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Due to the insufficient education of medical ethics and tending to medical moral educa-tion, the residents lack the ability to make ethical decisions. Therefore, we applied Four Topics method in the clinical ethics training of residents. The clinical ethics training was divided into three stages, and each stage had different training content and objectives. Dongyang People's Hospital adopted the form of lectures and panel discussions. During the group discussion, the group leader was in charge of case preparation, which came from clinical practice, and then all members applied the Four Topics method to analyze and discuss the ethical conflicts, and make the ethical decision. Through this process, residents' ability to solve ethical problems in clinical practice was enhanced.
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Objective To assess the efficacy and safety of intrapleural instillation of Yadanzi (Brucea Javan-ica)oil emulsion injection and cisplatin for malignant pleural effusion by literature searching and meta -analysis. Methods Databases were searched for random controlled trails (RCTs)including Pubmed,the Cochrane Library, CNKI,VIP,Wanfang Database and CBM.The quality of included RCTs was evaluated and the data were collected by 2 evaluators independently.Meta -analysis was performed using RevMan 5.2.Results 18 RCTs involving 1 322 par-ticipants was included.The results of meta -analysis indicated that intrapleural instillation of Yadanzi oil emulsion injection and cisplatin could improve the treatment efficiency of malignant pleural effusion (OR =3.82,95%CI 2.94 ~4.96,P <0.01)and improve the quality of life of patients(OR =4.07,95%CI 2.87 ~5.79,P <0.01),and reduce the gastrointestinal tract reaction (OR =0.55,95%CI 0.38 ~0.78,P <0.01)and white blood cell reduction occurs (OR =0.34,95%CI 0.25 ~0.46,P <0.01).Conclusion Intrapleural instillation of Yadanzi oil emulsion injection and cisplatin was effective and safe in the treatment of malignant pleural effusion,while the further studies should make efforts in improving research quality.
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Education of evidence-based medicine in clinical research is important in enhancing primary hospital clinical research capacity and quality.Dongyang People's Hospital of Zhejiang Province has carried out evidence-based medicine education and training,and greatly improved the performance of clinical research and development of scientific researchers.
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Clinical thinking of Clinicians in Dongyang People's Hospital is gradually shifting from ‘empirical medicine’ to ‘evidence-based medicine’ after popularizing of evidence-based medicine, training core members and implementing multi-layered, multi-channeled, comprehensive and sustainable resident doctor training mode with clear steps and purposes within three years. This paper discussed on reasonable clinical practice of evidence-based medicine in primary hospital and provided realistic basis for the further development and improvement of training of evidence-based medicine in primary hospital.
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AIMS: The purpose of the present study was to investigate the roles of transporters in the renal excretion of entecavir. MAIN METHODS: We analyzed the effect of probenecid, cimetidine, sulfobromophthalein sodium (BSP), verapamil, inhibitors of organic anion transporter (OAT), organic cation transporter (OCT), multidrug resistance-associated protein 2 (MRP2) and P-glycoprotein respectively, on the excretion of entecavir. The area under plasma concentration-time curve (AUC), body clearance, and renal clearance of entecavir was examined in each group. KEY FINDINGS: After intravenous coadministration with entecavir in conscious rats, cimetidine, probenecid, BSP and verapamil significantly increased the AUC of entecavir by 40.07%, 48.78%, 37.49%, and 54.58%, and reduced the body clearance by 27.14%, 31.69%, 29.79%, and 42.17%, respectively. Then the effects of these inhibitors on the renal clearance of entecavir in unconscious rats were studied. Coadministration of cimetidine and probenecid increased the steady plasma concentration of entecavir by 127.61% and 169.46%, reduced the renal clearance by 50.47% and 67.76%, and decreased the excretion ratio by 44.81% and 64.16% compared to initial values. However, the effects of BSP and verapamil were slight. Cimetidine and probenecid also increased the concentration of entecavir in kidney from 34.00±0.80ng/mL to 55.19±4.92ng/mL and 49.92±1.53ng/mL, while the concentration of entecavir in kidney from BSP and verapamil groups was 30.96±0.81ng/mL and 35.72±7.30ng/mL, respectively. SIGNIFICANCE: These results suggest that cimetidine and probenecid inhibit the renal excretion of entecavir in rats, which indicates the most likely involvement of organic anion and cation transporters in the renal excretion of entecavir.