吸入类固醇治疗新生儿肺部疾病 什么是支气管肺发育不良，如何治疗？ 早产的婴儿会有很高的风险罹患一种慢性肺部疾病称为支气管肺发育不良（bronchopulmonary dysplasia, BPD）。早产儿肺部炎症似乎在BPD的发展中起着重要作用。研究表明，将抑制炎症的药物（皮质类固醇）注射到血液中可以降低BPD的风险，但也可能对身体的其他部位（例如大脑）产生严重的副作用。通过吸入给予皮质类固醇可能会减少这些不良影响，因为理论上这些药物应该主要留在肺部，而不会对身体的其他部位造成不良影响。 我们希望了解什么？ 我们想了解与模拟治疗（安慰剂）相比，给予出生7天的早产儿吸入皮质类固醇是否可以提高存活率并减少 BPD。我们还想了解吸入皮质类固醇是否会产生不良影响。 我们做了什么? 我们检索了相关研究比较吸入皮质类固醇与安慰剂在有BPD风险的早产儿群体中。我们比较和总结了纳入研究的结果，并根据研究方法和规模等因素评估了证据的质量。 我们有什么发现? 我们确定了七项研究，这些研究在218名早产儿中调查了这种疗法。与安慰剂相比，我们无法得知从出生后7天开始使用吸入性皮质类固醇是否能减少有BPD风险的早产儿罹患BPD或死亡，我们也不知道这种治疗是否有任何不良影响。需要更多的研究来调查吸入皮质类固醇在该人群中的潜在益处和伤害。 证据存在哪些局限性？ 我们无法评定相关证据等级，因为研究所纳入的病例很...

Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Getting involved in Cochrane’s work means becoming part of a global community. The Cochrane International Mobility programme connects successful applicants with a placement in a host Cochrane Group, learning more about the production, use, and knowledge translation of Cochrane reviews. The prgramme offers opportunities for learning and training not only for participants but also for host staff.

In this series, we profile those that have participated in the Cochrane International Mobility Program and learn more about their experiences.

Name: Martina Albertella
Location: Italy
Cochrane International Mobility location: Cochrane Sweden

How did you first learn about Cochrane?
I first heard about Cochrane at my University (in Genoa, Italy): during lectures a lot of Professors used to mention Cochrane evidence and results, as it has such a high impact. I was interested in the paediatrics research field, so I looked for more information about the organization, I contacted Matteo at Cochrane Sweden and I started the Cochrane Interactive Learning modules before coming to Sweden. These modules were my first real learning opportunity about systematic reviews.

What was your experience with your Cochrane International Mobility?
I’ve always been interested in the research field and Cochrane is the perfect environment to learn everything about it. I also wanted to have an abroad experience so, thanks to Matteo’s help, I applied to start my Erasmus Traineeship at Cochrane Sweden for three months.

What are you doing now in relation to your Cochrane International Mobility experience?
My team and I submitted a few weeks ago our systematic review about the use of an enzyme to prevent a chronic disease in preterm infants. That was a great learning experience: Matteo and Martin have been always supportive. They explained to me very clearly how to do the work, step by step. Whenever we had a doubt, they were always there to help us! After that, I joined another team working on another systematic review, but still related to paediatrics: now I feel more confident and it’s great because I realize how much you can learn with this experience!

Do you have any words of advice to anyone considering a Cochrane International Mobility experience?
If you want to learn more about systematic reviews but also about how to read and understand a scientific text and its methodology, this is the perfect experience for you. It also gives you the opportunity to work and collaborate with people from all over the world and to improve your English skills. If you are a student like me, who didn’t have any experience in the research field before, my personal advice is: connect yourself to Cochrane! This is a chance to put into practice everything you are learning.

 

 

Wednesday, December 14, 2022

Specifications: Full Time, 37.5 hours per week
Employment Type: Permanent employment contract if in the UK, Denmark or Germany, consultancy contract if outside these three areas
Salary: £60,000 per annum full-time salary
Location: Flexible location but must have a demonstrable understanding of UK regulations
Application Closing Date: Sunday 8th January 2023 at midnight

Cochrane is a charity and a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. They do this by synthesising research findings to produce the best available evidence on what works. Their work has been recognised as the international gold standard for high quality, trusted information.

The core purpose of this role is to lead Cochrane’s governance and to support the strategic aims and operational activities of the organisation. The role will provide oversight of policy development, implementation, monitoring, and reporting to the Governing Board to ensure that Cochrane is compliant and follows the best practice.

Part of your duties will include:

• Maintaining knowledge and being well-informed of best practice and developments within charity governance and policy, advising the Board, CEO and Executive Leadership Team.
• Ensuring the appropriate support structures and processes are in place to enable Cochrane’s Governing Board to meet its responsibilities and obligations; and lead and oversee high-quality support to the Board, its Committees, the Cochrane Council, and other governance bodies.
• Contributing to Cochrane’s budget planning processes and manage the governance budget effectively.
• Working with the Chief Executive Officer and Director of Finance & Corporate Services, develop a strategy to ensure an appropriate level of assurance for the charity and wider Community with implementation, monitoring and evaluation plans.
• Working with the CEO and the ELT to establish and review policies and procedures that ensure the organisation meets constitutional, legal, and regulatory requirements relating to company administration.

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

How to apply

• For further information on the role and how to apply, please click here
• The deadline to receive your application is by 8 January 2023
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline
• Read our Recruitment Privacy Statement

Tuesday, December 13, 2022 Category: Jobs

Cochrane’s Editor in Chief, Dr Karla Soares-Weiser, has today published an editorial to mark the end of 2022 and the beginning of Cochrane's 30th anniversary year in 2023. In Looking back, looking forward: Cochrane at 30 and beyond, Karla reflects on Cochrane’s many contributions to global health, recognizes past and future challenges, and shares her deep gratitude to the Cochrane community – who for three decades have delivered the trusted evidence our rapidly changing world needs.

"As the third year of the pandemic draws to a close" Karla writes, "it seems we have reached something of an inflection point where as individuals, as an organization, and as a global community we are looking back and assessing the consequences and costs of COVID-19, and to consider what lies ahead."

In doing so, Karla looks back at the major challenges faced and achievements realized by Cochrane before and during the pandemic and looks forward as we transition to a new, sustainable model of evidence production in especially tumultuous times for health, funding and geo-political stability. She underscores the critical issue of equity following years of deepening health and wealth disparities, and restates Cochrane’s commitment to fostering diversity, tacking inequity and making a tangible contribution to the United Nations Sustainable Development Goals. 

Karla says:

Cochrane's values, focus on collaboration, and commitment to rigour and innovation have been vital to cementing our reputation as one of the most trusted sources of evidence in health and care decisions over three decades. We draw on these strengths now more than ever, as the shifting health landscape demands that we increase the pace of high-quality evidence production, deliver on our commitment to equity, diversity and inclusion, and respond in a more focused way to the diverse needs of all our users.

The shape and output of our organization continues to adapt to the needs of the times, while together we continue to deliver the evidence the world needs at this critical juncture for humanity.

• Read Karla’s full editorial
• Find out more about the changes underway within Cochrane 

Wednesday, December 14, 2022

清除囊性纤维化患者肺部“超级细菌”耐甲氧西林金黄色葡萄球菌（MRSA）的治疗方法 系统综述问题 我们寻找不同方法清除囊性纤维化患者肺部耐甲氧西林金黄色葡萄球菌（MRSA）（一种称为“超级细菌”）效果的证据。 系统综述背景 MRSA是一种对某些类型的抗生素（杀死或抑制细菌的药物）具有耐药性的细菌。由于MRSA难以治疗，它有时被称为“超级细菌”。这对于感染MRSA患有囊性纤维化的患者来说尤其令人担忧，这是一种遗传性疾病，除其他外，会导致肺部粘液积聚。患有囊性纤维化的患者很难咳出这种粘稠的粘液，使其成为包括MRSA在内的细菌的理想滋生地，并使这些患者更容易发生胸部感染。人们认为MRSA会比其他对抗生素无抗性的细菌造成更多的损害。我们想找到研究证据来支持治疗MRSA感染的最佳方法，并看看这种治疗是否会改善囊性纤维化患者的生活。这是对先前发表综述的更新。 检索日期 证据截止到2022年1月31日。 主要结果 我们发现了三项研究，其中涉及135名患有囊性纤维化和诊断MRSA感染的患者。 两项研究（106名患者）比较了对一组患者的治疗与仅对第二组患者的观察。在其中一项研究中，积极治疗组的患者接受口服甲氧苄氨嘧啶和磺胺甲恶唑联合利福平（这三种药物均为抗生素药物），外加额外的去污治疗。在第二项试验中，积极治疗组的患者口服两种抗生素（复方新诺明和利福平）和一种鼻腔喷雾剂（莫匹罗星）。 这些研究的结果...

涉及家庭的照护促进当地儿童早期健康 关键信息 当地儿童及其家庭在初级卫生保健服务中参加以家庭为中心的照护计划时，他们的整体健康和幸福感略有改善，但总体证据的质量极低。 所有的研究都使用了社区参与策略，这是与当地社区合作的一个重要方面。 进一步的充分有力的研究可能会更好地评估以家庭为中心的照护的影响。 什么是以家庭为中心的照护？ 以家庭为中心的照护是一种提供照护的方式，它聚焦于儿童的需求，并为整个家庭单位提供有计划的照护。以家庭为中心的照护认为所有家庭成员都是照护对象，旨在让家庭参与到初级卫生保健服务中来。 为什么在当地健康中需要特别聚焦于以家庭为中心的照护？ 以家庭为中心的照护对所有儿童都很重要，但干预必须考虑社会文化需求。照护当地家庭的儿童通常涉及大家庭成员的角色和责任、育儿实践文化以及对以联系为中心的幸福的整体理解（对整个人的治疗，考虑到心理和社会因素而不仅仅是疾病的症状）。通过初级卫生保健服务参与以家庭为中心的健康促进方法可能是向儿童提供照护的有效方式，这种方式考虑到了更多家庭的需求和功能。 我们想从中发现什么？ 目前还没有较完善的综述，评估通过初级卫生保健服务提供以家庭为中心的健康照护对当地儿童及其家庭的健康和幸福感的影响。2017年完成的一项范围综述（对研究和证据的简要评估）发现了18项研究，它们评估了对当地儿童和家庭进行的以家庭为中心的照护，其中包括了三项随机对照临床...

在手臂、前臂和手部使用神经修复装置 什么是神经损伤，如何修复？ 手臂、前臂和手的神经损伤很常见，并且会对人的活动能力和感觉产生持久影响。通常外科医生会将受伤的神经缝合在一起（我们称之为标准修复）。有时他们还使用神经移植物，这意味着从身体的另一个部位取出神经来弥合受损神经末端之间的间隙。标准修复方法并不总是成功的，即使成功，愈合过程也可能不完整且缓慢。获得用于移植的神经需要额外的手术并且会引起不适。其他类型的神经修复涉及使用包裹物（一种用于支持神经修复的器械）或导管（一种用于弥合间隙的器械）。目前有多种天然和合成神经修复包裹物和导管可供选择。 我们想从中发现什么？ 我们想比较使用包裹物或导管修复受伤神经与标准修复上的差异（有或没有神经移植）。我们特别感兴趣的是人的肌肉力量和感觉的恢复情况，以及其在手术中遇到问题（并发症）的频率。 我们做了什么？ 本综述作者收集了所有相关研究来回答这个问题，并找到了五项研究。神经在手术后至少需要12个月才能恢复，因此我们只纳入了从受伤后12个月开始衡量手术效果的研究。 我们发现了什么? 这些研究涉及213人，共有257处神经损伤。导管或包裹物（“器械”）用于129例损伤，标准修复用于128例损伤。四项研究在欧洲进行，一项在美国进行。制造该器械的公司资助了两项研究，反映了潜在的偏倚来源。 神经修复研究的一个已知挑战是缺乏单一可靠的测量方法来评估治疗效果...

肉碱补充剂用于需要透析的慢性肾病患者 研究问题是什么？ 肉碱缺乏症是需要透析的慢性肾病（chronic kidney disease, CKD）患者的一个重要问题。透析相关的肉碱缺乏症会加剧透析过程中的病症（例如肌肉症状，包括肌肉痉挛和虚弱，以及低血压）和肾衰竭的慢性并发症（例如贫血）。然而，补充肉碱是否可以改善与透析相关的肉碱缺乏症的症状目前尚不清楚。 我们做了什么？ 我们在医学文献中检索了所有对需要透析的CKD患者补充肉碱的随机试验。我们的目的是确定补充剂是否可以改善生活质量（quality of life, QoL）和肉毒碱缺乏症引起的病症。我们还评估了肉碱补充剂在不良事件方面的安全性。我们使用GRADE（Grading of Recommendations Assessment, Development and Evaluation）评价证据的质量。 我们发现了什么? 我们纳入了52项研究，共有3398名接受透析的CKD患者。我们无法确定左旋肉碱对生活质量（quality of life, QoL）和透析相关肉碱缺乏症引发病症的相关影响。左旋肉碱可以改善这些患者的贫血。此外，左旋肉碱补充剂对该患者人群产生不良反应的证据非常有限。 研究结论 我们发现补充肉碱对QoL、疲劳评分、肌肉痉挛和透析中低血压的影响仍不清楚。左旋肉碱可以改善需要透析的CKD患者的贫血相关标志物（血红蛋...

什么是三联吸入疗法？何时使用？它对哮喘有何作用？ 药物吸入如何用于哮喘的管理？ 根据疾病的严重程度，哮喘的管理涉及一系列阶梯式治疗。初始治疗通常从短效药物吸入治疗开始（第1步），并在需要时添加每日低至中剂量的吸入性糖皮质激素以更好地控制哮喘（第2步）。随后，如果需要，通常将一种称为长效β2受体激动剂（long-acting beta 2-agonist, LABA）的支气管扩张剂添加到吸入性糖皮质激素中（第3步和第4步），它会导致气道扩张和松弛，从而减少呼吸困难。 当吸入性糖皮质激素和LABA联合不能控制哮喘时，有什么选择？ 目前的指南建议，在使用中等剂量吸入性糖皮质激素和LABA二联治疗无法控制哮喘时，使用高剂量的吸入性糖皮质激素或添加另一种称为长效抗胆碱能药物（long-acting muscarinic antagonist, LAMA）的支气管扩张剂（即三联吸入疗法）（第5步）。 我们如何回答这个问题？ 我们收集并分析了17项研究的数据，包括17,161名患有未控制哮喘的青少年和成人，使用一种称为网状meta分析的特殊方法，使我们能够同时比较多个吸入性治疗。 我们发现了什么？ 三联吸入疗法（即吸入性糖皮质激素+LABA+LAMA）可减少哮喘发作，但不会减少与哮喘相关的住院。与二联吸入疗法（即吸入性糖皮质激素+LABA）相比，高剂量三联疗法而非中剂量三联疗法可能具有更好的耐...

慢性肾脏病患者的健康素养干预 研究问题是什么？ 慢性肾脏病（chronic kidney disease, CKD）是一种复杂的慢性疾病，其长期管理需要病人参与自我照护。很多CKD患者可能不了解如何使用健康信息来为他们的治疗和管理决策提供最佳支持。这种能力或技能被称为健康素养。提高CKD患者的健康素养可能会改善他们的健康状况，帮助控制疾病并避免并发症。 我们做了什么？ 我们在文献中检索了任何包含旨在提高CKD患者健康素养干预措施的研究。干预分为教育干预、自我管理培训干预、教育合并自我管理培训干预。 我们发现了什么? 我们纳入了120项研究，涉及21,149名受试者。与常规护理相比，教育干预可能会增加肾脏相关知识；然而，有关自我照护、自我效能、生活质量（quality of life, QoL）、死亡、肾功能和住院的信息无法分析或未报告。自我管理干预可以提高自我效能和部分QoL（躯体健康得分），但可能不会减缓一年后肾功能的下降。有关知识、自我照护行为、死亡和住院的信息无法分析或未报告。教育合并自我管理的干预措施可能会增加知识、提高自我照护行为分数、自我效能、QoL（躯体健康得分），并可能降低死亡风险，但可能对减缓肾功能下降影响很小或没有影响。住院数据无法分析。 研究结论 提高健康素养的干预措施是一个非常广泛的类别，包括教育干预、自我管理干预和教育合并自我管理干预。总的来说，这种类型...

吸入药物用于在镰状细胞病患者的急性胸部综合征病例中打开气道 综述问题 用于急性胸部综合征的吸入型短效支气管扩张剂能否降低镰状细胞病患者的患病率和死亡率？这种治疗是否会产生不良影响？ 研究背景 镰状细胞病是一种遗传性血红蛋白紊乱的疾病。患有镰状细胞病的患者经常患有急性胸部综合症。急性胸部综合症可导致发热、咳嗽、胸痛和呼吸急促，并可能危及生命。通常，患有镰状细胞病和急性胸部综合症的患者也会出现喘息。喘息表明气道变窄，就像哮喘那样。支气管扩张剂是放松呼吸道肌肉的药物，呼吸道会因此开放使呼吸更顺畅。它们以这种方式用于哮喘，因此在急性胸部综合症中可能有类似的作用。本综述是先前发表的Cochrane综述的更新版本。 文献检索日期 证据检索日期截止至：2022年7月25日。 研究特征 我们没有发现任何试验表明这些药物对这种情况的影响。 关键结果 研究需要评估使用吸入性支气管扩张剂用于治疗镰状细胞病患者急性胸部综合征的益处和风险。 作者结论:  如果支气管高反应性是镰状细胞病患者某些急性胸部综合征发作的重要组成部分，那么可能需要使用到吸入性支气管扩张剂。需要一项设计良好、功效充分的随机对照临床试验，以评估将吸入性支气管扩张剂增加到镰状细胞病患者急性胸部综合征的标准疗法中的益处和风险。 阅读摘要全文…… 研究背景:  支气管扩张剂常用于治疗哮喘中的支气管高反应性。支气管高反应性...

血友病患者长期关节疾病的手术治疗 对于处于血液凝结能力受影响的罕见状态（血友病）、患有慢性（长期）关节疾病的患者，手术与非手术治疗相比的安全性和有效性如何? 关键信息 我们没有找到任何相关研究。 这个领域需要更多的研究。未来的研究应比较血友病患者慢性关节病的手术和非手术治疗。 研究背景 血友病是一种影响血液凝结能力的疾病。患有严重血友病的人经常遭受关节出血（关节血肿）的痛苦。长期反复出血最终会导致慢性关节疾病（关节病），表现为关节炎、关节痛或关节僵硬。这可能导致生活质量恶化和肢体功能丧失。 由长期关节出血引起的慢性关节疾病可以通过非手术或手术治疗。但这两种治疗方案都不完美；两者都有各自的风险和益处。非手术治疗可能并不适用于所有人。如果它们不起作用，可能会建议手术。医生仍然不确定对于治疗血友病患者慢性关节病最安全、最有效的方法。 我们做了什么？ 我们检索了截至2022年8月的医学数据库和期刊，以获得随机对照临床试验（Randomized controlled trials, RCTs）的报告，这些研究比较了至少12岁、患有血友病和进行性慢性关节疾病的人的手术和非手术治疗。RCTs是指受试者被随机分配到两个或两个以上的治疗组。这是最佳的试验方式，能确保试验组与对照组组成相似，使得研究者与受试者不知道谁分在哪个组。 我们发现了什么？ 我们没有发现任何符合我们标准的研究。 作者结论:&n...

接受心脏手术的人的血压目标 综述问题 与低的血压目标相比，高的血压目标对接受心肺转流术（cardiopulmonary bypass, CPB）心脏手术的人有何影响。 关键信息 与较低血压目标相比，较高血压目标可能在导致肾损伤、认知（学习和理解的能力）损害或生存率方面几乎没有差异。 较高血压目标可能会稍微增加住院时长。 什么是心脏手术？ 心脏手术是全世界常见的手术类型。大多数的心脏手术都是采用CPB进行的。CPB是一种医疗设备，通过泵送血液，向血液中供给氧气并从血液中去除二氧化碳来取代心脏和肺的工作。接受心脏手术的人通常有较高的血压（称为高血压）。高血压患者需要更高的血压来保持血液流向大脑和肾脏等重要器官。然而，关于心脏手术期间使用的最佳血压目标的证据很少。 我们想知道什么? 我们想评估与较低的血压目标相比，较高的血压目标对肾脏、大脑、生活质量和住院期间发生的并发症的影响。 我们做了什么？ 我们在医学数据库中检索了比较CPB心脏手术期间较高血压和较低血压目标的临床试验。 我们发现了什么? 我们发现了3项研究，其中包括737名接受心脏手术的人。研究时长从2年到3年不等。纳入的受试者的平均年龄介于65.8岁和76岁之间，约72%为男性。 在肾脏损伤、认知损害或死亡方面，高的血压和低的血压目标之间几乎没有差异。虽然高的血压目标可能会稍微增加住院时间，但在住院期间的生活质量或并发症可能几...

彩色云芝在结直肠癌中的作用 综述问题 将云芝添加到结直肠（肠）癌治疗中是否会减少副作用并提高生存率？ 研究背景 放疗和化疗用于治疗结直肠癌，但副作用可能是个问题。彩色云芝蘑菇 （又称彩绒栓菌或“火鸡尾”） 及其提取物已被用于帮助癌症患者缓解副作用。 文献检索日期 我们在医学数据库中检索了在成人（18 岁或以上）中比较云芝加化疗或放疗与单独化疗或放疗的试验。目前的证据截至到2022年4月。 研究特征 我们纳入了七项试验，共有1569受试者，为患有2至4期癌症的男性和女性。在日本进行了六项研究，在中国进行了一项研究。研究测量了生存率的变化、副作用的发生频率以及因副作用导致的治疗变化。一项研究报告了生活质量。所有研究都使用了被称为云芝多糖（Polysaccharide-Krestin, PSK）的云芝提取物。 研究资金来源 没有研究报告任何关于资助的信息。 主要结果 我们发现，尚不清楚添加云芝是否会对因副作用而不得不停止治疗的患者数量产生任何影响。 我们发现关于在治疗中加入云芝是否能减少化疗或放疗引起的副作用的证据也不确定。我们研究了一系列不同副作用的证据，包括对血液测试的影响，以及口腔炎症、恶心和腹泻等问题。 我们发现低质量证据表明，与不添加云芝相比，添加云芝对五年生存率有较小的影响。五年前的影响尚不清楚。 癌症阶段不同，癌症治疗也不同。一些研究中的患者正在接受目前尚未在实践中广泛使...

癌症患者发热性中性粒细胞减少症的抢先性抗真菌治疗与经验性抗真菌治疗 对癌症患者进行强化化疗会导致严重和长期的血细胞减少症（血细胞数量低于正常水平），尤其是中性粒细胞减少症（利于抵抗感染的白细胞低于正常水平），其是一种可能危及生命的危急情况。当表现为发热和中性粒细胞减少时，称为发热性中性粒细胞减少症（febrile neutropenia, FN）。侵袭性真菌病（febrile neutropenia, IFD；由真菌引起的感染）是化疗引起的FN的严重原因之一。 此种情况下有两种治疗策略。在经验性抗真菌治疗中，当医生首次怀疑有真菌感染时（例如，在抗生素治疗4到7天后仍发热，或者医生仍试图查明发热原因），便会给予抗真菌药物。在抢先性治疗中，医生会在开始使用抗真菌药物之前通过一系列实验室筛查找出引起感染的原因。 与经验性抗真菌治疗相比，抢先性治疗可能会减少抗真菌药物的使用和相关的不良反应，但可能会增加死亡率。这两种治疗策略的利弊有待确定。 谁会对本综述感兴趣？ 肿瘤临床专家等医务人员、癌症患者及他们身边的人。 本综述旨在回答什么问题？ 本系统综述旨在寻找和评估抢先性和经验性抗真菌治疗在患有FN的癌症患者中的相对疗效（效果如何）、安全性（不良反应数和严重程度）以及对使用抗真菌药物的影响。 本综述纳入了哪些研究？ 我们检索了电子医学数据库，检索了所有纳入了患有FN的成年癌症患者的相关研究。...

比较第5天与第3天胚胎活检用于单基因缺陷病胚胎着床前的遗传学检测 研究背景 带有单基因遗传疾病（比如囊性纤维化）个人史或家族史的夫妻，现在可以利用辅助生殖技术（assisted reproductive technology, ART）降低生下患有相同遗传疾病孩子的几率。这种技术叫做单基因病胚胎着床前遗传学检测（preimplantation genetic testing for single gene disorders, PGT-M）。在PGT-M期间，受精胚胎的细胞被取出（活检）并分析遗传疾病，然后将没有遗传疾病的胚胎移植回女性子宫。胚胎细胞可以在胚胎发育的第3天或第5天进行活检，第5天活检是目前使用最广泛的技术。在第3天或第5天进行胚胎活检，可能会对胚胎的进一步发育和植入，以及妊娠和围产期结局产生不同的影响。 主要结果 我们发现了一项随机对照临床试验，该试验比较了总共20名接受ART的女性在第5天和第3天进行PGT-M胚胎活检的结果。这项研究没有提供足够的证据表明活产率和流产率是否存在差异；证据的质量低。 证据表明，如果假设第3天胚胎活检后活产率为40%，那么第5天活检后活产率介于15%和85%之间。 其它与妊娠和围产期相关的结局未见报告，结果尚无定论。 证据的局限性 我们对证据的可信度很低，因为我们只找到了一项小型研究，且进行试验的人知道这些妇女是在第3天还是第5天进...

Tuesday, November 22, 2022

药物可以预防减肥手术后的静脉血栓栓塞吗？ 什么是静脉血栓栓塞症？ 静脉血栓栓塞 (venous thromboembolism, VTE) 是一种临床病症，通常在静脉内形成血块时开始。该病症包括深静脉血栓（当血块在深静脉中形成时，通常在腿部）和肺栓塞（当血块在肺部血管中形成或到达肺部血管时）。这两种情况均会极大降低生活质量，甚至危及生命。肥胖或接受过手术的人更有可能患有静脉血栓栓塞症。因此，接受减肥手术（旨在通过限制食物摄入或吸收来减轻体重）的患者面临极高的风险。然而，尚不清楚这些人是否应该接受与患有其他疾病患者相同的干预措施来预防VTE。 如何预防静脉血栓栓塞？ VTE预防（预防性干预）可使用机械方法（例如弹力袜或外部加压装置）或药物方法（涉及减少血凝块形成的药物，例如肝素、五糖或抗血小板药物），或者可以结合这两种方法。 我们想从中发现什么？ 我们想评估是否有任何药物干预可以预防减肥手术患者静脉血栓栓塞症的发生，以及这些干预措施是否安全。 我们做了什么？ 我们检索了在减肥手术患者中检验任何药物预防VTE效果的研究，比较了不同剂量、不同频率或不同开始时间的相同药物、或不同药物、或药物与空白对照或安慰剂（虚拟治疗）之间的效果。也纳入了不同干预之间的组合。 我们比较和总结了研究的结果，并根据研究方法和样本大小等因素对证据质量评级。 我们发现了什么？ 我们纳入了七项研究，涉及1045名...

Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Getting involved in Cochrane’s work means becoming part of a global community. The Cochrane International Mobility programme connects successful applicants with a placement in a host Cochrane Group, learning more about the production, use, and knowledge translation of Cochrane reviews. The prgramme offers opportunities for learning and training not only for participants but also for host staff.

In this series, we profile those that have participated in the Cochrane International Mobility Program and learn more about their experiences.

Name: Themistoklis Paraskevas
Location: Greece
Cochrane International Mobility location: Cochrane Sweden

How did you first learn about Cochrane?
I first learned about Cochrane during my postgraduate studies, but I got to know the organization better when I participated in an entry-level seminar co-hosted by Cochrane Sweden and Cochrane South Africa in Spring of 2022.

What was your experience with your Cochrane International Mobility?
I consider this experience to have been crucial for my future career in Medicine and Research Synthesis. Since I first contacted Matteo and Martin, they have been nothing but helpful both in academic matters as well as smaller problems during the mobility period.

What are you doing now in relation to your Cochrane International Mobility experience?
Right now, we have just finished two Cochrane projects, a  Systematic Review of Interventions and an Overview. Additionally, I am collaborating with an amazing international team in a challenging methods review.

Do you have any words of advice to anyone considering a Cochrane International Mobility experience?
Do not hesitate to contact Cochrane teams, as they can provide a suitable environment to enter the field of Systematic Reviews and Methodology. Also, take advantage of the plethora of available Cochrane modules online and especially the Cochrane Handbook.

 

 

Monday, November 21, 2022

A comprehensive review of all the evidence available from randomised controlled trials of COVID 19 vaccines up to November 2021 has concluded that most protect against infection and severe or critical illness caused by the virus.

The review, a collaboration of independent, international experts, also found there was little or no difference between the number of people experiencing serious side effects after vaccination compared to those who were unvaccinated.

The researchers, led by Isabelle Boutron, Professor of Epidemiology at Université Paris Cité and Director of Cochrane France, analysed published data from 41 randomised controlled trials of 12 different COVID-19 vaccines, involving 433,838 people in various countries around the world. They assessed the certainty of the evidence and the risk of bias in the different studies.

The trials compared COVID-19 vaccines with placebo, no vaccine, or each other, and were published before 5 November 2021. The vaccines investigated were: Pfizer/BioNTech, Moderna, Oxford-AstraZeneca, Bharat (Covaxin), Janssen, Sinopharm-Beijing (WIBP-CorV and BBIBP-CorV), Novavax, Coronavac-Sinovac, Soberana 2 (Finlay-FR-2), Sputnik V (Gam-COVID-Vac) and Cure Vac AG (CVnCoV). Most trials were no longer than two months in length.

The review found that the following vaccines reduced or probably reduced the risk of COVID-19 infection compared to placebo: Pfizer/BioNTech, Moderna, CureVac COVID-19, Oxford-AstraZeneca, Janssen, Sputnik V (Gam-COVID-Vac), Sinopharm (WIBP CorV and BBIBP-CorV), Bharat (Covaxin), Novavax and Soberana 2 (Finlay-FR-2). The following reduced or probably reduced the risk of severe or critical disease: Pfizer/BioNTech, Moderna, Janssen, Sputnik V, Bharat and Novavax. In addition, the Janssen and Soberana 2 vaccines probably decreased the risk of death from any cause. There were very few deaths recorded in all the trials and so evidence on mortality for the other vaccines is uncertain.

For most of the vaccines investigated, more people who had been vaccinated reported localised or temporary side effects compared to those who had no treatment or placebo. These included tiredness, headache, muscle pains, chills, fever and nausea. With respect to the very rare side effects associated with some vaccines such as thrombosis, the team found that the reporting of these events was inconsistent, and the number of events reported in the trials was very low.

Given the evidence of efficacy of these vaccines, the researchers question whether further placebo-controlled trials are ethical. They suggest that further research compares new vaccines with those already in use.

The current review analysed data available up to November 2021. Since then, analyses have been updated and will continue to be made publicly available every two weeks by the COVID-NMA Initiative, which provides live mapping of COVID-19 trials. A living, systematic review of clinical trials is available to researchers and policy-makers alike on the COVID-NMA platform. This enables the team to provide the most up-to-date evidence on which to base further research and decisions about prevention and treatment for COVID-19.

Prof. Boutron said:

“The evidence on COVID-19 vaccines is constantly changing and updating. Everything moves so quickly that by the time the next Cochrane review is published, or other papers are published, the data are likely to be out of date. There are more than 600 randomised trials of vaccines registered at present, and about 200 of them are recruiting. COVID-NMA is the only initiative that continues to monitor the developing evidence from trials and provides a platform for researchers to conduct their own analyses via the metaCOVID tool on the website.

Researchers, clinicians and policy-makers have to take very rapid decisions about what to do to prevent and treat COVID-19. I hope that this initiative will help them to have access to the most up-to-date evidence on which to base their decisions.”

• Read the plain language summary and full review 
• Read this news item in Malay
• How to talk about vaccines when you’re not an expert: a Lifeology and Cochrane collaboration
• Evidently Cochrane Blog : Are COVID-19 vaccines effective and safe? New Cochrane evidence

Full citation: Graña C, Ghosn L, Evrenoglou T, Jarde A, Minozzi S, Bergman H, Buckley BS, Probyn K, Villanueva G, Henschke N, Bonnet H, Assi R, Menon S, Marti M, Devane D, Mallon P, Lelievre J-D, Askie LM, Kredo T, Ferrand G, Davidson M, Riveros C, Tovey D, Meerpohl JJ, Grasselli G, Rada G, Hróbjartsson A, Ravaud P, Chaimani A, Boutron I. Efficacy and safety of COVID-19 vaccines. Cochrane Database of Systematic Reviews TBD, Issue TBD. Art. No.: CD015477. DOI: 10.1002/14651858.CD015477.

About Cochrane
Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews. Cochrane is a not-for profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information. https://www.cochrane.org/

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office -pressoffice@cochrane.org

Wednesday, December 7, 2022