低压复苏治疗创伤失血性休克的系统评价

目的 系统评价低压复苏治疗创伤失血性休克的有效性.方法 计算机检索Pubmed、Embase和The Corchrane Library等数据库,纳入低压复苏治疗创伤失血性休克的随机对照试验或半随机对照试验,检索时间均为从建库至2015年8月.由2位研究者独立进行资料提取和质量评价,采用RevMan 5.3软件进行Meta分析,计数资料使用相对危险度(risk ratio,RR)及其95％可信区间(confidence interval,CI)进行评估,并采用GRADE 3.6.1软件对证据质量进行分级.结果 纳入4项研究,Meta分析及GRADE评级结果显示:与常规复苏比较,低压复苏有较低的总病死率[RR =0.77,95％ CI:0.62～0.95,P=0.01;n=984,GRADE评级:中]及24 h病死率[RR=0.47,95％CI:0.24～0.91,P=0.03;n=281,GRADE评级:中];但总病死率的亚组分析结果显示:在钝挫伤或穿透伤亚组以及穿透伤亚组,两组差异无统计学意义.结论 低压复苏能够降低创伤失血性休克患者的总病死率及24h病死率,证据质量为中级.未来研究应该着力于低压复苏对于不同创伤类型患者的疗效进行进一步探索.     

初始耐药结核治疗的系统评价与Meta分析

目的系统评价药物治疗初始耐药较非耐药肺结核的有效性。方法计算机检索Cochrane图书馆、MEDLINE、EMbase、VIP、CNKI和CBMdisc电子资料库,查找药物治疗初始耐药与非耐药肺结核的队列研究,然后由两位研究者独立进行资料提取和质量评价,采用RevMan 5.1软件进行Meta分析,并采用GRADEpro 3.6系统对证据质量和等级推荐进行分级。结果共将10个研究纳入Meta分析,初始耐药与非耐药肺结核病人相比,6个月末痰菌阴转率为91%[RR=0.91,95%CI（0.86,0.96）,P〈0.001],肺空洞闭合率为70%[RR=0.7,95%CI（0.60,0.82）,P〈0.001],2年后细菌学复发率为4.98倍[RR=4.98,95%CI（3.07,8.07）,P〈0.001]。GRADE系统评价结果显示,2年后细菌学复发率和肺空洞闭合率证据质量为中等,6个月末痰菌阴转率与肺部病灶吸收有效率证据质量为极低。结论初始耐药与非耐药肺结核相比,在6个月末痰菌阴转率、肺空洞闭合率等方面均低,2年后细菌学复发率较高。初始耐药是化疗失败的一个重要原因。鉴于系统评价为二次研究,受纳入分析的原始文献质量影响较大,且评价过程可能存在偏倚等局限性,上述结论尚需进一步通过开展大规模、高质量的基础和临床研究来验证。     

世界卫生组织基本药物遴选程序与具体评价方法研究

目的:为我国基本药物遴选和评价提供参考。方法:查阅文献,分析世界卫生组织(WHO)基本药物的评价程序和评价方法,与我国基本药物的评价方法进行对比研究,找出差异,进而提供参考。结果与结论:与我国基本药物评价相比,WHO基本药物评价程序透明化、方法科学化,充分运用了循证医学的方法,值得我国借鉴吸收。     

推荐分级的评估、制定与评价方法以及WHO在基本药物遴选中的应用

目的:研究推荐分级的评估、制定与评价(GRADE)方法以及WHO在基本药物遴选中的应用情况,为我国基本药物遴选提供借鉴。方法:采用文献研究方法,搜集所有介绍GRADE方法的文献以及使用GRADE方法对基本药物调入调出证据进行评价的参考文献。结果与结论:GRADE方法是WHO保证基本药物遴选科学性的重要方法,满足了其遴选标准规定的对安全性、有效性、经济性方面的要求。我国应充分利用WHO与国内外相关技术和信息资源,学习并且借鉴GRADE方法,使我国基本药物遴选更加科学、客观。     

Quality evaluation of systematic reviews of the effects of Baduanjin on diabete

ObjectiveRecently, the effects of Baduanjin (a traditional Chinese mind-body exercise) on diabetes have attracted increasing attention, and relevant systematic reviews (SRs) have emerged. However, the qualities of these SRs vary markedly, and their conclusions are inconsistent, which is not conducive to guiding decision-making. We sought to assess the quality of these SRs and provide more evidence for diabetes treatment.MethodsA literature search was conducted in 7 databases from inception to December 1_st, 2021. SRs of randomized controlled trials investigating the effects of Baduanjin were identified. A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) checklist, Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement, and Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were applied to evaluate the quality of the SRs.ResultsTen SRs were identified. All SRs were judged as critically low methodological quality by the AMSTAR-2 checklist. The total PRISMA score of the included SRs ranged from 15 to 21, and the mean score was 18.60 (1.90), indicating that all SRs had partial reporting deficits. Sixty outcomes were reported in the included studies, of which 25 (41.67%) were judged as low quality, and 34 (56.67%) as very low quality according to the GRADE system, indicating that the overall evidence quality of outcomes was not high.ConclusionBaduanjin seems to be an effective therapy for diabetes in improving glucose and lipid metabolism, mental health, quality of life, and waist-hip ratio (WHR). The overall quality of the SRs was less than optimal. This conclusion should be treated with caution, and researchers should conduct higher-quality clinical studies following AMSTAR-2checklist, PRISMA statement, and GRADE system in the future.     

Adjuncts for the evaluation of potentially malignant disorders in the oral cavity: Diagnostic test accuracy systematic review and meta-analysis—a report of the American Dental Association

Background

Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients’ values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity.

Use of platelet-rich plasma,platelet-rich growth factor with arthrocentesis or arthroscopy to treat temporomandibular joint osteoarthritis: Systematic review with meta-analyses

Background

The authors conducted a systematic review and meta-analysis to determine whether arthrocentesis or arthroscopy combined with platelet-rich plasma (PRP) or platelet-rich growth factor (PRGF) injection compared with no injection or saline injection (control group) or hyaluronic acid (HA) injection reduced pain and increased maximum mouth opening (MMO) in patients with temporomandibular joint (TMJ) osteoarthritis (OA).