Systematic reviews and meta-analyses to clarify outcomes of adjuvant interferon therapy in hepatocellular carcinoma, and to help implement clinical trials of postoperative antibiotic use in secondary peritonitis
Date Issued
2014
Date
2014
Author(s)
Huang, Ting-Shuo
Abstract
Systematic reviews (SRs) and meta-analyses (MAs) offer more information than individual studies for benefits or harms of interventions and are of crucial important to the advance of evidence-based health care and designs of clinical trials High-quality SRs and MAs could summarize up-to-date evidence for clinical practice and provide useful information for designs of clinical trials. In addition, they could determine whether the next clinical trials are needed. Here we applied such strategies to perform three studies. First, we conducted a SR and MA to investigate parenteral selenium supplementation for critically ill patients. We were the first study to demonstrate that parenteral selenium supplementation significantly reduces all-cause mortality among critically ill patients with SIRS or sepsis, particularly those who were treated more than 7 days. Second, adjuvant interferon therapy for viral hepatitis-related hepatocellular carcinoma is controversial. We conducted a SR and MA and showed that adjuvant interferon treatment significantly improves the recurrence-free survival and overall survival among patients with hepatitis C virus-related hepatocellular carcinoma (HCC). However, there was little evidence of beneficial effects for hepatitis B virus-related HCC. Third, we used information from SRs and MAs to design and conduct a clinical trial of a procalcitonin-based algorithm to guide antibiotic use in secondary peritonitis. Our prospective study indicated that the procalcitonin-guided algorithm, compared to the standard of care, significantly reduced the hazard of antibiotic exposure among patients with secondary peritonitis following emergency surgery without increasing the risk of adverse events. Incorporating systematic reviews and meta-analyses in the research frameworks is a scientific method in context, and it could provide timely evidence for evidence-based health care and trial designs.
Subjects
系統性回顧
統合分析
硒
敗血症
干擾素
肝癌
血清降鈣素原
腹膜炎
SDGs
Type
thesis
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