ObjectiveTo systematically review the outcomes reported in clinical trials of post-stroke dysarthria.MethodsPubMed, The Cochrane Library, EMbase, CNKI, Sinomed, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of post-stroke dysarthria from inception to December 6th, 2019. Two reviewers independently screened literature, extracted data and analyzed outcomes using qualitative method.ResultA total of 112 RCTs involving 39 outcomes (therapeutic effect assessment outcomes and safety outcomes) were included. The top 4 outcomes were the Frenchay dysarthria assessment scale, the dysarthria examination method developed by the Chinese rehabilitation center, the evaluation of the speech therapists or clinicians and GRBAS.ConclusionsCurrent evidence shows that there is no acceptable outcomes for post-stroke dysarthria. It is recommended to improve the suitable assessment scale for Chinese to improve quality of studies on post-strohe dysarthria.
ObjectiveTo compare the clinical effectiveness of Chinese medicine and integrated Chinese medicine and antimicrobial drugs in the treatment of pneumonia. MethodsThe electronic medical record (EMR) of patients with pneumonia who admitted to the Classical Department of Chinese Medicine of Guangdong Hospital of Traditional Chinese Medicine from November 29, 2012 to June 17, 2022 were retrospectively collected. The patients were divided into two groups according to whether they were treated with antimicrobial drugs on the basis of Chinese medicine treatment. The non-exposed group was the traditional Chinese medicine group, and the exposed group was the integrated Chinese medicine and antimicrobial drugs group. Propensity score matching method was used to balance possible confounding factors. COX regression analysis was performed on the matched cohort to compare death rates among the groups, and Kaplan-Meier curve was drawn to evaluate the survival probability during hospitalization. The proportion of maximum oxygen concentration and duration of fever remission were compared between the two groups. ResultsThis study included a total of 898 cases, with the majority (over 95%) falling within the range of mild to moderate severity. After propensity score matching,180 patients were remained in each group, among which the baseline characteristics were comparable. The primary outcome indicators showed that the risk of death during hospitalization was higher in the integrated Chinese medicine and antimicrobial drugs group than in the Chinese medicine group (HR=1.52, 95%CI 0.36 to 6.39, P=0.566), the subgroup analysis is consistent with the overall trend of the results, and the differences are not statistically significant. The results indicate that during the hospitalization, the overall and subgroup mortality rates were similar between the two groups. The treatment effectiveness on the disappearance of major symptoms such as fever, cough, sputum production, fatigue, shortness of breath, and chest pain were comparable in both groups. The secondary outcome indicators showed that there was no statistical significance in the comparison of the proportion of maximum oxygen therapy concentration and the stable duration of fever remission between the two groups. ConclusionIn the treatment of patients with mainly mild to moderate pneumonia, the effectiveness of the Chinese medicine group and the integrated Chinese medicine and antimicrobial drugs group in the hospitalization mortality, the disappearance of major symptoms, the proportion of maximum oxygen therapy concentration and the stable duration of fever remission are similar. Chinese medicine has a positive significance in reducing the use of antimicrobials in patients with pneumonia.
Acute diarrhea has a high incidence in children. Pediatric tuina has been widely used in children with acute diarrhea in China. However, there is no guideline on the treatment of tuina for children with acute diarrhea. This guideline was developed following evidence-based principles and the World Health Organization handbook for guideline development. The linked systematic review was conducted following the Cochrane handbook. The quality of evidence and the strength of recommendations were evaluated using the GRADE approach. The reporting followed the RIGHT statement. Seven clinical questions (2 foreground questions and 5 background questions) were identified by literature review and expert consensus. Based on the linked systematic review and through comprehensive consideration of the balance of benefit and harm, quality of evidence, patient preferences, and other resources, we formulated the recommendations using Delphi expert consensus. We suggested combination of a weak recommendation for tuina with Western medicine usual care to treat children with acute diarrhea. This guideline can be used by clinicians and nurses in the department of traditional Chinese medicine pediatrics, and department of pediatric tuina, and can also be used as a reference for relevant clinicians of Western medicine and is also applicable to all institutions that practice tuina treatment.