鱼油（ω-3脂肪酸）对手术后患者感染并发症、成本/效果影响的系统评价（2010~2016）

目的　评价鱼油（ω-3脂肪酸）干预对外科手术后非重症患者结局的影响。方法　计算机检索数据库PubMed、Embase、Cochrane、CNKI、万方等,检索符合纳入排除标准的择期手术后应用肠外营养患者进行静脉鱼油（Omegawen）干预有临床结局指标的随机对照研究（RCT）。文献发表时间从2010年1月至2016年6月。采用Jadad量表、Schulz隐蔽分组评价进行文献质量评价。采用RevMan 5.3软件进行Meta分析。结果　最终纳入19项RCT研究,含1 170例外科手术后患者。Meta分析结果显示：鱼油短期干预可降低感染并发症发生率［RR=0.44,95% CI（0.31,0.64）,P＜0.000 1］,减少手术后住院时间［MD=-0.85,95% CI（-1.67,-0.03）,P=0.04］,不影响病死率［RR=0.42,95% CI（0.07,2.63）,P=0.36］与住院总费用［MD=-216.60,95% CI（-718.94,285.75）,P=0.40］。敏感性分析结果与前一致。结论　现有证据表明外科手术后应用鱼油,可显著降低感染并发症和减少手术后住院时间。     

原发病灶切除对转移性乳腺癌患者生存期影响的系统评价

目的系统评价原发病灶手术治疗对转移性乳腺癌患者生存期的影响。方法计算机检索Cochrane Library、MED-LINE、EMbase、中国生物医学文献数据库及万方数据库等,收集符合纳入标准的研究,检索时限均为从建库至2014年5月,并追溯纳入研究的参考文献和手工检索相关会议资料。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用Revman 5.2.6软件进行Meta分析。结果共纳入13篇文献进行回顾性研究,合计13 277例患者。Meta分析结果显示,原发灶手术治疗组较未手术组总生存率明显改善,HR=0.68,95%CI为0.66~0.71,P<0.01。结论原发病灶手术治疗可以提高转移性乳腺癌患者的总生存率,手术方式建议尽可能以乳房全切术为主,以提高手术切缘阴性率,年轻患者更能从手术治疗中获益。在今后的研究中,需要开展设计严格的大样本随机对照试验进行临床验证。     

《中华流行病学杂志》55篇Meta分析文献的质量评价

目的 评价《中华流行病学杂志》公开发表Meta分析文献的方法学质量和报告质量.方法 计算机检索万方医学网,检索时间为1998年1月至2012年12月,同时辅以手工检索,查找《中华流行病学杂志》发表的Meta分析文献.由2名调查员分别按照纳入和排除标准筛查文献,并采用AMSTAR量表和PRISMA量表评估纳入文献的方法学质量和报告质量.采用SPSS13.0软件进行数据统计和分析.结果 共纳入文献55篇,方法学质量评价结果显示高质量者仅2篇(3.6％),中等质量35篇(63.7％),低质量18篇(32.7％);2008年以来发表的文献方法学质量有所改善,但仍然存在纳入和排除的研究文献清单提供不全、检索不够系统全面、纳入研究质量评价不受重视等问题.报告质量的评价结果显示纳入文献在报告题目、文献信息来源的描述、方法效应指标的概括以及Meta分析结果的综合方面质量较高,但是在摘要、资料检索和收集方法、单个研究内部偏倚评估、讨论中对证据总结、局限性及资金支持等方面报道不全面.结论 《中华流行病学杂志》发表的Meta分析文献为提供更为可靠的病因/危险因素的估计提供了证据,但其方法学质量和报告质量仍需提高.     

短期ω-3脂肪酸乳剂干预对手术后肠外营养患者临床结局影响的Meta分析

目的 探讨ω-3脂肪酸乳剂对手术后患者临床结局的影响。方法 计算机检索1996年1月至2010年6月PubMed、EMBASE、Cochrane图书馆、Web of Science以及中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方等中文数据库中研究择期手术后补充ω-3脂肪酸对患者临床结局影响的文献,同时进行手工检索和参考文献回溯。采用Jadad量表结合Schulz隐蔽分组评价方法对随机对照研究的质量进行评价。两组人员独立对研究方法详读综合后进行数据提取。采用RevMan 5.1软件进行Meta分析,研究ω-3脂肪酸乳剂对手术后患者感染并发症发生率、病死率、术后住院时间和术后ICU入住时间的影响。结果 共检索到320篇相关文献,大致符合计划要求的有22篇文献,排除数据重复、抄袭和无法获得方法学资料的文摘,最终纳入17个随机对照研究,合计1213例患者。Meta分析结果显示：ω-3脂肪酸乳剂干预能降低患者手术后感染并发症发生率[RR=0.44,95％CI (0.30,0.64),P＜0.0001],减少住院时间[MD=-1.65,95％CI（-2.72,-0.58）,P=0.003],对术后ICU入住时间无影响[MD=-0.31,95％CI（-1.20,0.58）,P=0.500]。结论 适当剂量和一定干预时间的ω-3脂肪酸乳剂能降低手术后患者感染并发症发生率和减少住院时间。今后需要更多样本量较大、质量较高的随机对照研究,观察ω-3脂肪酸乳剂干预对手术后患者临床结局和成本一效果的影响。     

系统评价妊娠期糖尿病胎盘差异表达蛋白对胎儿的影响

目的系统评价妊娠期糖尿病胎盘差异表达蛋白对胎儿的影响。方法于2019年6月计算机检索PubMed、Web of Science、Cochrane Library、EMBase、Medline (Ovid)、Scopus、中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普中与妊娠期糖尿病胎盘蛋白表达有关的文献,检索时限为2010年1月-2019年6月。采用主题词与自由词结合的方式进行检索,同时手工检索相关文献的参考文献。运用纽卡斯尔渥太华量表评价纳入研究的方法学质量,进行描述性分析。结果最终纳入15篇文献,均为病例对照研究,共包含844名研究对象。系统评价结果显示:胎盘差异表达蛋白通过干扰葡萄糖、脂质代谢与转运,影响氨基酸转运和蛋白质合成,调整胎盘屏障,增加水、甘油和铁转运4个途径影响胎儿生长发育和妊娠结局。结论胎盘蛋白表达失调可能介导胎盘营养转运能力的改变和影响胎盘屏障,参与胎儿宫内生长发育和增加不良胎儿结局的风险。但其因果关系及调控机制尚不明确,有待进一步深入研究。     

中孕期使用子宫颈托对双胎妊娠孕妇早产预防的系统评价

目的系统评价双胎孕妇中孕期使用子宫颈托预防双胎妊娠发生早产的有效性。 方法计算机检索相关文献数据库中,关于双胎孕妇中孕期使用子宫颈托预防双胎妊娠发生早产的相关文献。其中,英文数据库包括：Embase、PubMed、Cochrane Central Register of Controlled Trials (CCRT)、Cochrane Database of Systematic Reviews、Ovid-Medline及American College of Physicians (ACP)等;中文数据库包括：中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、维普(VIP)和万方数据库。此外,手工检索相关会议资料、论文集及学位论文汇编等。检索时间设定为自数据库建库至2018年1月,检索内容为双胎孕妇中孕期使用子宫颈托预防双胎妊娠发生早产的随机对照试验(RCT)。采用Cochrane系统评价法,对检索文献进行质量评价和Meta分析,参照系统综述和Meta分析优先报告的条目(PRISMA)报告规范进行报告。各研究间的异质性采用I²检验,若I²≤50%,则采用固定效应模型Meta分析;若I²>50%,则采用随机效应模型Meta分析。采用Mantel-Haenszel法评估RR值及其95%CI。 结果①通过相关文献检索,共计5篇RCT文献符合本研究纳入标准与排除标准,涉及2 465例双胎妊娠孕妇,其中宫颈长度(CL)缩短双胎妊娠孕妇为827例。②对纳入文献的方法学质量评价结果显示,纳入文献质量为中等质量文献。③对纳入的双胎孕妇中孕期使用子宫颈托的双胎妊娠预防早产主要/次要指标的Meta分析结果示,中孕期使用子宫颈托,可明显降低中孕期双胎妊娠者分娩新生儿的新生儿重症监护病房(NICU)治疗率(RR＝0.73,95%CI：0.53～1.00,P＝0.05),但是增加了双胎孕妇的阴道排液发生率(RR＝3.07,95%CI：1.29～7.30,P＝0.01)和早产儿视网膜病变(ROP)发生率(RR＝3.85,95%CI：1.19～12.45,P＝0.02)。对中孕期双胎妊娠合并CL缩短孕妇的亚组Meta分析结果显示,中孕期CL<38 mm双胎妊娠孕妇使用子宫颈托,可显著降低孕龄<37孕周前早产发生率(RR＝0.81,95%CI：0.69～0.94,P＝0.007),新生儿败血症发生率(RR＝0.50,95%CI：0.30～0.86,P＝0.01)与新生儿坏死性小肠结肠炎(NCE)发生率(RR＝0.43,95%CI：0.20～0.95,P＝0.04);中孕期CL≤25 mm双胎妊娠孕妇使用子宫颈托,不能显著改善双胎妊娠的胎儿/新生儿围生期结局。 结论双胎妊娠孕妇中孕期预防性使用子宫颈托,并不能有效预防早产发生,但是可明显降低CL<38 mm双胎妊娠孕妇孕龄≤37孕周前早产发生率。     

虚拟现实技术对老年痴呆患者干预效果的系统评价

目的 评价虚拟现实技术对老年痴呆患者的干预效果。方法 计算机检索Cochrane Library、PubMed、Web of Science、Embase、CINAHL、APA PsycNet、中国知网、万方、维普、中国生物医学文献数据库中,关于虚拟现实技术应用于老年痴呆患者的随机对照研究,检索时间为建库至2022年1月30日,由2名研究者独立筛选文献并提取资料,采用RevMan 5.4软件进行Meta分析。结果 共纳入11篇文献,总计643例患者。Meta分析结果显示,虚拟现实技术可改善老年痴呆症患者的认知功能、抑郁情绪,提高日常生活活动能力及生活质量(均P<0.01);对平衡与步态能力的效果差异无统计学意义(P>0.05),在焦虑情绪方面的效果尚不明确。结论 虚拟现实技术对于改善老年痴呆患者认知功能、抑郁情绪、日常生活能力和生活质量有效,而对于焦虑情绪、平衡与步态能力方面的作用尚缺乏足够证据。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。     

中西医联合治疗HBeAg阴性慢性乙型肝炎的系统评价

目的 了解中西医联合治疗HBeAg阴性慢性乙型肝炎的现状和发展趋势,科学评价中医药在HBeAg阴性慢性乙型肝炎防治中的作用和优势,为后续临床治疗和研究提供有价值的参考依据.方法 制定文献纳入标准和排除标准,全面检索中国期刊全文数据库、中文科技期刊数据库、中国生物医学文献数据库、中国优秀硕博论文数据库、中国学术会议论文集数据库等5大中文文献数据库关于中西医联合治疗HBeAg阴性慢性乙型肝炎的临床观察文献,对纳入文献进行方法学质量评级,采用专用软件Rev Man 4.2对入选文献进行Meta分析.结果 最终纳入系统评价有11篇RCT文献,共计929例患者,其中中西医联合治疗组549例,西药对照组380例,全部文献的方法学质量评级均为“c级”.分别有7篇及6篇文献报告了肝功能指标ALT、AST治疗前后的变化,由于异质性过高,均放弃meta分析.分别有6篇及9篇文献报告了肝功能指标TBIL变化及DNA阴转率,采用随机效应模型进行meta分析,两组差异均有统计学意义(P＜0.05).结论 中西医联合治疗HBeAg阴性慢性乙型肝炎在改善肝功能及抗病毒疗效总体优于单用西药治疗,可为系统评价中医药疗效提供可参考的循证医学证据.     

乙型肝炎病毒宫内感染危险因素的系统评价

目的综合评价乙型肝炎病毒(HBV)宫内感染发生的危险因素。方法计算机检索《MEDLINE》及《中国生物医学文献数据库》,手工检索和引文检索作为补充。对纳入的文献进行质量评价后提取数据信息。采用RevMan 4.2完成Meta分析过程。结果经筛选纳入符合标准的文献共有10篇,孕妇HBeAg阳性、孕妇HBV DNA阳性的合并OR值及95%CI分别为10.23(6.92～15.14)、11.86(8.09～17.40)。其他因素未显示与HBV宫内感染相关。结论孕妇HBeAg阳性、孕妇HBV DNA阳性与HBV宫内感染高度相关,是HBV宫内感染主要的危险因素。     

护理临床决策支持系统的评价研究

目的系统评价临床决策支持系统对护理实践的影响。方法利用计算机检索中英文数据库关于临床决策支持系统影响护理实践的干预性研究，检索时限为建库至2019年9月。采用澳大利亚JBI循证卫生保健中心质量评价手册（2016）评价文献质量，运用分类归纳法提取和整合结果。结果共纳入33篇文献，归纳出3类共9项结局指标。临床决策支持系统在护理程序、护士实践环境、批判性思维、患者安全、患者生活质量和护理服务资源等方面具有积极影响，对患者健康水平无明显作用，对经济资源和时间资源存在混合影响。结论临床决策支持系统对护理实践和患者结局发挥积极作用，但仍存在不足，需不断完善。     

FIMR and Other Mortality Reviews as Public Health Tools for Strengthening Maternal and Child Health Systems in Communities: Where Do We Need to Go Next?

This article examines FIMR in relationship to two other maternal and child health mortality reviews--child fatality review (CFR) and maternal mortality review (MMR), and explores how their approaches to reviewing deaths can complement one another. Identifying opportunities for collaboration among these case review methodologies may lead to greater efficiencies at the local and state levels and strengthen the case review approach as a public health tool for improving maternal and child health outcomes. To enable comparative analysis, a table was constructed that identifies the purpose, structure, and process features of each case review approach. This was followed by an examination of two possible ways to improve maternal and child mortality review processes in states: 1) better coordination; and 2) improving each individual process through adapting and adopting promising practices from the others. A discussion is also provided of the state Title V role in facilitating both the coordination of reviews and the process of sharing best practices. Given the similarities that exist among the three MCH mortality reviews, it is important to view each review as one component of a larger system of maternal and child health death reviews. Implementing widely the recommendations generated by these reviews may increase the likelihood of improvements in services and systems on behalf of women and children.     

Twelve recommendations for integrating existing systematic reviews into new reviews: EPC guidance

ObjectivesAs time and cost constraints in the conduct of systematic reviews increase, the need to consider the use of existing systematic reviews also increases. We developed guidance on the integration of systematic reviews into new reviews.MethodsA workgroup of methodologists from Evidence-based Practice Centers developed consensus-based recommendations. Discussions were informed by a literature scan and by interviews with organizations that conduct systematic reviews.ResultsTwelve recommendations were developed addressing selecting reviews, assessing risk of bias, qualitative and quantitative synthesis, and summarizing and assessing body of evidence.ConclusionsWe provide preliminary guidance for an efficient and unbiased approach to integrating existing systematic reviews with primary studies in a new review.     

Updating comparative effectiveness reviews: current efforts in AHRQ's Effective Health Care Program

Objectives

To review the current knowledge and efforts on updating systematic reviews (SRs) as applied to comparative effectiveness reviews (CERs).

Study Design and Setting

This article outlines considerations for updating CERs by including a definition of the updating process, describing issues around assessing whether to update, and providing general guidelines for the update process. Key points to consider include (1) identifying when to update CERs, (2) how to update CERs, and (3) how to present, report, and interpret updated results in CERs.

Results

Currently, there is little information about what proportion of SRs needs updating. Similarly, there is no consensus on when to initiate updating and how best to carry it out.

Conclusion

CERs need to be regularly updated as new evidence is produced. Lack of attention to updating may lead to outdated and sometimes misleading conclusions that compromise health care and policy decisions. The article outlines several specific goals for future research, one of them being the development of efficient guideline for updating CERs applicable across evidence-based practice centers.     

Survey revealed a lack of clarity about recommended methods for meta-analysis of diagnostic accuracy data

ObjectivesTo collect reasons for selecting the methods for meta-analysis of diagnostic accuracy from authors of systematic reviews and improve guidance on recommended methods.Study Design and SettingOnline survey in authors of recently published meta-analyses of diagnostic accuracy.ResultsWe identified 100 eligible reviews, of which 40 had used more advanced methods of meta-analysis (hierarchical random-effects approach), 52 more traditional methods (summary receiver operating characteristic curve based on linear regression or a univariate approach), and 8 combined both. Fifty-nine authors responded to the survey; 29 (49%) authors had used advanced methods, 25 (42%) authors traditional methods, and 5 (9%) authors combined traditional and advanced methods. Most authors who had used advanced methods reported to do so because they believed that these methods are currently recommended (n = 27; 93%). Most authors who had used traditional methods also reported to do so because they believed that these methods are currently recommended (n = 18; 75%) or easy to understand (n = 18; 75%).ConclusionAlthough more advanced methods for meta-analysis are recommended by The Cochrane Collaboration, both authors using these methods and those using more traditional methods responded that the methods they used were currently recommended. Clearer and more widespread dissemination of guidelines on recommended methods for meta-analysis of test accuracy data is needed.     

(Un)contested evidence: scientific literature,systematic reviews and the politics of evidence in the introduction of HPV vaccines in Colombia

This paper analyses the tensions between scientific literature and systematic reviews in the production of evidence in healthcare. Systematic reviews are devices developed – within evidence‐based medicine – to navigate the complexities of scientific literature promising a clear and simple account of the knowledge on a particular issue. However, in practice, systematic reviews have a more complex relation with literature. Systematic reviews are shaped according to the interest of the local groups that produce them. In this paper, I explore the formatting, making and managing of systematic reviews of evidence relating to HPV vaccines in Colombia. This case shows the ways in which systematic reviews mediate between the requirement of presenting the evidence that emerges from the international literature and the necessity of having data locally relevant.     

Want Your Paper Published Faster? Read on…

After nearly 5 years and 24 issues, the editor offers some tips to authors seeking the fastest route to seeing their work in print.     

Identifying,documenting, and examining heterogeneity in systematic reviews of complex interventions

This article describes approaches for planning, dealing, and analyzing heterogeneity in a systematic review of complex interventions. Approaches aim to generate a priori hypotheses of the mechanism of action of a complex intervention to identify the key variables that might contribute to variation among studies and guide statistical analysis. In addition to characteristics related to the population, intervention, and outcomes, we describe study-related variables, such as the way the interventions have been implemented and the context and conduct of studies. These approaches will guide reviewers planning a meta-analysis and provide a rationale for not meta-analyzing data if there is too much variability. Potential difficulties in applying meta-analytical techniques to examine statistical association among study results and sources of potential heterogeneity are described; these include the selection of a fixed or random-effects model, the risk of multiple testing and confounding when studies include different aspects of a complex intervention or different subsamples of the intended participant pool.     

腹腔镜手术在妇科领域的应用及进展（综述）

随着腹腔镜器械及技术的不断改进与临床技术水平的提高,腹腔镜已成为诊治妇科疾病的重要手段,且使微创治疗成为妇科领域的趋势,现将腹腔镜技术在妇科领域的应用现状与进展作一综述。