循证护理实践-医学课件.ppt

1.确定需解决的问题 留置导尿病人更换导尿管的最佳间隔时间是多少？ 2.文献检索:以“导尿管”、“更换时间”、““留置时间”、“更换频率”、“泌尿系感染率”及相应的英文等为检索词检索国内外数据库 循证护理实践应用举例 3.得出结论：一般硅胶导尿管在使用3-4周后才发生硬化现象 尿液pH值6.8者发生堵塞的机率比pH 6.7者高10倍 ?应动态监测尿液的pH值 ?pH 6.8： 更换导尿管的时间为2周 ? pH 6.7：4周 4.将研究结果应用于临床护理实践中 5,评价新措施的护理效果 阿司匹林对冠心病心肌梗死的疗效直至80年代初期仍有较大争论。 欧美等多国组织了ISIS-2（Second-International Study of Infarct Survival）多中心临床试验，观察了17000例病人，结果证实口服阿司匹林(162.5mg／d×4周)可显著降低AMI患者发生心肌梗死后35天的病死率，减少非致命再梗死。 l988年，ISIS-2多中心临床试验结果发表以后，在世界范围内开始广泛使用阿司匹林治疗AMI，使用率高达70％-80％，AMI临床治疗水平无疑大大提高。 * This is often referred to as the evidence pyramid. It is used to illustrate the evolution of the literature. The base of the pyramid is where information usually starts with an idea or laboratory research. As these ideas turn into drugs and diagnostic tools they are tested in laboratories models, then in animals, and finally in humans. The human testing may begin with volunteers and go through several phases of clinical trials before the drug or diagnostic tool can be authorized for use within the general population. Randomized controlled trials are then done to further test the effectiveness and efficacy of a drug or therapy. As you move up the pyramid the amount of available literature decreases, but increases in its relevance to the clinical setting. Meta-Analysis takes the systematic review (see below) a step further by using statistical techniques to combine the results of several studies as if they were one large study. Systematic Reviews usually focus on a clinical topic and answer a specific question. Extensive literature searches are conducted to identify studies with sound methodology. The studies are reviewed, assessed, and summarized according to the predetermined criteria of the review question. Randomized Controlled Trials are carefully planned projects that study the effect of a therapy or test on real patients. They include methodologies that reduce the potential for bias and that allow for comparison between intervention groups and c