Evidence-Based Medicine最新文献

英文中文

In patients with intracerebral haemorrhage and concomitant atrial fibrillation, optimal timing of reinitiating anticoagulants may be 7-8 weeks after ICH. 对于脑出血合并心房颤动的患者，重新启动抗凝药物的最佳时间可能是脑出血后7-8周。

Evidence-Based Medicine

Pub Date : 2017-06-01 Epub Date: 2017-05-16 DOI: 10.1136/ebmed-2017-110675

Catharina Jm Klijn, Floris Hbm Schreuder

Commentary on: Pennlert J, et al . Optimal timing of anticoagulant treatment after intracerebral haemorrhage in patients with atrial fibrillation. Stroke 2017: 48 ;314–320.In patients with intracerebral haemorrhage (ICH) and a concomitant diagnosis of atrial fibrillation (AF), the clinical dilemma arises whether anticoagulant treatment should be (re)started and when.1 In the absence of results from randomised controlled trials, guidelines provide no firm recommendations. Several observational studies have suggested that reintroduction of oral anticoagulants may be associated with a reduction in thrombotic events and all-cause mortality.2 3 Evidence regarding the optimal timing of reinitiating anticoagulant treatment is even scarcer.This was a nationwide observational study of 2619 patients with ICH (mean age 78.0 years) with a concomitant diagnosis of AF identified in the Swedish stroke register, Riksstroke, who survived hospital discharge. Patient characteristics, prescribed drugs after ICH and outcomes were extracted from various national databases. Primary outcome was …

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引用次数: 1

Grading evidence from test accuracy studies: what makes it challenging compared with the grading of effectiveness studies? 测试准确性研究的证据分级:与有效性研究的分级相比，是什么使其具有挑战性?

Evidence-Based Medicine

Pub Date : 2017-06-01 DOI: 10.1136/ebmed-2017-110717

Ewelina Rogozińska, Khalid Khan

Guideline panels need to process a sizeable amount of information to issue a decision on whether to recommend a health technology or not. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) is being frequently applied in guideline development to facilitate this task, typically for the synthesis of effectiveness research. Questions regarding the accuracy of medical tests are ubiquitous, and they temporally precede questions about therapy. However, literature summarising the experience of applying GRADE approach to accuracy evaluations is not as rich as one for effectiveness evidence. Type of study design (cross-sectional), two-dimensional nature of the performance measures (sensitivity and specificity), propensity towards a higher level of between-study heterogeneity, poor reporting of quality features and uncertainty about how best to assess for publication bias among other features make this task challenging. This article presents solutions adopted to addresses above challenges for judicious estimation of the strength of test accuracy evidence used to inform evidence syntheses for guideline development.

准则小组需要处理大量信息，才能就是否推荐一种卫生技术作出决定。评价、发展和评价(GRADE)在指南制定中经常被应用，以促进这项任务，通常用于综合有效性研究。关于医学测试的准确性的问题无处不在，它们暂时先于关于治疗的问题。然而，总结应用GRADE方法进行准确性评估的经验的文献并不像有效性证据那样丰富。研究设计类型(横断面)、性能测量的二维性质(敏感性和特异性)、研究间异质性倾向较高、质量特征报告不足以及如何最好地评估其他特征中的发表偏倚的不确定性使这项任务具有挑战性。本文提出了解决上述挑战的解决方案，以明智地估计用于指导指南制定的证据综合的测试准确性证据的强度。

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引用次数: 3

Clinical failure is more common in young children with acute otitis media who receive a short course of antibiotics compared with standard duration. 与标准疗程相比，接受短疗程抗生素治疗的急性中耳炎患儿临床失败更为常见。

Evidence-Based Medicine

Pub Date : 2017-06-01 Epub Date: 2017-04-12 DOI: 10.1136/ebmed-2017-110697

Roderick P Venekamp, Anne G M Schilder

Commentary on: Hoberman A, Paradise JL, Rockette HE, et al . Shortened antimicrobial treatment for acute otitis media in young children. N Engl J Med 2016;375:2446–56.[OpenUrl][1] Acute otitis media (AOM) is a leading cause of doctor consultations and antibiotic prescriptions in young children.1 Strategies to reduce antibiotic prescribing for AOM and thereby the emerging spread of antimicrobial resistance have focused on watchful waiting and delayed prescription, in particular in children over 2 years.2 An alternative strategy to combat antimicrobial resistance is to reduce the duration of antibiotic treatment. So far, the evidence to support this strategy in young children with AOM has been incomplete.3 Hoberman and colleagues recruited 520 children from an academic children's hospital and affiliated paediatric practices and a private paediatric research practice in the USA. Children were aged 6–23 months and diagnosed with AOM based on the … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.volume%253D375%26rft.spage%253D56%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx

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引用次数: 3

Urine concentration should be taken into account when interpreting pyuria in infants. 在解释婴儿脓尿时应考虑尿浓度。

Evidence-Based Medicine

Pub Date : 2017-06-01 Epub Date: 2017-05-19 DOI: 10.1136/ebmed-2017-110678

Shouja Alam, Judith van der Voort, Christopher C Butler

Commentary on: Chaudhari PP, Monuteaux MC, Bachur RG, et al . Urine concentration and pyuria for identifying UTI in infants. Pediatrics 2016;138:e20162370.The relationship between pyuria and true urinary tract infection (UTI) remains controversial. Most studies have assessed pyuria using manual microscopy in centrifuged urine. However, standard practice at most centres now involves automated urinalysis of uncentrifuged urine, thus pyuria in dilute samples may have more significance than pyuria in concentrated urine samples. It may therefore be important to consider the possible impact of urine concentration on the significance of white cell counts (WCC) or leucocyte esterase (LE) assessment.This was a retrospective study of routinely collected data from infants aged less than 3 months with suspected UTI, who presented to a busy US emergency department (ED) over 5 years. Automated urinalysis and culture were available for each eligible child. UTI was defined as ≥50 000 colony-forming units (CFU)/mL of a pathogenic organism, and all analysed samples were collected by catheter. Dipstick urinalysis was automated …

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引用次数: 0

Pregabalin is effective in reducing fibromyalgia pain. 普瑞巴林能有效减轻纤维肌痛。

Evidence-Based Medicine

Pub Date : 2017-04-01 Epub Date: 2017-02-27 DOI: 10.1136/ebmed-2016-110630

Charles Argoff

Commentary on: Derry S, Cording M, Wiffen PJ, et al. Pregabalin for pain in fibromyalgia in adults. Cochrane Database Syst Rev 2016;9:CD011790.Anticonvulsants have been widely used in pain management for more than 50 years. Published neuropathic pain treatment guidelines have suggested their use, especially for neuropathic pain.1 The review by Derry et al focuses on the use of one such agent, pregabalin, in the treatment of fibromyalgia, an accepted and validated but heterogeneous condition in which diagnosis is made through history, physical examination and the exclusion of other diseases explaining the key symptoms.This was a systematic review of randomised, double-blind trials lasting 8 weeks or longer comparing either pregabalin to placebo or an active treatment for the treatment of pain in fibromyalgia. The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were search for randomised controlled trials from inception to 16 March 2016 for this update. Reference lists of retrieved studies and reviews were also searched, and online clinical trial registries. Eight studies were included in this review and …

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引用次数: 2

Semaglutide is non-inferior to placebo for cardiovascular outcomes in patients with type 2 diabetes. 在2型糖尿病患者的心血管预后方面，Semaglutide不逊于安慰剂。

Evidence-Based Medicine

Pub Date : 2017-04-01 Epub Date: 2017-03-07 DOI: 10.1136/ebmed-2016-110652

Denise Campbell-Scherer

Commentary on: Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. NEJM 2016;375:1834–44.[OpenUrl][1]Semaglutide is a glucagon-like peptide 1 (GLP-1) analogue under development for the treatment of type 2 diabetes. It is molecularly related to liraglutide but has a longer half-life, requiring once weekly dosing. US Food and Drug Administration (FDA) regulatory guidance requires evidence that new therapies for type 2 diabetes are not associated with an unacceptable increase in cardiovascular risk.1 ,2 This is defined as evidence that compared with placebo the risk ratio estimate has an upper 95% CI of 1.3; the initial preapproval phase may target the 1.8 margin; however, if 1.3 is not achieved then a postmarketing randomised safety trial is required.1 ,2This was an industry-sponsored, non-inferiority randomised controlled trial in 3297 patients from 230 sites randomised (1:1:1:1), stratified (cardiovascular disease status, insulin treatment, and glomerular filtration rate at screening), to receive semaglutide (either 0.5 or 1.0 mg subcutaneously, weekly) or placebo. In … [1]: {openurl}?query=rft.jtitle%253DNEJM%26rft.volume%253D375%26rft.spage%253D1834%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx

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引用次数: 1

Both a stage shift and changes in stage-specific survival have contributed to reductions in breast cancer mortality. 分期转变和分期生存率的变化都有助于降低乳腺癌死亡率。

Evidence-Based Medicine

Pub Date : 2017-04-01 Epub Date: 2017-02-22 DOI: 10.1136/ebmed-2016-110632

Stephen W Duffy, Ruth Etzioni, Peter Sasieni

引用次数: 0

Survey of instructions for authors on how to report an update of a systematic review: guidance is needed. 关于如何报告系统综述更新的作者说明调查：需要指导。

Evidence-Based Medicine

Pub Date : 2017-04-01 Epub Date: 2017-01-30 DOI: 10.1136/ebmed-2016-110609

Dawid Pieper, Tim Mathes

Systematic reviews have become the cornerstone of evidence-based healthcare. Approximately half of the systematic reviews are out of date after 5.5 years, and keeping them up to date remains a huge challenge. Despite new guidance on when and how to update systematic reviews, there seems to be a lack of guidance on how to report updates of systematic reviews. Therefore, we decided to systematically analyse instruction for authors in biomedical journals regarding guidance on reporting updates of systematic reviews. We conducted a survey investigating 250 journals. The journal list was derived by a twofold strategy. First, we chose a list of journals that were included in a recently published survey of systematic reviews. This list was augmented by a PubMed search for published updates of systematic reviews. For each journal, we checked the instructions for authors for any content or links related to updating systematic reviews in September 2016. Out of 250 journals, we found only one with guidance clearly related to updates of systematic reviews, namely the BioMed Central journal, Systematic Reviews Nevertheless, concrete guidance on reporting is lacking as it is stated that authors are encouraged to be innovative in how to report and present systematic review updates. This makes clear that there remains a fundamental uncertainty of how authors willing to update a previously published systematic review should act as even the leading journal in evidence syntheses does not have clear guidance. Debate is necessary on how to report updates of systematic reviews.

系统综述已成为循证医疗的基石。大约有一半的系统综述在 5.5 年后就会过时，而保持系统综述的更新仍然是一个巨大的挑战。尽管在何时以及如何更新系统综述方面有了新的指导，但在如何报告系统综述的更新方面似乎缺乏指导。因此，我们决定系统地分析生物医学期刊中有关系统综述更新报告指南的作者指南。我们对 250 种期刊进行了调查。期刊列表是通过双重策略得出的。首先，我们选择了近期发表的系统综述调查中所包含的期刊列表。此外，我们还在 PubMed 上搜索了已发表的系统综述更新，从而扩充了这份期刊列表。对于每份期刊，我们都检查了作者须知中是否有与 2016 年 9 月更新系统综述相关的内容或链接。在 250 种期刊中，我们发现只有一种期刊有明确的与系统综述更新相关的指导，即 BioMed Central 期刊《系统综述》（Systematic Reviews）。这清楚地表明，即使是证据综述领域的权威期刊也没有明确的指导，对于愿意更新以前发表的系统综述的作者应该如何行动，仍然存在根本性的不确定性。有必要就如何报告系统综述的更新展开讨论。

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引用次数: 0

Adverse events associated with mood stabiliser treatment should be continuously monitored in patients diagnosed with bipolar affective disorder. 对于确诊为双相情感障碍的患者，应持续监测与情绪稳定剂治疗相关的不良事件。

Evidence-Based Medicine

Pub Date : 2017-04-01 Epub Date: 2017-03-02 DOI: 10.1136/ebmed-2016-110629

R E Nielsen, R W Licht

引用次数: 0

Thalamotomy using MRI-guided focused ultrasound significantly improves contralateral symptoms and quality of life in essential tremor. mri引导下聚焦超声丘脑切开术可显著改善特发性震颤患者对侧症状和生活质量。

Evidence-Based Medicine

Pub Date : 2017-04-01 Epub Date: 2017-02-27 DOI: 10.1136/ebmed-2016-110589

Ludvic Zrinzo

Commentary on : Elias WJ, Lipsman N, Ondo WG, et al. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med 2016;375:730–9.[OpenUrl][1][PubMed][2]Propranolol and primidone significantly reduce tremor by around 60% in 50% of patients with essential tremor (ET). When medication is ineffective or causes intolerable side effects, neurosurgical intervention may be considered. Until recently, radiofrequency (RF) ablation or deep brain stimulation (DBS) of the ventralis intermedius (VIM) thalamic nucleus were the main surgical options. Gamma knife thalamotomy avoids a burrhole but delayed effects make intraoperative validation impossible.1 Recent technical advances have enabled transcranial delivery of high-intensity focused ultrasound to create a thalamotomy with MRI guidance and … [1]: {openurl}?query=rft.jtitle%253DN%2BEngl%2BJ%2BMed%26rft.volume%253D375%26rft.spage%253D730%26rft_id%253Dinfo%253Apmid%252F27557301%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=27557301&link_type=MED&atom=%2Febmed%2F22%2F2%2F64.atom

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