Objective To systematically review the value of the perfusion paramenters of Ktrans and Kep of dynamic contrast enhanced MRI(DCE-MRI) in distinguishing different histological grades of rectal cancer. Methods Databases such as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 1, 2017), CBM, CNKI, WanFang Data and VIP were searched from 1990 to Feb 6th, 2017 to collect the studies according to the criteria. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies and then meta-analysis was performed by using STATA 12.0 software. Results A total of 11 studies involving 618 patients were included. The results of meta-analysis showed that there was significant difference of Ktrans between poorly differentiated grade and moderately-well differentiated grade (SMD=1.123, 95% CI 0.334 to 1.911,P=0.005), but there was no significant difference of Kep between these two groups (SMD=0.233, 95% CI –0.173 to 0.639,P=0.260). Conclusion Current evidence shows that Ktrans can be used to distinguish different histological grades of rectal cancer. The clinical application value of Kep still needs large sample original studies to further verify.
Objective To investigate the feedback of continuing medical education (CME) based on short message service (SMS) for village doctors in Gaolan County of Gansu Province, and to explore how to improve the efficiency of CME based on SMS. Methods A total of 75 village doctors were investigated with a questionnaire when attending the training program conducted by the Health Bureau of Gaolan County. Results A total of 75 valid questionnaires were collected back. The statistical analyses showed that 56% of the doctors received the majority of the messages sent to them, of whom, 98% could read the messages promptly, 81% saved the majority of the messages they received, 98% could read the saved massages occasionally, 25% transmitted messages to others, 93% thought that the messages might be helpful in varying degrees, 96% would like to continue receiving the messages in the future, 51% thought the biggest shortcoming of the messages was the poor relevance to their concern, and 70% wanted the most to receive short messages about clinical diagnosis and treatment. At present, 39% of the doctors thought the most convenient approaches to get the updated medical knowledge are attending the study or training program organized by higher authorities, while 37% thought those are reading short messages on the mobile, websites or papers. Conclusion The village doctors are willing to receive the short messages about the best clinical evidence. However, both the receiving rate and use rate of the short messages have yet to improve. A complete SMS transmission system and highly-relevant contents are regarded as important guarantees for improving the receiving rate and use rate.
Objective To investigate the decision-making situation of doctors in the township hospitals in Gaolan, Gansu province, and to discuss its scientificity and rationality. Methods Self-designed questionnaire was adopted to investigate the clinical decision-making situation of 108 doctors from 7 township hospitals in Gaolan county. The investigation contained three parts as follows: basic information of respondents, general information of clinical decision-making evidence, and comparison between respondents’ decision-making situation and current best clinical evidence. Results Among the total 108 questionnaires distributed, 89 valid were retrieved. The feedback showed that 79% of the doctors diagnosed and treated patients in accordance with medical textbooks; 53% took curative effect into consideration in the first place; 33% failed to consider patients’ willingness properly when making clinical decisions; and 52% made clinical therapy regimen for common diseases based on the evidence which was different from that in BMJ published Clinical Evidence. Conclusion While making clinical decisions, doctors in the township hospitals do not adequately refer to the best clinical evidence as their decision-making basis, and fail to take patients’ value and willingness into consideration properly. It is necessary to promote the concept of evidence-based medicine and spread the best evidence in the township health departments.