糖尿病视网膜病变护理措施的系统评价

[目的]系统评价糖尿病视网膜病变(DR)病人护理干预的有效性。[方法]计算机检索Cochrane Library,PubMed,EM-base,CNKI和万方数据库等,检索时限从建库至2014年,纳入关于DR病人护理干预的随机对照试验。由两名研究者按照纳入与排除标准选择文献、评价质量、提取资料并交叉核对后,采用RevMan 5.0软件进行Meta分析。[结果]共纳入9篇随机对照试验,均为中文。7项研究结果显示,护理干预对DR病人的空腹血糖(FPG)有效果;6项研究结果显示,护理干预对降低DR病人的餐后2h血糖(2 hPG)有效果;2项研究的结果显示,护理干预可以提高病人的生活质量;2项研究结果显示,护理干预可以提高DR病人的知识掌握情况以及定期眼科复诊率;4项研究结果显示,护理干预可以改善糖尿病视网膜病变病人的视力情况。[结论]护理干预可以有效降低DR病人的FPG和2 hPG,提高病人的生活质量,对病人视力的改善也有效果。     

口腔冲洗预防呼吸机相关性肺炎的Meta分析

[目的]评估口腔冲洗对降低呼吸机相关性肺炎的效果.[方法]计算机检索MEDLINE、PUBMED、OVID、EMbase、ELSEVIER、CNKI、重庆维普、CBM及万方等数据库中关于口腔冲洗对改善呼吸机相关性肺炎的随机对照试验,同时筛选纳入文献的参考文献.由两名研究者对文献质量进行严格评价和资料提取,对符合质量标准的随机对照试验(RCT)进行Meta分析.[结果]共纳入5篇RCT.5篇RCT的结果显示,口腔冲洗能降低病人呼吸机相关性肺炎的感染率,4篇RCT 结果认为口腔冲洗能降低病人口腔溃疡的发生率.2篇RCT结果显示口腔冲洗能降低病人口腔的真菌感染率.[结论]口腔冲洗能降低病人的呼吸机相关性肺炎的发生率和口腔溃疡及真菌的感染率.     

循证护理在预防放化疗病人口腔黏膜炎中应用效果的Meta分析

目的:系统评价循证护理在放化疗病人口腔黏膜炎预防中的应用效果.方法:系统检索万方数据库、中国知网(CNKI)、维普中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、Cochrane Library、PubMed、Embase,检索时限均为建库起至2019年11月,收集有关循证护理在预防放化疗病人口腔黏膜炎中效果的随机对照试验,对符合纳入标准的临床研究进行资料提取,采用RevMan 5.3软件进行Meta分析.结果:共纳入14篇文献,合计1611例病人.Meta分析结果显示,循证护理组与常规护理组口腔黏膜炎总发生率[OR=0.33,95％CI(0.26,0.43),P<0.00001]、严重口腔黏膜炎发生率[OR=0.17,95％CI(0.10,0.27),P<0.00001]及护理满意度[OR=11.74,95％CI(3.50,39.43),P<0.0001]比较差异均有统计学意义.结论:循证护理可降低放化疗病人口腔黏膜炎的发生率,减轻口腔黏膜炎的严重程度,提高护理满意度.     

循证护理在预防放化疗病人口腔黏膜炎中应用效果的Meta分析

目的:系统评价循证护理在放化疗病人口腔黏膜炎预防中的应用效果.方法:系统检索万方数据库、中国知网(CNKI)、维普中文科技期刊全文数据库(VIP)、中国生物医学文献数据库(CBM)、Cochrane Library、PubMed、Embase,检索时限均为建库起至2019年11月,收集有关循证护理在预防放化疗病人口腔黏膜炎中效果的随机对照试验,对符合纳入标准的临床研究进行资料提取,采用RevMan 5.3软件进行Meta分析.结果:共纳入14篇文献,合计1611例病人.Meta分析结果显示,循证护理组与常规护理组口腔黏膜炎总发生率[OR=0.33,95％CI(0.26,0.43),P<0.00001]、严重口腔黏膜炎发生率[OR=0.17,95％CI(0.10,0.27),P<0.00001]及护理满意度[OR=11.74,95％CI(3.50,39.43),P<0.0001]比较差异均有统计学意义.结论:循证护理可降低放化疗病人口腔黏膜炎的发生率,减轻口腔黏膜炎的严重程度,提高护理满意度.     

中药口腔护理研究文献计量学分析

[目的]应用文献计量学方法分析中药口腔护理研究现状,为临床实践提供相关依据。[方法]检索中国知网、万方数据库、中国生物医学文献数据库,对符合纳入标准的146篇中药口腔护理文献进行分析。[结果]中药口腔护理文献发表量逐年递增,近5年刊文量占总发文量的63.70%,以试验研究类文献为主,占78.08%;获得科研基金资助项目的占16.44%;研究设计以随机对照试验为主,研究对象居前3位的分别为危重病病人、脑血管病病人和放化疗病人;中药口腔护理液多为自拟中药,主要由具有清热解毒、燥湿、芳香、发散作用的药物组成,使用剂量不等;结局指标集中在实验室检查、口腔黏膜并发症和病人自我感受3方面。[结论]中药口腔护理具有特有的实践优势,口腔护理液组方体现了中医辨证论治的特点,但研究现状存在不足,需进一步提高研究设计的严谨性,完善中医口腔护理操作规范,扩大研究范围,促进成果转化,加大科研经费扶植力度,从根本上提升中药口腔护理研究质量,推动中医特色护理的发展。     

护理风险管理在急性诊疗中应用的Meta分析

[目的]系统评价护理风险管理在急性诊疗中应用的护理价值。[方法]计算机检索万方数据资源系统、中国期刊全文数据库(CNKI)、维普信息资源系统(VIP)、Pub Med数据库、Cochrane Library、外文医学信息资源检索平台(FMRS),搜集有关急性诊疗中应用护理风险管理的随机对照试验(RCT)文献。由两位研究者按照纳入与排除标准筛选文献、提取资料和评价质量后,采用Rev Man 5.2软件进行Meta分析。[结果]共纳入13个RCT文献,共有14 854例病人。Meta分析结果显示:护理风险管理与常规护理在护理质量、护理缺陷、护理不良事件、病人投诉及病人满意度方面的差异有统计学意义(均P0.05)。[结论]与常规护理相比,护理风险管理能提高护理质量,降低护理缺陷及不良事件,提升病人护理满意度。     

我国子宫切除术后病人性生活质量干预效果的Meta分析

[目的]评价医疗护理干预对子宫切除术后病人性生活质量的影响.[方法]计算机检索相关文献,按纳入和排除标准筛选文献后进行质量评价,共纳入10篇随机对照试验研究文献,采用Cochrane协作网提供的RevMan 4.3软件处理,从总体性生活质量评分、性欲、性频率、性满意率、性生活恢复率5个方面进行Meta分析.[结果]在术后6个月内实验组和对照组病人的总体性生活质量评分、性欲、性频率、性满意率、性生活恢复率差异有统计学意义,在术后9个月、12个月实验组和对照组病人的总体性生活质量评分差异无统计学意义.[结论]医务人员针对子宫切除术病人及其家属采取常规治疗护理外的针对性干预,对子宫切除术病人术后短期的性生活质量有一定作用;但医疗护理干预所发挥的长期作用并不明显,需要今后高质量的大样本随机对照试验进一步验证.     

口腔冲洗预防呼吸机相关性肺炎的Meta分析

[目的]评估口腔冲洗对降低呼吸机相关性肺炎的效果。[方法]计算机检索MEDLINE、PUBMED、OVID、EMbase、ELSEVI-ER、CNKI、重庆维普、CBM及万方等数据库中关于口腔冲洗对改善呼吸机相关性肺炎的随机对照试验,同时筛选纳入文献的参考文献。由两名研究者对文献质量进行严格评价和资料提取,对符合质量标准的随机对照试验（RCT）进行Meta分析。[结果]共纳入5篇RCT。5篇RCT的结果显示,口腔冲洗能降低病人呼吸机相关性肺炎的感染率,4篇RCT结果认为口腔冲洗能降低病人口腔溃疡的发生率。2篇RCT结果显示口腔冲洗能降低病人口腔的真菌感染率。[结论]口腔冲洗能降低病人的呼吸机相关性肺炎的发生率和口腔溃疡及真菌的感染率。     

我国子宫切除术后病人性生活质量干预效果的Meta分析

[目的]评价医疗护理干预对子宫切除术后病人性生活质量的影响。[方法]计算机检索相关文献,按纳入和排除标准筛选文献后进行质量评价,共纳入10篇随机对照试验研究文献,采用Cochrane协作网提供的RevMan 4.3软件处理,从总体性生活质量评分、性欲、性频率、性满意率、性生活恢复率5个方面进行Meta分析。[结果]在术后6个月内实验组和对照组病人的总体性生活质量评分、性欲、性频率、性满意率、性生活恢复率差异有统计学意义,在术后9个月、12个月实验组和对照组病人的总体性生活质量评分差异无统计学意义。[结论]医务人员针对子宫切除术病人及其家属采取常规治疗护理外的针对性干预,对子宫切除术病人术后短期的性生活质量有一定作用;但医疗护理干预所发挥的长期作用并不明显,需要今后高质量的大样本随机对照试验进一步验证。     

正念疗法对乳腺癌病人睡眠质量影响的系统评价

[目的]系统评价正念疗法在癌症病人中应用的效果。[方法]计算机检索Medline、Cochrane Library、CINAHL、PubMed、Web of science、CBM、中国知网、维普和万方数据库中有关正念疗法对癌症病人研究的随机对照试验(RCTs)。此外,采用百度、谷歌学术等搜索引擎查找有关文献,并追查已纳入文献的参考文献,以获取未检索到的文献,检索截至2018年6月。2位评价员按纳入与排除标准独立筛选文献,提取资料并进行质量评价后,如有歧义与第3人进行协商。[结果]据纳入原始研究设计的类型,共纳入6个随机对照试验,合计有818例病人。[结论]现有证据表明,正念减压疗法能够改善乳腺癌病人睡眠,但仍需大样本、高质量的RCTs进行验证。     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.