循证实践中杂志俱乐部应用的文献分析

目的了解杂志俱乐部在循证实践中的应用效果,为循证实践教育干预提供参考。方法对1975年1月至2009年10月在中国生物医学文献数据库、中国学术期刊网全文数据库（CNKI）、万方数据库、维普中文科技期刊数据库、PubMed、CochraneLi-brary等数据库发表的文献,以teaching、journal club、critical appraisal、education、evidence-based practice、循证实践、教育等为检索词进行检索,对所得文献进行系统复习及评价。结果 5篇文献被纳入,其Jadad得分为3～4分;研究对象517名。开展杂志俱乐部可有效提高患者生活质量、自尊,有效促进溃疡创口的恢复,有效减轻伤口疼痛。杂志俱乐部对医学生和临床医护人员的知识、态度、文献阅读习惯产生影响,而对循证实践技能及对干预对象运用证据的影响还需进一步考证。结论杂志俱乐部可以促进患者康复,提高临床医护人员的知识、态度、文献阅读习惯,杂志俱乐部是循证实践教育的有效途径。     

2003—2009年《中华胃肠外科杂志》发表临床随机对照试验文献情况分析

目的分析2003—2009年《中华胃肠外科杂志》发表临床随机对照试验（RCT）论文情况。方法研究2003—2009年《中华胃肠外科杂志》42期期刊刊载的临床RCT文献,对每篇文献收稿时间、发表时间、引文总数、中文引文数、英文引文数、文章所属单位、单（或多）中心研究情况、研究阳性结论情况、研究中患者例数、基金资助情况、研究起始时间、研究结束时间、研究作者人数等指标进行分析。结果2003—2009年《中华胃肠外科杂志》共刊出临床RCT文章80篇,期均RCT数1．6篇．RCT在所有临床研究类文献中占比为12％。80篇RCT研究的平均发文时滞为208d,篇均引文数为8．6条,篇均研究对象数为118例（名）,篇均研究周期为29．2个月。RCT研究中多中心研究7篇．单中心研究73篇．所有RCT研究均得出有阳性意义的结论。有基金资助的RCT研究17篇,占所有临床RCT数的21-3％。南京军区南京总医院发表临床RCT研究6篇,是最多的单位。结论《中华胃肠外科杂志》重视刊载循证依据极强的临床RCT研究,此类研究对国内胃肠外科领域临床指南及诊疗规范的制定具有重要意义。     

Iowa循证实践模式及在护理实践中的应用

本文系统阐述了Iowa循证实践模式的三个决策点,包括问题的优先度、证据的充分性及变革的适宜性;介绍了该模式从基于临床问题和基于知识更新而开展实践变革的触发器,到证据筛选、开展实践变革及结果评价的全过程;全面分析了该模式在护理教育培训、症状护理及护理管理实践中的应用现状,指出该模式对开展循证实践的启示,包括提供了框架及触发器,为用证和创证提供了决策方向。     

国内循证护理教育文献分析

目的分析2003~2009年循证护理教育文献,为循证护理教育研究提供参考。方法以＂循证护理教学＂或＂循证护理教育＂为关键词进行检索,或以＂循证护理＂且含＂教学＂或＂教育＂检索中国期刊全文数据库、中国知网有关循证护理教育方面论文的发表情况。结果检索到2003年1月至2009年12月中国期刊全文数据库、中国知网收录的有关循证护理教育的论文共31篇,文献量逐年上升趋势,但仅有13篇发表于护理核心期刊。临床循证护理教学论文9篇,其余22篇为在校理论课程教学。31篇文献均未很好体现随机对照方法、分配隐藏、盲法、样本量的估算、结果测量标准等。结论循证护理教育论文科学性不够,应加强护理科研方法培训,以提高护理人员及院校教师科研水平,推动循证护理教育的发展。     

国内循证护理教育文献分析

目的分析2003~2009年循证护理教育文献,为循证护理教育研究提供参考。方法以循证护理教学或循证护理教育为关键词进行检索,或以循证护理且含教学或教育检索中国期刊全文数据库、中国知网有关循证护理教育方面论文的发表情况。结果检索到2003年1月至2009年12月中国期刊全文数据库、中国知网收录的有关循证护理教育的论文共31篇,文献量逐年上升趋势,但仅有13篇发表于护理核心期刊。临床循证护理教学论文9篇,其余22篇为在校理论课程教学。31篇文献均未很好体现随机对照方法、分配隐藏、盲法、样本量的估算、结果测量标准等。结论循证护理教育论文科学性不够,应加强护理科研方法培训,以提高护理人员及院校教师科研水平,推动循证护理教育的发展。     

国内外循证实践教育培训现状分析

综述国内外循证实践教育培训模式在硕士、本科以及在职医疗护理人员继续教育中的教学现状。发现各大院校在开展循证实践教育培训对象、开课时间、课程持续时间、教学内容、教学评价等方面未形成一致意见，缺乏深入研究，有待进一步探索。     

国内外循证实践教育培训现状分析

综述国内外循证实践教育培训模式在硕士、本科以及在职医疗护理人员继续教育中的教学现状.发现各大院校在开展循证实践教育培训对象、开课时间、课程持续时间、教学内容、教学评价等方面未形成一致意见,缺乏深入研究,有待进一步探索.     

比较分析护理学杂志文献的状况

比较分析护理学杂志文献的状况第三军区大学护理系蔡晓莲，王仙园，陈宇英第三军医大学计算机中心李爱国，王关嵩，马均华（护理学杂志）（以下简称护理学）是由中华人民共和国卫生部主管、同济医科大学主办、国内外公开发行的全国性护理专业学术性期刊。创刊十年来积极进...     

知识转化模式在循证实践中的应用

系统阐述了知识转化模式的2个环节及该模式在循证实践中的应用方法,引导研究者和实践者通过确定问题,获取证据,不断裁剪,形成符合利益相关群体需要的证据传播形式,引入具体的临床情景,进行障碍因素分析和发展有效的干预策略,加强过程监测和效果评价,促进证据向实践的转化,并维持转化成果,不断缩短证据和实践的差距。旨在为我国护理人员开展证据转化提供框架、思路和方法指导。     

创新扩散理论及其在循证护理实践中的应用进展

通过介绍创新扩散理论的框架及在护理领域的适用性,重点阐述该理论在循证护理实践中的应用,并提出对我国循证护理实践研究和应用的指导启示。     

Evaluation of a multidisciplinary burn care journal club: Lessons learned

Background

Journal clubs allow discussion of the quality and findings of recent publications. However, journal clubs have not historically been multidisciplinary. Burn care is recognized as a true collaborative care model, including regular multidisciplinary rounds. Since 2011 we have offered a multidisciplinary burn journal club at our institution. We present an evaluation of the factors that have made the sessions successful to facilitate others to commence their own club.

Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol

A systematic review of the literature was performed to evaluate the role of exercise in treating rotator cuff impingement and to synthesize a standard evidence-based rehabilitation protocol. Eleven randomized, controlled trials (level 1 and 2) evaluating the effect of exercise in the treatment of impingement were identified. Data regarding demographics, methodology, and outcomes of pain, range of motion, strength, and function were recorded. Individual components of each rehabilitation program were catalogued. Effectiveness was determined by statistical and clinical significance. Although many articles had methodologic concerns, the data demonstrate that exercise has statistically and clinically significant effects on pain reduction and improving function, but not on range of motion or strength. Manual therapy augments the effects of exercise, yet supervised exercise was not different than home exercise programs. Information regarding specific components of the exercise programs was synthesized into a gold standard rehabilitation protocol for future studies on the nonoperative treatment of rotator cuff impingement.     

A pilot investigation of a pediatric surgery journal club

Background

The CanMEDS competency “scholar” encompasses the creation, dissemination, application, and translation of medical knowledge. We hypothesize that a structured journal club (JC) for pediatric surgical trainees would meet these objectives in an enjoyable and long-lasting manner.

Methods

A JC involving two pediatric surgery training programs was created with each session focusing on a specific study design. Pre-tests/post-tests were administered before/after each session with durability of learning assessed during the following session. Metrics analyzed included participant satisfaction and an appraisal of evidence-based medicine (EBM) principals. Test results were analyzed using the paired T-test with p < 0.05 considered significant.

Results

On average, 14 participants attended each session, with all trainees present (4). While participants believed they understood EBM principles, 40% were unfamiliar with question formulation, 48% were unfamiliar with critical appraisal tools, and 60% had not appraised an article within the previous year. Pre-test to post-test comparison yielded an improvement in mean score (20 = perfect score): 10.8 to 16.9, p < 0.01. Measures of participant satisfaction were uniformly positive.

Conclusion

A structured Pediatric Surgery Journal Club addresses scholarly training objectives in a highly satisfactory manner and yields durable learning. A web-based curriculum based on this model could serve as an important educational tool for trainees and attending staff alike.     

Advanced practice physiotherapy in patients with musculoskeletal disorders: a systematic review

ABSTRACT: BACKGROUND: The convergence of rising health care costs and physician shortages have made health care transformation a priority in many countries resulting in the emergence of new models of care that often involve the extension of the scope of practice for allied health professionals. Physiotherapists in advanced practice/extended scope roles have emerged as key providers in such new models, especially in settings providing services to patients with musculoskeletal disorders. However, evidence of the systematic evaluation of advance physiotherapy practice (APP) models of care is scarce. A systematic review was done to update the evaluation of physiotherapists in APP roles in the management of patients with musculoskeletal disorders. METHODS: Structured literature search was conducted in 3 databases (Medline, Cinahl and Embase) for articles published between 1980 and 2011. Included studies needed to present original quantitative data that addressed the impact or the effect of APP care. A total of 16 studies met all inclusion criteria and were included. Pairs of raters used four structured quality appraisal methodological tools depending on design of studies to analyse included studies. RESULTS: Included studies varied in designs and objectives and could be categorized in four areas: diagnostic agreement or accuracy compared to medical providers, treatment effectiveness, economic efficiency or patient satisfaction. There was a wide range in the quality of studies (from 25% to 93%), with only 43% of papers reaching or exceeding a score of 70% on the methodological quality rating scales. Their findings are however consistent and suggest that APP care may be as (or more) beneficial than usual care by physicians for patients with musculoskeletal disorders, in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. CONCLUSIONS: The emerging evidence suggests that physiotherapists in APP roles provide equal or better usual care in comparison to physicians in terms of diagnostic accuracy, treatment effectiveness, use of healthcare resources, economic costs and patient satisfaction. There is a need for more methodologically sound studies to evaluate the effectiveness APP care.