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 investigate the correlation between smoking, alcohol, chronic diseases, fasting plasma glucose levels, uric acid and the incidence of urolithiasis. Methods A 1∶1 pair-wise matching design was used in case-control study. We randomly selected 150 samples from 459 patients with urolithiasis in Zhongnan Hospital of Wuhan University from May 2015 to November 2015. Patient with intact information were identified as case group. The control group were patients who hospitalized in the same period without urolithiasis matched by gender, ethnic, and marital status. Univariate ANOVA and multivariate conditional logistic regression were used to test the differences between the two groups. Results A total of 125 patients in case group and 125 patients in control group were included. The peak age of urolithiasis was 50 to 70 years old, male patients accounted for 70.75% of the population, and one side urolithiasis accounted for 62.24% of the stone types. The results of multivariate conditional logistic regression showed that hyperuricemia was the related factor of urolithiasis (OR=5.19, 95%CI 2.27 to 11.91, P<0.01). Conclusions Hyperuricemia is a high risk factor for urolithiasis.
Objectives To evaluate the research status of hospital management in foreign countries using bibliometric analysis, in order to provide reference for domestic hospital management. Methods The Scopus and Web of Science databases were searched for hospital management related studies from inception to May 30th, 2017. The publication date, document type, country, affiliation, publication distribution, citation, and co-authorship of included studies were analyzed. Results During the past 20 years, the amount of hospital management related studies presented an increased trend, and original article was the major article type. The USA, UK, Germany, France, Japan, Australia, Austria, Italy, Spain and Canada were ranked as the top ten countries that had published the most related studies. Moreover, most of the affiliations which published the related studies were from the USA, UK and France. The results of co-authorship analysis indicated that some researchers existed close co-authorships. Conclusions Developed countries have better researches on hospital management and can provide a good reference for domestic researchers.
Objectives To evaluate the methodological quality of published clinical practice guidelines for benign prostatic hyperplasia. Methods PubMed, EMbase, CNKI, WanFang Data, VIP and CBM databases, website of Yimaitong, and international authoritative guide platforms were electronically searched to collect the relevant clinical practice guidelines or consensus for benign prostate hyperplasia. The retrieval covered the time up to December 13th, 2016. Literatures were independently screened by 2 reviewers. After data extraction, the methodological quality of included guidelines was evaluated by 4 reviewers using the AGREE Ⅱ. Each domain score was calculated and the intraclass correlation coefficient was used to evaluate the consistency among the reviewers. Results A total of 15 clinical practice guidelines were included. The mean scores for the six domains in AGREE Ⅱ were: 72%, 38%, 30%, 58%, 16%, and 40%, respectively. The intraclass correlation coefficient was larger than 0.87, which indicated the total consistency was well. Conclusions The quality of clinical practice guidelines for benign prostatic hyperplasia is not satisfactory as expected. They are heterogeneous in quality and some requires improvement. Guidelines are required to be further developed in methodology in future, especially in three domains, including participants, preciseness and applicability of the design.
ObjectivesTo systematically evaluate the efficacy and safety of the transurethral bipolar plasmakinetic prostatectomy (TUPKP) versus holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of TUPKP and HoLEP for treatment of BPH from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, the meta-analyses were performed by using RevMan 5.3 software.ResultsA total of 9 RCTs involving 784 patients were included. The results of meta-analyses showed that, in efficacy outcomes, TUPKP was superior to HoLEP in Qmax at 48 months, and was inferior to HoLEP in PVR at 3 months, Qmax in 60 and 72 months, and IIEF-5 at 48 and 72 months. No significant association was found between two groups in Qmax from 1 to 36 months, IPSS from 1 to 72 months, prostate volume, PVR from 6 months, IIEF-5 from 1 to 24 months, QoL at 1 to 36 months, and resected prostate weight. As for safety, TUPKP was superior to HoLEP in operation time, while inferior to HoLEP in blood loss during procedure, hospital stay, catheterization period, bladder irrigation period, irrigation fluid, massive hemorrhage and hematuresis. No significant association was observed between two groups in serum sodium decrease, hemoglobin decrease, PSA, postoperative urine retention, blood transfusion, cystospasm, temporary incontinence, urinary tract infection, TURS, epididymitis, temporary difficulty in urination, urinary tract irritation syndrome, reoperation, retrograde ejaculation, urinary incontinence, ED and urethrostenosis.ConclusionsCurrent evidence shows that the efficacy and safety of TUPKP and HoLEP for treatment of BPH are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Risk ratio (RR) and hazard ratio (HR) are two common effect measures in prospective studies. When describing the magnitude of clinical effects in the original study and meta-analysis, they cannot be used interchangeably. Selecting an appropriate measures and interpreting them correctly is critical in clinical research. In this study, we summarized similarities and differences between risk and hazard, compared differences between RR and HR in estimation methods and clinical interpretation. The magnitude of RR and HR estimated from the same studies were compared, and two feasible formulas converting between RR and HR were presented for meta-analysis.
ObjectiveTo develop the questionnaire and test its reliability for investigating route, prevention, and control of SARS-CoV-2 infection in medical staffs.MethodsThis questionnaire was development based on the COVID-19 relevant guidelines, official documents issued by the National Health Committee of the People's Republic of China, and published studies. The development group performed repeated discussions and drafted the first questionnaire, then performed expert consultation and revised the draft according to their suggestions. Eventually, some frontline medical staffs were invited to carry out pre-test investigation of the questionnaire and test its reliability.ResultsThe first draft included 48 items; 18 experts were invited in the first round questionnaire and 10 experts in the second round questionnaire. The positive coefficient of experts in these two rounds was both greater than 75%, and the authority coefficient of experts' opinions was greater than 0.70. The variation coefficient of these items was between 0.00 and 0.35, the coordination coefficient of experts was 0.193 (P<0.05). The experts of above two rounds put forward 14 suggestions for text modification or adjustment options of some items; after the development group held repeatedly discussions, a total of 8 items were performed secondary consultation and finally reached consensus. The final questionnaire included two domains of questionnaire before and after confirmed diagnosis. The domain "before confirmed diagnosis" covered 4 sections and 29 items involving infectious cause, plan and knowledge of prevention and control, and psychological symptoms. The domain "after confirmed diagnosis" covered 5 sections and 21 items, included symptoms, treatment, and psychological status after diagnosis; impact on the surrounding environment and people, and awareness of protection after infection. The pre-test results showed that the total items were considerably numerous, some items were difficult to understand, some laboratory results and treatment conditions were ambiguous, etc. After modification and re-testing, the test-re-test reliability of each domain was between 0.74 and 0.93, and the overall re-test reliability of the questionnaire content was 0.82.ConclusionsThis research has developed a questionnaire for investigating infection process, prevention and control of SARS-CoV-2 infection in medical staff, and the items considered two domains prior to and after confirmed diagnosis. The reliability and practicability of the questionnaire are acceptable.