Evidence-based Healthcare最新文献

{"title":"Healthcare quality improvement programme improves monitoring of people with diabetes","authors":"Petra Denig PhD (Commentary Author)","doi":"10.1016/j.ehbc.2004.03.005","DOIUrl":"https://doi.org/10.1016/j.ehbc.2004.03.005","url":null,"abstract":"<div><h3>Question</h3><p>Does a healthcare quality improvement programme, incorporating education and claims-based feedback about practice-specific models of monitoring diabetes care, increase the regularity with which primary care physicians assess people with diabetes mellitus receiving Medicare benefits?</p></div><div><h3>Study design</h3><p>Cluster randomised controlled trial.</p></div><div><h3>Main results</h3><p>22, 971 Medicare recipients with diabetes who could be linked with one of 477 study physicians in 123 non-urban counties were identified. The health care quality improvement programme significantly improved monitoring of circulating glycosylated haemoglobin (HbA1c) levels in people with diabetes compared with a no-intervention comparison group (see Table 1). There was no significant difference in number of eye exams or monitoring of urine protein levels between groups.<span><div><div><table><tbody><tr><td><strong>Table 1</strong> Proportion of people tested with quality indicators at baseline and follow-up.</td></tr><tr><td>Quality indicator test</td><td>Health care quality improvement programme</td><td>Comparison Group</td><td>Difference in change from baseline between intervention and control groups (95% CI)</td></tr><tr><td></td><td>Proportion of people tested at baseline (%)</td><td>Proportion of people tested at follow up (%)</td><td>Change from baseline to follow up</td><td>Proportion of people tested at baseline (%)</td><td>Proportion of people tested at follow up (%)</td><td>Change from baseline to follow up</td><td></td></tr><tr><td>HbA1c</td><td>34.3</td><td>51.1</td><td>16.8</td><td>37.2</td><td>50.2</td><td>13.0</td><td>4.0 (0.7 to 7.3)</td></tr><tr><td>Eye exams</td><td>38.9</td><td>39.4</td><td>0.5</td><td>39.3</td><td>39.5</td><td>0.2</td><td>1.0 (-1.1 to 3.1)</td></tr><tr><td>Quantitative urine protein</td><td>2.8</td><td>4.6</td><td>1.8</td><td>2.7</td><td>4.4</td><td>1.7</td><td>0.1 (-2.1 to 3.0)</td></tr></tbody></table></div></div></span></p></div><div><h3>Authors’ conclusions</h3><p>The population-based health care quality improvement programme, incorporating education and claims-based feedback about practice-specific models of monitoring diabetes care, improved care of people with diabetes.</p></div>","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"8 3","pages":"Pages 122-124"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehbc.2004.03.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71829091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common blood pressure treatments lower the risk of major cardiovascular events","authors":"F. Fuchs","doi":"10.1016/J.EHBC.2004.03.018","DOIUrl":"https://doi.org/10.1016/J.EHBC.2004.03.018","url":null,"abstract":"","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"34 1","pages":"153-155"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81172930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major bleeding episodes occur in people receiving anticoagulant therapy for venous thromboembolism","authors":"C. Pechlaner","doi":"10.1016/J.EHBC.2004.03.004","DOIUrl":"https://doi.org/10.1016/J.EHBC.2004.03.004","url":null,"abstract":"","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"13 1","pages":"171-173"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86953245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echinacea purpurea is ineffective for upper respiratory tract infections in children","authors":"Arch G Mainous III PhD (Commentary Author)","doi":"10.1016/j.ehbc.2004.03.010","DOIUrl":"https://doi.org/10.1016/j.ehbc.2004.03.010","url":null,"abstract":"<div><h3>Question</h3><p>How safe and effective is <em>Echinacea purpurea</em> at reducing the duration and severity of upper respiratory tract infections in children?</p></div><div><h3>Study design</h3><p>Multicentre randomised controlled trial.</p></div><div><h3>Main results</h3><p>There was no significant difference in duration or severity of symptoms with <em>Echinacea purpurea</em> compared with placebo in children with upper respiratory tract infection (median duration of symptoms (95% CI): 9 days (8 to 10 days) with <em>Echinacea</em> vs. 9 days (8 to 10 days) with placebo; <em>P</em>=0.89; median severity of symptoms (95% CI): 33 (29 to 40) with <em>Echinacea</em> vs. 33 (30 to 38) with placebo; <em>P</em>=0.69). Rash occurred in significantly more children receiving <em>Echinacea</em> compared with placebo (reports of rash: 24 with <em>Echinacea v</em> 10 with placebo; <em>P</em>=0.008).</p></div><div><h3>Authors’ conclusions</h3><p><em>Echinacea purpurea</em> is ineffective for treating upper respiratory tract infections in children aged 2 to 11 years.</p></div>","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"8 3","pages":"Pages 165-167"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehbc.2004.03.010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71829104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Common blood pressure treatments lower the risk of major cardiovascular events","authors":"Flávio Danni Fuchs MD, PhD (Commentary Author)","doi":"10.1016/j.ehbc.2004.03.018","DOIUrl":"https://doi.org/10.1016/j.ehbc.2004.03.018","url":null,"abstract":"<div><h3>Question</h3><p>What are the effects of different blood pressure lowering regimens on major cardiovascular events?</p></div><div><h3>Study design</h3><p>Prospectively designed meta-analysis of randomised controlled trials.</p></div><div><h3>Main results</h3><p>Twenty-nine RCTs with 2 to 8.4 years follow up were included in the analysis. ACE inhibitors, calcium antagonists or angiotensin-receptor blockers for high blood pressure significantly reduce the risk of major cardiovascular events compared with placebo or control (see Table 1). Setting a lower target blood pressure for treatment significantly reduces the risk of major cardiovascular events compared with setting a higher treatment target. There was no significant difference in the risk of major cardiovascular events among ACE inhibitor, calcium antagonist or diuretic/β-blocker-based treatment regimens. In general, a greater reduction of blood pressure resulted in a greater reduction in the risk of major cardiovascular events.<span><div><div><table><tbody><tr><td><strong>Table 1</strong> Effects of different treatment regimens on blood pressure and major cardiovascular risk</td></tr><tr><td>Treatment regimen</td><td>No. of RCTs</td><td>Weighted mean difference in blood pressure (SBP/DBP)(mmHg)</td><td>RR for major cardiovascular events (95% CI)</td></tr><tr><td>Angiotensin converting enzyme inhibitors vs placebo</td><td>5</td><td>−5/−2</td><td>0.78 (0.73 to 0.83)</td></tr><tr><td>Calcium antagonist vs placebo</td><td>3</td><td>−8/−4</td><td>0.82 (0.71 to 0.95)</td></tr><tr><td>Angiotensin receptor blocker vs control*</td><td>4</td><td>−2/−1</td><td>0.90 (0.83 to 0.96)</td></tr><tr><td>Angiotensin receptor blocker vs calcium antagonist</td><td>5</td><td>+1/+1</td><td>0.97 (0.92 to 1.03)</td></tr><tr><td>Angiotensin converting enzyme inhibitor vs diuretic or β blocker</td><td>6</td><td>+2/0</td><td>1.02 (0.98 to 1.07)</td></tr><tr><td>Calcium antagonist regimens vs diuretic or β blocker</td><td>9</td><td>+1/+1</td><td>1.04 (1.00 to 1.09)</td></tr><tr><td>Lower vs higher target blood pressure</td><td>4</td><td>−4/−3</td><td>0.85 (0.76 to 0.95)</td></tr><tr><td>*The comparison pooled trials where either some or all people in the non-angiotensin-receptor blocker group received active treatment.</td></tr></tbody></table></div></div></span></p></div><div><h3>Authors’ conclusions</h3><p>All widely used blood pressure lowering treatments reduce the risk of major cardiovascular events. A greater reduction in blood pressure leads to a greater reduction in the risk of major cardiovascular events.</p></div>","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"8 3","pages":"Pages 153-155"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehbc.2004.03.018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71829110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival of people with out-of-hospital cardiac arrest is not improved by equipping first responders with an automated external defibrillator","authors":"Judith Finn RN, PhD (Commentary Author) ,&nbsp;Ian Jacobs RN, PhD (Commentary Author)","doi":"10.1016/j.ehbc.2004.03.012","DOIUrl":"https://doi.org/10.1016/j.ehbc.2004.03.012","url":null,"abstract":"<div><h3>Question</h3><p>Will the use of automated external defibrillators by the police or firefighters result in better clinical outcomes for people with an out-of-hospital cardiac arrest?</p></div><div><h3>Study design</h3><p>Cross-over randomised controlled trial.</p></div><div><h3>Main results</h3><p>There was no significant difference in hospital discharge rates for people experiencing a cardiac arrest between areas in which firefighters and police officers were equipped with automated external defibrillators (AEDs) and those areas in which they were not (see Table 1). AEDs significantly improved the return of spontaneous circulation and admission to hospital.<span><div><div><table><tbody><tr><td><strong>Table 1</strong> Clinical outcomes by treatment group in people experiencing a cardiac arrest.</td></tr><tr><td>Outcome</td><td>AEDs used (n=243)</td><td>AEDs not used (n=226)</td><td>Odds ratio, AED used versus AED not used; (95% CI), P-value</td></tr><tr><td>Hospital discharge</td><td>44 (18%)</td><td>33 (15%)</td><td>1.3 (0.8 to 2.2), 0.33</td></tr><tr><td>Return of spontaneous circulation</td><td>139 (57%)</td><td>108 (48%)</td><td>1.5 (1.0 to 2.2), 0.05</td></tr><tr><td>Hospital admission</td><td>103 (42%)</td><td>74 (33%)</td><td>1.5 (1.1 to 1.6), 0.02</td></tr></tbody></table></div></div></span></p></div><div><h3>Authors’ conclusions</h3><p>Survival to hospital discharge in people experiencing an out-of-hospital cardiac arrest was not improved by equipping first responders with automated external defibrillators.</p></div>","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"8 3","pages":"Pages 139-141"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehbc.2004.03.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71829086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultraviolet germicidal irradiation of office ventilation systems reduces work-related mucosal and respiratory symptoms","authors":"Klaus P Kühn PhD (Commentry Author) ,&nbsp;Iris F Chaberny MD (Commentry Author)","doi":"10.1016/j.ehbc.2004.03.022","DOIUrl":"https://doi.org/10.1016/j.ehbc.2004.03.022","url":null,"abstract":"<div><h3>Question</h3><p>What is the effect of ultraviolet germicidal irradiation (UVGI) in office ventilation systems on worker's health and wellbeing?</p></div><div><h3>Study design</h3><p>Double blind multiple crossover trial.</p></div><div><h3>Main results</h3><p>Ultraviolet germicidal irradiation (UVGI) lights significantly reduced the incidence of overall work-related symptoms (14% of symptoms only reported when UVGI on vs. 18% symptoms only reported only when UVGI off; OR 0.8, 95% CI 0.7 to 0.99). UVGI significantly reduced work-related mucosal and respiratory symptoms but not systemic or musculoskeletal symptoms (OR for mucosal symptoms 0.7, 95% CI 0.6 to 0.9; OR for respiratory symptoms 0.6, 95% CI 0.4 to 0.9; OR for systemic symptoms 1.1, 95% CI 0.9 to 1.3; OR for musculoskeletal symptoms 0.8, 95% CI 0.6 to 1.1). UVGI reduced microbial and endotoxin concentrations on irradiated surfaces within ventilation systems by 99% (95% CI 67% to 100%).</p></div><div><h3>Authors’ conclusions</h3><p>UVGI may be a cost-effective method of alleviating work-related symptoms caused by microbial contamination of office ventilation systems.</p></div>","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"8 3","pages":"Pages 148-149"},"PeriodicalIF":0.0,"publicationDate":"2004-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehbc.2004.03.022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71829111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective decontamination of digestive tract in intensive care patients leads to fewer in-hospital deaths","authors":"C. Hollenbeak, D. Warren","doi":"10.1016/J.EHBC.2004.02.001","DOIUrl":"https://doi.org/10.1016/J.EHBC.2004.02.001","url":null,"abstract":"","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"36 1","pages":"107-109"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79813282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High alcohol and low folate intake increases risk of major chronic disease in women","authors":"L. Mennen","doi":"10.1016/J.EHBC.2004.02.007","DOIUrl":"https://doi.org/10.1016/J.EHBC.2004.02.007","url":null,"abstract":"","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"19 1","pages":"71-73"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81891595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oestrogen plus progestin significantly improves bone mineral density and reduces risk of fracture","authors":"B. Tengstrand","doi":"10.1016/J.EHBC.2004.02.004","DOIUrl":"https://doi.org/10.1016/J.EHBC.2004.02.004","url":null,"abstract":"","PeriodicalId":100512,"journal":{"name":"Evidence-based Healthcare","volume":"215 1","pages":"102-104"},"PeriodicalIF":0.0,"publicationDate":"2004-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76554412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}