Wednesday, May 11, 2022

Now is the time to ‘up our game’ in using evidence to address health challenges

The COVID-19 pandemic created a once-in-a-generation focus on evidence. We now have the opportunity to systematize the aspects of evidence use that are going well and to address the many gaps.

Alongside the 75th World Health Assembly, Cochrane and the Global Commission on Evidence to Address Societal Challenges co-hosted a virtual side event which brought together a global panel to discuss some of these issues.

Speakers:

• Dr Soumya Swaminathan, Chief Scientist, WHO
• Fitsum Assefa Adela, Ministry of Planning and Development, Ethiopia
• Steven J. Hoffman, member of Canada's WHA delegation; Scientific Director, CIHR Institute of Population & Public Health
• Dr Maria Endang Sumiwi, Director General of Public Health at the Ministry of Health, Indonesia
• John Lavis, Co-Lead, Evidence Commission
• Dr John Grove, Director of Quality Assurance for Norms and Standards, WHO

Co-chairs:

• Judith Brodie, Interim CEO, Cochrane
• Sylvia de Haan, Head of Advocacy, Communications and Partnerships, Cochrane

About the session

During the roundtable, leaders from WHO Member States who use evidence to guide national decision-making were encouraged to reflect on their work – and share what they need from evidence producers, evidence intermediaries, and multilateral organizations. Cochrane, the WHO Evidence-informed Policy Network and the Evidence Commission then discussed their shared vision and recommendations.

The session was a dialogue between both the demand and supply side of evidence – highlighting the key priorities for the evidence-informed future we want and need, and the conditions needed to get us there.

 

Related links:

• Cochrane Convenes report
• Evidence Commission report
• WHO EVIPNet 

Friday, May 27, 2022

Tuesday, May 10, 2022

在牙科用抗生素预防细菌性心内膜炎（心腔内璧严重性感染或发炎） 综述问题 本Cochrane综述旨在了解，细菌性心内膜炎（一种可致命的严重感染或心腔内壁炎症）风险增加者是否应在侵入性牙科手术前常规给予抗生素，以降低心内膜炎的发生率、死亡人数以及这群人所经历的严重疾病数。 研究背景 细菌性心内膜炎是一种感染，倾向于发生在之前心脏已有受损或畸形的区域。它通常可用抗生素治疗。虽然罕见，但细菌性心内膜炎可能会危及生命。即使用抗生素治疗，多达30%的感染者可能会死亡。 侵入性牙科手术可能会使有风险者发生细菌性心内膜炎。此方式所直接造成的细菌性心内膜炎（如果有的话）病例数尚不可知。许多牙科手术可导致菌血症，这是指血液中出现细菌。虽然菌血症通常可由身体的免疫系统迅速处理，但有些专家认为，它可能使某些高风险者发生细菌性心内膜炎。 许多国家的指南建议，在进行侵入性牙科手术前，给细菌性心内膜炎高风险者用抗生素。但其他权威人士则质疑抗生素的常规使用，争辩道，过度处方药已使许多生物体对常见抗生素产生了耐药性，而偶有发生的抗生素不良反应（严重过敏反应）可能超过潜在的益处。 2007年，美国心脏协会的指南更改了建议，指出仅在牙科手术前对细菌性心内膜炎高风险者使用抗生素。英格兰和威尔士的国家健康照护卓越研究所（National Institute for Health and Care Excellence, ...

'Interventions to reduce the risk of coronavirus SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus‐2) infection among workers outside healthcare settings'

What is the aim of this review?

Coronavirus (COVID‐19) is a respiratory infectious disease that has spread globally. People infected with SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus‐2) can develop critical illnesses and may die, particularly older people, and those with underlying medical problems. Different interventions that attempt to prevent or reduce workers' exposure to SARS‐CoV‐2 in the workplace have been implemented during the pandemic. This Cochrane Review evaluated the effects of these interventions on the COVID‐19 infection‐rate, absenteeism, COVID‐19‐related mortality, and adverse events.  

What was studied in this review?

The authors searched for studies that examined interventions according to the following four categories: 1) elimination (for example self‐isolation strategies); 2) engineering controls (for example barriers to separate or distance co‐workers, and workers from members of the public); 3) administrative controls (for example working from home); 4) personal protective equipment (for example use of face masks or other types of face covering). We included studies of any worker outside the healthcare setting. We searched for studies without language or time restrictions. 

What are the main findings of this review?

The author team screened more than 13 thousand reports, and included one study, conducted in 162 secondary and post‐secondary schools in England, from March to June 2021. The study enrolled more than 24 thousand workers. In the 86 schools in the control group (standard isolation), staff who were considered COVID‐19 contacts through contact tracing were required to self‐isolate at home for 10 days. In the 76 schools in the intervention group (test‐based attendance), staff who were considered COVID‐19 contacts through contact tracing were not required to isolate. Instead, they took a daily rapid test (lateral flow antigen test) for seven days. If the rapid test was negative, the staff member could go to work. If the rapid test was positive, the staff member would self‐isolate. The researchers wanted to know if there was a difference in COVID‐related absence between the two methods. 

The author team are uncertain whether a strategy of test‐based attendance changes COVID‐19 infection rates (any infection; symptomatic infection) compared with routine isolation after contact with a person with COVID‐19. COVID‐related absence may be lower or similar in the test‐based attendance group. 

However, they were uncertain about these findings, because the number of infections was very low among the participants. Mortality, adverse events, quality of life, and hospitalisation were not measured. Seventy‐one per cent of the test‐based attendance group followed the strategy; the researchers did not report on compliance for the standard isolation group. 

The team identified one ongoing study that also addressed the effects of screening in schools.

Another ongoing study is evaluating the effects of using a face shield to prevent COVID‐19 transmission. 

The authors did not find any studies that studied engineering or administrative controls.

Matteo Bruschettini, Director of Cochrane Sweden, who led the review explains, 

“Millions of scientific papers are published every year, and during the pandemic there were many about covid-19. It is not an easy task to keep up to date with the results of all these. Systematic reviews are one way of weighing up all the studies carried out in a specific field and providing an overview of the results of these studies.  This review investigating how workplace interventions reduced the spread of covid-19 assessed 13, 000 scientific articles published on the subject, however only one study could be included in the review. 

Almost none of the studies had the study design required to answer the question of whether the effects of the intervention reduced the risk of SARS-CoV-2 infection in non-healthcare workplaces. This surprised us. These systematic reviews are important because they can provide answers to questions that are of extreme concern to millions of people in workplaces around the world. 

We were able to identify two studies that had not been completed by September 2021 that may be included in the future. One assesses the benefit of face shields in preventing covid infection and the other looks at covid-19 screening in schools.”

How up‐to‐date is this review?

The author team searched for studies that were available up to 14 September 2021.

• Read the full review
• Read the Lund University press release (in Swedish)

 

Monday, May 9, 2022

Monday, May 9, 2022

在社区为高收入国家的难民儿童和青少年提供心理健康支持 定居在高收入国家的难民儿童和青少年由于在迁移之前、期间和之后面临的许多挑战而面临心理健康问题的风险。 关键信息 迄今为止，证据的数量或质量都不足以推荐在实践中应该实施哪些干预措施。有必要对现有的针对儿童难民和寻求庇护者的心理健康支持计划和干预措施进行评估，以便为支持该人群心理健康的有效方法提供证据。 我们想知道什么？ 我们旨在评估在社区中为生活在高收入国家的难民儿童和青少年开展的心理健康促进、预防和治疗的证据。一些项目或干预措施可能侧重于通过社区建设和社会支持促进心理健康（以改善心理健康），而另一些项目或干预措施可能侧重于通过个性化的专科护理来治疗心理健康问题。 我们做了什么? 我们于2021年2月23日通过在线数据库和注册库检索了研究。 若研究涵盖18岁及以下儿童或青少年难民，并在高收入国家进行基于社区的心理健康干预评估，均被评定为合格。 我们有何发现？ 我们纳入了38项包含广泛研究设计、受试者特征和干预措施的研究。三项研究采用了随机对照试验设计，这三项研究中患者接受的治疗是随机决定的；它们通常可以提供有关治疗效果的最可靠证据。我们通过这些研究来评估干预措施的有效性和不良事件发生所显示的可接受性。 证据的局限性是什么？ 纳入试验的质量存在重要的局限性。没有证据表明干预措施的可接受性。与心理健康问题症状、心理困扰和行为相关的有...

经胸多普勒超声心动图检测成人肺动脉高压 本综述研究了什么？ 肺动脉高压是从心脏右半部向肺部供应血液的血管有高血压。这是一种严重的疾病，可损害右侧心脏。血管壁变得厚硬，使得血液更难流动。这会导致心力衰竭。症状可包括气短、疲倦、胸痛、心跳加速或下肢和腹部肿胀。 症状可与其他心肺疾病相似，因此诊断需要时间。早期诊断有益，因为治疗可以尽早开始。尽早开始治疗会更好，因为人们在疾病的早期阶段对治疗的反应更好。不及早诊断可产生严重的后果，例如日常生活失能甚或死亡。 诊断肺动脉高压的最准确方法是用称为右心导管术的压力测量。然而，此法是侵入性的，而且会引起并发症。另一种技术被称为多普勒超声心动图，是无创的，更便宜，而且在医院有更广泛的应用。因此，许多指南推荐使用超声心动图作为初步诊断方法。我们想做本综述是因为有几项研究质疑超声心动图的准确性。我们想了解在诊断肺动脉高压方面，超声心动图与右心导管术相比是有多好。 本综述的目的是什么？ 评价超声心动图相较于右心导管术以识别成人肺动脉高压的能力的证据。 综述主要结果是什么？ 我们发现了17项研究，涉及3656名疑似肺动脉高压患者。 研究中有很多变化。我们发现，受试者的特征在年龄、性别、肺动脉高压的原因、条件环境和国家方面有所不同。选择用于诊断肺动脉高压的超声心动图读数的临界值也有变化。我们用可及数据来估计超声心动图相较于右心导管术的表现有多好。大多数纳入...

音乐疗法治疗自闭症患者 系统综述问题 我们评价了有关音乐疗法对自闭症患者疗效的证据。我们比较了接受音乐治疗（或标准治疗中加入音乐治疗）的人与接受类似治疗但没有音乐（“安慰剂”治疗）、标准治疗或不接受治疗的人的结果。 背景 自闭症是一种终身的神经发育疾病，会影响人们如何感知周围的世界，以及他们如何与他人交流和相处。因此，社交互动和社交沟通是自闭症患者面临的主要困难领域。音乐疗法利用音乐体验和通过其发展的关系，使自闭症患者能够与他人相处，交流，并分享他们的感受。通过这种方式，音乐疗法解决了自闭症患者的一些核心问题。自1950年代初以来，音乐疗法已应用于自闭症。它对自闭症患者的可用性因不同国家和环境的不同而异。音乐疗法的应用需要专门的学术和临床培训。这有助于治疗师根据患者的具体需求调整干预措施。我们想调查音乐疗法与其他疗法相比是否对自闭症患者有帮助。 检索日期 目前的证据截至2021年8月。 研究特征 我们在这次更新中纳入了16项新研究，所以现在本综述中的证据基于26项研究，总共有1165名受试者。这些研究检验了音乐疗法干预（三天到八个月）对于一对一或小组环境中的自闭症儿童、青少年和青壮年的短期和中期效果。没有一项研究报告研究结果受到与商业利益有关的机构资助；报告的资助来源包括政府、大学和基金会的资金；在三项研究中，音乐治疗协会提供了支持。 主要结果 与“安慰剂”治疗或标准治疗相比，音...

物质使用障碍者的音乐治疗 本综述的目的是什么？ 我们旨在评估标音乐治疗加标准照护对物质使用障碍者是否有效，在影响物质渴求、治疗动机和保持清醒或不用动机方面。我们还对其在抑郁和焦虑方面的影响证据感兴趣，因为这些是复发危险因素。 关键信息 音乐治疗作为标准照护的“附加”治疗，很可能会降低戒毒和康复机构内成年人的物质渴求，并增加其治疗动力。音乐治疗长于1节课时与物质渴求的更大降低有关。没有证据显示对抑郁、焦虑、保持清醒或不用动机或治疗保留有影响。没有关于不良事件的数据。 进行本综述为何重要？ 本综述可以帮助确定音乐治疗是否对有问题物质使用和治疗动机的某些方面产生有益影响。 本综述研究了什么? 物质使用障碍是指持续用药，包括非法药物和处方药，不论有无酒精，既使是在这些物质导致健康问题或对社会功能有负面影响时。全世界约有3500万人有药物使用问题，每年有超过300万人死于有害性饮酒。音乐治疗通过使用一系列主动和接受性音乐参与形式来消解物质使用障碍受治疗者的身心需求，这可促进各种神经生物、心理和社会过程。音乐治疗师是卫生专业人士，他们使用特定的音乐干预来帮助其客户管理情绪、应对刺激、体验掌控感并形成健康的人际关系。 本综述的主要结果是什么？ 我们纳入了21项研究，涉及1984名受试者。所有受试者都被诊断出患有物质使用障碍，其中有52%报告称酒精是其选用的物质。2项研究的受试者同时有心理健康问...

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:  Monday 6th June 2022, 9am GMT. The recruitment agency will be longlisting applications as soon as they receive them, so please apply early to register your interest. 

Cochrane aims to put evidence at the heart of health decision-making globally. They collaborate to produce trusted synthesized evidence, make it accessible to all, and advocate for its use. Cochrane is seeking a Director of Development to work with their global community to grow fundraising income and ensure Cochrane has a sustainable and successful future.

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 new role will lead the Development Directorate (which includes fundraising, advocacy, communications, partnerships, member and supporter engagement) and will establish a fundraising operation that works collaboratively to deliver significant global income growth. The Director of Development will play a key part in the transformation of the organisation as part of the 2021-2023 Strategy to ensure that Cochrane maintains its relevance and pre-eminence into the future.

Cochrane is seeking an ambitious individual who relishes a challenge, loves collaborative working, delivers results and has extensive experience of successfully delivering strategy. The ideal candidates will possess an understanding and experience of international fundraising, strong relationship management skills, and experience of working at director-level. 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.

• Obtain the candidate pack and further information on how to apply
• Read our Recruitment Privacy Statement 

Friday, May 6, 2022 Category: Jobs

负压伤口疗法用于管理腹腔开放非创伤患者有何益处与风险？ 关键信息 - 我们不知道，负压伤口疗法（negative pressure wound therapy, NPWT)，定义为低于给定参考压力的压力，通常会引起抽吸）是否有助于腹部伤口更快愈合或减少潜在的有害影响，相较于使用Bogota袋（用于闭合腹部伤口的消毒液袋）。 - 我们不知道，Suprasorb CNP系统（一种NPWT）是否有助于腹部伤口更快愈合或减少潜在的有害影响，相较于使用ABThera系统（另一种类型的NPWT）。 - 我们不知道NPWT是否增加肠穿孔的风险。未来的研究应探索愈合时间、潜在的不良或有害影响、全因死亡、住院时间、健康相关生活质量、再手术率、伤口感染以及疼痛结局。 何为开放腹腔？ 一个人的腹部有时需要在手术后愈合时保持开放。然而，高死亡率与手术后保持腹腔开放有关。管理腹腔开放对患者和医生来说是一个相当大的负担。 这是如何管理的？ NPWT用连接至真空泵的密封敷料从而自伤口排出液体。然而，NPWT作为腹腔开放治疗的安全性和有效性仍不确定。 近年来，NPWT已被用于治疗腹部术后的非创伤患者。非外伤患者是指需要手术治疗非外伤引起的疾病（如腹部感染、癌症、缺血）的人。 我们想了解什么？ 我们想了解，在任何照护环境中，NPWT是否对非创伤患者术后腹腔开放治疗有效。我们想将NPWT与其它治疗方法或其他类型的N...

老年综合评估用于有不良健康结局风险的社区老年人 随着全球预期寿命的增加，迫切需要探索不同的方式方法，从而在最适宜的环境中为有需要的老年人提供恰当的医疗照护。越来越多的老年人生活在衰弱中，这是一种临床综合征，其特征是负性健康结局（包括早逝、入住护理院或独立性丧失）的脆弱性。 我们想了解，有衰弱老年照护专长的健康照护专业人士（如医生、护士或治疗师）所提供的有组织的统筹照护，称为老年综合评估（Comprehensive Geriatric Assessment或CGA）），是否增加了老年人活着和仍然住在社区（而非护理院）的机会，与社区衰弱老年人的常规照护相比。我们还想了解CGA是否降低了入院或急诊就诊的可能性，以及CGA对老年人功能和生活质量造成的可能影响。 CGA可在老年人自己家里或在社区其他环境中进行，由具有老年医疗照护专长的健康照护团队来提供。我们寻找的研究，用以比较基于CGA的照护与老年人在社区接受的常规照护。 综述作者发现21项相关研究，提供了四大洲10个国家的7893名衰弱老年人的信息。本综述显示，接受CGA而非常规照护的老年人的总体死亡风险并无显著降低。 虽然入住护理院的机会似乎没有改变，但有低质量证据显示，接受CGA者的入院风险可能更低。 虽然CGA似乎对急诊就诊需求或跌倒没有影响，但并无足够的研究让我们查看这些方面并给出结论。 我们检索了截至2020年4月的研究。 作...

大麻和大麻素用于治疗多发性硬化症患者 关键信息 • 与安慰剂相比，萘哌啶醇治疗很可能导致痉挛改善且可能不会增加严重有害影响。 • 与安慰剂相比，大麻素（萘哌啶醇 、大麻提取物、合成大麻素）很可能会改善患者自评结局所衡量的健康状况。 • 由于缺乏稳健的证据，这些药物在治疗慢性神经性疼痛方面的益处并不清楚。 问题是什么？ 许多患有多发性硬化症（multiple sclerosis, MS）的人会经历痉挛，这也会引起疼痛，还会影响进行日常活动的能力。痉挛是肌肉张力增加的一种形式。基于大麻的药物是指使用大麻或其被称为大麻素的成分作为缓解MS痉挛、慢性疼痛和其他症状的药物疗法。1项国际调查发现，MS是最常使用大麻的五种病况之一。在英国进行的另1项调查发现，超过五分之一的MS患者报告称他们曾用大麻来控制其症状。 我们想知道什么？ 我们想知道大麻素是否比安慰剂更能用于改善成人MS： • 痉挛； • 慢性神经性疼痛； • 健康状况， 我们还想知道大麻素是否与以下情况有关： • 因不良反应而中断治疗； • 严重的有害影响； • 神经系统疾病或精神疾病； • 药物耐受性（定义为当身体习惯了一种药物因而需要更多药物时出现的一种状况）。 我们做了什么？ 我们检索了比较大麻素与安慰剂用于成人MS的研究。我们比较和总结了它们的结果，并根据研究方法和证据质量等因素来评定了我们证据的可信度。 我们发现了什么？ ...

Specifications: Full Time 6 month Fixed Term contract (potential opportunity to extend)
Salary:  circa £40,000 per annum
Location: UK, Remote
Application Closing Date: 18 May 2022 (midnight GMT)

The Evidence Production and Methods Directorate in Cochrane is made up of three departments that are responsible for the efficient and timely production of high-quality Cochrane Reviews addressing research questions that are most important to decision makers.

As Quality Assurance Editor within Cochrane’s Editorial Department, you will assess whether protocols, reviews and updates submitted to Cochrane’s Central Editorial Service have met Cochrane’s methodological standards. You will recommend editorial decisions based on the quality of the methods in the articles submitted, provide feedback to authors on their articles, and support members of the Central Editorial Service with methods queries. 

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 deadline to receive your application is by 18 May 2022. 
• 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 

Wednesday, May 4, 2022 Category: Jobs

Dear Friends and Colleagues

Due to the continued global impact of COVID-19 (coronavirus) with ongoing reduced/restricted travel from many regions, and the advent of geo-political instability and risks in the European region, we have taken the decision to postpone the Global Evidence Summit (GES 2), due to be hosted in Prague between 2 – 6 October 2023.

The Global Organising Committee (comprising four partners:  Cochrane, JBI, GIN and Campbell) concluded, with the agreement of our local host - CEBHC-KT and Masaryk University, that the most appropriate decision is to postpone the Summit until 9 – 13 September 2024. As global leaders in evidence-informed healthcare, the partners take very seriously our responsibility and duty of care to our communities in the face of continuing risks.

However, we are committed to working together, along with additional organizations, to present the third Annual World EBHC Day on 20 October, 2022. This is a global initiative that raises awareness of the need for better evidence to inform healthcare policy, practice and decision making to improve health outcomes globally.

This second postponement of the second Global Evidence Summit is disappointing news for all of us and we would like to thank the vast number of people, including our local hosts, who have been working hard on preparations over the past year. We are in no doubt that we will be able to build successfully on the work accomplished so far to ensure that when GES 2 does go ahead in September 2024 in Prague it will be everything we anticipated: a world-class scientific event and a memorable gathering of the evidence-based healthcare community. 

We thank you for your ongoing support and commitment to the Global Evidence Summit and will look forward to meeting again for this unique event in 2024. 

Recent developments have shown the world can be volatile and unpredictable, requiring us to remain vigilant and responsive – collaborations such as this are even more important.   We hope that you all remain safe and well during these extraordinary times. 

Miloslav Klugar
Director, CEBHC-KT (Czech Cochrane, JBI and GRADE centres), Chair of the GES Scientific Committee

Judith Brodie
Interim CEO, Cochrane

Zoe Jordan
Executive Director, JBI

Elaine Harrow
CEO, Guidelines International Network

Vivian Welch,
Interim CEO, The Campbell Collaboration

Wednesday, May 4, 2022

药品保险监管政策的效果 本Cochrane综述旨在了解药物保险计划是否会改变人们对药物的使用、药物花费以及其健康状况和对医疗保健的使用。Cochrane综述作者收集并分析了所有相关研究以回答此问题。他们找到了58项研究。这些研究大多是来自美国，评估了2006年1月所实施的单一政策的变化（医保D部分）。 关键信息 美国医保D部分为老年人提供免费处方药。此体系可增加老年人的药物用量，但药物花费却更少。我们不知道此体系是否会改变人们的健康或是改变其对医疗保健服务的使用，因为证据质量极低。 什么是药品保险计划？ 在药品保险计划中，政府或私人组织以低成本或免费向人们提供其所需要的药物。药费通常通过政府税收、雇主、人们所支付的保险计划会员费或是这些体系的组合来支付。 许多国家有混合的公共和私人药品保险体系。有些药品保险计划覆盖一个国家或环境内的每个人。其它计划则仅涵盖特定群体。例如，有些计划只涵盖有工作者，而另一些则仅覆盖穷人和老年人。 成功的药品保险计划可通过免费或以其负担得起的价格向其提供所需的药物，从而改善人们的健康。药品保险计划还可为政府和私人组织节省资金。例如，用药正确者可能需要更少的医疗保健服务。运行这些计划的政府和组织也可以与制药公司协商出更好的价格。 综述的主要结果是什么？ 综述作者发现了58项相关研究。这些研究大部分来自美国，其中54项研究评估了一种药物保险计划：医保D部分...

利塞膦酸钠预防绝经后妇女骨质疏松性骨折 本综述总结了我们从截至2021年3月24日的证据中了解到的关于利塞膦酸钠预防骨质疏松引起的骨折（骨头断裂）的作用。 什么是骨质疏松症，什么是利塞膦酸钠？ 骨骼是你身体中有生命的、不断生长的部分。在你的一生中，新的骨细胞生长，旧的骨细胞分解，为新的、更强壮的骨质腾出空间。当你患有骨质疏松症时，旧骨的分解速度要快于新骨的替代速度。在这种情况下，骨骼会失去矿物质（如钙）。这会使骨骼变得更脆弱，即使在轻微受伤后，如轻微碰撞或摔倒，也更容易发生骨折。经历过更年期的女性比其他人更容易患骨质疏松症。 利塞膦酸钠属于双磷酸盐类药物。它是一种减缓细胞分解旧骨速度的药物。 对于骨密度接近正常或脊柱尚未发生骨折的绝经后妇女，骨折风险较低： -没有足够的证据告诉我们利塞膦酸钠是否会减少女性骨折人数； -基于有限的数据，没有证据表明骨折风险较低的绝经后女性的不良事件增加。 已被诊断出患有骨质疏松症（骨密度低或脊柱骨骼已经发生骨折）的绝经后女性，骨折风险较高，利塞膦酸钠： -可能预防髋骨和除脊柱以外的骨骼骨折； -在预防腕部骨折方面可能不会产生任何差异； -没有足够的证据表明其是否可预防临床体征和症状提示的脊柱骨折； -对于骨折风险较高的绝经后女性，不良事件可能几乎无差异。 对服用利塞膦酸钠或安慰剂的骨折风险较低的绝经后妇女的最佳估计： -对于临床症状和体征提示的脊柱...

A potential game-changer in the tuberculosis epidemic was how the tuberculosis community viewed rapid molecular tests for tuberculosis and tuberculosis drug resistance. This was 12 years ago, with the launch of Xpert MTB/RIF, which gives results in less than two hours, simultaneously diagnosing tuberculosis and testing if the bacteria have rifampicin resistance, a type of drug-resistant tuberculosis. Multidrug-resistant tuberculosis is caused by resistance to at least both rifampicin and isoniazid, the two most effective first-line drugs used to treat tuberculosis. 

Yet, diagnostic tests only have an impact on health if they are put to use in a correct and timely manner. To ensure diagnostics are accessible and utilized, we need to understand the views of recipients and providers who have used these tests, and a new qualitative evidence synthesis review published by the Cochrane Infectious Diseases Group (CIDG) pulls together all relevant research to date on Xpert MTB/RIF and similar tests. The authors also wanted to understand the implications of the review findings on effective implementation and health equity.

Rapid molecular tests have been shown to be accurate in diagnosing tuberculosis and rifampicin resistance and are recommended by the World Health Organization as the initial test in people with presumptive tuberculosis, replacing sputum microscopy, a test from the 19th century. These tests have many benefits, including the fact that they do not require well-equipped laboratories and skilled personnel, and can be carried out in community health settings, nearer to where people live. This is particularly relevant in low- and middle-income countries, settings with a high burden of tuberculosis.

Examining the evidence from 32 included studies, the review author team identified aspects of these tests that users valued  most and challenges to realizing those values.  People with tuberculosis valued an accurate diagnosis (knowing what is wrong with me), avoiding delays, and keeping diagnostic-associated cost low. Similarly, healthcare providers valued test accuracy and confidence in results (which helps in starting treatment), rapid results, and keeping cost to people seeking a diagnosis low. In addition, providers valued diversity of sample types (for example, gastric aspirate specimens and stool in children) and ability to detect drug resistance early. Laboratory professionals appreciated the improved ease of use compared to microscopy and increased staff satisfaction.

Reported challenges included reluctance to test for tuberculosis owing to stigma or cost concerns; health system inefficiencies such as poor quality of specimens, difficulty in transporting specimens, lack of sufficient staff or equipment, increased workload for providers, inefficiencies in integrating the test into clinic routines and clinicians relying too much on the test result at expense of their own experience with diagnosing tuberculosis; as well as implementation processes hampered by insufficient  data about real-life situations, lack of inclusion of all relevant stakeholders (local decision-makers, providers or people seeking a diagnosis), and conflicts of interest between donors and people implementing the tests.

Nora Engel, lead author of the review, explains: 

“The findings reveal a fundamental paradox between supporting technological innovations but not in parallel investing in health system infrastructure strengthening. The view that these low-complexity diagnostics are a solution to overcome deficiencies in laboratory infrastructure and lack of skilled professional is misleading. Implementation of new diagnostic technologies, like those considered in this review, will need to tackle the challenges identified in this review including weak infrastructure and systems, and insufficient data on ground level realities prior and during implementation, as well as problems of conflicts of interest in order to ensure quality care and equitable use of resources.”

The review authors called for future research to examine the implications of repurposing diagnostic infrastructure and equipment for COVID-19 and the issue of competition for diagnostic resources more generally.

Engel N, Ochodo EA, Karanja PW, Schmidt BM, Janssen R, Steingart KR, et al. Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD014877. DOI: 10.1002/14651858.CD014877.pub2

• Read the plain language summary
• Read the full Cochrane Review
• Visit the Cochrane Infectious Disease website

This news article was first published on the LSTM website.

Monday, May 2, 2022

Cochrane is delighted to announce the availability for the first time of RevMan Web, its popular, web-based systematic-review production software, to the wider community beyond Cochrane – to support evidence synthesis development and evidence-based medicine education. Cochrane expects interest in use of the tool from those in guideline and Health Technology Assessment organisations, 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. 

Charlotte Pestridge, Cochrane’s Director of Publishing and Technology, says this is a hugely exciting opportunity:

“Making RevMan Web more widely available is an important element in Cochrane’s contribution to healthcare research and our mission to deliver evidence-informed policy and practice through the production of systematic reviews. It is important for Cochrane to be able to support the production of high-quality reviews using Cochrane standards and methodologies. Many review-producing organisations, including key Cochrane stakeholders, already use RevMan.”

 RevMan Web is now available by subscription to government and commercial organizations. Availability for academic institutions and individual subscribers is expected to come on stream before the end of 2022. Free access will be available in Reseach4Life Hinari low and middle-income countries.

To find out more:

• https://links.cochrane.org/revman
• RMWsubscriptions@cochrane.org
• View and Download flyer

Wednesday, June 1, 2022