目的 对电动牙刷和手动牙刷在去除菌斑、维护牙龈健康、对色素和牙结石的作用、可靠性、不良作用和成本等进行比较.方法 计算机检索Cochrane口腔健康协作组临床试验资料库(截至2004年6月17日)、Cochran临床对照试验中心资料库(Cochrane图书馆2004第2期)、MEDLINE(1966～2004)、EMBASE(1980～2004第2周)和CINAHL(1982～2004第2周),并与制造商联系以获取更多资料.根据下列标准纳入随机对照试验:随机分配研究对象;参加者为手运动无障碍的普通人群;干预措施为无监督的手动或电动牙刷刷牙,至少4周;主要结局指标为试验期间菌斑和牙龈炎的变化.由6个作者独立评价并纳入研究资料.用随机效应模型进行Meta分析,用标准化均数差(SMD)及其95%CI测量效果.检查可能的异质性来源,并针对研究质量和发表偏倚进行敏感性分析.为便于讨论,将SMD转换为百分率.结果 对包含3 855例研究对象的42个试验进行系统评价,结果显示,旋转振动型电动牙刷去除菌斑和减低牙龈炎的效果在短期内明显优于手动牙刷,并在3个月以上的研究中显示降低了牙龈炎指数.在1～3个月的研究中,菌斑SMD为-0.43 [95%CI (-0.72, 0.14)],牙龈炎SMD为-0.62 [95%CI (-0.90, 0.34)],Quigley Hein菌斑指数降低11%,Loe and Silness龈炎指数降低6%.在3个月以上的研究中,菌斑指数SMD为-1.29 [95%CI (-2.67, 0.08)], 龈炎指数为-0.51 [95%CI (-1.76, 0.25)],Ainamo Bay探诊出血指数降低17%.短期研究之间有异质性,敏感性分析显示当选择高质量的研究时结果是肯定的,没有证据表明有发表偏倚.采取其他设计的电动牙刷并不比手动牙刷更优.对成本、可靠性和不良作用的报道不一致,已报道的不良作用都是局限的、暂时的.结论 旋转振动型电动牙刷去除牙菌斑、减少牙龈炎的效果优于手动牙刷.遵守方法学指南和更标准化的设计有益于将来的研究和Meta分析.
Objective To introduce the method of reading systematic reviews. Methods Papers and books on reading and evaluating medical literature were searched comprehensively, and general principles and approaches of reading systematic reviews were summarized. Results The following 10 points were summarized to help read systematic reviews in a scientific, rapid, and efficient way: ① Was there any overviews of reviews? ② Was there a recent update? ③ Were the previous relevant systematic reviews integrated? ④ Were sound searching strategies established and implemented? ⑤ Was quality evaluation done concerning the original research? ⑥ Were the results of the original research conflated properly? ⑦ Was there any explanation to the limitations or weaknesses of the systematic review? ⑧ Were the problems to be solved in the next stage put forward? ⑨ Were the abstracts and full-texts reported sufficiently? ⑩ Were the systematic reviews helpful in solving practical problems? Additionally, the readers were divided into the four groups based on their application of the systematic reviews: health policy makers, health care suppliers, researchers as well as patients and common people. Conclusion The reading of the systematic reviews should be stressed in order to better guide decision-making and promote evidence-based practice.
目的 系统评价华蟾素治疗胃癌的疗效。 方法 计算机检索Cochrane （2011年第3期），PubMed （1966年1月－2011年9月），EMBASE（1974年1月－2011年9月），中国生物医学数据库（CBM，1978年1月－2011年9月），维普（1989年1月－2011年9月），中国期刊全文数据库（1994年1月－2011年9月）；手工检索相关杂志。纳入华蟾素治疗胃癌的随机对照试验（RCT），对纳入的RCT进行质量评价，并用RevMan 5.0软件进行Meta分析。 结果 共纳入9个RCT，Meta分析结果显示：华蟾素联合常规化学疗法（化疗）治疗中晚期胃癌的有效率高于常规化疗组，且差异有统计学意义[RR=1.23，95%CI（1.03，1.46），P=0.02]，而1年生存率两组比较差异无统计学意义[RR=1.28，95%CI（0.69，2.36），P=0.43]。 结论 常规化疗加华蟾素治疗胃癌的疗效优于常规化疗，但因为纳入研究质量较低，尚需高质量、大样本、长期的随机对照试验进一步验证上述结论。
Objective To systematically review the effectiveness and model building process of heparin treatment for animal model with smoke inhalation injury. Methods Databases including PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect animal experiments about the treatment of heparin for animal model with smoke inhalation injury from inception to November 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 software. Results A total of nine studies involving 11 animal experiments were included. The results showed that building animal model with smoke inhalation injury were through burning of cotton towels or pine sawdust by sheep or rats below 40℃. The results of meta-analysis showed that there was no significant difference in mortality rate between two groups (heparin group vs. control group: RR=0.38, 95%CI 0.14 to 1.05, P=0.06; heparin plus DMSO group vs. DMSO group: RR=0.10, 95%CI 0.01 to 1.51, P=0.10). In addition, the pulmonary artery pressure (MD=–3.31, 95%CI –4.51 to –2.11, P<0.000 01), wet to dry weight ratio (MD=–0.90, 95%CI –1.19 to –0.61, P<0.000 01), and lung water content (MD=–1.18, 95%CI –1.67 to –0.70, P<0.000 01) of the experimental group were lower than those in the control group. PaO2/FiO2 after 12 hours (MD=131.00, 95%CI 59.54 to 202.46, P=0.000 3), PaO2/FiO2 after 24 hours (MD=114.00, 95%CI 60.56 to 167.44, P<0.000 1), PaO2/FiO2 after 48 hours (MD=46.00, 95%CI 20.62 to 71.38, P=0.000 4) were higher than those in the control group. However, there was no significant difference in coagulation function between both groups. Conclusion The current evidence shows that the establishment of animal model of smoke inhalation injury is still lack of standard method. Heparin can decrease pulmonary artery pressure and lung water content in animal models with smoke inhalation injury. Due to the limited quality and quantity of included studies, the above conclusions are still needed to be verified by more high quality studies.
Objective To systematically review the efficacy and safety of acupuncture for the treatment of tumor-related cognitive dysfunction. Methods The PubMed, The Cochrane Library, EMbase, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies on acupuncture for the treatment of tumor-related cognitive dysfunction from the establishment of the database to February 13th, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4.1 software. Results A total of 16 studies involving 1 361 patients were included. The results of meta-analysis showed that the mini-mental state examination (MD=1.82, 95%CI 1.49 to 2.15, P<0.000 01) and Montreal cognitive assessment (MD=1.56, 95%CI 0.83 to 2.29, P<0.0001) scores of the acupuncture treatment group were superior to those in the control group. Furthermore, the acupuncture treatment group showed a reduced incidence of postoperative cognitive dysfunction (RR=0.50, 95%CI 0.39 to 0.63, P<0.000 01) and decreased levels of interleukin-6 (MD=−10.43, 95%CI −14.91 to −5.95, P<0.000 01), interleukin-1β (MD=−47.14, 95%CI −63.92 to −30.36, P<0.000 01), and tumor necrosis factor-α (MD=−9.13, 95%CI −12.38 to −5.89, P<0.000 01). In contrast, the visual analog scale score of the acupuncture treatment group (MD=−1.26, 95%CI −2.06 to −0.47, P=0.002) was better than that of the control group. No significant difference was found in the level of central nervous system-specific protein (S100β) (MD=−0.06, 95%CI −0.13 to 0.01, P=0.12) between the two groups. Conclusion Acupuncture therapy can improve tumor-related cognitive function in patients. Its curative effect is better than that of non-acupuncture therapy; however, its ability to reduce S100β levels is not significantly different from that of non-acupuncture therapy. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the protective effect of serum maternal respiratory syncytial virus (RSV) antibodies on infants with RSV infection. MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data databases were electronically searched to collect observational studies on the correlation between serum maternal RSV antibodies and infants with RSV infection from inception to July 18, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, then, qualitative analysis was performed. ResultsA total of 19 studies were included, and 60% of those studies suggested that a higher level of maternal antibodies could prevent RSV infection. However, the remaining 40% of them showed that there was no significant difference in the level of RSV maternal antibodies between the infected group and the non-infected group. Further more, in the studies of the correlation between maternal antibody level and disease severity after RSV infection, 55% of those showed that maternal antibody level was negatively correlated with disease severity. ConclusionThe protective effect of serum maternal RSV antibodies on infants reported in different studies varies. Whether it can prevent RSV infection and affect the severity of RSV infected children still needs to be explored.
The most important difference between systematic review and traditional narrative review lies in their respective quality, namely the degree of bias control. Generally speaking, the sources of bias include the process of literature searching, study selection, data extraction and original studies. A systematic review may greatly reduce bias, as it takes effective steps such as developing search strategies, undertaking funnel plot analysis, using established criteria for study selection, and assessment of the methodology quality of studies. All these help to control, identify and, describe the possible bias.
背景与目的 对卫生保健干预措施进行决策权衡需要有不良和有益的可靠证据,然而绝大多数系统评价针对的是研究方法非常成熟的随机对照试验及其有效性评价,系统地评价不良反应的方法尚未完善,对研究者而言,能作为相关指南的资源很少.为此,作者在文中报告了对不良反应进行系统评价的新近体会,同时提出进一步实践和研究的建议.方法 描述并比较3个包含不良反应评价的药物干预的系统评价的方法学,重点评价其研究问题、研究设计和质量评价.结果 1个研究关注于如何根据提供的特殊不良反应数据建立卫生经济学模式,而其它两个研究涉及更广泛的问题.尽管每个评价对纳入标准的定义不同,但它们均纳入了随机和观察性数据.对研究质量的评价采用了标准方法.由于研究设计不良、报告不充分和现有研究工具有限,在运用纳入标准和评估研究质量时,研究者遇到了各种问题.最终发现,3个评价都做了大量的工作,但对卫生保健决策者有用的资料不多.研究者确认,改善的关键在于如何提出系统评价的问题和发展不良反应研究的质量评价方法学.结论 若不良反应的系统评价只专注于一个中心问题,那么它会提供与临床决策更相关的资料,也有利于明确纳入系统评价研究的类型.系统评价中不良反应的质量评估的方法学需要进一步完善.
Objective To systematically review the impact of Beijing's comprehensive reform of medical consumption linkage on medical expenses, hospital services, and hospital income. Methods Databases including CNKI, WanFang Data, VIP, CBM, PubMed, and Web of Science were searched to collect empirical research on evaluating the impact of Beijing's comprehensive reform of medical consumption linkage on patient medical expenses and hospital operation (service volume and income structure) from June 15th, 2019 to August 15th, 2021. A descriptive analysis was performed after two reviewers independently screened the literature and extracted data. Results A total of 23 studies were included, and most of them found a relatively small change in the average outpatient and emergency medical expenses after the reform. However, the average inpatient expenses in some hospitals showed an increasing trend; the service volume of most hospitals increased slightly, and the income structure was optimized (e.g., surgery and other medical technology services revenue and its proportion increased). Conclusion The comprehensive reform of the medical consumption linkage in Beijing is the practice of deepening the reform of the medical service price mechanism. Based on the summary of the reform effect, it is recommended to further improve the price mechanism, improve service quality, and promote hierarchical diagnosis and treatment.
Objective To systematically review the current situation of health economics evaluation of gastric cancer screening. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect the health economics evaluation studies on gastric cancer screening from January 1st, 1975 to September 30th, 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Then, qualitative analysis was performed. Results A total of 44 studies were included. Most of the targeted populations of the study were high-risk groups in areas with a high incidence of gastric cancer. Screening methods such as endoscopy and Helicobacter pylori infection detection were mainly evaluated in those studies. According to the results, about 47% of the studies evaluated a single screening method. A total of 35 studies showed that they established models, however, only a few calibrated the models. Conclusion Most studies of gastric cancer screening reviews neither calibrate the results nor consider the effect of smoking on the progression of gastric cancer. Those evaluated screening programs are limited.