To explain how to treat common gastric diseases like chronic gastritis, peptic ulcer, functional dyspepsia and gastric oesophageal reflux disease (GORD) based on evidence-based medicine. Through this paper, we try to help readers find and use clinical evidence to solve clinical problems.
Objective To investigate the current status of randomized controlled trials (RCTs) and clinical controlled trials (CCTs) on pressure sore in China. Methods We searched Chinese Journal of Nursing, Chinese Journal of Practical Nursing and Journal of Nurses Training in CNKI and VIP (January 2000 to December 2005) for Chinese articles on pressure sore, using "pressure sore", "bed sore", "nursing", "treatment", "prevention", "evaluation" and "management" as search terms. The retrieved articles were summarized. Results We identified 16 reports (10 RCTs and 6 CCTs). The studies were judged to be of low quality.There was one study on the evaluation, two on the prevention, and 13 on the treatment of pressure sores. Conclusion The current studies on pressure sore in China are focusing on treatment. Randomized controlled trials of large sample size of pressure sore are needed to improve nursing quality.
Objective To find the most effective treatment for a patient with difficult selective biliary cannulation (DSBC) during endoscopic retrograde cholangiopancreatography (ERCP) by EBM practice. Methods Evidence was retrieved from The Cochrane Library (Issue 1, 2010), ACP online, NGC (1998 to June 2010), PubMed (1950 to June 2010), and CBM (1994 to June 2010). The collected evidence was then graded. Results After preliminary research, we identified 18 relevant articles. The evidence showed that pre-cutting technique could increase cannulation success rates in DSBC and was safe, effective, and time-saving for an experienced endoscopist. Pancreatic duct occupation was easier to perform than pre-cutting technique and could also increase selective cannulation success rates in DSBC. According to the evidence, together with endoscopist’s experience and the preference of the patient and his family, needle-knife precut papillotomy was performed. Successful selective biliary cannulation was accomplished after pre-cutting. Conclusion The current evidence suggests that pre-cutting technique and pancreatic duct occupation could increase selective cannulation success rates in DSBC. Patients’ condition and endoscopist’s experience should be considered properly before the operation.
This article reviews the progress, problems and future development of evidence-based neurology; introduces sources of clinical evidence and evidence-based recommendations on some common neurological disorders from the Quality Standards Subcommittee of the American Academy of Neurology. It promotes high quality clinical research to provide good evidence and the use of current best evidence in patient care.
We searched The Cochrane Library（Issue 3, 2005）, MEDLINE（1996-2005） ,CMCC（1996-2005）, VIP（1996-2005） ,CNKI（1996-2005） to summarize the available evidence of topiramate for an intractable epilepsy. After scanning all these articles, we identified 11 articles including meta-analysis, randomised controlled trials and systematic reviews to evaluate. Topiramate offered an alternative in the treament for intractable epilepsy, especially for partial epilepsy, and its efficacy was proven. Patients had good tolerance. And no intercross effects with the traditional anti-epileptic drugs were found. So topiramate had broad clinical value. The primary dosage of topiramate was 200mg/d. The sustaining dosage was 400-600mg/d. And we didn＇t recommend the dosage of more than 600mg/d.
目的 评价不同复苏方法和不同药物、氧疗、物理疗法等对新生儿窒息复苏和复苏后的预防措施的有效性和安全性.方法 计算机检索Cochrane Library(2004年第3期),MEDLINE(1966～2002年) 关于新生儿窒息复苏时不同复苏方法、氧气的应用、以及不同药物、剂量、给药途径治疗和预防新生儿窒息的系统评价、随机和半随机对照试验.结果 正压通气时使用100%氧气和应用室内空气的复苏效果并无差异.胎粪污染羊水(MSAF)与较高的新生儿缺血缺氧性脑病(HIE)的发生率有关,而气管内有胎粪者无论稀稠均与胎粪吸入综合征发生率无关.窒息复苏后预防性给予亚低温疗法、抗惊厥药、纳洛酮、多巴胺等在降低新生儿病死率,继发HIE的严重程度等方面与对照组相比无显著差异.应用肺表面活性物质(PS)预防和治疗新生儿呼吸窘迫综合征(RDS),可减少死亡率和并发症.结论 应用PS预防和治疗RDS可明显减少新生儿死亡率,且胎龄lt;32周的早产儿预防用药比治疗用药效果更好;目前尚无充分证据证明窒息复苏后预防性给予亚低温疗法、抗惊厥药、纳洛酮、多巴胺等治疗的有效性.
Objective To evaluate the effect of vitamin A (Vit A) supplementation on the morbidity and mortality in children with infectious diseases. Methods We searched Cochrane Library (Issue 1, 2004), MEDLINE (1966-2004.3) and The PedsCCM Evidence-Based Journal Club (1992-2002). Relevant systematic reviews and randomized controlled trials (RCTs) of Vit A supplementation on morbidity and mortality in children with infectious diseases were obtained. Results We collected 107 studies and identified 13 systematic reviews or RCTs. The evidence showed that the effect of Vit A supplementation on morbidity and mortality was affected by the nutritional status of the children. Vit A supplementation given to Vit A deficient children could reduce the morbidity of diarrhea and mortality of measles. However, Vit A supplementation would increase the morbidity of diarrhoea and respiratory infections in children with sufficient nutrition. Conclusions The nutritional status of children correlates with morbidity and mortality of some infectious diseases, and the nutritional status and serum Vit A level should be evaluated before Vit A supplementation applied.
Although anaphylaxis induced by vitamin K1 seldom happens, 4 allergic cases were observed in the patients we treated recently who were given intramuscular injection of vitamin K1 before renal biopsy. To provide the best clinical evidence, we searched MEDLINE （-May 2005） and evaluated the studies. The studies were only case reports and retrospective reviews which showed the anaphylaxis were mainly allergic dermatitis with different manifestation and reaction time. The serious reactions such as allergic shock was very rare. We conclude that although vitamin K1 anaphylaxis is rare, strict indications should be followed and the drug surveillance on adverse events should be strengthened.