Accuracy of urea breath test in Helicobacter pylori infection: Meta-analysis

AIM: To quantitatively summarize and appraise the available evidence of urea breath test(UBT) use to diagnose Helicobacter pylori(H. pylori) infection in patients with dyspepsia and provide pooled diagnostic accuracy measures.METHODS: We searched MEDLINE, EMBASE, Cochrane library and other databases for studies addressing the value of UBT in the diagnosis of H. pylori infection. We included cross-sectional studies that evaluated the diagnostic accuracy of UBT in adult patients with dyspeptic symptoms. Risk of bias was assessed using QUADAS(Quality Assessment of Diagnostic Accuracy Studies)-2 tool. Diagnostic accuracy measures were pooled using the random-effects model. Subgroup analysis was conducted by UBT type(13C vs 14C) and by measurement technique(Infrared spectrometry vs Isotope Ratio Mass Spectrometry).RESULTS: Out of 1380 studies identified, only 23 met the eligibility criteria. Fourteen studies(61%) evaluated 13 C UBT and 9 studies(39%) evaluated 14 C UBT. There was significant variation in the type of reference standard tests used across studies.Pooled sensitivity was 0.96(95%CI: 0.95-0.97) andpooled specificity was 0.93(95%CI: 0.91-0.94). Likelihood ratio for a positive test was 12 and for a negative test was 0.05 with an area under thecurve of 0.985. Meta-analyses were associated with a significant statistical heterogeneity that remained unexplained after subgroup analysis. The included studies had a moderate risk of bias.CONCLUSION: UBT has high diagnostic accuracy for detecting H. pylori infection in patients with dyspepsia. The reliability of diagnostic meta-analytic estimates however is limited by significant heterogeneity.

Outcomes research:science and action

Outcomes research, which investigates the outcomes of health care practices, is intended to provide scientific evidence for clinical decision making and health care. This paper elucidates the goal and domains of outcomes research. Also it shows the potential and promise of outcomes research to provide a methodology to uncover what to do and how to do it, and enable the health care profession to achieve the right care, for the right patient, at the right time, the first time, every time, nothing more, and nothing less.

Tumor necrosis factor-a and its role as a mediator in myocardial infarction:A brief review

Tumor necrosis factor-a (TNF-a) contributes to myocardial infarction (MI) injury. Polymorphism of TNF-a gene promoter region and secretion and release of TNF-a and its transformation by a series of signaling pathways are all changed at different points of pathophysiological process in MI. Researches also investigated TNF-a antagonists and their potential therapeutic role in the setting of MI and heart failure at both molecular and clinical level. This article briefly reviews TNF-a and its mechanism as a mediator in MI. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Preferences and attitudes of young Chinese clinicians about using a shared decision making tools for communicating cardiovascular risk

Objective: This study assesses the attitudes and preferences of Chinese clinicians toward their involvement in shared decision making (SDM). Methods: From May 2014 to May 2015, 200 Chinese clinicians from two hospitals were enrolled to complete a survey on their attitude towards SDM. We conducted the survey via face-to-face interviews before and after an educational intervention on SDM among young Chinese clinicians. The clinicians were asked to give the extent of agreement to SDM. They also gave the extent of difficulty in using decision aids (DAs) during the SDM process. The variation in the range of responses to each question before and after the SDM intervention was recorded. The frequency of changed responses was analyzed by using JMP 6.0 software. Data were statistically analyzed using Chi-square and Mann—Whitney U tests, as appropriate to the data type. Multiple logistic regressions were used to test for those factors significantly and independently associated with preference for an approach for each scenario. Results: Of the 200 young Chinese clinicians sampled, 59.0% indicated a preference for SDM and a desire to participate in SDM before receiving education or seeing the DA, and this number increased to 69.0% after seeing the DA with the sample video of the SDM process on Statin Choice. However, 28.5% of the respondents still reported that, in their current practice, they make clinical decisions on behalf of their patients. The clinicians who denied a desire to use the DA stated that the main barriers to implement SDM or DA use in China are lack of time and knowledge of SDM.

2型糖尿病患者强化血糖控制的利与弊

糖尿病是全球主要的健康问题,治疗花费高,有较高的发病率、致残率和死亡率,显著影响患者生活质量。绝大多数糖尿病患者属于2型糖尿病。从既往研究看,减少2型糖尿病并发症的主要策略是加强血糖控制。然而大量证据表明,除了降低非致死性心肌梗死的发生率外,强化(相对于适度)血糖控制对重要的微血管和大血管并发症预后没有显著获益。但是,严格的血糖控制却会增加严重低血糖的风险,并会增加药物种类、副作用和成本等额外负担。此外,来自心血管结局研究的数据表明,使用特定类别的降糖药可大大改善心血管、肾脏和死亡的结果,而这些效应在很大程度上不是由降糖作用带来的。因此,为2型糖尿病患者提供基于循证医学的、以患者为中心的诊疗,需要转变范式并脱离以血糖为中心的糖尿病管理观点。与其优先考虑加强血糖控制,不如将重点放在确保患者获得足够的糖尿病照护,使血糖目标和患者的目标与情况保持一致,最大程度地减少短期和长期并发症,减轻治疗负担以及改善生活质量上。

低度危险的甲状腺乳头状癌

甲状腺癌是发病率增长最快的疾病之一。每年新发的甲状腺癌病例超过白血病、肝癌、胰腺癌以及胃癌的总和。其中，原发的局灶性微小乳头状癌占新发病例的绝大多数。原发的局灶性微小乳头状癌患者的20年生存率为99％。这类肿瘤由于预后极其良好，被认为低度危险。低危甲状腺癌的发病率不断增加，很大程度上是由于影像学技术方法的进步，使得大量亚临床病例被诊断。尽管此类低危的亚临床肿瘤预后良好，但在临床实践中常被积极治疗。虽然传统观点仍认为手术是治疗甲状腺肿瘤的基本方法，但对于手术切除的范围是行甲状腺一叶切除还是次全切除，以及是否应该行预防性颈部中央区淋巴结清扫尚存在争议。放射性碘同位素治疗和促甲状腺素抑制治疗等手段也被用于这类肿瘤，这些治疗方法对于恶性程度高的甲状腺癌是有效的，然而对于低度危险肿瘤并未证明获益。这篇综述从循证医学角度阐述了低危甲状腺肿瘤的治疗方法。同时本文也着眼于讨论替代手术治疗的方法，如非手术局部微创治疗（乙醇消融和激光消融），和主动监测，为低危甲状腺乳头状癌提供个体化治疗方案。

抑郁症的非药物治疗：系统性综述与证据图

背景抑郁症非药物治疗的疗效比较目前仍然不清楚。方法我们对一些系统性综述作了概述，回顾了随机对照试验（RCT），比较抑郁症非药物治疗的有效性和认知行为治疗（CBT）。对多个电子数据库在2016年2月之前发表的所有文献进行了检索，不限制语言。成对的评阅人进行资料纳入、数据提炼并评估偏倚的风险。在适用的时候进行了荟萃分析。结果我们收录了367项RCT，纳入了约2000名患者，进行了11种治疗，导出17项独立的头对头比较。通过标准化的量表评估，发现CBT、自然疗法、行为干预与躯体活动干预可以降低抑郁的严重程度。然而，这些非药物干预的相对疗效仍然缺乏。这些干预对临床缓解和复发的效果不清楚。CBT的发生率比抗抑郁药物更低。局限性由于证据缺乏一致性、证据不清或偏倚风险高，导致证据的质量只是低到中等，限制了我们研究结果的可信度。结论抑郁症的非药物治疗能减少抑郁症状，在轻度到重度抑郁症患者中，应当合并抗抑郁药物治疗，一同进行。对于非药物治疗的选择，应当根据患者的价值观、偏好、临床和社会因素来与患者共同作出决定。

对低风险癌症重新命名

Brooke Nickel及其同事认为,对于不治疗也不会对患者造成伤害的低风险癌症,应该摘掉它们的癌症标签,这会减少过度诊断和过度治疗情况。越来越多的证据表明,疾病标签会影响人们的心理反应和他们对治疗手段的选择使用更多医学化的标签会增加患者对疾病的担忧,使得他们更偏向于侵入性的治疗方法。鉴于目前对于低风险癌症普遍存在过度治疗的状况2-5,我们考虑摘掉癌症标签的潜在影响,以及如何实现这一点。

筛查和治疗糖尿病前期的价值由于筛检的准确性低和对患者重要结果影响的间接证据而降低

糖尿病是导致高发病率和病死率的主要原因。为了减轻糖尿病对人和社会的负担，指南建议在健康人群中进行高血糖的筛查。这些建议假设，早发现和早干预措施可以预防与2型糖尿病及其并发症相关的病死率。在这项系统性综述中，Barry等试图评估筛查的准确性和早期干预（如生活方式干预或二甲双胍治疗）对预防2型糖尿病的疗效。