Objective To provide a reference for the best evidence-based medicine (EBM) education modelby retrospective analysis and summary the EBM education model of the EBM center of Lanzhou University for medicalpostgraduates. Methods To utilize students’ spare time we changed the traditional teaching method, and instead used problem based learning and academic discussions to teach postgraduates how to design and apply research. Results Sixtytwo postgraduates were trained and completed 73 research papers and registered 33 Cochrane systematic reviews. Twentythree papers were published in foreign journals (SCI) as first authors, 34 papers were published in domestic journals. Five students received awards in the academic conference of Lanzhou University. Conclusion Medical students will benefit from taking part in EBM research. This education model will help them not only understand the methods of clinical research and EBM and improve the quality of their research and their cooperative skills, but also master related clinical knowledge.
Objective To evaluate the clinical effectiveness of laparoscopic and open tension-free hernia repairs in adults. Methods A fully recursive literature search was conducted in PubMed (2002 to September, 2009), EMBASE (2002 to September, 2009), Cochrane Central Register of Controlled Trials (Issue 3, 2009), CBM (2002 to September, 2009) , CNKI and VIP Chinese Scientific Journals Full-text Database (2002 to September, 2009) in any language. Randomized or quasi-randomized controlled trials of inguinal hernia treated by laparoscopic and open methods in adults were considered for inclusion. The four analyzed outcome variables were chronic pain, long term recurrence, intraoperative complications and postoperative complication. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out using RevMan 5.0 software. Results Eighteen published reports of eligible studies involving 5816 participants met the inclusion criteria. Compared with open methods, laparoscopic inguinal hernia had no significant differences in long-term recurrence rate [OR 1.53, 95%CI (1.00 to 2.34), P=0.05] and postoperative complication rate [OR 0.74, 95%CI (0.52 to 1.05), P=0.09], and had lower tendency chronic pain [OR 0.45, 95%CI (0.34 to 0.59) , Plt;0.000 01] with statistical significance. There were significant differences in intraoperative complications between the two groups [OR 2.15, 95%CI (1.32 to 3.53), P=0.002]. Conclusion Current evidence suggests that laparoscopic hernia repair is superior to open methods in chronic pain .There is no significant difference in long-term recurrence rate and postoperative complications between the two methods. More studies are needed for intraoperative complications and other long-term postoperative complications.
Objective To systematically review the efficacy of ambroxol for lung protection in perioperative period. Methods We followed the Cochrane Collaboration methodology to conduct systematic reviews. We searched relevant randomized controlled trials (RCTs) from The Cochrane Library, PubMed, Embase, CBM, CNKI and VIP. We assessed the methodological quality for each outcome by grading the quality, and used RevMan5.0.0 to perform meta-analysis. Results Eight RCTs were eligible and included 669 patients. All of these trials used randomization but the quality scales were B. Compared to the control group, the ambroxol group had a statistically significant benefit in atelectasis, pulmonary complications, cough and expectoration degree. The RR (95%CI) were 0.44 (0.25, 0.78), 0.51 (0.34, 0.75), 0.39 (0.16, 0.94) and 0.22 (0.09, 0.53), respectively. The ambroxol group was also better than the control group in sputum volume, sputum characteristics, rales and pulmonary surfactant. Conclusion Ambroxol can improve respiratory system symptoms post-operatively, reduce pulmonary complications, and prevent pulmonary surfactant from decreasing during operation. Ambroxol has a satisfactory lung protective effect in the preoperative period, but we can’t define a proper dose and usage time.
Objective To evaluate the diagnostic value of MR imaging for anterior cruciate ligament. Methods We searched PubMed, EMBASE, CBM, CSJD and CJFD to find all diagnostic tests about MR imaging in anterior cruciate ligament. QUADAS items were used to evaluate the quality of the included studies. We used Meta-disc software for data collection, and sensitivity, specificity and SROC curves were calculated to assess the diagnostic value of individual diagnostic tests. Results Twenty-nine studies met the eligibility criteria and were included. Compared with arthroscope, the summary values of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and SROC curve of MR imaging were 93%, 93%, 9.85, 126.39, and 0.971 4, respectively. Conclusion MR imaging can be regarded as an effective and feasible method for ACL tears diagnosis and screening clinically, based on the results of this systematic review.
Decision-making is often a complex and hard-to-routinize process. Based on the decision-making experience of fighting COVID-19, policymakers have gradually realized that climate action, quality education, and other societal challenges, as well as the sustainable development goals (SDGs) need to be addressed with the best available evidence using an evidence-informed decision-making (EIDM) approach. The Global Commission on Evidence was established in 2021. In addition, the Evidence Commission issued reports in 2022 and 2023. A systematic methodology to address societal challenges with EIDM has been constructed in the report. Five types of domestic evidence (data analytics, evaluation, modeling, qualitative insights, and behavioural/implementation research) and four steps in decision-making process (understanding a problem and its causes, selecting an option for addressing the problem, identifying implementation considerations, and monitoring implementation and evaluating impacts) were used to support four types of decision-makers (government policymakers, organizational leaders, professionals and citizens) in EIDM, as demonstrated by the reports. To further disseminate the concept and methodology of EIDM globally, the secretariat works with 25 Evidence Commissioners to write the report, and continues to cooperate with Country Leads Group from 12 countries to conduct rapid evidence-support system assessments (RESSAs), and collaborates with Evidence Commission Implementation Council to accelerate the implementation of 24 recommendations. The main history, core methodology, and latest developments of the Global Committee on Evidence were systematically reviewed in this paper. We aimed to show decision-makers a new version of how to scientifically address the societal challenges of EIDM.
Objective To systematically evaluate the clinical effectiveness and safety of raltitrexed plus cisplatin in the treatment of malignant pleural mesothelioma (MPM) when compared with other chemotherapy regimens. Methods We electronically searched PubMed, Embase, The Cochrane Library and Chinese Biomedicine Database to March, 2007. Randomized controlled trials (RCTs) and quasi-RCTs were identified, and Revman 4.2.10 was applied for statistical analyses. Results One RCT involving 250 patients was included, which compared raltitrexed plus cisplatin versus cisplatin alone in the treatment of MPM. In the intention-to-treat population, the median survival time was statistically longer in the raltitrexed plus cisplatin group as compared to cisplatin alone group. (11.4 versus 8.8 months, P=0.048). The incidence of grade 3/4 toxicities was similar between the two groups. Conclusion The current evidence available showed that, the combination of raltitrexed and cisplatin may prolong the survival time for MPM patients, with a low incidence of grade 3/4 toxicities. However, more high-quality RCTs are required to further define its clinical effectiveness.
Objective To evaluate the efficacy of glucose-insul in-potassium (GIK) in patients with acute myocardialinfarction (AMI). Methods Both foreign language databases including The Cochrane Library (issue 4, 2007), PubMed, EMBASE and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials (RCTs) that reported the effect of GIK on the heart function (left ventricular ejection fraction LVEF, ST changes, left ventricular remodel ing) of patients with AMI. Two reviewers assessed the qual ity of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.10 software was used for statistical analysis. Results Five RCTs were included, all of which came from abroad. The methodological qual ity of the included studies was good. The basel ine data of each trial were comparable. Meta-analyses showed that no significant difference was observed in the improvement of LVEF between the GIK group and the control group (WMD=1.87, 95%CI -0.32 to 4.06, P =0.09), whereas GIK was more beneficial in decreasing ST (OR=1.92, 95%CI 1.25 to 2.96,P =0.003) and preventing left ventricular remodel ing (OR=0.08, 95%CI 0.01 to 0.68, P=0.02). Conclusion Based on the above evidence, although GIK may, to some extent, be beneficial for both ST decreasing and long-term prognoses in patients with AMI, it can not yet be concluded that GIK can improve the heart function of those patients. Therefore, it is imperative to design and implement further stricter, large-scale RCTs, so as to accurately identify the therapeutic effect of GIK solution in patients with myocardial infarction.
Fleming proposed the concept of evidence-based pathology (EBP) in 1996. In recent years, there have been a lot of evidence-based studies on the diagnosis and prognosis of diseases. However, there are still limitations and challenges in the development, and the growth in application of evidence-based medicine in the pathology is still slow. This study introduced the history of evidence-based pathology, summarized the primary application areas and the latest research progress, analyzed current opportunities and challenges of evidence-based pathology, and provided some suggestions.
Objective To evaluate the effectiveness and safety of doxepin in the treatment of primary insomnia. Methods We searched The Cochrane Library (Issue 4, 2009), PubMed (1966 to December 2009), EMbase (1974 to December 2009), ISI (1961 to December 2009), CNKI (1979 to December 2009), VIP (1989 to December 2008), CBM (1978 to December 2009), and WANFANG Data (1998 to December 2009). We also searched the correlated grey literature and conference literature for complement. Data were extracted, methodologically evaluated, and cross-checked by two reviewers independently. RevMan 5.0 was used for statistical analysis. Results One randomized controlled trial and three cross trials involving 171 patients were included. The results of meta-analyses showed that total sleep time (TST), wake time during sleep (WTDS), wake time after sleep (WTAS), and sleep efficiency (SE) were improved by low and medium dosage of doxepin (1-25 mg) with statistically significant difference compared with placebo. On the contrary, most indicators of sleep quality had no statistically significant difference between high dose doxepin (50 mg) and placebo. While the sleeping structural indicators of rapid eye movement sleep (REM), rapid-eyemovement latency (REM-L), and sleep stage II (St.II) were changed by high and medium dosage of doxepin (25-50 mg) with statistically significant difference. Conclusions Low and medium dosage of doxepin (1-25 mg) is effective in improvement of the sleep quality in patients with primary insomnia, but it is necessary to concern the side effects and the effects on sleep structure when treating primary insomnia with medium dosage of doxepin (25 mg). High dosage of doxepin (50 mg) is not recommended to treat primary insomnia. However, this conclusion still needs clinical trials to be further validated.
Objective To retrospectively compare short-term outcomes and health economics of PHS versus UHS for inguinal hernia repair. Methods We included 105 patients suffering from reducible inguinal hernia hospitalized in the First Affiliated Hospital of Lanzhou University from September, 2007 and September, 2012. The referred hernia types involved direct and indirect hernia (unilateral and bilateral). Based on different repair materials, the patients were divided into two groups, PHS group (n=53) and UHS group (n=52). Outcome parameters for comparison included incidences of seroma and scrotum edema, hospital duration, costs, etc. Results There were no differences in age, sex, hernia type, incidences of seroma and scrotum edema after surgery, hospital duration and costs between the two groups. However, the patients in the PHS group spent less money than those in the UHS group regarding the costs of materials and hospitalization, with significant differences. Conclusion For inguinal hernia repair, PHS and UHS are alike in reducing short-term complications, but PHS can significantly reduce patients’ economic burden due to less costs.