目的 查找并筛选成人接受造血干细胞移植后口腔黏膜炎护理的相关证据,并进行最佳证据总结.方法 检索指南、BMJ Best Practice、CINAHL、CNKI、Embase、JBI循证卫生保健中心数据库、PubMed、The Cochrane Library,WanFang等数据库中成人造血干细胞移植口腔黏膜炎的相关文献.由2名循证小组成员对文献进行检索、分类、评价,另外2名循证小组成员对符合JBI质量标准的文献进行证据汇总.结果 共纳入15篇文献,其中包括1篇指南,1篇证据总结,9篇系统评价,1篇Meta分析,2篇随机对照试验,1篇专家共识,共总结出13条关于成人造血干细胞移植后口腔黏膜炎护理的最佳证据.结论 成人造血干细胞移植后口腔黏膜炎的最佳证据可供医护人员评估患者口腔、开展口腔健康教育、及时采取预防措施和正确治疗口腔黏膜炎.

目的 指导护士识别并预警护理风险,提供风险防控计划及措施的决策支持.方法 建立智能化护理风险防控系统,经过文献检索、循证证据筛选、德尔菲专家咨询,筛选护理风险指标、确定护理风险的评估工具、制订评估指引及一系列针对不同风险及不同风险级别的防控措施,与电子病历整合,优化界面与功能.培训后在全院普通病区应用.护理部每季度审核各病区使用情况、统计不良事件发生率,并自行设计问卷进行满意度调查.结果 全院普通病区应用率达100％,应用后压力性损伤发生率显著下降(P＜0.05);护士对该系统的整体满意率为90.56％,对系统能够提高工作效率、保障患者安全、提供科学的决策支持的赞同率分别为85.66％、84.30％和89.66％.结论 智能化护理风险防控系统能够增强护士对护理风险的预见性及风险管理意识,提高工作效率,降低护理不良事件发生率,保障患者安全.

目的:构建基于循证的缺血性脑卒中二级预防患者指南,以提升缺血性脑卒中患者二级预防意识、提高医患共同决策能力、降低脑卒中复发率.方法:以国际指南协作网(GIN)发布的《患者版本指南构建规范》为指导,成立构建团队、收集健康问题、检索评价指南、筛选推荐意见、进行语言转化,最终构建指南,并通过外部评审评价质量.结果:共纳入7篇临床实践指南,AGREEⅡ评价结果整体质量较高,均为A级;指南涉及的内容包括院前处理、诊断与治疗、二级预防、并发症的预防与处理、早期康复5大模块;2轮专家咨询得分率为83.1％～100.0％,AGREEⅡ评价结果为A.结论:患者指南基于临床实践指南,结合医务人员专业经验,充分体现患者的价值与偏好,可为患者二级预防行为提供指导,也为不同领域学者研究患者指南提供借鉴.

目的 深入了解影响神经源性膀胱患者自我间歇清洁导尿依从性的因素.方法 采用行为事件访谈法,选取2019年6—9月从深圳龙城医院出院13例神经源性膀胱患者进行深度访谈,并运用Colaizzi七步分析法进行资料分析与整理.结果 共提炼出5个主题:对间歇导尿术相关认知不足;多重负性情感体验;肢体活动障碍;生理解剖特殊;经济状况.结论 神经源性膀胱患者自我间歇清洁导尿依从性受多种因素影响,管理者应制订有针对性干预措施以提高其依从性,改善生活质量.

目的 基于指南构建术前皮肤准备方案,指导临床护理实践,评价应用效果.方法 检索术前皮肤准备相关指南,采用指南研究与评价系统对指南进行评价,提取证据内容,结合临床情境构建术前皮肤准备方案并应用于临床,通过质量审核指标的制订与监测,评价其临床实施效果.结果 最终纳入5部指南,2部A级推荐,3部B级推荐,提取最佳证据6条,制订术前皮肤准备方案并在临床推行,应用6个月后,各评价指标审核依从率均≥90％;2016年-2018年全院Ⅰ类手术切口感染率分别为0.19％、0.43％、0.25％,均低于国家对三级甲等医院最低标准要求(0.50％).结论 基于指南构建的术前皮肤准备方案将最佳证据应用于临床,为护理人员提供了科学的实践指导,帮助护理人员规范操作流程,具有科学性和可行性.

目的 系统评价脑瘫患儿选择性脊神经后根切断术后进行康复训练的有效性,为术后康复护理提出可行性和合理化的建议和意见.方法 计算机检索PubMed、中国生物医学文献数据库、万方数据知识服务平台、中国知网、维普期刊资源整合服务平台等数据库中有关脑瘫患儿选择性脊神经后根切断术后进行康复训练的随机对照试验(RCT),检索时间限制为各数据库建库至2017年9月1日.由两位研究员按照纳入、排除标准分别独立对文献进行筛选并中提取资料,对纳入文献进行质量评价,利用Review Manger5.3分析软件进行统计学的Meta分析,并用GRADE Profiler 3.6.1软件进行GRADE评级.结果 最终纳入7篇原始研究文章,共644个病例.其中文献质量等级为A级的原始研究数量1篇,文献质量等级为B级的原始研究数量为4篇,质量等级为C级的原始研究数量为2篇.Meta分析结果显示:选择性脊神经后根切断术后进行康复训练能够提高患者的GMFM分数[MD=2.0,95％CI(0.42,3.57),P=0.04],经GRADE系统评级,证据体的质量为低等级别.结论 脑瘫患儿在选择性脊神经后根切断术后进行康复训练可以提高患儿的粗大运动功能评分(GMFM),提高患儿的肌张力与行走能力.但康复训练的具体方法各不相同,没有形成系统的体系,仍需大样本、多中心、高质量的研究对结果予以验证.

Objective To review the methodological quality of evidence-based guidelines on prevention and repair of perineal injury at vaginal delivery,and analyze the characteristics of guidelines to provide references for evidence-based decision-making.Methods We systematically searched websites of professional organizations,websites of clinical practice guidelines and databases for guidelines on prevention and repair of perineal injury,and used AGREE Ⅱ to evaluate the chosen guidelines.Results We identified totally 7 relevant evidence-based guidelines in this field.The average standardized scores of guidelines in 6 domains of AGREE Ⅱ were 90.21％(scope and purpose),68.25％ (stakeholder involvement),69.94％ (rigor of development),89.41％ (clarity of presentations),70.63％ (applicability),and 68.25％(independence),respectively.The overall standardized score for 7 guidelines was 75.65％,and the total score was 5.67 (7 points).For overall quality,4 of them were grade A and 3 of them were grade B.Conclusion The overall quality of included guidelines were high,but stakeholder involvement,rigor of development and independence in some guidelines needs to be improved.There was no Chinese evidence-based gui-deline in this field,and high-quality foreign guidelines could be used as evidence in combination with local conditions.

Objective To evaluate the quality of evidence-based guidelines on senile functional constipation management and provide references for decision-making and the development of evidence-based guidelines suitable for China. Methods A search of Guideline International Network (GIN), National Guideline Clearinghouse (NGC), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), Canadian Medical Association (CMA), New Zealand Guidelines Group (NZGG), Registered Nurses Association of Ontario (RNAO), National Health and Medical Research Council (NHMRC), American College of Gastroenterology (ACG), China Guideline Clearinghouse (CGC), Medlive website, and related websites and databases were conducted to screen the guidelines on senile functional constipation management with inclusion and exclusion criteria. Appraisal of Guidelines for Research & Evaluation Ⅱ (AGREE Ⅱ) was applied on the methodological value evaluation for searched guidelines. The overall agreement among 3 appraisers was measured by the intraclass correlation coefficient (ICC). The analysis of advices from guidelines was performed. Results A total of 5 evidence-based guidelines were included, which were all from abroad. The average scores of guidelines in six domains of AGREE Ⅱ were 97.78% (scope and purpose), 78.52% (stakeholder involvement), 79.86% (rigor of development), 89.63% (clarity of presentations), 63.89% (applicability), and 86.87% (independence) respectively. The ICC were 0.887- 0.971. Considering the overall quality evaluation, 3 of them were grade A and 2 of them were grade B. The recommendations of included guidelines were almost consistent. Conclusions The overall quality of included guidelines is high. There is no local evidence-based guideline of senile functional constipation management in China. High-quality guidelines can offer the evidence support for the development of clinical practical guideline for senile functional constipation management. Foreign guidelines should be localized before their application in the clinic in China.

从专科护理发展史、专科护士行业定位等方面介绍国内外专科护士发展概况;介绍了目前国内外专科护士准入条件、核心胜任力、资格认证、工作范围及角色等的人才管理现状;从专科护士岗位职责、工作模式、薪资体系等方面介绍了专科护士岗位管理现状;并且借鉴国内外专科护理发展的经验,结合我国国情,探讨了中医护理专科化的基础与必要性,并展望了中医护理专科化可能的发展思路,以期为我国中医护理专科化的发展有所启示.

Objectives To implement the guideline-based clinical practice program for identification and manage-ment of dysphagia in stroke patients,and to create a good evidence-based practice culture,and to improve the quality of clinical care. Methods In this study,we use the Iowa model of evidence-based practice as a guide, reference guide issued by RNAO to implement the corresponding implementation strategy tool,and gradually apply the program to the pilot ward. Results The implementation of the program had a positive impact on the patient level (quality of life,satisfaction and hospitalization),the nurse level(satisfaction and knowledge),and the level of eachau-ditcriteria. Conclusion It is possible to improve the clinical nursing quality by adapting the high quality guide-lines for the identification and management of dysphagia in foreign countries and this study can provide reference for the research of future guideline implementation.

The article summarized the research methods which reflected patient preference and value among health education,such as effectively evaluating patients needs,establishing therapeutic relationship with patient,using structured approaches to promote patient to study and cooperating with patient and our team.And analyzed the influencing factors of patients'willingness and values among health education under the view of patients and medical personnel.The article stated the research prospects of patients’ intention and values in future health education,in order to provide reference for the implementation of more appropriate health education under considering patients’ intention and values.

Objective: To evaluate the effectiveness of moxibustion therapy for patients with high-risk diabetic foot,and to provide reference for its treatment and prevention.Methods: Randomized controlled trial (RCT) and semi-randomized controlled trials (CCT) articles on moxibustion therapy for patients with high-risk diabetic foot were searched in Cochrane Library,JBI,PubMed,EMbase,China Biomedical Literature Database (CBM),China Knowledge Network (CNKI),Wanfang Data Knowledge Service Platform (WanFang Data),Weipu Periodical Resource Integration Service Platform (VIP) from database construction to May 1,2016.Data were collected and extracted by two researchers according to the inclusion criteria,and the quality of the literatures was evaluated by reference to the quality evaluation criteria of the Cochrane Handbook.Meta-analysis was performed by using Review Manger 5.3 analysis software.Results: A total of 9 pieces of literatures were included in this study,in which 8 RCTs and 1 CCT,involving 875 patients.There was 7 Grade B quality of original research and papers 2 Grade C quality of original research papers.Meta-analysis showed that:moxibustion treatment could effectively improve lower extremity pain,abnormal nerve reflex,sensory dysfunction,and numbness symptoms caused by high-risk diabetic foot[MD=-1.69,95%CI(-2.36,-1.02),P<0.000 01];moxibustion could effectively improve the median motor nerve conduction velocity in patients with high-risk diabetic foot[MD=2.82,95%CI(1.55,4.09),P<0.000 1];moxibustion could effectively improve the ABI of patients with high-risk diabetic foot[MD=0.15,95%CI(0.04,0.27),P=0.008].Conclusions: Moxibustion could improve the NCV and blood circulation velocity of high-risk diabetic foot,and prevent the occurrence of diabetic foot ulcer.

循证实践中证据应用具有复杂性,促进研究证据在临床实践的成功运用是成功循证实践的关键;PARIHS循证概念框架是健康服务领域研究成果应用的行动促进框架,是一种能够促进理论研究成果成功应用于临床实践的方法.该框架于1998年制定至今共演变3个版本,本文将分析框架演变的内涵与意义,理解和判断框架的应用方法,并提出对最新版本i PARIHS框架的应用思考.

Objective To evaluate the quality of evidence-based guidelines for diabetic foot prevention and management,in order to provide reference for decision-making and clinical practice.Methods To screen guidelines for prevention and management of diabetic foot by searching the databases such as Registered Nurses Association of Ontario (RNAO),Scottish Intercollegiate Guidelines Network (SIGN),National Institute for Health and Clinical Excellence (NICE),New Zealand Guidelines Group (NZGG),National Guideline Clearinghouse (NGC),Guideline Intemational Network (GIN),reviewed and assessed the guidelines by AGREE Ⅱ instrument and measured the overall agreement by the intragroup correlation coefficient (ICC).Results A total of 6 guidelines for prevention and management of diabetic foot were included,for general quality evaluation,4 guildlines were evaluated as level A,2 guildlines were evaluated as level B and the mean scores of 6 domains by AGREE Ⅱ were from 70.83％ to 87.04％.The ICC was from 0.642 to 0.951.Conclusion The quality of guidelines for prevention and management of diabetic foot are good in general.And they can offer the evidence support for clinical.However,before implement the guidelines,we must tailor and localize the content and recommendation of guidelines.

Objective To evaluate the efficacy of wax therapy for diabetic peripheral neuropathy, in order to provide suggestions for treatment and prevention.Methods Cochrane Library, JBI, PubMed, EMbase, CBM, CNKI, WANFANG DATA, VIP were searched by computer from inception to October, 2016 for randomized control trails in wax therapy for diabetic peripheral neuropathy. Two researchers searched and selected articles independently and the quality was assessed in accordance with Cochrane Manual. The articles were analyzed with Review Manager 5.3, and the evidence quality was assessed with GRADE profiler 3.6.1 software.Results A total of 8 randomized controlled trials were included. The number of literature quality grade A of original research is 3, while the number of literature quality grade B of original research is 4,and the number of literature quality grade C of original research is 1. Meta-analysis showed that the sensory nervus peronaeus conduction velocities improved by wax therapy for diabetic peripheral neuropathy patients,[MD=2.51, 95%CI(1.35,3.66), P<0.01]. By the GRADE system grading, the evidence quality is moderate.Conclusions The effect of wax therapy for diabetic peripheral neuropathy can improve the sensory nurve conduction velocities and speed of blood circle, so as to prevent ulcer of diabetic feet. Therefore, the clinical curative effects of the therapy require large-sample and high quality studies to confirm.

将证据应用到临床实践具有复杂性与多变性，借助证据应用模式将有助于这一转化，健康服务领域研究成果应用的行动促进（promoting action on research implemrntation in health severice，PARIHS）循证概念框架，即证据应用模式的一种，其目前在我国鲜见报道与应用。笔者对 PARIHS循证概念框架的理论予以介绍，包括3大核心要素，即证据、证据应用组织环境及促进因素的协调；理论起源与发展的历程，突出 PARIHS框架内涵与思路不断清晰化的发展过程；还对目前应用于不同目的、不同领域临床实践与科研活动中的应用现状进行分析。最终得出 PARIHS框架研究与应用价值突出，最大化框架使用价值基础上清晰化理论内涵、促进框架应用方式与效果评价的标准化及研发恰当合适的应用工具是 PARIHS框架探索研究的重点。

The Registered Nurses Association of Ontario (RNAO) is the professional voice of registered nurses, nurse practitioners and nursing students in the province of Ontario, Canada. RNAO’s mandate is to influence and promote public health policy and clinical excellence. RNAO’s best practice guideline (BPG) program established in 1999, focuses on BPG development, implementation and evaluation and has impacted clinical and academic excellence globally. The Best Practice Spotlight Organization (BPSO®) Designation, is RNAO’s unique organizational knowledge exchange strategy that supports health care and academic organizations to implement and integrate multiple best practice guidelines into daily practice and education. Beijing University of Chinese Medicine (BUCM) has recently become the first academic BPSO in China to enable successful implementation of BPGs which must include not only clinical nurses but also nursing educators and students. While relatively new in implementing BPGs into the nursing curricula, BUCM School of Nursing has developed key strategies to support this work. This paper will discuss the nursing educational innovation of integrating BPGs into the curricula to cultivate evidence-based practice (EBP) at the BUCM School of Nursing from the perspectives of undergraduates, graduates and nursing educators.

从政府、高校、医院三个层面,阐述我国护理专业学位硕士研究生的培养政策、培养方案、临床实践教育等现状;总结分析我国护理硕士专业学位的相关研究及实践探索;借鉴国外护理硕士专业学位的发展经验,提出对我国护理硕士专业学位发展的思考,以期为我国专科化护理人才的培养提供参考.

This paper systematically introduces the evidence grading systems in the world, the concept of Evidence-based Medicine and proposal for evidence grading and strength recommendations in development of clinical practice guidelines of Traditional Chinese Medicine (TCM). The paper also discusses the issues and challenges in regarding to characteristics and current status of clinical research in TCM, and to provide the referential basis in developing the clinical practical guidance for TCM.

Objectives: To systematically review the methodological quality of evidence-based guidelines on identiifcation and management of stroke dysphagia, then to compare the differences and similarities of the contents of the included guidelines, and to provide references for evidence-based decision-making and the development of evidence-based guidelines. Methods: The methodological quality of included guidelines searched from websites and databases was evaluated according to the AGREE II instrument, and the differences and similarities between recommendations of included guidelines were compared. Results: A total of 5 evidence-based guidelines on identiifcation and management of stroke dysphagia were included and they are all from abroad. To the overall quality, 2 of them were grade A and 3 of them were grade B. The average scores of guidelines in six domains of AGREE II were 90.00% (scope and purpose), 77.77% (stakeholder involvement), 77.08% (rigor of development), 85.93% (clarity of presentations), 52.78% (applicability), and 84.72% (independence), respectively. The recommendations of included guidelines were almost consistent. Conclusion: The overall quality of included guidelines was high. The lowest domain scores of "applicability" need to be improved. China's development of evidence-based guidelines in accordance with the standard of foreign AGREE II still have a certain gap, but there are still some high-quality foreign guidelines which could be tailored and implemented to the local context in order to improve the clinical quality of care.