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 通过调查临床护理实习生在临床实习工作中遭患者拒绝的情况，分析护生被拒绝的原因，引导学生正确面对被拒绝。 方法 2011年5月－6月采用自制调查问卷对实习8个月以上的护生进行调查。 结果 87.5%的护生在实习中遭遇过患者的拒绝，患者和家属的不信任是护生遭遇被拒绝的主要原因，多数护生在被患者拒绝后有不良情绪及消极应对。 结论 护生应加强基本知识和基本技能的学习，提高沟通交流技巧，带教老师要注意护生情商的培养，给予护生正面积极的鼓励才能使护生正确面对患者的拒绝。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.
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.
【摘要】 目的 了解成都市社区居民脑卒中的流行病学特征，为脑卒中预防、干预提供科学依据。 方法 采用整群随机抽样方法抽取成都市2个社区。对132 303人采用前瞻性的热追踪，搜集社区中脑卒中发病及死亡人群。 结果 2008年脑卒中发病率、死亡率分别为217.68/10万、49.13/10万，2009年发病率、死亡率分别为239.60/10万、41.57/10万，2008年—2009年标化发病率216.01/10万，标化死亡率43.61/10万。缺血性脑卒中患者构成比最高，占半数以上。发病率随年龄增长而增高（χ2=1 095.11，Plt;0.001），男女发病率差异无统计学意义（χ2=2.367，P=0.124）。 结论 成都市社区居民发病率与我国平均水平相当，死亡率略低于我国平均水平。【Abstract】 Objective To explore the epidemiologic features of cerebral apoplexy in community of Chengdu, and to provide references for intervention and prevention of cerebral apoplexy. Methods Two communitis in Chengdu were selected by randomized cluster sampling method. The morbidity and mortality in 132 303 people were calculated by prospective tracing. Results The annual incidence was 217.68 per 100 000, and the annual mortality was 49.13 per 100 000 in 2008. The annual incidence was 239.60 per 100 000, and the annual mortality was 41.57 per 100 000 in 2009. The age-standardized incidence was 216.01 per 100 000, and the age-standardized mortality was 43.61 per 100 000 in the two years. Ischemic cerebral apoplexy exceeded half of all and had a highest constituent ratio. The incidence Increased with the age (χ2=1 095.11, Plt;0.001), while there was no significant difference between the male and female (χ2=2.367, P=0.124). Conclusion The incidence of cerebral apoplexy in Chengdu City is similar to the average incidence of our country, and the mortality is lower than that of the average mortality.
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.
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.