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 

Wednesday, April 6, 2022

Tuesday, March 29, 2022

在没有附加条件的情况下向中低收入国家的人们捐款会带来更好的健康和其他生活改善吗？ 综述问题 在有些中低收入国家（low- and middle-income countries, LMICs），政府和其他组织有时会向穷人或弱势群体（如老年人或孤儿）提供资金，但并不要求其做任何特别的事情以获得资金（“无条件现金转移”）。在其他项目中，人们只有在做出需要的行为时才能收到这笔钱，如使用某些医疗服务或送孩子上学（“有条件的现金转移”）。本综述旨在了解，接受无条件现金转移是否会改善人们的医疗服务利用及实际健康状况，与不接受无条件现金转移、接受较小的无条件现金转移或有条件接受现金转移相比。它还旨在评估无条件现金转移对那些决定健康及医疗保健支出的日常生活条件的影响，如上学、拥有牲畜、有工作或极度贫困。 研究背景 无条件现金转移是一种针对收入的社会保护干预。目前尚不清楚，无条件现金转移与有条件转移相比是否更有效、较低效或同等有效。我们综述了相关结局证据，涉及无条件现金转移对中低收入国家儿童和成人卫生服务利用及健康结局的影响。 我们发现了什么? 我们纳入了LMICs中所有年龄段人群无条件现金转移的实验性研究和选定设计的非实验性研究。我们纳入了比较接受无条件现金转移者和那些未接受转移者的研究。我们寻找了查验卫生服务利用和健康结局的研究。 我们发现了34项研究（25项实验性研究和9项非实验性研究），共...

卒中患者认知损伤的职业治疗 本综述的目的是什么？ 本Cochrane综述旨在了解职业治疗是否能改善卒中后日常活动及认知功能。认知是由大脑进行的信息加工处理，如思考、留意您所看或所听事物、学习、记忆及解决问题。Cochrane研究人员收集并分析了所有相关研究以回答这个问题，共发现了24项研究。 关键信息 对于卒中后有认知问题者，职业治疗或许对个体进行自我照护活动（如淋浴和穿衣）的能力几乎产生不了有意义的影响，在职业治疗后即刻及6个月之后。职业治疗可能会提高这些人的一般信息处理技能和留意看某物的能力，在干预后即刻。职业治疗可能会略微改善某些方面的记忆力和灵活思考的能力。 证据质量意味着，我们的发现大多是低或极低证据质量。需要更多精心设计的研究来检验卒中后认知损伤的职业治疗干预。 本综述研究了什么？ 卒中后认知问题很常见，而且会影响个体进行日常自我照护活动（如穿衣、喂食和淋浴）以及居家或社区活动（如家务或杂货店购物）的能力。 卒中患者在卒中后可在医院、康复中心或居家接受一系列治疗。职业疗法是其中疗法之一。职业治疗师与有卒中后认知问题者一起工作，以帮助其尽可能变得独立。为此，治疗师通过教其适应或弥补问题的方法，或通过训练活动来提高其认知（如记忆力训练），亦或组合用这些方法。 本综述的主要结果是什么？ 综述作者发现了来自11个国家的24项有关研究。这些研究比较了职业治疗与对照组，对照组是卒...

导丝或造影对比：哪种更适合用于预防内镜下逆行胰胆管造影后胰腺炎？ 关键信息： • 内镜下逆行胰胆管造影（endoscopic retrograde cholangiopancreatography, ERCP）结合内窥镜检查及X射线来诊断和治疗胆管与胰管问题。与使用导管将造影剂注入胆管的传统技术相比，采用导丝技术进入胆管可能会降低ERCP后胰腺炎（pancreatitis, PEP）风险，还可能提高进入胆管的成功率。 • 该领域的未来研究应侧重于导丝技术的效果以及降低PEP风险的其他选择（例如，直肠给予抗炎药、向胰管插入塑料管）。 什么是ERCP术后胰腺炎（PEP）？ ERCP结合内镜（使用称为内窥镜的医疗器械检查身体的内部）和X射线来诊断和治疗胆管与胰管（支持消化过程的结构）方面的问题。患者处于镇静状态下，内窥镜经过食管（气管）进入小肠，及至胆管和胰管（乳头）开口所在处。导管通过内窥镜和乳头插入胆管。将造影剂注入胆管，并照射X射线以寻找胆结石或阻塞。然而，ERCP的主要风险是由于造影剂或导管对胰管的刺激而发生胰腺炎（胰腺炎症），这可能发生于全部手术的5%至10%之中。这可能是有自限性的、轻微的，但也可以严重的和需要住院治疗的。少见的是，它可能会危及生命。出血或肠壁穿孔的风险也很小。 我们想知道什么？ ERCP期间有两种进入胆管的技术。传统技术（造影对比）包括将导管插入乳头并注射...

抗生素用于治疗女性压力性尿失禁以预防术后感染 综述问题 接受失禁手术的压力性尿失禁女性用抗生素预防感染是否安全有效？ 研究背景 压力性尿失禁（stress urinary incontinence, SUI）定义为腹压剧增时（如咳嗽、打喷嚏或大笑时）尿液不受控制地漏出。失禁手术是SUI的一种治疗。有两种术式：开放手术，如阴道悬吊术（腹部切口，在尿道任一侧的阴道内缝合，置管使尿液自膀胱排出），或是侵入性较小的术式，如腹腔镜阴道悬吊术（用小切口以置入缝线）、吊带术（用胶带或网状物在尿道周围形成吊带以将其提升至正常位置并附于腹壁上），或膀胱颈部注射填充剂（如胶原蛋白）。手术部位或泌尿道感染是所有失禁手术后的常见并发症。预防性抗生素有预防术后伤口感染的潜力，但支持性证据仍然有限。 本综述的时效性如何？ 我们检索了截至2021年3月18日的随机对照临床试验（randomised controlled trial, RCTs；每个人都有相同的机会接受所测试的治疗）以及准RCTs（quasi-RCTs；有一种被测试的治疗，但并非每个人都有相同的机会接受它）。 研究特征 我们纳入了3项研究（有7份报告），共涉及390名女性，她们接受了两种不同失禁术式中的一种，并接受了3种不同剂量的抗生素（头孢唑啉）或安慰剂或不治疗中的一种。各试验样本量范围为26至305名女性。无1项纳入研究清楚地指明结局评估的...

益生菌治疗儿童慢性便秘 本综述的目的是什么? 本Cochrane综述旨在了解益生菌是否可用于治疗儿童儿童（0至18岁）非身体缘由的慢性便秘。 我们分析了来自14项研究的数据以回答此问题。 关键信息 有关益生菌相较于安慰剂治疗儿童非身体缘由的便秘对排便频率的影响，我们尚不能得出结论。2组之间的治疗成功率可能并无差异。 益生菌加缓泻剂与单用缓泻剂相比，排便频率或治疗成功率可能均无差异。 有关益生菌相较于氧化镁对排便频率或治疗成功率的影响，我们也不能得出结论。 与安慰剂相比，合生元制剂治疗过的儿童可能有更高的排便频率。 益生菌制剂相较于安慰剂，因不良事件而退出研究者可能并无差异。 因退出研究人数少，我们无法就其他任何比较的安全性得出结论。 本综述研究了什么？ 儿童常有长期便秘，当找不到潜在的身体缘由时，则被我们谓为“功能性便秘”。 已表明，益生菌与合生元制剂可能有助于改善这些儿童的症状。益生菌是含有活菌的制剂，已有提议认为其对消化系统有益。合生元还包括支持这些细菌生长的食物成分。 关于情况是否就是如此，或如何更好利用这些制剂，目前尚无共识。 本综述的主要结果是什么？ 我们检索了随机对照临床试验（其受试者经随机方法被分配至两个或更多个治疗组之一），以比较任何益生菌或合生元治疗与任何其他治疗（如假/安慰剂治疗）用于非身体缘由所致的慢性便秘儿童。我们找到了14项试验，纳入了1127名18岁以...

Specifications: Full Time (Permanent)
Salary: £60,000 per annum
Location: Flexible, UK
Application Closing Date:  Friday 15 April 2022

A wonderful new opportunity has come up on the team at Cochrane, a brilliant not-for-profit publishing organisation that facilitates global medical research. They are now looking for a new Head of Editorial who will lead the editorial operations and oversee the transition of editorial processes to a centralised system. With lots of change and growth planned, this is an exciting opportunity to join an expanding team and be involved with the strategic direction and leadership of the team.
 
Reporting into the Editor in Chief, you will have responsibility for:

• Overseeing a small team of direct and indirect reports
• Managing editorial operations for articles submitted, contributing to the development of new processes for direct submissions
• Attending editorial board meetings as part of senior management team
• Contributing to the editorial strategy for the launch of new journals and supplementary products
• Facilitating communication and collaboration among different directorates 

The ideal candidate will possess strong leadership skills and the ability to manage relationships with key stakeholders both internal and external to the business. Candidates applying do need experience with Editorial Manager as this is a new system which has been implemented. They will ideally come from an scholarly publishing background - ideally STM, and understand the importance of systematic reviews, research platforms and digital resources, and their role within research. Some experience of line management and budget management will be great, together with familiarity with a charity organisation or the healthcare sector.

Cochrane is 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. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information. An understanding of Cochrane’s work and health research more generally is an advantage, but not essential.

How to apply
If you're interested in finding out more about this great role, get in touch with Shalini Bhatt at Inspired Selection with your CV via s.bhatt@inspiredselection.com.

Friday, March 25, 2022 Category: Jobs

The World Health Organization (WHO) has issued an updated postnatal guideline which is supported by evidence from Cochrane Pregnancy and Childbirth reviews and one Cochrane Incontinence review.

Cochrane has been a non-governmental organization in official relations with WHO since 2011, and a major aspect of this partnership is supporting WHO’s global health guidelines with relevant evidence synthesis.

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.

In March 2022, WHO released the updated comprehensive guideline called ‘WHO recommendations on maternal and newborn care for a positive postnatal experience’. It focuses on the weeks shortly after the birth and makes 63 recommendations on maternal care, newborn care, health systems, and health promotion during the postnatal period.

The guideline draws on the evidence from a suite of systematic reviews and qualitative evidence syntheses, including 13 Cochrane Reviews. These Cochrane Reviews cover:

• Relief of postpartum pain (5 reviews; 3 recommendations) 
• Pelvic floor muscle training for pelvic floor strengthening (1 review; 1 recommendation) 
• Preventing and treating breast engorgement and mastitis (2 reviews; 4 recommendations) 
• Preventing postpartum constipation (1 review; 1 recommendation) 
• Vitamin D supplementation for term breastfed infants (1 review; 1 recommendation)
• Timing of discharge from health facilities to the home (1 review; 1 recommendation)
• Schedules for postnatal care contacts (1 review; 2 recommendations)

As well as the 12 Cochrane Reviews, a Cochrane qualitative evidence synthesis on the factors that influence the provision of postnatal care was used to help understand the acceptability and feasibility of different aspects of postnatal care, according to health workers. 

The Cochrane evidence highlights the broadened scope of the guideline, and sheds important light on some of the most common experiences of women after having a baby.

Evidently Cochrane Author Jessica Hatcher-Moore with her first baby at home, days after giving birth. Jessica had a positive first experience of birth but felt poorly prepared for what came next. Image: © Philip Hatcher-Moore

“The WHO guideline sets out clear recommendations around the common health issues women experience after giving birth. It brings renewed and due focus to the importance of a positive postnatal experience at the heart of care - because no woman should ever feel abandoned by health services after having a baby”, says Aleena Wojcieszek, a clinical epidemiologist, science communicator, and honorary research fellow at the Australian Centre of Research Excellence in Stillbirth (Stillbirth CRE). “I was excited to highlight the need for real investment in postnatal care and urgent need for high-quality research in a recently Evidently Cochrane blog. It’s written jointly with Jessica Hatcher-Moore, a new mother, and illustrates how good postnatal care should aim to meet every individual woman’s needs, leaving the new mother, her baby and family with a positive experience of this critical period in their lives.”

"Cochrane is extremely proud of this valuable work and our continued partnership with WHO", said Dr Karla Soares-Weiser, Editor in Chief of the Cochrane Library. "This particular collaboration makes it possible to translate the latest maternal and perinatal health evidence into practice quickly, which ultimately benefits more people's health."

• Read 'WHO recommendations on maternal and newborn care for a positive postnatal experience' 
• Read the Evidently Cochrane blog: 'Putting positive experiences at the centre of postnatal care' 
• Visit the Cochrane Pregnancy and Childbirth website
• Visit the Cochrane Incontinence website

 

Wednesday, March 30, 2022 Category: The difference we make

在HIV阴性或不明HIV状态的成人中进行症状问询和胸部X光以筛查肺结核的准确性如何？ 为何改进肺结核筛查很重要？ 在结核病常见环境中进行系统筛查是早期发现结核病的推荐策略。筛查有助于找出更可能患肺结核者，以便对其进行确认检测。这些是另外的检测用以确认存在结核分枝杆菌，即导致结核病的细菌。询问结核病症状（如咳嗽、咳血、发热和疲劳），做胸部X线（chest X-ray, CXR）以显示肺部异常，都是常用的筛查方法。结核病可用抗生素治疗，这意味着，早期发现可能会降低死亡率和患病率，减少结核病的传播，并能更公平地获得照护。 有肺结核存在但却未被识别出（假阴性结果）可能就会造成治疗延迟和进一步的传播。相反，认为是阳性的筛查结果可能会造成不必要的确认检测，这会给个体和公共卫生体系带来负担。 了解筛查检测如何经常造成假阳性和假阴性结果（此谓准确性）可能有助于选择筛查方法。 本综述的目的是什么？ 了解症状问询和CXR作为对HIV不明或阴性成人的肺结核筛查检测如何准确。 本综述研究了什么？ 我们研究了三种症状问题的诊断准确性：（i）咳嗽2周或更长时间，（ii）持续任何时间的咳嗽，以及（iii）任何肺结核症状。对于CXR，我们研究了对阳性结果的两种定义：（i）任何CXR肺部异常以及（ii）提示结核病的CXR肺部异常。结果由接受过放射影响培训的工作人员解读。 本综述的主要结果是什么？ 本综述纳入了59...

Cochrane's incidents with Instagram, Twitter, and YouTube highlight the realities of Cochrane’s call against misinformation while protecting trusted sources. Cochrane’s Instagram posts have been removed, their Instagram account has been shadow banned, a Youtube video removed, and a Cochrane Library Twitter post about winning a prestigious award for trustworthy information was tagged as misleading.

Cochrane’s health evidence syntheses are recognised as the international gold standard for high quality, trusted information. Cochrane Library reviews are used to support global and national health guidelines and policy. We advocate for evidence-informed healthcare and make our trusted evidence accessible and available to all. One way we do this is using social media to reach different audiences. 

Cochrane has been the subject of several Instagram misinformation blunders. A post about a Cochrane Review on Ivermectin for prevention and treatment of COVID-19 being removed from the platform in August 2021, and it wasn't until July 2022 that the review notification came back saying it was because it 'goes against Community Guidelines'. Also Cochrane’s Instagram account has been denied the verification blue check mark several times. 

In March 2022, the prestigious Harding Prize for Useful and Trustworthy Communication was jointly awarded to by the ONS Covid Infection Survey and the Cochrane Review of Hydroxychloroquine for COVID-19. The Harding Prize, run in association with Sense About Science and the Science Media Centre, and is supported by Sir David Harding,  goal is to draw attention to the unsung task of 'informing and not persuading' and celebrate those who were doing it well. The Harding Prize judges noted that the Cochrane Infectious Disease Group’s review of the evidence for the use of hydroxychloroquine in treating COVID-19 used clear language, communicated straightforwardly, and with balance that that there was no benefit to hydroxychloroquine which outweighed the side effects and that trials of it should be stopped. This review was done with rigorous methodology and communicated with clarity and directness, which enabled policy makers, journalists, and the public to discuss and make decisions based on the best evidence. 

It was particularly ironic that a celebratory tweet from the Cochrane Library about winning an award for useful and trustworthy communication was tagged by Twitter for being misleading. This tag does not allow it to be replied to, shared, or liked. 

The latest fumble has been a webinar video being removed from Cochrane's YouTube channel for violating Community Guidelines. The video is a recording on the topic of research integrity, where Dónal O'Mathúna discussed findings from his recent study comparing different systematic reviews of the ivermectin literature. After appealing the removal, the video has be restored back to YouTube: 'Ethics and integrity in reviewing research: lessons from ivermectin'.

“Social media platforms are starting to act on mis/disinformation by tagging posts that are deemed misleading and penalizing repeat offenders. But they don't always get it correct - we are aware that other research publishers, such as the BMJ, have also experienced similar issues with Facebook”, says Catherine Spencer, Cochrane’s CEO. “Having Cochrane blocked and posts removed, while other misleading posts remain, illustrates the system needs urgent improvement. This 'censorship' on credible sources of information such as Cochrane underscores the need to not only guard against misinformation but that we urgently need better mechanisms to protect trusted information on social media.”

“These social media blunders come after the  launch of the Cochrane Convenes Report which highlights the parallel challenges of generating trust in evidence and countering mis/disinformation and calls for concrete action to address these issues”, says Cochrane’s Editor in Chief, Dr Karla Soares-Weiser. “There is an ongoing issue with how you hold those deliberately creating and sharing mis/disinformation to account and how you form accreditation and approval for official sources of evidence that have met certain quality control standards. We need to make it easier for people to access trustworthy information – and that includes on social media or YouTube.”

Cochrane is a proud supporter of WHO’s call to action on infodemic management and is currently collaborating with science communicators at Lifeology and the Association for Healthcare Social Media. We would welcome the opportunity to discuss this recurrent issue with social media platforms directly and to work with others interested in supporting science communication. Write to us at cochrane@cochrane.org, and consider signing our call to action on trusted evidence for all in health emergencies.

• Cochrane Convenes website 
• Free Course: What is an infodemic and how can we prevent it?  Available in English, French, German, Malay, Simplified Chinese, and Spanish 
• Cochrane joint winner of 2021 Harding Prize for Useful and Trustworthy Communication

Friday, October 7, 2022

Tuesday, March 15, 2022

妇科癌症患者的围手术期加速术后康复计划 系统综述背景 妇科癌症导致大量的发病率和死亡率。手术，无论是通过腹腔镜（锁孔手术）还是开放手术技术，都是治疗妇科癌症最重要的方法之一。精心策划的围手术期护理（手术时或手术前后的护理）对于术后恢复至关重要。 近年来，研究人员和医生提出，传统围手术期护理实践的许多方面可能是不必要的，甚至是有害的。例如，使用口服泻药和灌肠剂可能导致术前钠、钾或钙水平异常以及脱水。术后加速恢复（enhanced recovery after surgery, ERAS）计划旨在减少手术压力并避免传统围手术期护理的有害方面。它已逐渐被引入各种外科领域，特别是肠外科。ERAS计划可能有助于术后恢复、缩短住院时间并节省住院费用，而不会使患者面临更大的风险。然而，关于ERAS计划对妇科癌症女性患者的影响知之甚少。本综述旨在评价围手术期ERAS计划在妇科癌症护理中的利弊。 研究特征 我们检索了中英文数据库（截至2020年10月），发现了涉及747名妇科癌症患者的七项试验，包括宫颈癌、子宫癌、卵巢癌和子宫内膜癌。其中五项研究仅招募了患有疑似或确诊妇科癌症的女性，两项研究还包括一小群患有良性或交界性肿瘤的女性。三项研究招募了接受剖腹手术（外科医生在腹部切开一个大切口）的女性，两项研究纳入了接受腹腔镜手术（一种只需要小切口的微创手术）的女性。另外两项研究同时使用了这两种手术。然后...

胰腺的排泌管附着于小肠第二部分是否比其他重建方法更能减少胰液渗漏至腹部组织？ 关键信息 - 我们尚不知道，相较于内陷胰空肠吻合术（将胰腺插入小肠的第二部分），导管对粘膜胰空肠吻合术（胰腺排泌管与小肠第二部分连接）是否减少术后胰瘘（胰液自胰腺渗漏至腹部组织）。 - 我们尚不知道，改良导管对粘膜胰空肠吻合术是否优于、等同于或劣于传统导管对粘膜胰空肠吻合术。 - 未来的研究应该用足够适当的方法来提高我们的证据可信度。 什么是术后胰瘘？ 胰腺是位于上腹后的消化腺；它对血糖的正常控制也很重要。胰腺癌或炎症的标准手术治疗是通过称为胰十二指肠切除术的手术部分切除胰腺头部及其附近肠道。胰十二指肠切除术涉及重新连接胰腺和小肠的第二部分（称为胰空肠吻合术），从而使含有消化酶的胰液进入消化系统。新连接愈合不当时，就会发生术后胰瘘，以致胰液从胰腺泄漏至腹部组织。术后胰瘘是一种会延迟手术恢复的并发症，通常需要进一步治疗以确保完全愈合。 我们可以做些什么来减少术后胰瘘？ 对于接受胰十二指肠切除术者，重新连接胰腺和小肠第二部分的方法包括： - 导管对粘膜胰空肠吻合术； - 内陷胰空肠吻合术； - 捆绑式胰腺空肠造口术（胰腺和小肠的第二部分捆扎在一起）。 导管对粘膜胰空肠吻合术是一种在世界范围内都常用的方法，用以减少胰十二指肠切除术后胰瘘。然而，导管对粘膜胰空肠吻合术的安全性和有效性仍不确定。 我们想了解什么？...

Monday, March 14, 2022

The inaugural Harding Prize for Useful and Trustworthy Communication has been jointly won by the ONS Covid Infection Survey and the Cochrane Review of Hydroxychloroquine for COVID-19.

The Winton Centre at the University of Cambridge launched the Harding Prize this year to celebrate individuals or teams who had communicated information in a trustworthy and useful way - that genuinely helped people decide what to do, or help them judge a decision made by others. The award was run in association with Sense About Science and the Science Media Centre, and is supported by Sir David Harding. The organisers wanted to draw attention to the unsung task of 'informing and not persuading' and celebrate those who were doing it well.

The Harding Prize aims to encourage evidence to be presented in a balanced, non-manipulative way, open to talking about pros and cons, and about uncertainties, designed to help the audience make up their own mind on a subject – not to lead them to the conclusions that the communicator wants them to draw.

Dr Bhagteshwar Singh, and his co-authors of the Cochrane Review, published by the Cochrane Infectious Diseases Group said:  “We are honoured to receive this award. Our aim was to provide clinicians, policymakers and the public with a balanced, trustworthy, and clear account of the potential benefits and harms of hydroxychloroquine when used for COVID-19. This award confirms that our review was communicated clearly and transparently, which we are thrilled to hear.”

The organisers bought together an illustrious judging panel, comprising:

• Helen Boaden (Chair): previously Director of BBC News.
• Professor Sir Jonathan Van-Tam: Deputy Chief Medical Officer for England
• Baroness Onora O’Neill: philosopher and presenter of 2002 Reith Lectures on ‘A Question of Trust’
• Fraser Nelson: Editor, Spectator
• Helen Jamison: previously Deputy Director of the Science Media Centre.

The judges made the following comments about Cochrane as a joint winner:

As with all its projects, the Cochrane review worked to internationally agreed methodology and prioritised high quality (randomised) evidence. This particular review was a summary of the evidence for the use of hydroxychloroquine in treating Covid-19. Using clear language, it communicated straightforwardly and with balance that that there was no benefit to hydroxychloroquine which outweighed the side effects and that trials of it should be stopped. That decision was then made. 

This subject may seem minor in the UK where treatment by hydroxychloroquine was never a big part of medical discussion. However, many millions of people around the world, especially in the USA and Brazil, were encouraged by their leaders to take this treatment seriously. 

The panel felt that just as the ONS survey was the bedrock of accurate information about Covid-19 infection rates in the UK, the Cochrane approach delivered rigorous, trustworthy and balanced reviews of scientific papers communicated with clarity and directness. Such reviews enabled policy makers, journalists and the public to discuss and make decisions based on the best evidence. 

Helen Boaden, Chair of the judging panel, commented: “It's never been more important for the public and policy makers to have access to the best possible evidence before they make significant decisions for themselves or others. Both our winners set the gold standard  for clearly communicating accurate, trustworthy, transparent data without frills or spin. The panel is delighted to jointly award them the inaugural Harding Prize.”

Professor Sir David Spiegelhalter, Chair of the Winton Centre, said: “The panel considered many fine examples, and we are delighted with the examples that they chose. We had intended to have a booby, ‘weasel words’ prize for untrustworthy communication dressed up as an unbiased source. There were many possible candidates, particularly in social media and in scientific pre-prints that had not gone through any peer review. But we finally decided that it would be inappropriate to highlight, and indeed publicise, such poor practice, and instead chose to focus on the positive efforts people have made. The Royal Society’s recent report makes clear that online misinformation is best tackled, not through censorship, but by encouraging a diverse media, independent fact-checking, careful monitoring, and education.”

Tracey Brown, director of Sense about Science, said: “Statistics are the currency of public life. They are how we can describe the world and debate what is getting worse or better, and never more so than during the pandemic. We are so pleased to support the Harding prize in celebrating the individuals who have sought to equip people with the means to be part of those debates."

Fiona Fox, Chief Executive of the Science Media Centre, said: “These are fantastic winners. The brilliant thing about the ONS survey is that it was communicated independently from the government communications machine so that the media and the public got to see the numbers every week free from government messaging.  And in the middle of an ‘infodemic’ where 1000s of scientific papers of variable quality were circulating, Cochrane’s high quality review summarising where the best evidence lay on a much-hyped treatment undoubtedly saved lives.”

Emma Rourke, Director of health analysis and pandemic insight at ONS, said: :The Covid Infection Survey has required the skill and perseverance of a large and multi-talented team. At our core has been the need to communicate such an important and sensitive issue accurately to a diverse audience, and be trusted to do so. We are delighted with this award, and are gratified that the information we have provided has proved valuable to expert users and influential on policy, but also understood clearly by the public."

• Read the full Cochrane Review Chloroquine or hydroxychloroquine for prevention and treatment of COVID‐19
• Learn more about Cochrane Infectious Diseases Group
• Liverpool School of Tropical Medicine Press Release

Monday, March 14, 2022 Category: The difference we make

哪些影响全身的治疗方法最适合治疗严重的皮肤反应（史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症）？ 关键信息 用依那西普（一种降低免疫系统特定部分的药物）而不是类固醇（广泛降低免疫系统）来治疗严重的皮肤反应，或许可以使史蒂文斯-约翰逊综合征和中毒性表皮的死亡人数减少。 我们不确定其他治疗的有效性，例如类固醇和环孢菌素（作用于免疫系统的药物）或免疫球蛋白（天然产生的抗体）。我们需要在多个地点开展更多研究，以比较最重要治疗方法的有效性和安全性。 是什么导致严重的皮肤反应？ 某些药物可能会引发严重的皮肤反应，称为史蒂文斯-约翰逊综合征 ( Stevens-Johnson syndrome, SJS)，更严重的疾病称为中毒性表皮坏死松解症 (toxic epidermal necrolysis, TEN)，或重叠综合征 (SJS/TEN)。这形成大的皮肤水泡，留下疼痛的疮。受影响的皮肤最终会剥落（坏死）。病例很少见，但如果它们导致感染或影响其他器官，则可以是致命的。 严重的皮肤反应是医疗紧急情况，需要在医院进行治疗，通常是在重症监护室或烧伤病房。治疗包括支持性护理，例如液体和营养、伤口护理和止痛药物。 我们想了解什么？ 除了支持性护理外，口服或注射治疗还包括作用于免疫系统的药物（例如依那西普）和静脉注射免疫球蛋白（抗体）。 我们想了解这些疗法在治疗严重皮肤反应方面的效果如何。 我们做了什么...