Objective To study the efect of montelukast for improving bronchial hyperresponsiveness (BHR) in treatment of bronchiolitis. Methods Four hundreds infants, 3 to 24 months old, hospitalized with acute bronchiolitis in three Hospitals (Urumqi Children’s Hospital, Pediatrics Department of First Ailiated Hospital of Xinjiang Medical University, and Pediatrics Department of Army General Hospital) from January, 2007 to January, 2008, were randomly assigned into four groups: placebo group (n=92), budesonide group (n=91), montelukast short-course group (7 days, n=88), and montelukast long-course group (28 days, n=90). Main outcome measure was BHR ater treatment, including recurrent bronchiolitis wheezing and asthma incidence rate. Secondary measures were changes in serum T-IgE level and eosinophilic cationic protein (ECP) level. Results All four groups were comparable at baseline. No signiicant diferences were observed between placebo group and budesonide group in changes of serum T-IgE (F=6.17, P=0.00), ECP (F=8.13, P=0.00), recurrent post-bronchiolitis-wheezing (χ2=49.46, P=0.00) and asthma incidence rate (χ2=27.21, P=0.00). Ater treatment with montelukast, there was statistical signiicance in T-IgE and ECP level, times of recurrent bronchiolitis wheezing and asthma incidence rate, as follows, montelukast short-course group versus placebo group (F=12.56, P=0.00), montelukast short-course group versus budesonide group (F=7.22, P=0.00), montelukast long-course group versus placebo group (F=20.48, P=0.00), montelukast long-course group versus budesonide group (F=13.56, P=0.00), montelukast short-course group versus montelukast long-course group (F=1.04, P=0.00). Conclusions Budesonide treatment for 7 days can not improve bronchial hyperresponsiveness induced by bronchiolitis, while montelukast does, that is, montelukast can decrease both the times of bronchiolitis wheezing and asthma incidence rate. Long-course treatment of montelukast is superior to that of short-course.
Objective To assess atomoxetine and methylphenidate therapy for attention- deficit/ hyperactivity disorder (ADHD) .Methods We electronically searched the Cochrane Library (Issue 2, 2008), PubMed (1970 to 2008), MEDLINE (1971 to 2008), EMbase (1971 to 2008), Medscape (1990 to 2008), CBM (1978 to 2008), and NRR (1950 to 2008). We also hand-searched some published and unpublished references. Two independent reviewers extracted data. Quality was assessed by the Cochrane Reviewer’s Handbook 4.0. Meta-analysis was conducted by The Cochrane Collaboration’s RevMan 4.2.8 software. Results We finally identified 3 randomized controlled trials that were relevant to the study. Treatment response (reducing ADHD-RS Inattention subscale score) was significantly greater for patients in the methylphenidate group than in the atomoxetine group with WMD= – 1.79 and 95%CI – 2.22 to 1.35 (Plt;0.000 01). There was no statistical difference in other outcome measures between two groups (Pgt;0.05). Conclusions The effectiveness and tolerance of methylphenidate and atomoxetine are similar in treatment of ADHD. Further large randomized, double blind, placebocontrolled trials with end-point outcome measures in long-term safety and efficacy are needed.
Informing is an initiative behavior of medical staff in their clinical practice. Besides, informing is a key principle of informed consent. The number of cases of infringing upon patient’s informed consent is increasing because of the underestimate or ignorance of the obligation of informing. This paper discusses the concept, significance, content, and procedure of informing as well as the relationship between informed consent and informing.
It is an inexorable trend that evidence-based medicine (EBM) is being adopted at clinical medicine education in the 21st century. EBM neurology has been developing with the progress of the world of evidence-based medicine and clinical neurology. New requirements have been proposed in neurology education with the development of EBM. The adoption of EBM in modern clinical education will be a great influence: promoting the further development of neurology, cultivating talented doctors, and improving the quality of treatment.
Objective To understand the attitude of xinjiang medical workers towards national essential drugs and the requirements and suggestions about training, so as to provide necessary baseline information for spreading the application of Essential Medicine List (EML) in Xinjiang. Methods A questionnaire designed by Chinese Evidence-Based Medical Center was distributed for a face-to-face survey. The data were double-input by EpiData 3.1 with double checks, and statistically analyzed by EXCEL with constituent ratio as the statistical index. Results A total of 80 questionnaires were distributed and then retrieved with 100% recovery rate. Respondents employed in six public hospitals at or above the county level and in six community health service centers as well. a) The accuracy of 80 respondents about the basic concepts of essential drugs, serviceable range of EML, and the relationship between EML and basic medicare drug list were 72.6%, 89.5% and 17.8%, respectively; b) 33.8% (27) of the respondents always firstly considered using the essential medicine in their prescription, and 22.5% (18) of the respondents considered using essential drugs in most cases; c) EML were welcome loy 35% (28) of the respondents; d) The problems of practicing EML issued by respondents were the following in order: doctors’ awareness of essential drugs and prescribing habit of doctors, the safety and effectiveness of essential drugs, lower income, patients’ awareness of essential drugs and preference to medication, and the applicability of the essential medicine list; e) The main approaches to getting information about essential drugs were academic seminars (37 person-time, 46.2%), professional journals (27 person-time, 33.8%) and documents (25 person-time, 31.2%); f) There were 46 respondents who had participated in EML training once or twice; g) The total EML training or learning time of 34 respondents (42.5%) was less than one week; and h) Respondents suggested that, the training objects should be medical personnel, pharmacists and administrators; the training contents should be rational drug use, formularies and the use of essential drugs, drug policy, and the effectiveness of integration of the traditional Chinese medicine and western medicine; the training methods should be theoretical teaching and online learning; and the training place should be hospitals, homes or offices. Conclusion It is extremely urgent to improve doctors’ awareness of EML and strengthen the training of usage, and to conduct the research on EML applicability and effectiveness evaluation, financial subsidies, medical staff income, purchase and reimbursement problems.