ObjectiveTo summarize the recent progress in prevention of prosthetic joint infection (PJI) so as to provide clinical references. MethodsThe publications concerning the etiology and surgical management of PJI were reviewed, analyzed, and summarized. ResultsThe prevention of PJI is related to preoperative, intraoperative, and postoperative aspects of PJI, comprehensive treatment is considered to be the most common method for PJI. ConclusionThese prevention strategies that may be utilized in all phases of perioperative care, a multifaceted approach to the patient undergoing total joint replacement will have the greatest positive effect
Objective To be aware of the treatment status and economic burden of people with hemophilia (PWH) in mainland China, so as to seek the optimal therapy for them. Methods The relevant Chinese and English databases such as CBM, CNKI, VIP, WanFang Database, PubMed, EMbase and The Cochrane Library (Issue 6 of 12, June 2011) were searched in June, 2011. The economic analyses and studies on PWH treatment and economic burden published from 1980 to 2011 were collected. Results The diagnosis and treatment of PWH in mainland China lagged behind. More than 30% of PWH did not receive or occasionally received treatment, and less than 10% received prophylactic therapy. Lots of PWHs still used FFP or cryoglobulin which were easily to cause blood-borne viral diseases. More than half of PWH families could afford a little or completely could not afford the therapy. Low dose prophylactic therapy was cost-efficient than on-demand therapy. Based on the therapy status, it was estimated that approximately RMB 53 844 yuan per year per patient should be put into practice in order to have PWH received low-dose prophylactic therapy, and to prevent 80% of bleeding. Conclusion PWH in mainland China is poor in treatment status and heavy in economic burden, so it is an optimal way to adopt comprehensive care model and low-dose prophylactic therapy in mainland China.
Objective To formulate an evidence-based nursing strategy of turning over for a patient with the risk of pressure ulcer. Methods The personalized clinical questions were put forward based on the PICO and patient’s condition, and the following databases such as NGC, The Cochrane Library of DARE, CDSR, CCTR, MEDLINE, PubMed and CBM were searched to collect the best clinical evidences of turning over for preventing pressure ulcer. Results One clinical guideline, one systematic review and three randomized controlled trials were included finally. According to the retrieval outcomes, patient’s clinical condition, and patients and their family members’ willingness, a reasonable nursing plan of turning over was formulated: lie on the visco-elastic foam decompression bed, turn over every 4 hours, and combine supine position with alternation of left-oblique 30° position and right-oblique 30° position. During hospitalization, the grade-I pressure ulcer in size of 4×6 cm2 on patient’s sacrococcygeal region was clear, dry and not broken, and the other part of body with pigmentation had no occurrence of pressure ulcer. Conclusion Evidence-based approaches are helpful to provide patient with a nursing plan that meets the needs of both scientificalness and individualization.
Objective To evaluate the effectiveness of topical fluoride on prevention of enamel demineralization during the orthodontic treatment in China. Methods The Cochrane Library（Issue 9, 2012), MEDLINE (1996 to 2012.10), EMbase (1974 to 2012.10), CNKI (1994 to 2012.10), VIP (1994 to 2012.10), WanFang data (1998 to 2012.10) and CBM (1978 to 2012.10) are searched for the randomized controlled trials (RCTs) and quasi-Randomized controlled trials (qRCTs) about topical fluoride preventing enamel demineralization during the orthodontic treatment. The bibliographies of the included studies were searched, too. Two reviewers evaluated the quality of the included studies and extracted data critically and independently, and then the extracted data were analyzed using RevMan 5.2 software. Results A total of 20 studies within 19 articles were included, which involved 26 323 teeth. The results of meta-analysis results show that, the rate of enamel demineralization of the fluoride varnish group (8.4%) was lower than that of the control group (16.0%) (OR=0.44, 95%CI 0.33 to 0.59, Plt;0.000 01); the rate of enamel demineralization of the fluoride coating group (8.3%) was lower than that of the control group (17.7%) (OR=0.46, 95%CI 0.35 to 0.60, Plt;0.000 01); the rate of enamel demineralization of the fluoride toothpaste group (9.0%) was lower than that of the control group (14.5%) (OR=0.59, 95%CI 0.49 to 0.71, Plt;0.000 01); the rate of enamel demineralization of the fluoride foam group (11.6%) was lower than that of the control group (18.2%) (OR=0.48, 95%CI 0.24 to 0.96, P=0.04); the rate of enamel demineralization of other groups (12.0%) was lower than that of the control group (21.8%) (OR=0.43, 95%CI 0.30 to 0.60, Plt;0.000 01). Two outcomes were low quality in the GRADE system and the other three are very low quality. Conclusion Current domestic evidence shows that topical fluoride is effective to prevent enamel demineralization during the orthodontic treatment. However, given the low methodological quality of most included studies, this conclusion still needs to be further proved by conducting more strictly-designed, high-quality and large-scale studies.
Objective To evaluate the efficacy and safety of acellular dermal matrix (ADM) in preventing Frey syndrome.Methods Studies of acellular dermal matrix in preventing Frey syndrome were searched in The Cochrane Library (Issue 1, 2010), MEDLINE, EMbase, SIGLE, GreyNet, NTIS, CBMdisc, VIP, CNKI and WANFANG DATA from 1995 to 2010. All the studies were selected, extracted and evaluated by four reviewers independently, and meta-analyses were performed with RevMan 5.0.0 software. Results A total of 15 studies involving 472 participants were included in the review. The studies showed that implantation of the ADM was able to efficiently reduce the incidence of Frey syndrome, and the difference in both subjective and objective was significant between the two groups after the therapy (RR=0.11, 95%CI 0.06 to 0.18, Plt;0.01; RR=0.14, 95%CI 0.10 to 0.19, Plt;0.01). The rate of temporary facial nerve paralysis was lower than that of the control group but the difference was not significant (OR=0.78, 95%CI 0.37 to 1.66, P=0.53). The incidens of both seroma and mucocele were higher than that of the control group but the difference was not significant(OR=2.63, 95%CI 0.09 to 79.25, P=0.58) and they could be alleviated by placing drainage tube and partial pressure bandage. The incidence rate of salivary fistula was lower than that of the control group and the difference was significant (OR=0.24, 95%CI 0.08 to 0.69, P=0.009). Conclusion The result of this system review shows that, the ADM can effectively and safely reduce the incidence of Frey syndrome. To perform preoperative hypersensitivity check for iodine or iodophors, to conduct rapid frozen section for defining the character of tumor, to fix the ADM stably, to place vacuum-drainage and to make partial pressure bandage are suggested.
Objective To investigate the rural residents’ payment will for disease control and its influencing factors, so as to provide evidence for the government to make policy of combing disease control and New Rural Co-operative Medical system (NRCMS). Methods The self-designed questionnaire was adopted to investigate 1 117 rural residents from 156 villages, 44 towns, 19 counties (cities, districts) in Henan province. The frequency analysis and the multiple logistic regression analysis were conducted by using SPSS 11.5 software. Results On the basis of NRCMS payment, 68.3% of the rural residents were willing to pay extra for disease control, 62.3% of whom were willing to pay RMB 1.00 or more, and the average willing payment were RMB 3.01±7.66. The multiple logistic regression analysis revealed that the people willing to pay extra were as follows: self-employed, graduates from a secondary technical school, dink family, and the respondents who believed NRCMS had relieved their medical financial burden. Conclusion In practicing the rural public health policy of combining disease control and NRCMS, it is suggested to ask rural residents to pay a little extra money on the basis of current NRCMS payment. The foundation of bringing this policy into force is to keep practicing NRCMS well so as to relieve more financial burdens for rural residents. During the implementation, low income families should be taken into consideration according to their occupation, educational level and family structure.
Objective To evaluate the adverse events following immunization (AEFI) of meningococcal vaccines, so as to provide references for the appraisal and treatment of AEFI. Methods The Chinese Bio-medicine Database (1978 to April, 2010), China Journal Full-text Database (1994 to April, 2010), VIP Database (1989 to April, 2010) and WangFang database (1988 to April, 2010) were fully searched, and the references listed in original studies were searched manually as well. Then two reviewers independently screened studies and abstracted relevant data.Results A total of 52 articles involving 61 cases were included. Among the AEFI cases, 72.13% were hypersensitive response, including henoch-schonlein purpura (accompanied with or without nephritis), anaphylactic shock, allergic eruption, angioedema, local allergic reaction and so on. Conclusion The results of this study show that meningococcal vaccines may result in AEFI. However, most AEFI are temporary and can be cured after treatment in time. In general, meningococcal vaccine is safe, but monitoring and treatment for AEFI are necessary.
Objective To investigate and analyze the epidemic characteristics and factors of pulmonary tuberculosis (PTB) to provide foundation and make prevention and treatment policy. Methods Statistical analysis was conducted to analyze the current existing PTB prevention and control data in the Center for Disease Control and Prevention of Zhushan County and corresponding prevention and treatment policy was proposed. Results Since 1997 when PTB was included into B infectious diseases in Zhushan County, 4 431 cases of PTB had been reported by the end of 2009. Annual reported incidence rate was 74.73 per 100 000 and the disease was found in 17 towns. All seasons witnessed the incidence but winter and summer had more sufferer. The youngest patient was 4 months whereas the oldest was 86 years old. The majority of the patients were from 20 to 59 years old, peasants were the main patients, and the incidence of male was higher than that of female. The use of chemotherapy resulted in a significant decline of PTB death rate. Poor immunity of elder group, population flow caused by poverty, low detection rate of patients and AIDS were the major causes to PTB epidemic. A lack of prevention and treatment in the grassroots hospital and difficulty to fully implement the Directly Observed Treatment, Short-course (DOTS) strategy in remote areas were also bottlenecks to PTB control process. Conclusion The followings should be performed to improve the quality of DOTS strategy implementation: strengthen the government’s commitment, provide policy and funding safeguard, conduct health education and health promotion widely, reinforce management according to the law, fully implement the DOTS strategy, and fortify the prevention and control construction.
Objective To investigate the clinical effectiveness and adverse event of preventive medicine for severe acute respiratory syndrome (SARS), and provide clinical data for designing prospective clinical trial. Method Retrospective study on medical staffs, that were exposed to SARS patients, was conducted in two main SARS designated hospitals to obtain information such as SARS exposure risk and preventive measures (medical and others). According to the type of preventive medicine, they were assigned to earthworm’s nucleases and protease (ENP) group, interferon group and blank control group respectively. Exposure risk, suspected sub-clinical infection rate and adverse event rate were compared between the three groups. Results Non-medical preventive measures used in each group were consistent, but the exposure intensity to risk factors between groups was statistically different, which biased the evaluation of clinical effectiveness of preventive medicine. The rate of suspected sub-clinical infection in earthworm’s nucleases and protease (ENP) group, interferon group and control group were 4.5%, 4.5%, and 9.9% (Pgt;0.05), respectively; and adverse event rate were 19.6%, 13.6% (Pgt;0.05), and 0%, respectively. Conclusions Suspected sub2clinical infection rate in ENP group, interferon (INF) group were lower than that in control group, which indicated that these two medicines might be effective in preventing SARS. Adverse event rate in ENP group was similar to that of interferon group, and the symptoms were mild in both groups, which was in accordance with the result of in vitro experiments. ENP spray is a kind of biological preparation; further purification may reduce its adverse event rate. However, because there had excessive confounding factors, especially because of the unequal of exposure risk between three groups, the results of this study can only provide insights to design prospective clinical trial in the future.
Backgroud Iodine deficiency is the main cause for potentially preventable mental retardation in childhood and is still prevalent in large parts of the world. Objectives To assess the effects of iodised salt in comparison with other forms of iodine supplementation or placebo in the prevention of iodine deficiency disorders.Search strategy We searched the Cochrane Library, Medline, the Register of Chinese trials developed by the Chinese Cochrane Centre, and the Chinese Med Database. We performed handsearching of a number of journals (Chinese Journal of Control of Endemic Diseases, Chinese Journal of Epidemiology, Chinese Journal of Preventive Medicine, and Studies of Trace Elements and Health up to February 2001), and searched reference lists, databases of ongoing trials and the Internet. Date of latest search: November 2001. Selection Criteria We included prospective controlled studies of iodised salt versus other forms of iodine supplementation or placebo in people living in areas of iodine deficiency. Studies reported mainly goitre rates and urinary iodine excretion as outcome measures. Data collection amp; analysis As the studies identified were not sufficiently similar and not of sufficient quality, we did not do a meta-analysis but summarised the data in a narrative format. Main results We found six prospective controlled trials relating to our question. Four of these were described as randomised controlled trials, one was a prospective trial that did not specify allocation to comparison groups, and one was a large population-based study comparing different interventions. Comparison interventions included non-iodised salt, iodised water, iodised oil, iodation with potassium iodide versus potassium iodate. Numbers of participants in the trials ranged from 35 to 334; over 20 000 people were included in the population-based study. There was a tendency towards goitre reduction with iodised salt, although this was not significant in all studies. There was aim an improved iodine status in most studies (except in small children in one of the studies), although urinary iodine excretion did not always reach the levels recommended by the WHO. Reviewers’ conclusions The results suggest that iodised salt is an effective and safe means of improving iodine status. However, high quality controlled studies are needed to address questions of dosage and best means of iodine supplementation in different population groups.