Дисбактериоз №2

[yananshs]

Results
A total of 1165 possible RCTs were retrieved in hard copy form for further scrutiny. Of these, 893 were excluded from further analysis because of lack of appropriate data. The 272 remaining RCTs of atopic eczema covered at least 47 different interventions, which could be broadly categorised into ten main groups.

Quality of reporting was generally poor, and limited statistical pooling was possible only for oral cyclosporin, and only then after considerable data transformation.

There was reasonable RCT evidence to support the use of oral cyclosporin, topical corticosteroids, psychological approaches and ultraviolet light therapy.

There was insufficient evidence to make recommendations on maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, topical coal tar and topical doxepin.

There was no RCT evidence to support any clear clinical benefit on the use of avoidance of enzyme washing powders, cotton clothing as opposed to soft-weave synthetics, biofeedback, twice-daily as opposed to once-daily topical corticosteroids, topical antibiotic/steroid combinations versus topical steroids alone and antiseptic bath additives.

There was complete absence of RCT evidence on short bursts of potent versus longer-term weaker topical steroids, dilution of topical corticosteroids, oral prednisolone and azathioprine, salt baths, impregnated bandages, wet-wrap bandages, water softening devices, allergy testing, and different approaches to organisation of care.

Conclusions
Coverage
The evidence base for the prevention and treat-ment of atopic eczema has many limitations. It is characterised by a profusion of short-term trials of ‘me too’ products, a lack of common outcome measures which measure things that are important to patientsý poor standards of clinical trial reporting, and a lack of data on questions that physicians and people with atopic eczema deem to be important. Little research has evaluated commonly used treatments compared with each other or in combination. This mismatch is probably due to a combination of the questions not being asked coupled with a lack of independent investment in primary atopic eczema research.

Recommendations for research
Urgent primary research priorities include RCTs of wet-wrap treatments, the clinical benefit of allergy testing, the use of water softeners, the role of specialist nurses, comparisons of tacrolimus and ascomycin against topical corticosteroids, studies of disease prevention, and the use of emollients in preventing disease relapse. Such RCTs should ideally be pragmatic and simple in design, with a few outcome measures that doctors and patients find easy to understand. They should ideally be of 4 months’ or more duration in order to capture the chronicity of disease as well as short-term effects. If such trials are intended to inform primary care, where patients may have milder disease, then they should be conducted in a primary care setting.

This review suggests that there is some scope for further secondary research by systematically reviewing some of the major treatment groups such as antihistamines and essential fatty acids in more detail, and some of these are already underway within the Cochrane Skin Group.

Future methodological research is needed to increase the clinical relevance and reliability of outcome measures for atopic eczema. The RCT database contained within this report also provides a good opportunity to conduct some general research into the relationship between study quality and treatment benefit. There is much scope for improving the standard of clinical trial reporting in atopic eczema by dermatology journals adopting rigorous checks on clinical trial reporting and by registering ongoing trials with the Cochrane Skin Group.

Publication
Hoare C, Li Wan Po A, Williams H. Systematic review of treatments of atopic eczema. Health Technol Assess 2000;4(37).

NHS R&D HTA Programme
The NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS.

Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme.

This has meant that the HTA panels can now focus more explicitly on health technologies (‘health technologies’ are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care) rather than settings of care. Therefore the panel structure has been redefined and replaced by three new panels: Pharmaceuticals; Therapeutic Procedures (including devices and operations); and Diagnostic Technologies and Screening.

The HTA Programme will continue to commission both primary and secondary research. The HTA Commissioning Board, supported by the National Coordinating Centre for Health Technology Assessment (NCCHTA), will consider and advise the Programme Director on the best research projects to pursue in order to address the research priorities identified by the three HTA panels.

The research reported in this monograph was funded as project number 96/17/01.

The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health. The editors wish to eme that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors.

Criteria for inclusion in the HTA monograph series
Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors.

Reviews in Health Technology Assessment are termed ‘systematic’ when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

HTA Programme Director: Professor Kent Woods
Series Editors: Professor Andrew Stevens, Dr Ken Stein and Professor John Gabbay
Monograph Editorial Manager: Melanie Corris

[yananshs]

По-моему, статья, приведенная Валентином Александровичем, относится к категории "cистематический обзор", а не "клинический разбор".
New England Journal of Medicine 352: 2314-2324 June 2, 2005 Number 22
Hywel C. Williams, Ph. D., Atopic Dermatitis
[Ссылки доступны только зарегистрированным пользователям ]
[Ссылки доступны только зарегистрированным пользователям ]

[yananshs]

Systematic review of treatments for atopic eczema.
Health Technology Assessment 2000; Vol. 4: No. 37
[Ссылки доступны только зарегистрированным пользователям ]
[Ссылки доступны только зарегистрированным пользователям ]

[Tim Vetrov]

Яна, Вы читали эти обзоры?

Речь ведь о том, что авторы статьи, которую пространно цитирует Валентин Александрович (пусть будет систематический обзор, хотя к чему тогда там 10-летняя девочка?), утверждая, что эффект пробиотиков при атопическом дерматите не доказан, ссылаются на 2 других обзора, ссылку на один из которых вы привели в последнем посте. Только эту ссылку я уже приводил (http://forums.rusmedserv.com/showpos...4&postcount=24) и обзор этот уже читал, и ничего там про эффективность/неэффективность пробиотиков нет.
Второй обзор, к сожалению, доступен только в виде абстракта. И из этого абстракта неясно мнение авторов (пожелавших остаться неизвестным).

К чему Вы привели эту огромную выдержку? Разве в ней есть что-либо про неэффективность пробиотиков? Если есть, значит, я проглядел (хотя смотрел 3 раза очень внимательно), ну, выделите жирным, пожалуйста...

Вы специально игнорируете мои посты? А если нет, зачем по второму и третьему разу приводите источники, не имеющие отношение к делу?

[Aminazinka]

Уважаемый Tim Vetrov!
Немного офaтоп, но касательно методологии. Вас удивляет, что нет работ о пробиотиках в лечении атопического дерматита? Знаете, меня удивляет, почему нигде в работах по депрессии не упоминаются антибиотики. Странное дело, может мне начать исследовать? В России это вроде позволено.. Вы как думаете, смысл будет? Ну как же, была же теория инфекционной шизофрении. Вдруг по мне Нобелевская плачет?
Ваше упорство найти пробиотики в лечении дерматита атопического - хорошее чувство. Но на чем основано это упорство? Давайте вернемся к процессу (атопическому дерматиту), вдруг выяснится, что состояние кишечника и "флоры его" никакого влияния на течение дерматита не оказывает?

[Tim Vetrov]

Уважаемая Ирина Геннадиевна!

Я уже много чего нашел, в том числе и гайдлайн по атопическому дерматиту, который признает эффективность пробиотиков при этом заболевании, опираясь на ряд двойных слепых плацебо контролируемых исследований... Эти исследования я также нашел, и ссылки на них в этом топике есть.

Так что Ваше предположение вряд ли верно: есть довольно убедительные данные, свидетельствующие об эффективности пробиотиков при атопическом дерматите.

Посмотрите вот здесь
[Ссылки доступны только зарегистрированным пользователям ]

Эта ссылка, между прочим, уже была приведена в данном топике.
http://forums.rusmedserv.com/showpos...5&postcount=19

Почему бы Вам не прочитать топик с начала до конца и не посмотреть те ссылки, которые приводятся? Может, тогда Вы поймете, на чем основано мое упорство?

[Aminazinka]

Мне непонятно, почему использование пробиотиков при атопическом дерматите Вы увязали со словом "дисбактериоз". В каком - нибудь из приведенных исследований проводился анализ кала на флору до или после введения пробиотиков?