Every country has its own clinical guideline to standardize medical care, and China is developing guidehnes too. Viewing the guidehne＇s usage in the world over many years, we find that it hasn＇t achieved good effect. The development of evidence-based medicine brings a primal change to guideline development. The evidence-based clinical guidehnes are arising in the world. We summarized the principle of developing evidence-based guideline according to the experience of Scotland to provide reference for domestic peers.
Objective We searched the best available evidence to provide a basis for the medical or palliative surgical treatment of a patient suffering from terminal colon cancer, complicated by intestinal obstruction (malignant intestinal obstruction), so as to improve the patient’s quality of life and alleviate her clinical symptoms. Methods We formed the clinical question according to the PICO principle. We searched for systematic reviews and randomized controlled trials in The Cochrane Library (Issue 1, 2007), MEDLINE (PubMed, January 1950 to March 2007) and ACP Journal Club (January 1991 to March 2007), and evaluated the evidence retrieveds.?Results We found that both scopolamine and octreotide could alleviate nausea, vomiting and abdominal pain, but that octreotide was superior to scopolamine in reducing the secretion of gastric acid. Metoclopramide was effective in relieving fatigue, vomiting and intestinal obstruction associated with advanced cancer. A nasogastric tube may be used to drain the secretions before the administration of medical treatment, but long-term use tubes may make patients intolerable and induced side effects, such as necrosis of nasal mucous membrane and infection. At present, empirical palliative surgery was used for the management of malignant intestinal obstruction. This varied in different regions, and so the patients’ clinical condition should be taken into consideration. Being informed of the advantages and disadvantages of different treatment regimens, the patient and her family made the final decision.Conclusion The current evidence suggests that medical treatment can improve quality of life and alleviate clinical symptoms for a patient suffering from terminal colon cancer complicated with intestinal obstruction. However, the effect of palliative surgical treatment remains to be proved, and the decision about the appropriate treatment needs to consider the patients’ condition and the doctors’ clinical experiences.
Objective To define risk factors of nosocomical pneumonia (NP) in elderly in-patients. Methods Two hundred elderly in-patients were selected in the Geriatric Department of West China Hospital from January 1999 to June 2002. Among them, 100 patients developed NP during their hospital days and the others didn’t have the episodes of NP at the same time. The following factors were analyzed: sex, age, multiple underline diseases and their severity, smoking, activity of daily life, conscious status, aspiration, nasogastrial intubations, antibiotics use and hospitalization. SPSS 10.0 was used for Logistic regression analysis to determine the factors significantly associated with the development of NP. Results The following factors were significantly associated with the development of NP in the logistic regression analysis: aspiration [OR 28.452, 95%CI (3.793 to 213.447)],multiple diseases [OR 17.157, 95%CI (2.734 to 107.651)], multiple antibiotics use [OR 6.396, 95%CI (1.861 to 21.980)], smoking [OR 1.774, 95%CI (1.211 to 2.600)] and prolonged hospitalization [OR 1.134, 95%CI (1.081 to 1.189)]. Conclusions Aspiration, multiple diseases, multiple antitiotics use, smoking and prolonged hospitalization are closely related to NP in elderly in-patients. Cautionary medical measures and shortening hospitalization were the key factors to decrease the incidence of NP for the patients in Geriatric Department.
Objectives To assess the efficacy and safety of statins for adult osteoporosis. Methods We electronically searched The Cochrane Library (Issue 4, 2007), MEDLINE (1990 to November 2007), EMBASE (1990 to November 2007), Current Controlled Trials, The National Research Register, CBM (1990 to November 2007), VIP (1990 to November 2007) and CNKI (1990 to November 2007). We also handsearched some related journals and identified randomized controlled trials of statins versus placebo in adults with osteoporosis. Results Two randomized controlled trials were included. We didn’t perform meta-analysis due to heterogeneity. No significant differences were observed in the changes of bone density at the lumbar spine and total hip from baseline between statins and placebo. However, a significant increase in bone density was found in response to simvastatin at the forearm. Biochemical markers of bone metabolism changes from baseline did not differ significantly between statins and placebo groups. Conclusions The evidence currently available does not support the use of statins in the treatment of osteoporosis. Further randomized, double-blind, placebo-controlled trials are needed in order to define the efficacy and acceptability of statins in the treatment of osteoporosis.
Rheumatoid arthritis is a chronic inflammatory disorder. It is characterized by a chronic polyarthritis that primarily affects the peripheral joints and related periarticular tissues. To a patient with rheumatoid arthritis, we searched the evidence and indentified the best available therapy for him: ① Ibuprofen was used to relieve pain. ② Methopterin ivgtt qw and oral methopterin after the discharge for 12 months. ③ Oral omeprazole 20 mg/d to prevent peptic ulcear. ④ Administration with fish oil and physical exercises after discharge were recommended.
This study aimed to investigate the effect of curcumin (Cur) against human cytomegalovirus (HCMV) in vitro. Human embryonic lung fibroblasts were cultured in vitro. The tetrazolium salt (MTS) method was used to detect the effects of Cur on cell viability. The cells were divided into control group, HCMV group, HCMV + (PFA) group and HCMV + Cur group in this study. The cytopathic effect (CPE) of each group was observed by plaque test, then the copy number of HCMV DNA in each group was detected by quantitative polymerase chain reaction (qPCR), and the expression of HCMV proteins in different sequence was detected by Western blot. The results showed that when the concentration of Cur was not higher than 15 μmol/L, there was no significant change in cell growth and viability in the Cur group compared with the control group (P>0.05). After the cells were infected by HCMV for 5 d, the cells began to show CPE, and the number of plaques increased with time. Pretreatment with Cur significantly reduced CPE in a dose-dependent manner. After the cells were infected by HCMV, the DNA copy number and protein expression gradually increased in a time-dependent manner. Pretreatment with Cur significantly inhibited HCMV DNA copies and downregulate HCMV protein expression levels in a concentration-dependent manner, and the difference was statistically significant (P<0.05). In conclusion, Cur may exert anti-HCMV activity by inhibiting the replication of HCMV DNA and down-regulating the expression levels of different sequence proteins of HCMV. This study provides a new experimental basis for the development of anti-HCMV infectious drugs.
Delirium is a common complication in elderly inpatients which could result in cognitive impairment, and increase the risk of disability, fall and mortality. Moreover, it could cause heavy social burden. Even with multiple bedside screening scales to detect delirium, the rate of missed diagnosis is still high. Maybe it is associated with the acute fluctuation and nocturnal onset of delirium. With the development of the intelligence and automation of the electronic medical record (EMR), previous studies have explored the use of EMR to identify delirium patients, and this method provides help for delirium diagnosis and prevention. In this paper, we reviewed and summarized the current situation of research on delirium recognition by EMR, and put forward the development prospect in this method in order to provide basis and lay a foundation for intelligent diagnosis of delirium.
Objective To compare the effectiveness and safety of linezolid with vancomycin for the treatment of people with Gram-positive bacteraemia. Methods We electronically searched The Cochrane Library (Issue 1, 2009), MEDLINE, EMbase, Current Controlled Trials, The National Research Register, CBM disc and CNKI. We also handsearched some relevant journals. The search time was up to March 10, 2009. Randomized controlled trials of linezolid versus vancomycin for treatment of Gram-positive bacteraemia were included. Meta-analyses were performed for the results of homogeneous studies using the Cochrane Collaboration’s RevMan 5.0 software. Results A total of 8 randomized controlled trials involving 670 patients with Gram-positive bacteraemia were included. The results indicated that there was no significant difference between linezolid and vancomycin groups in treatment of Gram-positive bacteraemia [RR= 1.07, 95%CI (0.98,1.17), P= 0.15], MRSA bacteraemia [RR=1.22, 95%CI (0.97,1.53), P= 0.10] or catheter-related bacteraemia [RR= 1.01, 95%CI (0.86,1.19), P= 0.90]. There was no difference between groups in the total adverse effect (P=0.64). The rate of renal dysfunction was higher in vancomycin group (P=0.0003) and the rate of thrombopenia was higher in linezolid group (P=0.01). Conclusion Linezolid is associated with the outcomes that are not inferior to those of vancomycin in the patients with Gram-positive bacteraemia. More high-quality, large-scale randomized controlled trials exclusive for the bacteraemia are required.
Delirium is an acute cognitive disorder caused by a variety of factors which lead to cerebral cortical dysfunction. At present the studies on the pathophysiology of delirium is still very few. But studies on serum biomarker of delirium can help to elucidate the pathophysiological mechanism of delirium, and the studies are significant for delirium diagnosis, severity classification and prediction of long-term outcome. This review examines three major groups of delirium related serum biomarkers: ① risk markers: those that are present or elevated prior to disease onset, including serum chemistries, genetic markers and so on; ② disease markers: those markers elevate with delirium onset and fall when delirium recovery, including acetylcholine and serum anticholinergic activity, serotonin, serum amino acids, and melatonin, interleukin, C-reactive protein; and ③ end products: those that rise in proportion to the consequences of disease, including S-100ß and neuron specific enolase. The three markers mentioned above are helpful to further investigate the mechanism of delirium.
Objective To report evidence-based treatment for 2 case of Ⅱ B stage non-small cell lung cancer. Methods We searched systematic reviews and randomized controlled trials in The Cochrane Library (Issue 2, 2009), MEDLINE (PubMed, January 1970 to June 2009) and ACP Journal Club (1996 to June 2009), and evaluated the evidence. Results The best clinical evidence for Ⅰ and Ⅱ stage non-small cell lung cancer patients showed that in the patients with resectable nonsmall cell lung cancer, postoperative adjuvant radiotherapy and chemotherapy could not improve survival compared with surgery alone. We did not find evidence which indicated that preoperative chemotherapy improved survival in people with resectable non-small cell lung cancer. Conclusion In accordance with the wishes of the patient and family, they do not accept the radiotherapy and chemotherapy, but choose palliative and supportive therapy.