Cochrane Database of Systematic Reviews最新文献

{"title":"Post-incident debriefing for people with schizophrenia after coercive measures.","authors":"Maritta Välimäki, Jaakko Varpula, Tella Lantta","doi":"10.1002/14651858.CD014487.pub2","DOIUrl":"10.1002/14651858.CD014487.pub2","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia and schizophrenia-type psychosis, severe mental illnesses globally impacting millions, present a dual challenge with their characteristic positive and negative symptoms, economic burdens, and heightened susceptibility to coercive measures. These measures, including seclusion and restraint, raise ethical concerns despite their intent to ensure safety, particularly during acute stages marked by violent behaviour. Addressing this backdrop, the significance of post-incident debriefing as an intervention to curtail the use and duration of coercive measures and alleviate the negative psychological effects of using these methods in managing individuals with schizophrenia is underscored. The employment of coercive measures, such as physical restraint and seclusion, to manage aggressive behaviour in psychiatric settings necessitates a thorough examination of their ethical implications and potential psychological harm. Although post-incident debriefing is recommended, the limited evidence supporting its efficacy and concerns about its impact on psychological well-being prompt a comprehensive analysis of existing literature.</p><p><strong>Objectives: </strong>To investigate the effects of post-incident debriefing after coercive measures for people with schizophrenia or schizophrenia-type psychosis.</p><p><strong>Search methods: </strong>The Information Specialist conducted searches of the Cochrane Schizophrenia Specialised Register (compiled from searches of CENTRAL, MEDLINE, Embase, PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, WHO ICTRP, ISRCTN, ProQuest Dissertations and Theses A&I) on 28 February 2023. We also inspected the references of all identified studies.</p><p><strong>Selection criteria: </strong>We included all randomised controlled trials (RCTs) of post-incident debriefing after coercive measures in adult psychiatric care with participants diagnosed with schizophrenia or schizophrenia-type psychosis, encompassing various clinical states and stages. We considered studies if the post-incident debriefing was the only intervention randomised.</p><p><strong>Data collection and analysis: </strong>At least two authors inspected the citations, selected studies, extracted data and conducted quality appraisal. We calculated a standard estimation of the risk ratio (RR) and its 95% confidence interval (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous outcomes. We assessed study risk of bias and used the GRADE approach to create a summary of findings table.</p><p><strong>Main results: </strong>We included one study; the total number of participants randomised was 422, of which 109 participated. Participants were between 18 and 65 years old with psychotic disorder, at the acute stage of their illness, and had experienced at least one coercive measure during their hospital stay. The study included a standardised post-coercion review that was conducted until the discharge of the parti","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD014487"},"PeriodicalIF":8.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12107513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149386","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":"Atypical antipsychotics for autism spectrum disorder: a network meta-analysis.","authors":"Nicolás Meza, Juan Va Franco, Yanina Sguassero, Vicente Núñez, Camila Micaela Escobar Liquitay, Reginald Rees, Katrina Williams, Valeria Rojas, Francisca Rojas, Tamara Pringsheim, Eva Madrid","doi":"10.1002/14651858.CD014965.pub2","DOIUrl":"10.1002/14651858.CD014965.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Individuals with autism spectrum disorder (ASD) exhibit a wide variety of symptoms related to social interaction and behaviour. Atypical antipsychotics have been widely evaluated and prescribed to treat distressing symptoms (e.g. irritability, aggression, obsessions, repetitive behaviours, etc.) in children and adults with ASD. Still, their effects and relative efficacy remain unclear.</p><p><strong>Objectives: </strong>Primary: to assess the comparative benefits of atypical antipsychotics for irritability through network meta-analyses in children and adults with ASD at short-term follow-up. Secondary: to assess the benefits and harms of atypical antipsychotics, compared to placebo or any other atypical antipsychotic, for different symptoms (e.g. aggression, obsessive-compulsive behaviours, inappropriate speech) and side effects (e.g. extrapyramidal symptoms, weight gain, metabolic side effects) in children and adults with ASD at short-, medium- and long-term follow-up.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, 10 other databases, and two trial registers, together with reference checking, citation searching and contact with study authors to identify studies for inclusion. The latest search was 3 January 2024.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials (RCTs) comparing any atypical antipsychotic drug with placebo or another atypical antipsychotic drug for adults and children with a clinical diagnosis of ASD.</p><p><strong>Outcomes: </strong>Critical outcomes included irritability, aggression, weight gain, extrapyramidal side effects, obsessive-compulsive behaviours and inappropriate speech.</p><p><strong>Risk of bias: </strong>We used the Cochrane RoB 2 tool to assess risk of bias in the included studies.</p><p><strong>Synthesis methods: </strong>We performed statistical analyses using a frequentist network meta-analysis for combined estimates for the outcome irritability and a random-effects model for pairwise comparisons for other outcomes. We rated the certainty of the evidence using GRADE.</p><p><strong>Included studies: </strong>We included 17 studies with 1027 randomised participants. One study evaluated adults (31 participants); the remaining 16 studies evaluated children (996 participants). The interventions were risperidone, aripiprazole, lurasidone and olanzapine.</p><p><strong>Synthesis of results: </strong>Comparative efficacy on irritability Based on the network meta-analysis, risperidone and aripiprazole may reduce symptoms of irritability compared to placebo in the short term in children with ASD (risperidone: mean difference (MD) -7.89, 95% confidence interval (CI) -9.37 to -6.42; 13 studies, 906 participants; low-certainty evidence; aripiprazole: MD -6.26, 95% CI -7.62 to -4.91; 13 studies, 906 participants; low-certainty evidence). Lurasidone probably results in little to no difference in irritability compared to placebo in the short term (MD","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD014965"},"PeriodicalIF":8.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109707","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":"Vaccines for preventing infections in adults with haematological malignancies.","authors":"Ana-Mihaela Zorger, Caroline Hirsch, Mandy Baumann, Merit Feldmann, Paul J Bröckelmann, Sibylle Mellinghoff, Ina Monsef, Nicole Skoetz, Nina Kreuzberger","doi":"10.1002/14651858.CD015530.pub2","DOIUrl":"10.1002/14651858.CD015530.pub2","url":null,"abstract":"<p><strong>Background: </strong>Vaccination aims to prevent infections. People who are immunocompromised, such as those with haematological malignancies, often experience higher immunosuppression, increasing their vulnerability to infections compared to individuals with solid tumours or healthy individuals.</p><p><strong>Objectives: </strong>The aim of this review is to summarise and evaluate the benefits and risks of vaccines for preventing infections in adults with haematological malignancies.</p><p><strong>Search methods: </strong>We conducted a comprehensive systematic search in CENTRAL, MEDLINE, Embase, LILACS, and Web of Science on 2 December 2024 for randomised controlled trials (RCTs) and for controlled non-randomised studies of interventions (NRSIs). We also searched ClinicalTrials.gov, WHO (World Health Organization) International Clinical Trials Registry Platform (ICTRP), and the Cochrane COVID-19 Study Register.</p><p><strong>Selection criteria: </strong>We included RCTs and controlled NRSIs evaluating the preventive effect of vaccines on outcomes prioritised by clinical experts, patients, and patient representatives. The prioritised outcomes for adults (≥ 18 years) with haematological malignancies (excluding those receiving cellular therapies) were infection incidence, all-cause mortality, quality of life, adverse events of any grade, serious adverse events, and adverse events of special interest. We looked for studies that evaluated a broad range of vaccine types (e.g. COVID-19, diphtheria, Haemophilus influenzae type b, hepatitis B, herpes zoster, influenza, Neisseria meningitidis, pertussis, polio, Streptococcus pneumoniae, or tetanus), but we excluded live-attenuated vaccines.</p><p><strong>Data collection and analysis: </strong>We followed current Cochrane methodological standards in the conduct of this review. We assessed the risk of bias using the Cochrane risk of bias 2 tool (RoB 2) for RCTs and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) for controlled NRSIs.</p><p><strong>Main results: </strong>We included six studies (four RCTs, two controlled NRSIs) with a total of 25,886 participants. We present the RCT results here and the NRSI findings from NRSIs in the full review. We judged one RCT on herpes zoster to be at low risk of bias overall, and we had 'some concerns' about bias in the other RCT on herpes zoster. We had 'some concerns' about bias in the RCTs on COVID-19 and influenza vaccines. Herpes zoster vaccines Two RCTs, involving 3067 participants with a range of haematological malignancies, evaluated vaccines for preventing herpes zoster compared to placebo or no vaccine. Vaccines may reduce herpes zoster incidence up to 21 months post-vaccination, although the 95% CI includes the possibility of no effect (4% versus 6%; RR 0.40, 95% CI 0.07 to 2.23; 2 RCTs, 3067 participants; low-certainty evidence). Vaccines probably have little to no effect on all-cause mortality up to 28 days post-vaccinatio","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015530"},"PeriodicalIF":8.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109653","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":"Perioperative immunotherapy strategies for resectable non-small cell lung cancer.","authors":"Corynne Marchal, Guillaume Eberst, François Calais, Virginie Westeel, Reem Malouf","doi":"10.1002/14651858.CD015819","DOIUrl":"10.1002/14651858.CD015819","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To compare, via a network meta-analysis, the effectiveness and safety of different immunotherapy agents that are administered in a perioperative setting to people with resectable non small-cell lung cancer To perform indirect comparisons in order to generate a clinically meaningful hierarchy of perioperative strategies of immunotherapy administration for overall survival in operable people with resectable non small-cell lung cancer.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015819"},"PeriodicalIF":8.8,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092910","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 people with chronic kidney disease undergoing dialysis.","authors":"Louise Beresford, Susan Dewhurst, Alastair Hutchison, Anand D Pandyan","doi":"10.1002/14651858.CD016155","DOIUrl":"10.1002/14651858.CD016155","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 neuromuscular electrical stimulation (NMES) on muscle structure and function in people undergoing dialysis.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016155"},"PeriodicalIF":8.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076542","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":"Prophylactic abdominal drainage for pancreatic surgery.","authors":"Chunmu Miao, Yali Hu, Guijuan Bai, Nansheng Cheng, Yao Cheng, Weimin Wang","doi":"10.1002/14651858.CD010583.pub6","DOIUrl":"10.1002/14651858.CD010583.pub6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;This is the fourth update of a Cochrane review first published in 2015 and last updated in 2021. The use of surgical drains is a very common practice after pancreatic surgery. The role of prophylactic abdominal drainage to reduce postoperative complications after pancreatic surgery is controversial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of routine abdominal drainage after pancreatic surgery; to compare the effects of different types of surgical drains; and to evaluate the optimal time for drain removal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, three other databases, and five trials registers, together with reference checking and contact with study authors, to identify studies for inclusion in the review. The search dates were 20 April 2024 and 20 July 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) in participants undergoing pancreatic surgery comparing (1) drain use versus no drain use, (2) different types of drains, or (3) different schedules for drain removal. We excluded quasi-randomised and non-randomised studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were 30-day mortality, 90-day mortality, intra-abdominal infection, wound infection, and drain-related complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane RoB 1 tool to assess the risk of bias in RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesised the results for each outcome using meta-analysis with the random-effects model where possible. 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 12 RCTs with a total of 2550 participants. The studies were conducted in North America, Europe, and Asia and were published between 2001 and 2024. All studies were at overall high risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;We considered the certainty of the evidence for intra-abdominal infection for the comparison of early versus late drain removal following pancreaticoduodenectomy to be moderate, downgraded due to indirectness. We considered the certainty of the evidence for the other outcomes to be low or very low, mainly downgraded due to high risk of bias, inconsistency, indirectness, and imprecision. Drain use versus no drain use following pancreaticoduodenectomy We included two RCTs with 532 participants randomised to the drainage group (N = 270) and the no drainage group (N = 262) after pancreaticoduodenectomy. The evidence is very uncertain about the effect of drain use on 30-day mortality (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.07 to 3.66; 2 studies, 532 participants), 90-day mortality (RR 0.25, 95% CI 0.06 to 1.15; 1 study, 137 participants), intra-abdominal infection rate (RR 0.85, 95% CI 0.21 to 3.51; 2 studies, 532 participants), and wound infection rate (RR 0.85, 95% CI 0.55 to 1.31; 2 studies, 532 participants","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD010583"},"PeriodicalIF":8.8,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076543","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":"Clinical pathways for secondary care and the effects on professional practice, patient outcomes, length of stay and hospital costs.","authors":"Thomas Rotter, Leigh D Kinsman, Agnès Alsius, Shannon D Scott, Adegboyega Lawal, Ulrich Ronellenfitsch, Christopher Plishka, Gary Groot, Phil Woods, Chloe Coulson, Leigh Anne Bakel, Kim Sears, Amanda Ross-White, Andreas Machotta, Timothy J Schultz","doi":"10.1002/14651858.CD006632.pub3","DOIUrl":"10.1002/14651858.CD006632.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Clinical pathways (CPWs) are structured multidisciplinary care plans. They aim to translate evidence into practice and optimize clinical outcomes. This is the first update of the previous systematic review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To investigate the effect of CPWs on patient outcomes, length of stay, costs and charges, adherence to recommended practice, and to measure the impact of different approaches to implementation of CPWs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;For this update, CENTRAL, MEDLINE, and Embase were searched on 25 July 2024. Two trial registries were searched on 26 July 2024, along with reference checking, citation searching and contacting authors to identify additional studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We considered two groups of participants: health professionals involved in CPW utilization, including (but not limited to) physicians, nurses, physiotherapists, pharmacists, occupational therapists and social workers; and patients managed using a CPW. We included randomized trials, non-randomized trials, controlled before-after (CBA) studies, and interrupted time-series (ITS) studies comparing (1) stand-alone clinical pathways with usual care, and (2) clinical pathways as part of a multifaceted intervention with usual care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two authors independently screened all titles, abstracts and full-text manuscripts to assess eligibility and the methodological quality of included studies using the Cochrane Effective Practice and Organization of Care 'Risk of Bias' tool. Certainty of evidence was assessed by two authors independently. Interventions were scored as 'high', 'moderate' or 'low' for the evidence-based implementation process.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;The update provided 31 additional studies for a total of 58 included studies (24,841 patients and 2027 healthcare professionals). Forty-one (71%) were randomized trials, four (7%) non-randomized trials, four (7%) CBA studies and nine (16%) ITS studies. Forty-nine studies compared stand-alone CPWs to usual care and nine compared multifaceted interventions including a CPW to usual care. Collectively, the risk of bias was high due to potential contamination by healthcare professionals, lack of blinding of patients and personnel, lack of allocation concealment and selective reporting in ITS studies. Stand-alone clinical pathway interventions It is uncertain whether stand-alone CPWs reduce inhospital mortality (13% v 16%: OR 0.79, 95% CI 0.53 to 1.20; P = 0.27; I² = 65%; 7 randomized trials; n = 4603; low-certainty evidence due to serious imprecision and inconsistency) or mortality (up to 6 months) (4% v 3%: OR 1.37, 95% CI 0.72 to 2.60; P = 0.34; I² = 20%; 3 randomized trials, n = 805; low-certainty evidence due to serious risk of bias and imprecision). Stand-alone CPWs likely reduce inhospital complications (10% v 17%: OR 0.57, 95% CI 0.41 to 0.80; P = 0.001; I² =","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD006632"},"PeriodicalIF":8.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971778","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":"Total neoadjuvant therapy for locally advanced rectal cancer.","authors":"Sophie Mueller, Yung-Shuo Kao, Carolin Kastner, Po-Huang Chen, Anne Hendricks, Gin Yi Lee, Franziska Koehler, Hong-Jie Jhou, Christoph-Thomas Germer, Enoch Yi-No Kang, Heidrun Janka, Ching-Liang Ho, Cho-Hao Lee, Armin Wiegering","doi":"10.1002/14651858.CD015590","DOIUrl":"10.1002/14651858.CD015590","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 and safety of total neoadjuvant therapy versus standard therapy in individuals with locally advanced rectal cancer.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015590"},"PeriodicalIF":8.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986122","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":"Early mobilization after skin graft for burn injury in adults.","authors":"Tamara S Sousa, Roger Andrey Carvalho Jardim, Caroline Fr Silva, André S Sousa, Natalia Iosimuta, Virginia Fm Trevisani, Ana Carolina Pereira Nunes Pinto","doi":"10.1002/14651858.CD016109","DOIUrl":"10.1002/14651858.CD016109","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 early mobilization after skin graft for burn injury in adults.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016109"},"PeriodicalIF":8.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989165","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":"Electromechanical-assisted training for walking after stroke.","authors":"Jan Mehrholz, Joachim Kugler, Marcus Pohl, Bernhard Elsner","doi":"10.1002/14651858.CD006185.pub6","DOIUrl":"10.1002/14651858.CD006185.pub6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Walking difficulties are common after a stroke. During rehabilitation, electromechanical and robotic gait-training devices can help improve walking. As the evidence and certainty of the evidence may have changed since our last update in 2020, we aimed to update the scientific evidence on the benefits and acceptability of these technologies to ensure they remain a viable option for stroke rehabilitation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Primary • To determine whether electromechanical- and robot-assisted gait training versus physiotherapy (or usual care) improves walking in adults after stroke. Secondary • To determine whether electromechanical- and robot-assisted gait training versus physiotherapy (or usual care) after stroke improves walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, and seven other databases. We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trial authors to identify further published, unpublished, and ongoing trials. The date of the latest search was December 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included all randomised controlled trials and randomised controlled cross-over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical- and robot-assisted gait training versus physiotherapy (or usual care).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcome was the ability to walk independently, measured with the Functional Ambulation Category (FAC). An FAC score of 4 or 5 indicated independent walking over a 15-metre surface, irrespective of aids used, such as a cane. An FAC score less than 4 indicates dependency in walking (supervision or assistance, or both, must be given in performing walking). Important outcomes included walking velocity and capacity, as well as dropouts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used Cochrane's RoB 1 tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We used random-effects models for the meta-analysis. We assessed the certainty of evidence using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 101 studies (39 new studies plus 62 studies from previous versions) with a total of 4224 participants after stroke in our review update.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Electromechanical-assisted gait training in combination with physiotherapy probably increases the odds of participants becoming independent in walking (odds ratio (OR) 1.65, 95% confidence interval (CI) 1.21 to 2.25; P = 0.001; I² = 31%; 51 studies, 2148 participants; moderate-certainty evidence); probably does not increase me","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD006185"},"PeriodicalIF":8.8,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957375","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}