美国高校医学图书馆系统综述写作支持服务调查研究

目的：学习和借鉴美国高校医学图书馆的系统综述写作支持服务经验,有利于创新我国医学图书馆的服务模式,拓宽科研论文写作支持服务思路,助力高校科研发展。方法：运用网络调查法和文献调查法,选取美国10所开展系统综述写作支持服务的高校医学图书馆进行调查、比较和分析。结果：系统综述写作支持服务是美国高校医学图书馆开展科研支持服务的一种重要形式。美国高校医学图书馆从咨询服务、检索服务、科研工具的选择与指导、写作与出版建议、课程教育5方面开展系统综述写作支持服务。结论：我国医学图书馆应夯实图书馆员的基本检索能力、提高其综合业务能力,优化网络资源导航,搭建学习平台或社交网站,通过完善课程设置等措施拓展系统综述写作支持服务。     

医学科研创新性的图形学分析

本文以一体化医学语言系统提供的医学语义网络为基础,结合医学文献数据库,采用语义网络的有向图结构,以图形学方法标识医学科研的研究内容,从而探讨医学科研创新性的语义特征,从图形学角度分析医学知识创新的机制。     

银杏叶片联合钙离子通道阻滞剂治疗高血压病的系统评价

运用Meta分析方法评价银杏叶片联合钙离子通道阻滞剂(CCB)治疗原发性高血压的临床疗效。方法检索PubMed、Cochrane Libray、EMBASE、维普、中国知网数据库(CNKI)、万方数据库、中国生物医学文献服务系统(SinoMed)关于银杏叶片治疗原发性高血压的临床随机对照试验,检索时间从建库以来至2018年9月30日,根据纳入和排除标准共纳入12项研究,1244例患者,使用Review Manager 5.3软件进行Meta分析。结果①银杏叶片联合CCB降压疗效优于单用CCB[OR=4.67,95%CI(3.25,6.71),P<0.00001];②两组收缩压[MD=-11.27,95%CI(-15.32,-7.21),P<0.00001],舒张压[MD=-8.41,95%CI(-8.94,-7.88),P<0.00001];③两组血清一氧化氮(NO)水平[MD=10.62,95%CI(8.48,12.76),P<0.00001],血清内皮素(ET)水平[MD=-1.05,95%CI(-1.31,-0.79),P<0.00001]。结论银杏叶片联合CCB可以提高降压疗效,但纳入研究方法学治疗偏低,可能影响到本研究的可靠性,仍需要高质量的RCT证实。     

Prevalence of Burnout in residents of obstetrics and gynecology: A systematic review and meta-analysis

Background: Burnout is currently a major concern among physicians due to their high level ofstress at work. There are several reports on various levels of burnout in residency programs due toseveral predisposing factors. The aim of this systematic review was to estimate a more precise prevalenceof burnout among residents of obstetrics and gynecology.Methods: PubMed, Science Direct and Scopus were searched to identify peer-reviewed Englishlanguagestudies published from January 1974 to 2005 reporting burnout among residents of obstetricsand gynecology. The key words used in the search were as follows: Residents, gynecology andobstetrics, professional burnout, depersonalization, distress, anxiety, or emotional exhaustion. Relevantadditional articles were identified from the lists of the retrieved articles.Results: We identified 12 studies which met our criteria. A total of 2509 participants were includedin this meta-analysis. The overall prevalence rate of burnout on all the three subscales was 44% (95%CI: 30 - 57) in this group of residents.Conclusion: This meta-analysis revealed a high prevalence of burnout syndrome in residents duringobstetrics and gynecology residency program. Therefore, it is recommended to consider and addressthis important issue to develop solutions and interventions which could improve the work conditionof the medical residents.     

单能量去金属伪影算法重建效果的系统评价及Meta分析

目的 通过系统评价和Meta分析评估基于单能量去金属伪影算法的CT后处理技术(SEMAR)对金属伪影的去除效果。 方法 检索2009年1月至2018年1月美国生物医学数据库PubMed、荷兰医学文摘Embase、Web of science、Cochrane图书馆和中国期刊全文数据库等发表的相关中英文文献,通过纳入及排除标准进行筛选,对纳入文献采用Cochrane风险偏移评估工具进行质量评估,提取文献中使用的评估标准及相关数据,并对相应数据进行合并。采用Review Manager 5.0对纳入文献汇总分析,根据文献异质性进行亚组分析及敏感性分析。 结果 符合纳入标准文献9篇,其中英文8篇,中文1篇。Meta分析显示,SEMAR技术可明显提升金属伪影和周围结构的评分,对金属伪影CT值、周围软组织噪声(SD值)具有良好的校正作用,MD_伪影评分=1.19(95%CI:0.99~1.39)、MD_{前列腺/子宫图像质量评分}=1.87(95%CI:0.69~3.05)、MD_{膀胱图像质量评分}=2.31(95%CI:1.28~3.34)、MD_伪影CT值=118.7 HU(95%CI:50.48~186.93)、MD_{周围软组织噪声}=298.05(95%CI:61.66~534.43);明显提高周围病变的检出率RD=0.07(0.02~0.13),但对周围组织的CT值［MD=-21.35(95%CI:-44.0~1.31)］及伪影指数［MD=3.11(95%CI:-0.97~7.15)］的影响无统计学意义。 结论 SEMAR具有良好的去除金属伪影及提升周围病变检出效果,且在去除金属伪影的同时,对周围软组织的CT值无明显影响。     

The Omaha System: a systematic review of the recent literature

Background

The Omaha System (OS) is one of the oldest of the American Nurses Association recognized standardized terminologies describing and measuring the impact of healthcare services. This systematic review presents the state of science on the use of the OS in practice, research, and education.

Aims

(1) To identify, describe and evaluate the publications on the OS between 2004 and 2011, (2) to identify major trends in the use of the OS in research, practice, and education, and (3) to suggest areas for future research.

Methods

Systematic search in the largest online healthcare databases (PUBMED, CINAHL, Scopus, PsycINFO, Ovid) from 2004 to 2011. Methodological quality of the reviewed research studies was evaluated.

Results

56 publications on the OS were identified and analyzed. The methodological quality of the reviewed research studies was relatively high. Over time, publications’ focus shifted from describing clients’ problems toward outcomes research. There was an increasing application of advanced statistical methods and a significant portion of authors focused on classification and interoperability research. There was an increasing body of international literature on the OS. Little research focused on the theoretical aspects of the OS, the effective use of the OS in education, or cultural adaptations of the OS outside the USA.

Conclusions

The OS has a high potential to provide meaningful and high quality information about complex healthcare services. Further research on the OS should focus on its applicability in healthcare education, theoretical underpinnings and international validity. Researchers analyzing the OS data should address how they attempted to mitigate the effects of missing data in analyzing their results and clearly present the limitations of their studies.     

初始耐药结核治疗的系统评价与Meta分析

目的系统评价药物治疗初始耐药较非耐药肺结核的有效性。方法计算机检索Cochrane图书馆、MEDLINE、EMbase、VIP、CNKI和CBMdisc电子资料库,查找药物治疗初始耐药与非耐药肺结核的队列研究,然后由两位研究者独立进行资料提取和质量评价,采用RevMan 5.1软件进行Meta分析,并采用GRADEpro 3.6系统对证据质量和等级推荐进行分级。结果共将10个研究纳入Meta分析,初始耐药与非耐药肺结核病人相比,6个月末痰菌阴转率为91%[RR=0.91,95%CI（0.86,0.96）,P〈0.001],肺空洞闭合率为70%[RR=0.7,95%CI（0.60,0.82）,P〈0.001],2年后细菌学复发率为4.98倍[RR=4.98,95%CI（3.07,8.07）,P〈0.001]。GRADE系统评价结果显示,2年后细菌学复发率和肺空洞闭合率证据质量为中等,6个月末痰菌阴转率与肺部病灶吸收有效率证据质量为极低。结论初始耐药与非耐药肺结核相比,在6个月末痰菌阴转率、肺空洞闭合率等方面均低,2年后细菌学复发率较高。初始耐药是化疗失败的一个重要原因。鉴于系统评价为二次研究,受纳入分析的原始文献质量影响较大,且评价过程可能存在偏倚等局限性,上述结论尚需进一步通过开展大规模、高质量的基础和临床研究来验证。     

Data use and effectiveness in electronic surveillance of healthcare associated infections in the 21st century: a systematic review

Objective

As more electronic health records have become available during the last decade, we aimed to uncover recent trends in use of electronically available patient data by electronic surveillance systems for healthcare associated infections (HAIs) and identify consequences for system effectiveness.

Methods

A systematic review of published literature evaluating electronic HAI surveillance systems was performed. The PubMed service was used to retrieve publications between January 2001 and December 2011. Studies were included in the review if they accurately described what electronic data were used and if system effectiveness was evaluated using sensitivity, specificity, positive predictive value, or negative predictive value. Trends were identified by analyzing changes in the number and types of electronic data sources used.

Results

26 publications comprising discussions on 27 electronic systems met the eligibility criteria. Trend analysis showed that systems use an increasing number of data sources which are either medico-administrative or clinical and laboratory-based data. Trends on the use of individual types of electronic data confirmed the paramount role of microbiology data in HAI detection, but also showed increased use of biochemistry and pharmacy data, and the limited adoption of clinical data and physician narratives. System effectiveness assessments indicate that the use of heterogeneous data sources results in higher system sensitivity at the expense of specificity.

Conclusions

Driven by the increased availability of electronic patient data, electronic HAI surveillance systems use more data, making systems more sensitive yet less specific, but also allow systems to be tailored to the needs of healthcare institutes’ surveillance programs.     

病案的作用与社会化服务问题

统计2008年-2010年医院病案统计室中病案在医院外部使用的情况并进行分析,探讨病案的作用及病案在社会化服务当中产生的问题,指出病案社会化服务过程中存在患者过度利用病案、医院有泄露患者隐私的可能性及病案管理人员素质不高等问题,提出提高病案管理人员素质,是做好病案社会化服务工作的关键。     

高血压脉象客观化临床研究的系统评价

目的为高血压脉象客观化的临床应用及后续研究提供循证医学依据。方法检索中国知网、万方数据、维普数据、PubMed和Web of Science,查找高血压脉象客观化的临床对照试验,运用RevMan 5.3软件进行统计学分析。结果共纳入12项研究,累计高血压病患者1503例,健康人972例。系统评价结果显示,结局指标中h1[P=0.0004,SMD 0.30,95%CI(0.13,0.46)]、h3/h1[P=0.003,SMD 0.46,95%CI(0.15,0.77)]、h5[P=0.0004,SMD 0.46,95%CI(-0.71,-0.20)]、w1/t[P<0.00001,SMD 0.39,95%CI(0.29,0.49)]等方面与对照组比较差异有统计学意义。h4/h1、t1、t3、t4及t5与对照组比较差异无统计学意义。结论本研究通过荟萃分析的方法证实了高血压患者与正常人的的脉诊信息差异客观存在,h1、h3/h1、h5及w1/t等变量可能与高血压相关,利用脉诊客观化可以为中医临床辩证诊断提供辅助依据。     

Prevalence,etiology, and types of dental trauma in children and adolescents: systematic review and meta-analysis

Background: Dental traumas are common among children and adolescents in many societies posing health and social problems. The aim of this study was to conduct a systematic review and meta-analysis on prevalence, etiology, types, and other epidemiologic aspects of dental trauma in children and adolescents (0-18 years old). Methods: In this systematic meta-analytical review, data were collected searching for key words including traumatic dental injuries, dental trauma, dental injury, dental trauma, tooth injuries, tooth trauma, traumatized teeth, dentoalveolar trauma, oral trauma, epidemiology, etiology, prevalence, incidence, occurrence, child*, and adolescence in the following databases: Scopus, CINAHL, Science Direct, PubMed and Google scholar. Results: From the total of 3197 articles, 44 completely relevant papers were included in the study. The prevalence of dental trauma was variable based on geographical area and was estimated 17.5% in the population, with higher prevalence in boys. Falling was the major cause for dental trauma, and the most frequent location was home. The most frequent type of trauma was enamel fracture. Conclusion: A relatively high prevalence was detected for dental trauma, which calls for effective planning and intervention to prevent the occurrence in children and adolescents. These may include special care for children, eliminating fall-prone areas, installing safety measures at homes, using protective appliances in sports, education, and raising the knowledge and availability of services to address enamel fracture. Region-specific criteria should be taken into account in programs and interventions.     

国内图书馆数字资源的长期保存研究述评

介绍了数字资源长期保存的必要性和重要性,梳理和归纳了数字资源长期保存的研究热点,包括保存项目、保存模式、保存困难和保存策略等,并分析了其特点和不足。     

肠脂肪酸结合蛋白对新生儿坏死性小肠结肠炎诊断价值的系统评价

目的系统评价肠脂肪酸结合蛋白（i-FABP）对新生儿坏死性小肠结肠炎（NEC）的诊断价值。方法利用PubMed、EMBASE、万方数据等数据库搜索潜在相关的研究,并对文献进行诊断试验质量评价-2（QUADAS-2）评价。计算纳入研究的合并灵敏度、特异度、阳性似然比（PLR）、阴性似然比（NLR）、诊断比值比（DOR）,并绘制SROC曲线用于总体性能的评估。结果共纳入7项研究。合并的灵敏度、特异度、PLR、NLR、DOR和AUC分别为0.70（95%CI：0.60~0.79）、0.89（95%CI：0.84~0.94）、5.33（95%CI：3.42~8.31）、0.39（95%CI：0.29~0.52）、17.11（95%CI：8.36~34.99）和0.8795。结论i-FABP在诊断NEC方面是一种有前途的生物标志物,其特异度和DOR均较高。     

糖皮质激素治疗重型病毒性肝炎有效性的系统评价

目的:评价糖皮质激素治疗重型病毒性肝炎的有效性?方法:计算机检索PubMed?EMbase?Science Direct?万方?维普?中国生物医学文献数据库,检索时限为1995~2010年,最后检索日期为:2010年10月10日?在严格质量评价的基础上,使用RevMan5软件进行系统评价?结果:初检出683篇文献,经筛选最终纳入12篇文献进行分析?Meta分析结果显示:①死亡率:激素组与对照组相比,有明显统计学差异,激素组死亡率减少达36%(RR=0.64,95%CI:0.42~0.98,P = 0.04)?②有效率:激素组与对照组相比,有明显统计学差异,激素组有效率增加达63%(RR=1.63,95%CI:1.35~1.98,P < 0.000 01)?结论:本系统评价显示使用糖皮质激素治疗重型病毒性肝炎与不使用相比,具有降低死亡率,改善肝功能的趋势?但由于本系统评价纳入的文献质量有限,有必要开展更多设计严谨,大样本?多中心的随机对照试验来确证?     

静脉输注免疫球蛋白对呼吸机相关肺炎疗效的系统评价

目的：系统评价免疫球蛋白( IVIG)治疗呼吸机相关性肺炎( VAP)相关研究,分析其有效性,为临床治疗策略提供依据。方法系统检索CNKI、万方、CBM、Pubmed、Embase、ISI及Cochrane数据库中相关文献,采用Cochrane标准评价纳入研究偏倚风险,Meta分析结合描述性分析研究数据。结果①纳入6个随机对照研究,435例低体质量儿、早产儿及婴儿VAP患者,质量一般。②Meta分析结果显示IVIG组死亡率低于非IVIG组[RR=0．33,95%CI(0．18~0．60),P=0．0002];IVIG组血液免疫球蛋白浓度比对照组高3．19 mg/L [MD=3．19,95%CI(3．02~3．37),P<0．05];③IVIG组败血症[RR=0．14,95%CI(0．04~0．51),P=0．003]和多器官功能衰竭发生率[RR=0．51,95%CI(0．30~0．88),P=0．02]低于对照。结论 IVIG主要用于早产儿及低体质量儿VAP患者,可能提高体液免疫,降低败血症和多器官功能衰竭发生率,减少患者病死率,改善预后。     

非甾体类抗炎药直肠给药预防ERCP术后胰腺炎的系统评价

目的评价非甾体类抗炎药（NSAIDs）直肠给药预防ERCP术后胰腺炎的有效性和安全性。方法制定严格纳入和排除标准,计算机检索Coehrane图书馆临床对照试验、Medline、PubMed、Embase、OVID数据库、中国生物医学文献数据库（CBMDisc）、维普中文期刊数据库、中国期刊全文数据库、万方学位论文数据库）。并手工检索相关会议论文集及查阅检索到的所有参考文献,全面收集国内外关于非甾体类抗炎药直肠给药预防ERCP术后胰腺炎的随机对照试验。按照国际Cochrane协作网推荐的方法进行系统评价。结果共纳入10个试验2802例患者,Meta分析显示：①PEP发生率、轻症PEP发生率及中一重症PEP发生率：NSAIDs治疗组优于安慰剂组（均P〈0．001）。②术后高胰淀粉酶血症发生率及术后血胰淀粉酶水平：NSAIDs治疗组优于安慰剂组（均Pd0．001）。③PEP病死率及不良反应发生率：无病死率及NSAIDs治疗相关不良反应的报道。结论NSAIDs直肠给药可以预防ERCP术后胰腺炎的发生,且安全性好。     

“基于问题的学习”对中医类学生学习效果影响的系统评价

目的 系统评价“基于问题的学习”( Problem-based learning,PBL)对国内中医类学生学习效果的影响.方法 通过检索CBM、CNKI、VIP文献数据库,纳入PBL与LBL教学模式下中医类学生学习效果的对照研究,采用Revman 5.1对数据进行分析.结果 纳入9篇文献,研究方法、质量均较低.两种模式下,学生理论考试成绩的差异无统计学意义[SMD=3.76,95％ CI(-0.62,8.15)];而实践操作成绩的差异具统计学意义,PBL组优于LBL组[SMD=7.62,95％CI(3.92,11.32)];在学习能力自评上,两组间差异有统计学意义,PBL组优于LBL组[OR=3.69,95％ CI( 1.88,7.21)].结论 PBL教学有助于提高学生主观能动性,提高学生实践能力,适用于中医临床专业课及其拓展型课程的教学;但各纳入研究的质量等级较低,有必要在教学中开展设计严谨的随机对照试验,提供高质量的证据,增加论证强度.     

来氟米特治疗原发性肾病综合征的系统评价

目的评价来氟米特治疗原发性肾病综合征的疗效和安全性。方法运用Cochrane图书馆、PUBMED、EMBASE、CBMdisc、CNKI、VIP等电子数据库,检索时间截止至2008—09—30,由3名系统评价员进行资料提取和质量评价,对同质资料进行Meta分析。结果共纳入8个研究350例患者,8个研究均为随机对照试验。来氟米特与环磷酰胺、霉酚酸酯、他克莫司对照,其,临床疗效指标均无统计学意义,在联合强的松与强的松对照,其临床指标有统计学意义（P〈0．05）。副作用方面,来氟米特副作用的发生率均低于环磷酰胺,而和霉酚酸酯、他克莫司、强的松对照均无统计学意义（P〉0．05）。结论来氟米特是一种相对较为安全的免疫抑制剂,其疗效并不优于其他免疫抑制剂,但由于纳入的研究质量差,存在着选择性偏倚、测量性偏倚的可能性,有必要进一步开展高质量、大样本随机对照试验评价其疗效和安全性。     

Effectiveness of azithromycin mass drug administration on trachoma: a systematic review

Backgrounds:Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts.Methods:PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment.Results:A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts.Conclusions:Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.     

超声内镜诊断类系统评价/meta分析现状

目的：分析当前国内外发表的超声内镜诊断类系统评价(SRs)/Meta分析(MAs)的研究现状。 方法：计算机检索PubMed, EMBASE, Cochrane Library, Web of Science,中国生物医学文献数据库,中国期刊全文数据库,万方数据库,中文科技期刊数据库,检索时间均为建库至2013年7月。根据纳入排除标准收集有关超声内镜诊断的SRs/MAs,两位评价员分别进行文献筛选,并按照预先设计的资料提取表进行资料提取,包括发表时间、发表杂志、作者机构及数量、疾病分类、图表使用、参考文献、被引用、质量评价工具等,同时对中英文对图表使用、参考文献、被引用分别进行比较。 结果：共纳入SRs/MAs72篇,发表数量从1998年的1篇增加至2012年的16篇,涉及病种以消化系统疾病居首(75.0%),其次为呼吸系统(8.3%);90.3%的SRs/MAs以英文形式发表,其余以中文形式发表;87.5%的SRs/MAs被SCI收录;93.1%的SRs/MAs作者来源自同一个国家,其中第一作者主要分布于中国(31.9%)和美国(30.6%),国际合作研究仅5篇;77.8%的SRs/MAs由一个机构(如医院、大学、研究所)完成。在图表使用类型方面,以纳入研究特征表(84.7%)、森林图(72.2%)居多。英文SRs/MAs参考文献数量约为中文的2.5倍,且近五年的数量较高。中英文SRs/MAs被引用率平均仅36.3次。54.2%的SRs/MAs使用Cochrane Handbook5.1推荐的QUADAS工具评价原始研究质量,但仍有38.9%的研究未报告质量评价的方法。所有纳入中文SRs/MAs均未报告基金资助信息。 结论：超声内镜诊断类系统评价/Meta分析研究的数量呈逐年增长趋势,国内外的研究者需加强不同国家不同研究机构间的合作及方法学人员的参与;鼓励使用诊断类质量评价QUADAS工具;严格按照PRISMA报告标准使用流程图及漏斗图。