Agency for Healthcare Research and Quality Evidence-based Practice Center methods for systematically reviewing complex multicomponent health care interventions

ObjectivesThe purpose of this Agency for Healthcare Research and Quality Evidence-based Practice Center methods white paper was to outline approaches to conducting systematic reviews of complex multicomponent health care interventions.Study Design and SettingWe performed a literature scan and conducted semistructured interviews with international experts who conduct research or systematic reviews of complex multicomponent interventions (CMCIs) or organizational leaders who implement CMCIs in health care.ResultsChallenges identified include lack of consistent terminology for such interventions (eg, complex, multicomponent, multidimensional, multifactorial); a wide range of approaches used to frame the review, from grouping interventions by common features to using more theoretical approaches; decisions regarding whether and how to quantitatively analyze the interventions, from holistic to individual component analytic approaches; and incomplete and inconsistent reporting of elements critical to understanding the success and impact of multicomponent interventions, such as methods used for implementation the context in which interventions are implemented.ConclusionWe provide a framework for the spectrum of conceptual and analytic approaches to synthesizing studies of multicomponent interventions and an initial list of critical reporting elements for such studies. This information is intended to help systematic reviewers understand the options and tradeoffs available for such reviews.     

无针输液接头临床应用的最佳证据总结

目的 全面检索和分析无针输液接头临床应用相关证据,并对最佳证据进行总结。 方法 首先通过计算机检索循证资源数据库,包括BMJ最佳临床实践（British Medical Journal best practice）、Uptodate等源数据库;再补充检索中英文综合数据库,纳入2014年—2019年5月内容涉无针输液接头包括临床决策、证据总结、指南、专家共识类型的中英文相关文献,由3名研究者对相关文献进行独立质量评价,并结合专业判断对最终纳入文献进行标准化的资料提取。结果 共筛选证据13篇,包括1篇临床决策、5篇证据总结、5篇指南、2篇专家共识。汇总了36条证据,总结为无针输液接头的政策管理、消毒、冲封管、接头类型及更换、使用注意事项6个方面的最佳证据。 结论 医护人员应该按照相关级别的循证医学证据,针对无针输液接头的临床应用制订规范,细化其管理与培训的内容,优化实践中对无针输液接头类型选择、更换、消毒、冲封管的临床行为标准,保证患者安全。     

医疗器械相关压力性损伤预防的证据总结

目的 遴选并获取预防医疗器械相关压力性损伤的临床实践依据,并对相关证据进行总结.方法 针对医疗器械相关压力性损伤提出问题,检索国内外数据库相关文献,检索时限为建库至2019年10月.由2名研究者依据JBI循证卫生保健中心的文献评价标准和证据分级系统,对各类研究进行文献质量评价及证据级别评定,纳入符合质量标准的文献,并提取证据.结果 共纳入证据8篇,包括指南6篇、专家共识1篇、系统评价1篇.最终形成包括皮肤评估、皮肤清洁、医疗器械的安置与移动、合理使用敷料和教育培训5个方面的最佳证据.结论 本研究总结了预防医疗器械相关压力性损伤的临床实践依据,在临床应用证据时,建议评估相关医疗机构的就医环境、设备条件及医护人员应用证据时的促进及阻碍因素、患者意愿等因素,筛选调适后,进行有针对性的证据使用,以促进证据有效地向临床转化,为临床护理实践提供更多科学依据,从而提升护理质量.     

鼻咽癌放疗后分泌性中耳炎的循证治疗

目的:分析鼻咽癌(NPC)放疗后分泌性中耳炎(SOM)的发生机制,依据循证医学(EBM)的原则,探索一种有效的、针对其发病机制各个环节的治疗方法。方法:对106例(112耳)NPC放疗后SOM患者,采用全身和局部抗炎、神经营养、扩张血管及激素治疗;加强鼻腔、鼻咽局部清理,治疗鼻腔鼻窦疾病;采用咽鼓管置管、冲洗及注药等综合治疗措施。结果:所有患者治疗前均有耳鸣、耳闷塞感及听力下降等症状,鼓室导抗图均为B型。经综合治疗后,耳鸣:消失81耳(72.32%),好转25耳(22.32%),无效6耳(5.36%),总有效率为94.64%耳闷塞感:消失92耳(82.14%),好转18耳(16.07%),无效2耳(1.79%),总有效率为98.21%。声阻抗检查:鼓室曲线A型56耳(50.00%),As型42耳(37.50%),B型2耳(1.79%),C型12耳(10.71%)。治疗后0.5、1.02.0kHz气导听阈均值为(28.5±3.0)dBHL,而治疗前为(47.0±5.0)dBHL,其差异有统计学意义(P<0.01)结论:依据EBM的原则,有针对性地对NPC放疗后SOM的发病机制的各个环节采取对因治疗,是非常有效和切实可行的,对提高NPC患者的生存质量具有重要意义。     

A Novel Data Mining Approach to the Identification of Effective Drugs or Combinations for Targeted Endpoints—Application to Chronic Heart Failure as a New Form of Evidence-based Medicine

Summary Background: Data mining is a technique for discovering useful information hidden in a database, which has recently been used by the chemical, financial, pharmaceutical, and insurance industries. It may enable us to detect the interesting and hidden data on useful drugs especially in the field of cardiovascular disease.Methods: & Results: We evaluated the current treatments for chronic heart failure (CHF) in our institute using a decision tree method of data mining and compared the results with those of large-scale clinical trials. We enrolled 1,100 patients with CHF (NYHA classes II–IV and EF < 40%) who were hospitalized at the National Cardiovascular Center during the past 31 months. Drugs prescribed at discharge were extracted from the clinical database. Both echocardiograms and plasma BNP level at 6–12 months after discharge were determined prospectively. It was found that beta-blockers, angiotensin converting enzyme inhibitors, and angiotensin II receptor antagonists independently improve both the plasma BNP level and %fractional shortening (FS), while oral inotropic agents increased the plasma BNP level and decreased %FS. These findings agree with evidence accumulated from several large-scale trials. Interestingly, statins, histamine receptor blockers, and alpha-glucosidase inhibitors also attenuated the severity of CHF, suggesting the possibility of new treatment of CHF.Conclusion: Clinical data mining using Japanese CHF patients yielded almost identical data to the results of large-scale trials, and also suggested novel and unexpected candidates for CHF therapy. Further validation of the data mining approved in the cardiovascular field is warranted.     

循证护理在股骨粗隆间骨折病人护理中的应用

目的 探讨股骨粗隆间骨折病人常见问题的护理对策.方法 将循证护理应用于股骨粗隆间骨折病人,解决患肢疼痛、肿胀、肺部感染、褥疮、泌尿系感染、深静脉血栓问题的实践过程.结果 56例患者住院期间无一例发生肺部感染、褥疮、泌尿系感染等并发症.结论 循证是临床护理基础,不仅可提高护理质量,对病人有益,而且可丰富护理人员的知识,进一步提高骨科护理的专业性和特殊性.     

循证护理在老年病科开展个性化封管护理中的应用

目的探索老年病科患者使用静脉留置针时实施个性化封管护理的方法。方法依据循证护理途径:确定循证问题、收集并列出证据、评估证据、结合临床实际使用证据得出循证结果,即个性化封管护理的具体做法,选择符合条件的病例32例作为实验效果观察对照。结果个性化封管护理在降低堵管率、延长置管时间(P<0.001)、预防相关并发症等方面有明显效果。结论循证护理应用于老年病科开展个性化封管护理,促进护士去寻求具有科学依据的护理实证指导解决临床实际问题,为患者提供最有效、最合理、最经济的护理,从而提高护理质量。     

循证护理在卒中后痴呆的应用研究

目的 探讨对卒中后痴呆患者实施循证护理的临床效果.方法 选择66例卒中后痴呆患者,随机分为两组,研究组和对照组,每组33例.研究组采用循证护理法,对照组用常规护理法,并通过简易精神状态检查(MMSE)及社会适应功能障碍调查表(FAQ)进行精神状态以及社会适应功能障碍评定.结果 8周后研究组精神状态以及社会适应功能障碍明显改善 ,而对照组没有明显变化.结论 循证护理在卒中后痴呆患者的康复护理疗效上具有明显的优势,能明显促进痴呆患者的认知能力及生活自理能力的改善,值得临床推广与应用.     

循证医学在放射学科的应用

随着现代科学技术的发展,临床医学的诊疗方式也发生着巨大变化。以经验医学模式为基础的传统医学在很大程度上已不能适应目前临床医学实践的要求。循证医学强调对临床医学更为理性和全面的认识,已成为当今欧美多国临床医学实践者的主流意识。放射学科提供多种影像检查和影像诊断。现阶段医学影像检查的新技术层出不穷,如何以循证医学理念在临床工作中合理应用这些技术,是医务工作者需要思考的课题。     

梅毒预防控制问题的思考

本文以循证医学的观点．对当今流行较为严重的梅毒预防控制问题加以研究,阐述了梅毒预防控制是性病艾滋病预防控制总体目标下进行的重要性。提示了过去预防梅毒的基本经验,并就当前梅毒控制及防治策略问题提出建议。