我国临床护理实践指南改编研究的范围综述

目的 探讨我国临床护理实践指南改编研究的内容、理论框架、改编过程、方法学质量及报告质量。 方法 系统检索PubMed、Cochrane Library、CINAHL、Embase、Scopus、Web of Science、中国知网、万方、维普、中国生物医学文献数据库、医脉通等数据库中以我国护理领域指南改编为主题的文献,检索时限为建库至2021年4月20日,由2名研究者独立筛选、提取数据,采用描述性分析对数据进行合成,采用临床指南研究与评价系统Ⅱ (appraisal of gui-delines for research and evaluationⅡ,AGREE Ⅱ) 工具和临床实践指南报告标准 (reporting items for practice guidelines in healthcare,RIGHT) 对指南的方法学质量和报告质量进行评价。 结果 共纳入23篇文献,16篇 (69.6%) 文献发表于近3年,仅7篇 (30.4%) 文献报告了基金支持。研究主题方面,15篇 (65.2%) 文献的主题为疾病及其症状的护理,仅12篇 (52.2%) 文献报告了改编过程中使用的方法,其中7篇 (30.4%) 文献采用指南改编方法 (guideline adaptation,ADAPTE) 。方法学质量评价结果显示,6个领域中平均得分>60%的领域包括范围和目的、参与人员、表达明晰性,得分最低的领域是编辑独立性。报告质量评价结果显示,7个领域中平均得分>4分的领域包括基本信息、背景、推荐意见,得分最低的领域是资金资助与利益冲突声明和管理。 结论 我国临床护理实践指南改编研究数量上呈现明显增加的趋势,但改编指南所依据的理论框架与改编指南方法学质量和报告质量欠佳。     

《2020版WCET®国际造口指南》(第二版)解读

世界造口治疗师协会(World Council of Enterostomal Therapists? ,WCET?)成立于1978年,是一家在英国注册的慈善结构,其使命是引领造口、伤口、失禁专科化职业化护理的全球发展。最初,WCET?仅涉及造口护理专业,进过多年的发展,伤口和失禁护理也被纳入实践领域。2022年12月WCET?发布了《2020版WCET?国际造口指南》(第二版),该指南旨在为即将进行或已经进行造口手术的患者提供循证护理的建议。以2014年第一版WCET?国际造口指南为基础,对自2014年指南发布以来发表的研究和文献进行了更新评估。2020版国际造口指南适用于在各国/地区的各种护理环境之下接受护理服务的所有造口人士,包含与全球范围内的造口患者护理有关的文化、宗教和/或种族资料,将帮助护理人员根据适当的文化、宗教和种族考虑因素制定护理计划。本文主要从指南发布的背景、指南的目标、指南推荐、指南推荐和证据评估、指南实施,WCET?成员的文化、宗教和社会考虑因素、附录、术语和定义等方面进行要点解读,以期能让造口护理相关领域的专业人员、组织以及造口患者和照顾者更好地了解本指南的核心内容,为进一步提高造口护理质量,改善造口患者的生活质量提供参考。     

《2021年AGA指南：SARS-CoV2检测与疫苗接种后 内镜检查》要点解读

2021年9月,美国胃肠病协会（American Gastroenterology Association,AGA）发布了更新版《SARS-CoV2检测与疫苗接种后内镜检查指南》。本文主要从指南推荐意见中个人防护与症状筛查、疫苗接种与医患安全、SARS-CoV2检测与内镜检查、SARS-CoV2检测方法选择等方面进行解读,以期帮助我国内镜工作人员更好地理解并参考借鉴该指南。     

Interventions to promote oral care regimen adherence in the critical care setting: A systematic review

BackgroundOral care is a fundamental nurse-led intervention in the critical care setting that provides patient comfort and prevents adverse outcomes in critically ill patients. To date, there has been minimal focus on nurse-focused interventions to improve adherence to oral care regimens in the adult intensive care unit setting.ObjectivesThe objectives of this study were to (i) identify types and characteristics of interventions to improve oral care adherence amongst critical care nurses and intervention core components, (ii) evaluate the effectiveness of interventions to improve adherence of oral care regimens, and (iii) identify the types of outcome measures used to assess oral care regimen adherence.DesignThis is a systematic review in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Data sourcesKey bibliographic databases and platforms, including Scopus, Cochrane, MEDLINE, CINAHL, Embase, PsycINFO, ProQuest, and Web of Science, were searched for studies published before July 2020. The Joanna Briggs Institute's quality appraisal tool was used to assess risk of bias in included studies.Results: A total of 21 original research studies were identified, of which 18 studies used multifaceted interventions. In accordance with the Joanna Briggs Institute's quality appraisal tools, four of the 20 quasi-experimental studies were rated as high quality. The one randomised control trial was of moderate quality. Outcome measures included oral care adherence behaviours, oral care knowledge, self-reported adherence, and documentation. Improved effectiveness in oral care adherence was reported in 20 studies.ConclusionsReview findings confirm interventions to change behaviours improve oral care adherence. The most effective interventional approach could not be determined owing to heterogeneity in intervention design and outcome measures. Oral care in the intensive care unit is a vital, nurse-led activity that reduces the risk of hospital-acquired infection. It is recommended that future research adopt implementation science methods to ensure stakeholder engagement and feasibility.Systematic Review Registration NumberThis review was submitted and subsequently registered on PROSPERO, the International Perspective Register of Systematic Reviews PROSPERO 2019 CRD42019123142.     

Efficacy and validity of guideline-concordant treatment according to the JRS guidelines for the managements of pneumonia in adults updated in 2017 for nursing and healthcare-associated pneumonia. A propensity-matching score analysis

IntroductionPatients with nursing and healthcare-associated pneumonia (NHCAP) commonly receive empiric antibiotic therapy according to the guideline's recommendation corresponding to the patient's deteriorated conditions. However, it is unclear whether guideline-concordant treatment (GCT) could be effective or not.Patients and methodsTo evaluate the efficacy and validity of GCT according to the current guideline for pneumonia, we conducted this retrospective study. NHCAP patients who were admitted to our institute between 2014 and 2017 were enrolled. Based on the initial antibiotic treatment, these patients were divided into two groups, the GCT group (n = 83) and the non-GCT group (n = 146). Propensity score matching (PSM) was used to balance the baseline characteristics and potential confounders between the two groups. After PSM, patients’ characteristics, microbial profiles, and clinical outcomes were evaluated.ResultsBoth groups were well-balanced after PSM, and 78 patients were selected from each group. There were no differences in patients’ characteristics or microbial profiles between the two groups. As for outcomes, there were no differences in 30-day, in-hospital mortality rate, duration of antibiotic treatment, or admission. The severity of pneumonia was more severe in patients with the GCT group than those with the non-GCT group. Anti-pseudomonal agents as initial treatment were more frequently seen in patients with the GCT group than those in the non-GCT group.ConclusionUnlike previous studies, GCT's recommendation for management of pneumonia by the JRS in 2017 would appear to be valid and does not increase the mortality rate.     

肝衰竭诊治指南(2012年版)

肝衰竭是临床常见的严重肝病症候群,病死率极高.多年来,各国学者对肝衰竭的定义、病因、分类、分型、诊断和治疗、预后判断等问题不断进行探索.2005年,美国肝病学会(AASLD)发布了《急性肝衰竭处理》的意见书(position-paper)[1].2006年10月,中华医学会感染病学分会肝衰竭与人工肝学组和中华医学会肝病学分会重型肝病与人工肝学组制订了我国第一部《肝衰竭诊疗指南》[2],从定义、诱因、分类、诊断和治疗等方面对肝衰竭进行了系统而精要的阐述,既与国际接轨,又具中国特色,诊断分型突出了实用性,指导和规范了我国肝衰竭的临床诊疗.2009年,亚太肝脏研究协会(APASL)推出了《慢加急性肝衰竭共识》[3].     

低温核供热堆辐射防护安全准则

作者提出了低温核供热堆辐射防护安全准则的建议，即①要求半径５０ｋｍ范围内加权人口不超过１０６；②禁区半径为２５０ｍ；③限制发展区半径２ｋｍ；④低温核供热堆正常运行期间，由于放射性向环境释放所致公众个人剂量（全身或有效）不应超过０．１ｍＳｖ／ａ，集体剂量不超过１００ｍａｎ·Ｓｖ／ａ；⑤低温核供热堆事故期间，公众个人剂量不超过５ｍＳｖ，集体剂量不超过１０００ｍａｎ·Ｓｖ；⑥低温核供热堆正常运行期间，放射性流出物（气体、液体）的释放量不应超过国标ＧＢ６２４９规定值的２／５；⑦热网水中的放射性活度不应超过０．３７Ｂｑ／Ｌ；⑧建议应急状态分为三级，即应急待命、厂房应急和场区应急。     

循证医学在美国的应用与实践

中国循证医学中心代表团对美国循证医学的现状与发展进行了考察,寻找我国与国际上存在的差距,为进一步促进和规划我国循证医学的发展提供借鉴.     

Subacute oral toxicity study of diethylphthalate based on the draft protocol for “Enhanced OECD Test Guideline no. 407”

We performed a 28-day repeated-dose toxicity study of diethylphthalate based on the draft protocol of the “Enhanced OECD Test Guideline 407” to investigate whether it has endocrine-mediated properties according to this assay. Diethylphthalate was orally administered to SD rats at doses of 0, 40, 200, and 1,000 mg/kg/day for at least 28 days, but no endocrine-mediated effects were detected based on any of the parameters examined, suggesting that diethylphthalate does not possess endocrine properties according to this assay.     

Potential for reported needlestick injury prevention among healthcare workers through safety device usage and improvement of guideline adherence: expert panel assessment

A prospective survey was conducted over six months in order to estimate the proportion of reported occupational needlestick injuries sustained by National Health Service (NHS) Scotland staff that could have been prevented through either safety device introduction, improved guideline adherence, guideline revision or a combination of these. This survey involved the administration of a standard proforma to healthcare workers followed by an expert panel assessment. All acute and primary care NHS Scotland trusts, the Scottish Ambulance Service and the Scottish National Blood Transfusion Service were included. Proforma and expert panel assessment data were available for 64% of injuries (952/1497) reported by healthcare staff. These injuries were all percutaneous. The expert panel concluded that: 56% of all injuries and 80% of venepuncture/injection administration injuries would probably/definitely have been prevented through safety device usage, 52% of all injuries and 56% of venepuncture/injection administration injuries would probably/definitely have been prevented through guideline adherence and 72% of all injuries and 88% of venepuncture/injection administration injuries would probably/definitely have been prevented through either intervention. Multi-factorial analysis indicated that injuries sustained through venepuncture/injection administration were significantly more likely to be prevented through safety device usage [adjusted odds ratio (OR) 5.09, 95% confidence intervals (CI) 3.11-8.31 and adjusted OR 2.70, 95% CI 1.64-4.45, respectively], and significantly less likely to be prevented through guideline adherence (adjusted OR 0.26, 95% CI 0.11-0.60 and adjusted OR 0.31, 95% CI 0.12-0.78, respectively). Injuries sustained after completing procedures were significantly more likely to be prevented through safety device usage and guideline adherence. The study's findings support the need for improvements to staff's adherence to needlestick injury guidelines and appropriate implementation of safety devices for venepuncture and injection administration.