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 formulate an evidence-based treatment plan for a patient with hepatitis C after kidney transplantation with combination of interferon-α and ribavirin. Methods Based on an adequate assessment of the patient’ s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2009), PubMed (1995 to March 2009), and CHKD (1995 to 2008.12). Results Eighteen studies were identified including 17 in English (5 case reports, 11 cohort studies, and 1 meta–analysis) and 1 in Chinese. According to the current evidence as well as the patient’ s clinical condition and preference, PEG-IFNα-2b 50 µg /week plus ribavirin 600 mg/day was given to the patient for 6 months. Conclusion Evidence-based approaches help us to prepare the anti-viral therapy plan and will improve the assessment of the efficacy and safety in kidney transplantation.
Lung cancer is an epithelial cancer arising from the bronchial surface epithelium or bronchial mucous glands. Non-small lung cancer constitutes about 75%-80% of all lung cancer. At the time of diagnosis, a lot of people have got stage Ⅲb non-small lung cancer which is unresectalbe. Both chemotherapy and radiotherapy are widely used in unresectable stage Ⅲ non-small lung cancer. The regimes of chemotherapy or radiotherapy are varied too. Systematic reviews and randomized controlled trials have provide much convincing evidence for us to choose and utilize the most appropriate treatment.
Objective To make an individualized therapeutic regimen for a patient with stage III relapsed ovarian cancer guided by evidence-based medicine.Methods According to the clinical problems this patient showed and the PICO (patient, intervention, comparison and outcome) principle, the best clinical evidence associated with relapsed ovarian cancer was retrieved and evaluated. Results The current evidence showed that the relapsed ovarian cancer with platinum resistance tended to be treated by pharmacotherapy. Consequently, on the basis of combining the recommended guidelines, randomized controlled trials (RCTs), systematic reviews or meta-analyses on RCTs, clinical experience from doctors and willingness of patient, the regimen of Irinotecan plus Pegylated Liposomal Doxorubicin for interventional chemotherapy was recommended for this patient. After three courses of the treatment, the disease got some relieved; the medical team would like to keep conducting the same regimen for another six to eight courses, and the follow-up visit was undergoing. Conclusion For patients with relapsed ovarian cancer with platinum resistance, an individualized therapeutic regimen under the guidance of evidence-based methods can not only improve the therapeutic efficacy but also guide both doctors and patients to take the indeterminate risk of medicine.
Objective To summarize the available clinical evidence on the treatment of non-proliferative diabetic retinopathy (NPDR). Methods Based on the basic methods and principles of evidence-based medicine, we searched and evaluated the NPDR-related evidence from the Cochrane Library(Issue 3,2007), PubMed (1966 to June 2007) and CBM(1979 to June 2007) Results We finally identified 1 systematic review and 20 randomized controlled trials. Clinical evidence showed that critical glycemic control and blood pressure control were essential in the treatment of NPDR, which might delay the progression of retinopathy. The effectiveness of other therapeutic measures needed to be further investigated. Conclusion NPDR is the early stage of diabetic retinopathy (DR). Relevant systematic reviews and high-quality randomized controlled trials have confirmed the effectiveness of critical control of blood glucose and blood pressure for NPDR. The effectiveness of other therapeutic measures needs to be confirmed by systematic reviews of high quality and rigorously designed randomized, multi-center and large-scale trials.
Objective To identify an evidence-based treatment for a patient with aneurysmal subarachnoid hemorrhage (aSAH). Methods We first put forward clinical problems about how to prevent complications and how to treat ruptured aneurysm of aSAH, then searched The Cochrane Library (Issue 4, 2006), Ovid ACP Journal Club (1991 to 2006), Ovid MEDLINE (1966 to 2006), NGC (1998 to 2006) and CBM (1978 to 2006) to identify systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines. Results Eleven studies and five guidelines were included. Current evidence indicated that nimodipine was effective for prophylaxis of poor outcome after vasospasm, while tirilazad was not effective in female patients with good grades. The effectiveness of other treatments to prevent complications was not clear. Evidence on the use of antifibrinolytics for the prevention of re-bleeding was inconsistent. If a ruptured aneurysm was considered suitable for both surgical clipping and endovascular coiling, coiling was associated with a better outcome. According to the available evidence and guidelines, considering the patient’s conditions and preferences, nimodipine and antifibrinolytics were administered to prevent complications and her aneurysm was treated by early endovascular embolization. She did not experience vasospasm or re-bleeding during her hospital stay. Short-term follow-up showed a good outcome. Long-term prognostic benefits after endovascular therapy need to be confirmed by prolonged follow-up. Conclusions Therapies based on the best clinical evidence and guidelines should be given to prevent complications and improve outcome for patients after an aSAH.
目的 针对近期收治的1例常规治疗疗效不理想的溃疡性结肠炎患者,我们进行了证据检索和评价,以期找到更有效的治疗方法.方法 计算机检索MEDLINE(1978～2004)、CBMdisc(1978～2004)及Cochrane图书馆(2004年第3期),查找 5-氨基水杨酸(5-ASA)灌肠液治疗溃疡性结肠炎及与病情缓解有关的系统评价、临床随机对照试验等,并对所获证据进行评价.结果 高质量的临床证据表明,5-ASA灌肠液治疗溃疡性结肠炎及帮助病情缓解均优于口服5-ASA及柳氮磺胺嘧啶局部灌肠治疗.据此临床证据,结合医生经验及病人意愿,对该例患者实施5-ASA 1g+生理盐水100 ml qd,睡前保留灌肠治疗.1周后,患者临床症状明显缓解,腹泻基本停止,每天解黄色黏液便1～2次.肠镜复查,炎症较前明显减轻.出院后继续用上述方案维持治疗,每周2次.门诊随访1年,患者未再复发,也无明显副作用发生.结论 5-ASA灌肠液是控制溃疡性结肠炎活动期间病情及帮助缓解、减少复发的有效药物.
Objective To make individualized evidence-based treatment for patients with diabetic peripheral neuropathy. Methods Based on the clinical questions we raised, evidence was collected and critically assessed. Patients’ preferences was also taken into consideration in the decision-making treatment. Results 157 studies were retrieved and finally 15 randomized controlled trials, 14 systematic reviews and meta-analyses, and 1 clinical guidelines were considered eligible. The evidence indicated that the first step in management of patients with diabetic peripheral neuropathy should aim for stable and optimal glycemic control; there was no statistically significant difference between aldose reductase inhibitors and placebo in the treatment of diabetic polyneuropathy, the same to nerve growth factor; alpha-lipoic acid is superior to placebo in reducing symptoms of diabetic peripheral neuropathy; 5-hydroxytryptamine and norepinephrine uptake inhibitor, tricyclic antidepressants and anticonvulsants might alleviate the pain in patients with diabetic peripheral neuropathy; vitamin B and capsaicin cream are is effective and safe in the management of diabetic peripheral neuropathic pain. The individualized treatment plans were developed based on the available evidence. After 3 month of treatment, the blood sugar returned to normal and symptoms were alleviated. Conclusion The treatment efficacy in diabetic peripheral neuropathy has been improved by determining an individulized treatment plan according to evidence-based methods.
Objective To find individualized evidence-based treatments for a patient with lower rectal cancer. Methods Based on the clinical questions raised, evidence was collected and critically assessed. Patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment. Results Twenty-four systematic reviews or meta analyses and 1 clinical guideline were included. The evidence showed that preoperative chemoradio- therapy reduces risk of local recurrence and death from rectal cancer compared to preoperative radiotherapy alone. Preoperative combined chemoradiotherapy, enhanced pathological response and improved local control in the resectable stage II and III rectal cancer. Preoperative chemoradiotherapy reduced the risk of local recurrence as compared with postoperative chemoradiotherapy. Postoperative radiotherapy alone did not improve survival for the patients with resected stage II and stage III rectal cancer, whereas either chemotherapy alone or combined chemotherapy and radiotherapy improved survival in comparison with observation. As compared with conventional radical surgery, total mesorectum excision (TME) resulted in lower postoperative local recurrence rate and higher survival rate. No significant differences in terms of disease-free survival rate, local recurrence rate, mortality, and morbidity were found between laparoscopic and open total mesorectal excision. Conclusion The patients with lower rectal cancer might benefit from preoperative chemoradiotherapy, postoperative chemotherapy, and chemoradiotherapy. TME is the standard rectal cancer surgery. However, long-term prognostic benefits need to be confirmed by further follow-up.
Objective To make an individualized administration scheme via evidence-based medicine methods, namely adding heparin into the total nutrient admixture (TNA) solution, so as to help a neonate to prevent the occlusion of peripherally inserted central catheter (PICC). Methods After carefully assessing the condition of neonate, this clinical issue was put forward in accordance with the PICO principles. Randomized controlled trials (RCTs) and systematic reviews on neonates’ PICC occlusion were collected from The Cochrane Library, CCTR, DARE, NGC, MEDLINE (Ovid) and CBM from inception to 2011. The clinical intervention scheme was finally made after the assessment of the retrieved evidence and neonate’s physiological condition. Results A total of 4 RCTs and 1 systematic review related to the issues were identified. The following scheme was finally made for the neonate through the assessment of the retrieved evidence and combination of intentions of the patient’s family members: heparin (0.5 U/mL) was added into TNA to prevent PICC occlusion. During the application, blood routine test and blood coagulation were monitored, and the catheter opening time and extubation reason were recorded. Through the above treatment, the neonate successfully completed the treatment before extubation. The time of both PICC detaining and opening was 20 days in total, and there were no PICC occlusion, no catheter thrombosis, and no catheter related bloodstream infection. Moreover, no observation showed thrombopenia and aggravated coagulation disorders resulted from heparin. Conclusion The evidence-based medicine method is an effective way to make reasonable heparin scheme for neonate, so as to prevent PICC occlusion, reduce catheter thrombosis, decrease risks of catheter related blood circulation infection, assure successful completion of treatment, and guarantee the safety of patients.