The establishment of the Australian and New Zealand Neonatal Network

The Australian and New Zealand Neonatal Network was established in 1994 to monitor high-risk newborns admitted for care. Uniquely, all units in both countries have participated since inception, making it integral to the care of babies. The network's objectives include auditing care, publishing aggregated results annually, providing feedback to units, monitoring technologies and developing clinical indicators. Networking provides a forum for clinicians and a consortium of knowledge and advice. It facilitates collaborative research and clinical groups, producing projects from observational studies to randomised controlled trials. Members take a major role in reviewing the evidence for care and ensuring its effective use in clinical practice.     

How Well Do Guidelines Incorporate Evidence on Patient Preferences?

BACKGROUND  Clinical practice guidelines (CPG) are meant to consider important values such as patient preferences. OBJECTIVE  To assess how well clinical practice guidelines (CPGs) integrate evidence on patient preferences compared with that on treatment effectiveness. DESIGN  A cross-sectional review of a listing in 2006 of CPGs judged to be the best in their fields by an external joint government and medical association body. STUDY SELECTION  Exclusion criterion was unavailability in electronic format. Sixty-five of 71 listed CPGs met selection criteria. MEASUREMENTS  Two instruments originally constructed to evaluate the overall quality of CPGs were adapted to specifically assess the quality of integrating information on patient preference vs. treatment effectiveness. Counts of words and references in each CPG associated with patient preferences vs. treatment effectiveness were performed. Two reviewers independently assessed each CPG. MAIN RESULTS  Based on our adapted instruments, CPGs scored significantly higher (p < 0.001) on the quality of integrating treatment effectiveness compared with patient preferences evidence (mean instrument one scores on a scale of 0.25 to 1.00: 0.65 vs. 0.43; mean instrument two scores on a scale of 0 to 1: 0.58 vs. 0.18). The average percentage of the total word count dedicated to treatment effectiveness was 24.2% compared with 4.6% for patient preferences. The average percentage of references citing treatment effectiveness evidence was 36.6% compared with 6.0% for patient preferences. CONCLUSION  High quality CPGs poorly integrate evidence on patient preferences. Barriers to incorporating preference evidence into CPGs should be addressed. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

手术病人术前留置尿管时机的探讨

目的:按照循证护理的路径为手术病人选择留置尿管的最佳时机,减少插尿管的不良刺激给病人带来的痛苦.方法:选择80例术前需留置尿管的择期手术病人,随机分为对照组与实验组.对照组按传统方法术前1～2 h在病房行留置尿管术;实验组采用在手术室于硬膜外麻醉或全麻效果满意后行留置尿管术.观测比较两组病人在插尿管时的疼痛程度、血压、心率等指标.结果:两组病人的观测指标在统计学上差异有显著意义.结论:术前病人在手术室于麻醉起效后留置尿管可明显减轻病人的疼痛不适及心理应激反应,对临床护理工作具有积极意义.     

引入循证医学模式 创新医院管理评审机制

目的拓展现代医院管理模式,形成新的医院循证管理模式。方法运用并拓展循证医学理念,融入医院管理。结果形成循证医院管理模式。结论把循证管理模式融入医院管理年活动,建立新的医院管理评审机制。     

基于模糊数学创新中医临床疗效评价方法探析

中医临床疗效评价方法学是制约着中医药发展的关键问题,现今的疗效评价方法或多或少的存在着缺陷,无法做到既体现中医特色,又提高中医药诊疗标准的普遍性,全面、系统、科学、客观反应中医药的临床疗效。所以亟待构建科学、系统地反映中医诊疗特色的疗效评价指标体系。文章分别讨论了中医药研究现行的疗效评价方法的弊端,提出引入模糊数学,进行中医药临床疗效评价。对结构复杂、又相互关联的评价指标,考虑各层次之间和内部的相互作用大小及对总体的影响,从整体出发进行综合评价,创新中医药疗效评价方法,促进中医药疗效评价的研究。     

遵循循证医学理念提高医院管理绩效

循证医学的兴起,为医院管理者提供了新的思路。文章探讨了循证医学与医院管理的关系:二者相辅相成;二者的契合点在于以人为本;可持续发展是二者的最终目的。阐述了在医院管理中如何遵循循证医学的基本理念,并提出4点措施:积极开展系列培训,使医务工作者对循证医学有充分的认识和理解;加强医院基础建设,为实施循证医学创造条件;以人为本,构建学习型医院;开展临床科研,循求医学证据。     

基于循证的医疗设备质量管理模式探讨

在医疗改革的新形势下,提高医疗设备质量管理水平是现代医院全面质量管理的重要组成部分.将循证医学的原理和方法运用到医疗设备质量管理之中,从广义的角度出发,提出了基于循证的医疗设备质量管理的基本思想和基本构架,并探讨了基于循证的组织结构、PDCA质量管理循环、质量循证规程和全面质量评测指标体系等医疗设备质量管理体系的建立.     

循证针灸临床实践指南结构特点及方法学探讨

目的 制定撰写高质量循证针灸临床实践指南的方法学工具.方法 本文结合循证医学的特点,着重分析并讨论形成中西医循证临床实践指南的异同点.结果 总结循证针灸临床实践指南的结构及指南制定方法学特点.结论 应用合理、优化的指南制定方法学工具,可以制定高质量的循证针灸临床实践指南.     

The extent of nursing research utilization in general medical and surgical wards

There has been extensive speculation about the lack of research utilization in nursing but little attempt to quantify this phenomenon outside of North America. The current demands for evidence-based practice necessitate research utilization as one element of the process. As part of a larger project, this study aimed to describe the extent of research utilization by registered nurses in general medical and surgical wards in the Scottish Health Service. A postal survey was conducted for nurses to self-report their level of utilization of 14 research-based practices. The 14 practices represented examples of direct, indirect and methodological utilization of research. A research utilization score was constructed for each of the 14 practices and a total mean score constructed for all 14 practices. A random two-stage stratified sampling resulted in a total sample of 936 nurses from 25 hospitals. A 73% response rate was achieved. The total mean research utilization score for all nurses across all 14 nursing practices suggests that on average, nurses had heard, believed in and were beginning to use the practices. The sampling technique over-represents nurses in large hospitals and charge nurses, hence a weighting calculation on all scores was completed. There was little difference in weighted and unweighted scores. Scores on individual practices ranged from 60% (405/680) of nurses never having heard of a practice to 85% (574/680) always using a practice. This approach provides a valid and reliable method of assessing the extent of nursing research utilization. In several of the practices, nurses are making significant attempts at research-based practice. The level of research utilization compares favourably with research completed in North America and provides a baseline for United Kingdom and other country studies.