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...

关于实施居家病房的多种看法 关键信息 - 在发展居家病房服务时，重要的是为医护专业人员建立一个简单的流程来转诊患者。这包括制定明确的指南，规定服务的适用人群。 - 居家病房服务需要一支训练有素的员工队伍，他们应具备在家中提供安全有效、以患者为中心的护理服务的技能，并在员工、病人和护理人员之间进行清晰一致的沟通。 - 我们提出了一些问题，供医护专业人员和管理人员在引入新的居家病房服务或运行现有服务时使用。这些问题旨在帮助规划和实施居家病房服务，并提高员工、患者和护理人员的满意度和效果。 什么是居家病房？ 居家病房为原本需要住院治疗的患者提供医院级别的居家护理。其中一种居家病房是为了避免入院。这就是所谓的“避免入院居家病房”。对于病情通常需要在居家病房上接受治疗的患者，例如肺部疾病复发的患者，这些服务可以取代入院治疗。相反，医生可以将其评估为适合在自己家中（或其通常居住的地方，包括寄宿护理机构）接受治疗的患者转介到医院，接受一段时间的治疗。另一种叫做“提前出院居家病房”。这些服务缩短了住院患者的住院时间，例如在手术或疾病治疗后。患者通常在医院病床上接受医护人员的护理，而这些护理将在患者家中提供，预计不会影响护理质量。 我们想了解什么？ 我们的目的是了解在引入、运行和接受居家病房服务时，什么是最重要的。我们希望探究一系列有关避免入院和提前出院服务的经验和观点。其中可能包括管理人员在计划...

Wednesday, March 13, 2024

Wednesday, March 13, 2024

Tuesday, March 12, 2024

In this blog for colorectal surgeons and health professionals involved in stoma reversals, Dr Stina Öberg, Dr Siv Fonnes, and Professor Jacob Rosenberg from the Cochrane Colorectal Group discuss new practice-changing Cochrane evidence, showing that a simple change of suture technique likely results in a large reduction in surgical site infections in people undergoing stoma reversal.

Take-home points

• The stoma closure site can be considered a clean-contaminated wound, and many patients develop a surgical site infection after having a temporary ileostomy or colostomy reversed.
• Surgeons often use linear skin closure after stoma reversal. In theory, a clean-contaminated wound can benefit from drainage, which is achieved by using the purse-string skin closure technique.
• A new Cochrane Review has demonstrated that the purse-string skin closure technique likely results in a large reduction in surgical site infections after stoma reversal compared with linear skin closure.
• This simple and inexpensive change of practice may also improve patient satisfaction slightly. Even though the evidence is very uncertain, there seems to be no difference in incisional hernias.

Can surgeons improve their skin closure technique after stoma reversal? Yes - in a straightforward way! Researchers have found clinically important evidence in a new Cochrane review, showing that a simple change of suture technique likely results in a large reduction of surgical site infections in people undergoing stoma reversal. This blog presents the key results from this Cochrane review.

Skin closure after stoma reversal
Temporary stomas are created to protect distal bowel segments. At the time of stoma reversal, the last step is to close the skin. Due to the proximity to intestinal content, the stoma closure site should be considered a clean-contaminated wound. This could also explain why surgical site infections are common after stoma reversal, occurring in up to 40% of patients. When a wound is potentially contaminated, it will in theory benefit from free drainage.

Linear skin closure
Most surgeons use linear (transverse) skin closure despite the possible contamination of the wound at the stoma reversal site. Linear skin closure provides poor or no wound drainage and is theoretically a poor choice for a clean-contaminated wound. The stoma reversal wound is often close to a circular shape, and there is an alternative skin closure technique that at the same time provides drainage - the purse-string technique.

Purse-string skin closure
The purse-string skin closure technique can be used for circular or ellipse-formed wounds. The technique is performed by using intradermal sutures that are drawn together like an old-fashioned drawstring purse (see illustration at the top of the page), leaving a small opening in the centre. The theoretical advantage of using purse-string skin closure for a clean-contaminated wound is that it provides free drainage. This advantage could lower the risk of developing surgical site infections compared with linear skin closure. A lower surgical site infection risk could also result in a better cosmetic result, a higher patient satisfaction, and fewer incisional hernias.

What are the benefits of the purse-string skin closure?
In the Cochrane review comparing purse-string skin closure versus linear skin closure in people undergoing stoma reversal, surgical site infection was assessed in nine randomised controlled trials including almost 800 patients. The purse-string technique likely results in a large reduction in surgical site infections compared with linear skin closure. The anticipated risk within 30 days after linear closure was 243 surgical site infections per 1000 patients versus 52 (95% confidence interval 28 to 85) per 1000 patients after purse-string skin closure.

Purse-string closure may also have other advantages over linear closure. Patients who received the purse-string skin closure seemed to be slightly more satisfied six and twelve months after surgery: the anticipated effect in two randomised controlled trials was 885 satisfied or very satisfied patients per 1000 patients having linear skin closure versus 994 (95% confidence interval 894 to 1000) per 1000 patients having purse-string skin closure.

Finally, a reduced risk of surgical site infections could reduce the risk of incisional hernias. This outcome was reported by four randomised controlled trials with nearly 300 patients followed between three and twelve months, showing an anticipated risk of 55 incisional hernias per 1000 patients after linear skin closure versus 29 (95% confidence interval 4 to 177) per 1000 patients having purse-string skin closure. Even though the purse-string skin closure theoretically could lower the risk of incisional hernias, this was not shown, and there seems to be little to no difference in the risk of developing incisional hernias regardless of the skin closure technique used. However, the evidence is very uncertain, and further randomised controlled trials with longer follow-up might alter this result.

What are the benefits of linear skin closure?
The Cochrane review showed no advantage of using linear skin closure compared with purse-string skin closure in patients undergoing stoma reversal.

What are the risks of the purse-string skin closure?
The Cochrane review suggested that there was no evidence of an increased risk when patients received the purse-string technique compared with linear skin closure.

Pros and cons of purse-string versus linear skin closure
To summarise:

The benefits of using purse-string skin closure:

• likely results in a large reduction in surgical site infections
• may improve patient satisfaction slightly

The benefits of using linear skin closure:

• none found

There seems to be no evidence of a difference between purse-string and linear skin closure regarding:

• incisional hernia (but the evidence is very uncertain)
• operative time (but the evidence is very uncertain)
• length of hospital stay (but the certainty of evidence is unknown)
• anastomotic leak (but the certainty of evidence is unknown)
• intestinal obstruction (but the certainty of evidence is unknown)

Which skin closure technique is best to use after stoma reversal?
Purse-string skin closure both has the theory and the evidence to back up a lower risk of surgical site infections compared with linear skin closure, seemingly without any risks of complications. The result from this Cochrane review could make surgeons reconsider their skin closure method in patients undergoing stoma reversal. A change of practice from linear to purse-string skin closure is both straightforward and inexpensive.

Clinical reflections on the implications of the review
When asking Professor Jacob Rosenberg, the co-ordinating editor of the Cochrane Colorectal Group, about the clinical implications of this Cochrane Review, he stated that:

• This review clearly shows that a simple change in skin closure technique can have a large impact on patient outcome after stoma reversal.
• The purse-string skin closure technique for the stoma site is simple, effective, and seemingly without negative effects.
• These results have the potential to change clinical practice around the world.
• The recommendation to use the purse-string method for skin closure of stoma sites should be included in future clinical guidelines.

Read the full Cochrane Review and plain language summary in the Cochrane Library 

Listen to the lead author, Shahab Hajibandeh from Health Education and Improvement Wales, to tell us more about this review in three minutes

Hajibandeh S, Hajibandeh S, Maw A. Purse‐string skin closure versus linear skin closure in people undergoing stoma reversal. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014763. DOI: 10.1002/14651858.CD014763.pub2. 

Image: The featured image at the top of the page was created by Malene Agnete Højland and Louise Rosengaard from the Cochrane Colorectal Group.

 

Tuesday, March 12, 2024

Tuesday, March 12, 2024

认知行为疗法加标准护理治疗首发和近期发病的精神病 关键信息 认知行为疗法（Cognitive behavioural therapy，CBT）可有效减轻精神分裂症的症状，并改善患者在初期的功能。 关于这一干预措施可能产生的不良影响的信息很少。 引言 精神分裂症是一种严重的精神障碍，因为其症状会对患者的日常生活造成严重影响。患有这种疾病的人很难区分自己的想法、信念和观念与现实之间的差异。例如，他们可能在自己脑中听到声音，但感觉就像真的有人在跟他们说话。疾病初期的治疗至关重要、以预防或减少慢性病程的风险。这一阶段通常被定义为 “首次发病”，“近期发病”一词也被用来描述首次发作病后的三至五年。 心理干预，如认知行为疗法，可以有效治疗一般精神分裂症患者的症状；目前尚不清楚这种干预是否对处于疾病初期阶段的患者也有帮助。 我们想知道什么？ 我们想知道认知行为疗法与标准疗法相结合对首次发病或近期发病的精神分裂症患者的治疗效果。 我们做了什么？ 我们检索了研究，这些研究对单独给予标准治疗或其它社会心理干预措施，与标准疗法（通常是药物）和认知行为疗法相结合进行了比较。 我们对研究结果进行了比较和总结，并对证据的可信度进行了评级。例如，研究中的某些因素（如受试者太少或结果不显著）会降低证据的可信度。 我们发现了什么？ 我们发现了28项研究，其中26项研究拥有2407名近期发病或首次发病精神分裂症受试...

比较造口复原术中两种伤口闭合方法：荷包缝合与线性缝合皮肤闭合术 关键信息 • 与线性缝合皮肤闭合术（LSC）相比，荷包缝合皮肤闭合术（PSSC）可能降低伤口感染的风险。 • 与接受LSC的患者相比，接受PSSC的患者可能对手术结果更满意。 造口复原术是什么意思？ 肠造口是通过手术在腹部表面创建的肠道开口。有临时造口的人将在初次手术（造口形成时）后的几个月进行造口复原。多达 40% 的造口复原患者会出现伤口感染，这主要是由于造口部位周围存在细菌。 有哪些技术可以关闭造口？ 复原造口的传统技术是线性皮肤闭合（LSC；直线闭合伤口），但该技术存在较高的伤口感染风险。另一种替代技术称为荷包缝合皮肤闭合（PSSC；一种连续缝合圆形造口伤口的技术，类似于用线缝合荷包袋的方式）。PSSC 在伤口中心留下一个小开口，允许污染物自由排出，从而可能降低伤口感染的风险。 我们想发现什么？ 我们想要了解 PSSC 技术是否比 LSC 技术更能改善以下方面： • 伤口感染的风险； • 患者满意度； • 切口疝（组织戳破手术伤口）风险；以及； • 手术时间。 我们做了什么？ 我们检索了对接受造口复原术的患者进行PSSC与LSC比较的研究。我们对研究结果进行了比较和总结，并根据研究方法和样本量等因素对证据的质量进行了评级。 我们发现了什么？ 我们发现了9项研究共涉及757名接受造口复原术的患者。 与 LSC ...

Monday, March 11, 2024

Cochrane marks the second anniversary of the commitment to Public Involvement in Health and Social Care Research, a pledge launched in March 2022. This commitment underscores Cochrane's ongoing efforts to enhance its practice of public involvement in health and social care research.

Cochrane is one of twenty-one organizations signed up to the pledge, including the UK’s National Institute for Health and Care Research (NIHR) and the Health Research Authority (HRA).

Richard Morley, Cochrane's Consumer Engagement Officer, reflects on this initiative: “Making a public commitment to involving the users of our evidence sets out our serious intent to build on our past achievements and deepen and broaden our work.”

A notable achievement is the establishment of the Co-Production Methods Group, launched in October 2023. Aligned with the ‘Putting People First’ commitment, this group will spearhead methods research, share resources for best practice, and supports learning and dissemination activities to help systematic review authors engage with and respond to the needs of consumers. 

To help people make sense of health evidence, Cochrane provides a free Evidence Essentials learning module. This free online resource offers an introduction to health evidence and how to use it to make informed health choices. The module has been co-produced by healthcare consumers, researchers and Cochrane's specialists, with contributions from a range of experts in their fields.

The Learning Live series builds on this, offering free webinars aimed at a range of audiences. Some webinars are aimed at Cochrane review authors, to help them make their research more widely accessible and understood. Others are aimed at helping people to engage with Cochrane research, such as webinars for teachers on using Cochrane Crowd in school projects. 

Looking ahead, Cochrane has a framework for consumer engagement and involvement that runs until 2027. This comprehensive approach revolves around five key elements. It emphasizes proactive engagement strategies, including communication, evidence dissemination, recruitment, and learning. Cochrane aims to elevate co-production by intensifying consumer involvement in the evidence production process, aligning reviews with user needs, and supporting consumer governance.

Prioritizing accessibility, the framework strives to enhance health literacy among healthcare consumers while making Cochrane's evidence more easily accessible. Strategic partnerships, particularly with patient groups, aim to enhance engagement, co-production, advocacy, and health literacy activities.

Finally, the framework incorporates an observatory to ensure evidence-based practices, monitor, and evaluate the impact of Cochrane's ongoing efforts in engagement and involvement.

• Learn more about Cochrane’s commitment to healthcare consumers
• Join Cochrane’s work as a patient, carer, or member of the public
• Email the Cochrane Consumers Network at consumers@cochrane.org 

 

Monday, March 11, 2024

Specifications: Permanent – Full Time
Salary:  £55,000 - £57,000 per Annum  
Location: Remote - Ideally based in the UK, Germany or Denmark. Candidates from the rest of the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries.
Closing date: 24 March 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.

The Executive Editor will be expected to prioritise and delegate editorial tasks as appropriate. The role holder will need to be an advocate for the Editorial Service internally and externally to Cochrane and remain alert to immediate demands of delivering high-quality review content for publication in a timely fashion.        

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, please click here
• The deadline to receive your application is 24th March 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

Friday, March 8, 2024 Category: Jobs

Thursday, March 7, 2024

基于运动的心脏康复对于心力衰竭患者的益处和风险是什么？ 关键信息 - 与不运动相比，没有证据表明基于运动的心脏康复会改变心衰患者的全因死亡率。基于运动的心脏康复可能会降低心衰患者因任何原因入院和心衰相关入院的风险，并可能显著改善“明尼苏达心力衰竭患者生活质量”问卷评估的健康相关生活质量。 - 重要的是，本次更新的系统评价提供了额外的证据支持使用替代的基于运动的心脏康复的干预模式，包括基于家庭和数字支持的干预项目。 未来的研究应该招募在现有研究中代表性较低的群体，例如老年心衰患者、女性心衰患者，以及射血分数保留型心衰患者。 什么是心衰？ 心衰是指心脏无法正常地将血液泵送到全身各处的情况。心衰患者会感觉到疲劳和呼吸短促。心衰会导致患者的日常活动变得困难，并会影响患者生活质量。心衰患者的住院风险和死亡风险较高。 什么是心脏康复？ 心脏康复旨在帮助人们从心脏疾病（包括心衰）中恢复。心脏康复项目包括运动训练，还可能包括生活方式和危险因素管理相关的教育，以及咨询和心理支持。 我们想要发现什么？ 我们想知道与不运动相比，基于运动的康复是否能够更好地改善心衰患者的健康结局： - 死亡事件 - 再入院事件 - 健康相关的生活质量 我们做了什么？ 我们检索了评估基于运动的心脏康复对心衰患者干预效果的研究。我们比较和总结了相关研究的结果，并根据研究方法和规模等因素对证据的质量进行了评级。 我们发现了什...

Tuesday, March 5, 2024

Tuesday, March 5, 2024