ICU转科患者家属迁移应激的过渡期护理研究进展

以过渡期护理内涵为基础对文献进行干预措施内容提取，以干预时间点为标准对ICU转科患者家属迁移应激的过渡期护理措施进行综述，护理干预措施包括干预前准备、转科前干预、转科中干预、转科后干预，并总结护理干预效果评价，以期为临床护理人员开展相关实践提供具体参考，推进以家庭为中心的护理工作，改善临床护理质量。     

Method’s corner: Allergist’s guide to network meta-analysis

Network meta-analyses (NMAs) simultaneously estimate the effects of multiple possible treatment options for a given clinical presentation. For allergists to benefit optimally from NMAs, they must understand the process and be able to interpret the results. Through a worked example published in Pediatric Allergy and Immunology, we summarize how to identify credible NMAs and interpret them with a focus on recent innovations in the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation). NMAs build on traditional systematic reviews and meta-analyses that consider only direct paired comparisons by including indirect evidence, thus allowing the simultaneous assessment of the relative effect of all pairs of competing alternatives. Our framework informs clinicians of how to identify credible NMAs and address the certainty of the evidence. Trustworthy NMAs fill a critical gap in providing key inferences using direct and indirect evidence to inform clinical decision making when faced with more than two competing courses of treatment options. This document will help allergists to identify trustworthy NMAs to enhance patient care.     

新冠肺炎临床评价核心指标集比较分析＊

目的 对已公开发表的新冠肺炎核心指标集及其研究方法进行比较分析，为临床试验和证据转化研究提供参考信息。方法 计算机检索COMET数据库，并补充检索CNKI、WanFang、PubMed、Web of Science、The Cochrane Library等数据库，收集发表的新型冠状病毒肺炎（Coronavirus Disease 2019，COVID-19）核心指标集（Core Outcome Set，COS）研究，检索时间截至为2021年3月31日。按照纳入排除标准筛选文献，并提取研究基本信息、研究方法及指标数据，对其进行描述性分析。结果 共纳入5项COVID-19核心指标集相关研究（4项为COVID-19-COS研究，1项为COVID-19核心指标测量工具研究）。相同的结局指标包括死亡率、病毒核酸检测、临床进展、恢复期、临床症状评分及临床分型等。指标来源主要来自临床试验注册平台和问卷调查；达成共识的方法主要采用共识会议；利益相关群体中临床专家、方法学专家和医疗管理人员涉及较多。结论 不同的新冠肺炎核心指标集研究有一定的共性，但由于应用场景不同，也存在一定差异。随着对疾病认识的深化，相关COVID-19核心指标需要加强测量方法和疗程推荐。     

医学生人格特质与共情能力的相关性研究

目的  测评医学生的共情能力现状，探讨人格特质对其共情能力的影响,为培养医学生的共情能力提供对策。方法  以上海市3所高校临床医学专业学生为研究对象，采用班级整群抽样的方式进行问卷调研。采用杰斐逊共情量表-医学生版（JSPE-S）和大五人格量表（NEO-FFI）分别评估医学生的共情和人格特质。结果  共发放问卷2 020份，回收有效问卷1 958份，有效率为96.93%。医学生的共情能力总分均值为（103.24±14.35）。共情能力总分与大五人格中的“外向性”“开放性”“宜人性”“严谨性”维度呈显著正相关（r=0.154~0.406, P<0.01），与大五人格中的“神经质”维度呈显著负相关（r=-0.175, P<0.01）。分层回归结果表明：“共情重要性”和“大五人格”量表的5个维度进入回归方程。其中，人格因素占可解释方差变异量的16.2%（P<0.01）。结论  我国医学生的共情能力低于国外医学生，重视人格特质的塑造有助于提高其共情能力。     

双侧延髓内侧梗死临床分析

目的分析并探究双侧延髓内侧梗死(BMMI)的血管病因、临床表现、MRI特征和预后,以期提高BMMI的早期诊断率.方法对青岛大学附属烟台毓璜顶医院诊治的14例BMMI患者临床资料进行分析.结果BMMI血管病因以动脉粥样硬化为主;临床症状表现为四肢瘫痪、舌瘫、感觉异常、头晕、构音障碍、饮水呛咳等,危重时出现呼吸衰竭.头颅DWI示双侧延髓内侧可呈特征性"心型"、"Y"字型、"V"字型或倒"八"字型高信号影.出院NIHSS评分、卒中进展(尤其呼吸衰竭)为BMMI的预后不良因素.结论BMMI临床少见,临床表现多样,预后较差;头颅MRI为其主要的影像学检查,有助于早期诊断.     

Metastasis of oral squamous cell carcinoma to the parotid lymph nodes

Parotid lymph node (PLN) metastasis greatly worsens the prognosis of patients with oral squamous cell carcinoma (OSCC) and poses a great challenge for further treatment of OSCC. The clinicopathological characteristics and treatment strategies for PLN metastasis from OSCC need to be comprehensively elucidated. A retrospective review of OSCC patients who experienced postoperative PLN metastasis in our department between 2000 and 2018 was performed in this study. A total of 47 OSCC patients with postoperative PLN metastasis were identified. PLN with metastasis were divided into three groups based on the location: parotid tail (PLN-t), superficial lobe (PLN-sl), and deep lobe (PLN-dl). Most of the patients experienced PLN metastasis within less than 12 months after the primary surgery for OSCC. Comparatively, patients with PLN-sl metastasis were more prone to have infiltration of the facial nerve. The tongue and buccal mucosa were the most frequent primary sites associated with PLN metastasis from OSCC. PLNs in the parotid tail were most commonly affected by the metastasized OSCC. Consequently, we recommend a series of strategies for the prevention and treatment of PLN metastasis for OSCC patients. In conclusion, PLNs should not be overlooked during preoperative evaluation and postoperative follow-up examinations for OSCC patients.     

Thinned-out skin paddle versus collagen matrix as an optimized peri-implant soft tissue following fibula osteoseptocutaneous free flap: 3-year retrospective study

The objective of this study was to compare the implant longevity following two methods of peri-implant soft tissue optimization following free fibula flap (FFF): thinning of skin paddle (SP) and collagen matrix (CM). All patients who underwent rehabilitation with dental implants after mandibular reconstruction with FFF between June 2009 to May 2014 were retrospectively reviewed. Two methods of peri-implant soft tissue optimization were applied: (1) SP group, (2) CM group. Outcome measurements were: modified plaque index (mPI), modified sulcus bleeding index (mSBI), probing depth (PD), marginal bone loss (MBL), implant success rate and complication rates. A total of 24 patients with 69 implants were included in the study, with 8.7% (n = 6) of implants lost in 3 years. No statistically significant difference was found regarding the outcome measurements in both groups. Failed implants presented with statistically significant higher mPI, mSBI, PD and MBL scores during prosthesis delivery and subsequent follow-ups (P<0.03). In the SP group, one patient experienced SP necrosis which later underwent soft tissue optimization using CM. CM is an alternative peri-implant soft tissue, while thinning of SP is feasible if thickness is well controlled.