《中医内科临床诊疗指南——头痛》制定中患者偏好与价值观的调查研究

目的:研究原发性头痛患者偏好与价值观,为形成推荐意见强度分级共识时提供参考。方法:采用横断面网络调查,通过半开放式电子问卷形式,使用视觉模拟评分(VAS)测量影响患者选择治疗措施的考虑因素重要性、总体治疗措施方向、头痛辨证汤剂治疗、原发性头痛的中成药及非药物治疗措施等方面的偏好与价值观。结果:调查共纳入研究对象217人。影响患者选择治疗措施的考虑因素重要性评分、总体治疗措施方向的偏好评分、偏头痛及紧张型头痛治疗措施的偏好评分差异具有统计学意义(P<0.01)。患者在选择治疗措施时最关注疗效,总体偏好于选择非药物疗法。在偏头痛治疗中,患者对针刺治疗偏好程度最高;在治疗紧张型头痛时,患者对推拿治疗的偏好程度最高;在治疗丛集性头痛时,患者对不同干预措施没有表现出明显偏好。结论:总体上,不良反应少的非药物疗法,如针灸、推拿等在原发性头痛治疗中更受患者欢迎,临床实践指南的制定应该考虑头痛患者的这一偏好与价值观结果。     

鼻整形患者疾病特异性生存质量量表的研究

鼻整形术后的疗效受多因素影响，鼻畸形整复术更注重鼻外形及功能的共同改善，其评价标准包括主观性与客观性内容。疾病特异性量表从患者主观角度对手术前后鼻部状况予以评估，是针对性改善患者生存质量（QoL）的重要工具。QoL的评价包括个体对健康状况的主观认知、症状、功能、患者偏好与价值观等，需要在保留客观性与科学性的基础上，尽可能反映患者的主观感受。本文就近年来疾病特异性量表在鼻整形患者QoL评估方面的应用进展进行综述。     

肝内胆汁淤积症孕妇的胎儿不良结局分析

目的对肝内胆汁淤积症孕妇的胎儿不良结局进行分析研究。方法随机选择在本院接受治疗的肝内胆汁淤积症孕妇作为观察组,与同期在本院正常分娩的对照组孕妇相比胎儿的不良结局。结果观察组的分娩结果 :12例早产、5例流产、5例死胎、4例新生儿窒息、40例正常分娩。对照组的分娩结果 :1例早产、1例新生儿窒息,64例正常分娩。观察组中胎儿不良结局发生率显著高于对照组,P <0.05;观察组中重度患者的胎儿不良结局发生率高于轻度患者,P <0.05。结论肝内胆汁淤积症导致胎儿不良结局发生率升高,应对加强对肝内胆汁淤积症的预防从而改善胎儿结局。     

Clinical outcomes of off-pump coronary artery bypass graft in patients with diabetes and non-diabetics: A systematic review and meta-analysis

Background and aimDiabetes mellitus is a prevalent risk factor for developing coronary artery disease which worsens the clinical outcomes of patients undergoing coronary artery bypass grafting (CABG). This study aimed to determine the clinical outcomes of patients with diabetes and non-diabetic patients who underwent off-pump CABG surgery.MethodMedline, Scopus, Proquest, Embase, Web of Science, and Google scholar were searched until September 10, 2021. The effect sizes including unstandardized mean difference and odds ratio with 95% confidence interval were calculated using “Metan” package. The Cochran's Q-test and I² statistic were used to assess heterogeneity, a random-effects model was applied to estimate the pooled effect sizes, and meta-regression was used to investigate the factors affecting heterogeneity between studies.Results10 studies with 6200 sample sizes were included in the study. In groups with diabetes, Summary odds ratio (SOR) and 95% confidence interval of infection was 2.18 more than non-diabetic groups. Also, odds renal complication was 1.74 more than non-diabetic groups, and the odds cardiovascular complication in groups with diabetes was 1.30 more than non-diabetics. There were no differences in mortality, neurologic, respiratory and surgical complications between groups with diabetes and non-diabetics. Based on meta-regression results, age (Coefficient: 0.942; p = 0.009) had a significant direct relationship and sample size (Coefficient: 0.001; p = 0.009) had an indirect significant relationship with heterogeneity of neurologic outcomes. There was no significant publication bias in our results.ConclusionOur study revealed that off-pump CABG led to some significant outcomes in patients with diabetes compared to non-diabetics. Renal and infection complications were higher in patients with diabetes but no significant differences were seen in most of other postoperative outcomes between the two groups.     

Family nursing with the assistance of network improves clinical outcome and life quality in patients underwent coronary artery bypass grafting: A consolidated standards of reporting trials-compliant randomized controlled trial

Background:Family nursing with the assistance of network (FNAN) improves nurses’ practice and provides family/community-oriented nursing care. This study aimed to explore the effects of FNAN on the clinical outcome and life quality of coronary atherosclerotic heart disease (CHD) patients underwent coronary artery bypass grafting (CABG).Trial Design:This study is a randomized, placebo-controlled and double-blind trial.Methods:One-hundred and twelve patients underwent CABG were randomly divided into control group (CG, routine family nursing care) and experimental group (EG, FNAN) and the allocation ratio was 1:1. The situation of anxiety and depression were analyzed using the Hamilton Anxiety Scale (HAMA) scale and Hamilton Depression Scale (HAMD). Sleep quality was measured by using Pittsburgh Sleep Quality Index (PSQI). Lung function parameters were measured, including minute ventilation (MVV), partial pressure of oxygen (PaO₂), partial pressure of arterial carbon dioxide (PaCO₂), oxygen saturation measurement by pulse oximetry (SpO₂), forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). Life quality was measured by using Chronic Obstructive Pulmonary Disease Assessment Test (CAT).Results:After a 3-month intervention, 10 and 6 patients were lost in the CG and EG groups, respectively. The scores of HAMA, HAMD, PSQI and CAT were reduced in the EG group when compared with the CG group (P < .05). The values of MVV, PaO₂, SpO₂, FEV1 and FVC in the EG group was higher than those in the CG group whereas the levels of PaCO₂ in the EG group was lower than those in the CG group (P < .05). PSQI score had a strong relationship with the values of MVV, PaO₂, PaCO₂, SpO₂, FEV1, and FVC.Conclusion:FNAN improves the clinical outcome and life quality in the patients underwent CABG.     

Breast reconstruction after therapeutic or prophylactic mastectomy for breast cancer: A comparison of guideline recommendations

BackgroundThe purpose of this article is to illuminate differences in published clinical practice guideline recommendations for breast reconstruction after prophylactic and therapeutic mastectomy.MethodsTen guidelines were identified through a systematic search of websites and databases of reputable oncology guideline developers, and key differences and gaps in recommendations were noted. Quality assessment of the guidelines was conducted by three reviewers using the AGREE II tool, focusing on breast reconstruction specific documents rather than the general breast cancer guidelines.ResultsThe most comprehensive guidelines were published by Alberta Health Services, Cancer Care Ontario, the American Society of Plastic Surgeons, and the Association of Breast Surgery/British Association of Plastic Reconstructive and Aesthetic Surgeons. AGREE II scores in the domains of “Scope and Purpose” and “Clarity and Presentation” were ranked relatively high for all four guidelines while “Applicability” and “Editorial Independence” were ranked relatively low. The Alberta and Ontario guidelines were the overall highest ranked guidelines across all domains.ConclusionOverall, these guidelines provide consistent recommendations on who should receive breast reconstruction education, who is a candidate for postmastectomy breast reconstruction, and the appropriate timing of reconstruction and extent of mastectomy. Future updates from all should focus on expanding to include alloplastic and autologous forms of reconstruction and should include a broad scope of relevant questions.