癌症幸存者体力活动的最佳证据总结

目的:评价与总结国内外癌症幸存者体力活动相关的最佳证据。方法:系统检索中国知网、万方数据库、维普数据库、中国生物医学文献数据库、Cochrane Library、Embase、PubMed、Web of Science、Springer、ProQuest、美国国立指南库、加拿大医学协会临床实践指南、新西兰指南协作组、国际指南网络、英国国家医疗保健优化研究所、苏格兰校际指南网络、安大略注册护士协会、澳大利亚JBI循证卫生保健中心、澳大利亚运动与体育科学协会、中国抗癌协会等国内外数据库、指南网站以及专业协会网站中关于癌症幸存者体力活动的所有指南、证据总结、推荐实践、专家共识及系统评价,检索时限为建库至2019年12月31日。由3名研究者对文献质量进行评价和证据提取。结果 :共纳入10篇文献,包括2部指南、1篇证据总结、1篇专家共识、6篇系统评价。从体力活动的益处,体力活动前评估,体力活动总量,体力活动方式、强度、频率与时间,体力活动的安全性及增加体力活动依从性的策略6方面汇总证据,最终总结10条最佳证据。结论 :癌症幸存者体力活动的证据较为全面,医疗机构和临床医务人员可结合机构环境,将证据进行转化和应用,开展体力活动实践,制定癌症幸存者体力活动方案,提高癌症幸存者体力活动水平,以改善其生命质量。     

国外最佳肠造口临床实践指南健康教育推荐意见的分析研究

[目的]提取、整合并分析国外肠造口临床实践指南健康教育推荐意见。[方法]检索并评价国外肠造口专科护理临床实践指南,提取、整合A级指南中的健康教育推荐意见,邀请专家对健康教育推荐意见合理性进行评价,并对整合后的健康教育推荐意见进行内容分析。[结果]共纳入5篇质量为A级的国外肠造口专科护理临床实践指南,提取70条推荐意见,纳入66条健康教育相关推荐意见,整合33条健康教育推荐意见。[结论]国外肠造口病人健康教育方面涉及内容较为全面,证据质量等级较高,对我国肠造口病人的健康教育实践具有一定参考价值。     

输血护理时限管理相关指南的质量评价及内容分析

目的 系统检索及评价输血护理时限管理相关指南及其质量并提取内容,为临床开展输血护理时限管理工作提供参考。方法 系统检索国内外数据库以及指南网站和输血相关协会网站,检索时限为建库至2023年5月5日。收集输血护理时限管理相关的临床指南,采用AGREEⅡ指南评价工具评价指南的方法学质量,并提取指南中输血护理时限管理相关推荐内容。结果 纳入1篇中文指南,5篇英文指南,共6篇。AGREEⅡ评价得出A级指南2篇,B级指南4篇。分析整合为6个推荐主题：人员管理、信息管理、领血和转运、工具设备使用、输注速度和时间管理、退血规定。结论 本研究通过系统检索输血时限管理相关临床实践指南,整体质量较好,指南推荐意见整合32条内容为输血护理时限管理临床实践提供参考依据。     

预防结直肠癌术后肠梗阻临床实践指南的质量评价与内容分析

目的:对预防结直肠癌术后肠梗阻临床实践指南进行质量评价及内容分析,为我国预防结直肠癌术后肠梗阻的实践提供参考。方法:检索苏格兰院际指南网、国际指南协作网、新西兰指南工作组等指南网站,检索促进术后恢复学会、美国结肠和直肠外科医师学会、美国胃肠病学会等肠梗阻相关网站,检索PubMed、Web of Science、中国知网、万方数据知识服务平台等数据库发布的结直肠癌术后肠梗阻相关指南,检索时限为2011年1月1日—2021年12月1日。由2名研究者独立对文献进行筛选和资料提取,采用临床指南与评价系统Ⅱ(AGREEⅡ)对指南进行评价,汇总分析预防结直肠癌术后肠梗阻的推荐内容。结果:共纳入相关指南5篇,纳入指南的总体质量评价为2篇A级、3篇B级。AGREEⅡ中6个领域平均标准化得分分别为范围和目的85.55%、参与人员67.78%、严谨性70.00%、清晰性86.67%、应用性53.33%、独立性78.33%。通过内容分析,最终出两大主题、29条推荐意见。结论:纳入的5篇指南总体质量一般,评价分析后得到的预防结直肠癌术后肠梗阻的部分推荐意见内容宽泛,需要不同程度的完善。     

口腔护理临床实践指南的质量评价及内容分析

目的:对国内外成人口腔护理相关临床实践指南进行质量评价和内容分析,以了解当前成人口腔护理相关临床实践指南的研究现状,为构建适合我国本土人群的成人口腔护理临床实践指南提供方法学和内容参考。方法:计算机检索电子数据库和相关指南网站,检索时限均为从建库至2017年5月,纳入公开发表的口腔护理相关临床实践指南。采用AGREEⅡ对纳入指南进行质量评价,利用NVivo 11软件对纳入指南进行内容分析。结果:共纳入12篇英文指南。纳入指南在AGREEⅡ6个领域平均得分由高到低依次为:范围和目的、清晰性、严谨性、参与人员、应用性和编辑独立性。经内容分析,最终提取出护理管理、护理教育、护理实践(评估、用物准备、实施、评价以及记录)三个方面,共11个大类,38项内容。结论:成人口腔护理临床实践指南的制定在严谨性、参与人员、应用性和编辑独立性四个方面有待提高。我国目前缺乏基于循证的高质量的口腔护理临床实践指南。     

妊娠期女性身体活动指南的质量评价及内容分析

目的 对国外妊娠期女性身体活动指南进行质量评价及内容分析,以期为我国妊娠期女性身体活动推荐意见、指导方案及指南的形成提供借鉴。方法 检索指南网站及数据库发布的妊娠期女性身体活动相关指南。2名研究者独立进行资料提取,2名评价者独立对指南进行评价。使用内容分析法汇总指南推荐意见。结果 共纳入10部指南,其中3部专家共识,7部循证指南。循证指南中A级3部,B级4部,AGREEⅡ的6个领域平均标准化得分依次为：范围和目的（92%）、清晰性（81%）、参与人员（81%）、独立性（73%）、应用性（68%）、严谨性（61%）。评价者间ICC得分均>0.75。内容分析总结出适用对象、禁忌证、活动处方、活动举例、活动警告信号、活动注意事项及特殊孕妇活动策略7方面的内容。结论 妊娠期女性身体活动相关指南质量较高,内容丰富,指导性强,可为我国妊娠期女性身体活动相关推荐意见、指导方案及指南的形成提供一定的借鉴。但在借鉴国外指南的内容时,需根据我国妊娠期女性身体素质、文化背景、社会环境等对推荐的内容进行具体分析。     

急性缺血性脑卒中后预防静脉血栓栓塞相关临床实践指南的质量评价和内容分析

[目的]对国内外急性缺血性脑卒中后静脉血栓栓塞预防的相关临床实践指南进行质量评价和内容分析,为制定急性缺血性脑卒中循证护理实践方案提供一定依据。[方法]检索相关数据库及指南网站中急性缺血性脑卒中后预防静脉血栓栓塞的相关临床实践指南,采用AGREEⅡ工具对纳入指南进行质量评价。[结果]共纳入9个指南,质量等级评价结果为5个A级、4个B级;纳入指南共综合了推荐意见12条,包括风险筛查、预防措施、知识培训与健康教育3个方面。[结论]纳入指南总体质量较高,但亟须构建以护理手段为主导的关于急性缺血性脑卒中病人预防静脉血栓栓塞的循证护理实践方案。     

危重患儿口腔护理相关临床实践指南的质量评价及内容分析

目的:评价危重患儿口腔护理相关临床实践指南的质量,为危重患儿口腔护理实践提供建议。方法:计算机检索国内外电子文献数据库、指南网站及相关专业协会网站中与危重患儿口腔护理相关的临床实践指南,检索时限为2009年1月1日至2021年1月1日。采用临床指南研究与评估工具（AGREE Ⅱ）对指南进行质量评价,对纳入指南的推荐意见...     

顺产产妇会阴损伤预防与修复护理最佳证据总结

目的 :总结顺产产妇会阴损伤预防与修复护理相关最佳证据,为产科护士及助产士的临床决策提供参考。方法 :系统检索与筛选专业团体网站、临床实践指南网站、数据库的会阴损伤预防与修复相关循证指南,采用AGREEⅡ对其进行方法学质量评价,选取其中的A级指南进行推荐意见的提取、翻译,B级指南予以排除;之后按照一定的原则对内容相同或相似的推荐条目进行综合;最后通过专家论证,遴选出适宜我国国情的护士及助产士权限范围内的推荐意见。结果 :共检索出国内外331篇文献,符合指南初筛纳入排除标准的指南为7部,AGREEⅡ评价后显示4部为A级,3部为B级;仅对4部A级指南的推荐意见进行提取,共得到92条推荐意见,按照相应的原则将推荐意见综合后得到63条最佳证据;专家论证后发现其中27条最佳证据属于我国护士及助产士权限范畴。结论:会阴损伤预防与修复的证据较为丰富,护士及助产士权限范围内的证据涉及范围较广但数量有限,有必要进行更多的实践探索及科学研究来丰富护理及助产领域的相关证据。     

基于指南的护士倒班睡眠障碍性失眠诊疗的证据总结

目的:总结睡眠障碍性失眠相关指南的最佳证据,为护士倒班睡眠障碍性失眠人员提供诊疗干预意见。方法:系统检索临床实践指南网站、专业团体网站、中英文数据库的睡眠障碍性失眠相关循证指南,应用临床指南研究与评价系统(AGREEⅡ)对指南进行质量评价,遴选高质量指南进行推荐意见的提取、翻译及合并整理。结果:共检索出24篇相关文献,符合纳入标准的指南共5部,根据AGREEⅡ评价结果显示5部指南质量均较好,提取得到54条推荐意见。按照相应的原则将推荐意见合并,得到11条最佳证据;专家论证后认为合并整理后的意见可用于护士倒班睡眠障碍性失眠的诊疗。结论:总结护士倒班睡眠障碍性失眠诊疗相关证据,建议护士针对性应用证据,以利于早期发现、早期干预倒班睡眠障碍。     

Routine surveillance care after cancer treatment with curative intent

BACKGROUND: Many consensus guidelines recommend routine surveillance to detect recurrent disease among cancer survivors. We compare surveillance care receipt to guideline recommendations. METHODS: Cohorts of patients aged 30 years or older diagnosed with breast, colorectal, endometrial, lung, or prostate cancer between 1990 and 1995 and treated with curative intent were identified (n = 100 per site). Receipt and indications for examinations and procedures were abstracted from medical records for as long as 5 years after treatment. Kaplan-Meier product estimates were used to estimate time to initial and subsequent service receipt. RESULTS: Most cancer patients received the recommended minimum number of physical examinations after treatment. In fact, a sizable number of cancer survivors received physical examinations at a frequency in excess of what is currently recommended. Similarly, most of these cancer survivors received recommended testing for local recurrence. Yet, less than two thirds of colorectal cancer patients received recommended colon examinations in the initial year after treatment. Among colorectal, lung, and prostate cancer patients who received recommended initial local recurrence testing, repeat testing tended to occur more frequently than what is currently recommended. The use of testing for metastatic disease that is not recommended in guidelines is also commonplace among these cancer survivors. CONCLUSIONS: Among cohorts of cancer patients, we found wide variation in the use of surveillance care, including patterns of care receipt reflective of both underuse and overuse relative to guideline recommendations. Clinical reasons for these variations and the cost and health implications deserve further study.     

Review and critique of the quality of exercise recommendations for cancer patients and survivors

The benefit of exercise for cancer patients is starting to become recognized. The purposes of this paper were to review the literature to examine whether research findings are being converted into guidelines for patients and survivors and to examine the quality of evidence on which they were based. A computer search of major health databases was conducted for peer-reviewed literature and books on exercise and cancer, and an Internet search was conducted for cancer websites reporting any exercise guidelines/recommendations for cancer patients. Seven peer-reviewed articles, eight books and eight cancer websites were identified that suggested exercise guidelines for cancer patients and survivors. None of the published guidelines identified appeared to have been developed via a process that would allow them to be cited as evidence-based guidelines. Based on the studies to date, no direct cancer-specific evidence about the best type, frequency, duration or intensity of exercise is currently available in the peer-reviewed literature. It is currently not known what would be most beneficial for which cancers, at which stage of disease or treatment. Given the current interest in cancer and exercise, there is an urgent need for an evidence-based set of exercise guidelines to be developed.     

基于GRADE康复临床实践指南证据质量与推荐强度研究

目的 分析康复临床实践指南的GRADE结果。方法 在PubMed、EMBASE、中国知网(CNKI)、中国生物医学文献数据库(CBM)和万方等数据库以及指南相关网站检索康复医学临床指南,检索时限均为建库至2020年1月11日。由2名研究员独立筛选采用GRADE系统的指南,并对GRADE分级结果进行提取分析。结果 共纳入康复临床实践指南83篇,其中46篇(55.4%)应用分级系统,采用GRADE分级系统的指南仅4篇(4.8%),包含44条推荐意见,其中39条(88.6%)具有明确的证据质量。在推荐意见所引用证据中,低质量证据最多(34.1%);在推荐意见中,弱推荐较多(56.8%)。强推荐支持证据的质量高于弱推荐(χ² = 8.218, P < 0.05)。 结论 康复临床实践指南对GRADE分级系统的应用仍待提高。建议指南制订者进一步掌握指南和GRADE方法学,更有效地改善康复临床实践指南的可靠性和应用性。     

ICU气管插管患者拔管指南的质量评价与内容分析

目的 对ICU气管插管患者拔管相关指南进行质量评价和内容分析,为国内指南的制订提供循证依据.方法 系统检索国内外指南网站、相关专业学会网站及中英文数据库,检索时限为建库至2021年8月,并根据纳入和排除标准进行文献筛选.2名研究者采用质量评价工具对纳入的指南进行质量评价,并对相应的推荐意见进行汇总分析.结果 最终纳入8...     

围产期哀伤辅导指南的系统评价

目的 对国内外围产期哀伤辅导相关指南进行质量评价和内容分析,汇总推荐意见。 方法 系统检索国内外权威指南网站、专业协会网站、中英文数据库及谷歌搜索引擎中围产期哀伤辅导指南,检索时限为2010年1月—2020年8月。4名研究者采用临床指南研究与评估工具Ⅱ对符合纳入和排除标准的指南独立进行质量评价,汇总围产期哀伤辅导的推荐意见。 结果 共纳入5篇指南,质量评价6个领域的平均标准化得分分别为:范围和目的91.11%、参与人员90.55%、制订的严谨性73.24%、清晰性与可读性81.67%、应用性60.00%和编辑的独立性60.83%。指南总体质量评价为l篇A级,4篇B级。经提取与整合,最终得出5个阶段、32条围产期哀伤辅导推荐意见。 结论 国内外围产期哀伤辅导指南数量较少,指南的总体质量有待提高,内容有待细化。可以将国际上的指南与国内的临床情境相结合,筛选基于证据的推荐意见并将其本土化,指导国内围产期哀伤辅导工作的开展。     

Systematic Review of Clinical Guidelines Related to Care of Individuals With Cerebral Palsy as Part of the World Health Organization Efforts to Develop a Global Package of Interventions for Rehabilitation

ObjectiveThe World Health Organization’s (WHO) Rehabilitation 2030 initiative is working to develop a set of evidence-based interventions selected from clinical practice guidelines for Universal Health Coverage. As an initial step, the WHO Rehabilitation Programme and Cochrane Rehabilitation convened global content experts to conduct systematic reviews of clinical practice guidelines for 20 chronic health conditions, including cerebral palsy.Data SourcesSix scientific databases (Pubmed, EMBASE, Scopus, Web of Science, PEDro, CINAHL), Google Scholar, guideline databases, and professional society websites were searched.Study SelectionA search strategy was implemented to identify clinical practice guidelines for cerebral palsy across the lifespan published within 10 years in English. Standardized spreadsheets were provided for process documentation, data entry, and tabulation of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Each step was completed by 2 or more group members, with disagreements resolved by discussion. Initially, 13 guidelines were identified. Five did not meet the AGREE II established threshold or criteria for inclusion. Further review by the WHO eliminated 3 more, resulting in 5 remaining guidelines.Data ExtractionAll 339 recommendations from the 5 final guidelines, with type (assessment, intervention, or service), strength, and quality of evidence, were extracted, and an International Classification of Functioning, Disability and Health Functioning (ICF) category was assigned to each.Data SynthesisMost guidelines addressed mobility functions, with comorbid conditions and lifespan considerations also included. However, most were at the level of body functions. No guideline focused specifically on physical or occupational therapies to improve activity and participation, despite their prevalence in rehabilitation.ConclusionsDespite the great need for high quality guidelines, this review demonstrated the limited number and range of interventions and lack of explicit use of the ICF during development of guidelines identified here. A lack of guidelines, however, does not necessarily indicate a lack of evidence. Further evidence review and development based on identified gaps and stakeholder priorities are needed.     

慢性肾脏病患者妊娠管理相关指南的质量评价及内容分析

目的 系统评价慢性肾脏病患者妊娠管理相关临床指南,为制订慢性肾脏病患者妊娠管理规范提供依据。方法 检索国内外文献数据库、专业学会网站和指南发布主要网站。由2名研究者独立进行文献的筛选和资料提取后,分别使用AGREEⅡ和澳大利亚JBI循证卫生保健中心专家共识评价标准评价循证指南和专家共识指南,并比较分析各指南的推荐内容。结果 共纳入9篇相关临床指南,其中循证指南3篇,专家共识指南6篇。循证指南均来自国外,l篇循证指南的总体质量评价为A级,2篇为B级,指南整体质量较高;基于专家共识的指南6篇,总体评价结果均为“纳入”。最终总结的慢性肾脏病患者妊娠管理相关推荐意见涉及孕前咨询与管理、妊娠期管理（涉及血压、饮食、随访）、产后管理3个方面26条推荐意见。结论 纳入的慢性肾脏病患者妊娠管理相关指南质量整体较高,但部分争议性问题有待进一步研究,需尽快开发适合我国慢性肾脏病患者妊娠管理循证指南。     

食管癌临床指南和共识的质量评价

目的评价食管癌临床指南和共识的方法学质量和报告质量。方法计算机检索PubMed、EMbase、Web of Science、CBM、WanFang Data和CNKI数据库,同时补充检索GIN、NICE、NGC和医脉通网站,搜集食管癌相关的临床指南和共识,检索时限均从建库至2018年8月。由2位评价员按照纳入与排除标准独立筛选文献和提取资料后,采用AGREEⅡ和RIGHT工具对纳入指南的质量进行评价。结果共纳入食管癌指南和共识26个。AGREEⅡ各领域平均得分分别为:范围和目的 49.63%、参与人员25.16%、制订严谨性23.42%、清晰性49.25%、应用性16.91%和编辑独立性21.07%;RIGHT评价条目中报告率最高的条目为5(84.62%),其次为1a(80.77%)、1c(65.38%)、13a(65.38%)、4(61.54%),其余条目报告率均在50%以下。亚组分析结果显示:基于循证医学方法制订的指南和共识在AGREEⅡ的6个领域和RIGHT评分平均得分均高于基于专家意见或综述等制订的指南和共识;国外指南和共识在AGREEⅡ的3个领域(制订严谨性、清晰性、编辑独立性)和RIGHT评分平均得分均高于国内指南和共识。结论食管癌临床指南和共识的方法学质量和报告质量均偏低,尤其是我国指南和共识更低,需进一步提高。建议指南制订者参考AGREEⅡ和RIGHT等标准,制订出高质量的指南并推广应用,更好地规范化食管癌的诊疗。     

Emerging and Ongoing Survivorship Challenges Among Childhood Cancer Survivors and Providing Risk-Based Focused Follow-Up Care

ObjectivesTo provide a summary of the emerging and ongoing survivorship challenges facing childhood, adolescent, and young adult cancer survivors and their families.Data SourcesResearch and review articles, websites, and clinical guidelines specific to childhood cancer survivorship were used.ConclusionMany challenges exist in assuring quality long-term follow-up and risk-based screening for childhood cancer survivors. Although many childhood cancer survivors survive well into adulthood, they are at risk for a vast number of later complications of their cancer treatment necessitating annual cancer surveillance. In addition, many childhood cancer survivors are not engaging in long-term follow-up recommendations for clinic attendance, risk-based surveillance, and screening for potentially life-ending events. Pediatric oncology nurses and advanced practice nurses have played an enormous role in the design of childhood cancer survivorship programs and are an integral member of the multidisciplinary health care team who care for this population. Nurses have an obligation to continue to advance the survivorship care of childhood cancer survivors and lead interventional opportunities to improve the lifelong health-related quality of life and overall physical health.Implications for Nursing PracticePediatric oncology nurses and advanced practice registered nurses must have a working knowledge of the many late effects that childhood cancer treatment has on the long-term health of childhood cancer survivors. Nurses are well-placed in positions to continue the efforts begun more than 2 decades prior by pediatric oncology nurses who saw the value and necessity of designated survivorship programs.