ObjectivesTo systematically review the efficacy of problem-based learning (PBL) model in clinical oncology teaching.MethodsPubMed, EMbase, CNKI, WanFang Data, CBM databases were electronically searched to collect randomized controlled trials (RCTs) of PBL model used in clinical oncology teaching in China from January, 2000 to March, 2019. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software.ResultsA total of 29 RCTs involving 2 238 subjects were included. The results of meta-analysis showed that: PBL model in clinical oncology teaching was superior to traditional lecture-based learning (LBL) model on the total score (MD=6.50, 95%CI 4.44 to 8.55, P<0.000 01), theoretical knowledge score (MD=4.58, 95%CI 3.38 to 5.78, P<0.000 01), case analysis score (MD=4.26, 95%CI 3.38 to 5.78, P<0.000 01), skill operation score (MD=6.10, 95%CI 4.77 to 7.43, P<0.000 01), overall course satisfaction (RR=1.74, 95%CI 1.34 to 2.27, P<0.000 01), increased learning interest (RR=1.52, 95%CI 1.28 to 1.81, P<0.000 1), improved teamwork cooperation (RR=1.67, 95%CI 1.39 to 2.01, P=0.002), and improved self-study ability (RR=1.51, 95%CI 1.20 to 1.90, P<0.000 1), the differences were statistically significant.ConclusionsCurrent evidence shows that the PBL model can improve clinical teaching effect of oncology and learning satisfaction. Due to limited quality and quantity of the included studies accumulated, more high quality studies are required to verify above conclusion.
Objective To establish a model for prognosis analysis of severe community-acquired pneumonia in order to find the independent risk factors for mortality. Methods The data of 88 patients with severe community-acquired pneumonia enrolled from 533 community-acquired pneumonia patients in Fujian Provincial Hospital from April 2012 to December 2015 were analyzed, they were divided into a survival group and a death group according to prognosis. The clinical materials of basic data of the population, clinical manifestation, treatment and prognosis and pulmonary severity indexes were collected. Then univariate analysis was used to screen risk factors of death before logistic multivaritae regression was applied to explore independent risk factors. Results The different pathogen groups including viral, bacterial, mixed infection, negative and other groups were compared and no differences were found in mortality (all P>0.05). Univariate analysis revealed antibiotics treatment before admission, higher APACHEⅡ score, higher Chalison's score, septicopyemia, and higher level of procalcitonin, blood urea nitrogen (BUN), blood glucose, lactate could increase death risk for the patients. While antiviral treatment and no invasive mechanical ventilation were determined as protective factors. Logistic multivaritae regression showed three factors including higher lactate and higher serum BUN and higher heart rates were independent death risk factors [OR values were 4.704 (95%CI 0.966-22.907), 1.264 (95%CI 0.994-1.606), and 1.081 (95%CI 1.003-1.165), respectively]. Whereas no invasive mechanical ventilation was protective factor (OR=0.033, 95%CI 0.001-0.764). Conclusion The patients with higher lactate and BUN, higher heart rate and accepting invasive mechanical ventilation have poor prognosis.