Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means to integrate individual clinical expertise with the best available external clinical evidence from systematic research. So evidence and its quality is the key issue of evidence-based medicine. The purpose of this article is to introduce to the healthcare professionals the sources of evidence and how to search for evidence for them.
目的 通過調查臨床護理實習生在臨床實習工作中遭患者拒絕的情況，分析護生被拒絕的原因，引導學生正確面對被拒絕。 方法 2011年5月－6月采用自制調查問卷對實習8個月以上的護生進行調查。 結果 87.5%的護生在實習中遭遇過患者的拒絕，患者和家屬的不信任是護生遭遇被拒絕的主要原因，多數護生在被患者拒絕后有不良情緒及消極應對。 結論 護生應加強基本知識和基本技能的學習，提高溝通交流技巧，帶教老師要注意護生情商的培養，給予護生正面積極的鼓勵才能使護生正確面對患者的拒絕。Objective To investigate the rejection phenomenon in the clinical practice of nursing students, and to analyze the reasons to guide the students to face the refusals appropriately. Methods From May to June 2011, 90 nursing students who had worked for over eight months were surveyed using the self-made questionnaire. Results About 87.5% of nursing students encountered the patient’s refusals in the clinical practice and the most important reason was that the patients and their families did not trust the experience of nursing students. Most of the students showed the negative emotion and response after the refusal. Conclusions Nursing students should strengthen their basic knowledge and basic skills, and improve their communication skills. Furthermore, the teachers also should pay attention to the cultivation of emotional intelligence and positive encouragement, which could assist the nursing students in dealing with the refusals in the right way.
Objective To study the clinical characteristics of mulifocal motor neuropathy. Methods Patients records in China Biological Medicine Database (CBM-disc 1980-2005)and WanFang Database were searched. Demographic data, clinical manifestations, electrophysiology, and laboratory findings on multifocal motor neuropathy were analyzed. Results Of the total 80 patients, 61 cases were males, and 19 were females. A single limb weakness began in all the patients. Weakness was usually accentuated distally(95.3%), accompanied by muscle amyotrophy(76.3%) and fasciculation(46.3%). Reflexes were reduced (96.4%). Sensory impairment and cranial involvement were rare. 92.1% of the patients showed conduction block of motor nerve. Results Of the total 80 patients, 61 cases were males, and 19 were females. A single limb weakness began in all the patients. Weakness was usually accentuated distally(95.3%), accompanied by muscle amyotrophy(76.3%) and fasciculation(46.3%). Reflexes were reduced (96.4%). Sensory impairment and cranial involvement were rare. 92.1% of the patients showed conduction block of motor nerve. Conclusions Clinical features about multifocal motor neuropathy are a single distal limb weakness, muscle amyotrophy, and conduction block of motor nerve. MMN should be differentiated from motor neuron disease and chronic inflammatory demyelinating polyneuropathy.
We searched MEDLINE and The Cochrane Library to find high quality evidence aboutCa2＋ channel blocker in primary or secondary stroke prevention and summarized the avaliable evidence. The results show that in addition to the effect on hypertension, Ca2＋ channel blocker has antiartherosclerotic effect and can reduce the frequency rate of stroke. It has played an important role in primary stroke prevention. But concomitantly it can increase the risk of heart disease and as yet there is no evidence on secondary stroke prevention. Accordingly, Ca2＋ channel blockers should not be recommended as the first-fine medicine for stroke prevention.
Evidence has been retrieved through MEDLINE and Cochrane Libray about the treatment for patients with advanced Parkinson’s disease who suffered from on-off, dyskinesia and depression after chronic use of L-dopa. All of the evidence has been evaluated. Methods of evidence-based treatment were drawn up according to the evidence, clinciams’ experiences and patients’ preferences. All symptoms of the patient have been improved obviously.
【摘要】 目的 分析無面部血管瘤的Sturge-Weber綜合征（SWS）的臨床特點。 方法 2008年10月收治1例女性患兒，8歲，因發作性四肢強直入院，患兒無面部血管瘤及眼部異常，僅表現為癲癇。患兒接受丙戊酸鈉抗癲癇治療。 結果 患兒經頭部CT、MRI確診為無面部血管瘤的SWS。抗癲癇治療后隨訪12個月，未再發癲癇，智力發育無減退，未出現癱瘓、蛛網膜下腔出血、腦出血、腦卒中樣發作等。 結論 無面部血管瘤的SWS確診依靠頭部CT及MRI，治療方法為藥物抗癲癇治療。復習文獻得出無面部血管瘤的SWS患者臨床表現不同于有面部血管瘤者，多僅表現出癲癇發作，且藥物治療有效，無需手術切除病灶，預后較好。【Abstract】 Objective To analyze the clinical features of Sturge-Weber syndrome without facial hemangioma. Methods One eight-year-old girl was admitted to the hospital for tonic seizure in October 2008. The physical examination results were normal with neither facial hemangioma nor ocular abnormalities. The only manifestation of the patient was epilepsy. The patient was treated with sodium valproate. Results According to cranial CT and MRI results, the patient was considered to have Sturge-Weber syndrome without facial hemangioma. The patient was treated with anticonvulsant drugs and experienced no recurrence of the seizures or any manifestations of mental retardation, hemiplegia, subarachnoid hemorrhage, cerebral hemorrhage, stroke-like episodes or migraine during the following 12 months of follow-up. Conclusion In the absence of facial hemangioma, the diagnosis can be based on cranial CT and MRI. Sturge-Weber syndrome patients without facial hemangioma are helped by anticonvulsant drugs. According to this case and the reports of literature, most patients without facial hemangioma only manifest epilepsy which can be treated effectively with antiepileptic drugs and such patients have a good prognosis without operation, which is different from those with facial hemangioma.
ObjectiveTo systematically review the association between migraine and lacunar infarcts on MR image.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials, cohort studies and cross-sectional studies on the association between migraine and lacunar infarcts from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 5 studies involving 5 104 participants were included. The results of meta-analysis showed that: there were no significant associations of migraine (OR=0.93, 95%CI 0.78 to 1.12, P=0.470) and aura (OR=1.10, 95%CI 0.89 to 1.36, P=0.390) with lacunar infarcts on MR image. Subgroup analysis by age, presence or absence of aura showed no significant tendency.ConclusionsThere is no significant relationship between migraine and lacunar infarcts. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Randomized controlled trials (RCTs) are the gold standard for the design of clinical trials. Because of some practical difficulties, more and more researchers think that the appropriate use of non-randomized controlled trials may make up for the weakness of RCT and will achieve the same research purpose. Therefore, non-RCTs are also very important. Taking studies on multiple sclerosis for example, this article briefly introduces the significance of non-randomized contolled trials.
The extraction of neuroimaging features of migraine patients and the design of identification models are of great significance for the auxiliary diagnosis of related diseases. Compared with the commonly used image features, this study directly uses time-series signals to characterize the functional state of the brain in migraine patients and healthy controls, which can effectively utilize the temporal information and reduce the computational effort of classification model training. Firstly, Group Independent Component Analysis and Dictionary Learning were used to segment different brain areas for small-sample groups and then the regional average time-series signals were extracted. Next, the extracted time series were divided equally into multiple subseries to expand the model input sample. Finally, the time series were modeled using a bi-directional long-short term memory network to learn the pre-and-post temporal information within each time series to characterize the periodic brain state changes to improve the diagnostic accuracy of migraine. The results showed that the classification accuracy of migraine patients and healthy controls was 96.94%, the area under the curve was 0.98, and the computation time was relatively shorter. The experiments indicate that the method in this paper has strong applicability, and the combination of time-series feature extraction and bi-directional long-short term memory network model can be better used for the classification and diagnosis of migraine. This work provides a new idea for the lightweight diagnostic model based on small-sample neuroimaging data, and contributes to the exploration of the neural discrimination mechanism of related diseases.
Objective To study the risk factors of urinary incontinence in acute stroke patients and provide scientific evidence for preventing and managing such complication. Methods A computerized literature search was performed on both English and Chinese databases including Embase, Medline, Wanfang Data, VIP, and CNKI from January 1990 to January 2017 based on such search strategies as literature review and manual retrieval. In addition, we tracked down the related reference lists. The RevMan 5.3 software was used for Meta-analysis. Categorical data were calculated by the pooled odds ratio (OR) values and 95% confidence intervals (CI), and numerical data were calculated by pooled mean difference (MD) and 95%CI. Results A total of 17 articles of controlled studies with 2 428 cases and 3 725 controls were included. According to the results of Meta-analysis, factors associated with urinary incontinence following acute stroke were age [MD=2.80, 95%CI (0.29, 5.30),P=0.03], female gender [OR=1.29, 95%CI (1.16, 1.45),P<0.000 01], diabetes [OR=1.40, 95%CI (1.13, 1.73),P=0.002], heart disease [OR=1.65, 95%CI (1.29, 2.13),P<0.000 1), former cerebrovascular disease [OR=1.43, 95%CI (1.21, 1.69),P<0.000 1), speech disorder [OR=4.20, 95%CI (3.45, 5.10),P<0.000 01], smoking [OR=0.68, 95%CI (0.50, 0.92),P=0.01]. Hypertension [OR=1.25, 95%CI (0.99, 1.58),P=0.06], left hemisphere involvement [OR=1.29, 95%CI (0.81, 2.06),P=0.29], and hemorrhagic stroke [OR=1.26, 95%CI (0.79, 2.03),P=0.33] were not correlated with urinary incontinence following acute stroke. Conclusions Older age, female gender, diabetes, heart disease, former cerebrovascular disease and speech disorder are risk factors associated with post-stroke urinary incontinence, while smoking lowers the potential risk. However, hypertension, hemorrhagic stroke and left hemisphere involvement do not significantly increase the risk of urinary incontinence following stroke.
