Tuesday, August 1, 2023

Cochrane Review reveals vital role of supportive managers to minimise physical restraint use in care homes

A new Cochrane review finds that the use of physical restraints on care home residents can be reduced without increasing the risk of falls, when frontline care staff are empowered by supportive managers.

Physical restraints are devices that restrict freedom of movement and are frequently used in residential care homes, such as nursing homes and assisted living facilities. Examples are bed rails or belts that prevent residents from getting out of bed unassisted. These restraints are ethically problematic as they are mostly used in people with dementia who are often unable to consent to their use.

Physical restraints are often intended to prevent falls and fall-related injuries. However, the benefits are often small and come with important negative consequences. For example, the restriction of movement can have negative implications on physical functioning and mobility, actually increasing the risk of falls and care dependency. The measures can also trigger or increase fear or aggressive behaviour. For this reason, guidelines and experts recommend avoiding physical restraints in residential care settings.

But how can this be implemented in practice? A Cochrane Review, first published in 2011 and recently updated to reflect the latest research, analyses the scientific evidence on interventions and strategies to reduce the use of restraints. The team of authors, led by Ralph Möhler of the University Hospital Düsseldorf, identified 11 studies with a total of 19,003 participants, evaluating different intervention approaches.

In their evaluation, the authors found the best evidence for organizational interventions, which were investigated in 4 studies with a total of 17,954 participants. Organizational interventions to reduce the use of restraints consist of different components to function as a package. They aim to improve knowledge, skills, and strategies to prevent restraint use among both frontline care staff and managers. In three studies, employees designated as ‘champions’, were trained to develop and implement individual strategies to prevent the use of restraints within their facilities.  Managers supported this, including by relieving them of other activities and provide them with sufficient time for their tasks.

Such interventions probably reduce the number of residents with physical restraints in nursing homes by 14%. There was no overall change in the number of residents with falls or fall-related injuries and there was no increase in the prescription of psychotropic medication. In addition, there was no evidence of adverse effects of the interventions. Based on the study data, the authors calculated that the number of residents with physical restraints could be reduced from 274 to 236 per 1000 individuals, if such interventions were implemented. Focusing on changes on the organisational level seems to be important for achieving long-term effects.

Six studies examined educational interventions addressing staff knowledge and attitudes regarding the use of restraints. The results of these studies were inconsistent and some of the studies had methodological limitations. Therefore, no clear conclusion on the effects of educational interventions can be drawn.

"The results of this review show that physical restraints in nursing homes can be reduced without increasing falls or fall-related injuries,” Ralph Möhler, lead author of the review.

“There is no evidence in the reviewed studies that psychotropic medications were prescribed more often. However, education for frontline staff alone doesn’t seem to be enough; the support of care home managers plays a decisive role."

• Read the plain language summary and full Cochrane Review

Friday, July 28, 2023

鼻间歇正压通气（NIPPV）与鼻持续气道正压通气（NCPAP）用于拔管后早产儿的疗效比较 关键信息 -与NCPAP相比，NIPPV可能降低拔管和重新插管后呼吸衰竭的风险。 -与NCPAP相比，NIPPV可以减少肺部空气间隙的空气泄露。 综述问题 鼻间歇性正压通气（nasal intermittent positive pressure ventilation, NIPPV）是否可以在脱离呼吸机时不对早产儿造成伤害前提下具有短期和长期益处，?它与鼻持续气道正压通气（nasal continuous positive airway pressure, NCPAP）相比如何？ 什么是NIPPV和NCPAP？为什么需要它们？ 在预产期之前出生的婴儿（早产儿）可能有自主呼吸困难，需要呼吸支持。有证据表明，在那些不再需要气管内插管（气管中的呼吸管）的早产儿中，使用NIPPV的支持可以提高NCPAP的有效性。有呼吸问题的早产儿通常需要机器（呼吸机）的帮助，通过气管内管提供稳定规律的呼吸。拔除（拔管）该管的过程并不总是顺利的，如果婴儿在没有外力帮助的情况下无法自行呼吸，则可能需要重新插入该管。NCPAP和NIPPV是一种以微创方式支持婴儿呼吸的方法，因为管子很短，只到达鼻子后部，因此对肺部的损害最小。拔管后可使用NCPAP和NIPPV，以减少需要重新插入气管内管的婴儿数量。NCPAP可以提供稳定...

透明质酸用于慢性伤口愈合 本综述的目的是什么？ 本综述旨在评估透明质酸对慢性伤口愈合的影响。透明质酸是一种存在于人体细胞中的天然分子。慢性伤口需要很长时间才能愈合。它们包括压疮、足部溃疡和腿部溃疡。 关键信息 我们无法确定含有透明质酸的敷料和外用制剂是否比其他敷料和外用制剂更能有效治愈糖尿病患者的压疮或足部溃疡。当用于腿部溃疡患者时，与敷料中作为透明质酸输送途径的非活性物质（中性载体）相比，透明质酸可能会促进溃疡的完全愈合，并可能略微减轻疼痛和增加溃疡大小的变化。但目前还没有足够的信息来确定含有透明质酸的敷料和外用制剂与其他敷料和外用制剂在潜在副作用方面的比较。 本综述研究了什么？ 慢性伤口是由于各种原因引起的难以愈合的伤口，包括对潜在疾病的反应。治疗方法包括不同类型的伤口敷料或外用制剂，其目的多种多样，包括：维持湿润的愈合环境；减少伤口中的细菌；以及预防感染。 我们做了什么? 我们在医学文献中检索了对透明质酸与其他敷料的效果进行评估的研究。我们对获得的数据进行了比较，对结果进行了总结，并根据研究方法和规模等因素对证据的可信度进行了评级。我们只纳入了随机对照试验，这是一种随机分配患者接受不同治疗的研究，因为它们能提供最可靠的健康证据。 本综述的主要研究结果是什么？ 我们发现了12项研究，共有1108名受试者。1022名受试者（57.24%为女性）报告了性别。平均年龄为69.60岁...

Spectacles that are marketed to filter out blue light probably make no difference to eye strain caused by computer use or to sleep quality, according to a Cochrane review of 17 randomised controlled trials of the best available evidence so far. 

Nor did the review, led by authors from the University of Melbourne and published in the Cochrane Database of Systematic Reviews, find any evidence that blue-light filtering lenses protect against damage to the retina, the light-sensitive tissue at the back of the eye.

Blue-light filtering lenses, also known as blue-light blocking spectacles, have been increasingly prescribed or recommended, often by opticians, since the early 2000s. An Australian survey-based study in 2018 found that, of the 372 optometrists who responded, 75% prescribed these lenses despite acknowledging limitations in the evidence to support their use.  

The Cochrane Eyes and Vision team set out to assess the effects of blue-light filtering lenses compared with non-blue-light filtering lenses for improving visual performance, providing protection to the retina and improving sleep quality. They analysed data from all the randomised controlled trials they could find on the topic and found 17 trials from six countries. Of the 17 trials, 12 were conducted in Australia, the Czech Republic, Japan, Norway, the USA and the UK. Five studies did not report the country in which the trial was conducted. Most of the studies were published after 2010, suggesting a growing research interest in blue-light filtering lenses over the past decade. The numbers of participants in individual studies ranged from five to 156, and the period of time over which the lenses were assessed ranged from less than one day to five weeks.

The senior author of the review is Associate Professor Laura Downie, Dame Kate Campbell Fellow and Head of the Downie Laboratory: Anterior Eye, Clinical Trials and Research Translation Unit, at the University of Melbourne, Victoria, Australia.

She said: “We found there may be no short-term advantages with using blue-light filtering spectacle lenses to reduce visual fatigue associated with computer use, compared to non-blue-light filtering lenses. It is also currently unclear whether these lenses affect vision quality or sleep-related outcomes, and no conclusions could be drawn about any potential effects on retinal health in the longer term. People should be aware of these findings when deciding whether to purchase these spectacles.”

However, the quality and duration of the studies also needs to be considered, she said. 

“We performed the systematic review to Cochrane methodological standards to ensure the findings are robust. However, our certainty in the reported findings is limited by the quality of the available evidence. The short follow-up period restricted our ability to consider potential longer-term outcomes.”

The first author of the review, Dr Sumeer Singh, a postdoctoral research fellow in the Downie Laboratory, said: “High-quality, large clinical research studies with longer follow-up in more diverse populations are still required to ascertain more clearly the potential effects of blue-light filtering spectacle lenses on visual performance, sleep and eye health. They should examine whether efficacy and safety outcomes vary between different groups of people and using different types of lenses.”

The review did not find any consistent reports of adverse side effects from using blue-light filtering lenses. Any effects tended to be mild, infrequent and temporary. They included discomfort wearing the spectacles, headaches and lower mood. These were likely to be related to the wearing of spectacles generally, as similar effects were reported with non-blue-light filtering lenses.

Prof. Downie said: “Over the past few years, there has been significant debate about whether blue-light filtering spectacle lenses have merit in ophthalmic practice. Research has shown that these lenses are frequently prescribed to patients in many parts of the world, and a range of marketing claims exist about their potential benefits, including that they may reduce eye strain associated with digital device use, improve sleep quality and protect the retina from light-induced damage. The outcomes of our review, based on relatively limited data, show that the evidence is inconclusive and uncertain for these claims. Our findings do not support the prescription of blue-light filtering lenses to the general population, and these results are relevant to a broad range of people, including eye care professionals, patients, researchers and the broader community.”

The potential mechanisms by which blue-light filtering lenses might be able to help with eye strain, sleep and protecting the retina are not known. One rationale for claims about the benefits of these lenses is that modern digital devices such as computers and smart phones emit more blue light than traditional lighting sources, and are being used for longer, and closer to bedtime. 

Dr Singh said: “The amount of blue light our eyes receive from artificial sources, such as computer screens, is about a thousandth of what we get from natural daylight. It’s also worth bearing in mind that blue-light filtering lenses typically filter out about 10-25% of blue light, depending on the specific product. Filtering out higher levels of blue light would require the lenses to have an obvious amber tint, which would have a substantial effect on colour perception.”

• Read the plain language summary and full review in the Cochrane Library 
• Visit the Cochrane Eyes and Vision website
• Read Evidently Cochrane blog post 'Blue light-filtering lenses: useful for eye strain, sleep, & eye health? Here’s the evidence'

Monday, August 21, 2023

Cochrane UK is proud to host Cochrane’s Colloquium at the Queen Elizabeth II Centre (QEII) in London, UK from 4-6 September 2023. The countdown has begun, but there is still time to register and be part of this enriching experience! 

We spoke with Sabrina Khamissa, Cochrane's Event Support Officer, who shares the measures taken to create an environmentally responsible Colloquium. 

A central location with many transportation options
Hi Sabrina, we're thrilled about Cochrane's upcoming in-person event in London, UK, and the central location you've chosen is truly exciting. Can you share some insights into how the location was selected and its significance in terms of environmental considerations?

"Certainly! When deciding on the location for #CochraneLondon, we took several factors into account, including our community's geographical distribution. Since a substantial portion of our attendees are based in Europe, hosting the conference in the UK made sense as it encourages participants to opt for more sustainable travel options, particularly trains, which can significantly reduce the event's overall carbon footprint.

London was an ideal choice for its vibrant atmosphere and outstanding public transportation links. By placing the conference at the heart of the city, we aimed to minimize the need for private vehicles and promote the use of eco-friendly transportation alternatives. The venue's close proximity to multiple tube stations and pedestrian-friendly surroundings provides attendees with ample opportunities to choose greener commuting options. We invite all attendees to participate in the Anne Anderson Walk and see the many spots of medical history and London landmarks that are just steps away from the venue."

Sustainability at the heart of the venue choice
The Queen Elizabeth II Centre, where the Colloquium is set to take place, indeed appears to be a fantastic location. Can you elaborate on what specifically drew you to this venue and how its commitment to sustainability aligns with Cochrane's environmental goals?

"When looking at venues we had a checklist of specific requirements, placing a strong emphasis on environmental stewardship and a formal sustainability policy. The Queen Elizabeth II Centre stood out as an exceptional choice, impressing us with its diverse green initiatives aimed at ensuring minimal ecological impact. These initiatives encompass responsible waste management, energy-efficient systems, water conservation efforts, and even hosting 10,000 bees on the fourth-floor area—an inspiring commitment to urban biodiversity.

 

Attendees will see our venue choice play out in very practical ways. The Centre's strategic location allows easy accessibility, with the majority able to walk or use public transportation from their hotels. Moreover, we are dedicated to reducing single-use plastic, eliminating items like cups and straws during the event. By incorporating LED motion-sensitive lighting and maximizing natural light, energy conservation is prioritized. In our efforts to minimize paper usage, we will be using lots of digital signage ver printed signs, contributing to a more sustainable and eco-conscious conference experience for everyone at #CochraneLondon."

Delicious and environmentally friendly food choices
No matter the event, food selection and taste is always something attendees comment on afterwards. Is this something that was considered?

"It was! We understand that the dining experience is a significant aspect of any in-person event, and we wanted to ensure that attendees not only enjoyed delicious meals but also made environmentally conscious choices. The venue has a British-first policy for sourcing ingredients, to support local farms and growers but also to make sure they are using seasonal produce and are reducing carbon footprints.  Only fair-trade coffee and teas are served. And we have taken a step further by selecting a menu that emphasises plant-based meals and are going with 'bowl food' which helps reduce waste.

Rest assured, the taste and quality of the meals served at #CochraneLondon are of paramount importance to us, and we have thoughtfully selected food options that not only delight the taste buds but also align with our commitment to environmental responsibility."

A shift from traditional swag bags and branded items
It's really reassuring that a lot of thought has gone into many aspects of the venue and experience that are environmentally conscious. One typical aspect of an academic conference is swag or branded items that they get at the start of the conference. What can attendees expect?

"Rather than traditional swag bags, we've taken an eco-conscious route by introducing a print-on-demand store. This innovative approach allows attendees to curate their own experience by selecting and purchasing limited-edition Cochrane items beforehand. This not only reduces unnecessary waste but also ensures that participants receive merchandise they truly value and intend to use. The print-on-demand store offers an exciting range of items, including tote bags, t-shirts, and mugs, which attendees can choose to purchase for their convenience during the conference or as cherished souvenirs of the event.

Even the smallest details have been thoughtfully considered from an environmental perspective. When attendees arrive at the registration desk, they will receive a lanyard and name badge. Here, too, we have opted for a sustainable approach, providing recyclable name badges that will be printed on location. This decision further minimizes our ecological footprint while ensuring that attendees can proudly display their identification throughout the conference in an eco-friendly manner."

We hope you enjoyed this insightful glimpse into #CochraneLondon's integration of sustainability. By showcasing how even the simplest choices can culminate in a profound impact, the Cochrane Colloquium sets a noteworthy example for fostering greener and more responsible event experiences worldwide. 

Join us at #CochraneLondon as we unite to propel our shared vision and build a more sustainable world, advancing together for trusted evidence. See you there!

• Visit the Colloquium website

Monday, July 31, 2023

Cochrane UK is proud to be hosting Cochrane’s Colloquium at the Queen Elizabeth II Centre (QEII) in London, UK from 4-6 September 2023. The countdown has begun, but there is still time to register and be part of this enriching experience! 

You can now explore the full programme and curate your own Colloquium experience. Take advantage of this opportunity to select the sessions you're most eager to attend and tailor your schedule to your needs and interests. Though it won't guarantee you a seat, it will help us allocate the bigger rooms for the most popular sessions. Once you have picked your sessions, you can add your chosen session to your Apple, Google, or Outlook calendar.

With the theme “Forward together for trusted evidence”, the 2023 Cochrane Colloquium is set to be a groundbreaking event, uniting individuals from diverse backgrounds in a journey of learning, networking, and unforgettable experiences. Immerse yourself in a captivating lineup of plenary talks, workshops, posters, oral presentations, and meetings that encompass a vast spectrum of topics and issues in evidence-based health care.

The colloquium isn't just about the academic content – it's about building connections and creating unforgettable memories. Engage in enriching networking events, ‘take a break’  with some fun social activities, and discover the wisdom of human 'books' at our thought-provoking Library of People. You'll also have the chance to join your colleagues and new Colloquium friends at an unforgettable social gathering at the iconic Natural History Museum. This event truly has something remarkable for everyone!

"Cochrane Colloquiums are more than just an academic gathering; they are a celebration of progress, collaboration, and camaraderie," says Sabrina Khamissa, Cochrane's Event Support Officer.  "The #CochraneLondon program is a testament to this spirit, offering a diverse and engaging lineup of sessions led by some of the most prestigious experts globally. From groundbreaking methodology in evidence synthesis to insightful discussions on knowledge translation, there's something for everyone. We are thrilled to welcome you all to this transformative experience that will shape the future of Cochrane and evidence-based healthcare on a global scale. Together, let's forge ahead for trusted evidence and make a lasting impact on the world of healthcare!"

As anticipation builds, we can't wait to welcome you to London and unite the community once again! Don't miss out on this transformative event, where trusted evidence takes center stage and lasting connections flourish.

Find out more:

• View and update your schedule
• Visit the Colloquium website
• List of Plenary speakers
• ‘Take a break’ activities
• The social event at the Natural History Museum
• The Anne Anderson walk

Get in touch: colloquium@cochrane.org

Tuesday, July 25, 2023

Cochrane UK is hosting Cochrane’s Colloquium at the Queen Elizabeth II Centre (QEII) in London, UK from 4-6 September 2023. With the theme “Forward together for trusted evidence”, the 2023 Cochrane Colloquium is set to be a groundbreaking event with a mix of learning, networking, plenary speakers; a unique and memorable experience at one of London's most renowned venues.

At Cochrane, nurturing aspiring minds and supporting professionals embarking on their career journey is part of the work we do. Our commitment is evident through initiatives like the Cochrane Early Career Professionals Network, Cochrane US Mentorship,  Cochrane International Mobility, and the student pathway to Cochrane Membership. Among these opportunities, the Cochrane Colloquium stands out as an inspirational experience not to be missed. This three-day event provides an enriching platform to learn, connect, and grow. Delve into a diverse range of sessions and engaging activities, fueling your knowledge and expanding your professional network in the world of evidence-based healthcare.

Exciting sessions relevant to students and early career professionals: 

• Putting evidence into practice - A satellite event for students and healthcare professionals: A half-day event on the Sunday ahead of the Colloquium. Learn about Cochrane Reviews, evidence-based practice, fraudulent research and trustworthy evidence. This interactive event is for students and healthcare professionals from any healthcare discipline that feels there is a gap in their current skill set. You may register just for this event or add this event to your colloquium experience. 
• Meet the Cochrane CEO and Editor-in-Chief - Networking doesn't get any more exciting than this! Meet some of the top people in Cochrane, ask questions, and interact in a casual environment. 
• Meet the Author Journey Lead - Find out more about how to propose a new or updated review, and what the topic experts that consider proposals are looking for.
• Forward Together: new ways to participate in Cochrane - Learn about all the many ways you get in involved in Cochrane's ecosystem!
• Cochrane-Wikipedia Initiative - Join this hands-on workshop to help improve the health content that people are accessing online.
• Interpreting systematic review findings - Join this small-group workshop to learn about how to translate research and support decision-making in health care. 
• Library of People - Just like a regular library where you check out books, come along to speak to someone you wouldn’t normally meet and listen to their story.

This is just a small section of the diverse programming offered at Cochrane London. There are plenty of short oral sessions, longer plenary sessions, posters, social events, and workshops. Over three days you will be able to immerse yourself in the latest advancements in systematic review methodology and network with the leading experts in evidence-based medicine. 

Don't miss out on this unique opportunity to be part of Cochrane's Colloquium and contribute to the pursuit of trusted evidence. Register today and let's move forward together towards a healthier future! 

Cochrane Colloquium
4-6 September 2023
London, UK
Registration fees with information about student discount and one-day registration
Full programme

 

Tuesday, August 1, 2023

Cochrane UK is hosting Cochrane’s Colloquium at the Queen Elizabeth II Centre (QEII) in London, UK from 4-6 September 2023. With the theme “Forward together for trusted evidence”, the 2023 Cochrane Colloquium is set to be a groundbreaking event with a mix of learning, networking, plenary speakers; a unique and memorable experience at one of London's most renowned venues. On the evening of Tuesday, September 5th, delegates will gather at the iconic Natural History Museum in South Kensington, for an extraordinary social event.

After the museum closes its doors to the public, Cochrane Colloquium attendees will be granted exclusive access to the main entrance area, Hintze Hall. This hall has dramatic Romanesque arches and a majestic staircase. You’ll have the opportunity to explore the surrounding museum specimens in the Hall and dance beneath the suspended 25-meter blue whale skeleton named ‘Hope’.

In the spirit of giving back, Cochrane Colloquium organizers have requested a £15 donation during registration, to be given to St. Mungo's, a national charity based in London that works to prevent homelessness and aid individuals in their journey to recover from it. By encouraging donations, we hope to minimize non-attendance and food waste, while positively impacting the community.

"One of the most anticipated aspects of every Cochrane Colloquium is the opportunity to gather with colleagues, share laughter, and dance the night away,” says Martin Burton, Director of Cochrane UK. “We are excited to host this year's social event at the Natural History Museum, which sets the stage for an unforgettable evening. Prepare to be captivated by the perfect blend of British charm, vibrant UK music, and the sheer delight of coming together with colleagues. We are confident that this year’s social event will create cherished memories for all who join us!"

The dress code is slightly ‘posher’ than the conference – so deerstalker hats and fascinators are welcome! Attendees will enjoy some delicious bowl food and canapés while the dance floor beckons. Embracing the tradition of previous Colloquiums, participants will sway to music representative of the host country. UK is rich in music tradition, from regency ballroom Contra Dancing to British punk rock. No prior dance experience is necessary; simply join in the fun on the dance floor!

Attendees can look forward to immersing themselves in the rich history and grandeur of the venue, enjoying the vibrant atmosphere, and creating lasting memories alongside colleagues from around the world. To get attendees excited and ready to dance the night away, an exclusive Spotify playlist has been created for #CochraneLondon. You can also contribute your favourite UK songs on social media using the event's official hashtag, #CochraneLondon. 

Cochrane Colloquium Social Event 
Tuesday 5 September 2023
7:30 pm
Natural History Museum
Address: Cromwell Rd, South Kensington, London SW7 5BD, UK
Provided: Bowl food, canapés, desserts, drinks
Dress Code: posh/spiffy casual
Guests: If you would like to bring guests, you’re welcome to buy additional tickets at £75 each (including VAT). To do so, please email registration@cochrane.org and let them know how many extra tickets you would like.

•       Visit the Colloquium website

Friday, July 28, 2023

Founded 30 years ago in Oxford, Cochrane UK was Cochrane’s first geographic group. Cochrane now has over 130 such groups across the world, working in-country to support the production, dissemination and use of evidence to guide decision-making in health and care.

In March 2024, Cochrane UK’s current contract with the National Institute for Health and Care Research (NIHR), hosted by the Oxford University Hospitals NHS Foundation Trust, will come to an end. As a result, Cochrane UK will shortly be seeking a new funder and host institution.

Catherine Spencer, Chief Executive of Cochrane, said: “Cochrane UK has been at the forefront of Cochrane throughout its 30 year history and was our first geographic group. Cochrane UK has made an extraordinary contribution to evidence-based health and care, I extend my heartfelt thanks to the incredible team in Oxford – past and present – for all they have done.

“As we look to the future, there is an exciting opportunity for a new institution to host Cochrane UK and help more people to benefit from health and care evidence. We will be reviewing what is needed in the UK before we begin a selection process. But I would encourage anyone interested in hosting Cochrane UK at their institution to get in touch with me in the meantime.”

Last November it was announced that in September 2023, Cochrane UK’s Director, Martin Burton, will be moving to Cambridge to become Master of Sidney Sussex College. This summer, Therese Docherty will take on the role of Acting Director, having managed Cochrane UK’s operations for nine years.

Catherine Spencer said: “Martin’s exceptional leadership at Cochrane UK has been truly inspiring. His dedication to advancing evidence-based healthcare and improving patient outcomes has left an indelible mark on our organization and the broader medical community. He has shown a peerless talent for fostering collaboration, supporting people and driving impactful work. As he embarks on the next chapter, we extend our heartfelt gratitude for his invaluable contributions and wish him all the best with his new role.”

Martin Burton said: “I have thoroughly enjoyed my time as Director of Cochrane UK, in particular for the opportunity it has given me to work with an excellent team here, and with so many wonderful Cochrane contributors in the UK and around the world. Cochrane UK is in safe hands and I look forward to hearing more about Cochrane’s future plans. The world needs high-quality evidence in general, and synthesised evidence in particular, now more than ever before. These are exciting times as Cochrane adapts and flexes to meet the new challenges ahead.”

Wednesday, July 19, 2023

早产儿早期经鼻间歇正压通气（NIPPV）与早期经鼻持续气道正压通气（NCPAP）的比较 系统综述问题 与NCPAP相比，NIPPV是否能给患有呼吸窘迫或存在呼吸窘迫风险的早产儿提供更多短期和长期获益且不造成伤害? 研究背景 对于存在呼吸困难或有呼吸困难风险的早产儿，经鼻间歇正压通气（nasal intermittent positive pressure ventilation, NIPPV）可能增加经鼻持续气道正压通气（nasal continuous positive airway pressure, NCPAP）的有效性。存在呼吸问题的早产儿往往需要通过气管中的导管提供稳定规律呼吸的机器（呼吸机）的帮助。照顾这些早产儿的儿科医生尽量避免使用呼吸机，因其会损害正在发育尚未成熟或早产的肺。NCPAP和NIPPV是以侵入性较小的方式支持婴儿呼吸—导管较短且仅到达鼻后部，因此对肺部造成的损伤较小。NCPAP和NIPPV可能能在出生后早期使用，以减少需要呼吸机辅助呼吸的婴儿数量。NCPAP可以提供稳定的气压到鼻后部，使空气传导到肺部，帮助婴儿更舒适地呼吸。NIPPV提供了相同的支持，但也通过呼吸机增加了一些呼吸。 研究特征 我们在科学数据库中检索了比较NCPAP和NIPPV用于出生后不久需要呼吸支持的早产儿（在妊娠未满37周出生）的研究。我们关注了对呼吸管的需求和长期副作用。 主要研...

适用于成人早期慢性肾脏疾病(无糖尿病)的降压药 研究问题 慢性肾脏病(Chronic kidney disease, CKD)是一种因肾脏损伤而发生的长期疾病。早期诊断和治疗CKD对于预防或延缓CKD的严重阶段(透析或移植)非常重要。患有慢性肾病的病人亦有罹患心血管疾病 (心肺疾病) 的风险。据报道，降血压药物可以减少或延缓成人CKD患者的心血管问题(包括早期、透析和移植)。然而，我们不太确定这些益处是否适用于没有糖尿病的早期(仅1至3期)CKD成人患者。 我们的目的是探究服用降压药是否比安慰剂效果更优或更差，以及如果效果优于安慰剂，哪种类型的降压药效果最佳。 我们做了哪些研究？ 我们探讨了有关降压药物对于降低早期慢性肾病（无糖尿病）患者死亡风险、心血管疾病、副作用，或改善肾功能的证据。我们找到了六项质量较差的研究。目前证据更新至2023年7月6日。 我们发现了什么？ 我们找到了六项研究，总共随机分配了9379名早期慢性肾病患者（仅限1至3期，无糖尿病）。患者年龄介于18至75岁之间，其中79%为男性，大多数患者患有高血压，并来自中国、欧洲、日本和美国。 所有六项研究都被认为存在高偏倚风险。这是因为试验方法描述不清，未能使所有患者对治疗保持盲态，且有大量受试者退出试验。六项研究中有五项是由药物制造商或对研究结果有商业利益的机构资助的，其中一项研究未公开其资金来源。 1.苯那普利（...

持续气道正压通气治疗早产儿呼吸暂停 关键信息 我们并未发现任何关于 CPAP与支持性疗法进行比较的研究。 而我们发现了四项研究将两种 CPAP 进行了比较。这些研究规模很小，且所提供的治疗可能因医护人员知晓婴儿所接受的治疗类型而受影响。因此，无法从这些研究得知，使用不同类型CPAP在减少早产儿呼吸暂停方面是否存在差异。 什么是早产儿呼吸暂停? 早产儿可能会经历长时间的呼吸暂停。对于早产儿，我们称这种暂停为早产儿呼吸暂停。呼吸暂停可能是由于体内呼吸控制机制不成熟或在呼吸过程中保持气道畅通的肌肉无力所致。 在严重呼吸暂停时，婴儿的心率会减慢，氧气含量会下降。若频繁发作，可能会影响婴儿的大脑发育。当婴儿有呼吸暂停时，通常会给予支持性治疗。这种支持性疗法可以是刺激性的形式，借由抚摸婴儿或移动四肢、提供氧气或两者并用。 什么是CPAP？ 持续气道正压通气 (continuous positive airway pressure, CPAP) 是呼吸支持的一种形式，通常被称为一种无创通气疗法。持续的压力通常通过鼻片施加，让婴儿可以持续自行呼吸，同时使呼吸变得更容易。这可能是因为施加的正压有助于保持气道畅通。 我们想知道什么？ 我们想知道在早产儿中使用CPAP是否会减少呼吸暂停，或者是否需要更有侵入性的治疗形式，如机械通气，即以机器代替婴儿呼吸。我们还想知道是否存在任何更有效的 CPAP 特定...

维得利珠单抗用于诱导和维持克罗恩病的缓解 关键信息 – 与安慰剂（虚拟治疗）相比，维得利珠单抗可有效诱导和维持克罗恩病患者的缓解。 – 在诱导或维持治疗期间，接受维得利珠单抗治疗的人可能不会比接受安慰剂的人更容易出现副作用，并且可能不会更容易出现严重的副作用。 我们想要了解什么？ 克罗恩病是一种影响胃肠道（肠道）的慢性炎症性疾病。维得利珠单抗被称为“生物”制药，可阻断一种名为α4β7的重要蛋白质，该蛋白质参与肠道炎症并产生肠道选择性抗炎活性。我们想知道维得利珠单抗治疗克罗恩病是否有效且安全。 我们做了什么？ 我们检索了在克罗恩病患者中比较维得利珠单抗和安慰剂的研究。我们比较和总结了这些研究结果，并根据研究方法和规模等因素评估了证据质量。 我们发现了什么？ 我们发现了4项研究，包括1126名受试者，调查了维得利珠单抗在诱导缓解（疾病不再活跃）方面的效果，3项研究，包括894名受试者，调查了维得利珠单抗在维持缓解方面的效果。 与安慰剂相比，维得利珠单抗在诱导克罗恩病缓解（4项研究，1126名受试者）和维持缓解（3项研究，894名受试者）方面更有效。维得利珠单抗比安慰剂更能有效诱导临床反应（即疾病进入缓解期；4项研究，涉及1126名受试者）。在诱导治疗（4项研究，1126名受试者）或维持治疗（3项研究，894名受试者）期间，它可能与安慰剂一样引起总体副作用，也可能与安慰剂一样引起严重副...

Friday, July 14, 2023

肾移植术后早期与晚期导尿管拔除的比较 问题是什么？ 输尿管是一种将尿液从肾脏排入膀胱的管道，尿液会一直在膀胱储存，直到患者去洗手间排尿。在肾脏移植手术中，新的肾脏被植入患者体内，而新的输尿管也被连接至患者的膀胱。在这个过程中，导尿管通过尿道插入膀胱并在术后保留，导尿管是一种允许尿液从膀胱排出的柔性的窄管。导尿管能够持续排出尿液并防止膀胱过度撑大。一般认为，通过保持膀胱排空，新的输尿管和膀胱之间的连接能够更好地愈合。然而，导尿管可能会将细菌引入膀胱并引起尿路感染。导尿管在膀胱内停留的时间越长，感染的风险就越大。因为器官移植患者需要服用抑制免疫系统的药物，尿路感染对于移植患者来说可能会造成巨大的麻烦。服用免疫抑制药物意味着患者很难对抗感染。目前而言，对于最佳移除导尿管的时间没有确切共识。我们希望找到答案，这样我们就可以将导尿管引起的尿路感染的风险降到最低，同时还能给膀胱和新输尿管之间的连接提供最好的愈合机会。 我们做了什么? 本研究旨在评估此领域以前发表的所有研究，以确定该问题的答案。我们找到了两项研究，共包含197名接受了肾脏移植的人。 我们发现了什么？ 目前尚不确定术后5天内拔除尿管的患者与术后5天以上拔除尿管的患者尿液中细菌的数量是否有所不同。本综述纳入的研究质量普遍较差。 结论 我们需要一项设计良好且高质量的研究来调查肾移植术后患者拔除导尿管的最佳时间。 如果您发现此证据有帮...

与其他药物相比，利尿剂作为高血压的一线治疗有什么益处和危害? 关键信息： - 当作为治疗高血压的一线药物时，噻嗪类以及噻嗪样利尿剂与β受体阻滞剂、钙通道阻滞剂、ACE抑制剂和α受体阻滞剂相比，可能会降低一些心血管不良事件的发生率。 - 利尿剂与其他类型药物之间的总死亡率可能没有差异。 - 与钙通道滞剂和α受体阻滞剂相比，一线利尿剂可能减少总心血管事件和心力衰竭。 - 与β受体阻滞剂、钙通道阻滞剂、ACE抑制剂和α受体阻滞剂相比，一线利尿剂似乎能减少受试者因负面效果或有害（不良）影响而脱落的情况。 什么是高血压？ 高血压是通过静息时的血压来定义的：轻度（140至159/90至99毫米汞柱），中度（160至179/100至109毫米汞柱)，和重度（180/110毫米汞柱或更高）。未控制的高血压可能导致中风、心脏病、心力衰竭和肾脏损伤。降血压药物已被证实能够减少60岁以上中度至重度高血压者发生上述不良事件；它们也能减少60岁以下患有高血压的成年人的中风风险。 如何治疗高血压？ 本综述主要关注当生活方式干预不足时，可以作为初始药物治疗的降压药物类别有哪些。涉及的药物类别包括利尿剂(如氢氯噻嗪、氯噻酮)；β受体阻滞剂(如心得安、阿替洛尔)；钙通道阻滞剂(如氨氯地平、硝苯地平)；血管紧张素转换酶(angiotensin-converting enzyme, ACE)抑制剂(如赖诺普利、依那普...

Cochrane is delighted to unveil the fully comprehensive edition of the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy. Designed for authors, editors, and researchers involved in Cochrane Reviews and systematic evaluations of test accuracy, this invaluable resource provides an extensive guide encompassing the most advanced methodologies and best practices. Whether you're a novice researcher or a seasoned expert, this groundbreaking Handbook equips you with the latest methodologies and expert tips, serving as an invaluable resource for conducting diagnostic test systematic reviews. This Handbook paves the way for better-informed healthcare choices, propelling us towards a future where the impact of medical tests is fully optimized.

This is Cochrane's second Handbook, following the success of the acclaimed Cochrane Handbook for Systematic Reviews of Interventions. Cochrane’s Editor in Chief, Karla Soares-Weiser warmly welcomed today’s launch, "This Handbook is an excellent addition to the Cochrane Handbook collection and represents a hugely collaborative effort from numerous methodologists, authors, and editors across Cochrane. Cochrane systematic reviewers and the evidence-based community now have access to well-respected guidance that will strengthen the skills, knowledge and standards of systematic reviewers of test accuracy across the world."

Under the guidance of the experts in the Cochrane Screening and Diagnostic Tests Methods Group, this Handbook is thoughtfully divided into three comprehensive parts. The first section provides insights into the intricacies of Cochrane Reviews, specifically focusing on diagnostic test accuracy. In the second section, readers are introduced to test accuracy studies, exploring the circumstances in which it may be appropriate to conduct them. The third and final section delves into the methodologies employed in systematic reviews of test accuracy, offering expert guidance on data collection, risk of bias assessment for included studies, and conducting impactful meta-analyses. This holistic approach ensures that readers are equipped with the necessary tools to conduct the systematic review and then confidently present their findings.

The first edition Handbook includes:

• An introduction to planning a Cochrane Review of diagnostic test accuracy, along with a supplementary protocol template that can be used by Cochrane or non-Cochrane authors.
• Core guidance on understanding the primary research included in systematic reviews of test accuracy to enable authors to make informed decisions in their review’s design, including the evaluation of medical tests, the design of test accuracy studies and understanding test accuracy measures.
• New guidance on defining the review question, covering how the review’s objective relates to the population, index tests and target condition and review’s eligibility criteria.
• Substantial developments on searching for and selecting studies, extracting data and assessing the risk of bias and applicability in included studies, which takes readers step-by-step through what they need to consider and at what point during the review.
• Brand new guidance on undertaking meta-analysis complements the updated understanding meta-analysis chapter, and includes supplementary code and datasets that you’ll need to complete the analyses in different software.
• Updated guidance on presenting findings and drawing conclusions.
• New guidance on writing a plain language summary, including a template that can be used by Cochrane or non-Cochrane authors.

The Handbook has been written by a team of authors and editors, led by Senior Editors Professor Jon Deeks and Professor Patrick M Bossuyt, alongside Associate Editors Mariska Leeflang and Yemisi Takwoingi. Professor Patrick  Bossuyt, Senior Editor of the Handbook, also said, “The new Handbook reflects current best practice based on the latest methods research, and provides the only such comprehensive guide to conducting systematic reviews of test accuracy. We are immensely proud of the collective contributions from the authors, peer reviewers and methodologists who have informed its gestation over the years; we would like to thank them all as we would not have been able to create this Handbook without them.”

Professor Jon Deeks, Senior Editor of the Handbook, said, “Cochrane Reviews of diagnostic test accuracy have a huge impact globally. Cochrane Reviews underpin many clinical guidelines, including World Health Organization ones. Cochrane evidence also informs the WHO Essential Diagnostics List, which covers many areas of infectious disease and addresses the need for countries to make essential diagnostics more accessible and affordable. This new guidance for both new and experienced authors will strengthen our ability to develop highly impactful reviews that make a real difference in people’s lives.”

Don't miss out on this game-changing resource! The online version of the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy is available for free, offering immediate access to its wealth of knowledge as a PDF. But for those seeking convenience and a cherished addition to their collection, the physical edition of the Handbook and the E-book is also available.

• Access the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy
• Learn more about the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy

 

Thursday, July 20, 2023 Category: The difference we make

With over 198 million speakers globally, Bahasa Indonesia is the official language of Indonesia, the world's fourth most populous country. Recently Bahasa Indonesia has been added along with four other new languages to Cochrane.org and the Cochrane Library. Adding Bahasa Indonesia to the list of 21 languages that plain language summaries are translated in, marks a significant stride in addressing the healthcare information needs of this extensive and diverse population. This inclusion not only breaks linguistic barriers but also empowers individuals to make evidence-informed health decisions globally.

From left to right: Datu Respatika, Lukman Ade Chandra, Kristia Hermawan, Anggraeni Ayu Rengganis (Translation Manager), Afrilia Intan Pratiwi, Alfia Fatma Zaharo, Mawaddah Ar Rochmah, Detty Siti Nurdiati (Director of Cochrane Indonesia), Ajeng Viska Icanervilia.

The addition of the new language addition is due to the strong collaboration between Cochrane Malaysia and Cochrane Indonesia. They have shared a longstanding history of mutual support since their inception and this new Indonesian translation project has deepened that bond between the teams. Cochrane Malaysia has graciously extended their assistance and expertise to support Cochrane Indonesia in establishing their translation project.

“I am particularly happy about it because I feel a part of the project. Malaysia and Indonesia are like siblings, and we try to support each other where we can."

- Prof. Jacqueline Ho, Cochrane Malaysia Co-Director

 

At the outset, Teguh Haryo Sasongko, Cochrane's Malaysia Translation Project Manager, arranged an online meeting with Cochrane Indonesia to outline the management of the Malaysian project and discuss how the team encourages its volunteers. In May of this year, during the Indonesian team's visit to Malaysia, they connected with Nila Pillai (as shown in the above photo; seen in the bottom right sharing with the Indonesian team). Nila has been serving as the Cochrane Malaysia Support Officer and coordinator of Cochrane Malaysia's Malay Translation Project since its inception in 2015. Nila shared insights on how she manages the translation project, highlighting both challenges and successes. The two teams recently collaborated in organizing joint Cochrane training workshops in both countries, with plans for further collaboration in various domains.

“Indonesia has the 4th largest population in the world and even though Malay and Indonesian have some similarities, being able to offer Cochrane evidence in Bahasa Indonesia, Indonesia’s main and official language, marks an important milestone for us."

- Dr. Detty Nurdiati, Cochrane Indonesia Director

• Read Cochrane evidence in your language
  
• Learn how you can volunteer in our translation projects
• Donate to support our work
• Memecahkan halangan bahasa: Cochrane menambah Bahasa Indonesia dalam usaha penterjemahan
• Mendobrak batasan bahasa: Cochrane menambahkan Bahasa Indonesia dalam upaya penerjemahan

Thursday, August 17, 2023

Tuesday, July 11, 2023