Pub Date : 2026-02-05DOI: 10.1002/14651858.CD013661.pub2
Lisa S Wieland, Emilie Ludeman, Yuan Chi, Termeh M Feinberg, I-Hui Chen, Kee-Hsin Chen, Yanan Zhu, Emma Wolverson, Hakima Amri
<p><strong>Background: </strong>Dementia is a neurocognitive disorder that interferes with cognition and independent functioning. Common dementia subtypes include Alzheimer's disease, vascular dementia, and mixed type. Mild cognitive impairment (MCI) is a risk factor for dementia, and subjective cognitive complaints may be the earliest manifestation. Although cholinesterase inhibitors may help reduce some cognitive and behavioral symptoms, there is no established treatment that cures or slows dementia progression. Ginkgo biloba (ginkgo) is a popular herbal preparation that is used to improve brain and circulatory health, and neuroprotective effects are biologically plausible.</p><p><strong>Objectives: </strong>To assess the benefits and harms of Ginkgo biloba for the treatment of people with cognitive impairment or dementia.</p><p><strong>Search methods: </strong>We searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, four other databases, and two trials registries on 8 December 2022. The search was updated in MEDLINE, Embase, CENTRAL, and the trials registers on 18 November 2024.</p><p><strong>Selection criteria: </strong>We included randomized controlled trials (RCTs) comparing ginkgo with placebo, usual treatment, or other treatments for cognitive problems in people with cognitive complaints or diagnoses of MCI or dementia.</p><p><strong>Data collection and analysis: </strong>Two review authors independently selected trials, extracted data, and assessed studies for risk of bias. Key outcomes were global clinical status, global cognitive function, activities of daily living (ADLs), adverse events (AEs), and serious adverse events (SAEs) at six months. When clinically appropriate, we pooled data using a random-effects model and expressed treatment effects as mean differences (MDs), standardized mean differences (SMDs), or risk ratios (RRs), each with its 95% confidence interval (CI). We used GRADE methods to assess the certainty of the evidence for each estimate.</p><p><strong>Main results: </strong>We included 82 studies with 10,613 participants; 72 studies with 9783 participants provided extractable data. Four studies were at low risk of bias in all domains. Below we present data for the comparison of ginkgo versus placebo in people with different clinical conditions. Subjective cognitive impairment Three studies (597 participants) compared ginkgo with placebo for people with subjective cognitive complaints. Based on one study that lasted six months, it is uncertain whether ginkgo has any effect on global clinical status measured on a five-point Likert scale (MD 0.00, 95% CI -0.33 to 0.33; P = 1.00; 1 study, 197 participants; very low-certainty evidence). There were no data on cognition or ADLs. One study reported no difference in minor side effects between treatment groups and did not mention SAEs. A larger study lasting three months found that the risk of AEs may be higher with ginkgo versus placebo. It
背景：痴呆是一种干扰认知和独立功能的神经认知障碍。常见的痴呆亚型包括阿尔茨海默病、血管性痴呆和混合型痴呆。轻度认知障碍（MCI）是痴呆的危险因素，主观认知主诉可能是最早的表现。尽管胆碱酯酶抑制剂可能有助于减少一些认知和行为症状，但目前还没有确定的治疗方法可以治愈或减缓痴呆症的进展。银杏叶（银杏）是一种流行的草药制剂，用于改善大脑和循环系统健康，神经保护作用在生物学上是合理的。目的：评估银杏叶治疗认知障碍或痴呆患者的益处和危害。检索方法：我们于2022年12月8日检索了Cochrane痴呆和认知改善组的注册、MEDLINE、Embase、其他四个数据库和两个试验注册。检索于2024年11月18日在MEDLINE、Embase、CENTRAL和试验登记处更新。选择标准：我们纳入了比较银杏与安慰剂、常规治疗或其他治疗认知问题的随机对照试验（rct），这些患者患有认知疾病或诊断为轻度认知障碍或痴呆。数据收集和分析：两位综述作者独立选择试验，提取数据，并评估研究的偏倚风险。主要结局是6个月时的总体临床状态、总体认知功能、日常生活活动（adl）、不良事件（ae）和严重不良事件（sae）。在临床合适的情况下，我们使用随机效应模型合并数据，并将治疗效果表示为平均差异（MDs）、标准化平均差异（SMDs）或风险比（rr），每个都有95%的置信区间（CI）。我们使用GRADE方法来评估每个估计的证据的确定性。主要结果：纳入82项研究，10,613名受试者；72项研究共9783名参与者提供了可提取的数据。四项研究在所有领域均为低偏倚风险。下面我们给出了银杏与安慰剂在不同临床条件下的比较数据。主观认知障碍三个研究（597名参与者）比较了银杏和安慰剂对主观认知障碍患者的影响。根据一项持续6个月的研究，不确定银杏是否对5点李克特量表测量的整体临床状态有任何影响（MD 0.00, 95% CI -0.33至0.33;P = 1.00； 1项研究，197名参与者；非常低确定性证据）。没有关于认知或adl的数据。一项研究报告说，治疗组之间的轻微副作用没有差异，也没有提到SAEs。一项持续三个月的大型研究发现，与安慰剂相比，银杏的ae风险可能更高。它提供了关于SAEs风险的非常不确定的证据。多发性硬化症和认知障碍两项研究（164名参与者）对多发性硬化症和认知问题患者进行了为期三个月的银杏和安慰剂对比试验。银杏可能对认知缺陷问卷测量的认知影响很小或没有影响（MD -0.09, 95% CI -0.41至0.22;P = 0.55, I²= 0%；2项研究，152名参与者；中等确定性证据）。没有关于全球临床状态或adl的数据。研究表明，两组之间不良反应的数量没有显著差异，也没有迹象表明银杏会导致不良反应。12项研究（1913名参与者）对轻度认知障碍患者的银杏和安慰剂进行了测试。在六个月,moderate-certainty证据表明银杏可能已经没有影响全球临床状态测量临床痴呆评定量表(MD -0.03, 95%可信区间-0.06到0.01;3研究中,631名参与者;我²= 0%),认知测量在阿尔茨海默病评定量表-认知(MD -0.07, 95%可信区间-0.67到0.51;我²= 0%;2研究中,508名参与者),和ADLs测量仪器ADL量表(MD -0.05, 95%可信区间-0.29到0.19,1的研究中,350名参与者)。在长达12个月的时间里，银杏和安慰剂在ae的风险上几乎没有差异（RR 0.98, 95% CI 0.77至1.24;I²= 58%；7项研究，991名受试者，379个事件；低确定性证据），在SAEs的风险上几乎没有差异（RR 0.95, 95% CI 0.82至1.09;I²= 0%；3项研究，714名受试者，327个事件；高确定性证据）。13项研究（3288名参与者）比较了银杏和安慰剂治疗痴呆症的效果。在6个月时，低确定性证据表明，服用银杏的人在6点李克特量表（越低越好；MD -0.06, 95% CI -1.00至-0.20;I²= 88%；5项研究，1359名参与者）上可能有更好的整体临床状态，通过短期认知表现测试（syndrome - kurztest; MD -1.86, 95% CI -3.48至-0）的下降来测量更好的认知。 24;I²= 96%；9项研究，2801名受试者)，在ADL国际量表上测量的ADL略好（MD -0.19, 95% CI -0.35至-0.03;I²= 91%；8项研究，2571名受试者）。在长达12个月的ae风险中，银杏和安慰剂之间可能几乎没有差异（RR 0.95, 95% CI 0.90至1.00;I²= 0%；9项研究，2746名参与者，1480个事件；中等确定性证据）。6个月时发生SAEs的风险可能很少或没有差异（RR 0.88, 95% CI 0.58至1.33;I²= 0%；6项研究，2463名受试者，89个事件；低确定性证据）。作者的结论是：对于有认知疾病的患者，我们不确定银杏是否能在6个月时改善总体临床状况，并且银杏可能与3个月时ae的风险增加有关。银杏可能对多发性硬化症患者在3个月时的认知没有好处；关于ae的数字数据是不可用的，但研究没有提出担忧。在轻度认知障碍患者中，银杏在6个月时对全球状态、认知或ADLS的影响可能很小或没有影响。在长达12个月的时间里，ae可能很少或没有差异，sae也可能很少或没有差异。在痴呆症患者中，在6个月时，对全球状态、认知和adl可能有小到中等程度的益处。在长达12个月的ae中可能很少或没有差异，并且在SAEs中可能没有差异。
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Pub Date : 2026-02-04DOI: 10.1002/14651858.CD014532.pub2
Elena Jimenez Tejero, Jesús Lopez-Alcalde, Ana Carralero-Montero, Noelia Álvarez-Díaz, Montserrat García Sastre, Ángel Luis Asenjo-Esteve, Francisco Javier Castro-Molina, Alfonso Muriel, Paulina Maravilla Herrera, Diana Monge Martín, Daniel Cuesta-Lozano
<p><strong>Rationale: </strong>Parents who are the primary caregivers of people with severe mental illness are at high risk of mental health problems, including stress, depression and anxiety. While growing evidence suggests that psychoeducation may be beneficial, no systematic review has assessed its specific effects on parents. Clarifying this impact is essential to guide mental health services and improve outcomes for both caregivers and patients.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of face-to-face psychoeducational interventions for parents of people with severe mental illness compared to inactive or active (pharmacological or non-pharmacological) interventions.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and ProQuest databases, and two trial registries, up to 11 November 2024. We contacted experts in the field, checked references and used forward 'snowballing' to identify additional studies. There were no restrictions on language or date of publication.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) in parents of people with severe mental illness that compared a face-to-face psychoeducational intervention versus either an inactive intervention (i.e. no intervention, placebo, sham intervention, waiting list, or usual or standard care), a pharmacological intervention or another non-pharmacological intervention. We excluded studies that compared different psychoeducational interventions or the same intervention delivered in different modes (e.g. face-to-face versus online).</p><p><strong>Outcomes: </strong>Our outcomes were psychosocial well-being, quality of life, adverse events, anxiety, and satisfaction with care (i.e. caregivers' subjective appraisal of their caregiving experience), assessed as clinically important change, any change or average endpoint score. Where possible, we stratified effect estimates into short term (≤ 3 months), medium term (> 3 to ≤ 6 months) and long term (> 6 months).</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool RoB 2 to assess possible bias in the RCTs.</p><p><strong>Synthesis methods: </strong>We synthesised outcome data using random-effects meta-analyses with an inverse-variance approach and the restricted-maximum-likelihood method to estimate between-study variance. For continuous outcomes, we reported the mean difference (MD) or standardised mean difference (SMD), along with the 95% confidence interval (CI) and 95% prediction interval (PI). We assessed the certainty of the evidence for each key outcome using GRADE.</p><p><strong>Included studies: </strong>We included five RCTs with 304 participants. The studies were conducted in Asia (Iran, Indonesia, Japan and China) and published between 2006 and 2020. Sample sizes ranged from 40 to 84 parents. Most parents were women over the age of 45 years, and their children with severe mental illness primarily
理由：父母是严重精神疾病患者的主要照顾者，他们患精神健康问题的风险很高，包括压力、抑郁和焦虑。虽然越来越多的证据表明心理教育可能是有益的，但还没有系统的评估它对父母的具体影响。澄清这种影响对于指导精神卫生服务和改善护理人员和患者的结果至关重要。目的：评估面对面心理教育干预对严重精神疾病患者父母的利弊，并与非主动或主动（药物或非药物）干预进行比较。检索方法：检索了CENTRAL、MEDLINE、Embase、PsycINFO、CINAHL和ProQuest数据库以及两个试验注册库，检索时间截止到2024年11月11日。我们联系了该领域的专家，检查了参考文献，并使用“滚雪球”的方法来确定其他研究。没有对语言或出版日期的限制。入选标准：我们纳入了严重精神疾病患者父母的随机对照试验（RCTs），将面对面的心理教育干预与非活动干预（即无干预、安慰剂、虚假干预、等候名单、常规或标准治疗）、药物干预或另一种非药物干预进行比较。我们排除了比较不同心理教育干预措施或以不同模式提供相同干预措施（例如面对面与在线）的研究。结果：我们的结果是心理健康、生活质量、不良事件、焦虑和对护理的满意度（即护理者对其护理经验的主观评价），评估为临床重要变化、任何变化或平均终点评分。在可能的情况下，我们将效果评估分为短期（≤3个月）、中期（bbb3至≤6个月）和长期（> 6个月）。偏倚风险：我们使用Cochrane偏倚风险工具RoB 2来评估随机对照试验中可能存在的偏倚。综合方法：我们使用随机效应荟萃分析综合结果数据，采用反方差方法和限制最大似然方法估计研究间方差。对于连续结果，我们报告了平均差异（MD）或标准化平均差异（SMD），以及95%置信区间（CI）和95%预测区间（PI）。我们使用GRADE评估每个关键结局证据的确定性。纳入研究：纳入5项随机对照试验，共304名受试者。这些研究是在亚洲（伊朗、印度尼西亚、日本和中国）进行的，并于2006年至2020年间发表。样本量从40到84名家长不等。大多数父母是45岁以上的女性，他们的孩子患有严重的精神疾病，主要是精神分裂症。干预持续3至12周，其中4至12个疗程。四项研究报告了至少一项评估结果的数据，大多是短期的。结果数据仅以平均终点评分报告。没有研究报告结果为“任何变化”或“临床重要变化”，也没有研究报告不良事件。因此，该综述的关键结局（不良事件和短期临床重要的社会心理健康和生活质量变化）没有数据。结果的综合：证据的确定性范围从非常低到低，主要是由于不精确和偏倚风险。偏倚风险涉及随机化和分配隐藏程序报告不足、偏离预期干预措施和缺乏结果评估者盲法。我们还关注所有效果估计的选择性结果报告。我们无法评估发表偏倚。心理教育与不积极干预（无干预、安慰剂、假干预、等待名单、常规或标准治疗）三项试验的荟萃分析显示，与不积极干预相比，心理教育可能在短期内显著改善心理社会健康（SMD -1.52, 95% CI -2.32至-0.72;I2 = 0%； 3项研究，150名参与者；低确定性证据；95% PI -2.32至-0.72）。一项试验发现，与标准治疗相比，心理教育可能会在中期显著改善心理社会健康（MD -19.06; 95% CI -24.99至-13.13；1项研究，37名参与者；低确定性证据）。一项试验发现，与不进行治疗相比，心理教育对短期生活质量的影响是非常不确定的（MD为1.28,95% CI为-6.70 - 9.26；1项研究，40名参与者；极低确定性证据）。一项试验发现，与常规治疗相比，心理教育可能会在短期内显著改善状态焦虑（MD -5.4, 95% CI -6.20至-4.60；1项研究，73名参与者；低确定性证据）和特质焦虑（MD -3.10, 95% CI -3.83至-2.37；1项研究，73名参与者；低确定性证据）。 一项试验发现，与等候名单相比，心理教育对儿童短期照顾满意度的影响非常不确定：阴性症状（MD 4.67, 95% CI -13.06至22.40；1项研究，36名参与者；极低确定性证据）；阳性症状（MD 4.33, 95% CI -0.77 - 9.43； 1项研究，36名受试者；极低确定性证据）。没有研究提供不良事件的数据。心理教育与药物积极干预没有研究评估这种比较。一项有37名参与者的试验提供了非常不确定的证据，证明心理教育与行为家庭管理在短期（MD -1.60, 95% CI -7.81至4.61）和中期（MD -3.00, 95% CI -9.43至3.43）对心理社会健康的影响（非常低确定性的证据）。没有研究提供其他结果的数据。作者的结论是：与不积极的干预相比，对患有严重精神疾病的父母进行面对面的心理教育可能会大大改善父母的心理社会健康（短期和中期）和父母的焦虑（短期）。然而，它对父母的生活质量和照顾满意度的影响是非常不确定的。与其他干预措施相比，心理教育效果的证据非常有限。没有研究评估长期结果或不良事件。总的来说，证据是有限的，低到非常低的确定性，主要是由于不精确和偏见的风险。未来的试验应该有足够的动力，有更多样化的样本，清楚地报告干预措施，并使用一个核心结果集，随访时间更长。资金来源：Cochrane综述没有专门的资金来源。注册：协议可通过DOI 10.1002/14651858.CD014532获得。
{"title":"Face-to-face psychoeducation for the parents of people with severe mental illness.","authors":"Elena Jimenez Tejero, Jesús Lopez-Alcalde, Ana Carralero-Montero, Noelia Álvarez-Díaz, Montserrat García Sastre, Ángel Luis Asenjo-Esteve, Francisco Javier Castro-Molina, Alfonso Muriel, Paulina Maravilla Herrera, Diana Monge Martín, Daniel Cuesta-Lozano","doi":"10.1002/14651858.CD014532.pub2","DOIUrl":"10.1002/14651858.CD014532.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Parents who are the primary caregivers of people with severe mental illness are at high risk of mental health problems, including stress, depression and anxiety. While growing evidence suggests that psychoeducation may be beneficial, no systematic review has assessed its specific effects on parents. Clarifying this impact is essential to guide mental health services and improve outcomes for both caregivers and patients.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of face-to-face psychoeducational interventions for parents of people with severe mental illness compared to inactive or active (pharmacological or non-pharmacological) interventions.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and ProQuest databases, and two trial registries, up to 11 November 2024. We contacted experts in the field, checked references and used forward 'snowballing' to identify additional studies. There were no restrictions on language or date of publication.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) in parents of people with severe mental illness that compared a face-to-face psychoeducational intervention versus either an inactive intervention (i.e. no intervention, placebo, sham intervention, waiting list, or usual or standard care), a pharmacological intervention or another non-pharmacological intervention. We excluded studies that compared different psychoeducational interventions or the same intervention delivered in different modes (e.g. face-to-face versus online).</p><p><strong>Outcomes: </strong>Our outcomes were psychosocial well-being, quality of life, adverse events, anxiety, and satisfaction with care (i.e. caregivers' subjective appraisal of their caregiving experience), assessed as clinically important change, any change or average endpoint score. Where possible, we stratified effect estimates into short term (≤ 3 months), medium term (> 3 to ≤ 6 months) and long term (> 6 months).</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool RoB 2 to assess possible bias in the RCTs.</p><p><strong>Synthesis methods: </strong>We synthesised outcome data using random-effects meta-analyses with an inverse-variance approach and the restricted-maximum-likelihood method to estimate between-study variance. For continuous outcomes, we reported the mean difference (MD) or standardised mean difference (SMD), along with the 95% confidence interval (CI) and 95% prediction interval (PI). We assessed the certainty of the evidence for each key outcome using GRADE.</p><p><strong>Included studies: </strong>We included five RCTs with 304 participants. The studies were conducted in Asia (Iran, Indonesia, Japan and China) and published between 2006 and 2020. Sample sizes ranged from 40 to 84 parents. Most parents were women over the age of 45 years, and their children with severe mental illness primarily ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD014532"},"PeriodicalIF":8.8,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12871467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118352","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 : 2026-02-04DOI: 10.1002/14651858.CD016324
Dima Touhami, Rebecca Ryan, Eshetu Haileselassie Engeda, Chiara Arienti, Melissa Atkinson-Graham, Nora Bakaa, Irene Battel, Paolo Capodaglio, Claudio Cordani, Pierre Côté, Simon Décary, Wouter De Groote, Matteo Johann Del Furia, Antony Duttine, Walter R Frontera, Francesca Gimigliano, Carlotte Kiekens, Theodore Konstantinidis, Sara Liguori, Silvia Minozzi, Qhayiya Mudau, Marco Paoletta, Stefano Negrini, Carla Sabariego
<p><strong>Background: </strong>Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews that synthesize current available evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four pillars of HPSR as identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. This overview examined implementation strategies, defined by EPOC as interventions designed to bring about changes in healthcare organizations, the behavior of healthcare professionals, or the use of health services by healthcare recipients.</p><p><strong>Objectives: </strong>This overview aimed to synthesize current evidence on implementation strategies in rehabilitation from a health policy and systems research (HPSR) perspective. Our series of four overviews have the following overarching objectives. • To offer a broad synthesis of the existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint the needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist.</p><p><strong>Methods: </strong>We searched the Epistemonikos database, the Health Systems Evidence database, and EPOC Group systematic reviews to identify reviews published between 1 January 2015 and 17 November 2024. We applied no language limitations. We included Cochrane and non-Cochrane systematic reviews of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) that evaluated the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to implementation strategies as defined in the EPOC taxonomy. All four overview teams collaborated to screen reviews and extract data. We used AMSTAR 2 to critically appraise the quality of the reviews. Results were analyzed descriptively and are based on reviews with ratings of high-to-moderate confidence, with low-confidence reviews reported separately.</p><p><strong>Main results: </strong>We identified 7882 systematic reviews, of which 15 met our inclusion criteria. Three reviews overlapped substantially with other reviews, and eight received low- or critically low-confidence ratings. Ultimately, four moderate- to high-confidence reviews contributed to the synthesis; two were Cochrane systematic reviews. Most primary studies were from high-income countries; none were from low-income countries. Most strategies targeting healthcare professionals (e.g. guideline dissemination, interactive workshops, opinion leaders, audit and feedback) or hea
{"title":"Implementation strategies for rehabilitation services in health systems: an overview of systematic reviews.","authors":"Dima Touhami, Rebecca Ryan, Eshetu Haileselassie Engeda, Chiara Arienti, Melissa Atkinson-Graham, Nora Bakaa, Irene Battel, Paolo Capodaglio, Claudio Cordani, Pierre Côté, Simon Décary, Wouter De Groote, Matteo Johann Del Furia, Antony Duttine, Walter R Frontera, Francesca Gimigliano, Carlotte Kiekens, Theodore Konstantinidis, Sara Liguori, Silvia Minozzi, Qhayiya Mudau, Marco Paoletta, Stefano Negrini, Carla Sabariego","doi":"10.1002/14651858.CD016324","DOIUrl":"10.1002/14651858.CD016324","url":null,"abstract":"<p><strong>Background: </strong>Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews that synthesize current available evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four pillars of HPSR as identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. This overview examined implementation strategies, defined by EPOC as interventions designed to bring about changes in healthcare organizations, the behavior of healthcare professionals, or the use of health services by healthcare recipients.</p><p><strong>Objectives: </strong>This overview aimed to synthesize current evidence on implementation strategies in rehabilitation from a health policy and systems research (HPSR) perspective. Our series of four overviews have the following overarching objectives. • To offer a broad synthesis of the existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint the needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist.</p><p><strong>Methods: </strong>We searched the Epistemonikos database, the Health Systems Evidence database, and EPOC Group systematic reviews to identify reviews published between 1 January 2015 and 17 November 2024. We applied no language limitations. We included Cochrane and non-Cochrane systematic reviews of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) that evaluated the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to implementation strategies as defined in the EPOC taxonomy. All four overview teams collaborated to screen reviews and extract data. We used AMSTAR 2 to critically appraise the quality of the reviews. Results were analyzed descriptively and are based on reviews with ratings of high-to-moderate confidence, with low-confidence reviews reported separately.</p><p><strong>Main results: </strong>We identified 7882 systematic reviews, of which 15 met our inclusion criteria. Three reviews overlapped substantially with other reviews, and eight received low- or critically low-confidence ratings. Ultimately, four moderate- to high-confidence reviews contributed to the synthesis; two were Cochrane systematic reviews. Most primary studies were from high-income countries; none were from low-income countries. Most strategies targeting healthcare professionals (e.g. guideline dissemination, interactive workshops, opinion leaders, audit and feedback) or hea","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016324"},"PeriodicalIF":8.8,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12871471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118422","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 : 2026-02-03DOI: 10.1002/14651858.CD012734.pub2
Rebecca Jeyaraj, Harry D Zacharias, Sonam Vadera, Zhi Yang Low, Lise Lotte Gluud, Marsha Y Morgan
<p><strong>Rationale: </strong>Hepatic encephalopathy is a common complication of cirrhosis. Its development is associated with increased morbidity and mortality. Its exact pathogenesis is unknown, but ammonia, produced by bacterial action in the intestine, plays a key role. Antibiotics modulate the gut flora and may reduce intestinal ammonia production. Aminoglycosides such as neomycin, paromomycin, and ribostamycin have been used to treat hepatic encephalopathy, as have other antibiotics such as vancomycin and metronidazole.</p><p><strong>Objectives: </strong>To assess the beneficial and harmful effects of aminoglycosides, vancomycin, and metronidazole versus placebo, no intervention, other antibiotics, or other active pharmacological interventions, for the prevention and treatment of hepatic encephalopathy in people with cirrhosis.</p><p><strong>Search methods: </strong>We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, and three other databases to 15 April 2025. We also searched online trials registries for ongoing and unpublished trials, undertook manual searches of meeting and conference proceedings, checked bibliographies of relevant articles, and corresponded with investigators and pharmaceutical companies.</p><p><strong>Eligibility criteria: </strong>We included randomised clinical trials (RCTs) involving participants with cirrhosis and hepatic encephalopathy, or who were at risk of developing hepatic encephalopathy, comparing aminoglycosides, vancomycin, or metronidazole to (1) placebo or no intervention; or (2) other pharmacological agents, including non-absorbable disaccharides, other antibiotics, or other potentially beneficial agents (e.g. branched-chain amino acids, L-ornithine L-aspartate, nitazoxanide (a broad-spectrum antiparasitic/antiviral agent), and nicotinohydroxamic acid (a potent urease inhibitor). We included trials irrespective of publication status, outcomes reported, language, or blinding. We excluded trials involving people with hepatic encephalopathy associated with acute liver failure or with non-cirrhotic portal hypertension.</p><p><strong>Outcomes: </strong>The critical outcomes were all-cause mortality, hepatic encephalopathy, and serious adverse events. The important outcomes were non-serious adverse events and health-related quality of life (HRQoL). Our primary time point was the maximum length of follow-up.</p><p><strong>Risk of bias: </strong>We used Cochrane's original risk of bias tool (RoB 1) to assess the risk of bias.</p><p><strong>Synthesis methods: </strong>We used standard Cochrane methods. We undertook random-effects meta-analyses to calculate risk ratios (RRs) or standardised mean differences (SMDs), with 95% confidence intervals (CIs). We assessed heterogeneity with the I<sup>2</sup> statistic, and the certainty of evidence with the GRADE framework.</p><p><strong>Included studies: </strong>We included 24 RCTs, involving 1405 participants experiencin
理由：肝性脑病是肝硬化的常见并发症。它的发展与发病率和死亡率的增加有关。其确切的发病机制尚不清楚，但细菌在肠道中产生的氨起着关键作用。抗生素可以调节肠道菌群，并可能减少肠道氨的产生。氨基糖苷类如新霉素、帕罗霉素和核糖素已被用于治疗肝性脑病，其他抗生素如万古霉素和甲硝唑也被用于治疗肝性脑病。目的：评估氨基糖苷类、万古霉素和甲硝唑与安慰剂、无干预、其他抗生素或其他积极药物干预在肝硬化患者肝性脑病预防和治疗中的有益和有害作用。检索方法：我们检索了Cochrane肝胆组对照试验注册库、CENTRAL、MEDLINE、Embase和其他三个数据库，截止到2025年4月15日。我们还在网上检索了正在进行和未发表的试验注册库，人工检索了会议和会议记录，检查了相关文章的参考书目，并与研究者和制药公司进行了通信。入选标准：我们纳入了随机临床试验（RCTs），涉及肝硬化和肝性脑病患者，或有发生肝性脑病风险的受试者，将氨基糖苷类、万古霉素或甲硝唑与安慰剂或无干预进行比较；或(2)其他药理学药物，包括不可吸收的双糖、其他抗生素或其他潜在有益的药物（如支链氨基酸、l -鸟氨酸l -天冬氨酸、硝唑胺（广谱抗寄生虫/抗病毒药物）和烟羟肟酸（有效的脲酶抑制剂））。我们纳入的试验与发表状态、报道结果、语言或盲法无关。我们排除了肝性脑病合并急性肝功能衰竭或非肝硬化门静脉高压症患者的试验。结局：关键结局是全因死亡率、肝性脑病和严重不良事件。重要的结局是非严重不良事件和健康相关生活质量（HRQoL）。我们的主要时间点是最长随访时间。偏倚风险：我们使用Cochrane的原始偏倚风险工具（RoB 1）来评估偏倚风险。合成方法：采用标准Cochrane方法。我们进行了随机效应荟萃分析，以95%置信区间（ci）计算风险比（rr）或标准化平均差异（SMDs）。我们用I2统计量评估异质性，用GRADE框架评估证据的确定性。纳入的研究：我们纳入了24项随机对照试验，涉及1405名参与者，经历了1418例肝性脑病事件。23项试验评价肝性脑病的治疗，1项试验评价肝性脑病的二级预防；我们联合分析了这些试验。这些试验评估了三种氨基糖苷：新霉素（15项试验）、帕罗霉素（3项试验）和核糖素（1项试验），以及万古霉素（2项试验）和甲硝唑（3项试验）。总的来说，670名参与者接受了这些药物治疗，而735名参与者接受了安慰剂或其他潜在有益的药物治疗。基于领域水平评估，我们将24项试验中的22项分类为总体偏倚高风险。结果的综合：所有比较的证据的确定性从低到非常低，主要是由于偏倚、不精确和异质性的风险。24项试验中有23项，涉及1383名参与者，报告了全因死亡率数据。与其他潜在的活性药物相比，氨基糖苷类药物可能略微增加死亡率（RR 1.64, 95% CI 1.03至2.62;I²= 0%；3项研究，166名受试者）。关于氨基糖苷与安慰剂（RR 1.02, 95% CI 0.62至1.69;I²= 0%；3项研究，137名受试者）、不可吸收的双糖（RR 1.21, 95% CI 0.57至2.59；I²不适用；4项研究，266名受试者）或其他抗生素（RR 1.00, 95% CI 0.24至4.23;I²= 83%；8项研究，496名受试者）是否会导致死亡风险的差异，证据非常不确定。当比较万古霉素与不可吸收双糖（RR 0.94, 95% CI 0.26至3.40；I²不适用；2项研究，72名受试者）和甲硝唑与其他活性药物（RR 0.97, 95% CI 0.14至6.66;I²= 0%；3项研究，242名受试者）时，证据也非常不确定。涉及1281名受试者的19项试验报告了肝性脑病的数据。氨基糖苷类与不可吸收的双糖的作用可能几乎没有差异（RR 0.84, 95% CI 0.67至1.05;I²= 0%；3项研究，251名受试者），氨基糖苷类与其他潜在的活性药物（RR 1.21, 95% CI 0.79至1.85;I²= 0%；3项研究，166名受试者），甲硝唑类与其他活性药物（RR 1.50, 95% CI 0.89至2）。 54;I²= 48%；2项研究，208名参与者)。关于氨基糖苷类与安慰剂、其他抗生素、万古霉素与不可吸收双糖的效果，证据非常不确定。20项试验，涉及1186名参与者，共报告了328例严重不良事件。与其他潜在的活性药物相比，氨基糖苷类药物可能会略微增加严重不良事件的风险（RR 1.60, 95% CI 1.03至2.47;I²= 0%；3项研究，166名受试者）。当将氨基糖苷与安慰剂和其他抗生素进行比较时，或将万古霉素与不可吸收的双糖进行比较时，证据是非常不确定的。18项试验，涉及922名参与者，共报告了96例非严重不良事件。将氨基糖苷类药物与安慰剂（RR 2.80, 95% CI 1.11 ~ 7.04； I²不适用；2项研究，98名受试者）和其他抗生素（RR 3.24, 95% CI 1.08 ~ 9.70; I²= 0%；8项研究，251名受试者）相比，不良事件的风险可能略有增加。关于氨基糖苷类与不可吸收的双糖或其他活性剂的作用，以及甲硝唑与其他活性剂的作用，证据非常不确定。只有一项试验评估了HRQoL，但报告数据的形式排除了荟萃分析。8项试验得到了制药公司的支持，6项没有。10项试验没有提供这一信息。作者的结论：由于低或极低确定性的证据，我们不知道与安慰剂或其他潜在的活性药物相比，氨基糖苷是否对肝性脑病有益。与其他药物相比，氨基糖苷类药物的死亡率和严重不良事件的风险可能略有增加，与安慰剂和其他抗生素相比，非严重不良事件的风险可能略有增加。我们不知道万古霉素或甲硝唑是否能改善临床相关结果。只有一项试验评估了与健康相关的生活质量。资助：本Cochrane综述未获得专项资助。注册:https://doi.org/10.1002/14651858.CD012734。
{"title":"Aminoglycosides, vancomycin, and metronidazole for people with cirrhosis and hepatic encephalopathy.","authors":"Rebecca Jeyaraj, Harry D Zacharias, Sonam Vadera, Zhi Yang Low, Lise Lotte Gluud, Marsha Y Morgan","doi":"10.1002/14651858.CD012734.pub2","DOIUrl":"10.1002/14651858.CD012734.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Hepatic encephalopathy is a common complication of cirrhosis. Its development is associated with increased morbidity and mortality. Its exact pathogenesis is unknown, but ammonia, produced by bacterial action in the intestine, plays a key role. Antibiotics modulate the gut flora and may reduce intestinal ammonia production. Aminoglycosides such as neomycin, paromomycin, and ribostamycin have been used to treat hepatic encephalopathy, as have other antibiotics such as vancomycin and metronidazole.</p><p><strong>Objectives: </strong>To assess the beneficial and harmful effects of aminoglycosides, vancomycin, and metronidazole versus placebo, no intervention, other antibiotics, or other active pharmacological interventions, for the prevention and treatment of hepatic encephalopathy in people with cirrhosis.</p><p><strong>Search methods: </strong>We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, and three other databases to 15 April 2025. We also searched online trials registries for ongoing and unpublished trials, undertook manual searches of meeting and conference proceedings, checked bibliographies of relevant articles, and corresponded with investigators and pharmaceutical companies.</p><p><strong>Eligibility criteria: </strong>We included randomised clinical trials (RCTs) involving participants with cirrhosis and hepatic encephalopathy, or who were at risk of developing hepatic encephalopathy, comparing aminoglycosides, vancomycin, or metronidazole to (1) placebo or no intervention; or (2) other pharmacological agents, including non-absorbable disaccharides, other antibiotics, or other potentially beneficial agents (e.g. branched-chain amino acids, L-ornithine L-aspartate, nitazoxanide (a broad-spectrum antiparasitic/antiviral agent), and nicotinohydroxamic acid (a potent urease inhibitor). We included trials irrespective of publication status, outcomes reported, language, or blinding. We excluded trials involving people with hepatic encephalopathy associated with acute liver failure or with non-cirrhotic portal hypertension.</p><p><strong>Outcomes: </strong>The critical outcomes were all-cause mortality, hepatic encephalopathy, and serious adverse events. The important outcomes were non-serious adverse events and health-related quality of life (HRQoL). Our primary time point was the maximum length of follow-up.</p><p><strong>Risk of bias: </strong>We used Cochrane's original risk of bias tool (RoB 1) to assess the risk of bias.</p><p><strong>Synthesis methods: </strong>We used standard Cochrane methods. We undertook random-effects meta-analyses to calculate risk ratios (RRs) or standardised mean differences (SMDs), with 95% confidence intervals (CIs). We assessed heterogeneity with the I<sup>2</sup> statistic, and the certainty of evidence with the GRADE framework.</p><p><strong>Included studies: </strong>We included 24 RCTs, involving 1405 participants experiencin","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD012734"},"PeriodicalIF":8.8,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112544","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 : 2026-02-03DOI: 10.1002/14651858.CD016177
Nurul Syafiqah Othman, Amy Hy Chan, Jeff Harrison, Kebede A Beyene, Adam Wright-St Clair, Nataly Martini, Jiayi Gong
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of metformin for exacerbations in people with asthma.
目的：这是Cochrane综述（干预）的一个方案。目的如下：评估二甲双胍对哮喘患者急性发作的影响。
{"title":"Metformin for asthma exacerbations.","authors":"Nurul Syafiqah Othman, Amy Hy Chan, Jeff Harrison, Kebede A Beyene, Adam Wright-St Clair, Nataly Martini, Jiayi Gong","doi":"10.1002/14651858.CD016177","DOIUrl":"10.1002/14651858.CD016177","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of metformin for exacerbations in people with asthma.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016177"},"PeriodicalIF":8.8,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112578","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 : 2026-02-02DOI: 10.1002/14651858.CD016323
Mohamad El-Khatib, Nizar El Bcherawi, Frida Atallah, Marc Moukarzel, Thuraya HajAli, Joanne Khabsa, Hassan Moukalled, Lynn Sibai, Patrick Maroun, Christian Raphael
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of high-flow nasal cannula (HFNC) use, versus conventional oxygen therapy or other non-invasive ventilation, for respiratory support in children for indications other than acute bronchiolitis.
{"title":"High-flow nasal cannula use for respiratory support in children for indications other than acute bronchiolitis.","authors":"Mohamad El-Khatib, Nizar El Bcherawi, Frida Atallah, Marc Moukarzel, Thuraya HajAli, Joanne Khabsa, Hassan Moukalled, Lynn Sibai, Patrick Maroun, Christian Raphael","doi":"10.1002/14651858.CD016323","DOIUrl":"10.1002/14651858.CD016323","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of high-flow nasal cannula (HFNC) use, versus conventional oxygen therapy or other non-invasive ventilation, for respiratory support in children for indications other than acute bronchiolitis.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016323"},"PeriodicalIF":8.8,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12862885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103936","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 : 2026-01-30DOI: 10.1002/14651858.CD016319
Patricia Rancke-Madsen, Jacob Rosenberg, Stina Öberg
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate possible benefits and harms of no fixation versus any fixation of mesh in laparoscopic groin hernia repair in adults.
{"title":"No mesh fixation versus mesh fixation in laparoscopic groin hernia repair.","authors":"Patricia Rancke-Madsen, Jacob Rosenberg, Stina Öberg","doi":"10.1002/14651858.CD016319","DOIUrl":"10.1002/14651858.CD016319","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate possible benefits and harms of no fixation versus any fixation of mesh in laparoscopic groin hernia repair in adults.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016319"},"PeriodicalIF":8.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084488","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 : 2026-01-30DOI: 10.1002/14651858.CD016226
Christopher Deacon, Christopher Busby, Katie E Rollins, Ian Cameron, Paul Greenhaff, Benjamin J Ollivere
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the relative benefits and harms of anabolic medications after hip fracture in older people.
{"title":"Anabolic medications for rehabilitation after hip fracture in older people.","authors":"Christopher Deacon, Christopher Busby, Katie E Rollins, Ian Cameron, Paul Greenhaff, Benjamin J Ollivere","doi":"10.1002/14651858.CD016226","DOIUrl":"10.1002/14651858.CD016226","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the relative benefits and harms of anabolic medications after hip fracture in older people.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016226"},"PeriodicalIF":8.8,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084496","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}
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective To assess the benefits and harms of tenecteplase compared to alteplase in people suffering from large vessel occlusion or non-large vessel occlusion acute ischemic stroke. Secondary objective To explore the effects of the interventions (tenecteplase and alteplase) in different groups based on age, sex, ethnicity, and place of residence (high-, middle-, low-income country), to inform health equity considerations.
{"title":"Tenecteplase versus alteplase for acute ischemic stroke.","authors":"Hemanshu Prabhakar, Indu Kapoor, Charu Mahajan, Chandini Kukanti, Mani Kalaivani","doi":"10.1002/14651858.CD016325","DOIUrl":"10.1002/14651858.CD016325","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective To assess the benefits and harms of tenecteplase compared to alteplase in people suffering from large vessel occlusion or non-large vessel occlusion acute ischemic stroke. Secondary objective To explore the effects of the interventions (tenecteplase and alteplase) in different groups based on age, sex, ethnicity, and place of residence (high-, middle-, low-income country), to inform health equity considerations.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016325"},"PeriodicalIF":8.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084525","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 : 2026-01-29DOI: 10.1002/14651858.CD016321
Amanda Brignell, Kris Chan, Tayla Chellew, Chathuri Vihanga Maddumahewa, Nicole Wong, Lotty Hooft, Mohammed Alshawsh, Katrina Williams
Objectives: This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: Primary objectives To evaluate the diagnostic accuracy of widely used ASD diagnostic tools (specifically CARS, GARS, ADOS, ADI-R, DISCO, 3di) in preschool children, compared with multidisciplinary team clinical judgement. We aim to: summarise sensitivity, specificity, and other accuracy measures for each ASD diagnostic tool; and for studies that compare two or more tools within the same study, describe and compare their diagnostic accuracy. To identify if any combination of diagnostic tools has greater diagnostic test accuracy than each single tool. We aim to: describe combined diagnostic test accuracy within a single study; and compare combined diagnostic test accuracy to individual test accuracy from primary objective 1a. Secondary objectives To assess whether there is different diagnostic test accuracy for subgroups such as intellectual disability, language level, setting, prospective versus retrospective, DSM diagnostic classification and specific ages (within the preschool age range).
{"title":"Diagnostic tests for autism spectrum disorder (ASD) in preschool children.","authors":"Amanda Brignell, Kris Chan, Tayla Chellew, Chathuri Vihanga Maddumahewa, Nicole Wong, Lotty Hooft, Mohammed Alshawsh, Katrina Williams","doi":"10.1002/14651858.CD016321","DOIUrl":"10.1002/14651858.CD016321","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: Primary objectives To evaluate the diagnostic accuracy of widely used ASD diagnostic tools (specifically CARS, GARS, ADOS, ADI-R, DISCO, 3di) in preschool children, compared with multidisciplinary team clinical judgement. We aim to: summarise sensitivity, specificity, and other accuracy measures for each ASD diagnostic tool; and for studies that compare two or more tools within the same study, describe and compare their diagnostic accuracy. To identify if any combination of diagnostic tools has greater diagnostic test accuracy than each single tool. We aim to: describe combined diagnostic test accuracy within a single study; and compare combined diagnostic test accuracy to individual test accuracy from primary objective 1a. Secondary objectives To assess whether there is different diagnostic test accuracy for subgroups such as intellectual disability, language level, setting, prospective versus retrospective, DSM diagnostic classification and specific ages (within the preschool age range).</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016321"},"PeriodicalIF":8.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084511","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}
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