Tuesday, January 31, 2023

急性视网膜中央动脉阻塞（眼睛视网膜血液供应受阻）的治疗 关键信息 目前没有足够的证据支持对急性非动脉性视网膜中央动脉阻塞的建议治疗。 我们想要研究什么？ 当流向视网膜內部（眼睛內部的感光层）的血液供应突然受阻时，就会发生视网膜中央动脉阻塞。若能及时清除阻塞物，恢复视网膜血液供应，就有可能完全复原。然而，若阻塞时间延长，视网膜细胞就会死亡。现已尝试过多种方法来消除这种阻塞，包括眼部按摩、降低眼内压和使用药物溶解血栓。目前尚不清楚恢复血液供应的最佳治疗方法，并且一些治疗方法可能会导致严重的不良反应。 我们做了什么？ 我们检索了关于急性非动脉性视网膜中央动脉阻塞治疗方法的研究。总结了研究结果，并根据研究方法和样本量等因素评估了证据的可信度。 我们发现了什么？ 与观察相比，目前尚不清楚是否有任何治疗方法可以改善视力敏锐度（眼睛可以清晰地看到和区分物体的程度）。有些接受组织型纤溶酶原激活剂（一种参与血栓溶解的蛋白质）治疗的人出现了严重的不良反应，例如脑组织出血。 证据的局限性是什么？ 由于纳入的研究数较少，因此我们对这些证据缺乏可信度。 本系统综述的时效性如何？ 我们检索了截至2022年2月15日发表的研究。 如果您发现此证据有帮助，请考虑向 Cochrane 捐款。我们是一家慈善机构，提供可获取的证据来帮助人们做出健康和护理决定。捐赠 作者结论:  目前的研究表明，对于急性非动...

Measures to eliminate hazards around the home, such as reducing clutter, adding railings to stairs and improving poor lighting, can reduce the risk of falls for older people by around a quarter, according to a Cochrane review recently published.

The review did not find any compelling evidence for other measures to reduce falls, such as making sure older people have the correct prescription glasses, special footwear, or education on avoiding falls.

It also found that decluttering and reducing hazards had the most benefit for older people who are at risk of falls, for example because they have recently had a fall and been hospitalised or need support with daily activities such as dressing or using stairs.

Nearly one third of people aged 65 years and older fall each year. Most falls occur in the home.

Lindy Clemson, Professor Emeritus at the University of Sydney, Australia was lead author of the review. She said: “Falls are very common among older people. They can cause serious injury or even death, but they are preventable. In this review we wanted to examine which measures could have the biggest impact on reducing falls among older people living at home.”

Professor Clemson and her colleagues analysed the results of 22 studies including data on 8,463 older people living in the community.

They found that taking measures to reduce fall hazards around the home lowers the overall rate of falls by 26%. This typically includes an assessment of fall hazards in and around the home and recommendations for lowering the risk, for instance by removing clutter and adding handrails and non-slip strips to steps. These measures have the biggest effect (38% fewer falls) for people who are at a higher risk of falls. Based on their analyses, the reviewers found that if 1,000 people who had previously had a fall followed these measures for about a year, the total number of falls would come down from 1,847 to 1,145.

Professor Clemson said: “Having had a fall or starting to need help with everyday activities are markers of underlying risk factors, such as being unsteady on your feet, having poor judgement or weak muscles. These risk factors make negotiating the environment more challenging and increase the risk of a trip or slip in some situations.

The research shows that, for those at risk of falls, being aware of fall hazards in and around the home, removing hazards and adapting with safe behaviours can significantly reduce the risk of falling. It appears that interventions to reduce fall hazards around the home need certain elements of assessment and support to work, not just a short check list of things to tick off. So, while everyone can take more care about their home environment and should do exercise for balance and lower limb strength, professional support from an occupational therapist is an important intervention for many people living at home."

“We encourage all people, as they age, to reduce fall hazards. These are often simple things like removing or changing slippery floor mats, improving lighting on stairs or de-cluttering the home. It seems this is not always ‘common sense’. People tend not to notice clutter around their home or realise that climbing ladders the way they always have is potentially a fall risk, particularly if their mobility or balance is not as it used to be.”

While the review showed fewer falls with hazard reduction, there was not enough data from the studies to determine if there were fewer admissions to hospital due to a fall. The authors found limited evidence for the other approaches to prevent falls that they examined – assistive technologies and education. They also found there was a lack of research on the impact on fall reduction of providing equipment or modifications to help older people carry out daily activities, such as showering or as cooking a meal.

Professor Clemson added: “Preventing falls is a really important way of helping people to remain healthy and independent as they grow older, and our review also highlights the need for more research in this area.”

• Clemson L, Stark S, Pighills AC, Fairhall NJ, Lamb SE, Ali J, Sherrington C. Environmental interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2023, Issue 1. Art. No.: CD013258. DOI: 10.1002/14651858.CD013258.pub2
• Read the Cochrane Library Editorial 'Preventing falls in older people: the evidence for environmental interventions and why history matters.' 
• Read the Evidently Cochrane blog 'Preventing falls in older people: new evidence on what helps.'

Friday, March 10, 2023

Friday, January 27, 2023

Cochrane London 2023: Forward together for trusted evidence
4-6 September 2023
Central London, UK

Cochrane UK is delighted to be hosting the  Cochrane Colloquium at the Queen Elizabeth II (QEII) Centre in London, UK from the 4 to 6 of September 2023, with satellite events and meetings on the 3rd September.

Cochrane holds an annual conference, known as a Colloquium, that brings together Cochrane researchers, clinical professionals, early career professionals, patients and carers, policymakers, and anyone interested in evidence synthesis and evidence-based healthcare. The events are a mix of keynote speakers, training opportunities, workshops, presentations, and a lively social and networking atmosphere. They are an exciting opportunity for a community of evidence synthesis enthusiasts to share, learn, and connect.  

The deadline for submissions has been extended until Monday 6 March 2023 (23:59 GMT)

The theme of the Colloquium is 'Forward together for trusted evidence', which explores the challenges for the future around the trustworthiness of healthcare information whilst also celebrating 30 years of producing trusted evidence. 

We invite abstract submissions for the following streams: producing trusted evidence; advocating for trusted evidence; informing health and care decisions; and co-production and working together. 

We recognize that everything Cochrane does is about and for patients and other health consumers. We ask that all abstract submissions consider the impact on patients and healthcare consumers. In particular, we welcome submissions that are co-produced, co-presented or co-designed with patients or other healthcare consumers.

If you are planning to submit an abstract, please see our guidance and recommendations:

• Abstract submission guidance (for posters and oral presentations)
• Workshop submission guidance 

 Catherine Spencer, Cochrane CEO said, “The Cochrane Colloquium will bring people together in one place to discuss, develop and promote Cochrane’s work. I am looking forward to a packed programme at my first Colloquium and encourage you to submit your contributions now.”

Martin Burton, Director of Cochrane UK, said: “We look forward to receiving your abstract submissions for London 2023. You can now submit abstracts for posters, oral presentations, or workshops – and we have guidance to help you.” 

We invite everyone to visit the Colloquium website for all information related to the Colloquium as it's released, including submissions for abstracts and awards/prizes, registration, stipend applications, and the event programme.

• Abstract submission guidance
• Workshop submission guidance 
• Colloquium website 
• #CochraneLondon
• Press contact: Katie Abbotts, Cochrane UK

 

Wednesday, March 1, 2023

Title: Head of Fundraising
Specifications: Permanent – Full Time
Salary: £60K 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: Development
Closing date: 21 Feb, 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.

The Head of Fundraising will lead a small and dedicated team to provide the necessary vision, leadership, and fundraising skills which will enable the organisation to achieve its fundraising targets and organisational Development Strategy. They will have substantial international fundraising and management experience, a talent for building relationships and a proven track record in securing funds from international institutions, statutory sources, major international trusts and foundations, and major donors.

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 everything 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 21st Feb, 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, January 25, 2023 Category: Jobs

免疫球蛋白对川崎病的治疗 关键信息 在川崎病患儿中，与阿司匹林或中、低剂量IVIG方案相比，高剂量静脉注射免疫球蛋白（IVIG）方案： • 与阿司匹林或中、低剂量IVIG方案相比，可能会降低冠状动脉异常形成的风险； • 没有明显的安全问题； • 可能减少发热持续时间，但与阿司匹林相比，在需要额外治疗方面几乎没有差异； • 与中剂量或低剂量IVIG相比，可缩短发热持续时间，减少额外治疗的需要。 为什么这个问题很重要？ 川崎病是一种导致血管肿胀和发炎的疾病。症状包括高温（发烧）以及嘴唇干裂，草莓舌（红舌肿胀、凹凸不平），眼睛发红，皮疹，手脚红肿或皮肤脱皮；以及颈部腺体肿大。它最常见于幼儿。向心脏供血的血管（冠状动脉）的肿胀和炎症是该疾病最严重的并发症，导致冠状动脉异常。这些异常可导致获得性心脏病，有时甚至死亡。快速诊断和治疗可以预防这些并发症。静脉注射免疫球蛋白和阿司匹林是用于治疗川崎病的主要药物。这些药物的不同组合、剂量或时间（方案）用于治疗患者。重要的是要知道哪种治疗方法和方案在预防心脏并发症方面是最安全和最有效的。 我们做了什么？ 我们检索了将IVIG治疗川崎病与另一种药物或方案治疗进行比较的随机对照临床试验（一种将受试者随机分配到两个或多个治疗组之一的研究）。我们发现了31项研究，共有4609名受试者。这些研究将IVIG与阿司匹林、另一种IVIG方案、英夫利昔单抗或泼尼松龙方...

改善卫生条件以预防腹泻的干预措施 本系统综述的研究目的是什么？ 本Cochrane系统综述的目的是评估提供、升级或鼓励人们使用厕所的卫生干预措施是否能减少腹泻。我们收集并分析了所有预先指定的严格研究设计类型的相关研究，发现51项研究，涉及238,535人。 关键信息 我们发现有证据表明，卫生措施可以预防腹泻。然而，其效果因干预类型和环境而异，证据的质量也从极低到中等。 本系统综述研究了什么? 腹泻是导致死亡和疾病的主要原因，特别是在低收入国家的幼儿中。许多引起腹泻的病原体是通过接触人类粪便传播的。厕所等卫生设施是将人类粪便中的病原体与环境隔离的主要屏障。本系统综述审查了改善卫生设施获取、设施或使用的干预研究。我们确定了51项此类干预研究，其中大多数来自中低收入国家。 本系统综述的主要结果是什么? 结果表明，在脆弱的幼儿和所有年龄人群中，卫生干预措施可将腹泻减少约15%~26%。然而，并非所有干预措施都具有保护作用，并且效果因干预措施的类型和环境而有很大差异。我们估计，为露天排便者提供卫生设施的干预措施可能会减少约11%~21%的腹泻，改善现有卫生设施的干预措施可能会减少约15%~35%的腹泻，而在不提供基础设施或补贴的情况下改善卫生设施的获取或使用的行为改变干预措施可能会减少约15%~18%的腹泻。然而，这些证据的质量从中等到极低，进一步的研究可能会改变这些估计值，特别是对于提供...

Cochrane is delighted to announce the availability of RevMan Web, its popular, web-based systematic-review production software, to the wider academic community beyond Cochrane – to support evidence synthesis development and evidence-based medicine education. Cochrane expects interest in use of the tool from those in universities and medical schools, and many other research sectors.

RevMan Web facilitates the creation of meta-analyses, forest plots, risk-of-bias tables, and other systematic review elements. It is acknowledged to be easy-to-use – and is also widely used in learning or training about systematic review production.

Cochrane is making RevMan Web available for use by institutions or individuals for their own systematic review development work. The product is presented on a Software-as-a-Service basis: Cochrane offers a hosted service, comprising the software and cloud storage of all review data uploaded. 

Laura Ingle, Cochrane’s Director of Publishing and Technology, says this is a hugely positive step forward: “Cochrane’s investment and development of RevMan Web has allowed the preparing and maintaining of Cochrane Reviews to reach our high standards and methodologies – making Cochrane reviews the gold standard in health evidence. Cochrane is committed to making RevMan Web the platform of choice for all systematic review production, and now we are enabling access to RevMan Web for the wider review community at a reasonable and affordable cost.

"In addition to reviews of studies of the effects of healthcare interventions, you can use RevMan Web to write reviews that synthesize qualitative evidence, reviews of prognosis studies, reviews of studies of methodology, diagnostic test accuracy reviews, and overviews of reviews. RevMan Web is easy to use, is a safe and central place to manage all reviews, and allows collaboration across people to work on the same project. With its included learning and training materials, it also makes it a great training tool for teaching systematic review techniques. 

"Cochrane authors have been using RevMan for 5 years and we are excited to offer this systematic review and meta-analysis software to individual researchers, those working on reviews together, and to those looking for licences for their university. It’s a great tool for those generating one-off meta-analyses and forest plots or conducting their own systematic reviews.”

Free access is available in Research4Life low and middle-income countries and to Cochrane Review authors working on Cochrane Reviews. Cochrane authors working on non-Cochrane reviews, Cochrane Members, students,  and academics are eligible for a discounted rate. 

To find out more:

• Visit the RevMan Web website
•  RMWsubscriptions@cochrane.org

Friday, March 24, 2023

Tuesday, January 24, 2023

Dr Jenny McSharry, Health Psychologist and lecturer in the School of Psychology at the University of Galway, explains what systematic reviews are and why they are a particularly trustworthy source of health evidence. 

Dr Jenny Mc Sharry was supported by an Evidence Synthesis Ireland Writing Mentorship (Grant code ESI-2021-001) and this blog post was originally posted on Evidently Cochrane.

When we are diagnosed with a new condition, experience a worrying symptom or need to make a health decision for ourselves or our loved ones, it can be hard to know where to turn. How often have we found ourselves unable to sleep, alone at 3AM, searching online for answers to questions we never thought we would have to ask?  In times of anxiety and uncertainty, how can we know what health evidence to trust when we need it most?

When looking for reliable information to help with health decisions, reviews of evidence, in particular systematic reviews, can be a good place to start.

Systematic reviews of multiple studies can be useful for health decisions

Reviews that bring together and summarise the existing evidence are more reliable than one research study, or one person’s opinion or experience. Lots of things can affect the findings of a research study and we can have more confidence in reviews that bring together lots of studies. There is more information on why Personal experiences or anecdotes (stories) are an unreliable basis for assessing the effects of most treatments on the Evidently Cochrane blog.

Systematic reviews are seen as the gold-standard of research evidence. A systematic review is a type of review that tries to find, assess, and summarise all the evidence that meets pre-specified criteria to answer a specific question. Researchers who complete systematic reviews follow a number of key steps to make their findings more trustworthy.

Systematic reviews summarise evidence related to a specific question

Systematic reviews look for evidence that might help answer a specific question, and clearly outline this question from the start. For example, a systematic review Antihistamines for motion sickness was done to find out if  medicines used for allergy symptoms (antihistamines) work and are safe in preventing travel (motion) sickness. The review summarises evidence on how antihistamines compare with dummy treatment (placebo), no treatment, and other medicines. This review is useful if you want to find evidence about medicines for travel sickness, but not if you want to know if you should avoid reading or drink ginger tea while travelling. When a review clearly states its focus, it helps us judge whether it is relevant and useful to us.

Systematic reviews aim to find all studies that meet certain criteria

Systematic reviews researchers try to find and include all studies relevant to a specific question. This is important, as we want all relevant information to be available to us when making a health decision. When using evidence from a review to decide if we should start a new treatment for example, we want to be sure that studies that found benefits, studies that found harms, and studies that found little or no difference, are just as likely to have been included.

Systematic review researchers try to find all relevant studies by clearly outlining the sources they will search, and by making a list of the criteria they will use to decide if studies should be included. For example, in our review Video calls for reducing social isolation and loneliness in older people, we wanted to find out if older people who used video calls to keep in touch with family and friends feel less lonely than those who did not. For this review, we needed to decide on what we meant by older adults, as the findings might be different for people aged 65 and older, or people aged 70 and older. For this review, we decided to include studies of people aged 65 and older and made it clear when reporting the findings that this was the group we had focused on.

Systematic review researchers clearly state the methods they will use to identify studies before starting the review. Other researchers should be able to use these methods and find the same set of studies.

Systematic reviews assess and report on the quality of evidence

When reading reviews of evidence, it is important to know how many relevant studies there are, but also to know if the studies are of good quality. Even if a number of studies find that a treatment is beneficial, we may not want to choose this treatment if we find out that the number of people included in the studies was very small, or that the way in which people were identified to take part in the studies was not clear. For a systematic review, researchers assess if the methods used in the included studies were appropriate. Researchers then make a judgement on the level of certainty we can have in the overall evidence, based on whether the included studies were done well or not.

Finding relevant systematic reviews: Where to look?

When it comes to trustworthiness, not all information we find is equal, and it is good to know that systematic reviews can be helpful in making health decisions. However, when feeling anxious about a health condition or symptom, or when trying to make an urgent health decision, it can be hard to know how to find relevant systematic reviews.

Cochrane is an independent global organisation that aims to provide high-quality evidence to inform decisions about health and care. Cochrane systematic reviews are published online in the Cochrane Library. The Cochrane Library is free to access for people in the UK and Ireland (and in many other countries). You can search by topic, and the reviews all have a Plain Language Summary. The blogs here on Evidently Cochrane aim to make health evidence easy to understand and use by providing summaries of Cochrane Reviews in context, often alongside patients’ and health professionals’ experiences. Evidently Cochrane includes an A-Z list of topics to make it easier to search for relevant evidence, and can be a good place to start when supporting family and friends or making choices about our own health.

What else can you do to work out if health information is trustworthy?

If you are interested in finding out more about health information and what we can trust, the blog, Making health decisions: things that can help, looks at some key things to consider to help us to make the right decision and to reduce the risk of regretting our choices later on. The blog also reminds us that summaries of research evidence are just one part of how we make health decisions, and our own preferences and values and the views of healthcare professionals are also very important. The blog includes lots of resources to help you think critically about health information and to support your decision-making.

• Learn more about health evidence in our free Cochrane Evidence Essentials resource
• Read more Evidently Cochrane blogs
• Join in on the conversation on Twitter with @jenmcsharry @CochraneUK or leave a comment on the blog

Tuesday, January 24, 2023

Monday, January 23, 2023

Friday, January 20, 2023

Friday, January 20, 2023

Family-centred care is a way of providing care that focuses on the needs of children while providing planned care around the whole family unit. A new Cochrane review published recently found there was a small improvement in the overall health and well-being of Indigenous children and their families when they participated in family-centred care programmes at a primary healthcare service.

‘Family centred-care is not new,’ says lead author Dr Natalie Strobel, Senior Research Fellow at Edith Cowan University’s Centre for Improving Health Services for Aboriginal and Torres Strait Islander Children and Families. ‘Aboriginal Medical Services have been doing this for years. For example, they don’t just immunise babies, they talk to mums, aunts, uncles, grandparents and everybody that’s part of that family unit – trying to ensure that everybody's getting care. That’s both health and social care, so it might be making sure there’s appropriate housing, referrals to services that they needed or for other types of support.’

‘We know that primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Of our author team of nine, four are Aboriginal and have worked in health services as nurses and midwives for a long time. Families want primary healthcare services that both support them and recognise Indigenous ways of knowing and doing business. This can be delivered through environmental, communication, educational, counselling, and family support approaches.’

A key finding of this new review was that family-centred care delivered by primary healthcare services may improve the overall health and well-being of children and their families, however, due to a range of factors, the evidence was rated as very low certainty. There was also evidence to suggest that families who participated in family-centred care increased their parenting knowledge and awareness to a small degree. However, for all other outcomes it was unclear whether family-centred care improves specific child health and well-being outcomes. Ultimately more high quality trials are needed to generate evidence to determine whether family-centred care improves the health and well-being of Indigenous children.

‘We consider family-centred care to be really promising, but we’re not confident in the evidence for a range of reasons, which are quite complex,’ Natalie says. ‘For example, people in the studies were aware of what intervention they were getting, many people did not come back to report their results, and not all the studies reported the information we were interested in. Also, some of the issues around low quality of evidence are really hard for communities that are doing this type of work to get around.’

‘For instance, in the United States you're delivering the intervention on a reservation and there's not a huge number of people to do this work. Often the person who delivers the intervention also collects the data. We know that's got a significant level of bias involved in it, but it's also very pragmatic, that's what happens and how it has to work because there's not enough people to complete the project. This highlights the challenges of conducting high quality studies, and underscores the need to build capacity and support people in communities.’

‘I think with the advent of this type of research, it will give people an idea of what's going on in the field so that they know where potentially they could identify and collect better evidence to add to this emerging evidence base. Ultimately it is quite a tricky space, and realistically when you are trying to do things that are good for your community, you have to make allowances and be pragmatic about how research is delivered.’

‘Overall, this was a huge and complex review that was really challenging to deliver but we’re so pleased we did,’ Natalie says. ‘I really have to hand it to the team though. It was their sheer persistence that delivered this review, and the reward now for us is having this really high quality piece of work that people from health services can use to show how effective their programs are. We wanted to support local services to advocate for themselves and now they can use this information as they need – either to show where they might need to make changes or to demonstrate that what they're doing is effective and benefits children, families and communities. They are really making a difference.’

Strobel NA, Chamberlain C, Campbell SK, Shields L, Bainbridge RG, Adams C, Edmond KM, Marriott R, McCalman J. Family‐centred interventions for Indigenous early childhood well‐being by primary healthcare services. Cochrane Database of Systematic Reviews 2022, Issue 12. Art. No.: CD012463. DOI: 10.1002/14651858.CD012463.pub2.

• Read the full systematic Review

Written by  Shauna Hurley, Cochrane Australia 

 

Thursday, January 19, 2023

出生后6月内发生内斜视（眼睛向内偏斜）的不同治疗方法 本综述的目的是什么？ 本Cochrane综述的目的是确定对于出生后6月内发生内斜视的儿童，是否有最佳的治疗方法（包括手术和非手术）。这种情况称为婴儿型内斜视。我们检索并纳入了发表的2项研究来回答这个问题。 本综述研究了什么？ 婴儿型内斜视会对视力和同时使用双眼的能力产生影响，也可能给患儿或其父母带来外貌上的困扰。针对该疾病的治疗方法包括手术和非手术两种，目的是减少眼睛偏斜程度，并改善双眼视觉。双眼视觉是指用双眼注视一个物体，最终只看到单一物象的能力。本综述对比了IE患者不同的治疗方法，以及接受每种治疗的时机。 本综述的主要结果是什么？ 我们发现了两项研究，共招募了234名儿童。一项研究来自南非（涉及110名儿童），患儿接受手术或注射肉毒杆菌毒素，并进行6个月的随访。少量的肉毒杆菌毒素可用于松弛肌肉（包括眼部肌肉）。该研究发现，与注射肉毒杆菌毒素相比，手术可以更好地改善眼位控制，且风险最小。但证据质量极低，因为仅有一项小样本研究，且研究设计和实施都不完善。 另一项研究在德国与荷兰招募了124名儿童，比较了单侧（即单眼）和双侧（即双眼）内直肌后徙术。该研究发现，在改善眼睛偏斜度或双眼视觉（即能够用双眼聚焦在一个物体）方面，没有证据表明这两种手术存在显著差异。但证据质量极低，因为仅有一项小样本研究，且研究设计和实施都不完善。 关键信...

对于接受血管手术的患者，短期人为阻断流向肢端的血液能减少死亡和器官损伤吗? 关键信息 • 我们发现，术前通过充气血压袖带（肢端缺血预处理，RIPC）进行短期肢体血流阻断，可能不会减少血管外科手术患者（例如修复动脉狭窄或肿胀的治疗方法）的死亡、器官损伤、住院时间或手术时间。 • 为了更好地评估RIPC对接受血管手术的患者的获益与潜在伤害，需要进行更大规模、设计良好的以患者为中心的结局的研究，如生活质量。 什么是肢端缺血预处理？ 随着人口老龄化，由于脂肪沉积或动脉膨胀而导致血管变窄，越来越多的人将经历血管疾病或动脉疾病。作为严重动脉疾病的基本治疗策略，血管外科手术可以去除沉积物或修复膨胀的血管，但这会增加死亡和并发症的风险。手术的高风险主要是由于血管手术过程中的血流阻塞和随后的血流恢复，也称为“缺血-再灌注损伤”。目前已采用多种方法降低手术风险，但效果有限。 暂时阻断（几分钟）流向某个器官的血液可以减少该器官的损伤（局部缺血预处理），但也可以减少其他器官的损伤（肢端缺血预处理，RIPC）。通常，RIPC通过在上臂或腿部放置血压计袖带进行频繁的充气和放气。RIPC作为一种安全简便的方法，已在动物实验中被证明可以预防心脏手术的器官损伤。 我们想知道什么？ 我们想要知道与不采用RIPC相比，采用RIPC是否可以减少血管手术患者的死亡和器官损伤，以及它可能造成的任何伤害。 我们做了什么？ 我...

Physical exercise can help to improve the severity of movement-related symptoms and the quality of life in people with Parkinson’s Disease. Findings from the first Cochrane review of the available evidence found that any type of structured exercise is better than none.

The Cochrane Movement Disorders review looked at 156 randomised controlled trials comparing physical exercise with no physical exercise or with different types of exercise, and it included a total of 7,939 people from around the world, making it the largest and most comprehensive systematic review to study the effects of physical exercise in people with Parkinson’s Disease. 

The review from Cochrane, a collaboration of independent, international experts, was led by Dr Elke Kalbe, Professor of Medical Psychology at the University of Cologne, Germany. It found that physical exercise ranging from dance, water-based exercise, strength and resistance exercise and endurance exercise, to tai chi, yoga and physiotherapy, made mild to large improvements to the severity of movement-related (‘motor’) symptoms and quality of life. 

“Parkinson’s Disease is a progressive disorder of the nervous system that mostly affects people over 60,” said Professor Kalbe. “Symptoms begin gradually and include movement problems such as trembling, stiffness, slowness of movement and balance, and lack of coordination. People can also have emotional and mood problems, fatigue, sleep problems and cognitive difficulties. Parkinson’s Disease cannot be cured, but the symptoms can be relieved, and physiotherapy or other forms of exercise may help too. Until now it has been unclear whether some types of exercise work better than others. We wanted to find out what exercise works best to improve movement and quality of life.”

The average age of the participants in the studies included in the review was between 60 and 74 years. Most had mild to moderate disease and no major impairment of their thinking processes. The review found that most types of exercise worked well for the participants compared to no physical exercise.

The first author of the review, Mr Moritz Ernst, is a member of Cochrane Haematology and deputy head of the working group on Evidence-based Medicine, which is led by co-author of the study, Professor Nicole Skoetz, at University Hospital Cologne. He said: “We observed clinically meaningful improvements in the severity of motor symptoms for most types of exercise. These included dancing, training to improve gait, balance and movement, multi-exercise training, and mind-body training.  

“We saw similar benefits in the severity of motor symptoms for water-based training, strength and resistance training, and endurance training, but the estimates of improvement were rather imprecise, meaning that we are not as confident in saying that these improvements are clinically meaningful.

“For the effects on quality of life, we observed clinically meaningful beneficial effects for water-based training, and effects that are probably clinically meaningful for several types of exercise, such as endurance training, mind-body training, training to improve gait, balance and movement and multi-exercise training. Again, these estimates were rather imprecise.”

The certainty in the estimates for the effects on symptoms from different forms of exercise varied because some studies were very small, and not all provided information on the severity of motor symptoms and quality of life for all the participants. However, the authors say that their review highlights that most types of exercise produced meaningful improvements, and they found little evidence of much difference between different exercises.

Prof. Kalbe said: “We think that our results are good news because they indicate that people with Parkinson’s Disease can benefit from various structured exercise programmes to improve the severity of motor symptoms and quality of life. Our review highlights the importance of physical exercise in general, while the exact exercise type may be secondary. Therefore, the personal preferences of people with Parkinson’s Disease should be given special consideration to help motivate them to adhere to an exercise programme. Any exercise counts! 

“It is important to point out that our conclusions do not rule out that certain motor symptoms may be treated most effectively by programmes, such as physiotherapy, that are designed specifically for people with Parkinson’s disease.”

Mr Ernst concluded: “Although our results are quite promising for people with Parkinson’s Disease, the certainty in the evidence on the efficacy of different exercise types and on potential differences between them, was usually limited. This was also because most studies had a very small sample size. Therefore, although there is already a large amount of research in this field, we would encourage researchers to conduct larger studies with clearly defined samples, as this would help to draw conclusions with more confidence. In addition, it would be admirable to see studies that focus on people with more advanced disease and thinking impairment, so that we could find out if physical exercise could also be beneficial for these people.”

Ernst M, Folkerts A-K, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, Cryns N, Monsef I, Dresen A, Roheger M, Eggers C, Skoetz N, Kalbe E. Physical exercise for people with Parkinson’s disease: a systematic review and network meta‐analysis. Cochrane Database of Systematic Reviews 2023, Issue 1. Art. No.: CD013856. DOI: 10.1002/14651858.CD013856.pub2.

• Read the full review on the Cochrane Library
• Visit the Cochrane Movement Disorders website
• Press contact information
• Read the Evidently Cochrane blog post 'Physical exercise for people

Wednesday, March 15, 2023

提高胎儿血红蛋白水平并减少非输血依赖性地中海贫血患者输血需求的药物 系统综述问题 提高非输血依赖型β-地中海贫血（Non-transfusion-dependent β-thalassaemia, NTDβT）患者胎儿血红蛋白（Foetal haemoglobin, HbF）水平的药物是否会降低他们的输血需求？ 什么是地中海贫血？ 地中海贫血是一种导致成人血红蛋白（红细胞的携氧成分）缺陷进而造成红细胞破坏以及不同严重程度贫血的遗传性血液疾病。持续性贫血会影响身体整体健康并降低生活质量。NTDβT患者可能需要定期输血来更换红细胞，这可能会导致过多的铁沉积在身体的各个器官中，从而影响器官功能。 NTDβT患者的HbF（在婴儿出生前的发育过程中发现的主要血红蛋白形式）水平较高，这种情况在出生后仍然存在。持续存在的HbF含量各不相同，HbF水平较高的人需要较低频率的输血。 什么是HbF诱导剂？ HbF诱导剂是在不改变基因的情况下提高HbF水平的物质。它们可能会减少NTDβT患者的输血需求。然而，我们尚不清楚哪些HbF诱导剂是有效和安全的，并且如果HbF诱导剂有效既安全，我们不知道其最佳剂量是多少以及应该在什么年龄开始治疗。 我们做了什么？ 我们检索了医学数据库中将单一HbF诱导剂与安慰剂（虚拟治疗）或常规治疗、与另一种诱导剂或诱导剂组合进行比较，或比较同一诱导剂的不同剂量的研究。 我们发...

在腹主动脉瘤的微创治疗中，经皮引入要优于股动脉切口的方式吗？ 关键信息 本研究发现在腹主动脉瘤的微创治疗中，缺乏比较经皮引入是否要优于股动脉切口的高质量证据。 在短期死亡率方面完全经皮引入可能（较股动脉切口引入）无显著差异。两组在动脉瘤排除失败（动脉瘤患处未能吻合）、伤口感染、主要并发症（术后30天内或住院期间）、中长期并发症（6个月）及并发症出血方面很可能几乎没有显著差异。与股动脉切口相比，经皮引入也许能略微减少手术时间。 需要更多设计完善的大型研究来更好地评价在腹主动脉瘤的微创治疗中两种不同穿刺方式的获益与潜在风险。 什么是腹主动脉瘤？ 腹主动脉瘤是指因血管壁薄弱在腹部最大的血管（腹主动脉）处的膨大。这种膨大一旦破裂可能会危及生命。当破裂的风险高于手术并发症的风险时，建议患者接受动脉瘤修复治疗。 如何治疗腹主动脉瘤？ 大部分修复术为增加动脉血管壁，会在血管内壁安置人造血管（一种塑料管道）。目前主要有两种方法进行修复。一种是将腹部完全切开，用人造血管取代病变血管的开放性手术。另一种方法就是动脉瘤腔内修复术。人造血管通过这种微创技术从腹股沟动脉（股动脉）进入腹部主动脉，避免了对腹部的大面积创伤。本综述探讨了一种将人造血管引入股动脉的代替方法（即经皮引入）。经皮引入的方式，不是在腹股沟处切口来暴露股动脉血管，而是将一根针插入股动脉，并通过针将柔性导线插入股动脉。随后将针取出，在皮肤...