ObjectiveTo systematically review the prognostic efficacy and safety of patients with ovarian cancer treated with systemic lymphadenectomy (SL). MethodsPubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the prognostic outcomes of patients with ovarian cancer treated with SL from inception to December 16th, 2020. Six reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.4 software. ResultsA total of 5 RCTs and 23 cohort studies involving 6 166 patients were included. The results of meta-analysis showed that there were no significant differences in the 3-year survival rate, 5-year survival rate, 3-year progression-free survival rate, and 5-year progression-free survival rate between SL group and the no systemic lymphadenectomy (NSL) group. The results of the subgroup analysis showed that pelvic and para-aortic lymph node dissection combined with large omentum resection had a better prognosis for patients. ConclusionsCurrent evidence shows that SL has no significant efficacy on survival and progression-free survival in patients with ovarian cancer. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
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.
ObjectiveIn order to summarize the best evidence, evaluate the efficacy and safety of interventions for the treatment of COVID-19, and provide practical guidance for medical workers, public health workers, and COVID-19 patients, we formulated the evidence-based practice points. MethodsWe followed the "Evidence-based practice points: methods and processes of development", with comprehensively considering the pros and cons of evidence, quality of evidence, public and patient preferences and values, cost of interventions, acceptability, and feasibility based on systematic reviews. Practice points Finally, 12 practice points were formed for non-severe, severe and critical COVID-19 patients. Non-severe: ① Consider Hanshiyi formula or Gegenqinlian pills for patients with nausea, vomiting and diarrhea; ② Consider Huashibaidu granules (decoration), Jinyinhua oral liquid, Jinhuaqinggan granules, Xuanfeibaidu granules (decoration), Lianhuaqingwen capsules (granules), or Reyanning mixture for patients with sore throat, fever, muscle aches or cough; ③ Consider Qingfeipaidu granules (decoration) for patients with nasal congestion, runny nose, cough, low-grade fever, aversion to wind and cold, and fatigue; ④ Consider Toujiequwen granules for patients with fever, chills, itchy throat, cough, dry mouth and throat, and constipation; ⑤ Consider Reduning injection or Xiyanping injection for patients with high fever, mild aversion to wind and cold, headache and body pain, cough, and yellow phlegm; ⑥ Consider molnupiravir, nirmatrelvir–ritonavir (Paxlovid), remdesivir or VV116 for patients within 5 to 7 days of the onset of symptoms and at high risk for progressing to severe disease. Severe: ① Consider Shenhuang granules or Xuebijing injection for patients with high fever, irritability, and thirst; ② Consider remdesivir used as soon as possible for patients with severe symptoms. Critical severe: Consider corticosteroids, IL-6 receptor inhibitors, and baricitinib for patients 7 days after the onset of symptoms.
In the clinical evidence-based decision-making process, factors including benefits and harms, evidence certainty, cost and feasibility of interventions should be considered based on the best evidence. The development of decision threshold of effect size (DTES) for patient health outcomes can help stakeholders understand the benefits and harms of interventions, assess evidence certainty, and interpret research results. Based on international experience, the MERGE Working Group through group discussions, semi-structured interviews, expert consensus, and pilot application developed a set of 8-step guidelines for the development of DTES for health outcomes. These steps included necessity assessment, formation of working groups, selection of patient important outcomes, creation of scenarios based on the best evidence, design of expert consultation questionnaires, analysis of expert consultation results, face-to-face expert consensus, dissemination of the application and reevaluation. The DTES guideline development is intended to provide methodological guidance for stakeholders to develop DTES for health outcome indicators in different domains.