乳腺癌放化疗患者癌因性疲乏运动干预最佳证据总结

目的 总结乳腺癌放化疗患者癌因性疲乏（cancer related fatigue,CRF）运动干预的最佳证据,为临床护理提供循证依据。方法 检索UpToDate、BMJ Best practice、 Cochrane Library、PubMed、美国国家综合癌症网络、加拿大安大略注册护士协会、苏格兰院际指南网、美国临床肿瘤协会、美国肿瘤护理协会、安大略省癌症护理中心、美国运动医学会、美国国立指南网、欧洲肿瘤内科学会、医脉通、JBI循证卫生保健国际合作中心图书馆、中国知网、万方、维普等网站和数据库中关于乳腺癌放化疗患者癌因性疲乏运动干预的临床指南、临床决策、系统评价、证据总结、专家共识、原始研究。检索时限为建库至2021年11月。结果 共纳入文献12篇,其中临床实践指南3篇、临床决策1篇、系统评价8篇。总结最佳证据21条,包括运动前评估、运动时机、运动形式、运动强度、运动效果、运动方案制定原则、注意事项7个方面。结论 乳腺癌放化疗患者CRF运动干预最佳证据可为临床应用提供循证依据,护理人员可根据证据进行临床护理实践。     

鼻咽癌放化疗患者口腔黏膜炎防护策略的循证实践

目的 为鼻咽癌放化疗患者制订有效防护口腔黏膜炎的循证护理方案.方法 提出临床问题并建立循证护理团队,检索Best practice、美国指南网、JBI数据库、Cochrane图书馆、CINAHL、PubMed、Embase、中国知网、万方数据库和中国生物医学文献数据库关于放化疗所致口腔黏膜炎的相关文献,进行文献质量评价,形成循证防护策略后,培训相关人员,将证据应用于临床实践.比较循证护理实施前后患者口腔黏膜炎症状等级、口腔黏膜疼痛程度及放化疗前后体质量差值.结果 经循证实践,形成了7项鼻咽癌放化疗患者口腔黏膜炎防护策略.经统计,实施循证干预后患者口腔黏膜炎症状等级、疼痛程度、放化疗期间体质量丢失量均优于实施前,差异有统计学意义(P＜0.05).结论 循证护理实践可促进护理人员科研证据意识的培养和参与积极性,提升了同步放化疗鼻咽癌患者照护质量和临床护理工作的有效率,改变了口腔黏膜炎的传统护理模式.     

癌症患者体力活动管理的最佳证据总结

目的基于澳大利亚乔安娜布里格斯研究所(JBI)循证卫生保健中心证据总结的方法学, 针对癌症患者体力活动管理进行证据总结, 为临床规范癌症患者的体力活动管理提供科学的依据。方法依照证据"6S"金字塔模型检索相关文献, 计算机检索BMJ Best Practice、UpToDate、JBI循证卫生保健中心数据库、Cochrane Library、全球各指南网站、癌症专业协会网站以及中英文相关数据库中关于癌症患者体力活动的所有证据。检索时限为2018年2月13日—2023年2月13日。基于JBI循证卫生保健中心证据总结的方法学指导, 由2名研究者对文献质量进行独立评价, 并结合临床情境, 提取符合标准的相关证据。结果共纳入30篇文献, 包括2篇指南、3篇专家共识、1篇证据总结、21篇系统评价、3篇随机对照试验, 从体力活动获益、体力活动人群、体力活动前评估、体力活动方案实施、体力活动安全性监测、持续支持策略6个方面汇总了29条最佳证据。结论本研究在现有证据的基础上补充并更新了15条证据, 最终形成了癌症患者体力活动管理的最佳证据总结, 能够为临床开展癌症患者的体力活动管理提供循证依据。证据大...     

一例多发性骨髓瘤患者化疗致口腔黏膜炎的循证护理

目的为血液系统恶性肿瘤化疗并发口腔黏膜炎患者提供循证护理方案。方法根据循证医学的原则,针对患者情况构建循证问题,全面检索美国指南网、加拿大安大略护士注册协会指南网,Cochrane系统评价数据库、Pubmed数据库和中国知网,获取并评价相关的临床指南、系统评价/Meta分析和随机对照试验证据。结果检索后纳入指南网推荐意见1篇,系统评价2篇,随机对照试验2篇,观察性研究1篇和专家共识4篇。根据证据结果,结合临床经验和患者/家属意愿综合考虑后为该患者制订循证护理方案,患者口腔黏膜基本恢复正常。结论应用循证医学方法,针对患者具体临床问题采用高质量的证据制订最佳护理决策,减轻了口腔黏膜炎给患者带来的痛苦,提高了临床治愈效果。     

2型糖尿病患者运动方案的最佳证据总结

目的 检索、评价和整合2型糖尿病患者运动方案的最佳证据,为临床制订2型糖尿病患者运动方案提供循证依据。 方法 应用循证护理方法,针对2型糖尿病患者运动治疗的问题,计算机检索相关文献,采用澳大利亚JBI循证卫生保健中心的文献评价标准和证据分级系统,对各类研究进行质量评价及证据级别评定。结果 共纳入10篇文献,包括指南4篇、系统评价2篇,推荐实践1篇、专家共识1篇和随机对照试验2篇。从运动的评估、运动方式、运动强度、运动时间和运动安全5个方面共总结了17条最佳证据。 结论 总结了有关2型糖尿病患者运动方案的最佳证据,形成了具体的推荐建议,可为护士及护理管理者制订相关护理方案提供循证依据,对科学管理2型糖尿病患者运动具有指导意义。     

头颈肿瘤放化疗患者吞咽困难预防性训练指导方案的最佳证据总结

目的 总结头颈肿瘤放化疗患者吞咽困难预防性训练的最佳证据,为临床医护人员提供参考。方法 系统检索关于头颈肿瘤放化疗患者吞咽困难预防性训练的临床决策、指南、专家共识、证据总结、系统评价证据,检索时间为建库至2022年4月,由2名经过循证培训的研究人员独立对文献进行质量评价和证据级别评定。结果 共纳入11篇文献,包括3篇临床决策、2篇指南、1篇证据总结、2篇专家共识、3篇系统评价,从多学科团队、健康教育、危险因素、评估和筛查、预防性训练内容、疼痛控制、基础口腔护理、食物和进食姿势的调整、知情同意9个方面汇总了22条最佳证据。结论 临床医护人员可参考头颈肿瘤放化疗患者吞咽困难最佳证据,结合临床情境和患者意愿,为头颈肿瘤放化疗患者提供个性化的预防性训练指导。     

腹部手术患者早期离床的证据总结

目的 检索、整理及汇总腹部手术患者早期离床的相关证据,为腹部手术患者早期离床提供循证依据。方法 系统检索英国国家卫生与临床优化研究所、苏格兰院际指南网、BMJ最佳临床实践、UpToDate、JBI图书馆、Cochrane图书馆、PubMed、中国知网、万方、中国生物医学文献数据库中,关于腹部手术患者早期离床相关的临床决策、推荐实践、指南、证据总结、专家共识及系统评价,进行方法学质量评价后,根据主题对证据进行提取与整合。结果 本研究共纳入16篇文献,包括指南9篇,临床实践指南1篇,证据总结1篇,专家共识1篇,系统评价2篇,前瞻性研究1篇,RCT 1篇,包括术前宣教、评估、计划、实施、评价5个方面,共37条证据。结论 本研究总结的腹部术后早期活动的最佳证据,为临床护士的护理实践提供了循证依据,并可基于循证依据实施临床护理,提高护理质量。     

特发性炎性肌病患者吞咽障碍管理最佳证据总结

目的 评价、总结特发性炎性肌病患者吞咽障碍管理的最佳实践证据,为炎性肌病患者吞咽障碍管理科学化提供依据。方法 系统检索相关指南网站及欧洲抗风湿病联盟、美国风湿病学会各专业协会网站和数据库,采用JBI循证卫生保健中心等文献质量评价工具进行文献评价和内容提取。结果 共纳入20篇文献,1篇Uptodate、5篇指南、4篇系统评价,1篇证据总结和9篇专家共识,最终形成多学科团队、吞咽障碍筛查与评估、药物干预、康复干预、营养管理、口腔管理、服药管理、健康教育共8个主题、20个条目的最佳证据。结论 证据应用者可根据实际情境应用炎性肌病患者吞咽障碍管理最佳证据,减少吞咽障碍并发症的发生,提高患者生活质量。     

头颈部肿瘤患者放射性皮炎预防及管理的最佳证据总结

目的 系统检索、评价和总结头颈部肿瘤患者放射性皮炎预防及管理的最新最佳证据,为临床制定个性化的皮肤管理方案提供循证依据。方法 计算机检索各指南及专业协会网站、Cochrane图书馆、JBI循证护理数据库、PubMed、CINAHL、Web of Science Core Collection、Embase、中国知网、维普数据库、万方数据库、中国生物医学文献数据库中所有关于头颈部肿瘤放射性皮炎预防及管理的文献,包括指南、专家共识、系统评价、最佳实践信息册等。检索时间为建库至2023年8月23日。结果 共纳入22篇文献,包括1篇指南、4篇专家共识、17篇系统评价或meta分析。从头颈部肿瘤患者放射性皮炎的发病率、危险因素、临床表现、评估监测、健康教育、日常护理、预防及治疗措施、感染控制、管理策略9个方面总结出43条证据。结论 头颈部肿瘤患者放射性皮炎预防及管理的最佳证据为医疗保健人员制定个性化皮肤管理方案提供循证依据,临床实践过程中需结合具体情境和患者个人意愿选择证据。     

造血干细胞移植患者口腔护理管理的最佳证据总结

目的 总结成人造血干细胞移植患者口腔并发症预防及管理的最佳证据，为临床护理工作提供参考。方法 检索BMJ、UpToDate、JBI、NGC、NICE、医脉通、Cochrane Library、PubMed、Embase、CINAHL、Web of Science、中国知网、万方数据库，选取符合标准的文献。由2名研究员对文献进行质量评价，证据提取及整合。结果 共纳入证据19篇，包括指南8篇，临床决策1篇、证据总结4篇、专家共识4篇、随机对照试验2篇，从8个维度即评估、基础口腔护理、物理干预、营养干预、药物干预、症状管理、出院指导和人员支持，共总结16条最佳证据。结论 该研究总结造血干细胞移植患者口腔护理管理最佳证据，为临床医护人员开展口腔护理提供循证依据。医务人员应根据临床实际情况及患者意愿选择并应用最佳证据。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.