Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult

Objective: Postpartum hemorrhage(PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses.Methods: Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire(OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance(M) >3.5, and coefficient of variation(CV) <0.25. Reliability of experts' opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated.Results: A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120.Conclusions: The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.

Landscape Design Elements in Rehabilitation Environment Founded on Evidence-based Design

The concept and development history of rehabilitation environment were summarized in this study,principles and techniques of applying evidence-based design in the design of rehabilitation environment were analyzed,classification and functions of landscape elements in rehabilitation environment were particularly discussed.

Research in spinal surgery: Evaluation and practice of evidence-based medicine

Evidence-based medicine(EBM) is a common concept among medical practitioners, yet unique challenges arise when EBM is applied to spinal surgery. Due to the relative rarity of certain spinal disorders, and a lack of management equipoise, randomized controlled trials may be difficult to execute. Despite this, responsibility rests with spinal surgeons to design high quality studies in order to justify certain treatment modalities. The authors therefore review the tenets of implementing evidencebased research, through the lens of spinal disorders. The process of EBM begins with asking the correct question.An appropriate study is then designed based on the research question. Understanding study designs allows the spinal surgeon to assess the level of evidence provided.Validated outcome measurements allow clinicians to communicate the success of treatment strategies, and will increase the quality of a given study design. Importantly,one must recognize that the randomized controlled trial is not always the optimal study design for a given research question. Rather, prospective observational cohort studies may be more appropriate in certain circumstances, and would provide superior generalizability. Despite the challenges involved with EBM, it is the future of medicine. These issues surrounding EBM are important for spinal surgeons, as well as health policy makers and editorial boards, to have familiarity.

Methods and Practices for Institutional Benchmarking based on Research Impact and Competitiveness: A Case Study of ShanghaiTech University

Purpose: To develop and test a mission-oriented and multi-dimensional benchmarking method for a small scale university aiming for internationally first-class basic research.Design/methodology/approach: An individualized evidence-based assessment scheme was employed to benchmark ShanghaiTech University against selected top research institutions,focusing on research impact and competitiveness at the institutional and disciplinary levels.Topic maps opposing ShanghaiTech and corresponding top institutions were produced for the main research disciplines of ShanghaiTech. This provides opportunities for further exploration of strengths and weakness. Findings: This study establishes a preliminary framework for assessing the mission of the university. It further provides assessment principles, assessment questions, and indicators.Analytical methods and data sources were tested and proved to be applicable and efficient.Research limitations: To better fit the selective research focuses of this university, its schema of research disciplines needs to be re-organized and benchmarking targets should include disciplinary top institutions and not necessarily those universities leading overall rankings.Current reliance on research articles and certain databases may neglect important research output types.Practical implications: This study provides a working framework and practical methods for mission-oriented, individual, and multi-dimensional benchmarking that ShanghaiTech decided to use for periodical assessments. It also offers a working reference for other institutions to adapt. Further needs are identified so that ShanghaiTech can tackle them for future benchmarking.Originality/value: This is an effort to develop a mission-oriented, individually designed,systematically structured, and multi-dimensional assessment methodology which differs from often used composite indices.

Delayed assessment and eager adoption of laparoscopic cholecystectomy:Implications for developing surgical technologies

Despite the prevailing emphasis in the medical literature on establishing evidence,many changes in the practice of surgery have not been achieved using proper evidence-based assessment.This paper examines the adoption of laparoscopic cholecystectomy(LC)into regular use for the treatment of cholecystitis and the process of its acceptance,focusing on the limited role of technology assessment in its appraisal.A review of the published medical literature concerning LC was performed.Approximately 3000 studies of LC have been conducted since 1985,and there have been nearly 8500 publications to date.As LC was adopted enthusiastically into practice,the results of outcome studies generally showed that it compared favorably with the traditional,open cholecystectomy with regard to mortality,complications,and length of hospital stay.However,despite the rapid general agreement on surgical technique,efficacy,and appropriateness,there remained lingering doubts about safety,outcomes,and cost of the procedure that suggested that essential research questions were ignored even as the procedure became standard.Using LC as a case study,there are important lessons to be learned about the need for important guidelines for surgical innovation and the adoption of minimally invasive surgical techniques into current clinical and surgical practice.We highlight one recent example,natural orifice transluminal endoscopic surgery and how necessary it is to properly evaluate this new technology before it is accepted as a safe and effective surgical option.

Operational effectiveness evaluation based on the reduced conjunctive belief rule base

To address the issue of rule premise combination explosion in the construction of the traditional complete conjunctive belief rule base(BRB),this paper introduces an orthogonal design method to reduce the conjunctive BRB.The reasoning method based on reduced conjunctive BRB is designed with the help of the conversion technology from conjunctive BRB to disjunctive BRB.Finally,the operational mission effectiveness evaluation is taken as an example to verify the proposed method.The results show that the method proposed in this paper is feasible and effective.

部分嵌套式设计在中医药“同病异治”疗效评价中的应用及方法学探索

目的本研究针对中医学同病异治、辨证论治的特征,引入部分嵌套式设计。方法部分嵌套式设计以复杂干预对照标准化治疗,中医组按“证型-治法-方药”分割为多个子集(存在嵌套结构),对照组采用标准化西医治疗(无嵌套结构);并以一项溃疡性结肠炎“同病异治”数据为例,套用该设计类型并采用多水平模型分析。结果部分嵌套式设计符合“同病异治”诊疗特征并满足循证评价的设计要求,通过多水平模型可实现类似数据结构的分析。结论利用部分嵌套式设计能实现对“同病异治”整体效果的评价,可为中医药临床疗效评价提供方法学参考。

老年头颈鳞癌患者的治疗现状

随着人口结构改变(老年人口数量持续上升为显著特点),恶性肿瘤已成为仅次于心血管疾病的老年人最常见死亡原因。大约30%头颈部鳞状细胞癌(HNSCC)患者在70岁以上,目前HNSCC的治疗仍以手术和放化疗为主,然而,老年患者在HNSCC临床试验中的代表性不足,且对这一人群临床医生经常不得不质疑侵入性治疗的合理性。由于老年HNSCC患者的比例正在增加,但对这一人群进行临床管理的证据很少,也几乎没有一致的治疗标准,而不合适的治疗方案可能会导致肿瘤治疗或功能重建结果的不良预后。本文从循证医学角度,呈现当前治疗的证据水平,为老年HNSCC患者提供具体的治疗建议。

成人患者困难静脉通路识别与处置的最佳证据总结

目的探讨识别和处置成人患者外周困难静脉通路的证据,为临床护理实践提供依据。方法由2名研究人员采用循证方法,检索数据库及专业网站的相关文献,检索时间为建库至2023年8月31日。应用JBI循证卫生保健中心的文献质量评价标准和证据分级系统,对文献进行质量评价和证据级别评定。结果最终纳入文献13篇,其中指南3篇、专家共识2篇、临床决策2篇、证据总结3篇、系统评价3篇。总结出包括危险因素识别、困难静脉通路评估、置管人员、置管策略、教育培训5个主题24条最佳证据。结论护理人员应关注识别和处置外周困难静脉通路的方法,有针对性地选择证据进行应用,提高困难静脉穿刺成功率。

基于健康理念的绿道规划设计导则优化

分析国内外绿道规划设计导则,提出基于健康理念的绿道规划设计导则优化技术思路,并以《杭州市绿道系统建设技术导则(试行)》为例,针对其总则与术语等一般规定、绿道分级分类、绿道选线、绿道构成系统4个方面的内容,基于研究循证,从健康风险控制与健康效用促进两个方面提出增补内容,从而明确健康理念融入绿道规划与设计的具体条款,以期进一步有效发挥绿道的健康促进效用。

确保设计研究有用的核心之一:设计参数与研究调参路径

【目的】通过揭示景观设计实践与科研的错位,强调设计参数的重要性并提出“通过研究调整设计参数”(简称研究调参)策略及可行路径,从而确保研究对设计实践有用,以应对日趋复杂和综合的景观设计需求。【方法/过程】首先,明晰设计参数的定义和分类;其次,针对设计参数的系统化研究思维,阐释研究调参的基本逻辑及具体路径。【结果/结论】研究调参是设计研究的核心抓手之一,其关键在于将设计参数转化为研究假设和自变量,设计参数可分为理念模式和物质环境两类。提出4种研究调参的路径:针对现在的“理念模式对比”和“物质环境差异”,以及针对未来的“理念模式情景”和“物质环境调参”。通过延展研究内容和实践重点,将研究调参的可行路径拓展至8种,进而促使设计研究区别于其他专业的研究,确保设计研究的实用性,更好地推动寻解研究以及循证设计。

风景园林策划——一种探究设计依据的途径

【目的】在当前风景园林项目的建设流程中,设计任务书的编制更多地依赖从业者的经验而非可靠的证据,设计依据的科学性、合理性难以把控。风景园林策划(landscape architectural programming)是研究设计依据形成过程的理论和方法,但当前风景园林策划相关研究尚处于起步阶段。【方法/过程】首先,通过追溯和比较分析策划在城市设计、建筑设计、风景园林领域的发展过程,对比设计策划在实践活动中所处的时序位置及内涵、目的等方面;其次,归纳开展科学研究的流程与层级,并应用至风景园林策划中,提出风景园林策划研究框架。【结果/结论】风景园林策划具有广义与狭义的不同内涵与定义,本质属性是导向设计科学决策的循证科学;风景园林策划的研究框架包含认识论与理论视角、策划方法论、策划程序、策划方法、策划技术5个部分。其中,策划方法论是开展策划所需的一套完整的行动计划,作为多种方法的系统化集合,统领策划程序、策划方法、策划技术3个方面,是当前风景园林策划领域的研究重点。

昆士兰儿童医院循证设计实证研究

儿童医院是医疗环境中较为特殊的空间,结合儿童心理需求和疗愈环境的设计对儿童的健康疗愈至关重要。基于对儿童健康的考虑,昆士兰儿童医院的设计师将循证设计理念融入儿童医院的设计,依据疗愈环境的设计原则为儿童营造了一个人性化的医疗环境。通过对昆士兰儿童医院的案例分析,系统梳理了循证设计理念在儿童医院的实践路径,可为儿童医院疗愈环境的理论研究和实践探索开拓新视角,也可为未来医疗空间的设计提供有益借鉴。

基于循证护理的护理风险评估干预在肾衰竭合并高血压患者并发症预防中的应用

目的:探讨基于循证护理的护理风险评估干预在肾衰竭合并高血压患者并发症预防中的应用效果.方法:选取2022年1月至2023年6月本院收治的83例肾衰竭合并高血压患者为研究对象.按照干预方案,将其分为观察组(n=43,给予基于循证护理的护理风险评估干预)和对照组(n=40,给予常规干预).观察并比较两组患者血压和血肌酐水平、弗汉明心脏病危险评分(FRS)、莫里斯基用药依从性问卷-8项(MMAS-8)和并发症.结果:干预后,观察组患者收缩压、舒张压及血肌酐水平均低于对照组,差异均有统计学意义(P<0.05);观察组患者FRS评分低于对照组,MMAS-8评分高于对照组,差异均有统计学意义(P<0.05);观察组患者并发症发生率低于对照组,差异具有统计学意义(P<0.05).结论:基于循证护理的护理风险评估干预可以提高肾衰竭合并高血压患者血压控制效果和服药依从性,并降低心血管疾病发生风险,有效预防并发症.

指向深度学习的高中物理循证教学探索

循证教学是一种基于证据、培养批判性思维的教学模式,具有系统性与结构性、实践性与持续性、开放性与生成性的特征.证据收集、问题解决和反思评价是循证教学的核心,通过感知与体验、探究与反思、引发与维持的过程促进经验概念化、概念结构化和结构系统化.基于教学目标明确证据收集的维度、基于问题解决确定证据背后的原因、基于迁移应用实现概念结构的迭代和基于反思内化促进深度学习的发生是循证教学的有效策略.

非奈利酮治疗糖尿病肾病的临床综合评价

目的 对非奈利酮治疗糖尿病肾病(DN)进行临床综合评价,为临床用药决策提供循证医学证据。方法 系统检索PubMed、Web of Science、Embase、Cochrane Library、WanFang Data和CNKI数据库,同时检索卫生技术评估(HTA)机构网站等,搜集非奈利酮治疗DN的系统评价/Meta分析、HTA报告和经济学评价证据,检索时限均从建库至2023年11月31日,通过快速HTA方法对非奈利酮的有效性、安全性和经济性进行评价。综合国家药品监督管理局、国家药品监督管理局药品审评中心等专业网站以及药品说明书中的相关数据,对非奈利酮的创新性、适宜性与可及性进行分析。结果有效性方面,与安慰剂或传统盐皮质激素受体拮抗剂(MRA)相比,非奈利酮可以显著降低DN患者肾脏复合终点事件风险和心血管复合终点事件风险。安全性方面,非奈利酮不良反应发生率和急性肾损伤发生率与安慰剂或传统MRA相似,但高钾血症发生率高于安慰剂对照组。经济性方面,2篇国外HTA报告显示,非奈利酮对比标准治疗整体具有经济性。创新性方面,非奈利酮是全球首个获批用于治疗2型DN的非甾体类选择性MRA类创新药物。适宜性方面,非奈利酮每日仅需要服用1次,在药学特性和药品临床使用过程都具有较好的适宜性。可及性方面,非奈利酮的国内价格低于国际售价,且已进入医保目录,市场覆盖率高,具有较好的可负担性和可获得性。结论 非奈利酮治疗DN的有效性和安全性均较好,但需注意高钾血症的发生风险。其经济性需要在我国进一步开展经济学评价研究。作为全球首个获批的非甾体类、选择性MRA类创新药物,非奈利酮的创新性、适宜性和可及性均较好。

糖尿病足评估的循证护理实践研究

目的根据糖尿病足评估的最佳证据,开展循证实践,并评价其应用效果。方法以知识-行动框架模式为指导,在前期糖尿病足评估的证据总结基础上,对证据在临床的适用性进行评价,筛选适宜在临床实施的证据,制订审查指标;进行基线审查,并分析障碍因素,制订干预措施。比较证据应用前后护士对糖尿病足评估的知识掌握程度、审查指标执行情况及伤口面积变化。结果最佳证据应用后,36个审查指标中24个执行率高于实施前(P<0.05),有3个审查指标执行情况为相关工具实现从无到有的改变,护士对糖尿病足评估知识的掌握程度有所提升,但患者伤口4周和12周的面积在实施前后差异没有统计学意义(P>0.05)。结论基于糖尿病足评估最佳证据的循证实践,可提高护士糖尿病足评估的知识水平及证据的执行率,能够规范糖尿病足评估的护理实践。

虚拟现实中情感营造:疗愈和活力街道微更新设计循证探索

【目的】旨在探索以循证设计为方法的活力与疗愈街道微更新设计。【方法】通过参与式工作营的形式开展上海市宝山区庙行镇共康路两个街段的微更新设计工作,并借助基于虚拟现实与可穿戴生理传感器的实验,验证活力街道设计与疗愈街道设计所营造的环境氛围对居民情绪的不同影响,评估设计方案的有效性。【结果】两个街段的微更新设计都在一定程度上达到预期情感氛围,体现在心理和生理情绪指标变化上。验证了公众参与结合虚拟现实与可穿戴生理传感器辅助设计技术的运作模式,有助于设计师在早期阶段检验设计方案中的环境情感氛围是否达到预期效果,提升设计方案的科学性与精准性。【结论】为活力与疗愈街道微更新设计增添实证证据,为循证设计流程提供了可参考的实践经验。

手术室器械相关压力性损伤预防的最佳证据总结

目的检索、评价并整合手术患者器械相关压力性损伤预防的相关证据,为临床实践提供参考。方法系统检索国内外计算机决策支持系统、指南网、压力性损伤专业学术网站以及综合数据库中关于预防手术患者器械相关压力性损伤的相关文献,文献类型包括临床决策、指南、专家共识、证据总结、系统评价、Meta分析、随机对照试验。检索时限为建库至2023年10月。循证团队对文献进行方法学质量评价,并根据主题对证据进行提取与汇总。结果共纳入10篇文献,其中指南3篇、专家共识4篇、系统评价2篇、随机对照试验1篇。从风险评估、器械的选择和使用、预防策略、术后交接与记录、教育与培训5个方面总结出23条最佳证据。结论整合的手术患者器械相关压力性损伤预防最佳证据为医护人员提供了循证依据,但证据使用者应基于前期充分的风险评估,结合手术室具体情境调整预防策略,以降低器械相关压力性损伤发生率。