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.
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.
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.
【摘要】 目的 分析无面部血管瘤的Sturge-Weber综合征（SWS）的临床特点。 方法 2008年10月收治1例女性患儿，8岁，因发作性四肢强直入院，患儿无面部血管瘤及眼部异常，仅表现为癫痫。患儿接受丙戊酸钠抗癫痫治疗。 结果 患儿经头部CT、MRI确诊为无面部血管瘤的SWS。抗癫痫治疗后随访12个月，未再发癫痫，智力发育无减退，未出现瘫痪、蛛网膜下腔出血、脑出血、脑卒中样发作等。 结论 无面部血管瘤的SWS确诊依靠头部CT及MRI，治疗方法为药物抗癫痫治疗。复习文献得出无面部血管瘤的SWS患者临床表现不同于有面部血管瘤者，多仅表现出癫痫发作，且药物治疗有效，无需手术切除病灶，预后较好。【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.
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.