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1.
《Journal of pediatric surgery》2023,58(7):1274-1280
BackgroundPerianal abscesses and anal fistulas are common. The principle of intention-to-treat has not been considered in previous systemic reviews. Thus, the comparison between primary and post-recurrence management was confused, and the recommendation of primary treatment is obscure. The current study aims to identify the optimal initial treatment for pediatric patients.MethodsUsing PRISMA guidelines, studies were identified from MEDLINE, EMBASE, PubMed, Cochrane Library, and Google Scholar without any language or study design restriction. The inclusion criteria include original articles or articles with original data, studies of management for a perianal abscess with or without anal fistula, and patient age of <18 years. Patients with local malignancy, Crohn's disease, or other underlying predisposing conditions were excluded. Studies without analyzing recurrence, case series of <5, and irrelevant articles were excluded in the screening stage. Of the 124 screened articles, 14 articles had no full texts or detailed information. Articles written in a language other than English or Mandarin were translated by Google Translation first and confirmed with native speakers. After the eligibility process, studies that compared identified primary managements were then included in the qualitative synthesis.ResultsThirty-one studies involving 2507 pediatric patients met the inclusion criteria. The study design consisted of two prospective case series of 47 patients and retrospective cohort studies. No randomized control trials were identified. Meta-analyses for recurrence after initial management were performed with a random-effects model. Conservative treatment and drainage revealed no difference (Odds ratio [OR], 1.222; 95% Confidential interval [CI]: 0.615–2.427, p = 0.567). Conservative management had a higher risk of recurrence than surgery without statistical significance (OR 0.278, 95% CI: 0.109–0.707, p = 0.007). Compared with incision/drainage, surgery can prevent recurrence remarkably (OR 4.360, 95% CI: 1.761–10.792, p = 0.001). Subgroup analysis of different approaches within conservative treatment and operation was not performed for lacking information.ConclusionStrong recommendations cannot be made due to the lack of prospective or randomized controlled studies. However, the current study based on real primary management supports initial surgical intervention for pediatric patients with perianal abscesses and anal fistula to prevent recurrence.Level of evidenceType of study: Systemic review; Evidence level: Level II. 相似文献
2.
收集2000年1月1日至2021年12月1日发表的以突发公共卫生事件中公众的信息需求为研究主题的中英文文献,探讨公众信息需求的动机、主题和特征,分析研究现状。在突发公共卫生事件中,信息需求的动机主要包括自我保护、缓解认知失调、缓解焦虑、维持社会关系;信息需求的主题为事件信息、疾病及治疗信息、健康防护知识、政府和专家权威信息;信息需求的特征表现为强烈而迫切,具有多样性和系统性。突发公共卫生事件中的公众信息需求相关研究主要针对普通群众和各种网络用户,关注老年人、高危工作人群等的信息需求是今后研究的重点。研究结果为突发公共卫生事件信息资源建设和科学决策提供了借鉴。 相似文献
3.
目的分析看图对话工具在妊娠期糖尿病(GDM)患者健康教育中的应用效果。方法选取2018年1月—2019年12月广西中医药大学附属瑞康医院收治的80例GDM患者,随机分为对照组和观察组,每组40例。对照组开展常规健康教育,观察组采用看图对话工具开展健康教育。比较两组健康教育前后的血糖指标和自护行为能力评分、自然分娩率。结果健康教育后,对照组患者空腹血糖、餐后2 h血糖及糖化血红蛋白水平分别为(6.62±1.24)mmol/L、(7.25±1.32)mmol/L及(6.84±1.26)%,观察组患者空腹血糖、餐后2 h血糖及糖化血红蛋白水平分别为(6.12±2.41)mmol/L、(7.92±1.25)mmol/L及(6.26±1.31)%,两组比较差异均有统计学意义(t=5.135、5.032、5.121,均P<0.05)。健康教育后,观察组患者自护行为能力评分均显著高于对照组(均P<0.05)。观察组自然分娩率为95.00%(38例),显著高于对照组(82.50%,33例),差异有统计学意义(χ2=5.314,P<0.05)。结论在GDM患者健康教育中应用看图对话工具取得了显著效果,不仅能控制患者的血糖水平,而且在提高自护行为能力评分和自然分娩率方面有显著优势。 相似文献
4.
目的 分析河南省老年人社会经济地位与精神健康的关系。方法 使用多阶段分层整群抽样方法,以河南省18个省辖市的5 570名60岁及以上老年人为研究对象,采用有序logistic回归模型分析社会经济地位对老年人精神健康的影响,探讨医疗保险和居住安排的中介效应。结果 河南省老年人精神健康受损1 999人,受损率35.89%。有序logistic回归分析显示社会经济地位的三个维度均对老年人精神健康有显著影响(均P<0.05),月收入水平(OR = 0.598,95%CI:0.446 ~ 0.801)和受教育程度(OR = 1.617,95%CI:1.004 ~ 2.604)越高,老年人精神健康水平越好;原来职业的层级越高(OR = 1.325,95%CI:1.155 ~ 1.520),老年人精神健康水平越差。影响路径分析显示,城镇职工医保对老年人精神健康有促进作用(低SES:OR = 0.609,95%CI:0.422 ~ 0.878;高SES:OR = 0.380,95%CI:0.248 ~ 0.582),城乡居民医保对高SES老年人精神健康有促进作用(OR = 0.285,95%CI:0.181 ~ 0.448);此外,与配偶/伴侣居住(OR = 0.610,95%CI:0.483 ~ 0.769)、与子女居住(OR = 0.646,95%CI:0.520 ~ 0.803)缓解了社会经济弱势地位对老年人精神健康的负面影响。结论 河南省老年人精神健康受损率较高,社会经济地位的三个维度影响老年人的精神健康水平,医疗保险和居住安排在社会经济地位与老年精神健康的关系中具有显著的中介效应。 相似文献
5.
《Research in social & administrative pharmacy》2022,18(9):3694-3698
In this paper, we argue that understanding and addressing the problem of poor-quality medical products requires a more interdisciplinary approach than has been evident to date. While prospective studies based on rigorous standardized methodologies are the gold standard for measuring the prevalence of poor-quality medical products and understanding their distribution nationally and internationally, they should be complemented by social science research to unpack the complex set of social, economic, and governance factors that underlie these patterns. In the following sections, we discuss specific examples of prospective quality surveys and of social science studies, highlighting the value of cross-sector partnerships in driving high-quality, policy-relevant research in this area. 相似文献
6.
目的 探讨影响山东省发热伴血小板减少综合征(SFTS)发病的危险因素,为科学防制该病提供依据。方法 应用1∶2匹配的病例对照研究方法,调查收集病例、对照的基本情况、可疑暴露因素等信息,采用单因素和多因素的配对条件logistic回归分析发病危险因素。结果 本研究共纳入374例SFTS确诊病例和748例对照。分析结果显示,有病例接触史(OR = 5.84,95%CI:1.11~30.88)、有家养动物(OR = 1.74,95%CI: 1.02~2.96)、近1个月见过蜱(OR = 5.85,95%CI: 2.73~12.53)、近2周有蜱叮咬史(OR = 29.58,95%CI: 6.70~130.60)、从事田间作业(OR = 2.63,95%CI:1.41~4.91)、住宅周围环境有杂草/农作物/菜地(OR = 3.24,95%CI:1.74~6.05)和住宅卫生条件差(OR = 2.20,95%CI:1.32~3.66)是SFTS发病的危险因素(P<0.05),近1个月有亲邻发病(OR = 0.01,95%CI:0~0.03)、采取防护措施(OR = 0.21,95%CI:0.10~0.46)是SFTS发病的保护因素(P<0.05)。结论 接触病例、饲养家养动物、蜱叮咬、无防护措施的野外作业及住宅周围环境卫生较差等是影响山东省SFTS发病的危险因素。应加强重点人群SFTS健康教育和行为干预,减少危险因素暴露,以控制SFTS传播。 相似文献
7.
8.
《Research in social & administrative pharmacy》2022,18(9):3492-3500
BackgroundPolypharmacy is commonly related to poor drug adherence, decreased quality of life and inappropriate prescribing in eldery. Furthermore, this condition also leads to a higher utilization of health services resources, due to the increased risk of adverse drug events, length of stays in hospitals and readmissions rates after discharge.ObjectiveThis Systematic Review aimed to synthesize the current evidence that evaluates pharmaceutical services on polymedicated patients, from an economic perspective.MethodsSystematic searches were conducted in MEDLINE, SCOPUS and Cochrane Library databases to identify studies that were published until January 2021. Experimental and observational studies were included in this review, using strict inclusion/exclusion criteria and were assessed for quality using the following tools: RoB and ROBINS-I. Two independent reviewers selected the articles and extracted the data.Results3,662 articles were retrieved from the databases. After the screening, 18 studies were included: 9 experimental and 9 observational studies. The studies reported that the integration of the pharmacist as a member of the healthcare team provides an optimized use of pharmacotherapy to polymedicated patients and contributes to health promotion, providing reduction of spending on medication, reduction of expenses related to emergency care and hospitalizations and other medical expenses. The ECRs made cost-effectiveness or cost-benefit analysis, and most of the Non Randomized studies had statistically significant cost savings even considering the expenses of pharmaceutical assistance. Experimental studies reported a cost reduction varying between US$ 193 to US$ 4,966 per patient per year. Furthermore, observational studies estimated a cost reduction of varying from US$ 3 to US$ 2,505 per patient per year. The cost savings are related to decrease in emergency visits and hospitalizations, through pharmacist intervention (medication review and pharmacotherapy follow-up).ConclusionsConsidering the set of studies included, pharmaceutical care services directed to polymedicated patients may cooperate to save financial resources. Most of the interventions showed positive economic trends and also contributed to improving clinical parameters and quality of life. However, due to the majority of the studies having exploratory or qualitative methodology, it is essential to carry out more robust studies, based on full economic evaluation. 相似文献
9.
【摘要】 目的:通过系统评价的方法分析腰椎手术患者术后症状性硬膜外血肿(postoperative symptomatic epid-ural hematoma,PSEH)发生的相关危险因素。方法:计算机检索PubMed、Embase、Web of Science、Cochrane Library、CBM、CNKI、万方和维普数据库,搜集有关腰椎手术患者术后发生PSEH危险因素的病例-对照研究和队列研究,检索时限均为建库至2022年3月。由2名研究者独立筛选文献、提取纳入研究的基本信息、基线特征及PSEH相关的危险因素,如手术时间、术中出血量、抗凝治疗等所关注的结局指标和结果测量数据。评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入17项研究,包括14项病例-对照研究和3项队列研究,共132363例患者,发生症状性硬膜外血肿525例。16篇文献的质量评分均≥6分,仅1篇文献质量评分为5分。Meta分析结果显示,年龄≥65岁[比值比(odds ratio,OR)=3.36,95%可信区间(confidence interval,CI)(2.13,5.30),P<0.00001]、术前血小板计数[OR=1.89,95%CI(1.31,2.71),P=0.0006]、合并高血压[OR=1.50,95%CI(1.22,1.85),P=0.0001]、止血材料使用[OR=2.91,95%CI(1.93,4.39),P<0.00001]、凝血障碍[OR=6.95,95%CI(1.76,27.43),P=0.006]、翻修手术[OR=5.87,95%CI(3.77,9.12),P<0.00001]、手术时间>2h[OR=3.52,95%CI(1.84,6.71),P=0.0001]、术中出血量≥600ml[OR=3.77,95%CI(1.31,10.89),P=0.01]、冰冻血浆输注[OR=8.13,95%CI(4.46,14.81),P<0.00001]及多节段手术[OR=1.98,95%CI(1.54,2.56),P<0.00001]是腰椎术后患者PSEH发生的危险因素。结论:当前证据表明,年龄≥65岁、术前血小板降低、合并高血压、止血材料使用、凝血障碍、翻修手术、手术时间>2h、术中出血量≥600ml、冰冻血浆输注及多节段手术为腰椎术后患者PSEH发生的危险因素。对具有以上危险因素的高危患者应高度关注及早期干预,以降低PSEH的发生率,改善患者临床预后。 相似文献
10.
Lampros Chrysavgis Ilias Giannakodimos Panagiota Diamantopoulou Evangelos Cholongitas 《World journal of gastroenterology : WJG》2022,28(3):310-331
Non-alcoholic fatty liver disease(NAFLD)has emerged as the most common liver disorder worldwide mainly attributed to the epidemic spread of obesity and type 2 diabetes mellitus.Although it is considered a benign disease,NAFLD can progress to non-alcoholic steatohepatitis,liver cirrhosis and hepatocellular carcinoma(HCC).Most data regarding the epidemiology of NAFLD-related HCC are derived from cohort and population studies and show that its incidence is increasing as well as it is likely to emerge as the leading indication for liver transplantation,especially in the Western World.Although cirrhosis constitutes the main risk factor for HCC development,in patients with NAFLD,HCC can arise in the absence of cirrhosis,indicating specific carcinogenic molecular pathways.Since NAFLD as an underlying liver disease for HCC is often underdiagnosed due to lack of sufficient surveillance in this population,NAFLDHCC patients are at advanced HCC stage at the time of diagnosis making the management of those patients clinically challenging and affecting their prognostic outcomes.In this current review,we summarize the latest literature on the epidemiology,other than liver cirrhosis-pathogenesis,risk factors and prognosis of NAFLD-HCC patients.Finally,we emphasize the prevention of the development of NAFLD-associated HCC and we provide some insight into the open questions and issues regarding the appropriate surveillance policies for those patients. 相似文献