Evidence-based Healthcare and Public Health最新文献

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Surgery for morbid obesity: which technique works best? 手术治疗病态肥胖:哪种技术效果最好?

Evidence-based Healthcare and Public Health

Pub Date : 2005-08-01 DOI: 10.1016/J.EHBC.2005.05.003

B. Ltd.

引用次数: 3

Specialist outreach into primary care: is it better than standard care? 专家拓展到初级保健:它比标准护理好吗?

Evidence-based Healthcare and Public Health

Pub Date : 2005-08-01 DOI: 10.1016/J.EHBC.2005.05.002

B. Ltd.

引用次数: 2

Evidence-based guidelines: The theory and the practice 循证指南:理论与实践

Evidence-based Healthcare and Public Health

Pub Date : 2005-08-01 DOI: 10.1016/J.EHBC.2005.05.012

D. Swinglehurst

引用次数: 14

From the Editor 来自编辑

Evidence-based Healthcare and Public Health

Pub Date : 2005-08-01 DOI: 10.1016/j.ehbc.2005.05.005

Dr Anna Donald

引用次数: 0

Computed tomography is probably a better diagnostic test than ultrasonography for adults and adolescents with suspected acute appendicitis 对于疑似急性阑尾炎的成人和青少年，计算机断层扫描可能是比超声检查更好的诊断方法

Evidence-based Healthcare and Public Health

Pub Date : 2005-06-01 DOI: 10.1016/j.ehbc.2005.03.025

Question

Is computed tomography diagnostically superior to ultrasonography for acute appendicitis in adults and adolescents?

Study design

Systematic review with meta-analysis.

Main results

Twenty-two studies (nineteen prospective cohort studies and three randomised controlled trials) were included in the review. Eight were of computed tomography, ten were of ultrasonography and four were of both. Recruitment to the majority of studies (21/22) was based on symptoms at presentation, physical examination and basic laboratory tests. Meta-analysis showed that both tests had high diagnostic accuracy (sensitivity: 0.90, 95% CI 0.86 to 0.92 for computer tomography v 0.84, 95% CI 0.80 to 0.86 for ultrasonography; specificity: 0.92, 95% CI 0.89 to 0.93 for computer tomography v 0.79, 95% CI 0.76 to 0.82 for ultrasonography). Meta-analysis of four studies that directly compared the tests with one another found that computed tomography increased the certainty of diagnosis more than ultrasonography (positive likelihood ratio: 12.2, 95% CI 7.1 to 21.2 with computed tomography v 3.4, 95% CI 2.4 to 4.8 with ultrasonography; negative likelihood ratio: 0.05, 95% CI 0.02 to 0.12 with computed tomography v 0.33, 95% CI 0.19 to 0.55 with ultrasonography). Sub-group analyses in studies of adults (≥18 years); those with differing presentations (suspected v atypical); and those including a high number of women (> 67%) found similar results.

Authors’ conclusions

Computed tomography is superior to appendiceal ultrasonography for diagnosing acute appendicitis in adults and adolescents with suspected appendicitis.

问题成人和青少年急性阑尾炎的计算机断层扫描在诊断上优于超声检查吗？研究设计采用荟萃分析的系统综述。主要结果本综述包括22项研究（19项前瞻性队列研究和3项随机对照试验）。8例为计算机断层扫描，10例为超声检查，4例同时为两者。大多数研究（21/22）的招募是基于表现时的症状、体检和基本实验室测试。荟萃分析显示，这两种测试都具有较高的诊断准确性（计算机断层扫描的灵敏度：0.90，95%CI 0.86至0.92 v 0.84，超声的95%CI 0.80至0.86；计算机断层扫描v 0.79的特异性：0.92，95%CI 0.89至0.93，超声的95%CI 0.76至0.82）。对四项直接比较测试的研究进行的荟萃分析发现，计算机断层扫描比超声检查更能提高诊断的确定性（阳性似然比：12.2，计算机断层扫描的95%CI 7.1至21.2比3.4，超声检查的95%CI 2.4至4.8；阴性似然比：0.05，计算机断层摄影的95%CI 0.02至0.12比0.33，超声检查为95%CI 0.19至0.55）。成人（≥18岁）研究中的亚组分析；有不同表现的患者（疑似或非典型）；而那些包括大量女性（>；67%）的人发现了类似的结果。作者的结论：在诊断成人和青少年疑似阑尾炎的急性阑尾炎方面，计算机断层扫描优于阑尾超声检查。

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引用次数: 0

Prolonged exposure to some agricultural pesticides may increase the risk of lung cancer in agricultural workers 长期接触某些农用农药可能会增加农业工人患肺癌的风险

Evidence-based Healthcare and Public Health

Pub Date : 2005-06-01 DOI: 10.1016/j.ehbc.2005.03.029

Barbara Dinham (Commentator)

Question

Does exposure to agricultural pesticides increase the risk of lung cancer?

Study design

Cohort study

Main results

Four of the most commonly used agricultural pesticides (diazinon, dieldrin, metalochlor and pendimethalin) significantly increased the risk of lung cancer in people with the greatest exposure, compared with people who had no exposure (see results table). Three other commonly used pesticides (carbofuran, chlorpyrifos, and dicamba) also increased the risk of lung cancer, but the results were not statistically significant (see results table).There were insufficient numbers of spouses with lung cancer who were directly exposed to specific pesticides to calculate any associated risk.

Authors’ conclusions

Prolonged exposure to the most commonly used agricultural pesticides increased the risk of lung cancer in farmers and commercial pesticide users. However, this increased risk was only significant for prolonged exposure to diazinon, dieldrin, metalochlor and pendimethalin. It is important to note that the participants in this study were exposed to higher levels for longer periods than the general population, due to their professional, agricultural use of insecticides and herbicides.

问题接触农业农药会增加患癌症的风险吗？研究设计队列研究主要结果与未接触过农药的人相比，使用最常用的农业农药（二嗪农、狄氏剂、金属氯和二甲哈林）显著增加了接触量最大的人患癌症的风险（见结果表）。其他三种常用的农药（呋喃丹、氯苯甘磷和麦草畏）也增加了患癌症的风险，但结果在统计学上并不显著（见结果表）。没有足够数量的癌症配偶直接接触特定农药来计算任何相关风险。作者的结论：长期接触最常用的农业农药会增加农民和商业农药使用者患癌症的风险。然而，这种增加的风险只有在长期暴露于二嗪农、狄氏剂、甲氯氯和二甲哌林时才显著。值得注意的是，这项研究的参与者比普通人群暴露在更高水平的环境中的时间更长，这是因为他们在专业和农业上使用杀虫剂和除草剂。

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引用次数: 12

Do nurse practitioners provide equivalent care to doctors as a first point of contact for patients with undifferentiated medical problems? 执业护士是否提供与医生同等的护理，作为无区别医疗问题患者的第一接触点?

Evidence-based Healthcare and Public Health

Pub Date : 2005-06-01 DOI: 10.1016/j.ehbc.2005.03.028

Bazian Ltd

引用次数: 4

Co-trimoxazole prophylaxis against opportunistic infections is safe, and effective in HIV-infected children 复方新诺明预防机会性感染对感染艾滋病毒的儿童是安全有效的

Evidence-based Healthcare and Public Health

Pub Date : 2005-06-01 DOI: 10.1016/j.ehbc.2005.03.005

Question

Does co-trimoxazole prophylaxis against opportunistic infections reduce mortality and hospital admissions in HIV-infected children more than 1 year old?

Study design

Double blind randomised controlled trial.

Main results

In HIV-infected children more than 1 year old, co-trimoxazole prophylaxis against opportunistic infections reduced deaths and hospital admissions compared with placebo at nearly 19 months. The number of treatment related adverse events were similar in both groups (see results table).

Authors’ conclusions

Children with HIV infection should receive cotrimoxazole prophylaxis in resource-poor settings, despite local bacterial resistance to this drug.

问题复方三唑预防机会性感染是否能降低1岁以上HIV感染儿童的死亡率和住院率？研究设计双盲随机对照试验。主要结果在1岁以上感染艾滋病毒的儿童中，与安慰剂相比，复方三恶唑预防机会性感染在近19个月时减少了死亡和住院人数。两组中与治疗相关的不良事件数量相似（见结果表）。作者的结论：尽管局部细菌对该药物有耐药性，但感染艾滋病毒的儿童应在资源匮乏的环境中接受复方新诺明预防治疗。

引用次数: 0

Peer-led approach to sex education in school has limited impact compared with teacher-led education 与教师主导的性教育相比，同伴主导的学校性教育方法影响有限

Evidence-based Healthcare and Public Health

Pub Date : 2005-06-01 DOI: 10.1016/j.ehbc.2005.03.022

Question

Do peer-led sex and relationship education programmes reduce unsafe sex and unwanted pregnancies compared with traditional teacher-led sex education in schools?

Study design

Randomised controlled trial.

Main results

There were no significant differences between intervention and control schools in the proportion of pupils reporting unprotected first heterosexual intercourse by 16 years of age (difference in cumulative proportion: −0.8%, 95% CI −3.5 to 1.8; $p = 0.53$ ). At 18 months follow up, peer-led education improved pupils’ satisfaction with their sex education compared with teacher-led education ( $p = 0.001$ ). Peer-led education non-significantly reduced unwanted pregnancies ( $p = 0.07$ ). Following intervention, girls were less likely to report having had sexual intercourse by 16 years ( $p = 0.0008$ ), although the difference was not significant for boys ( $p = 0.35$ ) (see results table).

Authors’ conclusions

Peer-led sex education in schools only modestly improved sexual behaviour. Young people report that they learn most about sex outside school. Wider strategies of education such as media and service delivery need to be assessed.

问题与传统的教师主导的学校性教育相比，同伴主导的性教育和关系教育计划是否减少了不安全的性行为和意外怀孕？研究设计随机对照试验。主要结果干预学校和对照学校报告16岁前无保护的首次异性性交的学生比例没有显著差异（累积比例差异：-0.8%，95%CI−3.5-1.8；p=0.53），与教师主导的教育相比，同伴主导的教育提高了学生对性教育的满意度（p=0.001）。同伴主导的教学没有显著减少意外怀孕（p=0.07）。干预后，女孩在16岁时报告性交的可能性较小（p=0.0008），尽管男孩的差异并不显著（p=0.035）（见结果表）。作者的结论同伴主导的学校性教育只是适度地改善了性行为。年轻人报告说，他们在校外学到的关于性的知识最多。需要评估更广泛的教育战略，如媒体和提供服务。

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引用次数: 0

Risk factors for breast cancer in elderly women are similar to those for younger post-menopausal women 老年妇女患乳腺癌的危险因素与年轻的绝经后妇女相似

Evidence-based Healthcare and Public Health

Pub Date : 2005-06-01 DOI: 10.1016/j.ehbc.2005.03.023

Question

What influence do known risk factors have on incidence of breast cancer in women over 75 years old?

Study design

Prospective cohort study.

Main results

Increases in BMI and height were associated with increasing risk of breast cancer among women over 75. Nulliparity was not a risk factor in this group, although five or more previous live births reduced risk of breast cancer. Older age at menopause increased risk (see results table).

Authors’ conclusions

In women aged 75–84 years, increasing BMI, a family history of breast cancer and older age at menopause increased risk of incident breast cancer while more than five live births was a protective factor. These risk factors are similar to those for younger post-menopausal women.

问题已知的危险因素对75岁以上女性乳腺癌症发病率有什么影响？研究设计前瞻性队列研究。主要结果75岁以上女性BMI和身高的增加与患癌症的风险增加相关。在这一组中，尽管五次或五次以上的活产降低了患癌症的风险，但无效并不是一个危险因素。绝经年龄越大，风险越高（见结果表）。作者的结论在75–84岁的女性中，BMI增加、有癌症家族史和绝经年龄越长，患癌症的风险越高，而五个以上的活产是一个保护因素。这些风险因素与年轻绝经后妇女的风险因素相似。

引用次数: 0

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