PICC输液技术有效性及安全性评估的系统评价再评价

目的对PICC输液技术的安全性及有效性的系统评价进行再评价。方法计算机检索The Cochrane Library、Medline、EMBASE、CNKI、CMB、WANFANG、VIP数据库,检索时间从建库至2015年10月,检索PICC与其他静脉输液技术安全性及有效性相关的系统评价和Meta分析,由2名研究者独立进行文献筛选及资料提取,采用AMSTAR工具评价纳入研究的方法学质量,采用GRADE系统对结局指标进行质量评价。结果最终纳入15篇系统评价/Meta分析,其中13篇发表在2010年之后,14篇对纳入研究进行了文献质量评价,9篇都采用Cochrane偏倚风险评估工具。AMSTAR评价显示,仅6篇为高质量,最主要缺陷是缺乏前期设计方案、未考虑纳入文献的发表状态、未列出排除文献清单及未说明相关利益冲突四个方面。对7篇系统评价的17个结局指标按照GRADE系统进行证据质量评价,仅6个结局指标的证据质量为中,其余均为低或极低。结论纳入研究的整体质量不高,结局指标的证据质量以低为主。总体上,PICC是否比CVC及VPA更安全尚缺乏证据支持;但PICC留置时间比VPA短;PICC输液技术在穿刺过程中的安全性优于CVC及VPA;但PICC在维护过程中的安全性较CVC及VPA差。受纳入研究的数量及质量限制,尚需要更高质量的研究去证实该结论的可靠性。     

太极运动防治骨质疏松症的系统评价再评价

目的 多元评价太极运动防治骨质疏松症相关系统评价的文献质量及其结局指标的证据质量.方法 计算机检索PubMed、Web of science、EMbase、The Cochrane Library、PROSPERO、CNKI、CBM、WanFang和VIP数据库,收集太极运动防治骨质疏松症的系统评价/Meta分析,分别...     

负压封闭引流治疗糖尿病足溃疡的系统评价/Meta分析的再评价

目的 对负压封闭引流(VSD)治疗糖尿病足溃疡(DFU)的系统评价/Meta分析的方法学质量和证据质量进行再评价研究.方法 采用计算机检索中国知网(CNKI)、维普(VIP)、万方、中国生物医学数据库(CBM)、PubMed、Embase、the Cochrane Library等数据库,检索VSD治疗DFU的系统评价...     

选择性5-羟色胺再摄取抑制剂治疗早泄的有效性和安全性系统评价

目的:评价选择性5-羟色胺再摄取抑制剂(SSRIs)治疗早泄的有效性和安全性。方法:采用Cochrane系统评价方法,电子检索MEDLINE(1950年1月至2008年3月)、EMBASE(1980年1月至2008年3月)、Cochrane图书馆(2008年第1期)和中国期刊全文数据库(1979年1月至2008年3月),并手工检索已发表和未发表试验,筛选和纳入SSRIs治疗早泄的随机对照试验(RCT)和随机交叉试验(RT)。由2名评价者独立评价纳入文献的方法学质量,对同质文献采用RevMan5.0软件进行Meta分析。结果:共纳入文献22篇,共包括研究病例4291例。Meta分析显示:舍曲林、氟西汀、帕罗西汀、西酞普兰、达伯西汀、三氟戊肟胺对阴道内射精潜伏时间(IELT)改变值的加权均数差WMD(95%CI)分别为2.63(1.80,3.46)、2.21(1.50,2.92)、4.31(2.71,5.91)、3.82(3.39,4.25)、1.57(1.31,1.84)、0.01(-0.71,0.73);前5者对患者性生活满意率的相对危险度RR(95%CI)分别为1.65(1.12,2.43)、2.93(0.50,17.31)、3.08(2.27,4.17)、2.48(1.99,3.09)、2.93(2.36,3.65);对配偶性生活满意率的RR(95%CI)分别为1.47(0.98,2.21)、2.88(0.38,21.77)、4.81(3.15,7.36)、5.38(3.75,7.72)、2.91(1.09,7.78)。结论:现有证据显示,现有SSRIs除三氟戊肟胺外均能不同程度地延长IELT,帕罗西汀、西酞普兰、达伯西汀能同时提高患者及配偶的性生活满意度,由于存在较多不良反应,应用时需注意。由于纳入文献存在选择偏倚、发表偏倚的中度可能性,可能在一定程度上影响结果的证据强度,故应谨慎看待上述结论,期待高质量的RCT提供更可靠的证据。     

非药物干预预防ICU获得性谵妄相关系统评价的再评价

目的对非药物干预预防ICU获得性谵妄的相关系统评价/Meta分析进行再评价,为预防ICU获得性谵妄循证护理实践方案的制定提供证据支持。方法计算机检索Cochrane Library、PubMed、CINAHL、OVID、EMbase、中国知网、万方和维普数据库中关于非药物干预预防ICU获得性谵妄的系统评价/Meta分析,筛选文献后,采用AMSTAR量表和GRADE系统对纳入文献进行方法学质量和证据质量等级评价。结果共纳入16个系统评价/Meta分析,AMSTAR评分4～9分;32条结局指标的证据质量分级为高1条,中7条,低15条,极低9条。结论非药物干预预防ICU获得性谵妄的相关系统评价/Meta分析的方法学质量不高,证据质量等级较低。目前最有效的预防措施为多组分联合干预,环境、睡眠、早期康复或物理治疗等干预措施的预防效果还有待进一步研究。     

黄葵胶囊治疗糖尿病肾病疗效和安全性的系统评价

目的：对公开发表的黄葵胶囊治疗DN的文献进行Meta分析,系统评价黄葵胶囊治疗DN的有效性及安全性。方法：计算机检索Pub Med、Cochrane Library、CNKI、VIP等中关于黄葵胶囊治疗DN的随机和半随机对照试验,并手工检索相关杂志,追溯相关研究及纳入文献的参考文献。由2位评价者独立筛选文献、提取资料和质量评价,然后采用Rev Man5.3.3软件进行Meta分析。结果：共纳入6个RCT。Meta分析显示,黄葵胶囊可减少DN患者的尿蛋白,改善肾功能,提高DN疗效,具有较好的安全性。但是受纳入研究的数量和质量所限。结论：上述结论尚需今后开展更多高质量的相关研究加以验证。     

针灸治疗痤疮系统评价的再评价

目的:对已发表的针灸治疗痤疮的系统评价进行再评价.方法:计算机检索CNKI、WanFang、VIP等中文数据库及Cochrane Library和PubMed等外文数据库中已发表的针灸治疗痤疮的系统评价,检索时间选为建库至2019年12月31日.由两名研究人员独立进行文献筛选及资料提取,采用AMSTAR2条目、PRIS...     

中药治疗糖尿病性骨质疏松疗效与安全性的系统评价

目的运用循证医学系统评价方法评价中药治疗糖尿病性骨质疏松的疗效与安全性,为临床实践和研究提供参考。方法计算机检索Pub Med、Web of science、Cochrane图书馆、CNKI、VIP、CBM和万方数据库,查找中药治疗糖尿病性骨质疏松与单独应用西药(钙尔奇D片)比较、中西药结合与单独应用西药(钙尔奇D片)比较的随机对照试验,检索时限均从建库至2015年09月。由2名研究者按照纳入与排除标准独立进行文献筛选、资料提取和质量评价后,采用Rev Man 5.2软件进行Meta分析。结果纳入8个RCT,共698例患者。Meta分析结果显示,与对照组比较,中西药联合治疗糖尿病性骨质疏松在增加患者骨钙素[MD=0.90,95%CI(0.22,1.57)]、腰椎骨密度[MD=0.02,95%CI(0.02,0.03)]、股骨颈骨密度[MD=0.03,95%CI(0.00,0.06)]、Ward’s三角骨密度[MD=0.03,95%CI(0.01,O.05)]方面均有统计学意义;但单纯中药组的腰椎骨密度与对照组相比无统计学意义。在不良反应方面,尚未见中医药的严重不良反应报告。结论现有临床证据表明,中医药可以提高糖尿病性骨质疏松症患者骨密度、缓解骨痛。但其疗效优势值得进一步研究,特别需要高质量的多中心大样本随机双盲对照试验来验证。     

ICU获得性衰弱相关系统评价的再评价

目的对ICU获得性衰弱相关系统评价进行再评价,为预防ICU获得性衰弱循证护理实践方案的制定提供证据支持。方法采用系统评价再评价的方法对与ICU获得性衰弱相关的系统评价进行再评价。结果共纳入15项系统评价,内容涉及ICU获得性衰弱的危险因素、发生率、评估和诊断、预防、治疗5个方面,文献方法学质量评分4～7分;对15项系统评价的43条主要结局指标进行证据质量评价,7条证据质量等级为"高",13条为"中",18条为"低",5条为"极低"。结论系统评价再评价对ICU获得性衰弱的危险因素、发生率、评估、诊断、预防、治疗等进行证据汇总,为预防ICU获得性衰弱循证护理实践方案的建立提供了可靠的证据支持。     

系统评价再评价摘要报告标准及在护理领域中的应用评价

对系统评价再评价摘要报告标准进行解读,详细介绍摘要报告条目、报告内容及局限性,针对当前摘要报告内容完整性欠缺,数据重复计算偏倚风险大等现存问题提供解决方案,为系统评价再评价文章摘要部分的报告规范及质量评价提供指导及参考。     

Low-intensity extracorporeal shockwave therapy for erectile dysfunction: an overview of systematic reviews

BackgroundLow-intensity extracorporeal shockwave therapy (LI-ESWT) may be a successful complementary treatment approach for erectile dysfunction (ED). In this study, we aimed to review and summarize the research evidence from systematic reviews (SRs)/meta-analyses (MAs) regarding the clinical effectiveness of LI-ESWT for ED.MethodsStudies on LI-ESWT for ED were searched using eight electronic databases from establishment of each database to 31 June 2021 with the language restrictions of Chinese and English. All articles were screened, and qualifying data were recorded based on the inclusion criteria. Methods including: the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2); the Risk of Bias in Systematic Reviews (ROBIS); the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); and Grading of Recommendations, Assessment Development, and the Evaluation (GRADE) were used by two independent raters to assess methodological quality, risk of bias, reporting quality, and SR evidence of quality, respectively.ResultsEight SRs/MAs met all inclusion criteria. Seven reviews were rated as critically low on overall confidence and one review was low on confidence based on the AMSTAR-2 appraisal tool. While most PRISMA criteria were met, the major reporting flaws were in relation the financial statements not being included, along with no protocol registrations. Three SRs/MAs were classed as low risk regarding bias as measured by the ROBIS tool. Based on the GRADE method, only one SRs/MAs of high-quality evidence and seven SRs/MAs of moderate-quality evidence were found. The present research results supported LI-ESWT as a complementary therapy for ED patients, but the evidence should be considered carefully due to the methodological flaws identified.DiscussionOur results showed that LI-ESWT as an adjunctive therapy has benefits for ED patients. There were no obvious side effects, and the number of shockwave treatments and energy flux density (EFD) would affect the IIEF-EF, EHS and PSV scores. However, due to the limited sample size and the quality of reporting evidence, our conclusions may not be fully representative.     

不同置管方式对PICC有效性及安全性影响的系统评价再评价

目的通过系统评价再评价探讨不同置管方式对PICC静脉输液技术安全性及有效性的影响,为护理人员临床决策提供参考。方法计算机检索Cochrane Library(2015年第10期)、Medline、Embase、中文期刊全文数据库、维普全文数据库、万方数据知识服务平台等数据库,检索时间从建库至2015年10月,检索不同置管方式对PICC静脉输液技术安全性及有效性影响的系统评价和Meta分析,采用AMSTAR工具评价纳入研究的方法学质量,采用GRADE系统对结局指标进行质量评价。结果最终纳入8篇系统评价/Meta分析,仅1篇为高质量,主要缺陷为缺乏前期设计方案、未考虑纳入文献的发表状态、未列出排除文献清单及未说明相关利益冲突4个方面。对5篇系统评价的15个结局指标按照GRADE系统进行证据质量评价,7个结局指标的证据质量为中,其余均为低。结论纳入系统评价/Meta分析的文献整体质量不高,结局指标的证据质量为中或低。总体上,超声引导/或结合改良赛丁格技术行PICC置管、并借助影像学标识可显著增加PICC的有效性及安全性,经不同静脉PICC置管的有效性无差异,但经贵要静脉穿刺可显著增加置管及维护的安全性。经不同上肢PICC置管的有效性和安全性无差异。受纳入研究的数量及质量限制,尚需更高质量的研究证实该结论的可靠性。     

同伴教育对2型糖尿病患者血糖控制的系统评价

目的系统评价同伴教育对2型糖尿病患者血糖控制的干预效果。方法通过检索PubMed、Embase、中国期刊全文数据库(CNKI)、万方数据库等资源,收集同伴教育对2型糖尿病患者血糖控制干预的随机对照试验,并进行文献质量评价和数据提取。对于糖化血红蛋白(HbA1c)的结局指标采用多时间点Meta分析,而对于餐前和餐后血糖则采用终末时间点Meta分析。结果最终纳入9篇文献,文献质量B级6篇,A级3篇。Meta分析结果显示,中等时间长度(13~26周)的同伴教育干预后,HbA1c低于对照组,差异有统计学意义(P0.05),长期同伴教育(26周以上)对HbA1c改善的作用尚未被证实;中等时间长度(13~26周)同伴教育干预后,餐前和餐后血糖低于对照组,差异有统计学意义(均P0.01)。结论同伴教育可以有效控制餐前和餐后血糖,中等时间长度(13~26周)的同伴教育项目对于HbA1c的改善有一定作用。     

同伴支持对降低糖尿病患者糖化血红蛋白效果的Meta分析

目的评价同伴支持模式对降低2型糖尿病患者糖化血红蛋白(HbA1C)效果的影响。方法计算机检索多个中英文数据库,搜集符合纳入排除标准的随机对照试验,进行文献质量评价后,采用RevMan5.2软件进行数据分析。结果共纳入17项随机对照研究,Meta分析结果显示同伴支持能降低T2DM患者的HbA1c水平,合并效应具有统计学意义[WMD=-0.21,95%CI(-0.35,-0.08),P=0.002]。且短期同伴支持干预(3个月、6个月)能够显著降低T2DM患者的HbA1c水平(均P0.05),然而干预时间延长(12个月、24个月)时,干预组与对照组在降低患者的HbA1c水平方面无明显差异(均P0.05)。单一形式(电话随访或个人访视或小组讨论等)对患者进行同伴教育,干预组与对照组在降低患者的HbA1c水平方面无明显差异(均P0.05);而采用多种形式联合(电话随访联合个人访视以及小组讨论等)能够明显降低患者的HbA1c水平(P0.01)。结论同伴支持能够降低T2DM患者的HbA1c,且短期效果优于长期效果,多种形式联合比单一干预形式能更好地降低HbA1c。但是考虑到此次纳入文献的质量为中等,因此期待更多临床多中心、大样本随机对照试验的开展来验证该模式的效果。     

Efficacy and safety of vildagliptin/pioglitazone combination therapy in Korean patients with diabetes

AIM: To assess the efficacy and safety of vildagliptin/pioglitazone combination therapy in Korean patients with type 2 diabetes mellitus (T2DM).METHODS: This was a post hoc analysis in Korean patients, from a 24-wk, randomized, active-controlled, double-blind, parallel-group, multicenter study. Eligible patients were aged between 18 and 80 years, drug naive, and had been diagnosed with T2DM [hemoglobin A_1c (HbA_1c): 7.5%-11.0% and fasting plasma glucose (FPG): < 270 mg/dL (< 15 mmol/L)]. Patients were randomized (1:1:1:1) to receive the vildagliptin/pioglitazone combination at 100/30 mg q.d. (high-dose) or 50/15 mg q.d. (low-dose), vildagliptin 100 mg q.d., or pioglitazone 30 mg q.d. monotherapies. The primary outcome measure was change in HbA_1c from baseline to endpoint.RESULTS: The distribution of baseline demographic and clinical parameters was well balanced between treatment groups. The overall mean age, body mass index, HbA_1c, FPG, and duration of disease were 50.8 years, 24.6 kg/m², 8.6%, 10.1 mmol/L, and 2.2 years, respectively. Adjusted mean changes (± standard error) in HbA_1c from baseline (~8.7%) to week 24 endpoint were -2.03% ± 0.16% (high-dose, N = 34), -1.88% ± 0.15% (low-dose, N = 34), -1.31% ± 0.21% (vildagliptin, N = 36), and -1.52% ± 0.16% (pioglitazone, N = 36). The high-dose combination therapy demonstrated greater efficacy than monotherapies [vildagliptin (P = 0.029) and pioglitazone (P = 0.027)]. Percentage of patients achieving HbA_1c < 7% and ≤ 6.5% was the highest in the high-dose group (76% and 68%) followed by low-dose (58% and 47%), vildagliptin (59% and 37%), and pioglitazone (53% and 28%) groups. The overall incidence of adverse events was comparable.CONCLUSION: In Korean patients, first-line treatment with high-dose combination therapy improved glycemic control compared to pioglitazone and vildagliptin monotherapies, consistent with results published for the overall study population.     

Guidance to best tools and practices for systematic reviews

Data continue to accumulate indicating that many systematic reviews are methodologically flawed, biased, redundant, or uninformative. Some improvements have occurred in recent years based on empirical methods research and standardization of appraisal tools; however, many authors do not routinely or consistently apply these updated methods. In addition, guideline developers, peer reviewers, and journal editors often disregard current methodological standards. Although extensively acknowledged and explored in the methodological literature, most clinicians seem unaware of these issues and may automatically accept evidence syntheses (and clinical practice guidelines based on their conclusions) as trustworthy. A plethora of methods and tools are recommended for the development and evaluation of evidence syntheses. It is important to understand what these are intended to do (and cannot do) and how they can be utilized. Our objective is to distill this sprawling information into a format that is understandable and readily accessible to authors, peer reviewers, and editors. In doing so, we aim to promote appreciation and understanding of the demanding science of evidence synthesis among stakeholders. We focus on well-documented deficiencies in key components of evidence syntheses to elucidate the rationale for current standards. The constructs underlying the tools developed to assess reporting, risk of bias, and methodological quality of evidence syntheses are distinguished from those involved in determining overall certainty of a body of evidence. Another important distinction is made between those tools used by authors to develop their syntheses as opposed to those used to ultimately judge their work. Exemplar methods and research practices are described, complemented by novel pragmatic strategies to improve evidence syntheses. The latter include preferred terminology and a scheme to characterize types of research evidence. We organize best practice resources in a Concise Guide that can be widely adopted and adapted for routine implementation by authors and journals. Appropriate, informed use of these is encouraged, but we caution against their superficial application and emphasize their endorsement does not substitute for in-depth methodological training. By highlighting best practices with their rationale, we hope this guidance will inspire further evolution of methods and tools that can advance the field.