发音障碍患者嗓音康复的最佳证据总结

目的 检索、评价并总结发音障碍患者嗓音康复的最佳证据,为临床开展嗓音康复护理提供循证依据。方法 按照“6S”证据金字塔模型检索临床决策支持系统、各大指南网、数据库及专业协会网站中关于发音障碍患者嗓音康复的相关证据,检索时间为2013年1月1日至2023年5月16日,涵盖临床决策、指南、专家共识、证据总结、系统评价等文献类型,对纳入文献进行方法学质量评价、证据提取整合、等级评价和推荐级别确定。结果 共纳入15篇文献,包括临床决策2篇、指南3篇、专家共识2篇、系统评价7篇和1篇证据总结,整合为发音障碍患者嗓音康复的多学科协作、嗓音评估、干预措施、随访4大方面,共17条证据。结论 总结的发音障碍患者嗓音康复的最佳证据可指导临床医护人员对患者实施嗓音康复训练,促进发音障碍患者的嗓音功能康复。     

造血干细胞移植后患者肠外营养管理的证据总结

目的 评价并总结造血干细胞移植后患者肠外营养管理的最佳证据,为临床干预提供方案。 方法 计算机检索JBI循证护理数据库、英国卫生医疗质量标准署数据库、美国国立指南库、Cochrane图书馆、PubMed、中国知网、万方数据库的相关指南、证据总结、专家共识等,按文献质量评价原则和标准提取证据。 结果 共纳入6篇文献,其中证据总结1篇,指南2篇,系统评价1篇、专家共识2篇。纳入最佳证据14条,包括肠外营养评估、预防外渗及导管并发症、预防代谢异常及标签管理4个方面。 结论 总结的最佳证据可用于造血干细胞移植后患者肠外营养管理;临床应用过程中宜根据当时情形针对性地选择证据,以保障适用、安全。     

肿瘤患者癌性厌食评估与干预的最佳证据总结

目的 整合肿瘤患者癌性厌食评估与干预的最佳证据，为临床实践提供参考。方法 计算机检索UpToDate、BMJ最佳临床实践、世界卫生组织网站、国际指南协作网、Cochrane Library、PubMed、Embase、美国临床肿瘤协会网站、中国知网、万方数据库等关于癌性厌食评估与干预的证据，包括临床决策、推荐实践、指南、专家共识、系统评价、证据总结，检索时限为建库至2023年5月10日。结果 共纳入15篇文献，包括指南6篇，专家共识4篇，系统评价2篇，证据总结1篇，临床决策2篇；从多学科团队管理、评估、食欲调节、营养管理4个方面总结21条最佳证据。结论 医护人员应重视肿瘤患者癌性厌食的管理，结合临床实际应用最佳证据进行评估和干预，以提高肿瘤患者的生存质量。     

儿童肠外营养给药实施和管理的最佳证据总结

目的 评价总结国内外儿童肠外营养给药实施和管理的最佳证据,为临床改善患儿结局提供参考.方法 系统检索计算机临床决策支持系统、专题证据汇总网站、证据摘要、系统评价及中英文数据库内关于儿童肠外营养给药实施和管理的证据,包括指南、共识、系统评价、证据总结.由2名研究者进行文献质量评价及证据提取.结果 共纳入21篇文献,其中指南12篇,共识5篇,系统评价2篇,证据总结2篇.提取的39条证据主要涉及系统安全、评估、导管选择、给药实施、并发症预防及监控等.结论 应结合临床情景、专业意见和患者意愿,筛选最佳证据,以建立适于我国临床的儿童肠外营养管理方案.     

造血干细胞移植患儿运动干预最佳证据总结

目的 总结造血干细胞移植患儿运动干预的最佳证据，为造血干细胞移植患儿运动干预提供参考。方法 依照证据“6S”金字塔模型, 计算机检索UpToDate、Cochrane图书馆、PubMed、中国知网等数据库关于造血干细胞移植患儿运动干预的证据。文献检索时限为建库至2023年2月19日。由2名研究者对纳入文献进行质量评价、证据提取和汇总。结果 共纳入12篇文献，包括指南3篇、临床决策1篇、专家共识3篇、系统评价3篇、随机对照试验2篇，从运动认知、运动益处、运动管理、运动评估、运动原则、运动处方、运动安全7个方面，共提取25条最佳证据。结论 儿童造血干细胞移植期间运动干预的最佳证据为临床实践提供循证依据，建议医护人员充分考虑临床情境，制定更为详细的个性化运动处方。     

卒中患者机器人辅助步态训练康复方案的最佳证据总结

目的 提取并汇总国内外卒中患者机器人辅助步态训练康复护理及管理的最佳证据，为制订适合我国的卒中患者机器人辅助步态训练康复方案提供参考。方法 按照循证资源“6S”模型，系统检索国内外各数据库及指南网关于卒中患者机器人辅助步态训练的证据，包括临床决策、指南、证据汇总、系统评价、专家意见/共识、随机对照试验，检索时间为2016年1月1日至2021年12月31日。由2名研究人员独立对文献进行整体评价，选择符合纳入标准的文献，纳入并提取证据。结果 共检索文献3 314篇，去除重复、结果指标不明确或不相关、质量不达标及不完整的文献，最终纳入19篇，包括指南4篇、证据总结3篇、系统评价8篇、随机对照试验4篇。总结的最佳证据包括评估、干预计划、干预时机、干预频率、干预前准备、参数调整、注意事项、效果评价和健康教育9个方面23条推荐意见。结论 该研究总结的卒中患者机器人辅助步态训练康复方案最佳证据具有一定的前沿性与科学性，可以为临床医护人员实施机器人步态康复训练提供相应的循证依据。     

体外膜肺氧合患者功能锻炼的最佳证据总结

目的 总结体外膜肺氧合患者功能锻炼的最佳证据,为制定科学的体外膜肺氧合患者功能锻炼方案提供参考。方法 系统检索国内外相关指南网站、循证数据库、相关协会网站及学术文献数据库等关于体外膜肺氧合患者功能锻炼的相关证据。检索时限为建库至2023年6月。由2名经过循证医学方法学培训的研究人员对所纳入的文献进行质量评价。结果 共纳入12篇文献,包括指南2篇,系统评价5篇,专家共识3篇,随机对照试验2篇。最终提取出了前期准备、评估、运动方法和安全监测4个方面共35条最佳证据。结论 总结的最佳证据可为开展体外膜肺氧合患者功能锻炼提供依据,从而为患者提供个性化的康复训练方案。     

造血干细胞移植患者饮食与营养教育的证据总结

目的 总结造血干细胞移植患者饮食与营养教育的最佳证据,为临床决策提供参考.方法 针对造血干细胞移植患者饮食与营养教育提出循证问题,按照证据检索"6S"模型进行计算机检索,由2名研究者独立评价文献质量,提取证据,最后由专家对证据进行质量评价及等级划分.结果 纳入14篇文献,包括指南4篇,证据总结1篇,系统评价2篇,专家共识4篇,专家意见3篇.提取与归纳造血干细胞移植患者营养筛查与评估、饮食与营养干预、干预效果评价3个方面24条证据.结论 造血干细胞移植患者饮食与营养教育最佳证据可为临床实践提供循证依据.     

基于ORTCC的成人结直肠癌患者围术期口服营养补充最佳证据总结

目的 检索及筛选成人结直肠癌患者围术期口服营养补充的最佳证据,结合ORTCC模型进行总结,为优化临床口服营养补充实施流程提供参考。 方法 依据“6S”模型检索国内外数据库及专业网站中关于成人结直肠癌患者围术期口服营养补充相关的证据,包括临床决策信息册、指南、专家共识、证据总结、系统评价,进行文献质量评价,参考ORTCC模型提取并汇总相关证据。 结果 共纳入18篇文献,其中包括7篇指南、6篇专家共识、2篇证据总结、3篇系统评价,总结5个维度26条证据。 结论 基于ORTCC的成人结直肠癌患者围术期口服营养补充最佳证据总结为临床实践提供循证依据,需结合临床实际加以应用,提高营养治疗效果,使患者受益。     

老年肌少症患者非药物干预的证据总结

目的总结和评价老年肌少症患者非药物干预的最佳证据,为其健康管理提供循证依据。方法按照"6S"证据资源金字塔模型,根据PICOS原则构建循证问题,系统检索老年肌少症非药物干预的相关证据,并对其进行质量评价、提取和总结。结果共纳入10篇文献,其中指南2篇,专家共识2篇,系统评价6篇。共提取总结8条证据,包括运动干预类型、运动干预处方、营养干预、健康教育和综合干预5个方面。结论建议证据使用者根据临床环境、专业技能及患者意愿,选择裁剪最佳证据,且在证据应用前,应对老年肌少症患者的基线运动水平和营养状况进行严格评估。     

Digital rectal stimulation as an intervention in persons with spinal cord injury and upper motor neuron neurogenic bowel. An evidenced-based systematic review of the literature

Context: Need for evidential support of practice guideline recommendations for management of neurogenic bowel management in adults with spinal cord injury.Objective: To determine evidence for digital rectal stimulation (DRS) as an intervention in the management of upper motor neuron neurogenic bowels (UMN-NB) in persons with spinal cord injury (SCI).Methods: A systematic review of the literature including research articles and practice guidelines evaluating upper motor neuron neurogenic bowel treatments and the use of digital rectal stimulation was performed using OvidMedline, PubMed and the Cochrane database and included research articles and practice guidelines. Limitations were made related to English language, patient age and focus on spinal cord injured patients. Strength of evidence was assessed using the Johns Hopkins Nursing evidence-based practice model.Results: Eleven articles were included in the systematic review. Only one used DRS as a primary intervention. There was moderate evidence for DRS in persons with SCI and UMN-NB. There was evidence of the physiologic effect of DRS and support for combining DRS with other treatment regimens.Conclusion: There is insufficient evidence to promote any one intervention for the management of UMN-NB. The promotion of DRS, and education as to the proper technique for DRS should remain an emphasis of education of home management of UMN-NB in persons with SCI. Future research should focus on the use of standardized, validated tools to evaluate management techniques for UMN-NB.     

神经源性肠道功能障碍患者基于Team STEPPS的出院准备

目的 探讨脊髓损伤致神经源性肠道功能障碍患者基于Team STEPPS出院准备的实施效果.方法 将78例脊髓损伤致神经源性肠道功能障碍患者按照住院时间顺序分为对照组和观察组各39例;对照组实施常规出院准备,观察组实施基于Team STEPPS的出院准备.结果 观察组出院准备度及出院指导质量得分除需要的内容维度外,总分和...     

Neurogenic bowel dysfunction: Clinical management recommendations of the Neurologic Incontinence Committee of the Fifth International Consultation on Incontinence 2013

Background

Evidence‐based guidelines for the management of neurological disease and lower bowel dysfunction have been produced by the International Consultations on Incontinence (ICI). These are comprehensive guidelines, and were developed to have world‐wide relevance.

Aims

To update clinical management of neurogenic bowel dysfunction from the recommendations of the 4th ICI, 2009.

Materials and Methods

A series of evidence reviews and updates were performed by members of the working group. The resulting guidelines were presented at the 2012 meeting of the European Association of Urology for consultation, and modifications applied to deliver evidence based conclusions and recommendations for the scientific report of the 5th edition of the ICI in 2013.

Results

The current review is a synthesis of the conclusions and recommendations, including the algorithms for initial and specialized management of neurogenic bowel dysfunction. The pathophysiology is described in terms of spinal cord injury, multiple sclerosis, and Parkinson's disease. Assessment requires detailed history and clinical assessment, general investigations, and specialized testing, if required. Treatment primarily focuses on optimizing stool consistency and regulating bowel evacuation to improve quality of life. Symptom management covers conservative and interventional measures to promote good habits and assist stool evacuation, along with prevention of incontinence. Education is essential to achieving optimal bowel management.

Discussion

The review offers a pragmatic approach to management in the context of complex pathophysiology and varied evidence base.     

Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease

Objective: To provide an overview of clinical assessments and diagnostic tools, self-report measures (SRMs) and data sets used in neurogenic bladder and bowel (NBB) dysfunction and recommendations for their use with persons with spinal cord injury /disease (SCI/D).

Methods: Experts in SCI/D conducted literature reviews, compiled a list of NBB related assessments and measures, reviewed their psychometric properties, discussed their use in SCI/D and issued recommendations for the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (NINDS) Common Data Elements (CDEs) guidelines.

Results: Clinical assessments included 15 objective tests and diagnostic tools for neurogenic bladder and 12 for neurogenic bowel. Following a two-phase evaluation, eight SRMs were selected for final review with the Qualiveen and Short-Form (SF) Qualiveen and the Neurogenic Bowel Dysfunction Score (NBDS) being recommended as supplemental, highly-recommended due to their strong psychometrics and extensive use in SCI/D. Two datasets and other SRM measures were recommended as supplemental.

Conclusion: There is no one single measure that can be used to assess NBB dysfunction across all clinical research studies. Clinical and diagnostic tools are here recommended based on specific medical needs of the person with SCI/D. Following the CDE for SCI studies guidelines, we recommend both the SF-Qualiveen for bladder and the NBDS for bowel as relatively short measures with strong psychometrics. Other measures are also recommended. A combination of assessment tools (objective and subjective) to be used jointly across the spectrum of care seems critical to best capture changes related to NBB and develop better treatments.     

Electrical stimulation of sacral nerves and roots for control of the neurogenic bladder and bowel

After damage to the spinal cord, some of the most frequent and severe complications are due to the neurogenic bladder and bowel, in spite of a variety of methods of management.Bladder and bowel emptying is usually impaired, but electrical stimulation of nerves surviving after spinal cord injury can produce controlled contraction of muscle, including the smooth muscle of the bladder and lower bowel, and this can be used to produce safe and effective bladder emptying on demand without catheters. It can also aid emptying of the bowel and reduce constipation. Hyper-reflexia of the bladder and lower bowel after spinal cord injury can produce reflex incontinence of urine and stool, and while this can sometimes be reduced by neuromodulation, it can be more predictably reduced by rhizotomy of the sacral sensory roots, while preserving the motor roots for stimulation. This combination of electrical stimulation and rhizotomy has restored bladder and bowel emptying and continence to several thousand patients, with reduced complications and improved quality of life over many years.     

Optimal treatment for severe neurogenic bowel dysfunction after chronic spinal cord injury: a decision analysis

BACKGROUND: When conservative management fails in patients with chronic spinal cord injury (SCI) and neurogenic bowel dysfunction, clinicians have to choose from a variety of treatment options which include colostomy, ileostomy, Malone anterograde continence enema (MACE) and sacral anterior root stimulator (SARS) implantation. This study employed a decision analysis to examine the optimal treatment for bowel management of young individuals with chronic refractory constipation in the setting of chronic SCI. METHODS: A decision analysis was created to compare the four surgical strategies using baseline analysis, one-way and two-way sensitivity analyses, 'worst scenario' and 'best scenario' sensitivity analyses, and probabilistic sensitivity analyses. Quality-adjusted life expectancy (QALE) was the primary outcome. RESULTS: The baseline analysis indicated that patients who underwent the MACE procedure had the highest QALE value compared with the other interventions. Sensitivity analyses showed that these results were robust. CONCLUSION: The MACE procedure may provide the best long-term outcome in terms of the probability of improving bowel function, reducing complication rates and the incidence of autonomic dysreflexia, and being congruent with patients' preferences. The analysis was sensitive to changes in assumptions about quality of life/utility, and thus the results could change if more specific estimates of utility became available.     

Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients

STUDY DESIGN: Cost-effectiveness analysis following international guidelines and taking the societal viewpoint. OBJECTIVES: To estimate the cost-effectiveness of transanal irrigation using a self-administered irrigation system when compared with conservative bowel management. SETTING: A randomized clinical trial was conducted at five spinal centres situated in Denmark, Germany, Italy, United Kingdom and Sweden. Estimates of resources and unit costs were made for the German health care system. METHODS: Efficacy outcomes were drawn from a randomized controlled trial conducted in 2003-2005. Adult spinal cord-injured patients with neurogenic bowel dysfunction were randomized to 10 weeks with either transanal irrigation using Peristeen Anal Irrigation or to conservative bowel management. Costs were calculated based on results from the clinical trial and on 24 interviews conducted in Germany. Unit costs were obtained from the Federal Statistical Office Germany and product list prices. RESULTS: When comparing outcome measures at termination, transanal irrigation significantly reduced symptoms of neurogenic bowel dysfunction. Product-related costs were higher for transanal irrigation using the self-administered system; however, costs for a carer to help with bowel management and changes/washing due to leakage were lower. For transanal irrigation, costs associated with urinary tract infections and patient time spent were reduced. Thus, the total cost to society is lower when patients use transanal irrigation. The results were shown to be robust in the sensitivity analysis. CONCLUSION: Transanal irrigation using a self-administered system reduces symptoms of neurogenic bowel dysfunction and results in a lower total cost to society than conservative bowel management. SPONSORSHIP: The study was supported by Coloplast A/S.     

A comparison of bowel care patterns in patients with spinal cord injury: upper motor neuron bowel vs lower motor neuron bowel.

STUDY DESIGN: A face-to-face interview survey. OBJECTIVE: To compare bowel care patterns in spinal cord injury (SCI) patients based on type of neurogenic bowel. SETTING: Department of Physical Medicine and Rehabilitation of a tertiary university hospital in Suwon, Korea. METHODS: Among chronic SCI patients, 22 patients with upper motor neuron bowel (UMNB) and 20 patients with lower motor neuron bowel (LMNB) participated in an interview survey for the evaluation of bowel care patterns. RESULTS: The patients with LMNB demonstrated increased frequency of defecation, increased frequency of fecal incontinence, increased use of oral medications for bowel care, increased required time for defecation and more diet modification than those with UMNB (P < 0.05). However, there was no significant difference in the subjective difficulty of bowel care. Among several available bowel care methods, suppositories were used most frequently by the UMNB group, whereas the Valsalva maneuver was the most frequently used method by the LMNB group. CONCLUSIONS: Patients with LMNB tend to suffer more difficulties in management of their neurogenic bowel than those with UMNB. Therefore, more intensive and aggressive bowel care programs should be provided for SCI patients with LMNB.     

Bladder and bowel management for the child with spinal cord dysfunction

Bladder and bowel management can be a challenge to adults and children with spinal cord dysfunction. Children are especially challenging due to their everchanging growth and developmental considerations. Bladder/bowel incontinence can bring about teasing from a child's peers and lead to social isolation. The achievement of continence is a major developmental landmark in the formation of social autonomy in children. Providing education and implementation of bladder/bowel management programs is essential for a child with neurogenic bladder/bowel. This article provides a general overview of common bladder and bowel management options for children with spinal cord dysfunction. Both traditional and innovative management options for the bladder and bowel will be described. Age-appropriate expectations and factors to assess child readiness as well as patient and family educational strategies to promote independence when implementing bladder and bowel programs are described.     

Intestinal diversion (colostomy or ileostomy) in patients with severe bowel dysfunction following spinal cord injury.

BACKGROUND: Spinal cord injury (SCI) affects motor and sensory nervous integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel. SCI leads to diminished or lost sensations of the need to defecate or inability to distinguish the presence of gas versus liquid versus solid stool in the rectal vault. Sensory loss, incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone increase the risk of fecal incontinence. Gastrointestinal symptoms are associated with depression, anxiety, and significant impairments in quality of life (QOL) in a significant portion of persons with SCI. OBJECTIVES: 1. To compare clinical, functional, or quality of life outcomes in spinal cord injured patients with gastrointestinal symptoms managed by conservative measures versus intestinal diversion (colostomy or ileostomy). 2. To identify complications associated with ostomy surgery in patients with bowel dysfunction and SCI. SEARCH STRATEGY: A systematic review of electronic databases MEDLINE and CINAHL (from January 1960 to November 2007) was undertaken using the following key words: (1) ostomy, (2) stoma, (3) colostomy, and (4) ileostomy. Boolean features of these databases were used to combine these terms with the key word "spinal cord injuries." Prospective and retrospective studies that directly compared clinical, functional, QOL outcomes or satisfaction among patients with intestinal diversions to patients managed by conservative means were included. RESULTS: Creation of an ostomy in selected patients provides equivocal or superior QOL outcomes when compared to conservative bowel management strategies. Both colostomy and ileostomy surgery significantly reduce the amount of time required for bowel management. Patients who undergo ostomy surgery tend to be satisfied with their surgery, and a significant portion report a desire to be counseled about this option earlier. There are no clear advantages when functional, clinical, or QOL outcomes associated with colostomy are compared to those seen in SCI patients undergoing ileostomy. IMPLICATIONS FOR PRACTICE: 1. The WOC nurse plays a pivotal role in both conservative bowel management and the decision to undergo ostomy surgery. 2. Preoperative stoma site marking is vital for the best surgical outcome. 3. The system best suited to an individual is based on a variety of factors including but not limited to stoma location, type of effluent, peristomal plane and contours, and the individual's capabilities and preferences. 4. Some individuals with a sigmoid or descending colostomy may benefit from colostomy irrigation as a management method. 5. Postoperatively, assessment of pressure points for signs of tissue breakdown, evaluation of treatment methods for existing pressure ulcers with suitable modification, and support surface assessment should be included in ongoing annual follow-up visits.