12种针灸相关疗法治疗银屑病网状Meta分析

目的 采用网状Meta分析评价针灸相关疗法治疗银屑病的疗效及安全性。方法 计算机检索CBM、CNKI、Wanfang、VIP、PubMed、Embase、Cochrane Library 7个数据库,检索时限自建库至2020年10月,对纳入的文献进行筛选、资料提取及偏倚风险评价。采用Stata15.0进行网状Meta分析。结果 共纳入27个研究（n=2 612）,涉及针刺+西医、针刺+放血+西医、火针+西医、艾灸+西医、放血+西医、针刺+火针+放血、针刺+火针、针刺、放血、火针+放血、针刺+放血、火针12种针灸疗法。网状Meta分析以总有效率为结局指标的RCTs 26项,涉及11种针灸疗法,以PASI为结局指标的RCTs 18项,涉及10种针灸疗法。改善银屑病疗效总有效率的SUCRA具体排序为：针刺+放血+西医＞针刺+放血＞针刺+火针＞针刺+火针+放血＞放血＞针刺+西医＞放血+西医＞火针+放血＞火针+西医＞针刺＞火针＞西医;改善银屑病PASI的SUCRA具体排序为艾灸+西医＞针刺+西医＞针刺+火针+放血＞放血+西医＞火针+西医＞针刺+火针＞火针+放血＞针刺＞放血＞火针＞西医。网状Meta结果分析：针刺+放血+西医、针刺+放血、针刺+火针、针刺+火针+放血、放血、针刺+西医、放血+西医、火针+放血、火针+西医、针刺治疗银屑病总有效率优于常规西医治疗。艾灸+西医、针刺+西医、火针+西医、火针+放血治疗改善银屑病PASI优于常规西医。结论 单一疗法推荐放血的治疗方案;联合治疗中推荐针刺+放血+西医的治疗方案,但因此次纳入研究较少,受研究质量限制,临床需谨慎施治。     

安慰剂对照在中药临床研究中的作用探讨

如何选择对照组是临床随机对照试验设计的关键环节之一。中药临床研究中对照组选择存在以下问题:1、由于历史原因,阳性对照药的有效性及安全性尚待质疑;2、难于找到合适的中药对照药;3、由于理论体系、治病机理不同,以化学药物作对照进行疗效评价,意义有待斟酌。安慰剂对照可以克服研究者和受试者由于心理因素所形成的偏倚,能够直接量度在试验条件下,试验药物和安慰剂之间的差别。提倡在伦理学所能认可的最大限度内,在临床试验中广泛应用安慰剂作对照。     

Feasibility of a randomized controlled trial to evaluate Text Reminders for Immunization Compliance in Kids (TRICKs)

Objective

To pilot test the Text Reminders for Immunization Compliance in Kids (TRICKs) program to evaluate its feasibility and potential to increase immunization coverage.

Design

Randomized controlled trial (RCT).

Setting

Pediatric clinic.

Participants

Parents of newborns being discharged from a local hospital who intended to seek child health care at the University-sponsored pediatric resident and faculty clinic.

Intervention

Text message immunization reminders prior to immunization due dates.

Main Outcome Measures

Receipt and timeliness of immunizations at 2, 4 and 6 months of age.

Results

Participants (N = 90) were English (83%) or Spanish (17%) speaking. The majority were female (83%), on public insurance (59%), and had adequate health literacy (96%). Parents were married or a member of an unmarried couple (62%). Over 66% had a high school diploma or less. Greater numbers of intervention children received immunizations and were “on time” using per protocol analysis; though not statistically significance. Limitations include sample size, problematic text messaging software, and loss of phone service at 7 months for 40% of intervention parents. However, post-intervention interviews (N = 18) indicated strong support for TRICKs; 83% found the text message reminders very helpful and 17% somewhat helpful.

Discussion

Pilot testing allowed us to assess processes, including recruitment, retention, and software, which will increase the success of an RCT. Software with built-in backup systems is needed for follow-up when mobile service is interrupted. However, in spite of limitations, immunization rates were higher in the text message reminder group, though not statistically significant. Parent support and interest was high. A fully powered RCT is needed with follow-up over the full 4-3-1-3-3-1 series. Based on our results, for 80% power where we expected 90% compliance in the intervention group and 80% in the control group we need 219 per group, plus increases to address drop out and loss of follow-up.     

中医药治疗更年期综合征随机对照试验文献的质量评价

目的:评价国内中医药治疗更年期综合征随机对照试验已发表文献的质量.方法:电子、手工检索获得发表的关于中医药治疗更年期综合征的随机对照试验或半随机对照试验或自称是随机对照试验无论是否采用盲法的文献,由两名研究者独立进行文献选择和资料提取工作,遵循循证医学的原则和文献系统性评价质量评价的原则,对文献质量进行分析评价.纳入试验的方法学质量采用Jadad评分标准与随机分配隐藏.结果:共51篇关于中医药治疗更年期综合征的随机对照试验满足纳入标准,2篇双盲试验被评为高质量试验,其余均为低质量.51篇文献中指出了具体随机方法的占7.9%,没有1篇提到分配隐匿;有明确诊断标准的占62.7%,明确疗效评价标准出处者占29.4%,明确指出组间有可比性的占56.9%,运用盲法的占7.8%,说明选择相应的统计学方法的依据或理由的占7.8%.结论:中医药治疗更年期综合征的随机对照研究中,高质量的随机对照试验较少,研究质量的总体水平亟待提高,应努力开展有资金资助的大样本、多中心、严格的前瞻性随机对照试验.     

Review of major measuring instruments in comorbid depression and coronary heart disease

Depression and coronary heart disease (CHD) are common comorbid conditions in which each may be a risk factor for the other condition. However, treating depression does not appear to favorably alter cardiac outcome when depression and CHD are comorbid. The National Heart Lung and Blood Institute working group convened in August, 2004 reviewed and recommended instruments to assess and treat depression in subjects with CHD. This paper focuses on these instruments and their limitations when compared and contrasted with the robust instruments available to assess CHD.As a result of our observations about the limitations of instruments and scales available to assess depression and depressive symptoms in subjects with comorbid CHD, we propose using the objectivity of CHD parameters to assess the efficacy of psychiatric interventions in patients with comorbid depression and to better define the link between depression and these cardiac conditions.     

Effects of preoperative combined aerobic and resistance exercise training in cancer patients undergoing tumour resection surgery: A systematic review of randomised trials

Background

Surgical management remains the cornerstone of treatment for many cancers, but is associated with a high rate of postoperative complications, which are linked to poor preoperative functional capacity. Prehabilitation may have beneficial effects on functional capacity and postoperative outcomes. We evaluated the effects of prehabilitation combining endurance and resistance training (CT) on physical fitness, quality of life (QoL) and postoperative outcomes in cancer patients undergoing tumour resection surgery.

硝苯地平和氨氯地平治疗高血压疗效与安全性的Meta分析

目的:系统评价硝苯地平和氨氯地平治疗高血压的有效性与安全性。方法:计算机检索中国知网、万方数据库、维普信息资源系统,采用Review Manager 5.0.25软件对检索到的文献进行Meta分析。结果:共纳入14篇临床随机对照试验,合计1151例患者符合纳入标准,其中4例患者退出/失访。Meta分析结果显示,氨氯地平的总有效率高于硝苯地平,差异有统计学意义[OR=2.40,95%CI(1.72,3.34),P<0.00001];氨氯地平的不良反应发生率小于硝苯地平,差异有统计学意义[OR=0.39,95%CI(0.28,0.53),P<0.00001]。结论:氨氯地平治疗高血压疗效与安全性明显优于硝苯地平。     

认知疗法辅助治疗双相情感障碍系统评价

目的系统评价认知疗法辅助治疗双相情感障碍的临床疗效,为临床有效干预提供依据。方法检索Cochrane图书馆临床对照试验资料库（1980-2008）,MEDLINE（1950-2008）,PubMed（1980-2008）、CBMdise（1979-2008）及同方数据库（1979-2008）,手工检索中、英文已发表的资料,收集所有认知疗法辅助治疗双相情感障碍的随机对照试验,根据纳入和排除标准筛选文献、提取资料,并进行质量评价、结果描述;采用RevMan5．0软件对数据进行Meta分析。结果共纳入有效文献6篇;经文献质量评估,5项研究为A级,1项为B级;3项研究对比了认知疗法与未干预的疗效差异,Meta分析显示认知疗法与未干预相比在减少复发率方面无差异性[RR=0．94,95％CI（0．79,1．12）,P=0．491;另3项研究对比了认知疗法与协同照护,结果不完全一致。结论由于纳入研究数量少,样本量小,数据间异质性高,难以证实认知疗法治疗双相障碍的有效性,因此,有待设计良好的随机对照研究进一步验证。     

Enhancing the validity and utility of randomized clinical trials in addictions treatment research: I. Treatment implementation and research design

PURPOSE: This paper is the first in a series that examines methods for improving the validity and utility of randomized clinical trials (RCTs) in addictions treatment research. The specific foci of this article are treatment implementation and research design. SCOPE: We begin by considering the conditions under which the RCT provides an appropriate design choice. Sections that follow discuss methodological issues with respect to RCT structure and collaborative arrangements; treatment specification, delivery and cost; experimental design; and randomization/blinding procedures. We emphasize the importance of advance planning; treatment integrity and discriminability; treatment standardization; staff training and supervision; client compliance; maintenance of between-group equivalence across study conditions; and inclusion of appropriate comparison groups in study designs. CONCLUSIONS: Investigators are encouraged to maximize the internal validity of RCTs, but also to consider methods for enhancing external validity. The utility of addictions RCTs for advancing theory and improving clinical practice can be enhanced by investigating underlying mechanisms of action.