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多学科文献导读与评判
$38.05
此书谨献给全世界为母亲、胎儿、新生儿安康做出贡献的医护、科研、教学、科普、管理人员。感谢参与"无痛分娩中国行"的来自世界各地的全体志愿者。
胡灵群 医生
目 录
第1章 晚期早产风险孕妇的产前糖皮质激素(倍他米松)预防性治疗 - 随机临床试验CONSORT清单
第2章 反安慰剂效应在局麻注射中诱导的痛觉过敏 - 随机临床试验浅析
第3章 硬膜外分娩镇痛与产后抑郁症风险的降低相关联:一项前瞻性队列研究 - 前瞻性队列研究浅析
第4章 择期剖宫产腰麻时患者体重指数对感觉运动阻滞和血管加压药用量的影响 - 优效性、等效性和非劣效性检验简介
第5章 产科专项临床细则的"存在"真的会明确改善妊娠结局吗? - 临床试验阴性结果的解读和评判
第6章 产科麻醉硬膜外血补丁的剂量:一项随机单盲临床试验 - 临床"经验"还是临床"试验"
第7章 新生儿5分钟Apgar 评分0分、癫痫发作或严重神经功能障碍与分娩环境相关性研究-高质量临床回顾性研究对临床指南的指导意义
第8章 早期应用氨甲环酸对产后出血患者死亡率、子宫切除率和其他并发症的影响:一项随机双盲、安慰剂对照的国际多中心临床试验-老药新用:发展中国家的大数据多中心临床试验
第9章 足月初产妇阴道试产中转剖宫产预测:多中心、前瞻性、成因研究结果 - 路漫漫其修远兮:从临床研究到临床指南到底有多远?
第10章 产科回收式自体输血的经济效益 - 卫生经济分析的几个评价类型
第11章 对利物浦女子医院产科回收式自体输血"经济效益评价"的评价 - 医疗的中心议题:是患者利益至上?还是经济效益至上?
第12章 上下法测定催产素输注防剖宫产术后宫缩乏力的90%有效剂量 - 过犹不及:催产素小有效剂量初探
第13章 高剂量与低计剂量缩宫素持续静点对在择期剖宫产术中维持子宫收缩力影响的疗效比较:一项前瞻性随机临床试验 -大剂量缩宫素的"经验主义"危害
第14章 阿司匹林与安慰剂在子痫前期早产高危妊娠中的比较研究 - 医疗决策对临床研究的诘问
第15章 硬膜外分娩镇痛-芬太尼剂量和母乳喂养成功率:一项随机双盲临床试验 - 从"证据联"到"证据链"
前 言
本书推介和提倡的"文献评判"是一种非常行之有效的、科研与实践相结合的团队学习模式。不同于传统的、个体的"文献复习","文献评判"要求团队共同学习,同时应用批判性思维,对学术研究进行审视。"文献评判"既可以学习他人研究成果,关注学术动态,洞察研究设计,拓展自身研究方向;更可以共同探讨前人研究的局限性或者得失,调整或纠正自己的研究思路和临床科研思维,促进科研成本效益化,终成果转化服务于临床实践。因此,文献评判(Journal Club)在西方国家的临床机构已经形成科室学习惯例并列为住院医师培训和专科医师培训的重要课程,在我国一些大型三甲医院也已经开始了尝试(文献学习会)。
本书是国内以文献评判为主要内容的医学专业书籍。作者们整合了摘要编译、质量评估、临床价值评审、统计学评审、多学科专科点评荟萃等各环节,构建了文献评判的逻辑框架;精心选取了国际知名医学期刊发表的十五篇现代产房相关的临床试验和大数据研究,针对不同研究内容、试验设计和统计方法,导入论文质量量化评估标准对其一一进行剖析。在逐层"解构"科研文献的同时,本书力求以循证医学为宗旨、以研究设计为重点、以医学统计学为准绳,引导临床读者们判断其证据质量、分析其研究局限性、评价其临床应用前景。此外,本书选取的各项临床试验无论在试验设计和统计学方法上都各具特色,对此作者们结合问题导向型学习模式(Problem-based learning, PBL)针对性地进行了讲解和评述,尽可能避免教科书式的摘抄。
纵览全书,十五篇文献评判涵盖了麻醉(产科麻醉)、产科(围产医学、母胎医学)、儿科(新生儿科)、精神科、临床药学、助产/护理(产房、手术室等)和医院管理等专科和亚专科领域;研究内容涉及晚期早产风险控制、子痫前期高危产妇的预防性阿司匹林治疗、产程中的分娩镇痛、阴道分娩中转剖宫产的风险预测模型、肥胖产妇剖宫产麻醉剂量、宫缩乏力的催产素剂量、产后出血的预防性用药和自体血回输、新生儿临床转归与分娩环境相关性、硬膜外血补丁剂量、分娩镇痛与产后抑郁症风险降低、分娩镇痛药物对母乳喂养的影响等等;均是当今众多热门而又富有争议的贯穿产前、产时、产褥期的临床研究话题。这些研究有的是大数据大样本,研究成果成为新一轮临床指南的重要证据,改变了全球医疗行为;有的却得到阴性结果,否定了人们之前的假设和猜想;还有的研究从假设、试验设计到统计学方法均有失严谨客观,得到的结论可信度较低,成为反面教材…… 本书作者精心汇编的这些论文文献,既着眼于与当前临床实践接轨、提升研究内容的临床应用价值,又力陈循证医学思维的重要性:临床决策和医疗行为绝不是拍脑袋的经验主义行为,而必须是基于人群的、经由严格论证的、可以推而广之的医学科学研究的成果转化。
"他山之石,可以攻玉",我们希望通过本书十五篇文献评判的精读,帮助广大临床读者提高文献学习的判读能力,进而提高试验设计和统计学分析的质量;重要的,转"临床经验"为"循证思维",理解高质量的医学研究和临床试验对于临床指南出台、临床实践更新的重要性,进一步领会和掌握现代医学"患者安全和医疗质量"两大基石的精髓。
唐琳 医学博士
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