痴呆和轻度认知损伤患者抑郁和焦虑的心理治疗 关键要点 - 基于认知行为疗法（侧重于改变想法和行为）的心理治疗可能对痴呆或轻度认知障碍（mild cognitive impairment, MCI）患者的抑郁、生活质量和日常生活活动能力有小的积极影响。 - 尚没有足够的证据以了解某些心理治疗是否对痴呆或MCI患者的焦虑有帮助。 - 需要有更多关于不同类型心理治疗以及哪些治疗或许最适合哪些人方面的证据。 什么是痴呆和轻度认知损伤？ 痴呆是一种认知（记忆和思维能力）出现问题的情况。罹患痴呆者不再能够独立管理其全部日常活动。轻度认知障碍（mild cognitive impairmemtn, MCI）相对较不严重，对日常活动没有显著的影响。某些MCI患者会继续发展为痴呆。 心理治疗于我们意味着什么？ 心理治疗，有时被称为“谈话疗法”，是基于心理学理论的治疗。它们涉及治疗师与个体或小团体一起发展技能并运用策略来改善安康状态。这些治疗经调整可用于有认知损伤者。 我们想要发现什么？ 抑郁和焦虑在痴呆和MCI患者中常见，但对其最佳疗法尚不清楚。通常用于治疗这些问题的药物可能对痴呆患者无效，或许还会引起副作用，因此许多指南建议首先尝试心理治疗。我们对旨在减轻痴呆或MCI患者焦虑或抑郁症状或改善其情绪健康的心理治疗感兴趣。有多种不同类型的心理治疗。我们想了解每种治疗对痴呆或MCI患者的抑郁和焦虑症状...

铁碘强化盐与单纯碘强化盐相比用于改善铁和碘状态 关键信息 与碘盐相比，双重强化盐（有铁和碘的强化盐）或许改善铁和碘营养测量，如血红蛋白（即赋予红细胞颜色的物质）浓度和体内铁储量。然而，它或许降低尿碘浓度，或许对铁蛋白（即储铁蛋白）浓度和转铁蛋白受体（即影响铁吸收的蛋白质）浓度几乎没有影响。与碘盐相比，它还可能降低贫血（缺乏血红蛋白）患病率，或许也降低缺铁性贫血（缺乏铁）患病率。 需要有精心设计的研究，用于评估双重强化盐对非研究人群（即现实生活环境）的影响，以及对盐摄入量（包括盐消耗量的变化）的测量。 什么是缺铁？ 近20亿人有维生素或矿物质（或两者皆有）缺乏，资源有限环境中的妇女儿童最常受到影响。铁相关性缺乏是世界上最常见的缺乏症之一，有重要的短期和长期健康后果。提供铁的干预经常包括铁补充剂，包括铁片、粉末或糖浆。然而，这些皆已知存在阻碍，食品强化策略或许是有吸引力的替代方案。盐是少数普遍食用的食物载体之一。强化碘盐可提供个体所需碘量的100%，且高度有效。所开发的双重强化盐，可向个体提供每日膳食铁需求量的30%和碘需求量的100%。在某些资源有限的环境中，铁相关性缺乏症是个常见的问题，人们对让公众更容易获得双重强化盐存有兴趣。这亟待进一步了解双重强化盐对相关结局的影响。 我们想知道什么？ 双重强化盐是否比单独碘强化盐更能改善铁和碘相关营养测量，特别是： - 血红蛋白浓度； - ...

Salary: £35,326 per annum
Contract type: Full-time Fixed term until March 2024
Closing date: 15 May 2022

LSTM’s Centre for Evidence Synthesis in Global Health runs the “Research, Evidence and Development Initiative” (READ-It) and contains the Cochrane Infectious Diseases Group (CIDG). The CIDG was established in 1995. They are world leaders in evidence synthesis related to public health in the tropics. They have a wide portfolio of Cochrane reviews in malaria and neglected tropical diseases, amongst other topics.

Teams are already in place for some of the reviews and they have experienced technical specialists in all areas. The successful candidate will assure the delivery of a portfolio of high-quality Cochrane reviews according to LSTM’s strategic plan.   You will be part of the READ-It Management Team and assure the delivery of the CIDG Partners deliverables.

Key Responsibilities are (but not limited to):

• Provide editorial feedback to the Managing Editor throughout the review life cycle
• To stay up to date with Cochrane methods, standards, and procedures and ensure reviews are in compliance
• Work with the CIDG team in ensuring efficient and effective editorial processes are in place
• Assessing technical and academic aspects of reports from READ-It Partners, and the draft READ-It annual reports to funders
• Actively manage review delivery and report and discuss progress of Liverpool associated outputs with the READ-It Management Team
• Participate in READ-It Management Team meetings, Partner meetings, and Advisory Group meetings
• Liaise with READ-It Liverpool staff and the Head of the Department of Clinical Sciences (DoCS) to assure appropriate line management including the performance conversation process
• Assure delivery of the CIDG strategic plan in relation to reviews by supporting teams and helping overcome review production obstacles
• Work with stakeholders, editors, and the CRG strategic advisory group in taking on new topics and teams in line with priorities, stakeholder needs and CIDG capacity
• Deliver seminars for Diploma and Master students
• Actively contribute to submissions for grant funding

The Candidate will ideally be:

Candidates must be experienced in Cochrane systematic reviews to work in our Liverpool team and with our global partners to help assure the delivery of the CIDG strategic plan. 

• Hold a Postgraduate professional qualification, such as the Diploma of Tropical Medicine, or health-related Masters’ degree
• Have knowledge of systematic reviews and RCT trial basics
• Have knowledge and an interest in LMICs and infectious disease problems
• Understand qualitative and quantitative research methods
• Be experienced in the critical appraisal of medical literature at postgraduate level

For a confidential discussion about this role, please contact Paul Garner at: Paul.Garner@lstmed.ac.uk(link sends e-mail)

Additional benefits of joining LSTM:

• 30 days annual leave, plus bank holidays, plus Christmas closure days
• Generous occupational pension schemes
• Government backed “cycle to work” scheme.
• Affiliated, discounted staff membership to the University of Liverpool Sports Centre
• Plus, a host of additional family friendly policies

Closing Date: 15th May 2022 
More information and to apply: https://www.lstmed.ac.uk/research-associate-66636

Tuesday, April 19, 2022 Category: Jobs

牙龈疾病的治疗是否有助于糖尿病患者控制血糖水平？ 系统综述问题 本系统综述涉及的主要问题是：与不积极治疗或常规护理相比，牙龈疾病（牙周炎）治疗对控制糖尿病患者的血糖水平（称为血糖控制）的效果如何？ 系统综述背景 治疗牙周炎的目的是减少肿胀和感染，稳定牙龈和支撑的骨组织状况。由于糖尿病患者血糖水平过高，因此保持血糖水平的控制是一个关键问题。一些临床研究表明牙龈疾病治疗和血糖控制之间存在关系。 血糖控制可以用不同的方式测量。在本系统综述中，我们重点关注HbA1c，它可以显示过去三个月的平均血糖水平。它可以以百分比（占总血红蛋白）或mmol/mol（毫摩尔每摩尔）的形式报告。糖尿病患者的良好血糖控制可能在6.5%或48mmol/mol左右。 本系统综述由Cochrane口腔健康组（Cochrane Oral Health）的作者进行，并且它是于2010年和2015年已发表综述的更新版的一部分。本系统综述评价了牙龈疾病治疗对比没有积极治疗或常规护理的情况。本系统综述的第二部分将比较不同类型的牙周治疗。由于研究牙龈疾病的治疗是否可以改善血糖控制，以确保临床资源的最佳利用是非常重要的，因此我们进行了本系统综述。 研究特征 我们检索了六个研究数据库，发现了35项相关试验，其中糖尿病和牙周炎患者被随机分配到试验组或对照组。试验组接受了称为“龈下器械”的牙龈疾病治疗，也称为洗牙和根面平整或深度清洁...

Monday, April 11, 2022

Specifications: Full Time 1 year Fixed Term contract/Consultancy contract
Salary:  £25,540 per annum
Location: Flexible (remote)
Application Closing Date: 22 April 2022 (midnight GMT)

Cochrane has established a Central Editorial Service to support the efficient and timely publication of high-quality systematic reviews in the Cochrane Library. The reviews that are published through the Central Editorial Service address some of the research questions considered to be the most important to decision makers. The Central Editorial Service is also instrumental in running a pilot aiming to improve editorial independence and efficiency within Cochrane. The Editorial Assistant role will play a key role in operationalising this pilot.

The Editorial Assistant will perform editorial tasks to support the smooth running of the Editorial Service. Tasks will include, but are not limited to: performing checks on manuscripts on submission and before publication; supporting the peer-review process including inviting peer reviewers and tracking progress; assisting authors and peer reviewers to use Cochrane’s Editorial Management System; running editorial reports for the Editorial Service Executive Editor; arranging and preparing documents for editorial meetings; and supporting the Head of Editorial in projects aimed at improving or developing editorial systems and processes.
Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.

For further information on the role and how to apply, please click here.  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.
Deadline for applications: 22 April 2022 (midnight GMT).

Friday, April 8, 2022 Category: Jobs

New Cochrane Review: Control interventions in randomised trials for people with a mental health disorder

KEY MESSAGES

• Researchers use many different control interventions in randomized trials on treatments for patients with mental health disorders, but there is little consensus on how to report and adequately design these controls. This practice has widespread consequences for the evidence base underpinning psychiatric treatments
• The choice, design and reporting of a control intervention is just as important as the experimental treatment in a randomized trial with psychiatric patients. This is not reflected in most randomized trials with mental health patients, as control interventions are often poorly reported upon and lack methodological rigor
• Some psychiatric treatments may be recommended based on just having compared the treatment with a waitlist or no-treatment control in a randomized trial, which may give a misleading picture of how effective the treatment is

Erlend Faltinsen, lead author,  commented, "There is a need to develop methodological guidelines on how to design and report upon control interventions in randomized trials on psychiatric treatments, as trialists working in the field of mental health do not have a solid evidence-based framework to draw from on this issue."

Why was this review conducted?
The review investigates the beneficial and harmful effects between different control interventions in randomized trials with mental health patients. We wanted to investigate how control interventions differ from each other and to lay the empirical groundwork to develop methodological guidelines on reporting, and the design of control interventions in psychiatric randomized trials.

What did the authors do?
The authors conducted a Cochrane systematic review and meta-analysis to assess the benefits and harms between placebo, usual care (or treatment as usual) and waitlist controls versus receiving no treatment.  In that way they assessed how effective and harmful different control interventions in psychiatric randomized trials are.

What did they find?

• 96 randomized trials were included and the trials involved 15 different types of mental health disorders
• When combining three different types of placebos, the beneficial effects compared with no-treatment or wait-list controls was small to moderate
• There was no significant difference between usual care controls and wait-list or no-treatment on benefits. The same was true for waitlist versus no-treatment controls
• Psychological placebos (non-active controls used mostly in psychotherapy research) showed moderate effects compared with no treatment whereas placebos used for physical treatments like surgery showed a small effect. We found no significant effects of pharmacological placebos versus no treatment
• There was little data on harms between the control interventions and the findings on harms were insignificant
• The control interventions were mostly poorly reported upon and there was little rationale for why a given control was used in most reports

What are the limitations of the evidence?
The certainty of the evidence was rated low to very low, and the risk of bias was rated high in all studies. The authors mostly included randomized trials with three intervention arms to compare two controls, which causes issues with blinding of participants and trial personnel. This limitation was due to the methodological objective of the review and may be viewed as part of the review itself rather than a flaw in the evidence-base. Many of the studies were small, however, leading to risk of small-study effects, which limits the evidence.

What gaps did the authors identify?
There is a need to develop methodological guidelines on control interventions in psychiatric randomized trials, as trialists working in the field of mental health do not have a solid evidence-based framework to work from when choosing and reporting upon controls

What important related questions were not addressed in this review?
The review did not compare usual care with placebo interventions, which would have been relevant. It did not quantify the level of reporting issues and rationale for choosing a control in a psychiatric randomized trial, which also would have been relevant.

Who will find this review most relevant?
Psychiatric researchers and especially those who conduct randomized trials will find the review relevant for their research work. It may also appeal to trialists in general and methodologists.

How up to date is this review?
The search was conducted in March 2018. The researchers were not able to screen records after this date, since the search process was very large and extracting data was exceptionally time-consuming.

• Read the full review here
• Visit the Cochrane Methodology Group page

Friday, April 8, 2022

远程虚拟评估诊断痴呆有多准确？ 此问题为何重要？ 痴呆是一种慢性进行性病况，会影响人们的记忆力和日常运作能力。痴呆的临床诊断通常包括脑部扫描、体格检查和病史采集。作为第一步，我们经常用记忆和思维测试以识别出需进一步评估者。传统上，这些测试是亲身执行的，但修改后的测试容许其通过电话或视频通话而使用，这有时谓为“远程评估”。 由于COVID-19，对远程评估的需求变得尤为急迫。然而，远程评估还有超出COVID-19大流行之外的各种潜在益处。对有些人来说，亲身赴约看诊会有困难，远程评估则提供了更大的便利。远程评估在研究中也很有用，因为可在相当短的时间内接触到大量的人。 通过电话进行的测试或许不像亲身等效测试那么好，正确进行这些测试也就很重要了。一方面，如果测试表明某人患有痴呆而其并没有（此谓假阳性），这可能会对个人及其家人产生情感影响。另一方面，如果记忆和思维出现问题时而未能识别出它们（此谓假阴性），意味着此人未得到其所需的治疗和支持。 本综述的目的是什么？ 我们旨在评估通过电话或视频通话进行的记忆和思维测试是否可检出痴呆。 本综述研究了什么？ 我们检视了各种记忆和思维测试。随着时间的推移，现已开发出诸多种测试，其内容及其应用各有相同，但多是基于对传统亲身测试的修改。 本综述的主要结果是什么？ 本综述纳入了31项研究，采用了19种不同测试，共有3075名受试者。 只有7种测试与我们关于...

比较窄带成像与常规膀胱镜治疗膀胱癌 综述问题 通过称为窄带成像的特殊可视化方法引导的膀胱组织切除与标准可视化方法（使用白光）引导的膀胱组织切除相比用于膀胱内壁肿瘤患者会如何？ 研究背景 人们在疑似患有膀胱癌或被诊断患有膀胱癌时，其医生则需要仔细检查膀胱并取出组织做进一步检查。切除肿瘤组织也可作为治疗。切除膀胱肿瘤的手术称为经尿道膀胱肿瘤切除术（transurethral resection of bladder tumor）或TURBT。TURBT是通过将一种特殊的器械穿过尿道并进入膀胱来完成的。有时，很难区分健康正常膀胱组织和肿瘤组织。有些医生使用被称为窄带成像的特殊可视化方法来帮助可视化肿瘤组织。 研究特征 我们分析了已发表研究（称为随机对照临床试验）的数据，以了解窄带成像是否降低了膀胱癌恶化风险，并查看有无任何副作用。我们仅纳入随机对照临床试验，因为此研究类型最可靠。 关键结果 我们找到了8项针对我们综述问题的随机对照临床试验。这些研究的受试者疑似患有膀胱癌或被诊断有局限于内壁的膀胱癌，这意味着癌症尚未侵入下面的肌肉层。基于有限的可用数据，采用窄带成像或许会降低随时间而疾病复发的风险。 未见有1项随机对照临床试验查验选用可视化方法是否对患者膀胱癌恶化风险或膀胱癌致死风险有任何影响，因此我们并不知道使用窄带成像是否会有效改善这2个结局。 我们发现，与标准可视化方法相比，使用窄...

Specifications: Full Time 1 year Fixed Term contract
Salary:  £42,000 per annum
Location: UK based (remote)
Application Closing Date: 25 April 2022 (9am GMT)

Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.

A Project Manager role has become available to support the Evidence Production and Methods Department (EPM), Publishing and Technology department (P&T), Cochrane Library Product Manager and other Central Executive Teams (CET) in delivering on high priority projects: to project manage the highest priority EPM, P&T and other Cochrane projects where appropriate.

Key essential criteria we are looking for:

• Project Management qualification
• Publishing experience
• 2-4 years’ experience in project management, change management and risk management. Proven track record in delivering projects
• Experience of Agile project management methodology
• Experience with project management software tools e.g. Microsoft Project, JIRA, Confluence, SmartSheets

For further information on the role and how to apply, please click here.  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.

Deadline for applications: Monday 25 April 2022 (9am GMT).

Thursday, April 7, 2022 Category: Jobs

Cochrane’s Governing Board is pleased to announce the appointment of Catherine Spencer as Cochrane’s new Chief Executive Officer. 

Catherine joins Cochrane from The Seafarers’ Charity where she held the position of CEO.

Prior to her role at The Seafarers’ Charity, Catherine was acting Chief Operating Officer and Director of Communications and Change Management at international public health research organisation, icddrb, in Dhaka, Bangladesh. Between 2008-2015 Catherine held various senior management roles at the Army Families Federation, including three years as Chief Executive.

Governing Board Co-Chairs, Tracey Howe and Catherine Marshall said: "We are delighted to welcome Catherine to Cochrane. Catherine is a proven Chief Executive with an exceptional record leading non-profit organisations. She brings expertise in strategic planning, change management, and communications backed by a global perspective. Catherine is well positioned to partner with the Editor-in-Chief, Karla Soares-Weiser, to lead Cochrane as we drive an exciting programme of delivering trusted evidence, promoting informed decisions, and better health.”

Catherine lives with her family in Wiltshire, England after many years moving frequently, including living and working in Canada, Germany, Cyprus and Bangladesh.

Catherine will take up the position as CEO in July 2022.

• Read Catherine’s full bio

Thursday, April 7, 2022

一种名为他克莫司的药物用于治疗难治性溃疡性结肠炎的综述 本综述的研究目的是什么？ 我们的目的是研究他克莫司是否是一种有效且安全的治疗方法，用于难以以任何其他方式治疗的溃疡性结肠炎患者。 研究背景 溃疡性结肠炎是一种慢性炎症性肠病，其特征是活动性疾病反复发作，通常影响直肠、结肠或两者兼有。患有活动性疾病的人可能会出现腹部绞痛、排便急迫感和出血性腹泻。溃疡性结肠炎患者可能会发现活动性疾病的标准治疗方法无效。他克莫司是一种降低免疫系统活性的药物。我们想知道他克莫司是否可以帮助那些其他治疗无效的溃疡性结肠炎患者。 几种类型的疗法已被用于尝试治疗溃疡性结肠炎的疑难病例，目前临床医生之间没有就哪种治疗更有效达成一致。 本综述研究了什么？ 本综述中，我们分析了五项研究的数据，这些研究将他克莫司与安慰剂（虚拟治疗）以及另外两种药物倍氯米松和环孢素进行了比较。 我们想看看他克莫司是否能更好地阻止溃疡性结肠炎的症状（达到缓解）或改善症状，以及是否可以安全使用。 关键讯息 在停止症状或改善症状方面，他克莫司可能比安慰剂疗效更好。 在停止症状或改善症状方面，他克莫司可能与倍氯米松并无差异。 比较他克莫司和环孢素的数据很少。 由于数据非常有限，很难判断他克莫司与安慰剂或其他两种药物相比是否会引起更多或更少的副作用。 本综述的主要结果是什么？ 我们检索了随机对照临床试验（临床研究中的受试者被随机分配到两个或...

持续气道正压通气（CPAP）治疗小儿急性毛细支气管炎 系统综述问题 持续气道正压通气（continuous positive airway pressure, CPAP）治疗儿童急性毛细支气管炎是否优于支持性疗法？ 研究背景 毛细支气管炎是指肺部小气道的炎症，也是儿科急诊治疗的常见原因。患有急性毛细支气管炎的儿童通常是接受支持性疗法，包括确保充分补水、并根据需要添加氧气。使用CPAP来治疗是通过从泵中吹气来提供正气压以保持气道畅通，这可能对患有细支气管炎的儿童有效。这是2015年首次发表并于2019年更新的综述的再次更新。 检索日期 2021年8月15 日 研究特性 我们纳入三项小型随机对照试验（将受试者随机分配到两个或两个以上治疗组中的一个），涉及122名12个月以下，被诊断为毛细支气管炎的儿童。我们没有找到任何新的试验纳入此次的更新。这三项研究在法国、英国和印度的单一中心进行。所有研究都将CPAP与标准治疗（支持性疗法）进行了比较。 研究资金来源 一项研究由大学医院资助、一项研究报告没有收到任何资金资助、第三项研究没有提及资金来源。 主要研究结果 有限的可用证据无法得出任何有关于CPAP对毛细支气管炎儿童机械呼吸需求影响的结论。有限的、低质量的证据表明，接受CPAP的儿童其呼吸得到改善（呼吸速率降低）。CPAP组和标准治疗组儿童的住院时间相似。研究中没有儿童死亡的报告。这些研...

还有开放性伤口的腿及手臂骨折的治疗时间 关键信息 我们不确定，不同治疗（抗生素、伤口清洁以及是否一次或多次手术完成所有操作）的时间是否影响人们从开放性长骨骨折中恢复得有多好。我们发现的研究很少，且并未提供可靠的证据。 什么是开放性骨折？ 有些骨折包括在骨折周围有开放性皮肤伤口。这些称作开放性骨折，最常见于高冲击损伤，例如道路交通事故或高处跌落。在本综述中，我们对长骨开放性骨折（大腿、胫骨、小腿、上臂和前臂）的治疗感兴趣。这些骨折可能是非常严重的伤害。因为开放性伤口，患者有严重感染风险。“深度感染”涉及到骨骼，因此需要进一步手术；它或许对肢体有威胁，并影响远期恢复。 有哪些治疗？ - 抗生素（抗感染）或许早用（伤后1小时内）或晚用；它们或许会用短时间（直至伤口手术闭合）或较长时间。 - 清创：通过手术去除伤口内的任何污垢、异物或死亡和受损的组织：这或会早做（伤后12小时内）或晚做。 - 治疗还包括固定骨骼和闭合伤口的手术，这可能涉及从另外的身体部位移动皮肤或肌肉，或两者皆有，以覆盖伤口。所有阶段（清创、骨骼固定、伤口闭合）或许一次性手术或多次手术完成。若是多次手术完成，伤口或许会早闭合（伤后72小时内）或晚闭合。 我们做了什么？ 我们检索了比较这些治疗中的一种或多种治疗的研究，用于有开放性皮肤伤口骨折的成年人中。我们想找出这些不同治疗方法的益处和伤害。如若我们发现有类似的研究、相同...

预防性环加氧酶抑制剂药物用于预防早产儿患病和死亡 综述问题 现有的环氧合酶抑制剂（cyclo-oxygenase inhibitor, COX-I) 药物（吲哚美辛、布洛芬、对乙酰氨基酚）用于之前不知有动脉导管未闭（patent ductus arteriosus, PDA）、出生72小时内的早产儿，其中哪种药物在预防其死亡和不良结局方面更加安全有效？ 研究背景 PDA是早产儿或低出生体重儿的常见并发症。PDA是心肺间的开放血管通道，该通道通常在出生后不久即关闭。早产儿中，PDA经常保持开放，或许引起危及生命的并发症。消炎痛、布洛芬和对乙酰氨基酚等COX-I药物或可预防 PDA及相关不良结局。这三种COX-I药物，哪种（如果有的话）可改善早产儿的临床结局，对此存有争议。 研究特征 我们检索了科学数据库的随机对照研究（其中的受试者被随机安排在两个或多个治疗组中的某个组的临床研究），针对早产儿（怀孕不足37周出生）或低出生体重儿（体重低于2500克），在出生后的前72小时内，在事先不知存在PDA的情况下给予COX-I药物。纳入研究对消炎痛或布洛芬或对乙酰氨基酚的给药进行相互比较或将其与安慰剂或不治疗相比。 关键结果 本综述对28项临床试验（3999名早产儿）的研究发现，预防性使用消炎痛可能会导致严重脑出血的小幅减少、死亡和PDA手术需求的中等程度减少，并可能导致慢性肺病的小幅增加。预...

为护理院痴呆患者提供逐步（基于演算法）疼痛管理 本综述的目的是什么？ 我们对护士如何最佳管理护理院痴呆患者的疼痛感兴趣。疼痛管理包括疼痛测量以及在必要时提供疼痛治疗。我们旨在了解有关如何管理疼痛的护士用逐步指引(一种演算法)是否能减轻疼痛或减少提示某人处于痛苦中的行为（如打人、喊叫或徘徊）。 本综述研究了什么？ 护理院痴呆患者经常会感到疼痛。然而，若他们感到疼痛，他们做不到总是能告诉其照护者，因此就很难识别出疼痛情况，而且我们知道，护理院有痴呆的居住者接受止痛药治疗比无痴呆者少。未经治疗的疼痛对幸福感和安康有负面影响，还会是挑战行为（例如攻击）的原因之一。设计了详细的护理人员用逐步指引（本综述称为演算法）以改善疼痛管理。演算法从结构化的疼痛评估开始，之后有设定的不同治疗步骤，治疗可以是非药物或药物治疗，以减轻疼痛。若检测到疼痛，则采用第一步所描述的治疗。如果该治疗并未减轻疼痛，则采用下一步的治疗，以此类推。 本综述纳入的研究 2021年6月，我们检索了探究基于演算法运用的疼痛管理的试验。我们找到3项研究，共有808名受试者。其中2项研究比较了基于演算法的疼痛管理与护理人员疼痛和痴呆教育，还有1项研究比较了基于演算法的疼痛管理与常规照护。 在这3项研究中，受试者的痴呆严重度及疼痛水平不同。1项研究纳入了护理院的全部居住者，其中大多数在研究开始时并没有疼痛或几乎没有疼痛（不到半数的被...

胸腹主动脉瘤的血管内或开放手术修复后患者结局是否更好？ 研究背景 胸腹主动脉瘤（thoracoabdominal aortic aneurysm, TAAA）是血管变宽或肿胀，比原血管直径大50%，同时影响胸主动脉和腹主动脉。TAAA直径大于6.0cm至6.5cm（取决于患者的性别或主动脉壁存在潜在的遗传性弱点），或TAAA年扩张速度超过1cm，若不治疗，则被视作有生命威胁的病况，而且会给外科医生为各患者确定最佳治疗路径带来复杂挑战。治疗选择包括开放式手术修复，这需要手术团队打开胸腹，以材料移植物替换病变主动脉；血管内修复包括通过腹股沟小切口将一系列有被覆材料的支架（内移植物）插入动脉瘤内，使用X线引导内移植物就位；而非干预性管理，则需要咨询患者及其家属，并在必要时为患者开药以控制风险因素。血管内和开放手术修复后存在包括死亡在内的严重并发症。然而，血管内修复从理念上看侵入性相对较小，正因为如此，我们旨在确定血管内修复对患者来说是否更安全，与开放手术修复相比。 研究特征和关键结果 我们检索了随机对照临床试验和对照临床试验文献，用以评价血管内相较于开放手术修复治疗胸腹主动脉瘤的有效性和安全性。随机对照临床试验和对照临床试验有助于知会医疗保健专业人员、政策制定者和消费者有关TAAA患者的最佳治疗选择。这些类型的试验旨在控制混杂因素，例如患者的健康状况或外科医生的经验，因此各疗法是公平比...

维持性血液透析患者导管相关性血流感染的干预治疗 问题是什么？ 肾衰竭患者需要肾脏替代疗法（kidney replacement therapy, KRT）来维持生命。各KRT选择中，HD是透析的首选疗法。经留置导管接受HD的患者发生血流感染的风险更高。这些血流感染有几种治疗选择。这些做法包括封管液（透析间期在每个导管端口注入高剂量的抗生素）、初步临床改善后移除导管其后再插入新管、通过导丝更换新管（经导管一个端口插入同一静脉以保留静脉穿刺位），再就是全身性抗生素（单用或与其他治疗联用）。每种治疗都有自身固有的风险。 我们做了什么？ 我们检索了截至2021年12月21日的Cochrane肾脏和移植组专业注册库（Cochrane Kidney and Transplant’s Specialised Register），并对HD患者导管相关性血流感染的治疗选择研究进行系统综述。 我们发现了什么? 我们找到了3项研究，纳入了760名受试者，这些研究比较了导管相关性血流感染的不同治疗方法。未见有研究比较相似的治疗策略或有相似的结局，因此我们无法在我们的meta分析中进行数据合并。比较包括全身性抗生素用两种不同的封管液、单用全身性抗生素与全身性抗生素联合乙醇封管液，以及全身性抗生素加导管移除相较于全身性抗生素联合更换导管。 1项研究报告到，全身性抗生素联合乙醇封管液清除感染的成功率高于单用全...

Grant to enhance evidence-informed guideline recommendations for newborn and young child health in South Africa, Malawi and Nigeria

The Global Evidence, Local Adaptation project aims to maximise the impact of evidence for poverty-related diseases by increasing the capacity of decision makers and researchers to use global research to develop locally relevant guidelines for newborn and child health. The project will support decision makers in South Africa, Malawi and Nigeria, and will build on and add value to the large-scale programme of child-health guideline development led by the World Health Organization (WHO), with adaptation and implementation led by the WHO Afro regional office, country offices and national ministries.

 “Despite progress in the health of newborns and children, most sub-Saharan African countries have not met the Sustainable Development Goals for under-five mortality,” said Tamara Kredo of Cochrane SA. “In the context of COVID-19, even though most children present with mild conditions, the consequences of the pandemic are being felt on health systems and services, hampering healthcare delivery to children and increasing poverty, food insecurity and inequity. To address these issues, policy makers and practitioners not only need evidence-based guidance on effective clinical care, they also need guidance on how to implement this care efficiently within the context of their own health systems, considering inequity (in health and access to services) caused by poverty and other factors.”

“MAGIC is thrilled to be partner in GELA,” said Per Olav Vandvik. “The need to allow WHO guidelines to make an impact in member states is critical. Now is the time to show this is possible and we believe this strong consortium of partners is excellently placed to get the work done.”

“Clinical practice guidelines offer a means to bridge the gap between research evidence and practice and are essential policy-implementation tools supporting implementation of effective, cost-effective healthcare,” added Kredo.

The European and Developing Countries Clinical Trials Partnership (EDCTP) has awarded three-year (2022 – 2025) funding of over 3 million Euro to a partnership coordinated by Cochrane South Africa (SA), South African Medical Research Council along with partners from the Norwegian Institute of Public Health, The Norwegian University of Science and Technology, Western Norway University of Applied Science, Stellenbosch University (South Africa), Cochrane Nigeria at the University of Calabar Teaching Hospital, Kamuzu University of Health Sciences (Malawi), Cochrane and the Stiftelsen MAGIC Evidence Ecosystem (Norway).  

 The specific objectives are to: 

1. ENGAGE: Identify child and newborn priority topics and the capacity needs of guideline panels. 
2. SYNTHESISE: Support policy makers and researchers to find, appraise and use best-available systematic reviews and guidelines. 
3. DECIDE: Support guideline panels’ capacity to contextualise global evidence using transparent, digitally supported standards and WHO methods for guideline development. 
4. SHARE: Disseminate and communicate guideline recommendations to healthcare providers and the public using innovative and user-friendly formats and digital platforms.
5. LEARN: Strengthen capacity of researchers and policy makers for all aspects of guideline development, adaptation and dissemination. 
6. EVALUATE: Monitor and evaluate policy makers’ experiences of this approach, preferences for receiving evidence, capacity development and overall impact of the project on evidence-informed decision-making processes. 

GELA will incorporate a multi-faceted, multidisciplinary research and capacity-strengthening programme using primary and secondary research, guideline-adaptation methodology and digital platforms to support delivery and dynamic local adaptation. This is enabled through a project team of African and international leaders in the field of evidence-based healthcare and guidelines methods partnering with national ministries in Malawi, Nigeria and South Africa, the WHO and its Afro regional office and the civil society group, Peoples Health Movement.

The European and Developing Countries Clinical Trials Partnership (EDCTP) is a public-public partnership between countries in Europe and sub-Saharan Africa, supported by the European Union. EDCTP focuses on enhancing research capacity and accelerating the development of new or improved medical interventions for the identification, treatment and prevention of poverty-related infectious diseases, including emerging and re-emerging diseases in sub-Saharan Africa, through all phases of clinical trials, with emphasis on phase II and III trials. 

 This project is part of the EDCTP2 programme supported by the European Union (grant number RIA2020S-3303-GELA).

 ABOUT THE PARTNERS

Cochrane South Africa

Cochrane South Africa (SA) is an intramural research unit of the South African Medical Research Council and is part of the global, independent Cochrane network of researchers, professionals, patients, carers and people interested in health. It aims to promote evidence-informed healthcare decision-making in South Africa and sub-Saharan Africa by producing high-quality, relevant, accessible systematic reviews and other synthesised research evidence.

https://southafrica.cochrane.org/about-us

Cochrane

Cochrane focuses on producing relevant and timely synthesised evidence and is a global advocate for evidence-informed health and health care. We work towards a world of improved health where decisions about health and health care are informed by high-quality, relevant and up-to-date synthesised research evidence. Our members and supporters come from more than 130 countries, worldwide.

https://www.cochrane.org/

MAGIC

The independent non-profit Norwegian MAGIC Evidence Ecosystem Foundation was set up in 2018 to provide sustainable and professional services to our customers (e.g. MAGICapp) while pursuing the evidence ecosystem vision through continued research and innovation.

MAGIC leads the work package on disseminating and communicating CPG recommendations to healthcare providers and the public. GELA will make use of innovative formats and the MAGIC authoring and publication platform (MAGICapp) to adapt, translate WHO guidelines for national and local use. MAGIC will also support development and adaptation of the guideline recommendations, customised to the needs of decision makers and making use of the GRADE EtD framework.

https://magicevidence.org/

Centre for Evidence-based healthcare, Stellenbosch University

The CEBHC is a recognised leader nationally and globally for research and practice in teaching and learning for evidence-based health care (EBHC). Based at the Faculty of Medicine and Health Sciences they support undergraduate and post-graduate training in all aspects of EBHC. They lead a Masters in Clinical Epidemiology programme recognised throughout the continent. Leads at SU have spearheaded several projects linked to evidence synthesis, knowledge translation, building capacity of policymakers and researchers for evidence-informed policymaking, and supported national and international guideline projects.  

https://www.cebhc.co.za/

NIPH

The Norwegian Institute of Public Health (NIPH) acts as a national competence institution placed directly under the Ministry of Health and Care Services. Our social mission is to provide knowledge and systematic reviews to contribute to good public health efforts and healthcare services. In this way we contribute to better health, both in Norway and globally.

https://www.fhi.no/en/

Cochrane Nigeria

Cochrane Nigeria at the University of Calabar Teaching Hospital's Institute of Tropical Disease Research and Prevention is involved in the production and dissemination of relevant and priority systematic reviews of healthcare interventions, provision of technical support for development of trustworthy clinical practice guidelines and knowledge translation activities involving the media. Our long term strategic goal is to strengthen stakeholders' capacity to use evidence to inform decisions for positive individual and population health outcomes within Nigeria and the West African sub-region.

https://nigeria.cochrane.org/

Kamuzu University of Health Sciences

Kamuzu University of Health Sciences (KUHeS) is a public-owned university established in 2019 under the act of parliament by merging the Kamuzu College of Nursing (est. 1979) and College of Medicine (est. 1991). As a key government partner, the university continues to serve the Malawi nation through provision of quality education and innovation through research as key to the health welfare of Malawi, the region and beyond. Through research the university generates evidence that informs government policies and practice in the health sector. KUHeS is an internationally recognised institution currently leading the teaching of systematic reviews, evidence-based healthcare and formulation of evidence-informed health guidelines in Malawi.

www.kuhes.ac.mw 

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