良性前列腺增生术后膀胱痉挛护理的证据总结

目的检索、评价和汇总减轻良性前列腺增生术后膀胱痉挛的护理最佳证据,为临床护理工作提供参考。方法计算机检索UpToDate、Cochrane Library、JBI、NGC、NICE、RANO、医脉通、中国知网等数据库及网站关于降低良性前列腺增生术后膀胱痉挛的高级别证据。检索时限从建库至2020年5月。结果共纳入15篇文献,包括临床实践指南3篇、系统评价/Meta分析3篇、证据总结1篇、临床决策1篇,随机对照研究7篇,最终获取23条最佳证据。结论临床护理人员需对证据应用的促进因素、影响证据使用的障碍因素等方面进行分析,结合患者的价值和意愿,利用专业知识来选择性应用证据,最终降低患者术后膀胱痉挛的发生。     

心脏康复:心血管疾病二级预防的标准治疗(第一部分)

尽管心血管疾病的诊断和急性事件的治疗得到了高度重视,但针对减少心血管事件反复再发的继续治疗即二级预防却没有得到应有的关注。过去的15年,心脏康复已经逐渐成为心血管疾病二级预防的一项标准治疗,持续不断的证据显示了心脏康复改善生活质量的诸多益处,在世界范围内心脏康复已经被包含在心血管疾病诊疗的临床实践指南中。尽管如此心脏康复并没有被充分应用,尤其在发展中国家。本综述主要描述心脏康复的基本概念、核心构成和相关益处。     

Chronology of Alcohol Dependence: Implications in Prevention

Background:

Study of the chronology of criteria of dependence in alcohol dependence syndrome (ADS) can enable us design strategies for the prevention for ADS, which aims at reducing the occurrence of ADS.

Objective:

To study the age-wise and order-wise chronologies of ICD-10 (DCR) dependence criteria in individuals with ADS.

Materials and Methods:

Consecutively admitted and consenting inpatients with ICD-10 (DCR) diagnosis of ADS were evaluated in a structured interview after detoxification using Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA)-II.

Results:

The total sample size was 81. The mean ages at the first onset of alcohol use, development of the first criterion and International Statistical Classification of Diseases and Related Health Problems 10^th Revision (ICD-10) dependence was 18.72 years (SD, 6.84), 24.33 years (SD, 9.21) and 27.51 years (SD, 9.28), respectively. In age-wise chronology, tolerance, loss of control and craving were present in 97.53%, 80.24% and 79%, respectively, of our study sample. In order-wise chronology, either craving (16%) or tolerance (71.6%) was present as the first criterion and the presence of craving (16%), tolerance (21%) or loss of control (18.5%) was observed in the first criterion in 55.5% of the subjects.

Conclusions:

Knowledge of chronology, its frequencies and time duration between various milestones in the development of the dependence criteria may enable the selection of the target population at an early stage. The pattern of development of dependence may provide us with an opportunity for interventions to reduce the incidence of ADS, as a step toward primary prevention. Adequate training of the primary care personnel and early psychiatric referral may help in the reduction in the incidence of ADS.     

临床试验用药品信息系统管理专家共识

主要论述《临床试验用药品信息系统管理专家共识》的起草背景、适用范围，以及试验用药品信息化管理系统的架构、配置、管理要求。从临床试验用药品管理的实际出发，对临床试验用药品的流转进行全程化、标准化、精准化和实时化的管理。促使临床试验用药品信息化管理能够实现试验用药品从申办者运输，研究中心接收、验收、入库、存储、出库、领用发放、用药、回收、返还、退回、销毁、留样（如适用）等全流程在线实时记录管理，提高药品管理规范性，保证数据的及时性、准确性、可靠性和可溯源性。     

子宫内膜异位症患者血清细胞因子水平的测定

子宫内膜异位症患者血清细胞因子水平的测定程凯灵令狐华子宫内膜异位症（ＥＭＳ）是妇科常见病。国内外学者的研究表明，免疫学的变化在该病的病理生理学中有重要意义。本研究通过酶联免疫吸附试验（ＥＬＩＳＡ），对ＥＭＳ患者血清细胞因子［白细胞介素（ＩＬ）－６、Ｉ...     

A single centre evaluation of risk prediction models and imaging modalities in acute appendicitis

IntroductionPatients with suspected appendicitis remain a diagnostic challenge. The aim of this study was to validate risk prediction models, and to investigate diagnostic accuracy of ultrasonography and computed tomography (CT) in adults undergoing appendicectomy.MethodsA retrospective case review was performed of patients aged 16–45 years having an appendicectomy between January 2019 and January 2020 at a tertiary referral centre. Primary outcomes were the accuracy of a high risk appendicitis risk score and ultrasonography and CT imaging modalities compared with histological reports following appendicectomy.ResultsA total of 206 patients (52% female) were included in the study. Removal of a histologically normal appendix was equally likely in men and women (13.1% vs 11.2% respectively, relative risk: 1.17, 95% confidence interval: 0.56–2.44, p=0.674). A high risk appendicitis score correctly identified 84.0% (79/94) of cases in men and 85.9% (67/78) of cases in women. Ultrasonography was reported as equivocal in 85.7% (18/21) of low risk women and 59.0% (23/39) of high risk women. CT correctly detected or excluded appendicitis in 75.0% (6/8) of low risk women and 88.5% (23/26) of high risk women.ConclusionsThis study suggests that risk prediction models may be useful in both women and men to identify appendicitis. Ultrasonography gave high rates of equivocal results and should not be relied on for the diagnosis of appendicitis. CT is a highly accurate diagnostic tool and could be considered in those at low risk where clinical suspicion remains to reduce negative appendicectomy rates.     

Two-year follow-up after catheter-based radiotherapy to inhibit coronary restenosis

BACKGROUND: Although early trials indicate the treatment of restenosis with radiation therapy is safe and effective, the long-term impact of this new technology has been questioned. The possibility of late untoward consequences, such as aneurysm formation, perforation, and accelerated vascular disease, is of significant concern. Furthermore, it is not known whether the beneficial effects of radiation therapy will be durable or whether radiation will only delay restenosis. METHODS AND RESULTS: A double-blind, randomized trial was undertaken to compare 192Ir with placebo sources in patients with previous restenosis after coronary angioplasty. Patients were randomly assigned to receive a 0.76-mm (0. 03-in) ribbon containing sealed sources of either 192Ir or placebo. All patients underwent repeat coronary angiography at 6 months. All living patients were contacted 24 months after their index study procedure. Patients were assessed with respect to the need for target-lesion revascularization or nontarget-lesion revascularization, occurrence of myocardial infarction, or death. Over a 9-month period, 55 patients were enrolled; 26 were randomized to 192Ir and 29 to placebo. Follow-up was obtained in 100% of living patients at a minimum of 24 months. Target-lesion revascularization was significantly lower in the 192Ir group (15.4% versus 44.8%; P<0. 01). Nontarget-lesion revascularization was similar in 192Ir and placebo patients (19.2% versus 20.7%; P=NS). There were 2 deaths in each group. The composite end point of death, myocardial infarction, or target-lesion revascularization was significantly lower in 192Ir-treated versus placebo-treated patients (23.1% versus 51.7%; P=0.03). No patient in the 192Ir group sustained a target-lesion revascularization later than 10 months. CONCLUSIONS: At 2-year clinical follow-up, treatment with 192Ir demonstrates significant clinical benefit. Although further follow-up (including late angiography) will be necessary, no clinical events have occurred to date in the 192Ir group to suggest major untoward effects of vascular radiotherapy. At the intermediate follow-up time point, vascular radiotherapy continues to be a promising new treatment for restenosis.