非药物干预对化疗所致恶心呕吐影响的系统评价再评价

目的 对化疗所致恶心呕吐的非药物干预措施进行系统评价再评价。方法 检索有关非药物干预防治化疗所致恶心呕吐的系统评价或Meta分析文献。检索数据库包括中国知网、万方全文数据库、维普全文数据库、中国生物医学文献数据库、Cochrane Library、卫生保健及护理学数据库(CINAHL)、Embase、Pubmed,检索时间为建库至2022年6月30日。筛选文献后,提取纳入文献的相关资料,并评价分析其方法学质量和证据质量。结果 共纳入19篇系统评价文献,其中中质量等级4篇,低质量等级8篇,极低质量等级7篇。文献共评价8种非药物措施的证据,其中穴位刺激对化疗所致恶心呕吐的积极影响最为显著。结论 通过对目前已发表的系统评价再评价发现,非药物干预可尝试作为临床或居家管理化疗所致恶心呕吐的辅助手段,其中穴位刺激可优先考虑。但纳入文献的方法学质量不高、证据等级偏低,其效果仍需进一步验证。     

脑卒中患者远程康复运动管理有效性及安全性的系统评价再评价

目的 检索、再评价脑卒中患者远程康复运动管理的系统评价,为临床医护人员临床决策及康复运动干预策略的持续改进提供借鉴。 方法 计算机检索Cochrane Library、Embase、PubMed、Web of Science、CINAHL、澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute,JBI）循证卫生保健中心数据库以及万方数据库、中国知网、维普数据库和中国生物医学文献数据库,查找关于脑卒中患者运动功能远程康复管理相关的系统评价/Meta分析/荟萃分析,检索时限为建库至2021年9月19日。2名经过循证知识系统培训的研究人员应用系统评价方法学质量评价工具（Assessment of Mutiple Systematic Reviews,AMSTAR）对文献进行方法学质量评价后,采用推荐分级的评估、制订与评价（Grades of Recommendations Assessment,Development and Evaluation,GRADE）系统进行证据汇总与分级。 结果 初检文献124篇,纳入文献14篇,AMSTAR质量评价结果显示,中等质量文献有5篇,其余9篇为高等质量,纳入文献的整体方法学质量较高。采用GRADE系统对14篇系统评价的67条主要结局指标的证据质量评价结果显示,22条证据为中等质量,29条证据为低等质量,16条证据为极低质量。 结论 该研究纳入的系统评价方法学质量较高,但其结局指标证据质量较低。远程康复运动管理有利于改善患者的运动功能、生活自理能力及生活质量,可提高患者的满意度与参与度,但远程运动管理干预方式的研究设计及结局指标的客观性仍需改进。     

脑卒中病人出院后有效社区管理的文献分析

[目的]综合分析与脑卒中有关的出院后有效社区管理的随机对照试验及系统评价,为卒中病人出院后进行有效的社区管理提供临床证据.[方法]应用计算杌检索Cochrane Library、Ovid MEDLINE、PubMed、中国期刊全文数据库（CNKI）、维普中文科技期刊数据库（VIP）、万方学术期刊等数据库,收集关于脑卒中病人出院后社区有效管理的随机对照试验（RCT）和系统评价,检索年限为2002年-2013年,按照纳入标准筛选文献、提取资料和评价质量后进行分析总结.[结果]共纳入13篇文献,其中11篇随机对照试验、2篇系统评价;4篇重点介绍了脑卒中病人出院后社区规范化管理的内容,7篇重点介绍了关于脑卒中病人出院后社区的康复治疗,2篇对脑卒中病人出院后规范化管理及康复进行了评价分析.[结论]对脑卒中病人进行有效的社区管理,能提高病人认知和行为水平,改善病人生活质量,降低医疗费用;有效的社区管理应建立家庭-社区-医院三级网络模式,完善健康档案,建立电话回访等流程.     

过渡期护理模式降低我国老年慢性病病人再入院率的系统评价

[目的]对应用过渡期护理模式降低我国老年慢性病病人再入院率进行系统评价。[方法]检索万方数据库、中国知网、Web of Science数据库中涉及我国老年慢性病病人采取过渡期护理模式的随机对照试验,检索时限为建库至2016年7月1日,严格按照纳入标准筛选文献、提取资料和评价质量。[结果]共纳入9篇文献,其中中文7篇,英文2篇;中等质量文献5篇,低质量文献4篇,共涉及2 442例病人;病人随访主要通过电话随访、家庭访问、门诊随访或其中两项相结合的方式进行,干预持续3个月~6个月时,再入院率降低,且干预效果稳定。[结论]应用过渡期护理模式干预3个月~6个月可降低我国老年慢性病病人的再入院率,但目前我国尚未形成系统的过渡期护理模式。     

健康推荐系统在癌症症状管理中应用的范围综述

目的 对健康推荐系统(health recommender systems, HRS)在癌症症状管理中的应用进行范围综述，为相关研究者构建HRS进行癌症患者症状管理提供参考。方法 遵循范围综述的方法学，2010年1月至2022年12月对Pubmed、Medline、中国生物医学文献数据库、中国知网等10个数据库中有关HRS在癌症症状管理研究的中英文文献进行检索、筛选、提取并总结。结果 共检索到文献4881篇，经筛选共纳入13篇。对纳入文献的发表时间、地点、干预对象、HRS的症状评估工具、功能模块、推荐步骤、数据来源、HRS评价中的评价指标进行了总结与分析。结论 HRS根据患者症状评估结果生成个性化症状自护建议，可改善患者症状管理效果，提高患者的生活质量；但目前癌症症状管理HRS开发缺乏理论框架支撑，推荐功能的智能化水平还有待提升，且临床推广应用不足。     

慢性病儿童家庭弹性干预的范围综述

目的 对慢性病儿童家庭弹性干预进行范围审查，以识别家庭弹性干预的干预要素和结局指标。方法 按照范围综述方法框架，检索了14个国内外数据库建库至2022年2月发表的中英文文献。筛选并纳入相关文献进行汇总和分析。结果 共纳入20篇文献，干预要素以增加社会和经济资源等家庭组织要素、提高情感分享及合作解决问题能力等家庭沟通要素为主。结局类型包括对慢性病儿童和家庭成员的效果评价及干预可行性指标。结论 家庭弹性干预以多要素结合的家庭弹性干预方案为主，对慢性病儿童及其家庭成员有积极影响。但存在参与者依从性低以及干预方案不够聚焦和系统全面、家庭弹性特色不足等问题，慢性病儿童家庭弹性干预研究还有待进一步完善。     

妊娠期糖尿病高危人群生活方式指导的最佳证据总结

目的 系统检索、评价并总结国内外有关妊娠期糖尿病（gestational diabetes mellitus,GDM）高危人群生活方式指导预防GDM的最佳证据,为临床医护人员指导GDM高危人群预防GDM提供循证证据。方法 系统检索BMJ Best Practice,Cochrane Library,医脉通指南网、英国国家卫生与临床优化研究所、国际糖尿病与妊娠研究组、PubMed,Web of Science,Science Direct,澳大利亚实践指南（Australian clinical practice guidelines,ACPG）、中国知网、万方、CBM数据库和相关协会网站中GDM高危人群生活方式指导的最佳证据。检索时限为2015年6月至2022年6月。由2名研究者分别对纳入的文献进行质量评价。结果 共纳入文献22篇,其中临床指南6篇,专家共识2篇,系统评价10篇,随机对照试验4篇。共总结了早期筛查、饮食指导、运动指导及体重管理指导四个方面17条最佳证据。结论 该证据总结可为临床医护人员对GDM高危人群进行生活方式指导及制定生活方式干预方案提供循证参考依据。     

脑卒中患者出院准备度管理的最佳证据总结

目的 检索、评价和总结脑卒中患者出院准备度管理的最佳证据,为临床医护人员制定护理实践方案提供参考。方法 检索中国知网、PubMed等国内外数据库,检索时限自建库至2023年7月,由2名循证护理研究者对纳入文献进行质量评价和证据提取。结果 共纳入18篇相关文献,包括2篇指南、9篇系统评价、1篇推荐实践、4篇随机对照试验、2篇类实验研究,文献整体质量较高。总结了入院启动出院准备服务、住院期间健康指导和心理干预、出院前家庭随访准备、出院后持续健康支持4个维度共30条最佳证据。结论 总结了脑卒中患者出院准备度管理的最佳证据,为临床构建提高脑卒中患者出院准备度干预方案提供循证依据。     

多阶段优化策略在慢性病多因素干预中应用的范围综述

目的 了解多阶段优化策略(multiphase optimization strategy, MOST)在慢性病多因素干预中的应用阶段及效果,以期为国内慢性病多因素干预模式构建及MOST持续完善提供思路。方法 按照范围综述的研究范式,系统检索8个中英文数据库中相关文献,检索时限自建库到2023年12月22日。结果 共纳入16篇文献,包括：癌症10篇,糖尿病2篇,高血压、急性冠状动脉综合征、心肺衰竭、哮喘各1篇;主要应用于心理问题、症状管理等需多个因素共同管理的复杂护理方案及健康教育宣传单的优化;主要优势为针对单一干预要素进行效果评价,劣势为缺乏客观性及科学标准的报告清单。结论 MOST在慢性病多因素干预中的应用尚处于起步阶段,各阶段研究方案有待进一步落实。未来应完善MOST并充分发挥其优势,促进慢性病多因素管理方案的切实可及。     

不孕女性体外受精⁃胚胎移植周期治疗不良心理应激评估与干预的最佳证据总结北大核心

目的:检索、评价并整合国内外关于不孕女性体外受精⁃胚胎移植周期治疗不良心理应激评估与干预的最佳证据。方法:系统检索指南库、专业学会及数据库中的指南、系统评价及原始研究,检索时限为建库至2022年12月15日,进行文献质量评价后,对证据进行提取和整合。结果:共纳入16篇文献,包括2篇指南、1篇专家共识、1篇Meta整合、6篇系统评价、6篇原始研究。总结了包括评估时机、评估工具、治疗前干预措施、治疗期间干预措施、治疗后失败干预措施、治疗后成功受孕干预措施6个方面的29条最佳证据。结论:医务人员应主动监测和精准识别不良心理应激高危人群,甄选可干预因素,确定最佳干预时机,制定相应的干预措施,根据本院实际情况将最佳证据总结应用于临床实践,以降低病人不良心理应激状态,提高其生育及生活质量,改善妊娠结局。     

冠状动脉粥样硬化性心脏病的遗传易感性

目的:概述冠状动脉粥样硬化性心脏病(简称冠心病)遗传易感性的研究进展,探讨冠心病的分子遗传学基础。资料来源:检索Pubmed及English Medical Current Contents(EMCC)数据库1990-01/2006-06关于冠心病分子遗传学研究的文献,检索词为“coronary artery disease,myocardial infarction,gene”。同时检索Chinese Medical Current Contents(CMCC)数据库2000-01/2006-06相关中文文献。资料选择:对检索结果进行初审,选取冠心病分子遗传学研究方面的信息进行整理,筛除明显不相关的或针对性不强的文章。资料提炼:进一步分析所选文献,收集整理关于冠心病和心肌梗死遗传易感性方面针对强且又可靠的文章49篇。资料综合:参考的49篇文章表明,冠心病是一种多病因、多因素的复杂疾病,其发病受复杂的环境因素及遗传因素的影响。遗传学基础在冠心病的发生发展中起着至关重要的作用。近年来,作为人类遗传学的核心技术,全基因组关联分析及大规模病例对照相关研究鉴定了一些与冠心病易感性相关的重要基因,这些基因涉及到血脂异常、内皮完整性、炎性因子的表达及免疫反应等方面。结论:易感基因或致病基因的检测为冠心病的发病机制研究提供了新的线索,这将有利于冠心病及心肌梗死的早期诊断、早期预防及特定基因个性化治疗。     

Predictors for health related quality of life in persons 65 years or older with chronic heart failure.

BACKGROUND: A main goal in nursing care of persons with chronic heart failure (HF) is to strengthen their health related quality of life (HRQoL). This presupposes knowledge about the relation between heart failure and HRQoL. Existing studies have shown incongruent results about whether HRQoL is affected differently depending on age or sex of elderly persons with chronic HF. AIM: This study aimed to investigate if age, sex, disease severity, comorbidity and living conditions predict health related quality of life among persons 65 years or older with chronic HF. METHODS: The study included a sample of 357 persons. HRQoL was measured by the Minnesota Living with Heart Failure Questionnaire and the Short Form-12 Health Survey Questionnaire. Multiple regression analyses were performed to analyse the relation between the predictors and HRQoL. RESULTS: The main finding was that self-rated disease severity was strongly associated with HRQoL, but also age, sex, diabetes and respiratory diseases was associated with some of the dimensions of HRQoL. CONCLUSIONS: Interventions aimed at delaying the progress of the disease, assist persons' to cope with the disease and maintain the domains of HRQoL that are still feasible could be important to improve HRQoL in elderly persons with chronic HF.     

基于文献计量学的慢性阻塞性肺疾病肺康复研究态势分析

目的：了解国际近十年慢性阻塞性肺疾病肺康复领域的研究现状，探讨研究热点与前沿，为相关学者提供借鉴与参考。方法：检索2010年～2019年Web of Science核心合集数据库收录的慢性阻塞性肺疾病肺康复相关文献，采用CiteSpace对国家/地区、机构、期刊、关键词和文献进行科学计量及可视化分析，并绘制科学知识图谱。结果：共纳入有效文献2010篇，文献发表量总体呈上升趋势。美国发文量最多，中国位于第8位；研究机构中，多伦多大学发文量最多；AM J RESP CRIT CARE为该领域高质量期刊。该领域研究方向涉及方面广泛，研究热点包括不同COPD分期患者肺康复、肺康复对COPD患者生活质量的影响、老年COPD患者肺康复方案的设计。研究前沿包括关注低体重COPD患者、COPD患者自我管理能力、医疗服务利用情况等。结论：慢性阻塞性肺疾病肺康复研究处于稳定发展阶段，研究内容不断丰富。未来可借鉴国际先进经验，促进我国研究发展。     

Mixed Study Systematic Review and Meta-analysis of Sexuality and Sexual Rehabilitation in LGBTQI+ Adults Living With Chronic Disease

ObjectiveTo systematically review how sexuality is experienced by lesbian, gay, bisexual, transgender, queer or questioning, intersex plus (other gender identifies and sexual orientations) (LGBTQI+) persons living with chronic disease.Data SourcesPsycINFO, Embase, MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health, and Web of Science were searched from date of inception to November 2021 for English language publications. Reference lists of relevant publications were also searched.Study SelectionEligible studies reported on sexuality among LGBTQI+ persons living with chronic disease. The search yielded 12,626 records; 665 full texts were assessed for eligibility and 63 documents included (59 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool.Data ExtractionCharacteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author.Data SynthesisA sequential, exploratory mixed-studies approach was used for synthesis. Pooled analysis indicated that among gay and bisexual men living with prostate cancer, 68.3% experienced erectile dysfunction and 62.9% had insufficient quality of erection to engage in anal sex. Among gay and bisexual men living with HIV or AIDS, 29.3% experienced loss of libido and 25.3% experienced erectile dysfunction. Although sexual dysfunction was common, LGBTQI+ persons had difficulty accessing appropriate sexual counseling and identified negative attitudes and heteronormative assumptions by health care providers as significant barriers to sexual health. Interventions to address sexuality focused entirely on reduction of risky sexual behavior among men living with HIV or AIDS. Women, transgender persons, and intersex persons were largely excluded from the research studies.ConclusionsCurrent understandings of the effect of chronic disease on LGBTQI+ sexuality are limited and mostly focus on the male sexual response. LGBTQI+ persons who experience difficulty with sexuality struggle to identify appropriate services, and there is an absence of evidence-based interventions to promote sexual health and well-being in this population.     

2010-2020年我国症状群研究领域的文献计量学分析

目的 分析我国症状群研究领域的研究现状和发展动态,为临床工作和科学研究提供参考借鉴.方法 检索中国全文期刊数据库(CNKI)、中国生物医学文献数据库(CMBdisc)、万方数据库、维普生物医学期刊数据库(VIP-CMJD)等收录的有关症状群的核心期刊文献或学位论文,运用BICOMB软件,对文献信息进行提取并分析.结果 ...     

Correlates of health-related quality of life in patients with myocardial infarction: A literature review

BackgroundBy the increasing emphasis on health-related quality of life (HRQoL) in patients with myocardial infarction (MI), it is necessary to explore factors that affect HRQoL in this population.ObjectivesThis study aimed to identify correlates of HRQoL in patients with MI.DesignA literature review of the factors that affect HRQoL in patients with MI (1995–2016).Data sourcesThree main databases—CINAHL, MEDLINE and PsychINFO—were searched to retrieve relevant peer-reviewed articles published in English.Review methodsIn consultation with a medical librarian, we identified relevant MeSH terms and used them for searching the literature: health-related quality of life/quality of life/HRQoL/QoL, myocardial infarction/heart attack/MI and predict*/factor. Data elements were extracted and narratively described variables synthesised into four categories.ResultsA total of 48 studies met the inclusion criteria and were included in the review. Correlates of HRQoL in patients with MI were identified in the following categories: demographic, behavioural, disease-related, and psychosocial factors. Specific correlates included age and gender-identity for demographic factors; physical activity and smoking for behavioural factors; severity of MI, symptoms, and comorbidities for disease-related factors; anxiety and depression for psychosocial factors.ConclusionsIdentifying correlates of HRQoL can help identify patients who are at risk for poor HRQoL in the recovery or rehabilitation stage of post-MI. Future intervention should focus on adjustable correlates such as behavioural and psychosocial factors to promote HRQoL among patients after experiencing MI.     

Dimensions of health-related quality of life in persons living with HIV disease

The purpose of this secondary analysis was to test empirically the influence of biological and physiological variables, symptom status, functional status, general health perceptions, characteristics of the individual and characteristics of the environment on overall quality of life in persons living with HIV disease. Path analysis, using multiple linear regression, was used to examine the fit between a health-related quality of life (HRQOL) theoretical model and data from a sample of 142 persons with an AIDS diagnosis. Thirty-two per cent of the variance in overall quality of life was explained by the HRQOL model with symptom status having the greatest influence (beta = -0.237, R2(Y x 2) = 5%). This analysis suggests that symptom status, functional status and general health perceptions are key dimensions of HRQOL. With a focus on prevention, health promotion, symptom management, and the alleviation of acute and chronic illness effects, HRQOL may be appropriate for capturing the outcomes of nursing interventions.     

A review of cost-effectiveness of varenicline and comparison of cost-effectiveness of treatments for major smoking-related morbidities

Rationale This review aims to examine economic evaluations of varenicline, to compare the reported cost‐effectiveness of varenicline with that of treatments for major smoking‐related diseases and to evaluate the findings for decision making. Methods A literature search was performed to identify published articles in English indexed in MEDLINE and the Cochrane Library (Issue 1, 2009), which includes the Economic Evaluation Database. Additional sources also were searched to identify unpublished varenicline studies, including conference abstracts. The search for varenicline studies was limited from 2006 to October 2009; searches for all other types of studies were limited from 1990 to October 2009. Results The search yielded a total of 20 relevant economic evaluations of varenicline. In addition, 37 reviews of economic evaluations in chronic obstructive pulmonary disease, non‐small cell lung cancer and cardiovascular disease, as well as studies evaluating the impact of economic rewarding were considered in this review. From these identified economic evaluations, the incremental cost‐effectiveness ratios for varenicline ranged from dominance (more effective and cost saving) to €18 582 per quality‐adjusted life‐year (including indirect costs). These estimates appeared substantially lower when compared with incremental cost‐effectiveness ratios reported for secondary prevention of smoking‐related diseases, which in some cases were as high as €66 218 per quality‐adjusted life‐year. Conclusions Varenicline appears to be cost‐effective from the perspective of both health care payers and employers, because of reduced health care consumption and costs. The cost‐effectiveness of varenicline also compares favourably to that of interventions recommended for the treatment and prevention of smoking‐related diseases.     

住院老年人生活质量状况调查分析

目的探讨住院老年人生活质量及其影响因素。方法采用老年人生活质量调查问卷,对2003年6月~2005年6月住院治疗的332名60岁以上的老年患者进行问卷调查,评价住院老年人生活质量现状及其影响因素。结果住院老年人生活质量总评分良、中、差分别为38.55%、50.60%和10.85%,在营养状况和居住条件方面普遍感到满足。患多种慢性病老人、丧偶老人、配偶健康状况较差的老人、高龄老人及文化程度不高的老人生活质量较差。结论对患病住院老人,在治疗的同时应有针对性地采取措施,根据情况开展心理疏导,使其树立战胜疾病的信心,尽量参与社会交往,最大限度地提高其生活质量。