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.
In 2014, the new concept of embolic stroke of undetermined source (ESUS) was first proposed by cryptogenic stroke/ESUS International Working Group. In the past 5 years, related clinical researches of ESUS have been deepened, and the results of many large clinical studies have been published. However, the guiding significance of this new concept to clinical practice is still controversial. By reviewing the background, diagnostic criteria, assessment, common emboli sources, anticoagulant therapy research advances and related limitations of ESUS, and analyzing the possible causes of negative anticoagulant therapy results, we explored the clinical value of this new classification.
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.
Objective To evaluate the efficacy and safety of sodium citicoline tablets in the treatment of acute cerebral hemorrhage within 72 hours from the onset. Methods A randomized , double -blind, double-dummy, active control clinical study was performed. Patients who met the inclusion criteria were randomized into two groups. The treatment group （18 cases） received sodium citicoline tablets （0.2 g tid） and placebo capsule （0. 2 g tid）, while the control group （18 cases） received sodium citicoline capsule （0.2 g tid） and placebo tablets （0. 2 g tid）. The duration of treatment was 21 days for the two groups. National Institutes of Health Stroke Scale （NIHSS） and Barthel Index （BI） were used to evaluate the recovery of neurological functions. Results NIHSS and BI scores increased significantly in both groups after treatment （P 〈0. 01 ）. There was no statistical difference of the improvement between the two groups （P 〉0. 05）. No adverse drug reaction or significant change in laboratory norms was found in either group. Conclusions Sodium citicoline tablets is effective and relatively safe in the treatment of acute cerebral hemorrhage. The efficacy and safety of sodium citicoline tablets in the treatment of acute cerebral hemorrhage is similar to that of sodium citicoline capsule.
Object To collect and summarize high quality clinical evidence on the use of hyperbaric oxygen (HBO) in health care generally. Method We searched MEDLINE (1980-2006), The Cochrane Library (Issue 1, 2006) and the China Biomedicine Database (1982-2006) for systematic reviews, meta-analyses and randomized controlled trials. The quality of included studies was critically evaluated. Result Thirteen systematic reviews (12 Cochrane reviews) on HBO were included. Results showed that HBO had some beneficial effect on acute coronary syndrome, ischemic stroke, multiple sclerosis, malignant otitis externa, idiopathic sudden sensorineural hearing loss and tinnitus. It might also promote chronic wound healing and relieve radiation damage.Conclusions Since the avaliable randomized controlled trials for the systematic reviews we included are too small, further well-designed multicentre large-scale trials are needed to determine the efficacy and safety of HBO .
Angiotensin converting enzyme inhibitor (ACEI) is an important type of antihypertensive drug. Much evidence shows that ACEI not only decreases the blood pressure but also has the protective effect on the cardiac and cerebral vessels. ACEI may prevent the stroke. To provide the best evidence for the clinical practice, we electronically searched RCTs and systematic reviews from MEDLINE and The Cochrane Library to evaluate the mechanisms and the effects of ACEI in stroke treatment and prevention.
