Evidence-based child health : a Cochrane review journal最新文献

英文中文

Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections 降钙素原在急性呼吸道感染中启动或停止使用抗生素

Evidence-based child health : a Cochrane review journal

Pub Date : 2013-07-12 DOI: 10.1002/ebch.1927

Philipp Schuetz, Beat Muller, Mirjam Christ-Crain, Daiana Stolz, Michael Tamm, Lila Bouadma, Charles E Luyt, Michel Wolff, Jean Chastre, Florence Tubach, Kristina B Kristoffersen, Olaf Burkhardt, Tobias Welte, Stefan Schroeder, Vandack Nobre, Long Wei, Neera Bhatnagar, Heiner C Bucher, Matthias Briel

Background

Acute respiratory infections (ARIs) comprise a large and heterogeneous group of infections including bacterial, viral and other aetiologies. In recent years, procalcitonin - the prohormone of calcitonin - has emerged as a promising marker for the diagnosis of bacterial infections and for improving decisions about antibiotic therapy. Several randomised controlled trials (RCTs) have demonstrated the feasibility of using procalcitonin for starting and stopping antibiotics in different patient populations with acute respiratory infections and different settings ranging from primary care to emergency departments (EDs), hospital wards and intensive care units (ICUs).

Objectives

The aim of this systematic review based on individual patient data was to assess the safety and efficacy of using procalcitonin for starting or stopping antibiotics over a large range of patients with varying severity of ARIs and from different clinical settings.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 2) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to May 2011) and EMBASE (1974 to May 2011) to identify suitable trials.

Selection criteria

We included RCTs of adult participants with ARIs who received an antibiotic treatment either based on a procalcitonin algorithm or usual care/guidelines. Trials were excluded if they exclusively focused on paediatric patients or if they used procalcitonin for another purpose than to guide initiation and duration of antibiotic treatment.

Data collection and analysis

Two teams of review authors independently evaluated the methodology and extracted data from primary studies. The primary endpoints were all-cause mortality and treatment failure at 30 days. For the primary care setting, treatment failure was defined as death, hospitalisation, ARI-specific complications, recurrent or worsening infection, and patients reporting any symptoms of an ongoing respiratory infection at follow-up. For the ED setting, treatment failure was defined as death, ICU admission, re-hospitalisation after index hospital discharge, ARI-associated complications, and recurrent or worsening infection within 30 days of follow-up. For the ICU setting, treatment failure was defined as death within 30 days of follow-up. Secondary endpoints were antibiotic use (initiation of antibiotics, dur

背景:急性呼吸道感染(ARIs)是一个庞大而异质性的感染群体，包括细菌、病毒和其他病因。近年来，降钙素原——降钙素的原激素——已成为一种有希望的细菌感染诊断和改善抗生素治疗决策的标志物。几项随机对照试验(RCTs)已经证明，在不同的急性呼吸道感染患者群体和不同的环境中，从初级保健到急诊科(EDs)、医院病房和重症监护病房(icu)，使用降钙素原开始和停止抗生素是可行的。本系统综述的目的是基于个体患者数据，评估在大范围不同急性呼吸道感染严重程度和不同临床背景的患者中，使用降钙素原开始或停止使用抗生素的安全性和有效性。我们检索了Cochrane中央对照试验注册库(Central 2011，第2期)，其中包含急性呼吸道感染组的专业注册库、MEDLINE(1966年至2011年5月)和EMBASE(1974年至2011年5月)，以确定合适的试验。我们纳入了接受基于降钙素原算法或常规护理/指南的抗生素治疗的ARIs成年参与者的随机对照试验。如果试验只针对儿科患者，或者将降钙素原用于其他目的，而不是用于指导抗生素治疗的开始和持续时间，则排除试验。数据收集和分析两组综述作者独立评估方法并从主要研究中提取数据。主要终点是30天的全因死亡率和治疗失败。对于初级保健机构，治疗失败的定义为死亡、住院、急性呼吸道感染特异性并发症、复发或恶化感染，以及患者在随访时报告任何持续呼吸道感染症状。对于急诊科，治疗失败的定义为死亡、ICU住院、指数出院后再次住院、急性呼吸道感染相关并发症以及随访30天内感染复发或恶化。对于ICU设置，治疗失败定义为随访30天内死亡。次要终点是抗生素的使用(抗生素开始使用、抗生素持续时间和抗生素总暴露(抗生素总天数除以患者总数))、住院患者的住院时间、重症患者的ICU住院时间，以及初级保健患者随机分组后14天内活动受限的天数。对于全因死亡率和治疗失败这两个共同主要终点，我们使用多变量分层逻辑回归计算了优势比(ORs)和95%置信区间(CIs)。分层回归模型调整年龄和临床诊断为固定效应。不同的试验作为随机效应加入到模型中。我们拟合了相应的抗生素使用线性回归模型。我们进行了按临床环境和ARI诊断分层的敏感性分析，以评估结果的一致性。我们纳入了14项试验，4221名受试者。降钙素原组2085例患者中有118例死亡(5.7%)，而对照组2126例患者中有134例死亡(6.3%)(校正OR 0.94, 95% CI 0.71至1.23)。降钙素原组398例(19.1%)和对照组466例(21.9%)治疗失败。降钙素原指导与任何临床环境下死亡率增加或治疗失败或ARI诊断无关。这些结果在各种敏感性分析中被证明是稳健的。总的抗生素暴露量显著减少(中位数(四分位数范围)从8(5至12)天减少到4(0至8)天;调整后的天数差异，-3.47,95% CI -3.78至-3.17，以及所有不同的临床设置和诊断。作者的结论:使用降钙素原指导ARI患者抗生素治疗的开始和持续时间与更高的死亡率或治疗失败无关。抗生素的使用在不同的临床环境和ARI诊断中显著减少。

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引用次数: 81

Prophylactic drug management for febrile seizures in children (Review) 儿童热性惊厥的预防性药物管理(综述)

Evidence-based child health : a Cochrane review journal

Pub Date : 2013-07-12 DOI: 10.1002/ebch.1921

Martin Offringa, Richard Newton

BACKGROUNDFebrile seizures occurring in a child older than one month during an episode of fever affect 2% to 4% of children in Great Britain and the United States and recur in 30%. Rapid-acting antiepileptics and antipyretics given during subsequent fever episodes have been used to avoid the adverse effects of continuous antiepileptic drugs.OBJECTIVESTo evaluate the effectiveness and safety of antiepileptic and antipyretic drugs used prophylactically to treat children with febrile seizures.SEARCH METHODSWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011. Issue 3); MEDLINE (1966 to May 2011); EMBASE (1966 to May 2011); Database of Abstracts of Reviews of Effectiveness (DARE) (May 2011). No language restrictions were imposed. We also contacted researchers in the field to identify continuing or unpublished studies.SELECTION CRITERIATrials using randomised or quasi-randomised patient allocation that compared the use of antiepileptic or antipyretic agents with each other, placebo or no treatment.DATA COLLECTION AND ANALYSISTwo review authors (RN and MO) independently applied pre-defined criteria to select trials for inclusion and extracted the pre-defined relevant data, recording methods for randomisation, blinding and exclusions. Outcomes assessed were seizure recurrence at 6, 12, 18, 24, 36 months and at age 5 to 6 years in the intervention and non-intervention groups, and adverse medication effects. The presence of publication bias was assessed using funnel plots.MAIN RESULTSThirty-six articles describing 26 randomised trials with 2740 randomised participants were included. Thirteen interventions of continuous or intermittent prophylaxis and their control treatments were analysed. Methodological quality was moderate to poor in most studies. We could not do a meta-analysis for eight of the 13 comparisons due to insufficient numbers of trials. No significant benefit for valproate, pyridoxine, intermittent phenobarbitone or ibuprofen versus placebo or no treatment was found; nor for diclofenac versus placebo followed by ibuprofen, acetominophen or placebo; nor for intermittent rectal diazepam versus intermittent valproate, nor phenobarbitone versus intermittent rectal diazepam. There was a significant reduction of recurrent febrile seizures with intermittent oral diazepam versus placebo with a relative risk (RR) of 0.67 (95% confidence interval (CI) 0.48 to 0.94) at 24 months), RR of 0.61 (95% CI 0.15 to 0.89) at 48 months, with no benefit at 6, 12 or 72 months. Phenobarbitone versus placebo or no treatment reduced seizures at 6, 12 and 24 months but not at 18 or 72 month follow up (RR 0.60, 95% CI 0.42 to 0.84 at 6 months; RR 0.59, 95% CI 0.46 to 0.75 at 12 months; and RR 0.65, 95% CI 0.49 to 0.88 at 24 months). Intermittent rectal diazepam versus no treatment or placebo also reduced seizures (RR 0.60, 95% CI 0.41 to 0.86 at 6 months; RR 0.65, 95% CI 0.49 to 0.87 at 12 months; RR 0

鉴于反复发热性惊厥是良性的，而且这些药物的不良影响非常普遍，应向父母和家庭提供充分的医疗服务联系方式和关于复发、急救管理的信息，最重要的是，应向他们提供这种现象的良性性质。儿童发热性惊厥的预防性药物管理与发热相关的惊厥是儿童中最常见的神经系统疾病，占所有儿童的2%至4%。平均而言，三分之一的发热性惊厥患儿会反复发作。本文综述了抗癫痫和退热药物对预防复发性癫痫发作的作用。没有发现这些药物对发热性癫痫发作的儿童有显著或重要的益处。药物的副作用很常见。2011年的一项研究发现氯巴唑治疗的益处需要重复，以表明这一发现是可靠的。与此同时，应向家长和家庭提供充分的医疗服务联系方式和关于复发、急救管理以及最重要的是，这种现象的良性性质的信息。

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引用次数: 25

More research is needed 需要更多的研究

Evidence-based child health : a Cochrane review journal

Pub Date : 2013-07-12 DOI: 10.1002/ebch.1931

Joan L. Robinson

I typically start my editorials by commenting on the Canadian weather as people here spend more time talking about the weather than they do about what is really happening in the world. It is now mid-May, which means that I can cycle to work today, yet I am headed to the mountains this weekend for one last downhill ski. I am not aware of any evidence on the long-term outcomes of living with erratic weather versus the ‘boring’ weather that those in more southern climates have to cope with. Many decisions made each day in pediatric offices and emergency departments would be simpler if there was a point-of-care laboratory test that could reliably differentiate bacterial from viral infections. Procalcitonin was first described as a marker for bacterial infection in 1993 (1). It is commonly measured in adults and children in Europe but for reasons that are unknown to me, use of procalcitonin has never caught on in most centres in North America. In this issue, the Cochrane review focuses on the impressive results from trials in adults with respiratory tract infections where clinicians were able to decrease the duration of antibiotic use without compromising outcomes (2). The commentaries by Enarson (3) and Irwin (4) lament the paucity of similar studies in paediatrics. As with adult studies, the best that we can hope for are high quality studies looking at outcomes when procalcitonin is used as part of an algorithm rather than studies that show the sensitivity and specificity of the test, given our crippling inability to determine even in retrospect if infections were bacterial or viral. As an aside, the one potential downside to algorithms that employ biomarkers is that they downplay clinical judgment. Often trainees need to be reminded that biomarkers are just one piece of the puzzle, and that the appearance of the patient should still over-rule the results of investigations. The Eco-Paediatrics page looks at use of corticosteroids for cystic fibrosis (5). Corticosteroids are a temporary fix for almost any condition that involves inflammation, but given their adverse event profile, they are being supplanted by other anti-inflammatory agents for long-term use wherever practical.

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引用次数: 0

Inhaled corticosteroids for cystic fibrosis—are they worth the risk? 吸入皮质类固醇治疗囊性纤维化——值得冒险吗?

Evidence-based child health : a Cochrane review journal

Pub Date : 2013-07-12 DOI: 10.1002/ebch.1920

Joan Robinson

Eco-paediatrics is an occasional feature in Evidence-Based Child Health: A Cochrane Review Journal. Our goal is to contribute to the worldwide discussion on reducing waste in health care. In each instalment, we will select a recent Cochrane review highlighting a practice, still in use, which the available evidence tells us should be discontinued.

生态儿科是《基于证据的儿童健康:Cochrane评论杂志》中偶尔出现的特色。我们的目标是促进世界范围内关于减少卫生保健浪费的讨论。在每一期中，我们将选择一篇最近的Cochrane综述，重点介绍一种仍在使用的做法，现有证据告诉我们应该停止这种做法。

引用次数: 2

Commentary on ‘Interventions for promoting re-integration and reducing harmful behaviour and lifestyles in street-connected children and young people’ with a response from the review authors† 对“促进街头儿童和年轻人重新融入社会和减少有害行为和生活方式的干预措施”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.1924

Rahila U. Christian, Esther Coren, Rosa Hossain

This is a commentary on a Cochrane review, published in the issue of EBCH, first published as: Coren E, Hossain R, Pardo Pardo J, Veras MMS, Chakraborty K, Harris H, Martin AJ. Interventions for promoting re-integration and reducing harmful behaviour and lifestyles in street-connected children and young people. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD009823. DOI: 10.1002/14651858.CD009823.pub2.

这是对发表在EBCH杂志上的Cochrane综述的评论，最初以Coren E, hosain R, Pardo Pardo J, Veras MMS, Chakraborty K, Harris H, Martin AJ发表。促进与街道有联系的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。Cochrane数据库系统评价2013，第2期。艺术。不。: CD009823。cd009823.pub2 DOI: 10.1002/14651858.。

引用次数: 1

Commentary on ‘Propofol versus thiopental sodium for the treatment of refractory status epilepticus—Still no answer’ 《异丙酚与硫喷妥钠治疗顽固性癫痫状态——仍无答案》评论

Evidence-based child health : a Cochrane review journal

Pub Date : 2013-07-12 DOI: 10.1002/ebch.1930

Jeffrey Buchhalter, Antonia Stang

This is a commentary on a Cochrane review, published in this issue of EBCH, first published as: Prabhakar H, Bindra A, Singh GP, Kalaivani M. Propofol versus thiopental sodium for the treatment of refractory status epilepticus. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD009202. DOI: 10.1002/14651858.CD009202.pub2.

这是对发表在本期《EBCH》上的Cochrane综述的评论，首次发表的标题为:Prabhakar H, Bindra a, Singh GP, Kalaivani M.异丙酚与硫贲妥钠治疗难固性癫痫持续状态的比较。Cochrane Database of Systematic Reviews 2012，第8期。艺术。不。: CD009202。cd009202.pub2 DOI: 10.1002/14651858.。

引用次数: 1

Response by authors. 作者的回应。

Evidence-based child health : a Cochrane review journal

Pub Date : 2013-07-01

Philipp Schuetz, Matthias Briel, Heiner C Bucher, Beat Mueller

引用次数: 0

Response by authors. 作者的回应。

Evidence-based child health : a Cochrane review journal

Pub Date : 2013-07-01

Esther Coren, Rosa Hossain

引用次数: 0

Commentaries on ‘Home safety education and provision of safety equipment for injury prevention’ “家居安全教育及提供预防伤害的安全装备”评论

Evidence-based child health : a Cochrane review journal

Pub Date : 2013-05-16 DOI: 10.1002/ebch.1912

Kelly Russell, Barbara Morrongiello, Kieran J. Phelan

These are commentaries on a Cochrane review, published in the issue of EBCH, first published as: Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C. Home safety education and provision of safety equipment for injury prevention. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD005014. DOI: 10.1002/14651858.CD005014.pub3.

以下是发表在《EBCH》杂志上的一篇Cochrane综述的评论:Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C.家庭安全教育和提供安全设备预防伤害。Cochrane Database of Systematic Reviews 2012，第9期。艺术。不。: CD005014。cd005014.pub3 DOI: 10.1002/14651858.。

引用次数: 7

Home safety education and provision of safety equipment for injury prevention (Review) 家居安全教育及提供预防伤害的安全装备(检讨)

Evidence-based child health : a Cochrane review journal

Pub Date : 2013-05-16 DOI: 10.1002/ebch.1911

Denise Kendrick, Ben Young, Amanda J Mason-Jones, Nohaid Ilyas, Felix A Achana, Nicola J Cooper, Stephanie J Hubbard, Alex J Sutton, Sherie Smith, Persephone Wynn, Caroline Mulvaney, Michael C Watson, Carol Coupland

Background

In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group.

Objectives

We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009.

Selection criteria

Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment.

Data collection and analysis

Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals.

两项大型研究可能解释了关于提供安全设备的干预措施与安全实践和伤害结果的相互矛盾的发现;一项以诊所为基础的研究提供了设备，但没有降低受伤率;一项以学校为基础的研究没有提供设备，但确实证明了受伤率的显著降低。没有一致的证据表明，无论是否提供安全设备，家庭安全教育在那些受伤风险更高的参与者中效果较差。还需要进一步的研究来证实这些关于受伤率的发现。家庭安全教育和提供预防伤害的安全设备伤害是工业化国家儿童死亡的主要原因。生活在不利环境中的人比条件较好的人受伤的风险更大。本综述考察了家庭安全教育和提供安全设备是否能减少伤害、增加安全行为和安全设备的使用。它还研究了家庭安全教育在弱势家庭中是否更有效。这篇综述的作者发现，涉及2605044名参与者的98项研究报告了许多不同的安全行为，但包含伤害信息的研究相对较少。作者发现，在家中提供的家庭安全干预可能会降低受伤率，但需要更多的研究来证实这一发现。不同研究的结果往往不同，但总体而言，接受家庭安全干预的家庭更有可能拥有安全的热水温度、有效的烟雾报警器、消防逃生计划、安装的楼梯门、未使用插座的插座盖、吐根糖浆、中毒控制中心的电话号码，以及存放儿童够不到的药品和清洁产品。研究人员发现，家庭安全教育对孩子受伤风险较高的家庭同样有效。

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引用次数: 98

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