Cochrane Database of Systematic Reviews最新文献

{"title":"Red blood cell transfusion to treat or prevent complications in sickle cell disease: an overview of Cochrane reviews.","authors":"Alvin M Katumba, Carolyn Dorée, Lise J Estcourt","doi":"10.1002/14651858.CD012082.pub3","DOIUrl":"10.1002/14651858.CD012082.pub3","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell disease (SCD) is one of the most common severe monogenic disorders globally. SCD can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Red blood cell (RBC) transfusions are used to treat complications of SCD, e.g. acute chest syndrome (ACS), or they can be part of a regular long-term transfusion programme to prevent SCD complications.</p><p><strong>Objectives: </strong>To summarise the evidence from Cochrane reviews of the benefits and harms of RBC transfusions versus no transfusion, or restrictive transfusion (to increase the total haemoglobin) versus liberal transfusion (to decrease the haemoglobin S level below a specified percentage), for treating or preventing complications experienced by people with SCD.</p><p><strong>Methods: </strong>We searched the Cochrane Database of Systematic Reviews on 3 June 2026. We included Cochrane reviews of randomised or quasi-randomised controlled trials that addressed various SCD complications and had RBC transfusion as an intervention or comparator. We assessed the methodological quality of included reviews according to the AMSTAR (A MeaSurement Tool to Assess systematic Reviews) quality assessment. The primary outcomes of the overview were: mortality from any cause; SCD-related serious adverse events; and transfusion-related adverse events. We extracted GRADE assessments from included reviews.</p><p><strong>Main results: </strong>We included 17 reviews, 11 had no included studies with an RBC transfusion intervention. Six reviews included trials with participants randomised to RBC transfusion; in one of these reviews, with no usable data, only 10 participants were randomised. This overview focuses on the five remaining reviews. Five reviews (containing nine trials with 1502 participants) reported data comparing short- or long-term RBC transfusions versus standard care; disease-modifying agents; a restrictive versus a liberal transfusion strategy; and long-term RBC transfusions versus transfusions to treat complications. All reviews were high-quality according to AMSTAR, however, the certainty of the evidence was variable across outcomes, with most being very-low certainty. Trials were downgraded according to GRADE methodology for risk of bias, indirectness (most trials were conducted in children with the HbSS phenotype), and imprecision (outcomes had wide confidence intervals). In all five reviews and all comparisons there may be little or no difference in the risk of death (low or very low-certainty evidence). There were either no deaths or death was a rare event. In all five reviews and all comparisons, evidence for several outcomes was of very-low certainty. These were: transfusion reactions, development of alloantibodies and serious infections. Short-term RBC transfusion versus standard care (one review: two trials, 434 participants) All reported outcomes were very-low certainty evidence. Long-term RBC transfusion v","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD012082"},"PeriodicalIF":11.1,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036825","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":"Antifungal therapy for newborn infants with invasive fungal infection.","authors":"Rameshwar Prasad, Md Habibullah Sk, Bijan Saha, Jagdish Sahoo, Amit Kumar, Michelle Fiander, Jane Cracknell, William McGuire","doi":"10.1002/14651858.CD003953.pub4","DOIUrl":"10.1002/14651858.CD003953.pub4","url":null,"abstract":"<p><strong>Rationale: </strong>A variety of antifungal drugs, drug preparations and drug combinations are available to treat newborn infants with suspected or confirmed invasive fungal infection. There is a need to assess their relative merits.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of treatment with one antifungal drug or drug combination or preparation versus another on mortality and morbidity in newborn infants with suspected or confirmed invasive fungal infection.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, Emcare, and three trial registers up to 14 November 2025; and CINAHL to June 2025. We searched reference lists of studies and reviews.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and quasi-RCTs comparing one antifungal agent or combination of agents with another in newborn (preterm and term) infants with suspected or confirmed invasive fungal infection. We excluded cross-over studies and studies with placebo as a comparator.</p><p><strong>Outcomes: </strong>Our outcomes of interest were death (all-cause) prior to hospital discharge; moderate to severe neurodevelopmental impairment (NDI); adverse reactions attributed to the antifungal agent resulting in discontinuation of the therapy; length of hospital stay; and escalation of antimicrobial therapy.</p><p><strong>Risk of bias: </strong>We used Cochrane's Risk of Bias 1 (RoB 1) tool.</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis where possible, calculating risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences (MDs) with 95% CIs for continuous outcomes. We used GRADE to assess the certainty of evidence.</p><p><strong>Included studies: </strong>We included six studies (229 infants) comparing one antifungal agent or combination of agents with another in newborns. Studies varied in the antifungal prescribed (one study compared amphotericin B with fluconazole, two studies compared amphotericin B with micafungin, two studies compared amphotericin B with caspofungin and one study compared micafungin with fluconazole). Studies were predominantly conducted in high- and middle-income countries.</p><p><strong>Synthesis of results: </strong>We downgraded the overall certainty of evidence for all outcomes because of limitations in study design (e.g. performance bias due to unblinded intervention and detection bias due to unblinded outcome assessment), indirectness and serious imprecision of results, with wide confidence intervals and few events. Fluconazole compared to amphotericin B We are very uncertain about the effect of fluconazole on death (all-cause) prior to hospital discharge (RR 0.73, 95% CI 0.26 to 2.05; I² not applicable; 1 study, 23 participants; very low-certainty evidence), adverse reactions attributed to the antifungal agent that resulted in discontin","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD003953"},"PeriodicalIF":11.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024071","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":"Combined hormonal versus nonhormonal versus progestin-only contraceptives for postpartum contraception in lactating individuals.","authors":"Michail Papapanou, Sarah Truitt, Angeliki C Syristatidi, Manthia Papageorgakopoulou, Georgios Gakis, Neil Murphy, Charalampos S Siristatidis","doi":"10.1002/14651858.CD016393","DOIUrl":"10.1002/14651858.CD016393","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 combined hormonal, progestin-only, and nonhormonal contraceptive methods for postpartum contraception in lactating individuals.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016393"},"PeriodicalIF":11.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023980","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":"Electrophysiology procedures for preventing falls in older people living in the community.","authors":"Kristen Gibson, Lauren Priest, Jane Ah Masoli, Vasi Naganathan, Anand Ganesan, Suzanne M Dyer","doi":"10.1002/14651858.CD016363","DOIUrl":"10.1002/14651858.CD016363","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane review (intervention). The objectives are as follows: To assess the efficacy and safety of electrophysiology procedures in preventing falls among older people living in the community.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016363"},"PeriodicalIF":11.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13598945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024066","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":"Biliary anastomosis using T-tube versus no T-tube for liver transplantation in adults.","authors":"Jose Jeova de Oliveira Filho, Rachel Riera, Diego R Kleinubing, Diego Adão, Daniel K Shiraiwa, Delcio Matos, Marcelo Moura Linhares","doi":"10.1002/14651858.CD013289.pub2","DOIUrl":"10.1002/14651858.CD013289.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;In liver transplantation, biliary reconstruction by performing bile duct anastomosis is a critical step of the operation. Biliary complications, especially fistula (leaks) and stenosis, remain the leading causes of morbidity and mortality. During the operation, surgeons can insert a T-tube into the bile duct following the bile duct reconstruction. This drain decompresses the biliary tract, and it is thought to reduce biliary tract-related complications. There is, however, no consensus on the use of a T-tube as a drainage technique during biliary reconstruction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of biliary anastomosis with the use of a T-tube compared with biliary anastomosis without the use of a T-tube in adults undergoing liver transplantation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE ALL Ovid, Embase Ovid, Latin American and Caribbean Health Science Information Database (LILACS; VHL Regional Portal), Science Citation Index Expanded (Web of Science), and Conference Proceedings Citation Index - Science (Web of Science). We also searched online trial registries, reviewed reference lists of identified studies, and contacted, when necessary, the main authors of the included trials. All electronic searches were performed on 28 April 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We considered for inclusion parallel-group randomised controlled trials (RCTs) comparing biliary reconstruction techniques, with or without a T-tube, in adults undergoing liver transplantation, irrespective of publication type, year, format, status, language, or reported outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were all-cause mortality, serious adverse events (including biliary leakage/fistula, stenosis, complications attributable to T-tube, retransplantation, and others), and health-related quality of life (HRQoL). Important outcomes were non-serious adverse events and pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane's risk of bias 1 (RoB 1) tool to assess the risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We used standard methodological procedures expected by Cochrane to develop the review. We analysed dichotomous outcomes using random-effects meta-analysis (inverse-variance method with restricted maximum likelihood estimation of the between-study variance) and expressed results as risk ratios (RR) with 95% confidence intervals (CI). We assessed the certainty of the evidence in the outcome results using the GRADE approach. We used the GRADE summary of findings table to display the outcome results for all-cause mortality and, among serious adverse events, anastomotic bile leak, anastomotic biliary stenosis, complications attributable to the T-tube, retransplantation, and serious biliary adverse events. We also ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD013289"},"PeriodicalIF":11.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015673","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":"Transanal tube for the prevention of anastomotic leakage in rectal cancer surgery.","authors":"Hidetaka Kawamura, Yasushi Tsujimoto, Teppei Miyakawa, Katsuhiko Hashimoto, Takaki Hirano, Michitaka Honda","doi":"10.1002/14651858.CD015472.pub2","DOIUrl":"10.1002/14651858.CD015472.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Anastomotic leakage is a serious complication of rectal cancer surgery, causing morbidity and increasing healthcare burden. A diverting stoma reduces anastomotic pressure but carries risks. A transanal tube near the anastomosis may reduce spasms and drain stool, potentially lowering leakage risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of a transanal tube for the prevention of anastomotic leakage in people undergoing rectal surgery, compared with no transanal tube.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, Embase via ProQuest, and four clinical trial registries. The latest search was conducted on 6 August 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included all randomised controlled trials (RCTs) that compared the use of a transanal tube with no intervention in adults undergoing rectal cancer surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcomes were anastomotic leakage, surgical re-intervention due to anastomotic leakage, and any postoperative adverse events other than anastomotic leakage within 30 days postoperatively. Important outcomes included the overall incidence of anastomotic leakage, postoperative length of hospital stay, accidental early removal of the transanal tube, and tube-related complaints.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane RoB 2 tool to assess risk of bias in the included RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We used random-effects meta-analyses to calculate risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). If meta-analysis was not feasible, we summarised the findings narratively. Heterogeneity was assessed using the I² statistic, and substantial heterogeneity (I² &gt; 50%) was explored via prespecified subgroup analysis. The certainty of evidence was evaluated with GRADE. Due to substantial heterogeneity in anastomotic leakage data, possibly influenced by diverting stoma status, we performed prespecified subgroup analyses according to diverting stoma status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;Four RCTs were included, involving 1318 participants: 666 in the transanal tube group and 652 in the no-intervention group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;All included studies were judged to have an overall risk of bias of \"some concerns\". Overall, the certainty of evidence ranged from very low to low because of the risk of bias, inconsistency, and imprecision. The evidence is very uncertain about the effect of a transanal tube on the risk of anastomotic leakage (RR 0.88, 95% CI 0.46 to 1.72; 4 RCTs, 1318 participants; very low-certainty evidence). The anticipated absolute risk of anastomotic leakage was 83 per 1000 in the no-intervention group and 73 per 1000 (95% CI 38 to 142) in the transanal tube group (NNT = 100). A test for subgroup differences suggested that the effect of a transanal tube di","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD015472"},"PeriodicalIF":11.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015700","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":"Osmotic and stimulant laxatives for the management of childhood constipation.","authors":"Morris Gordon, Shiyao Liu, Vasiliki Sinopoulou, Anna de Geus, Yuhong Yuan, M A Benninga, Merit M Tabbers","doi":"10.1002/14651858.CD016371","DOIUrl":"10.1002/14651858.CD016371","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane review (intervention). The objectives are as follows: To assess the efficacy and safety of osmotic and stimulant laxatives for the treatment of functional constipation in children.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016371"},"PeriodicalIF":11.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015679","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":"Mifepristone versus other interventions for the prevention of pregnancy in reproductive-age women using emergency contraception.","authors":"Shaalini Ramanadhan, Alison Edelman, Yan Che, Robin A Paynter, Alyssa Hersh, Jillian T Henderson","doi":"10.1002/14651858.CD016275","DOIUrl":"10.1002/14651858.CD016275","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Emergency contraception uses drugs or intrauterine devices to prevent pregnancy after unprotected intercourse. Understanding the effectiveness, safety, and acceptability of the various methods available is critical for reproductive healthcare providers and their patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the effectiveness, safety, and acceptability of mifepristone compared to other interventions in reproductive-age women using emergency contraception for the prevention of pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We used CENTRAL, MEDLINE, Embase, two other databases, and two trial registers, together with reference checking and contact with study authors and experts in the field, to identify the studies included in the review. The latest search date was 28 February 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomized controlled trials (RCTs) comparing mifepristone to oral emergency contraception pills (levonorgestrel, the Yuzpe regimen, and ulipristal acetate) or copper or levonorgestrel intrauterine devices (IUDs). We also planned to include non-randomized studies of interventions (NRSIs) for capturing rare adverse outcomes and detecting minimal clinically important differences (MCIDs). Participants were women seeking emergency contraception within five days of unprotected intercourse.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcome was the number of pregnancies. Important outcomes included any side effects, altered menses, and acceptability, assessed as treatment satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used Cochrane's RoB 1 tool to assess the risk of bias in the RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesized results for each outcome using meta-analysis where possible, using both fixed-effect and random-effects models. We used GRADE to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 87 studies with approximately 36,000 participants. Seventy-nine studies were conducted in China, four in the UK, two in Cuba, and two were multi-country studies. Forty-one studies compared mifepristone with levonorgestrel; three with the Yuzpe regimen (estrogen and progestin); 42 compared two or more doses of mifepristone; and two compared mifepristone with copper IUD. We excluded all relevant NRSIs identified because none reported additional outcome data that were unavailable from the included RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Mid-dose mifepristone (25 mg to 50 mg) versus levonorgestrel Compared to levonorgestrel, mid-dose mifepristone likely results in fewer pregnancies (risk ratio (RR) 0.67, 95% confidence interval (CI) 0.49 to 0.91; I&lt;sup&gt;2&lt;/sup&gt; = 0%; 27 studies, 6052 participants) and likely reduces the occurrence of any side effects (RR 0.55, 95% CI 0.39 to 0.76; I&lt;sup&gt;2&lt;/sup&gt; = 72%; 17 studies, 4350 participants), both with moderate-certainty evidence. It probably leads to fewer ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016275"},"PeriodicalIF":11.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012146","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":"Diagnostic accuracy of biological markers for detecting obstructive sleep apnoea.","authors":"Graziela De Luca Canto, Patricia Pauletto, Cristine M Stefani, Eliete Ns Guerra, Ana Carolina Pereira Nunes Pinto, Nelson Carvas Junior, Carlos Flores Mir, David Gozal, Virginia Fm Trevisani","doi":"10.1002/14651858.CD016281","DOIUrl":"10.1002/14651858.CD016281","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane review (diagnostic). The objectives are as follows: To determine the accuracy of any type of biological marker found in blood, saliva, urine or breath condensation to detect obstructive sleep apnoea (OSA) in adults (> 18 years). Secondary objectives To identify the accuracy of individual biomarkers alone or in combination for detecting OSA. To find the accuracy of biological markers compared to overnight polysomnography (PSG) and home sleep apnoea test (HSAT). To investigate the accuracy of biological markers compared to overnight PSG and to HSAT in people with different degrees of severity of OSA (mild, moderate, severe). To evaluate the accuracy of biomarkers from different sample types to identify OSA.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016281"},"PeriodicalIF":11.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012124","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":"Semi-recumbent position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation.","authors":"Wenjun Jiang, Yamin Chen, Xiao Li, Zhaoxia Li, Tyler Dong, Qiang Yuan, Xueli Tang, Zongxia Yang, Li Wang","doi":"10.1002/14651858.CD009946.pub3","DOIUrl":"10.1002/14651858.CD009946.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Ventilator-associated pneumonia (VAP) is associated with increased mortality, hospital stay, and healthcare costs in critically ill patients. Although guidelines recommend a semi-recumbent position for VAP prevention, the evidence remains uncertain due to limitations in prior reviews. This update revises the 2016 review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effectiveness and safety of semi-recumbent versus supine or another positioning, and different degrees or types of semi-recumbent positioning in mechanically ventilated intensive care unit (ICU) patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, AMED, three Chinese databases, and two trial registries up to 3 October 2025, and screened reference lists.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) comparing semi-recumbent versus supine or another positioning, or different degrees or types of semi-recumbent positioning in mechanically ventilated adult ICU patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Outcomes include clinically suspected or microbiologically confirmed VAP, ICU or hospital mortality, length of ICU or hospital stay, duration of ventilation, and pressure ulcers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed the risk of bias using Cochrane's RoB 1 tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Paired review authors independently screened studies, assessed risk of bias, and extracted data. We performed random-effects meta-analyses using mean difference (MD) for continuous and risk ratio (RR) for binary outcomes with 95% confidence intervals (CI). We evaluated evidence certainty using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;This update includes 38 new RCTs, making a total of 48 included studies (7955 participants).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;1. Semi-recumbent position versus supine position: 17 studies, 2640 participants A semi-recumbent position, versus a supine position, reduces clinically suspected VAP (RR 0.42, 95% CI 0.33 to 0.52; 14 studies, 2411 participants; high-certainty evidence), but may result in little to no difference in microbiologically confirmed VAP (RR 0.57, 95% CI 0.25 to 1.27; 5 studies, 555 participants; low-certainty evidence), and probably results in little to no difference in ICU or hospital mortality (RR 0.80, 95% CI 0.59 to 1.08; 3 studies, 430 participants; RR 0.86, 95% CI 0.67 to 1.12; 5 studies, 570 participants; both moderate-certainty evidence). Due to very low-certainty evidence, we do not know the effects on ICU or hospital length of stay (MD -3.25 days, 95% CI -7.14 to 0.63; 5 studies, 466 participants; MD -8.17 days, 95% CI -40.10 to 23.76; 3 studies, 320 participants). It may reduce the duration of ventilation (MD -3.26 days, 95% CI -6.02 to -0.51; 7 studies, 688 participants; low-certainty evidence). We do not know the effect on pressure ulcers (RR 0.69, 95% CI 0.30 to 1.56; 4 st","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD009946"},"PeriodicalIF":11.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012083","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}