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 To summarize the available clinical research evidence for the treatment of hepatorenal syndrome (HRS). Methods Using the basic methods and principles of evidence-based medicine, we searched and evaluated clinical studies involving the treatment of HRS. Results We found that plasma expansion, vasoconstrictor, transjugular intrahepatic portosystemic shunts (TIPS) and liver transplantation were effective interventions for patients with HRS. Conclusion HRS is a common complication of end-stage liver diseases and the prognosis for patients with HRS is extremely poor. However, due to the small number of clinical trials, small sample sizes and low methodological quality, the strength of the current evidence is limited. Rigorously-designed, randomized, multi-center, large-scale trials on HRS are required.
Objective Based on the methodology of evidence-based medicine, we explored the prognosis of a patient with gestational diabetes mellitus (GDM). Methods We searched ACP Journal Club (1991 to October 2006), The Cochrane Library (Issue 4, 2006), MEDLINE (1990 to October 2006) and Chinese Biomedicine database (CBM). Cohort studies, case-control studies and case series studies involving the prognosis of patients with GDM were collected. The available evidence was critically appraised. Results During the period from 6 weeks to 28 years after delivery, the incidence of type 2 diabetes mellitus appeared to vary from 2.6% to 70%. Patients with GDM suffered from an increased incidence of spontaneous premature delivery, hypertension, metabolic syndrome and vaginal infection. Conclusion Patients with GDM appears to be more liable to overt diabetes mellitus, and to suffer fromspontaneous premature delivery, hypertension, metabolic syndrome and vaginal infection than women with normal glucose tolerance during pregnancy. Further studies of the long-term follow-up data from GDM trials are needed.
【摘要】 目的 应用调查问卷分析培训前后成都市社区医生对肺炎球菌疫苗的认识，为推动社区肺炎球菌疫苗接种奠定基础。 方法 对215名成都市社区医生进行肺炎球菌疾病及预防知识的培训，并在培训前后行问卷调查，回收问卷并分析。 结果 经培训，社区医生提高了对肺炎球菌疾病及疫苗接种知识的掌握程度，加深了对肺炎球菌疾病及疫苗接种重要性的认识。 结论 对社区医生进行肺炎球菌相关知识的培训，有利于提高社区医生对肺炎球菌疫苗接种推荐的专业性和成功率。【Abstract】 Objective To know the community doctors’ understanding of pneumococcal vaccine before and after the education via questionnaire. Methods A total of 215 community doctors in Chengdu were educated in pneumococcal disease and the prevention knowledge. Questionnaire investigation was performed before and after the education and the results were analyzed. Results After the education, the acknowledgement of pneumococcal vaccination of the community doctors was improved. Conclusion The education of the knowledge of pneumococcal vaccine for the community doctors helps to improve the acknowledgement of pneumococcal vaccination.
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.
Little has been reported about deep venous thrombosis (DVT) that occurs after the implantation of the cardiac pacemaker. DVT affects the prognosis and quality of life of patients severely, or even causes fatal pulmonary embolism. Research on its risk factors, therapeutic strategy and secondary prevention does not coincide with one another. We have searched the systematic reviews and randomized controlled trials of DVT through PubMed, Cochrane Library and Guideline. Evidence has showed that previous DVT, over 40 years of age, and surgical history are the major risk factors. Initial treatment of DVT with heparin and maintenance therapy with oral anticoagulant are indispensable and effective, and could improve the prognosis of patients. If patients with previous DVT are at increased risk in the future, heparin and / or oral anticoagulant application may be used for prophylaxis.
【摘要】 目的 老年综合评估法筛查75岁以上2型糖尿病（type 2 diabetes mellitus，T2DM）合并老年综合征的情况，并观察以甘精胰岛素为基础的治疗方法对老年综合征、血糖、低血糖事件、治疗满意度等的影响。 方法 应用老年综合评估中的日常生活能力、工具性日程生活能力、简易智能量表、老年抑郁量表、微型营养评定法，分别评估2005年12月—2009年12月老年门诊及病房住院的日常生活能力、认知功能状态、情绪障碍和营养状态，对其合并功能障碍、痴呆、抑郁、营养障碍、伤害性跌倒等老年综合征的患病情况进行横断面调查；筛选至少合并一种老年综合征和一个其他合并疾病，血糖控制差、预期寿命有限的患者进行以甘精胰岛素为基础的降糖治疗，采用自身前后对照的方法了解对糖化血红蛋白（hemoglobin A1c， HbA1c）、低血糖事件、治疗满意度的影响，并观察甘精胰岛素治疗方案对上述老年综合征的影响。 结果 132例老年门诊及病房住院的75岁以上T2DM患者功能障碍者高达50.0%（66例），罹患包括轻度认知功能障碍在内的痴呆比例为39.4%（52例）；合并抑郁症28.0%（37例）；营养失衡30.0%（39例）。33例患者符合甘精胰岛素治疗纳入标准，经过2年的随访发现，以甘精胰岛素为基础的治疗方案在适当降低HbA1c水平时，不增加老年综合征的患病率，但可以减少胰岛素多次皮下注射的次数，降低低血糖事件发生次数（由1.58次/例降为0.81次/例），提高患者治疗满意度。 结论 75岁以上T2DM患者合并老年综合征的比例高，老年综合评估能及时发现老年综合征；以甘精胰岛素为基础的治疗方案不增加老年综合征的发生，并能显著降低低血糖事件数、改善营养状态、提高患者对治疗的满意度。【Abstract】 Objective To screen geriatric syndrome in patients older than 75 years with type 2 diabetes mellitus (T2DM) by the method of comprehensive geriatric assessment, and observe the impact of glargin-based therapy on geriatric syndrome, blood glucose level, the event of hypoglycemia and treatment satisfaction degree in patients older than 75 years with T2DM who suffered at least one kind of Geriatric syndromes. Methods From December 2005 to December 2009, activity of daily living (ADL), instrument activity of daily living (IADL), mini-mental state examination, geriatric depression scale and mini-nutritional assessment in comprehensive geriatric assessment were used to assess daily living ability, cognitive function status, emotional disorder and nutritional status of out/in-patients older than 75 years with T2DM in the Department of Geriatrics. Cross-sectional study was carried out to investigate geriatric syndromes such as combined functional disorder, dementia, depression, nutritional disorder and impairment falls in those patients, and patients with T2DM combined with at least one kind of geriatric syndrome and another kind of combined disease were screened out. A glargin-based anti-hyperglycemic therapy was carried out for those patients with poor blood glucose control limited remaining life time. The effects of this therapy on hemoglobin A1c (HbA1c), the event of hypoglycemia and treatment satisfaction degree of the patients were studied through a self-comparison method. Then, its effect on the above-mentioned geriatric syndromes was observed. Results Among all the 132 out/in patients older than 75 years with T2DM, the prevalence rates of functional disorder (including ADL and IADL), dementia including mild cognitive disorder, depression, and malnutrition were respectively 50.0% (66), 39.4% (52), 28.0% (37), and 30.0% (39). Only 33 patients met the criteria of glargin-based treatment. After 2 years of follow-up, we found that the glargin-based treatment could properly decrease the level of HbA1c without increasing the prevalence rate of geriatric syndrome. Moreover, it could reduce the frequency of insulin injection and the events of hypoglycemia, and treatment satisfaction degree was also significantly improved. Conclusions Geriatric syndrome has a relatively high prevalence rate in patients older than 75 years with T2DM. Comprehensive geriatric assessment is beneficial in finding out the geriatric syndrome, and glargin-based hypoglycemic therapy can significantly reduce the events of hypoglycemia, improve nutritional status, and increase treatment satisfaction degree without increasing the rate of geriatric syndrome .
ObjectiveTo observe the effect of rosiglitazone on cognitive function, serum high sensitive C reactive protein (hs-CRP) and expression of nuclear factor-κB (NF-κB), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) in hippocampal tissues of senile diabetic rats. MethodsThirty aged Wistar rats (20-22 months) were randomly divided into normal control group (n=6), diabetic model group (n=12), and rosiglitazone treatment group (n=12). Streptozotocin-induced diabetic rat model was established. In the rosiglitazone treatment group, the rats were treated with rosiglitazone 4mg/kg/d for 8 weeks. The cognitive function of rats was evaluated with the Morris water maze test. Serum hs-CRP was detected by ELISA. The expression of NF-κB in hippocampal tissues was detected by western blot and IL-6 and TNF-α by Real-time PCR. ResultsThe Morris water maze test showed that escape latency was longer in the rosiglitazone treatment group and the diabetic model group than that in the control group (P<0. 05). Compared with the diabetic model group, the rosiglitazone treatment group showed a significant decrease in the average time of escape latencies (P<0.05), and an increased percentage of time spent in the central area and the more times navigating the original platform position (P<0.05). Serum hs-CRP and the expression of NF-κB, IL-6 and TNF-α in the rosiglitazone treatment group and the diabetic model group was significantly higher than those in the control group (P<0.01). Compared with the diabetic model group, serum hs-CRP and the expression of NF-κB, IL-6 and TNF-α in the rosiglitazone treatment group was decreased (P<0.05). ConclusionCognitive impairment in senile diabetic rats is associated with serum hs-CRP. The cognitive function can be improved with rosiglitazone treatment. The protective mechanisms may be related to the decrease of serum hs-CRP, inhibition of NF-κB signal and down-regulation of the expression of IL-6 and TNF-α in hippocampal tissues.
Objective To investigate and assess the current status of communication between medical students and old patients so as to improve the communication skills of medical students. Methods A total of 90 medical students were surveyed by a questionnaire. Data analysis was performed with SPSS 13.0 software. Results Medical students have recognized the importance of communication with patients, but they rarely had active communication behaviors. In addition, their knowledge of communication skills was utterly inadequate. Conclusion It is necessary to strengthen the training of communication skills among medical students.