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1.
Medicine (Baltimore) ; 98(52): e18521, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876744

RESUMO

Genetic testing of children is faced with numerous problems. High-quality clinical practice guidelines (CPGs) are needed to ensure its safe, and appropriate use. This study aimed to systematically identify the current CPGs for genetic testing in children, and to assess the methodological quality of these CPGs.We searched 6 databases, 3 guideline clearinghouses, and 9 web sites of relevant academic agencies from inception to February 2019. CPGs focused on genetic testing in children were included. Four reviewers independently appraised the quality of the eligible CPGs using the appraisal of guidelines for research, and evaluation (AGREE) II instrument.Seventeen CPGs meeting our inclusion criteria were included. Among them, 16 CPGs were focused on the genetic diagnosis/evaluation of diseases, while only 1 CPG was focused on pharmacogenetics. The median domain scores from highest to lowest were: scope and purpose 80.56% (range: 56.95%-87.50%), clarity of presentation 72.22% (range: 45.83%-88.89%), stakeholder involvement 45.83% (range: 27.78%-55.56%), applicability 31.25% (range: 19.79%-54.17%), rigor of development 21.88%, (range: 13.02%-71.88%), and editorial independence 18.75% (range: 0%-83.33%). According to the overall quality, 6 (35%) CPGs were "not recommended," 8 (47%) CPGs were "recommended with modifications," and only 3 (18%) CPGs were "recommended." The clinical topics of the "recommended" CPGs were warfarin, familial Mediterranean fever, and pediatric pulmonary arterial hypertension.The quality of CPGs for genetic testing in children was generally low, and variable across different CPGs and different AGREE II domains. In future guideline development, more attention should be paid to the aspects of stakeholder involvement, rigor of development, applicability, and editorial independence. Not only will guideline users benefit from our results when determining whether to adopt related CPGs to guide genetic testing in children, but guideline developers could also take into account our results to improve the quality of future CPGs.


Assuntos
Testes Genéticos/normas , Guias de Prática Clínica como Assunto/normas , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Farmacogenética/normas
2.
J Evid Based Med ; 10(4): 271-280, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28276634

RESUMO

OBJECTIVE: Comparing the essential medicine lists for children and China national essential medicine list 2012, to provide the evidence for establishing essential medicine list for children in China. METHODS: Search the official websites of WHO and some other countries' ministry of health to get essential medicine lists for children (EMLc) that have already established. Compare the situation of updating, the number and classification of medicines, and the dosage forms in essential medicine lists for children and China national essential medicine list 2012. RESULTS: By December 2013, the WHO, India, and South Africa have established EMLc. The list of China was for people in all ages, so the number of medicines ranked first in four lists. WHO, India, and China classified the medicines by pharmacologic action, South Africa classified by ATC classification. Except for WHO, India, South Africa, and China did not have specific medicines for neonatal care or medicines for diseases of joints. The main administration routes in these four lists were oral administration, injection, and topical application. There were medicine restrictions in lists of WHO and India, but there were no medicine restrictions in the lists of South Africa and China. CONCLUSION: Compared with EMLs for children, the 2012 National Essential Medicine List for China is not suitable for children in China. Development of Chinese EMLc should be based on the burden of diseases for children, and should select applicable dosage forms and specifications.


Assuntos
Medicamentos Essenciais , Criança , China , Formas de Dosagem , Medicamentos Essenciais/economia , Medicina Baseada em Evidências , Humanos , Índia , África do Sul , Organização Mundial da Saúde
3.
Zhongguo Dang Dai Er Ke Za Zhi ; 18(7): 582-8, 2016 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-27412538

RESUMO

OBJECTIVE: To investigate the efficacy and safety of lamotrigine monotherapy in children with epilepsy via a systematic review. METHODS: PubMed, Cochrane, CNKI, VIP, CBM, Wanfang Data were searched for randomized controlled trials (RCTs) of lamotrigine monotherapy in children with epilepsy. Literature screening, data extraction, and quality assessment were performed according to the method recommended by Cochrane Collaboration. RevMan 5.2 software was used to conduct the Meta analysis. RESULTS: A total of 9 RCTs involving 1 016 participants were included. Lamotrigine yielded a significantly lower complete control rate of seizure than ethosuximide, but the complete control rate of seizure showed no significant differences between lamotrigine and carbamazepine/sodium valproate. Patients treated with lamotrigine had a significantly lower incidence rate of adverse events than those treated with carbamazepine, but the incidence rate of adverse events showed no significant differences between patients treated with lamotrigine and sodium valproate/carbamazepine. The drop-out rate showed no significant differences between the three treatment groups. CONCLUSIONS: Lamotrigine is an ideal alternative drug for children who do not respond to traditional antiepileptic medication or experience significant adverse reactions; however, more high-quality RCTs with a large sample size and a long follow-up time are needed to confirm these conclusions.


Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Triazinas/uso terapêutico , Humanos , Lamotrigina , Ensaios Clínicos Controlados Aleatórios como Assunto , Triazinas/efeitos adversos
4.
J Asian Nat Prod Res ; 17(3): 289-98, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25566886

RESUMO

We present in this paper the efficient synthesis of three macrocyclic lactone units which are core structures of natural resin glycosides by the use of a Keck macrolactonization approach.


Assuntos
Glicosídeos/isolamento & purificação , Lactonas/síntese química , Resinas Vegetais/química , Glicosídeos/química , Lactonas/química , Estrutura Molecular , Estereoisomerismo
5.
Taiwan J Obstet Gynecol ; 53(4): 443-51, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25510681

RESUMO

To describe the spectrum of pathogens isolated from Chinese women experiencing premature rupture of the membranes (PROM) and those of their neonates, in order to provide effective management of PROM. We searched Ovid Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and VIP Database for Chinese Technical Periodicals up to April 2012. The quality of studies was assessed utilizing the Strengthening the Reporting of Observational Studies in Epidemiology Statement. Among the included 36 studies, 11 (30.55%) were deemed to be at Level A, 12 (33.33%) at Level B, three (8.33%) at Level C, and 10 (27.78%) at Level D. Staphylococcus and Escherichia coli were the two primary microorganisms isolated from women with PROM and their infants. Subgroup analysis showed the distribution of microorganisms from the six regions of China varied. Staphylococcus bacteria were resistant to penicillins, except oxacillin, but more sensitive to first- and second-generation cephalosporins. Escherichia were sensitive to first- and second-generation cephalosporins and were more sensitive to aztreonam than cephalosporins. The main pathogens derived from women with PROM and their newborns were Staphylococcus and E. coli, which differs from the pathogens in Western countries. Hence, one might infer that the pathogens involved in PROM should be defined in each region to maximize antibiotic effectiveness. In addition, randomized controlled studies are needed to compare prophylactic use of antibiotics versus use of antibiotics after a positive culture for newborn infants with a history of PROM.


Assuntos
Escherichia coli/isolamento & purificação , Ruptura Prematura de Membranas Fetais/microbiologia , Staphylococcus/isolamento & purificação , China , Feminino , Humanos , Recém-Nascido , Gravidez
6.
Pediatr Neurol ; 49(5): 344-50, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24139534

RESUMO

OBJECTIVES: To assess the efficacy and safety of topiramate for children with Tourette syndrome. METHODS: Randomized controlled trials evaluating topiramate for children with Tourette syndrome were identified from the Cochrane library, PubMed, Cochrane Central, Embase, CBM, CNKI, VIP, WANG FANG database, and relevant reference lists. Two reviewers independently selected trials, assessed trial quality, and extracted the data. Disagreement was resolved by discussion. Quality assessment referred to the Cochrane Handbook for Systematic Reviews of Interventions (version 5.0.1.). RESULTS: Fourteen trials involving 1003 patients were included, of which 720 cases were male (71.8%). Ages were 2 to 17 years old. The general quality of included randomized controlled trials was poor. All trials were positive drug-controlled (12 randomized controlled trials used haloperidol as control, 2 used tiapride). The follow-up period was from 20 days to 12 months. Meta-analysis of 3 trials (n = 207), in which tics symptoms control was assessed by Yale Global Tic Severity Scale, suggested that there was significant difference in the mean change of Yale Global Tic Severity Scale score during the treatment period (mean difference = -7.74, 95% CI [-10.49, -4.99], I(2) = 0) between topiramate and control groups. Meta-analysis of 9 trials (n = 668) evaluating tics symptoms control ≥ 50% suggested that there was no significant difference in reduction of tics between topiramate and control group during the treatment period (relative ratio = 1.36, 95% CI [0.90, 2.06], I(2) = 0). Adverse events were reported in 13 trials. Drowsiness (3.3-16%), loss of appetite (4-16.7%), cognitive dysfunction (7.89-12.5%), and weight loss (6-10.5%) were common adverse events. CONCLUSIONS: The current evidence is promising but not yet sufficient to support the routine use of topiramate for Tourette syndrome in children due to low quality of the study designs. It deserves to confirm in further high-quality, placebo-controlled trials.


Assuntos
Anticonvulsivantes/uso terapêutico , Frutose/análogos & derivados , Síndrome de Tourette/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Frutose/uso terapêutico , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Topiramato , Resultado do Tratamento
7.
BMC Pediatr ; 13: 113, 2013 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-23914882

RESUMO

BACKGROUND: Quality assessment of pediatric randomized controlled trials (RCTs) in China is limited. The aim of this study was to evaluate the quantitative trends and quality indicators of RCTs published in mainland China over a recent 10-year period. METHODS: We individually searched all 17 available pediatric journals published in China from January 1, 2002 to December 30, 2011 to identify RCTs of drug treatment in participants under the age of 18 years. The quality was evaluated according to the Cochrane quality assessment protocol. RESULTS: Of 1287 journal issues containing 44398 articles, a total of 2.4% (1077/44398) articles were included in the analysis. The proportion of RCTs increased from 0.28% in 2002 to 0.32% in 2011. Individual sample sizes ranged from 10 to 905 participants (median 81 participants); 2.3% of the RCTs were multiple center trials; 63.9% evaluated Western medicine, 32.5% evaluated traditional Chinese medicine; 15% used an adequate method of random sequence generation; and 10.4% used a quasi-random method for randomization. Only 1% of the RCTs reported adequate allocation concealment and 0.6% reported the method of blinding. The follow-up period was from 7 days to 96 months, with a median of 7.5 months. There was incomplete outcome data reported in 8.3%, of which 4.5% (4/89) used intention-to-treat analysis. Only 0.4% of the included trials used adequate random sequence allocation, concealment and blinding. The articles published from 2007 to 2011 revealed an improvement in the randomization method compared with articles published from 2002 to 2006 (from 2.7% to 23.6%, p = 0.000). CONCLUSIONS: In mainland China, the quantity of RCTs did not increase in the pediatric population, and the general quality was relatively poor. Quality improvements were suboptimal in the later 5 years.


Assuntos
Pediatria , Publicações Periódicas como Assunto , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Adolescente , Criança , Pré-Escolar , China , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
8.
Epileptic Disord ; 13(4): 349-65, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21926048

RESUMO

AIM: In recent years, phenobarbital, as an antiepileptic drug, has become less popular based on adverse events, especially cognitive and behavioural side effects. Despite the development of better tolerated new generation AEDs, phenobarbital is still widely used particularly in developing countries because of its low cost. The purpose of this review was to: (i) investigate whether phenobarbital can be safely used as an antiepileptic drug and (ii) determine the questions which need to be addressed in order to comprehensively and adequately evaluate the safety of phenobarbital for the treatment of epilepsy. METHODS: The literature was searched using the Cochrane Central Register of randomised controlled trials (1800-2009), Medline (1966-2009), Embase (1966-2009) and three Chinese databases. RESULTS: Twenty studies were finally included in this systematic review. The determination of adverse effects of combined antiepileptic drugs (AEDs) from different studies was complicated by numerous factors including study design, different descriptions of adverse events and a lack of standardised data collection. These factors may also have been responsible for the heterogeneity present in the meta-analysis. The data did not demonstrate any evidence of association between phenobarbital and a higher risk of adverse events. However, phenobarbital appeared to be associated with a higher rate of adverse drug reaction related withdrawal (ADR-related withdraw), compared to carbamazepine, valproic acid and phenytoin. This may have been due to a concern for possible adverse effects of phenobarbital. CONCLUSIONS: Phenobarbital was associated with a higher rate of drug withdrawal although there was no evidence to suggest that phenobarbital caused more adverse events compared to carbamazepine, valproic acid or phenytoin. However, in the case of pregnant women, it is important for clinicians to evaluate the benefits and risks of phenobarbital administration before making a final recommendation. Furthermore, unified scales for the assessment of cognitive function should be applied for future studies particularly in children.


Assuntos
Anticonvulsivantes/efeitos adversos , Epilepsia/complicações , Fenobarbital/efeitos adversos , Anticonvulsivantes/uso terapêutico , Carbamazepina/efeitos adversos , Carbamazepina/uso terapêutico , Criança , Transtornos Cognitivos/induzido quimicamente , Transtornos Cognitivos/psicologia , Estudos de Coortes , Estudos Cross-Over , Coleta de Dados , Interpretação Estatística de Dados , Epilepsia/tratamento farmacológico , Epilepsia/psicologia , Feminino , Humanos , Masculino , Fenobarbital/uso terapêutico , Fenitoína/efeitos adversos , Fenitoína/uso terapêutico , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Pesquisa/normas , Projetos de Pesquisa , Resultado do Tratamento , Ácido Valproico/efeitos adversos , Ácido Valproico/uso terapêutico
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