Cochrane Database of Systematic Reviews最新文献

{"title":"Semi-recumbent position for the prevention of ventilator-associated pneumonia in adults requiring mechanical ventilation.","authors":"Wenjun Jiang, Yamin Chen, Xiao Li, Zhaoxia Li, Tyler Dong, Qiang Yuan, Xueli Tang, Zongxia Yang, Li Wang","doi":"10.1002/14651858.CD009946.pub3","DOIUrl":"10.1002/14651858.CD009946.pub3","url":null,"abstract":"<p><strong>Rationale: </strong>Ventilator-associated pneumonia (VAP) is associated with increased mortality, hospital stay, and healthcare costs in critically ill patients. Although guidelines recommend a semi-recumbent position for VAP prevention, the evidence remains uncertain due to limitations in prior reviews. This update revises the 2016 review.</p><p><strong>Objectives: </strong>To assess the effectiveness and safety of semi-recumbent versus supine or another positioning, and different degrees or types of semi-recumbent positioning in mechanically ventilated intensive care unit (ICU) patients.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, AMED, three Chinese databases, and two trial registries up to 3 October 2025, and screened reference lists.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) comparing semi-recumbent versus supine or another positioning, or different degrees or types of semi-recumbent positioning in mechanically ventilated adult ICU patients.</p><p><strong>Outcomes: </strong>Outcomes include clinically suspected or microbiologically confirmed VAP, ICU or hospital mortality, length of ICU or hospital stay, duration of ventilation, and pressure ulcers.</p><p><strong>Risk of bias: </strong>We assessed the risk of bias using Cochrane's RoB 1 tool.</p><p><strong>Synthesis methods: </strong>Paired review authors independently screened studies, assessed risk of bias, and extracted data. We performed random-effects meta-analyses using mean difference (MD) for continuous and risk ratio (RR) for binary outcomes with 95% confidence intervals (CI). We evaluated evidence certainty using GRADE.</p><p><strong>Included studies: </strong>This update includes 38 new RCTs, making a total of 48 included studies (7955 participants).</p><p><strong>Synthesis of results: </strong>1. Semi-recumbent position versus supine position: 17 studies, 2640 participants A semi-recumbent position, versus a supine position, reduces clinically suspected VAP (RR 0.42, 95% CI 0.33 to 0.52; 14 studies, 2411 participants; high-certainty evidence), but may result in little to no difference in microbiologically confirmed VAP (RR 0.57, 95% CI 0.25 to 1.27; 5 studies, 555 participants; low-certainty evidence), and probably results in little to no difference in ICU or hospital mortality (RR 0.80, 95% CI 0.59 to 1.08; 3 studies, 430 participants; RR 0.86, 95% CI 0.67 to 1.12; 5 studies, 570 participants; both moderate-certainty evidence). Due to very low-certainty evidence, we do not know the effects on ICU or hospital length of stay (MD -3.25 days, 95% CI -7.14 to 0.63; 5 studies, 466 participants; MD -8.17 days, 95% CI -40.10 to 23.76; 3 studies, 320 participants). It may reduce the duration of ventilation (MD -3.26 days, 95% CI -6.02 to -0.51; 7 studies, 688 participants; low-certainty evidence). We do not know the effect on pressure ulcers (RR 0.69, 95% CI 0.30 to 1.56; 4 st","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD009946"},"PeriodicalIF":11.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifactorial and multiple component interventions for preventing falls in older people living in the community.","authors":"Cynthia Swarnalatha, Lianne Wood, Paul Newell, Christopher E Clark, Olubusola Adedire, Lindy Clemson, Catherine Sherrington, Sarah E Lamb","doi":"10.1002/14651858.CD012221.pub3","DOIUrl":"10.1002/14651858.CD012221.pub3","url":null,"abstract":"<p><strong>Rationale: </strong>Multifactorial fall prevention interventions are those where intervention components are tailored to each person's individual fall risk factor profile. Multiple component interventions provide the same components to everyone. The evidence on the effects of these interventions is inconclusive. This review updates one published on the Cochrane Library in 2018.</p><p><strong>Objectives: </strong>To assess the effects of multifactorial and multiple component fall prevention interventions compared to usual care or attention control, exercise, and falls prevention advice or education in community-dwelling older people.</p><p><strong>Search methods: </strong>We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, ClinicalTrials.gov, the WHO ICTRP, and reference lists, without restrictions on language or full-text publication, on 16 May 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) of community-dwelling older people (≥ 60 years) evaluating multifactorial or multiple component fall prevention interventions. We excluded quasi-randomised trials, stroke or Parkinson's disease populations, and comparisons with single active interventions other than exercise.</p><p><strong>Outcomes: </strong>Our critical outcomes were falls rate (falls per person-year), risk of falling (number of people sustaining one or more falls), and risk of recurrent falls (number of people sustaining two or more falls).</p><p><strong>Risk of bias: </strong>We assessed risk of bias in the included studies using Cochrane's RoB 1 tool.</p><p><strong>Synthesis methods: </strong>We calculated rate ratios (RaR) and risk ratios (RR) with 95% confidence intervals (CIs). Where possible, outcomes were synthesised using random-effects meta-analysis and pooled with the generic inverse-variance method; otherwise, findings were narratively summarised. We assessed the certainty of evidence using the GRADE approach.</p><p><strong>Included studies: </strong>This update includes 110 RCTs involving 48,919 older people.</p><p><strong>Synthesis of results: </strong>Risk of bias was mixed, and there was potential publication bias in a few comparisons. Multifactorial interventions versus usual care or attention control Multifactorial interventions may reduce falls rate (RaR 0.76, 95% CI 0.67 to 0.87; I² = 92%; 29 trials, 9442 participants; low-certainty evidence) and the risk of recurrent falls (RR 0.87, 95% CI 0.78 to 0.98; I² = 45%; 17 trials, 4826 participants; low-certainty evidence). They may have little or no effect on the risk of falling (RR 0.95, 95% CI 0.90 to 1.01; I² = 55%; 38 trials, 12,774 participants; low-certainty evidence). Multifactorial interventions versus exercise The evidence on falls rate and risk of falling is very uncertain (very low-certainty evidence). Risk of recurrent falls was not evaluated. Multifactorial interventions versus falls advice or education Mul","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD012221"},"PeriodicalIF":11.1,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012066","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":"Lower-limb neuromuscular electrical stimulation (NMES) for adults with kidney failure undergoing dialysis.","authors":"Louise Beresford, Louise C Burgess, Susan Dewhurst, Alastair Hutchison, Anand D Pandyan","doi":"10.1002/14651858.CD016155.pub2","DOIUrl":"10.1002/14651858.CD016155.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Loss of skeletal muscle mass and function is a common, debilitating complication of kidney failure for individuals undergoing dialysis. It contributes to reduced physical capacity, quality of life (QoL), and increased death. Exercise training can mitigate these effects, but participation is often limited by comorbidities, fatigue, and logistical constraints of dialysis treatment. Neuromuscular electrical stimulation (NMES) offers a potential alternative or adjunct to exercise by inducing muscle contractions through surface electrodes. Despite increasing research interest, the evidence for its effectiveness and safety in adults with kidney failure undergoing dialysis remains uncertain. This review systematically evaluates the effects of lower-limb NMES training programmes on muscle structure and function, physical performance, cardiovascular outcomes, and biochemical markers in adults receiving dialysis.</p><p><strong>Objectives: </strong>The aim of this review was to assess the effects of NMES, compared with no NMES, on critical and important outcomes in adults with kidney failure receiving dialysis. The objectives were to evaluate the effect of NMES on critical outcomes, including life participation, fatigue, cardiovascular outcomes, pain, infection, death, and vascular access problems, and on important outcomes, including muscle function, functional performance, muscle structure, QoL, mechanisms, and treatment experience.</p><p><strong>Search methods: </strong>The Cochrane Kidney and Transplant Information Specialist conducted comprehensive searches in CENTRAL, MEDLINE, Embase, and trial registries, including ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform. Searches had no restrictions on language, publication date, or status (search date 16 June 2025). We hand-searched the reference lists of included studies and relevant reviews to identify additional studies.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and cluster RCTs evaluating lower-limb NMES interventions delivered via surface electrodes in adults (≥ 18 years) with kidney failure receiving haemodialysis or peritoneal dialysis. Eligible comparators included usual care, sham NMES, or exercise (where a usual care control was also present). We excluded studies using single-session NMES or NMES in transient acute dialysis samples, combining NMES with concurrent exercise without a control group, or conducted in non-dialysis chronic kidney disease populations. We contacted authors to obtain missing data when necessary.</p><p><strong>Outcomes: </strong>Critical outcomes included life participation, cardiovascular outcomes (blood pressure and resting heart rate), death, fatigue, pain, infection, and vascular access problems. Important outcomes included muscle function, functional performance, muscle structure, QoL, biochemical or hormonal markers related to muscle metabolism and inflammat","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016155"},"PeriodicalIF":11.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988345","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":"Exercise-based cardiac rehabilitation for coronary heart disease.","authors":"Grace Dibben, Frederique Bg de Vries, James Faulkner, Neil Oldridge, Karen Rees, Niels A Stens, Dick Thijssen, David R Thompson, Ann-Dorthe Zwisler, Rod S Taylor","doi":"10.1002/14651858.CD001800.pub5","DOIUrl":"10.1002/14651858.CD001800.pub5","url":null,"abstract":"<p><strong>Rationale: </strong>Coronary heart disease (CHD) is the leading cause of death globally. CHD mortality rates remain steady in low- and middle-income countries but are declining in high-income countries, meaning more people are living with CHD and need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health outcomes of people with CHD.</p><p><strong>Objectives: </strong>To assess the clinical and cost-effectiveness of exercise-based CR (exercise training alone or combined with psychosocial/educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD.</p><p><strong>Search methods: </strong>We updated searches from the previous Cochrane review, searching CENTRAL, MEDLINE, Embase, Web of Science, CINAHL, and two clinical trials registers in March 2026.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) of exercise-based CR, compared with 'no exercise' control, with follow-up of six months or longer, in adults with CHD.</p><p><strong>Outcomes: </strong>Primary outcomes included mortality (all-cause and cardiovascular), fatal and non-fatal myocardial infarction (MI), revascularisation (coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI)), and hospitalisation (all-cause and cardiovascular). Secondary outcomes included HRQoL and cost-effectiveness. We categorised follow-up as short-term (6 to 12 months), medium-term (> 12 to 36 months), and long-term (> 36 months).</p><p><strong>Risk of bias: </strong>We assessed risk of bias with the Cochrane Risk of bias 1 tool (RoB 1).</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis where possible, using random-effects models to calculate risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. We stratified meta-analyses by follow-up duration and used univariable meta-regression to explore potential sources of between-study heterogeneity. Where meta-analysis was not possible, we narratively synthesised results. We used GRADE to assess certainty of evidence for primary outcomes at short-term follow-up (the most common time point).</p><p><strong>Included studies: </strong>This review included 107 trials (26,886 adults with CHD). This update identified 22 new trials (3456 participants). Most participants were post-MI or post-revascularisation; their mean age ranged from 47 to 81 years. Although 78% of trials included women, they represented only 17% of the participants overall. Most trials were conducted in high-income settings in Europe (51/107, 48%), Asia (28/107, 26%) and North America (14/107, 13%). Twenty-six trials (11 in this update) were undertaken in low- and middle-income countries (LMICs). Overall, trial reporting was poor, although there was evidence of an ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD001800"},"PeriodicalIF":11.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988266","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":"Service delivery interventions for lipid testing and lipid-lowering therapy for primary and secondary prevention of cardiovascular disease in adults.","authors":"Ana-Mihaela Zorger, Annalena Muth, Kamyar Shokraee, Siavosh Olfati, Ina Monsef, Juan Va Franco, Nicole Skoetz","doi":"10.1002/14651858.CD016382","DOIUrl":"10.1002/14651858.CD016382","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 service-delivery interventions for lipid testing and lipid-lowering therapies, such as point-of-care testing and non-physician-led or collaborative care programmes, for primary or secondary prevention of cardiovascular disease.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016382"},"PeriodicalIF":11.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988324","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":"Monitoring strategies in adults eligible for pharmacological lipid-lowering therapy.","authors":"Kamyar Shokraee, Brenda Bongaerts, Petek Eylul Taneri, Camila Micaela Escobar Liquitay, Siavosh Olfati, Ana-Mihaela Zorger, Nicole Skoetz, Juan Va Franco","doi":"10.1002/14651858.CD016386","DOIUrl":"10.1002/14651858.CD016386","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 different laboratory monitoring strategies for treatment efficacy (lipid levels) and treatment safety (hepatic, muscular, and renal parameters) in adults eligible for or receiving pharmacological lipid-lowering therapy for primary and/or secondary prevention of cardiovascular disease, including whether such monitoring is performed and the frequency or timing with which it is repeated.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016386"},"PeriodicalIF":11.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988316","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":"Progesterone receptor modulators for endometriosis.","authors":"Alexandros Loukas Grammatis, Tatjana Gibbons, Eberechi N Anucha, Christian M Becker","doi":"10.1002/14651858.CD009881.pub3","DOIUrl":"10.1002/14651858.CD009881.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Endometriosis is defined as the presence of endometrium-like tissue developing outside the uterine cavity. This condition is oestrogen-dependent and thus is seen primarily during the reproductive years. Owing to their antiproliferative effects on the endometrium, progesterone receptor modulators (PRMs) have been advocated for the treatment of endometriosis. This is an update of a Cochrane review previously published in 2017.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effectiveness and safety of progesterone receptor modulators (PRMs) in the management of endometriosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;To identify studies, we searched online sources, including the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, ClinicalTrials.gov and the WHO (World Health Organization) trial registry up to 16 April 2026. We also checked reference lists and contacted study authors and experts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) comparing PRMs with placebo, no treatment or other medical treatment, in women with symptomatic endometriosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were overall pain; improvement in the most troublesome symptom, including dysmenorrhoea and dyspareunia; and adverse events resulting from the PRM intervention. Our important outcomes included quality of life (QoL) and patient satisfaction with treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane tool RoB 2 to assess the risk of bias in the outcomes of this review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors independently assessed studies against the inclusion criteria, extracted data and assessed risk of bias, consulting a third review author where required. We analysed dichotomous outcomes using Mantel-Haenszel odds ratios (ORs), 95% confidence intervals (CIs) and the fixed-effect model. We analysed continuous outcomes using the mean difference (MD) between groups, presented with 95% CIs. We employed the GRADE approach to assess the certainty of the evidence as high, moderate, low or very low.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;No new studies were eligible for inclusion in this update. Of the nine studies (922 women) already included in the review, two compared mifepristone versus placebo or compared different doses of mifepristone, and four either compared gestrinone versus danazol, gestrinone versus gonadotropin-releasing hormone (GnRH) analogues or compared different doses of gestrinone. One study compared asoprisnil versus placebo. The asoprisnil study did not provide extractable numerical data and was included in the narrative synthesis only. Two of the studies did not report any of the review's prespecified outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Certainty of the evidence We judged the certainty of evidence as low to very low. The main limitations of the evidence were","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD009881"},"PeriodicalIF":11.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975896","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":"Vitamin D supplementation for prevention of vitamin D deficiency in preterm and low birth weight infants.","authors":"Pramod Pharande, Jennifer L Middleton, Chris Cooper, Mohan Pammi, David A Osborn, Mohamed E Abdel-Latif","doi":"10.1002/14651858.CD011529.pub2","DOIUrl":"10.1002/14651858.CD011529.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Infants born prematurely or low birth weight (LBW) are at increased risk of vitamin D deficiency, poor bone health and rickets. Uncertainty exists regarding the need, dose and duration of vitamin D supplementation in preterm and LBW infants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of vitamin D (daily cumulative dose ≥ 200 IU) for prevention of vitamin D deficiency in preterm and low birth weight infants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, and trials registries, together with reference checking of related studies and included studies. The latest search date was February 2026.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Randomised controlled trials (RCTs), cluster- or quasi-RCTs of vitamin D supplementation versus no supplementation or placebo, or higher versus lower dose in preterm (&lt; 37 weeks' gestational age) and term LBW infants. We excluded studies that enrolled infants with rickets.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our outcomes of interest were: vitamin D deficiency (vitamin D level &lt; 30 nmol/L); vitamin D insufficiency or deficiency (≤ 50 nmol/L); vitamin D excess (≥ 250 nmol/L); osteopenia of prematurity; bone mineral content; nutritional rickets; and hypercalcaemia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane risk of bias tool (RoB 1) to assess bias in the RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesised results for each outcome using meta-analysis where possible, with a fixed-effect model, using risk ratio (RR), risk difference (RD), number needed to treat for an additional beneficial outcome (NNTB) or an additional harmful outcome (NNTH), mean difference or standardised mean difference (SMD) with 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 34 studies (5012 infants). Eleven studies (1514 infants) compared vitamin D supplementation versus no supplementation in preterm infants. Twenty-five studies (1546 infants) compared higher- versus lower-dose vitamin D supplementation in preterm infants. One study enrolled 2079 term LBW infants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;We assessed most of the studies at high risk of bias, downgrading the evidence to moderate or low. Many subgroup analyses were underpowered due to insufficient data. Vitamin D supplementation versus no supplementation in preterm infants Vitamin D supplementation probably reduces the risk of vitamin D deficiency (RR 0.20, 95% CI 0.12 to 0.35; RD -0.28, 95% CI -0.36 to -0.21; NNTB 4, 95% CI 3 to 5; 4 studies, 385 infants; moderate-certainty evidence); and may reduce the risk of vitamin D insufficiency or deficiency (RR 0.46, 95% CI 0.38 to 0.58; RD -0.38, 95% CI -0.47 to -0.29; NNTB 3, 95% CI 2 to 4; 4 studies, 385 infants; low-certainty evidence) up to discharge/term-corrected age. Radiological evidence of osteopenia of prematurity, ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD011529"},"PeriodicalIF":11.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975925","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":"Physical activity programmes for promoting bone mineralisation and growth in preterm infants.","authors":"Siree Kaempfen, Chris Cooper, Sven M Schulzke","doi":"10.1002/14651858.CD005387.pub4","DOIUrl":"10.1002/14651858.CD005387.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Lack of physical stimulation may contribute to metabolic bone disease of preterm infants, resulting in poor bone mineralisation and growth. Physical activity programmes combined with adequate nutrition might help to promote bone mineralisation and growth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The primary objective was to assess whether physical activity programmes in preterm infants improve bone mineralisation and growth and reduce the risk of fractures. The secondary objectives included assessment of other potential benefits in terms of complications of preterm birth, length of hospital stay, skeletal deformities, neurodevelopmental outcomes and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase and trial registries in October 2025. We checked the reference lists of included studies and systematic reviews where the subject matter related to the intervention or population examined in this review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) and quasi-RCTs of preterm infants born at less than 37 weeks' gestational age. We compared physical activity programmes (extension and flexion, range-of-motion exercises) with no organised physical activity programmes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our outcomes of interest were bone mineral content and density measured by absorptiometric x-ray techniques at completion of the physical activity programme and at 12 to 24 months' corrected age, fractures at completion of the physical activity programme, body weight gain (g/kg/day) and body length gain (cm/week) during the study period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane risk of bias tool (RoB 1).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesised results for each outcome using fixed-effect meta-analysis, where possible. We expressed our results using the mean difference (MD), standardised mean difference (SMD), risk ratio (RR) and risk difference (RD) with 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We identified five new RCTs for this update. In total, we included 15 RCTs enrolling 434 preterm infants (gestational age 26 to 34 weeks) in this review. All RCTs were small (N = 16 to 50), single-centre studies. The trials were similar in design, although they slightly differed in the physical activity protocol. They evaluated whether daily physical activity, varying in duration from three and a half weeks to eight weeks during initial hospitalisation, compared to routine care or tactile stimulation, promoted bone mineralisation and growth. Postnatal age at the start of the physical activity programme varied between less than three days and up to four weeks of age. Methodological quality and reporting of included trials were variable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;We downgraded the certainty of the evidence to l","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD005387"},"PeriodicalIF":11.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975911","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":"Pharmacological lipid-lowering therapies for primary and secondary prevention of cardiovascular disease in adults with dyslipidaemia: a systematic review and network meta-analysis.","authors":"Kamyar Shokraee, Brenda Bongaerts, Petek Eylul Taneri, Camila Micaela Escobar Liquitay, Siavosh Olfati, Ana-Mihaela Zorger, Nicole Skoetz, Juan Va Franco","doi":"10.1002/14651858.CD016387","DOIUrl":"10.1002/14651858.CD016387","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane review (intervention). The objectives are as follows: Primary To compare the effects and safety of lipid-lowering therapies, including statin regimens (high intensity, moderate intensity, and low intensity), non-statin therapies, and combination regimens, for the primary and secondary prevention of cardiovascular disease in adults, using pairwise and network meta-analysis where appropriate. Secondary To obtain an estimate of the relative ranking of these lipid-lowering therapies compared to placebo/no treatment.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"9 ","pages":"CD016387"},"PeriodicalIF":11.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975922","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}