One of the most important points in the meta-analyses is certainly represented by the assessment of the quality of the studies included in such research. The meta-analyses are considered the highest level of evidence ...One of the most important points in the meta-analyses is certainly represented by the assessment of the quality of the studies included in such research. The meta-analyses are considered the highest level of evidence in science. Also for this reason, the quality of the studies included should be accurately evaluated by standardized tools. The overall results of the metaanalysis depend indeed also on a rigorous evaluation of the studies quality. Among all the possible tools for this complex evaluation, the Newcastle Ottawa Scale(NOS) is one of the most used worldwide, above all for observational studies. In this review, we will discuss the strengths and limitation of the NOS, also on the basis of the branch of science in which it has been applied.展开更多
Nestled on the banks of the majestic Ottawa,Rideau and Gatineau Rivers,Ottawa,the capital city of Canada,is one of the most attractive cities in the world. The area was inhabited by American Indians when it was visite...Nestled on the banks of the majestic Ottawa,Rideau and Gatineau Rivers,Ottawa,the capital city of Canada,is one of the most attractive cities in the world. The area was inhabited by American Indians when it was visited by Samuel de Champlain in 1613,and the nearby rivers served traders and explorers over the next two centuries.Its settlement developed after展开更多
目的开发基于循证的、符合中国本土特色的乳腺癌乳房再造手术决策辅助工具,为临床开展决策制定提供思路,推动共享决策的实施。方法以“渥太华决策支持框架(the Ottawa decision support framework,ODSF)”作为理论基础,以“患者决策辅...目的开发基于循证的、符合中国本土特色的乳腺癌乳房再造手术决策辅助工具,为临床开展决策制定提供思路,推动共享决策的实施。方法以“渥太华决策支持框架(the Ottawa decision support framework,ODSF)”作为理论基础,以“患者决策辅助工具国际标准4.0版(IPDAS4.0)”作为标准框架,通过文献回顾形成乳腺癌乳房再造手术决策辅助工具初版;邀请18名乳腺癌与乳房再造领域的临床与护理专家展开2轮德尔菲函询后形成工具修订版;之后在临床中对5名患者及5名家属进行试运用,整合意见后确定工具终版。结果基于文献回顾整合证据形成工具初版含7项一级指标、14项二级指标,49项三级指标;第一轮三级指标函询各条目的重要性均分为4.06~4.94分,变异系数为0.05~0.22,满分比0.53~0.88;第二轮三级指标函询各条目的重要性均分为4.71~4.94分,变异系数为0.05~0.15,满分比为0.72~1.00;第二轮一、二、三级指标Kendall协调系数W分别为0.509、0.437、0.425,最终形成乳腺癌乳房再造手术决策辅助工具终版,包含7项一级指标(决策评估、疾病信息支持、风险利益分析、决策支持系统、平衡价值与偏好、促进决策制定、评价决策质量),14项二级指标,50项三级指标。经临床试运用,取得较好效果。结论基于“渥太华决策支持框架”的乳腺癌乳房再造手术决策辅助工具具备科学性和临床实用价值,可为乳腺癌患者在面对乳房再造手术方式选择困难时提供解决思路。展开更多
Colorectal cancer(CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in t...Colorectal cancer(CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred to in the literature, these differ greatly in grading methodology and categorization criteria. Published reliability and validity data are available for five bowel preparation quality assessment scales, which vary in several key attributes. However, clinicians and researchers continue to use a variety of bowel preparation quality measures, including nonvalidated scales, leading to potential confusion and difficulty when comparing quality results among clinicians and across clinical trials. Optimal clinical criteria for bowel preparation quality remain controversial. The use of validated bowel preparation quality scales with stringent but simple scoring criteria would help clarify clinical trial data as well as the performance of colonoscopy in clinical practice related to quality measurements.展开更多
AIM: To evaluate the efficacy, tolerability, acceptability and feasibility of bisacodyl plus low volume polyethyleneglycol-citrate-simeticone(2-L PEG-CS) taken the same day as compared with conventional split-dose 4-L...AIM: To evaluate the efficacy, tolerability, acceptability and feasibility of bisacodyl plus low volume polyethyleneglycol-citrate-simeticone(2-L PEG-CS) taken the same day as compared with conventional split-dose 4-L PEG for late morning colonoscopy. METHODS: Randomised, observer-blind, parallel group, comparative trial carried out in 2 centres. Out patients of both sexes, aged between 18 and 85 years, undergoing colonoscopy for diagnostic investigation, colorectal cancer screening or follow-up were eligible. The PEG-CS group received 3 bisacodyl tablets(4 tablets for patients with constipation) at bedtime and 2-L PEG-CS in the morning starting 5 h before colonoscopy. The control group received a conventional 4-L PEG formulation given as split regimen; the morning dose was taken with the same schedule of the low volume preparation. The Ottawa Bowel Preparation Scale(OBPS) score was used as the main outcome measure.RESULTS: A total of 164 subjects were enrolled and 154 completed the study; 78 in the PEG-CS group and 76 in the split 4-L PEG group. The two groups were comparable at baseline. The OBPS score in the PEG-CS group(3.09 ± 2.40) and in the PEG group(2.39 ± 2.55) were equivalent(difference +0.70; 95%CI:-0.09-1.48). This was confirmed by the rate of successful bowel cleansing in the PEG-CS group(89.7%) and in the PEG group(92.1%)(difference-2.4%; 95%CI:-11.406.70). PEG-CS was superior in terms of mucosa visibility compared to PEG(85.7% vs 72.4%, P = 0.042). There were no significant differences in caecum intubation rate, time to reach the caecum and withdrawal time between the two groups. The adenoma detection rate was similar(PEG-CS 43.6% vs PEG 44.7%). No serious adverse events occurred. No difference was found in tolerability of the bowel preparations. Compliance was equal in both groups: more than 90% of subjects drunk the whole solution. Willingness to repeat the same bowel preparations was about 90% for both regimes. CONCLUSION: Same-day PEG-CS is feasible, effective as split-dose 4-L PEG for late morning colonoscopy and does not interfere with work and daily activities the day before colonoscopy.展开更多
文摘One of the most important points in the meta-analyses is certainly represented by the assessment of the quality of the studies included in such research. The meta-analyses are considered the highest level of evidence in science. Also for this reason, the quality of the studies included should be accurately evaluated by standardized tools. The overall results of the metaanalysis depend indeed also on a rigorous evaluation of the studies quality. Among all the possible tools for this complex evaluation, the Newcastle Ottawa Scale(NOS) is one of the most used worldwide, above all for observational studies. In this review, we will discuss the strengths and limitation of the NOS, also on the basis of the branch of science in which it has been applied.
文摘Nestled on the banks of the majestic Ottawa,Rideau and Gatineau Rivers,Ottawa,the capital city of Canada,is one of the most attractive cities in the world. The area was inhabited by American Indians when it was visited by Samuel de Champlain in 1613,and the nearby rivers served traders and explorers over the next two centuries.Its settlement developed after
文摘目的开发基于循证的、符合中国本土特色的乳腺癌乳房再造手术决策辅助工具,为临床开展决策制定提供思路,推动共享决策的实施。方法以“渥太华决策支持框架(the Ottawa decision support framework,ODSF)”作为理论基础,以“患者决策辅助工具国际标准4.0版(IPDAS4.0)”作为标准框架,通过文献回顾形成乳腺癌乳房再造手术决策辅助工具初版;邀请18名乳腺癌与乳房再造领域的临床与护理专家展开2轮德尔菲函询后形成工具修订版;之后在临床中对5名患者及5名家属进行试运用,整合意见后确定工具终版。结果基于文献回顾整合证据形成工具初版含7项一级指标、14项二级指标,49项三级指标;第一轮三级指标函询各条目的重要性均分为4.06~4.94分,变异系数为0.05~0.22,满分比0.53~0.88;第二轮三级指标函询各条目的重要性均分为4.71~4.94分,变异系数为0.05~0.15,满分比为0.72~1.00;第二轮一、二、三级指标Kendall协调系数W分别为0.509、0.437、0.425,最终形成乳腺癌乳房再造手术决策辅助工具终版,包含7项一级指标(决策评估、疾病信息支持、风险利益分析、决策支持系统、平衡价值与偏好、促进决策制定、评价决策质量),14项二级指标,50项三级指标。经临床试运用,取得较好效果。结论基于“渥太华决策支持框架”的乳腺癌乳房再造手术决策辅助工具具备科学性和临床实用价值,可为乳腺癌患者在面对乳房再造手术方式选择困难时提供解决思路。
文摘Colorectal cancer(CRC) is the third most common cancer and second leading cause of cancer-related death in the United States. Colonoscopy is widely preferred for CRC screening and is the most commonly used method in the United States. Adequate bowel preparation is essential for successful colonoscopy CRC screening. However, up to one-quarter of colonoscopies are associated with inadequate bowel preparation, which may result in reduced polyp and adenoma detection rates, unsuccessful screens, and an increased likelihood of repeat procedure. In addition, standardized criteria and assessment scales for bowel preparation quality are lacking. While several bowel preparation quality scales are referred to in the literature, these differ greatly in grading methodology and categorization criteria. Published reliability and validity data are available for five bowel preparation quality assessment scales, which vary in several key attributes. However, clinicians and researchers continue to use a variety of bowel preparation quality measures, including nonvalidated scales, leading to potential confusion and difficulty when comparing quality results among clinicians and across clinical trials. Optimal clinical criteria for bowel preparation quality remain controversial. The use of validated bowel preparation quality scales with stringent but simple scoring criteria would help clarify clinical trial data as well as the performance of colonoscopy in clinical practice related to quality measurements.
文摘目的全面评估成人连续性肾脏替代治疗(Continuous renal replacement therapy, CRRT)患者中心静脉导管(Central venous catheter, CVC)维护证据在临床的应用现状,制订循证护理审查指标,分析障碍及促进因素,为临床拟定对策提供依据。方法以复旦大学循证护理中心证据临床转化模式为理论框架,确定临床护理问题,系统检索、评价、汇总证据,并评价证据的可行性、适宜性、临床意义及有效性,确定引入临床的证据。制订审查指标及审查方法,进行质量审查,根据基线审查结果,基于渥太华研究应用模式(Ottawa model of research use, OMRU)进行障碍及促进因素分析,并拟定相应对策。结果本研究共纳入23条最佳证据,基于最佳证据制订23条审查指标进行质量审查,其中仅5条指标依从率为100%,7条指标依从率>60%,4条指标依从率<60%,7条指标依从率为0。对审查结果逐条分析后得出主要障碍因素为:部分证据可操作性不强、增加工作量;护士缺乏专业培训和相关知识、技能;培训资料内容简单且形式单一;缺乏系统的护理规范、操作流程、考核质控机制和评估工具;缺乏相关耗材;护理工作量增加,缺乏时间。主要促进因素为:证据基于循证研究;管理者支持变革;护士学习氛围良好、有积极性;部分证据原有实践基础较好;证据应用对患者有益。根据障碍及促进因素分析结果,拟定综合性变革策略,主要包括:评估证据的可行性和适宜性;优化相关制度及流程;强化规范培训及考核;持续进行质量监控;申请人力资源调配;完善宣教资料及加强患者教育。结论 CRRT患者CVC维护的证据与临床实践存在较大差距,应科学、全面、动态评估临床情景中的障碍与促进因素,并给予综合性的干预策略,从而促进证据在临床的有效应用,提高临床护理质量。
文摘AIM: To evaluate the efficacy, tolerability, acceptability and feasibility of bisacodyl plus low volume polyethyleneglycol-citrate-simeticone(2-L PEG-CS) taken the same day as compared with conventional split-dose 4-L PEG for late morning colonoscopy. METHODS: Randomised, observer-blind, parallel group, comparative trial carried out in 2 centres. Out patients of both sexes, aged between 18 and 85 years, undergoing colonoscopy for diagnostic investigation, colorectal cancer screening or follow-up were eligible. The PEG-CS group received 3 bisacodyl tablets(4 tablets for patients with constipation) at bedtime and 2-L PEG-CS in the morning starting 5 h before colonoscopy. The control group received a conventional 4-L PEG formulation given as split regimen; the morning dose was taken with the same schedule of the low volume preparation. The Ottawa Bowel Preparation Scale(OBPS) score was used as the main outcome measure.RESULTS: A total of 164 subjects were enrolled and 154 completed the study; 78 in the PEG-CS group and 76 in the split 4-L PEG group. The two groups were comparable at baseline. The OBPS score in the PEG-CS group(3.09 ± 2.40) and in the PEG group(2.39 ± 2.55) were equivalent(difference +0.70; 95%CI:-0.09-1.48). This was confirmed by the rate of successful bowel cleansing in the PEG-CS group(89.7%) and in the PEG group(92.1%)(difference-2.4%; 95%CI:-11.406.70). PEG-CS was superior in terms of mucosa visibility compared to PEG(85.7% vs 72.4%, P = 0.042). There were no significant differences in caecum intubation rate, time to reach the caecum and withdrawal time between the two groups. The adenoma detection rate was similar(PEG-CS 43.6% vs PEG 44.7%). No serious adverse events occurred. No difference was found in tolerability of the bowel preparations. Compliance was equal in both groups: more than 90% of subjects drunk the whole solution. Willingness to repeat the same bowel preparations was about 90% for both regimes. CONCLUSION: Same-day PEG-CS is feasible, effective as split-dose 4-L PEG for late morning colonoscopy and does not interfere with work and daily activities the day before colonoscopy.
