Objective To evaluate the quality of Chinese clinical practice guidelines published in domestic medical journals in 2011. Methods The following 4 Chinese databases including WanFang Data, VIP, CNKI and CBM were searched from January 2011 to December 2011. The quality of included guidelines was assessed by using AGREE II. Results A total of 75 guidelines published in 2011 were included. Among them, 10 guidelines (13%) stated the conflict of interest, 10 guidelines (13%) mentioned evidence-based developing, 5 guidelines (7%) performed evidence grading system, 8 guidelines (11%) performed recommendation strength grading system, and 4 guidelines (5%) performed both evidence and recommendation strength grading systems. The ratio of the 6 domains’ scores of AGREEⅡ were as follows: scope and purpose (18%), stakeholder involvement (11%), rigour of development (8%), clarity of presentation (34%), applicability (5%), and editorial independence (14%). Conclusion Compared with the guidelines published before, the guidelines of 2011 have a higher quality and some of them are progressively standardized in developing methodology.
Objective To compare endoscopic sinius surgery plus middle meatus fenestration with endoscopic sinius surgery plus middle and inferior meatus fenestration for fungus ball maxillary sinusitis. Methods Applying a prospective randomized controlled trial, 80 patients with fungal ball maxillary sinusitis from January, 2010 to March, 2011 were collected and then divided into two groups, including experiment (40 cases) and control groups (40 cases). The trial group received endoscopic sinius surgery plus middle and inferior meatus fenestration, which the control group received endoscopic sinius surgery plus middle meatus fenestration. Then a follow-up was conducted from the end of surgery to February 28th, 2013. All patients took subjective and objective assessment before and after the surgery, including VAS, SNOT-20, Lund-Mackay CT system scores and Lund-Kennedy endoscopic mucosal score. Results with the trial group was superior to the control group in VAS score, SNOT rating and Lund-Kennedy mucosa score 6 months, 1 year, and 2 years after surgery (Plt;0.01). Lund-Mackay CT score of the control group was significantly higher than the trial group after 1 year of surgery (Plt;0.01). According to the Haikou standard to assess the efficacy of surgery, we found that the total effectiveness rate of the trial group (100.0%; recovery: 36 cases; improved: 4 cases) was higher than that of the control group (87.5%; recovery: 28 cases; improved: 4 cases), with a significant difference (P=0.021). Conclusion Endoscopic sinius surgery plus middle and inferior meatus fenestration with a lower reoccurrence rate is superior to endoscopic sinius surgery plus middle meatus fenestration for fungus ball maxillary sinusitis in clinical efficacy.
This investigation analyzes the management of medical schools merged with comprehensive universities through internet search and research review in order to reveal management model and effect of the merger. The conclusion is safely reached that governance models are divided into two different patterns: centralized management and decentralized management. Eight universities, representing the two models, were selected and evaluated comprehensively. Among them, the universities that carried out decentralized management have greater development after the merger based on a quality comparison concerning freshmen, faculty, teaching and research between the two patterns. In China, decentralized management in comprehensive universities is more beneficial to the development of medical schools
Objective To comprehensively summarize and analyze the status quo, assessing contents and problems of the assessment studies on appropriate health technology in China. Methods With the search terms and strategies predefined by repeated discussion and pre-retrieval, all literature on appropriate health technology assessment in China published from October 1949 to March 2012 were searched in the following databases: CBM, VIP, CNKI and WanFang Data. According to the inclusion and exclusion criteria, two reviewers independently screened literature, and extracted and cross-checked data. Disagreements were resolved by discussion or by involving a third researcher. The qualitative synthesis method was used to analyze the studies. Results Among total 174 included studies, 117 were cross-sectional. Targeted populations were patients and community residents who had received the service or treatment of appropriate health technology, as well as the grassroots medical staffs and workers from marketing organization who had used or carried out the appropriate health technologies. Appropriate health technologies mainly contained four fields of appropriate health technology: traditional Chinese medicine, western medicine, family planning services and community health services. Most types of diseases involved in those technologies were circulatory system diseases, and high blood pressure was highly concerned. The contents of appropriate health technology assessment mainly included 6 aspects: effectiveness, acceptability, economic characteristics, requirements, safety and technical specific property. The results of the included studies indicated that, most assessments focused on just one aspect, and were lack of comprehensive evaluation. The indexes used in each assessment covered a far too wide range, and was lack of unified index and standards. Conclusion Current studies show that the fields of appropriate health technology assessment distribute widely; the assessment content is simple and lack of comprehensive evaluation; the assessment index system has no unified standard; and the study design methods are different and lack of high quality study design. So it is necessary to conduct high quality assessment studies, establish scientific assessment index system, and systematically assess appropriate health technology, so as to provide more scientific basis for health decision makers.
Objective Through assessing the quality of systematic reviews/meta-analyses conducted by hospital pharmacists in China, to learn relevant situations and to promote the development and application of evidence-based pharmacy in hospital. Methods The following databases such as CBM, CNKI, Wanfang Database, VIP, CMCI, The Cochrane Library, EMbase and PubMed were searched from the establishment date to April 15th, 2011, to collect all published systematic reviews/meta-analyses conducted by hospital pharmacists in China. Two reviewers independently extracted the published information according to the inclusive and exclusive criteria, and assessed the methodology and reporting quality of the included literatures with OQAQ and PRISMA. Disagreements were discussed or resolved by the third reviewer. Data analysis was conducted by using SPSS17.0 software. Results Two hundred and sixteen Chinese literatures (including 40 on traditional Chinese medicine), and 15 English literatures were identified. The number of literatures has increased rapidly since 2008. Beijing and Sichuan were the top 2 districts in the number of literatures. All of the included literatures were published in 62 magazines sponsored by 87 hospitals, such as China Pharmacy, and Chinese Journey of Evidence-Based Medicine. The total downloads of Chinese literatures were 14346, and the total citations of all literatures were 154. The methodology and reporting quality of the randomized controlled trials (RCTs) involved in 220 systematic reviews/meta-analyses literatures were assessed, which showed the highest and lowest scores of methodological quality were 6 and 3, respectively, and the average score was 4.27±0.55. The highest and lowest scores of reporting quality were 22.5 and 9, respectively, and the average score was 16.49±2.98. Conclusion Although the evidence-based pharmacy in hospital begins late in China, it develops rapidly, and offers lots of evidence to policy decision, guidelines and rational drug use. However, there is still room for improvement of the methodology and reporting quality in future reviews.
Objective To assess the methodology and report quality of Chinese systematic reviews/ meta-analyses on prevention and control of six major diseases in public health. Methods Chinese literatures of systematic reviews/ meta-analyses on prevention and control of six major diseases, including cancer, cerebrovascular disease, cardiovascular disease, hepatitis B, tuberculosis, and AIDS were searched in CQVIP, WANFANG Database, CNKI, and the Chinese Biomedical Literature Database from the establishment date to June, 2010. Two researchers independently screened and evaluated the data, disagreements were resolved by discussion. Methodology quality and report quality of included reviews were evaluated by OQAQ scale and PRISMA scale. Result Of the 139 literatures included in the analysis, 32 were systematic reviews while 107 were meta-analyses. The highest and lowest scores of methodology quality were 6.5 and 1.5 respectively. The average score was 4.66±0.92 and no literature could meet all nine items. The main problems were insufficient in literatures resource, bias in data selection, lack of rigorous quality assessment for included original studies and so on. The average score of report quality were 15.28±2.91 and the main problems were incomplete report in abstract, data collection and analysis methods, bias control, conclusion and so on. Conclusion Both of the methodology quality and report quality of included literatures have problems in different levels, which require to be further improved.
Objective In order to improve the standing on the studies of Exercise Prescription (EP), a systematic review was conducted to provide reference and theory for further studies. Methods A broad computerized literature search of Medlin via Ovid, PubMed in all fields, Sport Discus, CINAHL, CAM, EMbase, EBM Cochrane Database of SR, and Web of Science was carried out till June 2008. Firstly, four categorical searches were conducted with the following keywords for searches: Exercise Prescription, Physical Fitness, Exercise Therapy, Fitness Assessment, Exercise Test and RCTs, and the searched results were checked by reviewers and duplicate results were removed. Then all titles were manually searched for potential inclusion in the review. Articles retrieved, review articles were examined for further relevant references. Results There were 318 relevant articles, however, the RCTs were only 7, and systematic review and meta-analysis were only one, respectively. Considering the importance and reference values there were 93 articles were included. 1970s was the developing age of EP; 1980s more specific EP were provided for many purposes; 1990s with the techniques developing of physical fitness, exercise therapy, fitness assessment and exercise test, EP for treating and rehabilitating more chronics and civilizing diseases were developed; 2000s the RCTs and CCTs were applied in the EP studies. Conclusions The developing of EP has close relationship with the developing of physical fitness, exercise therapy, fitness assessment, and exercise test. Although the RCTs researches in this field were limited, most of them were positive to support the advantage of EP. How to highly improve the advantages and greatly decrease the risk of EP is still valuable to study in the future.
Objective To assess the effectiveness and safety of one kind of ACEI—Ramipril, for providing proofs for clinical implement and we also tried to explore the practical method of evidence-based drug assessment. Method By using the methods and principles of systematic review (SR), and health technology assessment (HTA), we searched Medline and Cochrane Library, together with related materials provided by pharmaceutics and collected all the published clinical research reports on Ramipril. Based on principles of SR and HTA, we assessed all the included reports comprehensively. Results We totally collected 214 articles about Ramipril, in which there were 18 articles meeting the inclusion criteria and 31 139 patients were enrolled in these studies. The research contents include: hypertension, diabetes mellitus, heart failure, myocardial infarction, nephropathy and secondary prevention for cardio-cerebral vascular disease. Conclusion According to our clinical evidence assessment, Ramipril is an effective, safe and easy to take drug and is worthy to spread.
Background In the latter of 20th century, a global growth in allergic diseases has been witnessed, accompanying with spring-out of therapeutic drugs. However, trials did not clarify the comparative effectiveness and pharmaceutical economics of these agents. Severe adverse drug effects have been reported increasingly in the last few years. These made it difficult for clinical practice and selection of national essential drugs. Objective To assess astemizole, loratadine, cetirizine and tefenadine for allergic rhinitis (AR) and urticaria in terms of effectiveness, heart-related drug adverse effects and pharmaceutical economics. Search strategy Cochrane Library, Medline, Embase and Chinese Biomedical Database will be searched. Additional database should be searched for safety and economic studies. Selection Criteria The publication languages are restrained to English and Chinese. 1) Effectiveness: high-quality randomized controlled trials (RCTs) and systematic Reviews (SRs)/ meta-analysis for AR and uritcaria are included, with comparisons restrained to among these four drugs; 2) Safety: a hierarchy of evidences of these four drugs for allergic diseases are included. 3) Economical evaluation: cost-effectiveness and cost-utility assessment of these four drugs for AR and urticaria should be included. Methods of review data extraction sheet and quality appraisal table are separately designed. QUOROM STATEMENT and Jadad Scale are applied, respectively, to SRs and RCTs. Two reviewers independently select the studies, appraise the quality and extract the data. Any disagreement is solved by discussion. Data analysis Fixed effect model is first applied. Sensitivity analysis is employed to study the heterogeneity between trials. Randomized effect model is alternatively used when compromised.
Objectives To analyze and assess the status of detection of human immune-deficiency virus (HIV) by PCR, and to find a new screening test of HIV. Methods Using the following keywords "diagnosis tests", "AIDS", "PCR" and "HIV", we searched the Medline and CBM from 1991 to 2001. Then we assess each of diagnosis test according to the international standards. Results 567 articles were searched, in which 53 articles were chosen to assess. In these 53 articles, it was found that 47% applied comparison with Golden Standard, 25% calculated sensitivity, 23% calculated specificity, and 23% calculated predictive value, no likelihood ratio was calculated in these articles. Conclusions It was still a kind of pilot-study to apply PCR to screening detection of HIV. The design methods of study should be improved.