Evidence-based clinical practice guidelines on the diagnosis and management of breast cancer part I. Early breast cancer

The clinical area identified by the Philippine College of Surgeons (PCS) for the third evidence-based clinical practice guidelines (EBCPGs) was on the management of breast cancer. Funding for the research project was provided by the Philippine Council for Health Research and Development (PCHRD), and a Technical Working Group (TWG) was formed, composed of 5 general surgeons and 1 medical oncologist. The TWG was tasked to identify the clinical questions and to adhere to the PCS approved method of developing EBCPGs. The TWG decided to divide the report into two parts: Early Breast Cancer, and Locally Advanced and Metastatic Breast Cancer. This first report will focus on Early Breast Cancer The definition of early breast cancer is that used by the Early Breast Cancer Trialists Collaborative Group (EBCTG), since the regular systemic reviews (meta-analysis) of the group on the primary and adjuvant therapies of early breast cancer currently comprise the strongest evidence. "In women with "early breast cancer", all detectable cancer is, by definition, restricted to the breast and, in the case of node positive patients, the local lymph nodes can be removed surgically." The TWG began work on July 1, 2000. The literature search, limited to English publications, used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane library, Issue 2, 2000; 2) National Library of Medicine-Medline (PubMed, no time limit); and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD Titles of all articles were printed and at least 2 members of the TWG went over the list and checked the titles of articles whose abstract they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members of the TWG, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. The TWG then compiled, summarized and classified the evidence according to 3 levels and proposed a first draft to recommendations according to 3 categories.(Author)

A multicenter randomized clinical trial comparing the clinical efficacy of Imipenem/Cilastin and Ceftazidime plus Metronidazole in surgically treated serious intra-abdominal infections

An open, prostective, randomized multicenter clinical trial randomly allocated successive patient who were scheduled for a surgical procedure for serious intra-abdominal infections to receive either treatment CM (ceftazidine plus metronidazole) or monotherapy with treatment IC (imipenem/cilastatin). Out of 90 eligible patients, 87 were clinically evaluable of which 71 were clinically and bacteriologically evaluable (CBE). Cases allocated to each treatment group were comparable as to age, sex, diagnostic group distribution, mean APACHE II scores, and bacteriologic evaluability. Among the 87 clinically evaluable patients, there were 4 (9.1%) and 2 (4.7%) treatment failures among those who received treatments CM and IC respectively (p=0.486). For all eligible patients, the mean fever days was 2.07, mean treatment days was 6.01, and mean hospital days was 11.57, and was not significantly different between the two treatment groups. Among clinically evaluable cases, the mean APACHE II scores of patients with succesful outcomes (5.8) was very significantly lower (p=0.000) than that of patients whose treatment failed (13.8). This was also true for CBE cases. Logistic regression analysis showed that among six variables (diagnostic group, APACHE II score, antibiotic used, fever days, hospital days and treatment days) only the APACHE II score signficantly contributed to treatment failure (p=0.001).