Cochrane Database of Systematic Reviews最新文献

{"title":"Xpert MTB/RIF Ultra assay for pulmonary tuberculosis and rifampicin resistance in adults and adolescents.","authors":"David J Horne, Jerry S Zifodya, Adrienne E Shapiro, Elizabeth Chandler Church, Jonah S Kreniske, Alexander W Kay, Katie Scandrett, Karen R Steingart, Yemisi Takwoingi","doi":"10.1002/14651858.CD009593.pub6","DOIUrl":"10.1002/14651858.CD009593.pub6","url":null,"abstract":"<p><strong>Background: </strong>Xpert MTB/RIF Ultra (Xpert Ultra) is a molecular World Health Organization (WHO)-recommended rapid diagnostic test that simultaneously detects tuberculosis and rifampicin resistance. This review updates a comparative accuracy Cochrane review of Xpert MTB/RIF and Xpert Ultra as Xpert Ultra has replaced Xpert MTB/RIF.</p><p><strong>Objectives: </strong>To determine the diagnostic accuracy of Xpert MTB/RIF Ultra (Xpert Ultra) for detecting pulmonary tuberculosis and rifampicin resistance in adults and adolescents with presumptive tuberculosis based on signs or symptoms or with an abnormal chest x-ray suggestive of tuberculosis.</p><p><strong>Search methods: </strong>We searched seven databases including CENTRAL, MEDLINE, and Embase, plus two trial registers (ClinicalTrials.gov and the WHO ICTRP) to 16 October 2023 without language restrictions. A WHO Public Call for ongoing and unpublished studies was made between 30 November 2023 and 15 February 2024.</p><p><strong>Selection criteria: </strong>We included cross-sectional studies, cohort studies, and randomised controlled trials that provided data on the diagnostic accuracy of Xpert Ultra using respiratory specimens in adolescents (aged 10 to 14 years) and adults (aged 15 years and older) with presumptive pulmonary tuberculosis. For pulmonary tuberculosis detection, the reference standards were culture and a composite reference standard. For rifampicin resistance, the reference standards were culture-based phenotypic drug susceptibility testing with or without whole genome sequencing.</p><p><strong>Data collection and analysis: </strong>Two review authors independently extracted data using a standardised form. We assessed risk of bias using QUADAS-2. We performed meta-analyses using a bivariate model to produce summary sensitivities and specificities, separately for pulmonary tuberculosis detection and rifampicin resistance detection. We performed subgroup analyses by smear status, HIV status, and history of tuberculosis. We summarised Xpert Ultra trace-positive results.</p><p><strong>Main results: </strong>Pulmonary tuberculosis detection For detection of pulmonary tuberculosis, Xpert Ultra summary sensitivity and specificity against culture were 90.7% (95% confidence interval (CI) 88.2 to 92.7) and 94.8% (95% CI 92.8 to 96.3) (32 studies, 12,529 participants; high-certainty evidence). Most studies had low risk of bias in all QUADAS-2 domains. If the point estimates for Xpert Ultra are applied to a hypothetical cohort of 1000 people, where 100 of those presenting with symptoms have pulmonary tuberculosis, Xpert Ultra will miss nine cases. The number of people wrongly diagnosed with pulmonary tuberculosis would be 47. In people living with HIV, Xpert Ultra summary sensitivity and specificity were 87.7% (82.0 to 91.7) and 95.3% (92.2 to 97.2) (11 studies, 1164 participants). Amongst people with smear-negative, culture-positive pulmonary tuberculosis, Xpert Ultra summar","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD009593"},"PeriodicalIF":8.8,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728444","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":"Vaginal lasers for treating stress urinary incontinence in women.","authors":"Giulia M Ippolito, Irene M Crescenze, Hannah Sitto, Rita R Palanjian, Daniel Raza, Paholo Barboglio Romo, Sheila A Wallace, Giovany Orozco Leal, J Quentin Clemens, Philipp Dahm, Priyanka Gupta","doi":"10.1002/14651858.CD013643.pub2","DOIUrl":"10.1002/14651858.CD013643.pub2","url":null,"abstract":"<p><strong>Background: </strong>Stress urinary incontinence (SUI) in women is common and can have a profound impact on an individual's quality of life. Vaginal lasers, designed for treating vulvovaginal atrophy, have been explored as a clinic-based option for treating SUI. However, the effect of vaginal lasers on SUI remains unclear.</p><p><strong>Objectives: </strong>To assess the effects of vaginal lasers for treating SUI in women and to summarise the principal findings of relevant economic evaluations.</p><p><strong>Search methods: </strong>We performed a comprehensive search using the Cochrane Incontinence Specialised Register (searched 29 April 2024). The Register contains trials identified from multiple databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, and WHO ICTRP (all within the Register). We also handsearched journals and conference proceedings and searched the reference lists of relevant articles. We identified published reports of relevant economic evaluations through electronic literature searches, and performed a literature search for a brief economic commentary (BEC), but found no studies of economic evaluations that compare vaginal lasers with other treatments.</p><p><strong>Selection criteria: </strong>We included randomised controlled trials of women with SUI assessing therapy with a vaginal laser versus sham or control treatments or topical treatments.</p><p><strong>Data collection and analysis: </strong>Two review authors independently performed study selection, data extraction, and risk of bias assessment, with arbitration from a third review author as needed. We performed statistical analyses using a random-effects model. We rated the certainty of evidence according to the GRADE approach.</p><p><strong>Main results: </strong>We screened 227 references and included nine studies that reported outcomes on 689 women with SUI. The studies were conducted in Europe, North America, and South America. Five studies utilised CO₂ laser and four utilised Er:YAG laser therapy, delivered from one to three treatments occurring 28 to 45 days apart. The studies compared laser therapy to sham or topical therapy; two studies had three comparator arms. The time points for all the reported outcomes ranged from three to 12 months and were therefore considered either short term (less than one year) or medium term (one to five years). Generally, the certainty of evidence was downgraded due to concerns of risk of bias and imprecision and judged to be very low. Vaginal lasers versus sham or control treatments (such as topical lubricant) All nine studies, reporting outcomes for 689 women, investigated this comparison. There may be no difference in the number of continent women between women who underwent vaginal laser compared to those who underwent sham or control treatments in the short term; however, the CI is sufficiently wide enough to in","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD013643"},"PeriodicalIF":8.8,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12291154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706591","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":"Transcranial laser therapy for acute ischaemic stroke.","authors":"Haoyang He, Zhimeng Zhang, Hengshu Chen, Zhixuan Jiang, Yanan Wang, Xindi Song, Junfeng Liu, Simiao Wu","doi":"10.1002/14651858.CD012426.pub2","DOIUrl":"10.1002/14651858.CD012426.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Ischaemic stroke is a leading cause of disability and death worldwide, but limited treatment options are available to improve its outcomes. Some studies have explored transcranial laser therapy in people with acute ischaemic stroke, but the benefits and harms of this treatment are unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The primary objective was to assess the benefits and harms of transcranial laser therapy for improving functional outcomes after acute ischaemic stroke. The secondary objective was to assess the equity of transcranial laser therapy in people with acute ischaemic stroke.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, ISI Science Citation Index, CINAHL, PEDro (Physiotherapy Evidence Database), REHABDATA, and four ongoing trials registries. We also searched reference lists and databases of conference abstracts for other studies, including any that are ongoing or unpublished. The latest search date was 3 August 2024 for all databases except CenterWatch, which we searched on 1 November 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) comparing transcranial laser therapy with sham treatment or no treatment in people with acute ischaemic stroke, with or without standard treatment in both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcomes were unfavourable functional outcome, defined as a score of 3 to 6 on the modified Rankin Scale (mRS), and all-cause mortality. The important outcomes were improvement of stroke severity measured on the National Institutes of Health Stroke Scale (NIHSS), serious adverse events, and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used the Cochrane risk of bias tool (RoB 2) to assess the risk of bias for all outcomes in all RCTs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We planned to use risk ratios (RRs) with 95% confidence intervals (CIs) to compare all outcomes. However, for improvement of stroke severity, we extracted odds ratios (ORs) and 95% CIs from the original studies because the raw data were unavailable. Our meta-analyses used fixed-effect modelling. To assess statistical heterogeneity, we used the I&lt;sup&gt;2&lt;/sup&gt; statistic. We used the GRADE approach to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included four RCTs enrolling a total of 1420 people with acute ischaemic stroke. The studies were published between 2007 and 2014. All were multicentre studies, based in Europe, North America, South America, Asia, or more than one of these continents. All studies included people older than 40 years (mean age 68.3 years), and 59.6% of participants were men. All studies enrolled participants within 24 hours after onset of stroke symptoms, all used a transcranial laser of 808-nm wavelength, and all compared transcranial laser therapy with sham treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Critical outcomes Transcranial laser t","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD012426"},"PeriodicalIF":8.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697811","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":"Corticosteroids for treatment of leptospirosis.","authors":"Nathaniel Lee, Su Myat Han, Patrick Mukadi, Tansy Edwards, Hsu Thinzar Maung, Chris Smith, Tin Zar Win","doi":"10.1002/14651858.CD014935.pub2","DOIUrl":"10.1002/14651858.CD014935.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Leptospirosis is a bacterial disease caused by Leptospira spp, a zoonotic pathogen spread via contaminated soil and water. Corticosteroids have been used for the treatment or prevention of severe manifestations of disease, but the indications for their use and treatment efficacy remain uncertain. This review evaluates the existing evidence for the use of corticosteroids in leptospirosis from randomised trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of corticosteroids versus no intervention, no intervention beyond standard of care, or placebo for the treatment of people with leptospirosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;Electronic searches in the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase, LILACS, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, and other resources were conducted. We searched online clinical trial registries to identify unpublished or ongoing trials, and reviewed reference lists from the identified publications for potential trials. We contacted authors of identified trials, relevant individuals, and organisations for additional information. The last search date was 10 April 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We considered the inclusion of randomised clinical trials of any trial design which assessed corticosteroids for the treatment of leptospirosis. We imposed no restrictions on age, sex, occupation, comorbidity of trial participants, or outcomes reported. We looked for trials assessing corticosteroids irrespective of type, route of administration, dosage, and schedule versus no intervention, placebo, or no intervention beyond standard care. We included trials meeting any of these criteria, irrespective of the manuscript's primary language.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We adhered to Cochrane methodology. Data entry and analysis were facilitated by the use of the Review Manager. The primary outcomes were all-cause mortality and the proportion of individuals experiencing serious adverse events. The secondary outcomes were quality of life, the proportion of individuals experiencing non-serious adverse events, days of hospitalisation, and the proportion of individuals experiencing Jarisch-Herxheimer reactions. We employed the risk of bias 2 tool (RoB 2) to assess the bias risk of included trials. We used the GRADEPro software to evaluate the certainty of evidence. We presented dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean differences (MD), both accompanied by their corresponding 95% confidence intervals (CI). We applied a random-effects meta-analysis for the primary analysis and a fixed-effect model for the sensitivity analyses. Our primary outcome analyses included trial data at the longest follow-up. We analysed the outcome data regardless of the risk of bias.&lt;/p&gt;&lt;p","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD014935"},"PeriodicalIF":8.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697810","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":"Palivizumab for preventing severe respiratory syncytial virus (RSV) infection in children.","authors":"Luis Garegnani, Pablo Roson Rodriguez, Camila Micaela Escobar Liquitay, Ignacio Esteban, Juan Va Franco","doi":"10.1002/14651858.CD013757.pub3","DOIUrl":"10.1002/14651858.CD013757.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Respiratory viruses are the leading cause of lower respiratory tract infection and hospitalisation in infants and young children. Respiratory syncytial virus (RSV) is the main infectious agent in this population. Palivizumab is administered intramuscularly every month for five months in the first RSV season to prevent serious RSV lower respiratory tract infection in children. Given its high cost, it is essential to know if palivizumab continues to be effective in preventing severe RSV disease in children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of palivizumab in preventing severe RSV infection in children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, Scopus, and two trials registers from the inception of each database to July 2024 with no language or publication status restrictions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) and cluster-RCTs in children 0 to 24 months of age of any gender, regardless of RSV infection history, comparing palivizumab given at a dose of 15 mg/kg once a month (maximum five doses) with placebo, no intervention, or standard care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcomes were hospitalisation due to RSV infection, all-cause mortality, and adverse events. Important outcomes were hospitalisation due to respiratory-related illness, length of hospital stay, RSV infection, number of wheezing days, days of supplemental oxygen, intensive care unit length of stay, and mechanical ventilation days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used Cochrane's RoB 2 tool to assess risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We conducted meta-analyses using random-effects models to calculate risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals (CI). We used GRADE to assess the certainty of evidence for each outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included one new trial in this update, bringing the total number of RCTs to six studies with 3611 children. All studies were parallel RCTs assessing the effects of 15 mg/kg of palivizumab every month for up to five months, compared to placebo or no intervention in an outpatient setting, although one study also included hospitalised infants, and another study administered palivizumab intranasally. Most of the included studies were conducted in children with a high risk of severe RSV infection due to comorbidities like bronchopulmonary dysplasia or congenital heart disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Systemic palivizumab reduces hospitalisation due to RSV infection at two years' follow-up (RR 0.44, 95% CI 0.30 to 0.64; I² = 23%; 5 studies, 3343 participants; high-certainty evidence). Based on 98 hospitalisations per 1000 participants in the placebo group, this corresponds to 43 (29 to 62) per 1000 participants in the palivizum","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD013757"},"PeriodicalIF":8.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12284916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative interventions in pelvic organ prolapse surgery.","authors":"Usama Shahid, Nir Haya, Kaven Baessler, Corina Christmann-Schmid, Ellen Yeung, Zhuoran Chen, Christopher Maher","doi":"10.1002/14651858.CD013105.pub2","DOIUrl":"10.1002/14651858.CD013105.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pelvic organ prolapse (POP) is a common condition, with a significant proportion of women requiring surgical treatment. While the evidence supporting the surgical management of pelvic organ prolapse is well established, the evidence for perioperative interventions remains porous. The main goal of perioperative interventions is to reduce the rate of adverse events while improving women's outcomes following surgical intervention for prolapse.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the safety and effectiveness of a range of perioperative interventions versus other interventions or no intervention (control group) at the time of surgery for POP.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from CENTRAL, MEDLINE, two major international clinical trials registers, and handsearching of journals and conference proceedings (searched 30 April 2024). We also contacted researchers in the field.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) of women undergoing surgical treatment for symptomatic POP that compared a perioperative intervention related to POP surgery versus no treatment or another intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard methodological procedures recommended by Cochrane. Our primary outcomes were awareness of prolapse, repeat surgery for prolapse and objective failure at any site. We also measured adverse events and patient-reported outcomes. We used the GRADE approach to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;This review includes 49 RCTs that compared 19 different intervention groups versus a control. The trials were conducted in 15 countries, and involved 5657 women. The certainty of the evidence ranged from low to moderate. Most interventions could not be blinded, thus introducing a risk of bias. POP surgery with or without pelvic floor muscle training (PFMT): seven RCTs with 1032 women There may be no clinically relevant difference in awareness of prolapse following POP surgery with or without PFMT (odds ratio (OR) 1.07, 95% confidence interval (CI) 0.61 to 1.87; 1 study, 305 women; low-certainty evidence). This suggests that if 20% of women are aware of prolapse after surgery without PFMT, 13% to 31% are likely to be aware after POP surgery with PFMT. Similarly, there may be no clinically relevant difference in repeat surgery for prolapse with or without PFMT (OR 0.86, 95% CI 0.23 to 3.26; 1 study, 316 women; low-certainty evidence). Additionally, there may be no clinically relevant difference in objective failure at any site with or without PFMT (OR 1.24, 95% CI 0.67 to 2.29; P = 0.49; 1 study, 307 women; low-certainty evidence). Finally, there may be no clinically relevant difference in patient-reported outcomes measures with or without PFMT, including Pelvic Floor Distress Inventory-20 (P","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD013105"},"PeriodicalIF":8.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689073","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":"Continuous positive airway pressure versus methylxanthine for apnoea in preterm infants.","authors":"Muhd Alwi Muhd Helmi, Prema Subramaniam, Jacqueline J Ho, Michelle Fiander, Hans Van Rostenberghe","doi":"10.1002/14651858.CD001072.pub2","DOIUrl":"10.1002/14651858.CD001072.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Recurrent apnoea is common in preterm infants, particularly at very early gestational ages. These episodes of ineffective breathing can lead to hypoxaemia and bradycardia, sometimes severe enough to require resuscitation, including positive pressure ventilation. Various interventions have been used to manage apnoea of prematurity, including methylxanthines and continuous positive airway pressure (CPAP). However, CPAP and methylxanthines remain the most widely studied and utilised treatments due to their greater benefits and lesser harms compared to alternatives like CO₂ inhalation.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of CPAP compared to methylxanthines for apnoea of prematurity in preterm infants.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, CINAHL, three clinical trials databases, and conference proceedings. We checked references in included studies and related systematic reviews up to August 2024.</p><p><strong>Eligibility criteria: </strong>We included all trials using random or quasi-random allocation to CPAP or any methylxanthine in preterm infants with clinical recurrent apnoea with or without bradycardia. We excluded infants with secondary apnoea, defined as apnoea secondary to causes other than prematurity. We excluded cross-over studies since the severity of apnoea of prematurity can change in either direction over time, but most commonly improves with time. We excluded studies that evaluated combined interventions, such as CPAP plus methylxanthines versus either CPAP or methylxanthines alone.</p><p><strong>Outcomes: </strong>Our critical outcomes were failure of treatment at any time point during hospitalisation, neurodevelopmental outcomes assessed at 18 to 24 months, death in the first year from any cause, bronchopulmonary dysplasia at 36 weeks' postmenstrual age (PMA), and adverse effects such as nasal trauma, tachycardia within the first 24 hours of treatment initiation, feeding intolerance, and pneumothorax.</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool (RoB 1) to assess the risk of bias in the studies.</p><p><strong>Synthesis methods: </strong>We conducted a structured narrative synthesis based on the Synthesis Without Meta-analysis (SWiM) reporting guidelines, as only one eligible study was included. We grouped results by outcome, and extracted absolute and relative effects. No meta-analysis or subgroup analysis was performed.</p><p><strong>Included studies: </strong>We included one small randomised controlled trial (RCT) with a total of 32 participants, conducted in a high-resource setting and involving preterm infants. The trial compared CPAP and theophylline.</p><p><strong>Synthesis of results: </strong>CPAP compared to theophylline The evidence is very uncertain about whether there is any difference between CPAP and theophylline in failure of treatment during hospitalisation (risk ratio (RR) 2.89, 95%","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD001072"},"PeriodicalIF":8.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689071","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":"Implementation interventions to promote healthcare professional uptake of evidence-based opioid prescribing for adults with acute non-cancer pain.","authors":"Jason A Wallis, Aili V Langford, Denise O'Connor, Emily Reeve, Ilana N Ackerman, Romi Haas, Sean Docking, Amanda J Cross, Justin Turner, Renea V Johnston, Alexandra Gorelik, Sheila Cyril, Janet Wale, Rachelle Buchbinder","doi":"10.1002/14651858.CD016179","DOIUrl":"10.1002/14651858.CD016179","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The primary objective is to assess the effects of implementation interventions aimed at improving the uptake of evidence-based opioid prescribing by healthcare prescribers for adults with acute non-cancer pain, compared with no intervention. The secondary objectives are. To explore whether the effects vary by intervention type (e.g. audit and feedback), target (e.g. healthcare prescribers), setting of implementation intervention (e.g. primary care), and type of pain (e.g. postsurgical pain). To summarise the availability and principal findings of eligible economic evaluations of the implementation interventions.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD016179"},"PeriodicalIF":8.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674026","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":"Implementation interventions to promote healthcare professional uptake of evidence-based opioid deprescribing for adults with chronic non-cancer pain.","authors":"Aili V Langford, Jason A Wallis, Emily Reeve, Rachelle Buchbinder, Amanda J Cross, Justin Turner, Sean Docking, Romi Haas, Renea V Johnston, Ilana N Ackerman, Sheila Cyril, Janet Wale, Danijela Gnjidic, Alexandra Gorelik, Denise O'Connor","doi":"10.1002/14651858.CD016178","DOIUrl":"10.1002/14651858.CD016178","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The primary objective is to assess the effects of implementation interventions aimed at improving the uptake of evidence-based opioid deprescribing by healthcare professionals for adults with chronic non-cancer pain, compared with no intervention. The secondary objectives are: To explore whether the effects vary by intervention type (e.g. audit and feedback), target (e.g. healthcare organisations), setting of implementation intervention (e.g. primary care) and duration of opioid use (e.g. < 12 months, ≥ 12 months). To summarise the availability and principal findings of eligible economic evaluations of the implementation interventions.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD016178"},"PeriodicalIF":8.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674025","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":"Automated versus non-automated weaning for reducing the duration of mechanical ventilation for critically ill adults and children.","authors":"Louise Rose, Marcus J Schultz, Chris R Cardwell, Frederique Paulus, Keith Couper, Philippe Jouvet, Bronagh Blackwood","doi":"10.1002/14651858.CD009235.pub4","DOIUrl":"10.1002/14651858.CD009235.pub4","url":null,"abstract":"<p><strong>Rationale: </strong>Automated closed-loop systems may improve the adaptation of mechanical ventilatory support to an individual's ventilatory needs. They may also facilitate systematic and early recognition of the patient's ability to breathe spontaneously and come off the ventilator. This is an update of a Cochrane review originally published in 2013 and last updated in 2014.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of automated weaning systems compared with non-automated weaning methods in critically ill, mechanically ventilated adults and children.</p><p><strong>Search methods: </strong>We searched MEDLINE ALL, Embase Classic+Embase, the Cochrane Library (Wiley), CINAHL (EBSCO), the Web of Science Core Collection, and trial registries on 2 February 2024. We checked the reference lists of included studies and relevant systematic reviews for other potentially eligible studies.</p><p><strong>Eligibility criteria: </strong>We included randomized controlled trials (RCTs) evaluating automated closed-loop ventilator applications versus non-automated weaning methods (including non-protocolized usual care and protocolized weaning) in people aged over four weeks who were receiving invasive mechanical ventilation in an intensive care unit (ICU).</p><p><strong>Outcomes: </strong>Our critical outcomes were duration of mechanical ventilation (from randomization to successful unassisted breathing or death), mortality, ICU length of stay, and hospital length of stay. Our important outcomes included other ventilation durations, adverse events related to mechanical ventilation, and health-related quality of life.</p><p><strong>Risk of bias: </strong>Two review authors independently assessed risk of bias using the Cochrane risk of bias tool RoB 1.</p><p><strong>Synthesis methods: </strong>Two review authors independently extracted study data. We synthesized results for each outcome using meta-analysis (random-effects modeling). Subgroup and sensitivity analyses were conducted according to pre-established criteria. We used GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Included studies: </strong>This update included 62 trials (59 in adults, 3 in children) with 5052 participants (4834 adults, 218 children). The trials evaluated 10 commercially available automated closed-loop systems and one non-commercial system. Forty trials were conducted in mixed or medical ICU populations, the remainder in surgical ICU populations.</p><p><strong>Synthesis of results: </strong>Automated closed-loop systems probably reduce the duration of mechanical ventilation compared with non-automated weaning methods (mean difference [MD] -0.28 log hours, 95% confidence interval [CI] -0.36 to -0.20; I² = 87%; 51 RCTs, 3929 participants; moderate-certainty evidence). These data translate to a relative reduction of 24% (95% CI 18% to 30%). Automated closed-loop systems probably result in little to no difference in mo","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"7 ","pages":"CD009235"},"PeriodicalIF":8.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12272810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658515","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}