Cochrane Database of Systematic Reviews最新文献

{"title":"Music-based therapeutic interventions for people with dementia.","authors":"Jenny T van der Steen, Johannes C van der Wouden, Abigail M Methley, Hanneke J A Smaling, Annemieke C Vink, Manon S Bruinsma","doi":"10.1002/14651858.CD003477.pub5","DOIUrl":"10.1002/14651858.CD003477.pub5","url":null,"abstract":"<p><strong>Background: </strong>Dementia is a clinical syndrome with a number of different causes. It is characterised by deterioration in cognitive, behavioural, social and emotional functioning. Pharmacological interventions are available but have limited effect on many of the syndrome's features. However, receptivity to music may remain until the late phases of dementia, and music-based therapeutic interventions (which include, but are not limited to, music therapy) are suitable for people with advanced dementia. As there is uncertainty about the effectiveness of music-based therapeutic interventions, trials are being conducted to evaluate this. This review updates one last published in 2018 and examines the current evidence for the effects of music-based interventions for people with dementia.</p><p><strong>Objectives: </strong>To assess the effects of music-based therapeutic interventions for people with dementia on emotional well-being (including quality of life), mood disturbance or negative affect (i.e. depressive symptoms and anxiety), behavioural problems (i.e. overall behavioural problems or neuropsychiatric symptoms, and more specifically agitation or aggression), social behaviour and cognition, at the end of therapy and four or more weeks after the end of treatment, and to assess any adverse effects.</p><p><strong>Search methods: </strong>We searched the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), ClinicalTrials.gov and the World Health Organisation's meta-register-the International Clinical Trials Registry Platform on 30 November 2023.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials of music-based therapeutic interventions (of at least five sessions) for people with dementia that measured any of our outcomes of interest. Control groups either received usual care or other activities with or without music.</p><p><strong>Data collection and analysis: </strong>Two review authors worked independently to screen the retrieved studies against the inclusion criteria and then to extract data from included studies and assess their risk of bias. If necessary, we contacted trial authors to ask for additional data, such as relevant subscales. We pooled data using the random-effects model. We assessed the certainty of the evidence for our two comparisons and our main outcomes of interest using GRADE.</p><p><strong>Main results: </strong>We included 30 studies with 1720 randomised participants that were conducted in 15 countries. Twenty-eight studies with 1366 participants contributed data to meta-analyses. Ten studies contributed data to long-term outcomes. Participants had dementia of varying degrees of severity and resided in institutions in most of the studies. Seven studies delivered an individual intervention; the other studies deliv","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD003477"},"PeriodicalIF":8.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572365","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":"Models of care for managing non-specific low back pain.","authors":"Sean Docking, Shivadharshini Sridhar, Romi Haas, Kevin Mao, Helen Ramsay, Rachelle Buchbinder, Denise O'Connor","doi":"10.1002/14651858.CD015083.pub2","DOIUrl":"10.1002/14651858.CD015083.pub2","url":null,"abstract":"<p><strong>Background: </strong>Alternative care models seek to improve the quality or efficiency of care, or both, and thus optimise patient health outcomes. They provide the same health care but change how, when, where, or by whom health care is delivered and co-ordinated. Examples include care delivered via telemedicine versus in-person care or care delivered to groups versus individual patients.</p><p><strong>Objectives: </strong>To assess the effects of alternative models of evidenced-based care for people with non-specific low back pain on the quality of care and patient self-reported outcomes and to summarise the availability and principal findings of economic evaluations of these alternative models.</p><p><strong>Search methods: </strong>We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and trial registries up to 14 June 2024, unrestricted by language.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials comparing alternative care models to usual care or other care models. Eligible trials had to investigate care models that changed at least one domain of the Cochrane EPOC delivery arrangement taxonomy and provide the same care as the comparator arm. Participants were individuals with non-specific low back pain, regardless of symptom duration. Main outcomes were quality of care (referral for/receipt of lumbar spine imaging, prescription/use of opioids, referral to a surgeon/lumbar spine surgery, admission to hospital for back pain), patient health outcomes (pain, back-related function), and adverse events.</p><p><strong>Data collection and analysis: </strong>Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and the certainty of evidence using GRADE. The primary comparison was alternative models of care versus usual care at closest follow-up to 12 months.</p><p><strong>Main results: </strong>Fifty-seven trials (29,578 participants) met our inclusion criteria. Trials were primarily set within primary care (18 trials) or physiotherapy practices (15 trials) in high-income countries (51 trials). Forty-eight trials compared alternative models of care to usual care. There was substantial clinical diversity across alternative care models. Alternative care models most commonly differed from usual care by altering the co-ordination/management of care processes (18 trials), or by utilising information and communication technology (10 trials). Moderate-certainty evidence indicates that alternative care models probably result in little difference in referral for or receipt of any lumbar spine imaging at follow-up closest to 12 months compared to usual care (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.86 to 0.98; I<sup>2</sup> = 2%; 18 trials, 16,157 participants). In usual care, 232/1000 people received lumbar spine imaging compared to 213/1000 people who received alternative care models. We downgraded the certainty ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD015083"},"PeriodicalIF":8.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572356","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":"Vasodilators for women undergoing fertility treatment.","authors":"Rosa B Gutarra-Vilchez, Juan C Vazquez, Demián Glujovsky, Frank Lizaraso, Andres Viteri-García, Maria José Martinez-Zapata","doi":"10.1002/14651858.CD010001.pub4","DOIUrl":"10.1002/14651858.CD010001.pub4","url":null,"abstract":"<p><strong>Background: </strong>The rate of successful pregnancies brought to term has barely increased since the first assisted reproductive technology (ART) technique became available. Research suggests that vasodilators may increase endometrial receptivity, thicken the endometrium, and favour uterine relaxation, all of which could improve the chances of successful assisted pregnancy.</p><p><strong>Objectives: </strong>To evaluate the effectiveness and safety of vasodilators in women undergoing fertility treatment.</p><p><strong>Search methods: </strong>We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, three other databases, and two clinical trial registries in April 2024, with no language or date restrictions. We also searched grey literature sources and checked the reference lists of relevant articles.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) comparing vasodilators (alone or combined with other treatments) versus placebo or no treatment or versus other agents in women undergoing fertility treatment.</p><p><strong>Data collection and analysis: </strong>Two review authors independently selected studies, assessed risk of bias, extracted data, and calculated risk ratios (RRs). We combined study data using a fixed-effect model and assessed evidence certainty using the GRADE approach. Our primary outcomes were live birth or ongoing pregnancy and vasodilator side effects. Our secondary outcomes were clinical pregnancy, endometrial thickness, multiple gestation, miscarriage, and ectopic pregnancy.</p><p><strong>Main results: </strong>We included 45 studies with a total of 4404 women. The included studies compared a vasodilator versus a placebo or no treatment (40 RCTs), vasodilators plus another agent versus placebo or no treatment (3 RCTs) or versus oestrogens (3 RCTs). The mean length of follow-up was 15.45 weeks. Overall, the certainty of evidence was very low to moderate. The main limitations were imprecision (low number of events and participants) and risk of bias (lack of blinding in studies that reported subjective outcomes). Vasodilators versus placebo or no treatment Vasodilators may result in little to no difference in rates of live birth or ongoing pregnancy compared with placebo or no treatment (RR 1.21, 95% CI 0.93 to 1.58; I² = 0%; 6 RCTs, 740 women; low-certainty evidence), but probably increase overall rates of side effects (RR 2.14, 95% CI 1.55 to 2.98; I² = 0%; 7 RCTs, 668 women; moderate-certainty evidence). The evidence suggests that 246 per 1000 women achieve live birth or ongoing pregnancy with a placebo or no treatment, and 229 to 389 per 1000 will do so using vasodilators. Vasodilators compared with placebo or no treatment likely increase rates of clinical pregnancy (RR 1.45, 95% CI 1.28 to 1.64; I² = 22%; 25 RCTs, 2506 women; moderate-certainty evidence). Vasodilators compared with placebo or no treatm","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD010001"},"PeriodicalIF":8.8,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566269","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":"Blood pressure management in reperfused ischemic stroke.","authors":"Lucia B Varela, Samanta Díaz Menai, Camila Micaela Escobar Liquitay, Mariana Andrea Burgos, Diego Ivaldi, Luis Garegnani","doi":"10.1002/14651858.CD016085","DOIUrl":"10.1002/14651858.CD016085","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of intensive systolic blood pressure management (target less than 160 mmHg) versus conventional management (target less than 180 mmHg) in people undergoing ischemic stroke reperfusion via systemic thrombolysis or endovascular thrombectomy.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD016085"},"PeriodicalIF":8.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540302","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":"Epley maneuver, performed by family doctors or emergency physicians, for benign paroxysmal positional vertigo in adults.","authors":"Teresa Isabel Calheiros Cruz Vidigal, Yolanda Rando Matos, Gemma Flores Mateo, José Luis Ballvé Moreno, Eva Peguero Rodríguez","doi":"10.1002/14651858.CD016020","DOIUrl":"10.1002/14651858.CD016020","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of the Epley maneuver, performed by family doctors or emergency physicians, for adults with benign paroxysmal positional vertigo.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD016020"},"PeriodicalIF":8.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540317","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":"Cervical preparation for dilation and evacuation at 12 to 24 weeks gestation.","authors":"Tesfaye H Tufa, Fiona Stewart, Karen Meckstroth, Justin T Diedrich, Sara J Newmann","doi":"10.1002/14651858.CD007310.pub3","DOIUrl":"10.1002/14651858.CD007310.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Abortion is a common procedure. Complications associated with abortion increase as gestational age increases. Cervical preparation is recommended prior to second trimester surgical abortion. Evidence is lacking as to the most effective methods of cervical preparation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effectiveness of cervical preparation methods for people undergoing second trimester surgical abortion at gestational age between 12 and 24 0/7 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE ALL, Embase.com, Global Index Medicus, Scopus, and Google Scholar on 20 December 2021. We also searched reference lists, review articles, books, and conference proceedings. We contacted experts for information on other published or unpublished research. The COVID-19 pandemic greatly disrupted the writing and publication of this review; the search is outdated, but an updated search will be performed prior to the next update.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomized controlled trials (RCTs) investigating any cervical preparation method for second trimester surgical abortion from 12 to 24 weeks gestation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard Cochrane methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We identified 21 RCTs (3029 participants). Some trials were at high risk of detection and reporting bias. Prostaglandin versus osmotic dilators (4 studies, 373 participants; 12 6/7 to 20 weeks) Prostaglandin may result in little to no difference in ability to complete procedure (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.95 to 1.03; low-certainty evidence), but probably leads to less dilation achieved (mean difference [MD] -3.58 mm, 95% CI -4.58 to -2.58; moderate-certainty evidence) when compared to osmotic dilators. Mifepristone plus 400 μg buccal misoprostol versus osmotic dilators (1 study, 49 participants; 15 0/7 to 18 0/7 weeks) Mifepristone plus misoprostol may have little to no effect on ability to complete procedure (RR 1.00, 95% CI 0.92 to 1.08; low-certainty evidence) and procedure time (MD -0.30, 95% CI -3.46 to 2.86) when compared to osmotic dilators. The combination may lead to less dilation achieved (MD -1.67 mm, 95% CI -3.19 to -0.15; low-certainty evidence) and increased need for additional dilation (RR 1.92, 95% CI 1.16 to 3.18; low-certainty evidence) compared to osmotic dilators. 400 μg buccal misoprostol plus osmotic dilators versus placebo plus osmotic dilators (4 studies, 545 participants; 13 to 23 6/7 weeks) Misoprostol plus osmotic dilators probably has no effect on ability to complete procedure (RR 0.99, 95% CI 0.96 to 1.02; moderate-certainty evidence), but probably increases dilation achieved (MD 1.83 mm, 95% CI 0.27 to 3.39; moderate-certainty evidence) and reduces need for additional dilation (RR 0.65, 95% CI 0.50 to 0.84; moderate-certainty evidence) and procedure time (MD -0.99 min, 95% CI -2.05 to 0.0","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD007310"},"PeriodicalIF":8.8,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540313","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":"Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions.","authors":"Roger E Thomas, Tom Jefferson, Toby J Lasserson, Stan Earnshaw","doi":"10.1002/14651858.CD005187.pub6","DOIUrl":"10.1002/14651858.CD005187.pub6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;People who work in long-term care institutions (LTCIs), such as doctors, nurses, other health professionals, cleaners and porters (and also family visitors), may have substantial rates of influenza during influenza seasons. They often continue to work when infected with influenza, increasing the likelihood of transmitting influenza to those in their care. The immune systems of care home residents may be weaker than those of the general population; vaccinating care home workers could reduce transmission of influenza within LTCIs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of vaccinating healthcare workers in long-term care institutions against influenza on influenza-related outcomes in residents aged 60 years or older.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled Trials (via Cochrane Library), MEDLINE (via Ovid), Embase (via Elsevier), Web of Science (Science Citation Index-Expanded and Conference Proceedings Citation Index - Science), and two clinical trials registries up to 22 August 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;In this version of the review we restricted eligibility to randomised controlled trials (RCTs) of influenza vaccination of healthcare workers (HCWs) caring for residents aged 60 years or older in LTCIs. Previously we included cohort or case-control studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Outcomes of interest were: influenza (confirmed by laboratory tests) and its complications (lower respiratory tract infection; hospitalisation or death due to lower respiratory tract infection), all-cause mortality, and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used version one of the Cochrane risk of bias tool for RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors independently extracted data and assessed the risk of bias. We used risk ratios (RRs) with 95% confidence intervals (CIs) to summarise the effects of vaccination on our outcomes of interest. We accounted for clustering by dividing events and sample sizes for each study by an assumed design effect as part of a sensitivity analysis. We used GRADE to assess the certainty of evidence for our outcomes of interest.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We did not identify any new trials for inclusion in this update. Four cluster-RCTs from Europe (8468 residents) of interventions to offer influenza vaccination for HCWs caring for residents ≥ 60 years in LTCIs provided outcome data that addressed the objectives of our review. The average age of the residents was between 77 and 86 years, and most were female (70% to 77%). The studies were comparable in their intervention and outcome measures. The studies did not report adverse events. The principal sources of bias in the studies related to attrition, lack of blinding, contamination in the control groups, and low rates of vaccination coverage in the intervention arms, leading us to downgrade the certaint","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD005187"},"PeriodicalIF":8.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514874","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":"Renin inhibitors versus angiotensin receptor blockers for primary hypertension.","authors":"Gan Mi Wang, Liang Jin Li, Linyi Fan, Meng Xu, Wen Lu Tang, James M Wright","doi":"10.1002/14651858.CD012570.pub2","DOIUrl":"10.1002/14651858.CD012570.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Renin inhibitors, which inhibit the first and rate-limiting step in the renin angiotensin system (RAS), are thought to be more effective than other RAS inhibitors in blocking the RAS. Previous meta-analyses have shown that renin inhibitors have a favourable tolerability profile in people with mild-to-moderate hypertension and a blood-pressure-lowering magnitude that is similar to that of angiotensin receptor blockers (ARBs). ARBs inhibit the RAS by interfering with the binding of angiotensin II with its receptors. ARBs are widely prescribed and recommended as first-line therapy by some hypertension guidelines. However, a drug's efficacy in lowering blood pressure cannot be considered as a definitive indicator of its effectiveness in reducing mortality and morbidity. The benefits and harms of renin inhibitors compared to ARBs in treating hypertension are unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of renin inhibitors compared to angiotensin receptor blockers in people with primary hypertension.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;On 26 January 2024, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials: Cochrane Hypertension's Specialised Register, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Ovid Embase. The World Health Organization International Clinical Trials Registry Platform and the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) were also searched for ongoing trials. We contacted authors of relevant papers regarding further published and unpublished work and checked the bibliographies of included studies and relevant systematic reviews. The searches had no language restrictions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised, double-blind, parallel-design clinical trials comparing renin inhibitors and ARBs for people with primary hypertension. Studies recruiting people with proven secondary hypertension were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently selected the included trials, evaluated the risks of bias using the RoB 1 tool, and entered the data for analysis. We reported dichotomous outcomes as a risk ratio (RR) with a 95% confidence interval (CI) and continuous variables as mean difference (MD) with a 95% CI. The primary outcomes were all-cause mortality, total cardiovascular events, end-stage renal disease (ESRD), withdrawal due to adverse effects (WDAE), serious adverse events (SAE), and adverse events. The secondary outcomes were fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, fatal heart failure or hospitalisation for heart failure, systolic and diastolic blood pressure (SBP and DBP), and heart rate. We used the GRADE approach to rate our confidence in the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 11 double-blind RCTs involving 6780 participa","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD012570"},"PeriodicalIF":8.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514875","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":"Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis.","authors":"Johannes Hasskamp, Christian Meinhardt, Petrease H Patton, Antje Timmer","doi":"10.1002/14651858.CD000478.pub5","DOIUrl":"10.1002/14651858.CD000478.pub5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Maintenance of remission is essential in inflammatory bowel disease (IBD) in terms of disease course and long-term prognosis. The thiopurines azathioprine and 6-mercaptopurine have longstanding merit in ulcerative colitis, but more therapeutic options have been developed. This review is an update and extension of a review last published in 2016.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effectiveness and safety of azathioprine and 6-mercaptopurine in monotherapy or combined therapy regimens compared to placebo or active controls for the maintenance of remission in ulcerative colitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched Cochrane Central Register of Controlled Trials (until May 2023), ClinicalTrials.gov (until May 2023), Embase (until August 2022), MEDLINE (until May 2023), and WHO ICTRP (until May 2023). We checked reference lists of the included studies and, if needed, contacted the authors to request more data or information.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;Randomized controlled trials (RCTs) of at least 24 weeks' duration comparing azathioprine or 6-mercaptopurine with placebo or any other medication, or comparing different treatment modalities of azathioprine or 6-mercaptopurine, in persons of any age with quiescent ulcerative colitis were eligible. We only considered studies with mixed IBD populations or with a preceding induction period if separate results on participants with ulcerative colitis in remission were available or could be calculated. The primary outcome was failure to maintain clinical or endoscopic remission (relapse). Secondary outcomes included change in disease activity, quality of life, hospitalization, need for surgery, days off work, adverse events, and withdrawal due to adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two authors independently extracted data using standard forms, resolved any disagreements by consensus, and assessed study quality using the Cochrane risk of bias tool (RoB 2). We conducted separate analyses by type of control, calculated pooled risk ratios (RRs) or risk differences (RDs) using the fixed-effect model unless heterogeneity was likely, and assessed the certainty of evidence using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 10 studies in the review, including 468 adult participants with ulcerative colitis. The risk of bias across these was low for most outcomes, but we considered some outcomes to have some concerns or high risk of bias due to insufficient information on concealment of allocation and outcome measurement. Based on five placebo-controlled studies, azathioprine or 6-mercaptopurine may reduce the risk of failing to maintain remission. In the thiopurine group, 45% (64/143) of participants failed to maintain remission compared to 67% (96/143) of participants receiving placebo (RR 0.66, 95% confidence interval (CI) 0.54 to 0.82; 5 studies, 286 participants; low-certainty eviden","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD000478"},"PeriodicalIF":8.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514872","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":"Implementation strategies for WHO guidelines to prevent, detect, and treat postpartum hemorrhage.","authors":"Katherine Semrau, Ethan Litman, Rose L Molina, Megan Marx Delaney, Leslie Choi, Lindsay Robertson, Anna H Noel-Storr, Jeanne-Marie Guise","doi":"10.1002/14651858.CD016223","DOIUrl":"10.1002/14651858.CD016223","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Despite World Health Organization (WHO) guidelines for preventing, detecting, and treating postpartum hemorrhage (PPH), effective implementation has lagged.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the clinical benefits and harms of implementation strategies used to promote adherence to WHO clinical guidelines for the prevention, detection, and treatment of PPH.&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, Embase, CINAHL, and two trial registries, along with reference checking, citation searching, and contact with study authors. The latest search date was 25 April 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomized controlled trials (RCTs), including cluster, pragmatic, and stepped-wedge designs, and non-randomized studies of interventions (NRSIs), including interrupted time series (ITS) studies, controlled before-after (CBA) studies, and follow-up (cohort) studies containing concurrent controls that focused on or described implementation strategies of WHO guidelines for the prevention, detection, and treatment of PPH. Participants were birth attendants and people giving birth in a hospital or healthcare facility. We excluded studies that did not implement a WHO PPH recommendation, had no comparator group, or did not report clinical/implementation outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were: adherence to WHO-recommended guidelines for PPH prevention, detection, and treatment; PPH ≥ 500 mL; PPH ≥ 1000 mL; additional uterotonics within 24 hours after birth; blood transfusions; maternal death; severe morbidities (major surgery; admission to intensive care unit [ICU]); and adverse effects (variable and related to the clinical intervention) during hospitalization for birth. Our important outcomes were: breastfeeding at discharge; implementation outcomes such as acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability of the implementation strategy; and health professional outcomes such as knowledge and skill.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the RoB 2 and ROBINS-I tools to assess risk of bias in RCTs and NRSIs, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors independently selected studies, performed data extraction, and assessed risk of bias and trustworthiness. Due to the nature of the data, we reported relevant results for each comparison and outcome but did not attempt quantitative synthesis. We used GRADE to assess the certainty of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 13 studies (9 cluster-RCTs and 4 NRSIs) with a total of 1,027,273 births and more than 4373 birth attendants. The included studies were conducted in 17 different countries. Most trials were conducted in resource-limited settings. None of the included studies reported data on the use of additional uter","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016223"},"PeriodicalIF":8.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499626","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}