神经外科家庭参与式交班模式的实践

目的 探讨神经外科家庭参与式交班模式的效果。方法 依据神经外科专科疾病护理特点,设计神经外科家庭交班日志,比较分析实施前后交班护士对“病情十知道”掌握情况、交班缺陷发生率、患者及家属满意度。结果 运用家庭参与式交班模式后,护士病情交班缺陷率由44.2%降低至15.8%（P<0.001）,“患者十知道”掌握情况得分由实施前的（84.2±6.7）分提高到实施后的（90.7±4.7）分,P<0.001,患者/家属满意度由实施前的（87.4±5.8）分,提升到实施后的（93.2±4.3）分,P<0.001。结论 神经外科家庭参与式交班模式的实践证明家庭参与式交接班能减少护士交班信息遗漏,提高护士对患者的病情掌握度,改进护理工作质量,促进患者安全,提升患者满意度。     

坐卧式“六字诀”对卒中后轻中度抑郁患者抑郁及自我效能的影响

目的 探究坐卧式“六字诀”功法锻炼对卒中后轻中度抑郁患者抑郁及自我效能的影响。 方法 选择2019年2月—2020年3月深圳市中医院针灸科卒中后轻中度抑郁住院患者60例,采用随机数字表法分为对照组和观察组,各30例。对照组给予卒中后抑郁常规护理,观察组在对照组基础上给予坐卧式“六字诀”功法锻炼,2次/d,15~20 min/次,干预28 d。分别于干预前、干预28 d末采用汉密尔顿抑郁量表对受试对象进行评价。 结果 干预前,2组卒中后轻中度抑郁患者汉密尔顿抑郁评分和自我效能评分比较,差异均无统计学意义（P>0.05）;干预28 d末,2组卒中后轻中度抑郁患者患者汉密尔顿抑郁评分均低于干预前（P<0.01）,自我效能评分均高于干预前（P<0.01）;干预28 d末,观察组抑郁评分低于对照组（P<0.01）,自我效能评分高于对照组（P<0.05）。 结论 坐卧式“六字诀”功法练习可改善卒中后轻中度患者的抑郁及自我效能。     

基于改良早期预警评分护送方案在急危重症患者院内转运中应用效果的Meta分析

目的 评价基于改良早期预警评分护送方案在急危重症患者院内转运中应用效果。方法 计算机和手动结合检索中国知网、中国生物医学文献数据库、万方数据库、维普数据库、PubMed、EMbase、OVID、EBSCO和Cochrane图书馆中关于基于改良早期预警评分护送方案在急危重症患者院内转运中应用效果的随机对照试验和类实验性研究。检索时限均从2001年7月—2020年8月,由3名研究者严格筛选文献、提取资料、评价质量。运用RevMan 5.3软件对纳入的随机对照研究和类试验性研究进行Meta分析。结果 共纳入19篇文献,随机对照试验为6篇,类实验性研究为13篇。Meta分析结果显示,应用基于改良早期预警评分护送方案,能够减少不良事件发生率[OR=0.27,95%CI（0.24,0.30）,P<0.01],提高患者及家属满意度[OR=3.91,95%CI（2.79,5.49）,P<0.01],提高接收科室满意度[OR=4.72,95%CI（2.87,7.77）,P<0.01],缩短转运时间[MD=-2.47,95%CI（-2.68,-2.25）,Z=22.26,P<0.01],差异均有统计学意义。结论 针对院内转运的急危重症患者,基于改良早期预警评分护送方案与常规转运方式相比具有优越性,可以有效降低不良事件发生率,提高患者及家属满意度、接收科室满意度,缩短转运时间。     

对ICU行肠内营养支持患者胃残留量监测相关系统评价的再评价

目的 通过系统评价再评价对ICU行肠内营养支持护理及患者是否需要进行胃残留量监测及合理的阈值设置进行探讨,为护理人员临床决策提供参考。方法 计算机检索Cochrane Library、EMBASE、PubMed、Web of Science、中文期刊全文数据库、万方数据知识服务平台数据库,检索时间为建库至2018年4月,检索ICU行肠内营养支持患者胃残留量监测的相关系统评价和Meta分析,采用AMSTAR工具评价纳入研究的方法学质量,采用GRADE系统对结局指标进行质量评价。结果 共纳入7篇系统评价/Meta分析,文献质量整体不高。是否监测胃残留量对于ICU患者肠内营养并发症、ICU住院时间及ICU患者死亡率等并无影响;不常规监测胃残留量,患者的喂养不耐受及肠内营养中断减少;高胃残留量阈值（胃残留量阈值≥250 mL与胃残留量阈值<250 mL比较）可以明显增加肠内营养摄入量。结论 纳入研究的整体质量不高,结局指标的证据以低质量为主,ICU行肠内营养支持监测胃残留量的必要性不大,但合理的胃残留量阈值设置会使患者获益。受纳入研究的数量及质量限制,尚需更高质量的研究证实该结论的可靠性。     

《中国循证医学杂志》发表的干预类系统评价／Meta分析报告质量评价

目的评价《中国循证医学杂志》公开发表的干预类系统评价／Meta分析的报告质量,并分析其影响因素。方法对《中国循证医学杂志》从创刊至2011年底所发表的干预类系统评价／Meta分析进行检索。采用PRISMA清单评价和分析所有纳入文献,按照PRISMA清单各条目的符合程度由高到低分别评为“1分”、“0．5分”、“0分”。将所获数据录入Excle软件,并使用Meta—Analyst软件进行统计分析。结果共纳入干预类系统评价／Meta分析379篇,发表数量总体呈逐年上升之势。PRISMA清单平均评分19．97±3．15分（8．5-26分）。其中25篇（6．60％）评分为21—27分,认为报告相对完全;226篇（59．63％）评分为15～21分,认为报告存在缺陷;128篇（33．77％）评分为15分以下,认为有严重的信息缺失。分层分析结果显示：PRISMA的发布、有基金资助可以提高系统评价／Meta分析的报告质量（P〈0．05）;作者数≥3人、作者单位性质为大学和单位数≥2个有改善系统评价／Meta分析报告质量的趋势,但影响不具统计学意义（P〉0．05）。结论《中国循证医学杂志》所发表的干预类系统评价／Meta分析的报告质量有待提高,影响报告质量的主要因素有方案和注册、研究间偏倚、其他分析以及资金支持等,应加以重视。合理利用PRISMA将有助于提升系统评价／Meta分析的报告质量。     

乳腺癌双职双轨个案管理模式的应用效果观察

目的 探讨符合国情的乳腺癌个案管理模式,并在乳腺癌患者中实践以探讨其应用效果。方法 选取2018年7月—2019年1月收治的乳腺癌患者88例,按照所在病区分为观察组和对照组各44例。对照组由单独的个案管理师对患者实施常规护理,包括围术期护理及出院后居家延伸护理、随访;观察组实施双职双轨个案管理模式下的全程个性化管理。结果 干预6个月末,与对照组比较,观察组患者术后皮下积液的发生率显著低于对照组（P<0.05）,在淋巴水肿并发症发生方面比较差异无统计学意义（P>0.05）,2组乳腺癌患者生活质量得分比较差异有统计学意义（P<0.05）。结论 实施乳腺癌双职双轨个案管理模式实现了乳腺癌患者全程个性化管理,满足患者个性化需求,改善了患者的生活质量,降低并发症发生率,提高了患者满意度。     

护理能力在肿瘤科护士工作倦怠与心理资本间的中介效应

目的 探讨肿瘤科护士心理资本、护理能力和工作倦怠的关系,为制定改善肿瘤科护士工作倦怠的干预措施提供依据。方法 采取便利抽样法,以广西25所三级综合医院和专科医院1 203名肿瘤科护士为研究对象,采用一般情况调查表、护士心理资本问卷、护士护理能力量表及工作倦怠量表进行问卷调查。结果 工作倦怠量表中,情感衰竭评分为（2.23±1.61）分,消极怠慢评分为（1.63±1.15）分,成就感低落评分为（2.43±1.28）分;护士心理资本量表评分为（4.15±0.86）分,护理能力量表评分为（73.44±13.11）分。Pearson相关性分析显示肿瘤科护士情感衰竭与心理资本,护理能力呈负相关（r=-0.422,-0.283;P<0.05）,消极怠慢与心理资本,护理能力呈负相关（r=-0.519,-0.365;P<0.05）,个人成就感低落与心理资本,护理能力呈负相关（r=-0.477,-0.533;P<0.05）;结构方程模型结果显示,肿瘤科护士的心理资本能直接影响工作倦怠,直接效应为β=-0.58,护理能力在其中的中介效应效果量为β=-0.17。结论 肿瘤科护士心理资本对工作倦怠具有直接预测作用,护理能力在肿瘤科护士心理资本和工作倦怠之间存在中介效应。建议可通过制定提高肿瘤科护士的心理资本和护理能力的措施,以改善其工作倦怠。     

基于面向服务体系结构智能化交班系统的开发与应用

目的 开发设计适用于临床护理工作的智能化交班系统并对其有效性进行评价。方法 2016年8月—2017年6月使用传统手写交班报告,并调取传统手写交班报告的书写情况,在2017年7月—2018年4月应用智能化交班系统,比较两者交班报告的书写、记录所用时间、交班报告合格率、信息准确性等结果。结果 与传统交班方式相比,运用智能化交班系统后,记录交班所用时间显著减少,合格率显著升高,信息的传递更准确（字迹潦草、辨认不清导致错误、书写错误、记录不及时导致的错误等方面准确均显著提高,差异均有统计学意义（P<0.01）。结论 智能化交班系统能更规范护理交班流程,省时、准确,提高工作效率。     

住院康复期精神分裂症患者正念训练的效果观察

目的 探讨正念训练对住院康复期精神分裂症患者焦虑、抑郁及生活质量的影响。方法 选取2017年1—12月在江苏省扬州五台山医院精神科住院的62例住院康复期精神分裂症患者,采用抽签法随机分为观察组及对照组各31例,对照组给予常规的治疗及护理,观察组在此基础上进行为期8周的正念训练,采用世界卫生组织生存质量测定量表简表自评量表、汉密尔顿抑郁量表、汉密尔顿焦虑量表进行效果评价。结果 干预后,2组抑郁、焦虑总分均有下降,生活质量每项评分均增高;经组间比较,观察组抑郁、焦虑得分低于对照组（P<0.05）;观察组除社会关系维度评分外,生活质量评分各项评分均明显高于对照组（P<0.05）。结论 正念训练能够有效改善康复期精神分裂症患者抑郁、焦虑等情绪,调动患者的康复潜能,改善其生活能力,提高患者生活质量。     

穴位按摩联合生物反馈对气虚排便推进力不足型便秘患者的影响

目的 观察穴位按摩联合生物反馈对气虚排便推进力不足型便秘患者的影响。方法 采用便利抽样法,选取2017年5月—2019年5月在我院脾胃病重点专科住院的气虚排便推进力不足型便秘患者作为研究对象。将104例气虚排便推进力不足型便秘患者随机分为观察组51例和对照组53例,2组均接受生物反馈治疗和药物治疗、常规护理,在此基础上观察组给予长强、次髎、大肠俞穴位按摩,疗程均为12周。干预12周末评估2组患者临床总疗效,干预前、干预12周末评估2组患者便秘主症积分、3 D肛管直肠测压及生活质量评分。结果 干预前,2组气虚排便推进力不足型便秘患者便秘主症积分、3 D肛管直肠测压及生活质量评分比较,差异均无统计学意义（P>0.05）。干预12周末,2组患者总疗效、便秘主症积分、生活质量评分均较干预前改善,观察组优于对照组（P<0.05）;2组患者肛管静息压、初始感觉较干预前均下降,肛管最大收缩压、直肠压力及肛门松弛率均升高,观察组优于对照组（P<0.05）。结论 穴位按摩联合生物反馈治疗气虚排便推进力不足型便秘的疗效优于单纯生物反馈治疗,能够增强直肠推进力,改善便秘,从而提高其生活质量。     

PRISMA声明应用现状调查

目的了解PRISMA声明的应用情况。方法计算机检索PubMed、EMbase、The Cochrane Library(2013,第10期)、CBM、WanFang Data和CNKI数据库,收集应用PRISMA声明的相关文献,检索时限均为从2009年至2013年。由2位研究者按照纳入与排除标准筛选文献并提取资料,然后采用EXCEL软件进行文献计量分析。结果最终纳入175篇文献,其中会议摘要26篇,全文149篇。对149篇全文的文献计量分析结果显示:这些文献发表在118种期刊上,而PRISMA官网公布的支持期刊有176种。按研究类型分类,系统评价/Meta分析111篇(既用于制作,也用于报告),系统评价再评价20篇(用于报告质量评价),PRISMA声明解读文献7篇,其他11篇。131篇用于系统评价/Meta分析以及系统评价再评价的文献中,西医领域占77.8%,其次为公共卫生(8.4%)、中医(4.6%)。结论 PRISMA声明的应用尚处于起步阶段,并且主要局限在西医领域,对其重视和认识还很不够,应加强对其进行解读和推广。     

Epidemiology,methodological and reporting characteristics of systematic reviews of nursing interventions published in China

The importance of systematic reviews (SRs) of nursing interventions' impact on practice makes their methodological quality and reporting characteristics especially important as it directly influence their utility for clinicians, patients and policy makers.The study aims to assess the methodological quality and reporting characteristics of SRs of nursing interventions in Chinese nursing journals. Three Chinese databases were searched for SRs of nursing interventions from inception to October 2011. The assessment of multiple systematic reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statements were used to assess methodological quality and reporting characteristics. Seventy‐four SRs were included. The proportion of SRs complying with AMSTAR checklist items ranged from 0% to 82.4%. No SRs reported an ‘a priori’ design or conflict of interest. Only four items were found to be reported in more than 50% of the SRs: a list of included and excluded studies, the scientific quality of included studies, the appropriate use of methods to combine findings, and formulating conclusions appropriately. The majority of SRs of nursing interventions in China had major methodological and reporting flaws that limited their value to guide decisions. Chinese authors and journals should adopt and keep up with the AMSTAR and PRISMA statements to improve the quality of SRs in this field.     

我国“循证”冠名期刊发表干预类系统评价/Meta分析的现状调查

目的 调查我国以“循证”冠名的医学期刊发表的干预类系统评价/Meta分析(SR/MA)的现状.方法 根据纳入与排除标准选择《循证医学》(2001.1 ～ 2011.12)、《中国循证医学杂志》(2001.1～2011.12)、《中国循证儿科杂志》(2006.1 ～ 2011.12)和《中国循证心血管医学杂志》(2008.1 ～ 2011.12)所发表的干预类SR/MA,由两名评价者按制定的信息提取表独立提取资料并交叉核对,如有分歧,讨论解决.而后采用Excel软件进行统计分析.结果 共纳入SR/MA 487篇,其中《中国循证医学杂志》379篇(77.82％),《循证医学》70篇(14.38％),《中国循证儿科杂志》30篇(6.17％),《中国循证心血管医学杂志》8篇(1.63％).2001～2011年,SR/MA发表数量总体呈上升趋势,每篇文献作者的数量为5+2人;SR/MA纳入的RCT数量在1～129个不等,中位数8个;共涉及20个病种,研究领域较多的依次为肿瘤(83篇,17.04％)、循环系统疾病(63篇,12.73％)和泌尿生殖系统疾病(54篇,11.09％)等.所纳入的487篇SR/MA中,82.75％进行了方法学质量评价,44篇(9.03％)描述了质量评价方法但未展现质量评价结果,使用最多的评价标准为Cochrane偏倚风险评估工具(314篇,64.48％).结论 我国以“循证”冠名的医学期刊所发表的干预类SR/MA数量总体呈上升趋势,其选题来源广泛,但对纳入随机对照试验的质量评价标准的选择和实施尚待进一步加强.     

Effect of acupuncture in eczema: An overview of systematic reviews

BackgroundEczema is a common chronic relapsing inflammatory skin disease, which is characterized by intense itching. Acupuncture can be effective for eczema, and it is thus regarded as a common complementary treatment.ObjectiveThe intention of this overview is to methodically appraise and synthesize evidence about systematic reviews/meta-analyses (SRs/MAs) on acupuncture in eczema.MethodsWe searched for SRs/MAs of acupuncture with eczema in eight databases. We evaluated the methodological quality by Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the reporting quality with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020 Checkist), and the evidence quality according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.ResultsA total of 7 SRs/MAs were included. According to AMSTAR-2, all the SRs/MAs included were categorized as critically low-quality. According to the PRISMA 2020 checklist, none of the reviews completed all the 27 items, thus their compliance was relatively weak. On the base of GRADE system, 2 of the 12 outcomes were rated as moderate, and 5 outcomes were rated as low-quality, while the others were regarded as very low-quality.ConclusionCompared with the control group, the included reviews of the acupuncture group were more effective and safer; however, the conclusion should be treated cautiously because the quality of evidence was not high enough to support it. In order to improve the quality, more rigorous, standardized, and comprehensive SRs/MAs need designing in the future.     

The Effectiveness of Tai Chi in Patients With Breast Cancer: An Overview of Systematic Reviews and Meta-Analyses

BackgroundAs a mind-body exercise, Tai Chi (TC) may have a positive impact on physical function and psychological well-being in patients with breast cancer (BC). The aim of this current overview of systematic reviews (SRs) and meta-analyses (MAs) was to identify and summarize the existing evidence regarding the effectiveness of TC in patients with BC.MethodsA computerized search of electronic databases was performed to identify relevant SRs/MAs of TC related to BC from inception to June 2020. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklists were used to assess the methodological quality and reporting quality of SRs and MAs, respectively. The Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to assess the evidence quality of outcome measures.ResultsSix SRs/MAs in which quantitative synthesis was used to assess various outcomes of TC related to BC were included in this overview. The quality of the SRs/MAs and the evidence quality of the outcome measures were generally unsatisfactory. The limitations of the past SRs/MAs were the lack of a protocol and registration, a list of excluded studies, or inadequately reported computational details of meta-analyses. The critical problems were that the qualitative data synthesis relied on the trials with small sample sizes and of critical low quality.ConclusionsTC is possibly beneficial to BC treatment. However, further rigorous and comprehensive studies are required to provide robust evidence for definitive conclusions.     

Epidemiology, quality, and reporting characteristics of systematic reviews of acupuncture interventions published in chinese journals

Abstract Background: Systematic reviews (SRs) of acupuncture have become increasingly popular in China in recent years and have been published in large numbers. This review provides the first examination of epidemiological characteristics of these SRs as well as compliance with the PRISMA and AMSTAR guidelines. Objectives: The study objectives were to examine epidemiological and reporting characteristics as well as methodological quality of SRs of acupuncture published in Chinese journals. Methods: Four (4) Chinese databases were searched (CBM, CSJD, CJFD, and Wanfang Database) for SRs of Traditional Chinese Medicine, from January 1978 through to December 2010. Data were extracted into Excel spreadsheets. The PRISMA and AMSTAR checklists were used to assess reporting characteristics and methodological quality, respectively. Results: A total of 88 SRs were identified; none of the reviews had been updated. Less than one third (27.3%) were written by clinicians and one third (35.2%) were reported in specialty journals. The impact factor of 53.4% of the journals published was 0. Information retrieval was not comprehensive in more than half (59.1%) of the reviews. Less than half (36.4%) reported assessing for publication bias. Though 97.7% of the reviews used the term "systematic review" or "meta-analysis" in the title, no reviews reported a protocol and none were updated even after they had been published after 2 or more years. Conclusions: Although many SRs of acupuncture interventions have been published in Chinese journals, the reporting quality is troubling. Thus, the most urgent strategy is to focus on increasing the standard of SRs of acupuncture interventions, rather than continuing to publish them in great quantity.     

Adherence to the PRISMA statement and its association with risk of bias in systematic reviews published in rehabilitation journals: A meta-research study

BackgroundSystematic reviews (SRs) and meta-analyses are essential resources for the clinicians. They allow to evaluate the strengths and the weaknesses of the evidence to support clinical decision-making if they are adequately reported. Little is known in the rehabilitation field about the completeness of reporting of SRs and its relationship with the risk of bias (ROB).ObjectivesPrimary: 1) To evaluate the completeness of reporting of systematic reviews (SRs) published in rehabilitation journals by evaluating their adherence to the PRISMA 2009 checklist, 2) To investigate the relationship between ROB and completeness of reporting. Secondary: To study the association between completeness of reporting and journals and study characteristics.MethodsA random sample of 200 SRs published between 2011 and 2020 in 68 rehabilitation journals was indexed under the “rehabilitation” category in the InCites database. Two independent reviewers evaluated adherence to the PRISMA checklist and assessed ROB using the ROBIS tool. Overall adherence and adherence to each PRISMA item and section were calculated. Regression analyses investigated the association between completeness of reporting, ROB, and other characteristics (impact factor, publication options, publication year, and study protocol registration).ResultsThe mean overall PRISMA adherence across the 200 studies considered was 61.4%. Regression analyses show that having a high overall ROB is a significant predictor of lower adherence (B=-7.1%; 95%CI -12.1, -2.0). Studies published in fourth quartile journals displayed a lower overall adherence (B= -7.2%; 95%CI -13.2, -1.3) than those published in first quartile journals; the overall adherence increased (B= 11.9%; 95%CI 5.9, 18.0) if the SR protocol was registered. No association between adherence, publication options, and publication year was found.ConclusionReporting completeness in rehabilitation SRs is suboptimal and is associated with ROB, impact factor, and study registration. Authors of SRs should improve adherence to the PRISMA guideline, and journal editors should implement strategies to optimize the completeness of reporting.     

SBAR模式在护理优良事件分享学习管理中的应用

目的 探讨“现状-背景-评估-建议”（SBAR）模式在护理优良事件管理中应用的效果,提高护理安全质量管理水平。方法 选取2016年1—12月住院患者65 355例作为护理优良事件分享学习实施前临床资料,采用传统护理不良事件及优良事件管理,选取2017年1月—2018年12月住院患者145 747例作为护理优良事件分享学习实施后临床资料,其在护理不良事件管理基础上,建立标准化护理优良事件管理制度,并将SBAR模式用于优良案例的汇报和学习。比较实施前后不良事件发生率、优良事件上报率及患者对护理安全满意度等。结果 实施后护理不良事件发生率明显低于实施前（P<0.05）;实施后护理优良事件上报率和患者对护理安全满意度均明显高于实施前（P<0.05）。结论 采用基于SBAR模式在护理优良事件分享学习管理中的应用,降低护理不良事件发生率,提高护理优良事件上报率及患者对护理安全满意度,有效提升护士病情观察评判能力,进而提升了护理安全质量管理水平。     

国内护理领域高影响力期刊2016~2018年发表质性研究报告的质量评价

目的评价中国科学引文数据库(Chinese science citation database,CSCD)收录护理类期刊发表的质性研究报告质量。方法计算机检索CSCD数据库,搜集CSCD收录的4本护理期刊发表的质性研究,检索时限均为2016年1月至2018年12月。由2名研究者独立筛选文献和提取资料后,采用COREQ清单对纳入文献进行评价,使用SPSS 25.0软件进行统计分析。结果共纳入223篇质性研究,COREQ清单评价结果显示:43.8%(14/32)的条目充分报告率低于50%,其中78.6%(11/14)的条目充分报告率低于20%,条目4的充分报告率为0。亚组分析结果显示,被引频次是否≤5次和有无基金资助在COREQ各条目上的充分报告率差异无统计学意义。结论 CSCD收录护理类期刊发表的质性研究报告质量有待进一步提高,建议国内护理期刊在稿约中引入COREQ清单,并在编辑审稿和同行评议中严格执行。