INTRODUCTIONMore than 10 years ago ,an interventional technique for the creation of an intrahepatic decompressive shunt between a branch of the portal vein and a main hepatic vein using expandable metallic stents has ...INTRODUCTIONMore than 10 years ago ,an interventional technique for the creation of an intrahepatic decompressive shunt between a branch of the portal vein and a main hepatic vein using expandable metallic stents has been intriduced for the treatmint of portal hypertension[1,2],This transjugular portosystemic intrahepatic stent shunt (TIPS) functions as a side to side shunt ,similarly to surgical shunts .展开更多
Background:Non-pharmaceutical interventions(NPIs)are a crucial suite of measures to prevent and control infectious disease outbreaks.Despite being particularly important for crisis-affected populations and those livin...Background:Non-pharmaceutical interventions(NPIs)are a crucial suite of measures to prevent and control infectious disease outbreaks.Despite being particularly important for crisis-affected populations and those living in informal settlements,who typically reside in overcrowded and resource limited settings with inadequate access to healthcare,guidance on NPI implementation rarely takes the specific needs of such populations into account.We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability,feasibility,and effectiveness of NPIs among crisis-affected populations and informal settlements.Methods:We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility,acceptability,and effectiveness of NPIs in crisis-affected populations and informal settlements.We performed quality assessments of each study using a standardised questionnaire.We analysed the data to produce descriptive summaries according to a number of categories:date of publication;geographical region of intervention;typology of crisis,shelter,modes of transmission,NPI,research design;study design;and study quality.Results:Our review included 158 studies published in 85 peer-reviewed articles.Most research used low quality study designs.The acceptability,feasibility,and effectiveness of NPIs was highly context dependent.In general,simple and cost-effective interventions such as community-level environmental cleaning and provision of water,sanitation and hygiene services,and distribution of items for personal protection such as insecticide-treated nets,were both highly feasible and acceptable.Logistical,financial,and human resource constraints affected both the implementation and sustainability of measures.Community engagement emerged as a strong factor contributing to the effectiveness of NPIs.Conversely,measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable,despite apparent effectiveness.Conclusions:Overall,the evidence base was variable,with substantial knowledge gaps which varied between settings and pathogens.Based on the current landscape,robust evidence-based guidance is not possible,and a research agenda is urgently required that focusses on these specific vulnerable populations.Although implementation of NPIs presents unique practical challenges in these settings,it is critical that such an agenda is put in place,and that the lessons learned from historical and present experiences are documented to build a firm evidence base.展开更多
文摘INTRODUCTIONMore than 10 years ago ,an interventional technique for the creation of an intrahepatic decompressive shunt between a branch of the portal vein and a main hepatic vein using expandable metallic stents has been intriduced for the treatmint of portal hypertension[1,2],This transjugular portosystemic intrahepatic stent shunt (TIPS) functions as a side to side shunt ,similarly to surgical shunts .
基金SB,KF,AH,JS and IJS acknowledge funding from the MRC Centre for Global Infectious Disease 514 Analysis(reference MR/R015600/1)jointly funded by the UK Medical Research Council 515(MRC)and the UK Foreign,Commonwealth&Development Office(FCDO),under the 516 MRC/FCDO Concordat agreement and is also part of the EDCTP2 programme supported 517 by the European Union+2 种基金SB acknowledges funding from the Wellcome Trust(219415)JS acknowledges funding from the Wellcome Trust(grant reference:215163/Z/18/Z)IJS was supported by the QMEE CDT,funded by NERC grant number NE/P012345/1.The funding bodies played no role in the design of the study and collection,analysis,and interpretation of data and in writing the manuscript.
文摘Background:Non-pharmaceutical interventions(NPIs)are a crucial suite of measures to prevent and control infectious disease outbreaks.Despite being particularly important for crisis-affected populations and those living in informal settlements,who typically reside in overcrowded and resource limited settings with inadequate access to healthcare,guidance on NPI implementation rarely takes the specific needs of such populations into account.We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability,feasibility,and effectiveness of NPIs among crisis-affected populations and informal settlements.Methods:We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility,acceptability,and effectiveness of NPIs in crisis-affected populations and informal settlements.We performed quality assessments of each study using a standardised questionnaire.We analysed the data to produce descriptive summaries according to a number of categories:date of publication;geographical region of intervention;typology of crisis,shelter,modes of transmission,NPI,research design;study design;and study quality.Results:Our review included 158 studies published in 85 peer-reviewed articles.Most research used low quality study designs.The acceptability,feasibility,and effectiveness of NPIs was highly context dependent.In general,simple and cost-effective interventions such as community-level environmental cleaning and provision of water,sanitation and hygiene services,and distribution of items for personal protection such as insecticide-treated nets,were both highly feasible and acceptable.Logistical,financial,and human resource constraints affected both the implementation and sustainability of measures.Community engagement emerged as a strong factor contributing to the effectiveness of NPIs.Conversely,measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable,despite apparent effectiveness.Conclusions:Overall,the evidence base was variable,with substantial knowledge gaps which varied between settings and pathogens.Based on the current landscape,robust evidence-based guidance is not possible,and a research agenda is urgently required that focusses on these specific vulnerable populations.Although implementation of NPIs presents unique practical challenges in these settings,it is critical that such an agenda is put in place,and that the lessons learned from historical and present experiences are documented to build a firm evidence base.
