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Invasive fungal infections (IFI) are associated with significant health burden in preterm neonates. The objective of this study was to systematically review effect of probiotic supplementation (PS) for preventing IFI in preterm neonates. We searched Cochrane Central Register of Controlled Trials, Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, and proceedings of the Pediatric Academic Society meetings in August 2014. Study selection was performed on randomised controlled trials ( RCT) of PS in neonates born <37 weeks. Primary outcome of this study was IFI (Isolation of fungus in blood/body fluids) and secondary outcome was fungal gut colonisation. Information on IFI/colonisation was available in 8 of 27 RCT. Meta‐analysis (fixed effects model) showed that PS reduced the risk of IFI (RR: 0.50, 95% CI: 0.34, 0.73, I2 = 39%). Results were not significant with random effects model (RR: 0.64, 95%, CI: 0.30, 1.38, P = 0.25, I2 = 39%). Analysis after excluding the study with a high baseline incidence (75%) of IFI showed that PS had no significant benefits (RR: 0.89; 95% CI: 0.44, 1.78). Of the five studies reporting on fungal gut colonisation, three reported benefits of probiotics; two did not. Current evidence is limited to derive firm conclusions on the effect of PS for preventing IFI/gut colonisation in preterm neonates.  相似文献   
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Effective management of depression is predicated upon reliable assessment. The Quick Inventory of Depressive Symptomatology (QIDS) is a depression severity scale with both self-rated (QIDS-SR16) and clinician-rated (QIDS-C16) versions. Although widely used in research, the psychometric properties of the QIDS16 have not been systematically reviewed. We performed a systematic review of studies of the psychometric properties (factor structure, internal consistency, convergent validity, discriminant validity, test-retest reliability and responsiveness to change) of the QIDS-SR16 or QIDS-C16. Six databases were searched: MEDLINE, EMBASE, PsycINFO, CinAHL, Web of Science and the Cochrane Central Register of Controlled Trials. Findings were summarised, bias assessed and correlations with reference standards were pooled. 37 studies (17,118 participants) were included in the review. Both versions of the QIDS16 were unidimensional. Cronbach's alpha ranged from 0.69 to 0.89 for the QIDS-SR16 and 0.65 to 0.87 for the QIDS-C16. The QIDS-SR16 correlated moderately to highly with several depression severity scales. Seven studies were pooled where QIDS-SR16 was correlated with the HRSD-17 (r = 0.76, CI 0.69, 0.81) in patients diagnosed with depression. Four studies examined convergent validity with the QIDS-C16. Four studies examined discriminant validity, for the QIDS-SR16 alone. Eighteen studies had at least one author who was a co-author of the original QIDS16 study. Most studies were conducted in the USA (n = 26). The QIDS-SR16 and the QIDS-C16 are unidimensional rating scales with acceptable internal consistency. To justify the use of the QIDS16 scale in clinical practice, more research is needed on convergent and discriminant validity, and in populations outside the USA.  相似文献   
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Mindfulness meditation has been purported to be a beneficial practice for wellbeing. It would therefore be expected that the neurophysiology of mindfulness would reflect this impact on wellbeing. However, investigations of the effects of mindfulness have generated mixed reports of increases, decreases, as well as no differences in EEG oscillations in comparison with a resting state and a variety of tasks. We have performed a systematic review of EEG studies of mindfulness meditation in order to determine any common effects and to identify factors which may impact on the effects. Databases were reviewed from 1966 to August 2015. Eligibility criteria included empirical quantitative analyses of mindfulness meditation practice and EEG measurements acquired in relation to practice. A total of 56 papers met the eligibility criteria and were included in the systematic review, consisting of a total 1715 subjects: 1358 healthy individuals and 357 individuals with psychiatric diagnoses. Studies were principally examined for power outcomes in each bandwidth, in particular the power differentials between mindfulness and a control state, as well as outcomes relating to hemispheric asymmetry and event-related potentials. The systematic review revealed that mindfulness was most commonly associated with enhanced alpha and theta power as compared to an eyes closed resting state, although such outcomes were not uniformly reported. No consistent patterns were observed with respect to beta, delta and gamma bandwidths. In summary, mindfulness is associated with increased alpha and theta power in both healthy individuals and in patient groups. This co-presence of elevated alpha and theta may signify a state of relaxed alertness which is conducive to mental health.  相似文献   
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There has been a rapid increase in the use of cost‐effectiveness analysis, with quality adjusted life years (QALYs) as an outcome measure, in evaluating both medical technologies and public health interventions. Alongside, there is a growing literature on the monetary value of a QALY based on estimates of the willingness to pay (WTP). This paper conducts a review of the literature on the WTP for a QALY. In total, 24 studies containing 383 unique estimates of the WTP for a QALY are identified. Trimmed mean and median estimates amount to 74,159 and 24,226 Euros (2010 price level), respectively. In regression analyses, the results indicate that the WTP for a QALY is significantly higher if the QALY gain comes from life extension rather than quality of life improvements. The results also show that the WTP for a QALY is dependent on the size of the QALY gain valued. Copyright © 2014 John Wiley & Sons, Ltd.  相似文献   
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目的:系统评价免疫球蛋白( IVIG)治疗呼吸机相关性肺炎( VAP)相关研究,分析其有效性,为临床治疗策略提供依据。方法系统检索CNKI、万方、CBM、Pubmed、Embase、ISI及Cochrane数据库中相关文献,采用Cochrane标准评价纳入研究偏倚风险,Meta分析结合描述性分析研究数据。结果①纳入6个随机对照研究,435例低体质量儿、早产儿及婴儿VAP患者,质量一般。②Meta分析结果显示IVIG组死亡率低于非IVIG组[RR=0.33,95%CI(0.18~0.60),P=0.0002];IVIG组血液免疫球蛋白浓度比对照组高3.19 mg/L [MD=3.19,95%CI(3.02~3.37),P<0.05];③IVIG组败血症[RR=0.14,95%CI(0.04~0.51),P=0.003]和多器官功能衰竭发生率[RR=0.51,95%CI(0.30~0.88),P=0.02]低于对照。结论 IVIG主要用于早产儿及低体质量儿VAP患者,可能提高体液免疫,降低败血症和多器官功能衰竭发生率,减少患者病死率,改善预后。  相似文献   
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目的:系统评价半夏厚朴汤治疗梅核气的临床疗效。方法:计算机检索CNKI中国知网(总库)(1979-2013)、维普期刊资源整合服务平台(1989-2013)、美国图书馆Pub Med/MEDLINE相关文献。根据Jadad量表对纳入文献进行质量评价。采用Cochrane协作网提供的Rev Man 5.2.0分析软件进行Meta分析。结果:共纳入6项临床随机对照研究,包括649例梅核气患者。Meta分析结果显示,半夏厚朴汤与西药比较治疗梅核气的总体疗效RR=1.15,95%CI(1.08,1.23);半夏厚朴汤合西医治疗与单纯西医治疗梅核气的总体疗效RR=1.43,95%CI(1.19,1.73)。结论:当前的临床证据显示,单用半夏厚朴汤或联用西医治疗梅核气疗效均优于单用西医治疗者,且无明显副作用。由于纳入研究样本量小且质量较低,尚需开展高质量、多中心、大样本的临床随机双盲对照试验加以证实。  相似文献   
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大血管病变已经成为2型糖尿病(T2DM)致死、致残的主要原因,系统深入地研究T2DM大血管病变机制,并寻求有效药物进行防治,对改善T2DM患者预后有极其重要的意义。中医认为T2DM大血管病变的基本病机特点为本虚标实,气阴两虚为本、脉络瘀阻为标。西医认为机体内皮功能紊乱、氧化应激反应、基因表达异常等均可引起T2DM大血管病变。本文整理了近年来中西医的相关文献,对T2DM大血管病的病变机制进行探讨。  相似文献   
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目的:评价口服中药治疗肺间质纤维化的疗效和安全性。方法:计算机检索CNKI、VIP、CBM、PubMed和万方数据库等资源,收集以激素为对照的口服中药治疗肺间质纤维化的临床随机对照试验,按 Cochrane 系统评价方法,对纳入研究进行方法学质量评价,并采用 RevMan 5.2 软件进行 Meta 分析。结果:符合纳入标准的研究共22项(1 338例)。Meta分析结果显示:与激素比较,口服中药可提高治疗肺间质纤维化的有效率[RR=1.29,95%CI(1.16,1.42),P<0.000 01];缓解咳嗽[MD=-0.57,95%CI(-0.83,-0.30),P<0.000 1]、喘息[MD=-0.67,95%CI(-1.20,-0.14),P=0.01]、气短[MD=-0.45,95%CI(-0.65,-0.25),P<0.000 1]等症状;改善肺部Velcro啰音[MD=-0.49,95%CI(-0.73,-0.25),P<0.000 1];提高用力肺活量(FVC)[SMD=0.37,95%CI(0.16,0.58),P=0.000 7]、第一秒用力呼气量百分率(FEV1%)[MD=6.63,95%CI(1.67,11.60),P=0.009]、动脉血氧分压(PaO2)[MD=4.87,95%CI(2.74,7.01),P<0.000 01];减少肺部再感染次数[RR=0.75,95%CI(0.67,0.84),P<0.000 01]。结论:口服中药较激素治疗肺间质纤维化具有一定的优势,但由于本系统评价纳入研究的方法学质量偏低,影响了结论的可靠性,该结论尚需更高质量、多中心、大样本的临床随机双盲对照试验加以证实。  相似文献   
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