延迟引入渐进式肠内喂养以预防极低出生体重儿坏死性小肠结肠炎 研究背景 极早产（提前超过八周出生）或极低出生体重（VLBW；小于1500克）新生儿有发生严重肠道疾病的风险，称为坏死性小肠结肠炎（肠道发炎并坏死）。在子宫内生长受损的婴儿被认为具有发生坏死性小肠结肠炎的高风险。极早产儿或极低出生体重儿最初喂养少量牛奶，几天后逐渐增加奶量。在出生后将母乳的引入和增加量推迟几天（或更长时间）可能是降低这种情况风险的一种可能方法。 研究特征 我们检索了临床试验以评估延迟（出生4天后）与早期引入乳类喂养（母乳或配方奶粉直接通过胃管导入胃中）对极早产儿或极低出生体重儿坏死性小肠结肠炎、死亡和一般健康风险的影响。检索截至2021年10月。 主要研究结果 我们纳入了14项试验，共1551名婴儿参与。有证据显示这些婴儿中约有一半在子宫内有生长受限。对这些试验的综合分析表明，延迟引入渐进式肠内喂养可能不会降低坏死性小肠结肠炎或死亡的风险。延迟喂养可能会略微降低喂养不耐受的风险，但可能会增加发生严重感染的风险。 结论和证据质量 本综述提供的低质量证据表明，延迟引入肠内喂养可能不会降低极早产儿或极低出生体重儿（包括子宫内生长受损的婴儿）坏死性小肠结肠炎或死亡的风险。 作者结论:  将渐进性肠内营养的引入推迟到出生后4天之后（与早期引入相比）可能不会降低极早产儿或极低出生体重儿发生坏死性小肠结肠炎或...

Tuesday, January 18, 2022

在学校环境中实施控制COVID-19疫情的措施 本综述研究了什么？ 为减少导致疾病COVID-19的病毒的传播，很多政府和社会团体在学校内采取了减缓疫情的措施。但是，我们不知道这些措施在减少病毒传播方面是否有作用，或者这些措施是如何影响生活的其他方面，例如教育、经济或整个社会。 学校环境中所实施的措施有哪些？ 在学校环境中的措施可分为以下四大类。 1.减少接触机会的措施 ：通过减少班级或学校的学生人数，仅开放特定类型的学校（例如小学）或通过制定学生在不同日期或不同周次上学的时间表，即可减少学生之间面对面的接触。 2.使接触更安全的措施 ：通过落实戴口罩等措施，通过开窗或使用空气净化器来改善通风，还有清洁、洗手或调节身体活动如体育运动或音乐等，即可使接触更安全。 3.监测和应对措施 ：筛查症状或检测患病或有可能患病的学生或教师，或两者皆有，并将其置于隔离病房（对患者而言）或检疫隔离区（对可能的患病者）。 4.多成分措施 ：将第1、2和3类措施组合在一起。 本综述的目的是什么？ 我们旨在了解在COVID-19疫情期间，在学校环境中实施的哪些措施允许学校安全重开、保持开放或两者皆可。 我们做了什么？ 我们所检索的研究，要检视在学校环境中施行的各种措施的影响，涉及导致COVID-19的病毒的传播、医疗保健系统（即需要多少张病床）以及重要的社会方面（即学生多常去上学）。这些研究可侧重于学生...

在学校环境中实施控制COVID-19疫情的措施：一项快速综述 本综述研究了什么？ 为减少导致疾病COVID-19的病毒的传播，很多政府和社会团体在学校内采取了减缓疫情的措施。但是，我们不知道这些措施在减少病毒传播方面是否有作用，或者这些措施是如何影响生活的其他方面，例如教育、经济或整个社会。 学校环境中所实施的措施有哪些？ 在学校环境中的措施可分为以下四大类。 1.减少接触机会的措施 ：通过减少班级或学校的学生人数，仅开放特定类型的学校（例如小学）或通过制定学生在不同日期或不同周次上学的时间表，即可减少学生之间面对面的接触。 2.使接触更安全的措施 ：通过落实戴口罩等措施，通过开窗或使用空气净化器来改善通风，还有清洁、洗手或调节身体活动如体育运动或音乐等，即可使接触更安全。 3.监测和应对措施 ：筛查症状或检测患病或有可能患病的学生或教师，或两者皆有，并将其置于隔离病房（对患者而言）或检疫隔离区（对可能的患病者）。 4.多成分措施 ：将第1、2和3类措施组合在一起。 本综述的目的是什么？ 我们旨在了解在COVID-19疫情期间，在学校环境中实施的哪些措施允许学校安全重开、保持开放或两者皆可。 我们做了什么？ 我们所检索的研究，要检视在学校环境中施行的各种措施的影响，涉及导致COVID-19的病毒的传播、医疗保健系统（即需要多少张病床）以及重要的社会方面（即学生多常去上学）。这些研...

Cochrane Crowd is a citizen science platform  where a global community of volunteers help to classify the research needed to support informed decision-making about healthcare. Cochrane Crowd volunteers review descriptions of research studies to identify and classify clinical trials.

 A new task has just gone live on Cochrane Crowd. It is a citation screening task that we are doing in partnership with The Healthcare Improvement Studies Institute (THIS Institute).

It forms a part of a methodological study that aims to assess the accuracy of crowdsourcing the screening of search results. Unlike some of the previous studies we’ve done, this one is a little bit different. Instead of asking you to assess a record for possible relevance, we want you to assess it for irrelevance! Our hypothesis is that a crowd can still make a big difference in weeding out the obviously irrelevant records, and that by framing the task in this way, we will reduce the chances of possibly relevant records being rejected.

Are you up for joining this task? If so, head to crowd.cochrane.org and log in. On your tasks page you should see a task called: Training for healthcare professionals in electronic fetal monitoring using cardiotocograph.

We are going to run this study as a randomised study. When you click on the training module, you will be randomised to one of three tasks. Each of the three tasks will look exactly the same. The difference between the three tasks is the agreement algorithm in the background. This algorithm provides a ‘final’ classification on a record based on a certain number and order of individual classifications made by contributors. We are testing three different agreement algorithms as part of this methodological study.

There is of course a training module. It should only take around 10-15 minutes to complete. Once done you will be able to screen some ‘real’ records. Do as many as you like. If you manage to do 250 or more, you will get named acknowledgement in any write-ups of this methods study and be able to download a certificate.

As always, this kind of work would not be possible without the help of this fantastic community. If you are able to take part, then thank you very much indeed from the teams at THIS Institute and Cochrane Crowd.

If you have any questions, please don’t hesitate to get in touch with me: anna.noel-storr@rdm.ox.ac.uk

With best wishes to all and happy citation screening!

Anna and Sarah

• Visit Cochrane Crowd here
• Read The THIS-Crowd Exclusion Study FAQ's
• Follow Cochrane Crowd on Twitter

Friday, January 14, 2022

Location: UK based role with occasional global travel
Salary: £110-120,000 per annum
Contract type: Permanent
Date closing: 06/02/2022

Cochrane is a global independent community of more than 100,000 people who search for and summarize the best evidence from health and care research to help our beneficiaries make informed choices about health and care.  

Our members and supporters come from more than 220 countries worldwide including researchers, health professionals, patients, carers, and people passionate about improving health and care outcomes for everyone, everywhere.

Chief Executive
£110, 120,000 per annum
UK based role with occasional global travel

Cochrane’s work providing accessible, credible information to improve global health - has never been more important or relevant than it is today.

This Chief Executive role is an extraordinary opportunity for an inspirational, experienced and authentic leader, passionate about evidence and health care, to join Cochrane and work with a highly committed and engaged Board and talented staff team to lead the development of a new long-term strategy.

We are seeking someone with experience working in a multi-stakeholder environment, ideally in a global context, with exceptional interpersonal and communication skills with proven capacity to develop influential internal and external relationships.  Thoughtful, curious, and with a supportive leadership style; you will bring a strong track record of leading teams; fostering a high-performing culture; driving organisational change and growing income.  Critically, you will share our vision of a world of better health for all people where decisions about health and care are informed by high-quality evidence.

Cochrane is a global community and we value the diverse range of experience that this brings.  We strive to be an equal opportunities employer and welcome application from people from all races, religions, genders, sexual orientation, lived experience or ability.

• For further information, the role and how to apply please download the full appointment brief here  
• Closing Date: Sunday 6th February 2022
• If you require this document in an alternative format, please contact executiveadmin@prospect-us.co.uk or call 020 7691 1920

Thursday, January 13, 2022 Category: Jobs

Senior Research Integrity Editor, Lisa Bero, discusses this subject in a recent Nature article.

Never has it been more important to foster trust in scientific evidence than in the ongoing coronavirus pandemic. Cochrane is committed to independence, transparency, and integrity in healthcare research. The Research Integrity Team works to support and strengthen this commitment through research, policy development and implementation, advocacy and community outreach.

Recently, Senior Research Integrity Editor, Lisa Bero, has written a World View in Nature on the topic of working together to tackle the issue of problematic studies – studies where there are serious concerns about the trustworthiness of the data or findings. In the article she explains the tools and resources Cochrane uses as described in its policy for ‘Managing potentially problematic studies’, to empower reviewers to act when they suspect an issue. 

Research Integrity Editor, Stephanie Boughton, says “It was great to highlight Cochrane’s leading work in this area. We are building upon Cochrane’s strong history of conducting meta-research to detect research integrity problems. I hope all systematic review authors take up Lisa’s call to action and use tools described in Cochrane’s policy for ‘Managing potential problematic studies’ when they suspect an issue.”

• Read the full article by Lisa Bero in Nature
• Find out more about Cochrane’s Research Integrity Team  

Wednesday, January 19, 2022

接受透析治疗的成年人的运动训练 研究问题是什么？ 与一般人群相比，接受透析治疗者患心血管疾病和抑郁的风险更高，生活质量更低，且生存期有限。此外，许多接受透析者进行日常活动有困难，因为其缺乏身体能力和力量去这么做。有多项试验评估了运动训练用于改善成年透析者的状况，但尚未达成共识。 我们做了什么？ 我们检索了医学文献，以找到所有评估透析者结构化运动项目的随机临床试验。继之，我们评估了这些研究的质量，并合并其结果以做出结论，有关运动训练在改善对透析患者而言有重要价值的身心健康方面的影响。 我们发现了什么？ 我们发现了89项研究，涉及4291名受试者。运动训练项目持续8周至2年，多常在透析治疗期每周进行3次。我们无法确定运动训练对死亡、心血管事件（如心脏病发作）或心理健康的影响。中等质量证据表明，任何类型的运动训练都可能改善成年透析者的抑郁症状，尤其是当运动持续超过4个月时。中等质量证据还表明，运动训练或许会通过改善人们的行走能力及其腿部力量与耐力来提高其执行活动和任务的能力。运动训练或许还会改善疲劳及躯体层面的生活质量，但证据质量为低。我们无法就运动训练对个体心理健康的影响做出结论。 结论 对接受维持透析者进行运动训练可能会改善抑郁及其执行活动和任务的能力。运动训练或许也会轻微改善疲劳和疼痛。运动训练或许会改善身体层面的生活质量，但尚不清楚它是否能改善个体的心理健康。目前尚不清楚运动训...

胰和十二指肠（小肠的第一部分）部分切除术，肠道重建路径的益处和风险是什么？ 关键信息 -胰和十二指肠部分切除术后，结肠前重建可能不会减少胃排空延迟。 -我们的结果显示这两种技术在其他发病率、死亡率、住院天数和生活质量方面，并不存在相关差异。 背景 胰脏是位于上腹部的消化腺，对血糖的正常控制也很重要。而胰腺癌是工业化国家癌症死亡的主要原因之一。腺头癌和癌前病变的标准手术治疗是切除部分胰腺以及附属的十二指肠，这称为胰十二指肠切除术。切除十二指肠需要恢复从胃到肠道其余部分的消化路径。这可以通过将其连接到空肠（小肠的第二部分）或大肠（横结肠）的前端（前结肠）或后端（后结肠）来完成。 我们想要发现什么？ 我们想知道上述两种重建方法中是否有一种能减少胃排空延迟（进食后胃排空）、术后死亡率、其他并发症如胰瘘（胰液渗漏）、再手术、围手术期措施（术前、术中和术后）或住院天数，从而对患者有益，或提高生活质量。胃排空延迟是本综述的主要结局，因为它是胰十二指肠切除术后最常见的并发症之一，它会使患者由口进食变得困难并影响患者的生活质量，并且通常导致住院时间研长，延误进一步的治疗。 我们做了什么？ 我们检索了比较部分切除胰腺和十二指肠患者结肠后重建与结肠前重建的研究。比较和总结了研究的结果，并根据研究方法和样本量等因素评估了证据的可信度。 我们发现了什么？ 我们共纳入八项随机对照试验（发表在11篇文献上）8...

补钙以预防高血压 系统综述问题 研究旨在确定补钙对血压正常人群血压的影响。 研究背景 高血压是一种严重的健康问题，可增加心脏疾病和肾脏疾病的发病风险。多个研究表明，即使血压正常，增加钙摄入量也能降低血压。增加钙摄入量也对妊娠结局有益，这一作用被认为也是通过降低血压来实现的。高血压已被确定为是死亡的主要危险因素，即使是血压的小幅下降，也能减少冠状动脉疾病、卒中和死亡的发生。 研究特征 本研究纳入评估膳食钙干预措施（钙补充剂或食品强化剂）对所有年龄段血压正常者血压影响的研究。最新检索时间是2020年9月。 主要结果 本综述分析了20项试验的数据，其中18项试验（3140名受试者）提供了干预效果的数据。结果表明增加钙摄入量可使收缩压下降1.37mmHg，舒张压下降1.45mmHg。钙摄入量＞1000mg/天，效益更好；1000-1500mg/天时，收缩压降低1.05mmHg；≥1500mg/天时，收缩压降低2.79mmHg。 11-82岁的人群血压均有所下降，尤其年轻人的血压下降更明显。＜35岁人群收缩压降低1.86mmHg，≥35岁人群收缩压降低0.97mmHg。 尚无研究报告不良事件。现需进一步研究以确定理想的钙补充剂量，以及膳食钙和钙补充剂哪种更有效、更安全。 证据质量 男性和女性的收缩压和舒张压相关证据为高质量。≥35岁受试者的相关证据也是高质量，年轻受试者相关证据为中等质量。...

Specifications:  Part Time, 1 day per week
Location: UK based (remote)
Application Closing Date: 25 January 2022

Cochrane UK is seeking a dynamic, self-motivated Transition Support Project Manager to lead and manage a support service for UK-based Cochrane Review Groups (CRGs) and those who work with them during a period of transition to a new review production model. 

You will join a small and friendly team at Cochrane UK and will work closely with the UK-based CRGs, Cochrane’s Editorial and Methods Department (EMD) and Cochrane Support Service to develop and operate processes to minimize disruption during the transition period.   

You will have in-depth knowledge and understanding of the existing Cochrane publication model and editorial processes.  You will have experience of the processes involved in conducting and editing systematic reviews and submitting funding bids.  You will have excellent communication and project management skills with the ability to build effective stakeholder relationships.

The role will be for 1 day per week with the potential to increase if, and when,  the requirements of the project change over the next 12 months.   

This role can be arranged either as a secondment (with your employer’s permission) or with you working as a self-employed contractor. 

If you would like more information please contact Therese Docherty, Business & Programme Manager (therese.docherty@cochrane.nhs.uk) for the full job description and person specification.

Deadline for applications: 25 January 2022.

Monday, January 10, 2022 Category: Jobs

Specifications: Full Time
Salary:  £42,000 per annum
Location: UK based (remote)
Application Closing Date: 31 January 2022

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.

• 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 31 January 2022 (12 midnight GMT).

Monday, January 10, 2022 Category: Jobs

慢性阻塞性肺病患者的自我管理 综述问题 我们查看了有关自我管理干预对慢性阻塞性肺病（chronic obstructive pulmonary disease, COPD）患者的影响的现有证据。尤其是，我们评估了它们在健康相关生活质量（health-related quality of life, HRQoL）以及COPD相关住院方面的有效性。我们还想通过评估死亡人数来评估自我管理干预是否安全。 研究背景 COPD是一种常见的慢性肺病状态，历经多年缓慢恶化，并造成呼吸短促、咳嗽、喘鸣和多痰（粘液）等症状。这会导致COPD患者的幸福感下降（亦称HRQoL降低）。自我管理干预鼓励人们发展所需要的技能与行为，以成功管理其疾病及可能与之相随的情绪和实际问题。在本次更新中，我们综述了当前证据，涉及自我管理对HRQoL、COPD相关住院、任何原因死亡和COPD相关死亡以及其他健康结局的影响。 检索日期 我们检索了截至2020年1月的研究。 研究特征 我们纳入了27项研究，涉及6008名受试者，评估了COPD自我管理干预的有效性和安全性。受试者年龄范围为57岁至74岁。各研究有33%至98%的受试者是男性。研究开展是在四个不同的大陆（欧洲15项，北美8项，亚洲1项，大洋洲4项；1项研究在欧洲和大洋洲都有开展）。所有研究皆以接受常规照护的受试者为对照组，亦即COPD患者典型照护。各研究持续2.5...

钙通道阻滞剂与其他类别的降压药物对比 本系统综述的目的是什么? 在对2010年发表的系统综述首次更新中，我们想了解与其他降压药物相比，将钙通道阻滞剂（calcium channel blocker, CCB）用于高血压的患者，是否可以预防心血管伤害事件，如中风、心脏病发作和心力衰竭。 系统综述背景 适当降低高血压患者的血压，可以减少高血压主要并发症，如中风、心脏病发作、充血性心力衰竭，甚至死亡。CCB被用作一线降压药物，但其是否为减少心血管伤害事件的最佳方法，一直存在争议。 检索日期 我们收集并分析了截至2020年9月1日的所有相关研究。 研究特征 我们找到了在欧洲、北美、大洋洲、以色列和日本进行的23项相关研究。这些研究将CCB和其他类别的降压药物治疗高血压患者进行了对比，其中纳入了153849名受试者。对受试者的随访时间为2年至5.3年。 关键结果 对比CCB和其他降压药物，由各种原因导致的死亡人数无差异。相比于CCB，也许利尿剂更能减少心血管事件和充血性心力衰竭的总量。CCB可能比β受体阻滞剂更能减少心血管事件总量。与血管紧张素转换酶（angiotensin-converting enzyme, ACE）抑制剂相比，CCB可减少中风；与血管紧张素受体阻滞剂（angiotensin receptor blocker, ARB）相比，CCB可减少心脏病发作；但与ACE抑制剂和A...

Location: Flexible location (remote working) – contract type dependent on location.
Specifications: 1 Mar to 1 September 2022. Fixed-term employment contract if successful applicant based in UK, Germany or Denmark. Consultancy contract in other locations.
Hours: Full time 37.5 hours per week.
Salary: £30,000 per annum.
Application Closing Date: Sunday 23 January 2022 (Midnight GMT).

This role is an exciting opportunity to use your communication and problem-solving skills to make a difference in the field of healthcare research and publishing.  

Cochrane recently implemented Editorial Manager as the editorial and production system for Cochrane Reviews. This role has a significant focus on supporting authors, editors and peer reviewers in using Editorial Manager for submission and peer review; and our linked system Convey for managing Declarations of Interest. Applications are particularly welcomed from candidates with experience of using these or similar systems.

The Cochrane Support team provides technical and user support to Cochrane editorial teams and review authors; and handle enquiries from members of the public about Cochrane’s work. We pride ourselves on our timely and coordinated support service, covering a broad range of areas, with a focus on Cochrane review-writing software and editorial processing and publication.
The team works closely with Cochrane’s Central Editorial Service and other related departments, to ensure accurate, consistent responses to queries on Cochrane technology, policies and methods.

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.

• 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: Sunday 23 January 2022 (12 midnight GMT)
• Interviews to be held on: week beginning 31 January (times to be confirmed)

Thursday, January 6, 2022 Category: Jobs

New review from Cochrane Tobacco and Addiction Group

Key messages
Heated tobacco probably exposes people to fewer toxins than cigarettes, but possibly more than not using any tobacco. Falls in cigarette sales appeared to speed up following the launch of heated tobacco in Japan, but the authors are uncertain whether this is caused by people switching from cigarettes to heated tobacco.

The authors need more independently funded research into whether heated tobacco helps people stop smoking, whether it results in unwanted effects, and the impact of rising heated tobacco use on smoking rates. 

What are heated tobacco products?
Heated tobacco products are designed to heat tobacco to a high enough temperature to release vapour, without burning it or producing smoke. They differ from e‐cigarettes because they heat tobacco leaf/sheet rather than a liquid. Many of the harmful chemicals in cigarette smoke are created by burning tobacco. So heating not burning tobacco could reduce the amount of chemicals a user ingests. Some people report stopping smoking cigarettes entirely by switching to using heated tobacco.   Why the team did this Cochrane Review?
Because cigarette smoking is addictive, many people find it difficult to stop despite the harm it causes. The author team aimed to find out whether trying to switch to heated tobacco helps people stop smoking cigarettes, and whether it results in unwanted effects. They also wanted to find out whether rising heated tobacco use has affected smoking rates or cigarette sales.   What did the authors do
They looked for studies that reported on the use of heated tobacco for stopping smoking, and on unwanted effects and toxin exposure in people asked to use heated tobacco. Here they only included randomised controlled trials, where treatments were given to people at random. This type of study is considered the most reliable way of determining if a treatment works. Finally, they searched for studies looking at changes in smoking rates and cigarette sales following the launch of heated tobacco to market. They included studies published up to January 2021.   What they found
Their search found 13 relevant studies. No studies reported whether heated tobacco helps people stop smoking cigarettes. Eleven trials, all funded by tobacco companies and with 2666 adult smokers, compared unwanted effects and toxin levels in people randomly assigned to use heated tobacco or to continue smoking cigarettes or abstain from tobacco use.

Two studies looked at how trends in cigarette sales changed following the launch of heated tobacco in Japan.

What are the results of our review?
The authors do not know whether using heated tobacco helps people to stop smoking cigarettes (no studies measured this).

They are uncertain whether the chances of getting unwanted symptoms from being asked to use heated tobacco are different compared with cigarettes (6 studies, 1713 participants) or no tobacco (2 studies, 237 participants). Serious unwanted symptoms in the short time period studied (average 13 weeks) were rare in all groups, which means we are uncertain about any differences. Toxin levels were probably lower in people using heated tobacco than those smoking cigarettes (10 studies, 1959 participants), but may be higher than in people not using any tobacco products (5 studies, 382 participants).

The launch of heated tobacco products in Japan may have caused the decline in cigarette sales to speed up over time (two studies), but it is unclear whether the fall in the percentage of people who smoke also sped up because no studies looked at this. 

How reliable are these results?
Results are based on data from a small number of studies, most of which were funded by tobacco companies.

Results on unwanted effects are likely to change as more evidence becomes available. However, we are moderately confident that levels of measured toxins are lower in people using heated tobacco than smoking cigarettes, but less confident that levels were higher than in people not using any tobacco. We are also less confident that the launch of heated tobacco caused the fall in cigarette sales to speed up, as results came from a single country.

• Read the full review
• Learn more about the Tobacco and Addiction group

Thursday, January 6, 2022

肉毒杆菌毒素（A型；通常称为 "肉毒素"）治疗面部皱纹的效果如何？ 关键信息 注射A型肉毒杆菌毒素（一种类似肉毒杆菌的治疗方法）可以减少眉毛之间的皱纹，而且使用起来相对安全。在注射后4周的测量中，可以看到其对皱纹的影响。注射A型肉毒杆菌毒素可能会增加眼睑下垂的风险。需要更多的研究来评价反复使用肉毒杆菌毒素治疗的长期益处和危害。 治疗面部皱纹 脸部肌肉的持续运动会导致皮肤随着年龄的增长而产生皱纹，并变得缺乏弹性。A型肉毒杆菌毒素是一种可以放松肌肉的化学物质；它是由一种细菌产生的。通常通过将其注入面部肌肉，可以在短时间内停止肌肉运动以抚平细纹和皱纹。肌肉活动通常在注射后5至15天内完全停止。对肌肉的影响是暂时的，通常会持续四到六个月左右。 我们想了解什么？ 我们想了解肉毒杆菌毒素治疗面部皱纹的效果如何，以及它是否会导致任何不良影响。 我们做了什么？ 我们检索了测试肉毒杆菌毒素治疗面部皱纹效果的研究。 我们发现了什么？ 我们找到了65项研究，涉及14,919人（大部分是女性），她们到日间诊所或私人诊所进行治疗。研究时间从一周到一年不等；平均治疗时间为20周。这些研究将一种类型的肉毒杆菌毒素与另一种类型的肉毒杆菌毒素、安慰剂（不含任何肉毒杆菌毒素的注射液）或替代疗法进行了比较。有几项研究是由制药公司资助的。 这些研究测试了4种已获准使用的肉毒杆菌毒素和一些尚未获准使用...

加热烟草制品是否有助于人们戒烟？它们是否安全？它们是否可以降低吸烟率？ 关键信息 加热烟草可能使人们接触到的毒素比香烟少，但可能比不使用任何烟草多。在日本推出加热烟草后，香烟销量的下降似乎加快了，但我们不确定这是否因为人们从香烟转向加热烟草所致。 我们需要更多独立资助的研究来探索是否加热烟草可以帮助人们戒烟，是否它会导致不良影响，以及加热烟草使用增加对吸烟率的影响。 什么是加热烟草制品？ 加热烟草制品旨在将其加热到足够高的温度以释放蒸汽，而不会使其燃烧或产生烟雾。它们不同于电子烟，因为它们加热的是烟草叶或薄片，而非液体。香烟烟雾中的许多有害化学物质是由烟草燃烧产生的。因此，加热而非燃烧烟草可以减少使用者摄入其化学物质的量。有些人说可以通过转用加热烟草来完全戒烟。 我们为什么做本Cochrane综述 因为吸烟会使人上瘾，尽管它会造成伤害，很多人还是难以戒掉。我们的目的是了解尝试改用加热烟草是否可以帮助人们戒烟，以及是否它会导致不良影响。我们还想知道加热烟草使用的增加是否会影响吸烟率或香烟销量。 我们做了哪些工作？ 我们检索那些报告了使用加热烟草来戒烟的研究，这些研究还报告了加热烟草使用者的不良反应和毒物暴露情况。在这里，我们仅纳入那些随机给予人们治疗的随机对照试验。这种类型的研究被认为是确定治疗是否有效的最可靠方法。最后，我们检索有关加热烟草上市后吸烟率和香烟销量变化的研究。我们纳...

使用早期姑息性干预以改善原发性脑肿瘤患者及其护理者的预后 为什么这个问题很重要 脑肿瘤会对患者及其护理人员产生重大的影响。脑肿瘤会损害人们的身体、神经认知和社会功能，从而影响整个家庭，特别是非正式的护理人员，他们往往得不到足够的支持。有证据表明，其他癌肿的患者在疾病的早期阶段提供的姑息性支持，可以帮助改善他们及其照顾者的生活质量。然而，这种情况是否适用于脑瘤患者尚未得到证实。 研究目的 我们旨在评估涉及早期姑息治疗干预的研究，包括与常规治疗相比，转诊到专业的姑息治疗服务，以改善被诊断为原发性脑瘤的成人及其护理人员的预后。 我们如何寻找证据 我们检索了电子医学文献数据库，以查找包括已发表和正在进行的不同类型的医学试验的研究。我们手工检索了关键论文的参考文献，并检索了该领域研究的关键作者。我们纳入了确诊患有原发性脑肿瘤的成人和非正式的照顾者，如亲属。 我们发现了什么 我们没有找到任何研究专业姑息治疗团队对患者或其护理人员预后影响的试验。我们纳入了1项试验，该试验群体中约一半患有高级别肿瘤，研究侧重于单一症状领域——认知领域。该试验将患者随机分为2组，一组接受结构化认知康复干预，另一组接受常规的药物和物理疗法。认知康复包含以电脑管理化的训练方式进行，每次45分钟，每周4次，为期四周。除了接受认知康复治疗的患者在视觉注意和语言记忆方面有所改善外，两组之间没有显著的差异。然而，我们评估证据...

支气管扩张患者定期服用长期抗生素 研究背景 支气管扩张是一种由胸部反复感染循环所引起的常见疾病，这些感染会损害呼吸道，使其更容易受到进一步的感染。典型症状包括持续性的咳嗽和多痰。治疗的主要目的是减少肺部感染并提高生活质量。长期使用抗生素旨在打破这种再感染循环，但这必须与对抗生素产生的耐药性风险增加相平衡。间隔服用抗生素或许可以降低这种风险，但目前尚不清楚最有效的间隔时间。本系统综述将帮助临床实践指南制订者、医生和支气管扩张患者决定是否定期使用抗生素以及最佳的间隔时间。 研究特征 我们在2021年9月发现了8项研究，这些研究着眼于以28天间隔给予抗生素，然后28天停药；或14天给药然后14天停药；或14天和28天间隔之间的比较，最长48周。研究共涉及2180名成年患者，平均年龄63.6岁。没有涉及儿童的研究。 主要结果 与不使用抗生素相比，14天间歇使用抗生素轻微降低了胸部感染的频率。我们没有发现28天间隔使用抗生素会带来这些益处，但研究受试者的严重胸部感染较少。总体而言，无论剂量之间的间隔如何，在接受抗生素的人群中，抗生素耐药性的发生率是普通人群的两倍以上。在死亡或住院、肺功能的其他方面或健康相关生活质量等严重不良结局方面，各组之间没有发现差异。研究中有足够的人来评估治疗方案的益处和安全性。 证据质量 总体而言，纳入的研究质量良好。我们对胸部感染频率和抗生素耐药性发生的证据质量有...