玩偶疗法对老年痴呆患者干预效果的系统评价

目的 评价玩偶疗法对老年痴呆患者的干预效果.方法 计算机检索PubMed、Web of Science、Embase、Cochrane Library、SinoMed、中国知网、万方、维普等数据库中关于玩偶疗法应用于老年痴呆患者的随机对照研究,检索时间为建库至2021年5月23日.由2位研究员独立筛选文献并提取资料,采...     

罗替戈汀透皮贴剂治疗帕金森病的系统评价与Meta分析

目的：系统评价罗替戈汀透皮贴剂治疗帕金森病（PD）的有效性和安全性。方法：计算机检索中国期 刊全文数据库（CNKI）、万方学术期刊全文数据库（Wanfang）、维普中文科技期刊数据库（VIP）、中国生物医 学文献数据库（Sino Med）、PubMed、Cochrane图书馆（Cochrane Library）、Embase数据库等7个数据库,搜集 罗替戈汀透皮贴剂治疗PD的临床随机对照试验,检索时限均为建库至2020年11月11日。由两位研究者独 立对文献进行资料提取和质量评价后,使用Stata软件和RevMan软件进行Meta分析。结果：共纳入16项 RCT 研究,包括 4 682 例受试者。Meta 分析结果显示罗替戈汀透皮贴剂显著降低 PD 患者的 UPDRS-Ⅲ、 UPDRS-Ⅱ及UPDRS-(Ⅱ+Ⅲ)评分,改善了PD患者的运动症状和日常生活症状;此外,罗替戈汀透皮贴剂显 著降低了PD患者的PDSS-2评分,改善了PD患者的睡眠质量。与安慰剂对照组相比,罗替戈汀透皮贴剂并 未增加不良事件的发生率。结论：证实罗替戈汀透皮贴剂治疗PD的有效性和安全性。     

光动力疗法治疗皮肤鲍温病的系统评价

目的系统评价光动力疗法（photodynamic therapy,PDT）治疗皮肤鲍温病的疗效与安全性。方法计算机检索PubMed、OVID、Cochrane图书馆临床对照试验库、CBM和CNKI等电子数据库,纳入PDT治疗皮肤鲍温病的随机对照试验（RCT）。检索时间从1966年1月至2010年3月。检索语种限中、英文。对纳入RCT进行质量评价,提取有效数据,采用RevMan 5.0.23版软件进行Meta分析。结果共纳入5个RCT,共354例患者,496处皮损,其中试验组皮损237处,对照组皮损259处。Meta分析结果显示：PDT组的治愈率高于安慰剂组[RR=4.16,95%CI（1.69,10.25）]或外用氟尿嘧啶软膏治疗组[RR=1.38,95%CI（1.12,1.71）],而与冷冻治疗组无显著差别;PDT组的美容效果评价优于冷冻组[RR=1.48,95%CI（1.18,1.87）]或外用氟尿嘧啶软膏治疗组[RR=1.51,95%CI（1.05,2.15）];PDT组的复发率低于安慰剂治疗组[RR=0.29,95%CI（0.10,0.86）],但与冷冻组或外用氟尿嘧啶软膏组无显著差异。以红光为光源的PDT组治愈率高于绿光光源组的PDT[RR=1.29,95%CI（1.02,1.65）],复发率低于后者[RR=0.20,95%CI（0.05,0.87）]。两次光照治疗方案与单次光照治疗方案的治愈率及美容效果评价无显著差异。PDT治疗的不良反应包括不同程度的疼痛、局部感觉异常、局部炎症反应、色素沉着、结痂。结论现有有限证据表明,PDT治疗皮肤鲍温病的疗效优于安慰剂、冷冻或外用氟尿嘧啶软膏等对照治疗,复发率低于安慰剂,不良反应与对照组相似;红光-PDT治疗疗效优于绿光-PDT,复发率低,而不良反应两者相似;两次光照治疗方案与单次光照治疗的疗效无明显差异,但前者疼痛明显。     

Strategies to Improve Radiographic Practices for Patients With Alzheimer's Disease: A Systematic Review

BackgroundAlzheimer's disease (AD) patients are one of the highest health care service users globally. In the context of radiography, there are many AD patients who undergo imaging procedures for common age-related conditions. However, there is currently no literature on how radiographers can effectively manage such patients in imaging situations.MethodologyThis review examined the literature regarding the interaction between Alzheimer's patients and other health care professionals (eg, nurses) and the strategies that have been used to improve patient compliance and accommodate functional decline.FindingsMany strategies relating to care of patients with AD are long term, and cannot be applied in a radiographic setting, where patients may only present once. Transferrable strategies for a radiographic setting include the support of carers during the examination process, a reduction in noise and use of calming music, and allowing the patient to personalize the examination room by bringing a photograph or an item of comfort.ConclusionThese simple strategies can reduce the level of anxiety experienced by AD patients, reduce typical behavioral symptoms of agitation, aggression and discomfort, and increase patient cooperation and responsiveness.     

内分泌治疗对乳腺癌患者主客观认知功能影响的系统评价

目的 系统评价内分泌治疗对乳腺癌患者主客观认知功能的影响。方法 计算机检索The Cochrane Library、Medline、Embase、CINAHL、PubMed、Web of Science、中国生物医学文献数据库、万方、维普和中国知网期刊数据库建库至2021年10月31日的文献,根据纳入和排除标进行文献筛选、资料提取和质量评价,最后对纳入的文献进行总结分析。结果 共纳入11篇文献,结果显示,内分泌治疗对乳腺癌患者主客观认知功能影响的评定宜采用联合测试,客观认知表现以记忆力受损最为广泛,主客观认知功能影响的相关性较弱。结论 内分泌治疗对乳腺癌患者认知功能的影响结果尚待进一步统一,提示需关注乳腺癌患者远期认知功能损伤,开展更多高质量研究,进一步验证分析。     

针灸治疗帕金森病疗效的系统评价

目的系统评价针灸与西药比较治疗帕金森病的有效性与安全性。方法计算机检索CBM（1979～2008）、CNK（I1979～2008）、VIP（1989～2008）、万方数字化期刊群（1998～2008）、PubMe（d1966～2008）、EMbase（1980～2008）和Cochrane Library（2008年第4期）数据库,并辅以手工检索,纳入针灸与西药比较治疗帕金森病的随机对照试验。由两名评价者独立提取资料并交叉核对,而后按照Cochrane系统评价员手册4.2.8进行质量评估,采用RevMan5.0.20软件进行Meta分析。结果共纳入13个随机对照试验,包括832例患者。Meta分析结果显示：①有效率：针灸或针灸＋美多巴与单用美多巴比较,两组在Webster减分率方面差异均无统计学意义。针灸＋美多巴与单用美多巴比较,两组UPDRS减分率在第30天[RR=1.33,95%CI（0.95,1.88）]、第66天[RR=1.38,95%CI（0.84,2.24）]时差异无统计学意义,但在第84天时差异有统计学意义[RR=1.61,95%CI（1.19,2.17）]。针灸＋苄丝肼-左旋多巴与单用苄丝肼-左旋多巴比较,两组在第66天时有效率差异有统计学意义[RR=1.70,95%C（I1.08,2.68）]。②Webster评分：针灸与美多巴比较,两组在第30天、63天时差异有统计学意义[WMD=-2.51,95%CI（-2.83,-2.19）;WMD=-2.48,95%CI（-3.01,-1.95）];针灸＋美多巴与美多巴比较,两组在第30天时差异有统计学意义[WMD=-13.48,95%CI（-15.35,-11.61）],而在第42天时差异无统计学意义[WMD=0.50,95%CI（-1.22,2.22）]。③UPDRS评分：针灸与美多巴比较,两组在第60天时差异无统计学意义[WMD=-7.19,95%CI（-14.49,0.11）];针灸＋美多巴与单用美多巴比较,两组在第30天、第84天时UPDRS评分差异均有统计学意义[WMD=7.07,95%CI（2.95,11.19）;WMD=-12.49,95%CI（-16.75,-8.23）];但在第66天、33天时差异均无统计学意义[（WMD=-14.90,95%CI（-31.89,2.09）;WMD=-8.60,95%CI（-21.51,4.31）];针灸＋苄丝肼-左旋多巴与单用苄丝肼-左旋多巴比较,两组在第66天、33天差异均无统计学意义[WMD=-14.90,95%CI（-31.89,2.09）;WMD=-8.60,95%CI（-21.51,4.31）]。④不良反应：3个试验报道了针灸可能有头晕、心跳加速、轻微口干、恶心等不良反应,但均能在治疗过程中缓解和消失。结论针灸治疗帕金森病安全、有效。针灸配合西药可能优于单用西药。但因纳入文献数量有限且部分研究质量较低,上述结论需更多高质量的随机对照试验来进一步验证。     

人工全椎间盘置换治疗退行性腰椎间盘疾病的系统评价

目的分析人工全椎间盘置换治疗退行性腰椎间盘疾病的疗效.方法计算机检索Cochrane图书馆(2004年第2期)中的临床对照试验资料库和Cochrane协作网背痛专业试验数据库、MEDLINE(1966～2004)、EMBASE(1980～2004)、中国生物医学文献光盘数据库(CBMdisk,2003),手工检索中文文献(截自2004年6月),并询问相关厂家以及研究者.由两名评价员独立提取资料,并按Cochrane协作网提供的方法对纳入文献进行质量评价和结果分析.结果共纳入3个RCT,包括152例患者.文献质量评价结果显示,3个RCT均可能存在选择性偏倚、实施偏倚和测量偏倚的高度可能性.其中两篇使用ProDisc-Ⅱ人工全椎间盘置换,1篇使用SB-Ⅲ人工全椎间盘置换.3个RCT均未提供详细的原始数据,因此不能进行Meta分析.人工全椎间盘置换组病人术后早期VAS疼痛评分(visual analog scale)和ODI功能评分(oswestry disability index)有改善,但术后6个月与融合组无差异.病人满意率,术后6个月人工全椎间盘置换组有优于融合组的趋势.短期随访显示,人工椎间盘能够保存受累节段的运动功能.两篇RCT报告了相关并发症.结论人工全椎间盘置换短期内能够重建退变节段的高度及生理运动功能,但缺乏长期的随访,尤其对于能否防止毗邻节段的退变缺乏证据.尚需更多设计严格的研究以增加证据的强度.     

帕金森病冲动控制障碍的Scoping综述

目的 探讨帕金森病冲动控制障碍的流行病学、发病机制、危险因素、筛查和评估方法、诊断策略和治疗方法.方法 采用主题检索方式,检索PubMed、Medline、Embase、Cochrane Library、CNKI、维普数据库和万方数据帕金森病并发冲动控制障碍的中英文相关文献,截至2020年12月,并辅以参考文献回溯和手...     

Massage therapy as a complementary treatment for Parkinson’s disease: A Systematic Literature Review

ObjectiveThere is no definite cure for Parkinson’s disease (PD); therefore, the goals for symptomatic treatment are to improve quality of life and manage the motor and non-motor symptoms of the disease. Although massage is the one of the commonest used forms of complementary and alternative medicine (CAM), there is no systematically-oriented review focusing specifically on the efficacy of the different massage techniques on PD.Aim of this review was to evaluate the quality of evidence referring to massage therapy for PD.DesignA systematic search was conductedin the MEDLINE database to identify the efficacy of massage on PD between 01/01/1970 and 06/12/2019.ResultsA total of 12 studies were analyzed in this systematic review. Massage therapy seems to induce relaxation in most cases, which is accompanied by biological measures involving urine stress hormones. Quality of life has been shown to be improved upon various therapeutic massage styles, involving classical whole-body therapeutic massage and reflexology. Non-motor symptoms, such as sleep disturbances, pain, fatigue, anxiety and depressive symptoms have been demonstrated to be improved upon different massage techniques, including classical deep therapeutic massage, Traditional Japanese (Anma) massage, Thai massage, neuromuscular therapy and Yin Tui Na massage. Regarding motor symptoms, classical therapeutic massage, Traditional Japanese (Anma) massage, Thai massage, and neuromuscular therapy seemed to improve motor symptoms, whereas Yin Tui Na technique combined with acupuncture was associated with worse motor scores.ConclusionsDespite the methodological concerns regarding the existing evidence, there is a wide range of safe massage techniques with beneficial effects on both motor and non-motor symptoms of PD. Longitudinal studies are needed to justify the introduction of massage therapy into clinical practice.     

Pre-emptive Analgesia: A Systematic Review of Clinical Studies

Basic scientific evidence suggests that an analgesic intervention made before surgery will produce a better outcome than the same intervention made after surgery. The evidence from randomized controlled trials (RCTs) which tested this hypothesis in patients is reviewed. Four studies with paracetamol or NSAIDs did not show any preemptive effect. Of seven studies with local anaesthetic six did not show a pre-emptive effect. In the four studies with opioids there was weak evidence of a pre-emptive effect in three.

There are few perfect RCTs, and unfortunately this rule applies in the pre-emptive analgesia field. Many of the studies which did not show a pre-emptive effect lacked power. The opioid studies which did show a pre-emptive effect had other technical weaknesses.

One way to combat lack of power would be to combine data (meta-analysis). This is very difficult in this field because of the outcome measures which investigators are using.     

Therapeutic Options for the Treatment of Postherpetic Neuralgia: A Systematic Review

ABSTRACT

Postherpetic neuralgia (PHN) is a chronic and painful condition that may result in significant disturbances to normal activities and decreases in the quality of life for those affected. Despite the availability of several first- and second-line treatment options, many patients may experience refractory pain. The objectives of this review were to summarize evidence for Food and Drug Administration (FDA)-approved and off-label therapies for the treatment of PHN and to present gaps in the current literature for future research focus. Several agents, including pregabalin, gabapentin, and opioids, have been shown to significantly improve pain when compared with placebo. However, evidence regarding the comparative effectiveness of these treatment alternatives is lacking. In order to choose the optimal treatment, providers should consider issues related to efficacy, safety, and tolerability in conjunction with patient goals, preferences, and adherence issues. Evidence from randomized or observational studies that directly compare agents with each other should help to inform treatment choices.     

他汀类药物治疗早期糖尿病肾病的Meta分析

目的系统评价他汀类药物治疗早期糖尿病肾病（DKD）的疗效。方法计算机检索Cochrane图书馆临床对照试验资料库（2009年第2期）、MEDLINE（1991～2009年8月）、EMbase（1991～2009年8月）、CBMdisc（1991．2009年8月）、CNKI（1994～2009年8月）,手T检索相关文献,按纳入与排除标准选择随机对照试验（RCT）。评价质量及提取资料后,采用RevMan4．2软件对数据进行Meta分析。结果初检出281篇文献,经筛选最终纳入22篇文献共25个RCT,包括1838例患者。纳入文献总体质量不高,均为c级。由于各研究间存在异质性,故采用随机效应模型进行效应量合并。Meta分析结果显示,试验组尿白蛋白排泄率（UAER）[WMD=-55．77,95％CI（-74．20,-37．34）,P〈0．00001]、血肌酐（Scr）[WMD=-4．34,95％CI（-6．74,-1．94）,P=0．0004]、C反应蛋白（CRP）[WMD=-1．48,95％CI（-2．32,-0．63）,P=0．006]、总胆固醇（TC）[WMD=-1．33,95％CI（-1．75,-0．91）,P〈0．00001]以及甘油三脂（TG）[WMD=-O．72,95％CI（-1．17,-O．27）,P=0．002]较对照组均明显降低。倒漏斗图散点分布近似左有对称,提示纳入研究存在发表偏倚可能性小。纳入的22篇文献共报道12例患者出现转氨酶升高,经保肝治疗恢复正常,未见严重不良反应事件的报道。结论现有研究结果表明,他汀类药物在调节早期DKD患者血脂的同时,可以降低UAER和Scr,具有肾脏保护作用,其机制可能与降低血CRP水平有关,不良反应轻微。由于本研究纳入文献的质量缺陷,尚需更多高质量的随机双盲对照试验证实结论。     

肾癌患者的手术及术后辅助治疗

我们带着肾癌患者是否应进行手术治疗以及应选择何种术式、术后是否应进行辅助治疗及辅助治疗方案等问题,检索了从1996年1月～2005年9月的The Guidelines International Network、ACP Journal Club、Cochrane图书馆(2005年第3期)、MEDLINE、EMBASE和中国生物医学文献数据库.结果未找到比较单纯手术与不治疗或单用辅助治疗比较的研究;找到1篇研究转移性肾癌在辅助治疗的基础上是否应手术治疗的Meta分析,肯定了肾切除在转移性肾癌中的疗效;1篇比较不同术式的综述发现保留肾单位的肾切除与肾全切术同样有效,且并发症更少;14篇研究术后辅助治疗的RCT发现,细胞因子(干扰素和白细胞介素)和5-氟尿嘧啶在肾癌术后辅助治疗中无效且有增多不良反应的趋势,而疫苗治疗显示出较好的疗效.     

Internal Qigong for Pain Conditions: A Systematic Review

The objective of this systematic review was to assess the evidence for the effectiveness of internal qigong as a treatment option for pain conditions. Nineteen databases were searched through to February 2009. Controlled clinical trials testing internal qigong in patients with pain of any origin assessing clinical outcome measures were considered. Trials using any type of internal qigong and control intervention were included. The selection of studies, data extraction, and validation were performed independently by 2 reviewers. Four randomized clinical trials (RCTs) and 3 controlled clinical trials met all inclusion criteria. One RCT suggested no significant difference for low back pain compared with electromyographic biofeedback. Two RCTs failed to show effects of internal qigong in neck pain compared with exercise therapy and waiting list control. One RCT suggested that qigong is inferior to aerobic exercise in patients with fibromyalgia. There are few RCTs testing the effectiveness of internal qigong in the management of pain conditions. Collectively, the existing trial evidence is not convincing enough to suggest that internal qigong is an effective modality for pain management.

Perspective

This review of controlled clinical trials focused on the effects of internal qigong, a self-directed energy healing intervention involving movement and meditation. Collectively, the existing trial evidence is not convincing enough to suggest that internal qigong is an effective modality for pain management. Future studies should be of high quality with particular emphasis on designing an adequate control intervention.     

运动对慢性阻塞性肺疾病系统性炎症和骨骼肌功能障碍干预效果的系统综述

目的 系统综述运动对慢性阻塞性肺疾病(COPD)系统性炎症及骨骼肌功能障碍的干预效果。方法 检索建库至2021年6月PubMed、Web of Science、CNKI、维普和万方数据,运动对COPD系统性炎症及骨骼肌功能障碍干预效果的相关文献,并辅以参考文献回溯和手工检索。提取文献内容,对运动改善COPD系统性炎症及骨骼肌功能障碍的效果进行综述。结果 共检索到文献192篇,最终纳入8篇,245例被试。运动可以降低促炎因子水平,提高抗炎因子水平;提高COPD患者运动能力,改善骨骼肌结构。运动改善COPD系统性炎症与运动方式、强度以及持续时间有关,可能通过调控炎症反应,影响泛素-蛋白酶、胰岛素样生长因子1/磷脂酰肌醇-3-激酶/Akt等途径,改善骨骼肌功能障碍。结论 运动对降低COPD系统性炎症水平、改善骨骼肌功能障碍具有一定效果。