OBJECTIVE:To evaluate the curative effect and safety of dexamethasone for severe asthma and severe sepsis systematically. METHODS:Randomized controlled trials about dexamethasone for severe asthma and severe sepsis were retrieved from database,such as Cochrane library(1996～2007),PubMed(1966～2007),EMCC(1995～2007),CHKD(1994～2007)and pertinent literatures. The qualities of included studies were evaluated and extracted data were analyzed by Meta-analysis respectively. RESULTS:11 trials containing 1 435 cases were up to included standard. Therapy results of severe asthma:(1)in remission rate of the total symptom,difference between dexamethasone and prednisone was not statistically significant [OR 1.44,95%CI(0.75, 2.75);P=0.27];(2)In the incidence rate of ADR,dexamethasone was lower than prednisone [OR 0.13,95%CI(0.04,0.44);P= 0.001];(3)In the recurrence rate,no statistical significance was noted in difference between dexamethasone and prednisone [OR 0.58,95%CI(0.25,1.31);P=0.19]. Therapy results of severe sepsis:(1)In the mortality,difference between dexamethasone and placebo was not statistically significant [OR 0.85,95%CI(0.41,1.78);P=0.67];(2)In the incidence rate of ADR,no statistical significance was noted in difference between hydrocortisone and placebo [OR 1.05,95%CI(0.51,2.19);P=0.89]. CONCLUSION: Dexamethasone is similar to prednisone in the treatment of severe asthma but better than prednisone in drug safety. The safety of dexamethasone is similar to placebo in the treatment of severe sepsis.

OBJECTIVE:To focus on the situation of clinical pharmacists particpating in the clinical drug treatment consulta-tion in China. METHODS:With the keywords of“clinical pharmacists”,“consultation”and others,retrieved from China Hospital Knowledge Database (CHKD),Wanfang Database and China BioMedical Literature Service System (SinoMed),the situation of clinical pharmacists particpating in the clinical drug treatment consultation in China was concluded and summarized. RESULTS:A total of 186 literatures were included,invloving 114 effective literatures. 2 606 cases were clinical pharmacists particpating in the clinical drug treatment consultation,2 257 cases were all or part of adoption of clinical pharmacists’suggestions,the execution lev-el of clinicians for clinical pharmacists’consultation suggestions reached 93.02%. After carrying out the clinical pharmacists’con-sultation suggestions,patients’condition improved or cured reached 2 290 cases,with the effective rate of 94.47%. CONCLU-SIONS:Clinical pharmacists participating in the clinical consultation has certain function,however,the working method and mode need to be further explored and standarized.

Objective:To observe the efficacy of drug combined with red-blue light irradiation, chemical peeling by glycolic acid and intense pulsed light (IPL) in the treatment of moderate acne vulgaris.Methods:A total of 187 patients with moderate acne vulgaris were divided into five groups. There were 59 males and 128 females, aged from 16 to 29 years (21.79±2.52). In group A, patients were treated with oral medicines; the patients were treated with oral medicines combined with red-blue light irradiation, chemical peeling by glycolic acid and IPL respectively in group B, group C and group D. In group E, patients were treated with oral medicines combined with chemical peeling by glycolic acid and IPL. The number of different types of skin lesions (comedoes, papules, pustules) were compared between before and after treatment in five groups. The clinical effect of five treatment groups was evaluated by comparing regression rates of different types of skin lesions and total skin lesions and treatment efficiency.Results:All the patients with moderate acne vulgaris were brought into this study. The regression rates of comedoes, papules and total skin lesions were (86.37±9.64)%, (94.25±9.79)% and (88.80±9.40)% respectively in group E, and significantly higher than that of other four groups ( P<0.05). The treatment efficiency of group E also were significantly higher than that of other four groups ( P<0.05). Then, the regression rates of comedoes (70.91±18.52) in group C was significantly higher than that of group A and group B ( P<0.05). The regression rates of papules (91.42±13.86) in group D was significantly higher than that of group A and group B ( P<0.05). Conclusions:Oral medicines combined with chemical peeling by glycolic acid and IPL has obvious clinical efficacy in treatment of patients with moderate acne vulgaris. Oral medicines combined with chemical peeling by glycolic acid can obviously improve comedoes, and oral medicines combined with IPL can obviously improve papules.

Refeeding syndrome(RFS)has a high incidence among critically ill patients and significantly impacts the re-covery and prognosis of the patients.In this paper,we reviewed the literature on the risk factors and risk prediction models for RFS,finding the risk factors of RFS included patient-related,treatment-related factors and disease-related factors and the risk prediction models encompassed risk stratification model,risk score models and the Logistic regression models.It was concluded from the review that early assessment was crucial to preventing the occurrence of RFS.However,there was still a lack of reliable RFS risk prediction models with good predictive performance.It was found as well that it was crucial for the prevention of RFS to attach importance to nutritional and serological indicators and other factors.It was expected to be a necessity to conduct prospec-tive and multicenter studies to develop a risk prediction model for predicting RFS for ICU patients.Our review provides a refer-ence for early assessment and intervention for critically ill patients with RFS.

Objective To clarify and analyze the concept and connotation of the reflective practice in nurses.Methods CNKI,Wanfang,CBM,PubMed,Embase,Scopus,CIHNAL database were searched in relation to reflective practice in nurses.The retrieval period was from the inception to Dec.2022.Walker and Avant's concept analysis method was used to analyze the connotation.Results A total of 43 articles were retrieved.6 attributes of reflective practice in nurses were identified,including active engagement,critical thinking,openness and acceptance,making connections with previous knowledge or experiences,extemal support,dynamic and continuity.Antecedents included internal and extemal drivers.The reflective practice in nurses ultimately had a vital impact on themselves,patients and organizations.In recent years Reflective Practice Questionnaire has been one of the most commonly used data collection tools to measure the reflective practice in nurses.Conclusion The concept attributes of reflective practice in nurses were identified by concept analysis method,which provides references for nursing educators to cultivate reflective practice ability of nurses.In future research,researchers can combine the connotations of reflective practice for nurses to develop specific assessment tools for testing the level of reflective practice of nurses and construct the local reflective practice intervention scheme for nurses,so as to promote the development of reflective practice in nursing field in China.

Objective: To investigate the antimicrobial resistance, macrolide-resistance genes, virulence genes and emm types in Streptococcus pyogenes isolates. Methods: A total of 247 oropharyngeal swab specimens were collected from pediatric outpatients (aged 2-11 years) who were clinically diagnosed as scarlet fever in Children′s Hospital of Fudan University from January to December, 2018. These specimens were timely sent to the Microbiology Laboratory for isolation and identification of Streptococcus pyogenes strains were isolate after culturing and identified with bacitracin susceptibility test. Moreover, the diameter of bacitracin inhibition zone was measured by vernier caliper. Their susceptibility to seven antibiotics, including erythromycin, clarithromycin, clindamycin, ampicillin, ceftriaxone, norfloxacin and chloramphenicol, were measured using KB method. Macrolide-resistance genes (mefA, ermA, ermB and Tn916 transposon) and virulence genes (speA, speB, speC, speG, speH, speI, speJ and speK) were detected by PCR. Amplification and sequencing of emm gene were conducted according to the protocol in the website of Centre for Disease Control and Prevention (CDC). Results: A total of 86 strains of Streptococcus pyogenes were isolated from the 247 specimens. Their resistance rates to erythromycin, clarithromycin and clindamycin were 89.5%, 95.3% and 96.5%, respectively. However, these isolates showed high susceptibility to ampicillin (100.0%), ceftriaxone (100.0%), norfloxacin (90.7%) and chloramphenicol (95.3%). The positive rates of mefA, ermA, ermB and Tn916 genes were 20.9%, 24.4%, 98.8% and 97.7%. There was significant difference in the mefA-carrying rates between patients with scarlet fever and angina. The positive rates of virulence genes of speA, speB, speC, speG, speH, speI, speJ, speK, speL and speM were 8.1%, 100.0%, 95.3%, 100.0%, 80.2%, 90.7%, 10.5%, 100.0%, 5.8% and 5.8%. Seven emm types were identified and the predominant types were emm12.0 (75.6%), emm12.19 (9.3%) and emm1.0 (8.1%). The diameter of bacitracin inhibition zone was smaller in isolates of emm1.0 type than in emm12.0 type strains. The profile of virulence genes varied in the strains of different emm types. All types of strains carried speB, speG and speK genes. The isolates of emm1.0 type carried speA virulence gene, while speB, speC, speG, speH, speI and speK genes were more often identified in emm12.0 type isolates. Conclusions This study showed that emm types were associated with the profile of virulence genes and the diameter of bacitracin inhibition zone. It was recommended that the diameter of bacitracin inhibition zone should be measured in bacitracin inhibition susceptibility test apart from only observing the formation of inhibition zone.

[This corrects the article DOI: 10.1016/j.chmed.2022.08.005.].