Evidence-based medical practice: as viewed by a clinical researcher

In this era of information technology, clinicians need to understand how to conduct ethical and effective clinical research. The principles of Ը?good clinical practiceԸ? have been established to prevent mistakes and malpractice, and to protect research subjects. A researcher must carefully design the study and perform a thorough review of the literature. A detailed protocol that has been approved by the institution's Ethics Committee must be constructed before commencement of the study and followed accordingly. Comparable control group(s), recruited in a double-blind fashion, ensure that the effects observed are specific to the intervention itself. While a retrospective data review is sometimes useful, only prospective studies provide solid evidence. Outcome parameters must be defined that are clinically appropriate and measurable. Subjects should only be recruited with consent and in a randomised fashion. Elimination of inter- and intra-observer errors can be achieved by appointing an assessor (or team) and by training personnel. Proper documentation of all the events and outcome parameters is of paramount importance and is a requirement for good clinical practice. Data analysis should be done by a qualified and experienced biostatistician and the personnel involved in the study must be fully aware of their moral, legal, and scientific responsibilities and be able to work with each other.published_or_final_versio

Inhaled corticosteroids in COPD: Letters to the editor

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Extragastroduodenal conditions associated with Helicobacter pylori infection

Helicobacter pylori is a Gram-negative bacterium that is considered a causative agent of peptic ulcer disease, gastric lymphoma, and gastric carcinoma. Helicobacter pylori triggers an intense leucocyte infiltration of the gastric submucosa, an action which is mediated by pro-inflammatory cytokines. This pathogenetic mechanism is common to many other diseases and consequently, Helicobacter pylori seroprevalence has also been investigated in other diseases. It is now known that Helicobacter pylori seropositivity is associated with various cardiovascular, respiratory, extragastroduodenal digestive, neurological, dermatological, autoimmune, and growth disorders. Although the precise role of Helicobacter pylori is unknown in these diseases, the organism can be eradicated using simple and reliable drug regimens. The conditions associated with Helicobacter pylori seropositivity are highlighted in this article.published_or_final_versio

Chemotherapy for advanced non-small-cell lung cancer: Role of paclitaxel and gemcitabine

Objective. To review the role of chemotherapy in advanced non-small-cell lung cancer, focusing on cisplatin-based regimens and two new drugs: paclitaxel and gemcitabine. Data sources. Medline search of the relevant English literature. Study selection. Open and randomised comparative (phases II and III) studies, and meta-analyses of cytotoxic drugs/regimens used to treat advanced non-small-cell lung cancer. Data extraction. The following factors were studied and compared: symptomatic response rates; tumour response rates; median survival time and 1-year survival rates; and side effects of cisplatin-, paclitaxel-, and gemcitabine-based regimens. Data synthesis. Using cisplatin-based chemotherapy achieves significant relief of disease-related symptoms of advanced non-small-cell lung cancer and a slight improvement in the median survival time (by approximately 1.5 months). New cytotoxic drugs that are effective and have good safety profiles include paclitaxel and gemcitabine. When used as single agents, these two drugs give response rates of approximately 25%. When used with cisplatin/carboplatin, response rates increase to 45% to 62% and 1-year survival rates increase to 40% to 60%. Conclusion. Paclitaxel, gemcitabine, and other drugs such as decetaxel and vinorelbine are promising new chemotherapeutic agents in the treatment of advanced non-small-cell lung cancer. These drugs can palliate disease symptoms and improve the median survival time. The optimal dose and treatment schedules, however, are yet to be defined.published_or_final_versio

HRCT evaluation and immunohistochemistry of bronchiectatic airways: is there a relationship?

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Functional significance of CT quantified bronchial wall thickening in bronchbiectasis

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Bronchiolitis obliterans with organising pneumonia (BOOP) following allogeneic bone marrow transplant - a common pulmonary conplication following BMT?

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Preventive therapy on bone loss in asthmatic patients on high dose inhaled steroids

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Induction of interleukin-6 secretion and matrix protein synthesis in human peritoneal mesothelial cells (HPMCs) by Pseudomonas aeruginosa exotoxin pyocyanin

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Lymphangioleimyomatosis: the Hong Kong experience

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