ObjectiveTo systematically evaluate the measurement properties of observational pain assessment scales for pediatric patients after surgery. MethodsThe PubMed, Embase, CINAHL, PsycArticles, and SinoMed databases were electronically searched to collect studies related to the objects from inception to April 13, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. And the quality of measurement properties was rated using updated criteria for good measurement properties to determine recommendation levels. ResultsA total of 26 studies were finally included involving 12 observational pain assessment scales for pediatric patients after surgery. None reported measurement error or cross-cultural validity. The overall content validity of all 12 scales was evaluated by reviewers, with measurement properties rated as sufficient or inconsistent. For internal consistency, due to insufficient or uncertain content validity, the evidence quality was low. Eight scales calculated internal consistency, among which CHEOPS, CHIPPS, COMFORT, FLACC, and NCCPC-PV scales had sufficient measurement properties with evidence quality of low or above, receiving Grade A recommendations. ConclusionCompared with other scales, CHEOPS, CHIPPS, COMFORT, FLACC, and NCCPC-PV scales demonstrated good measurement property evaluation with acceptable evidence quality and can be recommended for use. Other scales still require further improvement in measurement property validation.
At present the parkinsonian rigidity assessment depends on subjective judgment of neurologists according to their experience. This study presents a parkinsonian rigidity quantification system based on the electromechanical driving device and mechanical impedance measurement method. The quantification system applies the electromechanical driving device to perform the rigidity clinical assessment tasks (flexion-extension movements) in Parkinson’s disease (PD) patients, which captures their motion and biomechanical information synchronously. Qualified rigidity features were obtained through statistical analysis method such as least-squares parameter estimation. By comparing the judgments from both the parkinsonian rigidity quantification system and neurologists, correlation analysis was performed to find the optimal quantitative feature. Clinical experiments showed that the mechanical impedance has the best correlation (Pearson correlation coefficient r = 0.872, P < 0.001) with the clinical unified Parkinson’s disease rating scale (UPDRS) rigidity score. Results confirmed that this measurement system is capable of quantifying parkinsonian rigidity with advantages of simple operation and effective assessment. In addition, the mechanical impedance can be adopted to help doctors to diagnose and monitor parkinsonian rigidity objectively and accurately.
Breast cancer, the most common malignancy in the world, also causes the most death cases of women among malignancies. Breast cancer risk reduction guidelines (version 2023) was updated by National Comprehensive Cancer Network (NCCN). Based on high-level evidences from evidence-based medicine and the latest research progress, the guidelines provided standardized guidance for breast cancer risk assessment and risk reduction strategies for individuals without a history of invasive breast cancer or ductal carcinoma in situ, which has attracted widespread attention from clinicians worldwide. Breast cancer is also the most common malignancy in Chinese women, and the number of newly diagnosed breast cancer cases each year in China ranks first in the world due to the large population, so the breast cancer prevention has become a major public health challenge in China. Aimed to provide reference for breast cancer prevention in China, this article interpreted the guidelines (the new version) based on the characteristics of breast structure in Asian women and the epidemiological characteristics of breast cancer in China.
Objective To explore the application of risk assessment of nosocomial infection control in outpatient departments, so as to find out the high-risk departments and high-risk links of nosocomial infection, and to provide basis for the formulation of nosocomial infection prevention and control measures in outpatient departments. Methods The improved risk assessment tool was used to evaluate the nosocomial infection management risk in the outpatient departments of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. We evaluated risk indicators and risk levels from three dimensions: likelihood of risk occurrence, severity of consequences, and integrity of the current system. Results Among the evaluated outpatient departments, the departments with extremely high risk levels included pediatric fever outpatient department (147.8 points), pediatric outpatient department (141.2 points), emergency internal medicine department (139.4 points), and pediatric emergency department (138.8 points). The departments with high risk levels included internal medicine outpatient department (138.4 points), dermatology outpatient department (136.0 points), otolaryngology-head and neck surgery outpatient department (135.6 points), and ophthalmology outpatient department (134.0 points). The risk assessment scores of 31 outpatient departments showed a normal distribution. The evaluation results of various risk indicators showed that among the 26 risk indicators, there were 2 extremely low risk, 4 low risk, 6 medium low risk, 7 medium high risk, 4 high risk, and 3 extremely high risk. The 3 extremely high risk indicators were lack of nosocomial infection prevention and control knowledge, patients with difficult to identify diseases (air/droplet transmission) seeking medical treatment, and crowded waiting areas for patients. Conclusions The comprehensive risk assessment of outpatient departments can screen out high risk outpatient departments and find out the main risk links. We can concentrate resources on key departments, prevent key risks, and improve the efficiency of nosocomial infection control.
【摘要】 目的 探讨高血压危象评估和处理原则及对高血压危象急诊处理的指导意义。 方法 依据高血压危象评估和处理原则对2008年1月-2009年12月期间收治的160例高血压危象患者进行诊断和治疗。结果 160例高血压危象患者中,高血压急症134例,高血压亚急症26例。高血压急症中,以心脑血管病变为主,包括脑卒中、急性冠脉综合征和急性左侧心力衰竭。依据高血压危象评估和处理原则进行急诊处理,能够对高血压危象进行准确评估和有效处理,减少诊治失误,降低死亡率并改善预后。结论 有关高血压危象的评估和处理原则能够指导高血压危象的急诊处理,取得良好的预后。【Abstract】 Objective To investigate the principles of evaluation and management of hypertensive crises in order to guide emergency clinical practice for better managements and prognosis. Methods One hundred and sixty patients with hypertensive crises admitted to our department from January 2008 to December 2009 had been diagnosed and treated. Results There were 134 patients with hypertensive emergencies (HE) and 26 patients with hypertensive urgencies(HU)in accordance with those principle. Cardiocerebralvascular diseases were the main symptom of HE including stroke, acute coronary syndrome and acute left ventricular failure. According to those principles,the emergency management was carried out, accuracy evaluation and effective management of hypertensive crises could reduce wrong diagnosis and treatment,decrease mortality and improve prognosis. Conclusion The principle of evaluation and management of hypertensive crises could guide the emergency management of hypertensive crises and obtain better prognosis．
目的 评估儿科补充与替代医学(Complementary and alternative medicine,CAM)随机对照试验报告的质量,检验报告质量是否随时间而变化.方法 以包含251篇CAM干预的RCT报告作为系统样本,对每一篇报告质量用CONSORT清单的部分项目,如分配隐藏不清楚的比例和5级质量评价来进行评估.结果 有近一半(40%)的CONSORT清单项目在所有RCT报告中列出,且有增多趋势.大多数RCT(81 3%)未清楚报告分配隐藏方案,且多年无改进.报告质量评分约为Jadad评估最高总评分的40%,且多年无改进.仅有约1/4(22%)的RCT报道了不良反应,而关于医疗成本的报道仅占很小比例(4%).结论 RCT是循证卫生保健决策的重要工具.如果这些研究要作为对CAM评估的一部分,那么高质量地实施和报告这些试验就显得十分重要.应加倍努力以确保儿童及其家庭进入实施和报告偏倚最小的RCT.这样的研究可以让利益共享者的范围更宽广,更具使用价值.
ObjectiveTo explore the significance of thyroglobulin in the evaluation of lymph node metastasis during the treatment and follow-up of differentiated thyroid carcinoma.MethodThe literatures about thyroid globulin evaluation of lymph node metastasis of differentiated thyroid carcinoma were collected through online database and summarized.ResultsThe determination of thyroglobulin played an important role in the perioperative evaluation of lymph node metastasis in patients with differentiated thyroid carcinoma, the guidance of postoperative radiotherapy for metastasis, and the monitoring of recurrence and metastasis, and thyroglobulin combined with imaging examination could improve its evaluation efficiency.ConclusionsThyroglobulin is an important marker for the evaluation of lymph node metastasis in the treatment and follow-up of differentiated thyroid carcinoma. Combination between thyroglobulin and imaging examination or other laboratory indicators to comprehensively explore its diagnostic threshold is a new idea, that can improve its value in the evaluation of lymph node metastasis.
ObjectiveTo explore the clinical value of Goddard CT grade for comprehensive evaluation of emphysema-type COPD. MethodsA total of 150 patients with emphysema-type COPD were recruited in the study. Chest CT scan was performed with German Siemens Difinition 64-slice spiral CT machine. The Goddard scoring of lung CT manifestations was used to grade lung emphysema. Lung function indexes were measured including FEV1, FVC, FEV1/FVC, RV, TLC, RV/TLC, DLCO, FEV1% pred, FVC% pred and DLCO% pred, etc. The correlation between Goddard scores and pulmonary function indexes were analyzed. The incidence of hospitalizations, length of hospital stay, severity of illness and complications in the previous year were compared between the patients with different Goddard CT grade. ResultsThere were 57 cases of mild emphysema, 53 cases of moderate emphysema, and 40 cases of severe emphysema judged by Goddard scoring. The pulmonary Goddard scores were positive correlated with RV, TLC, and RV/TLC which reflecting pulmonary function (r value was 0.385, 0.349, 0.455, respectively, all P < 0.05), and negatively correlated with DLCO and DLCO% pred which reflecting pulmonary diffusing capacity (r value was-0.771, -0.787, respectively, P < 0.05). Compared with the mild and moderate emphysema-type patients, the incidence of hospitalization more than one time due to acute exacerbation was significantly higher (χ2 value was 44.69, 25.66, respectively, P < 0.05), the average length of hospital stay was significantly longer [(13.5±4.2) d vs. (6.4±3.1) d and (9.0±3.8) d, P < 0.05] in the severe emphysema-type COPD patients. The severe emphysema-type COPD patients suffered from more severe acute exacerbation, and higher incidence of heart failure, ischemic heart disease and respiratory failure than the mild and moderate emphysema-type patients (P < 0.05). ConclusionsGoddard CT grade in complement with pulmonary function evaluation can provide more comprehensive evaluation of emphysema-type COPD. The higher Goddard score is, the more frequently and severe the acute exacerbation occurs, more easily the COPD patients complicated with respiratory failure, heart failure and other complications.