Objective To formulate an evidence-based nursing scheme of eye care for an unconscious patient undergoing mechanical ventilation with eye complication. Methods Under the principle of PICO, the issue was put forward aiming directly at patient’s clinical manifestations, and the following databases as The Cochrane Library (Issue 12, 2011), PubMed (January 1980 to November 2011), EMbase (1974 to 2011) and CBM (1978 to 2011) were searched. Results A total of 3 guidelines, 2 systematic reviews and 9 randomized controlled trials (RCTs) were included. The evidence showed that eye cleaning was the very important part of eye care, and the commonly-used cleaning or rinsing solutions were saline and sterile water. Both moist cover and lubricating eye drops / ointment were used to prevent dryness in the eyes. For instance, polyethylene moisture covers could effectively prevent corneal abrasion, and lubricating eye drops / ointment were beneficial to eye observation, so these two methods needed to be properly selected in combination with patient’s conditions. Nurses had to assess the ability of the patient to close eyelids daily and helped the patient to close eyes, but the passive eyelids closure was inferior to the artificial tear ointment in the effect on preventing corneal abrasions; the integrated intervention of maintaining eyelids closure and forming eyeballs moisture chamber was more effective to prevent eye complications. According to the available evidence mentioned herein and the patient’s conditions, the following nursing scheme of eye care was formulated: cleaning the eyelids and peripheral skin using 0.9% saline gauze, covering the eyes with sterile polyethylene films which were fixed by anti-allergic adhesive tapes, changing the dressing every 12 hours, and observing closure of the eyelids every day. Seven days later, eye symptoms got obviously improved, with decreasing secretion, without congestion and chemosis, and negative results of fluorescein staining test. Conclusion Eye cleaning removes secretion and bacteria from the eyes. Polyethylene film prevents tear from evaporation and fully promotes the immune function of tears which can reduce the risk of infection. Eyelids closure and local moisture environment benefit the corneal epithelial repair.
Objective To formulate an evidence-based treatment plan for a patient with advanced hepatocellular carcinoma. Methods The clinical problems were put forward after full evaluation of patient’s conditions, and then the evidence related to the diagnosis and treatment of primary hepatocellular carcinoma was collected from The Cochrane Library (Issue 4, 2010), PubMed (1980 to 2010), Embase (1990 to 2010) and Wanfang Data (1990 to 2010). All the collected evidence was critically assessed. Both patient preferences and physician clinical experience were also taken into consideration in the decision-making treatment. Results A total of 153 relevant literatures were detected, and 13 meta-analyses or systematic reviews, 23 RCTs and 4 practice guidelines were identified. A rational treatment plan was made upon a serious evaluation of the data and the opinion of the patient. After a 6-month follow-up, the plan proved to be optimal. Conclusion The individualized treatment plan according to evidence-based methods for patients with advanced hepatocellular carcinoma can effectively improve the therapeutic efficacy and the life quality.
Objective To make an evidence-based treatment plan for a smoker with periimplantitis. Methods Based on the clinical problems raised from the case, we searched The Cochrane Library (Issue 2, 2009), ACP Journal Club (1991 to July 2009), MEDLINE (1950 to July 2009), EMbase (1980 to July 2009) and Chinese Journal Fulltext Database (1994 to July 2009) for guidelines, systematic reviews, meta-analyses and randomized controlled trials (RCTs). The quality of the included studies was assessed. Results A total of 4 systematic reviews, 8 RCTs were included. The following methods were supported by Level A evidence: (1) Scaling combined with local antibiotics; (2) Guided bone regeneration; (3) Non-surgical debridement with titanium hand-instruments or with an ultrasonic device. Based on the available evidence, we proposed a three-stage therapy plan for the patient: In the first stage, full mouth ultrasonic scaling was performed. The peri-implant pocket was debrided with plastic curettes, and then minocycline gel was applied once a week for four times. The patient was persuaded to maintain oral hygiene and quit smoking. In the second stage, four weeks later, open flap debridement and guided bone regeneration were conducted. In the third stage, long-term care of oral hygiene and dental implants were performed. After 6 months of follow-up, the peri-implant tissues were healthy with no evidence of inflammation, bleeding or suppuration. Conclusion Based on the approach of evidence-based medicine, we accomplished the treatment of the case with reliable outcomes.
Objective To formulate an evidence-based treatment plan for a patient with hepatitis C after kidney transplantation with combination of interferon-α and ribavirin. Methods Based on an adequate assessment of the patient’ s condition and using the principle of PICO, we searched The Cochrane Library (Issue 1, 2009), PubMed (1995 to March 2009), and CHKD (1995 to 2008.12). Results Eighteen studies were identified including 17 in English (5 case reports, 11 cohort studies, and 1 meta–analysis) and 1 in Chinese. According to the current evidence as well as the patient’ s clinical condition and preference, PEG-IFNα-2b 50 μg /week plus ribavirin 600 mg/day was given to the patient for 6 months. Conclusion Evidence-based approaches help us to prepare the anti-viral therapy plan and will improve the assessment of the efficacy and safety in kidney transplantation.
Objective Evidence-based medicine was used to make an individualized treatment plan for newly diagnosed prostatic hyperplasia in an elderly patient. Methods After clinical problems were discovered, evidence was collected from CBM, CNKI, The Cochrane Library, PubMed, EMBASE, ScienceDirect, Springer, and ProQuest databases according to our predefined search strategy. The search was done through 2008. The internal and external validity of the evidence was assessed. The evidence, combined with the patient value, was applied to the patient. Results A total of 39 systematic reviews involving 137 randomized controlled trials were identified. A rational treatment plan was made upon a critical evaluation of the data. After one year follow-up, the treatment protocol was proven correct. Conclusion The treatment efficacy in newly diagnosed prostatic hyperplasia in the elderly has been improved by determining an individualized treatment protocol according to evidence-based methods.
Objective To give an individualized treatment to a young woman with primary dysmenorrhea. Methods According to the basic principle and methods of evidence-base medicine, we searched The Cochrane Library (Issue 1, 2009), MEDLINE (PubMed, January 1950 to May 2009), ACP Journal Club (OVID, January 1991 to May 2007) for systematic reviews and randomized controlled trials (RCTs) to acquire the best clinical evidence on the treatment of primary dysmenorrhea. Results A total of 11 systematic reviews and 1 RCT were identified. A reasonable treatment plan was made through combining the patient’s will with her family members’. Conclusion The treatment effect on primary dysmenorrhea of the young woman is improved by an individualized treatment plan based on an evidence-based method.
Objective Making an individualized pharmacological treatment plan for a patient of acute respiratory distress syndrome after operation. Methods First, six clinical problems were put forward after assessing the patient’ s health state. Then we searched OVID versions of the ACP Journal Club (1991~2009), CENTRAL (1st Quarter 2009), CDSR (1st Quarter 2009), and MEDLINE (1991~2009) databases. Systematic reviews, meta-analyses, and randomized clinical trials about treatment of acute respiratory distress syndrome were included. The pharmacological treatment plan was made accordingly.Results After evaluation, 13 studies were eligible. The evidence indicated that the restrictive strategy of fluid management, corrected hypoproteinaemia, diuresis, and low-dose corticosteroids given in the early phase could improve oxygenation and prognosis; inhaled nitric oxide, exogenous surfactant supplement, other pharmacological drugs were associated with limited improvement in oxygenation in patients with ARDS but confer no mortality benefit and may cause harm, so we did not recommend their routine use in ARDS patients. The individual treatment plan was made based on the evidence found. After 8 days of treatment, the patient was out the ICU. He recovered and was discharged after 1 month. Conclusions The individual treatment plan, which was made based on high quality evidence and patient’s condition, improved treatment efficacy, shortened the stay in ICU, reduced mortality, and decreased adverse reactions.
Methods of evidence-based medicine were used to discuss the drug treatment of postmenopausal osteoporosis. After clinical problems were put forward, we searched for and assessed the evidence. A rational treatment plan for osteoporosis patients with fractures was developed according to the results of systematic reviews and Meta-analysis.
Objective To formulate an evidence-based treatment plan for a child patient with Asymptomatic Wolff-Parkinson-White (WPW) Syndrome. Methods Based on the clinical problems whether the patients with asymptomatic WPW syndrome need prevent catheter ablation or not, we used “asymptomatic WPW syndrome” as the keywords and searched The Cochrane Library (Issue 3, 2007), MEDLINE (1981 to 2007), ACP Journal Club (1991 to 2007), BMJ Clinical Evidence (1999 to 2007) and NGC (1998 to 2007) for systematic reviews, randomized controlled trials (RCTs), controlled clinical trials and treatment guidelines. The methodological quality of the included studies was assessed to identify the current best evidence. Results Two RCTs were retrieved in MEDLINE. The results showed arrhythmic events increased significantly in the high-risk control group than those in the ablation group, and in the patients with multi-pathways than those with only one pathway. Based on the current evidence, integrated with clinical expertise and the patients’ values, the patients underwent electrophysiologic test and the result showed the dominance pathway in the right side and the concealed accessory pathway in the left side. Then prevent catheter ablation was performed, and no cardiovascular complications occurred in the following 12 months, which confirmed that the plan was proved optimal. Conclusion The findings of this study should reassure physicians and parents alike that in the children with the WPW syndrome who are at high risk for arrhythmias, ablation is an appropriate option.
