<p><strong>Rationale: </strong>Sucrose is, in general, safe and effective for analgesia during venepuncture in hospitalised neonates. However, there is a lack of evidence on its analgesic effects.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of orally administered sucrose for pain relief from venepuncture in preterm and term neonates compared to no intervention, standard care, and other types of analgesic interventions.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Ovid Embase, and trial registries in July 2025, and the China National Knowledge Infrastructure, VIP Chinese Science and Technology Periodicals, and Wanfang Data in August 2024. We checked reference lists of included studies and topic-related systematic reviews.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs), including cross-over and cluster-RCTs, that evaluated the effects of sucrose analgesia in neonates (including term and preterm infants) up to 44 weeks' postmenstrual age undergoing venepuncture. We excluded quasi-RCTs and studies reported only as conference abstracts. We included studies administering sucrose with or without non-nutritive sucking (NNS) before, at the time of, or after venepuncture. Sucrose could be of any concentration, volume, or dose. Sucrose was compared to: no intervention, water, or standard care; skin-to-skin care; breastfeeding; feeding; NNS alone (e.g. pacifier); glucose; positioning; or topical anaesthetics.</p><p><strong>Outcomes: </strong>Outcomes of interest were pain intensity score, as measured by validated pain assessment scales, and adverse events.</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool (RoB 1).</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis where possible. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous data (presence or absence of pain). We calculated the standardised mean difference (SMD) or mean difference (MD) for pain intensity scores (continuous outcome), each with its 95% CI. We used a fixed-effect model to combine data and quantified the impact of heterogeneity using the I² statistic. Where these methods were not feasible due to the nature of the data, we synthesised the results narratively. We used GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Included studies: </strong>We included a total of 29 studies, accounting for 2764 term and preterm neonates. There was a large variation in sucrose dose and concentration (from 0.1 mL/kg to 0.5 mL/kg or a set volume from 0.1 mL to 2 mL) as well as mode of administration (e.g. oral syringe, pacifier, dropper, in combination with a pacifier). Most of the studies compared sucrose to no intervention, water, or standard care (n = 17). Other comparisons include non-nutritive sucking, skin-to-skin care, breastfeeding, expressed breast milk, and other sweet solu
理由：一般来说，蔗糖用于住院新生儿静脉穿刺镇痛是安全有效的。然而，其镇痛作用缺乏证据。目的：评价口服蔗糖缓解早产儿和足月新生儿静脉穿刺疼痛的利与弊，与不干预、标准护理和其他类型的镇痛干预相比。检索方法：2025年7月检索CENTRAL、MEDLINE、Ovid Embase、trial registry； 2024年8月检索中国国家知识基础设施、VIP中文科技期刊、万方数据。我们检查了纳入研究的参考文献列表和与主题相关的系统综述。入选标准：我们纳入了随机对照试验（rct），包括交叉和聚类rct，评估蔗糖镇痛对经后44周接受静脉穿刺的新生儿（包括足月和早产儿）的影响。我们排除了准随机对照试验和仅作为会议摘要报道的研究。我们纳入了在静脉穿刺前、穿刺时或穿刺后给予或不给予非营养性吸吮（NNS）蔗糖的研究。蔗糖可以是任何浓度、体积或剂量。蔗糖与无干预、水或标准护理进行比较；肌肤护理;母乳喂养;喂养;单独的NNS（例如安抚奶嘴）；葡萄糖;定位;或者局部麻醉。结果：关注的结果是疼痛强度评分（通过验证的疼痛评估量表测量）和不良事件。偏倚风险：我们使用Cochrane偏倚风险工具（RoB 1）。综合方法：我们尽可能使用荟萃分析对每个结果进行综合。我们用95%置信区间（ci）计算了二分类数据（有无疼痛）的风险比（rr）。我们计算了疼痛强度评分（连续结局）的标准化平均差（SMD）或平均差（MD），每个评分都有95% CI。我们使用固定效应模型合并数据，并使用I²统计量量化异质性的影响。由于数据的性质，这些方法不可行，我们综合叙述的结果。我们使用GRADE来评估每个结果证据的确定性。纳入的研究：我们共纳入29项研究，涉及2764例足月和早产儿。蔗糖的剂量和浓度（从0.1 mL/kg到0.5 mL/kg或从0.1 mL到2ml的设定体积）以及给药方式（例如口服注射器、安抚奶嘴、滴管、与安抚奶嘴联合使用）都有很大的变化。大多数研究将蔗糖与无干预、水或标准治疗进行比较（n = 17）。其他比较包括无营养吸吮、皮肤对皮肤护理、母乳喂养、母乳表达和其他甜的解决方案。结果综合：不良事件（如窒息、呼吸暂停）未见任何比较报告。蔗糖（有或没有NNS）与没有干预、水或标准护理相比，有或没有NNS的蔗糖与没有干预相比，可能会降低静脉穿刺期间和30秒后的疼痛强度评分（SMD -0.82, 95% CI -1.02至-0.63；7项研究，477名参与者；中等确定性证据）。与无干预相比，在静脉穿刺后1分钟，蔗糖加NNS可降低疼痛强度评分（MD -9.15, 95% CI -9.91至-8.39；1项研究，100名受试者；高确定性证据）。与无干预相比，不加NNS的蔗糖对静脉穿刺后2分钟疼痛强度评分的影响尚不确定（SMD -0.99, 95% CI -1.31至-0.68；3项研究，186名受试者；极低确定性证据）。蔗糖（有或没有NNS）与皮肤对皮肤护理相比，无NNS的蔗糖可能对静脉穿刺疼痛评分几乎没有影响（MD 1.49, 95% CI 0.86至2.12；2项研究，208名受试者；低确定性证据）。30秒、1分钟和2分钟后的疼痛评分没有报告。通过新生儿面部编码系统（0 =无痛，> =痛）测量，蔗糖与母乳喂养相比可能减轻静脉穿刺时的疼痛（RR 1.38, 95% CI 1.01至1.88；1项研究，103名参与者；中等确定性证据）。与静脉穿刺后两分钟母乳喂养相比，蔗糖可能导致疼痛几乎没有差异（RR 1.06, 95% CI 0.94至1.19；1项研究，104名参与者；低确定性证据）。30秒和1分钟后的疼痛评分没有报告。蔗糖（有或没有NNS）与NNS相比，有NNS的蔗糖可能减轻静脉穿刺时的疼痛（SMD -1.52, 95% CI -1.92至-1.12；2项研究，136名受试者；中等确定性证据）。与NNS相比，无NNS的蔗糖可能不会降低静脉穿刺时的疼痛强度评分（MD 1.37, 95% CI 0.57至2.17；2项研究，133名受试者；低确定性证据）。 与NNS相比，NNS加蔗糖可降低静脉穿刺后1分钟的疼痛强度评分（MD -5.81, 95% CI -6.30至-5.32；2项研究，200名受试者；低确定性证据）。与单独使用NNS相比，使用NNS的蔗糖可能在静脉穿刺后2分钟减轻疼痛强度（SMD -1.30, 95% CI -1.71至-0.89；2项研究，136名受试者；中等确定性证据）。与NNS相比，无NNS的蔗糖可能导致静脉穿刺后2分钟疼痛强度评分几乎没有差异（MD 0.47, 95% CI -0.14至1.08；1项研究，56名参与者；中等确定性证据）。我们在几个比较中降低了证据的确定性，主要是由于选择、表现、检测和报告偏倚的不明确或高风险。异质性也很高。作者的结论：目前的证据表明，与没有干预、水或标准护理相比，蔗糖可能会减少静脉穿刺期间和之后不久的疼痛评分。与皮肤对皮肤护理相比，蔗糖对静脉穿刺镇痛的效果尚无确切证据。与母乳喂养相比，蔗糖可能会减少静脉穿刺时的疼痛评分，但静脉穿刺后两分钟的疼痛评分可能差别不大。有证据表明，与单独使用NNS相比，使用NNS的蔗糖可能会减少静脉穿刺期间和之后的疼痛评分。与NNS相比，单独使用蔗糖可能导致静脉穿刺后两分钟疼痛强度评分几乎没有差异。经费：本综述没有专门的经费。注册：协议可通过doi/10.1002/14651858.CD015221获得。
{"title":"Sucrose analgesia for venepuncture in neonates.","authors":"Mariana Bueno, Ligyana Candido, Jiale Hu, Michelle Fiander, Jane Cracknell, Emily Xu, Jiamin Kang, Janet Yamada","doi":"10.1002/14651858.CD015221.pub2","DOIUrl":"10.1002/14651858.CD015221.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Sucrose is, in general, safe and effective for analgesia during venepuncture in hospitalised neonates. However, there is a lack of evidence on its analgesic effects.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of orally administered sucrose for pain relief from venepuncture in preterm and term neonates compared to no intervention, standard care, and other types of analgesic interventions.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Ovid Embase, and trial registries in July 2025, and the China National Knowledge Infrastructure, VIP Chinese Science and Technology Periodicals, and Wanfang Data in August 2024. We checked reference lists of included studies and topic-related systematic reviews.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs), including cross-over and cluster-RCTs, that evaluated the effects of sucrose analgesia in neonates (including term and preterm infants) up to 44 weeks' postmenstrual age undergoing venepuncture. We excluded quasi-RCTs and studies reported only as conference abstracts. We included studies administering sucrose with or without non-nutritive sucking (NNS) before, at the time of, or after venepuncture. Sucrose could be of any concentration, volume, or dose. Sucrose was compared to: no intervention, water, or standard care; skin-to-skin care; breastfeeding; feeding; NNS alone (e.g. pacifier); glucose; positioning; or topical anaesthetics.</p><p><strong>Outcomes: </strong>Outcomes of interest were pain intensity score, as measured by validated pain assessment scales, and adverse events.</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool (RoB 1).</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis where possible. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous data (presence or absence of pain). We calculated the standardised mean difference (SMD) or mean difference (MD) for pain intensity scores (continuous outcome), each with its 95% CI. We used a fixed-effect model to combine data and quantified the impact of heterogeneity using the I² statistic. Where these methods were not feasible due to the nature of the data, we synthesised the results narratively. We used GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Included studies: </strong>We included a total of 29 studies, accounting for 2764 term and preterm neonates. There was a large variation in sucrose dose and concentration (from 0.1 mL/kg to 0.5 mL/kg or a set volume from 0.1 mL to 2 mL) as well as mode of administration (e.g. oral syringe, pacifier, dropper, in combination with a pacifier). Most of the studies compared sucrose to no intervention, water, or standard care (n = 17). Other comparisons include non-nutritive sucking, skin-to-skin care, breastfeeding, expressed breast milk, and other sweet solu","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD015221"},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12956425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347774","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}
Pub Date : 2026-03-04DOI: 10.1002/14651858.CD016337
Jonathan Livingstone-Banks, Claire Ma, Elias Klemperer, Rachel N Cassidy, Holly Jarman, Dorothy Hatsukami, Nicola Lindson, Jamie Hartmann-Boyce
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of using reduced-nicotine cigarettes, compared with standard cigarettes, in people who smoke. To evaluate the benefits and harms of smoking cessation or reduction interventions used as an adjunct to reduced-nicotine cigarettes in people who smoke, compared with the same interventions delivered without reduced-nicotine cigarettes.
{"title":"Reduced-nicotine cigarettes for smoking cessation and reduction.","authors":"Jonathan Livingstone-Banks, Claire Ma, Elias Klemperer, Rachel N Cassidy, Holly Jarman, Dorothy Hatsukami, Nicola Lindson, Jamie Hartmann-Boyce","doi":"10.1002/14651858.CD016337","DOIUrl":"10.1002/14651858.CD016337","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of using reduced-nicotine cigarettes, compared with standard cigarettes, in people who smoke. To evaluate the benefits and harms of smoking cessation or reduction interventions used as an adjunct to reduced-nicotine cigarettes in people who smoke, compared with the same interventions delivered without reduced-nicotine cigarettes.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD016337"},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354102","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}
<p><strong>Rationale: </strong>The effectiveness of magnesium sulphate for acute bronchiolitis in children under two years is unclear. There is a paucity of robust data favouring or opposing the use of magnesium sulphate in acute bronchiolitis. This is an update of a review first published in 2020.</p><p><strong>Objectives: </strong>To assess the effects of magnesium sulphate in acute bronchiolitis in children under two years of age.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, and two trial registries until 23 November 2024. We contacted trial authors and searched conference proceedings and reference lists of retrieved articles to identify additional studies. Both unpublished and published studies were eligible for inclusion.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials (RCTs) and non-randomised studies of magnesium sulphate (alone or with another treatment) compared with placebo or another treatment, in children under two years with acute bronchiolitis.</p><p><strong>Outcomes: </strong>Our critical outcomes were time to recovery; all-cause, in-hospital mortality; and adverse events. Important outcomes included duration of hospital stay, clinical severity score at 0 to 24 hours and at 25 to 48 hours after treatment, and hospital readmission rate within 30 days of discharge.</p><p><strong>Risk of bias: </strong>We assessed risk of bias using Cochrane's RoB 1 tool.</p><p><strong>Synthesis methods: </strong>We planned a priori to use a random-effects model for meta-analysis, but used a fixed-effect model when only a single study was available. We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence.</p><p><strong>Included studies: </strong>We identified three new trials for a total of seven trials (816 children) in this update. One study each received funding from a hospital, university, and funding agency; one study did not receive any funding; and three studies did not report funding sources. Comparator interventions were placebo, nebulised hypertonic saline, epinephrine, salbutamol, and standard care (humidified oxygen and hydration). The included studies were conducted in Qatar, Turkey, Iran, China, and India. We identified one study as an erratum that was unlikely to have affected the validity of the results.</p><p><strong>Synthesis of results: </strong>None of the studies measured time to recovery. The certainty of evidence was very low for most outcomes due to risk of bias and very serious imprecision. Magnesium sulphate compared with placebo (1 RCT, 160 children) The effects of magnesium sulphate on mortality or adverse events (no events in either intervention; risk ratio (RR) not estimable), duration of hospital stay (mean difference (MD) not estimable), or clinical severity (Wang score) (at 0 to 24 hours: MD 0.13, 95% confidence interval (CI) -0.28 to 0.54; at 25 to 48 hours: MD -0.42, 95% CI -0.84 to
理由：硫酸镁治疗两岁以下儿童急性细支气管炎的有效性尚不清楚。支持或反对使用硫酸镁治疗急性细支气管炎缺乏可靠的数据。这是对2020年首次发表的一篇综述的更新。目的：评价硫酸镁治疗2岁以下儿童急性细支气管炎的疗效。检索方法：我们检索了CENTRAL、MEDLINE、Embase、LILACS、CINAHL和两个试验注册中心，检索时间截止到2024年11月23日。我们联系了试验作者，检索了会议记录和检索文章的参考文献列表，以确定其他研究。未发表和已发表的研究均符合纳入条件。资格标准：随机对照试验（rct）和非随机研究，硫酸镁（单独或与另一种治疗）与安慰剂或另一种治疗相比，用于2岁以下急性细支气管炎儿童。结果：我们的关键结果是恢复时间；全因住院死亡率；以及不良事件。重要结局包括住院时间、治疗后0 ~ 24小时和25 ~ 48小时的临床严重程度评分以及出院后30天内的再入院率。偏倚风险：我们使用Cochrane的RoB 1工具评估偏倚风险。综合方法：我们先验地计划使用随机效应模型进行meta分析，但在只有单一研究时使用固定效应模型。我们采用Cochrane期望的标准方法程序。我们使用GRADE来评估证据的确定性。纳入的研究：在本次更新中，我们从总共7项试验（816名儿童）中确定了3项新试验。其中一项研究分别得到医院、大学和资助机构的资助；一项研究没有得到任何资助；还有三项研究没有报告资金来源。比较干预措施为安慰剂、雾化高渗生理盐水、肾上腺素、沙丁胺醇和标准护理（湿氧和水合）。纳入的研究在卡塔尔、土耳其、伊朗、中国和印度进行。我们将一项研究确定为不太可能影响结果有效性的勘误。综合结果：没有一项研究测量恢复时间。由于存在偏倚风险和非常严重的不准确性，大多数结果的证据确定性非常低。硫酸镁与安慰剂的比较（1项RCT， 160名儿童）硫酸镁对死亡率或不良事件（两种干预均无不良事件；风险比（RR）不可估计）、住院时间（平均差（MD）不可估计）或临床严重程度（Wang评分）的影响(0至24小时：MD 0.13, 95%可信区间(CI) -0.28至0.54；25至48小时：MD -0.42, 95% CI -0.84至-0.00)非常不确定。硫酸镁可能增加出院30天内的再入院率（RR 3.16, 95% CI 1.20 - 8.27； 158名儿童；低确定性证据）。其他结果没有测量。硫酸镁与高渗盐水的比较（1项随机对照试验，220名儿童）未测量死亡率和不良事件。硫酸镁对住院时间（天）（MD 0.00, 95% CI -0.28 ~ 0.28）或25 ~ 48小时呼吸窘迫评估仪（RDAI）评分的临床严重程度（MD 0.10, 95% CI -0.39 ~ 0.59）的影响非常不确定。其他结果没有测量。没有研究将硫酸镁与肾上腺素进行比较。硫酸镁与传统支气管扩张剂（沙丁胺醇）的比较（1项随机对照试验，37名儿童）硫酸镁对死亡率或不良事件（两种干预均无不良事件，RR无法估计）或住院时间(硫酸镁：24小时（95% CI 25.8 ~ 47.4）；沙丁胺醇：24小时（95% CI 23.4至76.9）)非常不确定。其他结果没有测量。硫酸镁+支气管扩张剂与未治疗或生理盐水+相同支气管扩张剂比较（1项随机对照试验，37名儿童）。硫酸镁对死亡率或不良事件（两种干预均无不良事件发生；RR无法估计）或住院时间(硫酸镁+沙丁胺醇：20小时（95% CI 15.3 ~ 39.0）的影响；沙丁胺醇：24小时（95% CI 23.4至76.9）)非常不确定。其他结果没有测量。没有研究比较硫酸镁+高渗盐水与不治疗或生理盐水+高渗盐水。硫酸镁+肾上腺素与未治疗或生理盐水+肾上腺素的比较（1项随机对照试验，120名儿童）未测量死亡率和不良事件。硫酸镁对住院时间（小时）（MD -0.40, 95% CI -3.94至3.14）或临床严重程度（RDAI评分）（0至24小时：MD -0.20, 95% CI -1.06至0.66；25至48小时：MD -0.90, 95% CI -1.75至-0.05）的影响非常不确定。其他结果没有测量。 硫酸镁+标准治疗与标准治疗的比较（2项随机对照试验，164名儿童）死亡率未测量。硫酸镁对不良事件的影响(没有事件干预;RR不是有价值的;2相关,164名儿童),住院时间(天)(MD -0.07, 95%可信区间-1.12到0.98,1个随机对照试验,60个孩子),临床严重程度(Wang和RDAI分数)(0到24小时:MD -0.65, 95%可信区间-1.71到0.42;2相关,164名儿童),30天内再入院率或放电(相对危险度3.41,95%可信区间0.14到80.59,1个随机对照试验,60个孩子)非常不确定。其他结果没有测量。作者的结论：现有证据不足以确定硫酸镁治疗两岁以下急性细支气管炎儿童的益处和危害。没有关于恢复时间的信息，关于死亡率和不良事件的信息也很少。需要设计良好的随机对照试验来研究硫酸镁在急性细支气管炎中的作用。结果如恢复时间、不良事件和住院时间应予以测量。经费：本综述未收到经费。注册：议定书（2018）：doi.org/10.1002/14651858.CD012965原审稿（2020）：doi.org/10.1002/14651858.CD012965.pub2。
{"title":"Magnesium sulphate for treating acute bronchiolitis in children under two years of age.","authors":"Sudha Chandelia, Dinesh Kumar, Deepika Tandon, Jyotsna Makol","doi":"10.1002/14651858.CD012965.pub3","DOIUrl":"10.1002/14651858.CD012965.pub3","url":null,"abstract":"<p><strong>Rationale: </strong>The effectiveness of magnesium sulphate for acute bronchiolitis in children under two years is unclear. There is a paucity of robust data favouring or opposing the use of magnesium sulphate in acute bronchiolitis. This is an update of a review first published in 2020.</p><p><strong>Objectives: </strong>To assess the effects of magnesium sulphate in acute bronchiolitis in children under two years of age.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, and two trial registries until 23 November 2024. We contacted trial authors and searched conference proceedings and reference lists of retrieved articles to identify additional studies. Both unpublished and published studies were eligible for inclusion.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials (RCTs) and non-randomised studies of magnesium sulphate (alone or with another treatment) compared with placebo or another treatment, in children under two years with acute bronchiolitis.</p><p><strong>Outcomes: </strong>Our critical outcomes were time to recovery; all-cause, in-hospital mortality; and adverse events. Important outcomes included duration of hospital stay, clinical severity score at 0 to 24 hours and at 25 to 48 hours after treatment, and hospital readmission rate within 30 days of discharge.</p><p><strong>Risk of bias: </strong>We assessed risk of bias using Cochrane's RoB 1 tool.</p><p><strong>Synthesis methods: </strong>We planned a priori to use a random-effects model for meta-analysis, but used a fixed-effect model when only a single study was available. We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence.</p><p><strong>Included studies: </strong>We identified three new trials for a total of seven trials (816 children) in this update. One study each received funding from a hospital, university, and funding agency; one study did not receive any funding; and three studies did not report funding sources. Comparator interventions were placebo, nebulised hypertonic saline, epinephrine, salbutamol, and standard care (humidified oxygen and hydration). The included studies were conducted in Qatar, Turkey, Iran, China, and India. We identified one study as an erratum that was unlikely to have affected the validity of the results.</p><p><strong>Synthesis of results: </strong>None of the studies measured time to recovery. The certainty of evidence was very low for most outcomes due to risk of bias and very serious imprecision. Magnesium sulphate compared with placebo (1 RCT, 160 children) The effects of magnesium sulphate on mortality or adverse events (no events in either intervention; risk ratio (RR) not estimable), duration of hospital stay (mean difference (MD) not estimable), or clinical severity (Wang score) (at 0 to 24 hours: MD 0.13, 95% confidence interval (CI) -0.28 to 0.54; at 25 to 48 hours: MD -0.42, 95% CI -0.84 to","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD012965"},"PeriodicalIF":8.8,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12954835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343900","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}
Pub Date : 2026-03-02DOI: 10.1002/14651858.CD016334
Panteleimon Pantelidis, Evangelos Oikonomou, Theodoros G Papaioannou, Panagiotis Papapetrou, Maria Bampa, Ioanna Miliou, Athina Gkoliopoulou, Ioannis Gialamas, Michael Spartalis, Polychronis Dilaveris, Gerasimos Siasos
Objectives: This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: To identify and evaluate AI-based prognostic models, in development and external validation studies, which predict impending episodes of ventricular tachycardia from continuous surface electrocardiogram (ECG) recordings in individuals at elevated risk for ventricular arrhythmias due to any relevant underlying condition.
{"title":"Artificial intelligence-enabled electrocardiography to predict impending episodes of ventricular tachycardia in individuals under continuous heart rhythm monitoring.","authors":"Panteleimon Pantelidis, Evangelos Oikonomou, Theodoros G Papaioannou, Panagiotis Papapetrou, Maria Bampa, Ioanna Miliou, Athina Gkoliopoulou, Ioannis Gialamas, Michael Spartalis, Polychronis Dilaveris, Gerasimos Siasos","doi":"10.1002/14651858.CD016334","DOIUrl":"10.1002/14651858.CD016334","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (prognosis). The objectives are as follows: To identify and evaluate AI-based prognostic models, in development and external validation studies, which predict impending episodes of ventricular tachycardia from continuous surface electrocardiogram (ECG) recordings in individuals at elevated risk for ventricular arrhythmias due to any relevant underlying condition.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"3 ","pages":"CD016334"},"PeriodicalIF":8.8,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12951566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147324815","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}
Pub Date : 2026-02-27DOI: 10.1002/14651858.CD005470.pub4
Sheena McHugh, Fiona Riordan, Aoife O'Mahony, Laura-Jane McCarthy, Ana Contreras Navarro, Claire Kerins, Jane Murphy, Eimear C Morrissey, Eilis J O'Reilly, Siobhan O'Connor, Danielle R Adams, Rosemary Meza, Cara C Lewis, Byron J Powell, Michel Wensing, Signe A Flottorp, Luke Wolfenden
<p><strong>Rationale: </strong>Tailored implementation strategies are frequently recommended to improve healthcare professional practice. Tailoring involves the selection and design of strategies to address context-specific barriers (referred to as determinants of practice) to best practice recommended in clinical guidelines. Improvements in practice are thought to be more likely if implementation strategies are selected to address identified practice determinants. This is an update of a review published in 2015.</p><p><strong>Objectives: </strong>To assess the effect of tailored implementation strategies, compared with a non-tailored strategy or no strategy, in improving healthcare professional practice. Secondary objectives were to assess whether the effects of tailored implementation strategies differ according to whether theory, evidence of the effectiveness of strategies, and input from stakeholders were involved in the tailoring process, and to assess whether the effects of tailored implementation strategies differ according to setting (high- or low-income country).</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, two other databases and two trials registers from 2014 to 5 March 2024. We performed a forward citation search for papers citing the previous update. We did not apply any restrictions on date of publication, publication status or language.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs), including cluster-RCTs, that compared tailored implementation strategies with strategies not tailored to address determinants of health professional practice, or no strategy. We excluded studies of tailored strategies targeting behaviour change among patients only.</p><p><strong>Outcomes: </strong>The primary outcome was healthcare professional practice assessed using measures of adherence to recommended practices or guidelines in a healthcare setting.</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool version 2 (RoB 2) to assess risk of bias in the studies.</p><p><strong>Synthesis methods: </strong>Review authors (working in pairs) screened all citations, extracted data, and assessed risk of bias independently and in duplicate. A third review author resolved disagreements. We performed meta-analyses using random-effects models for the primary outcome using the most conservative estimate of effect where multiple outcomes were reported. We also performed meta-analyses using the least conservative estimate in sensitivity analysis. Where data were unsuitable for pooling in meta-analyses, we conducted a narrative synthesis using a vote-counting approach. We assessed heterogeneity using the I² statistic and the certainty of the evidence for the main comparison using GRADE.</p><p><strong>Included studies: </strong>The previous version of this review included 32 studies. In this update, we excluded five of those studies as they no longer met the review's eli
{"title":"Tailored interventions to address determinants of practice.","authors":"Sheena McHugh, Fiona Riordan, Aoife O'Mahony, Laura-Jane McCarthy, Ana Contreras Navarro, Claire Kerins, Jane Murphy, Eimear C Morrissey, Eilis J O'Reilly, Siobhan O'Connor, Danielle R Adams, Rosemary Meza, Cara C Lewis, Byron J Powell, Michel Wensing, Signe A Flottorp, Luke Wolfenden","doi":"10.1002/14651858.CD005470.pub4","DOIUrl":"10.1002/14651858.CD005470.pub4","url":null,"abstract":"<p><strong>Rationale: </strong>Tailored implementation strategies are frequently recommended to improve healthcare professional practice. Tailoring involves the selection and design of strategies to address context-specific barriers (referred to as determinants of practice) to best practice recommended in clinical guidelines. Improvements in practice are thought to be more likely if implementation strategies are selected to address identified practice determinants. This is an update of a review published in 2015.</p><p><strong>Objectives: </strong>To assess the effect of tailored implementation strategies, compared with a non-tailored strategy or no strategy, in improving healthcare professional practice. Secondary objectives were to assess whether the effects of tailored implementation strategies differ according to whether theory, evidence of the effectiveness of strategies, and input from stakeholders were involved in the tailoring process, and to assess whether the effects of tailored implementation strategies differ according to setting (high- or low-income country).</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, two other databases and two trials registers from 2014 to 5 March 2024. We performed a forward citation search for papers citing the previous update. We did not apply any restrictions on date of publication, publication status or language.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs), including cluster-RCTs, that compared tailored implementation strategies with strategies not tailored to address determinants of health professional practice, or no strategy. We excluded studies of tailored strategies targeting behaviour change among patients only.</p><p><strong>Outcomes: </strong>The primary outcome was healthcare professional practice assessed using measures of adherence to recommended practices or guidelines in a healthcare setting.</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool version 2 (RoB 2) to assess risk of bias in the studies.</p><p><strong>Synthesis methods: </strong>Review authors (working in pairs) screened all citations, extracted data, and assessed risk of bias independently and in duplicate. A third review author resolved disagreements. We performed meta-analyses using random-effects models for the primary outcome using the most conservative estimate of effect where multiple outcomes were reported. We also performed meta-analyses using the least conservative estimate in sensitivity analysis. Where data were unsuitable for pooling in meta-analyses, we conducted a narrative synthesis using a vote-counting approach. We assessed heterogeneity using the I² statistic and the certainty of the evidence for the main comparison using GRADE.</p><p><strong>Included studies: </strong>The previous version of this review included 32 studies. In this update, we excluded five of those studies as they no longer met the review's eli","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD005470"},"PeriodicalIF":8.8,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-27DOI: 10.1002/14651858.CD015470.pub2
Julian L Muff, Fabian Lunger, Katrin Probyn, Elise Cogo, Stefan Holland-Cunz, Raphael N Vuille-Dit-Bille
<p><strong>Rationale: </strong>Inguinal hernia is one of the most prevalent paediatric conditions requiring surgical treatment. It can be repaired either by the laparoscopic technique or open surgery. There is a need for a high-quality systematic review with meta-analyses to evaluate the laparoscopic approach versus the open approach for inguinal hernia repair in children, as available evidence is based on different interpretations or calculations of the same RCTs.</p><p><strong>Objectives: </strong>To compare the benefits and harms of laparoscopic versus open repair in paediatric inguinal hernia.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, and Embase in May and June 2025. As the first laparoscopic repair of paediatric inguinal hernia was conducted in 1993, the search focused on studies published from that year onwards. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry. We screened reference lists of included studies and related systematic reviews for additional references. We also searched PubMed for retractions and errata (none identified).</p><p><strong>Eligibility criteria: </strong>We included studies that reported on children (aged under 18 years) of any sex and race with a diagnosis of unilateral or bilateral inguinal hernia. Accepted methods of diagnosis were clinical examination, photo documentation by parents/guardians, ultrasound, or intraoperative detection (of contralateral hernia). Only randomised controlled trials (RCTs) comparing mesh-free laparoscopic versus open repair were considered for this review, irrespective of their publication status or language. Quasi-randomised controlled trials were deemed ineligible.</p><p><strong>Outcomes: </strong>Our critical outcome was recurrence (< 12 months, 12 to 60 months, and > 60 months follow-up), assessed by clinical examination with or without verification by diagnostic imaging. Both repaired and unrepaired recurrences were considered. Important outcomes comprised intraoperative complications (intraoperative injury and conversion), complications according to Clavien-Dindo 3a, 3b to 4, and 5 within 30 days after the operation, postoperative acute pain within 24 hours, and chronic pain persisting for more than six months after surgery as a dichotomous outcome (yes/no per self-report) or as a continuous outcome of pain intensity measured on a visual analogue scale (VAS) or other validated scale.</p><p><strong>Risk of bias: </strong>Three review authors (JLM, FL, KP) independently assessed the risk of bias for each included study using the updated Cochrane risk of bias tool (RoB 2).</p><p><strong>Synthesis methods: </strong>We used random-effects meta-analyses to estimate treatment effects for dichotomous outcomes as odds ratios (ORs) and for continuous outcomes as mean differences (MDs), both with 95% confidence intervals (CIs). We explored heterogeneity using the I² sta
{"title":"Laparoscopic versus open repair for paediatric inguinal hernia.","authors":"Julian L Muff, Fabian Lunger, Katrin Probyn, Elise Cogo, Stefan Holland-Cunz, Raphael N Vuille-Dit-Bille","doi":"10.1002/14651858.CD015470.pub2","DOIUrl":"10.1002/14651858.CD015470.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Inguinal hernia is one of the most prevalent paediatric conditions requiring surgical treatment. It can be repaired either by the laparoscopic technique or open surgery. There is a need for a high-quality systematic review with meta-analyses to evaluate the laparoscopic approach versus the open approach for inguinal hernia repair in children, as available evidence is based on different interpretations or calculations of the same RCTs.</p><p><strong>Objectives: </strong>To compare the benefits and harms of laparoscopic versus open repair in paediatric inguinal hernia.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, and Embase in May and June 2025. As the first laparoscopic repair of paediatric inguinal hernia was conducted in 1993, the search focused on studies published from that year onwards. We also searched the World Health Organization (WHO) International Clinical Trials Registry Platform, ClinicalTrials.gov, and the ISRCTN registry. We screened reference lists of included studies and related systematic reviews for additional references. We also searched PubMed for retractions and errata (none identified).</p><p><strong>Eligibility criteria: </strong>We included studies that reported on children (aged under 18 years) of any sex and race with a diagnosis of unilateral or bilateral inguinal hernia. Accepted methods of diagnosis were clinical examination, photo documentation by parents/guardians, ultrasound, or intraoperative detection (of contralateral hernia). Only randomised controlled trials (RCTs) comparing mesh-free laparoscopic versus open repair were considered for this review, irrespective of their publication status or language. Quasi-randomised controlled trials were deemed ineligible.</p><p><strong>Outcomes: </strong>Our critical outcome was recurrence (< 12 months, 12 to 60 months, and > 60 months follow-up), assessed by clinical examination with or without verification by diagnostic imaging. Both repaired and unrepaired recurrences were considered. Important outcomes comprised intraoperative complications (intraoperative injury and conversion), complications according to Clavien-Dindo 3a, 3b to 4, and 5 within 30 days after the operation, postoperative acute pain within 24 hours, and chronic pain persisting for more than six months after surgery as a dichotomous outcome (yes/no per self-report) or as a continuous outcome of pain intensity measured on a visual analogue scale (VAS) or other validated scale.</p><p><strong>Risk of bias: </strong>Three review authors (JLM, FL, KP) independently assessed the risk of bias for each included study using the updated Cochrane risk of bias tool (RoB 2).</p><p><strong>Synthesis methods: </strong>We used random-effects meta-analyses to estimate treatment effects for dichotomous outcomes as odds ratios (ORs) and for continuous outcomes as mean differences (MDs), both with 95% confidence intervals (CIs). We explored heterogeneity using the I² sta","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD015470"},"PeriodicalIF":8.8,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12947301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303005","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}
Pub Date : 2026-02-27DOI: 10.1002/14651858.CD016331
Tina Kim, Mikayla Laube, Badal Sb Pattar, Anna Mathew, Meghan J Elliott, Matthew T James, Pietro Ravani, Paul E Ronksley, Giovanni Fm Strippoli, Tyrone G Harrison
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To estimate the effect of hospital-to-home discharge interventions designed to reduce early hospital readmission for people with kidney failure being treated with maintenance dialysis.
{"title":"Interventions to reduce hospital readmissions in people with kidney failure on maintenance dialysis.","authors":"Tina Kim, Mikayla Laube, Badal Sb Pattar, Anna Mathew, Meghan J Elliott, Matthew T James, Pietro Ravani, Paul E Ronksley, Giovanni Fm Strippoli, Tyrone G Harrison","doi":"10.1002/14651858.CD016331","DOIUrl":"10.1002/14651858.CD016331","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To estimate the effect of hospital-to-home discharge interventions designed to reduce early hospital readmission for people with kidney failure being treated with maintenance dialysis.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016331"},"PeriodicalIF":8.8,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12947302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303018","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}
Pub Date : 2026-02-26DOI: 10.1002/14651858.CD015266.pub2
Zhaolun Cai, Yang Meng, Wenming Yang, Yihui Han, Dan Cao, Bo Zhang
<p><strong>Rationale: </strong>The role of nonsteroidal anti-inflammatory drugs, particularly aspirin, in the primary prevention of colorectal cancer remains controversial. The debate over aspirin use is driven by the challenge of balancing uncertain preventive benefits against the risks of adverse effects. Given the inconsistent findings from clinical trials and conflicting clinical guidelines, a rigorous and updated systematic review is necessary to clarify the evidence base.</p><p><strong>Objectives: </strong>To assess the benefits and harms of nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, for preventing colorectal cancer (CRC) and colorectal adenoma (CRA) in the general population.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, and two clinical trial registers (ClinicalTrials.gov and WHO ICTRP) on 3 March 2025.</p><p><strong>Eligibility criteria: </strong>We included parallel-group or factorial-design randomized controlled trials (RCTs) comparing aspirin and other NSAIDs with either no treatment or a different treatment for preventing CRC or CRA in the general population.</p><p><strong>Outcomes: </strong>Our critical outcomes were CRC incidence and serious adverse events (SAE). Our important outcomes included CRC mortality, CRA incidence, serious extracranial hemorrhage, and hemorrhagic stroke. When data were available, we categorized findings into prespecified follow-up intervals: 5 to < 10 years, 10 to < 15 years, and ≥ 15 years.</p><p><strong>Risk of bias: </strong>We assessed the risk of bias for study outcomes as high risk, some concerns, or low risk, using the Cochrane RoB 2 tool.</p><p><strong>Synthesis methods: </strong>We synthesized data for each outcome using random-effects meta-analysis. For time-dependent outcomes, we prioritized time-to-event data, calculating hazard ratios (HRs) with 95% confidence intervals (CIs). When these were unavailable, we used dichotomous data to calculate risk ratios (RRs). For rare outcomes, we calculated Peto odds ratios (ORs) using a fixed-effect model. We used GRADE to assess the certainty of the evidence.</p><p><strong>Included studies: </strong>We included 10 RCTs involving a total of 124,837 participants. These studies compared aspirin with either placebo or no treatment for the primary prevention of CRC. Low-dose aspirin (75 to 100 mg per day) was typically used, though three studies evaluated higher doses. The studies were mostly conducted in Europe and North America. One study had sites in Australia, and there were two large studies conducted in Japan. Seven studies reported long-term results with extended observational follow-up where blinding had ceased. We did not identify any RCTs that evaluated the use of non-aspirin NSAIDs by the general population for primary CRC prevention.</p><p><strong>Synthesis of results: </strong>For the comparison of aspirin versus inactive control in the general population, we rated the certainty of the evidence
理由：非甾体类抗炎药，特别是阿司匹林，在结肠直肠癌一级预防中的作用仍然存在争议。关于阿司匹林使用的争论是由平衡不确定的预防益处与不良反应风险的挑战所驱动的。鉴于临床试验结果不一致，临床指南相互矛盾，有必要进行严格和更新的系统评价，以澄清证据基础。目的：评估包括阿司匹林在内的非甾体抗炎药（NSAIDs）在普通人群中预防结直肠癌（CRC）和结直肠腺瘤（CRA）的益处和危害。检索方法：我们于2025年3月3日检索了CENTRAL、MEDLINE、Embase和两个临床试验注册库（ClinicalTrials.gov和WHO ICTRP）。入选标准：我们纳入了平行组或因子设计随机对照试验（rct），比较阿司匹林和其他非甾体抗炎药在普通人群中预防结直肠癌或CRA的治疗，无论是不治疗还是不同治疗。结局：我们的关键结局是CRC发生率和严重不良事件（SAE）。我们的重要结局包括CRC死亡率、CRA发病率、严重颅外出血和出血性卒中。当数据可用时，我们将结果分类为预先指定的随访间隔：5至< 10年，10至< 15年和≥15年。偏倚风险：我们使用Cochrane RoB 2工具将研究结果的偏倚风险评估为高风险、部分关注或低风险。综合方法：我们使用随机效应荟萃分析综合了每个结果的数据。对于时间相关的结果，我们优先考虑时间到事件的数据，计算95%置信区间（ci）的风险比（hr）。当这些数据不可用时，我们使用二分类数据来计算风险比（rr）。对于罕见的结果，我们使用固定效应模型计算Peto优势比（ORs）。我们使用GRADE来评估证据的确定性。纳入的研究：我们纳入了10项随机对照试验，共涉及124,837名受试者。这些研究比较了阿司匹林与安慰剂或不治疗对结直肠癌一级预防的影响。通常使用低剂量阿司匹林（每天75至100毫克），尽管有三项研究评估了更高剂量。这些研究大多在欧洲和北美进行。一项研究在澳大利亚进行，还有两项大型研究在日本进行。7项研究报告了在停止盲法后延长观察随访的长期结果。我们没有发现任何评估普通人群使用非阿司匹林非甾体抗炎药预防原发性结直肠癌的随机对照试验。综合结果：在一般人群中阿司匹林与非活性对照的比较，我们将证据的确定性评级为非常低到高。我们降低了几个结果的确定性水平，主要是由于偏差和不精确的风险。关于CRC的发病率，阿司匹林在随访≥5年至< 10年期间（HR 1.00, 95% CI 0.81至1.24；3项研究，26,702名受试者；中等确定性证据）和≥10年至< 15年期间（HR 0.95, 95% CI 0.77至1.17；2项研究，42,412名受试者；中等确定性证据）可能几乎没有差异。阿司匹林可在随访≥15年时略微降低结直肠癌发病率（HR 0.78, 95% CI 0.67 - 0.91； 3项研究，47,464名受试者；极低确定性证据），但证据非常不确定。关于CRC死亡率,阿司匹林可能会增加死亡率在随访≥5 < 10年(HR 1.77, 95%可信区间1.02到3.07,1的研究中,19114名参与者,确定性的证据),可能导致死亡率几乎没有区别在随访≥10年,< 15年(皮托或1.14,95%可信区间0.73到1.78,1的研究中,39876名参与者,确定性的证据),但可能会降低死亡率在随访≥15年(皮托或0.74,95%可信区间0.60到0.90;5研究中,53909名参与者;非常低的确定性证据)，但证据是非常不确定的。关于CRA的发病率，阿司匹林在随访≥5年至< 10年时可能导致CRA发病率的差异很小或没有差异（Peto OR 0.42, 95% CI 0.10至1.87；1项研究，12,546名参与者；极低确定性证据），但证据非常不确定。关于安全性，尽管阿司匹林可能导致总体SAE的差异很小或没有差异（RR 1.06, 95% CI 0.84至1.34；3项研究，16,442名受试者；中等确定性证据），但阿司匹林确实增加了严重颅外出血的风险（RR 1.59, 95% CI 1.30至1.95；8项研究，97,567名受试者；高确定性证据），并可能增加出血性卒中的风险（Peto OR 1.40, 95% CI 1.11至1.77；8项研究，105,037名受试者；中等确定性证据）。作者的结论：根据目前的证据，不可能得出明确的结论或概述常规使用阿司匹林用于CRC一级预防的具体含义。 我们的研究结果揭示了复杂的、时间依赖性的预防效果，以及临床医生和患者需要考虑的潜在危害。极低到中等确定性的证据表明，在最初的15年里，对CRC或CRA的发病率几乎没有好处，而低确定性的证据表明，在最初的5到10年里，CRC死亡率可能会增加。非常低确定性的证据表明，长期随访（≥15年）对CRC发病率和死亡率有潜在的益处，但这些潜在的长期益处来自随机对照试验的观察性随访阶段的发现，其中标准的意向治疗分析对于随机化后的混杂因素（如治疗污染）并不可靠。不确定和延迟的潜在利益必须与明确的危害进行权衡。虽然阿司匹林可能对总体严重不良事件几乎没有影响（中等确定性证据），但它增加了严重颅外出血的风险（高确定性证据），并可能增加严重颅外出血的风险（中等确定性证据）。鉴于证据不一，临床实践应继续以个体化评估和共同决策过程为中心，仔细平衡患者已建立的心血管风险状况和出血风险。资助：本Cochrane综述由中国博士后科学基金项目（2024M752248）和中国博士后科学基金项目（BX20230244）资助（部分）。注册：协议可通过doi.org/10.1002/14651858.CD015266获得。
{"title":"Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) for preventing colorectal cancer and colorectal adenoma in the general population.","authors":"Zhaolun Cai, Yang Meng, Wenming Yang, Yihui Han, Dan Cao, Bo Zhang","doi":"10.1002/14651858.CD015266.pub2","DOIUrl":"10.1002/14651858.CD015266.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>The role of nonsteroidal anti-inflammatory drugs, particularly aspirin, in the primary prevention of colorectal cancer remains controversial. The debate over aspirin use is driven by the challenge of balancing uncertain preventive benefits against the risks of adverse effects. Given the inconsistent findings from clinical trials and conflicting clinical guidelines, a rigorous and updated systematic review is necessary to clarify the evidence base.</p><p><strong>Objectives: </strong>To assess the benefits and harms of nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, for preventing colorectal cancer (CRC) and colorectal adenoma (CRA) in the general population.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, and two clinical trial registers (ClinicalTrials.gov and WHO ICTRP) on 3 March 2025.</p><p><strong>Eligibility criteria: </strong>We included parallel-group or factorial-design randomized controlled trials (RCTs) comparing aspirin and other NSAIDs with either no treatment or a different treatment for preventing CRC or CRA in the general population.</p><p><strong>Outcomes: </strong>Our critical outcomes were CRC incidence and serious adverse events (SAE). Our important outcomes included CRC mortality, CRA incidence, serious extracranial hemorrhage, and hemorrhagic stroke. When data were available, we categorized findings into prespecified follow-up intervals: 5 to < 10 years, 10 to < 15 years, and ≥ 15 years.</p><p><strong>Risk of bias: </strong>We assessed the risk of bias for study outcomes as high risk, some concerns, or low risk, using the Cochrane RoB 2 tool.</p><p><strong>Synthesis methods: </strong>We synthesized data for each outcome using random-effects meta-analysis. For time-dependent outcomes, we prioritized time-to-event data, calculating hazard ratios (HRs) with 95% confidence intervals (CIs). When these were unavailable, we used dichotomous data to calculate risk ratios (RRs). For rare outcomes, we calculated Peto odds ratios (ORs) using a fixed-effect model. We used GRADE to assess the certainty of the evidence.</p><p><strong>Included studies: </strong>We included 10 RCTs involving a total of 124,837 participants. These studies compared aspirin with either placebo or no treatment for the primary prevention of CRC. Low-dose aspirin (75 to 100 mg per day) was typically used, though three studies evaluated higher doses. The studies were mostly conducted in Europe and North America. One study had sites in Australia, and there were two large studies conducted in Japan. Seven studies reported long-term results with extended observational follow-up where blinding had ceased. We did not identify any RCTs that evaluated the use of non-aspirin NSAIDs by the general population for primary CRC prevention.</p><p><strong>Synthesis of results: </strong>For the comparison of aspirin versus inactive control in the general population, we rated the certainty of the evidence","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD015266"},"PeriodicalIF":8.8,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12935488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147303080","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}
Pub Date : 2026-02-24DOI: 10.1002/14651858.CD016266
Leonie Goelz, Dirk Stengel, Wiebke Käckenmester, Cosima Prahm, Sven Mutze, Axel Ekkernkamp, Alexander Hoenning
Objectives: This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: The primary objective of this review is to determine the diagnostic accuracy of any form of ML algorithm for detecting ICH in participants who underwent hCT. We will assess diagnostic accuracy by individual and pooled indicators such as sensitivity and specificity with 95% confidence intervals, positive and negative likelihood ratios, and the summary receiver operating characteristic curve. Secondary objectives To investigate the following potential sources of heterogeneity in the diagnostic accuracy of ML: type of ML algorithm; year of development of the ML algorithm; certification of ML algorithm (Yes/No); type of reference standard; participant age (adults only/children only/mixed); hCT quality; hCT protocol; type of study (retrospective cohort study/prospective cohort study/RCT).
{"title":"Machine-learning algorithms for detecting intracranial hemorrhage on head computed tomography.","authors":"Leonie Goelz, Dirk Stengel, Wiebke Käckenmester, Cosima Prahm, Sven Mutze, Axel Ekkernkamp, Alexander Hoenning","doi":"10.1002/14651858.CD016266","DOIUrl":"10.1002/14651858.CD016266","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: The primary objective of this review is to determine the diagnostic accuracy of any form of ML algorithm for detecting ICH in participants who underwent hCT. We will assess diagnostic accuracy by individual and pooled indicators such as sensitivity and specificity with 95% confidence intervals, positive and negative likelihood ratios, and the summary receiver operating characteristic curve. Secondary objectives To investigate the following potential sources of heterogeneity in the diagnostic accuracy of ML: type of ML algorithm; year of development of the ML algorithm; certification of ML algorithm (Yes/No); type of reference standard; participant age (adults only/children only/mixed); hCT quality; hCT protocol; type of study (retrospective cohort study/prospective cohort study/RCT).</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016266"},"PeriodicalIF":8.8,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12930503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282566","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}
Pub Date : 2026-02-24DOI: 10.1002/14651858.CD007131.pub5
Linda Long, Cho Zin Lin, Philippa Davies, Valerie Wells, Sherry L Grace, Rod S Taylor
<p><strong>Rationale: </strong>Clinical practice guidelines routinely recommend that cardiac patients participate in rehabilitation programmes as part of comprehensive secondary prevention of heart disease. However, only a small proportion of these patients utilise rehabilitation across global health systems. This is an update of a Cochrane review last published in 2019.</p><p><strong>Objectives: </strong>Primary objective To assess the effects of interventions provided to increase patient enrolment in, adherence to, and completion of cardiac rehabilitation (CR) for people with myocardial infarction (MI), with angina, following coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI), or with heart failure (HF) who were eligible for CR in an inpatient or outpatient setting. Secondary objectives To assess intervention costs and associated harms with interventions intended to promote CR utilisation.</p><p><strong>Search methods: </strong>We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (Wiley), MEDLINE (Ovid), Embase (OVID), CINAHL Cumulative Index to Nursing and Allied Health Literature (EBSCO), and Conference Proceedings Citation Index - Science (CPCI-S) via Web of Science (Clarivate Analytics). We checked the reference lists of relevant systematic reviews for additional studies and searched two clinical trial registers. We did not apply any language restrictions. The date of search was 02 March 2025.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and quasi-RCTs in adults with MI, with angina, undergoing CABG surgery or PCI, or with HF who were eligible for CR in an inpatient or outpatient setting. Interventions had to aim to increase patient utilisation of CR, and we included any study that aimed to increase patient enrolment in, adherence to, or completion of CR.</p><p><strong>Outcomes: </strong>Critical outcome measures were CR programme enrolment, CR programme adherence, and CR programme completion. Important outcome measures included serious adverse events (SAEs) and costs.</p><p><strong>Risk of bias: </strong>We used the Cochrane RoB 1 tool to assess the risk of bias in eligible trials.</p><p><strong>Synthesis methods: </strong>One review author extracted trial data into piloted data extraction forms, which were checked by a second review author. We pooled outcome data across included studies using random-effects meta-analysis, and used meta-regression to explore the potential impact of prespecified intervention characteristics on intervention effects.</p><p><strong>Included studies: </strong>We included 47 studies (58 comparisons) with 10,803 participants. Trials were conducted over a range of geographical settings, principally North America and Europe or other high-income economies. No studies from low- and middle-income country settings were included. Participants in most of the included studies were primarily male
51;6项试验（6项比较），716名受试者；moderate-certainty证据)。关于促进CR利用的干预措施的成本或成本效益的信息很少（4项试验）。作者的结论：这篇更新的Cochrane综述显示，就CR入组而言，一系列干预措施可能增加CR的利用，并可能增加CR的依从性和完成度。由于各试验的统计异质性较高，证据的确定性为低至中等，这可能是由于纳入的干预措施的范围以及结果收集和报告的差异。资助：本Cochrane综述由美国国立卫生研究院（NIHR）在其全球卫生转型研究与创新（右）计划（资助编号：NIHR205540）下资助。LL， RST和VW作为格拉斯哥大学资助的工作人员承担了这项研究。注册：协议（2008）：DOI 10.1002/14651858。CD007131/全文（2010）：DOI 10.1002/14651858.CD007131。pub2 Review updates (2014): DOI 10.1002/14651858.CD007131.pub3；（2019）： DOI 10.1002/14651858.CD007131.pub4。
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