成人经鼻胃管喂养临床实践指南的构建

目的 构建基于证据的成人经鼻胃管喂养的临床实践指南,为促进鼻饲护理实践,保证鼻饲安全提供参考。 方法 以JBI 循证卫生保健模式为理论框架,严格按照循证临床实践指南制定的方法,构建《成人经鼻胃管喂养临床实践指南》草案,采用 AGREE 系统对指南草案进行专家评审,根据专家评审结果和建议对指南进行修改,形成正式指南。结果构建的指南推荐意见涵盖了鼻饲的适应证和禁忌证、胃管的选择及置管、确定胃管位置的方式、鼻饲喂养、营养配方、鼻饲给药、鼻饲相关并发症等内容,最终形成19 个方面,99 条推荐意见的指南草案。指南的 AGREE 评价得分较高,符合临床实践指南编写原则,也适用于我国成人鼻胃管喂养临床应用的现状,是一份实用性的指导意见。 结论 成人经鼻胃管喂养临床实践指南是根据我国临床实际、患者意愿和偏好、专业人员判断以及最佳证据而形成的循证指南,可为鼻饲临床护理实践提供参考,证据转化和临床应用是下一步研究的重点。     

How Old are African American Women When they Receive their First Mammogram? Results from a Church-Based Study

African American women in the U.S. have the highest breast cancer mortality though not the highest breast cancer incidence. This high mortality rate has been attributed in part to discrepancies in screening between African American and White women. Although this gap in mammography utilization is closing, little is known about what has been and is driving the screening practices of African American women, in particular age at first mammogram. This study examined the rates of breast cancer screening in an African American community sample from eight churches in greater Baltimore, Maryland and investigated the association between various factors and age at first mammogram. Participants were 213 women ages 22-89 years. About 77% of women had ever had a mammogram. Over 40% had their first mammogram before age 40. Women who first screened before age 40 had greater odds than women who had never screened of being knowledgeable about screening guidelines, of having received a physician recommendation to screen, and of having three or more female relatives who had been screened. Women who first screened at or after age 40 were more likely to have stronger religious beliefs of health than women who never had screened. These findings suggest the importance of reinforcing factors in screening behavior for African American women and have implications for physician training and public health education about breast cancer screening. A better understanding of African American women's mammography practice including early screening is needed to reduce this population's disproportionate breast cancer mortality risk.     

原发性高血压病的辨证施护

根据原发性高血压病的病理特点,结合中医治疗高血压病的辨证分型,着重于宏观与微观相结合、辨证与辨病施护相结合,药物与非药物疗法相结合的护理原则,强调高血压病患者护理个体化,以人为本,突出中医护理特色。     

Identifying scientific artefacts in biomedical literature: The Evidence Based Medicine use case

Evidence Based Medicine (EBM) provides a framework that makes use of the current best evidence in the domain to support clinicians in the decision making process. In most cases, the underlying foundational knowledge is captured in scientific publications that detail specific clinical studies or randomised controlled trials. Over the course of the last two decades, research has been performed on modelling key aspects described within publications (e.g., aims, methods, results), to enable the successful realisation of the goals of EBM. A significant outcome of this research has been the PICO (Population/Problem–Intervention–Comparison–Outcome) structure, and its refined version PIBOSO (Population–Intervention–Background–Outcome–Study Design–Other), both of which provide a formalisation of these scientific artefacts. Subsequently, using these schemes, diverse automatic extraction techniques have been proposed to streamline the knowledge discovery and exploration process in EBM. In this paper, we present a Machine Learning approach that aims to classify sentences according to the PIBOSO scheme. We use a discriminative set of features that do not rely on any external resources to achieve results comparable to the state of the art. A corpus of 1000 structured and unstructured abstracts – i.e., the NICTA-PIBOSO corpus – is used for training and testing. Our best CRF classifier achieves a micro-average F-score of 90.74% and 87.21%, respectively, over structured and unstructured abstracts, which represents an increase of 25.48 percentage points and 26.6 percentage points in F-score when compared to the best existing approaches.     

正念认知疗法在强迫症治疗中的研究现状

强迫症是一组以强迫思维和强迫行为主要临床表现的心理障碍。正念认知疗法(MBCT)作为一种新兴的心理治疗方法,在强迫症的治疗中有着积极作用。本文通过对MBCT在强迫症治疗中的现状和效果进行综述,为强迫症的临床心理治疗提供参考。     

A new clinical complexity model for the Australian Refined Diagnosis Related Groups

BackgroundThe Australian Refined Diagnosis Related Groups (AR-DRG) underwent a major review in 2014 with changes implemented in Version 8.0 of the classification. The core to the changes was the development of a new methodology to estimate the Diagnosis Complexity Level (DCL) and to aggregate the complexity level of individual diagnoses to the complexity of an entire episode, resulting in an Episode Clinical Complexity Score (ECCS). This paper provides an overview of the new methodology and its application in Version 8.0.MethodThe AR-DRG V8.0 refinement project was overseen by a Classifications Clinical Advisory Group and a Diagnosis Related Groups (DRG) Technical Group. Admitted Patient Care National Minimum Dataset and the National Hospital Cost Data Collection were used for complexity modelling and analysis.ResultIn total, Version 8.0 comprised 807 DRGs, including 3 error DRGs. Of the 321 Adjacent DRGs (ADRGs) that had a split, 315 ADRGs used ECCS as the only splitting variable while the remaining 6 ADRGs used splitting variables other than ECCS: 2 used age and 4 used transfer.Discussion and conclusionA new episode clinical complexity (ECC) model was developed and introduced in AR-DRG V8.0, replacing the original model introduced in the 1990s. Clear AR-DRG structure principles were established for revising the system. The new complexity model is conceptually based and statistically derived, and results in an improved relationship with actual variations in resource use due to episode complexity.     

黄宫绣循证本草学术思想探讨

黄宫绣的本草研究思想和方法为循证本草学术思想和研究方法.本文从黄宫绣《本草求真》“从往昔诸书,细加考订”的研究方法、“首宜分其形质气味、次宜辨其经络脏腑、终宜表其证治功能”诸研究内容、便“浅学医士、后学、粗工”于本草药物“开卷了了、无有错误”的研究目的等角度,概要论述了黄宫绣的循证本草研究学术思想.     

中医护理干预对颈椎病的临床护理效果分析

目的：探讨中医护理干预对颈椎病的临床护理效果。方法选择2014年5月～2016年2月收治的颈椎病患者112例作为研究对象,把全部患者随机分成对照组与观察组两组,每组56例。对照组实施常规性专科护理,观察组在此基础上实施中医护理干预,比较两组患者的临床护理效果。结果观察组护理后的日本骨科协会（JOA）评分与疼痛词语描述量表（VDS）评分要显著优于对照组与护理前（P＜0．05）;观察组护理有效率是96．4％,对照组护理有效率是76．8％,观察组护理效果要明显优于对照组（ P＜0．05）。结论临床上对颈椎病患者实施中医护理干预具有显著的临床护理效果,能够显著改善颈椎病疼痛,建议在临床护理工作中推广应用。