Thursday, October 13, 2022

重建手术治疗压疮的利弊是什么？ 关键信息 -目前尚不清楚重建手术（有时称为整形手术）治疗压疮（又称褥疮或压力性创伤）的利弊。 -我们发现一项小型研究（纳入20名受试者）调查了重建手术治疗深度、难以愈合性压疮的效果，但无法基于报告的结果得出任何结论。 -未来需要开展大型、设计严谨的研究解决当务之急。 什么是压疮？ 压疮是因个人长期保持同一姿势引起的皮肤和组织损伤。当身体某些部位长期受压时，皮肤与皮下组织的血液循环受限，导致该处皮肤或皮下组织出现损伤，特别是腰部和足跟等脂肪较少处。 压疮的易感群体包括老年人、行动不便者（例如需要坐轮椅）和长期住院的患者。 如何治疗压疮？ 压疮是一种严重的创伤，治疗费用高昂，因此重在预防。发生压疮后的治疗方法包括外用敷料、抗生素和杀菌剂。 重建手术通常用于深层或难以愈合的压疮。该手术分为多种类型，但大多数是清除坏死组织后使用人体其他部位软组织（如肌肉、脂肪或皮肤）填充。 我们想知道什么？ 我们拟评估与非手术治疗相比，重建手术治疗压疮的利弊；以及不同类型重建手术的利弊。我们关注以下结局指标的结果： -完全愈合； -疮口复溃或在原疮口发生新的溃疡； -资源利用和成本； -健康相关生活质量； -疮口感染；以及 -健康皮肤出现新的压疮。 研究内容 我们检索了电子数据库和临床试验注册平台以查找相关的随机对照临床试验，在该类试验中受试者被随机分至不同治疗组。这种类...

The World Health Organization (WHO) is currently running two consultations which will shape the future of global clinical trials policy. We encourage the Cochrane Community to participate. 

The surveys are being carried out following the passing of a resolution on ‘strengthening clinical trials to provide high-quality evidence on health interventions and to improve research quality and coordination’ at the World Health Assembly in May 2022.

Cochrane is submitting responses to both consultations at the central level. We also encourage members of our community who work with clinical trial data to also take part and share their perspectives.

Consultation 1: World Health Assembly Resolution on strengthening clinical trials

This survey requests input on implementation of the clinical trials resolution on a wide range of issues related to trials including data sharing, ensuring more representative trial populations, and planning and conducting trials in emergency circumstances. This is an opportunity to share examples of best practice and recommendations for improvement. The questions are available in PDF form here to help with preparing responses.

Consultation 2: WHO International Clinical Trials Registry Platform – draft guidance on reporting results in trial registries

This survey is a key opportunity to ensure that the reporting of results in clinical trial registries are fit for purpose. It concerns recommendations on the minimum elements of studies which should be reported. The questions are also available in PDF form here to help with prepare responses.

Both consultations close on 11 November 2022 – please consider participating.

If you are interested in finding out more about and contributing to Cochrane’s advocacy in this area, please write to Emma Thompson, Cochrane’s Advocacy and Partnerships Lead.

Wednesday, October 12, 2022

Cochrane appointments of two new governing board members, Professor Gillian Leng and Professor Wendy Levinson and says farewell to two retiring Trustees, Rae Lamb and Marguerite Koster.

Cochrane is an international non-profit network, which sets the gold standard for synthesizing health research findings  to facilitate evidence-based health care.  Cochrane Reviews, found in the Cochrane Library, are up-to-date, follow a rigorous scientific methodology, and are free from commercial conflicts of interest. Health professionals, patients, and policy makers trust Cochrane Reviews for their healthcare decision-making. Cochrane works with researchers, health professionals, patients, policy makers, and media representatives from around the world to make Cochrane Reviews relevant and usable.

Cochrane's Governing Board is responsible for setting Cochrane's strategic direction and overseeing the work of the Chief Executive Officer, Editor in Chief, and Central Executive Team. Tracey Howe has recently been appointed for a second term as Co-Chair of the Cochrane Governing Board.  Along with Co-Chair, Catherine Marshall, Tracey Howe,  announced the appointment of two new governing board members, Professor Gillian Leng and Prof essor Wendy Levinson and farewell to two retiring Trustees, Rae Lamb and Marguerite Koster.

Gillian Leng, former Chief Executive of the National Institute for Health and Care Excellence (NICE), and current trustee of the Guidelines International Network, has over 30 years’ experience of working within the national and international worlds of guideline development and associated evidence and research functions. Her knowledge and understanding of the development and use of evidence based health advice, in the Uk and internationally, will be valuable as the Cochrane Board continues its work developing a secure and strong role for the future.

Gill Leng said, "Cochrane is hugely important for international healthcare and plays a vital function in ensuring effective, robust evidence is available at a global level. As the trend for ‘living guidelines’ increases, the role of Cochrane as an evidence provider will become ever more essential, bringing alignment where appropriate with the needs for guideline developers. I have been a strong ‘Evidence advocate’ since I was a junior doctor, I contributed as a Cochrane Editor for many years, and I welcome the opportunity to help shape the future of Cochrane."

Wendy Levinson, is a Professor of Medicine at University of Toronto, currently Chair of Choosing Wisely Canada. She has a wide range of experience from her volunteer roles as Chair or President of the boards of the American Board of Internal Medicine, the Society of General Internal Medicine, the Professors of Medicine, and the Canadian Association of Professors of Medicine and full-time positions including serving as the Chair of Medicine at the University of Toronto  and the Division head of General Internal Medicine and Geriatrics at the University of Chicago. 

Wendy Levinson said of her appointment, "I admire the work of Cochrane and use the reviews frequently. Cochrane is undergoing major changes and I look forward to using my skills in leadership of large organizations, strategic planning, and fundraising to help support Cochrane’s future. Furthermore, my international network through Choosing Wisely may also serve to support Cochrane and build a useful collaboration, especially as we continue our important work identifying low value health care."

Catherine Spencer, Cochrane CEO said, ‘Wendy and Gill both bring an inspiring range of professional experience, which we welcome to help us navigate a new future for Cochrane. Both new Trustees also bring links with organisations Cochrane has partnered with and that rely on Cochrane Evidence for their work – the Guidelines International Network and Choosing Wisely.

We would also like to warmly thank leaving Trustees, Rae Lamb and Marguerite Koster for their service to and support for Cochrane.

Rae Lamb, is the Chief Executive of Te Pou in NZ, a national centre for workforce and leadership development for the mental health workforce in New Zealand, specialising in the development of evidence-based mental health resources and Deputy Chair of the NZ Quality and Safety Commission.  Ms Lamb initially trained as a reporter and broadcaster, then undertook a Harkness Fellowship in Health Policy at the Harvard School of Public Health and Institute for Healthcare Improvements in the United States. Rae has also served as a former New Zealand Deputy Health and Disability Commissioner and Australian Aged Care Complaints Commissioner.

Catherine Marshall, Co-Chair, said "Rae brought a wealth of experience in governance, organisational leadership, change management, complaint resolution and working with diverse stakeholder groups nationally and internationally. Rae understands the importance of evidence-based health care and decision making, and her professional, ethical approach has made a significant contribution to the governing board. We thank her for her work on our Complaints Policy and with the Complaints Committee and as a member of the Governance Committee."

Rae Lamb said “Cochrane and the work of its community is more important than ever in this late pandemic world where misinformation is rife. I am humbled to have had the opportunity to be part of Cochrane. I strongly believe there are exciting opportunities and times ahead for the organistion, its work and its people.”

Marguerite Koster,  Director of Evidence-Based Medicine at Kaiser Permanente Southern California, one of the largest not-for-profit health plans in the U.S., serving 12.2 million members. She oversees the efforts of the Southern California Permanente Medical Group’s Evidence-Based Medicine Services Unit within Kaiser Permanente’s Southern California Region, which provides medical care to more than 4.5 million members.   Marguerite will continue to serve Cochrane as a member of the Future of Evidence Synthesis Oversight Committee.

Tracey Howe, Co-Chair Governing Board, said "Marguerite was appointed to the Cochrane’s Governing Board in 2016 as one of its first externally appointed members. Marguerite has played an invaluable role as a Co-Chair of the Governing Board, Treasurer, Chair of the Finance, Audit & Investment Subcommittee, a member of the Remuneration and Governance Subcommittees, and the Cochrane/Guidelines International Network Partnership Advisory Group. Cochrane has benefited from Marguerite’s valuable experience in using Cochrane evidence to develop clinical practice guideline development, and inform health technology assessment, knowledge translation and evidence-based implementation."

Marguerite Koster said,  “Cochrane’s systematic reviews have been invaluable in informing evidence-based health care decisions within Kaiser Permanente. It has been my pleasure to serve on the Governing Board, especially to emphasize the vital role of the Cochrane Library in influencing health care policy and practice within a large health delivery system.”

• Learn more about Cochrane's governance and management

Wednesday, October 12, 2022

The World Health Organization (WHO) has issued updated recommendations on the induction of labour which is supported by evidence from Cochrane Pregnancy and Childbirth.

WHO develops global health guidelines, which are of a high methodological quality and are developed through a transparent, evidence-based decision-making process. Ensuring there is an appropriate use of evidence within these guidelines, represents one of the core aspects of Cochrane’s collobration with WHO. Cochrane has been a non-governmental organization in official relations with WHO since 2011.

The Cochrane Pregnancy and Childbirth Group has a long-standing collaboration with WHO on the development and updating of Cochrane reviews that inform WHO’s guidelines on global maternal and perinatal health.

 
The primary goal of the latest guidelines for induction of labour is to improve the quality of care and outcomes for pregnant women undergoing induction of labour in under-resourced settings. The target audience of these guidelines includes obstetricians, midwives, general medical practitioners, health-care managers and public health policy-makers. The guidance provided is evidence-based and covers selected topics related to induction of labour that were regarded as critical priority questions by an international, multidisciplinary group of health-care workers, consumers and other stakeholders.

The updated to the recommendation include:

• Outpatient settings for induction of labour
• Induction of labour, at or beyond term
• Mechanical methods for induction of labour

“Cochrane’s official relations with WHO ensures they are able to draw on high quality evidence in their guidelines and recommendations that will have an impact upon health policies and clinical practice worldwide,” says Cochrane’s Editor in Chief, Dr Karla Soares-Weiser. “It’s also a testament to the important and hard work that many in the Cochrane community are putting forward.”

• Visit the Cochrane Pregnancy and Childbirth website
• Read the WHO recommendations for induction of labour

Tuesday, October 11, 2022 Category: The difference we make

集体领导会改善医护人员的临床实践、病人医疗护理质量和职工幸福感吗？ 关键信息 集体领导涉及多学科专业人员分享观点与知识。基于已有证据，本研究不能确定集体领导能明显改善医护人员临床实践、患者医疗护理质量或职工幸福感。本研究对上述结局指标的可信度介于中等到特别低之间，主要受制于纳入研究的人数与质量较低。 我们想从中发现什么？ 本研究目的在于探索集体领导方式（相较于更中心化和等级化的领导模式）是否会改善医护人员的临床实践、患者医疗护理质量和职工幸福感。我们搜寻研究者比较了集体领导与中心化领导的研究。 我们做了什么？ 本研究收集和分析了有关集体领导干预方式（以多学科分享决策和互动为特点）的所有相关研究。 我们发现了什么？ 本研究发现3项相关研究（共955名受试者）。纳入研究分别在加拿大、伊朗和美国的医院开展。集体领导干预方式很可能改善领导力（3项研究，955名受试者），可能改善团队协作（1项研究，164名受试者），并可能稍微减少工作相关压力（1项研究，164名受试者）。研究无法确定集体领导对以下结果是否存在作用：临床实践（1项研究，60名受试者），住院病人死亡（1项研究，60名受试者）和职工缺勤（1项研究，60名受试者）。 证据的局限性是什么？ 集体领导对改善医疗照护领导力的可信度为中等。证据显示集体领导对领导力策略有很大的影响。研究不太确定团队协作改善和工作相关压力减轻的结果的可信度。...

夹板治疗婴儿髋关节脱位和浅髋关节 什么是髋关节脱位或浅髋关节？ 当股骨末端的股骨头和关节窝不能结合在一起时，就会出现髋关节脱位或浅髋关节。医学术语是“发育性髋关节发育不良”（developmental dysplasia of the hip, DDH）。每1000名新生儿中就有10名出现浅髋关节，但髋关节脱位较为罕见，每1000名新生儿中就有1名出现髋关节脱位。髋关节可能“脱位”、不稳定（即在检查过程中容易从关节窝中掉出）或“稳定”（即在整个检查过程中位于关节内）。 这些髋关节如何治疗？ 浅髋关节和髋关节脱位通常用髋关节夹板治疗。夹板控制腿的运动，引导髋关节进入关节窝，让髋关节自然改善。夹板既可以将腿固定在适当的位置，称为“静态夹板”，也可以让腿自由移动，称为“动态夹板”。有时，临床医生可能会建议使用体积较大的双层尿布，并轻轻地将双腿分开，以充当一种夹板。 我们想知道什么？ 我们想知道夹板是否可以成功运用，以及是否在不同婴儿群体中，最佳治疗方法可能不同。我们聚焦于关节窝的发育、进一步手术的需要，以及治疗后长达2年内的任何并发症。我们还对父母告诉我们很重要的因素感兴趣，例如母乳喂养的能力以及父母与婴儿之间的联系。 我们做了什么？ 我们检索了对6个月以下婴儿的浅髋关节和髋关节脱位进行夹板治疗的研究。我们关注将一种夹板与另一种夹板的成功进行比较的研究或者将夹板与未治疗进行比较的研究。...

Installing mosquito screening over house windows and closing the gaps in house eaves can help reduce infection with Plasmodium parasites and the number of people with anaemia in the household, according to an updated Cochrane Review published this week. Householders can implement many of these house modifications themselves, providing a simple malaria prevention tool to complement existing vector control strategies.

The review author team, from the UK, Spain, South Africa, and Malawi, included one randomized controlled trial (RCT) and six cluster-RCTs, and noted an additional six ongoing trials. Trials assessed screening of windows, doors, eaves, ceilings, or any combination of these; this was either alone, or in combination with roof modification or eave tube installation (an insecticidal "lure and kill" device that reduces mosquito entry whilst maintaining some air flow).

The seven included trials, conducted in sub-Saharan Africa, showed that people living in modified houses were less likely to have Plasmodium parasites in their blood, and were less likely to experience moderate or severe anaemia. There was also a large reduction in the number of mosquitoes trapped indoors at night in some of the included trials.

This approach is not a new phenomenon; research from 1901 first demonstrated the effect of simple house screening techniques for protecting families in Italy from mosquito-related illness, and many householders globally continue to screen their homes to protect from nuisance insects. House modifications may provide an important, long-term, sustainable option to reduce malaria.

CIDG Research Associate and lead author Tilly Fox noted, “These results are encouraging, and the reduction in indoor mosquitoes will mean householders will be motivated to screen houses simply to reduce the nuisance factor as well as the health benefits”.

Professor Steve Lindsay from Durham University said, “It is gratifying to see the protective effect of house screening against malaria in different sites. For the future, innovative new solutions are needed to provide better and longer-lasting protection, including tougher screened windows, self-closing doors, and re-designing housing which will help keep the occupants healthy, comfortable, and secure.”

• Read the full review and plain language summary here
• Visit the Cochrane Infectious Diseases Group here

Fox T, Furnival-Adams J, Chaplin M, Napier M, Olanga EA. House modifications for preventing malaria. Cochrane Database of Systematic Reviews 2022, Issue 10. Art. No.: CD013398. DOI: 10.1002/14651858.CD013398.pub4.

Article originally published on Liverpool School of Tropical Medicine website

Friday, October 7, 2022

Specifications: Full Time (Permanent role)
Salary: £85,000 per annum
Location: UK, homebased and remote-working (attendance at meetings will be expected to pursue development and build relations)
Application Closing Date:  Wednesday 19 October 2022, 9am GMT

Cochrane aims to put evidence at the heart of health decision-making globally. We collaborate to produce trusted synthesized evidence, make it accessible to all, and advocate for its use.   Cochrane is seeking a Director of Publishing and Technology.

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.

As a member of the Executive Leadership Team, this role will lead the Publishing and Technology Directorate (comprising Cochrane Library partnership, Informatics and IT Services, product and business development) to drive high performance, organizational growth and financial returns to Cochrane.

Cochrane is seeking an ambitious individual who relishes a challenge, loves collaborative working, delivers results and has experience of successfully delivering strategy. The ideal candidates will possess an understanding and experience of leading the management and development of a portfolio of products and services that are appropriately priced to generate income.  You will support Cochrane to navigate a sustainable and realistic route to Open Access publishing, working with the leadership team, expert advisers, the Governing Board and our publisher (Wiley). Finally, you will be enterprising and a strategic thinker with the ability to seek and find creative solutions and foster innovation in your teams.

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

To obtain the candidate pack and further information on how to apply please contact:

Abigail Barclay
Search Director
a.barclay@inspiredselection.com

PLEASE NOTE: The recruitment agency will be longlisting applications as soon as they receive them, so please apply early to register your interest. 

Thursday, October 6, 2022 Category: Jobs

Funding will support the centering of racial health equality in systematic reviews through national consensus building.

The Robert Wood Johnson Foundation (RWJF) is the largest American philanthropic organization focused solely on health and healthcare. The recent grant of $1 Million awarded to members and partners of the Cochrane US Network, including Texas Christian University (TCU), RTI International, Campbell Collaboration, Marymount University, and Georgia College, will support critical research to center racial health equity in systematic reviews through national consensus building.  

RWJF defines health equity to means that everyone has a fair and just opportunity to be as healthy as possible, which requires removing obstacles to health such as poverty, discrimination, and their consequences.  Systematic reviews—rigorous and comprehensive syntheses and critical appraisal of evidence—is a gold standard research tool to improve dissemination of evidence-based practices that can reduce or eliminate disparities.  To date, guidance documents for systematic reviews have not routinely considered health equity when- selecting topics, considering outcomes, conducting critical appraisal, assessing applicability of evidence to specific populations or settings, nor when communicating findings to key stakeholders and communities.

Cochrane Senior Officer Us Network, Tiffany Duque, states “by establishing standards to improve the methods, conduct, and reporting of systematic reviews specific to racial health equity, Cochrane can help reduce racial health disparities in the US. With this Robert Wood Johnson funding we will assess the gaps in primary and secondary research to help improve and guide future evidence synthesis toward improved racial health equity.”

This award is the largest to date for the Cochrane US Network, which was established in 2019. Catherine Spencer, Cochrane CEO states, “Racial health equality is a priority topic for Cochrane, the US, and globally. We encourage Cochrane reviews to include explicit descriptions of methods, effects of the interventions, and ability to reduce inequalities in health and to promote their applicability to all population groups. Cochrane is proud to lend its leadership and expertise to this project.”

This prestigious collaboration of investigators and institutions will undertake a comprehensive and ambitious effort to listen to stakeholders and communities, perform landscape analyses of existing resources, and prioritize next steps as the first phase to centering racial health equity in systematic reviews.  Principal Investigators include awardee Dr. Dru Riddle (TCU), Dr. Meera Viswanathan (RTI), Dr. Vivian Welch (Campbell), Dr. Patricia Heyn (Marymount), Dr. Damian Francis (Georgia College), and Tiffany Duque (Cochrane).

• Visit the Cochrane US Network website
• Learn more about equity methods at Cochrane

Thursday, October 13, 2022

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

Cochrane is an international non-profit network that provides evidence-based scientific knowledge to improve healthcare for all people worldwide. Cochrane Reviews summarise all available research on a specific health question. They are up-to-date, follow a rigorous scientific methodology, and are free from commercial conflicts of interest. Health professionals, patients, and policy makers trust Cochrane Reviews for their healthcare decision-making. Cochrane works with researchers, health professionals, patients, policy makers, and media representatives from around the world to make Cochrane Reviews relevant and usable.

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.  

Cochrane was founded 30 years ago in Oxford and to mark this anniversary the colloquium will be held in the United Kingdom. It will take place at the QEII Centre in Westminster, Central London, hosted by Cochrane UK. The main programme will run from the 4th to the 6th of September, with satellite events and meetings on the 3rd September 2023.

This will be the first time the Cochrane community has come together since 2018 and in recognition of this, it is being designed to celebrate the diverse, global and cohesive nature of the collaboration that is Cochrane. As in previous years there will be stipends to make it possible for students, early career professionals and those from low-and middle-income countries to attend. The Colloquium theme is forward together for trusted evidence. 

Martin Burton, Director of Cochrane UK, said: “After 30 years of producing and advocating for the use of high-quality evidence, Cochrane can look back on many significant achievements.  Now we need to look forward together.”

Catherine Spencer, Cochrane CEO said, “The 2023 Cochrane Colloquium is an event for everyone with an interest in the use of evidence in healthcare decision making. We welcome those engaged in evidence production, co-production, dissemination, implementation and policy making, as well as those making individual healthcare decisions to join us for this exciting event.”

Registration will open in early 2023. Scientific programme will be announced in the coming months.

• Find out more at the Colloquium website
• #CochraneLondon
• Press contact: Katie Abbotts, Cochrane UK

Tuesday, October 11, 2022

哪种激素疗法对卵巢早衰的女性更有效？ 关键信息 我们只发现了三项研究，分别研究了三种不同情况下的各种激素疗法。 根据这些小型研究的数据，我们无法得出任何明确的结论。 需要进行充分的、规模足够大的研究，以研究早发性卵巢功能不全女性的最佳激素疗法，以提高她们健康怀孕的机会。 什么是卵巢早衰？ 卵巢是一对对雌激素、孕酮和睾酮等激素作出反应并产生激素的腺体。它们在骨骼、心脏和生殖健康方面发挥着重要作用。卵巢早衰是一种影响约1%女性的疾病，表现为卵巢不能正常分泌激素。这会增加她们骨折、心脏疾病和不育的风险。如果女孩的第一次月经在16岁之前还没有开始，或者如果女性在40岁之前超过6个月不来月经，则可能会被诊断为卵巢早衰。还需要进行血液测试以确认各种激素的异常水平，这些激素与卵巢的功能有关。 卵巢早衰如何治疗？ 卵巢早衰通常采用激素疗法进行治疗，这种疗法模拟正常工作的卵巢分泌激素。治疗的目的是平衡这种疾病对骨骼、心脏和血管以及生殖健康的负面影响。治疗可能包括通过口腔、皮肤贴片、注射或阴道给药途径给予不同剂量的不同激素。 我们想知道什么？ 我们想找出最佳激素组合，使女性在卵巢早衰后能够生育。我们还想找出使用激素疗法治疗卵巢早衰后的不良影响。 我们做了什么？ 我们遵循标准的Cochrane方法学程序来检索研究，比较和总结研究结果，并根据研究方法和研究规模等因素来评估证据质量。 我们发现了什么？ 我...

A new Cochrane Library Editorial  has been published about the overtreatment with multiple medications and potentially inappropriate medications use in frail, older adults, and people with multimorbidity. 

The editorial introduces the Cochrane Library Special Collection on deprescribing which provides a summary of Cochrane Reviews on the topic. This collection of reviews highlight that deprescribing is likely feasible and safe and can lead to benefits in prescribing and clinical outcomes. However, they also highlight significant gaps in the literature and methodological challenges to both conducting deprescribing studies and systematic reviews of deprescribing. The editorial calls on the deprescribing research field to focus on universally accepted standards, definitions, and checklists and work collaboratively with Cochrane Sustainable Healthcare. 

• Read the deprescribing editorial 
• View the Cochrane Library Special Collection on deprescribing 
• Visit the Cochrane Sustainable Healthcare website
• Register for free webinar on abandoning existing low-value care practices: 20 October 2022

Wednesday, October 5, 2022

Wednesday, October 5, 2022

成人大腿骨下部骨折的治疗 关键信息 对于大腿下部分骨头（股骨远端）骨折患者的治疗，我们认为最好的比较方法是将金属棒放置在大腿骨内，对比将金属板放置在骨头外侧并用螺钉固定，但也使用其他方法。我们不确定哪种治疗更好，但有一些证据表明棒可以减少残疾。 哪种金属植入物最适合大腿骨下端的骨折仍存在不确定性。 需要进一步的研究来比较常用的手术方式。 为什么治疗股骨远端骨折很重要？ 大腿骨下部（股骨远端）的断裂（骨折）会使人虚弱且疼痛。这些受伤后行动不便也是导致健康不佳的一个重要原因。有时，这些骨折发生在以前做过膝关节置换术的人身上；这会使骨折的治疗更加复杂。 治疗股骨远端骨折有哪些选择？ 许多治疗方法已用于治疗这些损伤。过去，人们在床上用重物支撑腿部伸直进行治疗。最近则是在手术中使用金属植入物（手术固定）来修复断裂的股骨。手术固定的方法包括在股骨外侧使用钢板和螺钉或在股骨内使用棒以在骨折愈合时将骨头固定到位。这些植入物的技术变得越来越先进，组件“锁定”在一起，形成一个“锁定”装置。尽管取得了这些进步，但对这些损伤的最佳管理仍存在争议。 我们想知道什么？ 我们想了解不同方法治疗成人股骨下段骨折的效果。效果包括：功能评分、疼痛、生活质量（quality of life, QoL）以及干预方法引起的任何并发症。 我们做了什么？ 我们检索了截至2021年10月发表的随机对照临床试验（randomis...

Tuesday, October 4, 2022

上肢锻炼方案对肾衰竭患者的动静脉瘘成熟有效吗？ 问题是什么？ 动静脉瘘（An arteriovenous fistula, AVF）是一种在动脉和静脉之间建立的特殊连接，即构建一根强健的、可以在血液透析治疗期间重复使用的血管。一旦在构建后使用，通常需要六到八周的时间来恢复（或成熟）。成熟的结果表现为连接的静脉变得更大、血流增加使其管壁变得更厚和更坚固。锻炼方案可能会缩短AVF及其功能成熟所需的时间，然而，应该进行什么类型的锻炼方案以及何时进行锻炼（在AVF构建前或后）仍不清楚。 我们做了什么？ 我们检索了那些描述了上肢锻炼对肾衰竭患者AVF成熟作用研究的相关文献。我们从中收集了信息，并整合了这些信息来确定干预是否有帮助。我们检查了这些干预措施的质量，以此评判我们能在多大程度上确定我们观察到的效果是可靠的。 我们发现了什么？ 我们发现了9项研究，涉及579名受试者；2项研究着眼于在AVF创建之前进行锻炼，7项研究着眼于在AVF构建之后进行锻炼。不幸的是，只有7项在AVF构建之后锻炼的研究可以用来分析。使用的锻炼方案类型有等张（在锻炼关节的同时使肌肉承受恒定重量的练习）和等长（肌肉收缩，周围关节没有任何移动）。 与不干预相比，等张运动可以促进超声成熟度；而与等张运动相比，等长运动可以改善超声和临床成熟度。与等张运动相比，等长运动也可能增加静脉大小和动脉血流量。纳入的研究中没有一项报告...

电磁导航或内窥镜引导方法：哪种更适合将饲管置入小肠？ 关键信息 - 由于缺乏稳健的证据，我们仍然不清楚在小肠中置入鼻饲管时，电磁导航下置入是否优于内窥镜引导下置入。 - 相比于内窥镜引导下置入，电磁导航下鼻饲管置入可能花费较少。 研究背景 对于治疗不健康、营养不良、或两者兼具，以及虽有正常肠道功能但无法进食的人而言，使用鼻饲管通过肠道来给予营养是重要的。对于有食物或液体进入气道的高风险的人（可能会导致肺炎，一种肺部的炎症状态），鼻饲管可以用来协助将营养和药物送到小肠。两种置入鼻饲管的方式都涉及将管子借由导丝经鼻腔、食道和胃进入小肠。虽然内窥镜引导下置入——用一条带有摄像头的薄且可弯曲的管子——是最常见的将导管插入小肠的方式，但是需要多个医疗专业人员在X线检查室确定置管是否成功，而不是在患者床旁就能完成。相比之下，一个受过培训的护士使用电脑屏幕，可以在患者的床旁进行电磁导航下导管置入，并确认其是否成功。 我们想从中发现什么？ 我们想知道对于不健康和无法进食的人而言，电磁导航下置管是否比内窥镜引导下置管更好且更安全。 我们做了什么？ 我们检索了比较电磁导航下置管和内窥镜引导下经鼻置管的研究。我们比较并总结了这些研究的结果，并根据研究方法和样本量等因素对证据质量进行了评价。我们探索了医生第一次置管时将管道送到小肠的成功率，以及这些研究中肺炎患者的比例。此外，我们评估了使用这两种不同方法...

In November 2022 Jimmy Volmink, the 'father of evidence-based medicine in Africa' and dedicated Cochrane member was the speaker for the 2022 Cochrane Lecture. 

Cochrane Lectures provide a forum for influential thinkers to deliver thought-provoking talks on the key challenges for the future Evidence-Based Medicine.

Cochrane’s vision is for a world in which “decisions about health and care are informed by high-quality evidence.” As a trusted source of evidence, the organisation is making a substantial contribution to the realisation of this ideal. Yet, more can be done to extend Cochrane’s global reach, and enhance its relevance and impact worldwide. In this year’s Cochrane Lecture, Professor James "Jimmy" Volmink called for the adoption of global health equity as a strategic priority for Cochrane, and explored ways this can be actioned through steps such as prioritising review topics, enabling participation and promoting diversity and inclusion.

Professor Volmink, the founding Director of the South African Cochrane Centre has a lifelong unwavering commitment to keep on 'banging the drum about inequality' to affect real change. Jimmy reflects on his personal and professional journey in this 'Recommended Dose' podcast.

• Watch other Cochrane Lecture recordings
• Professor Volmink on Twitter

Thursday, December 1, 2022

The award supports critical research to help identify treatments to improve the lives of people suffering from debilitating eye diseases.

 The National Eye Institute (NEI) has awarded a $5 million grant to Tianjing Li, PhD, associate professor of ophthalmology at the University of Colorado School of Medicine, in a continuation of the NEI’s support of the Cochrane Eyes and Vision US Satellite (CEV US Satellite) at the Sue Anschutz-Rodgers Eye Center.

The award is one of the largest grants the CU Department of Ophthalmology has received from the NEI and ensures the project will remain on the CU Anschutz Medical Campus for the next five years.

“We are very grateful for NEI’s continued support in the research we are doing,” says Li. “It will help us grow new partnerships, produce trustworthy evidence, and ultimately improve the vision care our patients receive.”

The Cochrane Eyes and Vision (CEV) US Satellite is a team of US-based researchers and practitioners who review medical literature for content covering interventions to prevent or treat eye conditions and visual impairments and to help people adjust to visual impairment or blindness. CEV is a member review group of the Cochrane US Network, which formed in 2019.  Cochrane Senior Officer Tiffany Duque states "this grant is an exciting achievement for the US Network, and we thank Dr. Li for her continued efforts and dedication not only to CEV but also to the US Network. We look forward to the high-quality evidence that will result from this grant, and to engaging other US Cochrane Centers in ensuring national dissemination of this important work."

“Cochrane systematic reviews are published in the Cochrane Library, which contains high-quality, independent evidence to inform health care decision-making,” says Li, principal investigator for the CEV US Satellite. “These reviews are valuable sources of information for those receiving and providing care, as well as for policymakers and researchers. Our reviews have been highly cited by national and international practice guidelines.”

Although the reviews are written for health care professionals, each review can also help to assist patients and the public in making informed health care decisions. Topics for reviews are identified based on gaps in the literature, importance of the topics to influence practice, and from interest and suggestions of patients and experts in the field. Once a review topic has been identified, Li’s team works with eye doctors to produce the review, which is then peer reviewed and ultimately published in the Cochrane Library.

 “We are very proud of the program Dr. Tianjing Li has built here in the Sue Anschutz-Rodgers Eye Center,” says Naresh Mandava, MD, chair of the CU Department of Ophthalmology and Sue Anschutz-Rodgers Endowed Chair in Retinal Diseases. “Evidence-based medicine is critical to our understanding of disease and identifying effective therapies that will ultimately improve the lives of people suffering from debilitating eye diseases. The Cochrane project centered here at CU leads the way in this endeavor and we appreciate the National Eye Institute’s continued support of this important work.”

The project’s mission to promote informed health care decision-making and research is critical amid the current climate of increasing health care disparities and growth of health care misinformation from online sources.

“Vision health care should be based on science,” Li says. “In this era of data deluge, evidence-informed practice is needed more than ever.”

Since 2002, the CEV US Satellite has published more than 120 systematic reviews and more than 90 methodological papers and book chapters. The project has also trained more than 120,000 individuals in methods for systematic reviews and has informed hundreds of clinical practice guidelines in the United States and internationally.

• Visit the Cochrane Eyes and Vision website
• Visit the Cochrane US website

Originally posted on the University of Colorado website

Wednesday, September 28, 2022