背景中西医结合治疗腰痛的疗效显著,复合结局指标——有效率作为重要的疗效观察指标,在临床研究中尚未得到统一规范。目的系统回顾以有效率为复合结局指标的中西医治疗慢性腰痛的临床研究,分析其中有效率的定义和具体内容,为后期研究合...背景中西医结合治疗腰痛的疗效显著,复合结局指标——有效率作为重要的疗效观察指标,在临床研究中尚未得到统一规范。目的系统回顾以有效率为复合结局指标的中西医治疗慢性腰痛的临床研究,分析其中有效率的定义和具体内容,为后期研究合理地选择慢性腰痛的复合结局指标提供参考。方法计算机检索Web of Science、PubMed、EMBase、Cochrane Library、中国期刊全文数据库、维普网、万方数据知识服务平台和中国生物医学文献服务系统关于中西医治疗慢性腰痛的临床研究,检索时限为2015—2019年。由2名研究者根据纳入、排除标准独立排除不符合纳入标准的文献,根据BPICOS原则提取文献中的内容,并对复合结局指标(有效率)的判定标准进行回顾与总结。结果共纳入研究830篇,以腰肌劳损患者作为研究对象的最多,共178篇(21.4%),其他研究对象包括第三腰椎横突综合征患者103篇(12.4%)、腰椎间盘突出患者91篇(11.0%)、腰背痛患者89篇(10.7%)、腰背肌筋膜炎患者72篇(8.7%)、腰椎管狭窄患者69篇(8.3%)、腰椎滑脱患者61篇(7.3%)。830篇研究中808篇(97.3%)具体表述了有效率的参照标准或自定义评判标准,其中参考最多的是不同版本的《中医病证诊断疗效标准》,共271篇(32.7%)。在复合结局指标中使用最多的是临床症状、活动功能、疼痛、体征、工作生活能力这5项评判指标,常见以2~5项指标随意结合成三级或四级疗效评判标准,此外,常见的腰痛测量工具也被应用其中。结论由于缺乏统一的规范化标准,中西医治疗腰痛的临床研究在使用复合结局指标——有效率时存在诸多问题,例如定义、划分标准、评价项目等不统一,笔者认为有效率这一复合结局指标可通过核心结局体系(COMET)进一步规范,并提高其效度形成统一标准以供临床研究使用,以提高中西医临床研究的质量与价值。展开更多
AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were en...AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were enrolled. Sequential Organ Failure Assessment (SOFA) score was assessed immediately preceding the start of the study. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded on the first, fourth, seventh, and fourteenth day of the study period. GRV was measured every 4 h during enteral feeding. The relationship be-tween mean daily GRV and SOFA scores and the correlation between mean daily GRV and mean APACHE Ⅱ score of all patients were evaluated and compared. RESULTS: Of the 61 patients, 43 patients were survivors and 18 patients were non-survivors. The mean daily GRV increased as SOFA scores increased (P < 0.001, analysis of variance). Mean APACHE Ⅱ scores of all patients correlated with mean daily GRV (P = 0.011, Pearson correlation) during the study period. Patients with decreasing GRV in the first 2 d had better survival than patients without decreasing GRV (P = 0.017, log rank test). CONCLUSION: GRV is higher in more severely ill medical ICU patients. Patients with decreasing GRV had lower ICU mortality than patients without decreasing GRV.展开更多
To validate the use of the Index of Complexity, Outcome and Need （ICON） in assessing orthodontic treatment need among 12-13 year-olds in southern China, we determined the threshold value of ICON based on Chinese ort...To validate the use of the Index of Complexity, Outcome and Need （ICON） in assessing orthodontic treatment need among 12-13 year-olds in southern China, we determined the threshold value of ICON based on Chinese orthodontists＇ judgments. The samples consisted of 335 students in grade 7 from 16 randomly selected middle schools in Chengdu, China. Three associate professors provided ICON scores for each participant and the results were compared with the gold standard judgments from 25 experts on treatment needs. Based on the gold standard, 195 casts belonged to the treatment category, while the rest 140 belonged to the no-treatment category. With the international cutoff point of 43, the sensitivity and specificity of the iCON score were 0.29 and 0.98. The best compromise between sensitivity and specificity in Chengdu, compared with the gold standard, was found at a cutoff point of 29, and the sensitivity and specificity were 0.88 and 0.83. When used to evaluate the treatment need of 12-13 year-olds in southern China, the international ICON cutoff value did not correspond well with Chinese orthodontists＇ judgments; a lower cutoff value of 29 offered a ~reater sensitivitv and soecificitv with respect to exoert orthodontists＇ oerceotion of treatment need.展开更多
文摘背景中西医结合治疗腰痛的疗效显著,复合结局指标——有效率作为重要的疗效观察指标,在临床研究中尚未得到统一规范。目的系统回顾以有效率为复合结局指标的中西医治疗慢性腰痛的临床研究,分析其中有效率的定义和具体内容,为后期研究合理地选择慢性腰痛的复合结局指标提供参考。方法计算机检索Web of Science、PubMed、EMBase、Cochrane Library、中国期刊全文数据库、维普网、万方数据知识服务平台和中国生物医学文献服务系统关于中西医治疗慢性腰痛的临床研究,检索时限为2015—2019年。由2名研究者根据纳入、排除标准独立排除不符合纳入标准的文献,根据BPICOS原则提取文献中的内容,并对复合结局指标(有效率)的判定标准进行回顾与总结。结果共纳入研究830篇,以腰肌劳损患者作为研究对象的最多,共178篇(21.4%),其他研究对象包括第三腰椎横突综合征患者103篇(12.4%)、腰椎间盘突出患者91篇(11.0%)、腰背痛患者89篇(10.7%)、腰背肌筋膜炎患者72篇(8.7%)、腰椎管狭窄患者69篇(8.3%)、腰椎滑脱患者61篇(7.3%)。830篇研究中808篇(97.3%)具体表述了有效率的参照标准或自定义评判标准,其中参考最多的是不同版本的《中医病证诊断疗效标准》,共271篇(32.7%)。在复合结局指标中使用最多的是临床症状、活动功能、疼痛、体征、工作生活能力这5项评判指标,常见以2~5项指标随意结合成三级或四级疗效评判标准,此外,常见的腰痛测量工具也被应用其中。结论由于缺乏统一的规范化标准,中西医治疗腰痛的临床研究在使用复合结局指标——有效率时存在诸多问题,例如定义、划分标准、评价项目等不统一,笔者认为有效率这一复合结局指标可通过核心结局体系(COMET)进一步规范,并提高其效度形成统一标准以供临床研究使用,以提高中西医临床研究的质量与价值。
基金Supported by Kaohsiung Veterans General Hospital, Grant No.VGHKS 94-082
文摘AIM: To investigate whether illness severity has an impact on gastric residual volume (GRV) in medical critically ill patients. METHODS: Medical intensive care unit (ICU) patients requiring nasogastric feeding were enrolled. Sequential Organ Failure Assessment (SOFA) score was assessed immediately preceding the start of the study. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded on the first, fourth, seventh, and fourteenth day of the study period. GRV was measured every 4 h during enteral feeding. The relationship be-tween mean daily GRV and SOFA scores and the correlation between mean daily GRV and mean APACHE Ⅱ score of all patients were evaluated and compared. RESULTS: Of the 61 patients, 43 patients were survivors and 18 patients were non-survivors. The mean daily GRV increased as SOFA scores increased (P < 0.001, analysis of variance). Mean APACHE Ⅱ scores of all patients correlated with mean daily GRV (P = 0.011, Pearson correlation) during the study period. Patients with decreasing GRV in the first 2 d had better survival than patients without decreasing GRV (P = 0.017, log rank test). CONCLUSION: GRV is higher in more severely ill medical ICU patients. Patients with decreasing GRV had lower ICU mortality than patients without decreasing GRV.
文摘To validate the use of the Index of Complexity, Outcome and Need （ICON） in assessing orthodontic treatment need among 12-13 year-olds in southern China, we determined the threshold value of ICON based on Chinese orthodontists＇ judgments. The samples consisted of 335 students in grade 7 from 16 randomly selected middle schools in Chengdu, China. Three associate professors provided ICON scores for each participant and the results were compared with the gold standard judgments from 25 experts on treatment needs. Based on the gold standard, 195 casts belonged to the treatment category, while the rest 140 belonged to the no-treatment category. With the international cutoff point of 43, the sensitivity and specificity of the iCON score were 0.29 and 0.98. The best compromise between sensitivity and specificity in Chengdu, compared with the gold standard, was found at a cutoff point of 29, and the sensitivity and specificity were 0.88 and 0.83. When used to evaluate the treatment need of 12-13 year-olds in southern China, the international ICON cutoff value did not correspond well with Chinese orthodontists＇ judgments; a lower cutoff value of 29 offered a ~reater sensitivitv and soecificitv with respect to exoert orthodontists＇ oerceotion of treatment need.
