Cochrane Database of Systematic Reviews最新文献

{"title":"Service delivery, behavioural, and self-management interventions for adults with epilepsy.","authors":"Yun Huang, Sarah J Nevitt, Josephine Mayer, Nigel Fleeman, Ruaraidh A Hill, Alison J Doherty, Neil Wilson, Paul Boland, Andrew J Clegg, Helena Bilsborough, Elsie J Williams, Michelle Maden, Elizabeth J Shaw, Catrin Tudur Smith, Rachael Kelly, Anthony G Marson","doi":"10.1002/14651858.CD015284.pub2","DOIUrl":"10.1002/14651858.CD015284.pub2","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy is a common condition, affecting around 660 per 100,000 people worldwide. Despite treatment with anti-seizure medications, one-third of people do not achieve seizure control. There is a need to focus on models of service delivery and therapies that target cognitive, psychological, and behavioural aspects to improve seizure control and quality of life.</p><p><strong>Objectives: </strong>To assess the effects of service delivery, behavioural, and self-management inventions on seizure control and health-related quality of life in adults with epilepsy.</p><p><strong>Search methods: </strong>We used the Cochrane Register of Studies, MEDLINE, and two other databases, together with reference checking and contact with study authors, to identify the studies included in the review. The latest search date was 21 August 2023.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) or quasi-RCTs of any design (double/single-blinded, unblinded; parallel, cross-over, or cluster) involving participants with a mean age of 16 or older. Eligible interventions included behavioural, self-management, or service-delivery approaches. Behavioural and self-management interventions had to report seizure control as an outcome.</p><p><strong>Data collection and analysis: </strong>Our primary outcome was seizure frequency. Our secondary outcomes were: seizure severity, health-related quality of life (HRQoL), medication usage, knowledge, general health, social and psychological function, and adverse events. We classified outcomes as short-term (up to six months) or long-term (over six months). At least two review authors independently screened all papers, extracted data, assessed the risk of bias, and analysed data. We used GRADE to assess the certainty of the evidence.</p><p><strong>Main results: </strong>We included 36 studies with 5834 randomised participants. Twenty-six studies included participants with a diagnosis of epilepsy, six studies included participants with severe or drug-resistant epilepsy, and four studies included participants with epilepsy and another comorbidity, including depression, psychosocial problems, or learning disabilities. We rated 16 studies as having an overall low risk of bias, 11 studies as high risk, and nine studies with an unclear risk of bias. Twenty-one studies were conducted in high-income countries, seven in upper-middle-income countries, and eight in lower-middle-income countries. We categorised interventions into psycho-behavioural, mind-body, self-management, physical exercise, nurse-led service delivery, and other service delivery interventions. Seizure frequency Two studies showed that psycho-behavioural interventions likely reduce seizure frequency at three to six months (mean seizure frequency reduction 4.42 per month, 95% confidence interval (CI) 6.41 per month lower to 2.43 per month lower; 64 participants; moderate-certainty evidence). However, this int","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD015284"},"PeriodicalIF":8.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130349","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":"Resistance training for people with stroke.","authors":"David H Saunders, Graham Baker, Joshua D Cheyne, Kay Cooper, Natalie A Fini, Alixe Hm Kilgour, Paul A Swinton, Gavin Williams, Gillian E Mead","doi":"10.1002/14651858.CD016001","DOIUrl":"10.1002/14651858.CD016001","url":null,"abstract":"<p><strong>Rationale: </strong>Levels of physical activity and physical fitness are low after stroke. Low muscle strength is common, particularly on the affected side, and is associated with post-stroke disability. Resistance training exercise interventions could increase muscle strength, improve physical function and reduce disability, and may benefit secondary prevention.</p><p><strong>Objectives: </strong>The primary objective of this review is to determine whether resistance training after stroke has any effects on death, disability, adverse events, risk factors, fitness, walking, and indices of physical function when compared to a non-exercise control.</p><p><strong>Search methods: </strong>In January 2024, we searched nine databases (CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, WoS, PEDro and DORIS) and two trial registers (ClinicalTrials.gov and ICTRP), together with reference checking, citation tracking and contact with experts in the field, to identify eligible studies.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials comparing resistance training interventions with comparators of either usual care, no intervention, or a non-exercise intervention in people with stroke.</p><p><strong>Outcomes: </strong>Our critical outcome domains were death, disability, adverse events, risk factors, fitness, walking and indices of physical function. We assessed outcomes at the end of intervention and at the end of the longest follow-up. Our other important outcome domains were indices of quality of life, mood, cognition and fatigue.</p><p><strong>Risk of bias: </strong>We used the Cochrane Risk of Bias 1.0 tool to assess bias in the included studies.</p><p><strong>Synthesis methods: </strong>Where possible, we synthesised results for each outcome at the end of the intervention and at the end of follow-up using random-effects meta-analyses on arm-level data. For dichotomous outcomes, we calculated the risk difference (RD) and 95% confidence interval (CI). For continuous outcomes, we calculated a mean difference (MD), or standardised mean difference (SMD), and 95% CI. For outcomes not analysed using meta-analysis, we followed the Synthesis Without Meta-analysis (SWiM) guidance. We used GRADE to assess the certainty of evidence for critical outcomes.</p><p><strong>Included studies: </strong>We included a total of 27 studies with 1004 participants, with an average age of 62 years. Most studies recruited ambulatory participants (18/27) during the sub-acute (10/27) and chronic (16/27) stages of recovery living in high-income countries (18/27). Most study interventions lacked a balanced dose of control exposure (17/27). A follow-up period was included in 8/27 studies (mean 9.9 months; range 2 to 48 months). Interventions typically involved exercise machines (16/27) or bodyweight exercises (10/27) delivered two to three days per week for between two and 12 weeks, which progressed on the basis of intensity and/or v","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016001"},"PeriodicalIF":8.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130184","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":"Pharmacotherapy for mild hypertension.","authors":"Dominic Wang, James M Wright, Stephen P Adams, David K Cundiff, Francois Gueyffier, Guillaume Grenet, Anshula Ambasta","doi":"10.1002/14651858.CD006742.pub3","DOIUrl":"10.1002/14651858.CD006742.pub3","url":null,"abstract":"<p><strong>Rationale: </strong>This is an update of a Cochrane review published in 2012 of initiation of antihypertensive monotherapy or step-up therapy in people with untreated mild hypertension (systolic blood pressure 140 to 159 mmHg or diastolic blood pressure 90 to 99 mmHg, or both) and no pre-existing cardiovascular disease. The original review demonstrated no difference in the incidence of all-cause mortality, total cardiovascular events (stroke, myocardial infarction, and congestive heart failure), stroke incidence, coronary heart disease, or withdrawal due to adverse effects (WDAEs). Evidence for antihypertensive pharmacotherapy in people with mild hypertension for primary prevention remains uncertain in the literature with conflicting studies. We therefore performed an update of the original Cochrane review to reassess whether initiation of antihypertensive pharmacotherapy compared to placebo or no treatment in people with untreated mild hypertension and no pre-existing cardiovascular disease reduces the risk of all-cause mortality, total cardiovascular events, stroke, coronary heart disease, or WDAEs.</p><p><strong>Objectives: </strong>To reassess the efficacy and risks of initiating antihypertensive pharmacotherapy in adults with untreated mild hypertension and no pre-existing cardiovascular disease. The primary objective was to reassess the risk of all-cause mortality and total cardiovascular events (defined as fatal and non-fatal strokes, myocardial infarction, and congestive heart failure). The secondary objectives were to reassess the risk of stroke (fatal and non-fatal), coronary heart disease (fatal and non-fatal myocardial infarction and sudden cardiac death), and WDAEs.</p><p><strong>Search methods: </strong>We searched the Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to June 2024.</p><p><strong>Eligibility criteria: </strong>We included randomized controlled trials (RCTs) of at least one-year duration comparing initiation on antihypertensive monotherapy or step-up therapy, or both, versus placebo or no treatment in participants with mild hypertension and no pre-existing cardiovascular disease.</p><p><strong>Outcomes: </strong>Our critical outcomes were all-cause mortality and total cardiovascular events. Important outcomes were stroke, coronary heart disease (fatal and non-fatal myocardial infarction and sudden cardiac death), and WDAEs.</p><p><strong>Risk of bias: </strong>Two review authors assessed risk of bias independently and in duplicate using Cochrane's RoB 1 tool.</p><p><strong>Synthesis methods: </strong>Two review authors performed title and abstract screening, full-text review, and data extraction independently and in duplicate. We calculated risk ratio (RR) along with 95% confidence interval (CI) for all-cause mortality, total cardiovascular events, stroke events, coronary ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD006742"},"PeriodicalIF":8.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130197","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":"Remote ischaemic conditioning for preventing and treating ischaemic stroke.","authors":"Yue Qiao, Wen Hui, Sijie Li, Yuchuan Ding, Xunming Ji, Wenbo Zhao","doi":"10.1002/14651858.CD012503.pub3","DOIUrl":"10.1002/14651858.CD012503.pub3","url":null,"abstract":"<p><strong>Rationale: </strong>Remote ischaemic conditioning (RIC) has been innovatively utilised as a neuroprotective method in the prevention and treatment of stroke. RIC typically involves transiently restricting then restoring blood flow to limbs. The current evidence, as derived from various studies, indicates some beneficial effects of RIC, but also highlights the need for further investigation due to the presence of uncertainties and variations in study designs and outcomes.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of remote ischaemic conditioning in preventing and treating ischaemic stroke compared to sham or standard treatments.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, Web of Science, three Chinese databases, five trials registers, and conference proceedings, together with reference checking and citation searching. The latest search date was 11 March 2025.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) comparing RIC with sham RIC or standard medical management, over any length of follow-up, in people with ischaemic stroke.</p><p><strong>Outcomes: </strong>Our critical outcomes were mortality, recurrence of ischaemic stroke, and excellent functional outcome (Modified Rankin Scale (mRS) score 0-1). Our important outcomes were treatment-related adverse events, functional independence (mRS score 0-2), haemorrhagic stroke, stroke severity, improvement in neurological impairment, and cardiovascular events.</p><p><strong>Risk of bias: </strong>We assessed risk of bias using the original Cochrane risk of bias tool (RoB 1).</p><p><strong>Synthesis methods: </strong>We used standard Cochrane methodology. We synthesised results for each outcome through meta-analysis where possible, using either the inverse variance or Mantel-Haenszel method with a random-effects model. We used the GRADE approach to assess the certainty of the evidence.</p><p><strong>Included studies: </strong>This review included 20 RCTs with 7687 participants, though we analysed two publications from a single RCT as two separate studies. Sixteen RCTs with 7166 participants were new to this update. The studies were conducted in China, Denmark, the UK, the Netherlands, France, and Romania, and were published between 2012 and 2025. Fourteen studies investigated short-duration RIC, four evaluated medium-duration RIC, and three investigated long-duration RIC. Because studies reported the timing of RIC application after stroke onset in various ways, we made assumptions to combine data, which may have introduced extra heterogeneity or bias and affected the certainty of our conclusions regarding the optimal RIC application timing. We also identified 21 ongoing trials.</p><p><strong>Synthesis of results: </strong>The evidence suggests that RIC compared to non-RIC probably results in a slight reduction in the risk of ischaemic stroke recurrence (risk ratio (RR) 0.84, 95% confidence","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD012503"},"PeriodicalIF":8.8,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145130209","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":"Synchronised approach for intrauterine insemination in subfertile couples.","authors":"Melody Adesina, Astrid Ep Cantineau, Marian G Showell, Andy Vail, Jack Wilkinson","doi":"10.1002/14651858.CD006942.pub4","DOIUrl":"10.1002/14651858.CD006942.pub4","url":null,"abstract":"<p><strong>Rationale: </strong>Intrauterine insemination (IUI) is widely used as a first-line treatment for subfertile couples with favourable prognostic factors, yet pregnancy rates vary considerably. The optimal method for timing IUI - whether through different monitoring strategies or ovulation triggering techniques in natural or stimulated cycles - remains uncertain. This review explores which timing approaches and methods of ovulation monitoring and triggering lead to the best outcomes, including live birth and clinical pregnancy. It updates a Cochrane review last published in 2014.</p><p><strong>Objectives: </strong>To evaluate the effectiveness of different methods of synchronisation of insemination with ovulation on live birth or ongoing pregnancy, in natural and stimulated cycles for IUI in subfertile couples.</p><p><strong>Search methods: </strong>We used the Cochrane Gynaecology and Fertility Group specialised register, CENTRAL, MEDLINE, and two other databases, along with reference checking, citation searching, handsearching of conference abstracts, and contact with study authors to identify the studies included in the review. The latest search date was October 2023.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) comparing timing methods in natural or stimulated cycles, and different ovulation triggering methods. These included: varying the time interval between ovulation triggering and insemination, luteinising hormone (LH) detection in urine, LH detection in blood, basal body temperature charts, ultrasound detection of ovulation, human chorionic gonadotropin (hCG) administration, a combination of LH detection and hCG administration, gonadotropin-releasing hormone (GnRH) agonist administration, and other trigger administrations.</p><p><strong>Outcomes: </strong>Critical outcome: live birth or ongoing pregnancy rate per couple. Important outcomes (all are rate per couple): clinical pregnancy; multiple pregnancy; miscarriage; ovarian hyperstimulation syndrome; tubal pregnancy.</p><p><strong>Risk of bias: </strong>We used the Cochrane Collaboration's original tool to assess the risk of bias in the included RCTs.</p><p><strong>Synthesis methods: </strong>After the search, we screened the trials, extracted the data, and assessed the risk of bias and trustworthiness of the included studies. We synthesised results for each outcome using meta-analysis where possible. We expressed results for each included study as Mantel-Haenszel odds ratios (OR) with 95% confidence intervals (CI). We used GRADE to assess the certainty of the evidence for each outcome.</p><p><strong>Included studies: </strong>This review update includes 42 studies: 18 from the 2014 version, plus 24 studies newly identified in the updated search.</p><p><strong>Synthesis of results: </strong>Of the 42 included studies (a total of 6603 couples), we included seven in the primary meta-analyses (1917 couples) and 12 in the sensitivity ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD006942"},"PeriodicalIF":8.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124569","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":"Misoprostol for intrauterine device placement.","authors":"Lauren B Zapata, Emily Snyder, Antoinette T Nguyen, Nathalie Kapp, Angeline Ti, Maura K Whiteman, Kathryn M Curtis","doi":"10.1002/14651858.CD015584.pub2","DOIUrl":"10.1002/14651858.CD015584.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Identifying effective approaches to reduce pain and improve providers' ease of intrauterine device (IUD) placement may reduce barriers to IUD access and use. The cervical softening and dilation effects of misoprostol might make IUD placement less painful for women and technically easier for providers. However, evidence suggests that misoprostol does not improve many outcomes and may only be helpful for some patients (e.g. those with a recent failed IUD placement).</p><p><strong>Objectives: </strong>To examine the effect of misoprostol for routine IUD placement on patient and provider outcomes compared to placebo or no treatment.</p><p><strong>Search methods: </strong>In November 2021 we searched CENTRAL, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and ClinicalTrials.gov. We conducted update searches in July 2022 and September 2024. We searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) in July 2025.</p><p><strong>Eligibility criteria: </strong>We included randomized controlled trials (RCTs) of women undergoing interval IUD placement (i.e. placement outside the postabortion or postpartum period) that compared misoprostol to placebo or no treatment. We included trials that examined the placement of currently available levonorgestrel (LNG)-releasing IUDs, or any copper T IUD, for women of any age, of any parity, and for any indication.</p><p><strong>Outcomes: </strong>Our core critical and important outcomes were pain (during tenaculum placement, during IUD placement, and after IUD placement before clinic discharge); providers' ease of placement; need for cervical dilation; placement success; patient satisfaction; misoprostol side effects (preplacement abdominal pain or cramping, and diarrhea); and adverse events (vasovagal reaction).</p><p><strong>Risk of bias: </strong>We used the Risk of Bias 2 tool (RoB 2) to assess the risk of bias for outcomes.</p><p><strong>Synthesis methods: </strong>We synthesized results for each outcome using meta-analysis. We calculated mean differences (MD) for continuous outcomes using inverse variance estimation and random-effects models. We calculated risk ratios (RR) for dichotomous outcomes using Mantel-Haenszel estimation and random-effects models. We used GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Included studies: </strong>We included 14 RCTs with a total of 1972 women. The trials were conducted in North America, South America, Europe and Africa, and were published between 2007 and 2022.</p><p><strong>Synthesis of results: </strong>The results below summarize the effect of misoprostol on outcomes compared to placebo or no treatment. Pain: misoprostol results in little to no difference in pain during tenaculum placement (MD -0.73, 95% confidence interval [CI] -1.19 to -0.28; 3 RCTs, 261 women; high-certainty evidence) and after IUD placement before clinic discharge (","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD015584"},"PeriodicalIF":8.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12455695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124619","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":"Call to action: building a better future together, powered by evidence, guided by collective impact.","authors":"Karla Soares-Weiser, Zoe Jordan, Laura Boeira, Laurenz Mahlanza-Langer, Will Moy, Rhona Mijumbi, Ruth Foxlee, John N Lavis","doi":"10.1002/14651858.ED000175","DOIUrl":"https://doi.org/10.1002/14651858.ED000175","url":null,"abstract":"","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"ED000175"},"PeriodicalIF":8.8,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HMG-CoA reductase inhibitors (statins) versus placebo for people with schizophrenia.","authors":"Yusuke Saishoji, Saehyeon Kim, Masahiro Banno, Kunihiro Kohmura, Yuki Kataoka, Yasushi Tsujimoto","doi":"10.1002/14651858.CD014565","DOIUrl":"10.1002/14651858.CD014565","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 HMG-CoA reductase inhibitors (statins) compared with placebo for schizophrenia in adults.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD014565"},"PeriodicalIF":8.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085102","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":"Single-incision versus conventional multi-incision laparoscopic appendicectomy for suspected uncomplicated appendicitis.","authors":"Ahmer Irfan, Ahsan Rao, Irfan Ahmed","doi":"10.1002/14651858.CD009022.pub4","DOIUrl":"10.1002/14651858.CD009022.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Appendicectomy is a well-established surgical procedure to manage acute appendicitis. The operation was historically performed as an open procedure and is currently performed using minimally invasive surgical techniques. A recent development in appendicectomy technique is the introduction of single-incision laparoscopic surgery. This incorporates all working ports (either one multi-luminal port or multiple mono-luminal ports) through a single skin incision; the procedure is known as single-incision laparoscopic appendicectomy or SILA. Unanswered questions remain regarding the efficacy of this novel technique, including its effects on patient benefit and satisfaction, complications, and long-term outcomes, when compared to multi-incision conventional laparoscopy (CLA). This is an update of a review published in 2011.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of single-incision laparoscopic appendicectomy compared with multi-incision laparoscopic appendicectomy, on benefits, complications, and short-term outcomes, in patients with acute appendicitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled trials (CENTRAL, the Cochrane Library 2018 Issue 2), Ovid MEDLINE (1983 to January 2024), Ovid Embase (1983 to January 2024), the WHO International Clinical Trial Register (January 2024), and Clinicaltrials.gov (January 2024). We also searched reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases. The searches were carried out on 20 January 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) that compared the single-incision procedure SILA against CLA for patients (male and female) over the age of 10 years, diagnosed with appendicitis, or symptoms of appendicitis, and undergoing laparoscopic appendicectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently selected studies for inclusion, extracted data into a standardised form, and assessed the risk of bias in the studies. We extracted data relevant to the predetermined outcome measures. Where appropriate, we calculated a summary statistic: odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous data and mean difference (MD) with 95% CI for continuous data. We used Review Manager Web for our statistical analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;This review was first published in 2011, when there was no RCT evidence available. For this update, we identified 11 RCTs involving 1373 participants (689 in the SILA groups and 684 in the CLA groups). The participants were similar at baseline in terms of age (mean 31.7 (SILA) versus 30.9 years (CLA)) and sex (female: 53.0% (SILA) versus 50.3% (CLA)). Diagnosis of appendicitis was based on clinical assessment; none of the studies used a diagnosis confirmed by imaging as part of their inclusion criteria. The certainty of the evide","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD009022"},"PeriodicalIF":8.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085080","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":"Calcium supplementation commenced before pregnancy for preventing hypertensive disorders and related problems.","authors":"Catherine A Cluver, Christa Rohwer, Anke Rohwer, Maria Eduarda Dos Santos Santos Puga, Maria Regina Torloni, G Justus Hofmeyr","doi":"10.1002/14651858.CD011192.pub4","DOIUrl":"10.1002/14651858.CD011192.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. Calcium supplementation commenced before pregnancy may prevent the development of these disorders. This is an update of a review last published in 2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of calcium supplementation commenced before pregnancy on hypertensive disorders of pregnancy and related maternal and neonatal outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, CINAHL, Portal Regional BVS-Lilacs, Scopus, Web of Science, WHO ICTRP and ClinicalTrials.gov on 7 January 2025 and searched reference lists of retrieved trials and relevant systematic reviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) that compared calcium supplementation commenced before pregnancy with placebo or standard care. Trials conducted after 2010 needed to be prospectively registered. We applied a trustworthiness checklist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical outcomes for women were pre-eclampsia or pregnancy loss, and pre-eclampsia. The critical outcome for children was perinatal loss. Our main important outcomes for women were pregnancy loss at any gestational age, maternal death, maternal death or severe morbidity, and adverse effects. Our main important outcomes for children were preterm delivery before 37 weeks, neonatal death or severe morbidity, stillbirth, neonatal death, and early neonatal death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used version 2 of the Cochrane tool for assessing risk of bias in randomised trials (RoB 2).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors independently selected trials, extracted data, and assessed risk of bias and trustworthiness. We pooled data using random-effects meta-analysis. We assessed the certainty of the evidence using GRADE. Because conception and pregnancy loss are intermediate outcomes potentially on the causal pathway to pre-eclampsia, we chose the composite outcome 'pre-eclampsia or pregnancy loss' as the first critical outcome (and most relevant to pregnant women), and included sensitivity analyses including only women who conceived during the trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included one multicentre, double-blind, randomised, placebo-controlled trial. It included 1355 parous women, whose most recent planned pregnancy had been complicated by pre-eclampsia or eclampsia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Pre-eclampsia or pregnancy loss at any gestational age Compared to placebo, calcium may result in little to no difference in pre-eclampsia or pregnancy loss at any gestational age (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.67 to 1.07; 1 RCT, 1355 women; risk difference (RD) 28/1000 fewer, 95% CI 61 fewer to 13 more; low-certainty evidence). Sensitivity analysis including only women who conceived during the trial yielded ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD011192"},"PeriodicalIF":8.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079879","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}