Objectives To assess the efficacy and safety of misoprostol for intrauterine insemination (IUI). Methods The Cochrane Library, EMbase, MEDLINE, SCIENCE Direct Database, CBM, Wangfang Data and CNKI were searched for collecting randomized controlled trials or controlled clinical trials published before October, 2009. Statistical analysis was performed with RevMan 5.0 software. Results Five Randomized controlled trials (RCTs) were included according to the inclusion and exclusion criteria at last. Five RCTs involving 546 participants and 1 133 cycles are included. Meta-analysis showed that, compared with placebo group, 400 μg misoprostol could increase pregnancy rate of IUI (RR=1.95, 95%CI 1.19 to 3.19); compared with 200 μg misoprostol group, 400 μg misoprostol also has higher incidence rate of abdominal pain (RR=3.13, 95%CI 1.86 to 5.26) and vaginal bleeding (RR=5.25, 95%CI 2.08 to 13.21). Conclusions Because of the limited studies, recommendation of using misoprostol in IUI cycles is not fully convinced, which has to be further proved by more randomized controlled trials in large sample with high quality.
ObjectiveTo systematically review the satisfaction of Chinese residents with the contract services of family doctors. MethodsCNKI, WanFang Data, VIP, PubMed, Web of Science, and EMbase databases were electronically searched to collect cross-sectional studies related to the Chinese residents' satisfaction with the service of family doctors from January 2011 to May 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 14.1 software. ResultsA total of 42 cross-sectional studies were included. The results of meta-analysis showed that the overall satisfaction rate of residents with the contract services of family doctors was 77.7% (95%CI 73.7% to 81.7%). The results of subgroup analysis showed that the satisfaction rate of the male and female residents were 83.0% and 84.3%; <60 and ≥60 years old residents were 83.5% and 81.7%; junior high school or below, senior high school or technical secondary school, junior college or above educational level residents were 84.1%, 76.4% and 81.2%; the monthly income less than 4000 yuan and more than 4000 yuan residents were 78.5% and 79.3%; with and without diseases residents were 85.3% and 79.7%; with and without spouse residents were 80.6% and 82.4%; on and off the job residents were 77.7% and 73.9%; urban and rural residents were 78.7% and 80.0%; in 2011-2015 and 2016-2020 were 67.6% and 76.2%; eastern and western regions residents were 76.5% and 79.7%; relevant studies which were conducted by random sampling and nonrandom sampling were 80.5% and 73.5%. ConclusionsThere is still room for improvement in residents' satisfaction with family doctor contract service. Residents with different education levels, disease situations, on-the-job situations, time, regions and sampling methods have differences in their satisfaction with the contract services of family doctors.
ObjectiveTo review individual treatment effect (ITE) models developed from randomized controlled trials, with the aim of systematically summarizing the current state of model development and assessing the risk of bias. MethodsPubMed and Embase databases were searched for studies published between 1990 and 14 June 2024. Data were extracted using the CHARMS inventory, and the PROBAST risk of bias tool was used to assess model quality. ResultsA total of 11 publications were included, containing 19 ITE models. The ITE modelling methods were regression models with interaction terms (n=8, 42.1%), dual-range models (n=5, 26.3%) and machine learning (n=6, 31.6%). The ITE models had a reporting rate of 78.9%, 73.2% and 10.5% for differentiation, calibration and clinical validity, respectively. Fourteen models were assessed as having a high risk of bias (73.7%), particularly in the area of statistical analysis, due to inappropriate handling of missing data (n=15, 78.9%), inappropriate consideration of model fit issues (n=5, 26.3%), etc. ConclusionCommon approaches to ITE model development include constructing interaction terms, dual procedure theory, and machine learning, but suffer from a low number of model developments, more complex modeling methods, and non-standardized reporting. In the future, emphasis should be placed on further exploration of ITE models, promoting diversified modeling methods and standardized reporting to improve the clinical promotion and practical application value of the models.
Objective To systematically review the efficacy of total glycosides extracted from Rehmannia glutinosa Libosch leaf in the treatment of diabetic nephropathy. Methods Databases including PubMed, EMbase, MEDLINE, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP were electronically searched to collect randomized controlled trials of total glycosides from Rehmannia glutinosa Libosch for diabetic nephropathy from inception to May 30th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. RevMan 5.4 software was then used to perform meta-analysis. Results A total of 7 RCTs involving 504 patients were included. The results of meta-analysis showed that there were no significant differences in creatinine levels (MD=?1.71, 95%CI ?3.97 to 0.56, P=0.14) and urea (MD=?0.18, 95%CI ?0.44 to 0.08, P=0.19) between the two groups. In terms of regulating proteinuria, the urinary albumin excretion rate (MD=?39.41, 95%CI ?48.46 to ?30.36, P<0.000 01), urinary microalbumin (MD＝?9.94, 95%CI ?12.16 to ?7.73, P<0.000 01), and 24-hour urinary protein (MD=?0.67, 95%CI ?0.85 to ?0.49, P<0.000 01) were all lower in the treatment group compared with control group. However, there were no differences between groups in terms of blood glucose metabolism as indicated by changes in levels of the long-term blood glucose metabolism indicator (HbA1c: MD=?0.16, 95%CI ?0.67 to 0.35, P=0.53). Only one study suggested that short-term blood glucose metabolism indicators, fasting blood glucose and postprandial blood glucose levels were not different between groups. In terms of blood lipid metabolism, only one study suggested glycoside treatment produced lower serum levels of cholesterol and triglycerides compared with control group. Conclusions Current evidence suggests that adjunctive therapy with total Rehmannia glutinosa Libosch glycosides can benefit diabetic nephropathy patients more than angiotensin II receptor inhibitor or pancreatic kininogen by alleviating proteinuria and likely improving lipid metabolism. However, no benefit is observed in terms of renal function improvement or blood glucose metabolism. Due to limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusions.
Objective To compare the effectiveness of aspheric intraocular lenses(IOL) versus spherical IOL in the treatment of cataract. Method Randomized controlled trials comparing aspheric IOL with spherical IOL were identified by searching PubMed (2000 to October, 2008), EMbase (2000 to October, 2008), MEDLINE (2000 to October, 2008), and The Cochrane Library (Issue 3, 2008). Two reviewers independently assessed trials for eligibility and quality, as well as the extracted data. Data were synthesized using RevMan software (release 5) provided by the Cochrane Collaboration. Results A total of 14 trials (1383 eyes) were included for systematic review, and 11 out of 14 studies were included in the meta-analysis. Subgroup analyses were used according to different aberrations of aspheric IOL. The results showed a significant difference in the mean best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD -0.02, 95% CI -0.03 to -0.01(Plt;0.0001). It showed a significantly worse difference in the mean of the best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD –0.02, 95%CI –0.03 to –0.01 (Plt;0.000 1). It showed a significant worse in the mean the best corrected visual acuity in the Tecnis Z9000 IOL group with WMD 0.02, 95%CI 0.01 to 0.03 (P=0.002); and there was no significant difference between the two groups with WMD 0.00, 95%CI –0.02 to –0.03 (P=0.71). The results did display markedly less spherical aberration and total higher order aberrations than eyes implanted with the traditional spheric IOL in all subgroups (WMD –0.06, 95%CI –0.07 to –0.06, Plt;0.000 01, WMD –0.06, 95%CI –0.07 to –0.02, Plt;0.000 1, respectively). The majority of studies suggested significant improvement in the aspheric IOL group in contrast sensitivity, especially at mesopic low spatial frequencies, although some trials showed no significant difference. Conclusion The effectiveness of aspheric IOL is superior to spherical IOL during cataract surgery. No differences in aspheric IOL with different aberration are found in this series, and further study is required.
Objective To evaluate the effect of prophylactic removal of asymptomatic impacted wisdom teeth in adolescents and adults compared with the retention of these wisdom teeth. Methods We searched the Cochrane Oral Health Group Trials Register （to 4 August, 2004）, the Cochrane Central Register of Controlled Trials （CENTRAL）, PubMed （1966 to 4 August, 2004）, EMBASE （1974 to 4 August, 2004）. There was no restriction to publication of language. Key journals were handsearched. An attempt was made to identify ongoing and unpublished trials. All randomised or controlled clinical trials （KCTs/CCTs） comparing the effect of prophylactic removal of asymptomatic impacted wisdom teeth with no-treatment （retention） were included. Assessment of relevance ,validity and data extraction were conducted in duplicate by three independent reviewers. Where uncertainty existed, authors were contacted for additional information about randomisation and withdrawals. The quality assessments of the trials were carried out. Results Only three trials were identified to fulfill the selection criteria. Two complete RCTs assessed the influence of prophylactic removal on late incisor crowding in adolescents. One ongoing RCT was identified, but the researchers were unable to provide any data and intended to publish in the near future. Although both complete trials met the inclusion criteria, different outcome measures were prevented us from pooling data. Conclusions No evidence has been found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults. There is some reliableevidence that suggests that the prophylactic removal of asymptomatic impacted wisdom teeth in adolescents neither reduces nor prevents late incisor crowding.
The comparative diagnostic test accuracy (CDTA) study is an important part of diagnostic test accuracy, which aims to compare the accuracy of two or more index tests in the same study. With the development of CDTA studies and the methodology of systematic reviews, the number of CDTA systematic reviews has grown year by year and has provided evidence to support clinical decision-making. Compared with systematic review of single diagnostic test accuracy, the CDTA systematic review has its own unique features, especially in data extraction, risk of bias, and statistical analysis. This paper introduced the steps and precautions for writing a CDTA systematic review to provide references for CDTA systematic reviewers.
ObjectiveTo systematically review the efficacy and safety of probiotics for the treatment of Helicobacter pylori (H.pylori) infection in children.
MethodsWe electronically searched The Cochrane Library, PubMed, EMbase, CNKI, VIP and WanFang Data databases to collect randomized controlled trials (RCTs) about probiotics for the treatment of H.pylori infection in children from inception to January 2015. The references of included studies and conference proceedings were manually searched for additional studies. Two reviewers independently screened literature, extracted data and assessed the risk of bias of include studies. Then, meta-analysis was performed by using RevMan 5.3 software.
ResultsA total of twelve RCTs were included, involving 1 227 patients. The result of meta-analysis showed that the probiotics adjuvant therapy group was superior to the control group in H.pylori eradication rates (OR=2.23, 95%CI 1.66 to 2.99, P<0.000 01) and the incidence of adverse effect (OR=0.31, 95%CI 0.18 to 0.53, P<0.000 1).
ConclusionCurrent evidence shows that probiotics adjuvant therapy may be a new effective and safe solution in the treatment of H.pylori infections in children. Due to the limited quality and quantity of the included studies, more higher quality studies are needed to verify the above conclusion.
Objective To evaluate the efficacy of statins pretreatment in patients before percutaneous coronary intervention (PCI). Methods Published literature on relevant randomized controlled trials (RCTs) were retrieved via electronic and handsearch in databases CNKI, CBM, MEDLINE and The Cochrane Library from January 1990 to May 2011. The references of these articles were also retrieved. Two reviewers independently identified articles according to the inclusion and exclusion criteria, extracted the data, assess the quality of the included studies, and then conducted meta-analysis using RevMan 5.0 software. Results A total of 10 trials involving 3 012 patients were included. The results of meta-analyses showed that: during the periprocedural period, the trial group had a lower incidence than the control group (98 of 1 514 cases, incidence 6.5%) in periprocedural myocardial infarction with a significant difference (OR=0.43, 95% CI 0.34 to 0.56, Plt;0.000 01). The composite of death, myocardial infarction, or target vessel revascularization in one month, essentially driven by periprocedural myocardial infarction, was reported 6.8% in the trial group and 15.1% in the control group (OR=0.41, 95% CI 0.32 to 0.53, Plt;0.000 01). Conclusion Current evidence supports the effectiveness of statin pretreatment used to reducing the rate of periprocedural myocardial infarction in patients before receiving PCI.
