Objective To evaluate the published case-reports of evidence-based practice(EBP) over three years,and to improve the quality of the papers and provide a recommended writing model. Methods Collecting the published 20 case-report of EBP and assessing their writing quality in 5 aspects according to the steps of EBP. Results Many Abstracts did not reflect entire context, and convey the overall information to readers, a formative structured Abstract should be taken. Most case-reports only involved with therapy,few diagnostic,harm and prognostic case-reports were republished,few EBP of surgery and other specialties, such as ENT,ophthalmology were mentioned.Searching strategies were not sufficiently described.Most authors only search The Cochrane Library and PubMed,while predigested sources were seldom used.Critical appraisal of evidence was difficult to each author,most papers were lack of appraisal or simply evaluated the validity of used evidence,and applicability of evidence was not clearly explained.All the papers did not conduct post evaluation.Conclusions Much needs to be done in improving the quality of published case-reporters of EBP,a standardized writing model should be recommended.
This paper is to reveal how the traditional practice is being challenged by evidence-based medicine and it also indicates where does the best evidence come from, how to find and classify them. This paper will also show the clinicians how to practice evidence-based medicine, especially in the treatment of respiratory disease in a step by step fashion. Finally this paper will guide the Chinese physicians how to solve the commonly confronting problems in practicing evidence-based medicine.
Objective To study the effectiveness, safety and tolerance of testosterone undecanoate （TU） in improving exhaustion and quality of life （QOL） of the elderly male patients with chronic disease in advanced stage. Methods Using a simple randomized controlled trial design, eighty patients were randomized into two groups. The treatment group took routine therapy and TU and the control group with routine therapy alone. Results 1. Baseline characteristics in both groups were similar. 2. The PADAM grade decreased, and the QOL scale increased in the treatment group （P〈0.05 ）. 3. Serum total testosterone in the treatment group rose, upper arm circumference and right hand grip improved （P〈0.05 ）. 4. There were no significant differences in adverse effects between both groups. Conclusions TU can improve the clinical health status in the elderly male patients with chronic disease in advanced stage and increase serum testosterone level, there is a satisfactory tolerances and few adverse reactions.
Objective To identify the best therapy regime for dyspnea in an end-stage cancer patient.Method We searched The Cochrane Library (Issue 2, 2006), SUMsearch (1978 to 2006) and MEDLINE (1978 to 2006), and identified 4 systematic reviews and 28 randomised controlled trials. We critically assessed the quality of these studies. Result Evidence supported the use of breathing exercise, desensitisation, oral or parenteral opioids and antianxiety drugs to pall iate breathlessness. Patients with hypoxemia were found to benefit from oxygen therapy. Conclusions Physiotherapy, psychotherapy, oxygen therapy, opioids and antianxiety drugs can be considered in treating cancer patients with dyspnea.
Prostate cancer is a common disease in the USA and Europe, with a gradually increasing incidence in China, and presents a significant health burden for older men. The lack of modifiable risk factors has made early detection as a strategy to reduce mortality. Current methods of screening involve the measurement of serum prostate-specific antigen (PSA) and digital rectal examination followed by biopsy. With PSA screening evidence of level I absent, the evidence on the use of PSA as a screening test is still highly controversial. Furthermore, there is controversy over whether screen-detected lesions will become clinically significant. There are three major treatment options for localized disease: radical prostatectomy, radical radiotherapy and monitoring with treatment if required. There is no evidence of randomized controlled trial (RCT) to suggest a survival advantage of any of these treatments. Opinions about the related benefits and risks of screening vary widely. In the absence of RCT of benefit for screening, many now suggest “informed consensus” screening, which encourages a discussion between the patient and his physician with both sides informed of all of the issues.
Through searching and evaluating the evidence on advanced prostate cancer, we found that different types of androgen deprivation had similar effect, and immediate androgen deprivation had survival benefit. For the patient with hormone-refractory prostate cancer, therapies including mitoxantrone, prednisone, docetaxel and surmine were more effective. Strontium-89 provided more effective pain relief than external beam radiation. And bisphophonate had no effect. Antiandrogen withdrawal suggested prostate specific antigen would decline, but the clinical outcome wasn’t reported.
Objective To evaluate the efficacy and safety of trimetazidine (TMZ) for chronic congestive heart failure. Methods We searched The Cochrane Library (Issue 3, 2006), MEDLINE (1990-2006), EMBASE (1990-2004), and the Chinese Biomedicine Database (1990- 2006 ) for parallel group randomized controlled trials (RCTs) and cross-over design trials comparing TMZ and placebo or open controls for patients with heart failure.We used The Cochrane Collaboration’s RevMan 4.2 software for data analyses. Results Four RCTs and two cross-over design trials were included. Meta-analyses showed that: compared with the control group, TMZ may improve the NYHA cardiac functional grade (RR 0.85, 95%CI 0.76 to 0.95), increase the total exercise time (WMD 51.40 seconds, 95%CI 15.56 to 87.25), the maximal metabolic equivalents (WMD 0.82, 95%CI 0.28 to 1.37), and the ejection fraction (WMD 7.29%, 95%CI 6.28 to 8.31), but may decrease the left ventricular end-diastolic volume (WMD –12.19 ml, 95%CI –15.29 to –9.09), the left ventricular end-diastolic diameter (WMD –6.05 mm, 95%CI –7.10 to –4.99), the left ventricular end-systolic volume (WMD –16.94 ml, 95%CI –20.34 to –13.55), the left ventricular end-systolic diameter (WMD –5.42 mm, 95%CI –5.98 to –4.86), and the serum brain natriuretic peptide (WMD –239.59 pg/ml, 95%CI –276.53 to –202.65). TMZ may also improve the quality of life (WMD 12.36, 95%CI 5.16 to 19.55). Conclusions TMZ plus standard medical therapy has a beneficial effect on the indices of cardiac function, and may also improve the patient’s quality of life. However, because available RCTs for this systematic review are too small and poor quality, (mainly focusing on the heart failure induced by ischemic heart diseases and merely taking intermediate indices as outcome measures), further high-quality large-scale RCTs with death as the endpoint and which include subgroup analysis of non-ischemic heart failure, are required in order to provide more reliable evidence.