Cochrane Database of Systematic Reviews最新文献

{"title":"Bioimpedance spectroscopy to estimate target weight in patients on maintenance haemodialysis.","authors":"Kaiane Stigger, Eduardo Ribes Kohn, Rony Kafer Nobre, Guilherme Pitol, Natan Feter, Maristela Bohlke","doi":"10.1002/14651858.CD016044","DOIUrl":"10.1002/14651858.CD016044","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 incorporating bioimpedance spectroscopy into the clinical assessment for estimating target weight in maintenance haemodialysis recipients compared with physical examination alone.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016044"},"PeriodicalIF":8.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079942","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":"Active treatments for unilateral amblyopia in adults.","authors":"Catherine Suttle, Miriam Conway, Lisa Asper, Rakhee Shah, Sieu Khuu, John G Lawrenson","doi":"10.1002/14651858.CD016116","DOIUrl":"10.1002/14651858.CD016116","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 monocular and binocular (known as dichoptic) active treatments for unilateral amblyopia in adults.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016116"},"PeriodicalIF":8.8,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074560","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":"Melatonin for blood pressure control in adults.","authors":"Muhammad Zia Ul Haq, Javeria Mansoor, Celia C Lima Dos Santos, Aida A Perez Ramos, Emilio Pinzon Cueva, Arash Harzand","doi":"10.1002/14651858.CD016159","DOIUrl":"10.1002/14651858.CD016159","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Critical objective To assess the effects of oral melatonin supplementation (immediate‑release (IR) and controlled‑/sustained‑release CR/SR; any dose; ≥ 1 week) versus placebo or no treatment on change in systolic and diastolic blood pressure (SBP, DBP) in adults. Important objectives To examine dose‑response relationships between melatonin dose and changes in SBP and DBP. To assess effects by key participant and intervention characteristics (prespecified subgroups): baseline blood pressure status; concomitant antihypertensive medication use; presence of diagnosed sleep disorder/insomnia; melatonin formulation (IR versus CR/SR); blood pressure measurement method (office versus ambulatory versus home; daytime versus nocturnal); age (< 65 versus ≥ 65 years); sex. To evaluate adverse events (serious and non‑serious) and select patient‑important outcomes (quality of life, sleep quality). To describe any reported longer‑term cardiovascular outcomes (e.g. incident cardiovascular disease events, mortality) when sufficient data are available. These analyses are exploratory given anticipated sparse data.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016159"},"PeriodicalIF":8.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12439326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069105","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":"Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting: a network meta-analysis.","authors":"Anna Lee, Jack Zhenhe Zhang, Jing Xie, Vesa Cheng, Man Kin Henry Wong, Derek King Wai Yau","doi":"10.1002/14651858.CD003281.pub5","DOIUrl":"10.1002/14651858.CD003281.pub5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Antiemetic drugs are only partially effective in preventing PONV. Stimulating the PC6 acupoint(s) on the wrist offers an alternative approach, but the effectiveness of the various common techniques is unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To update and compare the effects and safety of PC6 acupoint stimulation with or without antiemetic drug(s) versus sham or antiemetic drug(s) for preventing postoperative nausea (PON) and postoperative vomiting (POV) in people undergoing surgery, and to identify the most effective techniques using network meta-analyses (NMAs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, ISI Web of Science, CINAHL, WHO Global Index Medicus, major trial registries, and reference lists of articles for studies up to 6 June 2025, with no language restrictions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Parallel randomised controlled trials of techniques that compared any combinations of PC6 acupoint stimulation, drug therapy, and sham for preventing PONV in children and adults were eligible. Interventions included invasive techniques (e.g. needle acupuncture) and noninvasive techniques (e.g. acupressure wristbands). Drug therapy included antiemetics that belonged to one of the following substance classes: 5-HT&lt;sub&gt;3&lt;/sub&gt; receptor antagonists, D&lt;sub&gt;2&lt;/sub&gt; receptor antagonists, corticosteroids, and antihistamines. The sham group included sham PC6 interventions and/or placebo saline antiemetic interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical outcomes: incidence of PON and POV. Important outcomes: need for rescue antiemetic therapy when prophylaxis failed and adverse events (side effects).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed the risk of bias in the included studies using RoB 1.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We performed frequentist NMAs using random-effects models to report risk ratios (RRs) with 95% confidence intervals (95% CIs). We compared the relative effects (with sham as reference) of six broad classes of PC6 acupoint stimulation techniques and their combined use with antiemetic drugs on the outcomes. We summarised the safety data narratively due to heterogeneous reporting of adverse events (side effects). We assessed the certainty of evidence of the NMA treatment effect on outcomes according to the CINeMA and GRADE approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;This update included 77 trials, conducted between 1986 and 2022, involving 9847 participants. The majority were adults across several countries (USA, South Korea, India, China, Turkey, and Iran). There were 58 (33.9%) sham groups, 16 (9.4%) invasive PC6 acupoint stimulation groups, 50 (29.3%) noninvasive PC6 acupoint stimulation groups, 32 (18.7%) antiemetic(s) groups, 4 (2.3%) combined invasive PC6 acupoint stimulation and antiemetic(s) groups, 10 (5.8%) combin","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD003281"},"PeriodicalIF":8.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039262","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":"Ocular light exposure interventions for sleep, circadian rhythms, rest-activity cycles, mood, and cognitive function in older adults: An Overview of Cochrane and non-Cochrane Systematic Reviews.","authors":"Resshaya Roobini Murukesu, Zahrah Alwi Alkaff, Charlene Bridges, Manuel Spitschan","doi":"10.1002/14651858.CD016157","DOIUrl":"10.1002/14651858.CD016157","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (overview). The objectives are as follows: To summarise the evidence on the effects of ocular light exposure interventions on sleep, circadian rhythms, rest-activity cycles, mood, and cognitive function in older adults. To outline opportunities and challenges for developing evidence-based recommendations for the effective use of ocular light exposure for older adults. To highlight areas of remaining uncertainty and gaps in the evidence regarding the effects of ocular light exposure interventions on sleep, circadian rhythms, rest-activity cycles, mood, and cognitive function in older adults.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016157"},"PeriodicalIF":8.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12427608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039277","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":"Probiotics for the prevention of Clostridioides difficile-associated diarrhea in adults and children.","authors":"Zahra Esmaeilinezhad, Nirjhar Ruth Ghosh, Catharine M Walsh, Jeremy P Steen, Angelica M Burgman, Dominik Mertz, Bradley C Johnston","doi":"10.1002/14651858.CD006095.pub5","DOIUrl":"10.1002/14651858.CD006095.pub5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Antibiotics can disturb gastrointestinal microbiota, which may lead to reduced resistance to pathogens such as Clostridioides difficile. Probiotics are live microbial preparations that, when administered in adequate amounts, may confer a health benefit to the host, and are a potential C difficile infection prevention strategy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of probiotics for preventing C difficile-associated diarrhea (CDAD) in adults and children receiving an antibiotic for any reason.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, and Ovid Embase from 18 March 2017 (search date of the previous version of the review) to 3 March 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomized controlled trials with a placebo, alternative prophylaxis, or no-treatment control investigating probiotics (any strain or dose) for the prevention of CDAD in adults and children receiving an antibiotic for any reason.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcome was incidence of CDAD. Important outcomes included detection of C difficile in stool (i.e. colonization in absence of symptoms), adverse events, antibiotic-associated diarrhea (AAD), and length of hospital stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Two review authors independently assessed risk of bias using Cochrane's RoB 1 tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We pooled dichotomous outcomes (e.g. incidence of CDAD) using a random-effects complete-case model to calculate the risk ratio (RR) and absolute risk reduction (ARR) and corresponding 95% confidence interval (95% CI). We pooled continuous outcomes (e.g. length of hospital stay) using a random-effects model to calculate the mean difference (MD) and corresponding 95% CI. We conducted sensitivity analyses to explore the impact of missing outcome data on benefits and harms outcomes. To investigate heterogeneity, we conducted a priori subgroup analyses on risk of bias, probiotic dose, probiotic species, adults versus children, inpatients versus outpatients, and the event rate in the control group for developing CDAD (low 0% to 2%; moderate 3% to 5%; high &gt; 5%). The certainty of the evidence for each outcome was independently assessed using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;Eight new studies (n = 4595) met our inclusion criteria, for a total of 47 included studies (n = 15,260). Although we noted a high risk of bias in individual studies for sequence generation or allocation concealment, this did not impact our findings. Around 30% of studies lacked a published protocol or clinical trial registration, and in some cases there were inconsistencies between the reported methods and published results. We noted authors' affiliation with a probiotic company and financial support received from probiotic companies in 28 studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of res","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD006095"},"PeriodicalIF":8.8,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12424122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032841","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":"Prognostic models for radiation-induced complications after radiotherapy in head and neck cancer patients.","authors":"Toshihiko Takada, Makbule Tambas, Enrico Clementel, Artuur Leeuwenberg, Marjan Sharabiani, Johanna Aag Damen, Zoë S Dunias, Jan F Nauta, Demy L Idema, Jungyeon Choi, Lotta M Meijerink, Johannes A Langendijk, Karel Gm Moons, Ewoud Schuit","doi":"10.1002/14651858.CD014745.pub2","DOIUrl":"10.1002/14651858.CD014745.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Radiotherapy is the mainstay of treatment for head and neck cancer (HNC) but may induce various side effects on surrounding normal tissues. To reach an optimal balance between tumour control and toxicity prevention, normal tissue complication probability (NTCP) models have been reported to predict the risk of radiation-induced side effects in patients with HNC. However, the quality of study design, conduct, and analysis (i.e. risk of bias (ROB)), as well as the predictive performance of these models, remains to be evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To identify, describe and appraise NTCP models to predict the risk of radiation-induced side effects in patients with HNC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched Ovid MEDLINE, Embase and the World Health Organization International Clinical Trials Registry Platform from conception to January 2024. In addition, we screened references cited in the retrieved articles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;Two review authors independently included articles reporting on the development and external validation of NTCP models to predict any type of radiation-induced side effects in patients with HNC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;One reviewer extracted data from each article based on the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies and assessed their applicability and ROB using the Prediction model ROB Assessment Tool, while another reviewer carefully verified the results. For models externally validated at least twice for the same outcome as their original developmental study, we performed qualitative analyses of the model performance. The GRADE system was not applied, since it has not been established for reviews of prognostic model studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;Amongst 592 models developed from 143 articles, including 140,767 HNC patients, only 49 (8%) models from six articles were judged to have low ROB and low concerns for applicability. No external validation was performed for 480 models (81%). For the remaining 112 models and six additional models which were not eligible for the present review, 152 external validations were performed in 34,304 patients with HNC in 41 articles. The results of models externally validated at least twice are discussed below. Models for xerostomia Amongst 275 models for xerostomia, two models were externally validated at least twice. The Beetz 2012b model for xerostomia six months after radiotherapy was validated in two studies. C-statistics ranged from 0.70 to 0.74. Calibration performance was reported in one study. One validation study was rated as having low ROB in all domains, while the other was rated as having high ROB in the analysis domain. The Cavallo 2021 model for acute xerostomia during radiotherapy for patients with nasopharyngeal cancer was externally validated in the same study, using two different ty","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD014745"},"PeriodicalIF":8.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029179","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 children and adolescents with type 1 diabetes in low- and middle-income countries: a scoping review.","authors":"Brenda Bongaerts, Anna Leuwer, Fayola Sadiq, Benedikt Wolters, Yang Guo, Karina Tapinova, Omolola T Alade, Heidrun Janka, Juan Va Franco","doi":"10.1002/14651858.CD016214","DOIUrl":"10.1002/14651858.CD016214","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In order to improve the outcomes of children and adolescents with type 1 diabetes mellitus (T1DM), access to and quality of comprehensive acute and chronic care services in low- and middle-income countries (LMIC) must be improved.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To identify and summarise the characteristics of models of care for T1DM in children and adolescents in LMIC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and the World Health Organization (WHO) Global Index Medicus from inception to 11 December 2023 without restrictions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We conducted a scoping review following the Joanna Briggs Institute guidelines. We included all study types describing the implemented organisation (setting, healthcare facilities, financial resources) and delivery of T1DM care (treatment, self-management support, clinical monitoring) for the management of T1DM in children and adolescents in LMIC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently screened and selected eligible studies, and charted relevant data from the included studies. The charted data were presented in a descriptive format.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 40 studies that described models for T1DM care in 19 LMICs across the different WHO regions. African Region We identified models of care in Cameroon, Kenya, Rwanda, Tanzania, and Uganda, largely supported by international initiatives like Changing Diabetes in Children (CDiC) and Life for a Child (LFAC). Models were implemented between 2004 and 2012, and aimed to enhance infrastructure and care delivery, including access to insulin, glucose monitoring supplies, and diabetes education for patients and caregivers. Multidisciplinary teams provided care across urban and rural settings, with some countries offering tele-support and diabetes camps. Financial and logistical barriers persisted despite governmental and humanitarian support. Region of the Americas We identified models of care in Brazil and Cuba, focusing on reducing complications, training human resources, and supporting psychosocial development. In Brazil, care was delivered at a secondary-level facility by a multidisciplinary team. In Cuba, care was provided by a tertiary-level childhood diabetes clinic. Both models emphasised diabetes education for patients and families, regular specialist consultations, and community awareness initiatives. Unique features included holiday camps in Cuba and internship programs for healthcare professionals in Brazil. Diabetes care in Brazil was free, with additional resources for those in need. South-East Asia Region We identified models of care in Bangladesh, India, Myanmar, Sri Lanka, and Thailand, with implementation between 2009 and 2015. These models aimed to improve access to care, self-management education, and awareness amongst healthcare ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016214"},"PeriodicalIF":8.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145029128","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":"Virtual reality simulation training for health professions trainees in gastrointestinal endoscopy.","authors":"Nasruddin Sabrie, Rishad Khan, Joanne Plahouras, Bradley C Johnston, Michael A Scaffidi, Samir C Grover, Catharine M Walsh","doi":"10.1002/14651858.CD008237.pub4","DOIUrl":"10.1002/14651858.CD008237.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Training in endoscopy has traditionally been based upon an apprenticeship model, where novices develop their skills on real patients under the supervision of experienced endoscopists. In an effort to prioritise patient safety, simulation training has emerged as a means to allow novices to practice in a risk-free environment. This is the second update of the review, which was first published in 2012 and updated in 2018. It evaluates the effectiveness of virtual reality (VR) simulation training in gastrointestinal endoscopy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine whether VR simulation training can supplement and/or replace early conventional endoscopy training (apprenticeship model) in diagnostic oesophagogastroduodenoscopy, colonoscopy, and/or sigmoidoscopy for health professions trainees with limited or no prior endoscopic experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, and 13 other databases, together with reference checking and handsearching of review articles, conference abstracts and proceedings, to identify the studies included in the review. We conducted database searches to 18 October 2023, and grey literature searches to December 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised and quasi-randomised clinical trials comparing VR endoscopy simulation training to any other method of endoscopy training (e.g. conventional patient-based training, another form of endoscopy simulation), or no training. We also included trials comparing two different methods of VR training. We included only trials evaluating outcomes on humans in the clinical setting. Participants were health professions trainees: physicians (medical students, residents, fellows, and practitioners), nurses, and physician assistants with limited or no prior endoscopy experience.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two authors independently assessed the eligibility and methodological quality of trials, and extracted trial characteristics and outcome data. The primary outcome was the composite score of competency, as defined by authors. Secondary outcomes were independent procedure completion, performance time, adverse event or critical flaw occurrence, patient discomfort, global rating of performance, and visualisation of mucosa. We pooled data for meta-analysis where participant groups were similar, studies assessed the same intervention and comparator, and had similar definitions of outcome measures. We calculated risk ratios (RRs) for dichotomous outcomes with 95% confidence intervals (CIs). We calculated mean differences (MDs) and standardised mean differences (SMDs) with 95% CIs for continuous outcomes when studies reported the same or different outcome measures, respectively. We used GRADE to rate the certainty of evidence. We assessed the risk of bias using the original Cochrane domain-based tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 20 trials (","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD008237"},"PeriodicalIF":8.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013979","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":"Opioid agonist therapy for opioid use disorder in primary versus specialty care.","authors":"Danielle Perry, Jessica Em Kirkwood, Marissa L Doroshuk, Michael Kelmer, Christina S Korownyk, Joey Ton, Scott R Garrison","doi":"10.1002/14651858.CD013672.pub2","DOIUrl":"10.1002/14651858.CD013672.pub2","url":null,"abstract":"<p><strong>Background: </strong>Opioid use disorder (OUD) is commonly treated in specialized care settings with long-acting opioid agonists, also known as opioid agonist therapy, or OAT. Despite the rise in opioid use globally and evidence for a 50% reduction in mortality when OAT is employed, the proportion of people with OUD receiving OAT remains small. One initiative to improve the access and uptake of OAT could be to offer OAT in a primary care setting; primary care clinics are more numerous, might reduce the visibility and potential stigma of receiving treatment for OUD, and may facilitate the care of other medical conditions that are unrelated to OUD. However, it is unknown how effective treating OUD in primary care would be.</p><p><strong>Objectives: </strong>To assess the benefits and harms of using opioid agonist therapy (OAT) to treat people with opioid use disorder (OUD) in a primary care setting, as compared to a traditional specialty care setting.</p><p><strong>Search methods: </strong>We searched the Cochrane Drugs and Alcohol Group Specialized Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, three other databases, and two trials registers in March 2025. We did not restrict searches by language or publication date.</p><p><strong>Selection criteria: </strong>Eligible studies were parallel randomized controlled trials (RCTs) and cluster-randomized trials comparing OAT for OUD treatment in primary care versus specialty care settings. Participants were community-dwelling adults with OUD, as identified and defined by trial-specific inclusion criteria. We excluded trials if they included only pregnant women, or those who were incarcerated, but accepted all other comorbidity requirements (e.g. being HIV positive).</p><p><strong>Data collection and analysis: </strong>Primary outcomes included treatment retention, abstinence from non-prescribed opioids, major adverse events, and withdrawals due to adverse events. Secondary outcomes were other patient-oriented outcomes, including quality of life, patient satisfaction, all-cause mortality, opioid-related mortality, all-cause hospitalization or emergency room visit, all-cause incarceration, and minor adverse events. Two review authors independently extracted data using a predesigned RCT template in Covidence. We assessed risk of bias using the Cochrane RoB 1 tool, and certainty of evidence using GRADE. We analyzed outcomes using Review Manager and a random-effects model to account for variability in care models and populations.</p><p><strong>Main results: </strong>We included seven RCTs involving 1992 participants. The studies were completed in France (1 study), Ukraine (1 study), and the US (5 studies), and enrolled predominantly males (75%) with a mean age of 38 years. Risk of bias in individual trials was typically low or unclear in all domains except for blinding, where it was high, given participants and providers could not realistically be blinded to setting. One","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD013672"},"PeriodicalIF":8.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145014017","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}