Evidence is the core of Evidence-Based Medcine; the Grades of Recommendations Assessment, Development and Evaluation (GRADE System) is a milestone in the history of evidence development. This paper outlines the GRADE System and GRADEpro 3.2 software, and briefly explores the right and wrong application which was published in the Chinese Journal of Evidence-Based Medicine. The GRADEpro 3.2 software is easy to operate, but for evaluating the reasons of upgrade and downgrade, and the importance of the parameters of outcomes, it needs to comprehensively and systematically understand the knowledge of relevant background, and to construct a solid foundation in clinical epidemiology and systematic review. In view of this paper based on the current GRADE System, there may be some discrepancy to the later content with the GRADE System constant improvement. Therefore, it is bly recommended that readers should keep constant learning and improving.
Objective To evaluate the efficacy and safety of acellular dermal matrix (ADM) in preventing Frey syndrome.Methods Studies of acellular dermal matrix in preventing Frey syndrome were searched in The Cochrane Library (Issue 1, 2010), MEDLINE, EMbase, SIGLE, GreyNet, NTIS, CBMdisc, VIP, CNKI and WANFANG DATA from 1995 to 2010. All the studies were selected, extracted and evaluated by four reviewers independently, and meta-analyses were performed with RevMan 5.0.0 software. Results A total of 15 studies involving 472 participants were included in the review. The studies showed that implantation of the ADM was able to efficiently reduce the incidence of Frey syndrome, and the difference in both subjective and objective was significant between the two groups after the therapy (RR=0.11, 95%CI 0.06 to 0.18, Plt;0.01; RR=0.14, 95%CI 0.10 to 0.19, Plt;0.01). The rate of temporary facial nerve paralysis was lower than that of the control group but the difference was not significant (OR=0.78, 95%CI 0.37 to 1.66, P=0.53). The incidens of both seroma and mucocele were higher than that of the control group but the difference was not significant(OR=2.63, 95%CI 0.09 to 79.25, P=0.58) and they could be alleviated by placing drainage tube and partial pressure bandage. The incidence rate of salivary fistula was lower than that of the control group and the difference was significant (OR=0.24, 95%CI 0.08 to 0.69, P=0.009). Conclusion The result of this system review shows that, the ADM can effectively and safely reduce the incidence of Frey syndrome. To perform preoperative hypersensitivity check for iodine or iodophors, to conduct rapid frozen section for defining the character of tumor, to fix the ADM stably, to place vacuum-drainage and to make partial pressure bandage are suggested.
Objective To evaluate the clinical effectiveness of Smecta versus Xilei Powder in treatment of oral ulcer in children.Methods CBM, CNKI, VIP and WanFang Data were searched for the randomized controlled trials (RCTs) of Smecta versus Xilei Powder in treatment of oral ulcer in children from the date of their establishment to June 31, 2010. The bibliographies of the included studies were searched, too. Two reviewers evaluated the quality of the included RCTs and extracted data critically and independently, and then the extracted data were analyzed by using RevMan 5.1 software. Results Twenty-two RCTs involving 1 489 patients meeting the inclusion criteria. The results of meta-analyses showed that compared with Xilei Powder, Smecta could increase the total effective rate by 1.38 times (RR=1.38, 95%CI 1.31 to 1.45, Plt;0.000 01) and decrease the average course of treatment (MD= –1.54, 95%CI –1.77 to –1.31, Plt;0.000 01), with significant differences. Only 3 RCTs mentioned adverse events, but no adverse events were reported. Conclusion The current evidence shows that Smecta is effective and safe in treatment of oral ulcer in children. Due to the limitations of the included RCTs, the quality of outcomes are moderate based on GRADE, which should be recommended by clinicians as “Weak Recommendation”. More large-sample and high-quality RCTs are needed to confirm the reliability of this study.