Research on the development methodology for clinical practice guidelines for organic integration of traditional Chinese medicine and Western medicine

Integrated traditional Chinese medicine(TCM)and Western medicine(WM)is a new medical science grounded in the knowledge bases of both TCM and WM,which then forms a unique modern medical system in China.Integrated TCM and WM has a long history in China,and has made important achievements in the process of clinical diagnosis and treatment.However,the methodological defects in currently published clinical practice guidelines(CPGs)limit its development.The organic integration of TCM and WM is a deeper integration of TCM and WM.To realize the progression of"integration"to"organic integration",a targeted and standardized guideline development methodology is needed.Therefore,the purpose of this study is to establish a standardized development procedure for clinical practice guidelines for the organic integration of TCM and WM to promote the systematic integration of TCM and WM research results into clinical practice guidelines in order to achieve optimal results as the whole is greater than the sum of the parts.

循证医学教学评估工具设计与优化的系统评价

目的对比、分析近5年内循证医学教学评估工具的特点,为进一步设计与优化课程评价方式提供参考依据。方法计算机检索PubMed、Web of Science、中国生物医学文献数据库、中国知网、万方数据库。检索时限为2018年1月1日至2022年9月16日。分别由2位研究人员筛选文献,提取工具的应用对象、聚焦主题、心理测量学指标、条目内容等,对现有工具进行全面性分析。结果最终纳入16篇文献(涉及14个工具),均具有一定的可靠性。其中,11个工具关注调查对象对循证医学相关知识和(或)技能的掌握水平(条目数在6~24之间),多涉及对循证医学的综合性认知、常用术语的了解程度、关键概念的判断、共享和应用循证实践等,评估标准多采用是非判断、自我评价、反馈内容的客观评估等。7个工具聚焦调查对象对开展循证实践的真实态度(条目数在3~21之间),评估标准多设置主观性意向选项;4个工具了解调查对象对循证实践关键环节的实施频次、时间分配、分享等(条目数在6~18之间),评估标准多为频率程度的主观选择。结论循证医学课程评估可考虑采用相关知识/技能及其态度和行为等问卷作为教学评估辅助工具,但仍需进一步根据授课对象的教学特点及目标,优化条目内容和比重,研发循证医学课程教学过程监测评估工具。

Treatment and surveillance for non-muscle-invasive bladder cancer:a clinical practice guideline(2021 edition)

Non-muscle invasive bladder cancer(NMIBC)is a major type of bladder cancer with a high incidence worldwide,resulting in a great disease burden.Treatment and surveillance are the most important part of NIMBC management.In 2018,we issued“Treatment and surveillance for non-muscle-invasive bladder cancer in China:an evidencebased clinical practice guideline”.Since then,various studies on the treatment and surveillance of NMIBC have been published.There is a need to incorporate these materials and also to take into account the relatively limited medical resources in primary medical institutions in China.Developing a version of guideline which takes these two issues into account to promote the management of NMIBC is therefore indicated.We formed a working group of clinical experts and methodologists.Through questionnaire investigation of clinicians including primary medical institutions,24 clinically concerned issues,involving transurethral resection of bladder tumor(TURBT),intravesical chemotherapy and intravesical immunotherapy of NMIBC,and follow-up and surveillance of the NMIBC patients,were determined for this guideline.Researches and recommendations on the management of NMIBC in databases,guideline development professional societies and monographs were referred to,and the European Association of Urology was used to assess the certainty of generated recommendations.Finally,we issued 29 statements,among which 22 were strong recommendations,and 7 were weak recommendations.These recommendations cover the topics of TURBT,postoperative chemotherapy after TURBT,Bacillus Calmette–Guérin(BCG)immunotherapy after TURBT,combination treatment of BCG and chemotherapy after TURBT,treatment of carcinoma in situ,radical cystectomy,treatment of NMIBC recurrence,and follow-up and surveillance.We hope these recommendations can help promote the treatment and surveillance of NMIBC in China,especially for the primary medical institutions.

“互联网+”新型教学模式形成性评价体系构建及其应用于循证医学课程的思考

“互联网+”给医学教育带来巨大挑战,融入信息技术的新型教学活动应用日益广泛,它们具有较强的开放性、自主性和灵活性,如何强化对课程教学过程的监督、管理和评估,已成为推动教学改革的难点。作为课程教学评价的重要方式之一,形成性评价在“教学-反馈-改进”过程中起着重要作用。本文分析了医学教育领域“互联网+”教学模式及其形成性评价体系特点,提出了评价体系的建设方向及改革着力点,结合武汉大学循证医学混合式教学的授课经验,以该课程为例提出了形成性评价体系建设思路。期望能与同行相互探讨,共同推动信息技术与循证医学类课程的深度融合,充分发挥其在医学生循证医学能力培养中的作用。

循证医学课程体系的建设与实践--以武汉大学为例

循证医学教育是国际及我国医学教育的基本要求内容,其目的在于培养具备解决临床实际问题能力、批判性思维能力、创新能力等的医学人才。武汉大学自2004年首次开设循证医学课程至今,进行了全方位、系统性的探索与实践,完成了教研室的创建、师资力量的构建、课程体系的打造,实现了医学专业学生全覆盖,有效地将循证医学教育特色融入新时代医学生培养进程中。本文对武汉大学循证医学课程体系定位及建设思路进行介绍,特别是对创新“1+4”的课程教学模式、建立全过程“教”与“学”的评价、创新师资力量的培养与传承三大具体措施进行了总结,以期为我国循证医学教育及其教学改革提供参考,服务于培养符合时代需求的医学人才。

医学生对循证医学课程思政认知与态度的横断面研究

目的调查医学生对课程思政的态度和思政元素的需求,贯彻三全育人理念,为医学类课程思政设计和教学改革提供参考。方法选择武汉大学第二临床学院2021-2022学年第一学期选修循证医学的研究生,设计“课程思政认知与态度”问卷,就学生对思政内容的要求和评价进行调查,利用SPSS 22.0软件进行数据录入与分析。结果共纳入138名学生,其中83.33%的学生对课程思政融入循证医学专业课感兴趣,学生对专业课中思政内容的兴趣越大,越认可授课教师在理想信念(r=0.33,P<0.001)、仁爱之心(r=0.28,P<0.001)、道德情操(r=0.24,P=0.005)和扎实学识(r=0.21,P=0.020)方面对自己的影响。学生主要关注的课程思政元素是专业知识与思政相结合的内容(51.45%),并希望思政内容能有机融入、不要太“刻意”(84.06%)。结论大部分医学生对课程思政融于专业课持肯定态度。自然、适度、适时地融入思政元素并采用创新的教学方法,可获得更好的效果。

混合式教学在我国临床医学专业教学中应用效果的系统评价和Meta分析

目的采用Meta分析方法探讨混合式教学在我国临床医学专业教学中的应用效果,为培养临床医学人才、提高医学教育质量提供参考。方法在PubMed、中国知网(CNKI)、万方(WanFang Data)和中国生物医学文献数据库(SinoMed)中检索有关临床医学专业混合式教学的文献,由两位研究者独立进行文献筛选、资料提取及质量评价,采用Stata12.0软件进行Meta分析。通过亚组分析探讨异质性来源、敏感性分析探讨单个研究对合并效应量的影响。结果共纳入66篇文献,纳入研究间的异质性较大,基于随机效应模型的Meta分析结果显示,在理论知识[SMD=1.73,95%CI(1.32,2.15),P<0.05]、实践/操作技能[SMD=1.28,95%CI(0.81,1.75),P<0.05]、满意度[RR=1.35,95%CI(1.23,1.49),P<0.05]方面,混合式教学均优于传统教学;未发现不同学历层次学生在理论知识、实践/操作技能方面存在差异;本科学生在理论知识[SMD=1.79,95%CI(1.27,2.31),P<0.001]、实践/操作技能[SMD=1.62,95%CI(1.12,2.13),P<0.001]方面,混合式教学均优于传统教学;专科学生在理论知识[SMD=1.28,95%CI(0.60,1.96),P<0.001]方面,混合式教学优于传统教学,而实践/操作技能[SMD=-0.11,95%CI(-2.48,2.26),P=0.929]方面差异无统计学意义。结论相较于传统教学,混合式教学对提高我国临床医学专业学生理论知识和实践/操作技能效果更佳,且满意度更高,提示可以充分发挥混合式教学的优势,助力医学教育改革及临床医学人才的培养。

A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV) infected pneumonia(standard version)

In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province;and then named "2019 novel coronavirus(2019-nCoV)" by the World Health Organization(WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world’s attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development;we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control(including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.

Methodological quality(risk of bias) assessment tools for primary and secondary medical studies: What are they and which is better?

Methodological quality(risk of bias)assessment is an important step before study initiation usage.Therefore,accurately judging study type is the first priority,and the choosing proper tool is also important.In this review,we introduced methodological quality assessment tools for randomized controlled trial(including individual and cluster),animal study,non-randomized interventional studies(including follow-up study,controlled before-and-after study,before-after/pre-post study,uncontrolled longitudinal study,interrupted time series study),cohort study,case-control study,cross-sectional study(including analytical and descriptive),observational case series and case reports,comparative effectiveness research,diagnostic study,health economic evaluation,prediction study(including predictor finding study,prediction model impact study,prognostic prediction model study),qualitative study,outcome measurement instruments(including patient-reported outcome measure development,content validity,structural validity,internal consistency,cross-cultural validity/measurement invariance,reliability,measurement error,criterion validity,hypotheses testing for construct validity,and responsiveness),systematic review and meta-analysis,and clinical practice guideline.The readers of our review can distinguish the types of medical studies and choose appropriate tools.In one word,comprehensively mastering relevant knowledge and implementing more practices are basic requirements for correctly assessing the methodological quality.

The immunological roles in acute-on-chronic liver failure:An update

Background: Acute-on-chronic liver failure (ACLF) refers to the acute deterioration of liver function that occurs in patients with chronic liver disease. ACLF is characterized by acute decompensation, organ failure and high short-term mortality. Numerous studies have been conducted and remarkable progress has been made regarding the pathophysiology and pathogenesis of this disease in the last decade. The present review was to summarize the advances in this field. Data sources: A comprehensive search in PubMed and EMBASE was conducted using the medical subject words “acute-on-chronic liver failure”,“ACLF”,“pathogenesis”,“predictors”, and “immunotherapy” combined with free text terms such as “systemic inflammation” and “immune paralysis”. Relevant papers published before October 31, 2018, were included. Results: ACLF has two marked pathophysiological features, namely, excessive systemic inflammation and susceptibility to infection. The systemic inflammation is mainly manifested by a significant increase in the levels of plasma pro-inflammatory factors, leukocyte count and C-reactive protein. The underlying mechanisms are unclear and may be associated with decreased immune inhibitory cells, abnormal expression of cell surface molecules and intracellular regulatory pathways in immune cells and increased damageassociated molecular patterns in circulation. However, the main cause of susceptibility to infection is immune paralysis. Immunological paralysis is characterized by an attenuated activity of immune cells. The mechanisms are related to elevations of immune inhibitory cells and the concentration of plasma antiinflammatory molecules. Some immune biological indicators, such as soluble CD163, are used to explore the pathogenesis and prognosis of the disease, and some immunotherapies, such as glucocorticoids and granulocyte colony-stimulating factor, are effective on ACLF. Conclusions: Overwhelming systemic inflammation and susceptibility to infection are two key features of ACLF. A better understanding of the state of a patient’s immune system will help to guide immunotherapy for ACLF.

Perceived infection transmission routes, infection control practices, psychosocial changes, and management of COVID-19 infected healthcare workers in a tertiary acute care hospital in Wuhan: a cross-sectional survey

Background:Many healthcare workers were infected by coronavirus disease 2019(COVID-19)early in the epidemic posing a big challenge for epidemic control.Hence,this study aims to explore perceived infection routes,influencing factors,psychosocial changes,and management procedures for COVID-19 infected healthcare workers.Methods:This is a cross-sectional,single hospital-based study.We recruited all 105 confirmed COVID-19 healthcare workers in the Zhongnan Hospital of Wuhan University from February 15 to 29,2020.All participants completed a validated questionnaire.Electronic consent was obtained from all participants.Perceived causes of infection,infection prevention,control knowledge and behaviour,psychological changes,symptoms and treatment were measured.Results:Finally,103 professional staff with COVID-19 finished the questionnaire and was included(response rate:98.1%).Of them,87 cases(84.5%)thought they were infected in working environment in hospital,one(1.0%)thought their infection was due to the laboratory environment,and 5(4.9%)thought they were infected in daily life or community environment.Swab of throat collection and physical examination were the procedures perceived as most likely causing their infection by nurses and doctors respectively.Forty-three(41.8%)thought their infection was related to protective equipment,utilization of common equipment(masks and gloves).The top three first symptoms displayed before diagnosis were fever(41.8%),lethargy(33.0%)and muscle aches(30.1%).After diagnosis,88.3%staff experienced psychological stress or emotional changes during their isolation period,only 11.7%had almost no emotional changes.Arbidol(Umifenovir;an anti-influza drug;69.2%)was the drug most commonly used to target infection in mild and moderate symptoms.Conclusion:The main perceived mode of transmission was not maintaining protection when working at a close distance and having intimate contact with infected cases.Positive psychological intervention is necessary.

Chemoprophylaxis, diagnosis, treatments, and discharge management of COVID-19: An evidence-based clinical practice guideline(updated version)

The novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)is the cause of a rapidly spreading illness,coronavirus disease 2019(COVID-19),affecting more than seventeen million people around the world.Diagnosis and treatment guidelines for clinicians caring for patients are needed.In the early stage,we have issued"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)";now there are many direct evidences emerged and may change some of previous recommendations and it is ripe for develop an evidence-based guideline.We formed a working group of clinical experts and methodologists.The steering group members proposed 29 questions that are relevant to the management of COVID-19 covering the following areas:chemoprophylaxis,diagnosis,treatments,and discharge management.We searched the literature for direct evidence on the management of COVID-19,and assessed its certainty generated recommendations using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)approach.Recommendations were either strong or weak,or in the form of ungraded consensus-based statement.Finally,we issued 34 statements.Among them,6 were strong recommendations for,14 were weak recommendations for,3 were weak recommendations against and 11 were ungraded consensus-based statement.They covered topics of chemoprophylaxis(including agents and Traditional Chinese Medicine(TCM)agents),diagnosis(including clinical manifestations,reverse transcription-polymerase chain reaction(RT-PCR),respiratory tract specimens,IgM and IgG antibody tests,chest computed tomography,chest X-ray,and CT features of asymptomatic infections),treatments(including lopinavirritonavir,umifenovir,favipiravir,interferon,remdesivir,combination of antiviral drugs,hydroxychloroquine/chloroquine,interleukin-6 inhibitors,interleukin-1 inhibitors,glucocorticoid,qingfei paidu decoction,lianhua qingwen granules/capsules,convalescent plasma,lung transplantation,invasive or noninvasive ventilation,and extracorporeal membrane oxygenation(ECMO)),and discharge management(including discharge criteria and management plan in patients whose RT-PCR retesting shows SARS-CoV-2 positive after discharge).We also created two figures of these recommendations for the implementation purpose.We hope these recommendations can help support healthcare workers caring for COVID-19 patients.

Updating the diagnostic criteria of COVID-19 “suspected case” and “confirmed case” is necessary

On 6 February 2020,our team had published a rapid advice guideline for diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infection,and this guideline provided our experience and make well reference for fighting against this pandemic worldwide.However,the coronavirus disease 2019(COVID-19)is a new disease,our awareness and knowledge are gradually increasing based on the ongoing research findings and clinical practice experience;hence,the strategies of diagnosis and treatment are also continually updated.In this letter,we answered one comment on our guideline and provided the newest diagnostic criteria of"suspected case"and"confirmed case"according to the latest Diagnosis and Treatment Guidelines for COVID-19(seventh version)that issued by the National Health Committee of the People’s Republic of China.

Periodontal disease and risk of benign prostate hyperplasia: a cross-sectional study

Background:Both periodontal disease and benign prostatic hyperplasia are age-related diseases that affect millions of people worldwide.Hence,this study aimed to investigate the association between periodontal disease and the risk of benign prostatic hyperplasia.Methods:A total of 4930 participants were selected from an available health examination that was carried out in 2017,only males were considered for further analysis.All eligible males were divided into benign prostatic hyperplasia and normal groups,the benign prostatic hyperplasia group was then divided into prostate volume≤60 g and>60 g subgroups;all their periodontal status was extracted and then into normal(CPI score of 0),periodontal disease(CPI score between 1 and 4),and periodontitis(CPI score between 3 and 4)groups.The correlation between periodontal disease and benign prostatic hyperplasia was investigated using logistic regression analyses and greedy matching case-control analysis.Subgroup analysis based on prostate volume was also performed.All analyses were conducted with SAS 9.4 software.Results:A total of 2171 males were selected for this analysis.The presence of periodontal disease significantly increased the risk of benign prostatic hyperplasia by 1.68 times(OR=1.68,95%CI:1.26–2.24),and individuals with periodontitis showed a higher risk(OR=4.18,95%CI:2.75–6.35).In addition,among matched cases and controls,this association remained robust(periodontal disease:OR=1.85,95%CI:1.30–2.64;periodontitis:OR=4.83,95%CI:2.57–9.07).Subgroup analysis revealed that periodontal disease significantly increased benign prostate hyperplasia risk as well(for prostate volume≤60 g:OR=1.64,95%CI:1.22–2.20;for volume>60 g:OR=2.17,95%CI:1.04–4.53),and there was a higher risk in the group with a prostate volume greater than 60 g.Conclusions:Periodontal disease is significantly and positively associated with an increased risk of benign prostatic hyperplasia.Further validation studies should be performed to explore the relationship between periodontal treatment and benign prostate hyperplasia.

A summary of the evidence and evaluation of the effectiveness of nonpharmacological interventions for mild cognitive impairment

Objective: To summarize and evaluate the evidence of guidelines and systematic reviews(SRs) of nonpharmacological interventions for mild cognitive impairment(MCI) to support the development of future guidelines and clinical decisions for MCI patients.Methods: Scottish Intercollegiate Guideline Network(SIGN), National Institute for Health and Clinical Excellence(NICE), American Academy of Neurology(AAN), Registered Nurses Association of Ontario(RNAO), Web of Science, PubMed, Cochrane Library, CNAHL, VIP, China National Knowledge Infrastructure(CNKI), and Wanfang Database were searched for relevant publications, including guidelines and SRs, from January 2014 to March 2019. Two authors independently screened articles, extracted data, and assessed the publications for adherence to the inclusion criteria. Appraisal of Guidelines for Research and Evaluation(AGREE II) was used to assess the quality of the guidelines, and Assessment of Multiple Systematic Reviews(AMSTAR 2) was used to assess the quality of SRs. In addition, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) approach was used to evaluate the quality of outcomes.Results: Thirty-two articles were retrieved, including 1 guideline and 31 SRs. Fourteen SRs of physical exercise for MCI, six articles describing cognitive interventions, four articles describing acupuncture, and seven articles assessing dietary interventions(including four articles employing a Mediterranean diet, one article using vitamin B supplementation, and two articles assessing the effects of tea, coffee, and caffeine) were included. The quality of the articles was very low for 4(13%), low for 10(32%), and moderate for 17(55%).Conclusions: Based on the evidence available to date, nonpharmacological interventions may improve the current cognitive function of persons with MCI. In particular, physical exercise, cognitive interventions, and acupuncture exerted promising effects. However, due to the limited number and quality of the included publications, additional high-quality reviews are needed to further confirm.

Acupuncture combined with Buyang Huanwu decoction in the treatment of sequelae of cerebrovascular accident:a systematic review and meta-analysis

Background:Cerebrovascular accident has high morbidity,high disability,and high mortality,possibly causing several serious sequelae and bringing a heavy burden to the patient,the family,and the society.Buyang Huanwu decoction,a classic ancient prescription of traditional Chinese medicine,and acupuncture are often used in combination to treat the sequelae of cerebrovascular accident.In the present study,we systematically evaluated the clinical efficacy and safety of acupuncture combined with Buyang Huanwu decoction in treating the sequelae of cerebrovascular accident.Methods:Relevant randomized controlled trials of acupuncture combined with Buyang Huanwu decoction in treating the sequelae of cerebrovascular accident were comprehensively retrieved from electronic databases from inception to May 8,2020,including PubMed,Embase,The Cochrane Library,China National Knowledge Infrastructure,WanFang Data,and China Science and Technology Journal Database.The main outcomes of clinical efficacy,degree of nerve function impairment,daily self-care capacity,Fugl-Meyer locomotor function score,life quality score,and occurrence of adverse reactions were subjected to meta-analysis.Results:The 28 randomized controlled trials included 2,341 patients with the sequelae of cerebrovascular accident.Systematic review and meta-analysis indicated that compared with acupuncture alone,its combined treatment with Buyang Huanwu decoction significantly increased clinical efficacy(RR=1.19,95%CI(1.14,1.23),P<0.001),improved nerve function impairment(WMD=−4.89,95%CI(−8.25,−1.53),P=0.004),promoted daily self-care capacity(WMD=15.87,95%CI(11.22,20.51),P<0.001),strengthened Fugl-Meyer locomotor function(WMD=20.89,95%CI(13.79,27.98),P<0.001),enhanced physical functioning(WMD=16.99,95%CI(6.01,27.96),P<0.001)and mental health(WMD=16.91,95%CI(9.14,24.69),P<0.001)in terms of life quality score(SF-36 scale)of patients with sequelae of cerebrovascular accident,with few adverse reactions.Conclusion:Compared with acupuncture alone,its combination with Buyang Huanwu decoction had better comprehensive effects on sequelae of cerebrovascular accident without obvious adverse reactions.

新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(完整版)

2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)感染的肺炎,因2019年12月发生在武汉的不明原因病毒性肺炎病例而被发现,并于2020年1月12日被世界卫生组织(World Health Organization,WHO)命名。在之后的一个月时间内,2019-nCoV在湖北省内外甚至其他国家传播造成了数以千计的病例出现,同时也引起了民众一定程度的恐慌。本指南的制订希望能够从疾病流行病学、病因学、诊断、治疗、护理、医院感染控制等方面给临床医生、社区居民等提供医疗护理及居家照护相关指导。

新型冠状病毒肺炎药物预防、诊断、治疗与出院管理临床指南计划书

本计划书为《新型冠状病毒(2019-nCoV)感染的肺炎诊疗快速建议指南(标准版)》更新版的研究方案。计划书涵盖指南制定方法学、指南的目标用户、指南的目标人群、利益冲突调查与声明、临床问题和结局指标的遴选与确定、证据的检索、合成与评价、证据与推荐意见分级标准、推荐意见的形成、指南的更新,并附录指南临床问题清单、文献检索策略及利益冲突调查表。

医疗机构工作人员是否需要戴口罩?——基于最佳证据的论述

目的目前关于医疗机构工作人员是否需要戴口罩仍存在较大争议,本研究意在评价和总结针对这一问题的现有最佳证据,以期为临床医务工作人员使用口罩提供参考。方法计算机检索PubMed、Cochrane图书馆、Web of Science、CINAHL、中国知网、万方、维普、中国生物医学文献数据库,指南数据库平台及相关专业学会组织,检索时限为建库至2019年10月27日,以获取相关指南、专家共识、系统评价,应用国际公认的质量评价工具对纳入的证据进行质量评价,汇总现有证据对医疗机构人员是否需要戴口罩这一问题的相关推荐内容。结果共纳入35篇文献,其中6篇指南,27篇专家共识,2篇系统评价,证据质量整体较高。现有证据均推荐使用口罩作为个人防护措施之一,且与不使用呼吸防护设备相比,戴口罩在预防院内感染方面具有明显的优势,并根据不同的应用情景如手术区域、实验室区、产科等提出多项推荐意见。结论现有证据充分认可戴口罩作为个人防护措施之一在医疗机构中预防院内感染的重要作用。但本研究纳入的证据质量仍有一定的局限性。临床医务工作人员应当结合自身工作经验、临床实际情况等因素综合考虑,合理、规范使用口罩。

新型冠状病毒院内感染调研与分析工具的开发与验证

目的制定2019-nCoV院内感染调研与分析工具,并行初步验证。方法研究小组基于前期循证制定的"新型冠状病毒医护感染过程及防控调研问卷",主要通过细化问卷调研目的、建立问卷条目池、评估问卷的效度三个步骤进行改编。结果形成了新型冠状病毒院内感染调研与分析工具,包括行政后勤感染组、医护对照组、行政后勤对照组3个问卷。问卷内容与研究目标具有较高的一致性。行政后勤感染组问卷包括"确诊前"、"确诊后"2个领域的调查,其中,"确诊前"涉及感染原因分析、确诊前防控方案、确诊前防控知识、确诊前心理上对疫情的应对状态4个部分,共计16个条目;"确诊后"包括确诊后症状、确诊后治疗、感染后对周围环境和人造成的影响、确诊后心理、感染后防护认识5个方面,共计21个条目。医护对照组问卷涉及与是否感染有关的工作或生活行为、防控相关行为、防控相关知识、心理上对疫情的应对状态4个方面,共计29个条目。行政后勤对照组问卷涉及的领域与医护对照组问卷相同,共计20个条目。结论本研究完成了2019-nCoV院内感染调研与分析工具的制定,共涉及2019-nCoV感染医院非医护工作人员感染过程及防控调研——行政、后勤人员专用,2019-nCoV感染医护感染对照组调研问卷——医护对照组,2019-nCoV感染医护感染对照组调研问卷——行政后勤对照组3个问卷,问卷的信度和效度均可靠、可行性良好。