哌醋甲酯对患有注意力缺陷多动障碍（ADHD）的儿童和青少年是否有效？它是否会引起不良影响？ 关键信息 - 哌醋甲酯可能会减少多动和冲动，并可能帮助儿童集中注意力。哌醋甲酯也可能有助于改善日常行为，但似乎不会影响生活质量。 - 哌醋甲酯在使用长达六个月时似乎不会增加严重的不良反应（危及生命）的风险。然而，它与睡眠问题和食欲下降等不严重的不良反应的风险增加有关联。 - 未来的研究应该更多地关注报告不良反应，并且应该持续更长的时间。 什么是注意力缺陷多动障碍（ADHD）？ 注意力缺陷多动障碍（attention deficit hyperactivity disorder, ADHD）是最常被诊断和治疗的儿童精神疾病之一。患有多动症的孩子很难集中注意力。他们常常过度活跃（烦躁，无法长时间静坐）和冲动（做事不加思考）。多动症会让孩子们很难在学校有好的表现，因为对于他们来说很难遵循指示和集中注意力。他们的行为问题会影响他们与家人和朋友相处的能力，而且他们经常比其他孩子遇到更多的麻烦。 如何治疗多动症？ 哌醋甲酯（例如利他林）是最常用于患有多动症的儿童和青少年的药物。哌醋甲酯是一种兴奋剂，有助于增加一部分的大脑活动，例如与注意力有关的部分。哌醋甲酯可以片剂形式服用，也可以以皮肤贴剂形式服用。它可以配制为立即起效，也可以在数小时内缓慢发挥作用。哌醋甲酯可能会引起不良反应，例如头痛、胃痛和睡眠问...

皮肤保留乳房切除术是治疗乳腺癌的安全有效的外科手术吗？ 本系统综述的目的是什么？ 我们评价了皮肤保留乳房切除术（SSM，即去除包括乳房和乳晕（乳头周围皮肤）在内的乳房组织，但是保留覆盖乳房的皮肤）与传统乳房切除术（去除覆盖在乳房上的皮肤，包括乳头和乳晕）的证据。 关键信息 我们发现SSM和传统的乳房切除术在乳腺区域癌症复发风险（局部复发）、死于乳腺癌的概率（整体存活率）或术后并发症风险上可能没有什么不同。评估的手术并发症包括乳房重建造成的损失（因并发症需要手术切除乳房重建皮瓣或植入物）、皮肤坏死、局部感染、出血（流血）、生活质量和美容效果。本综述的结果基于14项研究，其中大多数研究可能由于设计上的缺陷而存在偏倚。 什么是皮肤保留乳房切除术？ 传统的乳腺癌乳房切除术是一种切除整个乳房组织、覆盖在乳房上的皮肤和乳头乳晕复合体的外科手术。此手术20年后癌症复发在胸壁（乳房切除部位）的概率约为2.3%。为了提高美容效果，人们开始使用皮肤保留乳房切除术（skin-sparing mastectomy, SSM）作为传统乳房切除术的替代方法。此手术尽可能多地保留了乳房皮肤，留下最少的乳房组织，并提升更高的心理满意度和更少的伤害感。SSM在过去的二十年里一直被用于乳腺癌的治疗。 我们想要知道什么？ 我们想要了解SSM治疗乳腺癌是否和传统乳房切除术同样有效，并评估手术并发症的发生率是否不同。 我...

吸入性皮质类固醇与安慰剂治疗稳定型慢性阻塞性肺病（COPD）的比较 关键信息 单独吸入皮质类固醇可能会减少慢性阻塞性肺病（chronic obstructive pulmonary disease, COPD）的发作，减缓肺功能的下降（以一秒钟从肺部呼出的气体量来衡量），并导致生活质量的小幅改善。然而，单独吸入皮质类固醇也可能增加患肺炎和口腔疾病副作用的风险，并且可能不会提高生存率。这些发现支持吸入皮质类固醇疗法继续考虑与其他治疗方法联合使用，未来的研究应该集中在这一领域。 什么是慢性阻塞性肺疾病？ COPD是用于描述引起呼吸困难的肺部疾病的术语。这些疾病包括慢性支气管炎（肺部长期炎症）和肺气肿（肺泡损伤）。不再推荐COPD患者单独吸入皮质类固醇（称为“单一疗法”），但由于联合治疗更有效，吸入皮质类固醇疗法与其他长效吸入药物一起使用。吸入皮质类固醇有助于减少哮喘患者气道中的炎症。然而，目前尚不确定这些药物是否对COPD患者有益。 我们想知道什么？ 我们更新了关于吸入皮质类固醇的一个综述，以帮助解决其在COPD患者中作用的持续不确定性。我们分析了吸入皮质类固醇疗法对急性发作频率（“病情恶化”）、生活质量、呼吸能力、死亡率和诸如肺炎等副作用的影响。 我们做了什么？ 我们检索了医疗数据库，以比较吸入皮质类固醇和吸入安慰剂（虚假治疗）在稳定期COPD患者中的研究。 我们发现了什么？ 我们...

On the 20th June 2019, Cochrane members published an overview review in the PAIN Journal on the efficacy of pharmacological interventions for children with chronic pain and cancer-related pain (https://bit.ly/2MMm5UH). The overview summarises the evidence from 23 systematic reviews, including several Cochrane Library reviews from our NIHR Programme Grant (https://papas.cochrane.org/nihr-programme-grant-2014-17). This work also builds on a policy workshop we held in 2018 focussing on this topic (https://bit.ly/2RGOGcK).

 

The overview highlights the lack of available evidence across all drugs aimed at relieving pain in children (just 6 trials of 393 participants). Therefore, we have launched a large dissemination plan to share these findings. We are publishing articles, blogs, newsletters, videos, and co-ordinating a social media campaign to help us start a conversation about the importance of evidence production in children’s pain.

 

We thank everyone who has contributed to this important piece of work. Please do feel free to use these links and distribute them widely to help us improve the science, policy and practice of paediatric pain management.

 

 

Resources

 

• Open access overview in PAIN: https://bit.ly/2MMm5UH and commentary via Ovid

 

• Cochrane Special Collection: https://bit.ly/2IM11ta

 

• Cochrane editorial: https://bit.ly/2YgN5N0

 

• Blogs on this evidence base (or its absence)
  • Pharmacotherapy for treating chronic pain in children: A need for pragmatic idealism; Thomas 2020: https://doi.org/10.1111/pan.13781 (download pdf here)
  • Body in Mind blog https://bit.ly/2Flwtwe
  • The Conversation https://bit.ly/2YeBfmI (also shared on Yahoo News here; and IOL here; and MENAFN here)
  • Evidently Cochrane https://bit.ly/2IPzerQ
  • Press release from University of Bath https://bit.ly/2LjwLYp

 

• Supporting videos
  • Dr Emma Fisher’s summary on YouTube https://bit.ly/2RDldjA
  • University of Bath video summary https://twitter.com/UniofBath/status/1143800625764999169
  • PAIN Journal Editor’s Pick video https://bit.ly/2X7HEUh

 

• Summary of the  impact story so far (2019): https://bit.ly/2ITbzXz

 

• Key people to follow on Twitter (hashtag #timeforchange)
  • @Chris_Eccleston
  • @EmmaFisher1
  • @cochranecollab
  • @CochraneUK
  • @CochraneLibrary
  • @UniofBath

 

Other external links

• Somerset Live: Bath Hospital Trust supports study into drug treatment of chronic pain in children (here)
• Medical Xpress: Researchers reveal lack of evidence for drugs prescribed to treat chronic pain in children (here)
• News Medical (Life Sciences): Are Chronic Pain Relief Drugs for Children Effective? (here; also on Medicine News Line here; linked to via BioPortfolio here; and on herenciageneticayenfermedad here); and Study reveals lack of evidence for pediatric drugs prescribed to treat chronic pain (here)
• American News Report: Lack of evidence for drugs prescribed to treat chronic pain in children (here)
• EurekAlert: Researchers reveal lack of evidence for drugs prescribed to treat chronic pain in children (here)
• 7th Space: Researchers reveal lack of evidence for drugs prescribed to treat chronic pain in children (here)
• Newswise: Researchers reveal lack of evidence for drugs prescribed to treat chronic pain in children (here)
• Physical Therapy Products: Chronic Pain in Kids Needs to Be Studied More, Researchers Urge (here)
• The Independent: Children’s pain is under-researched (here - scroll down to end of page)
• Technology.org: Researchers reveal lack of evidence for drugs prescribed to treat chronic pain in children (here)
• BBC 1 West - BBC London News (here; here; here)
• BBC Bristol (here)
• Health Canal: Researchers reveal lack of evidence for drugs prescribed to treat chronic pain in children (here)
• Europa Press: in Spanish (here and here)
• The Courier & Advertiser Fife edition: Pain relief for children called into question (here - Press Reader account required)
• Health Medicine Network: Researchers reveal lack of evidence for drugs prescribed to treat chronic pain in children (here)
• ScienMag: Researchers Reveal Lack Of Evidence For Drugs Prescribed To Treat Chronic Pain In Children (here)
• Science Codex: Researchers reveal lack of evidence for drugs prescribed to treat chronic pain in children (here)
• Bioengineer.org: Researchers Reveal Lack Of Evidence For Drugs Prescribed To Treat Chronic Pain In Children (here)
• Bright Surf: Researchers reveal lack of evidence for drugs prescribed to treat chronic pain in children (here)

  The story continues...

In 2020, Professor Christopher Eccleston, Dr Emma Fisher, and others produced The Lancet Child and Adolescent Health Commission’s report to address paediatric pain and recommend what more can be done to help children and young people: https://www.thelancet.com/commission/paediatric-pain

More links related to the Lancet launch in October 2020:

• Versus Arthritis news
• University of Bath press announcement
• The New York Times: Respecting Children’s Pain
• Artist Shaniah Barry - You can't see my pain
• Video Abstract: Delivering transformative action in paediatric pain
• The Lancet: Paediatric pain management in low-income and middle-income countries
• Follow on Twitter @LancetChildAdol
• Dalhousie University news

 

And continues...

In December 2020, the WHO published Guidelines on the management of chronic pain in children: access here.

Our Cochrane Reviews contributed to the guideline and Dr Emma Fisher led the review of effectiveness.

Overview (taken from the guideline)

In these guidelines, the World Health Organization (WHO) provides evidence-informed recommendations for the management of chronic pain in children. The recommendations are based on the most current, high-quality scientific evidence, and were formulated following processes and using methods that meet the highest international standards for guideline development. The recommendations in this guideline are based on systematic reviews of the evidence on benefits, harms, acceptability and feasibility, as well as on equity and resource considerations. The recommendations were formulated by the Guideline Development Group, consisting of individuals with diverse expertise and experiences and with global representation. 

The purpose of this guideline is to assist WHO Member States and their partners in developing and implementing national and local policies, regulations, pain management protocols and best practices. It will help countries balance concerns about ensuring access to appropriate therapies for pain relief with the harms arising from misuse of medications and other potential adverse effects of interventions for pain management. 

These guidelines focus on physical, psychological and pharmacological interventions for the management of primary and secondary chronic pain in children 0 to 19 years of age.

Wednesday, March 22, 2023

Specifications: Maternity cover (12 months)
Salary:  £49,000 per annum
Location: UK or Denmark (based in either the London or Copenhagen office)
Directorate: Publishing and Technology
Closing date: April 06 2023
 
Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. Cochrane's strength is in its collaborative, global community. Cochrane's members and supporters come from more than 190 countries. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into five directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

The Product Owner (PO) ensures that the Scrum team works efficiently on stories that maximize value for Cochrane in an agile development process, and is primarily focusing on the development of the new web-based Cochrane review authoring tool RevMan.

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everting we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.  

You can expect: 

• An opportunity to truly impact health globally  
• A flexible work environment  
• A comprehensive onboarding experiences
• An environment where people feel welcome, heard, and included, regardless of their differences

Cochrane welcomes applications from a wide range of perspectives, experiences, locations and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply, please click here.
• The deadline to receive your application is 6th April, 2023.
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. 
• Read our Recruitment Privacy Statement

Wednesday, March 22, 2023 Category: Jobs

Tuesday, March 21, 2023

Specifications: 12-month fixed term
Salary:  £37,000 per annum
Location: Flexible; can be based anywhere
Directorate:  Evidence Pipeline and Data Curation Team, Publishing and Technology Directorate
Closing date: April 11 2023
 
Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. Cochrane's strength is in its collaborative, global community. Cochrane's members and supporters come from more than 190 countries. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into five directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

The purpose of this role is to support the study identification stages critical in the production of Cochrane evidence. To enable this, we have developed the Cochrane Evidence Pipeline. The Evidence Pipeline aims to combine traditional search and retrieval processes with machine learning and crowdsourcing to expedite the study identification process and better enable the recuse of data.

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everting we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.  

You can expect: 

• An opportunity to truly impact health globally  
• A flexible work environment  
• A comprehensive onboarding experiences
• An environment where people feel welcome, heard, and included, regardless of their differences

Cochrane welcomes applications from a wide range of perspectives, experiences, locations and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply, please click here.
• The deadline to receive your application is 11th April, 2023.
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. 
• Read our Recruitment Privacy Statement

Monday, March 20, 2023 Category: Jobs

We are delighted to share that Cochrane’s first open access journal, Cochrane Evidence Synthesis and Methods, has published its first articles.

Working in conjunction with our publisher, Wiley, this journal strengthens Cochrane’s ability to meet our stakeholders’ needs and publish different types of evidence synthesis beyond systematic reviews. It also includes methods research evaluating how evidence syntheses is planned, produced and disseminated, and research articles on critical areas for evidence synthesis, such as, priority setting, consumer involvement, and research integrity.  

With the launch Editorial New directions beyond the boundaries of evidence synthesis, Michael Brown (Editor, Cochrane Evidence Synthesis and Methods) and Ella Flemyng (Editorial Product Lead, Cochrane) discuss the scope and ethos of the journal, and how they hope the journal will contribute to the field.

Cochrane Evidence Synthesis and Methods’ first published paper is the rapid review on the effect of pharmacological interventions for the treatment of people with post-COVID-19, which is an exemplar for the types of rapid reviews we will feature. The authors, led by KM Saif-Ur-Rahman and Declan Devane (University in Galway, Ireland), worked closely with the World Health Organization, to ensure that the rapid review was relevant, timely and narrowly focused on therapeutic questions that directly apply to health care decisions.

Want to join the journal’s growing community?

• Sign up for content alerts so you never miss a new article
• Find out how to submit
• Register to be a peer reviewer (by creating an account in our Scholar 1 system)

Want to learn more about Cochrane Evidence Synthesis and Methods?

Michael Brown and Ella Flemyng recently discussed why Cochrane launched a new journal, what its aim is, and how people from across the community can get involved.

 

Monday, March 20, 2023

注射抗血管内皮生长因子治疗晚期糖尿病视网膜病变 系统综述问题 注射抗血管内皮生长因子（抗-VEGF）联合或不联合激光治疗对晚期糖尿病视网膜病变患者的视力和病情进展有帮助吗？这种治疗方式安全吗? 关键信息 ·抗-VEGFs（联合或不联合激光）改善视力，但其改善程度无临床意义。它们还可以减少新血管的生成、减少出血和手术切除玻璃体（玻璃体切除术）的需要。 ·抗-VEGFs（联合或不联合激光）的安全性仍然不确定，因为我们对发现的证据缺乏信心。 ·需要更多高质量的临床试验，以更好地确定合适的抗-VEGFs治疗剂量和给药时间。 研究背景 增生性糖尿病视网膜病变（Proliferative diabetic retinopathy, PDR）是视网膜晚期损伤的医学术语。PDR包括视网膜新生血管生成或玻璃体或视网膜前出血（血液渗漏在充满晶状体和视网膜之间空间的凝胶内和周围），可导致失明。激光全视网膜光凝治疗术（Panretinal photocoagulation, PRP）是目前的治疗PDR的方法。然而，它有视力丧失的副作用。抗-VEGFs阻止了新生血管的形成。我们想知道抗-VEGFs联合其他治疗或单独治疗的疗效是否安全，是否比标准替代疗法能更好地改善PDR。 我们做了什么？ 我们检索了抗血管内皮生长因子（联合或不联合激光治疗）治疗PDR患者与另一种积极治疗、假治疗或不治疗进行比较的随机对照试...

Specifications: Fixed Term – 1 Year (Full Time, Open for Part-Time Role as well)
Salary: £35K per annum  
Location: Ideally based in the UK, Germany or Denmark. Candidates from the rest of the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries (1-year fixed-term contracts)
Directorate: Evidence Production & Methods
Closing date: 27 March 2023
 
Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. Cochrane's strength is in its collaborative, global community. Cochrane's members and supporters come from more than 190 countries. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into five directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

The Future of Evidence Synthesis (FES) is a critical programme of work for Cochrane over the next 3-5 years. Successful delivery is essential for Cochrane’s future and sustainability. A core component of the new production model is the creation of Cochrane Evidence Synthesis Units (ESU) and Thematic Groups (TG). This role will work closely with the Head of Change Management, to 1) create, launch and manage the initial application process for Evidence Synthesis Units and 2) revise the application process and launch a second round for Thematic Groups and help to manage the initial stages of the ESU and TG pilots.

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everting we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.  

You can expect: 

• An opportunity to truly impact health globally  
• A flexible work environment  
• A comprehensive onboarding experiences
• An environment where people feel welcome, heard, and included, regardless of their differences

Cochrane welcomes applications from a wide range of perspectives, experiences, locations and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply, please click here.
• The deadline to receive your application is 27th  March 2023.
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. 
• Read our Recruitment Privacy Statement

Thursday, March 16, 2023 Category: Jobs

Tuesday, March 14, 2023

什么是消费者与卫生服务提供者进行合作以改进卫生服务规划、提供与评估的观点与看法？ 关键信息 ——卫生服务提供者和消费者之间的权力不平衡会阻碍消费者参与卫生服务规划、提供和评估。 ——可能因消费者被招募的方式、会议进行的程序和进行决策的方式而导致权力不平衡问题。 ——为与消费者建立良好的伙伴关系，卫生服务提供者应当解决这些权力不平衡问题。 ——部分消费者和卫生服务提供者认为，伙伴关系改善了卫生服务的文化和环境，以及卫生服务规划和发展方式。 为什么消费者与卫生服务提供者进行合作以改进卫生服务规划、提供与评估很重要？ 过去，卫生服务提供者决定着如何规划、提供和评估卫生服务。近来，人们开始重视更好地规划卫生服务以满足消费者的需求、偏好和价值观。这促使消费者开始与卫生服务提供者进行合作规划、提供和评估卫生服务。通常，消费者和卫生服务提供者之间以正式团体形式开始合作，例如委员会、医院董事会或工作组。 研究预期结果 我们希望探索消费者与卫生服务提供者进行合作以改进卫生服务规划、提供与评估的观点和经验。同时也想发现以正式团体形式进行合作的最佳实践原则。 研究内容 研究者进行了一项定性证据综合（qualitative evidence synthesis, QES）来了解合作的卫生服务提供者和消费者的观点与经验。该定性证据综合汇总并分析了来自单个定性研究的结果。定性研究通过访谈、焦点小组、问卷和观...

肉毒杆菌毒素治疗斜视 关键信息 由于缺乏强有力的证据，关于使用肉毒杆菌毒素与斜视手术比较的获益和危害的证据尚不确定。 我们想知道什么？ 我们想知道肉毒杆菌毒素是否比手术治疗斜视更好。我们还想知道肉毒杆菌毒素是否与任何不良影响有关。 什么是斜视？ 当眼睛没有对齐时，就会出现斜视。通常一只眼睛向内或向外转动。较少的情况下，一只眼睛向上或向下转动。它通常被称为“斜视”（strabismus/ squint）。 斜视可导致视力模糊或复视。在儿童中，它可以影响患眼视力的长期发展。斜视的原因有很多。大多数情况下，眼睛周围的肌肉或神经存在问题。 医生可以使用肉毒杆菌毒素来暂时阻止眼睛周围的个别肌肉的工作。这可能有助于眼睛变得更加对齐，并可能减少视力模糊或复视。使用肉毒杆菌毒素的一个问题是它会导致眼睑下垂。 我们研究了什么？ 我们检索了研究肉毒杆菌毒素注射与其他治疗方法（如手术）比较在斜视患者中的研究。我们比较和总结了相关研究的结果，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。 我们发现了什么？ 我们发现了四项针对242名患有斜视的成人和儿童的研究。最大的研究受试者数量涉及110名儿童，最小的研究涉及30人。这些研究是在加拿大、南非和西班牙进行的。两项研究持续了六个月，最长的研究持续了36个月。 本系统综述显示。 •在需要斜视初治或复治的人群中，与肉毒毒素治疗比较，斜视手术可能有更好的机...

改良式小梁切除术治疗青光眼 系统综述问题 我们评价了通过设备对标准小梁切除术进行改良以治疗青光眼的有效性和安全性的证据。 什么是青光眼以及如何治疗？ 青光眼是一种累及视神经的疾病，而视神经则负责将眼睛获取的信息传递到大脑以产生图像。眼内压力增加（即IOP）会损害视神经，导致视力丧失，甚至失明。青光眼是全球范围内50岁及以上人群失明的第二大病因，其治疗旨在降低眼内压，从而减缓或阻止视力的进一步下降，这可以通过药物、激光或手术治疗来实现。小梁切除术是治疗青光眼最常见的标准手术之一。它通过在眼睛内部和结膜下间隙（即眼表面下一个充满液体的空间）之间建立通道来降低眼内压，也可以通过植入一些设备对这类手术进行改良。已发表的研究中报告了不同的装置，例如Ex-PRESS、XEN凝胶支架和PreserFlo微型引流器，以及使用Ologen、羊膜、膨体聚四氟乙烯（ePTFE）膜、凝胶膜等材料。 我们做了什么？ 我们检索了医学数据库，以获取在青光眼患者中开展的对比改良式小梁切除术与标准小梁切除术的临床研究，这些研究需要具备良好的设计。 我们发现了什么？ 有八项研究符合纳入标准。这些研究涉及961名青光眼患者，对比了改良式小梁切除术（植入两种设备）与标准小梁切除术的效果。其中七项研究使用了Ex-PRESS（涉及434名受试者），仅一项研究使用了PreserFlo微型引流器（涉及527名受试者）。这些研究...

抗生素治疗急性细菌性结膜炎有哪些利弊? 关键信息 局部使用抗生素可以改善急性细菌性结膜炎患者的症状，并有助于细菌的清除。然而，一些抗生素可能会对眼睛或眼睑造成有害影响；没有证据表明抗生素会对身体的其他部位产生不良影响。 什么是急性细菌性结膜炎？ 急性细菌性结膜炎是指单眼或双眼白色区域和眼睑内侧的薄层由于细菌感染而变红和发炎的情况。急性细菌性结膜炎通常具有传染性，因此建议儿童和在职成年人在受到感染时避免上学或工作。幸运的是，大多数情况下它会自然消退。 急性细菌性结膜炎应如何治疗？ 急性细菌性结膜炎患者通常会在感染部位使用抗生素眼药水或是软膏来治疗，以加速康复。然而，考虑到抗生素会引起眼内和眼周或周围皮肤的刺激或过敏反应，抗生素的益处一直受到质疑。 我们想知道什么？ 我们研究了单独使用抗生素或联用类固醇，是否可以改善结膜炎的体征和症状或帮助清除相关细菌。我们还评估了抗生素是否会对眼睛产生不良影响。 我们做了什么？ 我们通过检索比较抗生素滴眼液、软膏或片剂与非活性对照的研究来进行系统评价。我们总结了这些研究结果，并根据研究的实施方式报告了这些结果的可信度。 我们发现了什么？ 我们发现，与安慰剂相比，经过一个疗程后，抗生素可能会提高临床治愈率和微生物学治愈率。抗生素的使用也和少数受试者比预期更早停止他们的治疗相关。然而，对于某些个体，与安慰剂相比，非氟喹诺酮类抗生素（并不是氟喹诺酮类抗生...

除了药物治疗之外，其他治疗方法对于持续性姿势-知觉性头晕（PPPD）的益处和风险是什么？ 关键信息 关注持续性姿势-知觉性头晕（persistent postural-perceptual dizziness, PPPD）治疗方法的研究较少。我们只找到了一项非常小型的研究，该研究着眼于大脑电刺激（称为经颅直流电刺激）的使用。 该领域需要进一步的研究，以帮助确定是否有任何治疗方法可以有效治疗这种疾病，并确定是否会引起任何不良或有害的影响。 什么是PPPD？ 患有PPPD的人会出现头晕或失衡感的症状，在站立或四处走动时，或者在视觉刺激丰富（来自复杂的图案或繁忙的移动图像）时，这些症状会更严重。 如何治疗PPPD？ 有时人们可能会服用药物来尝试缓解他们的 PPPD 症状。也可能会使用其他治疗方法，例如一种称为前庭康复的物理疗法，或谈话疗法。 我们想知道什么？ 我们想知道： - 是否有证据表明药物以外的治疗可能有助于改善 PPPD 的症状； - 这些治疗是否会造成任何伤害。 我们做了什么？ 我们检索了将不同类型的治疗（不包括药物治疗）与无治疗或安慰剂（虚拟）治疗进行比较的研究。 我们发现了什么？ 我们发现了一项小型研究，该研究着眼于使用经颅直流电刺激治疗 PPPD。这种治疗通过放置在头皮表面的小电极向大脑施加弱电流。参与研究的人被提供了一个在家中使用的设备来进行治疗，每周进行五次，持续三...

创伤性前房积血的药物治疗 关键信息 我们没有发现任何证据表明哪种药物治疗会影响视力（视力敏锐度）（无论是在几周内测量还是在更长时间内测量）。我们也没有发现任何药物治疗可以减少前房积血本身的并发症，这一证据质量很低，因为此类事件很少发生。我们发现有限的证据表明，抗纤维蛋白溶解药(影响凝血的药物)可以降低眼部新出血的风险。 我们想知道什么？ 我们想找出哪些药物治疗对治疗创伤性前房积血有效，创伤性前房积血是严重创伤（眼部物理损伤）后血液聚集在眼前节（眼前）的病症。评价创伤性前房积血可能的治疗方法很重要，因为该病的并发症会影响最终视力。 我们做了什么? 我们检索了在创伤性前房积血患者中将一种医学（非手术）治疗与另一种医学治疗或对照组进行比较的研究。我们对研究结果进行了比较和总结，并根据研究方法和规模等因素，对证据的质量进行了评估。 我们发现了什么？ 为解决该系统综述问题，我们找到了30项研究，共涉及2969名受试者。研究在美国、加拿大、瑞典、丹麦、中国、南非、马来西亚、伊朗和以色列进行。这些研究纳入的男性多于女性，且受试者多为儿童或年轻人。治疗包括口服或直接应用于眼睛的抗纤维蛋白溶解剂（氨基己酸、氨甲环酸和氨甲基苯甲酸）、口服或局部皮质类固醇、其他种类的眼药水、阿司匹林、雌激素、中药、遮盖、抬高头部和卧床休息。大多数研究关注新出血发生的频率，因为这种继发性出血通常与更多并发症有关。检查的...

 

The Cochrane Review 'Physical interventions to interrupt or reduce the spread of respiratory viruses' was published in January 2023 and has been widely misinterpreted.

Karla Soares-Weiser, Editor-in-Chief of the Cochrane Library, has responded on behalf of Cochrane:

  

Many commentators have claimed that a recently-updated Cochrane Review shows that 'masks don't work', which is an inaccurate and misleading interpretation.

It would be accurate to say that the review examined whether interventions to promote mask wearing help to slow the spread of respiratory viruses, and that the results were inconclusive. Given the limitations in the primary evidence, the review is not able to address the question of whether mask-wearing itself reduces people's risk of contracting or spreading respiratory viruses. 

The review authors are clear on the limitations in the abstract: 'The high risk of bias in the trials, variation in outcome measurement, and relatively low adherence with the interventions during the studies hampers drawing firm conclusions.' Adherence in this context refers to the number of people who actually wore the provided masks when encouraged to do so as part of the intervention. For example, in the most heavily-weighted trial of interventions to promote community mask wearing, 42.3% of people in the intervention arm wore masks compared to 13.3% of those in the control arm. 

The original Plain Language Summary for this review stated that 'We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.' This wording was open to misinterpretation, for which we apologize. While scientific evidence is never immune to misinterpretation, we take responsibility for not making the wording clearer from the outset. We are engaging with the review authors with the aim of updating the Plain Language Summary and abstract to make clear that the review looked at whether interventions to promote mask wearing help to slow the spread of respiratory viruses.

• Read  the Cochrane Review 'Physical interventions to interrupt or reduce the spread of respiratory viruses'

Friday, March 10, 2023

Specifications: Permanent – Full Time
Salary: £55,257 (Paid in DKK, as per market exchange rate) per annum
Location: Copenhagen, Denmark
Directorate: Publishing & Technology
Closing date: March 24 2023
 
Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. We have 110,000+ members and supporters from more than 220 countries. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into five directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

As software development team lead, you will manage an Agile/Scrum software development team (3 developers, 1 test engineer) who develop web applications that accelerate the production of systematic reviews of health evidence. You will support the team in their work, coordinate with product owners on timelines, and contribute to software testing within the team as needed to ensure sprint goals are met.

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everting we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.  

You can expect: 

• An opportunity to truly impact health globally  
• A flexible work environment  
• A comprehensive onboarding experiences
• An environment where people feel welcome, heard, and included, regardless of their differences

Cochrane welcomes applications from a wide range of perspectives, experiences, locations and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply, please click here.
• The deadline to receive your application is 24 March 2023.
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. 
• Read our Recruitment Privacy Statement

Friday, March 10, 2023 Category: Jobs

减少环境中的跌倒风险 关键信息 对于跌倒风险较高的老年人，例如那些在过去一年中跌倒、最近住院或需要日常活动护理的老年人，消除家中的环境跌倒危险因素可以将老年人的跌倒次数减少38%。环境跌倒危险因素包括没有栏杆的楼梯、湿滑的小路以及光线不足。 为什么将环境危害视为预防跌倒计划的一部分很重要 跌倒的发生是很常见的，并且可能是致命的，但是是可以预防的。每年约有三分之一的65岁及以上人群跌倒。大多数跌倒发生在家中，超过30%的跌倒是由环境危险因素引起的。环境跌倒危害因素消除计划是由专业人员提供的干预措施，用于识别和消除环境跌倒危害因素。 我们想知道什么？ 我们想知道： -哪些类型的环境因素干预项目对预防跌倒最有效。 我们还想知道预防跌倒的方案： -提供这些环境因素干预方案的最佳方式以及 -这些干预方案能否防止严重伤害的跌倒 我们研究了四种类型的方案： -仅消除家庭内部和周围的环境的跌倒危险因素 -仅提供防跌倒辅助设施，如最新的眼镜或特殊鞋类 -仅提供环境跌倒危险因素的健康教育 -仅进行家居改造，使其能够在家中独立完成日常工作 我们做了什么？ 我们检索了调查居住在社区的老年人的不同类型的环境跌倒危害计划的相关研究。我们比较和总结了这些研究的研究结果，并根据研究方法和样本量等因素进行了质量评价。 我们发现了什么？ 我们检索了22项研究，共8463名居住在社区的老年人。研究受试者的平均年龄为7...