Cochrane Database of Systematic Reviews最新文献

{"title":"Surgical interventions for presbyopia.","authors":"Rosa Alvarado-Villacorta, Tsz Wing Yim, Everardo Hernandez-Quintela, Enrique De La Torre-Gonzalez, Cesar Antonio Loza Munarriz, Maria José Martinez-Zapata","doi":"10.1002/14651858.CD015711.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD015711.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Presbyopia is a progressive condition that everyone who lives long enough will experience, irrespective of gender, ethnicity, or economic status. A wide range of surgical options has emerged for overcoming near and intermediate visual impairment; however, questions about the effectiveness and safety of these interventions remain unanswered. Given the global burden of presbyopia and the need to improve decision-making practices in tailoring management and allocating scarce resources, it is essential to review the available evidence on this issue systematically.</p><p><strong>Objectives: </strong>The primary objective was to compare the effectiveness and safety of surgical interventions for people with presbyopia; the secondary objective was to produce a brief economic commentary summarizing relevant economic evaluations that have compared different surgical interventions.</p><p><strong>Search methods: </strong>We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, two other databases, and trial registries on 29 February 2024.</p><p><strong>Eligibility criteria: </strong>We included randomized controlled trials in participants with presbyopia, including those who had pseudophakic presbyopia with or without previous corneal refractive surgery, in which one surgical intervention was compared with another or a modified version of the same intervention. We excluded trials that had enrolled participants mainly for cataract surgery or who had other ocular comorbidities such as glaucoma, diabetes mellitus, age-related macular degeneration, or myopic retinopathy.</p><p><strong>Outcomes: </strong>Outcomes of interest were spectacle independence for near and intermediate vision, change in quality of life (QoL), improvement in or maintenance of binocular uncorrected distance visual acuity (VA), participant satisfaction, change in binocular contrast sensitivity (CS), and frequency of adverse events (AE).</p><p><strong>Risk of bias: </strong>We used the Cochrane RoB 2 tool to assess bias for each outcome in each included trial.</p><p><strong>Synthesis methods: </strong>We planned to synthesize results for each outcome using meta-analysis (random-effect models) where possible, or else use synthesis without meta-analysis methods. However, due to insufficient data for each pairwise comparison (i.e. only one study reported data per analysis), we employed narrative synthesis. We used GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Included studies: </strong>We included four studies that enrolled 300 participants (600 eyes); most participants were women; mean ages ranged between 46 and 58 years. Two trials were conducted in Croatia, one in Egypt, and one in Turkey. Three studies compared a surgical intervention for presbyopia with another, and one study compared a surgical intervention with a modified version of the same intervention. All enrolled participants had presbyopia without ca","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD015711"},"PeriodicalIF":8.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966870","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":"Switching antipsychotics versus continued current treatment in people with non-responsive schizophrenia.","authors":"Myrto T Samara, Elisabeth Kottmaier, Bartosz Helfer, Claudia Leucht, Nikos G Christodoulou, Maximilian Huhn, Philipp H Rothe, Johannes Schneider-Thoma, Stefan Leucht","doi":"10.1002/14651858.CD011885.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD011885.pub2","url":null,"abstract":"<p><strong>Background: </strong>Many people with schizophrenia do not respond to an initially prescribed antipsychotic drug. In such cases, one treatment strategy could be to switch to a different antipsychotic drug.</p><p><strong>Objectives: </strong>To examine the effects of switching antipsychotic drugs in treating people with schizophrenia who have not responded to initial antipsychotic treatment.</p><p><strong>Search methods: </strong>We searched the Cochrane Schizophrenia Group Trials Register (to December 2022). We inspected the references of all included studies for further relevant trials.</p><p><strong>Selection criteria: </strong>We included all relevant randomised controlled trials (RCTs) comparing switching to a different antipsychotic drug rather than continuing treatment with the same antipsychotic drug for people with schizophrenia who did not respond to their initial antipsychotic treatment.</p><p><strong>Data collection and analysis: </strong>At least two review authors independently extracted data. The primary outcomes were: clinically relevant response as defined by study authors; tolerability (participants leaving the study early due to adverse effects); and quality of life assessed by the change score in the 36-Item Short Form survey. We analysed dichotomous data using the risk ratio (RR) and its 95% confidence interval (CI). We analysed continuous data using mean differences (MD) and corresponding 95% CI. We assessed the risk of bias of the included studies and used GRADE to evaluate the certainty of evidence for the following outcomes: clinically relevant response, tolerability (leaving the study early due to adverse effects), quality of life score change, acceptability (leaving the study early for any reason), general mental state (average change in general mental state scores), duration of hospitalisation, and number of participants experiencing at least one adverse effect.</p><p><strong>Main results: </strong>We included 10 RCTs with 997 participants in the review. Nine studies used a parallel design, and one used a cross-over design. Seven studies were double-blind, two were single-blind and one did not provide any detail regarding blinding. All studies included people who were non-responsive to ongoing antipsychotic treatment. The minimum duration of the ongoing antipsychotic treatment ranged from three days to two years. The length of the comparison phase varied from two weeks to six months. The studies were published between 1993 and 2022. In about half of the studies, the methods of randomisation, allocation and blinding were poorly reported. The evidence is very uncertain regarding the effect of switching antipsychotics on clinically relevant response (RR 1.25, 95% CI 0.77 to 2.03; I² = 43%; 7 studies, 693 participants), quality of life (MD -1.30, 95% CI -3.44 to 0.84; 1 study, 188 participants), Positive and Negative Syndrome Scale (PANSS) score change (MD -0.92, 95% CI -4.69 to 2.86; I² = 47%; 6 studies, 777 par","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD011885"},"PeriodicalIF":8.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11988422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982068","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":"Abdominal drainage to prevent intraperitoneal abscess after appendectomy for complicated appendicitis.","authors":"Yunhao Tang, Jie Liu, Guijuan Bai, Nansheng Cheng, Yilei Deng, Yao Cheng","doi":"10.1002/14651858.CD010168.pub5","DOIUrl":"https://doi.org/10.1002/14651858.CD010168.pub5","url":null,"abstract":"<p><strong>Rationale: </strong>This is the third update of a Cochrane review first published in 2015 and last updated in 2021. Appendectomy, the surgical removal of the appendix, is performed primarily for acute appendicitis. People who undergo appendectomy for complicated appendicitis, defined as gangrenous or perforated appendicitis, are more likely to suffer postoperative complications in comparison to uncomplicated appendicitis. The routine use of abdominal drainage to reduce postoperative complications after appendectomy for complicated appendicitis is controversial.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of abdominal drainage in reducing intraperitoneal abscess after appendectomy (irrespective of open or laparoscopic) for complicated appendicitis; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, two other databases, and five trials registers, together with reference checking, citation searching, and contact with study authors, to identify studies for inclusion in the review. The latest search date was 12 October 2023.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and quasi-RCTs in people with complicated appendicitis comparing (1) use of drain versus no drain, (2) open drain versus closed drain, or (3) different schedules for drain removal. We excluded studies in which not all participants received antibiotics after appendectomy.</p><p><strong>Outcomes: </strong>Our critical outcome was intraperitoneal abscess. Important outcomes were wound infection, morbidity, mortality, and hospital stay.</p><p><strong>Risk of bias: </strong>We used the Cochrane RoB 1 tool to assess the risk of bias in RCTs and quasi-RCTs.</p><p><strong>Synthesis methods: </strong>We synthesised the results for each outcome in a meta-analysis using the random-effects model, except for the Peto odds ratio, which only has a fixed-effect model. We planned to use the Synthesis Without Meta-analysis (SWiM) approach to report studies when it was not possible to undertake a meta-analysis of effect estimates. We used GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Included studies: </strong>We included eight studies (five RCTs and three quasi-RCTs) with a total of 739 paediatric and adult participants, of which 370 participants were randomised to the drainage group and 369 participants to the no-drainage group. The studies were conducted in North America, Asia, and Africa and published between 1973 and 2023. The majority of participants had perforated appendicitis with local or general peritonitis. All participants received antibiotic regimens after open or laparoscopic appendectomy. All studies were at overall high risk of bias.</p><p><strong>Synthesis of results: </strong>Use of drain versus no drain We assessed the certainty of the ev","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD010168"},"PeriodicalIF":8.8,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062800","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":"Music-based interventions for people with chronic kidney disease undergoing haemodialysis.","authors":"Hiroki Nishiwaki, William Mm Levack, Takeshi Hasegawa, Erika Ota, Hisashi Noma, Taihei Suzuki, Yoshitaka Watanabe, Yoshifusa Abe, Hiroi Tomioka, Daichi Kondo, Davey Li, Yunan Han, Tanika N Kelly","doi":"10.1002/14651858.CD016139","DOIUrl":"https://doi.org/10.1002/14651858.CD016139","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 music-based interventions on fatigue, blood pressure, depression, pain, anxiety, stress, QoL, and sleep quality in people with CKD receiving HD.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD016139"},"PeriodicalIF":8.8,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11983671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977379","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":"Drug treatment for myotonia.","authors":"Jennifer Spillane, Jeroen Trip, Gea Drost, Catharina G Faber, Michael G Hanna, Sarah J Nevitt, Vinojini Vivekanandam","doi":"10.1002/14651858.CD004762.pub3","DOIUrl":"10.1002/14651858.CD004762.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Abnormal delayed relaxation of skeletal muscles, known as myotonia, can cause disability in myotonic disorders. The main myotonic disorders are non-dystrophic myotonia and myotonic dystrophy. Non-dystrophic myotonia is a genetic muscle channelopathy predominantly causing myotonia. Myotonic dystrophic is a more systemic neuromuscular disorder causing myotonia as well as progressive myopathy and systemic manifestations, such as arrhythmias and cataracts. Myotonia manifests as stiffness, cramps, locking, pain, and fatigue, and can cause marked morbidity and disability. Sodium channel blockers, tricyclic antidepressive drugs, benzodiazepines, calcium antagonists, taurine, and prednisone may reduce myotonia. This is an update of a review first published in 2005 and updated in 2006.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To review evidence from randomised controlled trials (RCTs) on the efficacy and tolerability of drug treatment in people with clinical myotonia due to myotonic disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and World Health Organization ICTRP on 29 March 2023. We handsearched the grey literature and contacted disease experts and antimyotonic drug manufacturers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included RCTs involving participants with myotonia treated with any drug treatment versus no therapy, placebo, or any other active drug treatment. We included clinical trials where the reported primary outcome was a participant-reported measure of myotonia. We excluded non-RCTs and where myotonia may have been part of the condition (e.g. paramyotonia or Brody's disease). The primary myotonic conditions were myotonic dystrophy and non-dystrophic myotonia. Our primary outcome was participant-reported improvement in clinical myotonia. Our secondary outcomes were relaxation time, electromyographic relaxation time, adverse events, and quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Review authors independently extracted the data onto standardised extraction forms. Three review authors independently assessed risk of bias and we collected adverse events data from the included trials. We assessed the certainty of the evidence using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;This review includes 17 double-blind or single-blind RCTs involving a total of 392 participants, 219 with myotonic dystrophy type 1 and 173 with non-dystrophic myotonia. Seven RCTs were newly identified and included in this update. Four of these RCTs investigated the effect of mexiletine or lamotrigine versus placebo in people with non-dystrophic myotonia. The remaining RCTs explored mexiletine in myotonic dystrophy. Myotonic dystrophy Mexiletine No RCTs reported improvement in clinical myotonia according to validated scales. Mexiletine likely reduces hand grip relaxation time compared to placebo (mean difference ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD004762"},"PeriodicalIF":8.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802792","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":"Closure of mesenteric defects for prevention of internal hernia after Roux-en-Y gastric bypass in bariatric surgery.","authors":"Katsuhiro Murakami, Nobuaki Hoshino, Koya Hida, Kazutaka Obama, Yoshiharu Sakai, Norio Watanabe","doi":"10.1002/14651858.CD014612.pub2","DOIUrl":"10.1002/14651858.CD014612.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Internal hernia is one of the most severe complications observed in people undergoing Roux-en-Y gastric bypass (RYGB). There are some who advocate for the closure of defects to prevent internal hernias. However, the closure of these defects might be associated with an increased risk of small bowel obstruction, resulting from a kink in the anastomosis of the small intestines. Currently, there is a lack of robust evidence demonstrating the benefits of defect closure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of defect closure for prevention of internal hernia after Roux-en Y gastric bypass in bariatric surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, and Embase to August 2024. We reviewed the reference lists of included studies and reached out to the study authors to obtain any missing data. We also searched PubMed, grey literature in the OpenGrey database, Clinical Trials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) that included people with obesity (defined as a body-mass index (BMI) ≥ 35 kg/m²) who underwent laparoscopic or robotic RYGB in bariatric surgery, and compared the closure of defects with the non-closure of defects. We excluded quasi-randomised trials, cluster-RCTs, and cross-over trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcomes assessed were the incidence of internal hernia with bowel obstruction within 10 years, the incidence of postoperative overall complications within 30 days, and the incidence of postoperative mortality within 30 days. The important outcomes included the incidence of intraoperative overall complications, length of hospital stay, and the postoperative pain resulting from gastric bypass surgery, assessed using a visual analogue scale (VAS) two years after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Two review authors independently evaluated the risk of bias for each included study using the Cochrane RoB 2 tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors independently assessed the methodological quality and extracted data from the included trials. We performed a random-effects meta-analysis for data synthesis. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) with 95% CIs for continuous outcomes. We assessed the certainty of evidence based on the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We identified three RCTs with 3010 participants, which met our inclusion criteria. The closure of mesenteric defects used non-absorbable, interrupt closure in one study, and non-absorbable running sutures in two studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;The closure of defects during RYGB may reduce the incidence of internal hernia with bowel obstruction within 10 years compar","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD014612"},"PeriodicalIF":8.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802790","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":"Delayed initiation or reduced initial dose of calcineurin-inhibitors for kidney transplant recipients at high risk of delayed graft function.","authors":"Laia Oliveras, Pamela López-Vargas, Edoardo Melilli, Sergi Codina, Ana Royuela, Ana Coloma López, Alexandre Favà, Anna Manonelles, Carlos Couceiro, Nuria Lloberas, Josep M Cruzado, Nuria Montero","doi":"10.1002/14651858.CD014855.pub2","DOIUrl":"10.1002/14651858.CD014855.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Kidney transplantation is the preferred therapy for many patients with kidney failure. Delayed graft function (DGF) is more common in donors after cardiac death (DCD), especially those with older age, longer cold ischemia time, or higher creatinine levels. Currently, there is no agreement on the optimal immunosuppressive approach for patients at increased risk of DGF. Strategies include delaying the introduction of calcineurin inhibitors (CNI) or using an initial low dose of CNI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of delayed initiation of CNI or reduced CNI dose as initial immunosuppression therapy for kidney transplant recipients at high risk of DGF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;The Cochrane Kidney and Transplant Register of Studies was searched up to 11 December 2024 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;All randomised controlled trials (RCTs) and quasi-RCTs evaluating delayed versus early initiation of CNI or reduced versus standard initial dose of CNI in kidney transplant recipients at high risk of DGF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Three authors independently assessed study eligibility, and two assessed the risk of bias, certainty of evidence, extracted the data, and performed the analysis. Results were reported as risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes and as mean difference (MD) with 95% CI for continuous outcomes. Statistical analysis was performed using the random-effects model. Risk of bias was assessed with the Cochrane risk of bias assessment tool 1.0, and the certainty of the evidence according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods, which are presented in the summary of findings tables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 12 studies (2230 randomised participants). All studies were performed in Europe. Around 60% of the participants were males, reflecting the expected proportion in the population on kidney replacement therapy in Europe. Most studies had insufficient information to judge adequate random sequence generation and, or allocation concealment. All studies were unblinded, and judged as high risk of bias for DGF if the definition was based on need for dialysis, and for acute rejection if the diagnosis did not require a biopsy. Overall, the level of certainty was low, and reasons to downgrade were mainly due to risk of bias and imprecision. Delayed versus early initiation of CNI There may be little or no difference in DGF between the groups (6 studies, 905 recipients: RR 0.92, 95% CI 0.76 to 1.12; low certainty evidence) or in ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD014855"},"PeriodicalIF":8.8,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802791","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":"Digital tracking, provider decision support systems, and targeted client communication via mobile devices to improve primary health care.","authors":"Smisha Agarwal, Weng Yee Chin, Lavanya Vasudevan, Nicholas Henschke, Tigest Tamrat, Hakan Safaralilo Foss, Claire Glenton, Hanna Bergman, Marita S Fønhus, Natschja Ratanaprayul, Shivani Pandya, Garrett L Mehl, Simon Lewin","doi":"10.1002/14651858.CD012925.pub2","DOIUrl":"10.1002/14651858.CD012925.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Digital tracking on mobile devices, combined with clinical decision support systems and targeted client communication, can facilitate service delivery and potentially improve outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of using a mobile device to track service use when combined with clinical decision support (Tracking + CDSS), with targeted client communications (Tracking + TCC), or both (Tracking + CDSS + TCC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;Cochrane CENTRAL, MEDLINE, Embase, Ovid Population Information Online (POPLINE), K4Health and WHO Global Health Library (2000 to November 2022).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;Randomised and non-randomised trials in community/primary care settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;primary care providers and clients Interventions: 1. Tracking + CDSS 2. Tracking + TCC 3. Tracking + CDSS + TCC Comparators: usual care (without digital tracking) DATA COLLECTION AND ANALYSIS: Two authors independently screened trials, extracted data and assessed risk of bias using the RoB 1 tool. We used a random-effects model to meta-analyse data producing risk differences (RD), risk ratios (RR), or odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Evidence certainty was assessed using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We identified 18 eligible studies (11 randomised, seven non-randomised) conducted in Bangladesh, China, Ethiopia, India, Kenya, Palestine, Uganda, and the USA. All non-randomised studies had a high risk of bias. These results are from randomised studies. 'Probably/may/uncertain' indicates 'moderate/low/very low' certainty evidence. Tracking + CDSS Relating to antenatal/ postnatal care: Providers' adherence to recommendations May slightly increase home visits in the week following delivery (2 studies, 4531 participants; RD 0.10 [0.07, 0.14]) May slightly increase counselling for initiating complementary feeding (2 studies, 4397 participants; RD 0.12 [0.08, 0.15]) May slightly increase the mean number of home visits in the month following delivery (1 study, 3023 participants; MD 0.75 [0.47, 1.03]) Uncertain effect on home visits within 24 hours of delivery Clients' health behaviours May slightly increase skin-to-skin care (1 study, 1544 participants; RD 0.05 [0.00, 0.10]) May slightly increase early breastfeeding (2 studies, 4540 participants; RD 0.08 [0.05, 0.12]) Uncertain effects on applying nothing to the umbilical cord, taking ≥ 90 iron-folate tablets during pregnancy, exclusively breastfeeding for six months, delaying the newborn's bath at least two days and Kangaroo Mother Care. Clients' health status May reduce low birthweight babies (1 study, 3023 participants; RR 0.53 [0.38, 0.73]) May increase infants with pneumonia or fever seeking care (1 study, 3470 participants; RR 1.13 [1.03, 1.24]) Uncertain effects on stillbirths, neonatal and infant deaths, or testing positive for HIV d","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD012925"},"PeriodicalIF":8.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794799","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":"Gonadotropins for ovulation induction in women with polycystic ovary syndrome.","authors":"Nienke S Weiss, Elena B Kostova, Ben Willem J Mol, Madelon van Wely","doi":"10.1002/14651858.CD010290.pub4","DOIUrl":"10.1002/14651858.CD010290.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Ovulation induction with follicle-stimulating hormone (FSH) is a second-line treatment in women with polycystic ovary syndrome (PCOS) who do not ovulate or conceive on clomiphene citrate or letrozole, though induction protocols and types of gonadotropins used vary greatly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the effectiveness and safety of gonadotropins as a second-line treatment for ovulation induction in women with PCOS who do not ovulate or conceive after clomiphene citrate or letrozole.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;In March 2024, we searched the Cochrane Gynaecology and Fertility Group Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase and PsycINFO. We checked references of all relevant studies. We had no language or date restrictions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;All randomised controlled trials (RCTs) reporting data on clinical outcomes in women with PCOS who did not ovulate or conceive on clomiphene citrate or letrozole, and were undergoing ovulation induction with urinary-derived gonadotropins, including urofollitropin in purified FSH (uFSH) or highly purified FSH (HP-FSH) form, human menopausal gonadotropin (HMG) and highly purified human menopausal gonadotropin (HP-HMG), or recombinant FSH (rFSH) were eligible. We included trials reporting on ovulation induction followed by intercourse or intrauterine insemination. We excluded studies that described co-treatment with clomiphene citrate, metformin, luteinising hormone, or letrozole.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;We implemented the core outcome set for infertility. Our critical outcomes were live birth rate and multiple pregnancy rate per woman. Important outcomes were clinical pregnancy, pregnancy loss, incidence of ovarian hyperstimulation syndrome (OHSS) per woman, total gonadotropin dose, total duration of stimulation per woman, gestational age at birth, birthweight, neonatal mortality, and major congenital anomaly.&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 the included studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Where meta-analysis was possible, we combined data using a fixed-effect model to calculate the risk ratio (RR) or mean difference. We summarised the overall certainty of evidence for the main outcomes using GRADE criteria.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 15 studies with 2348 women. Ten trials compared rFSH with urinary-derived gonadotropins (one compared rFSH with human menopausal gonadotropin (HMG), and nine compared rFSH with urinary FSH). Three trials compared HMG with purified FSH (uFSH). One trial compared HP-FSH with purified FSH (uFSH) and one trial compared gonadotropins with continued clomiphene citrate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Recombinant FSH (rFSH) versus urinary-derived gonadotropins There may be little or no difference in the birth rate between rFSH and urinary-derived gonadotropins (R","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD010290"},"PeriodicalIF":8.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794800","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":"Next-generation sequencing (NGS) techniques for pre-symptomatic identification of genetic diseases in newborns.","authors":"Sara Pessano, Maria Boldor, Francesca Faravelli, Michelle Fiander, Karsten Juhl Jørgensen, Roger F Soll, Matteo Bruschettini","doi":"10.1002/14651858.CD016118","DOIUrl":"10.1002/14651858.CD016118","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 using NGS techniques compared to conventional newborn screening alone for pre-symptomatic identification of genetic diseases in newborns.</p><p><strong>Secondary objectives: </strong>to explore equity and ethical issues in the application of the new techniques, to inform healthcare decisions by families, carers, and policymakers.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD016118"},"PeriodicalIF":8.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794803","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}