A quality appraisal using the AGREE II instrument of endotracheal tube suction guidelines in neonatal intensive care units

BackgroundEndotracheal tube (ETT) suction is among the most common procedures performed in neonatal intensive care units (NICUs). Although necessary, it is associated with significant risks. To mitigate these risks, clinical practice guidelines are developed to provide evidence-based recommendations.ObjectiveThe aim of the study was to appraise the quality of neonatal ETT suction guidelines from all NICUs in Australia and New Zealand.MethodsAll level III NICUs in Australia and New Zealand were invited to participate. Three researchers graded the methodological quality of the received guidelines using the AGREE II instrument. Item and domain scores were calculated by scaling as a percentage of the total possible score out of 100%. A threshold score of <50% is considered to be of limited potential use.ResultsTwenty-three (79.31%) clinical practice guidelines were received from 29 invited facilities. The scaled results of the AGREE II domains were as follows: Scope and Purpose, mean = 73%, 95% confidence interval (CI) = 63–83%; Stakeholder Involvement, mean = 23%, 95% CI = 15–31%; Rigour of Development, mean = 17%, 95% CI = 12–21%; Clarity of Presentation, mean = 63%, 95% CI = 56–70%; Applicability, mean = 5%, 95% CI = 20–30%; and Editorial Independence, mean = 50%, 95% CI = 50–50%. Overall assessment indicated low methodological quality (31%; 22–39%), with only five clinical practice guidelines scoring >50%, suggesting that they could be recommended for use with modifications. The remaining 18 could not be recommended for use.ConclusionsNeonatal ETT suction guidelines are of a low methodological quality. All guidelines poorly incorporated latest evidence in guideline development. This appraisal highlights the need to improve the quality of neonatal ETT suction guidelines to promote optimal patient care.     

Systematic review of clinical practice guidelines on the management of community acquired pneumonia in children

Childhood community acquired pneumonia (CAP) is the leading cause of mortality in children under 5 years worldwide. Clinical practice guidelines (CPGs) may be limited by method of development, scope of recommendations and the quality of supporting evidence. This study systematically identified, appraised and compared the recommendations of CPGs for the management of paediatric CAP using the AGREE II tool.The systematic review yielded 1409 non-duplicate results, of which 14 CPGs were appraised. Four of the fourteen CPGs were deemed high quality. Most CPGs were considered low-medium quality with ‘rigour of development’ and ‘applicability’ the weakest domains. These areas should be considered in deriving CPGs in the future. Recommendations were generally similar across all guidelines; however, there was notable heterogeneity in three areas. This suggests the need for further evidence to guide management decisions on oxygen saturation thresholds for admission, the utility of investigations such as acute phase reactants, and the duration of antibiotic therapy.     

智能化人体排泄护理仪KAP认知调查分析

[目的]了解民众对新研发的高新护理仪器———智能化人体排泄护理仪的认知现状。为其进一步研发和临床推广应用提供可资借鉴的实证依据。[方法]采用随机抽样的方法对浙江省内18岁以上具有行为能力的自愿参加本项目的公民进行问卷调查。[结果]75.8%的民众没听说过人体排泄护理仪,83.1%的民众想了解该护理仪；87.3%的人建议大小便失禁病人使用该机器；95.5%的调查对象对于人体排泄护理仪的推广持支持态度。[结论]虽然民众对护理仪认知不足,但对其生产及推广持积极的肯定态度。因此,建议加快进行该产品的设计与临床应用推广工作,尽早造福二便失禁病人,提高他们的舒适度和生活质量。     

己糖激酶-Ⅱ在胃癌组织中的表达及其临床意义

目的探讨己糖激酶-Ⅱ(HK-Ⅱ)在人体胃癌组织中的表达情况及其临床意义,分析HK-Ⅱ与临床病理特征之间的关系。方法选取2013年3—9月在东南大学医学院附属江阴医院确诊的胃癌病患100例,切除标本,运用免疫组化及RTPCR方法检测胃癌组织及正常胃黏膜组织中HK-Ⅱ的表达情况,并分析其与性别、年龄、浸润深度、TNM分期、分化程度、淋巴结转移、脉管侵犯、肿瘤大小等的关系。结果 HK-Ⅱ在胃癌组织中的阳性表达率为68.00%,显著高于正常胃黏膜组织(P0.05)。HK-Ⅱ表达与性别、年龄、浸润深度无关(P0.05);与TNM分期、分化程度、淋巴结转移、脉管侵犯、肿瘤大小有关(P0.05)。胃癌组织HK-ⅡmRNA阳性率显著高于正常胃黏膜组织(P0.01)。结论 HK-Ⅱ在胃癌组织中高表达,可作为胃癌的恶性预后指标和临床治疗靶点。     

长效硝酸酯对心力衰竭大鼠心脏血管紧张素Ⅱ受体表达水平的影响

目的:探讨长效硝酸酯(异乐定)对心肌梗死后慢性心力衰竭(CHF)大鼠心功能、血浆肾素活性(plasma renin activity,PRA)和血管紧张素II(Angiotensin II,Ang II)水平以及非梗死区左心室组织血管紧张素II受体(Angiotensin II receptor,ATR)各亚型表达水平的影响。方法:选用雄性Wistar大鼠,随机分为正常对照组(N组)、假手术组(SH组),结扎左冠状动脉前降支制作心肌梗死后心力衰竭模型,分为心力衰竭模型组(HF组)、硝酸酯小剂量组(LN组)、硝酸酯大剂量组(HN组)、阳性药物对照组(奥美沙坦酯,OL组)及硝酸酯大剂量联合阳性药物组(HN+OL组),灌胃法给药6周。超声心动图检测用药前后心功能,放射免疫法检测血浆PRA、Ang II水平,RT-PCR和Western blot检测各组心肌AT1R及AT2R的表达水平。结果:1用药后,与HF组相比,HN组、OL组和HN+OL组左心室射血分数(LVEF)显著升高(P<0.05);与OL组相比,HN+OL组LVEF显著升高(P<0.05)。2与SH组相比,HF组PRA、Ang II水平显著升高(P<0.01),AT2R表达水平明显上调(P<0.05),AT1R表达水平明显下调(P<0.05);与HF组相比,HN、OL和HN+OL组PRA、Ang II水平均显著下降(P<0.05、P<0.01),AT2R表达明显下调(P<0.05),AT1R表达明显上调(P<0.05);与OL组相比,HN+OL组AT1R显著上调,AT2R显著下调(P<0.05)。结论:应用长效硝酸酯能降低CHF循环中PRA、Ang II水平,同时使CHF心脏AT1R、AT2R的表达水平反向调节趋于正常,并提高LVEF,显著改善了心功能。大剂量硝酸酯的疗效明显优于小剂量,并可协同奥美沙坦改善心功能。     

天麻钩藤饮加减对妊娠期高血压疾病患者RSS系统的影响

目的观察天麻钩藤饮加减对妊娠期高血压疾病(HDCP)患者RSS系统的影响。方法将160例HDCP患者随机分为治疗组和对照组各80例。对照组给予硫酸镁注射液静脉滴注;治疗组在硫酸镁注射液治疗基础上加用天麻钩藤饮加减治疗。于两组治疗前和治疗72 h后比较血压、24 h尿蛋白定量及血清肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)水平变化。结果两组治疗后收缩压和舒张压与治疗前比较均明显下降,差异均有统计学意义(P0.01)。治疗后,治疗组收缩压和舒张压显著优于对照组,与对照组比较差异具有统计学意义(P0.01)。两组治疗后24 h尿蛋白定量与治疗前比较均明显下降,差异均有统计学意义(P0.01)。治疗后,治疗组24 h尿蛋白定量显著优于对照组(P0.01)。治疗后,治疗组血清肾素活性(PRA)和血管紧张素Ⅱ(AngⅡ)下降明显(P0.01)。结论在硫酸镁解痉药物治疗基础上应用天麻钩藤饮加减治疗HDCP能够显著改善患者血压和24 h尿蛋白定量,其作用可能与降低血清PRA和AngⅡ水平有关。     

三种消毒剂对体检中心物体表面消毒效果与使用成本的比较研究

目的对3种消毒剂在体检中心物体表面消毒的消毒效果及使用成本进行比较,为体检中心优选合适的物体表面消毒方式提供依据。方法分别使用I型复合双链季铵盐卫生湿巾、500mg/L含氯消毒剂、75%乙醇擦拭消毒健康体检中心采血台、彩超机和乳腺红外线诊断仪的表面,在消毒前、消毒后即刻、消毒后30min及1h分别对各区域进行棉拭子涂抹采样及培养。结果受检物体表面细菌菌落数采血台为(78.4±6.2)cfu/cm2,彩超机为(36.2±2.1)cfu/cm2,乳腺红外线诊断仪为(45.9±3.0)cfu/cm2。3种消毒剂消毒后各时间点采样菌落数与消毒前比较,差异有统计学意义(均P0.01)。I型复合双链季铵盐卫生湿巾消毒效果在消毒后即刻、消毒后30min及1h优于500mg/L含氯消毒剂、75%乙醇(P0.05,P0.01);每次消毒成本I型复合双链季铵盐卫生湿巾最低。结论 3种消毒剂对各监测表面均有良好的消毒效果,但I型复合双链季铵盐卫生湿巾的消毒持续效果优于其他两种,且使用成本低,使用方便、侵蚀性小,适用于体检中心物表消毒。     

丹参酮ⅡA对压力超负荷大鼠心肌骨桥蛋白表达的影响

目的:观察丹参酮ⅡA(TanⅡA)对压力超负荷大鼠心肌骨桥蛋白表达的影响,探讨TanⅡA防治心肌纤维化的作用机制。方法:在50只雄性6周龄SD大鼠中随机取42只行腹主动脉缩窄术制备压力超负荷模型(手术组),另外8只大鼠行假手术(假手术组)。4周后,手术组大鼠死亡12只,假手术组大鼠无死亡。将存活的30只手术组大鼠随机分为模型组、TanⅡA高剂量组和TanⅡA低剂量组。给药4周后,处死所有大鼠,HE和Masson染色观察大鼠心肌病理学改变,测量胶原容积分数(CVF)和血管周围胶原容积分数(PCVF)。碱水法检测心肌羟脯氨酸含量。免疫组织化学法分析心肌α-平滑肌肌动蛋白(α-SMA)、结缔组织生长因子(CTGF)和骨桥蛋白的表达水平。结果:TanⅡA能显著减少压力超负荷大鼠心肌CVF、PCVF、羟脯氨酸含量,降低α-SMA、CTGF、骨桥蛋白的表达水平(P0.05),且高剂量TanⅡA的改善作用更为明显。结论:TanⅡA改善压力超负荷大鼠心肌纤维化的作用机制可能与抑制骨桥蛋白的表达有关。     

23例恒牙根管机械预备断针的原因分析和处理

目的：近年来，临床上通过镍钛机用根管器械，采用逐步深入法进行患牙根管预备的病例越来越多，导致根管内断针的病例也在逐渐增多，对这类断针原因进行分析以减少并发症的发生。方法：针对23例近两年来采用Step-down或Crown-down技术进行机械根管预备后所出现的根管内断针进行分析和根管再处理。结果：断针位于根管上、中、下的比率为4：12：7，原因包括：①未按操作规程。②操作的方法不当。③忽视手动器械的作用。④根管冲洗不到位。⑤使用的器械不当。经过处理后，大部分病例通过取出断针或建立旁路的方法完成治疗。结论：不当操作还可导致根管内产生台阶、穿孔或折裂，同时，金属疲劳和扭矩是影响器械寿命的重要因素。通过合理操作，综合运用机械法、手动法甚至超声法的根管预备技术，大多数并发症均可避免。