Two Evidence-Based Acupuncture Models

Modern clinical trials have produced controversial data interpretation which refutes conventional standard teachings and practices. Acupuncture scholars and practitioners have been stimulated to scrutinize these trials and analyze conventional practices. This paper presents two acupuncture models which address these issues. One rationalizes the clinical trial results with newer understanding of acupuncture points and techniques, while the other reconciles these results with rediscovered techniques of palpating points and performing needling. These two models indicate that acupuncture is in transition from classical model to evidence-based models.     

对《对〈中国乙型肝炎病毒母婴传播防治指南(2019年版)〉的商榷》一文的回复

2011年,美国医学研究所(Institute of Medicine,IOM)对已使用20年的临床实践指南的定义进行了修改,强调指南应基于系统评价证据,平衡不同干预措施利弊,在此基础上形成能够为患者提供最佳保健服务的推荐意见[1]。《中国乙型肝炎病毒母婴传播防治指南(2019年版)》(下称《指南》)[2]由中华医学会感染病学分会发起,联合感染、肝病、妇产、生殖及循证医学等多学科专家,严格遵守IOM对指南的最新定义和《世界卫生组织指南制订手册》[3]的规范和流程,运用证据推荐分级的评估、制订与评价方法(Grading of Recommendations Assessment,Development and Evaluation,GRADE)[4],历时近2年完成。《指南》发表后,在巡讲和宣贯过程中,受到相关领域专家及临床医师的积极评价,并逐步应用于临床实践。近期我们也注意到部分专家对指南的某些内容提出商榷和争鸣,我们高度重视并认真听取。本文就周乙华教授等《对〈中国乙型肝炎病毒母婴传播防治指南(2019年版)〉商榷》(下文简称《商榷》)一文中提出的问题,遵循学术争鸣原则,逐一予以回复和说明,以示对原作者的尊重,也是对《指南》广大读者和使用者负责。     

How national context,project design,and local community characteristics influence success in community-based conservation projects

Community-based conservation (CBC) promotes the idea that conservation success requires engaging with, and providing benefits for, local communities. However, CBC projects are neither consistently successful nor free of controversy. Innovative recent studies evaluating the factors associated with success and failure typically examine only a single resource domain, have limited geographic scope, consider only one outcome, or ignore the nested nature of socioecological systems. To remedy these issues, we use a global comparative database of CBC projects identified by systematic review to evaluate success in four outcome domains (attitudes, behaviors, ecological, economic) and explore synergies and trade-offs among these outcomes. We test hypotheses about how features of the national context, project design, and local community characteristics affect these measures of success. Using bivariate analyses and multivariate proportional odds logistic regressions within a multilevel analysis and model-fitting framework, we show that project design, particularly capacity-building in local communities, is associated with success across all outcomes. In addition, some characteristics of the local community in which projects are conducted, such as tenure regimes and supportive cultural beliefs and institutions, are important for project success. Surprisingly, there is little evidence that national context systematically influences project outcomes. We also find evidence of synergies between pairs of outcomes, particularly between ecological and economic success. We suggest that well-designed and implemented projects can overcome many of the obstacles imposed by local and national conditions to succeed in multiple domains.     

An expert consensus on the evaluation and treatment of acute thoracolumbar spine and spinal cord injury in China

This is an expert consensus on the evaluation and treatment of thoracolumbar spinal injury, estab- lished from February 2009 to July 2010. The expert consensus consists mainly of six parts with a total of 54 recommendations including the overview （one item）; pre-hospital care （one item）; evaluation and diagnosis （13 items）; treatment （23 items）; prevention and treatment of major com- plications （12 items）; and rehabilitation （four items）. This is the first time that Chinese experts have published a consensus on spine and spinal cord injury. The expert consensus was established based on Delphi methods, literature analysis, and clinical experiences. Each recommendation is supported by and was interpreted using multi-level evidences. The level of agreement with the rec- ommendation among the panel members was assessed as either low, moderate, or strong. Each panel member was asked to indicate his or her level of agreement on a 5-point scale, with ＂1＂ cor- respondJng to neutrality and ＂5＂ representJng maxJmum agreement. Scores were aggregated across the panel members and an arithmetic mean was calculated. This mean score was then translated into low, moderate, or strong. After all of the votes were collected and calculated, the results showed no low-level recommendations, 10 moderate-level recommendations, and 44 strong-level recom- mendations. An expert consensus was reached and was recognized by Chinese spine surgeons. Wide-scale adoption of these recommendations is urgent in the management of acute thora- columbar spine and spinal cord injury in a broader attempt to create a standard evaluation and treatment strategy for acute thoracolumbar spine and spinal cord injury in China.     

Paediatric rehabilitation in Italy

In Italy, paediatric rehabilitation is part of the activity of services for neurological and psychiatric diseases in childhood and adolescence. These services (UONPIA) have an integrated, multi-professional, child- and family-oriented approach to paediatric disabling conditions. At present, inadequate territorial distribution of services, shortage of resources and need of epidemiological monitoring and specific designs of bio-medical research are the main problems.     

A 24-month evaluation of amalgam and resin-based composite restorations: Findings from The National Dental Practice-Based Research Network

BackgroundKnowing which factors influence restoration longevity can help clinicians make sound treatment decisions. The authors analyzed data from The National Dental Practice-Based Research Network to identify predictors of early failures of amalgam and resin-based composite (RBC) restorations.MethodsIn this prospective cohort study, the authors gathered information from clinicians and offices participating in the network. Clinicians completed a baseline data collection form at the time of restoration placement and annually thereafter. Data collected included patient factors, practice factors and dentist factors, and the authors analyzed them by using mixed-model logistic regression.ResultsA total of 226 practitioners followed up 6,218 direct restorations in 3,855 patients; 386 restorations failed (6.2 percent) during the mean (standard deviation) follow-up of 23.7 (8.8) months. The number of tooth surfaces restored at baseline helped predict subsequent restoration failure; restorations with four or more restored surfaces were more than four times more likely to fail. Restorative material was not associated significantly with longevity; neither was tooth type. Older patient age was associated highly with failure (P N/A .001). The failure rate for children was 4 percent, compared with 10 percent for people 65 years or older. Dentist’s sex and practice workload were associated significantly with restoration longevity.ConclusionsIn this prospective cohort study, these factors were significantly predictive of failure for amalgam and RBC restorations: patient’s age, a higher number of surfaces restored at baseline, the dentist’s sex and the practice workload. Material choice was not significantly predictive in these early results.Practical ImplicationsIf clinicians can recognize and identify the risk factors associated with early restoration failure, more effective treatment plans may be offered to the patient.     

PICC置管前评估的临床实践指南构建及AGREE评价

目的构建以证据为基础的经外周穿刺中心静脉导管(PICC)置管前评估的临床实践指南并进行AGREE评价。方法通过现况调查,制作PICC置管前评估的系统评价,对PICC置管前评估相关临床实践指南进行文献内容分析,构建指南草案并通过德尔菲法对指南相关附件进行修订,使用AGREE评估系统进行评价。结果指南形成包含置管护士、环境与设备、患者评估、导管选择、穿刺技术与穿刺部位、知情同意6个方面共31项推荐意见。AGREE评价的标准化总分分别为98%、93%、95%、92%、89%、100%,6名PICC护理专家均给予"强烈推荐"评价。结论该指南是基于我国临床现状、循证证据、患者意愿和偏好、专业人员判断的循证性临床实践指南,可作为PICC置管前评估的依据。     

集束化护理的误区分析与正确应用

分析我国护理人员在构建和实施集束化护理方案过程中,忽略集束化护理方案基于证据的实质、对各集束措施之间的关联性理解不够及认为集束化护理中的措施一成不变等误用情况;阐述了集束化护理的正确应用、集束化护理实施过程中的挑战与应对策略.旨在促使护理人员正确认识和应用集束化护理,以促进护理质量的持续改进.     

A practitioner's guide to developing critical appraisal skills: observational studies

BACKGROUND: and Overview. Observational investigations provide an opportunity to document the distribution of diseases in various populations and to explore correlations between exposures and outcomes. Interpreting such correlations as causal is challenging and can lead to more harm than good when used as a basis for advising lifestyle changes or interventions to healthy people. The aim of this review is to provide a brief introduction to observational study designs and describe some of their strengths and weaknesses. CONCLUSIONS AND PRACTICE IMPLICATIONS: Observational findings can be useful to guide clinical research, but often they do not provide a reliable basis for clinical decision making. Caution in applying observational findings to clinical practice is particularly important when caring for healthy people.