Cochrane Database of Systematic Reviews最新文献

{"title":"Motivational interviewing for improving functional and psychosocial outcomes among stroke survivors.","authors":"Huanyu Mou, Wai Tong Chien, Ho Yu Cheng, Suzanne Hoi Shan Lo, Mimi Wai Man Chan, Shanshan Kong, Kai Chow Choi","doi":"10.1002/14651858.CD016110","DOIUrl":"10.1002/14651858.CD016110","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of motivational interviewing for functional and psychosocial outcomes in stroke survivors, compared to no intervention, waiting list, or attention controls.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD016110"},"PeriodicalIF":8.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transversus abdominis plane (TAP) blocks for prevention of postoperative pain in women undergoing laparoscopic and robotic gynaecological surgery.","authors":"Sarah Alsamman, David M Haas, Insiyyah Patanwala, David A Klein, Kelly Kasper, Charlotte M Pickett","doi":"10.1002/14651858.CD015145.pub2","DOIUrl":"10.1002/14651858.CD015145.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Pain control following laparoscopic gynaecologic surgery is key to successful recovery. The efficacy of the transversus abdominis plane (TAP) block compared to no block or a local anaesthetic injection has not been well established in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of single-shot transversus abdominis plane blocks for the prevention of postoperative pain in women undergoing laparoscopic and robotic gynaecological surgery compared to no block, sham block, or injection of local anaesthetic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, two trials registers, and handsearched abstracts to 6 December 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included prospective randomised controlled trials (RCTs) of adult women undergoing minimally invasive gynaecologic surgery that compared single-shot TAP block to no block, sham block, or injection of local anaesthetic. We excluded studies that were non-randomised or of non-gynaecologic surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical and important outcomes: participant-reported pain intensity 24 hours following surgery (combined, at rest, and with movement), adverse events (serious adverse events, nausea and vomiting, postoperative sedation), opioid consumption 24 and 48 hours after surgery. Other outcomes: pain intensity 2, 6, 12, and 48 hours after surgery, opioid consumption intraoperatively, time from surgery to first participant requirement for postoperative opioid, time from surgery until discharge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed the risk of bias with RoB 1.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We conducted meta-analyses using random-effects models. We calculated mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes. We reported serious adverse events as described by the study authors. We summarised the certainty of evidence using GRADE methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 21 RCTs with a total of 1645 participants. Studies were conducted in 10 countries, and published between 2011 and 2023. Six studies compared TAP block to no block, eight compared TAP block to an injection of local anaesthetic, and seven studies compared TAP block to sham block. Studies reported pain outcomes in various ways, so we made assumptions to allow us to combine data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;1. TAP block compared to no block TAP blocks may result in little or no difference in pain 24 hours after surgery for women undergoing laparoscopic or robotic gynaecologic procedures (MD -4.66, 95% confidence interval (CI) -11.06 to 1.74; 4 RCTs, 242 women; I&lt;sup&gt;2&lt;/sup&gt; = 88%; very low-certainty evidence). TAP blocks may result in little or no difference in pain at rest (MD -0.16, 95% CI -1.60 to 1.28; 2 RCTs, 146 women; I&lt;sup&gt;2&lt;/sup&gt; = 0%, low-certainty evidence), or pain with movement (MD -1.59, 95% CI -4.4","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD015145"},"PeriodicalIF":8.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stem cell injections for osteoarthritis of the knee.","authors":"Samuel L Whittle, Renea V Johnston, Steve McDonald, Daniel Worthley, T Mark Campbell, Sheila Cyril, Tanay Bapna, Jason Zhang, Rachelle Buchbinder","doi":"10.1002/14651858.CD013342.pub2","DOIUrl":"10.1002/14651858.CD013342.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Stem cells are specialised precursor cells that can replace aged or damaged cells and thereby maintain healthy tissue function. Stem cell therapy is increasingly used as a treatment for knee osteoarthritis, despite the lack of clarity around the mechanism by which stem cell therapy may slow down disease progression in osteoarthritis, and uncertainty regarding its benefits and harms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of stem cell injections for people with osteoarthritis of the knee. A secondary objective is to maintain the currency of the evidence, using a living systematic review approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase on 15 September 2023, unrestricted by date or language of publication. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) for relevant trial protocols and ongoing trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs), or trials using quasi-randomised methods of participant allocation, comparing stem cell injection with placebo injection, no treatment or usual care, glucocorticoid injection, other injections, exercise, drug therapy, surgical interventions, and supplements and complementary therapies in people with knee osteoarthritis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors selected studies for inclusion, extracted trial characteristics and outcome data, assessed risk of bias and assessed the certainty of evidence using the GRADE approach. The primary comparison was stem cell injection compared with placebo injection. The primary time point for pain, function and quality of life was three to six months, and the end of the trial period for participant-reported success, joint structure changes and adverse event outcomes. Major outcomes were pain, function, quality of life, global assessment of success, radiographic joint progression, withdrawals due to adverse events and serious adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We found 25 randomised trials (1341 participants) comparing stem cell injections with placebo injection (eight trials), no treatment or usual care (analgesia, weight loss and exercise) (two trials), glucocorticoid injection (one trial), hyaluronic acid injection (seven trials), platelet-rich plasma injections (two trials), oral acetaminophen (paracetamol) (one trial), non-steroidal anti-inflammatory drugs plus physical therapy plus hyaluronic acid injection (one trial) and stem cell injection plus intra-articular co-intervention versus co-intervention alone (three trials) in people with osteoarthritis of the knee. Trials were predominantly small, with sample sizes ranging from 6 to 252 participants, with only two trials having more than 100 participants. The average age of participants across trials ranged from 51 ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD013342"},"PeriodicalIF":8.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Withdrawal of antihypertensive drugs in older people.","authors":"Danijela Gnjidic, Aili V Langford, Vanessa Jordan, Mouna Sawan, James P Sheppard, Wade Thompson, Adam Todd, Ingrid Hopper, Sarah N Hilmer, Emily Reeve","doi":"10.1002/14651858.CD012572.pub3","DOIUrl":"10.1002/14651858.CD012572.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hypertension is an important risk factor for subsequent cardiovascular events, including ischaemic and haemorrhagic stroke, myocardial infarction, and heart failure, as well as chronic kidney disease, cognitive decline, and premature death. Overall, the use of antihypertensive medications has led to a reduction in cardiovascular disease, morbidity rates, and mortality rates. However, the use of antihypertensive medications is also associated with harms, especially in older people, including the development of adverse drug reactions and drug-drug interactions, and can contribute to increasing medication-related burden. As such, discontinuation of antihypertensives may be considered appropriate in some older people.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the effects of withdrawal of antihypertensive medications used for hypertension or primary prevention of cardiovascular disease in older adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;For this update, we searched the Cochrane Hypertension Specialised Register, CENTRAL (2022, Issue 9), Ovid MEDLINE, Ovid Embase, the WHO ICTRP, and ClinicalTrials.gov up to October 2022. We also conducted reference checking and citation searches, and contacted study authors to identify any additional studies when appropriate. There were no language restrictions on the searches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) of withdrawal versus continuation of antihypertensive medications used for hypertension or primary prevention of cardiovascular disease in older adults (defined as 50 years of age and over). Eligible participants were living in the community, residential aged care facilities, or based in hospital settings. We included trials evaluating the complete withdrawal of all antihypertensive medication, as well as those focusing on a dose reduction of antihypertensive medication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We compared the intervention of discontinuing or reducing the dose of antihypertensive medication to continuing antihypertensive medication using mean differences (MD) and 95% confidence intervals (95% CIs) for continuous variables, and Peto odds ratios (ORs) and 95% CI for binary variables. Our primary outcomes were mortality, myocardial infarction, and the development of adverse drug reactions or adverse drug withdrawal reactions. Secondary outcomes included hospitalisation, stroke, blood pressure (systolic and diastolic), falls, quality of life, and success in withdrawing from antihypertensives. Two review authors independently, and in duplicate, conducted all stages of study selection, data extraction, and quality assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We identified no new studies in this update. Six RCTs from the original review met the inclusion criteria and were included in the review (1073 participants). Study duration and follow-up ranged from 4 weeks to 56 weeks. Meta-analysis ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD012572"},"PeriodicalIF":8.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of amphetamines on blood pressure.","authors":"Magnus Chan, Jocelyn Joy Chan, James M Wright","doi":"10.1002/14651858.CD007896.pub4","DOIUrl":"10.1002/14651858.CD007896.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Daily ingestion of amphetamines is common, as they are widely prescribed for attention-deficit hyperactivity disorder (ADHD) and other diagnoses. People also use amphetamines recreationally or in an attempt to boost cognitive or athletic performance. Amphetamines have the potential to increase blood pressure, and we do not know if the long-term benefits of daily amphetamine use outweigh the potential harms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Primary: to quantify the changes in systolic and diastolic blood pressure in children and adults taking amphetamines, compared to placebo. Secondary: to quantify the changes in heart rate in children and adults taking amphetamines, compared to placebo; to quantify the number of withdrawals due to adverse effects of amphetamine, compared to placebo.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We used the Cochrane Hypertension Specialized Register, CENTRAL, MEDLINE, Embase and two clinical trial registers, together with reference checking and contact with study authors to identify the studies included in the review. We imposed no restrictions on language, publication year or publication status. The latest search date was March 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;Randomized controlled trials (RCTs) that compared the effects of daily oral amphetamines versus placebo on blood pressure. There were no restrictions on participants' age or gender.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard methods expected by Cochrane. Primary outcomes were change in systolic and diastolic blood pressure (measured in millimeters of mercury (mmHg) above atmospheric pressure; continuous outcomes). Secondary outcomes were heart rate (measured as beats per minute; continuous outcome) and withdrawals due to adverse effects (dichotomous outcome). We calculated continuous outcomes as mean differences (MD) with 95% confidence intervals (CI). We expressed withdrawals due to adverse effects as a risk ratio with 95% CI. We used a fixed-effect model to pool effect sizes from all studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 56 RCTs with a total of 10,583 participants, both adults and children. Most studies were conducted in North America (mainly the USA), followed by Europe. A few studies took place in Asia (Japan) and Australia. The studies tested racemic amphetamine, dextroamphetamine, mixed amphetamine salts, lisdexamfetamine dimesylate, methyl​enedioxy​methamphetamine (MDMA) and methylphenidate. The amphetamines were prescribed for ADHD, weight loss and other indications. In 48 RCTs, blood pressure was measured within 24 hours of the last dose. Based on data from all included studies, amphetamines increased systolic blood pressure (SBP) by 1.93 mmHg (95% CI 1.54 to 2.31) and diastolic blood pressure (DBP) by 1.84 mmHg (95% CI 1.51 to 2.16) (56 studies, 10,583 participants; high-certainty evidence for both). Amphetamines increased heart rate by 3.71 beats per minute","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD007896"},"PeriodicalIF":8.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucolytics for children with chronic suppurative lung disease.","authors":"Hannah E O'Farrell, Esther R McElrea, Anne B Chang, Stephanie T Yerkovich, Thomas Mullins, Julie M Marchant","doi":"10.1002/14651858.CD015313.pub2","DOIUrl":"10.1002/14651858.CD015313.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic suppurative lung disease (CSLD) is an umbrella term to define the spectrum of endobronchial suppurative lung disease, including bronchiectasis and protracted bacterial bronchitis (PBB), associated with chronic wet or productive cough. Research that explores new therapeutic options in children with CSLD has been identified by clinicians and patients as one of the top research priorities. Mucolytic agents work to improve mucociliary clearance and interrupt the vicious vortex of airway infection and inflammation, hence they have potential as a therapeutic option.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of mucolytics for reducing exacerbations, improving quality of life and other clinical outcomes in children with CSLD (including PBB and bronchiectasis), and to assess the risk of harm due to adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;An Information Specialist searched the Cochrane Airways Trials Register to June 2022, and a review author searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase databases to 27 September 2024. Other review authors handsearched respiratory journals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs), of both cross-over and parallel design, that compared a mucolytic with a placebo or 'no intervention' control group and included children (aged 18 years and under) with any type of CSLD (including PBB and bronchiectasis). We excluded studies with adult participants and studies in children with cystic fibrosis, empyema, pulmonary abscess or bronchopulmonary fistula.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two authors independently reviewed titles and abstracts to assess eligibility for inclusion. The authors then assessed study quality and extracted data. They assessed the quality of the study using the Cochrane risk of bias tool (RoB 2), and used GRADE to assess the certainty of evidence. Outcomes of interest to be analysed included: i) for maintenance or stable state: rate of exacerbations, ii) for exacerbation state: time to resolution of respiratory exacerbation, iii) lung function - forced expiratory volume in one second (FEV&lt;sub&gt;1&lt;/sub&gt;) and forced vital capacity (FVC), iv) quality of life and v) adverse events. Only one study met the inclusion criteria, so we could not perform a meta-analysis. Data were continuous, so we reported outcomes as mean differences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;The sole included RCT was a cross-over study of 63 children in the total cohort, with reported data and analysis of only 52 children (26 per arm) with non-cystic fibrosis bronchiectasis. The study compared 3% hypertonic saline nebulised before chest physiotherapy with a control arm (physiotherapy alone), with each phase lasting eight weeks. Children in the hypertonic saline arm had a mean age of 9.80 (SD 2.97) years and 42.3% were male; those in the control arm had a mean ag","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD015313"},"PeriodicalIF":8.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided versus anatomic landmark-guided percutaneous femoral artery access.","authors":"Shira A Strauss, Gar-Way Ma, Chanhee Seo, Jeffrey J Siracuse, Sreekumar Madassery, Alexander G Truesdell, Keith Pereira, Ethan C Korngold, Ahmed Kayssi","doi":"10.1002/14651858.CD014594.pub2","DOIUrl":"10.1002/14651858.CD014594.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The use of percutaneous arterial access for endovascular procedures has broad applications, from diagnostic angiography in the coronary and peripheral arteries, to thromboembolectomy in people with ischemic stroke and percutaneous coronary intervention in those with acute myocardial infarction. The rise of these procedures worldwide underscores the importance of obtaining precise and timely arterial access while minimizing the risk of adverse events. Traditionally, anatomic landmarks, such as the anterior superior iliac spine and symphysis pubis, have guided percutaneous common femoral artery (CFA) access, along with manual palpation of the pulse and fluoroscopy to confirm bony landmarks. Anatomic landmarks can be deceptive, however, especially in certain subpopulations, such as those with a high femoral artery bifurcation, elevated body mass index (BMI), or non-palpable femoral pulses. Ultrasound has emerged as a promising tool to guide percutaneous CFA access, offering enhanced visualization and providing real-time guidance. Notwithstanding this theoretical advantage, trials have inconsistently demonstrated an advantage to ultrasound guidance over anatomic landmarks, and concerns surrounding added set-up time and training have limited its uptake both clinically and across society guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the efficacy and safety of ultrasound compared to anatomic landmarks to guide percutaneous access of the CFA for the purpose of endovascular arterial imaging or treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 25 January 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We selected randomized controlled trials comparing ultrasound guidance to anatomic landmark guidance (using manual palpation or fluoroscopy, or both) for percutaneous CFA access in people undergoing endovascular therapy for diagnostic or therapeutic purposes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard Cochrane methods. Primary outcomes included first-pass success, time to successful CFA access, and major bleeding (including hematoma requiring transfusion, hematoma extending length of stay, hematoma ≥ 5 cm, unexplained hemoglobin drop, or major/severe bleeding as defined by each trial). Secondary outcomes included overall cannulation success, venipuncture, pain scores, number of access attempts, major complications (including retroperitoneal hematoma, pseudoaneurysms, dissections, arteriovenous fistulae, or occlusions), adverse events (including minor bleeding, infection, and neuropathy) up to 30 days, quality of life, re-intervention rate up to 30 days, and total number of access sites attempted. We conducted sensitivity analyse","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD014594"},"PeriodicalIF":8.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic treatment for non-tuberculous mycobacteria lung infection in people with cystic fibrosis.","authors":"Nikki Jahnke, Valerie Waters, Felix Ratjen, Sherie Smith, Ian R Hambleton, Naomi Scharf","doi":"10.1002/14651858.CD016039","DOIUrl":"10.1002/14651858.CD016039","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Cystic fibrosis (CF) is a common genetic condition in which progressive lung disease leads to morbidity and mortality. Non-tuberculous mycobacteria (NTM) are mycobacteria, other than those in the Mycobacterium tuberculosis complex, and are commonly found in the environment. NTM pulmonary infections affect a significant proportion of people with CF worldwide, which may be associated with a more rapid decline in lung function and even death in certain circumstances. Although there are guidelines for the antimicrobial treatment of NTM lung disease, there is no specific evidence from studies of people with CF to inform recommendations for their treatment. It is not clear which antibiotic regimen may be the most effective in the treatment of people with CF. This is an update of a previous review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare antibiotic treatment to no antibiotic treatment, or to compare different combinations of antibiotic treatment, for suppressing or eradicating non-tuberculous mycobacteria (NTM) lung infections in people with cystic fibrosis (CF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched Cochrane's Cystic Fibrosis Trials Register, online databases (MEDLINE, Embase and PubMed) and online trials registries (www.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinicaltrials: &lt;/strong&gt;gov and the World Health Organization International Clinical Trials Registry). We also searched the reference lists of included studies and relevant reviews. The date of the last search was 14 October 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Randomised controlled trials (RCTs) or quasi-RCTs with a parallel design; non-randomised studies of interventions (NRSIs) with the following designs: instrumental variables; regression discontinuity; interrupted time series; difference-in-differences and fixed-effect designs. These should have compared antibiotic treatment to no antibiotic treatment, or different combinations of antibiotic treatment, in people with CF of any age with NTM pulmonary infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;We aimed to assess the critical outcomes of microbiological clearance of NTM in sputum, quality of life, adverse events, lung function and pulmonary exacerbations. Further, we planned to assess important outcomes of mortality, nutritional parameters, hospitalisations and use of additional oral antibiotics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We planned to use the recommended Cochrane tools for RCTs or NRSIs. These were not suitable for the included study, so we assessed the risk of bias using a tool for case series developed by the Joanna Briggs Institute.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We were only able to report the limited results from the single included study narratively. We assessed the certainty of the results using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;Due to a lack of studies of the types planned, we were only able to include a single retrospective case review, which presented data a","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD016039"},"PeriodicalIF":8.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of adrenergic agonist oral decongestants on blood pressure.","authors":"Jocelyn Joy Chan, Magnus Chan, James M Wright","doi":"10.1002/14651858.CD007895.pub3","DOIUrl":"10.1002/14651858.CD007895.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adrenergic agonist oral decongestants are commonly taken daily over long periods of time to relieve sinus and nasal congestion. The mechanism of action of decongestants potentially increases blood pressure, and these effects may be acute or chronic. However, no systematic reviews to date have comprehensively assessed the chronic blood pressure effects of adrenergic agonist oral decongestants as a drug class, despite their widespread non-prescription availability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Primary objective To assess the effects of adrenergic agonist oral decongestants on systolic and diastolic blood pressure compared to placebo. Secondary objective To assess the effects of adrenergic agonist oral decongestants on heart rate and withdrawals due to adverse effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials (RCT) up to July 2024: Cochrane Hypertension Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Register of Studies, Ovid MEDLINE, Ovid Embase, and ClinicalTrials.gov. There were no language, publication year, or publication status restrictions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included RCTs of at least seven days' duration with parallel groups (intervention and placebo) comparing adrenergic agonist oral decongestants versus placebo on blood pressure in people aged over six years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors (JJC and MC) independently assessed the trials for inclusion, extracted the data, and assessed the risk of bias from the included trials. In cases where there were disagreements, the third review author (JMW) adjudicated. For any missing or unclear information in the studies, we contacted the study author to request the missing information or seek clarification. The primary outcomes were systolic blood pressure and diastolic blood pressure. Secondary outcomes were heart rate and withdrawal due to adverse effects. We used a fixed-effect model to combine the effect sizes from all studies. We assessed the certainty of the evidence using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;Five RCTs randomizing 882 participants met the inclusion criteria. The shortest study duration was one week, and the longest study duration was 24 weeks. These studies measured blood pressure and heart rate after one to seven weeks of taking oral decongestants. The largest study included 568 people, and the smallest study included 18 people. The mean age of participants was 20.0 years, with 326 males and 591 females. The studies were conducted in the USA and Europe; most were set in the USA. Pharmaceutical companies funded three of the five included studies. The findings are relevant to all people using adrenergic agonist oral decongestants for seven days or longer regardless of comorbidities or pre-existing conditions. The","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD007895"},"PeriodicalIF":8.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews.","authors":"Rodrigo Rn Rizzo, Aidan G Cashin, Benedict M Wand, Michael C Ferraro, Saurab Sharma, Hopin Lee, Edel O'Hagan, Christopher G Maher, Andrea D Furlan, Maurits W van Tulder, James H McAuley","doi":"10.1002/14651858.CD014691.pub2","DOIUrl":"10.1002/14651858.CD014691.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Low back pain (LBP) is a significant public health issue due to its high prevalence and associated disability burden. Clinical practice guidelines recommend non-pharmacological/non-surgical interventions for managing pain and function in people with LBP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To provide accessible, high-quality evidence on the effects of non-pharmacological and non-surgical interventions for people with LBP and to highlight areas of remaining uncertainty and gaps in the evidence regarding the effects of these interventions for people with LBP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched the Cochrane Database of Systematic Reviews from inception to 15 April 2023, to identify Cochrane reviews of randomised controlled trials testing the effect of non-pharmacological/non-surgical interventions, unrestricted by language. Major outcomes were pain intensity, function and safety. Two authors independently assessed eligibility, extracted data and assessed the quality of the reviews using AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) and the certainty of the evidence using GRADE. The primary comparison was placebo/sham.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 31 Cochrane reviews of 644 trials that randomised 97,183 adults with LBP. We have high confidence in the findings of 19 reviews, moderate confidence in the findings of two reviews, and low confidence in the findings of 10 reviews. We present results for non-pharmacological/non-surgical interventions compared to placebo/sham or no treatment/usual care at short-term (≤ three months) follow-up. Placebo/sham comparisons Acute/subacute LBP Compared to placebo, there is probably no difference in function (at one-week follow-up) for spinal manipulation (standardised mean difference (SMD) -0.08, 95% confidence interval (CI) -0.37 to 0.21; 2 trials, 205 participants; moderate-certainty evidence). Data for safety were reported only for heated back wrap. Compared to placebo, heated back wrap may result in skin pinkness (6/128 participants versus 1/130; 2 trials; low-certainty evidence). Chronic LBP Compared to sham acupuncture, acupuncture probably provides a small improvement in function (SMD -0.38, 95% CI -0.69 to -0.07; 3 trials, 957 participants; moderate-certainty evidence). Compared to sham traction, there is probably no difference in pain intensity for traction (0 to 100 scale, mean difference (MD) -4, 95% CI -17.7 to 9.7; 1 trial, 60 participants; moderate-certainty evidence). Data for safety were reported only for acupuncture. There may be no difference between acupuncture and sham acupuncture for safety outcomes (risk ratio (RR) 0.68, 95% CI 0.42 to 1.10; I&lt;sup&gt;2&lt;/sup&gt; = 0%; 4 trials, 465 participants; low-certainty evidence). No treatment/usual care comparisons Acute/subacute LBP Compared to advice to rest, advice to stay active probably provides a small reduction in pain intensity (SMD -0.22, 95% CI -0.02 to -0.41; 2 trials, 401 parti","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD014691"},"PeriodicalIF":8.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11945228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}