中药治疗糖尿病视网膜病变的安全性系统评价

摘 要 目的：对中药治疗糖尿病视网膜病变的中药组方、中成药信息及文中报道的安全性指标进行概述及评价。方法：系统检索Cochrane Library、PubMed、CNKI、SinoMed、VIP和万方数据库,从建库至2015年12月。纳入中药与常规治疗或西药或安慰剂比较的随机对照试验。两名作者独立进行文献筛选、资料提取和纳入研究质量评价,质量评价采用Cochrane协作网的偏倚风险评估工具。应用RevMan 5.3进行数据分析。结果：共纳入56项研究,4 104名受试者。中药治疗方法包括37种中药汤剂,15种中成药。3个试验评价为低偏倚风险,其余为高偏倚风险。14项试验报告了安全性指标,5项试验发生了不良事件。结论：虽然本研究结果显示中药治疗组与对照组相比患者不良事件发生情况无差异,但是现有的临床试验对药物安全性重视程度不够,建议今后的研究能够完善对安全性指标的监测及报告,增加研究的临床参考价值。     

国内针灸临床实践指南制定中存在问题的思考

对国内已发布的35部《循证针灸临床实践指南》(团体标准)中存在的问题进行梳理,发现存在制定方法和制定过程欠清晰、证据评价体系还不能充分体现针灸特色的问题。因此,《针灸临床实践指南制定及其评估规范》应要求针灸临床实践指南在充分考虑针灸学科特色、综合评价现代文献证据、整合古籍文献与医家经验基础上,形成临床指导作用较好的推荐意见;同时应在指南制定过程提出针对性要求以促使制定过程更加清晰,研究方法更加严谨。     

个性化护理在恶性肿瘤术后静脉血栓形成中的作用分析

目的探讨个性化护理在恶性肿瘤术后深静脉血栓形成(DVT)中的作用,为护理方式的优化提供理论依据。方法选取本院2016年10月至2017年10月收治的60例恶性肿瘤患者为研究对象,运用随机数表法分为实验组和对照组,每组30例。对照组患者进行常规护理管理干预,实验组患者在其基础上实施个性化护理干预,比较2组患者DVT情况,并对患者护理满意度及遵循医嘱程度进行调查。结果对照组有6名患者发生DVT,24名无DVT;实验组有1名患者发生DVT,29名无DVT,差异具有统计学意义(P<0.05)。对照组有16名患者对护理满意,14名不满意;实验组有26名患者对护理满意,4名不满意,差异具有统计学意义(P<0.05)。对照组有22名患者遵循医嘱,8名不遵循;实验组有29名患者遵循医嘱,1名不遵循,差异具有统计学意义(P<0.05)。结论个性化护理可以明显降低恶性肿瘤患者术后血栓发生率,改善患者对护理满意度、患者遵循医嘱程度。     

《针灸临床实践指南》国际需求的调查:一项横断面研究

ObjectiveThis study aims to get the medical management of acupuncture and moxibustion in the countries and regions where the society members of World Federation of Acupuncture-Moxibustion Societies (WFAS) are located, including the educational background of acupuncture and moxibustion practitioners and the local clinical practice of acupuncture and moxibustion, and the demands of the content and evidence types of Clinical Practice Guidelines (CPGs) of acupuncture and moxibustion in accordance with WFAS standards, so as to provide requirements and reference principles for the development of CPGs of acupuncture and moxibustion in accordance with WFAS standards.MethodsThe convenient sampling method was used to collect the questionnaires, and the WFAS secretariat distributed the questionnaires to 294 contacts of society members from 70 countries and regions in the form of Questionnaire Star four times in April 2020, July 2020, March 2021, and April 2021 respectively. They were then distributed to individual members of acupuncture-moxibustion societies by the contacts. The study content involved the basic information of respondents, including their nationality, occupation, educational background of acupuncture and moxibustion, their local clinical practice and medical management of acupuncture and moxibustion, as well as their demand for CPGs of acupuncture and moxibustion, etc. After the questionnaires were collected, the data were analyzed and described by quantitative research method.ResultsIn all, 302 respondents from 37 countries of six continents responded. The 302 respondents were members of the WFAS society members. (1) Basic information of respondents. They all had acupuncture and moxibustion learning experience, among which, 76.5% (231/302) had the education background of acupuncture and moxibustion professional college training, and 88.4% (267/302) had experience of acupuncture and moxibustion clinical practice. Acupuncturists or traditional Chinese medicine doctors accounted for 63.9% (193/302), western medicine doctors, nurses, and pharmacists accounted for 18.2% (55/302), and researchers and teachers accounted for 6.3% (19/302). (2) Local clinical practice and medical management of acupuncture and moxibustion. The level of clinical practice of acupuncture and moxibustion varies greatly among the regions where the WFAS society members lived. Among them, more countries in Europe have not included acupuncture and moxibustion in medical insurance than those in other continents (x²=26.049, P < 0.01), and more countries have not included acupuncture and moxibustion in public hospital treatment system than those in other continents (x²=113.488, P < 0.01). (3) Demand for CPGs of acupuncture and moxibustion. A total of 93.0% (281/302) respondents believed that WFAS CPGs of acupuncture and moxibustion would be helpful for their local practice. The order of their demand and concern for WFAS CPGs was: acupuncture manipulation > latest progress of acupuncture treatment > choice of acupuncture therapies > safety of acupuncture and moxibustion > combination of acupuncture and other programs. A total of 87.4% (264/302) respondents believed that ancient classics could guide clinical practice, and the ancient literature should be used as evidence for the development of guidelines.ConclusionThe respondents are those future practitioners of CPGs of acupuncture and moxibustion conforming to WFAS standards. Commonly they have clinical practice experience and professional education background. They believe that guidelines will be of help to the clinical practice of acupuncture and moxibustion, hope that WFAS CPGs would recommend effective guidelines for acupuncture manipulation and provide the latest progress in acupuncture treatment and so on, and they believe that classical ancient books can guide their clinical practice. It indicates the necessity and feasibility of formulating the WFAS CPGs of acupuncture and moxibustion. In view of the results of this study, it is suggested that the formulation process of WFAS CPGs of acupuncture and moxibustion should take into account the clinical practice level of acupuncture and moxibustion in each region, as well as its legislation and management situation of acupuncture and moxibustion, so as to meet the needs of users as much as possible.