Objectives About 12.9-50% patients of SARS (Severe Acute Respiratory Syndrome), require brief mechanical ventilation (MV) to save life. All the reported principles and guidelines for therapy SARS were based on experiences from clinical treatments and facts of inadequacy. Neither prospective randomized controlled trials (RCT) nor other high quality evidences were in dealing with SARS. Our objective is to seek safe and rational non-drugs interventions for patients with severe SARS by retrospectively reviewing clinical studies about MV all over the world, which include clinical guidelines, systematic reviews (SR), Meta-analysis, economic researches and adverse events. Methods To search MEDLINE and Cochrane Library with computer. According to the standards of inclucion or exclusion, the quality of the article which as assessed, and relevant data which were extracted double checked. The Meta-analysis was conducted if the studies had no heterogeneity. Results 14 papers were eligible. Due to the significant heterogeneity between these studies, further Meta-analysis could not be conducted, and the authors’ conclusions were described only. Conclusions The outcome of PPV is better than that of VPV. Patients who underwent PPV had a significantly lower mortality than that of VPV. Of course, the volutrauma should be watched. With low tidal volume and proper PEEP, or decreased FiO2, even permissive hypercapnia, the mortality and length of stay were cut down. Non-invasive mechanical ventilation (NIMV) was effective in treating haemodynamical stable patients, minimizing complications and reducing medical staff infection. Patients with serious dyspnea with PaO2/FiO2lt;200, no profit of NIMV, or couldn’t tolerance hypoxaemia were unlikely to benefit from this technique and needed ventilation with endotracheal intubation. Prone position could improve PaO2/FiO2, NO maybe increased pulmonary perfusion, improved V/Q, and raised oxygenation. Furthermore, Inhaled NO sequentially (SQA) was better than Inhaled NO continuouly (CTA). Some studies implied that practice of protocol-directed weaning from mechanical ventilation implemented by nurses excelled that of traditional physician-directed weaning.
针刺平行随机对照试验通常没有准确报告试验组和对照组的干预方法.为促进标准化,国际上有经验的针刺医师和研究者组成的小组制定了一些原则,即针刺临床对照试验中干预措施报告的标准(缩写为STRICTA).在征求意见过程中,一些期刊编辑协助对此标准进行了修改,使之与随机对照试验报告的标准(CON-SORT)格式一致,作为该指南对针剌研究报告的延伸.参与此事的杂志编辑已确定要发表该标准,建议其作者群按照此标准准备论文,并将邀请更多杂志采用该标准.目的是使针剌对照试验的干预措施充分报告,从而有利于对这些研究的严格评价、分析及这些措施的推广.
ObjectiveTo introduce a Bayesian meta-analysis method for quantitatively integrating evidence from both randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs), using concrete examples and R code, thereby supporting the combined utilization of both study types in empirical research. MethodsUsing a meta-analysis on the association between low-dose methotrexate exposure and melanoma as an example, we employed the jarbes package in R to conduct both a traditional Bayesian meta-analysis and a Bayesian nonparametric bias-correction meta-analysis model for quantitative integration. The differences between the two pooled results were then compared. ResultsThe traditional Bayesian meta-analysis indicated a posterior probability of 99% that low-dose methotrexate exposure increases melanoma risk. The Bayesian nonparametric bias-correction meta-analysis model showed a posterior probability of 92% that low-dose methotrexate exposure increases melanoma risk. ConclusionCompared to the traditional Bayesian meta-analysis model, the nonparametric bias-correction meta-analysis model is more suitable for quantitatively integrating evidence from RCTs and NRSIs, demonstrating potential for broader application. However, the comparability between the two evidence bodies should be carefully assessed prior to quantitative integration.
Objectives To systematically review the efficacy of multimodal nonpharmacological interventions in mild cognitive impairment (MCI). Methods An electronically search was conducted in PubMed, EMbase, The Cochrane Library, PsycINFO, Web of Science, CINAHL, VIP, CBM, WanFang Data and CNKI databases from inception to November 2017 to collect randomized controlled trials (RCTs) on multimodal nonpharmacological interventions for MCI. 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. Results A total of 12 RCTs involving 1 359 patients were included. The results of meta-analysis showed that there were no statistical differences between two groups in MMSE scores (SMD=0.33, 95%CI–0.13 to 0.78, P=0.16). However, the MoCA scores (SMD=0.52, 95%CI 0.38 to 0.67, P<0.000 01) and ADAS-Cog scores (SMD=1.13, 95%CI 0.75 to 1.51, P<0.000 01) in the multimodal nonpharmacological interventions group were better than those in the control group. Additionally, multimodal nonpharmacological interventions produced significant effects on ADL (SMD=–0.64, 95%CI –0.83 to–0.45, P<0.000 01), QOL-AD (MD=3.65, 95%CI 1.03 to 6.27, P=0.006) and depression (SMD=–0.83, 95%CI –1.41 to–0.26, P=0.005). There were no statistical differences between two groups on conversion rate to Alzheimer's disease (RR=0.27, 95%CI 0.06 to 1.26, P=0.10). Conclusions The current evidence shows that multimodal nonpharmacological interventions are feasible for patients with MCI as they have positive effects on overall cognitive abilities, daily living skills, and quality of life and depression. Nevertheless, due to the limited quantity and quality of included studies, more high quality studies are required to verify the conclusion.
Post operational recovery from cardiac surgery can be affected by many factors, including preoperative, intraoperative, and postoperative factors. Prolonged mechanical ventilation (PMV) , one of the major complications, has been widely accepted as a measure to evaluate the performance and outcomes of cardiac surgeries. Great progress has been made in the studies of risk factors contributing to PMV following cardiac surgeries in recent years. However, no clear and effective measures and approaches are available yet to prevent PMV. In this review, the authors try to summarize the risk factors that are associated with PMV throughout the perioperative period of cardiac surgery, as well as possible interventions when applicable.
ObjectivesTo systematically review the efficacy of seven types of cognitive interventions for older adults with mild to moderate Alzheimer's Disease (AD).MethodsWe searched The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, VIP and CBM databases to collect randomized controlled trials on cognitive interventions for mild to moderate Alzheimer's Disease (AD) from inception to January 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. STATA 14.0 software was then used to perform a meta-analysis.ResultsA total of 49 randomized controlled trials (RCTs) were included. The results of network meta-analysis revealed that each cognitive intervention had significantly improved the cognitive ability of AD patients. Specifically, nursing intervention (NI) (MD=3.01, 95%CI 1.70 to 4.50, P<0.005) was the most effective enhancer of cognitive ability, followed by music therapy (MT) (MD=2.60, 95%CI 0.96 to 4.30, P<0.001), physical exercise (PE) (MD=2.4, 95%CI 1.0 to 3.9, P<0.001), cognitive rehabilitation (CR) (MD=2.3, 95% CI 0.92 to 3.7, P=0.013), cognitive simulation (CS) (MD=1.7, 95%CI 1.2 to 2.3, P=0.037), computerized cognitive training (CCT) (MD=1.6, 95%CI 0.42 to 2.8, P<0.001), and pharmacological therapies (PT) (MD=1.5, 95%CI 0.24 to 2.8, P=0.041).ConclusionsThe seven types of cognitive interventions are helpful in improving the cognitive ability of Alzheimer's patients, and nursing intervention is the most effective cognitive intervention. Moreover, non-pharmacological therapies may be better than pharmacological therapies.
Traditional Chinese medicine (TCM) is a treasure of the Chinese nation. Presence of clinical effects represents a fundamental issue for TCM development. Nevertheless, the complexities of TCM interventions often result in presented effects deviating from expected ones, a phenomenon so called as "effect off-target"; this issue has become a major challenge for the development and use of TCM interventions. In continuing efforts, we have proposed an innovative evidence-based medicine model for studying the effects of TCM interventions, termed "systems evidence-based medicine (sysEBM)". Essentially, the sysEBM model integrates clinical and non-clinical evaluation to develop a systematic pathway for studying effects of TCM interventions, and the methodological steps typically include the development of PICO framework for a putative effect, exploration of the effect and confirmation of the effect by using animal models, observational studies and clinical trials. As an additional step, multidisciplinary technologies including pharmaceutical, pharmacological, information and biological technologies will be used to provide multidimensional analyses of potential action networks and mechanisms of TCM interventions. Building on this concept, we have developed a sysEBM model ("6R" model) for acupuncture and marketed Chinese patent medicines by integrating real-world evidence, clinical trials, evidence syntheses, and rapid recommendation methodologies, as well as information technology and biomedical technologies. We also applied this model for developing TCM interventions for maternal health, critical care, and knee osteoarthritis.
ObjectiveTo learn the status quo and characteristics of multi-drug resistant organism (MDRO) infection in a comprehensive hospital of the first grade in Sichuan Province, analyze the effect of prevention and control intervention, in order to provide a scientific basis for clinical MDRO prevention and control. MethodsWe collected MDRO data from January to June 2014 and from January to June 2015 through multi-drug resistance reporting software, and analyzed and compared the infection of MDRO during those two time periods. Then, we evaluated the prevention and control effect of MDRO infection. ResultsThe number of inpatients from January to June 2014 was 24709, among which 813 were detected with MDRO infection. Of those infected patients, 196 had nosocomial infection of MDRO and the other 617 had community infection/colonization. The proportion of nosocomial MDRO infection was 24.10%. The MDRO nosocomial infection case rate was 0.79%. The proportion of community MDRO infection/colonization was 75.90%. The number of inpatients from January to June 2015 was 25329, and 739 of them were found with MDRO infection, of whom 132 had nosocomial infection and 607 community infection/colonization. The proportion of nosocomial MDRO infection was 17.86%. The MDRO nosocomial infection case rate was 0.52%. The proportion of community infection/colonization was 80.14%. Compared with the first half of 2014, the proportion of nosocomial MDRO infection was lower with a statistically significant difference (χ2=9.062, P<0.001), and MDRO nosocomial infection case rate was also significantly lowered (χ2=14.220, P<0.001). There were significant differences between the first half of 2015 and the same period of 2014 in hospital department distribution of MDRO infection, patient infection site distribution and pathogen detection. ConclusionThe nosocomial MDRO infection control situation of our hospital is improved after the comprehensive prevention and control interventions, and we should focus on the prevention and control of key departments, important infection sites and major resistant bacteria in the future MDRO hospital infection control work.
Objective To explore the effect of multimodal interventions in improving the compliance rate of core infection control measures on reducing the incidence rate of vessel catheter associated infection (VCAI). Methods Inpatients with intravascular catheters in 5 departments with high rates of vascular catheterization and infection of Dongguan People’s Hospital between January 2021 and December 2022 were selected. According to the hospital stay, patients were divided into a pre-intervention group (January to December 2021) and a post-intervention group (January to December 2022). The core infection control measures assessment pass rates of medical staff between the two periods and the differences in the incidence rate of VCAI, average catheterization days, and catheterization rate before and after intervention in both groups were compared. Results A total of 8174 patients were included. Among them, there were 3915 patients in the pre-intervention group and 4259 patients in the post-intervention group. In the pre-intervention group, the total length of hospital stay was 122885 days, the total number of catheterization days was 48028 days, and 28 cases of VCAI occurred. In the post-intervention group, the total length of hospital stay was 126966 days, the total number of catheterization days was 51253 days, and 12 cases of VCAI occurred. After intervention, the compliance rate of VCAI core infection control measures was improved [69.21% (2907/4200) vs. 91.24% (3832/4200); χ2=642.090, P＜0.001], the pass rate of medical staff’s core infection control measures assessment was improved [53.33% (128/240) vs. 91.67% (220/240); χ2=88.443, P＜0.001], the catheterization rate was increased [39.08% (48028/122885) vs. 40.37% (51253/126966); χ2=42.979, P<0.001], and the incidence rate of VCAI was reduced [0.58‰ (28/48028) vs. 0.23‰ (12/51253); incidence-rate ratios =0.40, 95% confidence interval (0.20, 0.79), P=0.008]. Conclusions Improving the compliance rate of VCAI core infection control measures through multimodal interventions can significantly improve the passing rates of core infection control measures of medical staffs. This will help to reduce the incidence of VCAI and ensuring patient safety, provide evidence-based support for the prevention and control of VCAI.