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 search evidence in the treatment of Philadelphia chromosome （Ph）-positive acute lymphocytic leukemia （ALL） for guiding chnical practice. Methods We searched MEDLINE （February, 1970～July, 2005 ） and SUMSEAILCH （till July, 2005 ）to identify systematic reviews（SIL）, randomized controlled trials（RCTs） and controlled clinical trials （CCTs） in the treatment of Ph-positive ALL. Results One RCT and 8 CCTs were identified. The results showed that Ph-positive ALL had a very poor prognosis . Chemotherapy and bone marrow transplantation （BMT） were the two main ways to treat the disease. Outcome of conventional chemotherapy treatment for adults with the disease was poor. Outcome of treatment with hyper-CVAD and imatinib mesylate was better and BMT was the only way which could potentially cure the disease. Conclusions Treatment of Ph-positive ALL with hyper-CVAD and imatinib mesylate may induce higher remission rate and disease free survival rate. BMT is the best way to cure the disease.
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 Methods of evidence-based medicine were used to make an individulized treatment plan concerning newly diagnosed type 2 diabetes mellitus in elderly patients. Method After clinical problems were put forward, evidence was collected from third issue, 2003, Cochrane Library, Medline (PubMed 1990.1-2003.2) and http:// sumsearch.uthscsa.edu/ searchform4.htm according to the search strategy. Subject words were: diabetes mellitus non-insulin-dependent; self-monitor of blood glucose; micro-and macro-vascular complications; sulphonylureas; insulin ; aspirin; metformin; acarbose; self-monitor of blood glucose; older patient; hypertension management; Lipid management; RCT; human; meta-analysis；systmatic review. Results A total of 112 RCTs, and 24 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data. After one year follow-up, the plan was proved optimal. Conclusions The treatment efficacy in newly diagnosed type 2 diabetes mellitus in the elderly has been improved by determining an individulized treatment plan according to evidence-based methods.
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 formulate an evidence-based treatment plan for a patient with advanced hepatocellular carcinoma. Methods The clinical problems were put forward after full evaluation of patient’s conditions, and then the evidence related to the diagnosis and treatment of primary hepatocellular carcinoma was collected from The Cochrane Library (Issue 4, 2010), PubMed (1980 to 2010), Embase (1990 to 2010) and Wanfang Data (1990 to 2010). All the collected evidence was critically assessed. Both patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment. Results A total of 153 relevant literatures were detected, and 13 meta-analyses or systematic reviews, 23 RCTs and 4 practice guidelines were identified. A rational treatment plan was made upon a serious evaluation of the data and the opinion of the patient. After a 6-month follow-up, the plan proved to be optimal. Conclusion The individualized treatment plan according to evidence-based methods for patients with advanced hepatocellular carcinoma can effectively improve the therapeutic efficacy and the life quality.
Objective To formulate an individualized evidence-based treatment for a first-diagnosed patient with coronary artery-pulmonary artery fistula. Methods Aiming at the issue of whether interventional operation was necessary for first-diagnosed coronary artery-pulmonary artery fistula or not, the computer retrieval was conducted in the US National Guideline Clearinghouse, The Cochrane Library, PubMed and MEDLINE from 1990 to 2011, to collect and assess the best evidence of relevant systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines, in order to be applied in clinical treatment. Results There were 1 clinical guideline for treating coronary artery fistula and 3 different high-quality evidence studies were retrieved. The results showed percutaneous coronary intervention was the best treatment currently. According to the obtained evidence and patient’s willingness, the relevant examinations were taken, and the preoperative preparation for percutaneous coronary intervention was done actively after the patient was admitted. Three days after hospitalization, the selective coronary angiography showed right coronary artery-pulmonary artery fistula and left coronary circumflexus artery-left atrial multiple fistulae, then the percutaneous coronary intervention spring coil embolization was successfully conducted for right coronary artery-pulmonary artery fistula. After operation, bayasprin enteric-coated tablets 0.1 g/d was taken for anti-platelet aggregation and preventing thrombotic diseases. The observation during operation and postoperative 5-day hospitalization showed no relevant complications. Conclusion Percutaneous coronary intervention is safe and effective for the symptomatic patients with coronary artery-pulmonary artery fistula.
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.
Objective Evidence-based medicine was used to make an individualized treatment plan for newly diagnosed prostatic hyperplasia in an elderly patient. Methods After clinical problems were discovered, evidence was collected from CBM, CNKI, The Cochrane Library, PubMed, EMBASE, ScienceDirect, Springer, and ProQuest databases according to our predefined search strategy. The search was done through 2008. The internal and external validity of the evidence was assessed. The evidence, combined with the patient value, was applied to the patient. Results A total of 39 systematic reviews involving 137 randomized controlled trials were identified. A rational treatment plan was made upon a critical evaluation of the data. After one year follow-up, the treatment protocol was proven correct. Conclusion The treatment efficacy in newly diagnosed prostatic hyperplasia in the elderly has been improved by determining an individualized treatment protocol according to evidence-based methods.
