Cognitive behavioural therapy for primary insomnia: a systematic review

AIM: This paper reports a systematic review of seven studies evaluating the efficacy of cognitive behavioural therapy (CBT) for persistent primary insomnia. BACKGROUND: Insomnia is one of the most common health complaints reported in the primary care setting. Although non-pharmacological treatments such as the CBT have been suggested to be useful in combating the persistent insomnia, the efficacy and clinical utility of CBT for primary insomnia have yet to be determined. METHOD: A systematic search of Ovid, MEDLINE, psychINFO, PsycARTICLES, CINAHL, and EMBASE databases of papers published between 1993 and 2004 was conducted, using the following medical subject headings or key words: insomnia, primary insomnia, psychophysiological insomnia, sleep maintenance disorders, sleep initiation disorders, non-pharmacological treatment, and cognitive behavioural therapy. A total of seven papers was included in the review. FINDINGS: Stimulus control, sleep restriction, sleep hygiene education and cognitive restructuring were the main treatment components. Interventions were provided by psychiatrists except for one study, in which the CBT was delivered by nurses. Among beneficial outcomes, improvement of sleep efficacy, sleep onset latency and wake after sleep onset were the most frequently reported. In addition, participants significantly reduced sleep medication use. Some studies gave follow-up data which indicated that the CBT produced durable clinical changes in total sleep time and night-time wakefulness. CONCLUSIONS: These randomized controlled trial studies demonstrated that CBT was superior to any single-component treatment such as stimulus control, relaxation training, educational programmes, or other control conditions. However, heterogeneity in patient assessment, CBT protocols, and outcome indicators made determination of the relative efficacy and clinical utility of the therapy difficult. Therefore, the standard components of CBT need to be clearly defined. In addition, a comprehensive assessment of patients is essential for future studies.     

不同体外受精-胚胎移植方法妊娠结局分析

目的 探讨选择性单胚胎移植、选择性单囊胚移植对行体外受精-胚胎移植者妊娠结局的影响.方法 860例行体外受精-胚胎移植不孕患者,其中260例行选择性单胚胎移植(eSET组),400例行选择性单囊胚移植(eSBT组),200例行双胚胎移植(DBT组),回顾性分析3组临床资料,比较其妊娠率及妊娠结局的差异.结果 3组年龄、基础卵泡刺激素及黄体生成素水平、子宫内膜厚度、促性腺激素用量及使用时间、获卵数、正常受精率、两原核率、胚胎形成率和流产率比较差异无统计学意义(P＞0.05);eSET组临床妊娠率为32.31％,多胎妊娠率为3.08％,早产率为11.92％,低体质量儿出生率为12.31％;eSBT组以上指标分别为54.00％、2.00％、12.00％、10.00％;DBT组分别为56.50％、32.50％、29.50％、37.00％,eSET组临床妊娠率低于eSBT组和DBT组(P＜0.05),DBT组多胎妊娠率、早产率、低体质量儿出生率高于eSET组和eSBT组(P＜0.05).结论 与双胚胎移植相比,选择性单胚胎移植和选择性单囊胚移植可明显降低多胎妊娠率、早产率和低体质量儿出生率.     

胚胎移植环节在改善体外受精-胚胎移植妊娠结局中的作用

胚胎移植并不仅是简单的胚胎转移。一次成功有效的胚胎移植,除了优质的胚胎、合适的宫腔环境,移植本身的技术性也占据着至关重要的地位,重视并掌握胚胎移植环节有助于提高体外受精-胚胎移植的成功率。该文主要就胚胎移植过程的相关技术方法及临床技巧在改善妊娠结局中的作用进行讨论,以期为临床实践者提供实用的参考建议。     

The efficacy of cognitive behavioural therapy and advocacy interventions for women who have experienced intimate partner violence: A systematic review and meta-analysis

Abstract

Objective. To determine the efficacy of Advocacy and Cognitive Behavioural Therapy interventions (CBT) in reducing physical, psychological, sexual, or any intimate partner violence (IPV).

Methods. A systematic review and meta-analysis were conducted using randomized control trials (RCTs) published in MEDLINE, PsycINFO, Scopus, Cochrane, and Clinical trials. The occurrence of physical, psychological, sexual, and/or any IPV measured efficacy.

Results. Twelve RCTs involving 2666 participants were included. Advocacy interventions resulted in significant reductions in physical (standardized mean difference (SMD) –0.13; 95% confidence interval (CI) –0.25, –0.00) and psychological (SMD –0.19; 95% CI –0.32, –0.05) but not in sexual (SMD –0.20; 95% CI –0.43, 0.02) or any IPV (SMD –0.32; 95% CI –0.69, 0.04). CBT interventions showed a significant reduction in physical (SMD –0.79; 95% CI –1.26, –0.33) and psychological (SMD –0.80; 95% CI –1.25, –0.36) but not sexual (SMD –0.35; 95% CI –1.73, 1.03) or any IPV (SMD 0.09; 95% CI –0.05, 0.23).

Conclusions. Both advocacy and CBT interventions reduced physical and psychological IPV but not sexual or any IPV. Limitations include the low number of studies and the heterogeneity of interventions.     

宫腔镜在首次体外受精-胚胎移植失败患者中的意义

目的探讨宫腔镜对首次体外受精-胚胎移植（IVF-ET）失败者子宫内异常的诊断和治疗的重要性。方法2004年2月～2005年3月该院腔镜中心对首次IVF-EF失败的53例患者（观察组）行宫腔镜检查,并与同期人工授精前进行宫腔镜检查的24例正常妇女（男性无精症）（对照组）进行比较分析。结果53例IVF-EF失败者中24例发现宫腔异常,占45.3%。其中12例为宫腔粘连,占50.0%;5例为宫腔息肉,占20.8%;4例为子宫肌瘤,占16.7%。24例人工授精者中仅3例宫腔有异常,占12.5%,二组差异有显著性（P〈0.05）。所有异常患者均行相应治疗。观察组53例患者中50例在其后进行了再次IVF-ET术,共有19例获得妊娠,妊娠率为38.0%。结论宫腔镜能准确诊断和治疗IVF-ET失败者子宫腔内病变,提高IVF-ET的成功率,具有良好的可接受性。     

Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis

BackgroundIn 2009, the Institute of Medicine (IOM) published a revision to its 1990 recommendations on gestational weight gain (GWG). The objective of this review is to update a previous systematic review and meta-analysis to evaluate the effectiveness of nutrition interventions in achieving recommended GWG.MethodsWe conducted updated literature searches in MEDLINE^® (2012 through 2019), Web of Science (2012 to 6 February 2017), Embase (2016 through 2019), and Cochrane Central Register of Controlled Trials (2012 through 2019). Literature published before January 2012 was identified from a published systematic review. We included controlled trials conducted in the U.S. or Canada among generally healthy pregnant women that compared nutrition interventions with or without exercise to controls (e.g., usual care) and reported total GWG or rate of GWG based on the 2009 IOM GWG guidelines. Two independent investigators conducted screening, data extraction, and risk-of-bias (ROB) assessment. Random-effects meta-analyses were conducted when data were sufficient.ResultsEighteen unique studies were included, of which 11 were conducted in women with overweight or obesity. Nutrition interventions, compared to controls, had a similar effect on total GWG (mean difference = −1.24 kg; 95% CI [−2.65, 0.18]; I²=67.6%) but significantly decreased second and third trimester rate of GWG (−0.07 kg/week; 95% CI [−0.12, −0.03]; I²=54.7%). Nutrition interventions also reduced the risk of exceeding IOM’s rate of GWG targets (pooled RR = 0.71; 95% CI [0.55, 0.92]; I²=86.3%). Meta-analyses showed no significant differences in achieving IOM’s total GWG or any secondary outcome (e.g., preterm birth or small/large for gestational age) between groups. Most studies were assessed as having some or high ROB in at least two domains.ConclusionMultimodal nutrition interventions designed to meet the 2009 IOM’s GWG targets may decrease the rate of GWG over the second and third trimesters but may not decrease total GWG.

Key messages

• Excessive gestational weight gain is associated with higher risk of many adverse maternal and fetal outcomes and represents a public health concern in the United States and Canada.
• Nutrition interventions designed to meet the 2009 IOM GWG guidelines may decrease the rates of GWG over the second and third trimesters but may not be effective at reducing total GWG.

     

The effects of forest bathing on psychological well-being: A systematic review and meta-analysis

Globally, around half (55%) of the population live in fast-paced urban settings where many people find it challenging to manage their stress and respond to crises with a positive mindset. This resulted in prolonged distress where anxiety and fatigue caused physical and mental health concerns. Nature walks involving immersive exposure in the forest, and green spaces have been posited to offer physiological and psychological benefits. Therefore, in this systematic review, we evaluated the effects of forest bathing on psychological and physiological outcomes. We searched four English and five non-English databases (Chinese and Korean) for peer-reviewed studies published between January 2000 and March 2021. This review adhered to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement 2020. The primary outcomes explored in this review were mainly psychological, including anxiety, depression, mood and quality of life. The secondary outcomes were physiological outcomes such as blood pressure and heart rate. We conducted a meta-analysis on each outcome using the random-effects model. Heterogeneity was assessed by the I² statistic. Thirty-six articles (21 in English, 3 in Chinese and 12 in Korean) with 3554 participants were included in this review. Our meta-analysis suggested that forest bathing can significantly reduce symptoms of depression and anxiety. However, we did not observe as many benefits in physiological outcomes. Against the background of the negative effects of urbanization on mental well-being, this review highlighted the potential therapeutic role of forests in the contemporary world, lending further evidence-based support for forest conservation.     

两种麻醉方法用于取卵术的临床效果分析

目的研究不间麻醉方式下取卵手术效果及对获卵率的影响。方法将体外受精-胚胎移植、卵胞浆内单精子注射手术的患者随机分为全麻组（异丙酚静脉推注，80例）和局麻组（度冷丁肌注＋利多卡因宫颈旁阻滞，80例），观察两组患者的麻醉效果、循环系统的变化及获卵率。结果术中两组麻醉效果比较无显著性差异（P〉0．05），局麻组术后镇痛效果明显优于全麻组（P〈0．05）；术中两组患者血压比较有非常显著性差异（P〈0．01）、心率有显著性差异（P〈0．05）；两组获卵率比较无显著性差异（P〉0．05）。结论两种麻醉方法对取卵手术过程中的镇痛效果及获卵率没有影响，但是术后局麻镇痛效果明显优于全麻；全麻组多数患者在手术中出现一过性血压和心率下降。     

进入体外受精-胚胎移植治疗周期后患者焦虑情绪的分析

目的探讨不孕症患者进入体外受精-胚胎移植（IVF-ET）治疗周期后不同时点状态焦虑的特点,及其与特质性焦虑的关系。方法采用状态-特质焦虑量表对96例接受IVF—ET治疗的患者进行测评,包括降调当日、取卵前1h内、移植后第12天3个时点。结果,本组特质焦虑分值的均数为（37．66±9．11）分;降调当日状态焦虑得分为（36．44±9．20）分,取卵前1h内为（39．37±11．27）分,移植后第12天为（40．98±12．73）分,差异均有统计学意义;特质焦虑分值≥38分组降调当日的状态焦虑分值与取卵前1h内比较,以及与移植后第12天比较,差异均有统计学意义;将特质焦虑分值≥38分和〈38分两组在3个时点的状态焦虑分值之间进行比较,其状态焦虑分值的差异均有统计学意义。结论护理人员应关注进入IVF—ET治疗周期患者的心理状态,采取各种措施减轻他们的心理压力,以提高治疗依从性和妊娠成功率。     

Efficacy and safety of daratumumab in the treatment of multiple myeloma: a systematic review and meta-analysis

ObjectiveTo systematically evaluate the efficacy and safety of combination regimens containing daratumumab in patients with multiple myeloma (MM).MethodsA systematic search of publications listed on electronic databases (PubMed®, The Cochrane Library, Science Direct and Web of Science) between inception and 13 November 2020 was conducted to find randomized controlled trials (RCTs) that included patients with MM that were treated with combination regimens containing daratumumab.ResultsA total of seven RCTs were included (n = 4268 patients). Meta-analysis showed that compared with the control group, the group containing daratumumab showed a significantly better overall response rate and a complete response or better. Daratumumab improved efficacy in both standard-risk and cytogenetically high-risk patients with MM. The prevalence of neutropenia (≥grade 3) and pneumonia was significantly higher in the daratumumab group compared with the control group.ConclusionThe available evidence demonstrated that the clinical application of combination regimens containing daratumumab improved the efficacy in patients with MM and had acceptable safety.     

The diagnostic value of magnetic resonance urography for detecting ureteric obstruction: a systematic review and meta-analysis

Abstract

Objective

To evaluate the diagnostic accuracy of magnetic resonance urography (MRU) and determine its value for detecting ureteric obstruction.     

心理干预对体外受精-胚胎移植临床妊娠率影响的Meta分析

目的 评价心理干预对体外受精-胚胎移植临床妊娠率的影响.方法 通过计算机检索中文文献数据库,包括中国知网(CNKI)、中国生物医学文献数据库(CBM)、维普、万方等,关键词为心理护理、体外受精;外文数据库Pubmed,关键词包括in vitro fertilization-embryo transfer、psychological.获取文献之后按照入选标准要求筛选相关文献,选择合适文献纳入进行相关数据的Meta分析,探讨心理干预对体外受精-胚胎移植临床妊娠率的影响.结果 共有13篇中文文献,3篇外文文献纳入,进行Meta分析.结论 心理干预应贯穿于体外受精-胚胎移植的过程之中,可以提高体外受精-胚胎移植患者的妊娠成功率,是值得推广应用的护理措施.     

探讨应用复方炔诺酮对多囊卵巢综合征行体外授精-胚胎移植的妊娠率影响

目的探讨对多囊卵巢综合征(PCOS)患者在行IVF-EF前1周期中应用复方炔诺酮对妊娠率的影响.方法65例因输卵管因素或反复促排卵失败的PCOS患者随机分为二组,治疗组月经第5d开始口服复方炔诺酮,1片/d,服药第15d加注GnRH-a激动剂(达菲林),另一组月经第21d或第2d肌注GnRH-a激动剂;二组均常规行IVF-ET,观察二组的妊娠率.结果治疗组妊娠率明显高于对照组(p<0.05).结论多囊卵巢综合征患者在行IVF-ET前1周期中应用复方炔诺酮后,妊娠率明显提高.