成年体外循环心脏手术患者医护一体化液体管理的最佳证据总结

目的 总结成年体外循环心脏手术患者医护一体化液体管理的最佳证据。方法 按照“6S”金字塔证据模型，系统检索BMJ Best Practice、UpToDate、国际指南协作网（GIN）、苏格兰院际指南网（SIGN）、美国国立指南库（NGC）、英国国家卫生与临床优化研究所（NICE）网站、加拿大安大略省注册护士协会（RNAO）网站、医脉通指南网、澳大利亚乔安娜布里格斯研究所（JBI）循证卫生保健中心数据库、Cochrane Library、Web of Science、PubMed、Embase、中国生物医学文献数据库（CBMdisc）、维普中文期刊服务平台、中国知网、万方数据知识服务平台公开发表的体外循环心脏手术患者液体管理相关文献，并手动检索相关文献的参考文献，检索时间为建库至2022-05-31。由2名研究人员根据文献的纳入和排除标准及文献质量评价结果进行文献筛选及内容提取。采用内容分析法，从最终纳入的文献中提取与本研究相关的证据，并进行证据整合，同时评估最佳证据的等级、推荐级别。结果 最终共纳入15篇文献，其中专家共识4篇、指南3篇、临床决策3篇、系统评价3篇、最佳实践1篇、Me...     

针灸治疗原发性高血压病系统评价的再评价

目的汇总当前针灸治疗原发性高血压病的系统评价,评价其方法学偏倚及其证据体质量。方法计算机检索Pubmed、EMbase、The Cochrane library、CBM、CNKI及Wangfang Data等中英文数据库,检索针灸疗法治疗原发性高血压病的系统评价,检索时限从建库到2016年11月。采用系统评价方法学质量评估工具AMSTAR评价纳入的系统评价方法学质量,采用GRADE系统方法学评估纳入的系统评价主要结局指标的证据质量。结果共纳入14个系统评价,7篇是中文文献,7篇是英文文献。对原始研究方法学质量评估使用risk of bias工具的有9篇,使用改良Jadad量表的有4篇,1篇使用改良牛津量表。AMSTAR工具评价结果显示,影响系统评价方法学质量的11个条目中,条目1"是否提供了前期方案",条目3"是否进行了全面的文献检索",条目4"发表状态是否已考虑在纳入标准中"和条目10"是否评估了发表偏倚的可能性"存在的方法学偏倚最大。GRADE系统方法学对主要结局指标进行了证据质量评估,均为低级别或者极低级别。结论当前针灸治疗原发性高血压病有一定疗效,但其证据质量级别较低,临床实际中应用该证据时应当慎重。     

老年护理健康评估项目实施的系统评价

目的全面回顾中国老年护理健康评估的研究现状,系统总结和分析中国老年护理健康评估项目的实施情况。方法经检索人员讨论确定检索词及检索策略,电子检索VIP、CNKI数据库,查找2004年至今发表的所有有关老年护理健康评估的文献。由两名研究者按照纳入与排除标准独立进行文献筛选、资料提取并交叉核对,如有分歧讨论解决,必要时参考第三方意见。采用定性方法系统总结纳入文献的研究结果。结果最终纳入13篇文献;地区分布包括北京、上海、重庆、湖北、江苏、广东、辽宁、河北、陕西;研究人群包括社区、养老院、住院及门诊老人,百岁老人,退休老年干部及特殊病种老年人等;老年护理健康评估一般包括身体健康评估、心理健康评估和社会健康评估三个维度的不同指标。结论评价结果显示,山东省尚未开展老年护理健康评估;纳入文献中针对老年人高级日常生活能力(ADL)评估较少,量表多选用ADL量表,其他量表使用率较低;缺乏针对老年角色功能及所处物理环境的评估;多为横断面研究,其本身存在方法学局限性;评估内容较单一,缺乏综合性。以后应加强针对老年人群的全面系统的护理健康评估。     

肺静脉隔离联合肾交感神经消融术治疗心房颤动合并高血压的系统评价再评价

目的 再评价肺静脉隔离（PVI）联合肾交感神经消融术（RDN）治疗心房颤动（以下简称房颤）合并高血压的系统评价。方法 计算机检索PubMed、Cochrane Library、Web of Science、万方数据知识服务平台、中国知网、维普网发表的PVI联合RDN治疗房颤合并高血压的系统评价，检索时限均为建库至2022-03-31。由两名研究员严格按照文献纳入与排除标准独立筛选和提取资料，然后采用PRISMA声明、AMSTAR2量表和GRADE方法分别评价纳入文献的报告质量、方法学质量和结局指标的证据质量。结果 9篇文献的报告质量平均得分为16.5分，其中最高分22.0分、最低分11.0分；其中高质量报告1篇，中等质量报告5篇，低质量报告3篇。4篇文献的方法学质量等级为低质量，5篇文献的方法学质量等级为极低质量。9篇文献的结局指标共27个证据体，其中高质量证据体2个（7.4%），中等质量证据体6个（22.2%），低质量证据体14个（51.9%），极低质量证据体5个（18.5%）。系统评价结果显示，试验组患者房颤复发率低于对照组（P<0.05）（证据等级为低、中等、高）。试验组患...     

稳定期COPD患者认知障碍的Meta分析

目的 系统评价稳定期COPD患者认知障碍.方法 通过检索Cochrane Library、PubMed、中国学术期刊全文数据库、维普数据库、中国生物医学文献光盘数据库、万方数据库,全面收集通过简易精神状态检查(MMSE)量表评估稳定期COPD患者的认知功能障碍的病例对照研究.按照纳入、排除标准纳入文献后提取有效数据进行Meta分析.结果 最终纳入9篇文献,其中中文4篇,英文5篇,包括520例患者和381例对照者.Meta分析结果显示:稳定期COPD组与正常对照组相比,MMSE评分明显降低,差异有统计学意义(SMD=-0.973,95％CI:-1.565～-0.380,P＜0.01).累积Meta分析结果显示,稳定期COPD患者与认知功能障碍之间始终有相关性.对单个研究的敏感性分析提示,单项研究剔除后对总体结果影响不大.本研究通过Begg's检验和Egger's检验进行发表偏倚的识别和评估,结果不存在发表偏倚(P值均＞0.05).结论 稳定期COPD患者存在明显的认知障碍,但仍需更多高质量、大规模、多中心的临床随机对照研究加以证实.     

近十年中国主要心血管指南的推荐分类和证据水平分析

目的:分析近十年中国心血管领域主要指南的推荐分类和证据水平分布,及基于中国研究的证据比例。方法:检索近十年(2010年1月1日至2020年5月31日)国内学会发布的主要心血管相关指南,筛选满足纳入标准的18篇涉及冠心病、高血压、心力衰竭、心肌病和瓣膜病等疾病的指南,提取推荐意见分类和证据水平等相关数据后进行分析。结果:18篇指南共包含1 575条推荐,其中Ⅰ类推荐56.3%,Ⅲ类推荐5.7%;A级证据[多个随机对照试验(RCT)或其荟萃分析]比例22.7%,C级证据高达44.0%;各个指南"推荐分类-证据水平"组合的分布呈现较大的变异:肥厚型心肌病指南中没有Ⅰ-A推荐,而中国高血压防治指南Ⅰ-A推荐高达40.0%以上。有4篇(22.2%)指南未在推荐后标注相应的参考文献;其他14篇指南共标注有1 132篇参考文献,平均每条推荐约标注0.85篇;来自中国的参考文献有180篇(15.9%),其中40篇为中国其他指南或共识,中国RCT仅有62篇(5.5%)。高血压指南采用中国RCT证据比例最高(9.3%),而瓣膜心脏病指南中没有中国RCT证据的支持。结论:相对于美国心脏病学院/美国心脏协会(ACC/AHA)有约9.0%的A级证据,我国心血管指南中有超过五分之一的推荐为A级证据;中国心血管病指南参考文献标注不规范,且缺少来自中国RCT研究的证据。     

中医功法对高血压干预效果系统评价的再评价

目的再评价中医功法干预高血压病人效果的系统评价。方法计算机检索PubMed、Cochrane Library、EBSCO、Web of Science、知网、万方、维普等数据库,检索时间为建库至2018年12月,收集常用中医功法干预高血压病的系统评价和Meta分析,采用AMSTAR量表及GRADE系统对纳入研究进行方法学质量和证据等级评价。结果本研究共纳入1 0篇系统评价文献。AMSTAR评价结果显示,纳入的系统评价方法学质量普遍不高。GRADE证据质量评价显示,共纳入44个结局指标,仅5个结局指标证据质量为中级,其余均为低级或极低级。结论中医功法干预高血压系统评价方法学质量和结论的证据质量较低,虽然中医功法配合药物或其他治疗高血压疗效确切,且未见明显不良反应,但单纯中医功法是否优于药物或其他常规运动需进一步探讨。     

针灸疗法干预血脂异常的系统评价和Meta分析的汇总评价

目的对当前针灸疗法治疗血脂异常的系统评价与Meta分析进行汇总评价。方法通过检索Pubmed,Embase,Cochrane Library,CBM,CNKI和万方数据库,查找针灸疗法治疗血脂异常的系统评价与Meta分析的研究,对纳入的研究采用系统评价方法学质量评估工具AMSTAR评估方法学质量,并采用证据质量分级工具GRADE系统评估证据等级。结果最终纳入符合要求的系统评价1篇,比较针灸疗法与药物疗法。AMSTAR评估工具共有11个条目,结果显示:在条目一方面,该系统评价并未提供注册信息,也未提供研究计划书;条目二,该研究虽然介绍了有两名评价员分别评价,但没有详细列出具体评价员的信息;在条目十和条目十一方面,该系统评价在制作过程中,没有评估发表偏倚,也未对相关利益冲突做出说明;其余七个条目,该系统评价均做了较为充分的解释和说明。GRADE证据质量等级评估因"偏倚风险","不一致性","间接性","精确性"和"发表偏倚"5个方面降低证据质量。该系统评价关注的10个结局指标经评估后,证据质量均为"极低级",均因存在"偏倚风险"、"不一致性"和"发表偏倚"而降级。结论当前针灸疗法治疗血脂异常的系统评价数量少,方法学质量不高且证据等级低,临床实践时应谨慎。     

高血压合并冠心病患者血压管理的最佳证据总结

目的总结高血压合并冠心病患者血压管理的最佳证据。方法按照“6S”金字塔证据模型检索BMJ Best Practice、UpToDate、国际指南协作网、美国国立指南库、加拿大安大略省注册护士协会(RNAO)网站、英国国家卫生与临床优化研究所网站、苏格兰院际指南网(SIGN)、澳大利亚临床实践指南平台、新西兰指南工作组网站、国际高血压学会网站、日本高血压学会网站、美国心脏协会(AHA)网站、欧洲心脏病学会(ESC)网站、法国高血压学会(FSAH)网站、韩国高血压学会网站、意大利心血管疾病预防学会网站、Nursing Consult、Embase、Cochrane Library、PubMed、医脉通、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库等网站或数据库中关于高血压合并冠心病患者血压管理的文献。检索时限为建库至2023年3月。由2名研究者进行文献筛选、内容提取、文献质量评价(指南为4名)及证据提取与证据等级评价。结果共纳入文献19篇,包括8篇指南、5篇系统评价、3篇专家共识、2篇随机对照试验、1篇临床决策。纳入的1篇临床决策,原始文献为1篇随机对照试验、3篇系统评价(总分均为11.0分);纳入的8篇指南中4篇指南的推荐级别为A级,4篇指南的推荐级别为B级;纳入的3篇专家共识总分均≥5.5分;纳入的5篇系统评价的总分均≥9.0分;纳入的2篇随机对照试验中SPRINT Research Group等研究的所有条目评价为“是”,SHERWOOD等研究的条目4和条目5评价为“不清楚”,其他条目评价为“是”。通过提取与整合证据,最终形成了高血压合并冠心病患者血压管理的最佳证据,包括系统评估血压、降压目标、降压策略、非药物干预、随访及院外血压管理5个方面共34个条目。结论该研究总结了包括系统评估血压、降压目标、降压策略、非药物干预、随访及院外血压管理5个方面共34个条目的高血压合并冠心病患者血压管理的最佳证据,为临床制定规范的高血压合并冠心病患者血压管理方案提供了借鉴。     

老年冠心病患者经皮冠状动脉介入治疗后饮食管理的最佳证据总结

目的 总结老年冠心病患者经皮冠状动脉介入治疗（PCI）后饮食管理的最佳证据。方法 按照“6S”金字塔证据模型检索BMJ Best Practice、UpToDate、澳大利亚乔安娜布里格斯研究所（JBI）循证卫生保健中心、英国国家卫生与临床优化研究所（NICE）网站、苏格兰院际指南网（SIGN）网站、加拿大安大略省注册护士协会（RNAO）网站、国际指南协作网（GIN）网站、美国心脏协会（AHA）网站、美国心脏病学会（ACC）网站、欧洲心脏协会（ESC）网站、Cochrane Library、PubMed、Medline、Web of Science、Embase、卫生保健及护理学数据库（CINAHL）、医脉通、中国知网、中国生物医学文献数据库、万方数据知识服务平台、维普网公开发表的老年冠心病患者PCI后饮食管理的证据相关文献。检索时限为建库至2023年3月。由2名研究人员进行文献筛选及内容提取、文献质量评价、证据提取与证据等级评价。结果 共纳入文献16篇,其中6篇指南、5篇专家共识、2篇系统评价、2篇临床决策、1篇证据总结。纳入的6篇指南中,3篇的推荐级别为A级,3篇的推荐级别为B级;...     

Measuring Asthma Severity: Instrument Refinement

The focus of this study is to evaluate a brief parent-report instrument, the Severity of Chronic Asthma (SCA) scale, that conforms to the national guidelines for assessing asthma. Convergent validity was found between the SCA and other measures related to asthma severity including an illness severity scale (How Bad is the Asthma?), asthma management scales for parents and children, and the pediatric quality-of-life scale. The SCA is a multidimensional scale with appropriate evidence of reliability and validity that may be a heuristic and effective measure in both clinical practice and research endeavors.     

Health-related quality of life of pre-school children with wheezing illness

Pre-school children are frequently affected by wheezing illness, with substantial influences on their health-related quality of life (HRQL). The Infant/Toddler Quality of Life Questionnaire (ITQOL) is the only generic health status measure for children aged 2 months up to 5 years. In this present study we evaluated the impact of wheezing illness in pre-school children on the HRQL, using the ITQOL. A questionnaire including the ITQOL and ISAAC questions on frequency and severity of respiratory complaints were sent to parents of patients aged 6 months-5 years visiting the outpatient department with wheezing illness. Scale scores of ITQOL of the included children were compared with general population scores. Using multivariate analysis, the influence of general and clinical characteristics on ITQOL scale scores was evaluated. Results are based on 138 children, 59% male, mean age 34 months. Children with wheezing illness scored differently to the general population sample on 8 of the 11 ITQOL scales. Age, comorbidity and employment of the respondent affected scales on child's physical and emotional functioning and parental functioning. Severity of dyspnoea and wheezing, presence of cough, corticosteroid use, and number of GP visits negatively affected scales on the child's physical and emotional functioning. In conclusion, the HRQL as measured by the ITQOL was lower in a group of Dutch pre-school children with wheezing illness compared to a general population sample. The scale scores were sensitive to age, co morbidity, socio-economic situation, and disease severity.     

Development and use of a quality assessment scale specifically constructed for the assessment of studies that compare hemodialysis modalities

There are currently many hemodialysis modalities that are believed to be superior to conventional hemodialysis. In order to compare the effectiveness and security of the different hemodialysis techniques a systematic review was carried out. Faced with the fact that the scales available mainly focus on study design and tend to ignore external validity, a quality scale was specifically developed to assess the quality of the studies included in the review. The objective of this article is to introduce the quality assessment scale developed and present the results of its usability and applicability. The following databases were searched in order to identify the studies: MEDLINE, EMBASE, Cochrane, HTA, CRD and others. The articles obtained were selected based on previously established inclusion/exclusion criteria. The scale covers three issues: general aspects of the studies, specific aspects of the studies and patient characteristics. This scale allowed for a more accurate classification of the global quality of the studies and was reproducible. In general, those studies classified as high quality studies received the highest score and those studies classified as low quality studies received the lowest scores. The median value was 5,35 (53,5%). The intraclass correlation coefficient was 0,96. As a conclusion of this work it can be stated that currently available scales have serious limitations for the use in studies that compare different hemodialysis modalities and that the use of a scale specifically constructed for this purpose provides more accurate information on the quality of the evidence which is fundamental to interpret results and generate inferences.     

基于文献计量学的螺类肠道菌群研究现状及热点分析

目的 了解当前螺类肠道菌群研究领域现状及热点问题。方法 检索1998-2017年Web of Science核心数据库中螺类肠道菌群研究领域相关论文,采用文献计量学方法,通过CiteSpace软件进行定量分析。结果 共检索到螺类肠道菌群领域文献139篇,发文量居前3位的国家为美国、巴西、韩国,发文较多的研究机构包括庆熙大学、奥斯瓦尔多·克鲁兹基金会、牛津大学等。螺类肠道菌群研究领域关键主题词包括多样性、纤维素酶、木质纤维素、褐云玛瑙螺、新物种,被引频次＞15的文献有5篇。主题词聚类分析共形成了肠道菌群的应用、肠道菌群多样性、肠道菌群功能、环境与螺类肠道菌群差异及螺类肠道新发现菌种等5个聚类。结论 肠道菌群多样性及肠道菌群的功能和应用研究是当前螺类肠道菌群研究领域的热点问题。 ［关键词］     

Changes in Millon Clinical Multiaxial Inventory scores among opiate addicts as a function of retention in methadone maintenance treatment and recent drug use

The Millon Clinical Multiaxial Inventory (MCMI) was administered to 144 men and 86 women within 1 month of admission to methadone maintenance treatment and was readministered 18 months following admission. Based on prior research, we hypothesized there would be significant decreases on scales measuring affective disturbance, anxiety, and social isolation and little change in scales measuring antisocial and narcissistic traits. In addition, it was hypothesized that changes on the MCMI would be related to retention in treatment and illicit drug use during the interim between initial assessment and follow-up. Data were analyzed using a multivariate analysis of variance (MANOVA) for repeated measures. There was an overall decrease in MCMI scores, indicating less psychopathology between initial assessment and follow-up. MCMI scales did not change as a function of retention status, but decreases in MCMI scale scores were greater for subjects who were light drug users in the 6 months prior to the follow-up compared to heavy users. Inspection of individual MCMI scales supported our hypothesis; there were decreases on scales measuring affective disturbance, anxiety, and social isolation, but not on scales measuring antisocial and narcissistic traits.     

Latent variable approach to the measurement of physical disability in rheumatoid arthritis

OBJECTIVE: To measure physical disability in rheumatoid arthritis (RA) using a latent variable derived from a generic and a disease-specific self-reported disability instrument and an observer-assessed functional status scale. METHODS: Consecutive patients with RA completed the modified Health Assessment Questionnaire (M-HAQ) and the Short Form 36 (SF-36) physical function scale. An observer assigned a Steinbrocker functional classification. We used principal component factor analysis to extract a latent variable from the 3 scales. We used the Bayesian Information Criterion to compare how well the new latent variable and the 3 primary scales fit the criterion standards of current work status; vital status at 6 years; grip strength; walking velocity; the timed-button test; pain; and joint tenderness, swelling, and deformity. RESULTS: Complete data were available for 776 RA patients. The extracted latent variable explained 75% of the variance in the 3 primary scales. On a scale of 0-100, higher scores representing less disability, its mean +/- SD was 56.4 +/- 22.5. Correlation between the latent variable and the M-HAQ was -0.87; between the latent variable and SF-36 physical function scale was 0.89, and between the latent variable and Steinbrocker class was -0.85. Multivariate models that included the latent variable had superior fit than did models containing the primary scales for the criteria of current working; death by 6 years; pain; joint tenderness, swelling, or deformity; grip strength; walking velocity; and timed button test. CONCLUSION: A latent variable derived from the M-HAQ, the SF-36 physical function scale, and the Steinbrocker functional class provides a parsimonious scale to measure physical disability in RA. The fit of the latent variable to comparison standards is equivalent or superior to that of the primary scales.     

Systematic review of noncancer presentations with a median survival of 6 months or less

PurposeWe report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival.MethodsThe MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of ≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of ≥50%.ResultsThe search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment.ConclusionThis systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.     

Prospective evaluation of pneumonia severity index in hospitalised patients with community-acquired pneumonia

The aim of the present study was to investigate whether the pneumonia severity index (PSI) could adequately predict the severity of community-acquired pneumonia (CAP) and could be used as a severity of illness classification system. Furthermore, reasons that may influence the decision to admit low risk patients were analysed. In a prospective study 260 patients with CAP were included. Stratification in five risk classes according to the PSI was compared with parameters that are closely related to severity of CAR A significant difference in severity parameters, such as length of stay (P < 0.001) and simplified acute physiologic score and acute physiologic and chronic health evaluation II score (P < 0.001) was found between the five risk classes. Furthermore, a positive British Thoracic Society (BTS) rule and modified BTS rule score was significantly more prevalent in the higher risk classes (P < 0.001). The patient population had an average 30-day mortality of 10% and a mean Intensive Care Unit (ICU) admission rate of 8%. The mortality rate and ICU admission rate significantly differed between the five risk classes (P < 0.001), in which the highest ICU admission rate (40.9%) and the highest mortality percentage (40.9%) were both found in risk class V. Several clinical factors (n = 64), such as an exacerbation of chronic obstructive pulmonary disease in 17 patients and clinical appearance of being ill in 16 patients, lack of improvement on outpatient antibiotic therapy (n = 15) and social circumstances (n = 3) were reasons that influenced the decision to hospitalise low risk patients (n = 82). The results show that the PSI adequately predicted the severity of CAP and can be used as a severity of illness classification in CAP. Clinical and social factors other than those mentioned in the PSI have to be considered when making the decision to hospitalise patients with CAP.     

Symptoms and treatment burden of gastroesophageal reflux disease: validating the GERD assessment scales

BACKGROUND: A comprehensive assessment instrument that measures the burden of both symptoms and treatment is needed to determine the optimal management of gastroesophageal reflux disease (GERD), and we developed such an instrument. METHODS: This validation study included 3 groups: patients with active GERD (n = 193), surgical patients with prior GERD (n = 197), and general medical outpatients (n = 63). All completed an initial survey. General medical patients and patients with active GERD were resurveyed after 2 to 6 weeks. The main outcome measures were test-retest reliability, internal consistency, discriminant validity, and responsiveness to change for 3 scales graduated from 0 to 100: a GERD burden (or overall impact on quality of life scale), a symptoms scale, and a treatment scale. Higher scores indicated greater disease burden. RESULTS: The GERD burden, symptoms, and treatment scales all demonstrated good discriminant validity, as patients in the active-GERD group had the highest scores. Scores on each scale effectively classified the patients who belonged to the active-GERD group. Moreover, scores improved substantially 8 weeks after surgery, thereby demonstrating the scales' responsiveness to change. As hypothesized, the burden of treatment was distinct from that of symptoms, as 23% of patients not bothered by GERD symptoms described their GERD treatment to be a moderate or serious problem. Indeed, the impact of treatment problems approached that of symptoms problems. All pairwise comparisons were significant (P<.02). CONCLUSIONS: The GERD burden, symptoms, and treatment scales were valid, reliable, and responsive instruments for use in patients with GERD. Our analyses highlight the importance of assessing both symptoms and treatment burden in patients with GERD.