Cochrane Database of Systematic Reviews最新文献

{"title":"Enteral lipid supplements for the prevention and treatment of parenteral nutrition-associated liver disease in infants.","authors":"Muralidhar H Premkumar, Katie A Huff, Chris Cooper, Jane Cracknell, Mohan Pammi","doi":"10.1002/14651858.CD014353.pub2","DOIUrl":"10.1002/14651858.CD014353.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Enteral lipid formulations may offer benefits according to preclinical studies, but their effectiveness and safety in preventing and treating parenteral nutrition-associated liver disease (PNALD) in infants remains unknown.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of enteral lipid supplementation for the prevention and treatment of PNALD in infants.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase and trial registers, together with reference checking and contact with study authors. The latest search was in December 2024.</p><p><strong>Eligibility criteria: </strong>We included parallel, randomized control trials (RCTs) in infants comparing enteral lipid supplements with either a placebo or no intervention in infants who were either at risk or who had PNALD. We excluded studies involving infants receiving enteral feeds without the need for parenteral nutrition, as they were neither at risk for PNALD, nor diagnosed with PNALD, and infants with cholestasis secondary to primary liver disease, inborn errors of metabolism, or congenital infection.</p><p><strong>Outcomes: </strong>Our primary outcomes were the prevention of PNALD during hospital stay and the first year of life; and resolution of PNALD during hospital stay and the first year of life. Other outcomes included feeding intolerance during the hospital stay, time to full feeds measured in days during the hospital stay, length of hospital stay in days, need for liver transplantation in the first year of life and all-cause mortality up to hospital discharge and in the first year of life.</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias 1 (RoB 1) tool to assess bias in the RCTs.</p><p><strong>Synthesis methods: </strong>We synthesized results for each outcome using meta-analyses where possible, using random-effect models to calculate risk ratios (RRs) and risk difference (RD) with 95% confidence intervals (CIs) for dichotomous outcomes. For continuous outcomes, we calculated mean differences (MDs). If combining the data was not feasible, we summarized data narratively using Synthesis without Metaanalysis (SWiM). We summarized the certainty of evidence according to GRADE methods.</p><p><strong>Included studies: </strong>We included 11 studies (2192 infants). A variety of enteral lipids were used as interventions, including algal oil, fungal oil, and fish oil, either alone or in combination. The intervention groups received: - Fish oil alone or in combination with other oils (three studies; n = 1328); - Algal oil alone or in combination with other oils (eight studies; n = 864). The comparison groups received either no intervention or other oils, such as sunflower oil, safflower oil, olive oil, or medium-chain triglyceride (MCT) oil. Most studies included preterm infants who received enteral lipid supplements while primarily on parenteral nutrition and minimal enteral nutrition, thus being co","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD014353"},"PeriodicalIF":8.8,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioural interventions for improving oral hygiene in adults with periodontal diseases.","authors":"Lucy O'Malley, Sharon R Lewis, Philip M Preshaw, Philip Riley, Pauline Adair, Marc L E Edwards, Heather Raison, Matthew J Byrne, George Kitsaras, Pia-Merete Jervøe-Storm","doi":"10.1002/14651858.CD012049.pub2","DOIUrl":"10.1002/14651858.CD012049.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Periodontal diseases are common chronic inflammations in adults and can impact quality of life. Optimal oral hygiene behaviour is essential for establishing and maintaining periodontal health and ensuring treatment has the best chance of success. Therefore, it is important to establish effective ways to support adults with periodontal disease to maintain their oral hygiene.</p><p><strong>Objectives: </strong>To determine the impact of behavioural interventions aimed at improving oral hygiene in adults with periodontal diseases (including gingivitis and periodontitis).</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, and three other databases up to 3 July 2024. We also searched two trials registers (26 February 2025) and reference lists of eligible studies and related systematic reviews.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) involving adults with periodontitis or gingivitis that evaluated interventions involving behaviour change techniques (BCTs) aimed at improving oral hygiene.</p><p><strong>Outcomes: </strong>Our outcomes were bleeding, gingival inflammation, other clinical markers of periodontal disease (plaque, probing pocket depth (PPD), and clinical attachment loss (CAL)), and self-reported measures of oral health-related behaviours. We used any clinically relevant measure and the final follow-up time point reported by study authors.</p><p><strong>Risk of bias: </strong>We used the Cochrane RoB 1 tool to assess risk of bias.</p><p><strong>Synthesis methods: </strong>Given the nature of the data, we synthesised results using Synthesis Without Meta-analysis (SWiM) methods. We used GRADE to assess the certainty of evidence.</p><p><strong>Included studies: </strong>We included 25 RCTs involving 1422 adults. Nineteen studies included only adults with periodontitis, and five only adults with gingivitis; one study included both disease types. Each study included different interventions, which we classified according to the Behaviour Change Technique (BCT) taxonomy (Michie and colleagues 2013) and described using BCT cluster labels. The evaluated interventions adopted a range of BCTs, including: goals and planning, feedback and monitoring, shaping knowledge, natural consequences, comparison of behaviour, associations, repetition and substitution, comparison of outcomes, reward and threat, regulation, antecedents, identity, scheduled consequences, and self-belief. Active controls included feedback and monitoring, shaping knowledge, comparison of behaviour, repetition and substitution, and antecedents.</p><p><strong>Synthesis of results: </strong>We judged the certainty of evidence for all outcomes below to be very low due to risk of bias, inconsistency (between directions of effect), and imprecision (small sample sizes, or effect estimates including no benefit to either group). Behavioural interventions compared with an active control for adults ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD012049"},"PeriodicalIF":8.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12849544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive surgery (robot-assisted or laparoscopic) versus open surgery for presumed benign ovarian tumours.","authors":"Lidia Rf Medeiros, Maria Ines da Rosa, Tamy Colonetti, Antonio Jose Grande, Maria Laura Rodrigues Uggioni, Airton T Stein","doi":"10.1002/14651858.CD015717","DOIUrl":"10.1002/14651858.CD015717","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 minimally invasive surgery (robot-assisted or laparoscopic) compared with open surgery (laparotomy or mini-laparotomy) on benefits and harms in the management of presumed benign ovarian tumours.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD015717"},"PeriodicalIF":8.8,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12849974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methods of induction of labour: a network meta-analysis.","authors":"Siwanon Rattanakanokchai, Ioannis D Gallos, Chumnan Kietpeerakool, Nuntasiri Eamudomkarn, Kyaw Lwin Show, Khaing Nwe Tin, Olufemi T Oladapo, Doris Chou, Ben Willem J Mol, Wentao Li, Pisake Lumbiganon, Arri Coomarasamy, Malcolm J Price","doi":"10.1002/14651858.CD015234.pub2","DOIUrl":"10.1002/14651858.CD015234.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Induction of labour (IoL) aims to initiate labour when the risks of continuing pregnancy outweigh the benefits. Over 10 methods are currently available, yet the most effective and safest method remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the benefits and harms of various cervical ripening and IoL methods at or beyond term labour and to rank the methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the WHO ICTRP until 1 February 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) evaluating IoL methods among women with a live fetus at or beyond term labour (gestational age ≥ 37 weeks). We focused on the methods currently recommended by international guidelines and those proposed by previous Cochrane reviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes included failure to achieve vaginal delivery within 24 hours, caesarean section due to any causes, caesarean section due to non-reassuring fetal status, uterine hyperstimulation with changes in the heartbeat of the baby before birth, perinatal death, and severe neonatal morbidity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed bias and trustworthiness using the Cochrane RoB 1 tool and the Cochrane Pregnancy and Childbirth Trustworthiness Tool (CPS-TST), respectively. The final analyses only included trials that met the CPS-TST.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We performed pair-wise meta-analyses using a random-effects model and network meta-analyses (NMA) with a frequentist approach. We reported analyses and results separately for two populations: 1) women without a previous caesarean section and a mix of women with or without a previous caesarean section (where more than 50% of participants had no previous caesarean section), and 2) women with a previous caesarean section. We used risk ratio (RR) and mean difference (MD) to present treatment effects with 95% confidence intervals (CIs). We assessed the certainty of evidence for critical outcomes using the GRADE approach for NMA. We used the surface under the cumulative ranking curve (SUCRA) to estimate treatment ranking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;The analysis included 106 RCTs assessing 13 IoL methods among 30,348 women. Most trials (84.9%) were conducted in inpatient settings. Only two RCTs recruited women with previous caesarean section, and seven RCTs recruited a mix of women with or without a previous caesarean section.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;We evaluated the effects of the following IoL methods: vaginal misoprostol (≤ 50 μg), oral misoprostol (≤ 50 μg), sublingual or buccal misoprostol (≤ 50 μg), controlled-release misoprostol vaginal pessary, vaginal dinoprostone (tablet or gel), controlled-release dinoprostone vaginal pessary, oxytocin (alone), nitric oxide donors, balloon catheters, osmotic cervical dilator","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD015234"},"PeriodicalIF":8.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12834601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinically indicated removal versus routine removal of peripheral venous catheters.","authors":"Karina R Charles, Jessica A Schults, Nicole Marsh, Sonya R Osborne, Sharon Rees, Gabor Mihala, Sarah Smith, Claire M Rickard","doi":"10.1002/14651858.CD007798.pub6","DOIUrl":"10.1002/14651858.CD007798.pub6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Catheter-related bloodstream infection is a potentially life-threatening complication of peripheral venous catheters (PVCs). Routine PVC removal at set time intervals may prevent bloodstream infection and thrombophlebitis; however, it requires additional replacement PVC insertions and costs. An alternative is clinically indicated removal when the PVC is no longer needed, functional, comfortable or complication-free.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of clinically indicated removal versus routine removal of PVCs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the CENTRAL, MEDLINE, Embase and CINAHL databases, and the WHO ICTRP and ClinicalTrials.gov registries to 21 January 2025. We also searched the reference lists of retrieved studies and potentially useful articles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) comparing clinically indicated with routine PVC removal for patients requiring a PVC. We excluded randomised cross-over trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical outcomes were catheter-related bloodstream infection, primary bloodstream infection, local infection and mortality. Important, but not critical, outcomes were thrombophlebitis, infiltration and catheter occlusion. Outcomes considered of limited importance included cost, pain during infusion, satisfaction and the number of catheters per participant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;For this update (4th; initial publication 2010), we used the Cochrane risk of bias tool (RoB 1) to assess risk of bias in the studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Six review authors independently selected studies, extracted data and assessed the risk of bias. Where appropriate, we pooled data using fixed-effect models in the first instance. Effect measures included risk ratios (RR) for categorical outcomes, mean difference (MD) for continuous outcomes and rate ratio (RaR) for incidence rates, each with 95% confidence intervals (CI). We assessed the certainty of evidence using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;All studies in the previous version of the review were included (n = 9), and we identified five new studies. The update included 14 RCTs with 11,428 participants. Studies were conducted in Australia, Brazil, China, India, Iran, Taiwan and the United Kingdom. Thirteen studies were conducted in acute hospitals and one in a community setting. Eleven studies assessed adult populations, and three studies included paediatric or neonatal populations. All studies had a high risk of bias in one or more risk of bias domains. The certainty of the evidence was low to moderate, limited by potential detection bias for subjective outcomes, inconsistency across studies and imprecision due to small sample sizes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Clinically indicated removal likely results in little to no difference in the incidence of catheter-related bloodstre","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD007798"},"PeriodicalIF":8.8,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12838767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bipolar coagulation techniques versus the clamp-crush technique for elective liver resection.","authors":"Mario Kopljar, Roman Pavić, Zrinko Madžar, Tihomil Žiger","doi":"10.1002/14651858.CD016320","DOIUrl":"10.1002/14651858.CD016320","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 a bipolar coagulation technique versus a clamp-crush technique for liver resection in children and adults undergoing elective liver resection.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016320"},"PeriodicalIF":8.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blastocyst-stage versus cleavage-stage embryo transfer in assisted reproductive technology.","authors":"Demián Glujovsky, Simone Cornelisse, Deborah Blake, Andrea Marta Quinteiro Retamar, Cristian Roberto Alvarez Sedo, Agustín Ciapponi","doi":"10.1002/14651858.CD002118.pub7","DOIUrl":"10.1002/14651858.CD002118.pub7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Blastocyst-stage transfer has increasingly replaced cleavage-stage transfer in IVF (in vitro fertilisation) programmes. It is thought to improve live birth rates by better synchronising embryo development with the endometrium and allowing self-selection of viable embryos. However, it remains uncertain whether extended culture confers a true biological advantage or mainly reflects selection in vitro, and whether benefits per transfer translate into improved cumulative live birth rates across different patient populations and laboratory settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of blastocyst-stage (day 5 to 6) embryo transfer compared with cleavage-stage (day 2 to 3) embryo transfer on cumulative live birth rate per woman (defined as the occurrence of at least one live birth resulting from the fresh transfer and all subsequent frozen-thawed embryo transfers derived from the same oocyte retrieval), live birth rate per fresh transfer, and cumulative preterm birth outcomes using the same definition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;On 1 October 2024, we searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. In addition, we searched two trial registries, reference lists of relevant papers, and contacted experts in the field for any additional trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) that involved women undergoing an assisted reproductive technology cycle and compared blastocyst-stage versus cleavage-stage embryo transfers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes of interest were cumulative live birth rate from fresh and frozen-thawed cycles, live birth rate per fresh transfer, and cumulative preterm birth rate from fresh and frozen-thawed cycles. Our important outcomes of interest were clinical pregnancy rate per fresh transfer, miscarriage rate per fresh transfer, embryo freezing rate, and failure-to-transfer rate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed the risk of bias in the evidence using Cochrane's RoB 2 tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesised results for each outcome using meta-analysis where possible (with a fixed-effect Mantel-Haenszel model). Where this was not possible due to the nature of the data, we provided a narrative description of the results. We used GRADE to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 36 parallel-design RCTs (8389 participants). Three studies reported cumulative live birth rate (cLBR); two studies reported cumulative obstetric and perinatal outcomes; and 19 studies reported live birth rate (LBR) per fresh transfer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Blastocyst-stage transfer may increase cLBR within 12 months after oocyte retrieval (OR 1.24, 95% CI 1.04 to 1.47; I² = 70%; 3 studies, 2328 women; low certain","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD002118"},"PeriodicalIF":8.8,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight management for chronic low back pain.","authors":"Emma Mudd, Amanda Tutty, Steven J Kamper, Aidan G Cashin, Zoe A Michaleff, Simon Re Davidson, Eduardo Alves, Stuart Browne, Jane Linton, James H McAuley, Christopher M Williams","doi":"10.1002/14651858.CD016276","DOIUrl":"10.1002/14651858.CD016276","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 weight management interventions for chronic non-specific low back pain in adults.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016276"},"PeriodicalIF":8.8,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12825355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rehabilitation interventions for oropharyngeal dysphagia in people with Parkinson's disease.","authors":"Irene Battel, Chiara Arienti, Matteo Johann Del Furia, Stefano Giuseppe Lazzarini, Tobias Warnecke, Margaret Walshe","doi":"10.1002/14651858.CD015816.pub2","DOIUrl":"10.1002/14651858.CD015816.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Oropharyngeal dysphagia is a common and disabling symptom in people with Parkinson's disease, affecting the safety and efficiency of swallowing and increasing the risk of malnutrition and aspiration pneumonia. Despite its clinical relevance, the effectiveness of rehabilitation interventions for managing dysphagia in this population remains uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effectiveness of rehabilitation interventions for oropharyngeal dysphagia in improving swallowing safety and efficiency in people with Parkinson's disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Speech Pathology Database for Best Interventions and Treatment Efficacy up to 26 September 2025. We also searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform to retrieve ongoing and recently completed trials, and OpenGrey for grey literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) of rehabilitation interventions aimed at improving oropharyngeal dysphagia in people with Parkinson's disease. We included any rehabilitation intervention for oropharyngeal dysphagia, alone or in combination with another rehabilitation intervention, with or without concurrent pharmacological treatments. Comparators included no intervention, usual care, a placebo/sham stimulation or attention control intervention, or any other rehabilitation intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical outcomes: swallowing safety and swallowing efficiency Important outcomes: dysphagia severity, saliva management, quality of life, respiratory outcomes, nutritional and dietary outcomes, and adverse events RISK OF BIAS: We assessed the risk of bias in the included studies using Cochrane's revised risk of bias (RoB 2) tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;When two or more studies were pooled, we conducted a random-effects meta-analysis to calculate standardised mean differences (SMDs) and 95% confidence intervals (CIs). When only one study was available, we used a fixed-effect model to estimate the effect, calculating mean differences (MDs) or odds ratios (ORs) with 95% CIs for all outcomes. We used the GRADE approach to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 18 studies (1216 participants). Five studies were conducted in Europe, four in the USA, and nine in the rest of the world. Generally, studies were heterogeneous and often poorly reported. We included only two studies in the meta-analysis. Ten studies tested behavioural interventions, while eight studies tested one or more stimulation interventions: neuromuscular treatments (three studies), repetitive transcranial magnetic stimulation (two studies), deep brain stimulation (tw","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD015816"},"PeriodicalIF":8.8,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12821585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational therapy for multiple sclerosis.","authors":"Daphne Kos, Ashley Boers, Ciara O'Meara, Geertruida E Bekkering, Leen De Coninck, Marja Koen, Jennifer Freeman, Sinéad M Hynes, Isaline Cjm Eijssen","doi":"10.1002/14651858.CD015371.pub2","DOIUrl":"10.1002/14651858.CD015371.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Occupational therapy (OT) enables individuals to engage in meaningful daily activities and is considered a valuable component of care for people with multiple sclerosis (MS). However, the specific impact of OT on MS remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of occupational therapy interventions for improving daily functioning, participation and quality of life in people with multiple sclerosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched seven electronic bibliographic databases until November 2024. We also searched grey literature and trial registers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised and non-randomised controlled trials that compared OT for adults with MS versus no intervention, usual care or active control.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical outcomes were daily functioning, quality of life and adverse effects. Important outcomes were participation, self-efficacy, self-management, mood, resilience and impact on caregivers. Our time points of interest were post-intervention, medium term (up to six months after the end of the intervention) and long term (longest follow-up after six months).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed risk of bias (RoB) for the outcomes reported in our summary of findings tables. We used the Cochrane tools RoB-2 (for randomised controlled trials) and ROBINS-I (for non-randomised controlled trials).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesised results using meta-analysis (random-effects model, inverse variance). The effect measure was mean difference (MD) or standardised mean difference (SMD). Where meta-analysis was not possible, we synthesised results narratively using Synthesis Without Meta-analysis guidelines. We used GRADE to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 20 studies (1628 participants), three of which were non-randomised. Nineteen of the studies were conducted in high-income countries. The studies included adults with MS (aged 18 to 70 years) with low to moderate levels of disability. Ten studies evaluated fatigue management programmes, nine examined OT interventions for daily functioning (e.g. skills training) and one targeted social participation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Daily functioning Post-intervention: OT interventions may provide a small benefit for daily functioning compared to active control (SMD 0.22, 95% CI -0.02 to 0.46; I² = 17%; 7 studies, 364 participants; low certainty), and a moderate benefit compared to no intervention (SMD 0.56, 95% CI -0.26 to 1.37; I² = 68%; 2 studies, 164 participants; low certainty). There may be a large effect compared to usual care, but the evidence is very uncertain (SMD 1.19, 95% CI 0.29 to 2.09; I² = 62%; 2 studies, 120 participants; very low certainty). Medium term: OT may make little to no difference to daily functioning compared to active control","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD015371"},"PeriodicalIF":8.8,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12817330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009196","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}