Cochrane Database of Systematic Reviews最新文献

{"title":"Telerehabilitation for neck pain.","authors":"Junior V Fandim, Lisandra Almeida de Oliveira, Tiê P Yamato, Steven J Kamper, Leonardo Op Costa, Christopher G Maher, Bruno T Saragiotto","doi":"10.1002/14651858.CD014428.pub2","DOIUrl":"10.1002/14651858.CD014428.pub2","url":null,"abstract":"<p><strong>Background: </strong>Neck pain is a very common condition, ranked fourth in terms of years lived with disability worldwide. Telerehabilitation has been growing in popularity with advances in technologies and telecommunication. Despite the potential benefits and the increased number of trials, there is uncertainty about the effectiveness of telerehabilitation in people with non-specific neck pain.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of telerehabilitation to improve pain and function compared to no treatment, waiting list, usual care, or any other active intervention in people with acute, subacute, and chronic non-specific neck pain.</p><p><strong>Search methods: </strong>We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, five other databases, and two trial registers to 11 April 2024 without language or publication status restrictions. We screened reference lists of relevant potential studies.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials of telerehabilitation in adults with non-specific neck pain. We classified telerehabilitation interventions into three categories: 1. telehealth delivery of psychological or education interventions; 2. telehealth delivery of exercise or physical activity interventions; and 3. telehealth delivery of multicomponent interventions. We included trials comparing telerehabilitation with minimal intervention, matched non-telehealth treatment, and unmatched treatment controls. The primary outcomes were pain intensity, function, health-related quality of life, anxiety, depression, any adverse events, withdrawals due to adverse events, and short-term serious adverse events. The secondary outcomes were return to work, self-efficacy, fear avoidance, pain catastrophising, and adherence.</p><p><strong>Data collection and analysis: </strong>Two review authors independently screened relevant records, extracted data, and assessed risk of bias in included studies. We extracted data using a standardised form. We pooled trial results using a random-effects model meta-analysis. We combined results in a meta-analysis using mean difference (MD with pain and disability outcomes expressed on a 0 to 100 scale) or standardised mean difference (SMD), and 95% confidence intervals (CI) for continuous outcomes at immediate-, short-, intermediate-, and long-term follow-up. Otherwise, we report the data with a narrative summary. We assessed heterogeneity using the I<sup>2</sup> value and Chi<sup>2</sup> test, and assessed the certainty of the evidence using the GRADE approach.</p><p><strong>Main results: </strong>We included 13 randomised controlled trials (1042 participants). Most studies included women (71%), aged 21 to 60 years (mean 39 years, standard deviation 11 years). Studies used different modalities for telerehabilitation, such as telephone, smartphone applications, pre-recorded videos, videoconference, and websites.","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD014428"},"PeriodicalIF":8.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820710","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 therapy for the treatment of delirium in the intensive care unit.","authors":"Luis Garegnani, Diego Ivaldi, Mariana Andrea Burgos, Lucia B Varela, Samanta Díaz Menai, Sabrina Rico, María L Giménez, Camila Micaela Escobar Liquitay, Juan Va Franco","doi":"10.1002/14651858.CD015830.pub2","DOIUrl":"10.1002/14651858.CD015830.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Exercise therapy in critical illness is a safe, feasible, and cost-effective approach that may improve cognitive function and reduce delirium as part of multicomponent nonpharmacologic approaches. However, there is still uncertainty regarding the effectiveness of each individual component.</p><p><strong>Objectives: </strong>To assess the benefits and harms of exercise therapy for the treatment of delirium in critically ill adults in the intensive care unit, compared to no intervention, usual care or any pharmacological treatment.</p><p><strong>Search methods: </strong>We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO and major trial registers as well as citation searching up to 12 July 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and cluster-RCTs assessing the effects of exercise therapy in adults with a diagnosis of delirium after admission to the intensive care unit (ICU), with or without mechanical ventilation, compared to no intervention, usual care or any other pharmacological treatment. We excluded cross-over RCTs and quasi-RCTs.</p><p><strong>Outcomes: </strong>Outcomes of interest were duration of delirium, health-related quality of life, delirium severity, cognitive function, mortality in the ICU, ICU length of stay, hospital length of stay and adverse events.</p><p><strong>Risk of bias: </strong>We used Cochrane's risk of bias 2 tool (RoB 2) for assessing RCTs.</p><p><strong>Synthesis methods: </strong>We conducted meta-analyses using random-effects models to calculate risk ratios (RR) or mean differences (MD) and their 95% confidence intervals (95% CI) for all outcomes reported in the included trials. We summarised the certainty of the evidence using GRADE methods.</p><p><strong>Included studies: </strong>We included four parallel RCTs with a total of 491 participants. Three studies were conducted in mixed ICUs and one in a medical ICU. The studies were published between 2016 and 2023 and were conducted in China, Germany, the UK, and Turkey.</p><p><strong>Synthesis of results: </strong>Exercise therapy compared to no intervention or usual care In adults with a diagnosis of delirium after admission to the ICU, exercise therapy may reduce the duration of delirium (MD -1.07 days, 95% CI -1.75 to -0.39; 4 studies, 121 participants; low-certainty evidence). Additionally, exercise therapy may result in no adverse events in adults with a diagnosis of delirium after admission to the ICU, as no adverse events were reported in either group (2 studies, 90 participants; low-certainty evidence). Exercise therapy probably reduces the ICU length of stay in adults with a diagnosis of delirium after admission to the ICU (MD -2.24 days, 95% CI -3.63 to -0.85; 3 studies, 107 participants; moderate-certainty evidence). None of the included studies assessed ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD015830"},"PeriodicalIF":8.8,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12341365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144820757","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":"Interventions in addition to broad-spectrum intravenous antibiotic therapy for the treatment of radiologically proven tubo-ovarian abscess.","authors":"Haylee Boyens, Magdalena Bofill Rodriguez, Jordon Wimsett, Katherine At Culliney, Anna Marshall, Charlotte Oyston","doi":"10.1002/14651858.CD016056","DOIUrl":"10.1002/14651858.CD016056","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of surgical or radiological intervention in addition to broad-spectrum intravenous antibiotics, compared to broad-spectrum antibiotics alone, for the treatment of radiologically proven tubo-ovarian abscesses in non-pregnant adults.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD016056"},"PeriodicalIF":8.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-targeted immunosuppressive and immunomodulatory therapies for idiopathic inflammatory myopathies.","authors":"Joost Raaphorst, Nicola J Gullick, Farhad Shokraneh, Ruth Brassington, Minoesch Min, Saadia S Ali, Patrick A Gordon","doi":"10.1002/14651858.CD015855","DOIUrl":"10.1002/14651858.CD015855","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Idiopathic inflammatory myopathies (IIM) are autoimmune-mediated inflammatory disorders of skeletal muscles with non-muscle involvement in some people, which carry significant morbidity and mortality. Treatment of IIM represents an area of unmet need. This review is an update of a review previously published in 2012, as new and promising data on non-targeted treatments have emerged.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects (benefits and harms) of non-targeted immunosuppressant and immunomodulatory treatments for IIM: dermatomyositis (DM, including juvenile dermatomyositis, jDM), immune-mediated necrotising myopathy (IMNM), anti-synthetase syndrome (ASS), overlap-myositis (OM) and polymyositis (PM). We also included cancer-related myositis and amyopathic dermatomyositis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;On 3 February 2023, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, Embase, MEDLINE, ClinicalTrials.gov and WHO ICTRP. We intended to check references and citations, and contact experts to identify additional studies, but lacked the resources.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included all randomised controlled trials (RCTs) or quasi-RCTs involving participants (adults and children) with IIM according to defined criteria. We included non-targeted immunosuppressants and immunomodulatory treatments alone or in combination, compared with a placebo, no treatment or another non-targeted immunosuppressant or immunomodulatory treatment. Our two primary outcomes were improvement of function or disability and improvement of muscle strength compared with baseline. By preference, we used the Health Assessment Questionnaire Disability Index (HAQ-DI) for disability and the Manual Muscle Test-8 (MMT8) score (adults or children) for muscle strength. Other outcomes were achievement of definitions of improvement (DOI) (the International Myositis Assessment and Clinical Studies (IMACS) Group or the more recent total improvement scores (TIS); for children, we reported achievement of improvement defined by the Paediatric Rheumatology International Trials Organisation (PRINTO)), cumulative corticosteroid dose, change in skin disease activity, serious adverse event and withdrawals for lack of benefit or adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We followed standard Cochrane methodology. To assess the risk of bias, we used the domain-based Cochrane risk of bias tool (RoB 1). We used fixed-effect models and, when needed, random-effects models for meta-analysis. We created summary of findings tables for any comparison for which data were available but prioritised comparisons of the following with placebo, no treatment or standard care: immunoglobulin, azathioprine and methotrexate. We included other comparisons as additional tables. We assessed the certainty of evidence using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We identified 16 studies (78","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD015855"},"PeriodicalIF":8.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815935","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":"Amplitude-integrated electroencephalography compared with conventional video-electroencephalography for detection of neonatal seizures.","authors":"Abhijeet A Rakshasbhuvankar, Lakshmi Nagarajan, Zhivko Zhelev, Shripada C Rao","doi":"10.1002/14651858.CD013546.pub2","DOIUrl":"10.1002/14651858.CD013546.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Conventional video-electroencephalography (cEEG) is the reference standard for diagnosing and managing neonatal seizures. However, continuous bedside cEEG services are not available in most neonatal units. Hence, an alternative and relatively simple method called amplitude-integrated EEG (aEEG), which uses a limited number of scalp electrodes, has become popular. aEEG allows continuous bedside monitoring of the electrical activity of the brain in neonates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The primary objective of the review was to assess the accuracy of aEEG against the reference standard cEEG for the detection of 'neonates with seizures' and 'individual seizures'. Detection of 'neonates with seizures' refers to the ability of the test to correctly identify a 'neonate' as 'seizure positive' or 'seizure negative' based on the detection of at least one seizure episode in the entire aEEG recording. Detection of 'individual seizures' refers to the ability of the test to correctly identify 'individual' seizure episodes within the same neonate rather than just diagnosing the neonate as 'seizure positive' or 'seizure negative'.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, clinical trials registries, and grey literature (Open Grey, Trove, and American Doctoral Dissertations) to 26 July 2022. We did not apply any language or publication status restrictions or any other filters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included prospective and retrospective studies investigating the accuracy of aEEG (index test) against the reference standard cEEG for the detection of neonatal seizures. To be eligible for inclusion, the studies must have compared aEEG with simultaneously recorded cEEG. There was no restriction on the number of leads, use of raw EEG traces, or experience and training of an aEEG interpreter. cEEG should have been recorded using at least nine electrodes and interpreted by a qualified person experienced in the interpretation of neonatal cEEG.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Working independently, two review authors collected data from the included studies in a prespecified form and assessed the quality of the included studies using the QUADAS-2 tool. For the outcome of 'neonates with seizures', we used a bivariate mixed-effects regression model to conduct a meta-analysis to derive pooled sensitivity, specificity, positive and negative likelihood ratios (LR), and their respective 95% confidence intervals (CI). We generated a summary receiver operating characteristic (SROC) curve to display the results of individual studies. We calculated post-test probabilities based on Bayes' theorem through Fagan nomograms. For the outcome of 'individual seizures', pooling of data was not possible because of the 'unit of analysis' issue. Instead, we performed a narrative synthesis. We assessed the certainty of the evidence using GRADE guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main res","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD013546"},"PeriodicalIF":8.8,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144815933","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":"Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.","authors":"Emilie Sbidian, Anna Chaimani, Robin Guelimi, Cheng-Chen Tai, Quentin Beytout, Cherry Choudhary, Alexia Mubuanga Nkusu, Camille Ollivier, Quentin Samaran, Carolyn Hughes, Sivem Afach, Laurence Le Cleach","doi":"10.1002/14651858.CD011535.pub7","DOIUrl":"10.1002/14651858.CD011535.pub7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Psoriasis is an immune-mediated disease with either skin or joints manifestations, or both, and it has a major impact on quality of life. Although there is currently no cure for psoriasis, various treatment strategies allow sustained control of disease signs and symptoms. Despite multiple available treatments, their comparative efficacies and safety remain unclear due to the limited number of direct comparisons. We conducted a network meta-analysis to comprehensively compare systemic treatments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the benefits and harms of non-targeted systemic agents, targeted synthetic agents, and biologic targeted treatments for people with moderate-to-severe psoriasis using a network meta-analysis, and to rank these treatments according to their benefits and harms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;For this update of the living systematic review, we updated our searches monthly up to July 2024 in the following databases and trial registers: CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, and WHO ICTRP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Randomised controlled trials of systemic pharmacological treatments in adults over 18 years of age with moderate-to-severe plaque psoriasis, at any stage of treatment, compared to placebo or another active agent, irrespective of dose and duration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcomes were proportion of participants who achieved clear or almost clear skin, that is, at least Psoriasis Area and Severity Index (PASI) 90 and proportion of participants with serious adverse events (SAEs) at induction phase (8 to 24 weeks after randomisation).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane RoB 2 tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We conducted study selection, data extraction, risk of bias assessment, and analysis in duplicate. We synthesised data using pairwise and network meta-analyses to compare treatments and rank them according to effectiveness (PASI 90 score) and acceptability (inverse of SAEs). We assessed the certainty of network meta-analysis evidence for the two critical outcomes and all comparisons using CINeMA, as very low, low, moderate, or high. We contacted study authors when data were unclear or missing. We used the surface under the cumulative ranking curve (SUCRA) to infer treatment hierarchy, from 0% (worst for effectiveness or safety) to 100% (best for effectiveness or safety).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;This update includes 26 new studies, taking the total number of included studies to 204, and randomised participants to 67,889 (67% men), mainly recruited from hospitals. The average age was 44.4 years, and the mean PASI score at baseline was 20.5 (range: 9.5 to 40). Most studies were placebo-controlled (56%). We assessed 26 treatments. Most (171) trials were multicentric (2 to 231 centres). Most studies (157/204) declared funding by a pharmaceutical company, and 27 studies ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD011535"},"PeriodicalIF":8.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788432","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 versus late tracheostomy in people with multiple trauma.","authors":"Kelly Ansems, Eva Steinfeld, Nicole Skoetz, Elena Aleksandrova, Maria-Inti Metzendorf, Thomas Breuer, Carina Benstoem, Sandra Dohmen","doi":"10.1002/14651858.CD015932.pub2","DOIUrl":"10.1002/14651858.CD015932.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;According to TraumaRegister DGU (the trauma registry of the German Trauma Society), 83% of trauma patients are admitted to an intensive care unit (ICU), with 34.8% receiving mechanical ventilation. However, specific data for people with multiple trauma are lacking. Prolonged ventilation due to acute respiratory failure or difficult weaning are common indications for tracheostomy in critically ill people. Despite numerous studies, the optimal timing for tracheostomy remains unclear. This review was initiated during the development of the Association of the Scientific Medical Societies in Germany (AWMF) S3 guideline 'Intensivmedizin nach Polytrauma' (intensive care after multiple trauma) to systematically assess the effects of early versus late tracheostomy in people with multiple trauma in the ICU.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of early tracheostomy compared with late tracheostomy in adults with multiple trauma in the intensive care unit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Web of Science, ClinicalTrials.gov, and WHO ICTRP from inception to 15 March 2024 without language restrictions. We also screened reference lists and contacted experts in the field.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We followed standard Cochrane methodology. We included randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) comparing early and late tracheostomy, defined according to any cutoff time point, in critically ill adults with multiple trauma, irrespective of sex, ethnicity, disease severity, or setting. We excluded studies published as abstract only, studies recruiting people with only one type of trauma, and studies recruiting people who needed immediate tracheostomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcome was all-cause mortality. Important outcomes included duration of stay (ICU or hospital), quality of life, pulmonary complications, adverse events, and time from tracheostomy to decannulation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used Cochrane risk of bias tools (RoB 2 for RCTs and ROBINS-I for NRSIs) to assess risk of bias at the outcome level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Our meta-analyses used a random-effects model. Our main comparison was early tracheostomy (&lt; 10 days) versus late tracheostomy (≥ 10 days) after intubation. Because the timing of early tracheostomy varied considerably across studies, we explored the impact of different timings in subgroup analyses. We used the GRADE approach to assess the certainty of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included one RCT (60 participants) and 22 NRSIs (44,811 participants). The RCT was a single-centre, parallel-group trial conducted in the USA over 38 months. It was halted prematurely after the first interim analysis. Most NRSIs (91%) were retrospective. Six studies, including the RCT, specifically addressed our main compar","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD015932"},"PeriodicalIF":8.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive mechanical ventilation for chronic hypoventilation in myotonic dystrophy.","authors":"Alexandra Vr Childs, Amanda J Piper, George Tp Tay, Jana Y Waldmann, Irene Szollosi","doi":"10.1002/14651858.CD014726","DOIUrl":"10.1002/14651858.CD014726","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The objective of this review is to evaluate the efficacy of non-invasive mechanical ventilation (NIV) in chronic hypoventilation due to myotonic dystrophy (MD). The aims of this review are to synthesize and assess the available literature to support evidence-based clinical practice and to provide recommendations for future evaluation and research.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD014726"},"PeriodicalIF":8.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788431","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":"Natalizumab for multiple sclerosis.","authors":"Chunyu Liu, Zhaolun Cai, Liangping Zhao, Muke Zhou, Lingli Zhang","doi":"10.1002/14651858.CD015123.pub2","DOIUrl":"10.1002/14651858.CD015123.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Natalizumab (NTZ) is the first monoclonal antibody approved for the treatment of highly active relapsing-remitting multiple sclerosis (RRMS). Since 2010, several new studies on NTZ for MS have emerged.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of NTZ alone or associated with other treatments in people with any form of MS.</p><p><strong>Search methods: </strong>We searched CENTRAL, PubMed, Embase, and two trials registries together with reference checking and contact with study authors to identify studies for inclusion in the review. The latest search date was 1 February 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) in adults with any subtype of MS comparing NTZ alone or associated with other medications versus inactive control or other approved disease-modifying treatments.</p><p><strong>Outcomes: </strong>Our outcomes included: relapse, disability worsening, serious adverse events (SAE), quality of life (QoL), number of participants with active magnetic resonance imaging (MRI) lesions (new or enlarged T2 lesions and gadolinium-enhancing (Gd+) lesions), and treatment discontinuation caused by adverse events (AE).</p><p><strong>Risk of bias: </strong>We assessed risk of bias using the Cochrane RoB 2 tool.</p><p><strong>Synthesis methods: </strong>Where possible, we performed a meta-analysis for each outcome by calculating risk ratios (RR), mean differences (MD), and hazard ratios (HR) with 95% confidence intervals (CI) for dichotomous outcomes, continuous outcomes, and time-to-event data respectively. Where meta-analysis was precluded by the nature of the data, we summarised the results narratively. We used GRADE to assess the certainty of evidence.</p><p><strong>Included studies: </strong>We included five parallel-group, multicentre RCTs enrolling a total of 3255 randomised participants who received NTZ 300 mg intravenously (IV) every four weeks or comparators. The included studies were conducted mostly in Europe and North America in white participants. Four of the five included studies were commercially funded.</p><p><strong>Synthesis of results: </strong>This review includes four comparisons; we have summarised the findings for the three main comparisons here, as evidence for the fourth comparison, NTZ versus interferon-beta in RRMS following NTZ discontinuation, was insufficient to draw conclusions as it was based on a single small study. The certainty of evidence was downgraded primarily due to high risk of bias and imprecision. All results are for NTZ 300 mg IV. NTZ versus placebo for RRMS At two-year follow-up, NTZ reduces the risk of relapse (HR 0.47, 95% CI 0.39 to 0.55; 2 studies, 2113 participants; high-certainty evidence) and sustained disability progression (HR 0.67, 95% CI 0.52 to 0.88; 2 studies, 2113 participants; high-certainty evidence); probably reduces the risk of SAEs (RR 0.83, 95% CI 0.70 to 0.99; 2 studies, 2110 pa","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD015123"},"PeriodicalIF":8.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12327181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788430","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":"Low-complexity automated nucleic acid amplification tests for extrapulmonary tuberculosis and rifampicin resistance in adults and adolescents.","authors":"Mikashmi Kohli, Leeberk Raja Inbaraj, Angela Salomon, Katie Scandrett, Alexei Korobitsyn, Nazir Ismail, Vignes Anand Srinivasalu, Jefferson Daniel, Karen R Steingart, Yemisi Takwoingi","doi":"10.1002/14651858.CD012768.pub4","DOIUrl":"10.1002/14651858.CD012768.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Low-complexity automated nucleic acid amplification tests (LC-aNAATs) are molecular World Health Organization (WHO)-recommended rapid diagnostic tests widely used for simultaneous detection of Mycobacterium tuberculosis complex and rifampicin resistance in sputum. To extend our previous review on extrapulmonary tuberculosis, we performed this update to inform a WHO policy update.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To estimate the diagnostic accuracy of LC-aNAATs for extrapulmonary tuberculosis and rifampicin resistance in adults and adolescents with presumptive extrapulmonary tuberculosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Science Citation Index, Latin American Caribbean Health Sciences Literature, Scopus, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, the International Standard Randomized Controlled Trial Number Registry, and ProQuest, up to 11 October 2023, without language restriction. A WHO public call for data was made between 30th November 2023 and 15th February 2024 to identify unpublished studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included cross-sectional and cohort studies using non-respiratory specimens and eight forms of extrapulmonary tuberculosis: tuberculous meningitis and pleural, lymph node, bone or joint, genitourinary, peritoneal, pericardial, and disseminated tuberculosis. Reference standards were culture and a study-defined composite reference standard (tuberculosis detection); and phenotypic drug susceptibility testing with or without genotypic drug susceptibility testing (rifampicin resistance detection). Index tests included Xpert Ultra, Truenat assays, STANDARD M10, and Iron qPCR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently extracted data and assessed the risk of bias and applicability using the QUADAS-2 tool. For tuberculosis detection, we performed separate analyses by specimen type and reference standard using the bivariate model to estimate summary sensitivity and specificity with 95% confidence intervals (CIs). Based on a pre-defined condition, based on sample sizes and type of technology for performing class-based analysis, data for Truenat MTB Plus were not included in the meta-analyses for LC-aNAATs. Hence, we present results for Xpert Ultra and Truenat MTB Plus separately. We assessed the certainty of evidence using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 37 unique studies where 36 studies evaluated Xpert Ultra and three studies evaluated Truenat MTB plus. We found no eligible studies for the other index tests. Overall, the risk of bias was low for patient selection, index test, and flow and timing domains. For the reference standard, the risk of bias for included studies was low (75%) or unclear (25%). Applicability for the patient selection domain was unclear for most studies because w","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"8 ","pages":"CD012768"},"PeriodicalIF":8.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12320217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144774814","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}