Cochrane Database of Systematic Reviews最新文献

{"title":"Implementation strategies for WHO guidelines to prevent, detect, and treat postpartum hemorrhage.","authors":"Katherine Semrau, Ethan Litman, Rose L Molina, Megan Marx Delaney, Leslie Choi, Lindsay Robertson, Anna H Noel-Storr, Jeanne-Marie Guise","doi":"10.1002/14651858.CD016223","DOIUrl":"10.1002/14651858.CD016223","url":null,"abstract":"<p><strong>Rationale: </strong>Despite World Health Organization (WHO) guidelines for preventing, detecting, and treating postpartum hemorrhage (PPH), effective implementation has lagged.</p><p><strong>Objectives: </strong>To evaluate the clinical benefits and harms of implementation strategies used to promote adherence to WHO clinical guidelines for the prevention, detection, and treatment of PPH.</p><p><strong>Search methods: </strong>We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and two trial registries, along with reference checking, citation searching, and contact with study authors. The latest search date was 25 April 2024.</p><p><strong>Eligibility criteria: </strong>We included randomized controlled trials (RCTs), including cluster, pragmatic, and stepped-wedge designs, and non-randomized studies of interventions (NRSIs), including interrupted time series (ITS) studies, controlled before-after (CBA) studies, and follow-up (cohort) studies containing concurrent controls that focused on or described implementation strategies of WHO guidelines for the prevention, detection, and treatment of PPH. Participants were birth attendants and people giving birth in a hospital or healthcare facility. We excluded studies that did not implement a WHO PPH recommendation, had no comparator group, or did not report clinical/implementation outcomes.</p><p><strong>Outcomes: </strong>Our critical outcomes were: adherence to WHO-recommended guidelines for PPH prevention, detection, and treatment; PPH ≥ 500 mL; PPH ≥ 1000 mL; additional uterotonics within 24 hours after birth; blood transfusions; maternal death; severe morbidities (major surgery; admission to intensive care unit [ICU]); and adverse effects (variable and related to the clinical intervention) during hospitalization for birth. Our important outcomes were: breastfeeding at discharge; implementation outcomes such as acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability of the implementation strategy; and health professional outcomes such as knowledge and skill.</p><p><strong>Risk of bias: </strong>We used the RoB 2 and ROBINS-I tools to assess risk of bias in RCTs and NRSIs, respectively.</p><p><strong>Synthesis methods: </strong>Two review authors independently selected studies, performed data extraction, and assessed risk of bias and trustworthiness. Due to the nature of the data, we reported relevant results for each comparison and outcome but did not attempt quantitative synthesis. We used GRADE to assess the certainty of evidence.</p><p><strong>Included studies: </strong>We included 13 studies (9 cluster-RCTs and 4 NRSIs) with a total of 1,027,273 births and more than 4373 birth attendants. The included studies were conducted in 17 different countries. Most trials were conducted in resource-limited settings. None of the included studies reported data on the use of additional uter","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016223"},"PeriodicalIF":8.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of SARS-CoV-2 vaccination in pregnancy to prevent COVID-19 in mothers and early infancy.","authors":"Odette de Bruin, Emily Wem Phijffer, Fariba Ahmadizar, Nicoline At Van der Maas, Joanne G Wildenbeest, Miriam Cjm Sturkenboom, Louis J Bont, Carlos E Durán, Kitty Wm Bloemenkamp","doi":"10.1002/14651858.CD015785","DOIUrl":"10.1002/14651858.CD015785","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of SARS-CoV-2 vaccination during pregnancy, versus placebo or no vaccination during pregnancy, for preventing COVID-19 disease in mothers and infants.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD015785"},"PeriodicalIF":8.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499682","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":"Balloon dilatation of the Eustachian tube for obstructive Eustachian tube dysfunction in adults.","authors":"Chloe Swords, Matthew E Smith, Anant Patel, Gill Norman, Alexis Llewellyn, James R Tysome","doi":"10.1002/14651858.CD013429.pub2","DOIUrl":"10.1002/14651858.CD013429.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Eustachian tube dysfunction (ETD) causes symptoms and signs of pressure dysregulation in the middle ear, and is associated with tympanic membrane retraction, otitis media with effusion, and chronic otitis media. Interventions aiming to improve symptoms can be non-surgical or surgical, including balloon dilatation of the Eustachian tube, also known as balloon eustachian tuboplasty (BET) for obstructive ETD. However, existing published evidence for the effectiveness and safety of BET remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the effects of balloon dilatation of the Eustachian tube in adults with obstructive Eustachian tube dysfunction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid M&gt;DLINE; Ovid Embase; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The final search was updated on 18th January 2024. There were no restrictions on language, publication date or study setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;Randomised controlled trials were included if they allocated adult participants with chronic obstructive ETD to treatment randomly and compared BET with non-surgical treatment, no treatment, or other surgical treatment. Studies with other designs were excluded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;At least two review authors independently selected trials using predetermined inclusion criteria, assessed the risk of bias, extracted data, and rated the certainty of evidence (CoE) according to GRADEpro. Statistical analyses were performed using a random-effects model and interpreted according to the most recent version of the Cochrane Handbook. Predefined primary outcomes were obstructive ETD symptoms, Eustachian tube function (objective or semi-objective tests), or serious adverse events. Secondary outcomes were hearing, tympanic membrane abnormalities, quality of life, and other adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;Nine trials were identified with 684 randomised participants across three comparisons: BET versus non-surgical treatment (five trials, 422 participants), BET versus no treatment (sham surgery; one trial, 17 participants), and BET versus other surgery (four trials, 275 participants). None of the studies were rated with an overall low risk of bias. Comparing BET to non-surgical treatment up to three months, there is low-certainty evidence showing that BET may reduce patient-reported ETD symptoms (change in ETDQ-7: mean difference (MD) -1.66 (95% CI -2.16 to -1.16; I&lt;sup&gt;2&lt;/sup&gt; = 63%; 4 RCTs, 362 participants)). There is very low-certainty evidence that BET may improve ETD as assessed by objective or semi-objective measures (improvement in tympanometry: RR 2.51 (95% CI 1.82 to 3.48; I&lt;sup&gt;2&lt;/sup&gt; = 0%; 3 RCTs, 369 participants). Between three and 12 months, the evidence i","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD013429"},"PeriodicalIF":8.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499681","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":"Non-vitamin K antagonist oral anticoagulants (NOACs) after transcatheter aortic valve replacement (TAVR): a network meta-analysis.","authors":"Samer Al Said, Klaus Kaier, Edris Nury, Dima Alsaid, C Michael Gibson, Jeroen Bax, Dirk Westermann, Joerg J Meerpohl","doi":"10.1002/14651858.CD013745.pub2","DOIUrl":"10.1002/14651858.CD013745.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Balancing the risk of thromboembolism and bleeding after transcatheter aortic valve replacement (TAVR) remains clinically challenging. Questions regarding the efficacy and safety of non-vitamin K oral anticoagulants (NOACs) after TAVR still need to be definitively answered.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the efficacy and safety of NOACs after TAVR in individuals with and without indication for anticoagulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, Web of Science, ClinicalTrials.gov, and WHO ICTRP on 7 October 2023 together with reference checking and citation searching to identify additional studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We searched for randomised controlled trials (RCTs) that compared NOACs versus antiplatelet therapy or vitamin K antagonists (VKAs) after TAVR in adults with or without an indication for anticoagulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard Cochrane methods and conducted random-effects pair-wise analyses and network meta-analyses (NMAs). Our primary outcomes were all-cause mortality, cardiovascular mortality, stroke, and major bleeding. We used GRADE to assess the certainty of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included four RCTs with 4808 participants in the NMA. Of these, one compared rivaroxaban versus antiplatelet therapy in people without an indication for anticoagulation after TAVR; one compared apixaban versus antiplatelet therapy in people without an indication for anticoagulation or versus VKA in people with an indication for anticoagulation after TAVR; one compared edoxaban versus VKA in people with an indication for anticoagulation after TAVR; and one compared edoxaban with antiplatelet therapy in people without an indication for anticoagulation after TAVR. The mean age of trial participants was 81 years. Follow-up duration ranged from 6 to 18 months. Overall, we judged the risk of bias in the included trials to be low in all domains except for blinding, which was assessed as high in all four studies. No studies evaluated dabigatran. In people without an indication for anticoagulation, rivaroxaban and apixaban may increase all-cause mortality after TAVR as compared to antiplatelet therapy (rivaroxaban: risk ratio (RR) 1.67, 95% confidence interval (CI) 1.13 to 2.46; studies = 1, participants = 1644; moderate-certainty evidence; apixaban: RR 1.71, 95% CI 0.97 to 3.02; studies = 1, participants = 1049; low-certainty evidence), while edoxaban may result in little or no difference (RR 1.59, 95% CI 0.27 to 9.36; studies = 1, participants = 229; low-certainty evidence). Low-certainty evidence suggests little or no difference between rivaroxaban, apixaban, or edoxaban and antiplatelet therapy in cardiovascular mortality (rivaroxaban: RR 1.28, 95% CI 0.78 to 2.10; studies = 1, participants = 1644; apixaban: RR 1.30, 95% CI 0.64 to 2.65; studies = 1, participants = 1049; ed","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD013745"},"PeriodicalIF":8.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482323","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":"Effectiveness of SARS-CoV-2 testing strategies.","authors":"K M Saif-Ur-Rahman, Nadra Nurdin, Ani Movsisyan, Kavita Kothari, Thomas Conway, Marie Tierney, Petek Eylul Taneri, Deirdre Mulholland, Andrea C Tricco, Jacqueline Dinnes, Declan Devane","doi":"10.1002/14651858.CD016192","DOIUrl":"10.1002/14651858.CD016192","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of different SARS-CoV-2 testing strategies in reducing COVID-19 cases, hospitalisations, and deaths among suspected cases and asymptomatic individuals.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016192"},"PeriodicalIF":8.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482321","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":"Acupuncture for neonatal abstinence syndrome in newborn infants.","authors":"Berndt Urlesberger, Rita Cabano, Greg Soll, Adrienne Pahl, Ju Lee Oei, Georg M Schmölzer, Wolfgang Raith, Matteo Bruschettini","doi":"10.1002/14651858.CD014160.pub2","DOIUrl":"10.1002/14651858.CD014160.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Neonatal abstinence syndrome (NAS) is a drug-withdrawal syndrome, mostly occurring after antenatal exposure to opioids. A neonate may be born physically dependent on opioid medications, which causes withdrawal symptoms (such as high-pitched crying, disruptions in the sleep-wake cycle and tremors) after birth. This is diagnosed with a standardised withdrawal assessment, such as the Finnegan score. Newborns developing NAS require medical treatment and longer hospital stays after birth than neonates without this condition. Treatments for NAS include multiple multimodal treatments to ease symptoms of withdrawal, such as swaddling, 'rooming in' and breastfeeding. If the standardised assessment exceeds a certain threshold, newborns are treated pharmacologically with an orally administered opioid. However, optimal NAS management continues to be debated. Acupuncture has been proposed as a potential intervention. Acupuncture involves stimulation of specific points on the body, either through the insertion of thin metal needles or with techniques that do not penetrate the skin, such as acupressure and laser.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess if acupuncture (acupressure, needle, laser) reduces the treatment duration of neonatal abstinence syndrome (NAS) in newborn infants, reduces adverse events and reduces length of hospital stay.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We used bibliographic databases (CENTRAL, PubMed, Embase) and trial registries, together with reference checking, citation searching and contact with study authors, to identify the studies that are included in the review. The latest search date was 25 August 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) or quasi-RCTs, and cluster-randomised trials. We included infants born at full term and late preterm who were diagnosed with NAS within the first 72 hours after birth (i.e. showing significant signs as assessed using a standardised NAS assessment tool, e.g. presenting with withdrawal syndrome and Finnegan score &gt; 8). We included studies where acupuncture (using invasive or non-invasive techniques) was compared with: 1) no intervention; 2) placebo or sham treatment; 3) any pharmacological treatment; or 4) another type of acupuncture (e.g. penetration of the skin with a needle versus acupressure). Acupuncture could be given alone or in combination with conventional medical treatment for NAS ('standard care'), as long as the latter was administered to the control group as well.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used the standard methodological procedures expected by Cochrane. Our primary outcomes were duration of any pharmacological treatment for NAS, adverse events and length of hospital stay. We used GRADE to assess the certainty of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included two single-centre RCTs (104 infants). Both studies compared non-invasive acupuncture added","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD014160"},"PeriodicalIF":8.8,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466936","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":"Cardiovascular training for fatigue in people with cancer.","authors":"Carina Wagner, Moritz Ernst, Nora Cryns, Annika Oeser, Sarah Messer, Andreas Wender, Joachim Wiskemann, Freerk T Baumann, Ina Monsef, Paul J Bröckelmann, Ulrike Holtkamp, Roberta W Scherer, Shiraz I Mishra, Nicole Skoetz","doi":"10.1002/14651858.CD015517","DOIUrl":"10.1002/14651858.CD015517","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Cancer-related fatigue (CRF) is the most prevalent and severe symptom among people with cancer. It can be attributed to the cancer itself or to anticancer therapies. CRF affects the individual physically and mentally, and cannot be alleviated by rest. Studies show a positive effect of exercise on CRF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the effects of cardiovascular training on cancer-related fatigue (CRF), quality of life (QoL), adverse events, anxiety, and depression in people with cancer, with regard to their stage of anticancer therapy (before, during, or after), up to 12 weeks, up to six months, or longer, postintervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and World Health Organization ICTRP to identify studies that are included in the review. The latest search date was October 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) evaluating cardiovascular training for CRF or QoL, or both, in people with cancer. Trials were eligible if training was structured, included at least five sessions, and instruction was face-to-face (via video tools or in person). We excluded studies with fewer than 20 randomised participants per group and where only an abstract was available.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were: short-, medium-, long-term CRF and QoL. Important outcomes were adverse events, and short-, medium-, long-term anxiety and depression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane RoB 1 tool to assess bias in RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We used standard Cochrane methodology. We synthesised results for each outcome using meta-analysis where possible (inverse variance or Mantel-Haenszel; random-effects model). We pooled data for the respective assessment periods above. We used GRADE to assess certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 23 RCTs with 2135 participants, of whom 96.6% originated from high-income countries; 1101 participants were randomised to cardiovascular training and 1034 to no training. Studies included mostly females who were diagnosed with breast cancer. We also identified 36 ongoing and 12 completed studies that have not yet published (awaiting assessment). We only present findings on CRF, QoL and adverse events. For details regarding anxiety and depression, see full text.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Cardiovascular training before anticancer therapy versus no training for people with cancer We identified no studies for inclusion in this comparison. Cardiovascular training during anticancer therapy versus no training for people with cancer We included 10 studies (1026 participants); eight studies contributed data to quantitative analyses (860 participants). Cardiovascular training probably reduces short-term CRF slightly (mean difference (MD) 2.85, 95% con","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD015517"},"PeriodicalIF":8.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457070","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":"Tumor necrosis factor (TNF) inhibitors for juvenile idiopathic arthritis.","authors":"Giovanni Cagnotto, Carsten B Juhl, Fredrik Ahlström, Filip Wikström, Matteo Bruschettini, Ingemar Petersson, Lene Dreyer, Michele Compagno","doi":"10.1002/14651858.CD013715.pub2","DOIUrl":"10.1002/14651858.CD013715.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Juvenile idiopathic arthritis (JIA) is a rheumatic disorder that causes chronic joint inflammation beginning before the age of 16 years. Pharmacological treatment necessary to prevent joint destruction and functional impairment includes non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroids, conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate (MTX), and biologic DMARDs (bDMARDs) such as tumor necrosis factor inhibitors (TNFi), abatacept, anakinra, and tocilizumab. More recently, targeted synthetic DMARDs (tsDMARDs) like tofacitinib, baricitinib, and upadacitinib have been approved for the treatment of JIA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of TNFi in children with JIA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), Embase (via Ovid), and ClinicalTrials.gov and the WHO ICTRP from inception to 28 February 2024, with no language restrictions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomized controlled trials (RCTs), quasi-RCTs, and data from the randomized part of withdrawal trials conducted in individuals with JIA where TNFi were compared to placebo, MTX, NSAIDs, other bDMARDs, tsDMARDs, or other TNFi. Our major outcomes were treatment response, pain, function, participant global assessment of well-being (disease activity), remission, withdrawals due to adverse events, and serious adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard Cochrane methods. At least two review authors performed study selection, data extraction, and risk of bias and GRADE assessment. The primary comparison was TNFi versus placebo. The primary time point was up to 16 weeks and up to the end of the trials for efficacy and safety outcomes, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included nine studies with 678 participants (80% females) with JIA. The mean age of participants ranged from 8 to 15 years, and the mean duration of symptoms ranged from 0.8 years to 6.7 years. Seven studies compared TNFi to placebo (570 participants), and two studies compared TNFi combined with MTX to MTX alone (108 participants). We identified no studies investigating the other predefined comparisons. Only two studies had a low risk of bias in all domains, while five studies had a high risk of bias in at least one domain, predominantly other bias. Two studies were at unclear risk of selection bias, and two studies were at unclear risk of detection bias. TNFi versus placebo Benefits at up to 16 weeks Low-certainty evidence (downgraded for risk of bias and imprecision) suggests that treatment with TNFi may increase the likelihood of achieving a treatment response, defined as pedACR70 (34% compared to 14% with placebo) (risk ratio [RR] 2.47, 95% confidence interval [CI] 1.48 to 4.14; 4 studies, 245 participants). The evidenc","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD013715"},"PeriodicalIF":8.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457080","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":"Carbon dioxide detection for diagnosis of inadvertent respiratory tract placement of enterogastric tubes in children.","authors":"Fiona Smith, Agi McFarland, Marie Elen","doi":"10.1002/14651858.CD011196.pub2","DOIUrl":"10.1002/14651858.CD011196.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The insertion of an enterogastric tube (oral or nasal) (EGT) is the passage of a tube through the nose or mouth into the stomach. In a paediatric setting, EGTs are used within clinical practice for a variety of reasons including enteral feeding, decompression, post-gastrointestinal surgery, patient assessment, and drug and fluid administration. Confirmation of EGT placement is required immediately following insertion and thereafter prior to each use, including after the administration of enteral feed or medication. Although the majority of these tubes are inserted and used without incident, there is an established risk that the tube can be misplaced into the lungs or move out of the stomach. This misplacement can result in significant harm or mortality. As such, diagnostic tests are required to assess the placement of EGTs and to rule out the target condition of potential airway placement. Various methods are used to determine EGT position, including bedside assessment and observing for signs of respiratory distress. Air insufflated (blown) through the EGT in combination with epigastric auscultation (listening to the stomach with a stethoscope) for whooshing sounds has also been used. Although these tests are widely recognised, they are not officially recommended for use as standalone measures of EGT placement. Current American and UK guidelines recommend a combination of aspirate testing and radiological confirmation of EGT placement in infant, child, and adult populations. In adults, objective measures of pH of the aspirate may be used, with a pH reading between 1 and 5.5 considered a reliable method for excluding placement in the pulmonary tree. However, testing for acidity of aspirate obtained from the EGT does not accurately differentiate between bronchial and gastric secretions in paediatric practice. Additionally, there may be difficulty in obtaining aspirate from the EGT especially within a paediatric population due to the size of the EGT and the smaller volumes of gastric secretions produced. Radiography or direct visualisation are the only reliable methods of confirming EGT placement (valid at time of X-ray and point of insertion, respectively) in this population and are thus considered the reference standard. However, within the paediatric population, there is a known difficulty with obtaining radiographs that visualise the entire course of the EGT and a recognised risk in radiation exposure in the paediatric setting. The measurement of carbon dioxide (CO₂) in exhaled air is a recognised and mandatory standard of care for confirming and monitoring endotracheal tube or airway placement under general anaesthesia. The measurement of CO₂ can be achieved in one of two ways: capnography or colorimetric capnometry. Capnography is the measurement of inspired and expired CO₂ using the absorption of infrared light by CO₂ molecules to estimate CO₂ concentrations. These measurements are then displayed against time t","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD011196"},"PeriodicalIF":8.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448501","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":"Angioplasty or stenting for deep venous thrombosis.","authors":"Ronald Lg Flumignan, Luis Cu Nakano, Carolina Dq Flumignan, Jose Cc Baptista-Silva","doi":"10.1002/14651858.CD011468.pub2","DOIUrl":"10.1002/14651858.CD011468.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The best medical treatment (BMT) for treating deep venous thrombosis (DVT) includes anticoagulation and compression stockings. Angioplasty and stenting restore vessel patency and facilitate blood flow. In some people with DVT, angioplasty or stenting is used to minimise complications such as post-thrombotic syndrome (PTS), but their effects are under discussion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of adjunctive angioplasty or stenting on a background treatment of anticoagulation and thrombolysis, compared with BMT, sham procedure, thrombolysis, or any combination of these treatments, in people with DVT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, LILACS, IBECS, CINAHL, and AMED databases, as well as the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers, to 20 April 2023. We checked the bibliographies of included trials for further references to relevant trials and contacted specialists in the field, manufacturers, and authors of the included trials for any unpublished data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) comparing angioplasty or stenting on a background treatment of anticoagulation and thrombolysis, compared with BMT, sham procedure, thrombolysis, or any combination of these treatments, in the management of people with acute obstruction due to DVT. We excluded participants who had a baseline PTS diagnosis or who had received any form of mechanical thrombectomy, as this was investigated in a separate Cochrane review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard Cochrane methods. The primary outcomes were PTS and venous thromboembolism (VTE); secondary outcomes were mortality, major bleeding, secondary patency, duration of hospitalisation, quality of life (QoL), and adverse events. We used the Cochrane RoB 1 tool to assess the risk of bias for RCTs and GRADE to assess the certainty of evidence. We performed meta-analysis where appropriate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included two RCTs (134 participants) that were conducted in China and presented comparisons for acute obstruction after DVT based on length of follow-up (12 months (early), 24 months (intermediate), and 36 months (long term)). Angioplasty or stenting plus BMT and thrombolysis versus BMT and thrombolysis for acute obstruction due to DVT (intermediate time point) In the intermediate time point, angioplasty or stenting may have little to no effect on PTS (Venous Clinical Severity Score (VCSS): mean difference (MD) -3.21, 95% confidence interval (CI) -7.74 to 1.33; 2 studies, 133 participants; very low-certainty evidence) and adverse events (limb pain) (risk ratio (RR) 0.68, 95% CI 0.04 to 10.33; 1 study, 67 participants; very low-certainty evidence), but the evidence is very uncertain. Angioplasty or stenting may increase secondary patency (RR 0.","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD011468"},"PeriodicalIF":8.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448498","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}