Cochrane Database of Systematic Reviews最新文献

{"title":"Surgical approaches for inserting hemiarthroplasty of the hip in people with hip fractures.","authors":"Aidan T Morrell, Sarah E Lindsay, Kathryn Schabel, Martyn J Parker, Xavier L Griffin","doi":"10.1002/14651858.CD016031","DOIUrl":"10.1002/14651858.CD016031","url":null,"abstract":"<p><strong>Rationale: </strong>Hip fractures affect over 10 million people annually worldwide and are expected to increase with an ageing population, contributing significantly to morbidity, mortality, and healthcare costs. Hemiarthroplasty, a common treatment for displaced femoral neck fractures, accounts for more than half of hip fracture surgeries in older adults. However, the optimal surgical approach - anterior, lateral, or posterior - remains uncertain, with decisions often based on surgeon preference or institutional protocols.</p><p><strong>Objectives: </strong>To assess the effects of different surgical approaches for hemiarthroplasty in the treatment of hip fractures.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, and six other databases in November 2024. We also searched two trials registries, nine different conference proceedings, reference lists of included studies, and systematic reviews published within the last five years.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and quasi-RCTs in adults with hip fractures comparing different surgical approaches for hemiarthroplasty. We excluded studies of participants with high-energy hip fractures, fractures not associated with osteoporosis, or studies comparing hemiarthroplasty with total hip arthroplasty (THA).</p><p><strong>Outcomes: </strong>We were interested in a primary core outcome set: activities of daily living (ADL), health-related quality-of-life (HRQoL), mobility or functional status, mortality, and pain. Our secondary outcomes were complications, operative details and postoperative care outcomes.</p><p><strong>Risk of bias: </strong>We used the Cochrane RoB 1 tool to assess risk of bias.</p><p><strong>Synthesis methods: </strong>We performed meta-analyses using RevMan with a generic inverse-variance approach and random-effects models to calculate risk ratios (RRs), mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs). We used GRADE to determine the certainty of evidence.</p><p><strong>Included studies: </strong>We included 27 studies (23 RCTs, three quasi-RCTs, and one combined RCT/quasi-RCT) with a total of 3369 participants. The studies were conducted in Europe and Asia and published between 1981 and 2024. All studies but one focused on intracapsular fractures. The 'typical' included participant was a geriatric woman with an osteoporotic hip fracture treated with hip hemiarthroplasty who was ambulatory prior to injury and had a varying level of cognitive impairment at baseline.</p><p><strong>Synthesis of results: </strong>All but three studies were at high risk of detection bias and had unclear/high risk of bias in at least one domain. We downgraded many outcomes for imprecision, and for risk of bias where sensitivity analysis indicated the estimate was influenced in size or direction by studies with limitations. Anterior versus posterior approaches (7 s","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD016031"},"PeriodicalIF":8.8,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282730","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":"Antiplatelet versus anticoagulation treatment for people with heart failure in sinus rhythm.","authors":"Monika Kozieł-Siołkowska, Eduard Shantsila, Alena Shantsila, Gregory Yh Lip","doi":"10.1002/14651858.CD003333.pub4","DOIUrl":"10.1002/14651858.CD003333.pub4","url":null,"abstract":"<p><strong>Background: </strong>People with chronic heart failure have an increased risk of thrombotic complications, including stroke and thromboembolism, which in turn contribute to high mortality. Oral anticoagulants (e.g. warfarin) and antiplatelet agents (e.g. aspirin) are the principal oral antithrombotic agents. Many people with heart failure in sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure. Oral anticoagulation (OAC) has become a standard in the management of heart failure with atrial fibrillation. However, uncertainty regarding the appropriateness of OAC in heart failure with sinus rhythm remains. This is an update of a review previously published in 2016.</p><p><strong>Objectives: </strong>To assess the effects of OAC versus antiplatelet agents for all-cause mortality, non-fatal cardiovascular events and risk of major bleeding in adults with heart failure (either with reduced or preserved ejection fraction) who are in sinus rhythm.</p><p><strong>Search methods: </strong>In April 2025, we updated the searches of CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) portal. We searched the reference lists of papers and abstracts from cardiology meetings and contacted study authors for further information. We did not apply any language restrictions.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) comparing antiplatelet therapy versus OAC in adults with chronic heart failure in sinus rhythm. Treatment had to last for at least one month. We compared oral antiplatelets (aspirin, ticlopidine, clopidogrel, prasugrel, ticagrelor, dipyridamole) versus OAC (coumarins, warfarin, non-vitamin K oral anticoagulants).</p><p><strong>Data collection and analysis: </strong>Three review authors independently assessed trials for inclusion and assessed the benefits and harms of antiplatelet therapy versus OAC by calculating risk ratios (RRs) with 95% confidence intervals (CIs). We used GRADE criteria to assess the certainty of evidence.</p><p><strong>Main results: </strong>This update did not identify additional studies for inclusion, so the evidence base remains unchanged since the previous review version (published in 2016). We included four RCTs with 4187 eligible participants. All studies compared warfarin with aspirin. One RCT additionally compared warfarin with clopidogrel. All included RCTs studied people with heart failure with reduced ejection fraction. Analysis of all outcomes for warfarin versus aspirin was based on 3663 participants from four RCTs. Warfarin and aspirin probably both reduce all-cause mortality, with little to no difference between their risks: 21.9% for warfarin, 21.9% for aspirin (RR 1.00, 95% CI 0.89 to 1.13; 4 studies, 3663 participants; moderate-certainty evidence). OAC probably reduces the risk of non-fatal cardiovascular events (6.6% for warfarin, 8.3% for aspirin), which in","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD003333"},"PeriodicalIF":8.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265510","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":"Multifaceted behavioral interventions to improve topical glaucoma therapy adherence in adults.","authors":"Zanna Kruoch, Pathik Amin, Erica Shelton, Aaron B Zimmerman, Emily Stephey, Megan Hunter, Laura E Downie, Riaz Qureshi","doi":"10.1002/14651858.CD015788.pub2","DOIUrl":"10.1002/14651858.CD015788.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Glaucoma is a leading cause of vision loss and blindness, characterized by optic nerve damage and commonly by increased intraocular pressure (IOP). Topical medical therapy is the most common first-line treatment option, yet adherence to these medications is notably low. Improving medication adherence is critical for managing glaucoma effectively.</p><p><strong>Objectives: </strong>To assess the impact of two or more behavioral interventions (i.e. multifaceted interventions) on topical glaucoma therapy adherence in people utilizing IOP-lowering therapy for at least three months for treating ocular hypertension or glaucoma.</p><p><strong>Search methods: </strong>We searched four electronic databases (CENTRAL, MEDLINE, Embase, LILACS), two clinical trial registries, and checked references. The latest search date was 31 May 2024.</p><p><strong>Eligibility criteria: </strong>We included randomized controlled trials (RCTs) evaluating multifaceted behavioral interventions (≥ 3 months) for topical glaucoma therapy adherence compared with standard care in adults with glaucoma or ocular hypertension.</p><p><strong>Outcomes: </strong>Outcomes were change in adherence to topical IOP-lowering medications, change in IOP, optical coherence tomography (OCT) stability, visual field (VF) stability, proportion of participants with disease stability, change in quality of life scores, and adverse events. The time point for these measurements was three months or longer follow-up. We extracted any information related to equity and social determinants of health, and their potential influence on the administration of or outcomes from the interventions.</p><p><strong>Risk of bias: </strong>We assessed the risk of bias for all outcomes reported in the summary of findings tables using the Cochrane risk of bias 2 (RoB 2) tool, except for outcomes where no data were available.</p><p><strong>Synthesis methods: </strong>Where possible, we synthesized results for outcomes using random-effects meta-analysis of risk ratios (RRs) for dichotomous outcomes, and mean difference (MD) or standardized mean difference (SMD) for continuous outcomes. Where meta-analysis was not possible due to the available data, we synthesized the results qualitatively following Cochrane-recommended approaches; including summarizing effect estimates and vote counting, accompanied by forest plots to show estimates without meta-analyses and harvest plots. We used the GRADE approach to assess the certainty of the evidence for prespecified outcomes.</p><p><strong>Included studies: </strong>We included 17 RCTs that enrolled 4536 participants, ranging from 64 to 1800 per study. The mean age of participants ranged from 42 to 76 years. Studies were conducted across North America, Europe, and Asia, with most in the USA (47%). Among 12 studies reporting race and ethnicity, most participants were White (62%), followed by Black (26%), Asian (7%), Hispanic (1%), and others (3%). Follow-up","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD015788"},"PeriodicalIF":8.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265512","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":"Interventions to prevent obesity in children aged 2 to 4 years old.","authors":"Sophie M Phillips, Francesca Spiga, Theresa Hm Moore, Sarah Dawson, Hannah Stockton, Rita Rizk, Hung-Yuan Cheng, Rebecca K Hodder, Yang Gao, Frances Hillier-Brown, Kiran Rai, Connor B Yu, Kate M O'Brien, Carolyn D Summerbell","doi":"10.1002/14651858.CD015326.pub2","DOIUrl":"10.1002/14651858.CD015326.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Early childhood presents an important opportunity for obesity prevention, an international public health priority. Interventions aiming to prevent obesity typically promote healthy diets or activity levels (physical activity, sedentary behaviour), or both. There is uncertainty over which approaches are more effective. This is one of a suite of three reviews addressing interventions for preventing obesity in children, each focusing on different age groups up to 18 years. These reviews replace and update a 2019 Cochrane review on interventions for preventing obesity in children from birth to 18 years.</p><p><strong>Objectives: </strong>To assess the effects of interventions that aimed to prevent obesity in children aged two to four years by changing dietary intake or activity levels, or both, on body mass index (BMI), BMI z-score (zBMI), BMI percentile, and serious adverse events.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, six other databases, and two trial registers, together with reference checking, citation searching, and contact with study authors to identify eligible studies. The latest search date was 7 February 2023.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) in children aged two to four years, comparing dietary or activity interventions (or both combined) to prevent overweight or obesity versus no intervention, usual care, or another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post-baseline. There were no language restrictions.</p><p><strong>Outcomes: </strong>Our outcomes were BMI, zBMI, BMI percentile, and serious adverse events.</p><p><strong>Risk of bias: </strong>We used version 2 of the Cochrane risk of bias tool (RoB 2) to assess included RCTs.</p><p><strong>Synthesis methods: </strong>Working independently, two authors screened studies, extracted data, and conducted risk of bias and GRADE assessments. We conducted random-effects meta-analyses stratified by type of intervention and follow-up duration.</p><p><strong>Included studies: </strong>We included 67 studies (36,601 participants), with 56 studies (21,404 participants) pooled in the meta-analyses. Sixty-three studies were conducted in high-income countries. Study settings were split between childcare (26 studies; 39%), home (23 studies; 34%), and home plus childcare settings (10 studies; 15%). Few studies were conducted in the community (three studies; 5%) or healthcare settings (five studies; 7%). Most studies compared a combined dietary/activity intervention with a control group.</p><p><strong>Synthesis of results: </strong>Dietary interventions versus control Dietary interventions may have little to no effect on BMI at short-term follow-up (mean difference (MD) 0.00, 95% confidence interval (CI) -0.28 to 0.28; 1 study, 94 participants; low-certainty evidence). At medium- and long-term follow-up, dietary interven","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD015326"},"PeriodicalIF":8.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265511","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":"Parallel use of low-complexity automated nucleic acid amplification tests on respiratory and stool samples with or without lateral flow lipoarabinomannan assays to detect pulmonary tuberculosis disease in children.","authors":"Laura Olbrich, Bada Yang, Hayley Poore, Alia Razid, Brittney Sweetser, Mathias Weis Damkjær, Alexander W Kay, Johanna Åhsberg, Ruvandhi R Nathavitharana, Ian Schiller, Nandini Dendukuri, Andreas Lundh, Maunank Shah, Stephanie Bjerrum, Devan Jaganath","doi":"10.1002/14651858.CD016071.pub2","DOIUrl":"10.1002/14651858.CD016071.pub2","url":null,"abstract":"<p><strong>Background: </strong>Low-complexity automated nucleic acid amplification tests (LC-aNAATs) are molecular assays widely used to diagnose tuberculosis disease in children. The lateral flow urine lipoarabinomannan assay (LF-LAM) is recommended for use amongst children with HIV. Previous systematic reviews have assessed the diagnostic accuracy of LC-aNAATs and LF-LAM separately in children, but in clinical practice the tests may be used concurrently, i.e. in 'parallel'.</p><p><strong>Objectives: </strong>To compare the diagnostic accuracy of the parallel use of LC-aNAAT on respiratory and stool specimens in children, and with LF-LAM on urine amongst children with HIV, versus each assay alone for detecting pulmonary tuberculosis disease.</p><p><strong>Search methods: </strong>We searched MEDLINE, Embase, Science Citation Index-Expanded, Conference Proceedings Citation Index - Science, Biosis Previews, the Cochrane Central Register of Controlled Trials, Scopus, WHO (World Health Organization) Global Index Medicus, ClinicalTrials.gov, and the WHO International Clinical Trials Registry up to 3 November 2023. There was a WHO public call for data on the accuracy of LC-aNAAT and LF-LAM for children until December 2023.</p><p><strong>Selection criteria: </strong>We included studies that enroled children under 10 years of age with presumptive pulmonary tuberculosis, and provided data to assess the accuracy of parallel testing and at least one of the component tests, against a microbiological reference standard (MRS) based on culture or composite reference standard (CRS) that included clinical diagnosis.</p><p><strong>Data collection and analysis: </strong>We extracted data using a standardised form and assessed study quality using QUADAS-2 and QUADAS-C tools. We performed bivariate random-effects meta-analysis using a Bayesian approach to estimate sensitivity and specificity and absolute differences between index tests. Diagnostic accuracy estimates were calculated primarily against the MRS and secondarily against the CRS. We used GRADE to assess the certainty of the evidence on comparative accuracy.</p><p><strong>Main results: </strong>We included 14 studies to assess parallel testing in children with and without HIV. In addition, six of the 14 studies were included to evaluate LC-aNAATs with LF-LAM amongst children with HIV. Other than a high risk of bias with the CRS due to the potential incorporation of index results in clinical diagnoses, studies generally had low risk of bias across QUADAS-2 and QUADAS-C domains. Parallel use of respiratory and stool LC-aNAATs Children without HIV or HIV status unknown We included eight studies (2145 participants, tuberculosis prevalence 8.1% (173/2145)) for assessment against the MRS. Parallel use of LC-aNAAT on respiratory samples and stool had an estimated pooled sensitivity of 79.9% (95% credible interval (CrI) 67.9 to 89.8) and an estimated pooled specificity of 93.4% (95% CrI 87.2 to 97.0). Compared to ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD016071"},"PeriodicalIF":8.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265513","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":"Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology.","authors":"David M Haas, Magdalena Bofill Rodriguez, Taylor J Hathaway, Patrick S Ramsey","doi":"10.1002/14651858.CD003511.pub6","DOIUrl":"10.1002/14651858.CD003511.pub6","url":null,"abstract":"<p><strong>Rationale: </strong>Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. Miscarriage is an early pregnancy loss. For women who have recurrent miscarriage, it has been suggested that a causative factor may be inadequate secretion of progesterone. Therefore, clinicians sometimes use progestogens (drugs that interact with the progesterone receptors), beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. It is important to understand if this is beneficial or harmful. This is an update of the review, last published in 2019. Previous versions included two trials that have since been retracted. This update included an updated trial search and evaluation of all trials using the Cochrane Trustworthiness Screening Tool.</p><p><strong>Objectives: </strong>To assess the benefits and harms of progestogens as a preventative therapy against recurrent miscarriage.</p><p><strong>Search methods: </strong>For this update, we searched CENTRAL, MEDLINE, Embase, CINAHL, Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (July 2024). We also searched reference lists from relevant articles, attempted to contact trial authors where necessary, and contacted experts in the field for unpublished works.</p><p><strong>Eligibility criteria: </strong>We included randomized or quasi-randomized controlled trials in pregnant participants comparing progestogens with placebo or no treatment, given in an effort to prevent miscarriage. We included trials of participants who were diagnosed with recurrent miscarriage (usually of unknown origin) and who began treatment with progestogens in the first trimester of pregnancy. We excluded trials treating participants with threatened miscarriage or who had conceived by in-vitro fertilization.</p><p><strong>Outcomes: </strong>The critical outcome was miscarriage. The main important outcomes were live birth rate and preterm birth (< 37 weeks' gestation). Other important outcomes were neonatal death, fetal genital abnormalities, stillbirth, low birthweight (< 2500 g), maternal adverse events and neonatal intensive care unit admission. Other maternal outcomes of interest were severity of 'morning sickness', thromboembolic events, depression, admission to special care unit and subsequent fertility.</p><p><strong>Risk of bias: </strong>Two review authors assessed the studies using the RoB 1 tool for selection, performance, detection, attrition, incomplete outcome data, selective reporting and other bias.</p><p><strong>Synthesis methods: </strong>Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two reviewers assessed the certainty of the evidence using the GRADE approach. We utilized a random-effects model to synthesize the results.</p","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD003511"},"PeriodicalIF":8.8,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265514","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":"Parallel use of low-complexity automated nucleic acid amplification tests and lateral flow urine lipoarabinomannan assays to detect tuberculosis disease in adults and adolescents living with HIV.","authors":"Stephanie Bjerrum, Bada Yang, Johanna Åhsberg, Laura Olbrich, Mathias Weis Damkjær, Ruvandhi R Nathavitharana, Tobias Broger, Ioana Diana Olaru, Brittney Sweetser, Hayley Poore, Alia Razid, Alexander W Kay, Claudia M Denkinger, Ian Schiller, Nandini Dendukuri, Devan Jaganath, Andreas Lundh, Maunank Shah","doi":"10.1002/14651858.CD016070.pub2","DOIUrl":"10.1002/14651858.CD016070.pub2","url":null,"abstract":"<p><strong>Background: </strong>Low-complexity automated nucleic acid amplification tests (LC-aNAATs) are molecular World Health Organization (WHO)-recommended rapid diagnostic tests (also known as mWRDs) widely used to diagnose tuberculosis disease. The lateral flow urine lipoarabinomannan assay (LF-LAM) is recommended by the WHO to assist in diagnosing tuberculosis disease amongst people with HIV. Previous systematic reviews have assessed the diagnostic accuracy of LC-aNAATs and LF-LAM used in isolation for the detection of tuberculosis, but in clinical practice the tests may be used in parallel (i.e. LC-aNAAT in combination with LF-LAM).</p><p><strong>Objectives: </strong>To compare the diagnostic accuracy of the parallel use of LC-aNAAT on respiratory samples and LF-LAM on urine versus LC-aNAATs on respiratory samples alone for detection of tuberculosis disease in adults and adolescents with HIV who present with presumptive tuberculosis.</p><p><strong>Search methods: </strong>We searched Cochrane CENTRAL, MEDLINE, Embase, Science Citation Index-Expanded, Biosis Previews, Conference Proceedings Citation Index - Science, Scopus, WHO Global Index Medicus, ProQuest Dissertations & Theses, ClinicalTrial.gov, and the WHO International Clinical Trials Registry up to 3 November 2023.</p><p><strong>Selection criteria: </strong>We included studies that allowed assessment of the diagnostic accuracy of parallel testing and LC-aNAAT on respiratory samples in the same study group. Participants were adults and adolescents (defined as 10 years of age and older) with HIV who presented with presumptive tuberculosis. The reference standards we used for the detection of tuberculosis disease were microbiological or composite. As well as published studies, we included unpublished data if the data provided by study authors on request were the final data and could be used to compare diagnostic accuracy of parallel testing to one of the component tests.</p><p><strong>Data collection and analysis: </strong>Two review authors independently extracted data using a standardised form and assessed methodological quality using QUADAS-2 and QUADAS-C tools. We performed bivariate random-effects meta-analysis using a Bayesian approach to estimate sensitivity, specificity, and absolute differences between index tests. We performed subgroup analyses based on the presence of signs and symptoms, CD4 cell count, and clinical setting, as well as separate analyses for those with a positive screen for tuberculosis, advanced HIV, or serious illness.</p><p><strong>Main results: </strong>In 27 studies involving 12,651 participants, of whom 2368 (19%) had tuberculosis based on a microbiological reference standard, the parallel use of respiratory LC-aNAAT and urine LF-LAM had a pooled sensitivity of 77.5% (95% credible interval (CrI) 73.4 to 81.3) and specificity of 89.4% (95% CrI 85.8 to 92.3). Compared to respiratory LC-aNAAT alone, parallel testing had 6.7 (95% CrI 3.8 to 10.7) percentag","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD016070"},"PeriodicalIF":8.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257476","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":"Lymphadenectomy or sentinel node biopsy for the management of endometrial cancer.","authors":"Joanne Moffatt, Katie E Webster, Kerry Dwan, Jonathan A Frost, Jo Morrison","doi":"10.1002/14651858.CD015786.pub2","DOIUrl":"10.1002/14651858.CD015786.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Endometrial cancer, which affects the lining of the uterus, is the most common form of uterine cancer (96%), and the sixth most common cancer in females worldwide, accounting for 4.5% of all cancers in females. In 2022, there were 420,242 cases of uterine cancer and 97,704 deaths from the disease worldwide. Most women have early-stage endometrial cancer at diagnosis. Traditionally, surgical staging included removal of all lymph nodes (lymphadenectomy) in the pelvis (pelvic lymphadenectomy) with or without para-aortic areas (pelvic/para-aortic lymphadenectomy), to determine the need for further treatment. However, rates of lymph node involvement are relatively low and may be predicted by uterine histopathology and molecular markers. Lymphadenectomy carries a significant risk of long-term morbidity from lymphoedema and previous studies comparing pelvic lymphadenectomy with no lymphadenectomy found no survival benefit. Detecting the first draining lymph node(s) from each side of the uterus, called sentinel lymph node biopsy, can replace lymphadenectomy in terms of accuracy of detecting nodes, but no studies have shown whether sentinel lymph node biopsy is beneficial to women, despite its wide use.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of lymphadenectomy and sentinel lymph node biopsy for the management of endometrial cancer comparing different head-to-head comparisons in a network meta-analysis allowing ranking of treatment strategies.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and the WHO ICTRP for studies up to 22 March 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) of women with early-stage endometrial cancer, comparing combinations of no lymphadenectomy, pelvic lymphadenectomy, pelvic/para-aortic lymphadenectomy and sentinel lymph node biopsy. We excluded non-randomised studies and studies assessing diagnostic test accuracy of lymph node sampling.</p><p><strong>Outcomes: </strong>Overall survival; progression-free survival; morbidity and mortality related to surgery; early and late adverse events, including lymphoedema and lymphocyst formation; and quality of life.</p><p><strong>Risk of bias: </strong>We used RoB 2 to assess risk of bias.</p><p><strong>Synthesis methods: </strong>We conducted meta-analyses using random-effects models to calculate hazard ratios (HR) for time-to-event data and risk ratios (RR) and mean difference (MD) for other outcomes, with 95% confidence intervals (CI). We used GRADE to summarise the certainty of evidence. We intended to compare treatments in a network meta-analysis.</p><p><strong>Included studies: </strong>We included five RCTs (one remains ongoing) with 2074 women. Studies were conducted in the UK, South Africa, Poland, New Zealand, Chile, Italy, Egypt and Brazil, and published between 2008 and 2023. Another 10 studies are ongoing. Three studie","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD015786"},"PeriodicalIF":8.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257475","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":"Stapler versus scalpel resection followed by handsewn closure of the pancreatic remnant for distal pancreatectomy.","authors":"Pascal Probst, Felix J Hüttner, Ulla Klaiber, Phillip Knebel, Alexis Ulrich, Markus W Büchler, Markus K Diener","doi":"10.1002/14651858.CD008688.pub3","DOIUrl":"10.1002/14651858.CD008688.pub3","url":null,"abstract":"<p><strong>Background: </strong>Resections of the pancreatic body and tail reaching to the left of the superior mesenteric vein are defined as distal pancreatectomy. Most distal pancreatectomies are elective treatments for chronic pancreatitis, benign or malignant diseases, and they have high morbidity rates of up to 40%. Pancreatic fistula formation is the main source of postoperative morbidity, and is associated with numerous further complications. Researchers have proposed several surgical resection and closure techniques of the pancreatic remnant in an attempt to reduce these complications. The two most common techniques are scalpel resection followed by handsewn closure of the pancreatic remnant and stapler resection and closure.</p><p><strong>Objectives: </strong>To assess the effects of stapler resection and closure compared to scalpel resection followed by handsewn closure of the pancreatic remnant in people undergoing distal pancreatectomy.</p><p><strong>Search methods: </strong>We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from database inception to October 2023, and the ISGPS Evidence Map of Pancreatic Surgery to 9 April 2025.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) comparing stapler versus scalpel resection followed by handsewn closure of the pancreatic remnant for open distal pancreatectomy (irrespective of language or publication status).</p><p><strong>Data collection and analysis: </strong>Two review authors independently assessed trials for inclusion and performed data extraction. Our outcomes of interest were postoperative mortality and morbidity, especially postoperative pancreatic fistula. Taking into account the clinical heterogeneity between trials (e.g. different endpoint definitions), we analysed data using a random-effects model in RevMan, calculating risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence.</p><p><strong>Main results: </strong>In three trials, a total of 515 participants underwent distal pancreatic resection and were randomised to closure of the pancreatic remnant either with stapler (n = 259) or scalpel resection followed by handsewn closure (n = 256). One study was a single-centre pilot RCT, and two studies were multicentre RCTs. The single-centre pilot RCT evaluated 69 participants in five intervention arms (stapler, handsewn, fibrin glue, mesh, and pancreaticojejunostomy), although we only assessed the stapler and handsewn closure groups (14 and 15 participants, respectively). The two multicentre RCTs had two interventional arms: stapler (n = 177 and 68) and handsewn closure (n = 175 and 66). Stapler may have similar effects on postoperative mortality compared to scalpel resection followed by handsewn closure, although the CI is wide (4 deaths per 1000 compared with 8 per 1000; RR 0.49, 95% CI 0.05 to 5.40; 3 RCTs; 515 participants; low","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD008688"},"PeriodicalIF":8.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257477","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":"Gonadotropin-releasing hormone (GnRH) analogues for premenstrual syndrome (PMS).","authors":"Bushra Naheed, Jan Herman Kuiper, Fidelma O'Mahony, Patrick Ms O'Brien","doi":"10.1002/14651858.CD011330.pub2","DOIUrl":"10.1002/14651858.CD011330.pub2","url":null,"abstract":"<p><strong>Background: </strong>Premenstrual syndrome (PMS) is a psychological and somatic disorder affecting 20% to 30% of women of reproductive age. PMS results from ovulation: symptoms recur during the luteal phase of the menstrual cycle and remit by the end of menstruation. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS experienced by three to eight per cent of menstruating women. In this review, we use the term PMS to cover all core premenstrual disorders, including PMDD. The symptoms of all types are severe enough to affect daily functioning, interfering with work, school performance or interpersonal relationships. Gonadotropin-releasing hormone (GnRH) analogues are a pharmacological treatment to suppress ovulation. They can be administered as GnRH-agonists or GnRH-antagonists, though currently, GnRH-antagonists are not generally used to treat PMS. Suppressing ovarian function induces a hypo-oestrogenic state that can cause menopausal side effects such as hot flushes and mood changes. Having menopausal side effects instead of PMS symptoms can be distressing and can confuse clinical management. Longer-term GnRH therapy carries the risk of osteoporosis. To counteract these adverse effects, oestrogen or progestogen can be added to the PMS treatment; this is known as 'add-back' therapy or simply 'add-back'. Add-back may reduce menopausal side effects, allowing GnRH therapy to be used for a longer period without reducing efficacy.</p><p><strong>Objectives: </strong>To evaluate the therapeutic effectiveness and safety (adverse effects) of GnRH analogues (agonists or antagonists), with or without add-back, in the management of PMS.</p><p><strong>Search methods: </strong>A Cochrane Information Specialist searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO and two trials registers on 29 May 2023. We also checked reference lists and contacted study authors and subject experts to identify additional studies.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) of GnRH analogues used in the management of PMS in women of reproductive age with PMS diagnosed by at least two prospective menstrual cycles and no current psychiatric disorder. Control conditions could be no treatment, placebo, another type of GnRH, another dosage of GnRH or add-back.</p><p><strong>Data collection and analysis: </strong>We used the standard methodological procedures recommended by Cochrane. Our primary outcomes were overall severity of PMS symptoms (global symptoms), quality of life and adverse events.</p><p><strong>Main results: </strong>The review found 11 RCTs that analysed results from 275 women. The evidence is of very low to high certainty. The evidence is limited by serious imprecision due to low sample sizes and a high risk of bias related to blinding and attrition. Quality of life and long-term effects on bones were not reported in the studies. Most studies","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD011330"},"PeriodicalIF":8.8,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12150362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257474","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}