Cochrane Database of Systematic Reviews最新文献

{"title":"Ultrasound-guided versus anatomic landmark-guided percutaneous femoral artery access.","authors":"Shira A Strauss, Gar-Way Ma, Chanhee Seo, Jeffrey J Siracuse, Sreekumar Madassery, Alexander G Truesdell, Keith Pereira, Ethan C Korngold, Ahmed Kayssi","doi":"10.1002/14651858.CD014594.pub2","DOIUrl":"10.1002/14651858.CD014594.pub2","url":null,"abstract":"<p><strong>Background: </strong>The use of percutaneous arterial access for endovascular procedures has broad applications, from diagnostic angiography in the coronary and peripheral arteries, to thromboembolectomy in people with ischemic stroke and percutaneous coronary intervention in those with acute myocardial infarction. The rise of these procedures worldwide underscores the importance of obtaining precise and timely arterial access while minimizing the risk of adverse events. Traditionally, anatomic landmarks, such as the anterior superior iliac spine and symphysis pubis, have guided percutaneous common femoral artery (CFA) access, along with manual palpation of the pulse and fluoroscopy to confirm bony landmarks. Anatomic landmarks can be deceptive, however, especially in certain subpopulations, such as those with a high femoral artery bifurcation, elevated body mass index (BMI), or non-palpable femoral pulses. Ultrasound has emerged as a promising tool to guide percutaneous CFA access, offering enhanced visualization and providing real-time guidance. Notwithstanding this theoretical advantage, trials have inconsistently demonstrated an advantage to ultrasound guidance over anatomic landmarks, and concerns surrounding added set-up time and training have limited its uptake both clinically and across society guidelines.</p><p><strong>Objectives: </strong>To assess the efficacy and safety of ultrasound compared to anatomic landmarks to guide percutaneous access of the CFA for the purpose of endovascular arterial imaging or treatment.</p><p><strong>Search methods: </strong>The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 25 January 2024.</p><p><strong>Selection criteria: </strong>We selected randomized controlled trials comparing ultrasound guidance to anatomic landmark guidance (using manual palpation or fluoroscopy, or both) for percutaneous CFA access in people undergoing endovascular therapy for diagnostic or therapeutic purposes.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methods. Primary outcomes included first-pass success, time to successful CFA access, and major bleeding (including hematoma requiring transfusion, hematoma extending length of stay, hematoma ≥ 5 cm, unexplained hemoglobin drop, or major/severe bleeding as defined by each trial). Secondary outcomes included overall cannulation success, venipuncture, pain scores, number of access attempts, major complications (including retroperitoneal hematoma, pseudoaneurysms, dissections, arteriovenous fistulae, or occlusions), adverse events (including minor bleeding, infection, and neuropathy) up to 30 days, quality of life, re-intervention rate up to 30 days, and total number of access sites attempted. We conducted sensitivity analyse","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD014594"},"PeriodicalIF":8.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729124","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":"Antibiotic treatment for non-tuberculous mycobacteria lung infection in people with cystic fibrosis.","authors":"Nikki Jahnke, Valerie Waters, Felix Ratjen, Sherie Smith, Ian R Hambleton, Naomi Scharf","doi":"10.1002/14651858.CD016039","DOIUrl":"10.1002/14651858.CD016039","url":null,"abstract":"<p><strong>Rationale: </strong>Cystic fibrosis (CF) is a common genetic condition in which progressive lung disease leads to morbidity and mortality. Non-tuberculous mycobacteria (NTM) are mycobacteria, other than those in the Mycobacterium tuberculosis complex, and are commonly found in the environment. NTM pulmonary infections affect a significant proportion of people with CF worldwide, which may be associated with a more rapid decline in lung function and even death in certain circumstances. Although there are guidelines for the antimicrobial treatment of NTM lung disease, there is no specific evidence from studies of people with CF to inform recommendations for their treatment. It is not clear which antibiotic regimen may be the most effective in the treatment of people with CF. This is an update of a previous review.</p><p><strong>Objectives: </strong>To compare antibiotic treatment to no antibiotic treatment, or to compare different combinations of antibiotic treatment, for suppressing or eradicating non-tuberculous mycobacteria (NTM) lung infections in people with cystic fibrosis (CF).</p><p><strong>Search methods: </strong>We searched Cochrane's Cystic Fibrosis Trials Register, online databases (MEDLINE, Embase and PubMed) and online trials registries (www.</p><p><strong>Clinicaltrials: </strong>gov and the World Health Organization International Clinical Trials Registry). We also searched the reference lists of included studies and relevant reviews. The date of the last search was 14 October 2024.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials (RCTs) or quasi-RCTs with a parallel design; non-randomised studies of interventions (NRSIs) with the following designs: instrumental variables; regression discontinuity; interrupted time series; difference-in-differences and fixed-effect designs. These should have compared antibiotic treatment to no antibiotic treatment, or different combinations of antibiotic treatment, in people with CF of any age with NTM pulmonary infection.</p><p><strong>Outcomes: </strong>We aimed to assess the critical outcomes of microbiological clearance of NTM in sputum, quality of life, adverse events, lung function and pulmonary exacerbations. Further, we planned to assess important outcomes of mortality, nutritional parameters, hospitalisations and use of additional oral antibiotics.</p><p><strong>Risk of bias: </strong>We planned to use the recommended Cochrane tools for RCTs or NRSIs. These were not suitable for the included study, so we assessed the risk of bias using a tool for case series developed by the Joanna Briggs Institute.</p><p><strong>Synthesis methods: </strong>We were only able to report the limited results from the single included study narratively. We assessed the certainty of the results using GRADE.</p><p><strong>Included studies: </strong>Due to a lack of studies of the types planned, we were only able to include a single retrospective case review, which presented data a","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD016039"},"PeriodicalIF":8.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718263","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":"Effect of adrenergic agonist oral decongestants on blood pressure.","authors":"Jocelyn Joy Chan, Magnus Chan, James M Wright","doi":"10.1002/14651858.CD007895.pub3","DOIUrl":"10.1002/14651858.CD007895.pub3","url":null,"abstract":"<p><strong>Background: </strong>Adrenergic agonist oral decongestants are commonly taken daily over long periods of time to relieve sinus and nasal congestion. The mechanism of action of decongestants potentially increases blood pressure, and these effects may be acute or chronic. However, no systematic reviews to date have comprehensively assessed the chronic blood pressure effects of adrenergic agonist oral decongestants as a drug class, despite their widespread non-prescription availability.</p><p><strong>Objectives: </strong>Primary objective To assess the effects of adrenergic agonist oral decongestants on systolic and diastolic blood pressure compared to placebo. Secondary objective To assess the effects of adrenergic agonist oral decongestants on heart rate and withdrawals due to adverse effects.</p><p><strong>Search methods: </strong>The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials (RCT) up to July 2024: Cochrane Hypertension Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Register of Studies, Ovid MEDLINE, Ovid Embase, and ClinicalTrials.gov. There were no language, publication year, or publication status restrictions.</p><p><strong>Selection criteria: </strong>We included RCTs of at least seven days' duration with parallel groups (intervention and placebo) comparing adrenergic agonist oral decongestants versus placebo on blood pressure in people aged over six years.</p><p><strong>Data collection and analysis: </strong>Two review authors (JJC and MC) independently assessed the trials for inclusion, extracted the data, and assessed the risk of bias from the included trials. In cases where there were disagreements, the third review author (JMW) adjudicated. For any missing or unclear information in the studies, we contacted the study author to request the missing information or seek clarification. The primary outcomes were systolic blood pressure and diastolic blood pressure. Secondary outcomes were heart rate and withdrawal due to adverse effects. We used a fixed-effect model to combine the effect sizes from all studies. We assessed the certainty of the evidence using GRADE.</p><p><strong>Main results: </strong>Five RCTs randomizing 882 participants met the inclusion criteria. The shortest study duration was one week, and the longest study duration was 24 weeks. These studies measured blood pressure and heart rate after one to seven weeks of taking oral decongestants. The largest study included 568 people, and the smallest study included 18 people. The mean age of participants was 20.0 years, with 326 males and 591 females. The studies were conducted in the USA and Europe; most were set in the USA. Pharmaceutical companies funded three of the five included studies. The findings are relevant to all people using adrenergic agonist oral decongestants for seven days or longer regardless of comorbidities or pre-existing conditions. The","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD007895"},"PeriodicalIF":8.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718264","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-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews.","authors":"Rodrigo Rn Rizzo, Aidan G Cashin, Benedict M Wand, Michael C Ferraro, Saurab Sharma, Hopin Lee, Edel O'Hagan, Christopher G Maher, Andrea D Furlan, Maurits W van Tulder, James H McAuley","doi":"10.1002/14651858.CD014691.pub2","DOIUrl":"10.1002/14651858.CD014691.pub2","url":null,"abstract":"<p><strong>Background: </strong>Low back pain (LBP) is a significant public health issue due to its high prevalence and associated disability burden. Clinical practice guidelines recommend non-pharmacological/non-surgical interventions for managing pain and function in people with LBP.</p><p><strong>Objectives: </strong>To provide accessible, high-quality evidence on the effects of non-pharmacological and non-surgical interventions for people with LBP and to highlight areas of remaining uncertainty and gaps in the evidence regarding the effects of these interventions for people with LBP.</p><p><strong>Methods: </strong>We searched the Cochrane Database of Systematic Reviews from inception to 15 April 2023, to identify Cochrane reviews of randomised controlled trials testing the effect of non-pharmacological/non-surgical interventions, unrestricted by language. Major outcomes were pain intensity, function and safety. Two authors independently assessed eligibility, extracted data and assessed the quality of the reviews using AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) and the certainty of the evidence using GRADE. The primary comparison was placebo/sham.</p><p><strong>Main results: </strong>We included 31 Cochrane reviews of 644 trials that randomised 97,183 adults with LBP. We have high confidence in the findings of 19 reviews, moderate confidence in the findings of two reviews, and low confidence in the findings of 10 reviews. We present results for non-pharmacological/non-surgical interventions compared to placebo/sham or no treatment/usual care at short-term (≤ three months) follow-up. Placebo/sham comparisons Acute/subacute LBP Compared to placebo, there is probably no difference in function (at one-week follow-up) for spinal manipulation (standardised mean difference (SMD) -0.08, 95% confidence interval (CI) -0.37 to 0.21; 2 trials, 205 participants; moderate-certainty evidence). Data for safety were reported only for heated back wrap. Compared to placebo, heated back wrap may result in skin pinkness (6/128 participants versus 1/130; 2 trials; low-certainty evidence). Chronic LBP Compared to sham acupuncture, acupuncture probably provides a small improvement in function (SMD -0.38, 95% CI -0.69 to -0.07; 3 trials, 957 participants; moderate-certainty evidence). Compared to sham traction, there is probably no difference in pain intensity for traction (0 to 100 scale, mean difference (MD) -4, 95% CI -17.7 to 9.7; 1 trial, 60 participants; moderate-certainty evidence). Data for safety were reported only for acupuncture. There may be no difference between acupuncture and sham acupuncture for safety outcomes (risk ratio (RR) 0.68, 95% CI 0.42 to 1.10; I<sup>2</sup> = 0%; 4 trials, 465 participants; low-certainty evidence). No treatment/usual care comparisons Acute/subacute LBP Compared to advice to rest, advice to stay active probably provides a small reduction in pain intensity (SMD -0.22, 95% CI -0.02 to -0.41; 2 trials, 401 parti","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD014691"},"PeriodicalIF":8.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11945228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729119","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":"Positron emission tomography-adapted therapy for first-line treatment in adults with Hodgkin lymphoma.","authors":"Nina Kreuzberger, Marius Goldkuhle, Bastian von Tresckow, Carsten Kobe, Marie-Therese Sickinger, Ina Monsef, Nicole Skoetz","doi":"10.1002/14651858.CD010533.pub3","DOIUrl":"10.1002/14651858.CD010533.pub3","url":null,"abstract":"<p><strong>Background: </strong>Hodgkin lymphoma (HL) is one of the most curable cancers worldwide. Treatment options comprise more- or less-intensified regimens of chemotherapy plus radiotherapy depending on the disease stage. An interim-[18F]-fluorodeoxy-D-glucose (FDG)-positron emission tomography (PET), a procedure to illustrate a tumour's metabolic activity, stage and progression, could be used during treatment to distinguish between individuals who are good or poor early responders to therapy. Subsequent therapy could be de-escalated in PET-negative individuals (good responders) or escalated in those who are PET-positive (poor responders).</p><p><strong>Objectives: </strong>To assess the effects of interim [18F]-FDG-PET-imaging treatment modification in previously untreated individuals with HL.</p><p><strong>Search methods: </strong>For this review update, we searched MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase, clinicaltrials.gov and the WHO ICTRP up to 17 November 2023.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials (RCTs) comparing interim-FDG-PET-adapted therapy with non-adapted standard treatment in adults with untreated HL of all stages.</p><p><strong>Data collection and analysis: </strong>Two review authors independently screened results for inclusion, extracted data into a standardised data extraction sheet and assessed the risk of bias according to the Cochrane risk of bias tool. We collected (modified) intention-to-treat effect estimates for the predefined outcomes: overall survival (OS), progression-free survival (PFS), treatment-related mortality (TRM), adverse events (AE) including secondary malignancies and quality of life (QoL), where available, and used random-effects models for meta-analysis. We analysed early, intermediate and advanced stage HL and PET-negative versus PET-positive participants separately. We used the GRADE approach to rate our certainty in the evidence.</p><p><strong>Main results: </strong>We included 10 studies covering early (1 RCT, 667 participants), intermediate (1 RCT, 651 participants), early-to-intermediate (3 RCTs, 1639 participants) and advanced-stage HL (5 RCTs; 3629 participants). We did not identify eligible ongoing studies. Generally, the risk of bias was low or, sometimes, unclear except for detection bias, which was rated as high for all studies for subjective outcomes such as PFS, TRM and AE due to the lack of blinding. PET-based adaptation in early-stage PET-negative participants The effect of treatment adaptation (omission of radiotherapy with or without additional chemotherapy) on OS and PFS is uncertain (HR 0.84, 95% CI 0.13 to 5.32; and HR 4.52, 95% CI 0.72 to 28.41, 1034 participants). Adaptation may have little to no effect on the incidence of secondary malignancies (RR 0.83, 95% CI 0.46 to 1.50; 984 participants; low-certainty). No studies reported on TRM, serious adverse events (SAE) or QoL. PET-based adaptation","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD010533"},"PeriodicalIF":8.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708782","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":"Perceptions and experiences of the prevention, identification and management of pre-eclampsia and eclampsia: a qualitative evidence synthesis.","authors":"Katherine E Eddy, Nicole Minckas, Rana I Zahroh, Steve McDonald, Özge Tunçalp, Koiwah Kkl Koi-Larbi, Jennifer Scott, Joshua P Vogel, Meghan A Bohren","doi":"10.1002/14651858.CD016164","DOIUrl":"10.1002/14651858.CD016164","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: The overall objective of this qualitative evidence synthesis is to describe and explore the perceptions and experiences of key stakeholders who have experience with pre-eclampsia/eclampsia or its prevention, identification, or management. The key stakeholders are women who have experienced pre-eclampsia/eclampsia, people in the community, lay health workers, and skilled health workers. Our specific objectives are to: synthesise qualitative studies that explore key stakeholders' understanding of pre-eclampsia/eclampsia and their perceptions regarding its causes and consequences; develop a conceptual understanding of women's 'journeys' with pre-eclampsia/eclampsia, including their experiences of the condition or preventive interventions, and their values and challenges; explore how health workers prevent, identify, and manage pre-eclampsia/eclampsia in community settings, or during transfer or referral to health facilities; and synthesise the factors affecting the implementation of different pre-eclampsia/eclampsia prevention, identification, and management strategies in health facility settings, including perceptions, experiences, values, acceptability, and feasibility.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD016164"},"PeriodicalIF":8.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699830","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":"Multimodal interventions for cachexia management.","authors":"Joanne Reid, Carolyn Blair, Martin Dempster, Clare McKeaveney, Adrian Slee, Donna Fitzsimons","doi":"10.1002/14651858.CD015749.pub2","DOIUrl":"10.1002/14651858.CD015749.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cachexia (disease-related wasting) is a complex metabolic syndrome which occurs in people with chronic illnesses, including cancer, HIV/AIDS, kidney disease, heart disease, and chronic obstructive pulmonary disease (COPD). People with cachexia experience unintentional weight loss, muscle loss, fatigue, loss of appetite, and reduced quality of life. Multimodal interventions which work synergistically to treat the syndrome could lead to benefits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of multimodal interventions aimed at alleviating or stabilising cachexia in people with a chronic illness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, PsycINFO, and two trials registers in July 2024, together with reference checking, citation searching, and contact with study authors to identify studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) in adults with or at risk of cachexia, comparing multimodal interventions combining two or more modalities (of pharmacology, nutrition, exercise) to treatment as usual, variation of the intervention, or unimodal intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently screened potentially eligible studies, extracted data, and assessed risk of bias (RoB 1). Primary outcomes were physical function, strength, and adverse events. Secondary outcomes were body composition and weight, quality of life (QoL), appetite, fatigue, and biochemical markers. We assessed the certainty of evidence with GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included nine studies with 926 adults (mean age: 63 years). Study sample sizes ranged from 20 to 332 participants. Six studies were conducted in Europe, and one each in Turkey, New Zealand, and the USA. There were six studies in people with cancer, and one each in people with COPD, chronic kidney disease, and HIV/AIDS. We judged four studies to be at an overall high risk of bias, and five at an overall unclear risk. All outcomes in all comparisons had very low-certainty evidence, downgraded once for risk of bias and/or indirectness and twice for imprecision. Multimodal intervention (pharmacological, nutritional, and/or exercise) compared to treatment as usual One cancer study randomised 46 participants, with 41 included in all analyses except adverse events. The study assessed outcomes immediately after treatment, lasting six weeks. Compared to treatment as usual, there is no clear evidence for an effect of a multimodal intervention on: physical function (mean difference (MD) -16.10 m, 95% confidence interval (CI) -79.06 to 46.86; 41 participants); strength (MD 3.80 kg, 95% CI -3.21 to 10.81; 41 participants); adverse events (risk ratio (RR) 1.36, 95% CI 0.70 to 2.65; 46 participants); body composition (MD 7.89 cm&lt;sup&gt;2&lt;/sup&gt;, 95% CI -10.43 to 26.21; 41 participants); weight (MD 5.89 kg, 95% CI -1.45 to 13.23; 41 par","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD015749"},"PeriodicalIF":8.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699826","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":"Audit and feedback: effects on professional practice.","authors":"Noah Ivers, Sharlini Yogasingam, Meagan Lacroix, Kevin A Brown, Jesmin Antony, Charlene Soobiah, Michelle Simeoni, Thomas A Willis, Jacob Crawshaw, Vivi Antonopoulou, Carly Meyer, Nathan M Solbak, Brenna J Murray, Emily-Ann Butler, Simone Lepage, Martina Giltenane, Mary D Carter, Guillaume Fontaine, Michael Sykes, Michael Halasy, Abdalla Bazazo, Samantha Seaton, Tony Canavan, Sarah Alderson, Catherine Reis, Stefanie Linklater, Aislinn Lalor, Ashley Fletcher, Emma Gearon, Hazel Jenkins, Jason A Wallis, Liesl Grobler, Lisa Beccaria, Sheila Cyril, Tomas Rozbroj, Jia Xi Han, Alice Xt Xu, Kelly Wu, Geneviève Rouleau, Maryam Shah, Kristin Konnyu, Heather Colquhoun, Justin Presseau, Denise O'Connor, Fabiana Lorencatto, Jeremy M Grimshaw","doi":"10.1002/14651858.CD000259.pub4","DOIUrl":"10.1002/14651858.CD000259.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Audit and feedback (A&F) is a widely used strategy to improve professional practice. This is supported by prior Cochrane reviews and behavioural theories describing how healthcare professionals are prompted to modify their practice when given data showing that their clinical practice is inconsistent with a desirable target. Yet there remains uncertainty regarding the effects of A&F on improving healthcare practice and the characteristics of A&F that lead to a greater impact.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of A&F on the practice of healthcare professionals and to examine factors that may explain variation in the effectiveness of A&F.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;With the Cochrane Effective Practice and Organisation of Care (EPOC) group information scientist, we updated our search strategy to include studies published from 2010 to June 2020. Search updates were performed on 28 February 2019 and 11 June 2020. We searched MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), the Cochrane Library, clinicaltrials.gov (all dates to June 2020), WHO ICTRP (all dates to February Week 3 2019, no information available in 2020 due to COVID-19 pandemic). An updated search and duplicate screen was completed on February 14, 2022; studies that met inclusion criteria are included in the 'Studies awaiting classification' section.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;Randomised trials, including cluster-trials and cross-over and factorial designs, featuring A&F (defined as measurement of clinical performance over a specified period of time (audit) and provision of the resulting data to clinicians or clinical teams (feedback)) in any trial arm that reported objectively measured health professional practice outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;For this updated review, we re-extracted data for each study arm, including theory-informed variables regarding how the A&F was conducted and behaviour change techniques for each intervention, as well as study-level characteristics including risk of bias. For each study, we extracted outcome data for every healthcare professional practice targeted by A&F. All data were extracted by a minimum of two independent review authors. For studies with dichotomous outcomes that included arms with and without A&F, we calculated risk differences (RDs) (absolute difference between arms in proportion of desired practice completed) and also odds ratios (ORs). We synthesised the median RDs and interquartile ranges (IQRs) across all trials. We then conducted meta-analyses, accounting for multiple outcomes from a given study and weighted by effective sample size, using reported (or imputed, when necessary) intra-cluster correlation coefficients. Next, we explored the role of baseline performance, co-interventions, targeted behaviour, and study design factors on the estimated effects of A&F. Finally, we conducted exploratory meta-regressions to test presel","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD000259"},"PeriodicalIF":8.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699758","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":"Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales for detecting anxiety disorders in adults.","authors":"Zekeriya Aktürk, Alexander Hapfelmeier, Alexey Fomenko, Daniel Dümmler, Stefanie Eck, Michaela Olm, Jan Gehrmann, Victoria von Schrottenberg, Rahel Rehder, Sarah Dawson, Bernd Löwe, Gerta Rücker, Antonius Schneider, Klaus Linde","doi":"10.1002/14651858.CD015455","DOIUrl":"10.1002/14651858.CD015455","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anxiety disorders often remain undetected and can cause substantial burden. Amongst the many anxiety screening tools, the 7-item Generalized Anxiety Disorder (GAD-7) scale and its short version, the 2-item Generalized Anxiety Disorder (GAD-2) scale, are the most frequently used instruments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Primary: to determine the diagnostic accuracy of GAD-7 and GAD-2 to detect generalised anxiety disorder (GAD) and any anxiety disorder (AAD) in adults. Secondary: to investigate whether their diagnostic accuracy varies by setting, anxiety disorder prevalence, reference standard, and risk of bias; to compare the diagnostic accuracy of GAD-7 and GAD-2; to investigate how diagnostic performance changes with the test threshold.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched MEDLINE, Embase, PubMed-not-MEDLINE subset, and PsycINFO from 1990 to 18 January 2024. We checked reference lists of included studies and review articles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included cross-sectional studies conducted in adults, containing diagnostic accuracy information on GAD-7 and/or GAD-2 questionnaires for the target conditions generalised anxiety disorder and/or any anxiety disorder, and allowing the generation of 2x2 tables. The target conditions must have been diagnosed using a structured or semi-structured clinical interview. We excluded case-control studies and studies in which the time elapsed between the index tests and reference standards exceeded four weeks. We excluded studies involving people (1) seeking help in mental health settings or (2) recruited specifically due to mental health symptoms in other settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;At least two review authors independently decided on study eligibility, extracted data, and assessed the risk of bias and applicability of included studies. For each questionnaire and each target condition, we present sensitivity and specificity with 95% confidence intervals (95% CI) in forest plots. We used the bivariate model to obtain summary estimates based on cut-offs closest to the recommended values (i.e. within a core range). In secondary analyses, we used the bivariate model and the multiple thresholds model to obtain summary estimates for all available cut-off points. Using the multiple thresholds model, we also calculated the area under the receiver operating characteristic curve to obtain a general indicator of the diagnostic accuracy of GAD-7 and GAD-2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 48 studies with 19,228 participants from 27 different countries, evaluating the GAD-7 and the GAD-2 in 24 different languages. Seven studies were performed in non-clinical settings, nine in clinical settings recruiting participants across conditions, and 32 in clinical settings with participants having specific conditions. Even after categorisation into three settings, the study populations were substantially diff","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD015455"},"PeriodicalIF":8.8,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Next-generation sequencing for guiding matched targeted therapies in people with relapsed or metastatic cancer.","authors":"Farasat Kazmi, Nipun Shrestha, Tik Fung Dave Liu, Thomas Foord, Philip Heesen, Stephen Booth, David Dodwell, Simon Lord, Kheng-Wei Yeoh, Sarah P Blagden","doi":"10.1002/14651858.CD014872.pub2","DOIUrl":"10.1002/14651858.CD014872.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Matched targeted therapies (MTT) given alone or in combination with systemic anti-cancer therapies have delivered proven survival benefit for many people with newly diagnosed cancer. However, there is little evidence of their effectiveness in the recurrent or late-stage setting. With this uncertainty, alongside the perception that late-stage cancers are too genetically heterogenous or too mutationally diverse to benefit from matched targeted therapies, next-generation sequencing (NGS) of tumours in people with refractory cancer remains a low priority. As a result, next-generation sequencing testing of recurrent or late-stage disease is discouraged. We lack evidence to support the utility of next generation sequencing in guiding matched targeted therapies in this setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of matched targeted therapies in people with advanced cancers in randomised controlled trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organisation International Clinical Trials Registry Platform (WHO-ICTRP) search portal up to 30th October 2024. We also screened reference lists of included studies and also the publications that cited these studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) that had enroled participants with advanced/refractory solid or haematological cancers who had progressed through at least one line of standard anti-cancer systemic therapy. To be eligible, all participants should have received matched targeted therapy based on next-generation sequencing carried out on their tumour (tumour tissue, blood or bone marrow).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We systematically searched medical databases (e.g. MEDLINE, Embase) and trial registers for randomised controlled trials (RCTs). Outcomes of interest were progression-free survival (PFS), overall survival (OS), overall response rates (ORR), serious (grade 3 or 4) adverse events (AEs) and quality of life (QOL). We used a random-effects model to pool outcomes across studies and compared predefined subgroups using interaction tests. Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment of certainty was used to evaluate the quality of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We identified a total of 37 studies, out of which 35 studies (including 9819 participants) were included in the meta-analysis. All included studies compared a matched targeted therapy intervention to standard-of-care treatment, non-matched targeted therapies or no treatment (best supportive care): Matched targeted therapy versus standard-of-care treatment Matched targeted therapy (MTT) compared with standard systematic therapy probably reduces the risk of disease progression by 34% (hazard ratio (HR) = 0.66, 95% co","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD014872"},"PeriodicalIF":8.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691107","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}