Cochrane Database of Systematic Reviews最新文献

{"title":"Aural toilet (ear cleaning) for chronic suppurative otitis media.","authors":"Mahmood F Bhutta, Karen Head, Lee Yee Chong, Jessica Daw, Anne Gm Schilder, Christopher G Brennan-Jones","doi":"10.1002/14651858.CD013057.pub3","DOIUrl":"10.1002/14651858.CD013057.pub3","url":null,"abstract":"<p><strong>Background: </strong>Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media, is a chronic inflammation and often polymicrobial infection of the middle ear and mastoid cavity, characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Aural toileting describes processes for manually cleaning the ear, including dry mopping (with cotton wool or tissue paper), suction clearance (typically under a microscope), or irrigation (using manual or automated syringing). Aural toileting can be used alone or in addition to other treatments for CSOM, such as antibiotics or topical antiseptics. This is one of a suite of seven Cochrane reviews evaluating the effects of non-surgical interventions for CSOM. This is the first update of a Cochrane review published in 2020.</p><p><strong>Objectives: </strong>To assess the benefits and harms of aural toilet procedures for people with chronic suppurative otitis media.</p><p><strong>Search methods: </strong>We searched the Cochrane ENT Register, CENTRAL, Ovid MEDLINE, Ovid Embase, and five other databases. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP). The searches were run on 15 June 2022.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials with at least a one-week follow-up involving adults or children who had chronic ear discharge of unknown cause or CSOM, where the ear discharge had continued for more than two weeks. We included any aural toileting method as the intervention, at any frequency, and for any duration. The main comparisons were aural toileting versus placebo or no intervention, and one aural toileting method versus another aural toileting method. Within each comparison, we separated studies into those in which both groups received other concomitant treatments (e.g. antiseptics or antibiotics) and those without concomitant treatments.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methodology. Our primary outcomes were resolution of ear discharge or 'dry ear' (whether otoscopically confirmed or not), measured at one week to up to two weeks, two weeks to up to four weeks, and after four weeks; health-related quality of life using a validated instrument; and ear pain (otalgia) or discomfort or local irritation. Secondary outcomes were hearing, serious complications, and adverse events (dizziness/vertigo/balance problems, ear bleeding). We used GRADE to assess the certainty of the evidence for each outcome.</p><p><strong>Main results: </strong>This update did not find any new studies. We included three studies with 431 participants (465 ears) reporting on two comparisons. Two studies included only children with CSOM in the community (351 participants) and the other study (80 participants) included children and adults with chronic ear ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD013057"},"PeriodicalIF":8.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246778","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":"Topical antibiotics with steroids for chronic suppurative otitis media.","authors":"Christopher G Brennan-Jones, Karen Head, Lee Yee Chong, Jessica Daw, Tamara Veselinović, Anne Gm Schilder, Mahmood F Bhutta","doi":"10.1002/14651858.CD013054.pub3","DOIUrl":"10.1002/14651858.CD013054.pub3","url":null,"abstract":"<p><strong>Background: </strong>Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media (COM), is a chronic inflammation and often polymicrobial infection of the middle ear and mastoid cavity that is characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Topical antibiotics aim to kill or inhibit the growth of micro-organisms that may be responsible for the infection. Antibiotics can be used alone or in addition to other CSOM treatments, such as steroids, antiseptics or ear cleaning ('aural toileting'). Antibiotics are commonly prescribed in combined preparations with steroids. This is one of a suite of seven Cochrane reviews evaluating the effects of non-surgical interventions for CSOM. It is the first update of the original review published in 2020.</p><p><strong>Objectives: </strong>This review aims to assess the effects of adding a topical steroid to topical antibiotics in the treatment of people with chronic suppurative otitis media.</p><p><strong>Search methods: </strong>We searched the Cochrane ENT Specialised Register, CENTRAL, Ovid MEDLINE, Ovid EMBASE and five other databases on 15 June 2022. We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP).</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) that involved participants (adults and children) with chronic ear discharge of unknown cause or CSOM, where the ear discharge had continued for more than two weeks, and participants had been followed up for at least one week. The intervention of interest was any combination of a topical antibiotic agent(s) and a topical corticosteroid (steroid) applied directly into the ear canal.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methods. Primary outcomes were: resolution of ear discharge or 'dry ear' (whether otoscopically confirmed or not), measured at three time points (between one and two weeks, two weeks to four weeks and after four weeks); health-related quality of life; and ear pain (otalgia) or discomfort or local irritation. Secondary outcomes were hearing, serious complications and ototoxicity. We used GRADE to assess the certainty of the evidence for each comparison and outcome.</p><p><strong>Main results: </strong>This update found two new studies, bringing the total number of included studies to 19. The 19 studies addressed 13 treatment comparisons. The studies included a total of at least 2044 participants (one study of 40 ears did not report the number of participants). No studies reported health-related quality of life. 1. Topical antibiotics with steroids versus placebo or no treatment Three studies (210 participants) compared a topical antibiotic-steroid to saline or no treatment. Results for resolution of discharge were not reported at one to two weeks. One study (50 participants) re","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD013054"},"PeriodicalIF":8.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246781","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":"Antibiotics versus topical antiseptics for chronic suppurative otitis media.","authors":"Karen Head, Lee Yee Chong, Mahmood F Bhutta, Jessica Daw, Tamara Veselinović, Peter S Morris, Shyan Vijayasekaran, Anne Gm Schilder, Christopher G Brennan-Jones","doi":"10.1002/14651858.CD013056.pub3","DOIUrl":"10.1002/14651858.CD013056.pub3","url":null,"abstract":"<p><strong>Background: </strong>Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media, is a chronic inflammation and often polymicrobial infection of the middle ear and mastoid cavity. It is characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Antibiotics and antiseptics kill or inhibit the micro-organisms that may be responsible for the infection. Antibiotics can be applied topically or administered systemically via the oral or injection route. Antiseptics are always directly applied to the ear (topically).</p><p><strong>Objectives: </strong>To assess the benefits and harms of antibiotics versus antiseptics for people with chronic suppurative otitis media (CSOM).</p><p><strong>Search methods: </strong>We searched the Cochrane ENT Register, CENTRAL, Ovid MEDLINE, Ovid Embase, and five other databases. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (ICTRP). The latest search date was 15 June 2022.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) with at least a one-week follow-up involving adults and children who had chronic ear discharge of unknown cause or CSOM, where ear discharge had continued for more than two weeks. The intervention was any single, or combination of, antibiotic agent, whether applied topically (without steroids) or systemically. The comparison was any single, or combination of, topical antiseptic agent, applied as ear drops, powders, or irrigations, or as part of an aural toileting procedure. The comparisons were 1. topical antiseptics compared to topical antibiotics, and 2. topical antiseptics compared to systemic antibiotics. We further separated these comparisons into those in which a. both groups of participants received aural toileting in addition to the intervention, or b. both groups received some other add-on therapy treatment (such as systemic antibiotics) to both arms.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methodology. Our primary outcomes were resolution of ear discharge or 'dry ear' (whether otoscopically confirmed or not), measured at between one week and up to two weeks, two weeks to up to four weeks, and after four weeks; health-related quality of life using a validated instrument; and ear pain (otalgia) or discomfort or local irritation. Secondary outcomes were hearing, serious complications, and ototoxicity. We used GRADE to assess the certainty of the evidence for each outcome.</p><p><strong>Main results: </strong>This updated review included eight new studies. Overall, we identified 15 studies (2371 participants) across seven comparisons with antibiotics compared to acetic acid, aluminium acetate, boric acid, and povidone-iodine. None of the included studies reported health-related quality of life or serious complications. 1.","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD013056"},"PeriodicalIF":8.8,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246777","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":"Hormonal contraception for women at risk of HIV infection.","authors":"Christa Rohwer, Michael McCaul, G Justus Hofmeyr, Anke C Rohwer","doi":"10.1002/14651858.CD015701.pub2","DOIUrl":"10.1002/14651858.CD015701.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>There is controversy about a possible link between hormonal contraception, specifically injectable depot medroxyprogesterone acetate (DMPA) and HIV acquisition. Following the results of a large randomised controlled trial, there is a need to update the previous version of this Cochrane review.</p><p><strong>Objectives: </strong>To determine the effects of hormonal contraception on HIV acquisition in women who live in settings with high HIV prevalence.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, SCOPUS, Global Index Medicus and trial registries (together with reference checking, citation searching and contacting study authors), to identify studies up to 13 September 2023.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) comparing hormonal contraception with non-hormonal or other methods of contraception for women at high risk of HIV.</p><p><strong>Outcomes: </strong>Outcomes of interest were HIV acquisition, pregnancy, discontinuation of method, amenorrhoea, adverse events and condomless sexual activity.</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias 2 tool to assess bias in the RCTs.</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using random-effects meta-analysis where possible and meaningful. We assessed the certainty of evidence with GRADE.</p><p><strong>Included studies: </strong>We included four trials with 9726 participants, conducted across four countries.</p><p><strong>Synthesis of results: </strong>DMPA injection compared to copper intrauterine device (IUD) DMPA compared to copper IUD likely results in little to no difference in HIV acquisition (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.82 to 1.26; 2 RCTs, n = 6417; moderate-certainty evidence), resulting in one more woman per 1000 acquiring HIV (from 9 fewer to 13 more). DMPA compared to copper IUD results in a slight reduction in pregnancy (RR 0.53, 95% CI 0.39 to 0.71; 1 RCT, n = 5216; high-certainty evidence), resulting in 21 fewer women per 1000 becoming pregnant (from 27 to 13 fewer). DMPA compared to copper IUD results in a reduction in discontinuation of method (RR 0.50, 95% CI 0.40 to 0.62; 1 RCT, n = 5216; high-certainty evidence) and in adverse events (RR 0.53, 95% CI 0.38 to 0.75; 1 RCT, n = 5216; high-certainty evidence). In the DMPA group 'any unprotected sex' was reported at 66.4% of follow-up visits, compared to 70.9% in the copper IUD group. Levonorgestrel (LNG) implant compared to copper IUD LNG compared to copper IUD likely results in little to no difference in HIV acquisition (RR 0.84, 95% CI 0.66 to 1.06; 1 RCT, n = 5159; moderate-certainty evidence), resulting in nine fewer women per 1000 acquiring HIV (from 18 fewer to 3 more). LNG compared to copper IUD likely results in a slight reduction in pregnancy (RR 0.67, 95% CI 0.51 to 0.89; 1 RCT, n = 5220; moderate-certainty evidence), resulting ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD015701"},"PeriodicalIF":8.8,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12142725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233396","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":"Community care navigation intervention for people who are at risk of unplanned hospital presentations.","authors":"Rebecca K Pang, Brendan Shannon, Taya Collyer, Velandai Srikanth, Nadine E Andrew","doi":"10.1002/14651858.CD014713.pub2","DOIUrl":"10.1002/14651858.CD014713.pub2","url":null,"abstract":"<p><strong>Background: </strong>Care navigation is a type of care co-ordination used to manage people with chronic conditions with the goal of reducing unplanned hospital presentations and improving patient care and outcomes. Care navigation involves individual case management by a trained professional who is not involved in the person's direct care. Care navigation has been used in various healthcare settings, adopted as a single or multi-component intervention by different health services. However, little is known about its effect on unplanned hospital presentations and patient-reported outcome measures (PROMs).</p><p><strong>Objectives: </strong>Primary: to assess the effects of care navigation, delivered in the community, on hospital presentations and patient-reported outcome measures in people at risk of unplanned hospital presentations. Secondary: to assess whether the effects of community care navigation differ according to the type of clinician delivering the intervention and the populations receiving the intervention.</p><p><strong>Search methods: </strong>We used CENTRAL, MEDLINE, four other databases and two clinical trial registers, together with reference checking, citation searching and contact with study authors to identify the studies included in this review. The latest search date was October 2024.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) and cluster-RCTs that recruited people who were at risk of hospital admission and utilised care navigation delivered in the community as an intervention. The comparison was usual care.</p><p><strong>Data collection and analysis: </strong>Two review authors independently extracted data from the included studies, evaluated study quality, and judged the certainty of the evidence using the GRADE approach. We performed a meta-analysis of the results where possible, and a narrative synthesis of the remainder of the results. We present results in a summary of findings table, showing effect sizes for all outcomes.</p><p><strong>Main results: </strong>We included 19 studies (36,745 participants), all conducted in high-income countries. Eighteen were RCTs. Of these, four studies were pragmatic non-blinded RCTs that randomised participants prior to obtaining consent. One study was a cluster-RCT. Follow-up ranged from one to 24 months. All studies included various healthcare professionals as care navigators: registered nurses in seven studies, social workers in five, and community health workers in one. In six studies, a multidisciplinary team delivered the care navigation intervention. The studies investigated the effects of community care navigation interventions in a variety of groups, including older people, those with chronic diseases (such as heart failure, chronic obstructive pulmonary disease, diabetes, mental health problems, cancer, alcohol and other drug use), people with complex psychosocial needs, high readmission risk and frequent emergency dep","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD014713"},"PeriodicalIF":8.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224584","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":"Corticosteroids for treating sepsis in children and adults.","authors":"Djillali Annane, Josef Briegel, David Granton, Eric Bellissant, Pierre Edouard Bollaert, Didier Keh, Yizhak Kupfer, Romain Pirracchio, Bram Rochwerg","doi":"10.1002/14651858.CD002243.pub5","DOIUrl":"10.1002/14651858.CD002243.pub5","url":null,"abstract":"<p><strong>Background: </strong>Sepsis occurs when an infection is complicated by organ failure. Sepsis may be complicated by impaired corticosteroid metabolism. Thus, providing corticosteroids may benefit patients. This is an update of a review originally published in 2004 and previously updated in 2010, 2015 and 2019.</p><p><strong>Objectives: </strong>To examine the benefits and harms of corticosteroids in children and adults with sepsis.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, LILACS, ClinicalTrials.gov, ISRCTN and the WHO Clinical Trials Search Portal on 31 December 2023. In addition, we conducted reference checking and citation research, and contacted study authors, to identify additional studies as needed. We updated this search in December 2024, but these results have not yet been incorporated.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) of corticosteroids versus placebo or usual care (antimicrobials, fluid replacement and vasopressor therapy as needed) in children and adults with sepsis. We also included RCTs of continuous infusion versus intermittent bolus of corticosteroids.</p><p><strong>Data collection and analysis: </strong>We used the same methods in comparisons of corticosteroids versus placebo or usual care, and of continuous infusion versus intermittent bolus administration of corticosteroids. The primary outcome was all-cause mortality at 28 days. The most critical secondary outcomes were (i) all-cause mortality in the long term (last follow-up from 90 days to one year) and in the hospital; (ii) length of stay in the intensive care unit and in hospital; (iii) adverse effects, i.e. superinfection and muscle weakness (within 28 days). All review authors screened and selected studies for inclusion. One review author extracted data, which was checked by the others, and by the lead author of the primary study when possible. For this update, we used Covidence software for screening and selection of studies and abstraction of data by paired review authors, with discrepancies resolved by a third review author. We obtained unpublished data from the authors of some trials. We assessed the risk of bias in trials using the Cochrane risk of bias tool (RoB 1) and applied GRADE to assess the certainty of evidence. The review authors did not contribute to the assessment of eligibility or risk of bias, nor to data extraction, for the trials they had participated in.</p><p><strong>Main results: </strong>We included 87 trials (24,336 participants), of which six included only children, two included children and adults, and the remaining trials included only adults. Seventeen additional trials are ongoing and will be considered in future versions of this review. We judged 25 trials as being at low risk of bias. Corticosteroids versus placebo or usual care Compared to placebo or usual care, corticosteroids probably reduce 28-day mortality (risk ratio (RR) 0.89, 95% c","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD002243"},"PeriodicalIF":8.8,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224585","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":"The use of telemedicine services for medical abortion.","authors":"Amanda Cleeve, Antonella Lavelanet, Kristina Gemzell-Danielsson, Margit Endler","doi":"10.1002/14651858.CD013764.pub2","DOIUrl":"10.1002/14651858.CD013764.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Telemedicine models for medical abortion are service delivery models where care is provided by a health worker using telecommunications to support the abortion process. Existing evidence suggests that telemedicine for medical abortion is safe, effective, and acceptable to women compared to when care is provided in-clinic. However, the available data are often constrained by several factors. We sought to strengthen the evidence base by comparing telemedicine models for medical abortion with medical abortion provided in-clinic.</p><p><strong>Objectives: </strong>To assess the safety, success rate, and acceptability of telemedicine models for medical abortion, according to which phase or phases (pre-abortion, abortion, and/or post-abortion) telecommunications were used as the primary means of service delivery, compared to in-clinic care for medical abortion in the corresponding phase/phases.</p><p><strong>Search methods: </strong>We searched CENTRAL (Ovid EBM Reviews), MEDLINE ALL (Ovid), Embase.com, CINAHL (EBSCOhost), LILACS, Global Health (Ovid), Scopus, Google Scholar, and grey literature sources from the inception of the database to 13 August 2024. We screened the references of included studies and contacted authors to identify additional data or enquire about ongoing studies.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and non-randomised studies (NRS) of telemedicine models compared with in-clinic care (standard care) for medical abortion. We only included studies that used an interactive type of telecommunication and studies where telemedicine services were provided by a health worker.</p><p><strong>Outcomes: </strong>Critical: successful abortion (a terminated pregnancy without the need for surgical intervention to complete the abortion within 42 days of the abortion). Important: continuing pregnancy, blood transfusion, hospitalisation, emergency visits, satisfaction, adherence.</p><p><strong>Risk of bias: </strong>We used the RoB 2 and ROBINS-I tools to assess the risk of bias in the included RCTs and NRS, respectively.</p><p><strong>Synthesis methods: </strong>Two review authors (AC and ME) independently screened and extracted data in Covidence. We grouped interventions according to which abortion phase or phases (pre-abortion, abortion, post-abortion) telecommunications were used to deliver care. We graded the certainty of the evidence using the GRADE approach.</p><p><strong>Included studies: </strong>We included 22 studies: six RCTs and 16 NRS, comprising a total of 131,278 individuals undergoing medical abortion up to 12 weeks' gestation. Studies were conducted across five high-income and four middle-income countries. Due to the heterogeneity among included NRS, we performed meta-analyses only for comparisons where we had RCTs.</p><p><strong>Synthesis of results: </strong>Main intervention: Pre- to post-abortion care telemedicine models for medical abortion ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD013764"},"PeriodicalIF":8.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215142","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":"Regional analgesia techniques for postoperative pain after breast cancer surgery: a network meta-analysis.","authors":"Pascal Rd Clephas, Sharon Orbach-Zinger, Martina A Gosteli-Peter, Moshe Hoshen, Stephen Halpern, Nicole D Hilber, Cornelia Leo, Michael Heesen","doi":"10.1002/14651858.CD014818.pub2","DOIUrl":"10.1002/14651858.CD014818.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Postoperative pain is an important outcome for individuals undergoing breast cancer surgery. Regional analgesia techniques are considered integral to postoperative pain management, but are not without risks.</p><p><strong>Objectives: </strong>To assess the analgesic benefits and harms of different regional analgesia techniques in women undergoing breast cancer surgery.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, CINAHL, Scopus, and Web of Science from inception to 6 June 2023 without restrictions on language, publication year, or publication status.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) comparing two or three of the following regional analgesia techniques in women undergoing breast cancer surgery: paravertebral block (PVB), erector spinae plane block (ESPB), pectoral nerve block (PEC), and serratus anterior plane block (SAPB).</p><p><strong>Outcomes: </strong>Our critical outcomes were postoperative pain (rated on a visual analogue scale (VAS) or numeric rating scale (NRS) of 0-10) and rates of regional analgesia-related complications. Our important outcomes were quality of recovery, time to first analgesic request, postoperative opioid and nonsteroidal anti-inflammatory drug (NSAID) use, and postoperative nausea and vomiting (PONV).</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool (RoB 2) to assess risk of bias.</p><p><strong>Synthesis methods: </strong>We conducted network meta-analyses (NMAs) using multivariate frequentist random-effects models to calculate mean differences (MDs), standardised mean differences (SMDs), or risk ratios (RRs), each with its 95% confidence interval (CI). We used CINeMA to rate the certainty of evidence. We only included studies with an overall low risk of bias in the primary analysis. For postoperative pain, we considered one point difference as the minimal clinically important difference (MCID).</p><p><strong>Included studies: </strong>We included 39 RCTs with a total of 2348 participants. The studies were conducted between 2013 and 2023 in Egypt, India, Turkey, China, Japan, USA, and Thailand. Most used single-shot long-acting anaesthetics administered with ultrasound guidance. In 35 studies, the surgery was modified radical mastectomy. All studies performed surgery under general anaesthesia in the hospital. Our primary analysis for postoperative pain included 16 studies.</p><p><strong>Synthesis of results: </strong>Critical outcomes Postoperative pain at rest at two hours This NMA included seven studies (384 participants). PEC is slightly more effective than PVB in reducing postoperative pain at rest at two hours (MD -0.47, 95% CI -0.73 to -0.22; P < 0.001, I<sup>2</sup> = 0%; high-certainty evidence), but this difference is smaller than the MCID. Compared with PVB, ESPB is similarly effective (MD -0.12, 95% CI -0.31 to 0.07; P = 0.21, I<sup>2</sup> = 0%; high-certaint","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD014818"},"PeriodicalIF":8.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215141","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":"Effects of combinations of diagnostic and treatment strategies for postpartum haemorrhage: a network meta-analysis.","authors":"Idnan Yunas, Malcolm J Price, Kugajeevan Vigneswaran, Aurelio Tobias, Adam J Devall, Arri Coomarasamy","doi":"10.1002/14651858.CD016259","DOIUrl":"10.1002/14651858.CD016259","url":null,"abstract":"<p><strong>Rationale: </strong>Postpartum haemorrhage (PPH) is a major cause of maternal mortality worldwide. The combination of accurate diagnosis and effective treatment is necessary to improve outcomes. There is uncertainty about which combination of diagnostic and treatment strategies is most effective.</p><p><strong>Objectives: </strong>To assess the comparative effectiveness of various combinations of 'diagnostic and treatment' strategies for PPH in women giving birth, and rank them. To explore the relative effects of various diagnostic strategies, when the treatment strategies are the same or similar. To explore the relative effects of various treatment strategies, when the diagnostic strategies are the same or similar.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform to 18 October 2024.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials or cluster-randomised trials comparing the effects of different combinations of 'diagnostic and treatment' strategies for PPH were eligible. We included studies of women having vaginal or caesarean birth in any setting.</p><p><strong>Outcomes: </strong>Critical outcomes were: PPH ≥ 500 mL within 24 hours after birth; additional blood loss of ≥ 500 mL following diagnosis of PPH and within 24 hours after birth; PPH ≥ 1000 mL within 24 hours after birth; need for blood transfusion; use of additional uterotonics, and PPH treatment rate. Important outcomes included maternal death.</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool (RoB 1).</p><p><strong>Synthesis methods: </strong>At least two review authors independently assessed trials for inclusion, trustworthiness, risk of bias, and certainty of the evidence using GRADE. We calculated direct and indirect effect estimates, where possible, for critical and important outcomes. Due to limited data, we were unable to perform pairwise meta-analyses and network meta-analyses for the available combinations, or generate rankings.</p><p><strong>Included studies: </strong>We included five trials (10 trial arms, 236,771 women); all included women giving birth vaginally and four had a hospital setting. The combinations of diagnostic and treatment strategies were: visual estimation-based diagnosis plus usual care for treatment; 3-option trigger PPH diagnosis with calibrated drape (1. clinical concern, or 2. blood loss ≥ 300 mL to < 500 mL plus abnormal observations, or 3. blood loss ≥ 500 mL) plus MOTIVE (uterine Massage, Oxytocics, Tranexamic acid, IntraVenous fluids, and Examination and Escalation of care) treatment bundle; 2-option trigger PPH diagnosis with calibrated drape (1. clinical concern, or 2. blood loss ≥ 500 mL) plus MOTIVE treatment bundle; calibrated drape-based diagnosis plus usual care for treatment; gravimetric method-based diagnosis plus usual care for treatment; MaternaWell t","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD016259"},"PeriodicalIF":8.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215139","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":"Immunomodulators and immunosuppressants for myasthenia gravis: a network meta-analysis.","authors":"Lucia B Varela, Nicolás Meza, Camila Micaela Escobar Liquitay, Samanta Díaz Menai, Juan Franco, Luis Garegnani","doi":"10.1002/14651858.CD016208","DOIUrl":"10.1002/14651858.CD016208","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary To assess the comparative benefits and harms of immunomodulators and immunosuppressants for people with generalised myasthenia gravis through a network meta-analysis. Secondary To estimate the relative ranking of immunomodulators and immunosuppressants according to their effects.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"6 ","pages":"CD016208"},"PeriodicalIF":8.8,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12135144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215140","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}