At the Cochrane Collaboration, open science has long been at the heart of our ethos. From publishing free plain language summaries in multiple languages to making study data available, we have always strived to make our evidence accessible, transparent and useful to as many people as possible.

Since 2013, we’ve made all Cochrane reviews freely available 12 months after publication and all protocols freely available immediately. Over 3 billion people worldwide have immediate access to all content through national access agreements and our free access offering to over 100 low- and middle-income countries.

We’d like to go further to ensure that everyone can benefit from access to Cochrane evidence. However, in this challenging funding environment, we still need income to keep producing and publishing the reviews that are trusted by researchers, clinicians and policymakers worldwide.

We have to balance our open access ambitions with our responsibility to run the charity sustainably. A model that made our content free, but deprived us of the income to produce or publish it in the first place, would be of little benefit to anyone. Our original ambition was to make all Cochrane reviews open by 2025 if we could identify a financially sustainable path to get there, without putting the onus on authors. However, it became clear that this would not be possible in that timescale. While full open access remains our ambition, we have to be realistic about how long this will take and are exploring ways to broaden access to our content in the meantime.

Standing by our principles

Our independence is one of our core founding principles; we do not accept donations or sponsorship from conflicted sources, such as pharmaceutical or medical device companies. That makes us unusual among medical and scientific charities, many of which rely on corporate benefactors to pay the bills. Not Cochrane. As a charity that publishes impartial assessments of many medical interventions and diagnostics produced and promoted by corporations, we have a strong conflict of interest policy to protect our content from undue influence.

We want our reviews to be accessible to as many people as possible, but we won’t compromise our principles or quality. The complexity of producing, editing and publishing systematic reviews makes Cochrane a poor fit for the current ‘gold’ open access model, where authors pay a fee to cover publishing costs. Conducting and publishing systematic reviews is neither cheap nor easy, and this vital work needs to be funded.

Investing in the future

As we can’t make everything open access immediately, we are working with our publisher, Wiley, to broaden global access to Cochrane content while ensuring we can still produce it.

We are working together to significantly expand free public access worldwide. Fourteen countries currently have national provisions whereby government agencies sponsor free public access for everyone in the country. Visitors from those countries do not encounter paywalls and can access Cochrane Library content without logging in. Building on this, we aim to unlock content for large regions when a critical mass of countries within the region subscribe to the Cochrane Library via national provisions. We will work towards this goal collaboratively with Cochrane groups across the world, national funding agencies and Wiley.

We intend to make all review protocols open access from 2025 onwards with a CC-BY license and are exploring open access for other outputs such as editorials and plain language summaries. We will continue to invest in our open access journal, Cochrane Evidence Synthesis and Methods, helping the global evidence synthesis community to keep up with the latest methodological developments. We may also add other open access journals to our core database of products in the future.

Looking ahead

We are still working out the details of our long-term transition to open access, but we are confident that we will arrive at a sustainable solution that balances the needs of authors, readers and subscribers. The Cochrane Collaboration was founded 30 years ago to fill a crucial evidence gap, and we need to preserve our income and integrity to ensure we can continue to fulfil our mission in the decades to come. We hope that you will support us on this journey as we strive to produce the best health evidence and make it accessible to everyone, everywhere.

Monday, April 8, 2024

对于接受消化系统手术的人来说，手术前补充营养比正常饮食更好吗？ 关键信息 - 由于证据的不确定性，我们还不知道除了正常饮食之外，营养补充剂是否更适合接受消化系统手术的人。 - 有证据表明，口服补充剂可减少体重下降或营养不良者的感染。 - 这一领域需要更多的研究。 背景 即将接受消化道手术的患者在手术前往往会出现营养不良（即营养水平低下，可能是因为饮食中没有适量的营养，或者身体对营养的吸收不好）。这会增加死亡、其他疾病或问题的可能性，并导致住院时间延长。研究表明，营养不良和体重下降与消化系统手术后的感染和其他并发症有关，如手术部位愈合不良、心脏不能正常向全身泵血、血栓或出血等。我们研究了在手术前为患者提供额外营养的效果。 我们想知道什么？ 我们想知道，在消化道手术前，除了正常饮食外，通过口服、胃管（肠内）或静脉管（肠外）给患者补充营养是否会减少非感染性并发症（即感染以外的并发症）、感染性并发症（即与手术部位或身体其他部位感染有关的并发症）以及缩短住院时间。在口服营养补充剂方面，我们研究了标准营养补充剂和免疫增强营养补充剂（富含增强人体免疫系统的成分，有助于抵抗感染）。 我们做了什么？ 我们在科学数据库中检索了对接受消化道手术的患者进行额外营养治疗与常规护理比较的相关研究。 主要结果 我们确定了16项研究，包括2164名受试者。对于肠外和肠内喂养，我们不确定是否对发生非传染性并发症或...

New online learning is now freely available about critical appraisal of rapid reviews as part of Cochrane’s flagship Evidence Essentials modules for the public.

Written from the perspective of a healthcare consumer this new module is for anyone interested in the critical appraisal of rapid systematic reviews or any review.

By the end of this module, you should be able to:

• Outline when and why a rapid review may be conducted
• Describe the differences between rapid and systematic reviews
• Understand and apply key concepts for assessing the quality of a rapid review by using the CASP tool

The learning is interactive, with quizzes, animations, and ways to check your knowledge.

This module is the latest in Cochrane’s “Evidence Essentials” that gives an introduction to Evidence Based Medicine, clinical trials, systematic reviews and how to use evidence when making decisions about your health. The modules have been visited over 97,000 times since their launch, and the first 4 modules have now been translated into Spanish, German, and Russian.

The module’s content creation has been led by Emily Clark, National Collaborating Centre for Methods and Tools at the McMaster University, School of Nursing. Emily welcomed the launch of the new module:

“I’m so excited to see the launch of the module. It builds on the work that we have been doing at McMaster to spread understanding of critical appraisal of rapid reviews amongst the wider public. We’ve used a rapid review about risk factors associated with severe COVID-19 outcomes in children 5 years and under as the basis for this learning, and we show people how to use the CASP framework to appraise a review. This new Evidence Essential model should give non-scientists a way to check the quality of a review.”

Richard Morley, Cochrane’s Consumer Engagement Officer, said:

“The Evidence Essentials puts into one exciting place information that consumers (patients, carers and the public) can use to understand about health research, and in the case of this latest module, assess the quality of a review before using it to make decisions about healthcare choices. In a world where information and misinformation are abundant, the ability to judge the evidence is vital for the public.”

There are now six interactive modules in Evidence Essentials: an introduction to Evidence-Based Medicine, Randomized Controlled Trials, Introduction to systematic reviews, Understanding and using systematic reviews; Consumer involvement in Cochrane and the latest, Critical appraisal of rapid reviews.

Modules are free to use, with a Cochrane account and are found at https://training.cochrane.org/essentials

Monday, April 29, 2024

Wednesday, April 3, 2024

A new Cochrane review has found that taking zinc may help to reduce the duration of common cold symptoms by about two days, but the evidence is not conclusive and potential benefits must be balanced against side-effects. 

Since the 1980s, zinc products have been marketed as treatments for the common cold and are particularly popular in the USA. Zinc is an essential mineral naturally found in many foods and plays a role in immune function. Most people in high-income countries get enough zinc through their diets, although aging and some chronic diseases may lead to deficiency. 

The theory behind zinc-based lozenges, sprays and syrups is that the zinc may interfere with viral replication when it comes into contact with viral particles in the nose, mouth and throat. Zinc has been shown to interfere with viral replication in petri dishes and mice, although this alone doesn't tell us whether something will work in real people. 

To test if zinc is useful in preventing or treating a cold, a team of researchers looked at 19 human trials examining zinc as a treatment and 15 as a preventative measure. They identified a lot of variation between the studies in how zinc was administered, how much was given, how they defined a ‘cold’ and what they measured. 

Eight studies with 972 participants investigated zinc as a treatment to reduce cold duration. Combining the results of these studies yielded low-certainty evidence that it may help to reduce duration by around two days, down from an average week-long duration in the groups who received placebo.  

The review found no strong evidence to conclude that zinc treatment impacts the severity of cold symptoms. The prevention studies showed no clear evidence of benefit from taking zinc before the onset of a cold; those taking zinc preventatively had similar outcomes to those who didn’t. 

Common side-effects of zinc reported in the trials included bowel problems, nausea and unpleasant taste. There was no clear evidence of more serious side-effects directly resultant from zinc. 

“People considering zinc to treat a cold should be aware of the limited evidence base and possible side-effects,” says Assistant Professor Daryl Nault of Maryland University of Integrative Health, first author of the review. “Ultimately, it’s up to the individual to decide whether the risk of potential unpleasant side-effects is worth the benefit of potentially shortening their illness by a few days. The best advice remains to consult your physician if you’re feeling unwell and inform them if you use any supplements. While there have been many trials investigating zinc, the approaches vary, so it is difficult to draw conclusions with certainty.” 

The trials included in the review varied in many ways including the type of zinc, the dose of zinc given, whether it was given as a lozenge or nasal spray, and how the outcomes were reported and measured. Some trials measured for a fixed time window and asked participants if they still had a cold at the end. Others measured the time between symptoms starting and resolving, although this was defined slightly differently by each study. Few studies monitored the status of individual symptoms, such as sore throat, cough or fever, so there was insufficient evidence to draw any reliable conclusions about specific symptoms. 

“The evidence on zinc is far from settled: we need more research before we can be confident in its effects,” says Assistant Professor Susan Wieland of the University of Maryland School of Medicine, senior author of the review. “Future studies should adopt standardized methods for administering and reporting treatments and defining and reporting outcomes. Additional studies focusing on the most promising types and doses of zinc products and using appropriate statistical methods to assess outcomes that are important to patients will enable us to understand whether zinc may have a place in treatment of the common cold.” 

• Read the full Cochrane review and plain language summary in the Cochrane Library 
• Listen to the podcast

Thursday, May 9, 2024

Specifications: Permanent – Full Time (1.0 FTE.)
Salary:   circa £35,000 per Annum
Location: (Remote – Flexible) Ideally based in the UK, Germany or Denmark. Candidates anywhere from the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries for 1-Year.
Closing date: 21 April 2024

Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. We have 110,000+ members and supporters around the world. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into four directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

To help maintain and evolve Cochrane’s cloud hosting and application deployment infrastructure, ensure applications’ dependencies are kept current (both independently and in collaboration with development teams), and promote operational awareness across the infrastructure. This role works across development and operations (DevOps).

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everything we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.

You can expect:

• An opportunity to truly impact health globally.
• A flexible work environment
• A comprehensive onboarding experiences.
• An environment where people feel welcome, heard, and included, regardless of their differences.

Cochrane welcomes applications from a wide range of perspectives, experiences, locations, and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply
• The deadline to receive your application is 21 April 2024.
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Read our Recruitment Privacy Statement

Monday, April 15, 2024 Category: Jobs

人们如何看待中、低收入国家识别结核病病例的策略？ 什么是主动病例发现？ 主动病例发现（active case finding, ACF） 指的是医务人员深入社区，寻找那些可能不会去诊所寻求帮助的结核病患者（例如，由于住得离医疗设施太远或无法负担去医疗设施的费用）。ACF 的目的是找到结核病患者并为他们提供治疗，以减少疾病传播并改善感染者的健康。 我们想了解什么？ 我们旨在了解 ACF 参与者的经历和观点，包括结核病患者、社区成员和医务人员。 我们发现了什么？ 我们纳入了45项研究，并从世界卫生组织的多个地区（非洲、东南亚、东地中海和美洲）的20项研究中进行了抽样。依据这些数据，我们得出以下五个主要结论。 • ACF 提高了许多人被诊断的机会，但对帮助最贫困的人却收效甚微。 ACF 改善了健康状况较差和资源较少的人获得卫生服务的机会。然而，这些项目有时并没有充分考虑人们在日常生活中面临的困难。那些因工作而移居或居住在偏远地区的人也很少有机会获得 ACF。 • 人们害怕被诊断及其影响。 成为筛检的对象令人感到害怕。这会让人们因污名化而受到歧视，并且人们可能会因此怀疑自己患有HIV。出于这些原因，有些人可能会拒绝参与诊断和治疗。此外，有人在被诊断后感到不知所措和恐惧，因为他们预期药物会产生副作用，且可能会患上严重的疾病。 • 筛查工作受到薄弱的卫生基础设施的削弱。 在许多情况下，缺乏投...

哪项干预措施对癌症患者重返工作的帮助最大呢？ 关键信息 – 多学科和体育干预可能帮助癌症患者重返工作。 – 心理教育对重返工作的影响从很小到没有，职业干预的效果尚不明确。 本系统评价是关于什么的？ 每年，很多癌症患者在接受治疗后存活下来。尽管许多癌症生存者继续经历着持久的疲乏、疼痛和抑郁等困扰，但他们能生活的很好。这些长期影响可能会对他们的工作生涯造成影响。因此，癌症是造成缺勤、失业和提前退休的一个重要原因。癌症患者、他们的家人和整个社会都承担着部分负担。在本Cochrane系统评价中，我们评估了帮助癌症患者重返工作岗位的干预的效果。 我们想要发现什么？ 我们想知道非药物干预在改善重返工作方面是否比常规护理更好。我们还想探讨这些干预措施是否能提高生活质量。我们考虑了四种类型的干预措施： – 心理教育（癌症患者了解身体副作用、应对与压力，并参与小组讨论）； – 职业干预（针对与工作相关的问题）； – 体育干预（癌症患者参与步行等身体锻炼）； – 多学科干预（职业咨询、患者教育、患者咨询、身体锻炼或以上组合）。 我们做了什么？ 我们检索了旨在探索改善癌症患者重返工作（雇员或自雇）相关干预措施的文章。我们比较和总结了这些研究结果，并根据研究方法和规模等因素评估了证据的质量。 我们发现了什么？ 我们发现15项涉及1477名癌症患者并探索其重返工作情况的研究。所有研究都在高收入国家进行。其...

We are thrilled to announce the publication of a new editorial titled "Unlocking the Power of Global Collaboration: Building a Stronger Evidence Ecosystem Together," authored by Prof Zoe Jordan of JBI, Dr Vivian Welch of The Campbell Collaboration, and Dr Karla Soares-Weiser of Cochrane. This editorial is now available simultaneously in JBI Evidence Synthesis, Campbell Systematic Reviews, and the Cochrane Database of Systematic Reviews. It underscores the urgent need for collaborative efforts to harness the potential of evidence synthesis on a global scale. This collaborative endeavour reflects the shared commitment of the three organisations to foster cooperation, aiming to enhance both health outcomes and policy efficacy worldwide.

The editorial highlights the pivotal role of collaboration in addressing contemporary global challenges, emphasizing the collective commitment of JBI, The Campbell Collaboration, and Cochrane to foster cooperation for enhanced health outcomes and policy efficacy worldwide. Dr. Karla Soares-Weiser said: "This co-publication marks a significant milestone for all three of our organizations and reaffirms our dedication to collaboration. Our respective communities are profoundly collaborative and communicative within their domains, and we'd now like to catalyze further collaboration between and across them. We're particularly excited about the upcoming Global Evidence Summit, where leaders in evidence synthesis and evidence-based practice, including Cochrane, JBI, Guidelines International Network (GIN), and The Campbell Collaboration, will convene to share best practice and promote cross-disciplinary working."

Scheduled for September 2024, the Global Evidence Summit represents a unique opportunity for professionals across various sectors to engage in discussions about evidence production, summarization, and dissemination, informing policy and practice. Dr. Soares-Weiser emphasized the importance of this event: "The GES serves as a platform for knowledge exchange and collaboration, crucial for addressing global challenges in health, education, social justice, and the environment." As the editorial advocates for a shift towards enhanced collaboration, the Global Evidence Summit sets the stage for meaningful dialogue and action.

• Learn more about the Global Evidence Summit
• Read the editorial

Jordan Z, Welch V, Soares-Weiser K. Unlocking the power of global collaboration: building a stronger evidence ecosystem together. Cochrane Database of Systematic Reviews 2024, Issue 4. Art. No.: ED000166. DOI: 10.1002/14651858.ED000166.

Tuesday, April 16, 2024

Wednesday, March 27, 2024

Wednesday, March 27, 2024

Wednesday, March 27, 2024

手机短信提醒能否帮助心血管疾病患者规律服药 关键信息 由于缺乏有力的证据，短信对服药依从性、致命心血管事件（死于心脏病）、非致命心血管事件（心脏并发症或中风）、合并心血管事件（死于心脏病、心脏并发症或中风）、胆固醇、血压和心率的益处尚不明确。 需要进行规模更大、设计更合理的研究，以衡量短信对改善心脏病患者服药依从性的长期影响，尤其是在低收入国家。 为什么本综述很重要？ 全世界至少有 5.23 亿人患有心脏病。这种疾病通常需要用药物治疗。然而，大多数人并没有服用药物来防止心脏出现更多问题。改善服药行为的一种可行方法是使用短信提醒。手机短信可以向心脏病患者发送健康信息和短信提醒，帮助他们服药。不过，短信能否帮助心脏病患者按时服药，目前还不清楚。 我们想要了解什么？ 我们想知道，与不接收短信的人相比，短信是否能有效改善心脏病患者的服药依从性。我们还关注短信对致命心血管事件（死于心脏病）、非致命心血管事件（心脏并发症或中风）、合并心血管事件（死于心脏病、心脏并发症或中风）、血压、胆固醇和心率的影响。 我们做了什么？ 我们在医学数据库中检索了有关手机短信对心脏病患者坚持服药的影响的研究。 我们发现了什么？ 我们共纳入18项研究，包含8136名心血管疾病患者。这些研究在11个不同国家进行。并且所有研究都针对使用手机短信和不适用手机短信进行对比。 主要结果 所有研究均在中高收入国家中进行，没有...

Door-to-door tuberculosis (TB) screening and contact tracing can improve diagnosis rates, but must be paired with effective follow-up care to be successful, a new Cochrane review has found.

Active case finding (ACF) seeks to improve diagnosis rates in people living in communities who may not otherwise present to health facilities, helping them access treatment and reduce onward transmission.

Despite being a key strategy of most TB strategies globally, there is often little consideration of how these programmes are experienced by communities. This is essential in designing appropriate and effective services.

Published ahead of World TB Day (24 March), a new review published by Cochrane Infectious Diseases, based at Liverpool School of Tropical Medicine, looked at studies of community experiences towards ACF programmes for TB in any endemic low- or middle-income country. This was a qualitative evidence synthesis that looked at the evidence from 45 studies. 

Senior author and Cochrane Infectious Diseases Editor, Professor Sandy Oliver,  said, “The power of qualitative syntheses like these is in their ability to capture rich information from various contexts to develop a deep understanding of how policies play out in the real world – how services deliver them, how communities receive them or avoid them, what might make them work a little better, and why”.

The review authors found that ACF improves access to diagnosis for many, but does little for those in financial need to continue care. People may also experience stigma in relation to screening.

It was also shown that ACF can create expectations for follow-up care that health systems may not be able to meet, as well as health workers finding it difficult to implement.

This Cochrane Review will help to better understand policy in action and the perceived benefit relative to the harm of ACF.

Lead author Melissa Taylor said: “Active case finding brings diagnosis to many of those who may otherwise not have received it. However, our review demonstrates it is essential that active case finding is linked to well-resourced follow up services and wider health system strengthening.”

• Read the full Cochrane review and plain language summary
• Learn more about this review on the Cochrane Infectious Diseases website

Taylor M, Medley N, van Wyk SS, Oliver S. Community views on active case finding for tuberculosis in low‐ and middle‐income countries: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014756. DOI: 10.1002/14651858.CD014756.pub2

Thursday, March 21, 2024

成人心脏手术时使用皮质类固醇有什么益处和风险？ 关键信息 -皮质类固醇等消炎药物对于心脏术后存活率几乎没有影响，对于肺功能有益处、但是对于心脏可能不利甚至是伤害的效应。 -尤其是对高危人群，目前并无足够大型且设计严谨的研究来证实皮质类固醇的临床效果。未来的研究应探讨这些药物在易感人群中的作用。 对于心脏手术有哪些顾虑？ 接受心脏手术的人可能会对各种压力源产生强烈的反应。这种“炎症反应”经常被认为和许多合并症有关，并且可能会在使用心肺机（手术时暂时取代心肺功能的一种仪器）时加重炎症反应。 皮质类固醇在心脏手术中的作用是什么？ 皮质类固醇是治疗过度炎症反应最有名、也最常用的药物。评估心脏手术后使用皮质类固醇的研究结果利弊兼具，好处是改善肺功能且恢复较快，但优势却会因感染、出血和心脏损伤等重大副作用大打折扣。 我们想知道什么？ 我们想知道使用皮质类固醇对于心脏手术后发生重大合并症 （死亡、心肺损伤）的利弊。 我们做了什么？ 我们检索了主要的医学文献数据库，寻找接受心脏手术的成人使用皮质类固醇与不治疗、或是安慰剂（假药）比较的随机对照试验。我们还分析了他们的综合结果。 我们发现了什么？ 我们共发现了72项研究，涉及17,282名受试者，时间跨度约为50年。纳入这些研究的人平均年龄约为60岁。研究中最常见的手术是冠状动脉搭桥移植术，这是一种恢复心肌血流的常见手术。 研究汇总结果显示：与不治...

婴儿毛细支气管炎的高流量氧疗法 什么是毛细支气管炎？ 毛细支气管炎是一种影响婴儿（24个月以下）下（较小）呼吸道的常见疾病，通常由病毒感染引起，会造成呼吸问题，包括咳嗽、呼吸急促和喘鸣，并可能造成喂养不良。毛细支气管炎是婴儿住院的主要原因。它的治疗以支持性为主。对于需要住院治疗的婴儿而言，需要帮助他们呼吸直到感染消失。一种越来越常用的辅助呼吸方法是通过鼻导管（管子）输入每分钟2升以上的混合、加热、加湿的空气和氧气，这是传统（低流量）干氧输送的流速最大值。这被称为高流量鼻插导管疗法，它可以提供舒适的高流量空气/氧气混合物，从而改善通气。持续气道正压通气（continuous positive airway pressure, CPAP）也越来越多地用于治疗毛细支气管炎。它以预设的压力输送空气/氧气混合物，以保持呼吸道通畅，防止呼气（吐气）时气道塌陷。 我们想了解什么？ 高流量氧气疗法可减少对有创呼吸支持（如插管）的需求，并能防止上呼吸道干燥，比其他疗法更具临床优势。本综述评估了高流量鼻导管疗法与其他呼吸支持疗法在治疗婴儿毛细支气管炎方面的效果。 我们做了什么? 有 16 项研究（2813 名受试者）符合我们的纳入标准。这些研究比较了高流量氧气治疗与传统氧气治疗（低流量）或CPAP。这些研究都是在世界各地的儿科病房和重症监护室进行的。我们发现有 11 项试验对高流量和低流量进行了比较...

心理疗法能否有效减轻长期居住在护理机构中的老年人的抑郁情绪？ 关键信息 -对于居住在长期护理（long-term care, LTC）机构（如疗养院或养老院以及生活辅助机构）的老年人来说，心理疗法（有时也称为谈话疗法）治疗抑郁症状的效果可能优于非治疗对照组。 -在短期内提高生活质量和心理健康（个人的情绪健康和整体功能）方面，心理疗法也可能优于非治疗组。 -由于证据不足，心理疗法的广泛益处和长期效果尚不明确。 我们想发现什么？ 我们想要了解心理疗法是否有益于在长期护理环境中控制抑郁。 为什么这很重要？ 抑郁症在居住于长期护理中心的老年人中很常见。他们通常需要服用药物来控制抑郁。心理疗法可能是一种可行的替代方法。 哪些心理疗法可用于治疗老年人抑郁症？ 治疗居住在长期护理中心的老年人抑郁症的心理疗法包括行为疗法、认知行为疗法和回忆疗法。 我们做了什么？ 我们检索比较了针对居住在长期护理机构中患有抑郁症的老年人的心理疗法和替代护理方法的研究。我们纳入了治疗结束后的结果，以及短期（最多三个月）、中期（三至六个月）和长期（六个月以上）的随访结果。 我们对研究结果进行了比较和总结，并根据研究方法和规模等因素对证据的可信度进行了评级。 我们发现了什么？ 我们纳入了19项研究，涉及873名抑郁症患者。大多数研究将认知行为疗法、行为疗法或回忆疗法与常规护理服务或为居民提供类似程度的关注（例如，志愿者...

二甲双胍是治疗成人二型糖尿病有效的方案吗？ 研究背景 二型糖尿病是一种导致血液中糖分高水平的疾病。血糖水平是由胰腺产生的一种叫胰岛素的激素所控制的。胰岛素指示肝脏、肌肉和脂肪细胞把糖分从血液中移除并储藏起来。当胰腺不能产生足够的胰岛素，或者身体对胰岛素没有反应的时，过多的糖分就会滞留在血液中。目前有许多药物可以治疗二型糖尿病，这些药物旨在降低血液中的糖量并减少糖尿病的长期并发症。通常来说，给二型糖尿病患者开出的第一种药物是二甲双胍，它的作用是减少肝脏释放到血液里的糖量。同时，它也能够改善身体对胰岛素的反应方式。 我们想了解二甲双胍是不是治疗二型糖尿病的有效药物，以及它是否会造成任何不良反应。我们还将它的效果与其他的抗糖尿病药物、饮食运动或者两者的效果进行了对比。我们特别关注的结局是死亡、严重不良反应事件、与健康相关的生活质量，心血管原因导致的死亡以及糖尿病的非致命并发症（例如心脏病发作、中风或者肾衰竭）。 我们想找到什么？ 我们在医学数据库中检索了以下特征的研究： - 随机对照试验：随机对照试验是将受试者随机分配到其中的一个治疗组的医学研究。这种类型的研究为治疗是否有差别，提供了最可靠的证据； - 纳入了18岁及以上的患有二型糖尿病的人群； - 将二甲双胍与以下方式进行对比：安慰剂（一种假的治疗）；不进行治疗；能帮助人们吃的更健康的饮食计划；或者其他降低血糖水平的药物； - 持续...

Friday, March 15, 2024

玻璃体切除术和气体填塞治疗黄斑部流变性视网膜脱离后，面朝下体位是否比其他体位更好？ 关键信息 - 目前还没有足够的高质量信息来说明，是否应该向视网膜中心（黄斑）视网膜脱离手术后的患者推荐面朝下的体位。 - 总体而言，研究证据表明，术后体位朝下可能会导致较少的并发症，术后视网膜移位、视网膜外皱褶和双眼复视（双眼睁开时出现复视）的情况较少。这些并发症会给患者带来很大困扰，但对其生活质量的影响却没有进行研究。 - 与支撑破损体位（头部定位取决于视网膜破损的位置[视网膜上的孔洞或撕裂]）相比，面朝下体位可能会增加眼内压（眼内液体压力）；不过，眼内压通常可以得到成功治疗。 什么是黄斑浸润性流变性视网膜脱离？ 视网膜是眼睛后部的一层组织，它提供视力。通常附著在眼壁上。当视网膜与眼球壁分离时，就称为视网膜脱离。如果视网膜脱落是由视网膜撕裂或破裂引起的，则称为流变性视网膜脱落。黄斑是视网膜的中心。如果黄斑也脱离，则称为黄斑浸润性流变性视网膜脱离。 视觉细胞（视网膜上提供视觉的细胞）通过眼球壁上的血管获得营养。如果视网膜脱离眼球壁，视觉细胞就得不到营养。结果，视力就会损失。 视网膜脱离的治疗方法是手术，通常是一种叫做玻璃体切除术的手术。在玻璃体切除手术中，填充眼球中央的凝胶（称为玻璃体）会被移除，通常会在眼球内注入气体，将视网膜推回原位（气体填塞）。气体像气球一样上升。有些外科医生会要求患者在手术...