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1.
This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.  相似文献
2.
Health policy makers are faced with competing alternatives, and for systems of health care financing. The choice of financing method should mobilize resources for health care and provide financial protection. This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge. Overall, the evidence base is limited in scope and questionable in quality. There is strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending. There is evidence of moderate strength that such schemes improve cost-recovery. There is weak or no evidence that schemes have an effect on the quality of care or the efficiency with which care is produced. In absolute terms, the effects are small and schemes serve only a limited section of the population. The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing. To improve reliability and validity of the evidence base, analysts should agree on a more coherent set of outcome indicators and a more consistent assessment of these indicators. Policy makers need to be better informed as to both the costs and the benefits of implementing various financing options. The current evidence base on community-based health insurance is mute on this point.  相似文献
3.
肠外营养临床有效性的大样本临床研究与系统评价   总被引:15,自引:0,他引:15  
肠外营养(PN)的发展推动了临床营养的进步,但过度应用可能造成的不良反应已引起关注,1991年美国VA研究发现,PN对无严重营养不良的患不仅无益,反而可能有害。2001年美国胃肠病学会运用循证医学方法对PN临床有效性进行了评价。合并所有纳入研究的总Meta分析发现,与空白对照相比,PN对死亡率和总并发症发生率无影响。但感染率明显较高。进一步的亚组分析发现PN的疗效与患类型有关。对择期术后患PN能降低并发症,最近我们基于高质量中研究的Meta-分析也发现,较之PN,使用肠内营养(EN)患的肝功能受影响更少,并有助于节省费用,虽然上述证据提示EN有较多优势,但患方面的需求也在很大程度上决定营养支持方式的选择。临床医生需要结合患和客观证据两方面考虑对营养支持途径的选择。  相似文献
4.
There is increasing demand for evidence-based health care. Back pain is one of the most common and difficult occupational health problems, but there has been no readily available evidence base or guidance on management. There are well-established clinical guidelines for the management of low back pain, but these provide limited guidance on the occupational aspects. Occupational Health Guidelines for the Management of Low Back Pain at Work were launched by the Faculty of Occupational Medicine in March 2000. These are the first national occupational health guidelines in the UK and, as far as we are aware, the first truly evidence-linked occupational health guidelines for back pain in the world. They were based on an extensive, systematic review of the scientific literature predominantly from occupational settings or concerning occupational outcomes. The full evidence review is on the Faculty web site (www.facoccmed.ac.uk), but an abridged version is presented here to aid its dissemination.  相似文献
5.
紧急避孕药系统评估   总被引:10,自引:4,他引:6  
目的:评估两种(0.75mg双剂、1.5mg单剂)左炔诺孕酮(LNG)及两种低剂量(10mg、25mg)米非司酮(MFP)紧急避孕方案的有效性和副作用。方法:通过电子及手工检索方式检索相关文献,筛选出其中的随机对照临床试验,提取信息并进行Meta分析。结果:共检索到63篇相关文献,其中28篇纳入本评估。结果显示,两种剂量LNG方案有效性及副反应的发生率均相似。在服用紧急避孕药后无性生活的对象中,25mgMFP与10mgMFP(方法失败率)相似,然而25mgMFP总失败率(在所有对象中计算出的失败率)略低于10mgMFP,但差别没有统计学意义。25mgMFP方案恶心发生率比10mgMFP方案略高。10mgMFP方案与单剂1.5mgLNG方案总失败率相似,而前者方法失败率略低。25mgMFP方案方法失败率与总失败率均略低于单剂及双剂LNG方案,但差别无统计学意义。MFP紧急避孕方案月经延迟的发生率比LNG方案高,而后者点滴出血的发生率比前者高。无保护性生活后越早接受紧急避孕,失败率越低。结论:两种LNG方案和两种MFP方案有效性和副反应发生基本相似,由于LNG为传统避孕药物,其安全性已被证实,并为非处方药,故优先推荐使用LNG方案,单剂1.5mgLNG方案更为方便。  相似文献
6.
Occupational risk factors for shoulder pain: a systematic review   总被引:10,自引:5,他引:5       下载免费PDF全文
OBJECTIVES—To systematically evaluate the available evidence on occupational risk factors of shoulder pain.
METHODS—Relevant reports were identified by a systematic search of Medline, Embase, Psychlit, Cinahl, and Current Contents. The quality of the methods of all selected publications was assessed by two independent reviewers using a standardised checklist. Details were extracted on the study population, exposures (physical load and psychosocial work environment), and results for the association between exposure variables and shoulder pain.
RESULTS—29 Studies were included in the review; three case-control studies and 26 cross sectional designs. The median method score was 60% of the maximum attainable score. Potential risk factors related to physical load and included heavy work load, awkward postures, repetitive movements, vibration, and duration of employment. Consistent findings were found for repetitive movements, vibration, and duration of employment (odds ratio (OR) 1.4-46 in studies with method scores  60%). Nearly all studies that assessed psychosocial risk factors reported at least one positive association with shoulder pain, but the results were not consistent across studies for either high psychological demands, poor control at work, poor social support, or job dissatisfaction. Studies with a method score 60% reported ORs between 1.3 and 4.0. Substantial heterogeneity across studies for methods used for exposure assessment and data analysis impeded statistical pooling of results.
CONCLUSIONS—It seems likely that shoulder pain is the result of many factors, including physical load and the psychosocial work environment. The available evidence was not consistent across studies, however, and the associations were generally not strong. Future longitudinal research should evaluate the relative importance of each individual risk factor and the role of potential confounding variables—such as exposure during leisure time—to set priorities for the prevention of shoulder pain in occupational settings.


Keywords: systematic review; shoulder pain; risk factors  相似文献
7.
The efficacy of Tai Chi Chuan in older adults: a systematic review   总被引:9,自引:0,他引:9  
OBJECTIVES: The purpose of this study was to assess the effect of Tai Chi Chuan (TCC) on fall prevention, balance and cardiorespiratory functions in the elderly. METHODS: A systematic review was carried out according to the Cochrane standards. A computerized literature search was carried out. Studies were selected when they had an experimental design; the age of the study population was >50; one of the interventions was a form of TCC; and when falls, balance or cardiorespiratory functions were used as an outcome measure. A total of seven studies were included, with in total 505 participants, of whom all but 27 were healthy seniors, age between 53 and 96 years. RESULTS: In most studies, the intervention of TCC is a modified Yang style, varying from 10 to 24 forms. The intensity of TCC varies from 1 h weekly for 10 weeks to 1 h every morning for 1 year. One study used falls as outcome measure and reported a beneficial effect of 47% in the TCC group. All studies mention a beneficial effect of TCC, but in most studies this conclusion was based on a pre-post analysis. CONCLUSION: There is limited evidence that TCC is effective in reducing falls and blood pressure in the elderly.  相似文献
8.
中国结核病控制直接面视下督导化疗的系统评价   总被引:7,自引:0,他引:7  
目的 评价直接面视下督导化疗(DOT)对结核病病例管理的效果.方法 通过《中国全文期刊网》(CNKI)、万方数据库和Medline数据库检索1994-2004年关于DOT有关文献和资料,并进行系统评价,包括定量分析(Meta分析)和定性分析;评价指标为治愈率.结果 共检索204篇文献,入选120篇.(1)管理措施:全程督导组与全程管理组治愈率合并后率差RD值(95%CI)为0.14(0.06~0.22),P<0.000 01.按全程管理执行严格程度进行分层分析,全程督导和管理严格的全程管理组差异无统计学意义(P=0.06),RD值(95%CI)为0.02(0.00~0.03),全程督导与未提及是否严格的全程管理组差异有统计学意义(P=0.004),RD值(95%CI)为0.18(0.06~0.30),不严格组差异有统计学意义(P<0.05),RD值(95%CI)为0.16(0.07~0.24).全程督导组与自服药组差异有统计学意义(P=0.002),RD值(95%CI)为0.24(0 10~0.38).(2)化疗方案:短疗程与长疗程化疗方案治愈率差异有统计学意义(P=0.003),合并RD值(95%CI)为0.04(0.01~0.07).结论 只要管理严格,强化对结核病病例的不同管理模式,如全程督导和全程管理,可以使患者达到相同的治疗依从性.患者的依从性与化疗方案、给药方式(每日给药或间歇给药)等因素有关.  相似文献
9.
综合医院转诊结核病患者对发现结核病影响的系统评价   总被引:6,自引:0,他引:6  
目的 评价近10年来综合医院及乡镇卫生院对疑似结核病和结核病患者实施报告转诊制度对提高中国结核病患者发现率的影响。方法 系统评价、Meta分析,通过原始数据计算出每个研究的RR值或RD值(率差),通过合并RR或RD值来评价总的效果;使用Excel、SPSS、RevMan软件进行统计学分析。结果 采取干预措施后随访5年,涂阳患者新登记率和新发涂阳患者登记率5年均为上升的趋势,前3年增长幅度逐年增大,从第4年开始增长幅度出现下降。漏转率合并RR值为0.36,95%CI为0.25~0.53。结论 合并的结果显示,实施综合医院转诊制度后有益于结核病患者发现率的提高。  相似文献
10.
BACKGROUND: Polychlorinated biphenyls (PCBs) are complex mixtures of persistent contaminants that are widespread in the environment. Newborns are exposed across the placenta and through breast feeding. Experimental animal studies have indicated that PCBs are neurotoxic. The neurological effects of these compounds on children are not clear. METHODS: A systematic review of literature on the relation between neurological development in children and exposure to polychlorinated biphenyls. RESULTS: Seven follow up studies evaluated the effect of prenatal exposure to PCBs. Two of these studies evaluated highly exposed children. In newborns, an increase of the abnormal reflexes was observed in all four studies evaluating it. During the first months of life, a decrease in motor skills was observed in four of the five studies that investigated psychomotor development; deficits in the acquisition of cognitive skills were observed only in one study assessing non-highly exposed populations. At 4 years of age, an effect on the cognitive areas was observed in four of the five studies that evaluated it. Postnatal exposure to PCBs through breast feeding was not clearly related to any effect on neurological development. CONCLUSIONS: These studies suggest a subtle adverse effect of prenatal PCBs exposure on child neurodevelopment. Differences in study design, inconsistency in some of the results, and the lack of adequate quantitative exposure data, do not allow the derivation of the degree of risk associated with neurodevelopmental effects at current levels of exposure.  相似文献
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