Monday, April 17, 2023

Cochrane's flagship event, the Cochrane Colloquium,  brings together anyone with an interest in the use of evidence in healthcare decision-making to learn, collaborate, and network. The impact of the Cochrane Colloquium goes beyond the scientific program. For many attendees, it is a life-changing experience that inspires them, connects them with like-minded individuals, and broadens their perspectives.

We already collect stories from the Cochrane Community about how they got involved with Cochrane. This edition of  #MyCochraneStory invites anyone who attended a past Cochrane Colloquium to share their personal stories and reflections on the event. Whether you have a favourite Colloquium moment, a connection you made,  or something you're proud of presenting  - we want to hear from you! 

To share your #MyCochraneStory please contact Lydia Parsonson - lparsonson@cochrane.org - with the following:

• 1-4 photos from past Colloquiums. Please provide a caption for each photo you share. We'll be sharing them as a collage in the news item but may like to share them individually with some context on social media. 
• Your country of residence: Our community is diverse and we want to celebrate this!
• Your Cochrane Story: We want to hear about what your favourite Colloquium memories are and what you think makes the event memorable. 
• Social media handles: We will give your Twitter or Instagram account a tag; just let us know your handles!

Top-left: Cochrane Rehabilitation in Cape Town. Middle: Cochrane Rehabilitation dinner in Edinburgh. Top-right: Cochrane Rehabilitation spaghetti dinner in our Cape Town apartment. Bottom-left: Cochrane Rehabilitation approved by the Governing Board in Seoul. Bottom-right: On the hotel roof terrace during the curfew in Santiago de Chile.

Prof. Stefano Negrini – “Cochrane Rehabilitation was approved at the colloquium in Seoul where Carlotte Kiekens and I participated. Since the start we have been a global collaboration and many representatives from Cochrane Rehabilitation can meet almost exclusively at Colloquia. It’s a great time for us to meet, learn, talk business and have some fun. The days of the Colloquium are filled with meetings, interesting sessions, lots of learning, and networking with new people. And in the evenings we find time to connect with the colleagues of our group and old friends! Beyond the many other moments with Fields representatives and other Cochrane friends, the highlights of Cochrane Rehabilitation included having a Spaghetti dinner in our apartment in Cape Town and going out for dinner together in Edinburgh. Our team is counting down the days to London and looking forward to see you there!”

Richard Morley - "Patients, caregivers and the public (what Cochrane calls consumers) are an integral part of the Cochrane...as well at the Colloquium! I remember the first Patients Included certified event in Edinburgh, and it was an incredibly meaningful and special experience for everyone involved. Patients, advocates, and caregivers felt truly included, and attendees were able to see the direct impact of their work. It's with great pride that I share that this year's Colloquium will be a Patients Included certified event for the second time. This means that patients and caregivers will be actively involved in shaping the program, and that their perspectives and needs will be fully considered throughout the event. It's a true testament to Cochrane's commitment to putting patients at the centre of everything we do, and I can't wait to see the positive impact it will have on all attendees!"

Sabrina Khamissa - "As Cochrane's Event Support Officer, what strikes me most about the Colloquium is the personal touches the host organizing team adds to make it special. From traditional dances to local cuisine, the team highlights the host country's culture, making the event more than just a typical academic conference. This year, I'm excited to see the small details the team has added to decrease the conference's environmental impact, such as venue choice and offering vegetarian food options. The Cochrane Colloquium is a unique opportunity to connect with the evidence synthesis community, learn from experts, and be part of an event that values diversity and sustainability."

Roses Parker - "My first and only Cochrane Colloquium was Santiago in 2019, and I’m still benefiting from the relationships I built there. The program is impressive and deciding what not to go to will be the most difficult thing. As Cochrane's new Commissioning Editor, I am attracted to anything with an equity focus as well as having an interest in priority setting, and stakeholder engagement sessions.  I’m excited to meet my team face-to-face as we’ve not had that opportunity so far. There have been many people I’ve already collaborated with but never met in person. And of course, I’m looking forward to meeting new people too and forging relationships that will support my role in the future.”

Muriah Umoquit - "In 2015, I attended my first Cochrane Colloquium in Vienna with the expectation of a typical academic conference. But I was pleasantly surprised by the unique and inspiring experience that awaited me! From the large plenary sessions to smaller research presentations and poster halls, each Colloquium has something for everyone. More than that, it provides opportunities to connect with experts in evidence synthesis, feel part of the Cochrane Community, and engage in social activities that showcase the host country's culture. As a remote worker, I found it meaningful to connect with people whom I normally only exchange emails with or tag on social media. Everyone is enthusiastic, friendly, and proud to contribute to Cochrane's important work. The Anne Anderson Walk is a beloved tradition that I look forward to at each Colloquium. It's an event where we tour the host city, have some social time, and raise money for the special Anne Anderson Prize. If you're looking for a conference that's more than just another ordinary event, the Cochrane Colloquium in London this year is not to be missed!"

 To share your #MyCochraneStory, please contact Lydia Parsonson - lparsonson@cochrane.org - with the following:

• 1-4 photos from past Colloquiums. Please provide a caption for each photo you share. We'll be sharing them as a collage in the news item but may like to share them individually with some context on social media. 
• Your country of residence: Our community is diverse and we want to celebrate this!
• Your Cochrane Story: We want to hear about what your favourite Colloquium memories are and what you think makes the event memorable.
  Social media handles: We will give your Twitter or Instagram account a tag; just let us know your handles!

Tuesday, August 22, 2023

Registration is open for the Cochrane Colloquium, which will take place in London from 4th to 6th September 2023, with satellite events on 3rd September. Cochrane is offering stipends and bursaries to help cover travel and accommodation costs for those who might otherwise be unable to attend, including participants from low- and middle-income countries (LMICs).

The Colloquium will provide an opportunity for individuals to network with other like-minded professionals, share knowledge and expertise, and engage in discussions around evidence-based healthcare. Cochrane believes that by offering these stipends and bursaries, it will be able to attract a diverse group of participants, who will bring with them a range of perspectives and experiences that will enrich the event. 

We spoke to Sabrina Khamissa, Cochrane’s Event Support Officer, about Colloquium stipends and bursaries.

What inspired Cochrane to offer stipends and bursaries for individuals from low- and middle-income countries to attend the Colloquium?

“Cochrane is committed to promoting diversity and inclusion within its network and recognizes the importance of making its events accessible to individuals from all backgrounds. The organization understands that individuals from low and middle-income countries may face financial barriers that prevent them from attending the Colloquium and wants to help alleviate those barriers by offering stipends and bursaries. This is a long tradition at Cochrane and we have been offering this for many years.

We are also delighted to have TDR sponsor a limited number of bursaries. TDR is the Special Programme for Research and Training in Tropical Diseases, and is a global programme of scientific collaboration that helps facilitate, support and influence efforts to combat diseases of poverty. It is co-sponsored by the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and the World Health Organization (WHO).”

How will Cochrane ensure that the stipends and bursaries are distributed fairly and equitably?

“Cochrane has set out clear criteria for eligibility for the stipends and bursaries, and the LMIC Stipend Committee will assess applications based on those criteria. The committee is made up of members who reside in low- or middle-income countries or who are familiar with the practical issues and challenges faced by applicants. They will be mindful of ensuring that the stipends and bursaries are distributed fairly and equitably and will prioritize applicants who demonstrate a clear interest in evidence-based healthcare and who are members of the Cochrane network.”

What kind of activities can attendees expect at the Colloquium?

“Attendees can expect to engage in a range of activities, including interactive sessions, presentations, and workshops. The Colloquium will provide an opportunity for individuals to network with other like-minded professionals, share knowledge and expertise, and engage in discussions around evidence-based healthcare. It’s an excellent opportunity to tap into the global network of Cochrane colleagues! I am personally excited for the social evening event we are planning and the ‘take a break’ floor – there are lots of small touches that are going to make this a unique event for everyone to enjoy!

Check out this video from May Loong Tan. She received a stipend to attend the 2018 Colloquium and shares her experience.”

 How does Cochrane hope that attendees from low- and middle-income countries will contribute to the Colloquium?

“Cochrane’s global network is made up of 50+ countries. Cochrane believes that by promoting the attendance of individuals from low- and middle-income countries, it will bring a range of perspectives and experiences that will enrich the event and will help to foster a more diverse and inclusive community of individuals committed to evidence-based healthcare.” 

If you are interested in attending the Cochrane Colloquium and would like to apply for a stipend or bursary, please visit the Colloquium website for more information and to submit your applications soon! We look forward to welcoming you to London in September 2023!

Friday, April 14, 2023

早期识别囊性纤维化患者胸部感染的数字技术 系统综述问题 数字技术能否比标准治疗更早地识别囊性纤维化（cystic fibrosis, CF）患者的胸部感染？而这对临床结局又有何影响？ 什么是囊性纤维化？ CF是一种影响寿命和多个器官系统的疾病，尤其是肺部。胸部感染会加重CF患者的肺部损伤，早期发现和治疗非常重要。数字技术，例如智能手机应用程序（apps）和通过检测呼吸追踪症状变化的设备，可能使我们更早识别CF患者的胸部感染，尽快开始抗生素治疗。 我们想知道什么？ 早期识别CF患者的胸部感染是否有助于缓解肺部病情的恶化。 我们做了什么？ 我们在医学数据库中检索了针对CF患者的临床试验（受试者有同等的机会进入使用数字技术的干预组或常规治疗组）。 我们发现了什么？ 最终纳入三项研究，涉及415名年龄介于15至41岁的CF患者。所有干预组都使用能够追踪呼吸问题的一种技术，其中两项研究还要求干预组的患者使用特殊设备进行常规呼吸检查。所有研究都开展了为期一年的随访。 主要研究结果 纳入研究要求患者使用特殊的设备定期进行呼吸检查，以追踪可能出现的问题，这确实比常规治疗组能更早地发现胸部感染。但研究结束时，两组患者之间的呼吸检查是相似的。 两组患者的生活质量、医院就诊次数或费用也几乎没有差异。受试者并没有因为使用这种数字技术而出现任何严重的不良事件，但问题在于他们通常无法定期提供数据，因为这确实...

多不饱和脂肪酸（PUFA）补充剂用于儿童和青少年注意缺陷多动障碍（ADHD） 什么是注意力缺陷多动障碍？ 注意力缺陷多动障碍（Attention deficit hyperactivity disorder, ADHD）是儿童和青少年的常见问题。受影响的人可能难以集中注意力、感到不安或冲动行事。由于这些困难，ADHD会导致长期的社会、学术和心理健康问题。药物是治疗ADHD最常用的方法，但它们并不总是有效，还可能引起不必要的副作用。 什么是多不饱和脂肪酸？ 多不饱和脂肪酸（Polyunsaturated fatty acids, PUFA）是一种脂肪。它们是正常大脑发育所必需的，存在于鱼类（ω-3 PUFA）和植物油（ω-6 PUFA）等食物中。 多不饱和脂肪酸（PUFA）对注意力缺陷多动障碍（ADHD）有什么作用？ 一些证据表明，ADHD可能与低水平的PUFA有关，尤其是ω-3 PUFA。因此，PUFA补充剂可能改善ADHD症状、行为问题以及相关心理健康症状，如焦虑和抑郁。 我们想知道什么？ 我们想知道PUFA补充剂能否改善患有ADHD的儿童和青少年的ADHD症状。 虽然在最初的综述中有一些有限的数据表明PUFA改善了ADHD症状，但目前几乎没有证据表明补充PUFA有益。重要的是更新证据以纳入自原始综述发表以来的新研究。 我们做了什么？ 我们检索了所有在儿童或青少年ADHD患者中...

对于需要血管内修复主动脉瘤的患者，全麻还是局部麻醉更好? 关键信息 ‐我们没有发现任何随机对照试验来帮助回答我们的问题 ‐需要高质量的证据来比较全身麻醉与局部麻醉对接受主动脉瘤血管内修复术患者的利弊 什么是主动脉瘤？ 当动脉或静脉的直径超过一定大小时，它们被称为动脉瘤。动脉瘤继续生长超过一定大小就有破裂的危险。主动脉是人体内最大的动脉，动脉瘤破裂的患者很有可能出现严重的并发症，比如死亡。 如何治疗主动脉瘤？ 为了治疗或修复主动脉瘤，外科医生可以切开患者的胸部和腹部，露出动脉瘤，并用一种被称为移植物的合成材料代替。这被称为开放式动脉瘤修复术。另一种选择是外科医生使用x射线（或类似技术）来引导他们将移植物插入患者动脉的小切口，从而避免需要大的手术切口。这被称为血管内动脉瘤修复术。 接受血管内主动脉瘤修补术的患者可以进行全身麻醉，在此期间他们会暂时昏迷，依靠机器呼吸（俗称睡眠）这种麻醉方法的优点是麻醉师可以控制患者的气道，外科医生也知道患者在手术的精细阶段不会移动。然而，在手术过程中或手术后也存在低血压、血栓和呼吸困难的风险。另外，患者也可以在不睡觉的情况下接受药物治疗，以控制手术带来的疼痛和焦虑。这就是所谓的局部麻醉。这种方法的优点是避免了全身麻醉的风险。然而，局部麻醉要求患者在手术过程中充分配合并保持静卧，手术过程中保持清醒可能会给他们带来明显的不适。 我们想知道什么？ 我们想知道...

 At Cochrane, we aim to collaborate and create reliable synthesized evidence, making it accessible to all. We are dedicated to promoting access and the widest possible dissemination of our valuable evidence.

We're now making some big improvements to help continue that mission, by changing the way we share the data that is associated with Cochrane Reviews. Making data available to everyone is at the heart of our core principles. It opens opportunities for collaboration, reduces research waste, makes systematic reviewing more efficient, and ensures transparency and quality.

We are confident that these changes will improve the systematic review process by enabling easier re-use of data across Cochrane Reviews, meaning less time and effort being duplicated. It will also make it easier for users and decision-makers to access and examine the relevant data they need and use it to impact policy.

"I am confident that improving how we share data will appeal to our community of rigorous, passionate researchers. By embracing these new changes, we can to maximise the benefits from the investment in developing Cochrane Reviews, for both authors and users of our evidence .”

- Ella Flemyng, Cochrane Editorial Product Lead

 

“This is a really exciting milestone for Cochrane. This new data format facilitates data re-use, not only in RevMan but other tools too, such as Excel and different statistical packages. It also opens up opportunities for how we can use the data to innovate to best meet our stakeholder needs."

- Gert van Valkenhoef, Head of IT Development and Infrastructure

 Summary: 

• Cochrane is changing the way we share data in a bid to promote collaboration, reduce research waste and ensure quality by making Cochrane Review data more accessible. 
• From 25 April, data associated with Cochrane Reviews can be downloaded from RevMan Web in standard formats, such as CSV and RIS.
• This new data package will include not only analysis data but also all other data associated with the Review related to the included studies, risk of bias assessments, and references.
• As Reviews with this data package are published, it will increase the impact of Cochrane’s Reviews and allow researchers, policymakers, practitioners and others to access and use Cochrane evidence more easily.
• We plan to continue making changes and improvements to pave the way for further innovation, with the potential to improve evidence and patient care.

 What is changing?

From 25 April, changes to RevMan Web mean that authors will be able to download all available data files associated with a Cochrane Review in user-friendly formats like CSV and RIS. These downloadable files will include the Review's analyses data, along with other data associated with the Review - such as study characteristics, study data, risk of bias data and references. But that’s not all – once published, readers of the Cochrane Library will also be able to explore the data associated with the Review. All you have to do is select the 'Download statistical data' option on published Reviews and you'll have all the information you need at your fingertips.

Going forward, this data package will be available with new publications on the Cochrane Library under the same license as the associated Review (‘green’ or ‘gold’). This will of course be reassessed as part of Cochrane’s commitment to move to full open access by 2025.

For Cochrane Reviews published before this change, a conversion service will be available to convert the current downloadable RevMan 5 analyses files into the standard, easily reusable format.

What does it mean for you? 

Authors: We believe these changes are good news for Cochrane authors because they mean that your published Reviews are going to have an even bigger impact. According to extensive research, sharing data leads to increased visibility, usage and impact of your research. This will help your hard work be seen and heard by everyone out there. We also know from our funders that better data sharing is increasingly becoming a key requirement in this area. And this way, RevMan automatically structures and organizes the data so you don’t have to.

Readers and end users: Unlocking data and information has now been made even easier for our users by our new shareable data. With our more streamlined and accessible Reviews, researchers, policymakers, practitioners and other user groups are now able to find the information they need to make impactful decisions.

What’s next?

With this new approach, we aim to make reusing Cochrane Reviews more efficient and effective. Our mission is to increase the visibility and discovery of research data, promote transparency and ensure our information and data can be reproduced. It is the start of Cochrane’s journey towards FAIR principles - Findability, Accessibility, Interoperability and Reuse - of data, which will open up new opportunities for how we can innovate with Cochrane evidence.

Further information:

• Data sharing editorial policy on the Cochrane Library
• Cochrane's FAQs on data sharing
• This is a fundamental step and is all about sharing reusable data so we can pave the way for improved evidence and patient care, as described in Cochrane’s  Linked Data Project

Thursday, May 4, 2023

预防前庭性偏头痛发作的非药物治疗效果如何？ 关键信息 目前尚不清楚这些疗法是否能有效预防前庭性偏头痛的发作。 很少有研究评价了使用这些疗法在预防疾病发作上可能带来的获益和危害。 所发现的研究规模较小，结果也没有定论。 什么是前庭性偏头痛？ 偏头痛（有时称为“头痛型偏头痛”）是一种导致反复头痛的常见疾病。前庭性偏头痛是一种相关疾病，其主要症状是反复发作的严重头晕或眩晕（旋转感）。这些发作通常伴有头痛或其他类似偏头痛的症状（如对光或声音敏感、恶心或呕吐）。这是一种相对常见的疾病，每100人中就有1人患病，并对日常生活造成严重影响。 如何治疗前庭性偏头痛？ 典型的治疗方案包括在眩晕开始发作时使用药物来尝试并阻止发作，或改善症状。此外，患者可能会使用旨在预防发作的治疗方法（预防性或预防性治疗）。目前尚无广泛推荐的治疗方法来预防或控制前庭性偏头痛发作的症状。患者有时会被建议服用治疗偏头痛的药物。假设这些药物也可能对前庭性偏头痛有效。有时，患者也会尝试非药物治疗，来帮助预防或改善症状，并尝试减少发作频率。这可能包括改变饮食（如少吃盐）或服用补充剂（如维生素或矿物质）。其他治疗方法包括谈话疗法和物理疗法。 我们想知道什么？ 我们想知道： -是否有证据表明，任何非药物疗法都能有效预防前庭性偏头痛的发作，或在发作时减轻症状； -治疗是否会造成任何伤害。 我们做了什么？ 我们检索了包括成年人的研究，...

气道清除技术与无气道清除技术治疗囊性纤维化的比较 系统综述问题 在清除囊性纤维化患者肺部多余粘液时，使用任何气道清理技术与不使用气道清理技术相比的效果如何？ 研究背景 囊性纤维化患者的肺部会产生过量粘液。这会导致肺部的反复感染和组织损伤。使用药物和气道清理技术（物理疗法）清除粘液非常重要。有各种不同的气道清除技术可以清除黏液，其中一些可能包括使用机械设备。日常物理治疗费时且麻烦，所以了解它是否有效很重要。我们检索了参与研究的人员在使用气道清理技术组和未使用气道清理技术组中机会均等的研究。这是对之前发表的一个综述的更新。 检索日期 当前的证据检索时间截止2022年10月17日。 研究特征 我们纳入了12项研究，包含194名囊性纤维化患者。这些研究间有极大的不同，并且有些研究将多重治疗与无治疗进行了比较。一项研究使用自体引流（一种控制呼吸的技术，使用不同的呼气速度和深度将粘液排出气道，以便透过咳嗽将其清除）；五项研究使用了常规的胸部物理治疗（通常在物理治疗师或亲属帮助下，对胸壁进行叩击和振动的手动技术）；九项研究使用正压呼气（通过面罩或吸嘴呼气，对抗肺部积聚的压力以移动黏液），其中一项研究使用标准和高呼气正压；三项研究使用振荡呼气正压（正呼气压与气道内振动相结合使粘液松动）；两项研究使用了锻炼（在跑步机上运动）；两项使用高频率胸腔振动疗法（通过充气服装在胸腔外壁施加高频率的振动）。我...

早产儿动脉导管未闭的治疗 系统综述问题 有哪些措施可以安全有效地预防或治疗早产儿动脉导管未闭（patent ductus arteriosus, PDA）这一常见心脏病？ 研究背景 PDA是早产儿和低出生体重新生儿的常见并发症。PDA是肺和心脏之间的一条开放血管通道，通常在出生后很快闭合，对早产儿和低出生体重新生儿来说，PDA有可能不会闭合，进而导致危及生命的并发症。本研究目的是了解有哪些干预措施可以安全有效地预防和治疗PDA及其相关问题。 研究特征 共纳入16个Cochrane系统综述。其中，有六个系统综述研究了使用药物、手术或其他非药物/手术方式预防PDA。一个系统综述研究患儿出现症状之前治疗PDA的证据，其他研究则提供了患儿出现PDA症状时使用药物或手术治疗的证据。 主要研究结果 本概述发现，在早产儿出现PDA症状前使用吲哚美辛和布洛芬可以减少重度颅内出血，以及对PDA手术的需要。当患儿出现PDA症状时，所有可用的药物，即吲哚美辛、布洛芬和对乙酰氨基酚（尤其是早期给药）均可有效闭合PDA。如果使用布洛芬治疗，口服给药似乎比静脉注射给药更有效；相较于标准剂量，大剂量布洛芬似乎更有效。 证据质量 根据GRADE方法（一种评估每项结局指标研究质量的方法），本研究纳入的证据质量分布于极低质量到高质量之间。根据AMSTAR 2标准（一种评价系统综述质量的方法），纳入系统综述的质量也分...

麦肯基方法对于治疗（亚）急性非特异性腰痛有效吗？ 关键信息 麦肯基方法可能在短期（最接近两周）和中期（最接近三个月）内对（亚）急性非特异性腰痛患者的疼痛和残疾几乎没有益处。麦肯基方法并不是一种治疗（亚）急性非特异性腰痛的有效方法。我们不知道麦肯基方法是否会导致任何副作用，因为本综述中纳入的试验均未测量任何副作用。 什么是（亚）急性非特异性腰痛？ 非特异性腰痛（non-specific low back pain, NSLBP）是最常见的腰痛类型，由无法识别的疾病或问题（如骨折、癌症、感染、神经根痛等）引起的腰部疼痛或不适组成。当NSLBP持续长达12周时，被视为（亚）急性。 什么是麦肯基方法？ 麦肯基方法是由经过培训的医疗保健提供者（通常是物理治疗师）采用的一种治疗方法，用于护理NSLBP患者。它包括基于评估过程中观察到的临床线索（疼痛位置的变化或运动受限）的个性化锻炼计划。它还包括姿势教学和家庭练习，以鼓励人们自己控制症状。 我们想知道什么? 我们想知道麦肯基方法对于（亚）急性NSLBP患者是否有效。 我们做了什么？ 我们检索了将麦肯基方法与最小干预（例如，一本关于脊髓疼痛信息的小册子）（主要比较）或其他治疗（亚）急性NSLBP的方法进行比较的研究。我们关注麦肯基方法是否可以在短期（最接近两周）和中期（最接近三个月）减少疼痛和残疾。我们比较和总结了研究结果，并根据研究方法和规模...

全身性阿片类药物对新生儿术后疼痛控制和管理的有效性和安全性如何？ 系统综述问题 全身性阿片类药物在减轻新生儿手术后疼痛方面的有效性和安全性如何？ 研究背景 新生儿（出生后前4周内的婴儿）可能会接受手术或外科手术。与成人一样，婴儿也会经历疼痛，并且必须在手术后控制（减轻）这种疼痛。阿片类药物是止痛药，例如可待因和吗啡。阿片类药物通过与体内的阿片受体相互作用并减轻疼痛感来发挥作用。 阿片类药物会影响整个身体系统，因此本综述将它们称为全身性阿片类药物。阿片类药物可以通过不同途径以几种方式给予婴儿。一种方法是使用针头注入静脉；这称为胃肠外给药。另一种方法（或途径）是将药物放入婴儿口中、舌下或用管道。这些类型的药物输送称为肠内给药。与大多数药物一样，阿片类药物可以不同强度（剂量）给药。阿片类药物可以连续给药（不间断），或在一段时间内断断续续（间歇性）。 总结来说，如何给婴儿使用阿片类药物，使用阿片类药物的频率，以及阿片类药物的强度，这就是药物治疗方案。 本综述旨在评估不同的阿片类药物治疗方案对婴儿的影响。 主要研究结果 本综述纳入了七项研究，涉及504名婴儿。我们发现没有研究比较相同阿片类药物的不同剂量。我们没有发现研究比较相同阿片类药物的不同途径。六项研究比较了连续阿片类药物给药与间歇性阿片类药物给药。一项研究评估了连续输注吗啡与父母或护士控制给药的使用情况。 根据这些研究，我们发现我们...

阿片类药物以外的止痛药，用于治疗经受痛苦手术的婴儿的疼痛 关键信息 • 尚无充足的证据表明，非阿片类止痛药可以缓解婴儿的操作性疼痛。我们发现只有两项小型研究，将一种止痛药（氯胺酮）与另一种止痛药（阿片类药物）或甜溶液进行比较，对不同的手术程序进行管理。 • 需要对各种止痛药进行更大规模的研究，以更好地了解不同止痛药的益处与伤害以及最佳的给药方式。 研究目的 婴儿，尤其是早产儿或重病患儿，在住院期间可能会经受许多痛苦的手术。目前尚不清楚哪种止痛药最能充分、安全地缓解疼痛。本综述特别关注评估非甾体抗炎药（NSAIDs），如布洛芬，以及N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，如氯胺酮，在处于操作性疼痛的婴儿中的作用。我们想了解止痛药如何影响婴儿在手术过程中的疼痛强度，以及其引起的任何副作用。 研究内容 我们检索了以下研究并进行了比较： • 比较NMDA 受体拮抗剂（如氯胺酮）或NSAID（如布洛芬）与无治疗、安慰剂（虚拟治疗）、口服甜溶液或非止痛药干预； • 比较一种止痛药与另一种止痛药的治疗效果；或 • 比较使用同一种止痛药的不同给药途径（例如，通过口腔或静脉）。 我们对研究进行了评估，并根据研究方法评价了证据质量。 研究发现 我们发现了两项研究，共涉及269名经受操作性疼痛的婴儿。在尼日利亚进行的一项研究，比较了包皮环切术中口服氯胺酮和糖浆的治疗疗效。另一项在印度进行的研究，...

与生理盐水溶液相比，雾化高渗盐水治疗婴儿急性细支气管炎的获益和风险是什么？ 关键信息 与雾化生理盐水相比，雾化高渗盐水可使急性细支气管炎入院婴儿的住院时间缩短近10小时;可改善医生用来评估疾病严重程度的“临床严重程度评分”;并可将门诊或急诊科儿童的住院风险降低13%。 我们发现，当给予雾化高渗盐水以放松气道（支气管扩张剂）时，使用雾化吸入的高渗盐水仅发现轻微且自行缓解的不良事件（如咳嗽恶化、躁动、支气管痉挛、心动过缓、饱和度下降、呕吐和腹泻）。 我们对证据的信心为低到极低;未来的大型研究需要证实雾化吸入高渗盐水对急性毛细支气管炎患儿的获益。 什么是急性毛细支气管炎？ 急性细支气管炎是两岁以下儿童最常见的下呼吸道感染。当导致肺部的小结构（细支气管）受到感染，引起炎症、肿胀和粘液产生时，就会发生细支气管炎。这使得呼吸困难，特别是在非常年幼的儿童中，他们会出现咳嗽和喘息。 由于细支气管炎通常是由病毒引起的，因此药物治疗通常无效。使用雾化器以细雾形式吸入高渗盐水（一种强或高度浓缩的无菌盐水溶液）可能有助于缓解喘息和呼吸困难。 本综述想知道什么？ 我们想了解与生理盐水溶液相比，雾化高渗盐水对急性毛细支气管炎婴儿的治疗是否更有效和安全。 我们做了什么？ 我们检索了比较雾化高渗（≥3%）盐水溶液单独或联合支气管扩张剂与雾化吸入正常（0.9%）盐水或标准治疗急性毛细支气管炎婴儿的研究。我们合并了...

Monday, April 3, 2023

现金转账用于卫生的经验和看法 本项证据综合的目的是什么？ 这项Cochrane定性证据综合的目的是探索接受与健康相关的有条件或无条件现金转账的人是如何经历这些的。我们分析了41项定性研究来回答这个问题。 关键信息 人们感谢现金转账，并将其视为满足其基本需求所必需的。然而，现金转账可以以积极和消极的方式影响人们的关系。并非所有人都希望获得现金，一些受助者认为仅凭现金不足以改变他们的健康行为。 本项证据综合的研究内容是什么？ 有条件和无条件的现金转账计划遍布世界各地。有条件的现金转账是指如果人们按照某种方式行事，就给予他们钱（现金）。例如，如果父母带孩子去保健中心，他们可以获得现金。无条件现金转账是在没有任何使用条件或规则的情况下给予钱。在某些情况下，人们通过政府计划获得现金转账。在其他情况下，现金转账主要通过非政府组织或研究项目提供。其中许多规划旨在改善人们的健康，但衡量这些规划对健康影响的研究表明，结果好坏参半。因此，我们想探索人们如何体验这些计划。 主要发现有哪些？ 我们在综述中纳入了127项研究，并抽取了其中41项研究进行分析。在2022年7月5日更新检索后发现了32项进一步的研究，正在等待分类。抽样研究来自世界卫生组织所有地区的24个不同国家。这些研究主要探讨了具有不同健康状况的现金转账接受者的观点和经验，例如传染病、残疾和长期疾病、性健康和生殖健康以及母婴健康。我们的研究...

压力源对早产儿经鼻持续气道正压通气（CPAP）的影响 关键信息 与机械通气机或婴儿呼吸装置提供的持续气道正压通气（continuous positive airway pressure, CPAP）相比，气泡式CPAP可降低CPAP治疗失败的风险。气泡式CPAP可能对死亡风险或与早产相关的其他并发症的风险影响很小或没有影响，但可能会增加中至重度鼻损伤的风险。 什么是CPAP？ CPAP是一种呼吸支持的形式，可用于支持有肺部问题的早产儿的呼吸。各种类型的机器都可以提供CPAP，包括水下气泡装置 （气泡式CPAP）、机械通气和婴儿呼吸装置。 我们想要发现什么？ 我们想确定是否有证据支持气泡式系统与通气或婴儿呼吸装置系统相比能够降低CPAP治疗失败率（婴儿病情恶化或婴儿需要机械通气）并减少并发症和伤害。 我们做了什么？ 我们在医学数据库中检索了截至2023年1月的随机对照临床试验（一种受试者被随机分配到两个或多个治疗组中的一个的研究）。 我们发现了什么？ 我们纳入了15项试验，这些试验在总共1437名早产儿中比较了气泡式CPAP与呼吸机或婴儿呼吸装置CPAP的使用。试验大多规模较小，并且存在设计缺陷，可能会使他们的发现面临偏倚风险。 主要研究结果 合并分析结果表明，使用气泡式CPAP而不是通气或婴儿呼吸装置CPAP可以降低CPAP治疗失败的风险，但气泡式CPAP可能不会影响死亡或其他早...

补充锌对于6个月至12岁儿童预防死亡和疾病以及促进生长是否有效？是否会造成不良影响？ 关键信息 - 6个月至12岁儿童补充锌对全因死亡率几乎没有影响，并且可能对腹泻死亡没有影响。补锌可能会降低下呼吸道感染和疟疾引起的死亡率，但不能排除死亡风险增加的可能性。 - 6个月至12岁儿童补充锌可能会预防腹泻引起的疾病，但补充后可能会导致呕吐。这可能会导致身高小幅增加。 为什么研究补锌很重要？ 锌是一种必需的微量营养素。帮助儿童正常成长并促进健康的免疫系统非常重要。缺乏锌可能导致腹泻、肺炎、疟疾甚至死亡。饮食中锌摄入量低通常与贫困有关。低收入和中等收入国家多达一半的儿童可能缺锌。肉、鱼、蛋和乳制品是锌的良好天然来源，但价格昂贵。缺乏清洁水和恶劣的卫生条件会增加人们感染疾病的机会，而锌可能有助于对抗疾病。人体无法产生或储存锌，因此膳食补充剂很重要。 我们想知道什么？ 我们想了解给儿童补充锌是否有助于预防儿童死亡和疾病，并促进生长。 我们做了什么？ 我们检索了随机分配6个月至12岁儿童接受补锌或不补锌的研究。 我们比较和总结了研究结果，并根据研究方法和规模等因素评价了证据的可信度。 我们发现了什么？ 我们在综述中纳入了96项研究，涉及219584名儿童。研究在34个国家进行，主要是低收入和中等收入国家。研究中的大多数儿童都在五岁以下。锌最常以糖浆（硫酸锌）形式服用，最常见的剂量为每天10毫克至...

糖尿病视网膜病变的血压控制 系统综述问题 控制血压能预防糖尿病视网膜病变或延缓其病程进展吗？ 研究背景 糖尿病的特点是高血糖（循环血液系统中的糖）水平，根据血糖升高的根本原因分为1型或2型糖尿病。糖尿病患者常见的并发症是糖尿病视网膜病变，通常被称为“糖尿病眼病”，它会影响眼睛后方血管。糖尿病视网膜病变是世界范围内劳动年龄的成年人视力不佳和失明的主要原因。控制血糖可降低糖尿病视网膜病变的风险，并防止病情恶化。 对于糖尿病患者而言，同时控制血糖和血压也是另一种减少糖尿病视网膜病变发生风险与减少恶化的建议，其降低风险的幅度超过控制血糖所达到的。 研究特征 本研究纳入了29项主要在北美和欧洲开展的随机对照临床试验（一种将受试者随机分配到两组或多组中的研究），在4620名1型糖尿病患者和22565名2型糖尿病患者中探索多种降低血压方法的效应，单个研究的受试者从16到4477名不等。这些试验的治疗和随访时间从少于1年到9年不等。8项试验接受1家或多家药企的全额资助。其他10项试验通常以取得研究药物的形式接受药企资助。剩下的11项研究在政府资助的经费或机构支持下进行，或并未报告资助来源。证据更新至2021年9月。 主要研究结果 总体而言，来自19项试验的证据为降低血压预防糖尿病视网膜病变提供了适度的支持，在这些试验中，受试者接受了 5 年或更长时间的治疗。然而，降低血压并不能阻止糖尿病性视网膜...

Monday, March 27, 2023