Objective To give an individualized treatment to a young woman with primary dysmenorrhea. Methods According to the basic principle and methods of evidence-base medicine, we searched The Cochrane Library (Issue 1, 2009), MEDLINE (PubMed, January 1950 to May 2009), ACP Journal Club (OVID, January 1991 to May 2007) for systematic reviews and randomized controlled trials (RCTs) to acquire the best clinical evidence on the treatment of primary dysmenorrhea. Results A total of 11 systematic reviews and 1 RCT were identified. A reasonable treatment plan was made through combining the patient’s will with her family members’. Conclusion The treatment effect on primary dysmenorrhea of the young woman is improved by an individualized treatment plan based on an evidence-based method.
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 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 explore the methods of evidence-based individualized treatment for a patient with oral pemphigus. Methods According to chnical problems, we searched The Coehrane Library （Issue 1,2005 ） , MEDLINE （1966 -Jan. 2005 ）, SUMSEAR.CH （Jan. 2005 ）, TRIPDATABASE （1997 - 2005 ）, CMCC （1994 - 2004 ）and handsearched four Chinease journals （starting pubhcation -2004）. Results No Systematic review was found. Six randomised controlled trials, two reviews of high quality and one guidehne were identified. We found that corticosteroid was the firsthne medicine in the treatment of pemphigus. However, corticosteroid at higher dose did not work more effectively than that at lower dose. Corticosteroid at middle-dose was preferred in treating oral pemphigus. Additionally, corticosteroid combined with immunosuppressants led to lower mortality. Among them, cyclophosphamide and azathioprine were recommended, and methopterin should be avoided. Plasma exchange in combination with corticosteroid at lowor middle-dose should not be recommended in conventional therapy. Chinese traditional treatment combined with Western medicine might work. A treatment with prednisone at the dose of 60 mg/d and in combination with azathioprine 100mg/d was made based on the evaluation of the data available and was proved optimal by 6 months following-up. Conclusions The therapeutic effect of pemphigus has been improved by evidence-based treatment.
Objective To make an individualized treatment plan for a newly diagnosed Barrett esophagus patient by means of evidence-based medicine. Methods After the clinical problems were put forward, both the systematic reviews and randomized controlled trials (RCTs) were collected from The Cochrane Library (Issue 3, 2009) and PubMed (1995 to 2010) and SCIE (1995 to 2010). The treatment protocol was made by combining the evidence and the preference of patient. Results A total of 21 RCTs and 6 systematic reviews (meta-analyses) were identified. A rational treatment plan was made upon a serious evaluation and patient’s preferences: improving the lifestyle and adopting the APC therapy combined with acid-suppressive drugs (Omeprazole, 40 mg, bid) for six weeks. Three months later, the endoscope reexamination showed the patient was much better. After another twelve-month follow-up, the plan proved to be optimal. Conclusion In accordance with the evidence-based methods, the rational treatment plan made for a diagnosed Barrett esophagus male can effectively relieve symptoms and improve quality of life.
Objective To apply the evidence-based treatment method to direct the clinical therapy of refractory chronic lymphocytic leukemia (CLL). Methods Such evidence-based medicine databases as The Cochrane Library (Issue 10, 2010), OVID database, PubMed (January 1992 to October 2010) and http://www.nccn.org/ were searched to find the clinical evidence with high quality and the optimum treatment was designed based on the patient’s preferences. Results Two RCTs and five CCTs were included. The available clinical evidence displayed that rituximab could improve the therapeutic effect of combined chemotherapy on the refractory CLL, the COP/CHOP regimens were effective for the fludarabine-resistant CLL, and hematopoietic stem cell transplantation could be an effective salvage therapy for the relapsed/refractory CLL, but not the first-line recommendation drug. This patient was treated by CHOP regimen combined with rituximab, the condition of disease was improved two months after stopping chemotherapy, and the follow-up was conducted. Conclusion Current evidence reveals that rituximab combined with CHOP regimen produces good tolerance with a better clinical outcome than that of CHOP regimen. Clinical practice results display that the combination of rituximab and CHOP regimen can bring good prognosis to the patient, but still needs high-quality evidence to prove．
Cirrhosis is an end stage of condition of various liver diseases with specific clinic and pathologic process. The incidence is high and it seriously affects the quality of life for patients. In order to obtain the best prevention and treatment for end-stage cirrhosis, we searched The Cochrane Library (Issue 3, 2004), SUMsearch (1981~2004) and MEDLINE (1981~2004), and identified 15 systematic reviews and 65 randomized controlled trials. We critically assessed the quality of studies. The results showed the principal treatment of cirrhosis was to deal with complications, such as the prevention and treatment of variceal bleeding, the treatment of ascites etc.
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.
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 report evidence-based treatment for 2 case of Ⅱ B stage non-small cell lung cancer. Methods We searched systematic reviews and randomized controlled trials in The Cochrane Library (Issue 2, 2009), MEDLINE (PubMed, January 1970 to June 2009) and ACP Journal Club (1996 to June 2009), and evaluated the evidence. Results The best clinical evidence for Ⅰ and Ⅱ stage non-small cell lung cancer patients showed that in the patients with resectable nonsmall cell lung cancer, postoperative adjuvant radiotherapy and chemotherapy could not improve survival compared with surgery alone. We did not find evidence which indicated that preoperative chemotherapy improved survival in people with resectable non-small cell lung cancer. Conclusion In accordance with the wishes of the patient and family, they do not accept the radiotherapy and chemotherapy, but choose palliative and supportive therapy.
