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Swimming training for asthma in children and adolescents aged 18 years and under 18岁及以下儿童和青少年哮喘的游泳训练
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-09-18 DOI: 10.1002/ebch.1935
Sean Beggs, Yi Chao Foong, Hong Cecilia T Le, Danial Noor, Richard Wood-Baker, Julia AE Walters

Background

Asthma is the most common chronic medical condition in children and a common reason for hospitalisation. Observational studies have suggested that swimming, in particular, is an ideal form of physical activity to improve fitness and decrease the burden of disease in asthma.

Objectives

To determine the effectiveness and safety of swimming training as an intervention for asthma in children and adolescents aged 18 years and under.

Search methods

We searched the Cochrane Airways Group's Specialised Register of trials (CENTRAL), MEDLINE , EMBASE, CINAHL, in November 2011, and repeated the search of CENTRAL in July 2012. We also handsearched ongoing Clinical Trials Registers.

Selection criteria

We included all randomised controlled trials (RCTs) and quasi-RCTs of children and adolescents comparing swimming training with usual care, a non-physical activity, or physical activity other than swimming.

Data collection and analysis

We used standard methods specified in the Cochrane Handbook for Systematic reviews of Interventions. Two review authors used a standard template to independently assess trials for inclusion and extract data on study characteristics, risk of bias elements and outcomes. We contacted trial authors to request data if not published fully. When required, we calculated correlation coefficients from studies with full outcome data to impute standard deviation of changes from baseline.

Main results

Eight studies involving 262 participants were included in the review. Participants had stable asthma, with severity ranging from mild to severe. All studies were randomised trials, three studies had high withdrawal rates. Participants were between five to 18 years of age, and in seven studies swimming training varied from 30 to 90 minutes, two to three times a week, over six to 12 weeks. The programme in one study gave 30 minutes training six times per week. The comparison was usual care in seven studies and golf in one study. Chlorination status of swimming pool was unknown for four studies. Two studies used non-chlorinated pools, one study used an indoor chlorinated pool and one study used a chlorinated but well-ventilated pool.

No statistically significant effects were seen in studies comparing swimming t

哮喘是儿童最常见的慢性疾病，也是住院治疗的常见原因。观察性研究表明，特别是游泳，是一种理想的体育活动形式，可以改善健康，减少哮喘疾病的负担。目的探讨游泳训练干预18岁及以下儿童和青少年哮喘的有效性和安全性。检索方法我们于2011年11月检索了Cochrane Airways Group的specialized Register of trials (CENTRAL)、MEDLINE、EMBASE、CINAHL，并于2012年7月重复检索CENTRAL。我们还手工检索了正在进行的临床试验注册。我们纳入了所有儿童和青少年的随机对照试验(rct)和准rct，将游泳训练与常规护理、非体育活动或游泳以外的体育活动进行比较。我们使用Cochrane干预措施系统评价手册中规定的标准方法。两位综述作者使用标准模板独立评估纳入试验并提取有关研究特征、偏倚风险因素和结果的数据。我们联系了试验作者，要求他们提供未完全发表的数据。当需要时，我们从具有完整结果数据的研究中计算相关系数，以估算基线变化的标准差。主要结果纳入8项研究，共262名受试者。参与者有稳定的哮喘，严重程度从轻微到严重不等。所有研究均为随机试验，其中3项研究有高戒断率。参与者年龄在5到18岁之间，在7项研究中，游泳训练时间从30到90分钟不等，每周2到3次，持续6到12周。在一项研究中，该计划每周进行6次30分钟的训练。七项研究中的常规护理和一项研究中的高尔夫球进行了比较。游泳池的氯化状况在四项研究中是未知的。两项研究使用了不含氯的游泳池，一项研究使用了室内含氯游泳池，另一项研究使用了含氯但通风良好的游泳池。在比较游泳训练与日常护理或其他体育活动对主要结果的研究中，没有发现统计学上显著的影响;生活质量、哮喘控制、哮喘加重或使用皮质类固醇治疗哮喘。与常规训练相比，游泳训练对运动能力有临床意义的影响，以最大努力运动试验(VO2 max)中的最大耗氧量来衡量(两项研究，n = 32)，平均增加9.67 mL/kg/min;95%置信区间(CI) 5.84 ~ 13.51。当其他运动能力的测量也被合并(4项研究，n = 74)时，发现了等量的差异，给出了标准化平均差异(SMD) 1.34;95% CI 0.82 ~ 1.86。游泳训练与静息肺功能参数的小幅增加相关，但差异有统计学意义;平均差值(MD)预测为8.07;95% CI 3.59至12.54。在敏感性分析中，通过消耗偏差的风险或使用估算的标准偏差，效应量没有重大变化。未知池氯化状态有限亚群分析。基于有限的数据，对哮喘控制或急性发作没有不良影响。本综述表明，游泳训练在患有稳定哮喘的儿童和青少年中具有良好的耐受性，并且可以增加肺功能(中等强度证据)和心肺健康(高强度证据)。没有证据表明游泳训练对18岁及18岁以下患有任何严重程度的稳定哮喘的年轻人的哮喘控制产生不利影响。然而，游泳是否比其他形式的体育活动更好还不能从这篇综述中确定。为了更好地评估游泳的长期益处，需要进一步的、有充分动力的、随访时间更长的试验。18岁及患有哮喘的儿童和青少年的哮喘游泳训练是儿童和青少年中引起间歇性喘息、咳嗽和胸闷的常见疾病。 担心体育锻炼，如游泳，会加重哮喘，可能会减少参与，并导致身体健康下降。本综述旨在确定游泳训练对18岁及以下哮喘儿童和青少年的有效性和安全性。我们总共回顾了8项研究，涉及262名年龄在5至18岁之间、哮喘控制良好的参与者。在七项研究中，他们在六到十二周的时间里，每周进行两到三次30到90分钟不等的游泳训练，在一项研究中，每周进行六次30分钟的训练。本综述发现，与对照组(常规护理或其他体育活动)相比，游泳训练在静息肺功能测试中有改善，但在生活质量、哮喘症状控制或哮喘恶化方面没有发现影响。与常规护理相比，游泳训练提高了身体素质。在游泳训练期间，很少有不良哮喘事件的报道。相对较少的研究和参与者限制了本综述测量一些感兴趣的结果的能力，特别是对生活质量和哮喘恶化的影响。总之，游泳训练在患有稳定哮喘的儿童和青少年中具有良好的耐受性，并能增强体质和肺功能。然而，游泳是否比其他形式的体育活动更好和/或更安全并不能从这篇综述中确定。更长期的后续研究可以帮助我们了解游泳的长期好处。
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引用次数: 0
Hypothermia for neuroprotection in children after cardiopulmonary arrest 低温在儿童心肺骤停后的神经保护中的应用
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-09-18 DOI: 10.1002/ebch.1939
Barnaby Scholefield, Heather Duncan, Paul Davies, Fang Gao Smith, Khalid Khan, Gavin D Perkins, Kevin Morris

Background

Cardiopulmonary arrest in paediatric patients often results in death or survival with severe brain injury. Therapeutic hypothermia, lowering of the core body temperature to 32 °C to 34 °C, may reduce injury to the brain in the period after the circulation has been restored. This therapy has been effective in neonates with hypoxic ischaemic encephalopathy and adults after witnessed ventricular fibrillation cardiopulmonary arrest. The effect of therapeutic hypothermia after cardiopulmonary arrest in paediatric patients is unknown.

Objectives

To assess the clinical effectiveness of therapeutic hypothermia after paediatric cardiopulmonary arrest.

Search methods

We searched the Cochrane Anaesthesia Review Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 11); Ovid MEDLINE (1966 to December 2011); Ovid EMBASE (1980 to December 2011); Ovid CINAHL (1982 to December 2011); Ovid BIOSIS (1923 to December 2011); and Web of Science (1945 to December 2011). We searched the trials registry databases for ongoing trials. We also contacted international experts in therapeutic hypothermia and paediatric critical care to locate further published and unpublished studies.

Selection criteria

We planned to include randomized and quasi-randomized controlled trials comparing therapeutic hypothermia with normothermia or standard care in children, aged 24 hours to 18 years, after paediatric cardiopulmonary arrest.

Data collection and analysis

Two authors independently assessed articles for inclusion.

Main results

We found no studies that satisfied the inclusion criteria. We found four on-going randomized controlled trials which may be available for analysis in the future. We excluded 18 non-randomized studies. Of these 18 non-randomized studies, three compared therapeutic hypothermia with standard therapy and demonstrated no difference in mortality or the proportion of children with a good neurological outcome; a narrative report was presented.  

Authors' conclusions

Based on this review, we are unable to make any recommendations for clinical practice. Randomized controlled trials a

背景:小儿心肺骤停常导致严重脑损伤患者死亡或存活。治疗性低温，将核心体温降至32℃至34℃，可在血液循环恢复后的一段时间内减少对大脑的损伤。这种疗法对新生儿缺氧缺血性脑病和成人心室颤动心肺骤停后有效。小儿心肺骤停后低温治疗的效果尚不清楚。目的探讨小儿心肺骤停后低温治疗的临床效果。检索方法检索Cochrane麻醉评论组专业注册;Cochrane中央对照试验登记册(Central) (Cochrane图书馆2011年第11期);Ovid MEDLINE(1966年至2011年12月);Ovid EMBASE(1980 - 2011年12月);Ovid CINAHL(1982 - 2011年12月);Ovid BIOSIS(1923 - 2011年12月);Web of Science(1945年至2011年12月)。我们检索了正在进行的试验注册数据库。我们还联系了治疗性低温和儿科重症监护方面的国际专家，以找到进一步发表和未发表的研究。我们计划纳入随机和准随机对照试验，比较24小时至18岁儿童心肺骤停后治疗性低温与常温或标准护理。资料收集与分析两位作者独立评估文章纳入。我们没有发现符合纳入标准的研究。我们发现了四个正在进行的随机对照试验，这些试验可能在将来用于分析。我们排除了18项非随机研究。在这18项非随机研究中，有3项比较了治疗性低温疗法与标准疗法，结果显示在死亡率或具有良好神经预后的儿童比例方面没有差异;提出了一份叙述性报告。基于这篇综述，我们无法对临床实践提出任何建议。需要进行随机对照试验，并在可用时对正在进行的试验的结果进行评估。摘要治疗性低温作为儿童心肺骤停后的神经保护治疗儿童心肺骤停并不常见，但存活的儿童数量非常低。对幸存者造成的脑损伤对孩子和家庭来说可能是毁灭性的。将患者冷却至32°C至34°C，比正常温度低3°C至4°C(治疗性低温)，先前已发现可提高出生时缺氧的新生儿的生存率并减少脑损伤，也可用于心肺骤停后的成人。儿童发生心肺骤停的原因与成人不同，出生时的窒息也不同，因此治疗性低温对儿童存活或脑损伤比例的影响尚不清楚。因此，我们对文献进行了Cochrane系统评价，检索了医学数据库(CENTRAL, MEDLINE, EMBASE)，直到2011年12月，并联系了国际专家以获取高质量的已发表和未发表的证据。我们的搜索没有找到任何符合我们纳入标准的随机对照研究。然而，我们发现了四个正在进行的试验，完成后可能有助于我们的综述。目前，没有随机对照试验的证据支持或反对在儿童心肺骤停后恢复自发血流后几小时内使用治疗性低温。国际复苏指南目前建议医生考虑在婴儿和儿童中使用这种疗法，尽管需要更多的研究来确保这是正确的建议，因为除了在重症监护病房提供的支持性护理之外，缺乏其他治疗选择。
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引用次数: 0
New directions for EBCH EBCH的新方向
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-09-18 DOI: 10.1002/ebch.1934
Denise Thomson
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引用次数: 0
Propofol versus thiopental sodium for the treatment of refractory status epilepticus (Review) 异丙酚与硫喷妥钠治疗难治性癫痫持续状态(综述)
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-07-12 DOI: 10.1002/ebch.1929
Hemanshu Prabhakar, Ashish Bindra, Gyaninder Pal Singh, Mani Kalaivani

Background

Failure to respond to antiepileptic drugs in uncontrolled seizure activity such as refractory status epilepticus (RSE) has led to the use of anaesthetic drugs. Coma is induced with anaesthetic drugs to achieve complete control of seizure activity. Thiopental sodium and propofol are popularly used for this purpose. Both agents have been found to be effective. However, there is substantial lack of evidence as to which of the two drugs is better in terms of clinical outcome.

Objectives

To compare the efficacy, adverse effects, and short- and long-term outcomes of RSE treated with one of the two anaesthetic agents, thiopental sodium or propofol.

Search methods

We searched the Cochrane Epilepsy Group Specialized Register (10 May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL Issue 4 of 12, The Cochrane Library 2012), and MEDLINE (1946 to May week 1, 2012). We also searched (10 May 2012) ClinicalTrials.gov, The South Asian Database of Controlled Clinical Trials, and IndMED (a bibliographic database of Indian Medical Journals).

Selection criteria

All randomised or quasi-randomised controlled studies (regardless of blinding) of control of RSE using either thiopental sodium or propofol.

Data collection and analysis

Two review authors screened the search results and reviewed abstracts of relevant and eligible trials before retrieving the full text publications.

Main results

One study was available for review. This study was a small, single-blind, multicentre trial studying adults with RSE and receiving either propofol or thiopental sodium for the control of seizure activity (Rossetti 2011). This study showed a wide confidence interval suggesting that the drugs may differ in efficacy up to more than two-fold. There was no evidence of a difference between the drugs with respect to the outcome measures such as control of seizure activity and functional outcome at three months.

Authors' conclusions

There is lack of robust and randomised controlled evidence that can clarify the efficacy of propofol and thiopental sodium over each other in the treatment of RSE. There is a need for large, randomised controlled trials fo

背景:在诸如难治性癫痫持续状态(RSE)等不受控制的癫痫发作活动中抗癫痫药物无效导致了麻醉药物的使用。昏迷是用麻醉药物诱导，以达到完全控制癫痫发作的目的。硫喷妥钠和异丙酚常用于此目的。这两种药剂都被发现是有效的。然而，就临床结果而言，这两种药物中哪一种更好，缺乏大量证据。目的比较硫喷妥钠和异丙酚两种麻醉剂治疗RSE的疗效、不良反应和短期和长期结局。检索方法我们检索了Cochrane癫痫组专门登记(2012年5月10日)、Cochrane中央对照试验登记(中央12期第4期，Cochrane图书馆2012年)和MEDLINE(1946年至2012年5月第1周)。我们还检索了(2012年5月10日)ClinicalTrials.gov、南亚对照临床试验数据库和IndMED(印度医学期刊书目数据库)。选择标准:所有随机或准随机对照研究(不考虑盲法)使用硫喷妥钠或异丙酚控制RSE。数据收集和分析两位综述作者在检索全文出版物之前对检索结果进行筛选，并对相关和符合条件的试验的摘要进行审查。主要结果1项研究可供回顾。该研究是一项小型、单盲、多中心试验，研究患有RSE的成年人，并接受异丙酚或硫喷妥钠来控制癫痫发作活动(Rossetti 2011)。这项研究显示了一个广泛的置信区间，表明这两种药物的疗效可能相差两倍以上。没有证据表明两种药物在三个月时癫痫发作活动控制和功能结果等结果测量方面存在差异。作者的结论:缺乏可靠的随机对照证据来阐明异丙酚和硫喷妥钠在治疗RSE方面的疗效。有必要对这种严重疾病进行大规模的随机对照试验。异丙酚与硫喷妥钠治疗难治性癫痫持续状态持续惊厥是一种与显著发病率和死亡率相关的主要医学紧急情况。有时，这些抽搐对一线和二线药物治疗无效，可能在高达31%的持续癫痫发作或抽搐活动的患者中观察到。持续的癫痫活动可能对抗癫痫药物变得难治。在这种情况下，经常使用硫喷妥钠和异丙酚等麻醉剂来控制癫痫发作。这两种药物都有固有的副作用和并发症。这篇综述评价了这些麻醉药物在控制RSE患者癫痫发作活动中的证据。目前缺乏高质量的证据来支持选择麻醉药物治疗RSE患者。只能确定一项试验，由于征聘问题而提前终止。这两种药之间没有任何差别。唯一的区别是硫喷妥钠组患者需要延长机械通气时间。这可能是由于该药的半衰期很长。很明显，需要一项大型随机对照试验来研究麻醉药物治疗RSE的疗效。
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引用次数: 9
Commentary on ‘Prophylactic drug management for febrile seizures in children’ 《儿童热性惊厥的预防性药物管理》述评
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-07-12 DOI: 10.1002/ebch.1922
Jeanette Robertson

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Offringa M, Newton R. Prophylactic drug management for febrile seizures in children. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD003031. DOI: 10.1002/14651858.CD003031.pub2.

这是对发表在本期《EBCH》上的Cochrane综述的评论，最初发表的标题为:Offringa M, Newton R.儿童发热性惊厥的预防性药物管理。《Cochrane数据库系统评价》2012年第4期。艺术。不。: CD003031。cd003031.pub2 DOI: 10.1002/14651858.。
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引用次数: 1
Treatment of acute gastroenteritis in children: an overview of systematic reviews of interventions commonly used in developed countries 儿童急性胃肠炎的治疗:发达国家常用干预措施的系统综述
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-07-12 DOI: 10.1002/ebch.1932
Stephen B. Freedman, Samina Ali, Marta Oleszczuk, Serge Gouin, Lisa Hartling

Background:

Acute gastroenteritis (AGE) is an extremely common paediatric condition, which results in significant morbidity in children and is a financial burden to the society.

Objective:

The purpose of this overview is to critically evaluate the evidence currently available in the Cochrane Database of Systematic Reviews (CDSR) regarding the efficacy and safety of commonly considered treatment options in children with AGE.

Methods:

All Cochrane reviews evaluating the following treatments in children with AGE were eligible for inclusion: oral rehydration therapy, anti-emetics and probiotics. We excluded those focusing on the treatment of antibiotic associated or nosocomial diarrhoea, persistent (chronic) diarrhoea and the prevention of gastroenteritis. We focused on the following outcomes that were selected a priori as clinically important: rate of admission to the hospital; length of stay in hospital; rate of return visits; administration of intravenous (IV) therapy owing to failure of oral rehydration therapy; adverse events and dysnatremia.

Main results:

Children who received oral rehydration therapy had a shorter length of stay in hospital compared with children who received IV therapy [mean difference, MD = −1.20 days (−2.38, −0.02)]; however, the result was no longer significant when an outlying study was removed. Children who received IV therapy were at increased risk of developing phlebitis [risk difference, RD= − 0.02 (−0.04, −0.01)], while paralytic ileus was more common in children receiving ORT [RD = 0.03 (confidence interval, CI 0.01–0.05)]. Children who received oral ondansetron had lower hospital admission rates to the emergency department (ED) and lower rates of IV rehydration during their ED stay compared with children receiving placebo [risk ration, RR = 0.40 (CI 0.19–0.83) and RR = 0.41 (CI 0.29–0.59), respectively]. Children receiving IV ondansetron had lower hospital admission rates to the ED than patients receiving placebo [RR = 0.21 (0.05, 0.93)]. Probiotic use amongst children hospitalized following AGE reduced the mean duration of hospitalization by 1.12 days (CI −1.16, −0.38).

Conclusions:

Given that oral rehydration is less invasive than IV rehydration with no evidence of important clinical differences, it is the first choice for rehydration in children with AGE and mild-to-moderate dehydration. As the vast majority of children with AGE do not re

背景:急性胃肠炎(AGE)是一种极为常见的儿科疾病，在儿童中发病率很高，是社会的经济负担。目的:本综述的目的是批判性地评估目前在Cochrane系统评价数据库(CDSR)中可获得的关于AGE儿童常用治疗方案的有效性和安全性的证据。方法:所有评价以下治疗方法的Cochrane综述均符合纳入条件:口服补液治疗、止吐药和益生菌。我们排除了抗生素相关性腹泻或院内腹泻、持续性(慢性)腹泻和肠胃炎预防的研究。我们重点关注以下先验选择的具有临床重要性的结果:住院率;住院时间;回访率;由于口服补液治疗失败而给予静脉(IV)治疗;不良事件和钠血症。主要结果:接受口服补液治疗的患儿比接受静脉输液治疗的患儿住院时间短[平均差异，MD = - 1.20天(- 2.38，- 0.02)];然而，当一项外围研究被移除时，结果不再显著。接受静脉注射治疗的儿童发生静脉炎的风险增加[风险差，RD= - 0.02(- 0.04， - 0.01)]，而麻痹性肠梗阻在接受ORT治疗的儿童中更为常见[RD = 0.03(置信区间，CI 0.01 - 0.05)]。与服用安慰剂的儿童相比，口服昂丹司琼的儿童在急诊科(ED)住院率和静脉补液率较低[风险比，RR = 0.40 (CI 0.19-0.83)和RR = 0.41 (CI 0.29-0.59)]。静脉注射昂丹司琼的儿童因急症住院率低于安慰剂组[RR = 0.21(0.05, 0.93)]。在AGE后住院的儿童中使用益生菌使平均住院时间减少1.12天(CI - 1.16， - 0.38)。结论:口服补液比静脉补液侵入性小，无明显临床差异，是AGE患儿轻中度脱水的首选补液方法。由于绝大多数AGE患儿不需要静脉补液，对于出现明显呕吐的患儿应口服昂丹司琼，以减少静脉补液的使用和住院的需要。对于被认为身体不适而不能接受口服补液治疗的儿童，静脉注射昂丹司琼是一种选择，因为它的使用与较低的住院率相关。虽然益生菌似乎是治疗住院儿童AGE的有效选择，但门诊数据缺乏，迫切需要更多的研究来确定最佳的微生物、剂量和治疗时间。
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引用次数: 91
Glucocorticoids for the treatment of anaphylaxis 治疗过敏反应的糖皮质激素
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-07-12 DOI: 10.1002/ebch.1925
Karen Jui Lin Choo, F Estelle R Simons, Aziz Sheikh

Background

Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may result in death. Anaphylaxis guidelines recommend glucocorticoids for the treatment of people experiencing anaphylaxis. 

Objectives

We sought to assess the benefits and harms of glucocorticoid treatment during episodes of anaphylaxis.

Search methods

In our previous version we searched the literature until September 2009. In this version we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), MEDLINE (Ovid) (1956 to September 2011), EMBASE (Ovid) (1982 to September 2011), CINAHL (EBSCOhost) (to September 2011). We also searched the UK National Research Register and websites listing ongoing trials, and contacted international experts in anaphylaxis in an attempt to locate unpublished material.

Selection criteria

We planned to include randomized and quasi-randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline (epinephrine), an antihistamine, or any combination of these).

Data collection and analysis

Two authors independently assessed articles for inclusion.

Main results

We found no studies that satisfied the inclusion criteria.

Authors' conclusions

We are, based on this review, unable to make any recommendations for the use of glucocorticoids in the treatment of anaphylaxis.

Glucocorticoids for the treatment of anaphylaxis  

Anaphylaxis is a serious allergic reaction that is rapid in onset and may result in death. It is commonly triggered by a food, insect sting, medication, or natural rubber latex. The reaction typically occurs without warning and can be a frightening experience both for those at risk and their families and friends. Steroids (glucocorticoids) are often recommended for use in the management of people experiencing anaphylaxis. However, the evidence base in support of the use of steroids is unclear. We therefore conducted a systematic review of the literature, searching key databases for high quality published and u

背景:过敏反应是一种严重的超敏反应，发病迅速，可导致死亡。过敏反应指南推荐糖皮质激素用于过敏反应患者的治疗。目的:我们试图评估在过敏反应发作期间糖皮质激素治疗的益处和危害。在我们之前的版本中，我们检索了2009年9月之前的文献。在这个版本中，我们检索了Cochrane中央对照试验登记册(Central) (Cochrane图书馆2011年第3期)，MEDLINE (Ovid)(1956年至2011年9月)，EMBASE (Ovid)(1982年至2011年9月)，CINAHL (EBSCOhost)(至2011年9月)。我们还检索了英国国家研究注册表和列出正在进行的试验的网站，并联系了过敏反应方面的国际专家，试图找到未发表的材料。我们计划纳入随机和准随机对照试验，比较糖皮质激素与任何对照(安慰剂、肾上腺素、抗组胺药或这些的任何组合)。资料收集与分析两位作者独立评估文章纳入。我们没有发现符合纳入标准的研究。作者的结论:基于这篇综述，我们无法对使用糖皮质激素治疗过敏反应提出任何建议。糖皮质激素治疗过敏反应过敏反应是一种严重的过敏反应，发作迅速，可能导致死亡。它通常是由食物、昆虫叮咬、药物或天然胶乳引起的。这种反应通常是在没有任何警告的情况下发生的，对于那些处于危险中的人以及他们的家人和朋友来说，这可能是一种可怕的经历。类固醇(糖皮质激素)通常被推荐用于管理经历过敏反应的人。然而，支持使用类固醇的证据基础尚不清楚。因此，我们对文献进行了系统的回顾，检索了关键数据库中关于使用类固醇紧急治疗过敏反应的高质量已发表和未发表的材料。此外，我们还联系了该卫生领域的专家和相关制药公司。通过我们的搜索，我们无法找到任何关于这个主题的随机对照试验。我们的结论是，高质量的研究没有证据表明在过敏反应的紧急管理中使用类固醇。因此，我们既不能支持也不能反对使用这些药物来达到这个目的。
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引用次数: 32
Commentaries on ‘Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections’ with a response from the review authors 关于“降钙素原在急性呼吸道感染中启动或停止使用抗生素”的评论以及综述作者的回应
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-07-12 DOI: 10.1002/ebch.1928
Vikram Sabhaney, Paul Enarson, Adam D. Irwin, Enitan D. Carrol, Philipp Schuetz, Matthias Briel, Heiner C. Bucher, Beat Mueller, for the Procalcitonin-stewardship study group

These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Schuetz P, Müller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, Luyt CE, Wolff M, Chastre J, Tubach F, Kristoffersen KB, Burkhardt O, Welte T, Schroeder S, Nobre V, Wei L, Bhatnagar N, Bucher HC, Briel M. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007498. DOI: 10.1002/14651858.CD007498.pub2.

这些是发表在本期《EBCH》上的一篇Cochrane综述的评论，首次发表的标题为:Schuetz P, m ller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, Luyt CE, Wolff M, Chastre J, Tubach F, Kristoffersen KB, Burkhardt O, Welte T, Schroeder S, Nobre V, Wei L, Bhatnagar N, Bucher HC, Briel M.原降钙素在急性呼吸道感染中启动或停止使用抗生素。Cochrane Database of Systematic Reviews 2012，第9期。艺术。不。: CD007498。cd007498.pub2 DOI: 10.1002/14651858.。
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引用次数: 2
Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people 促进街头儿童和青年重新融入社会和减少有害行为和生活方式的干预措施
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-07-12 DOI: 10.1002/ebch.1923
Esther Coren, Rosa Hossain, Jordi Pardo Pardo, Mirella MS Veras, Kabita Chakraborty, Holly Harris, Anne J Martin

Background

Numbers of street-connected children and young people run into many millions worldwide and include children and young people who live or work in street environments. Whether or not they remain connected to their families of origin, and despite many strengths and resiliencies, they are vulnerable to a range of risks and are excluded from mainstream social structures and opportunities.

Objectives

To summarise the effectiveness of interventions for street-connected children and young people that promote inclusion and reintegration and reduce harms. To explore the processes of successful intervention and models of change in this area, and to understand how intervention effectiveness may vary in different contexts.

Search methods

We searched the following bibliographic databases, from inception to 2012, and various relevant non-governmental and organisational websites: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE and PreMEDLINE; EMBASE and EMBASE Classic; CINAHL; PsycINFO; ERIC; Sociological Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; LILACS; System for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit; IDEAS Economics and Finance Research; JOLIS Library Catalog of the holdings of the World Bank Group and IMF Libraries; BLDS (British Library for Development Studies); Google, Google Scholar.

Selection criteria

The review included data from harm reduction or reintegration promotion intervention studies that used a comparison group study design and were all randomised or quasi-randomised studies. Studies were included if they evaluated interventions aimed to benefit street-connected children and young people, aged 0 to 24 years, in all contexts.

Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias of included studies. Data were extracted on intervention delivery, context, process factors, equity and outcomes. Outcome measures were grouped according to whether they measured psychosocial outcomes, risky sexual behaviours or substance use. A meta-analysis was conducted for some outcomes though it was not possible for all due to differences in measurements between studies. Other outcomes were evaluated narratively.

Main results

世界范围内与街头有联系的儿童和青年人数高达数百万，其中包括在街头环境中生活或工作的儿童和青年。无论他们是否与原籍家庭保持联系，尽管他们有许多优势和韧性，但他们很容易受到一系列风险的影响，并被排除在主流社会结构和机会之外。目的总结针对街头儿童和青少年的干预措施的有效性，促进他们融入社会，重新融入社会，减少伤害。探索该领域成功干预的过程和变化模式，并了解干预效果在不同背景下的差异。检索方法我们检索了以下文献数据库，从建立到2012年，以及各种相关的非政府和组织网站:Cochrane Central Register of Controlled Trials (Central);MEDLINE和PreMEDLINE;EMBASE和EMBASE Classic;CINAHL;PsycINFO;埃里克•;社会学的抽象;社会服务文摘;社会工作摘要;Healthstar;紫丁香;欧洲灰色文学系统(OpenGrey);ProQuest学位论文;EconLit;IDEAS经济与金融研究;JOLIS图书馆世界银行集团和国际货币基金组织图书馆馆藏目录;英国发展研究图书馆;谷歌，谷歌学术。本综述纳入了采用对照组研究设计的减少危害或促进重返社会干预研究的数据，这些研究均为随机或准随机研究。如果研究评估了旨在使所有情况下0至24岁的街头儿童和年轻人受益的干预措施，则将其纳入研究。资料收集和分析两位综述作者独立提取资料并评估纳入研究的偏倚风险。提取干预措施交付、背景、过程因素、公平性和结果方面的数据。结果测量根据是否测量社会心理结果、危险性行为或药物使用进行分组。对一些结果进行了荟萃分析，但由于研究之间的测量差异，不可能对所有结果进行荟萃分析。其他结果以叙述方式评估。我们纳入了11项研究，评估了来自高收入国家的12项干预措施。尽管存在许多相关计划，但我们没有发现在低收入和中等收入国家(LMICs)进行的任何足够有力的评估。总体而言，研究质量为低至中等，研究使用的测量方法差异很大，使得比较困难。参与者都是临时参加的。尽管在研究中收集了许多测量数据，但我们在社会心理健康、药物滥用和性危险行为领域的一系列相关结果中没有发现一致的结果。正在评估的干预措施包括时间有限的基于治疗的方案，在大多数结果和大多数研究中，这些方案并没有证明比标准收容所或临时服务更有效。在治疗干预和标准服务中，大多数参与者的结果与基线相比发生了有利的变化。研究之间存在相当大的异质性，报告的公平数据不一致。没有研究测量了重返社会的主要结果或报道了不良反应。审查讨论部分包括考虑研究结果与低收入和中等收入国家设置的相关性。对纳入研究的分析发现，与针对街头儿童和年轻人的标准服务相比，“新”干预措施并没有持续显著的好处。然而，后一种干预措施尚未得到严格评估，特别是在中低收入国家。对干预措施进行有力的评估将有助于为提供服务提出更好的建议。未来有必要对低收入和中等收入国家进行研究，包括由于城市化、战争或移民而流落街头的儿童，以及可能容易受到贩运等风险的儿童。减少风险和促进街头儿童和青年融入社会的干预措施据估计，全世界有数百万儿童和青年在街头生活和工作。 许多国家已经变得有弹性，但仍然容易受到风险的影响。为了促进他们在生活中获得最佳机会，需要提供服务，以减少风险并防止被主流社会边缘化。11项研究对12项干预措施进行了严格的评估，以支持与街头有联系的儿童和青少年，所有这些都在发达国家。他们将以治疗为基础的服务与通常的庇护所和上门服务进行了比较。这些研究的结果好坏参半，但总的来说，我们发现接受治疗或常规服务的参与者受益程度相似。有必要进行研究，考虑到通常的上门服务和庇护服务的好处，特别是在低收入和中等收入国家，其中包括街头儿童和年轻人的参与。没有一项研究纳入的参与者与低收入国家的一些街头儿童相当，这些儿童可能主要是为了谋生，也可能是战争、移民或城市化的结果。
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引用次数: 20
Commentary on ‘Glucocorticoids for the treatment of anaphylaxis’ “糖皮质激素治疗过敏反应”综述
Evidence-based child health : a Cochrane review journal
Pub Date : 2013-07-12 DOI: 10.1002/ebch.1926
Alexandra F. Santos, Gideon Lack

This is a commentary on a Cochrane review, published in the issue of EBCH, first published as: Choo KJL, Simons FER, Sheikh A. Glucocorticoids for the treatment of anaphylaxis. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD007596. DOI: 10.1002/14651858.CD007596.pub3.

这是对发表在EBCH杂志上的Cochrane综述的评论，首次发表的标题为:Choo KJL, Simons FER, Sheikh a .糖皮质激素用于治疗过敏反应。《Cochrane数据库系统评价》2012年第4期。艺术。不。: CD007596。cd007596.pub3 DOI: 10.1002/14651858.。
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引用次数: 10
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Evidence-based child health : a Cochrane review journal
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