Objective
To evaluate the efficacy and safety of Chinese medicine for the treatment of angina pectoris.
Methods
PubMed, EMbase, The Cochrane Library (Issue 11, 2015), VIP, WanFang Data and CNKI databases were used to evaluate the curative effect and safety of proprietary Chinese medicine in the treatment of angina pectoris. The retrieval time was up to November 2015. Two reviewers screened literatures, extracted data and assessed the methodological quality of included studies, and then the GRADE evaluation system was used to assess the quality of evidence.
Results
A total of 42 systematic reviews/Meta-analysises were included in the study. There were 15 kinds of proprietary Chinese medicines, and the drugs published most were compound composite salvia. AMSTAR evaluation results showed that the quality of all studies were low. The main problems were: ① no consideration was given to the publication of the inclusion criteria (eg, gray literature); ② only the list of articles included in the study literature was not available; ③ all articles did not describe the relevant conflicts of interest. The results of GRADE systems showed that: ① as to the total effective rate: musk pills (RR=3.44, 95%CI 2.99 to 3.96,P=0.08) and suxiaojiuxin Pills (RR=4.25, 95% CI 3.31 to 5.47,P<0.01) were superior to Western medicine, and the level of evidence was very low. ② As to the ECG changes efficiency rate: Puerarin (RR=3.61, 95% CI 2.95 to 4.42,P=0.05), Musk pill (RR=2.48, 95%CI 2.12 to 2.91,P<0.01) and Shuxuening (RR=1.62, 95% CI 1.33 to1.97,P<0.01) were superior to Western medicine, and the evidence level was low. The level of evidence was low for the remaining effective rate of proprietary Chinese medicine; ③ as to the adverse reactions: the musk Baoxin pill (RR=0.05, 95% CI 0.01 to 0.37,P=0.04) was less than Western medicine, and the evidence level was low.
Conclusion
Although the number of systematic reviews of published proprietary Chinese medicines for angina pectoris is high, but the methodological quality and evidence level are low. There are serious defects in the low quality of the original research literature and the systematic evaluation method. We suggest future studies to improve for two aspects: ① reasonable design to reduce the selective bias, to carry out the required clinical trials to reduce the implementation bias, the implementation of multi-center, the sample size of sufficient randomized controlled clinical trials to reduce the number of patients into the group less resulting in the loss of bias, strict implementation of the standard data collection methods to reduce the occurrence of measurement bias; ② in accordance with the requirements of clinical trials to report to improve the report quality of the literature.
ObjectiveTo access the current study status and the existing problems of studies on National Essential Medicines System (NEMS) in China based on systematic review methods, and provide the evidence-based evidence and references to the studies of this field.
MethodsThe following databases such as PubMed, EMbase, The Cochrane Library (Issue 3, March 2014), CNKI, WanFang Data, VIP and CBM were electronically searched to collect studies related to the policy analysis, implementation background, implementation strategies, implementation situation, implementation problem and implementation effects about NEMS in China. The retrieval time was from inception to December 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and finally conducted analysis on study types, study time, source journals, authors' units, study themes, etc. of the included studies.
ResultsA total of 1 607 articles were finally included, encompassing 56.38% qualitative studies and 43.62% quantitative studies. The number of published studies per year, the number of quantitative studies as well as the number of financiallysupported studies out of the total studies published per year had increased by year since 2009. The study topics focused on every parts during the implementation of NEMS in different proportions. The proportion of the national studies in the quantitative studies was lower than that of others. The regional distribution involved in the quantitative studies was unbalanced, and the ratio of which located on the East, the Central and the West of China was 2 to 1 to 1.
ConclusionThe implementation of NEMS and related studies are mutually promoted. More studies are needed to be carried out on remote areas as well as West China. Although the studies related to these areas tend to be standardized and evidence-based, but more in-depth studies should be well advanced. Most of the topics of the studies are widely covered, and the topics of further studies should be enforced in the detail of implementation links. Most of the studies focus on primary medical institutions, and more studies are also needed for supporting and expanding the implementation of NEMS in second and three degree medical institutions.
ObjectivesTo provide a useful framework for improved understanding of international value drivers in the decision-making process of medical insurance access, and to explore the value assessment criteria of orphan drugs from stakeholders’ perspective.MethodsPubMed, EMbase, CINAHL Plus, ProQuest, Web of Science, CNKI and WanFang Data databases were electronically searched to collect studies from January 1st, 1983 to December 31st, 2018. Research questions were constructed based on SPIDER model. We established the inclusion and exclusion criteria to filter studies. Study quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. A thematic synthesis was undertaken to develop descriptive themes, analytical constructs and third-level themes of value drivers by NVivo 11 software, and confidence in the findings was assessed using the CERQual method.ResultsA total of 10 studies including 20 research countries were included. Fifty descriptive themes were interpreted and embedded within 14 analytical constructs and 3 third-level themes after induction. Specifically, 3 broad themes were disease-related influence factors, which included severity, unmet requirements, disease burden, affected individuals, and moral and ethical considerations; drug-related influence factors, which included safety, efficacy, economics, innovation, quality of evidence; and some external and non-pharmaceutical intrinsic properties factors, which included reimbursement status in other countries or regions, government goals and priorities, confirmed drug supply and impact on environment.ConclusionsIn addition to conventional considerations such as efficacy and pharmacoeconomics, stakeholders are willing to take a broader perspective when in the case of the value assessment of orphan drugs. Comprehensive understanding of these value drivers is important to shape policy and enhance decision-making.
ObjectivesTo evaluate the current situation and rationality of electronic prescription in retail pharmacies in Chengdu, so as to provide references for further improving the sales of prescription drugs in retail drugstores and the level of rational drug use.MethodsA set of evaluation index system was constructed, and a prescription review group was set up. Eventually, 7 200 sample electronic prescriptions were collected for retrospective analysis and evaluation.ResultsPrescriptions from private medical institutions constituted the majority (3 543, 49.21%), and the majority of patients were junior and middle-aged, primarily respiratory diseases (38.24%) and circulatory diseases (17.11%), etc. The average quantity of drugs was 1.60 per prescription, percentage of antimicrobial use was 65.25%, percentage of essential medicines used was 34.92%, and reasonable rate of prescription was 95.21%.ConclusionsElectronic prescription services mode for retail pharmacy follows with the trend of “Internet + drug circulation” and complies with the rules of reasonable medical guidance and medication. However, optimizations are required, such as the lack of high-quality medical resources and the urgent need to optimize structure of prescription, and it is still essential to strengthen the management of antibacterial drugs and national essential medicines.
Objective To study the cl inical appl ication of Mobi-C prosthesis in treatment of anterior cervical discectomy and artificial disc replacement (ADR). Methods Between January 2009 and June 2009, 20 cases of degenerative cervical disease were treated with anterior discectomy and ADR by Mobi-C prosthesis, including 13 cases of cervical disc herniation and 7 cases of cervical spondylotic radiculopathy, and 25 Mobi-C prosthesis were implanted. There were 8 males and 12 females, aged 29-54 years (mean, 45.2 years). The disease duration was from 4 days to 5 years (mean, 1.2 years). Affected segments of process included C3, 4 in 1 case, C4, 5 in 2 cases, C5, 6 in 7 cases, C6, 7 in 5 cases, C4, 5 and C5, 6 in 2 cases, and C5, 6 and C6, 7 in 3 cases. Radiographs were taken regularly, and cervical range of motion (ROM) on segments of disc replacements were measured. The functions of cervical spinal cord were evaluated by “40 score” system (COA) preoperatively, immediately postoperatively, and at follow-up. The qual ity of l ife was evaluated by neck disabil ity index (NDI) and visual analogue scale (VAS) score. Results All incisions healed by first intention. No perioperative compl ication was found. All cases were followed up 16.5 months on average (range, 14-18 months). There was no significant difference in cervical ROM of operatied segment between preoperation and follow-up duration (t=0.808，P=0.440). No heterotopic ossification was found at follow-up. COA score at last follow-up (38.20 ± 1.14) was significantly higher than preoperative one (32.10 ± 2.96) , (t=9.278，P=0.000) , and the improvement rate at last follow-up was 77.2% ± 5.4%. VAS score at last follow-up (3.20 ± 1.23) had significant difference when compared with preoperative one (5.10 ± 1.29), (t=10.585，P=0.000). NDI score at last follow-up (29.40 ± 4.55) had significant difference when compared with preoperative one (39.20 ± 3.80), (t=16.039, P=0.000). Conclusion A satisfactory short-term curative effect can be obtained by using Mobi-C prosthesis in treatment of anterior cervical discectomy and ADR.
