We have performed guided chemoembolization on 84 patients of moderate and advanced carcinoma of liver using adriamycin lipiodol emulsion (A/L) since 1986. Result showed that the rate of improvement of symptoms was 86.1%, in 75% cases the AFP were decreased and in 79.2% the size of tumor were reduced. The mean survival time was 10.3 months which was much higher than that of the control group (5.6 months,Plt;0.001). THe survival rates of 1/2,1,2,3 year were 89.3%,43.4%,13.5% and 3.8% respctively that were significantly higher than those of the control group (51.2%, 11.5%,0) (Plt;0.01). Three patients underwent secondary resection after using A/L chemoembolization ans gelatin spinge central embolization with a longer survival rate. This may be a good method of treatment to the nonresectable liver cancers and may also be an easy way for postoperative observation.
OBJECTIVE To confirm membrane-guided tissue regeneration in the healing course of segmental bone defects and study the mechanism. METHODS Segmental, 1 cm osteoperiosteal defects were produced in both radii of 12 rabbits. One side was covered with hydroxyapatite/polylactic acid(HA/PLA) membrane encapsulated as a tube. The contralateral side served as an untreated control. Healing courses were detected by radiographic and histologic examinations. RESULTS All control sides showed nonunion, whereas there were consistent healing pattern in test sides. CONCLUSION Membrane technique can promote bone regeneration.
ObjectiveTo study the function and effectiveness of self-manufacture osteotomy guide device in osteotomy. MethodsA guide device was manufactured, which could guide the drill and osteotome. Sixty femoral moulds which cover with bubble were used as human femurs, and a 3 cm long, 1 cm wide crack was made in the femoral moulds supracondylar to imitate operation incision. The femoral moulds were divided into 3 groups (n=20): non-guiding group (group A), simple drill guiding group (group B), and drill-osteotome guiding group (group C). The osteotomy time, the variation range of the drill holes (incision side and the contralateral side), the variation range of the osteotome incisions (incision side and the contralateral side), and the match rate of drill holes and osteotome incision were recorded. And between February 2013 and January 2014, the osteotomy guide device was used to guide proximal tibia osteotomy in 6 patients with tibia infected nonunion to excise of infected bones. ResultsThe osteotomy time of groups B and C was significantly less than that of group A, and it was significantly less in group C than group B (P<0.01). The match rate of drill holes and osteotome incision in groups B and C was significantly higher than that of group A, and group C was significantly higher than group B (P<0.05). The variation range of the drill holes in both incision side and contralateral side of groups B and C was 0, which was significantly less than that of group A (P<0.01). The variation range of the osteotome incisions in both incision side and contralateral side of groups B and C was significantly less than that of group A, group C was significantly less than group B (P<0.01). Preliminary clinical results showed that the osteotomy guide device was simple to use, and precise in guidance for drill and osteotome, so it could reduce the time for repeated targeting during drilling and osteoming. The osteotomy time was 8.3-11.2 minutes (mean, 9.5 minutes). The surface of osteotomy was smooth and no split;and there was rich callus formation during bone transport. Six patients were followed up 13-25 months (mean, 16 months). The bone healing index was 0.92±0.13. ConclusionThe osteotomy guide device can reduce the damage to surrounding tissue and bone caused by drill and osteotome, reduce the difficulty of osteotomy, and significantly shorten the cost time.
ObjectiveTo systematically review the clinical applicability of the global guidelines evaluation index system, and to provide some foundation for the evidence-based establishment of the clinical applicability evaluation index system in China. MethodsThe PubMed, Embase, Cochrane Library, CNKI, WanFang and VIP databases were electronically searched to collect literature on the clinical applicability evaluation index system of guidelines from inception to November 2022. Two reviewers independently screened literature, extracted data and then organized the data to form the evaluation items pool through qualitative systematic review and thematic synthesis. ResultsA total of 82 articles were finally included, and 141 clinical applicability evaluation indicators were obtained, including 5 third-level topics, 14 analytical topics and 141 descriptive topics. The third-level topics were availability, readability, feasibility, acceptability and overall evaluation. Influencing factors in the feasibility field were summarized as medical staff factors, patient/patient family factors, environmental factors and guideline factors. ConclusionThis study systematically sort out the applicability evaluation items of the guidelines, which provide an evidence-based reference for the construction of relevant evaluation index systems in China.
ObjectiveTo evaluate the reliability and validity of Guideline Implementation Success Assessment Tool (A-GIST). MethodsWith the guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition) as the target guideline, health care providers and patients from different hospitals across the country were investigated by questionnaire using A-GIST. Spearman-Brown coefficient and Cronbach's α coefficient were used to evaluate the split-half reliability and internal consistency reliability, while the structural validity, convergent validity and discriminant validity were investigated by confirmatory factor analysis based on structural equation. ResultsThe internal consistency reliability and split half reliability coefficients of the whole tool and each dimension ranged from 0.650 to 0.986. The scale-level content validity index (S-CVI/Ave) of content validity was 0.846. Confirmatory factor analysis showed that, the χ2/df of two sections of the tool were 8.695 and 6.123, respectively. The root mean square residual (RMR), the standard root mean square residual (SRMR) and the root mean square error of approximation (RMSEA) were under or almost under the threshold. Besides, the goodness-of-fit index (GFI) of them were 0.901 and 0.822, the adjusted goodness-of-fit index (AGFI) were 0.836 and 0.787, and the parsimonious normed fit index (PNFI) were 0.545 and 0.788, respectively. ConclusionGuideline Implementation Success Assessment Tool (A-GIST) was proved to be valid and reliable, and it shows that it is necessary to optimize the items under the dimensions of maintenance and evaluation of diagnosis and treatment effect in the future.
Diabetic retinopathy (DR) is the most common cause of preventable blindness in the working-age population. In addition to optimizing the hyperglycemia, hypertension, hyperlipidemia and other risk factors, regular fundus examination is essential for early diagnosis asymptomatic DR and timely treat the sight-threatening DR, so as to reduce blindness and severe visual impairment caused by DR. Clinical practice guidelines for the screening and management of DR have been implemented throughout the world, but there are reasonable differences between existing guidelines in the recommended timing of first retinal examination, screening intervals, methods for examination and criteria for referral to an ophthalmologist. It is of great clinical significance to have a detailed understanding of the current guidelines for DR screening and their clinical basis.
ObjectivesThis study aimed to evaluate the validity and reliability of the clinical practice guidelines (CPGs) applicability evaluation tool, a preliminary revised tool, by using it to appraise specific clinical guidelines.MethodsMedical staffs were sampled from relevant departments in domestic medical institutions to use tool to evaluate the two guidelines. Spearman-Brown coefficient of odd-even split-half method and Cronbach's alpha coefficient were used to evaluate the split-half reliability and internal consistency reliability. The convergent and discriminant validity were evaluated by correlation analysis and correlation coefficient comparison hypothesis test, and the structural validity was investigated by confirmatory factor analysis based on structural equation.ResultsThe split-half reliability of the evaluation tool was 0.86, and the Cronbach's coefficient of the whole tool and each dimension were greater than 0.7 for two guidelines. The success rates of tool convergent and discriminant validity calibration were 100%. In the second-order confirmatory factor analysis model, the χ2 and df were 3.38 and 2.46, the comparative fit index (CFI) were 0.872 and 0.974, the goodness of fit index (GFI) were 0.954 and 0.983, and the adjusted goodness of fit index (AGFI) were 0.846 and 0.959 for two guidelines respectively. Both standard root mean square residual (SRMR) and root mean square error of approximation (RMSEA) were less than 0.09. Both P values of RMSEA hypothesis test were greater than 0.05.ConclusionsThe evaluation scale is a valid and reliable instrument for assessing the applicability of CPGs, which should be further evaluated in practical applications in the future.
Chronic kidney disease (CKD) and hypertension are very common chronic diseases. Active and standardized treatment of hypertension in patients with CKD can not only delay the progress of renal disease, but also reduce the risk of cardiovascular events. In recent years, although the guidelines for hypertension have put forward detailed suggestions for the management of hypertension in CKD patients, there are differences in the recommendation of blood pressure target value for CKD patients. Combined with the latest guidelines, this review interprets the blood pressure measurement methods, diagnostic criteria, antihypertensive targets and drug therapy in patients with CKD.
Objective To systematically review simple hypertension guidelines through methods as follows: (a) compare differences and similarities of the recommended drugs; (b) analyze differences of the recommended frequencies in different regions and quality levels; and (c) explore the recommended evidence basis, so as to better understand relevant guidelines. Methods Uncomplicated hypertension guidelines concerning pharmacological interventions were identified (terminated by March 2012) in Ovid, EMbase, Chinese Biomedical Disc (CBM) and WangFang database as well as guideline websites including NGC (National Guideline Clearinghouse), GIN(Guidelines International Network), NICE(National Institute for Health and Clinical Excellence) and CPGN (Clinical Practice Guideline Net, guidelines concerning pharmacological intervention in simple hypertension were included. A total of 6 domains (involving 23 items) in the Appraisal of Guidelines for Research and Evaluation (AGREE) were applied to assess the methodological quality of the guidelines. A comparative study was performed regarding the recommendations in guidelines from different regions as well as of different methodological qualities. Results A total of 27 guidelines concerning pharmacological intervention in simple hypertension were included, involving 6 continents, 13 counties, 3 regions and 3 international organizations. Publication dates ranged from 2003 to 2012. According to the AGREE instrument, 4, 17 and 6 guidelines were graded as Level A, B and C, respectively. There were only 2 domains, “Scope and Purpose” and “Clarity of Presentations”, getting high average scores (more than 60%) among all guidelines. The average scores of guidelines in different domains of AGREE varied with regions. There were 8 evidence-based guidelines which got higher average scores in each domain of AGREE than those of non-evidence-based guidelines. Guidelines varied with the standards of classifying ideal, normal, high normal blood pressure and hypertension. Diuretics were the first agent recommended by all guidelines, and the other recommendations were correlated with age and race. There was a tendency to recommend diuretics as basic drugs in two-drug combination therapy in North America, while calcium channel blockers (CCBs) were the most recommended agents in Asian guidelines. Conclusion The overall methodological quality of simple hypertension guidelines is suboptimal in different countries or regions. The 6 domains involving 23 items in AGREE vary with scores, while the scores of evidence-based guidelines are higher than those of non-evidence-based guidelines. There are differences in the standards of classifying ideal, normal, high normal blood pressure and hypertension. The first-line drug recommendations differ in regions and relate to age and race. Two-drug combination therapy regimens also vary with region.
ObjectiveTo investigate the type, development time, regional distribution, development methods, structure and contents of therapeutic drug monitoring (TDM) guidelines, so as to provide references for the development of TDM guidelines in China. MethodsGuidelines concerning TDM were electronically retrieved in PubMed, Ovid-EMbase, CNKI, VIP, CBM, WanFang Data, NGC (National Guideline Clearinghouse ), GIN (Guidelines International Network), World Health Organization (WHO) guideline database, official websites of governments and societies associated with TDM from inception to October 2015. Two reviewers independently screened literature, extracted data including basic characteristics, formulation methods and text structure, etc.. Then a descriptive analysis was conducted. ResultsA total of 37 guidelines concerning TDM were included, which involved 4 guidelines for management of TDM, 32 for technical practice and 1 for both of them. The results of analysis showed that: for the integrity of reporting items of guidelines, three (75%) management guidelines ranked grade A, but only 1 (3.13%) technical guidelines ranked grade A. The management specifications of TDM included four aspects as follows: standard terminology, the process specification, quality control and personnel qualification. The recommendations to TDM technology of specific drugs included evidence of TDM, standards and procedures, and personnel qualification. ConclusionThere is a rapid but unbalanced development for abroad TDM guidelines. Most of them are TDM technical guidelines. Evidence-based methods are suggested to be used to develop local TDM guidelines, especially for commonly used medicines and technologies without supporting of existed guidelines.