RESUMO
Objective:To integrate the best evidence of non-drug intervention of urinary incontinence in elderly women and to formulate practical recommendations.Methods:In this systematic review study, using “elderly woman”,“urinary incontinence”,“bladder training”,“pelvic floor muscle training”,“enuresis”,“leakage of urine” as the key words, the 6S evidence resource pyramid model was used to search in British Medical Journal best practice, Uptodate, World Health Organization, Guidelines International Network, National Institute for Health and Care Excellence, Chinese Medical Association, Scottish Intercollegiate Guideline Network, Registered Nurses Association of Ontario, Cochrane Library, The Joanna Briggs Institute (JBI), New Zealand Guidelines Group, Polish Society of Gynecologists and Obstetricians, PubMed, Embase, Medline, Web of Science, SinoMed, China National Knowledge Infrastructure, WanFang Data, etc. The evidence retrieved included evidence-based knowledge base resources, clinical practice guidelines, expert consensus, systematic review, etc. Data were retrieved from January 1, 2017 to May 1, 2022, and collated from May 2, 2022 to May 25, 2022. Two researchers independently evaluated the quality of literature and extracted data using the AGREE Ⅱ and JBI evidence-based health care center assessment tools. The JBI evidence-based health care center′s evidence pre-rating system and evidence recommendation rating system were applied to rank the evidence; and under the guidance of the evidence structure of JBI, the strength of evidence recommendation was determined and the best evidence was extracted and summarized in combination with the study group discussion and expert opinion.Results:A total of 9 articles were retrieved, including 7 guidelines and 2 systematic reviews; and 6 guidelines were classified as Grade A and 1 as grade B; both 2 systematic reviews were rated as Grade A; 84% (27/32) of the items were evaluated as “Yes”. Evidence were summarized as 34 pieces of best evidence from 6 dimensions, including “overall recommendation, evaluation of type and degree of urinary incontinence, lifestyle change, behavioral therapy, prevention of precipitating factors, intervention in special population”; the flow chart of screening, evaluation, special symptoms, life style and behavior therapy was combed, and the practical suggestions were formed.Conclusions:The overall quality of the literature on non-drug intervention of urinary incontinence in elderly women is high, and the level of evidence is high. Early identification of urinary incontinence types and assessment of disease severity, lifestyle changes, avoidance of predisposing factors and behavioral therapy are the key to non-drug treatment of urinary incontinence in those patients.
RESUMO
The concentrations of prostaglandin in high mobility group box-1 ( HMGB1 ) and highsensitive C-reactive protein (Hs-CRP) in serum and peritoneal fluid were detected in 76 patients with endometriosis (study group) and 30 patients without endometriosis (ovary cysts or uterine myoma, as control group). The peritoneal fluids were collected during laparoscopic operation, and the serum samples were collected before surgery. The HMGB1 and Hs-CRP concentrations in serum and peritoneal fluid of study group were significantly higher than those of control group, ( 8. 2 ± 0. 8) mg/L vs. (2. 1 ±. 0. 2) mg/L、 ( 14. 4 ±3.0) mg/L vs. (4.5 ±2.3) mg/L (both P＜0. 01);HMGB1 and Hs-CRP levels in serum and peritoneal fluid of stage Ⅲ-Ⅳ endometriosis were significantly higher than those of stage Ⅰ-Ⅱ, ( 9. 2 ± 0. 8) mg/L vs.(6.7 ±0.7) mg/L,(18.7 ±2.9) mg/L vs. (11.2 ±2. 8) mg/L,(6.5 ±0.6) mg/L vs. (3.4 ±0.5) mg/L,(8.4 ±2.7) mg/L vs. (5.4 ±2.4) mg/L (all P ＜0.05). The concentrations of HMGB1 were positively correlated with Hs-CRP in endometriosis group (r =0. 72, P ＜0. 01 ). The results indicate that concentrations of HMGB1 and Hs-CRP may be of value in assessing the severity of endometrosis.
