Perineal care is a classic topic for obstetrics. After thousands of years of practice, we have accumulated some experience and meanwhile, we are also taking some attempts. The effectiveness and reliability of these methods need evaluation. Nowadays, the best evidence comes from randomized controlled trials (RCT) and systematic reviews (SR). We searched The Cochrane Library (Issue 3, 2007), MEDLINE (Jan. 1980 to May 2007) databases and CBM-disc (Jan. 1980 to May 2007) to obtain current best evidence for perineal care.
ObjectiveTo systematically review the efficacy of cognitive behavioral therapy (CBT) for improving mental health and social functions in patients with multiple sclerosis (MS). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 4, 2016), CBM and CNKI from inception to May 2016, to collect randomized controlled trials (RCT) about CBT on mental health and social function in patients with MS. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 11 RCTs involving 1 102 patients were included. The results of meta-analysis showed that, the HADS scores (depression: MD=-1.28, 95%CI-2.07 to-0.48, P=0.002; anxiety: MD=-1.52, 95%CI-2.99 to-0.06, P=0.04), BDI scores (MD=-9.11, 95% CI-15.82 to-2.40, P=0.008), HRDS scores (MD=-7.23, 95% CI-13.65 to-0.82, P=0.03), Chalder scores (MD=-4.88, 95% CI-6.61 to-3.16, P < 0.000 01), MFIS scores (MD=-2.98, 95% CI-4.52 to-1.44, P=0.000 2) and GHQ-12 scores (MD=-3.61, 95%CI-5.20 to-2.02, P < 0.000 01) in the CBT group were lower than that in the control group. No significant difference was found in WSAS scores (MD=-1.98, 95%CI-4.88 to 0.93, P=0.18) between two groups. ConclusionCBT may be effective for improving the negative mental experience, fatigue and quality of life in MS. No evidence to support CBT has benefits in social functions. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality studies.
Objective To evaluate the efficacy, safety and economics of digestive enzyme for dyspepsia. Methods Electronic databases such as PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CBM, VIP and CNKI were searched from establishment dates of databases to June 2010 to identify the randomized controlled trials (RCTs) of digestive enzyme for dyspepsia. Then studies were identified according to predefined inclusion and exclusion criteria, and their quality was evaluated. The meta-analysis was performed using RevMan 5.0 software. Results Eight studies involving 1 092 patients were included, 3 of which were Grade B while the rest were Grade C. The results of the meta-analysis showed that the total efficacy rate of oryz-aspergillus enzyme and pancreatin tablet, compound digestive enzymes capsule, and compound azintamide enteric-coated tablet for dyspepsia were better than either placebo or blank intervention, with the results as (OR=49.70, 95%CI 17.16 to 143.96), (OR=7.71, 95%CI 3.88 to 15.33) and (OR=16.27, 95%CI 6.85 to 38.66), respectively. The efficacy for treating loss of appetite, abdominal distension, abdominal pain, diarrhea and belching was superior to either placebo or blank intervention. Oryz-aspergillus enzyme and pancreatin tablet was inferior to compound digestive enzyme capsule in treating dyspepsia following cholecystectomy. No significant difference was observed in treating dyspepsia following chronic pancreatitis between compound azintamide enteric-coated tablet and compound digestive enzymes capsule. Drug-related adverse reactions as well as economic evaluation were not reported in included studies. Conclusion Digestive enzyme is effective for dyspepsia caused by various diseases. The OR of digestive enzyme versus the placebo/blank-control group shows that oryz-aspergillus enzyme and pancreatin tablet is better than other digestive enzyme drugs.
Objective To investigate the efficacy and safety of polyethersulfone highflux dialyzer for uremic patients. Methods Forty eligible uremic patients were randomized into two groups, i.e. polyethersulfone (PES) group and polysulfone(PSF) group, according to a random number table. The PES group received hemodialysis for 4 hours with polyethersulfone highflux dialyzer (Chengdu OCI Medical Device Co., Ltd), and the PSF group with polysulfone highflux dialyzers (Fresenius Polysulfones, Fresenius Medical Care, Bad Homburg, Germany). Changes in serum creatinine, urea, β2-microglobulin, hemoglobin and albumin levels were determined for efficacy and safety evaluation. Results All the 40 patients completed the trial. The serum creatinine, urea, β2-microglobulin levels of all the patients in the two groups decreased (gt;30%) after the hemodialysis with different highflux dialyzers, and no significant difference was observed between the two groups (Pgt;0.05). Changes in solute clearance index (KT/V) value, hemoglobin and albumin levels were also comparable between the two groups (Pgt;0.05). Conclusions The efficacy and safety of the PES hollow fiber membrane hemodialyzer is equivalent to that of the PSF hemodialyzer in hemodialysis for uremic patients.
Objective Evidence-based medicine was used to make an individualized treatment plan for newly diagnosed prostatic hyperplasia in an elderly patient. Methods After clinical problems were discovered, evidence was collected from CBM, CNKI, The Cochrane Library, PubMed, EMBASE, ScienceDirect, Springer, and ProQuest databases according to our predefined search strategy. The search was done through 2008. The internal and external validity of the evidence was assessed. The evidence, combined with the patient value, was applied to the patient. Results A total of 39 systematic reviews involving 137 randomized controlled trials were identified. A rational treatment plan was made upon a critical evaluation of the data. After one year follow-up, the treatment protocol was proven correct. Conclusion The treatment efficacy in newly diagnosed prostatic hyperplasia in the elderly has been improved by determining an individualized treatment protocol according to evidence-based methods.
Objective To evaluate the effects of cardioselective beta-blockers on respiratory function in patients with chronic obstructive pulmonary disease ( COPD) . Methods We used computer to search the Cochrane Controlled Trials Register database, Medline, Netherlands EMBASE/Excerpta Medica,EBSCO database, China Academic Journal and the Chinese Biomedical Literature Database, as well as respiratory magazines and conference abstracts, without language restrictions. The information was retrieved until December 2011. We collected all the randomized, blinded, controlled clinical trails ( RCTs ) of cardioselective beta-blockers on respiratory function in patients with COPD. Then two evaluators evaluated the quality of RCTs according to the Cochrane Review Manual 4. 2 independently. Meta-analysis was performed using statistical software Stata 11. 0. X2 test was used to analyze their heterogeneity. Standardizedmean difference ( SMD) was used to describe continuous variables. Relative risk degree ( RR) was used to describe categorical variables, and 95% CI was used to describe treatment effect. Results 22 trails met the selection criteria. Meta-analysis showed no change of FEV1 in COPD patients after taking single dose of cardioselective beta-blockers [ SMD - 0. 367, 95% CI( - 0. 786, 0. 052) ] and no respiratory symptoms aggravation [ RR1. 000, 95% CI( 0. 848, 1. 179) ] . Meta-analysis also showed no change of FEV1 in COPD patients who received long-term cardioselective beta-blockers treatment [ SMD - 0. 236, 95% CI( - 0. 523,0.051) ] , and no respiratory symptoms aggravation [ RR 1. 000, 95% CI ( 0. 830, 1. 205) ] . Inhaled beta-2 agonists showed no effect on FEV1 in COPD patients after either long-term administration [ SMD - 0. 200,95% CI( - 0. 586, 0. 187) ] or single dose administration of cardioselective beta-blockers [ SMD - 0. 078,95% CI( - 0. 654, 0. 497) ] . Conclusion Cardioselective beta-blockers, given to patients with COPD in conditions such as heart failure, coronary artery disease and hypertension in the identified studies did not produce adverse respiratory effects.
ObjectivesTo compare the efficacy and safety of weekly nedaplatin compared with weekly cisplatin as postoperative concurrent chemoradiotherapy scheme for cervical cancer patients.MethodsThis trial was performed in the Department of Radiation Oncology in the Second Affiliated Hospital of Fujian Medical University from June 2016 to January 2017. A total of 200 patients with stage ⅠB1-ⅡB cervical cancer were randomly assigned to the nedaplatin group and the cisplatin group after signing informed content. The dose of nedaplatin or cisplatin ranged 35 to 40 mg/m2, once a week for 5 weeks. Intensity-modulated radiation therapy or three-dimensional conformal radiation therapy were used for patients. The progression-free survival, overall survival and adverse reactions were compared between two groups. Statistical analysis was performed by SPSS 24.0 software.ResultsA total of 105 patients were enrolled in the nedaplatin group, and 95 patients were in cisplatin group. The three-year progression-free survival rate was 80.5% vs. 79.5% in the nedaplatin group and the cisplatin group, respectively; and no statistical significant difference was found (χ2=0.198, P=0.656) between two groups. The 3-year overall survival rates were 72.5% and 69.9% for the nedaplatin group and the cisplatin group, respectively, and there was no significant difference between the two groups (χ2=0.261, P=0.609). The incidence of grade 3/4 nausea and vomiting in the nedaplatin group was 6.67%, which was significantly lower than that of 15.79% in the cisplatin group, and statistical significant difference was found (χ2=2.555, P=0.011); however, the incidence of grade 3/4 thrombocytopenia in the nedaplatin group was 9.52%, which was significantly higher than that in the cisplatin group (3.15%); and the difference was statistically significant (χ2=1.985, P=0.047). There was no difference in the incidence of adverse reactions such as anemia, neutropenia, and radiological proctitis in both groups.ConclusionsNedaplatin-based concurrent chemoradiotherapy has similar efficacy compared to cisplatin-based concurrent chemoradiotherapy, and it could significantly reduce the digestive tract reaction, which can be used as an alternative to cisplatin.
Objective To compare the efficacy of plating versus intramedullary nailing in the treatment of adult humeral shaft fracture. Methods We identified eligible studies in PubMed (1950 to September 2007), MEDLINE (1950 to September 2007), OVID CINAHL (1950 to September 2007), OVID EBM (3rd Quarter 2007), CBMdisk (1978 to June 2007) and CNKI (1981 to June 2007). We also handsearched several Chinese orthopedic journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials (RCTs) comparing plating versus intramedullary nailing for humeral shaft fracture in adults were included and the quality of these trials was critically assessed. Data analyses were conducted with Stata 10.0. Results Six RCTs involving 425 patients were included, among which the statistical heterogeneity was not significant (Pgt;0.1). Cumulative meta-analyses showed that intramedullary nailing might increase the re-operation rate in studies conducted before the year of 2000 (OR=0.39, 95%CI 0.17 to 0.90, P=0.03), but the difference was not significant in studies conducted after 2000 (OR=0.54, 95%CI 0.27 to 1.08, P=0.08). Intramedullary nailing might increase the incidence of shoulder impingement compared with plating (OR=0.13, 95%CI 0.03 to 0.65, P=0.01). The rates of non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure were similar between plating and intramedullary nailing. Meta-analyses were not conducted for union time, operation time and bleeding (transfusion) volume, because the relevant data were not available from the included trials. Conclusion Intramedullary nailing may increase the incidence of shoulder impingement. The rates of re-operation, non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure are similar between plating and intramedullary nailing. Further well-designed and large-scale randomized controlled trials are required to determine the effects of plating and intramedullary nailing on these outcomes.
Objective To systematically review the effectiveness and safety of arsenic trioxide (ATO) versus retinoic acid for patients with acute promyelocytic leukemia (APL). Methods Such databases as PubMed, The Cochrane Library (Issue 12, 2012), CNKI, WanFang Data and VIP were electronically and comprehensively searched from inception to December 2012, for randomized controlled trials (RCTs) on the effectiveness and safety of ATO versus retinoic acid for patients with APL. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0.2 software. Results Eight RCTs involving 586 cases of APL patients. The results of meta-analysis showed that, ATO and all-trans-retinoic (ATRA) were not statistically different in CR rates (OR=0.85, 95%CI 0.54 to 1.35, P=0.50), CR time (OR=–8.14, 95%CI –16.42 to 0.13, P=0.05), recurrence rates (OR=0.14, 95%CI 0.02 to 1.21, P=0.07), early mortality (OR=0.82, 95%CI 0.32 to 2.06, P=0.67), and five-year total survival rates (OR=1.19, 95%CI 0.54 to 2.60, P=0.66). ATO had lower incidences of adverse reaction such as hyperleukocytosis syndrome (OR=0.32, 95%CI 0.18 to 0.58, P=0.000 1) and retinoic acid syndrome (OR=0.05, 95%CI 0.02 to 0.14, Plt;0.000 01). Conclusion ATO and ATRA are alike in CR rates, CR time, recurrence rates, early mortality, and five-year total survival rates, but ATO causes less adverse reaction. Due to the limited quantity and quality of the included studies, ATO should be applied with caution according to patients’ conditions in clinic.
Objectives To systematically review the efficacy and safety of clopidogrel 600 mg and 300 mg loading dose in Chinese patients underwent percutaneous coronary intervention (PCI). Methods We searched The Cochrane Library, EMbase, PubMed, CNKI, WanFang Data, CBM and VIP databases to collect randomized controlled trials (RCTs) of the efficacy and safety of clopidogrel 600 mg and 300 mg loading dose in Chinese patients underwent PCI from inception to April, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 14.0 software. Results A total of 10 RCTs involving 1 166 patients were included. The results of meta-analysis showed that: the 600 mg loading dose group had lower incidence rate of major adverse cardiovascular events (MACE) in comparison with the 300 mg loading dose group (RR=0.29, 95%CI 0.17 to 0.48, P<0.000 1). However, no significant difference was found in the incidence of major bleeding events within 30 days between two groups (RR=1.64, 95%CI 0.70 to 3.80,P=0.252). Conclusions The current evidence shows that in Chinese patients underwent PCI, administration of a 600 mg loading dose of clopidogrel is associated with a lower risk of MACE than is administration of a 300 mg loading dose of clopidogrel, without increasing major bleeding risk in 30 days. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.