Objective To formulate an individualized evidence-based treatment for a first-diagnosed patient with coronary artery-pulmonary artery fistula. Methods Aiming at the issue of whether interventional operation was necessary for first-diagnosed coronary artery-pulmonary artery fistula or not, the computer retrieval was conducted in the US National Guideline Clearinghouse, The Cochrane Library, PubMed and MEDLINE from 1990 to 2011, to collect and assess the best evidence of relevant systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines, in order to be applied in clinical treatment. Results There were 1 clinical guideline for treating coronary artery fistula and 3 different high-quality evidence studies were retrieved. The results showed percutaneous coronary intervention was the best treatment currently. According to the obtained evidence and patient’s willingness, the relevant examinations were taken, and the preoperative preparation for percutaneous coronary intervention was done actively after the patient was admitted. Three days after hospitalization, the selective coronary angiography showed right coronary artery-pulmonary artery fistula and left coronary circumflexus artery-left atrial multiple fistulae, then the percutaneous coronary intervention spring coil embolization was successfully conducted for right coronary artery-pulmonary artery fistula. After operation, bayasprin enteric-coated tablets 0.1 g/d was taken for anti-platelet aggregation and preventing thrombotic diseases. The observation during operation and postoperative 5-day hospitalization showed no relevant complications. Conclusion Percutaneous coronary intervention is safe and effective for the symptomatic patients with coronary artery-pulmonary artery fistula.
Objective To establish the evidence-based treatment strategy for an advanced lung cancer case with spinal metastasis, regarding the patient’s condition and treatment expectations. Methods According to PICO principles, questions in the patient’s treatment were converted into a search strategy. The literature searching was performed in several databases. In accordance with the five evidence grading standards in evidence-based medicine, the best clinical evidence was interpreted to guide the treatment decisions. Results A total of 148 papers were detected and screened, of which 4 systematic reviews or meta-analyses were included finally. Four issues that patients concerned, including restoring spinal cord function (walking and sphincter function), local pain control, long-term survival, and treatment complications, were all supported by grade-1 evidence. The patient finally chose surgical decompression, which was of a higher complication risk, but better possibility of restoring nerve function, significant pain relief, and improved long-term survival. The patient obtained fully recovery and regained walking function after surgery. Conclusion The evidence-based treatment is able to provide reasonable treatment options for lung cancer patients with spinal metastasis. Decompression surgery for patients with walking dysfunction should be carried out as soon as possible, in order to early restore spinal marrow function, relieve pain and improve long-term survival. But both doctors and patients should fully acquaint themselves with the higher risk of surgical complications.
Objective To discuss the common clinical problems and make the individualized treatment for a patient with obscure gastrointestinal bleeding by means of evidence-based medicine, so as to ultimately control the symptoms and reduce the mortality. Methods After the clinical problems were put forward, the systematic reviews and randomized controlled trials (RCTs) were collected in The Cochrane Library (online), MEDLINE, EMBase, SCIE and CNKI databases, from the date of their establishment to 2010. The treatment protocol was made by combining the assessment of evidence with the willingness of both patient and relatives. Results A total of 30 RCTs and 5 systematic reviews were identified. A rational diagnostic and therapeutic plan was made upon a serious evaluation of the data and willingness of patients. The Mickel’s diverticulum was found through capsule endoscopy, which was then locally excised under laparoscopy. After a 6-month follow-up, the plan proved to be optimal. Conclusion The treatment efficacy in diagnosed obscure gastrointestinal bleeding has been improved by adopting an individualized treatment plan according to evidence-based methods.
Objective To make an individulized treatment plan for a patient with locally advanced non-small cell lung cancer (NSCLC). Methods After clinical problems were put forward, evidence was collected from http://www. nccn.org. The Cochrane Library (Issue 4, 2008), Medline (PubMed 1990. 1-2008.11) and CHKD periodical database were searched. Results A total of 21 RCTs, 5 systematic reviews and 13 CT phase Ⅲ trials were identified. A rational treatment plan was made upon a serious evaluation of the data. After nine monthes of follow-up, the plan was proved optimal. Conclusion For locally advanced NSCLC patients, an individulized treatment plan made by evidence-based methods not only can inprove the treatment efficacy but also can lead both of doctors and patients to assume the indeterminateness of medicine.
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 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 To explore an approach of evidence-based treatment for acute hypertensive cerebral hemorrhage. Methods (1) Thoroughly evaluating the patient’s condition. (2) Formulating clinical problems. (3) We searched The Cochrane Library (Issue 1, 2006), Ovid EBM REVIEWS (2001 to 2006), MEDLINE (1980 to 2006) and CNKI (1994 to 2006) for evidence. (4) Assessing evidence. (5) Applying evidence. Results Total 13 relevant studies were retrieved. Results indicated that all kinds of interventions for the treatment of hypertensive cerebral hemorrhage showed different degrees of efficacy, including the Stroke Unit, blood pressure control, mannitol, hemostyptic and neuroprotective agents, promotion of blood circulation and resolving of blood stasis, stereotactic aspiration etc. However, the effects of other interventions need further validation except Stroke Units which had higher quality evidence. Based on the patient’ specific conditions, we recommended the following evidence-based treatment plan: immediate transfer to the Stroke Unit; sequential application of reptilase (within 6 h), citicoline (within 24 h), mannitol and Compound Danshen Injection (after 24 h); temporary withhold of enalapril meleate; monitoring of blood pressure, ECG, renal function and electrolytes; and if intracranial hemorrhage occurs again during the treatment, stereotactic aspiration should be applied. Conclusions Through evidence-based method, an individualized treatment plan could obviously improve the treatment effectiveness and reduce the incidence of adverse effects in patients with hypertensive cerebral hemorrhage.
Objective To search evidence in the treatment of Philadelphia chromosome （Ph）-positive acute lymphocytic leukemia （ALL） for guiding chnical practice. Methods We searched MEDLINE （February, 1970～July, 2005 ） and SUMSEAILCH （till July, 2005 ）to identify systematic reviews（SIL）, randomized controlled trials（RCTs） and controlled clinical trials （CCTs） in the treatment of Ph-positive ALL. Results One RCT and 8 CCTs were identified. The results showed that Ph-positive ALL had a very poor prognosis . Chemotherapy and bone marrow transplantation （BMT） were the two main ways to treat the disease. Outcome of conventional chemotherapy treatment for adults with the disease was poor. Outcome of treatment with hyper-CVAD and imatinib mesylate was better and BMT was the only way which could potentially cure the disease. Conclusions Treatment of Ph-positive ALL with hyper-CVAD and imatinib mesylate may induce higher remission rate and disease free survival rate. BMT is the best way to cure the disease.
Objective To report an evidence-based treatment of Mycophenolate Mofetil for idiopathic membranous nephropathy (IMN) with nephrotic syndrome (NS). Methods We searched The Cochrane Library (Issue 3, 2005), MEDLINE (1978 to 2006) and CNKI (1978 to 2006), and critically appraised the available evidence. Results The available Level C (low quality) evidence showed that Mycophenolate Mofetil was effective for the remission of proteinuria, and effective in patients who were resistant to steroid or cytotoxic agents. However, there was no evidence on its long-term effect on renal survival. Given the current evidence, together with our clinical experience and the patient’s preference, Mycophenolate Mofetil and glucocorticoid were administered to the patient. After 3 months of treatment, proteinuria was relieved. The patient is still can followed up. Conclusions We only find Level C evidence to support the short-term efficacy of Mycophenolate Mofetil on the remission of proteinuria. Further studies on its long-term effects on renal survival, and a health economics evaluation are needed.
Objective To make an individualized treatment plan for a premature menopause female who was diagnosed as stable coronary heart disease with the symptom of frequent palpitation after physical activity for over 1 month.. Methods Seven clinical problems were put forward after assessing the patient＇s health state. We searched The Cochrane Library （Issue 2, 2005 ） , evidence-based medicine reviews （EMBtk） （1991 - 2005 ） , and MEDLINE （1991 - 2005 ） databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of coronary heart disease were included. The treatment plan was developed accordingly. Results After evaluating, thirty-four studies were ehglble. The evidence indicated that three kind of drugs （aspirin, h-blockers and statins）, exercise and dietary therapy, and 75mg/d aspirin for secondary prevention, could improve the therapy effect and the prognosis by controlling LDL below 2.6 mmol/L; ACEIs should be used depending on the patient＇s condition; coronary arteriography and interventional strategy helped little for patients without coronary artery events in recent 3 months, and their cost-effectiveness was lower; hormone replacement therapy even increased the risk of thrombosis. The individualized treatment plan was developed based on the available evidence. After 2 months, the patient＇s weight declined, the symptom of angina disappeared and the lipidemia reduced to aimed level. Conclusions The individualized treatment plan based on the high quality evidence and patient＇s condition is optimal for the short-term treatment of stable coronary heart disease. However, the long-term prognostic benefits need to be confirmed by continuing follow-up.