This study systematically explores the assessment tools for balance function in elderly patients after total hip arthroplasty and their clinical applications, while also envisioning future trends toward multidimensional integration and intelligent development. By summarizing the commonly used subjective and objective assessment in clinical practice and analyzing the application of these methods in preoperative prehabilitation and postoperative rehabilitation monitoring for elderly total hip arthroplasty patients, this article proposes that future efforts should focus on promoting the integration of subjective and objective assessment, developing intelligent predictive models, and establishing closed-loop rehabilitation systems to enhance the precision and effectiveness of assessment and rehabilitation.
The QUADAS-2, QUIPS, and PROBAST tools are not specific for prognostic accuracy studies and the use of these tools to assess the risk of bias in prognostic accuracy studies is prone to bias. Therefore, QUAPAS, a risk of bias assessment tool for prognostic accuracy studies, has recently been developed. The tool combines QUADAS-2, QUIPS, and PROBAST, and consists of 5 domains, 18 signaling questions, 5 risk of bias questions, and 4 applicability questions. This paper will introduce the content and usage of QUAPAS to provide inspiration and references for domestic researchers.
ObjectiveTo investigate the reporting and methodological quality of systematic reviews/ meta-analyses conducted by hospital pharmacists in China, so as to improve the quality of systematic reviews/ meta-analyses in this field. MethodsThe literatures were retrieved from CNKI, WanFang Data, VIP, CBM, CMCI, PubMed, EMbase, The Cochrane Library from the establishment date to March 17th, 2016. According to the inclusive and exclusive criteria, authors independently screened and extracted the published information. Reporting and methodological quality of included reviews were evaluated by PRIMSA statements and AMSTAR checklists. Data analysis was conducted by using Excel 2013 software and SPSS 20.0 software. ResultsOne thousand and eighteen systematic reviews/ meta-analyses were included, including 871 Chinese literatures and 147 English literatures. The average score of PRIMSA was 18.41±2.84, and the average score of AMSTAR was 7.38±1.28. The main problems of PRIMSA were structured summary, objectives, protocol and registration, additional analyses and funding. The main problems of AMSTAR were priori design, status of publication and list of studies (included and excluded). Univariate analysis showed that some factors could improve the quality of methodology and reporting, including studies in English (P<0.000 1), published after checklists' (P<0.000 1), hospital in higher-level (P<0.000 1), illuminating the funding or interest conflict (P<0.000 1). Pearson analysis indicated that linear correlation were detected between PRISMA scores and AMSTAR scores (P<0.000 1), as well as citations and AMSTAR scores (P=0.045). ConclusionEvidenced-based pharmacy in hospital has developed rapidly, the quality of methodology and reporting have increaseed year by year, but further improvement should be considered in different aspects. The methods to evaluate the clinical application of these systematic reviews/ meta-analyses should be developed in the future.
Improving the quality of infection management in outpatient and emergency departments is crucial for ensuring medical safety and advancing infection control practices. To enhance the level of infection management in outpatient and emergency departments, Tengzhou Central People’s Hospital developed a two round risk assessment system for outpatient and emergency departments hospital infection management using risk matrix and failure mode and effects analysis methods, including hospital-outpatient and emergency departments, very high risk outpatient and emergency departments-high risk point. Based on the enterprise risk management integration framework, the risk management system has been optimized to provide decision support for the prevention and control of outpatient and emergency departments hospital infection. This article will introduce the practical exploration experience of optimizing management in outpatient and emergency departments hospital infection based on risk assessment.
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.
ObjectiveThrough neuropsychological assessment, explore the factors that may cause cognitive impairment in patients with focal epilepsy.MethodsCollected 53 epilepsy patients in outpatients and inpatients of Tianjin Medical University General Hospital from March 2016 to January 2020, including 25 males and 28 females, with an average age of (23.58±13.24) years old, and the course of disease (6.49±7.39), all met the 2017 ILEA diagnostic criteria for focal epilepsy, and there was no history of progressive brain disease or brain surgery. Carry out relevant cognitive assessments for the enrolled patients, use SPSS statistical software to conduct Spearman correlation analysis on the cognitive functions of the study subjects, and further analyze the related factors of cognition through Logistic regression analysis to clarify the factors related to cognition whether it may be a risk factor for cognitive impairment in patients with focal epilepsy.Results Spearman correlation analysis showed that the FIQ of patients with focal epilepsy was related to education level, age of onset, seizure pattern, total number of seizures, AEDs and EEG interval discharge side (P<0.05). Binary Logistic regression analysis shows that among all cognitive-related factors, only the number of AEDs (P=0.003) and EEG interval discharge (P=0.013) are the risk of cognitive impairment in patients with focal epilepsy factor.ConclusionIn the clinical treatment of epilepsy, seizures should be actively controlled, but the types of drugs should be minimized. When there are more than 3 kinds of drugs, surgical treatment or other non-surgical treatments can be considered. At the same time, the EEG should be reviewed regularly to understand the changes in epileptiform discharges between episodes.
ObjectiveTo utilize a rapid health technology assessment to evaluate the efficacy, safety and cost-effectiveness of the MitraClip device for patients with severe mitral regurgitation (MR). MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, CBM and the CRD databases were electronically searched to collect clinical evidence and economic evaluations on the efficacy, safety and cost-effectiveness of the MitraClip device for patients with severe MR from inception to May 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, descriptive analyses and data summaries were performed. ResultsA total of 33 studies, involving 4 HTA reports, 3 RCTs, 16 systematic reviews or meta-analyses, and 10 economic evaluations were included. In the evidence comparing MitraClip and surgery, most of the literature showed that the MitraClip group had higher postoperative residual MR, fewer blood transfusion events, and fewer hospital days. We found no significant treatment effects on 30-day adverse events and mortality, and the 1-year and above survival rate. In the evidence of MitraClip versus medical therapy alone, all included studies showed that MitraClip benefited mid-term and long-term survival and reduced the incidence of subsequent cardiac hospitalizations. Economic evaluations showed that the clinical benefits were cost-effective in the setting of their health service systems. ConclusionThe available high-grade clinical evidence shows that MitraClip is effective and safe to some extent, and has cost-effectiveness compared with traditional treatment in other countries. However, the real-world effectiveness and cost-effectiveness of the MitraClip need to be tested in the Chinese population and health-care setting.
Objective To search for, assess, and summarize the best evidence for antimicrobial allergy assessment in hospitalized patients, so as to provide an evidence-based basis for clinical nursing practice. Methods UpToDate, BMJ Best Practice, National Guideline Clearinghouse, Guidelines International Network, Yimaitong, JBI Evidence Synthesis, Cochrane Library, CINAHL, Embase, PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Data, CQVIP, SinoMed, and related association websites were searched by computer for literature about clinical decisions, guidelines, expert consensuses, evidence summaries, systematic reviews and meta-analyses related to antimicrobial allergy assessment in hospitalized patients. The search time limit was from the establishment of the databases to September 2024. Two researchers trained in evidence-based practice screened the literature and evaluated the quality independently. Finally, the evidence-based research group extracted and integrated the evidence after discussion. Results Totally 8 articles were involved, including 6 guidelines and 2 systematic reviews. Finally, 25 pieces of best evidence were obtained across 6 aspects, including the importance of antimicrobial allergy assessment, the subjects of allergy assessment, the personnel conducting allergy assessment, the content of allergy assessment, the recording of allergy history, and assessment tips. Conclusion When applying and transforming evidence, medical staff should fully consider the actual clinical situation and explore the evaluation scheme of antimicrobial allergy history of hospitalized patients with local characteristics, to improve the accuracy of evaluation of antimicrobial allergy history of hospitalized patients, so as to strengthen the safety management of drug use and improve the level of rational drug use.
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.
Objective To investigate and analyze the past and on-going pro-poor programs related to health equity, and the relevant policies, documents, interventions measures, etc. to improve the China prisoners’ accessibility and utilization of tuberculosis (TB) control services in TB control programs, then evaluate their impacts and influences to provide evidences and suggestions for the further work of TB prevention and treatment. Methods Retrieve published documents about TB prevention and treatment of transient population dating from 1998 to 2008 from MEDLINE, PubMed, CNKI, CBMdisc CDDB and VIP with computers. Simultaneously, a series of interviews was conducted after we got the agreement of the interview people by using non-probability statistics methods. Results A total of 23 documents were retrieved, and they were consonant with the criteria, among which 8 were published and 5 were policy documents. The study on the second document showed the measures that presently applied on TB patients among prisoners in China: find patients through surveys, inspect every prisons and patients going to visit doctors with symptoms; concerning differences between various groups of prisoners, the measure of “classify and instruction, enroll together and treat” was applied; carry out health education in the prisons and so on. After the implement of various measures, the knowledge awareness, discovery rate, accomplishment ratio, cure rate and so on were all improved. The results of the qualitative interviews showed: the TB patients and the doubts among prisoners could be well gotten together and isolated to receive DOTS; doctors were able to receive trainings on TB treatment and take appointment with certificate. Conclusion According to the results of qualitative interviews, the published and the secondary documents, it could be seen that DOTS are well implemented with remarkable effects.