医疗器械相关压力性损伤预防和管理的最佳证据总结

目的探讨分析医疗器械相关压力性损伤预防及管理的证据,为临床护理人员采取针对性护理提供依据。方法采用循证方法,检索数据库及专业网站的相关文献,应用2012版临床指南研究与评价系统、2014版JBI证据预分级、证据推荐级别系统对文献进行质量评价和证据级别评定。结果最终纳入4篇指南和1篇证据总结,归纳得出22条证据,包括风险评估、医疗器械的选择和佩戴、皮肤和医疗器械的评估、预防措施4个方面。结论临床护理人员应重视医疗器械相关压力性损伤的预防及管理,根据具体临床情境、患者意愿有针对性地选择证据进行应用。     

哺乳期妇女膳食营养管理的最佳证据总结

目的 检索、评价和汇总哺乳期妇女膳食营养管理的相关证据,为规范哺乳期妇女膳食营养管理提供循证依据.方法 通过计算机检索国内外相关指南网站、协会网站和中英文数据库中有关哺乳期妇女膳食营养管理的相关证据,包括指南、证据总结、系统评价及专家共识.对文献进行质量评价和证据的提取、汇总.结果 共纳入15篇文献,包括6篇指南、3篇...     

非药物干预对阿尔茨海默病患者照顾者负担影响系统评价的再评价

目的 对非药物干预影响阿尔茨海默病患者照顾者负担的相关系统评价/Meta分析进行再评价,旨在为我国改善照顾者负担提供借鉴。方法 计算机检索国内外数据库中有关阿尔兹海默症患者照顾者负担的非药物干预的系统评价/Meta分析,进行文献筛选、资料提取,并对纳入文献进行方法学质量和证据质量等级评价。结果 共纳入15篇系统评价/Meta分析,其中2篇质量等级为中,5篇为低,8篇为极低。21条证据质量分级为中等质量7条,低质量7条,极低质量7条。结果显示多组分干预、基于互联网的干预措施、心理教育、健康教育、个案管理对照顾者负担具有积极影响。结论 非药物干预在一定程度上可降低照顾者负担,但纳入的系统评价/Meta的方法学质量和证据质量均较低,需谨慎采纳相关证据。     

重症患者暴露性角膜炎预防及管理最佳证据总结

目的 整合重症患者暴露性角膜炎预防及管理的最佳证据,为制订暴露性角膜炎预防及管理规范提供参考.方法 针对重症患者暴露性角膜炎预防及管理的问题,按照"6S"模型检索相关文献,采用约翰·霍普金斯证据分级系统进行证据分级,采用澳大利亚JBI循证卫生保健中心的文献质量评价标准和证据推荐系统(2014版),对各类研究进行质量评价及证据推荐级别评定.结果 共纳入文献13篇,包括8篇指南,1篇临床决策,1篇推荐实践及3篇系统评价.最终总结了22条最佳证据.结论 重症患者暴露性角膜炎预防及管理的最佳证据可为临床医疗决策者提供参考,最佳证据应用需结合临床患者具体情况,并在临床实践中不断完善.     

成人围术期肺康复管理的最佳证据总结

目的总结成人围术期肺康复管理的相关证据,为临床提供参考.方法从国内外循证资源和文献数据库中检索成人围手术期肺康复管理的证据.对各类型文献进行质量评价后提取并汇总证据.结果共纳入8篇文献.其中3篇临床决策,1篇指南,2篇证据总结,2篇专家共识.从危险因素、评估方式、物理康复、患者教育、心理康复、围术期营养和术后镇痛7个方...     

妊娠期肥胖管理的最佳证据总结

目的 总结与妊娠期肥胖管理有关的最佳证据,为临床实践提供参考.方法 按照"6S"金字塔证据模型,检索有关妊娠期肥胖管理的所有证据资源类型,包括临床指南、临床决策、专家共识、系统评价和随机对照试验等.由2名循证护理研究员对纳入文献的质量进行独立评价并进行证据的归纳总结.结果 共纳入11篇文献,其中7篇指南、1篇系统评价、3篇随机对照试验;汇总了20条有关妊娠期肥胖管理的最佳证据,包括体质量管理、母体筛查与评估、胎儿监测和围生期保健及干预4个方面.结论 总结的妊娠期肥胖管理最佳证据,可为临床相关人员管理肥胖孕妇提供参考和借鉴,以降低母亲及其后代长期不良健康结局的风险,提高妊娠结局质量.     

成人急性胰腺炎患者喂养管管理的证据总结

目的 总结成人急性胰腺炎患者喂养管管理的相关证据,为护理人员临床实践提供参考.方法 基于PIPOST模式确定循证问题,计算机检索指南网站及相关数据库,由2名接受过循证培训的护理研究生独立对纳入文献进行文献质量评价、证据提取和证据综合.结果 共纳入11篇相关文献,包括9篇指南、1篇证据总结、1篇系统评价.从11篇文献中共提取44条证据,最终整理综合为6个维度24条最佳证据,分别是喂养管喂养时机、喂养管置管选择、喂养管置管方法、喂养管喂养制剂选择、喂养管护理、喂养管并发症预防.结论 成人急性胰腺炎患者喂养管管理的证据总结形成过程规范,可为临床循证实践的开展提供参考.     

Advances in management of wet pack in central sterile supply department

综述消毒供应中心医疗器械物品包经高压蒸汽灭菌后湿包的概念、发生率、影响因素及管理措施.提出针对湿包问题和随着医疗器材的不断更新,跟进和完善管理制度,以避免湿包,保证消毒灭菌质量.     

早产儿低体温预防及管理的最佳证据总结

目的检索、评价和整合早产儿低体温预防及管理的最佳证据。方法使用计算机检索国内外相关数据库中关于早产儿低体温预防及管理的临床决策、指南、证据总结、系统评价和专家共识。由2名研究者对文献进行质量评价、证据提取和汇总。结果共纳入11篇文献,包括临床决策4篇、指南2篇、证据总结1篇、系统评价3篇、专家共识1篇,最终总结包括危险因素、评估、体温测量、预防及管理措施、培训5个方面的22条最佳证据。结论早产儿低体温预防及管理的最佳证据涉及低体温管理的全过程,涵盖产房、转运、病房,可为医护人员提供循证依据。     

儿童癌症幸存者向成人医疗过渡准备的最佳证据总结

目的 总结儿童癌症幸存者向成人医疗过渡准备的最佳证据,为我国制订和开展相关循证实践提供参考.方法 根据证据金字塔"6S模型",检索国内外相关数据库建库至2020年6月30日有关儿童癌症幸存者向成人医疗过渡准备相关的指南、专家意见、证据总结、推荐实践及系统评价,并对文献质量进行评价.结果 共纳入25篇文献(指南10篇,系...     

Reducing disposable equipment waste for tonsillectomy and adenotonsillectomy cases

Large amounts of waste in hospitals are generated in the operating rooms from disposable surgical supplies. Tonsillectomy/adenotonsillectomy (T&A) cases use many disposable supplies that are not recyclable. It is critical to reduce disposable waste, as such waste directly affects the environment and increases health care costs. The authors noticed a difference between the number of disposable items prepared, available, but almost never used, for each tonsillectomy case between a children's hospital setting and a university ambulatory surgery center setting. The aims were the following: (1) identify what disposable medical supplies were unnecessarily opened for each case, (2) eliminate all disposable medical waste that was not critical to the case in both settings, and (3) determine the cost reduction at both hospital and surgery center facilities by revising the current disposable instruments/supplies pulled for tonsillectomy cases. The authors report projected cost savings and reduction in waste for one children's hospital and nationally based on their waste reduction.     

Ten rules for reading clinical research reports

This was not a scientific assessment of the scientific quality of the papers published by The American Journal of Surgery. It was an informal audit of the adequacy of the data analysis in the clinical research reports appearing in the 1987-1988 issues. As one who has devoted more than three decades to helping a great variety of people make sense of scientific data, I found the overall quality of data analysis in these papers to be above average for the medical literature; and yet, I found many instances of errors so serious as to render invalid the conclusions of the authors. My 10 proposed rules for reading clinical research reports constitute only an interim solution to a very worrisome problem. The real solution must come from the producers of and the gatekeepers for the medical literature.     

生殖中心手术室实施国际ISO 9001质量体系标准化护理管理的可行性探讨

国际ISO 9001:2008质量体系标准是国际标准化组织制定的关于质量标准的要求,是现代化医疗质量管理常用方法之一。西北妇女儿童医院生殖中心将国际ISO 9001:2008质量体系应用于生殖医学手术室管理,全面提高了手术室全体护士对质量管理的认识,规范了护理工作中的行为与操作,提高了手术室工作效率,推进了护理质量管理的标准化,使手术室耗材的管理得到了不断的完善。应用结果表明:国际ISO 9001:2008质量体系可良好地应用于生殖医学手术室管理。     

持续质量改进在妇幼保健院感染控制管理中的应用

目的探讨持续质量改进（CQI）在妇幼保健院感染质量管理中的应用效果。 方法本院感染控制管理中引入持续质量改进方法,建立质量改进小组,完善相关标准方案,并在医疗各个环节中贯彻执行。比较实施持续质量改进前后的医院感染控制效果。 结果实施CQI后,患者院内感染知晓率由69.5%上升至90.8%,患者满意度由71.5%上升至98.8%,患者医院感染率由5.5%下降至2.0%,医护人员手卫生合格率由84.0%上升至91.7%,医疗用品消毒合格率由80.4%上升至97.9%,医疗垃圾处理合格率由82.3%上升至99.4%,与实施CQI前比较,差异均具有统计学意义（P均< 0.05）。 结论引入CQI方法有效提高了感染控制质量,得到了各级管理部门、医务工作人员和患者的一致认可。     

手术室一次性低值耗材套餐式管控平台的开发与应用

目的探讨一次性低值耗材套餐式管控平台对手术低值耗材的管理效率。方法采用历史对照研究,2019年5～12月手术室完成手术量17 522台,低值耗材按常规管理(精准管控前);2020年5～12月完成手术量15 447台,低值耗材行精准管控(精准管控后),即根据手术室各专科手术特点,开发一次性低值耗材套餐式管控平台,并对一次性低值耗材进行精控管理。结果一次性低值耗材精准管控后,每周库存检查时间和临时申请次数显著低于精准管控前(均P<0.01);一次性低值耗材库存余量、按效期规范摆放率与精准管控前比较,差异有统计学意义(均P<0.01)。结论手术室实施一次性低值耗材套餐式精准管控,有利于手术室低值耗材的动态管理,提高低值耗材管理质量,减少库存和损耗。     

Hip Arthroscopy for Femoracetabular Impingement in China: A Review and Meta‐Analysis

ObjectiveTo explore the development of hip arthroscopy in China through reviewing the change of the application of hip arthroscopy operation on treating femoracetabular impingement (FAI).MethodPapers were retrieved from January 1, 2005 to November 1, 2019, from databases CNKI, Wanfang Data, VIP, PubMed, and Embase. The keywords are Hip Impingement, Femoroacetabular impingement, Hip arthroscopy, Arthroscopic operation, Hip Arthroscopy operation, and Arthroscope, etc. The quality of papers was assessed through MINORS , and statistics and meta‐analysis were performed by Word, Excel, and Revman 5.3 Zurich, Switzerland.ResultsFrom a total of 8,953 papers, 46 review articles without data and 48 articles with data were involved, and 25 papers were included in the Meta‐analysis. The twenty‐five papers were selected from 48 papers with data, of which 41 were reported in Chinese, 11 were missing complete Harris scores, five did not mention the number of patients who had lost follow‐up, three had minors quality scores below 7, one did not have enough FAI cases, and three did not have standard deviations in Harris scores. Overall, in China, the application of hip arthroscopy regarding FAI has flourished while maintaining a high level of treatment and has reached its peak in the past 2 years.ConclusionWith the rapid development of hip arthroscopy in China, hip operation is widely recognized, many reports on its application on FAI have emerged successively, and the scope of application and technical level have been improved.     

Variation in cost of disposable operating room supplies at a children's hospital

BackgroundOperating room (OR) costs account for 40% of hospital costs. Disposable supplies make up a portion of OR costs and are the only cost that is under control of the surgeon. There are little data to explain how surgeons select surgical supplies and what factors predict supply selection. Our goal with the current work was to assess variation in cost of disposable OR supplies at the surgeon level, hypothesizing high variability would be observed.Study designCost data were reviewed for the most common procedures performed by five surgical divisions at a single children's hospital over a six-month period in 2021. For each procedure, the average disposable OR costs for each surgeon were tabulated and compared to the median supply cost for a given procedure at the group level.ResultsFor each procedure, the variation ranged from 149% (gastrostomy tube placement) to 758% (tonsillectomy and adenoidectomy). The median supply cost for an individual surgeon was not always above or below the median supply cost for that procedure for the group. No relationship was observed between whether the supply cost was above or below the median for a given case and a surgeon's case volume, years in practice, or operative length. There was also no relationship between surgeon volume and median cost, surgery length, and years of experience.ConclusionThese data demonstrate variation in the cost of disposable OR supplies at the individual surgeon level at a single institution. This variation is not explained by case volume, years in practice, or operative length.     

1983?1996年中、外文骨质疏松论文的计量分析

目的了解１９８３～１９９６年国内外骨质疏松研究的情况。方法对１９８３～１９９６年研究骨质疏松的中、外文原始研究论文进行计量分析和词频分析。结果中、外文１９９６年的骨质疏松论文总量分别是１９８３年的５７．６７倍和４．１７倍；有１５种中国医学期刊的４９篇论文被ＭＥＤＬＩＮＥ收录；中、外文论文在病因学、预防和控制、药物疗法、诊断的词频量百分比基本相同；外文论文在病理生理学、代谢、病理学、流行病学等的词频量均不同程度地高于我国；中文论文在遗传学、超声检查、膳食疗法、心理学、酶学、死亡率、免疫学、放射疗法、微生物等方面的词频为零；外文论文在中医药疗法、中西医结合治疗等方面的词频为零。结论骨质疏松研究正受到中、外医学工作者的日益重视，我国骨质疏松研究起步较晚，虽近年来进步较快，但和发达国家相比仍有差距。我国在骨质疏松的中医药疗法和中西医结合治疗的研究中具有明显的优势。     

Disposable material for tracheal intubation: pilot study using Penlon Crystal blades and Penlon Lary Gard sheaths

OBJECTIVE: The risk of cross infection due to non-conventional infectious agents has led to the development of single-use disposable medical material. For laryngoscopy, two attitudes have been proposed: the use of disposable blades or disposable translucide cover sheaths with steel blades. Practice studies assessing the quality of these devices are scarce, leaving the physician to his own experience. STUDY DESIGN: Open pilot study assessing satisfaction of the users during tracheal intubation. PATIENTS AND METHODS: Hundred patients of general surgery requiring tracheal intubation underwent laryngoscopy in routine condition with disposable blades (Penlon Crystal) or disposable cover sheaths (Penlon Lary Gard) with steel blades. The users gave a general appreciation of the device and specific comments on the easiness of insertion of the blade, intensity of light and its focus, quality of glottic exposure, easiness of tracheal tube insertion, and solidity of the device. RESULTS: With both devices, intubation was impossible in 6% of the patients. The users considered that intubation was performed in comfortable conditions with both devices. Dim light was noticed with Crystal blade. CONCLUSION: In case of use of disposable material, both devices seem to be close in terms of quality of intubation.