Patients with early Parkinson＇s disease should be treated rationally in order to improve their quality of life and reduce the motor complications. The early employment of drugs which provides sustained central dopamine agonism and dopaminergic neuroprotection may reach this aim to some extent. Evidence of effective therapy in early Parkinson＇s disease will be introduced including： dopamine agonists, monoamine oxidase inhibitor 13, coenzymeQ10, L-dopa and a gait training.
Objective To give an individualized treatment to a young woman with primary dysmenorrhea. Methods According to the basic principle and methods of evidence-base medicine, we searched The Cochrane Library (Issue 1, 2009), MEDLINE (PubMed, January 1950 to May 2009), ACP Journal Club (OVID, January 1991 to May 2007) for systematic reviews and randomized controlled trials (RCTs) to acquire the best clinical evidence on the treatment of primary dysmenorrhea. Results A total of 11 systematic reviews and 1 RCT were identified. A reasonable treatment plan was made through combining the patient’s will with her family members’. Conclusion The treatment effect on primary dysmenorrhea of the young woman is improved by an individualized treatment plan based on an evidence-based method.
①供体授精:我们发现,在供体授精的效果方面,尚缺乏高质量证据.②胞浆内精子注射+体外授精:1篇系统评价发现,尚无足够的证据说明胞浆内精子注射+体外授精与单独使用体外授精何者效果更好.③宫腔内人工授精:两篇系统评价发现,宫腔内人工授精较宫颈内授精或自然性交,能明显增加每个周期的妊娠率.④体外授精与配子输卵管内移植:1个RCT显示,尚无足够证据证明体外授精与配子输卵管内移植何者效果更好.
①关于药物引起的卵巢抑制:1篇系统评价发现,使用卵巢抑制药治疗子宫内膜异位症与安慰剂或达那唑相比,妊娠率无明显差异.该评价还发现,卵巢抑制药引起的不良反应包括体重增加、潮热和骨质疏松症,达那唑可能引起剂量相关的体重增加和雄激素样作用. ②宫腔内人工授精+促性腺激素:1个RCT发现,宫腔内人工授精+促性腺激素治疗与不治疗相比,可明显提高活产率.第2个RCT发现,期待疗法与宫腔内人工授精+垂体降调节+促性腺激素治疗后的分娩率无明显差异.第3个RCT发现,宫腔内人工授精+促性腺激素治疗与单用宫腔内人工授精相比,仅明显提高妊娠率. ③体外受精:我们没有找到关于子宫内膜异位症引起不孕妇女接受受精体外治疗的RCT. ④手术治疗:两个比较腹腔镜手术与诊断性腹腔镜的RCT发现,在妊娠率和活产率方面结论不一.
Objective To find the most effective treatment for a patient with difficult selective biliary cannulation (DSBC) during endoscopic retrograde cholangiopancreatography (ERCP) by EBM practice. Methods Evidence was retrieved from The Cochrane Library (Issue 1, 2010), ACP online, NGC (1998 to June 2010), PubMed (1950 to June 2010), and CBM (1994 to June 2010). The collected evidence was then graded. Results After preliminary research, we identified 18 relevant articles. The evidence showed that pre-cutting technique could increase cannulation success rates in DSBC and was safe, effective, and time-saving for an experienced endoscopist. Pancreatic duct occupation was easier to perform than pre-cutting technique and could also increase selective cannulation success rates in DSBC. According to the evidence, together with endoscopist’s experience and the preference of the patient and his family, needle-knife precut papillotomy was performed. Successful selective biliary cannulation was accomplished after pre-cutting. Conclusion The current evidence suggests that pre-cutting technique and pancreatic duct occupation could increase selective cannulation success rates in DSBC. Patients’ condition and endoscopist’s experience should be considered properly before the operation.
Objective To provide evidence of the role of helicobacter pylori eradication in the treatment of functional dyspepsia. Methods We searched VIP, CBMdisc, MEDLINE and The Cochrane Library for systematic reviews, meta-analysis, randomized controlled trials and clinical guidelines involving helicobacter pylori and functional dyspepsia, so as to provide the best evidence for clinical practice. Results We included two systematic reviews, one meta-analysis and eleven randomized controlled trials. The evidence identified showed that helicobacter pylori infection was more prevalent in functional dyspepsia than in asymptomatic patients, but the effect of H pylori infection in the pathogenesis of functional dyspepsia remained controversial. H pylori eradication therapy had a relatively weak effect in H pylori positive functional dyspepsia. An economic model suggested that this modest benefit may still be cost-effective, but more studies are needed to assess this. Conclusion According to the current evidence, it can be concluded that helicobacter pylori eradication for the treatment of functional dyspepsia should be individualized.
To explain how to treat common gastric diseases like chronic gastritis, peptic ulcer, functional dyspepsia and gastric oesophageal reflux disease (GORD) based on evidence-based medicine. Through this paper, we try to help readers find and use clinical evidence to solve clinical problems.
Having searched The Cochrane Library (Issue 4, 2005), we found: fluoride can reduce the occurrence and severity of white spot lesions; removal of premature contacts of the primary teeth can prevent posterior crossbite; expanding the top teeth can decrease the risk of a posterior crossbite; CSF may help retaining teeth; clear overlay retainer may settle teeth quicker than Hawley retainer; adhesives for fixed orthodontic brackets is still in dispute.
Evidence-based dentistry has been established for more than a decade, and described as ‘the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients＇. However, Orthodontic clinicians in China still tend to base their treatment protocols on the ‘it works in my hands＇evidence provided by their peers, mainly due to their weak experience in searching and applying clinical evidences. In this article, authors are willing to share their experience with their Chinese peers, and to promote the dissemination and application of evidence-based orthodontics in clinical practice.