Cochrane Database of Systematic Reviews最新文献

{"title":"Clinical outcomes of out-of-office versus in-office blood pressure monitoring in adults with hypertension.","authors":"Victoria Roncal-Belzunce, Fernanda Ramón-Espinoza, Marta Gutiérrez-Valencia, Leire Leache, Luis Carlos Saiz, Juan Erviti","doi":"10.1002/14651858.CD015304","DOIUrl":"https://doi.org/10.1002/14651858.CD015304","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 out-of-office compared to in-office blood pressure (BP) monitoring for improving clinical outcomes in adults with hypertension.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015304"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964782","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":"Typhoid conjugate vaccines for preventing typhoid fever (enteric fever).","authors":"Natasha R Gloeck, Trudy D Leong, Mashudu Mthethwa, Chinwe Juliana Iwu-Jaja, Patrick Dmc Katoto, Charles S Wiysonge, Tamara Kredo","doi":"10.1002/14651858.CD015746.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD015746.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Typhoid fever is a major cause of enteric disease-related morbidity and mortality. Vaccination reduces disease burden and prevents outbreaks, but policies and programmes should be informed by the most recent evidence as newer vaccines become available.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of typhoid conjugate vaccines (TCVs) compared to no vaccine, placebo, typhoid-inactive agents (vaccines for another disease) or other typhoid vaccines for preventing morbidity and mortality associated with typhoid fever in adults and children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;In April 2024, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Global Index Medicus, United States Advisory Committee on Immunization Practices and the World Health Organization vaccine repository for randomised controlled trials (RCTs), with no restrictions. We also searched clinical trial registries for ongoing trials (www.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinicaltrials: &lt;/strong&gt;gov and the WHO International Clinical Trials Registry Platform), grey literature, bibliographic citations of reviews and key articles for additional studies. We contacted study authors for information about ongoing studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included RCTs and cluster-RCTs of children and adults living in typhoid-endemic areas or travelling to typhoid-endemic areas. We included studies comparing TCVs to controls (i.e. no vaccine, placebo or vaccines for another disease), non-conjugated typhoid vaccines or other TCVs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Outcomes included acute typhoid fever, defined by laboratory-confirmed isolation of Salmonella typhi, all-cause mortality, adverse events (AEs) and serious adverse events (SAEs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Review authors independently assessed risk of bias for all outcomes, using the Cochrane RoB 2 tools. We resolved disagreements through discussion or adjudication. We assessed the intention-to-treat effect and used the overall RoB judgement to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Three review authors independently screened titles and abstracts for eligible studies, followed by full-text assessment. Disagreements were resolved through discussion or adjudication by a fourth author. Four authors independently extracted characteristics of included studies and outcome data using a piloted, standardised data extraction form. We synthesised results for each outcome where possible, using the Mantel-Haenszel statistical method and random-effects analysis model. Where meta-analysis was not possible due to the nature of the data, we planned to synthesise results based on direction of effect. We used GRADE to assess the certainty of evidence for each outcome, assessing risk of bias, inconsistency, indirectness, imprecision and other bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 19 t","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015746"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971509","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":"Dietary Approaches to Stop Hypertension (DASH) for the primary and secondary prevention of cardiovascular diseases.","authors":"Abdelsalam Bensaaud, Suzanne Seery, Irene Gibson, Jennifer Jones, Gerard Flaherty, John William McEvoy, Fionnuala Jordan, Wael Tawfick, Sherif Ah Sultan","doi":"10.1002/14651858.CD013729.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD013729.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Dietary Approaches to Stop Hypertension (DASH) diet is designed to lower blood pressure and improve cardiovascular health by reducing sodium and unhealthy fats while increasing nutrients, including potassium, calcium, magnesium, and fibre. While evidence supports its benefits for managing cardiovascular risk factors, gaps remain in understanding its long-term impact on preventing cardiovascular disease (CVD), particularly in terms of hard clinical outcomes such as myocardial infarction and stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of the DASH diet for the primary and secondary prevention of cardiovascular diseases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We used standard extensive Cochrane search methods. The latest search date was in May 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) comparing a DASH diet intervention to no intervention (including usual care), minimal intervention, or other dietary interventions. In the context of this review, 'minimal intervention' includes brief dietary advice or informational leaflets provided during a medical consultation, without a structured dietary intervention. 'Other dietary interventions' include any other dietary programme besides the DASH diet. Participants were adults with or without CVD. The minimum duration of eligible interventions was eight weeks and the minimum follow-up was three months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard Cochrane methods. Primary outcomes were myocardial infarction, heart failure, and stroke. Secondary outcomes were the need for coronary revascularisation, carotid revascularisation, peripheral revascularisation, all-cause mortality, cardiovascular mortality, changes in blood pressure, blood lipids, the occurrence of type 2 diabetes, health-related quality of life, and adverse effects. We used GRADE to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;Five RCTs involving 1397 participants met our inclusion criteria and were included in this review. All five trials contributed at least one intervention arm to one or more of the three prespecified comparisons. In total, 1075 participants across eligible arms were included in the meta-analyses. The difference reflects trial arms that did not meet our prespecified intervention and comparison definitions, and were therefore not analysed, though all participants were randomised within eligible trials and are accounted for in the review total. The trials assessed the DASH diet in a primary prevention setting; none evaluated its effects in secondary prevention. Participants were generally healthy adults aged 18 years or older, without diagnosed cardiovascular disease. The intervention duration ranged from 16 weeks to 12 months, with follow-up periods between 16 weeks and 18 months (medium- and long-term). The trials were conducted in the USA and Poland, wit","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD013729"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971779","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 utility of limited channel sleep studies versus polysomnography for obstructive sleep apnoea.","authors":"Sander van Doorn, Demy L Idema, Pauline Heus, Johanna Aag Damen, René Spijker, Eva J Japenga, Herre J Reesink, Lotty Hooft","doi":"10.1002/14651858.CD013810.pub2","DOIUrl":"10.1002/14651858.CD013810.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obstructive sleep apnoea (OSA) is a common cause of sleep disturbance, characterised by the presence of repetitive upper airway obstruction during sleep. OSA is associated with sleepiness during the day, reduced quality of life and an increased risk of cardiovascular disease. OSA can be diagnosed using several different strategies. The current reference test is fully supervised polysomnography, which is expensive and time-consuming. Other diagnostic tests, referred to as limited channel sleep studies because they include fewer parameters than polysomnography, are less resource-intensive but may also have different diagnostic performances, resulting in a difference in clinical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the clinical impact (outcome on a participant level) of a strategy where treatment follows diagnostic testing (test-treatment combination) using limited channel sleep studies compared to polysomnography in people with suspected obstructive sleep apnoea (OSA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched two databases (CENTRAL, MEDLINE) up to 11 May 2023 using search terms related to OSA and polysomnography developed by our information specialist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials that compared any limited channel sleep studies with Level I fully supervised polysomnography in adults (aged 18 years and older) with suspected OSA. Our primary outcome was sleepiness, and our secondary outcomes were quality of life, all-cause mortality, cardiovascular events and correlating risk factors, continuous positive airway pressure (CPAP) usage, serious adverse events, and cost-effectiveness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Four review authors extracted data from the included trials and assessed the risk of bias. We summarised treatment effects using random-effects meta-analyses and expressed as mean difference (MD) or standardised mean difference (SMD) with corresponding 95% confidence intervals (CI) where possible. We used GRADE to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included three trials with 1143 participants. One trial compared Level III sleep studies to a Level I fully supervised polysomnography, one trial compared Level IV sleep studies to Level I sleep studies, and one trial compared Level IV sleep studies versus Level III sleep studies versus Level I sleep studies. The follow-up of these trials ranged from four to six months. Level III sleep studies versus Level I sleep studies There is high-certainty evidence that Level III sleep studies result in little to no difference in sleepiness (MD 0.47, 95% CI -0.23 to 1.18; P = 0.19, I&lt;sup&gt;2&lt;/sup&gt; = 0%; 2 trials, 701 participants) or quality of life (SMD 0.01, 95% CI -0.14 to 0.16; P = 0.93, I&lt;sup&gt;2&lt;/sup&gt; = 0%; 2 trials, 701 participants) compared to Level I sleep studies. Level III sleep studies are also probably slightly more cost-ef","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD013810"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983916","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":"Weight-neutral interventions for people with obesity and the perspective of patients, carers and healthcare professionals: a mixed methods review.","authors":"Juan Va Franco, Jan Hindemit, Yang Guo, Brenda Bongaerts, Maria-Inti Metzendorf, Rainer Peelen, Rasmus Køster-Rasmussen, Lene B Meyer, Jane Noyes, Ralph Möhler","doi":"10.1002/14651858.CD016107","DOIUrl":"10.1002/14651858.CD016107","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To assess the effects of weight-neutral interventions for managing obesity in children and adults (quantitative data). To explore the views, perspectives and experiences of children and adults receiving the intervention, their close family members or, if appropriate, carers, and healthcare personnel who recommend or deliver weight-neutral interventions to determine their feasibility and acceptability and any factors that create barriers and facilitators to optimal implementation (qualitative data). To determine whether the programme theories, components and delivery of interventions take account of the views, perspectives and experiences of intervention recipients and whether patient-centred interventions have greater effects.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD016107"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975848","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":"Sedation for moderate-to-severe traumatic brain injury in adults.","authors":"David R Williamson, Lindsay Dryden, Wei Cheng, Brian Hutton, Becky Skidmore, Sangeeta Mehta, Eyal Golan, Alexis F Turgeon, Neill Kj Adhikari, Louise Rose, Lisa Burry","doi":"10.1002/14651858.CD012639.pub2","DOIUrl":"https://doi.org/10.1002/14651858.CD012639.pub2","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 sedative, analgesic, and anaesthetic drugs on neurological outcomes in adults with moderate-to-severe traumatic brain injury.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD012639"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981543","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":"Psychological therapies for post-traumatic stress disorder in children and adolescents.","authors":"Dyveke B Illum, Sidsel Cb Døssing, Maria Quistgaard, Mie S Jørgensen, Lise Møller, Donna Gillies, Magnus T Tang Kristensen, Sabrina Nestved, Julie Perrine Schaug, Christian Gluud, Pia Jeppesen, Ole Jakob Storebø","doi":"10.1002/14651858.CD015983","DOIUrl":"https://doi.org/10.1002/14651858.CD015983","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 (i.e. benefits and harms) of psychological therapies for post-traumatic stress disorder and complex post-traumatic stress disorder in children and adolescents.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"5 ","pages":"CD015983"},"PeriodicalIF":8.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990603","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":"Melatonin in cancer treatment.","authors":"Ze Yu Yu, Rong Yan Peng, Nuo Cheng, Rui Ting Wang, Meng Die Nan, Stefania Milazzo, Karen Pilkington, Dugald Seely, Markus Horneber, Jian Ping Liu","doi":"10.1002/14651858.CD010145.pub2","DOIUrl":"10.1002/14651858.CD010145.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Preserving health-related quality of life is an aspect of care that requires constant attention from the time of cancer diagnosis. Melatonin has been used to diminish treatment-related side effects and cancer symptoms, and as a medication to regulate circadian rhythm. An up-to-date systematic review is needed to investigate the current evidence concerning possible beneficial effects of melatonin on quality of life and sleep in cancer patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of melatonin for preserving health-related quality of life and sleep in cancer patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;To identify studies for inclusion in this review, we used CENTRAL, MEDLINE, 10 other databases, and four trial registers, together with reference checking, citation searching, and contact with study authors. The latest search date was 10 September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) of adults (18 years or over) with histologically proven cancer of any stage that evaluated melatonin (alone or in combination with standard anticancer treatment) versus no treatment or placebo (alone or in combination with standard anticancer treatment), or standard anticancer treatment. Standard anticancer treatment refers to treatments to stop or prevent cancer, including chemotherapy, radiation therapy, surgery, immunotherapy, and hormonal therapies (such as androgen deprivation therapy).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The primary outcomes of interest were quality of life and sleep quality within three months, and melatonin-related adverse events. Other outcomes included survival, disease-free survival, progression-free survival, tumour response, and anticancer treatment-related harms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used Cochrane's risk of bias tool (RoB 1) to assess the risk of bias in the studies included in the review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesised results for each outcome using random-effects meta-analysis. The effect size was presented as risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, with 95% confidence intervals (CI). If this was not possible, due to the nature of the data, we synthesised results in a narrative format. We used GRADE to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We identified 30 RCTs (reported in 49 publications) involving 5093 adult participants with cancer (2470 males, 2228 females, 395 not reported). Studies were conducted in a hospital setting and took place in at least 10 countries. We assessed two studies at low risk of bias and the other 28 at high risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Melatonin plus standard treatment versus placebo plus standard treatment The evidence is very uncertain about the effect of melatonin on quality of life score (MD 2.60, 95% CI -14.53 to ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD010145"},"PeriodicalIF":8.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977402","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":"Multi-level factors affecting adolescent and youth engagement in HIV-research in low- and middle-income countries: a qualitative evidence synthesis.","authors":"Carmen Späth, Neetha Shagan Morar, Anja van der Westhuizen, Bey-Marrié Schmidt","doi":"10.1002/14651858.CD016010","DOIUrl":"https://doi.org/10.1002/14651858.CD016010","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: To explore the views and experiences of adolescents and youth who engaged with (i.e. were approached for participation) or participated in HIV research in low-and middle-income countries. To develop a logic model or visual representation that depicts the variety of factors affecting adolescent and youth engagement in HIV-related research, and how these factors potentially work together.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD016010"},"PeriodicalIF":8.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977375","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":"Treatment for ulnar neuropathy at the elbow.","authors":"Pietro Caliandro, Giuseppe La Torre, Roberto Padua, Fabio Giannini, Giuseppe Reale, Luca Padua","doi":"10.1002/14651858.CD006839.pub5","DOIUrl":"https://doi.org/10.1002/14651858.CD006839.pub5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome. Treatment may be conservative or surgical, but optimal management remains controversial. This is an update of a review first published in 2011 and previously updated in 2012 and 2016.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the effectiveness and safety of conservative and surgical treatment for ulnar neuropathy at the elbow (UNE). We intended to test whether: - surgical treatment is effective in reducing symptoms and signs and in increasing nerve function; - conservative treatment is effective in reducing symptoms and signs and in increasing nerve function; - it is possible to identify the best treatment on the basis of clinical, neurophysiological, or nerve imaging assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, four other databases, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform to July 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;The review included only randomised controlled clinical trials (RCTs) or quasi-RCTs evaluating people with clinical symptoms suggesting the presence of UNE. We included trials evaluating all forms of surgical and conservative treatments. We considered studies regarding therapy of UNE with or without neurophysiological evidence of entrapment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently reviewed titles and abstracts of references retrieved from the searches and selected all potentially relevant studies. The review authors independently extracted data from included trials and assessed risk of bias. We contacted trial investigators for any missing information. The primary outcome was clinically relevant improvement in function compared to baseline. The secondary outcomes of interest were change in neurological impairment, change from baseline of the motor nerve conduction velocity across the elbow, change from baseline in the nerve diameter/cross-sectional area at the elbow, evaluated by ultrasound or MRI, change in quality of life and adverse events. We used GRADE methodology to assess the certainty of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 15 RCTs (970 participants), of which six studies were new for this update. Sequence generation was inadequate in one study and not described in six studies; other studies had a low risk of selection bias. We evaluated the clinical outcomes (3 trials, 261 participants) and neurophysiological outcomes (2 trials, 101 participants) of simple decompression versus decompression with submuscular or subcutaneous transposition. Moreover, we evaluated the clinical outcomes of endoscopic versus open decompression surgery (2 trials, 99 participants). We found there was probably little t","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"4 ","pages":"CD006839"},"PeriodicalIF":8.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956922","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}