the results. The key words we used were "nasopharyngeal carcinoma, chemotherapy and radiotherapy randomized" and "meta analysis or randomized control trial". Results Through searching, we got 17 papers including 1 systematic review and 16 randomized control trials, in which there were 8 prospective randomized phase Ⅲ trials. Most of these trials concluded that combination chemo-radiotherapy were better than radiotherapy alone. We think these results were suitable for our patient’treatment decision. Conclusion To treat our patients,we choosed the method of the mutimodality of squeitial neoadjuvant chemotherapy, concurrent chemo-radiotherapy and adjuvant chemotherapy with the drug doses down-adjusted.
Objective We intended to get a good understanding of the current role of alkylating agents in the treatment of idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS). Methods We searched the Cochrane Library ( Issue 3, 2005), MEDLINE (1978 Jun., 2005) and CBM disc(1978-2005) to get the current best evidence of alkylating agents for treating IMN with NS and further critically appraised the available evidence. Results Alkylating agents showed a significant beneficial effect on complete remission of proteinuria. The treatment of glucocorticoid with cyclophosphamide (MP+CTX) was one of the best managements among the various regimens suggested for IMN, but it was not clear about its long-term effect on renal survival rate. Given the current best evidence together with our clinical experience and the attitudes of the patient and family members, the treatment of (MP+CTX) was administered. There was a significant remission of proteinuria after 6 months follow-up. Conclusions The treatment of (MP+CTX) can significantly improve the remission of proteinuria, however further observations on the long-term effect of alkylating agents on renal survival rate are required.
Objective To discuss the diagnosis, treatment, and follow-up visit mode of thyroid carcinoma showing thymus-like elements (CASTLE). Mothods For a systematic review of a case with CASTLE, the domestic and overseas literature was searched to analyze final diagnosis, treatment and follow-up visit indexes of that case. Results For CASTLE, the pathology combined with immunohistochemistry was the only method for final diagnosis, the operation was the main treatment, and the ultrasound as well as the computed tomography (CT) could be the follow-up visiting indexes. Conclusion CASTLE is a special kind of thyroid carcinoma, which is different from differentiated thyroid carcinoma in diagnosis, treatment and follow-up visit.
Lung cancer is an epithelial cancer arising from the bronchial surface epithelium or bronchial mucous glands. Non-small lung cancer constitutes about 75%-80% of all lung cancer. At the time of diagnosis, a lot of people have got stage Ⅲb non-small lung cancer which is unresectalbe. Both chemotherapy and radiotherapy are widely used in unresectable stage Ⅲ non-small lung cancer. The regimes of chemotherapy or radiotherapy are varied too. Systematic reviews and randomized controlled trials have provide much convincing evidence for us to choose and utilize the most appropriate treatment.
Objective To make an individualized therapeutic regimen for a patient with stage III relapsed ovarian cancer guided by evidence-based medicine.Methods According to the clinical problems this patient showed and the PICO (patient, intervention, comparison and outcome) principle, the best clinical evidence associated with relapsed ovarian cancer was retrieved and evaluated. Results The current evidence showed that the relapsed ovarian cancer with platinum resistance tended to be treated by pharmacotherapy. Consequently, on the basis of combining the recommended guidelines, randomized controlled trials (RCTs), systematic reviews or meta-analyses on RCTs, clinical experience from doctors and willingness of patient, the regimen of Irinotecan plus Pegylated Liposomal Doxorubicin for interventional chemotherapy was recommended for this patient. After three courses of the treatment, the disease got some relieved; the medical team would like to keep conducting the same regimen for another six to eight courses, and the follow-up visit was undergoing. Conclusion For patients with relapsed ovarian cancer with platinum resistance, an individualized therapeutic regimen under the guidance of evidence-based methods can not only improve the therapeutic efficacy but also guide both doctors and patients to take the indeterminate risk of medicine.
Objective Methods of evidence-based medicine were used to make an individulized treatment plan concerning newly diagnosed type 2 diabetes mellitus in elderly patients. Method After clinical problems were put forward, evidence was collected from third issue, 2003, Cochrane Library, Medline (PubMed 1990.1-2003.2) and http:// sumsearch.uthscsa.edu/ searchform4.htm according to the search strategy. Subject words were: diabetes mellitus non-insulin-dependent; self-monitor of blood glucose; micro-and macro-vascular complications; sulphonylureas; insulin ; aspirin; metformin; acarbose; self-monitor of blood glucose; older patient; hypertension management; Lipid management; RCT; human; meta-analysis；systmatic review. Results A total of 112 RCTs, and 24 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data. After one year follow-up, the plan was proved optimal. Conclusions The treatment efficacy in newly diagnosed type 2 diabetes mellitus in the elderly has been improved by determining an individulized treatment plan according to evidence-based methods.
Objective To make an individualized administration scheme via evidence-based medicine methods, namely adding heparin into the total nutrient admixture (TNA) solution, so as to help a neonate to prevent the occlusion of peripherally inserted central catheter (PICC). Methods After carefully assessing the condition of neonate, this clinical issue was put forward in accordance with the PICO principles. Randomized controlled trials (RCTs) and systematic reviews on neonates’ PICC occlusion were collected from The Cochrane Library, CCTR, DARE, NGC, MEDLINE (Ovid) and CBM from inception to 2011. The clinical intervention scheme was finally made after the assessment of the retrieved evidence and neonate’s physiological condition. Results A total of 4 RCTs and 1 systematic review related to the issues were identified. The following scheme was finally made for the neonate through the assessment of the retrieved evidence and combination of intentions of the patient’s family members: heparin (0.5 U/mL) was added into TNA to prevent PICC occlusion. During the application, blood routine test and blood coagulation were monitored, and the catheter opening time and extubation reason were recorded. Through the above treatment, the neonate successfully completed the treatment before extubation. The time of both PICC detaining and opening was 20 days in total, and there were no PICC occlusion, no catheter thrombosis, and no catheter related bloodstream infection. Moreover, no observation showed thrombopenia and aggravated coagulation disorders resulted from heparin. Conclusion The evidence-based medicine method is an effective way to make reasonable heparin scheme for neonate, so as to prevent PICC occlusion, reduce catheter thrombosis, decrease risks of catheter related blood circulation infection, assure successful completion of treatment, and guarantee the safety of patients.
Objective To summarize the available clinical research evidence for the treatment of hepatorenal syndrome (HRS). Methods Using the basic methods and principles of evidence-based medicine, we searched and evaluated clinical studies involving the treatment of HRS. Results We found that plasma expansion, vasoconstrictor, transjugular intrahepatic portosystemic shunts (TIPS) and liver transplantation were effective interventions for patients with HRS. Conclusion HRS is a common complication of end-stage liver diseases and the prognosis for patients with HRS is extremely poor. However, due to the small number of clinical trials, small sample sizes and low methodological quality, the strength of the current evidence is limited. Rigorously-designed, randomized, multi-center, large-scale trials on HRS are required.
Objective To make an individualized treatment plan for one first-visit gastro-esophageal reflux disease patient via evidence-based medicine methods. Methods The condition of the patient was evaluated comprehensively, then clinical problems were put forward according to PICO principle, and high-quality evidence was collected from The Cochrane Library (1990 to 2010), PubMed (1990 to 2010), and EMbase (1990 to 2010). The treatment plan was designed based on the evaluation of evidence, doctor’s experience, and patient’s preferences. Results A total of 17 RCTs and 10 meta-analyses/ systematic reviews were included. The evidence showed that the therapeutic effect of PPI was better than that of H2RA, and meanwhile prokinetic drugs should be used. When PPI needed to be use for a long time, HP eradication operation was required for the combination of HP inflammation. Laparoscopic fundoplication surgery was a better choice if the operation was required. Based on the above evidence combined with the patient’s preferences, the combination of general treatment, esomeprazole and cisaPride were adopted to treat. Meanwhile, anti-HP medicine was used to control the HP inflammation caused by the long-term maintenance therapy. The gastro-esophageal reflux symptoms were remarkably relieved six months after the treatment. Conclusion PPI plus prokinetic drugs, combined with HP eradication of gastroesophageal reflux surgery, can improve the clinical outcomes and patient’s quality of life. However, long-term prognostic benefits need to be confirmed by further follow-up.