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.
Objective To evaluate the efficacy, safety and economical values of nucleic acid/nueleotides for clinical nutritional support and immune treatment. Methods The following electronic databases were searched: Chinese Biomedicine database (CBM), MEDLINE, EMBASE and SCI. Data were extracted by two reviewers. Applied RevMan 4.1 for statistical analyse. Results Forty-six randomized controlled trials were identified, involving nucleic acids/nucleotides for clinical nutritional support, infant feed, immune treatment. Eighteen randomized trials comparing the use of immunonutrition which comprises nucleotides with standard enteral nutrition in surgical and critical ill patients. Combined analysis directed that immunonutrition therapy decrease infection events, length of hospitalization and the cost. Only one trial reported the effects of adding nucleotides to breast milk substitute, but there is no valuable results for clinical practice. Twenty-seven low quality trials compared the use of "immune RNA (iRNA)" with standard methods in hepatitis, carcinoma and burn patients, combined analysis directed that there are not valid evidences to confirm the value of iRNA. Conclusions Immunonutrition may decrease infection rates, length of hospitalisation and cost in surgery and critical ill patients, but we can not affirm the role of the nucleotides in irmnunonutrition. No evidences support the point of adding nucteotides in breast milk substitute. Also, we can not affirm the role of iRNA in clinical immune regulation treatment. There are no available evidences in nucleic acids for caducity prevention and improvement of aging people’s health. Consequently, we advice Chinese health officials to enhance the management for applying "nucleic acids nutrients".
Objective This review compared clinical effectiveness, cardiac safety and economics of astemizole, loratadine, cetirizine and terfenadine to provide evidence for adjustment of Essential Drug List in China. Search strategy We searched Medline, Cochrane Library, Embase and Chinese Biomedical Database. Fourteen databases for drug safety and pharmaceutical economics were additionally searched. Selection Criteria Randomized controlled trials and systematic reviews, published in English and Chinese and comparing two or more of these four antihistamines for allergic rhinitis and urticaria were included for study of effectiveness. Non-randomized clinical trials were additionally included for economic evaluation. Cardiac safety studies of antihistamines for allergic diseases of any type were included. Quality Appraisal Jadad scale was primarily applied to randomized controlled trials. Allocation concealment and intention-to-treat analysis were also appraised. The QUOROM statement was applied to systematic reviews and meta-analysis. Data extraction and analyses For the study of effectiveness, composite data were primarily extracted and analyzed by fixed effect model. Sensitivity analysis was done to explore the heterogeneity. For the study of cardiac safety, cases of adverse drug reactions and death were summarized. Difference of occurrence rate in sex and age were analyzed if possible.Electrocardiography and clinical symptoms were summarized. Results No studies on economic evaluation were identified. 27 and 6 randomized controlled trials, including 3 227 participants, for allergic rhinitis and urticaria were identified. Cetirizine was superior to loratadine (n=709) in symptom score and onset of action, superior to terfenadine (n=645) in Quality of Life and superior to astemizole (n=498) in patient satisfaction and onset of action. 73 h-ADR cases were identified in astemizole, 27 cases in terfenadine, 1 case in loratadine and none in cetirizine. No deaths were identified. Combination of terfenadine plus grapefruit juice (n=l8), itraconazole (n=6), nefazodone (n=67), and loratadine administration concomitant with cemitidine (n=30) significantly prolonged QTc interval. Conclusions Cetirizine was superior to other three antihistamines in terms of clinical effectiveness and drug safety. Astemizole and terfenadine could cause significantly more cardiac-related adverse reactions than cetirizine and loratadine.
ObjectiveTo rapidly review the effectiveness, safety, costs and applicability of helical tomotherapy (HT), so as to provide currently-available best evidence for decision makers of government health policies. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP, CBM and other relevant professional websites. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed quality, and then performed descriptive analysis. Resultsa) We finally included 150 studies, encompassing 5 health technology assessments (HTAs), 18 clinical controlled trials (CCTs), and 127 observational studies. b) Four included HTAs were published during 2006-2009, providing fairly less evidence of low quality and the results of 145 primary studies showed that:HT was mainly used in the treatments of 14 types of cancer, with relatively low total toxicity and high survival rates. Although the quality of the included studies was poor, there was much evidence about prostate cancer, head and neck cancer, nasopharynx cancer, cervical cancer, lung cancer and liver cancer, with accumulatively enough sample size and fairly reliable results in HT's efficacy and safety. And c) a total of 56 clinical trials had bee registered in Clinicaltrials.gov, most of which were registered by the occident; among them, 9 had been come to the end, yet without results published. ConclusionCurrent evidence of this study showed that, HT is safe and effective in clinic. But the abovementioned conclusion needs to be verified by conducting more high quality studies with long-term follow-up. The costs of HT in procurement, maintenance and application are high; and the skills, training and qualification of operators are required. We suggest that the procurement of HT should be reduced; it should be allocated rationally and effectively used after comprehensive assessment in China's cancer epidemiology characteristics, health resource allocation, disease burden, medical service level, etc.; and also high quality studies with long-term follow-up should be financially supported on the basis of establishing projects, so as to provide local evidence and consistently guide and improve scientific decision making.
Hospital-based health technology assessment (HB-HTA) refers to the practice of health technology assessment for hospital management decision-making based on the actual situations in hospitals. It includes processes and methods of health technology assessment carried out in and for hospitals. Under the background of comprehensively promoting the reform of public hospitals in China, HB-HTA is undoubtedly an important scientific method to enhance the fine management of public hospitals and implement the policy of medical reform. This paper introduced the concept, the international and domestic development status, the characteristics of HB-HTA, and put forward the scheme of development of HB-HTA macroscopically, so as to promote the popularization and applications of HB-HTA in China.
ObjectiveTo present the application of mini-health technology assessment (Mini-HTA) method in configuration management of anti-magnetic anesthesia machine.MethodsFrom February to March 2019, the specialist operation assistant used Mini-HTA method to analyze and evaluate the anti-magnetic anesthesia machine applied by the department from basic situation and four dimensions, including technical dimension, patient dimension, hospital dimension, and economic dimension.ResultsA hospital health technology assessment report was prepared based on the evaluation of the specialist operation assistant, the suggestion of which was adopted by the hospital. As a result, an anti-magnetic anesthesia machine was arranged in the MRI room.ConclusionMini-HTA method can provide decision support for hospital equipment configuration and is conducive to the scientific and rational allocation of resources in hospitals.
ObjectivesTo explore classification management method of evidence-based evidence for medical consumables based on cost multiplication and to conduct empirical test.MethodsFour quadrants was used to explore the classification management of consumables evidence.Results95.22% of the “recommended” items in the consumables department were “recommended” by the group. 100% of group “recommended” items passed the committee resolution. Advice of consumables department and group was highly relevant with decision of commission.ConclusionsOne-dimensional recommendations allow the decision-making of group and committee to be more convenient. Cost calculation is based on all consumables required for medical treatment, which is similar to reality. The classification threshold requires further optimization, and the classification basis requires continual adjustment under different conditions of hospital. The evidence-based evidence evaluation method for medical consumables based on incremental cost ratio is a simple and rapid hospital health technology assessment method suitable for China’s national conditions.
With the increasing demand for health technology decision making in hospitals, the activities of hospital-based health technology assessment are increasing globally. Several developed countries, such as France, Finland, Denmark, Italy, Canada, The United State and Australia have carried out hospital-based health technology assessment activities. In order to further promote the development of health technology assessment in China and establish evidence-based management and decision-making concept of hospitals, the National Center for Medical Service Administration has carried out theoretical and practical research on hospital technology assessment by fully drawing on foreign advanced experience. This paper introduces the background, object, method and content of the research, the achievements of the pilot project and the prospect of the future, so as to provide a reference for readers to understand the overall situation of the project and related work.