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241. Influence of delay on survival in patients with breast cancer: a systematic review.
作者: M A Richards.;A M Westcombe.;S B Love.;P Littlejohns.;A J Ramirez.
来源: Lancet. 1999年353卷9159期1119-26页
Most patients with breast cancer are detected after symptoms occur rather than through screening. The impact on survival of delays between the onset of symptoms and the start of treatment is controversial and cannot be studied in randomised controlled trials. We did a systematic review of observational studies (worldwide) of duration of symptoms and survival.
242. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma.
作者: E G Zandbergen.;R J de Haan.;C P Stoutenbeek.;J H Koelman.;A Hijdra.
来源: Lancet. 1998年352卷9143期1808-12页
Studies to assess the prognostic value of early neurological and neurophysiological findings in patients with anoxic-ischaemic coma have not led to precise, generally accepted, prognostic rules. We did a systematic review of the relevant literature to assess whether such rules could be derived from the combined results of these studies.
243. Postoperative radiotherapy in non-small-cell lung cancer: systematic review and meta-analysis of individual patient data from nine randomised controlled trials. PORT Meta-analysis Trialists Group.
来源: Lancet. 1998年352卷9124期257-63页
The role of postoperative radiotherapy in treatment of patients with completely resected non-small-cell lung cancer (NSCLC) remains unclear. We undertook a systematic review and meta-analysis of the available evidence from randomised trials.
244. Systematic review of evidence on thrombolytic therapy for acute ischaemic stroke.
Recent trials of thrombolytic therapy in acute ischaemic stroke have given apparently conflicting results. Only one trial, the National Institute of Neurological Disorders and Stroke trial of tissue plasminogen activator (tPA), suggested that thrombolysis was definitely beneficial. To make sense of these results, we have done a systematic review of all available randomised trials of thrombolysis in acute ischaemic stroke.
245. Systematic review of amodiaquine treatment in uncomplicated malaria.
作者: P Olliaro.;C Nevill.;J LeBras.;P Ringwald.;P Mussano.;P Garner.;P Brasseur.
来源: Lancet. 1996年348卷9036期1196-201页
Opinion and policy over the use of amodiaquine for treating malaria vary. Amodiaquine is more palatable than chloroquine and may be more effective but serious adverse events have been reported in travellers taking it as prophylaxis. It is not recommended as first-line treatment. In the light of the global debate over the use of this drug, we conducted a systematic review of the effectiveness and tolerability of amodiaquine in the treatment of uncomplicated falciparum malaria.
246. Systematic review of randomised trials of interventions to assist patients to follow prescriptions for medications.
Low adherence of patients to prescribed, self-administered medical interventions is ubiquitous. Low adherence limits the benefits of current medical care. Efforts to assist patients to follow treatments might improve the efficiency of care and substantially enhance benefits. Our objective was to summarise the results of randomised controlled trials (RCTs) of interventions to help patients follow prescriptions for medications.
247. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations.
Although interest in clinical guidelines has never been greater, uncertainty persists about whether they are effective. The debate has been hampered by the lack of a rigorous overview. We have identified 59 published evaluations of clinical guidelines that met defined criteria for scientific rigour; 24 investigated guidelines for specific clinical conditions, 27 studied preventive care, and 8 looked at guidelines for prescribing or for support services. All but 4 of these studies detected significant improvements in the process of care after the introduction of guidelines and all but 2 of the 11 studies that assessed the outcome of care reported significant improvements. We conclude that explicit guidelines do improve clinical practice, when introduced in the context of rigorous evaluations. However, the size of the improvements in performance varied considerably.
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