中医技术耳穴贴压对脑卒中病人便秘疗效的Meta分析

[目的]评价耳穴贴压治疗脑卒中便秘的疗效。[方法]计算机检索PubMed、EMbase、CBMdisc、万方数据库、维普网、中国知网全文数据库(CNKI)、中国生物医学文献数据库(CBM)中关于耳穴贴压治疗脑卒中便秘的随机对照临床试验。采用Cochrane手册5.1.0推荐的偏倚风险评估对纳入的文献进行质量评价,用RevMan5.3软件进行Meta分析,对不能合并的文献采用描述性分析。[结果]共纳入7个随机对照试验,实验组290例,对照组289例,6个研究报告了临床有效率,5个研究报告了痊愈率,Meta分析结果显示,耳穴贴压组临床有效率优于常规护理组(Z=6.93,P0.01),耳穴贴压组痊愈率优于常规护理组(Z=4.22,P0.01)。[结论]护理常用中医技术耳穴贴压治疗脑卒中便秘的疗效优于常规护理,且耳穴贴压有可能减少西药副作用的产生。     

中药治疗慢性功能性便秘效果的系统评价

目的系统评价中药治疗慢性功能性便秘的疗效及安全性。方法计算机检索CNKI（1989～2009.11）、CBM（1989～2009.11）、VIP（1989～2009.11）、CochraneLibrary（2009年第4期）、PubMed（1966～2009.11）和EMbase（1986～2009.11）等,纳入中药与空白、安慰剂或西药对照治疗慢性功能性便秘的随机和半随机对照临床试验,由两名研究者按照CochraneHandbook5.0.2标准独立评价文献质量、提取数据并交叉核对,使用RevMan5.0软件进行Meta分析。结果共纳入21个研究,合计2-602例患者。Meta分析结果显示：中药能改善慢性功能性便秘患者的症状及结肠传输功能,其疗效优于促胃肠动力药[有效率RR=1.18,95%CI（1.12,1.25）;痊愈率RR=1.59,95%CI（1.35,1.88）]及泻剂[有效率RR=1.18,95%CI（1.10,1.27）;痊愈率RR=1.65,95%CI（1.29,2.10）];中药联合促胃肠动力药疗效优于促胃肠动力药[有效率RR=1.21,95%CI（1.09,1.34）;痊愈率RR=1.41,95%CI（1.11,1.79）]。结论部分中药治疗慢性功能性便秘安全有效,但因尚缺乏高质量的研究,目前还不能得到较为可靠的结论。     

耳穴贴压联合西药治疗原发性高血压的临床疗效Meta分析

目的 评价耳穴贴压联合西药治疗原发性高血压的临床疗效Meta分析.方法 计算机检索PubMed、Embase、The Cochrane Library、Web of Science、中国生物医学文献服务系统、中国期刊全文数据库、万方、维普等数据库,查找关于耳穴贴压联合西药治疗原发性高血压的随机对照试验,并对纳入文献的参考文献进行检索,检索时限为建库至2015年3月.由2位评价员严格按照纳入与标准独立筛选、提取资料,并按照Cochrane handbook中文献质量评价标准,进行方法学质量评价后,采用RevMan 5.3和Stata 12.0进行Meta分析.结果 最终纳入15个随机对照试验,共1435例患者.Meta分析结果显示:与对照组相比,耳穴贴压联合西药能显著提高原发性高血压的降压疗效[RR=1.17,95%CI(1.12,1.23),P<0.01],改善临床症状疗效[RR=1.29,95%CI(1.16,1.44),P<0.01],降低患者收缩压[SMD=-0.66,95%CI(-0.86,-0.46),P<0.01],降低患者舒张压[SMD=-0.59,95%CI(-0.79,-0.39),P<0.01].结论 耳穴贴压联合西药治疗原发性高血压的临床疗效显著优于单纯西药.但受纳入研究规范性、统一性等方面的限制,研究结果的推广还有待更多高质量的随机对照试验加以验证.     

耳穴贴压干预糖尿病胃轻瘫的系统评价和Meta分析

[目的]系统评价耳穴贴压治疗糖尿病胃轻瘫的疗效。[方法]计算机检索8个中英文数据库中有关耳穴贴压治疗失眠的随机对照试验,追溯纳入文献的参考文献。文献检索时限为各数据库建库至2015年9月,按照纳入和排除标准筛选文献提取资料并评价纳入研究的方法学质量,对耳穴贴压治疗糖尿病胃轻瘫的随机对照试验进行系统评价,数据采用专用软件RevMan5.3版进行统计分析。[结果]8篇研究共565例病人满足纳入标准。Meta分析果显示:耳穴贴压治疗糖尿病胃轻瘫的有效率优于对照组[RR=1.26,95%CI(1.15,1.38),P0.000 01];实验组糖尿病胃轻瘫病人的餐后2h血糖[RR=-0.29,95%CI=(-0.55,-0.02),P0.05]优于对照组,且差异具有统计学意义。[结论]与单纯西药治疗相比,耳穴贴压治疗糖尿病胃轻瘫病人的疗效更佳,且安全性好,但由于试验方法学质量不高,尚不能充分肯定,需高质量的试验进一步证实。     

耳穴贴压治疗偏头痛的系统评价与meta分析

目的评价耳穴贴压治疗偏头痛的临床疗效和安全性。方法计算机检索中国知网、万方数据库、中国生物医学文献数据库、维普网、PubMed数据库、Cochrane library从建库至2020年3月收录的耳穴贴压治疗偏头痛头的中英文随机对照临床试验文献。由2名研究者独立进行文献筛选与数据提取。对纳入文献进行质量评价后,采用RevMan5.3软件进行Meta分析。结果初检共检出文献261篇,筛选后最终纳入文献15篇,均为中文文献。纳入的15篇文献中全部提及随机,均未报告分配隐藏、盲法、随访和脱落的相关信息,均报告了预设结局指标。Meta分析结果显示,耳穴贴压组治疗总有效率、治愈率均高于对照组[OR=3.78,95%CI(2.62,5.44),Z=7.14,P0.00001];[OR=3.14,95%CI(2.29,4.30),Z=7.14,P0.00001],治疗后头痛积分低于对照组[MD=0.43,95%CI(-0.97,1.83),Z=0.61,P=0.55]。所有纳入试验未表明不良反应发生情况,耳穴贴压组和对照组患者的正常生理指标均未产生影响。基于治疗总有效率绘制漏斗图,图形左右不对称,提示可能存在发表偏倚。结论耳穴贴压治疗偏头痛疗效较好、操作方便且无毒副作用。     

耳穴贴压防治阿片类药物所致便秘的系统评价

[目的]系统评价耳穴贴压防治阿片类药物所致便秘的有效性及安全性,并探讨耳穴贴压防治阿片类药物所致便秘的选穴规律。[方法]计算机检索数据库,中文检索包括中国知网数据库(CNKI)、中国维普数据库(VIP)、中国生物医学数据库(CBM)、万方数据库(WanFang),英文检索PubMed、Embase、The Cochrane library数据库,检索耳穴贴压防治癌痛病人应用阿片类药物所致便秘的随机对照试验(RCT)。[结果]共纳入研究9个,总计870例病人。Meta分析结果显示:耳穴贴压防治癌症病人使用阿片类药物后所致便秘的总有效率优于对照组[OR=4.09,95%CI(2.91,5.75),Z=8.13,P<0.01]。耳穴贴压频次统计5次以上的穴位为大肠、脾、直肠下段、便秘点、三焦。[结论]耳穴贴压可有效防治癌症病人使用阿片类药物后所致便秘,耳穴贴压防治癌症病人使用阿片类药物后所致便秘避免了口服药物产生的肠胃刺激,在安全性上更具优势。其选穴多以大肠、脾、直肠下段、便秘点、三焦为主,以达到通调肠府,刺激肠蠕动的作用。     

耳穴贴压治疗原发性痛经疗效的Meta分析

[目的]系统评价耳穴贴压治疗原发性痛经(PD)的疗效。[方法]计算机检索The Cochrane Library、PubMed、Embase、Web of Science、CBM、CNKI、VIP、万方数据库,搜集耳穴贴压治疗PD的随机对照试验(RCT),检索时限为建库至2016年11月,用Revman5.3进行Meta分析。[结果]纳入10个RCT,共1 151例病人。Meta分析结果显示:与对照组相比,耳穴贴压可以提高PD病人的总有效率、降低MDQ评分、VAS评分以及血清EI-1水平,差异有统计学意义。[结论]耳穴贴压治疗PD安全有效。     

神阙穴贴敷治疗肿瘤患者化疗相关性便秘疗效的Meta分析

目的 中药穴位贴敷神阙穴治疗肿瘤患者化疗相关性便秘的疗效及安全性的Meta分析。方法 通过检索中国生物医学文献数据库、中国知网、万方数据库、维普数据库、PubMed、Embase、Cochrane、Web of Science 、CINAHL Complete、Medline,收集神阙穴贴敷治疗化疗相关性便秘的随机对照试验。检索时间为数据库建成至2018年12月。Meta分析采用Review Manager 5.3。结果 本研究共纳入7篇文献,总样本量为494例。Meta分析结果显示,穴位贴敷神阙穴组总有效率[RR=1.31,95%CI（1.17,1.47）,P<0.01;RR=1.40,95%CI（1.20,1.63）,P<0.01]、治愈率[RR=1.66,95%CI（1.28,2.15）,P<0.01]高于西医常规治疗组。2篇文献报道共发生2例不良反应,不良反应发生率为3%。结论 与西医常规治疗方法相比,神阙穴贴敷对化疗相关性便秘疗效更优,但存在以皮疹、腹泻为主的安全风险。     

耳穴贴压及持续时间对产后泌乳影响的Meta分析

目的系统评价耳穴贴压对产后泌乳的效果及贴压持续使用时间。方法计算机检索中国期刊全文数据库、中国生物医学文献数据库、万方数据库等数据库,检索时间1996年至2016年4月,纳入耳穴贴压方法促进产妇乳汁分泌的随机对照试验(randomized controlled trial,RCT)。文献的筛选与资料提取均由2名评价员独立进行,分歧通过协商或第三方解决。纳入文献的质量根据cochrane偏倚风险评估工具进行评价,使用RevMan5.0软件进行数据处理。结果共纳入9篇文献,共计1187例产妇。Meta分析结果显示:与产后常规护理措施相比,实施耳穴贴压的产妇在24h内泌乳始动的有效率[OR=4.53,95%CI(2.81,7.33),P0.05]、产后泌乳量充足率[OR=2.60,95%CI(1.41,4.79),P=0.002]、72h内[OR=4.52,95%CI(1.86,10.98),P0.001]以及产后24h内血清泌乳素含量[MD=48.18,95%CI(6.43,89.93),P=0.02]差异均有统计学意义。结论产后耳穴贴压24h能促进产妇提早泌乳,增加产后泌乳量,提高产妇体内血清垂体泌乳素分泌水平,连续使用3d泌乳效果更佳。     

耳穴压豆防治便秘效果的系统评价

目的:系统评价耳穴压豆防治便秘的效果。方法:计算机检索Cochrane图书馆、Pubmed、中国知网(CNKI)、维普中文期刊数据库公开发表的各类文献,检索时间为建库至2016年4月20日。按照纳入和排除标准筛选耳穴压豆改善便秘的随机对照试验、临床对照试验、系统评价文献,参照Cochrane Handbook(5.1.0)评价偏倚风险的方法评价纳入文献的研究质量,并用Rev Man 5.3.3软件对每一个结局指标进行Meta分析。结果:共纳入16篇文献(1632例患者),但大部分文献的方法学质量不高。Meta分析显示,耳穴压豆改善便秘有效率与对照组比较有统计学差异(OR=4.10,P0.001)、耳穴压豆组便秘发生率与对照组比较有统计学差异(OR=0.22,P0.001)。结论:耳穴压豆能有效防治便秘,但由于部分研究质量不高,因此上述结论需大样本、高质量的临床随机对照研究加以验证。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.