Beyond direct impact: Evidence synthesis towards a better understanding of effectiveness of environmental health interventions

Systematic reviews are a cornerstone of evidence-based public health, and there is much discussion on how this method may need to be modified to do justice to complex interventions, such as environmental health interventions. This paper asserts that intervention effectiveness is influenced by variability in five distinct layers – direct (intrinsic) impact, user compliance, delivery, programming and policy measures – which are embedded in the broader geographical, socio-economic, political and cultural context. The multi-component, multi-sectoral nature of most environmental health interventions results in a complex relationship between these layers of influence, involving systemic interactions. As illustrated with examples, understanding environmental health interventions critically relies on considering all of these layers. These distinct layers of influence can serve as a framework towards the comprehensive analysis of environmental health interventions in systematic reviews, drawing on quantitative and qualitative methods and a variety of disciplines.     

抗菌药物管理措施及成效探讨

目的 加强抗菌药物管理,确保抗菌药物合理使用.方法 确立抗菌药物一品双规、分级使用、特殊使用、抗菌药物专家会诊与医嘱点评制度等.结果 抗菌药物种类减少,使用量下降,医务人员越级使用情况减少,不规范处方数量减少,医务人员抗菌药物知识水平提升.结论 通过加强抗菌药物管理,抗菌药物滥用现象得到遏制,一定程度上保证了抗菌药物合理使用.     

Prolonged effectiveness of coronary artery bypass surgery versus drug-eluting stents in diabetics with multi-vessel disease: An updated systematic review and meta-analysis

Background

Currently, the appropriateness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) for patients with diabetes (DM) and multi-vessel disease (MVD) is uncertain due to limited evidence from few randomised controlled trials (RCTs). We aimed to compare the clinical effectiveness of CABG versus PCI-DES in DM-MVD patients using an evidence-based approach.

Methods

A systematic review and meta-analyses were conducted to compare the risk of all-cause mortality, myocardial infarction (MI), repeat revascularisation, cerebrovascular events (CVE), and major adverse cardiac or cerebrovascular events (MACCE).

Results

A total of 1,837 and 3,052 DM-MVD patients were pooled from four RCTs (FREEDOM, SYNTAX, VA CARDS, and CARDia) and five non-randomised studies. At mean follow-up of 3 years, CABG compared with PCI-DES was associated with a lower risk of all-cause mortality and MI in RCTs. By contrast, no significant differences were observed in the mean 3.5-year risk of all-cause mortality and MI in non-randomised trials. However, the risk of repeat revascularisations following PCI-DES compared with CABG was 2.3 (95% CI = 1.8–2.8) and 3.0 (2.3–4.2)-folds higher in RCTs and non-randomised trials, respectively. Accordingly, the risk of MACCE at 3 years following CABG compared with PCI-DES was lower in both RCTs and non-randomised trials [0.65 (: 0.55–0.77); and 0.77 (0.60–0.98), respectively].

Conclusions

Based on our pooled results, we recommend CABG compared with PCI-DES for patients with DM-MVD. Although non-randomised trials suggest no additional survival-, MI-, and CVE- benefit from CABG over PCI-DES, these results should be interpreted with care.     

The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review

BackgroundThe nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings.PurposeThe purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders.MethodsStudies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included.FindingsSeventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms.DiscussionMore high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings.     

Effectiveness of Procedural Sedation and Analgesia in Pediatric Emergencies. A Cross-Sectional Study

IntroductionPain is defined as an unpleasant emotional and sensory experience associated with bodily harm or with situations that cause fear and anxiety. However, it is often undertreated in pediatric emergency departments. This study aims to assess the effectiveness of sedation-analgesia techniques, level of satisfaction among health care professionals and relatives, and agreement between the satisfaction of health care professionals and relatives.MethodsA cross-sectional design was conducted. Sociodemographic and clinical variables were recorded, together with those for effectiveness using the Face, Legs, Activity, Cry, and Consolability scale and the Wong-Baker FACES scale, and the satisfaction using the 10-point Likert scale. Stata 16.1 was used for data analysis.ResultsA total of 94 procedures were registered. The results suggested that these techniques were effective or mildly effective in only half of the cases. Satisfaction was considered good across the board, and the agreement between health care professionals (ie, pediatric nurses and pediatricians) was considered substantial. However, the agreement between health care professionals and relatives was moderate.DiscussionOur results suggested that the adequate management of pain in pediatric emergency departments is still a challenge, despite the availability of international guidelines. Future research lines should be focused on analyzing possible causes of the inefficacy of some sedation-analgesia techniques and the causes of the differences between the perspectives of health care professionals and relatives. These research lines may be useful to improve quality of care and pediatric patient comfort.     

中西医结合治疗单纯性卵巢囊肿临床分析

目的：研究中西医结合治疗单纯性卵巢囊肿的有效性。方法选取2007年3月～2012年6月我科收治的单纯性卵巢囊肿170例进行回顾性分析,所选患者囊肿直径均＜6cm,根据治疗方法将患者分为治疗组和对照组,治疗组85例,在患者月经来潮前1周进行中西医结合治疗,即采用一般西药和口服中药治疗。对照组85例,患者采用一般西药治疗,两组均为3个月为1个疗程,1个疗程后在月经干净后3～7d,用B超检测其囊肿变化情况。结果治疗组治愈46例,好转37例,无效2例,总有效率达到97.6%;对照组治愈27例,好转43例,无效15例,总有效率达到82.4%。两组比较差异具有统计学意义（P＜0.05）。结论中西医结合治疗单纯性卵巢囊肿比单纯的西药治疗更有效,可供临床参考。     

多脏器切除在进展期胃癌手术中的临床应用

目的探讨多脏器切除在进展期胃癌手术中应用的指征及疗效。方法回顾性分析我院1990年1月～1996年1月手术治疗的46例进展期胃癌的临床资料。对不同性质手术结果进行分析。结果46例中多脏器切除手术32例,姑息性手术14例。多脏器切除的患者平均存活时间2年,而姑息切除患者平均存活时间0.8年,两者比较P<0.005,差异有显著性意义。结论在进展期胃癌手术中严格掌握多脏器切除的指征,注重患者围手术期支持,并不增加手术并发症及死亡率,而能明显延长患者的生存期。     

南沙区街道干部艾滋病健康教育效果评价

目的 评价采用集中方式对街道干部进行艾滋病健康教育的效果.方法 随机抽取广州市南沙区各街道干部共100名,采用医务人员讲课、发放预防艾滋病健康教育三折页(每人1份)、现场有奖抢答、观看艾滋病科普知识展览、观看如何预防艾滋病VCD等集中教育方式进行艾滋病健康教育,并在健康教育前后以无记名自填式问卷对调查对象艾滋病相关知识知晓率、对5项艾滋病相关行为的态度、对3项艾滋病相关行为的倾向等进行对照分析.结果 与教育前比较,15项艾滋病相关知识有11项知晓率显著提高,5项艾滋病相关行为的态度有4项及3项艾滋病相关行为的倾向有2项有积极的变化,差异均有统计学意义(P＜0.01).结论 采用集中教育这种健康教育形式在街道干部中进行预防艾滋病健康教育效果明显,建议推广应用.