Objective To evaluate the effectiveness of four-handed dentistry versus two-handed dentistry in root canal therapy. Methods The CBM, VIP, CNKI, Wanfang, PubMed, EMbase, and CENTRAL were searched for collecting relevant randomized controlled trails (RCTs) in English or Chinese from establishment dates to August 31, 2011. After quality evaluation and data extraction independently conducted by two authors, the meta-analyses were performed using the RevMan 5.1, and the evidences were graded using the GRADEprofile 3.6. Results Fourteen studies involving 2 906 patients were included. The results of qualitative analysis and meta-analyses showed that compared with two-handed dentistry, four-handed dentistry could obviously shorten operating time, improve satisfaction of patients and doctors, lower the risk of hole pollution, and improve treatment quality, all the differences were significant; but there was no significant difference in postoperative pain during the first week. Based on the GRADE system, the importance of outcomes was “important” or “critical”, while the level of evidences was from “extremely low” to “high”. Conclusion Current evidence shows that four-handed dentistry is superior to two-handed dentistry, but it suggests a weak recommendation to dental workers. Due to the limitations of included studies, more large-sample and high-quality RCTs, and especially performing “cost-effectiveness analysis” as the key outcome are required.
ObjectiveTo systematically review the willingness rate of the first consultation in primary health care institutions among Chinese residents.MethodsCNKI, WanFang Data, VIP, PubMed, Web of Science and EMbase databases were electronically searched to collect cross-sectional studies on the willingness rate of the first consultation in primary health care institutions of residents in China from January 2006 to November 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; meta-analysis was then performed using Stata 14.1 software.ResultsA total of 26 cross-sectional studies involving 36 430 subjects were included. The results of meta-analysis showed that the willingness rate of Chinese residents for the first consultation in primary health care institutions was 61.4% (95%CI 54.5% to 68.3%). The results of subgroup analysis showed that for the willingness rates of the first treatment at the grassroots level in male and female residents were 65.6% and 64.9%; urban and rural residents were 49.9% and 58.9%; <60 and ≥60 years old residents were 60.5% and 71.6%; primary school and below, junior high school, high school or technical secondary school, junior college or above educational level residents were 72.8%, 68.1%, 64.2%, and 52.8%; employees, residents, and other types of insurance residents were 74.1%, 75.9%, and 64.4%; residents with monthly income <3 000, 3 000-5 000, and >5 000 yuan were 65.8%, 65.3%, and 58.5%; high, medium, and poor levels of health status residents were 56.8%, 52.6%, and 48.8%; with and without chronic diseases residents were 61.0% and 56.9%; with and without spouse residents were 63.9% and 64.6%; with and without contracted family doctor residents were 87.1% and 62.6%; on duty, retired, and other employment status residents were 70.7%, 69.9% and 71.5%; primary medical institutions residents those were satisfied, average, and dissatisfied were 77.3%, 60.7%, and 49.4%.ConclusionsCurrent evidence suggests that it remains room for improvement in the level of willingness of Chinese residents for first consultation in primary health care institutions. Residence, age, educational level, type of medical insurance, income level, health level, family doctors contracted status, and satisfaction with primary medical institutions have an impact on residents' willingness to receive first treatment at primary hospitals. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusions.
ObjectiveTo systematically review the satisfaction of Chinese residents with the contract services of family doctors. MethodsCNKI, WanFang Data, VIP, PubMed, Web of Science, and EMbase databases were electronically searched to collect cross-sectional studies related to the Chinese residents' satisfaction with the service of family doctors from January 2011 to May 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 14.1 software. ResultsA total of 42 cross-sectional studies were included. The results of meta-analysis showed that the overall satisfaction rate of residents with the contract services of family doctors was 77.7% (95%CI 73.7% to 81.7%). The results of subgroup analysis showed that the satisfaction rate of the male and female residents were 83.0% and 84.3%; <60 and ≥60 years old residents were 83.5% and 81.7%; junior high school or below, senior high school or technical secondary school, junior college or above educational level residents were 84.1%, 76.4% and 81.2%; the monthly income less than 4000 yuan and more than 4000 yuan residents were 78.5% and 79.3%; with and without diseases residents were 85.3% and 79.7%; with and without spouse residents were 80.6% and 82.4%; on and off the job residents were 77.7% and 73.9%; urban and rural residents were 78.7% and 80.0%; in 2011-2015 and 2016-2020 were 67.6% and 76.2%; eastern and western regions residents were 76.5% and 79.7%; relevant studies which were conducted by random sampling and nonrandom sampling were 80.5% and 73.5%. ConclusionsThere is still room for improvement in residents' satisfaction with family doctor contract service. Residents with different education levels, disease situations, on-the-job situations, time, regions and sampling methods have differences in their satisfaction with the contract services of family doctors.
Objective To explore the clinicopathological features of bilateral primary breast cancer (BPBC) at different ages. Methods Clinical data of 105 BPBC patients admitted to the Department of Breast Surgery in The First Affiliated Hospital of Zhengzhou University from January 2017 to January 2020 were collected and divided into young group (≤40 years old) and middle-old group (>40 years old) according to age. The characteristics and differences of bilateral tumor lesions in pathological type, molecular type, tumor diameter, histological grade, clinical stage, lymph node metastasis, recurrence or distant metastasis, immunohistochemical indexes expression characteristics, consistency and difference, and overall prognosis between the two groups were retrospectively analyzed. Results There were statistically significant differences between the two groups in the size of the first primary cancer, lymph node metastasis, the high expression rate of Ki-67 in the second primary cancer, clinical stage of double primary cancer and recurrence or distant metastasis (P<0.05). In the young group, the proportion of the first primary cancer with T3–T4 stage was higher, the incidence of lymph node metastasis was higher, the proportion of high expression of Ki-67 in the second primary cancer was higher, and the proportion of patients with double primary cancer at first diagnosed as stage Ⅳ were higher than those in the middle-old group, and were prone to recurrence or distant metastasis. The expression of immunohistochemical indexes in bilateral cancer foci was consistent between the two groups (P<0.05). The expression consistency of ER and Ki-67 in the young group was better, and the expression consistency of PR and HER-2 in the middle-old group was better. The histological grade of the first primary cancer, TNM stage of bilateral primary cancer and recurrence or metastasis were independent factors affecting the prognosis of patients (P<0.05). Conclusions The BPBC patients of different ages have different clinicopathological features, and the expression of immunohistochemical indexes in bilateral cancer foci is consistent. Tumor histological grade of the first primary cancer may affect the prognosis of patients with BPBC, and the prognosis of patients with early bilateral TNM stage is better.