The Centre for Epidemic Intervention Research at the Norwegian Institute of Public Health, located in Oslo, Norway,  is currently seeking applicants for the following positions:

• 2 full-time researcher positions in effect studies
• 1 full-time Researcher/(bio-)statistician

The overall mission for the newly established centre is to produce more and better evidence on the effects of public health and social interventions, and non-pharmacological infection control measures, specifically. This also includes adverse consequences. The centre will collaborate with researchers, institutions, organisations, and stakeholders both nationally and internationally. The centre works closely with the World Health Organization's intiative to strengthen the evidence base for decisions about public health and social measures.

Application deadline 15 December 2021.

Friday, November 19, 2021 Category: Jobs

In this interview with lead author Christopher Gibbons, we find out more about the recently published review,  Routine provision of information on patient-reported outcome measures to healthcare providers and patients in clinical practice.

Tell us about this review
The aim of this Cochrane Review was to find out whether healthcare workers who receive information from questionnaires completed by their patients give better health care and whether their patients have better health. We collected and analysed all relevant studies.

What did you find out?
Patient questionnaire responses fed back to health workers and patients may result in moderate benefits for patient\provider communication and small benefits for patients' quality of life. Healthcare workers probably make and record more diagnoses and take more notes. The intervention probably makes little or no difference for patient's general perceptions of their health, social functioning, and pain. There appears to be no impact on physical and mental functioning, and fatigue. Our confidence in these results is limited by the quality and number of included studies for each outcome.

What was studied in the review?
When receiving health care, patients are not always asked about how they feel, either about their physical, mental or social health. This can be a problem as knowing how the patient is feeling might help to make decisions about diagnosis and the course of the treatment. One possible solution is to ask the patients to complete questionnaires about their health, and then give that information to the healthcare workers and to patients.

What are the main results of the review?
We found 116 studies (49,785 participants), all of which were from high income countries. We found that feeding back patient questionnaire responses to healthcare workers and patients probably slightly improves quality of life and increases communication between patients and their doctors, but probably does not make a lot of difference to social functioning. We are not sure of the impact on physical and mental functioning or fatigue of feeding back patient questionnaire responses as the certainty of this evidence was assessed as very low. The intervention probably increases diagnosis and note taking. We did not find studies reporting on adverse effects defined as distress following or related to Patient reported outcomes measures (PROM) completion.
 
What would you like to see happen next to provide more evidence in this area?
I would like to see more large, high quality, cluster randomized clinical trials that increase the evidence base for the intervention that use Computerized Adaptive Testing in the measurement of patient reported outcomes. In these interventions, the information which is fed-back combines standardized and individualized measurement, these randomize patients and clinicians to different modalities of feed-back interventions and recipients (including patient only, patient and professional, professional only).

Outcomes of interest include:

• adverse effects
• general health perceptions,
• specific symptoms, (cough, insomnia, nausea, anorexia, constipation, diarrhoea),
• clinicians ratings of severity,
• counselling,
• different types of visits, admissions and their length,
• patient physician relationship,
• unmet patient needs,
• quality of care and costs;
• and that focus on people with multimorbidity

Further research on the mechanisms by which the intervention operates is needed.

• Read the review in full
• Visit the Cochrane Effective Practice and Organisation of Care Group page 

Wednesday, November 24, 2021

改变急性蛛网膜下腔出血患者血压的不同治疗方法评估 系统综述背景 蛛网膜下腔出血是一种由脑部周围空间出血引起的中风，每年每100000人中有多达九人受此影响。蛛网膜下腔出血的死亡率为30%至45%，20%的幸存者的日常活动会受限。目前，短期治疗可能涉及改变血压和诱发高血压（即升高血压）或降低血压，但尚不清楚改变血压对于急性蛛网膜下腔出血患者的获益和伤害。 系统综述问题 我们的目的是评价改变血压对急性蛛网膜下腔出血患者的获益和伤害。 文献检索日期 我们检索了从建库到截至2020年9月的科学数据库。 研究特征 我们确定了3项评价急性蛛网膜下腔出血患者血压变化的随机临床试验（将患者随机分入两种疗法组或多种疗法组）。有2项纳入了61名受试者的随机临床试验将升高血压组与安慰剂（假治疗）组或不治疗组进行了比较。有1项纳入了224名受试者的随机临床试验将降低血压组与安慰剂组进行了比较。我们使用试验序贯分析来估计拒绝或检测重要治疗效果所需的受试者人数（信息量）。试验序贯分析表明，缺乏有关所有结局的信息。所有试验都存在高偏倚风险，我们对结果非常不确定。 关键结果和结论 我们的系统综述表明，缺乏有关升高血压或降低血压对急性蛛网膜下腔出血患者的重要治疗效果的信息。因此，无法彻底评价获益和伤害。迫切需要随机试验来评价改变血压对急性蛛网膜下腔出血患者的影响，报告患者重要结局，如死亡率、严重副作用、再出血、迟...

Salary: €46,442 - €56,369
Start Date: 4th Jan 2022
Application closing date: 25 November 2021
More information/apply: https://www.universityvacancies.com/national-university-ireland-galway/systematic-reviewer-post-doctoral-researcherresearch-fellow

Applications are invited from suitably qualified candidates for a four year (1.0 FTE) fixed term contract position as Post-Doctoral Researcher/Research Fellow with Evidence Synthesis Ireland (ESI).

Evidence Synthesis Ireland is an all-Ireland initiative funded by the Health Research Board (HRB) and the Health and Social Care, Research and Development (HSC R&D) Division of the Public Health Agency in Northern Ireland.

 Position is full-time (1.0 FTE) and is available from 4th Jan 2022 to 30 November 2025. The successful candidate will be based in the Centre for Health Evaluation, Methodology Research and Evidence Synthesis (CHEMRES) in NUI Galway. CHEMRES is also host to Cochrane Ireland and the HRB-Trials Methodology Research Network.

The role is to plan, conduct and support ESI activity in relation to the co-ordination of prioritised national and international evidence syntheses relevant to policy and practice on the island of Ireland and integration of capacity building into this activity. This role will require substantial evidence synthesis methodology experience and expertise as well as demonstratable evidence of leadership ability.

The successful candidate will contribute to the research programme of ESI. The successful candidate is expected to build capacity in evidence synthesis by supporting ESI’s training programme. The successful candidate will also have access to a large program of education for their own professional development.

The successful candidate will be responsible for leading and supporting evidence syntheses across a range of study designs and for leading a program of primary synthesis methodology research. The successful applicant will be highly motivated, passionate about developing high quality research, self-motivated with strong attention to detail and quality.

• Learn more about this position and apply before 25 November

Tuesday, November 16, 2021 Category: Jobs

哪种药物组合是最适合预防成人癌症化疗引起的恶心呕吐？ 化疗引起的恶心呕吐负担以及什么有助于预防其发生？ 在大约70%到80%的成人癌症患者中，化疗会引起恶心呕吐（chemotherapy induces nausea and vomiting, CINV）。取决于化疗类型，治疗可能会导致严重或中度的不适，以下称为高度致吐化疗（highly emetogenic chemotherapy, HEC）和中度致吐化疗（moderately emetogenic chemotherapy, MEC）。在接受HEC或MEC的成人中，多种药物组合显示出高CINV获益性。 本综述的目的是什么？ 使用网络meta分析，我们旨在比较不同药物组合在接受HEC或MEC者中预防CINV的益处和伤害，并找出疗效等级。网络meta分析是一种用于比较已发表试验中所描述的不同治疗方法的技术，即使各原始个别研究没有描述这些比较。 我们参考了哪些研究？ 我们检索了医学数据库和试验注册库，截至2021年2月。我们纳入的研究，在接受临床常用HEC或MEC的任何类型癌症成人中，比较了多种药物组合以预防CINV。尤其是，我们查看了抑制两种特定生化受体（神经激肽受体和血清素受体）的药物，这些受体会在化疗后激发恶心呕吐。我们查看了这些治疗在五天之中的预防效果。这是在化疗开始后预期出现最高强度CINV并进一步达到峰值的一段时期。...

辛波莫德是多发性硬化症（MS）的有效治疗方法吗？它是否会引起不良反应？ 关键信息 ·我们不知道辛波莫德（siponimod）是否是多发性硬化症（multiple sclerosis, MS）患者的有效治疗。在每天1次2mg的剂量下，辛波莫德可能会减少治疗6个月后的症状复发（复发率按年算），还可能减少治疗3个月后有残疾恶化的受试者人数。 ·我们不知道辛波莫德是否会引起不良反应，因为研究持续时间不够长，无法对其进行全面评估。 ·未来的研究应持续更长时间，从而更好地监测辛波莫德的不良影响和益处，且应采用更稳健的方法。他们应比较辛波莫德与其他药物。 什么是多发性硬化症？ 多发性硬化症（multiple sclerosis, MS）是一种因身体免疫系统（保护身体免受疾病和感染）错误地攻击部分中枢神经系统结构（大脑和脊髓）而导致的病况。症状包括平衡和行走问题以及视力模糊。MS是一种可导致严重残疾的终生疾病。有些患者的症状可能会渐进发展。然而，大多数患者会经历“攻击”，见于新症状出现或现有症状恶化（称为“复发”），随后进入无症状变化阶段（称为“缓解”）。此种MS类型称为“复发缓解型”MS。最终，MS患者病程可能会改变。这些无症状或症状无恶化阶段可能会停止，之后症状可能会持续恶化。这称为“继发进行性MS”。 辛波莫德如何起作用？ 辛波莫德是一种附着在攻击中枢神经系统的白细胞（淋巴细胞）上的药物。...

成人特发性膜性肾病 (idiopathic membranous nephropathy)的免疫抑制治疗 (Immunosuppressive treatment) 研究问题是什么？ 原发性膜性肾病(primary membranous nephropathy, PMN) 是一种自体免疫疾病，是指自身的免疫系统攻击自己的肾脏。术语“原发性”，是用来描述不是由其他疾病造成的膜性肾病。PMN 是成人肾病综合征的主要原因。肾病综合征是一种病况，是指肾脏的过滤膜受损导致蛋白质可以穿透的病症。原发性膜性肾病是通过肾活检结果和出现肾病综合征来诊断的。 PMN 对于约三分之一的患者是无害的，他们会出现自发的“完全缓解”，也就是该疾病会自行痊愈。然而，会有另外约三分之一的患者在经历自然缓解后仍出现蛋白尿，但他们的肾功能是正常的。这种患者通常只需要支持疗法，而不需要与免疫系统交互作用的疗法。若不治疗，约有 15% 至 50% 的患者会在 10 年内进展为终末期肾病 (end-stage kidney disease, ESKD)。 在些患者即使在接受 6 个月的支持性治疗后，PMN 可能变非常严重或持续恶化。对于这些患者，有可能采用额外的抑制免疫系统活性的治疗来减轻对肾脏的损害。目前尚不清楚这些治疗中哪一种最有效，以及会出现哪些副作用。因此，免疫抑制治疗的持续时间和强度需要与可能的副作用相平衡。有...

选择性血清素再摄取抑制剂用于卒中康复 综述问题 选择性血清再摄取抑制剂（selective serotonin reuptake inhibitors, SSRIs)药物对卒中康复有何影响？ 研究背景 卒中是残疾的主要原因。卒中相关性残疾包括日常任务（像如厕、洗衣和步行）困难。有时，残疾很严重，以致一个人要依赖他人以从事基本活动（此即所谓“依赖”）。我们之前发表过本Cochrane综述的更新，旨在了解SSRIs（一类治疗情绪问题的常用药，它通过改变大脑化学物质的水平而起作用）是否会改善卒中后的恢复。 自2019年更新以来，已有2项大型研究完成，因此有必要进一步更新本综述。在我们的主要分析中，我们仅纳入了高证据质量试验，亦即那些采用严格方法以避免偏倚的试验（例如结局评估者意识到卒中幸存者是否接受了活性药物或安慰剂）。我们将这些研究称作“低偏倚风险”研究。 我们还想了解SSRIs是否还有其他益处，例如改善任何手臂或腿部虚弱性、情緒、焦虑、认知、生活质量，以及SSRIs是否与出血或癫痫等副作用有关。 研究特征 我们共找到76项研究，招募了13029名卒中1年内的卒中幸存者。年龄范围很大。约半数研究需要受试者有抑郁方可进入试验。各研究的持续时间、药物和剂量有差别。然而，这些研究中仅有6项研究的偏倚风险为低；这些研究的受试者不需非有抑郁即可进入研究，且都是在卒中后不久即被招募的。 关键结果...

评价对于结核病患者使用Xpert MTB/RIF诊断测试代替涂片镜检是否可以减少死亡并成功完成治疗？ 本系统综述的目的是什么？ 結核病（TB）是一种细菌感染，通过吸入感染者咳嗽或打喷嚏产生的微小飞沫而传播。它主要影响肺部，但也可以影响身体的任何部位。结核病通常可以通过服用抗结核抗生素六个月来治愈。有些细菌具有耐药性，因而需要用不同的抗生素组合治疗。许多国家/地区使用Xpert MTB/RIF测试来诊断结核病。我们想了解使用此测试是否会影响健康结局，例如疑似患有结核病的人的死亡或成功治疗。 本系统综述的研究内容是什么？ 结核病的快速、准确诊断可确保生病的人尽快开始服用正确的抗生素。这可能会减少死亡人数，而且，如果及早发现耐利福平结核病，患者更有可能得到合适的治疗。这还有助于确保未患结核病的人不需要接受不必要的治疗。 Xpert MTB/RIF测试是一种自动分子测试，通常用于在两小时内同时识别结核病和利福平耐药性。世界卫生组织（WHO）建议使用Xpert MTB/RIF测试诊断结核病，而不是使用涂片镜检——使用显微镜在痰液样本（唾液和粘液的混合物，从肺部咳出）中寻找细菌。本综述调查了使用Xpert MTB/RIF代替显微镜是否能改善健康结局。 本系统综述的主要结果是什么？ 我们检索了一些研究，这些研究评价了疑似患有结核病并寻求治疗的患者以及使用Xpert MTB/RIF测试或涂片镜检...

膀胱内注射吉西他滨治疗非肌肉浸润性膀胱癌 系统综述问题 在患有膀胱浅层肿瘤（即非肌层浸润性膀胱癌[non-muscle invasive bladder cancer, NMIBC]）的病人身上，肿瘤切除后，置入膀胱的吉西他滨与其他药物相比如何? 背景 NMIBC可以用小型器械和光源（称为经尿道手术）从膀胱中取出。然而，这些肿瘤通常会伴随侵袭性的特征卷土重来（复发），如扩散至膀胱深层。为避免诸如此类不良后果，我们可以在膀胱中放置不同的药物。在本系统综述中，我们想要了解吉西他滨（一种化疗药物）与其他药物相比，是优是劣。 研究特征 证据截至2020年9月11日。我们仅纳入了那些随机决定人们是否接受吉西他滨或其他药物的研究。我们发现了7项研究，共涉及1222名受试者。2项研究对比了吉西他滨和生理盐水。1项研究对比了吉西他滨和丝裂霉素（一种化疗药物）。3项研究对比了吉西他滨和BCG（Bacillus Calmette-Guérin卡介苗；一种用于防止癌细胞生长的药物）。1项研究对比了吉西他滨和三分之一剂量的BCG。 主要结果 与生理盐水相比，吉西他滨可能会随着时间的推移降低复发风险，但是在疾病进展（癌症变得更加严重）和严重负性影响方面，二者效果相似。相比于丝裂霉素，吉西他滨可以预防复发和疾病进展。相比于丝裂霉素，我们非常不确定吉西他滨在严重不良负性效果方面的作用。在BCG单疗程治疗后复发...

The latest update of the Cochrane review ‘Vaccines for preventing rotavirus diarrhoea: vaccines in use’ has found that rotavirus vaccines pre-qualified by the World Health Organization (WHO) (Rotarix, RotaTeq, Rotasiil, and Rotavac), prevent episodes of rotavirus diarrhoea in children and no increased risk of serious adverse events was found.

Rotavirus infection is a common cause of diarrhoea in infants and in young children, and can cause mild illness, hospitalization, and death. Since 2009, the WHO has recommended that a rotavirus vaccine be included in all national infant and child immunization programmes. To date, 107 countries have followed this recommendation. In the years before infants and children started receiving rotavirus vaccine, rotavirus infection resulted in about 0.5 million deaths per year in children under five years of age, mainly in low- and middle-income countries.

This Cochrane Review, processed by the Cochrane Infectious Diseases Group (CIDG) editorial base at Liverpool School of Tropical Medicine, was first published in 2004 and has been updated five times. In 2012, in consultation with the WHO, the data underwent major restructuring by country mortality rates to reflect the observation that vaccine efficacy profiles are different in countries with different mortality rates.

The 2012, 2019, and 2021 review updates were preceded by systematic reviews commissioned by the WHO Immunization, Vaccines & Biologicals department and were used for WHO policy decisions on rotavirus vaccination schedules. These reviews were carried out by members of the author team and the subsequent Cochrane review updates built on the WHO reviews and vice versa.

The most recent review includes 60 studies: Rotarix (36 trials), RotaTeq (15 trials), Rotasiil (5 trials), and Rotavac (4 trials). The findings were presented at Session 6 - Rotavirus Vaccines at the October 2020 SAGE Meeting and was provided to SAGE Members as key background material to inform discussions (access presentation and background materials here).  As a result of this SAGE discussions, an updated WHO Rotavirus Vaccine Position Paper was published on 16 July 2021).  This position paper provides global advice on rotavirus vaccine policy.  In turn, the updated WHO position paper and the supporting background materials support Regional and National Immunization Technical Advisory group discussions which lead to decisions for local rotavirus vaccine policies.

Lead author, Hanna Bergman, noted, “The two globally established vaccines already have a proven track record and we now have high confidence in the two newer vaccines, all showing similar efficacy in preventing severe rotavirus diarrhea in infants and young children in high-mortality settings. This review also reinforces that more work needs to be done to improve and explore the reasons behind the lower efficacy of rotavirus vaccines seen in high-mortality countries.”

Bergman H, Henschke N, Hungerford D, Pitan F, Ndwandwe D, Cunliffe N, Soares‐Weiser K. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database of Systematic Reviews 2021, Issue 11. Art. No.: CD008521. DOI: 10.1002/14651858.CD008521.pub6.

The editorial base of the Cochrane Infectious Diseases Group is funded by UK aid from the UK government for the benefit of low- and middle-income countries (project number 300342-104). The views expressed do not necessarily reflect the UK government’s official policies.

• Read the full review here
• Visit the Cochrane Infectious Diseases Group website here

Thursday, November 18, 2021

慢性痛风的膳食补充剂 什么是痛风，什么是膳食补充剂？ 痛风由血液中的高尿酸水平导致关节中形成晶体引起。人们会出现关节疼痛、发热和肿胀，通常发生于大脚趾。有些人在皮肤下方形成大量晶体，称为痛风结节。如果血液中的尿酸水平长期恢复正常，使晶体沉积物溶解，患者将痊愈。 膳食补充剂为制剂，例如维生素、必需矿物质和益生菌。几乎没有研究评价它们的益处，更少有研究评价它们的不良副作用。 研究特征 本系统综述是对2014年发表的原始系统综述的更新。这次我们检索了截至2020年8月的医学文献，没有检索到新的研究。我们保留了原始系统综述中的两项研究。 一项研究（120名受试者）将浓缩脱脂奶粉（含有被认为可能具有抗炎作用的肽）与标准脱脂牛奶和乳糖粉进行比较，以期减少痛风发作的频率。第二项研究（40名受试者）将别嘌醇与维生素C-（一种常用于降低痛风患者血液中尿酸水平的药物）。这两项研究都招募了以中年男性为主的痛风患者。在脱脂牛奶组研究中，受试者似乎患有严重的痛风（其痛风发作频繁），20%到43%的受试者患痛风结节。维生素C组研究的受试者看起来与普通痛风患者相似。 关键结果——痛风患者喝了浓缩脱脂奶粉会怎样？ 痛风发作 喝了三个月脱脂浓缩奶粉的人每月痛风发作次数减少0.21次（从减少0.76次至增加0.34次），或每年减少2.5次痛风发作： -饮用浓缩脱脂奶粉的人每月有0.49次痛风发作（或每年6次痛风发作...

混合专业（多学科）团队是帮助老年人从髋部骨折中恢复的最佳方式吗？ 关键信息 -与常规治疗相比，由老年科医生或其他专科医生带领的不同专业的医疗保健专业团队（多学科康复团队）提供的治疗，可以帮助更多住院的老年人在髋部骨折后康复。 -由于证据不足，我们不知道多学科康复是否优于出院后常规治疗。 -未来的研究应着眼于确定由多学科专业团队提供的最佳治疗方法，以便患者早日出院并得到社区支持。 髋部骨折如何治疗？ 髋部骨折是老年人常见的严重损伤。大约三分之一的髋部骨折患者在受伤后一年内死亡。髋部骨折患者也可能有其他不利于康复的情况。许多人无法恢复骨折前的活动能力和独立生活能力，之后可能需要住在疗养院接受护理。 手术是髋部骨折患者的常规治疗，其次是在医院病房进行治疗以恢复活动能力和日常生活的基本功能，例如洗澡和穿衣。这可能涉及医院其他部门的人员。然而，髋部骨折患者需要在他人的协助下进行一系列活动，且在手术后可能会出现精神和身体问题。因此，帮助他们恢复或“康复”更好的方法是让一组来自不同领域或具有不同学科专业知识的人参与。他们根据患者的需要为每个人制定康复计划。这个“多学科康复”团队通常由专门从事老年人护理的医生或其他康复医学专家领导，还包括其他医生、护士、物理治疗师、营养师、社会工作者和心理健康专家。多学科康复可以在医院的急（短期住院）病房、康复病房，或在患者的家里进行。某些类型的多学科康复涉及在...

运动训练对成人肺移植受者的影响 研究问题是什么？ 肺移植通常是慢性肺病患者的最后治疗选择。有建议称肺移植受者应该进行运动训练，以加快恢复速度。这将有助于受者回归正常生活，提高生活质量。然而，运动训练对于这类病人的真正疗效并不明确，目前没有明确的指导方针用以指导如何进行运动训练。 我们做了什么？ 我们检索了电子数据库和临床研究记录，评价了与本主题相关的研究文献。我们的目的在于确认那些能帮助我们了解运动训练对于肺移植成人受者效果的研究。我们也对已纳入本综述的研究进行质量评价。 我们发现了什么？ 我们发现有8项研究符合本综述的纳入标准。2项研究将抗阻运动训练和常规护理或无运动训练进行对比，3项研究将抗阻运动训练和另一种抗阻运动训练进行对比，2项研究将多通道运动训练（多种不同的训练）和常规护理或无运动训练进行对比，1项研究将同意向多通道运动训练项目进行7周和14周的情况进行对比。 我们非常不确定运动训练对于任何一项结局的影响。尽管一些研究报告了6分钟步行距离（运动与无运动、不同的训练计划）中肌肉力量（运动或多通道运动与无运动）和骨密度（运动与无运动）的改善，但是大多数研究报告它们在不良事件、生活质量、肺部功能或死亡风险方面没有差异。 已纳入研究的证据质量极低。由于物理干预的性质，受试者和研究人员并未被施以盲法，而且通常存在报告偏倚。此外，对于结果的所有估计均不精确，主要是由于受试者数量较...

出生后晚期（从7天起）全身性皮质类固醇预防早产儿支气管肺发育不良 系统综述问题：为确定出生后1周的早产儿使用糖皮质激素抗炎药物预防或治疗肺损伤，即支气管肺发育不良（也称为慢性肺病）的相关利弊。 研究背景：皮质类固醇可减轻新生儿支气管肺发育不良引起的肺炎，但可能导致不良反应。支气管肺发育不良是新生儿重症监护病房中新生儿的一个主要问题，并且与较高的死亡率和幸存者的长期预后较差有关。肺部持续炎症是支气管肺发育不良最可能的原因。皮质类固醇药物具有很强的抗炎作用，因此已被用于预防或治疗支气管肺发育不良，尤其是对无法脱离机械通气的婴儿。 研究特征：我们评价了关于早产儿出生后第一周全身性使用皮质类固醇（即注射或药物）的所有临床试验，以及有关新生儿后期支气管肺发育不良率的可用数据。我们纳入了23项研究（1817名婴儿）。检索截至2020年9月25日。 主要结果：本综述表明，在出生后7天或更晚开始给予婴儿全身性皮质类固醇可降低死亡和支气管肺发育不良的风险，而不会增加儿童后期脑瘫（一种影响运动能力的疾病）的发生率。然而，长期结局尚未得到很好的研究。将全身性皮质类固醇的晚期使用限制在无法脱离机械通气的婴儿身上，并尽量减少任何疗程的剂量和持续时间似乎是明智的。 目前正在等待两项正在进行的研究的结果。 证据质量：总体上，支持我们主要结局结论的证据为高质量。 作者结论:  晚期全身性皮质类固醇治疗...

This review provides insight into the effectiveness of measures implemented in the school setting to contain the COVID-19 pandemic.

While there are limitations to this review, the review demonstrates that a range of different measures can be effective at reducing COVID-19 transmission, especially when multiple interventions are implemented together. Importantly, the review demonstrates that schools can stay open (or reopen) safely when prevention measures are implemented effectively. The effectiveness of interventions is influenced by many things, including the levels of community transmission. Given the rapid and widespread advancements in prevention and containment measures, most notably, the COVID-19 vaccines and increases in testing capacity, as well as the rise of more transmissible variants of the virus, an update to this review may yield very different results.

What was studied in the review?
In order to reduce the spread of the virus that causes COVID-19, many governments and societies put mitigation measures in place in schools. However, we do not know whether these measures work with regards to reducing the spread of the virus, or how these measures affect other aspects of life, such as education, the economy or society as a whole.

Key messages
Reopening schools or keeping schools open while having a broad range of measures in place can reduce transmission of the virus that causes COVID-19. Such measures can also reduce the number of people who will need to go to hospital due to developing COVID-19. However very little is known about other consequences of these measures, such as those linked to education, resources, and physical or mental health, as this knowledge is mostly based on studies modelling the real world. More studies set in the real world using real-world data are needed.

Lead author Shari Krishnaratne explains:

“This review provides insight into the effectiveness of measures implemented in schools to contain the COVID-19 pandemic. Whilst the review addresses a very important question there are limitations to the evidence it provides. We searched for studies for the review in December 2020, at a time when there was a lack of real-world evidence. As such, most of the studies included in this review use modelling. This review therefore shows an overall absence of real-world evidence about the effectiveness of these measures. However, there is enough evidence from the modelling studies and in other reviews such as one on travel measures for us to have some confidence that there is likely to be a positive effect on transmission, but how an intervention works in one location might not be the same as in another.
 
There are limitations to the evidence, but it does suggest that schools can stay open (or reopen) safely when prevention measures are implemented effectively. The effectiveness of interventions is influenced by many things, including the levels of community transmission. Given the rapid and widespread advancements in prevention and containment measures, most notably, the COVID-19 vaccines and increases in testing capacity, as well as the rise of more transmissible variants of the virus, an update to this review may yield very different results.”

What are measures implemented in the school setting?
Measures in the school setting can be grouped into the following four broad categories.

1. Measures reducing the opportunity for contacts: by reducing the number of students in a class or a school, opening certain school types only (for example primary schools) or by creating a schedule by which students attend school on different days or in different weeks, the face-to-face contact between students can be reduced.
2. Measures making contacts safer: by putting measures in place such as face masks, improving ventilation by opening windows or using air purifiers, cleaning, handwashing, or modifying activities like sports or music, contacts can be made safer.
3. Surveillance and response measures: screening for symptoms or testing sick or potentially sick students, or teachers, or both, and putting them into isolation (for sick people) or quarantine (for potentially sick people).
4. Multicomponent measures: measures from categories 1, 2 and 3 are combined.

What is the aim of the review?
The authors aimed to find out which measures implemented in the school setting allow schools to safely reopen, stay open, or both, during the COVID-19 pandemic.

What did we do?
They searched for studies that looked at the impact of these types of measures in the school setting on the spread of the virus that causes COVID-19, the impact on the healthcare system (i.e. how many hospital beds are needed), as well as important social aspects (i.e. how often students attended school). The studies could focus on students, teachers and other school staff, as well as on families and the whole community. They could use real-life data (observational studies) or data from computer-generated simulations (modelling studies).

View the video in German, French, or Spanish

What are the main results of the review?
The authors found 38 relevant studies. Most of these were modelling studies (33 studies). Five studies used real-world data. Twenty studies were conducted in North or South America, 16 in Europe and two in China.

Below we summarise the main findings by category.

1. Measures reducing the opportunity for contacts
   The authors found 23 modelling studies assessing measures to reduce the opportunity for contacts. All studies showed reductions in the spread of the virus that causes COVID-19 and the use of the healthcare system. Some studies also showed a reduction in the number of days spent in school due to the intervention.
2. Measures making contacts safer
   The authors found 11 modelling studies and two real-world studies looking at measures, such as mask wearing in schools, cleaning, handwashing, and ventilation. Five of these studies combined multiple measures, which means we cannot see which specific measures worked and which did not. Most studies showed reductions in the spread of the virus that causes COVID-19; some studies, however, showed mixed or no effects.
3. Surveillance and response measures
   We found 13 modelling studies and one real-world study assessing surveillance and response measures. Twelve studies focused on mass testing and isolation measures, while two looked specifically at symptom-based screening and isolation. Most studies showed results in favour of the intervention, however some showed mixed or no effects
4. Multicomponent measures
   They found three studies that looked at multicomponent interventions, where it was not possible to determine the effect of each individual intervention. These included one modelling study and two real-world studies. These studies assessed physical distancing, modification of activities, cancellation of sports or music classes, testing, exemption of high-risk students, handwashing, and face masks. Most studies showed reduced transmission of the virus that causes COVID-19, however some showed mixed or no effects.

How confident are we in the findings of this review?
Confidence in these results is limited. Most studies used models, that is, they estimated the effects of the interventions rather than observing outcomes. As the models are built on assumptions about how the virus spreads and how people behave, we lack real-world evidence. Many studies were published as 'preprints' without undergoing rigorous checks of published studies, which further limits confidence. Also, the studies were very different from each other (for example, with regards to the levels of transmission in the community).

How up to date is this evidence?
The evidence is up-to-date to December 2020. It is expected this review will be updated in Spring 2022.

• Read the full review
• Visit the Cochrane Public Health group website

Monday, January 17, 2022

Cochrane Library Special Collections provide a round-up of up-to-date Cochrane evidence on a specific topic. This Special Collection contains Cochrane Reviews summarizing data on the benefits and harms of several interventions for preventing and treating influenza. The Cochrane Reviews look at  vaccines, antiviral drugs, and physical interventions, such as the use of masks and hand washing.

This evidence for physical interventions may help inform policies and practices relevant to the ongoing COVID-19 pandemic. These comprehensive reviews provide valuable information for patients, doctors, and healthcare decision-makers about what steps to take or interventions to use to prevent influenza or aid its treatment.

• View the Special Collection
• Visit the Cochrane Acute Respiratory Infections website 

Thursday, December 9, 2021

New podcast series looks at initiatives to wind back the medical excess that is causing harm to people and the planet.

 

Cochrane Sustainable Healthcare has joined forces with the BMJ to launch a new podcast series called The Recovery - Voices of action towards sustainable healthcare co-hosted by The BMJ’s Editor in Chief Dr Fiona Godlee and journalist and Bond University health researcher Dr Ray Moynihan.

The series will feature compelling and inspirational conversations with healthcare researchers, doctors, and activists from around the world who are actively working to wind back medical excess and forge more sustainable healthcare systems to improve our health, wellbeing, and climate.   

Over six episodes, listeners will hear about new and sometimes radical initiatives that are changing the way doctors practice medicine, to ensure better access to high quality, evidence-based, and safe healthcare.

Highlights include: 

• Australian doctors fearlessly challenging professional norms to wind back ineffective and dangerous care
• A high-profile cancer specialist in India helping to reduce wasteful care in low- and middle-income countries
• A US-based doctor leading a non-violent revolution of care, built on compassion and solidarity
• A UK general practitioner championing physical activity, creating garden spaces, and improving access to fresh food, to empower patients, improve equity, and enhance the community’s wellbeing and health

“All these voices are part of a growing global chorus campaigning for fundamental reform of how we practice medicine and showing that radical new alternatives are imminently feasible,” write Godlee, Moynihan and Dr Minna Johansson, Director of Cochrane Sustainable Healthcare in an opinion article to launch the series.

“All those unnecessary tests, treatments, and diagnoses bring direct harm to people through adverse effects of drugs and surgeries, psychosocial harms of labelling, and increasing the burden of treatments. And since resources for healthcare are finite, waste is also harming patients indirectly because the overuse of some medical interventions means there are less resources to tackle underuse and underdiagnosis in other areas.”

They acknowledge that the drivers of unsustainable healthcare are complex and diverse and say we must adapt to support more sustainable decision-making within healthcare. 

“Most healthcare extends lives and reduces suffering, but too much medicine remains unnecessary and harmful,” they warn. “Reducing medical excess is not primarily about saving money, it is about avoiding harm to people and the planet.”

We hope this podcast series will inspire listeners all over the world to imagine novel and radical approaches for a more sustainable healthcare, and to dare to move from imagination to action.

• Listen to the The Recovery podcast
• Visit the Cochrane Sustainable Healthcare website
• Read 'Spotlight on Cochrane’s Sustainable Healthcare Field: An interview with Minna Johansson'

Monday, November 15, 2021

Tuesday, November 9, 2021

接受乳房手术的女性在手术前后服用止痛药（NSAIDs：非甾体抗炎药） 本系统综述的目的是什么？ 本综述旨在找出与不服用药物（安慰剂）或服用其他止痛药（例如阿片类药物）相比，NSAID止痛药是否能减轻乳房手术前后的疼痛。评价了NSAIDs可能产生的副作用，并比较了患者服用NSAIDs与未服用药物或服用其他类型缓解疼痛药物的副作用。NSAID止痛药包括酮咯酸、氟比洛芬、布洛芬和塞来昔布。 为什么本系统综述很重要？ 非甾体抗炎药已被证明可以减少炎症、疼痛和发热，同时也可能增加出血等并发症的风险。在乳房手术期间，NSAID止痛药的安全性仍令人担忧，但它们仍可能优于其他有不同副作用的药物（阿片类药物）。 本系统综述研究了什么？ 研究纳入了服用NSAID止痛药、安慰剂、其他止痛药或不服用任何药物的女性。我们想评价乳房出血、手术后疼痛、术后恶心和呕吐、任何部位出血、需要输血、使用NSAID报告的其他副作用、手术后24小时内使用阿片类药物、住院时间长短、乳腺癌复发和使用非处方NSAID。 我们发现了什么？ 我们共找到12项研究，涉及1596名受试者。证据截至2020年9月。有7项研究将NSAID（酮咯酸、双氯芬酸、氟比洛芬、帕瑞昔布和塞来昔布）与安慰剂进行了对比。有4项研究将NSAID（酮咯酸、氟比洛芬、布洛芬和塞来昔布）与其他止痛药进行了对比。有1项研究将NSAID（双氯芬酸）与不服用药物进行...