Overview

概述
  • 文章类型: Journal Article
    To identify, describe, and map contemporary nutrition guidelines (NGs) from reviews that used the Appraisal of Guidelines, Research and Evaluation (AGREE) tool.
    We performed an overview of reviews that systematically assessed the quality of NGs using the AGREE tool. We searched MEDLINE and EMBASE from inception to February 2018. Two authors independently selected and assessed reviews and extracted data.
    We included nine evaluations with a total of 67 NGs. The higher median AGREE scores were for the domains \"scope and purpose\" (80%, Q1-Q3: 59-89%) and \"clarity and presentation\" (69%, Q1-Q3: 53-89%), while the lower were for \"rigor of development\" (58%, Q1-Q3: 31-84%), \"editorial independence\" (53%, Q1-Q3: 19-79%), \"stakeholder involvement\" (50%, Q1-Q3: 28-72%), and \"applicability\" (22%, Q1-Q3: 11-50%). The median AGREE overall rating was 5 (Q1-Q3: 4-6), and most were recommended for use (75%; 30/40). Twenty-nine NGs (43.3%; 29/67) scored ≥60% in three or more domains, including \"rigor of development\" domain. The methodological quality of NGs did not improve over time.
    The methodological quality of NGs varies widely, but there is general need for improvement in most AGREE domains. NG developers could incorporate available tools to ensure the development of high-quality NGs.
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  • 虽然印度成瘾性障碍的社会心理干预指南较早植根于临床经验和全球经验证据,最近,根据当地对特定人群的需求评估,努力制定干预指南,对干预措施有效性的测试。本关于成瘾性疾病的心理社会干预的补充涵盖了五个部分的心理社会干预的一些重要方面。第一节包括管理的一般原则和具体的评估方法,筛查认知功能障碍和评估共病。第二节侧重于具体的心理社会干预措施,包括简短的干预措施,预防复发,认知行为干预,精神分析干预措施,认知康复,对双重疾病的干预,婚姻和家庭治疗,性功能障碍和性瘾的社会心理干预。第三节描述了创新方法,包括第三波疗法,基于视频的复发预防,数字技术作为心理社会干预以及技术成瘾中的心理社会干预的工具。本节的后半部分还涉及包括儿童和青少年在内的特殊人群的社会心理干预措施,女人,性少数群体和老年人。第四节介绍基于社区的心理社会干预措施,包括社区营地和工作场所预防。强调需要通过训练有素的卫生工作者的参与来开展任务共享,以提供社区和家庭干预措施。第五节强调了社会心理干预的不同方面的道德问题以及在这一领域进行研究的必要性。尽管有一种倾向是在生物医学或社会心理方面制定成瘾,并将干预措施视为药理学或社会心理,这些二分法既不存在于受影响的个体的头脑中,也不应该出现在治疗临床医生中。对成瘾的全面了解需要对他/她的环境中的人的理解,并且需要一种个性化的整体方法来解决多样化的身体/心理健康,职业,legal,社会和善后需要。
    While guidelines for psychosocial interventions in addictive disorders in India were earlier rooted in clinical experience and global empirical evidence, recently there have been efforts to develop guidelines for intervention based on the local needs assessments of specific populations and more appreciably, a testing of the effectiveness of the interventions. This supplement on psychosocial interventions for addictive disorders covers some of the important aspects of psychosocial interventions in five sections. Section I covers the general principles of management and specific assessment approaches, screening for cognitive dysfunction and assessment of co-morbidities. Section II focuses on specific psychosocial interventions including brief interventions, relapse prevention, cognitive behavioural interventions, psychoanalytical interventions, cognitive rehabilitation, interventions in dual disorders, marital and family therapy, psychosocial interventions for sexual dysfunction and sexual addictions. Section III describes innovative approaches including third wave therapies, video-based relapse prevention, digital technology as a tool for psychosocial interventions as well as psychosocial interventions in technological addictions. The latter part of this section also deals with psychosocial interventions in special populations including children and adolescents, women, sexual minorities and the elderly. Section IV pans into community based psychosocial interventions including community camps and workplace prevention. The need to develop task sharing through the involvement of trained health workers to deliver community and home-based interventions is highlighted. Section V underscores the ethical issues in different aspects of psychosocial intervention and the need for research in this area. Although there is a tendency to formulate addiction in either biomedical or psychosocial terms and to view interventions either as pharmacological or psychosocial, these dichotomies neither exist in the affected individual\'s mind, nor should be present in the treating clinician. A comprehensive understanding of addiction requires an understanding of the person in his/her environment and needs a personalised holistic approach that addresses the diverse physical/mental health, occupational, legal, social and aftercare needs.
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  • 文章类型: Journal Article
    病理性近视是视觉障碍的主要原因。近视脉络膜新生血管(CNV)的发展是导致病理性近视患者中心视力丧失的最常见并发症之一。如果不及时治疗,它可以导致瘢痕形成,黄斑萎缩扩大,导致在短至5年的时间内不可逆的视力丧失。多模态成像技术的进步进一步加深了我们对这种情况的理解;然而,有必要进一步研究以扩大其在近视CNV诊断中的应用。玻璃体内注射抗血管内皮生长因子(抗VEGF)治疗已成为近视性CNV的标准治疗和推荐的一线治疗选择。长期研究表明,使用玻璃体内抗VEGF剂对确诊的近视CNV病例进行早期治疗可避免晚期并发症。该策略还被证明可以实现长达4年的视觉结果改善和长达6年的视觉稳定。本文概述了有关近视CNV的最新知识,并讨论了该病的诊断和管理方面的最新进展。此外,根据作者的专家意见提供治疗建议。
    Pathologic myopia is a leading cause of visual impairment. Development of myopic choroidal neovascularization (CNV) is one of the most common complications that leads to central vision loss in patients with pathologic myopia. If left untreated, it can cause scarring with expanding macular atrophy leading to irreversible visual loss in a period as short as 5 years. Advancements in multimodal imaging technology have furthered our understanding of the condition; however, further studies are necessary to extend its utility in the diagnosis of myopic CNV. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has become the standard-of-care and the recommended first-line treatment option for myopic CNV. Long-term studies have demonstrated that early treatment of confirmed myopic CNV cases with an intravitreal anti-VEGF agent is useful to avoid late-stage complications. This strategy has also been shown to achieve visual outcome improvements for up to 4 years and visual stabilization up to 6 years. This review article provides an overview of the current knowledge on myopic CNV and discusses recent updates in the diagnosis and management of the condition. Furthermore, treatment recommendations are provided based on the authors\' expert opinions.
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  • 文章类型: Journal Article
    目的:本概述的目的是调查有关计划家庭分娩的指南和实践的现状,并调查有关北欧国家计划家庭分娩的比较研究的可能性(丹麦,冰岛,挪威,芬兰和瑞典)。
    方法:调查了有关家庭分娩和助产的国家文件以及有关计划家庭分娩管理和登记的建议。
    结果:在4个纳入的国家发现了关于计划家庭分娩的指南。在丹麦,任何妇女都有权在家庭分娩期间由助产士照顾,每个县议会必须提出组织分娩服务的计划,包括家庭分娩服务。在挪威和冰岛,这项服务的全部或部分资金来自税收,并且有国家指导方针,但接生助产士的机会在地理上有所不同。在斯德哥尔摩县议会中,已经制定了公共资助计划家庭分娩的准则;对于瑞典其他地区,尚未制定任何国家准则,该服务由私人资助。
    结论:北欧国家家庭分娩服务的不一致意味着妇女在首选的分娩地点上有不同的助产护理机会。统一的社会人口统计学,北欧国家的卫生保健系统和文化背景是有利于进一步研究的因素,以比较和汇总该地区计划家庭分娩的数据。由于国家登记册不足以涵盖计划的出生地,因此需要额外的数据收集。
    OBJECTIVE: The objective of this overview was to investigate the current situation regarding guidelines and praxis for planned homebirths and also to investigate possibilities for comparative studies on planned homebirths in the Nordic countries (Denmark, Iceland, Norway, Finland and Sweden).
    METHODS: National documents on homebirth and midwifery and recommendations regarding management and registration of planned homebirths in the included countries were investigated.
    RESULTS: Guidelines regarding planned home birth were found in four of the included countries. In Denmark any woman has the right to be attended by a midwife during a homebirth and each county council must present a plan for the organization of birth services, including homebirth services. In Norway and Iceland the service is fully or partly funded by taxes and national guidelines are available but access to a midwife attending the birth varies geographically. In the Stockholm County Council guidelines have been developed for publicly funding of planned home births; for the rest of Sweden no national guidelines have been formulated and the service is privately funded.
    CONCLUSIONS: Inconsistencies in the home birth services of the Nordic countries imply different opportunities for midwifery care to women with regard to their preferred place of birth. Uniform sociodemography, health care systems and cultural context in the Nordic countries are factors in favour of further research to compare and aggregate data on planned home births in this region. Additional data collection is needed since national registers do not sufficiently cover the planned place of birth.
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