At present a better way for the treatment of SARS is to search and apply the best evidence that comes from the same kind of diseases and symptoms in the past and include personal experiences of clinicians. The intervention should be adjusted with the development of basic research. In this paper the important of projects are predicted and necessity of randomized controlled trials are discussed emphasizing scientific value of case reports and case series for such disease. It is essential to well justify priority and integrate resources for the trials against SARS.
Objective To evaluate the quality of clinical studies on dentistry from the Chinese Journals. Methods Clinical studies in Chinese Journal of Conservative Dentistry of 2002 were searched. The quality of the clinical studies on assessment of treatments’ efficacy was evaluated. Results Among 204 related studies from 12 issues, there were 93 (45.58%) restrospective intervention studies, 6 randomized controlled blinded trials (2.94%), 42 randomized trials without blindness (20.58%), 20 controlled trials without randomization (9.80%) and 25 clinical observational studies (12.25%). The statistical analysis showed that 20 studies were with inappropriate methods. Conclusions It is necessary to improve the design and statistical analysis of clinical studies on stomatology in China to produce high-quality research evidence.
Objective To investigate problems in applying clinical epidemiology and evidence-based medicine in the field of dentistry in China. Method In early April of 2001, about 200 copies of a questionnaire were sent to chief editors of dental journals, directors and famous experts of the university dental schools and/or dental departments of the provincial/metropolitan hospitals located in the mainland of China. The sent back questionnaires were summarized and analysized. Results At the end of June, 2001, 40 replies from the experts of 12 universities and one metropolitan dental hospital were received. The main points are summarized as following: EBM in China is at starting stage of "anti-illiteracy" campaign. There are 6 out of 12 universities having delivered clinical epidemiology courses to postgraduates (2 to undergraduates), only 3 added lectures on evidence-based medicine to dental students and/or professionals, only one university held intensive training courses on EBM to clinicians. In dental practice there are still scram dentists making decisions simply by experiences. In the research practice some dentists are eager for quick success, and instant benefits, ignoring, scientific design aid quality control of the studies. Randomized controlled clinical trials are seldom appeared in Chinese dental journals. To popularize EBM in all dental clinicians is important for them to use and produce the best evidences. Conclusions EBM in dental field of China is at starling stage. Collection and dissemination of best dental evidences in dental professionals is a key to raise the dental care levels in China.
Objective To assess the effectiveness of intraarticular injection of hyaluronate (HA) on temporomandibular disorders (TMD). Methods Searching various databases available, handsearching 15 Chinese dental journals to find articles, abstracts and unpublished literature with randomized or quasi-randomized design on the effects of intraarticular injection of HA on TMD.Data extraction, appraisal, and the methods for Meta-analysis were conducted based on the Cochrane guidelines. Results 12 RCTs and 2 CCT on TMD and 1 RCT on rheumatoid arthritis involving temporomandibular joints (TMJ) were located, 10 of them fulfilled inclusion criteria in which 561 patients were reported.Except 71 cases with only qualitative data, 490 cases could be calculated in Meta-analysis: 277 on HA, 113 on placebo or non-treatment (PL) and 100 on corticosteroids (CO). In comparison with PL, HA injection showed no statistically significant effect on short and long term improvement of symptoms, and short term improvement of VAS as well. But it presented significant better effects than PL in short and long term improvement of clinical signs, especially mouth opening. When sensitivity analysis was conducted for improvement of short term signs, the conclusion was not stable. Comparison of the effect between HA and CO showed the same efficacy levels. Adverse reactions of HA were mild and transient. Conclusions HA may improve short and long term clinical signs of TMD and have only mild and transient adverse reactions. However, more RCTs are needed to confirm its therapeutic effect.
Objective To assess the evidence of Cochrane systematic reviews on the treatment of temporomandibular disorders (TMD) as well as the methodological quality of all randomized controlled trials (RCTs) of the included systematic reviews. Methods The Cochrane Library (Issue 3, 2008) was searched for systematic reviews on the treatment of temporomandibular disorders. The risk of bias was assessed independently by two authors. Results Three systematic reviews involving 25 RCTs were included. The methods of 23 studies were rated as of lower quality with high risk of various biases. Only 2 studies were of high quality. Conclusion There is insufficient or inconsistent evidence to support the use of hyaluronate, occlusal adjustment, and stabilization splint therapy for the treatment of TMD. The overall quality of RCTs about the treatment of TMD is generally low. Analysis of the included trials showed that some trials had no clear description of randomization methods, allocation concealment, sample size calculation, and intention-to-treat analysis. To improve the quality of the reporting of RCTs, clinical trial registration and the revised Consolidated Standards of Reporting Trials (CONSORT) statement should be introduced into the trial design and strictly followed.
This article mainly introduced the purpose and scope relating to the 11 Cochrane methods groups for Cochrane systematic reviews and encourage more people to contribute to the research on methodology.
Objective To hand search all formally published articles on randomized controlled clinical trials (RCT) and controlled clinical trials (CCT) for inputting into the database of Chinese Cochrane Center (CCC) and the Central Database of Cochrane Collaboration. Method All Chinese dental journals of the mainland of China that started publication before the end of 1996 were hand searched page by page. Criteria of RCT and CCT were based on the guideline of Cochrane Oral Health Group. All included articles were copied and the titles of the articles and names of the journals were translated into English and input to Procite for submission. A senior professional monitored the process and checked the translation item by item. Results Fifteen dental journals were included. One started from 1953, six from 80s, and the rest from 90s. Ten of them were listed by Ministry of Science and Technology as part of the government database for scientific articles. From 1953 to 1990, 42 RCTs and 97 CCTs were found in 291 journal issues, from 1991-1995, 157 RCTs and 154 CCTs in 241 issues, from 1996-2000 358 RCTs and 264 CCTs in 316 issues. In the three periods, the average RCTs per journal issue were 0.14, 0.65, 1.13 respectively, the averages of CCTs per issue were 0.33, 0.64, 0.84 respectively. The ratios of RCT to CCT are 0.43, 1.02, 1.36 respectively which showed greatly increasing along with time. There are 113 articles accounting 10.54% of the total specially for testing the effect of various Chinese traditional medicines and therapies. The common problems for the searched RCTs and CCTs is small sample size, insufficient descriptions on randomization and concealment, compliance and drop outs. Some titles were improperly written such as using trade name of drugs etc. In translation into English, some words indicating category or main components of the drugs were added. Conclusions In comparison of one fourth of the world population and more than 30 thousands dental professionals of China, 557 RCTs and 515 CCTs in dental literature are quite small number but the increasing speed is encouraging. More effort should be offered to spread knowledge of evidence-based medicine (EBM) to the dental care workers of China to produce more evidences. RCTs and/or CCTs should be good tools to determining real effects of traditional Chinese medicines in dental fields to make them applicable to all.
Objective A systematic review was conducted based on the domestically published literature for improving the quality of oral nursing care.Methods The terms "oral nursing care", "oral hygiene care", "mouth care" were used to search related studies in Chinese databases (up to April 30, 2004) along with handsearching additional studies. Four authors screened and selected the studies, appraised the methodological quality and extracted data from these selected studies. The results were presented by description or Meta-analysis. Results A total of 28 studies were identified, of which 6 were excluded. The methodological quality varied among the studies, 7 scored as B, 15 as C (11 randomized controlled trials, 4 quasi-randomized trials). A total of 2 372 patients were observed including some were critically ill, or intubated, or receiving radiotherapy or chemotherapy or undergoing surgical operations.Six authors of RCT replied and four of them provided more information on methods of randomization. Data analysis revealed that traditional oral nursing procedure was suitable for the severely sick patients who could not take self-care. Brushing and gargling were suitable for conscious patients who could use their hands. Tea and toothpaste were safe, economical and convenient oral nursing agents. Oral pH was a useful index for the selection of oral nursing agents and mouthwashes. A gargle containing sodium bicarbonate was used in the acidic oral environment and reduced fungal infection. The mouthwash with tea polyphenols had good effect for oral health, and might be as the first choice for prophylaxis of stomatitis induced by radiotherapy and/or chemotherapy. Some mouthwashes developed by Chinese herbs improved oral health efficiently. Some disinfectants with good safety and low toxicity might be used as supplementary agents in oral nursing care. Conclusions Oral nursing care procedures have improved the efficiency of oral care. But the conclusion should be verified by more, well designed randomized controlled trials involving a collaborative multidiscipliary health care professionals. Oral nursing care practice needs to be evidence based.
The data collection form is a bridge in-between the original studies and the final systematic reviews. It’s the basis for data analyses, directly related to the results and conclusions of systematic reviews, and plays an important role in systematic reviews. There are strict requirements of data collection forms in making Cochrane systematic reviews. In this article, the authors introduce their experiences regarding to the design of data collection form.
Objective To explore the type and frequency of oral care practice in intensive care units (ICUs) in Mainland China, and to provide evidence and suggestions for improving oral care practice. Methods Three survey methods, including mailing questionnaires to ICUs of Grade 3A hospitals, consulting experts in this field and visiting accessible ICUs, were used to survey current oral care practice in Mainland China. Results A total of 184 questionnaires were given to the subjects, of which 79 effective ones were collected, and the response rate was 42.93%. All 79 respondents considered oral care very unimportant, and 98.7% of the ICUs performed oral care in different ways. Currently, the cotton ball wipe-off method was the most frequently used for oral care (62.5%), with an average (9.1± 5.1) min per time, twice or three times daily. The mouthwashes often used were saline (76.1%), solutions containing sodium bicarbonate (22.8%), furacilin (13.9%), and hydrogen dioxide (13.9%). Conclusion The oral care practice for the critically-ill patients in ICUs of China is unsatisfactory, although it is perceived as an important item in nursing care. More evidence–based training should be given and it is necessary to establish a national oral care guideline for critically-ill patients.