A review of external lumbar drainage for the management of intracranial hypertension in traumatic brain injury

BackgroundThe Brain Trauma Foundation (BTF) published evidence-based guidelines with a detailed approach to the management of intracranial hypertension (ICH) in traumatic brain injury (TBI) patients. However, management with cerebrospinal fluid (CSF) drainage in TBI patients remains a controversial topic and is a recent addition to the 4^th Edition of the BTF guidelines. External lumbar drainage (ELD) has been proposed for the management of patients with refractory ICH despite aggressive measures. ELD has been described in the literature with possible benefits in outcomes; still, many questions remain unanswered.MethodsA systematic search on MEDLINE was conducted for articles that studied lumbar CSF drainage in adult TBI patients with ICH.ResultsEleven studies met the inclusion criteria, which included 5 prospective and 6 retrospective studies. Several studies showed that CSF drainage via lumbar drain resulted in significant reduction of ICP compared to before ELD placement and had a low complication rate. However, the data reporting mortality and functional outcomes are varied across studies.ConclusionThe literature suggests that ELD may play a role in the management of refractory ICH in TBI patients when first and second-tier measures fail and may be a safe, effective, and minimally invasive method to significantly lower ICP. Additional research and standardized treatment protocols are necessary.     

基于研究报告规范的批判性文献阅读对护士实施科研培训

目的 探讨基于研究报告规范的批判性文献阅读对临床护士科研能力培养的效果。方法 选取39名护理科研骨干,通过成立护理科研文献阅读小组,以研究报告规范为导向开展每月1次的批判性文献阅读活动,持续10个月。比较培训前后临床护士科研能力和职业认同感得分。结果 培训后临床护士科研能力得分、职业认同感得分显著高于培训前(均P<0.01)。结论 对临床护士开展基于研究报告规范的批判性文献阅读,可提高临床护士科研能力和职业认同感。     

经典名方当归四逆汤的药物剂量考证

目的 通过系统整理经典名方当归四逆汤的中医古代文献,梳理当归四逆汤的药物剂量演变,试确定当归四逆汤的适宜剂量,使其更适合临床实际应用,也为该方的新药开发提供一定的参考。方法 采用文献计量学方法,对记载当归四逆汤药物剂量的文献资料进行分析,考证当归四逆汤的原书剂量、历代用量演变、药物剂量比例及近现代名医的使用情况。结果 经文献考证,发现当归四逆汤药物使用剂量经历由大变小的过程,并根据当归四逆汤的用量演变规律,推算东汉1两约为现今3 g。且历代医家在运用当归四逆汤时,当归、桂枝、白芍、细辛、通草、甘草的配伍比例多取3∶3∶3∶3∶2∶2。结论 建议当归四逆汤汤剂的药物剂量为当归9 g、桂枝9 g、白芍9 g、细辛9 g、木通6 g、甘草6 g、大枣4枚,日服3次;煮散剂的药物剂量为当归4.5 g、桂枝4.5 g、白芍4.5 g、细辛4.5 g、木通3 g、甘草3 g、大枣2枚。     

Testicular plasmacytoma: report of a case and review of the literature

Plasmacytomas of the testis are rare neoplasias; they may occur as isolated tumors or in concomitance with generalized multiple myeloma. We report the case of a 77-year-old man with previous clinical evidence of multiple myeloma involving skin, ribs, and lungs, and initially treated with surgery, radiotherapy, and chemotherapy attaining partial response. Fourteen months after the onset, the patient presented with left testicular enlargement due to plasmacytoma. Immunohistochemical stains showed monoclonal cytoplasmic IgA-lambda in tumour cells; serum M component showed the same immunoglobulin. Following radiotherapy the tumour mass disappeared. Nonetheless, 2 months later while on chemotherapy, disease recurred with progressive increase of skeletal lesions. The patient is currently alive with disease progression 22 months after onset. On the basis of a review of the literature, the clinical significance of testicular myeloma localization is discussed.     

Efficient literature searching: a core skill for the practice of evidence-based medicine

Background Efficient literature searching and the application of formal rules of evidence in evaluating the clinical literature are the two key skills defining the practice of evidence-based medicine. Although clinicians embrace the concepts of evidence-based medicine, most identify limited personal time as the major barrier towards its implementation into daily practice. Busy clinicians who practice evidence-based medicine identify systematic reviews and evidence-based clinical practice guidelines as very useful resources.Methods This review presents a simple, easy-to-follow, three-step searching strategy that emphasises the use of powerful new PubMed features that allow clinicians to retrieve high-quality systematic reviews, clinical practice guidelines and primary studies with a single mouse click. The overall effectiveness of the process is further improved by highlighting the major features of successful and unsuccessful literature searches.Conclusions At the end of this tutorial the reader should be able to conduct efficient and effective literature searches that support clinical decision making in under 10 minutes.This work was supported by unrestricted educational grants from ResMed and the Northcare Foundation.An editorial regarding this article can be found in the same issue ()