Systematic reviews provide information about the effectiveness of interventions by identifying, appraising, and summarizing the results of otherwise unmanageable quantities of primary research in an effort to provide valid, reliable evidence for health decision-making and clinical practice. They differ from traditional reviews produced by "content experts" in that they use a replicable, scientific and explicit approach that seeks to minimize bias. They are particularly useful when there is uncertainty regarding the potential benefits or harm of an intervention and when there are variations in practice. Poor quality systematic reviews may mislead policy-makers and clinicians. This paper will introduce the basic methods of Cochrane systematic reviews in order to help those who are interested in conducting systematic review.
【摘要】 目的 加强输血管理是保障血液合理利用和临床用血安全的重要手段。 方法 通过对医院临床用血情况的分析，以减少手术输血为切入点，采取强化意识，严控指征，完善术前准备，倡导自体输血，加强考核管理等方式促进临床合理用血。 结果 有效提升了医疗服务品质，保障医疗安全。 结论 其方法与措施此方法与措施供大型医院医疗管理参考借鉴。【Abstract】 Objective Strengthening blood transfusion management is an important means to ensure reasonable blood usage and clinical security during blood use. Methods With reducing surgery blood transfusion as a breakthrough point, We promotes clinical reasonable blood use and medical service quality by strengthening awareness of health workers, controlling indicators strictly, perfecting preoperative preparation, initiating autologous blood transfusion, enhancing assessment and management, and so on. Results The medical service quality was improved and the medical safety was ensured. Conclusion The experience could provide a reference for medical management in large hospitals.
Objective To evaluate the diagnostic value of anti-nucleosome antibody (AnuA) in patients with systemic lupus erythematosus (SLE). Methods We searched MEDLINE, EMbase and The Cochrane Library to identify studies on the diagnostic value of AnuA in patients with SLE. The searching time was from 1990 to 2005. The quality of included studies was evaluated and the data were extracted. The Cochrane Collaboration’s RevMan software was used to analyze heterogeneity, and MetaDisc was used to perform meta-analyses and draw summary receiver operator characteristic curve (SROC). Results Twenty-five studies involving 7 289 patients (2 459 SLE and 5 030 non-SLE patients were diagnosed by gold standard) were included, most of which were poor in quality. The heterogeneity among studies was high (Plt;0.000 01, I2=87.2%). The pooled sensitivity was 64.9%, 95% CI 63.0 to 66.85, and the pooled specificity was 92.6%, 95% CI 91.8% to 93.3%. Area under the SROC was 0.918, SE0.0212. These data suggested that AnuA had a relatively high false negative rate (35.1%) and a relatively low false positive rate (7.4%). Conclusions AnuA has some value in diagnosing SLE and could possibly be used as one of the diagnostic tests for SLE.
Objective To explore how to integrate the various sources of information in designing an evidence-based nursing care plan for preventing gastrointestinal hemorrhage (GIH) after pancreaticoduodenectomy (PD). Method Papers and references about prevention of GIH after PD were searched between September and October 2015, and an evidence-based nursing care plan was drawn up and implemented from November 2015 to January 2016. Results A total of 79 papers were found and of which 17 were aviliable. Thirty-nine patients were cared on the basis of the effective project, of whom one was dignosed with GIH on the 3rd postoperative day and the rate of post-PD hemorrhage was 2.6%. All patients were diacharged on the 6th or 7th postoperative day. Conclusion Exploring evidences under the guidance of scientific method and applying them to clinical nursing can prevent post-PD hemorrhage and improve life quality of patients.
ObjectiveTo explore the clinical outcomes of acetabular revision using a metal reconstruction cage. MethodsBetween October 2006 and October 2013, 16 patients (16 hips) underwent acetabular revision with a metal reconstruction cage. There were 4 males and 12 females, with the mean age of 62.7 years (range, 49-78 years). The time from total hip arthroplasty to revision was 3-15 years (mean, 8.2 years). The causes for revision were aseptic acetabular loosening in 15 cases, and femoral periprosthetic fracture (Vancouver type B3) in 1 case. According to the American Academy of Orthopaedic Surgeons (AAOS) classification, there were 12 cases of type III and 4 cases of type IV; according to the Paprosky classification, there were 12 cases of type IIIA and 4 cases of type IIIB. Harris score was used for hip function evaluation, and visual analogue scale (VAS) for pain in the thigh. X-ray films were taken for imaging evaluation. ResultsHealing of incision by first intention was obtained in all patients. Deep venous thrombosis occurred in 1 patient, and was cured after anticoagulation therapy. No complications of infection, neurovascular injury, and prosthetic dislocation were found. Sixteen patients were followed up 6.8 years on average (range, 2-9 years). The Harris score was significantly increased from preoperative 42.44±4.66 to 91.88±3.28 at last follow-up (t=–106.30, P=0.00). Two patients had mild pain in the thigh, but pain disappeared at 1 year after operation. At immediate after operation, the abduction angle was 37-54° (mean, 42.9°). The distance between acetabular rotation centre and teardrop line was (33.67±12.19) mm for preoperative value and was (20.67±9.63) mm for postoperative value, showing significant difference (t=–9.60, P=0.00). The distance between acetabular rotation centre and lateral teardrop was (34.98±12.30) mm for preoperative value and was (40.04±6.61) mm for postoperative value, showing significant difference (t=–3.15, P=0.00). X-ray film results showed bony fusion at the osteotomy sites at 4 to 12 months after operation. No continuous radiolucent line, prosthetic dislocation, or osteolysis was found, and bony ingrowth was observed in all patients. No patient received re-revision due to prosthetic loosening. ConclusionThe metal reconstruction cage for acetabular revision can achieve good effectiveness for patients with serious bone defect.
Objective To study the effect of alpha fetoprotein-tumor burden score (ATS) on the long-term prognosis of hepatocellular carcinoma (HCC) after resection. MethodsThe data of 2 907 patients with HCC who underwent first hepatectomy from West China Hospital of Sichuan University, West China Ziyang Hospital/Ziyang Central Hospital, The First People’s Hospital of Neijiang, West China Yibin Hospital/The Second People’s Hospital of Yibin between 2015 and 2022, were retrospectively analyzed. The X-tile software was used to calculate the optimal truncation of the ATS score. Cox proportional hazard regression model was used to explore risk factors affecting postoperative recurrence-free survival (RFS) and overall survival (OS) in HCC patients, respectively. ResultsAll patients were followed-up with a median of 37 months, 1 364 cases (46.9%, the recurrence time was 1–89 months after surgery) of them experienced recurrence and 841 cases (29.1%) died (the death time was 1–88 months after surgery). The 1-, 2- and 3-year OS rates were 89.3%, 81.4% and 75.9%, respectively. The 1-, 2- and 3-year RFS rates were 76.0%, 64.3% and 57.2%, respectively. The 5-year RFS rate of HCC patients with low-, medium-, and high-ATS scores were 56.4%, 45.0% and 27.2%, respectively, and patients with low ATS score had better RFS (χ2=264.747, P<0.001). The 5-year OS rate of HCC patients with low-, medium-, and high- ATS scores were 78.0%, 59.8% and 38.8%, respectively, and patients with low-ATS score had better OS (χ2=372.685, P<0.001). Multivariate Cox proportional hazard regression model suggested that, in condition of adjusting gender, age, liver function, microvascular invasion, tumor differentiation, and BCLC stage, medium-ATS score [RR=1.375, 95%CI (1.209, 1.564), P=0.005] and high-ATS score [RR=2.048, 95%CI (1.764, 2.377), P<0.001] were risk factors for postoperative RFS; the medium-ATS score [RR=1.779, 95%CI (1.499, 2.112), P<0.001] and high ATS score [RR=2.676, 95%CI (2.211, 3.239), P<0.001] were also risk factors affecting postoperative OS. ConclusionATS score can predict the prognosis of HCC patients after resection, patients with high ATS scores had a higher incidence of postoperative recurrence and mortality.