Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidel...Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidelines based on expert consensus and evidence-based guidelines.Since there is no research and clinical application of a specific stoma guidance in China.It is of great significance to understand the application status of the recommended guidelines and the influencing factors in promoting the development of stoma care.Purpose:To investigate the application status of recommended clinical practice guidelines for stoma nursing in China,and to analyse the reasons for the knowledge and application of recommendations.Methods:The Questionnaire on the Application of Recommendations in Clinical Practice Guidelines for Ostomy Nursing was adopted.Results:We collected 195 questionnaires and 183 valid questionnaires were available.(1)The average knowledge rate of a total of 31 recommendations was 73.65%.The main reasons for unknown were insufficient dissemination and lack of training.(2)The average application rate of the 31 recommendations was 58.08%.The overall satisfaction rate of people who used them was high.The main reasons for not applying recommendations were complex.Conclusions:Different levels of recommendations awareness and application are different.There is a lack of evidence-based guidelines for clinical practice in ostomy nursing in the field of stoma care in China,which limits the scientific development of stoma care to a certain extent.However,this study provides reference for the future construction of a guidebook adapted to our country’s localization.展开更多
Background: A number of strategies exist for the implementation of clinical practice guides (CPGs). Aim: To assess the efficacy of implementing a cardiovascular risk CPG based on an educational method involving opinio...Background: A number of strategies exist for the implementation of clinical practice guides (CPGs). Aim: To assess the efficacy of implementing a cardiovascular risk CPG based on an educational method involving opinion leaders, and the habitual method of dissemination among primary healthcare teams. Design and Setting: Controlled, blinded, community intervention trial randomised by clusters. Methods: 21 primary healthcare centres were randomly assigned to either the intervention arm (n = 11) or the control arm (n = 10). The study subjects were patients aged ≥45 years assigned to the centres. The overall impact of the intervention was measured as the difference between the increase in the proportion of patients whose medical records showed the recording of all the variables necessary to calculate cardiovascular risk in both arms. Analyses were performed with Generalized Lineal Model on an intention-to-treat basis. Results: 917 subjects were included at the beginning of the trial (437 in the intervention arm and 480 in the control arm). 826 subjects were included in the final evaluation (436 in the intervention group and 390 in the control arm). At the end of the trial, the recording of the variables necessary for the calculation of the cardiovascular risk in the intervention group had increased more than in the control group (difference between increases 7.49% (95% CI 4.62 - 10.35)) after adjusting for confounding variables. Conclusions: Compared to the habitual method of dissemination, the implementation of this CPG using an educational method involving opinion leaders, improved the recording of the variables needed to calculate patients’ cardiovascular risk.展开更多
BACKGROUND Primary osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue,leading to enhanced bone fragility and a consequent increase in fracture risk. Primary os...BACKGROUND Primary osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue,leading to enhanced bone fragility and a consequent increase in fracture risk. Primary osteoporosis is particularly common in senile persons and in postmenopausal women.It ranks the fifth of diseases in the modern society.展开更多
Dysmenorrhea refers to periodic abdominal pain,or radiating to lumbosacral region.For the severe case,it is intolerable,combined with nausea and vomiting sometimes.This disease is commonly seen in unmarried young wome...Dysmenorrhea refers to periodic abdominal pain,or radiating to lumbosacral region.For the severe case,it is intolerable,combined with nausea and vomiting sometimes.This disease is commonly seen in unmarried young women.Epidemiological studies have shown that dysmenorrhea is the most common gynecological disease,especially in young women[1].Acupuncture and moxibustion have a long history in the treatm ent of primary dysmenorrhea(hereinafter referred to as PD),and compared with medication,the advantages are presented in the treatment.Entrusted by the Standardization Working Committee of China Association for Acupuncture and Moxibustion(CAAM),Department of Acupuncture and Moxibustion,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine has undertaken the drafting of Evidence-Based Clinical Practice Guideline of Acupuncture and Moxibustion:Primary Dysmenorrhea(hereinafter referred to as the Guideline).The Guideline was issued in 2014 by CAAM.It summarizes the research achievements in acupuncture-moxibustion treatm ent for dysmenorrhea in recent decades and is intended to standardize the clinical regimen of treatm ent with acupuncture and moxibustion so as to improve the clinical effect.展开更多
Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer pa...Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer patients receiving chemotherapy based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT).Methods:Based on the theoretical framework of CAN-IMPLEMENT,A multidisciplinary team was established,barriers and facilitators obstacles of guidelines implementation in medical oncology units were assessed,corresponding solutions were formulated,the guidelines implementation process was monitored,and implementation results were evaluated.Results:The multidisciplinary team developed review criteria,standardized work paths,assessment tools,training manuals for healthcare professionals,education manuals for patients and their caregivers.After guidelines implementation,the completion rate of the distress management record came up to 97.9%(189/193).From September 2017 to December 2018,the compliance of medical staff on most items in the audit checklist was improved,ranging from 57.1%(100/175)to 100.0%(193/193).The positive distress rate of gastric cancer patients receiving chemotherapy was decreased from 22.7%(32/141)to 9.3%(18/193)(P<0.05),and the Median(range)of the distress score declined from 2(0e9)to 0(0e7)(P<0.001).Conclusions:The implementation of guidelines based on CAN-IMPLEMENT promotes the establishment of a distress management system in the medical oncology units.The review standards,standardized work paths,and evaluation tools for distress in cancer patients formulated by the multidisciplinary team had clinical applicability and effectiveness.Quality control in the practice of distress management was effective.The compliance of healthcare professionals with distress management was improved.The distress of gastric cancer patients receiving chemotherapy was alleviated effectively.展开更多
A closed loop audit of the ear nose and throat(ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed,referral source, appropriateness of referral, presenting complain...A closed loop audit of the ear nose and throat(ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed,referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The reaudit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of ￡32490 in a period of 3 mo(￡590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are nonlabour intensive can have a significant impact on service provision and cost.展开更多
Many prevalent practices and guidelines related to Gastrointestinal endoscopy and procedural sedation are at odds with the widely available scientific-physiological and clinical outcome data. In many institutions, str...Many prevalent practices and guidelines related to Gastrointestinal endoscopy and procedural sedation are at odds with the widely available scientific-physiological and clinical outcome data. In many institutions, strict policy of pre-procedural extended fasting is still rigorously enforced, despite no evidence of increased incidence of aspiration after recent oral intake prior to sedation. Supplemental oxygen administration in the setting of GI procedural sedation has been increasingly adopted as reported in the medical journals, despite clear evidence that supplemental oxygen blunts the usefulness of pulse oximetry in timely detection of sedation induced hypoventilation, leading to increased number of adverse cardiopulmonary outcomes. Use of Propofol by Gastroenterologist-Nurse team is erroneously considered dangerous and often prohibited in various institutions, at the same time worldwide reports of remarkable safety and patient satisfaction continue to be published, dating back more than a decade. Of patient monitoring practices that have been advocated to be standard, many merely add cost, not value. Advances in the technology often are not incorporated in a timely manner in guidelines or clinical practices, e.g., Capsule endoscopy or electrocautery during GI procedures do not interfere with proper functioning of the current pacemakers or defibrillators. Orthopedic surgeons have continued to recommend prophylactic antibiotics for joint replacement patientsprior to GI procedures, without any evidence of need. These myths are explored for a succint review to prompt a change in clinical practices and institutional policies.展开更多
文摘Background:Clinical practice guidelines refer to the guidance provided by the expert system to help medical staff and patients decide on appropriate treatments for a specific clinical situation,mainly including guidelines based on expert consensus and evidence-based guidelines.Since there is no research and clinical application of a specific stoma guidance in China.It is of great significance to understand the application status of the recommended guidelines and the influencing factors in promoting the development of stoma care.Purpose:To investigate the application status of recommended clinical practice guidelines for stoma nursing in China,and to analyse the reasons for the knowledge and application of recommendations.Methods:The Questionnaire on the Application of Recommendations in Clinical Practice Guidelines for Ostomy Nursing was adopted.Results:We collected 195 questionnaires and 183 valid questionnaires were available.(1)The average knowledge rate of a total of 31 recommendations was 73.65%.The main reasons for unknown were insufficient dissemination and lack of training.(2)The average application rate of the 31 recommendations was 58.08%.The overall satisfaction rate of people who used them was high.The main reasons for not applying recommendations were complex.Conclusions:Different levels of recommendations awareness and application are different.There is a lack of evidence-based guidelines for clinical practice in ostomy nursing in the field of stoma care in China,which limits the scientific development of stoma care to a certain extent.However,this study provides reference for the future construction of a guidebook adapted to our country’s localization.
文摘Background: A number of strategies exist for the implementation of clinical practice guides (CPGs). Aim: To assess the efficacy of implementing a cardiovascular risk CPG based on an educational method involving opinion leaders, and the habitual method of dissemination among primary healthcare teams. Design and Setting: Controlled, blinded, community intervention trial randomised by clusters. Methods: 21 primary healthcare centres were randomly assigned to either the intervention arm (n = 11) or the control arm (n = 10). The study subjects were patients aged ≥45 years assigned to the centres. The overall impact of the intervention was measured as the difference between the increase in the proportion of patients whose medical records showed the recording of all the variables necessary to calculate cardiovascular risk in both arms. Analyses were performed with Generalized Lineal Model on an intention-to-treat basis. Results: 917 subjects were included at the beginning of the trial (437 in the intervention arm and 480 in the control arm). 826 subjects were included in the final evaluation (436 in the intervention group and 390 in the control arm). At the end of the trial, the recording of the variables necessary for the calculation of the cardiovascular risk in the intervention group had increased more than in the control group (difference between increases 7.49% (95% CI 4.62 - 10.35)) after adjusting for confounding variables. Conclusions: Compared to the habitual method of dissemination, the implementation of this CPG using an educational method involving opinion leaders, improved the recording of the variables needed to calculate patients’ cardiovascular risk.
基金Supported by a grantedfrom West-Pacific Region of World Health Organization(No.WP/2006/CHN/EDM/3.2/001)
文摘BACKGROUND Primary osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue,leading to enhanced bone fragility and a consequent increase in fracture risk. Primary osteoporosis is particularly common in senile persons and in postmenopausal women.It ranks the fifth of diseases in the modern society.
基金State Administration of Traditional Chinese Medicine(Department of Policy,Regulation and Supervision)“Evidence-based clinical practice guideline of acupuncture and moxibustion:primary dysmenorrhea”:No.ZYYS-2009-0009-4Scientific Specific Project of China Base Business Construction for Clinical Research of Traditional Chinese Medicine,State Administration of Traditional Chinese Medicine:No.JDZX2015063
文摘Dysmenorrhea refers to periodic abdominal pain,or radiating to lumbosacral region.For the severe case,it is intolerable,combined with nausea and vomiting sometimes.This disease is commonly seen in unmarried young women.Epidemiological studies have shown that dysmenorrhea is the most common gynecological disease,especially in young women[1].Acupuncture and moxibustion have a long history in the treatm ent of primary dysmenorrhea(hereinafter referred to as PD),and compared with medication,the advantages are presented in the treatment.Entrusted by the Standardization Working Committee of China Association for Acupuncture and Moxibustion(CAAM),Department of Acupuncture and Moxibustion,Dongzhimen Hospital,Beijing University of Traditional Chinese Medicine has undertaken the drafting of Evidence-Based Clinical Practice Guideline of Acupuncture and Moxibustion:Primary Dysmenorrhea(hereinafter referred to as the Guideline).The Guideline was issued in 2014 by CAAM.It summarizes the research achievements in acupuncture-moxibustion treatm ent for dysmenorrhea in recent decades and is intended to standardize the clinical regimen of treatm ent with acupuncture and moxibustion so as to improve the clinical effect.
基金funded by Fudan-Fuxing Nursing Research Funds(No.FNF201701)JBI Evidence Based Clinical Fellowship Pro-gram Funds(No.FNF201861)from Fudan University,China.
文摘Objective:To standardize the distress management of gastric cancer patients receiving chemotherapy,the adapted Cancer-related Distress Management Guidelines were implemented in nursing practice among gastric cancer patients receiving chemotherapy based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT).Methods:Based on the theoretical framework of CAN-IMPLEMENT,A multidisciplinary team was established,barriers and facilitators obstacles of guidelines implementation in medical oncology units were assessed,corresponding solutions were formulated,the guidelines implementation process was monitored,and implementation results were evaluated.Results:The multidisciplinary team developed review criteria,standardized work paths,assessment tools,training manuals for healthcare professionals,education manuals for patients and their caregivers.After guidelines implementation,the completion rate of the distress management record came up to 97.9%(189/193).From September 2017 to December 2018,the compliance of medical staff on most items in the audit checklist was improved,ranging from 57.1%(100/175)to 100.0%(193/193).The positive distress rate of gastric cancer patients receiving chemotherapy was decreased from 22.7%(32/141)to 9.3%(18/193)(P<0.05),and the Median(range)of the distress score declined from 2(0e9)to 0(0e7)(P<0.001).Conclusions:The implementation of guidelines based on CAN-IMPLEMENT promotes the establishment of a distress management system in the medical oncology units.The review standards,standardized work paths,and evaluation tools for distress in cancer patients formulated by the multidisciplinary team had clinical applicability and effectiveness.Quality control in the practice of distress management was effective.The compliance of healthcare professionals with distress management was improved.The distress of gastric cancer patients receiving chemotherapy was alleviated effectively.
文摘A closed loop audit of the ear nose and throat(ENT) urgent referral clinic at a London hospital was conducted assessing the number of patients reviewed,referral source, appropriateness of referral, presenting complaint and assigned follow-up appointments. Data was sourced from clinic letters and the patient appointment system over a 3-mo period. The initial cycle analysed 490 patients and the subsequent cycle 396. The initial audit yielded clinically relevant and cost effective recommendations which were implemented, and the audit cycle was subsequently repeated. The reaudit demonstrated decreased clinic numbers from an average 9.8 to 7.2 patients per clinic, in keeping with ENT United Kingdom guidelines. A 21% decrease in patient follow-up and 13% decrease in inappropriate referrals was achieved. Direct bookings into outpatient clinics decreased by 8%, due to correct referral pathway utilisation. Comparisons of all data sets were found to show statistical significance P < 0.05. We reported a total financial saving of ￡32490 in a period of 3 mo(￡590 per clinic). We demonstrated that simple guidelines, supervision and consultant-led education which are nonlabour intensive can have a significant impact on service provision and cost.
文摘Many prevalent practices and guidelines related to Gastrointestinal endoscopy and procedural sedation are at odds with the widely available scientific-physiological and clinical outcome data. In many institutions, strict policy of pre-procedural extended fasting is still rigorously enforced, despite no evidence of increased incidence of aspiration after recent oral intake prior to sedation. Supplemental oxygen administration in the setting of GI procedural sedation has been increasingly adopted as reported in the medical journals, despite clear evidence that supplemental oxygen blunts the usefulness of pulse oximetry in timely detection of sedation induced hypoventilation, leading to increased number of adverse cardiopulmonary outcomes. Use of Propofol by Gastroenterologist-Nurse team is erroneously considered dangerous and often prohibited in various institutions, at the same time worldwide reports of remarkable safety and patient satisfaction continue to be published, dating back more than a decade. Of patient monitoring practices that have been advocated to be standard, many merely add cost, not value. Advances in the technology often are not incorporated in a timely manner in guidelines or clinical practices, e.g., Capsule endoscopy or electrocautery during GI procedures do not interfere with proper functioning of the current pacemakers or defibrillators. Orthopedic surgeons have continued to recommend prophylactic antibiotics for joint replacement patientsprior to GI procedures, without any evidence of need. These myths are explored for a succint review to prompt a change in clinical practices and institutional policies.
