Cochrane Database of Systematic Reviews最新文献

{"title":"Financial arrangements for rehabilitation services in health systems: an overview of systematic reviews.","authors":"Francesca Gimigliano, Sara Liguori, Chiara Arienti, Marco Paoletta, Olivier Butzbach, Giovanni Iolascon, Melissa Atkinson-Graham, Nora Bakaa, Irene Battel, Paolo Capodaglio, Claudio Cordani, Pierre Côté, Simon Décary, Wouter De Groote, Matteo Johann Del Furia, Antony Duttine, Eshetu Haileselassie Engeda, Walter R Frontera, Carlotte Kiekens, Theodore Konstantinidis, Silvia Minozzi, Qhayiya Mudau, Rebecca Ryan, Carla Sabariego, Dima Touhami, Stefano Negrini, Antimo Moretti","doi":"10.1002/14651858.CD016327","DOIUrl":"10.1002/14651858.CD016327","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 focuses on financial arrangements, which Cochrane EPOC defines as changes in how funds are collected, how insurance schemes are structured, how services are purchased, and the use of targeted financial incentives or disincentives.</p><p><strong>Objectives: </strong>This overview aimed to synthesize the current evidence on financial arrangements in rehabilitation from a health policy and systems research (HPSR) perspective. Our series of four overviews, incorporating evidence on governance arrangements, delivery arrangements, financial arrangements, and implementation strategies, 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 financial arrangements 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. Reviews with ratings of high-to-moderate confidence are reported separately from low-confidence reviews.</p><p><strong>Main results: </strong>We identified two non-Cochrane systematic reviews relevant to rehabilitation and the EPOC category of financial arrangements. We excluded one review from the synthesis due to low methodological quality. The other review included 18 primary studies, but only one study reported data relevant to rehabilitation. This study, conducted in a single country (China), compared insured and uninsured children aged birth to 17 years with intellectual disabilities, focusing on the likeliho","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016327"},"PeriodicalIF":8.8,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12910665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146212234","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":"Intermittent fasting for adults with overweight or obesity.","authors":"Luis I Garegnani, Gisela Oltra, Diego Ivaldi, Mariana Andrea Burgos, Paola J Andrenacci, Sabrina Rico, Melinda Boyd, Diane Radler, Camila Micaela Escobar Liquitay, Eva Madrid","doi":"10.1002/14651858.CD015610.pub2","DOIUrl":"10.1002/14651858.CD015610.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Weight loss remains the primary strategy for reducing health risks and societal consequences associated with overweight and obesity. The most common dietary interventions are calorie-restricted diets, including various permutations of energy restriction, macronutrients, foods, and dietary intake patterns, which achieve initial but often unsustained weight loss. Intermittent fasting involves eating patterns during which individuals take little or no energy for extended time periods, alternated with periods of normal food intake. The mechanism for weight loss is related to caloric restriction, increased fat metabolism, enhanced insulin sensitivity, and improved glucose metabolism. Intermittent fasting has been publicised in blogs and news articles but studies show inconsistent effects on health, highlighting the uncertainty faced by physicians and people with overweight or obesity when considering intermittent fasting as a feasible approach for sustained weight loss.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of intermittent fasting versus regular dietary advice, no intervention or waiting list for adults with overweight or obesity.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE (Ovid), and two trials registers up to 5 November 2024, as well as reference checking, citation searching and contact with study authors to identify additional studies.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and cluster-RCTs that compared intermittent fasting (including time-restricted feeding, periodic fasting, alternate-day fasting, and modified alternate-day fasting) with regular dietary advice, no intervention or waiting list in men and women with overweight or obesity, with or without associated comorbid conditions. The minimum duration of the intervention was four weeks, and the minimum duration of follow-up was six months. We excluded cross-over and quasi-RCTs.</p><p><strong>Outcomes: </strong>Our outcomes were weight loss, quality of life, participant satisfaction, diabetes status, and adverse events. We considered outcomes measured up to and including 12 months after randomisation as short-term, and longer than 12 months as long-term.</p><p><strong>Risk of bias: </strong>We used the Cochrane risk of bias tool (RoB 2) and the RoB2 extension for cluster-RCTs.</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis where possible, using random-effects models to calculate risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) or standardised mean differences (SMD) for continuous outcomes. Where this was not possible due to the nature of the data, we would have synthesised results using narrative synthesis, including the summary of effect estimates. We used GRADE to assess the certainty of evidence for each outcome.</p><p><strong>Included studies:","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD015610"},"PeriodicalIF":8.8,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12906965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200371","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":"Robotic-assisted versus conventional total knee arthroplasty for treating osteoarthritis.","authors":"Lauro Av Costa, Celso Gp Dias, Vinícius Y Moraes, Eliane Antonioli, Mário Lenza","doi":"10.1002/14651858.CD016286","DOIUrl":"10.1002/14651858.CD016286","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 robotic-assisted versus conventional total knee arthroplasty for the treatment of osteoarthritis.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016286"},"PeriodicalIF":8.8,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12903641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146178026","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":"Training health professionals in smoking cessation.","authors":"Kelsey J Sharrad, Kristin V Carson-Chahhoud, Marjolein Ea Verbiest, Sarah Greenslade, Thomas Parkhouse, Willem Jj Assendelft, Mathilde R Crone, Jonathan Livingstone-Banks","doi":"10.1002/14651858.CD000214.pub3","DOIUrl":"10.1002/14651858.CD000214.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Cigarette smoking is one of the leading causes of preventable death worldwide. There is good evidence that brief interventions by health professionals can increase smoking cessation attempts. However, as new studies become available, the effectiveness of these training programmes needs to be re-assessed to inform public policy, clinical care, and guideline recommendations. This is an update of a Cochrane review first published in 2000, and previously updated in 2012.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effectiveness of training healthcare professionals to deliver smoking cessation interventions to their patients, and to assess the effects of training characteristics (such as content, setting, delivery, and intensity).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the following databases from inception to August 2024: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ClinicalTrials.gov (through CENTRAL); and the World Health Organization International Clinical Trials Registry Platform (through CENTRAL). We also searched the references of eligible studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised trials in which the intervention was training of healthcare professionals in smoking cessation. We considered trials for inclusion if they reported outcomes for patient smoking at least six months after the intervention. Process outcomes needed to be reported. However, we excluded trials that reported effects only on process outcomes and not smoking behaviour.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcome measure was abstinence from smoking six months or more after baseline, using the strictest measure of abstinence available at the longest follow-up. Prolonged or continuous abstinence was preferred over point prevalence. Our important outcome was the number of participants who made a quit attempt.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Working independently, two review authors evaluated the risk of bias using the Cochrane RoB 1 tool, following guidance from the Cochrane Tobacco Addiction Group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Working independently, two review authors extracted information about the characteristics of each included study (i.e. interventions, participants, outcomes, and methods). We pooled studies using random-effects meta-analysis where possible and otherwise summarised findings using narrative synthesis in text and tables. We used the GRADE framework to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 29 studies in the review, published between 1989 and 2024. Together, the studies provided training for over 4030 health professionals, and data for 38,178 participants. We assessed 10 studies to have an overall low risk of bias, 17 an unclear risk, and two to have an overall high risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Sixteen studies compared training of h","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD000214"},"PeriodicalIF":8.8,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12895530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164549","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":"Substitution of nurses for physicians in the hospital setting for patient, process of care, and economic outcomes.","authors":"Michelle Butler, Marcia Kirwan, Vera Jc Mc Carthy, Judith A Cole, Timothy J Schultz","doi":"10.1002/14651858.CD013616.pub2","DOIUrl":"10.1002/14651858.CD013616.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;The demand for health services to deliver hospital-based care has increased due to an ageing population, more complex healthcare needs, comorbidities, and increasing healthcare costs. Nurse-physician substitution can improve access to care for patients who may otherwise have a significant wait for review by a physician.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The main objective of this review was to examine the impact of substituting nurses for physicians in the hospital setting (hospital inpatient units and outpatient clinics) on patient outcomes, process of care outcomes, and economic outcomes. The secondary objectives of this review were to assess whether the effects of nurse-physician substitution differ according to healthcare setting (low- and middle-income countries (which included low-income, lower middle-income, and upper middle-income countries) versus high-income countries), patient type, patient disease, intervention type (inpatient care, nurse-led clinics, role substitution, and task substitution), nurse grade, additional training, level of responsibility, and mode of substitution for nurse-led clinics (telephone/telehealth, partial substitution, enhanced substitution, and full substitution).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, NHSEED, CINAHL, ProQuest, two citation indexes, and two trial registries. We also conducted handsearches, reference checking, and contacted study authors to identify eligible studies. We searched five grey literature databases and contacted experts relevant to the review area. The evidence is current to 25 June 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials of both individual and cluster design that compared the effects of care delivered by a nurse to that delivered by a physician on patient, process of care, and economic outcomes. We included care of inpatients or outpatients in hospital settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were mortality, patient safety events, and clinical outcomes. Important outcomes were quality of life, self-efficacy, relative performance of practitioner, and direct costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed the risk of bias using the Cochrane RoB 2 tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesised results for six outcomes (70 studies) using meta-analysis. We calculated odds ratios (OR) or risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes, and standardised mean differences (SMD) or mean differences (MD) with 95% CI for continuous outcomes. Data for clinical outcomes and relative performance of practitioner were stratified, and direct costs were summarised narratively. We assessed the certainty of evidence using GRADE for all outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 80 parallel-group single or multi-site randomised studies and two cross-over single-site randomised studies. Ther","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD013616"},"PeriodicalIF":8.8,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12893813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146164407","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":"Antifibrinolytics (lysine analogues) for the prevention of bleeding in people with haematological disorders.","authors":"Rita Champaneria, Lise J Estcourt, Louise Geneen, Susan J Brunskill, Carolyn Dorée, Simon J Stanworth, Michael Jr Desborough","doi":"10.1002/14651858.CD009733.pub4","DOIUrl":"10.1002/14651858.CD009733.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;People with haematological disorders are frequently at risk of severe or life-threatening bleeding as a result of thrombocytopenia (reduced platelet count). This is despite the routine use of prophylactic platelet transfusions to prevent bleeding once the platelet count falls below a certain threshold. Platelet transfusions are not without risk and adverse events may be life-threatening. A possible adjunct to prophylactic platelet transfusions is the use of antifibrinolytics, specifically the lysine analogues tranexamic acid (TXA) and epsilon aminocaproic acid (EACA). This is an update of a Cochrane review last published in 2016 (with database searches conducted on 7 March 2016).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To determine the benefits and harms of antifibrinolytics (lysine analogues) in preventing bleeding in people with haematological disorders.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Transfusion Evidence Library, and ongoing trial databases on 21 January 2025. We handsearched the reference lists of all identified randomised controlled trials (RCTs). We contacted the authors of relevant studies, study groups, and experts worldwide known to be active in the field to request information about unpublished material or further information on ongoing studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included RCTs in people with haematological disorders who required prophylactic platelet transfusions to prevent bleeding. We only included RCTs in which the interventions were the lysine analogues TXA or EACA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;We assessed bleeding severity using the World Health Organization (WHO) bleeding scale (ordinal grades 0 to 4, with higher grades indicating more severe bleeding), which has been widely applied in thrombocytopenia studies. The outcomes prioritised for the summary of findings tables were: number of participants with grade 2 bleeding or higher; number of participants with grade 3 bleeding or higher; number of participants with any thromboembolism; all-cause mortality; and adverse events attributable to antifibrinolytic drugs. We provide results only for these outcomes below.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used Cochrane's risk of bias 2 (RoB 2) tool. We used this tool to re-assess the previously included trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;For this update, two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We used fixed-effect models for the meta-analysis. We analysed dichotomous outcomes using risk ratios (RRs) with 95% confidence intervals (CIs), and the Peto odds ratio (Peto OR) for outcomes with very low event rates (&lt; 3% in both arms). We assessed the certainty of the evidence using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included eight RC","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD009733"},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156107","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}

{"title":"Treatment for primary avascular necrosis of the lower limb in childhood.","authors":"Stephanie Ball, Rhianydd Thomas, Adam M Galloway, Luke M Davies, Kelly Gray, Sue Brennan, Renea V Johnston, Nicole Williams, Craig F Munns, Verity Pacey","doi":"10.1002/14651858.CD016326","DOIUrl":"10.1002/14651858.CD016326","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate the benefits and harms of surgical, non-surgical, and pharmacological interventions for paediatric primary lower limb avascular necrosis (AVN). This is a common review protocol, outlining the approach for four separate Cochrane reviews for paediatric primary lower limb AVN. To assess the benefit and harm of surgical interventions for paediatric primary lower limb AVN on function, pain, patient-reported outcomes, and radiological outcomes. To assess the benefit and harm of non-surgical interventions for paediatric primary lower limb AVN on function, pain, patient-reported outcomes, and radiological outcomes. To assess the benefit and harm of pharmacological interventions for paediatric primary lower limb AVN on function, pain, patient-reported outcomes, and radiological outcomes. To assess the comparative effectiveness of surgical, non-surgical, and pharmacological interventions for paediatric primary lower limb AVN on function, pain, patient-reported outcomes, and radiological outcomes. The secondary objective for all four of the reviews is to evaluate health equity by assessing the effects across different geographical regions, gender, and age groups.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016326"},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12892395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156122","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":"Immune checkpoint inhibitors and chemotherapy versus chemotherapy for early triple-negative breast cancer.","authors":"Ya Gao, Ming Liu, Lun Li, Junhua Zhang, Fujian Song, Jinhui Tian","doi":"10.1002/14651858.CD015072.pub2","DOIUrl":"10.1002/14651858.CD015072.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Triple-negative breast cancer (TNBC), an aggressive subtype lacking oestrogen and progesterone receptors and amplification of HER2 receptors, accounts for 12% to 17% of breast cancers. Adjuvant and neoadjuvant chemotherapy improve survival; however, 30% to 40% of early-stage TNBC cases progress to metastatic disease. Recent evidence suggests that combining immune checkpoint inhibitors (PD-1/PD-L1 inhibitors) with chemotherapy may improve pathological complete response and event-free survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of immune checkpoint inhibitors (PD-1 or PD-L1 inhibitors) plus chemotherapy compared with chemotherapy for people with early TNBC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, the WHO ICTRP, and ClinicalTrials.gov up to 6 November 2024. We also searched the reference lists of identified relevant trials or reviews for potentially eligible studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;Randomised controlled trials (RCTs) comparing PD-1 or PD-L1 inhibitors plus chemotherapy with chemotherapy alone in participants with early TNBC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Pairs of review authors independently identified studies for inclusion and performed data extraction and risk of bias assessment. Outcomes were pathological complete response, event-free survival (EFS), overall survival (OS), health-related quality of life (HRQoL), and overall rates of any adverse events and serious adverse events (SAEs). We calculated hazard ratios (HRs) for time-to-event data, risk ratios (RRs), odds ratios (ORs), or risk differences (RDs) for dichotomous outcomes, and mean differences (MDs) for continuous outcomes with corresponding 95% confidence intervals (CIs). We performed random-effects meta-analyses to summarise the evidence and evaluated the certainty of evidence using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included seven RCTs with a total of 4341 participants. Two trials investigated PD-1 inhibitors (i.e. pembrolizumab), and five investigated PD-L1 inhibitors (i.e. durvalumab, atezolizumab) in the intervention group. Six studies used neoadjuvant chemotherapy (NACT), and one study used adjuvant chemotherapy (ACT) in the control group. The studies cover a five-year follow-up period. Two studies were at low risk of bias for all reported outcomes. The main limitation of the other trials was lack of blinding. PD-1 or PD-L1 inhibitors plus chemotherapy versus chemotherapy alone beforebreast cancer surgery PD-1 or PD-L1 inhibitors plus chemotherapy probably increase pathological complete response rate (RR 1.47, 95% CI 1.15 to 1.86; 6 studies, 1564 participants; moderate-certainty evidence); improve EFS (HR 0.64, 95% CI 0.52 to 0.79; 4 studies, 1789 participants; high-certainty evidence); and probably improve OS (HR 0.56, 95% CI 0.34 to 0.93; 3 studies, ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD015072"},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12892397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146156066","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":"Clarithromycin for treating sepsis in adults.","authors":"Xin Lu, Yanxia Gao, Chao Gong, Qin Zhou, Mubing Qin, Zengrui Song, Yi Li","doi":"10.1002/14651858.CD016328","DOIUrl":"10.1002/14651858.CD016328","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 clarithromycin for treating sepsis in adults versus standard care with or without placebo or with an alternative active intervention, or clarithromycin in combination with antibiotic therapy versus standard care.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016328"},"PeriodicalIF":8.8,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149353","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":"Interventions for childhood apraxia of speech.","authors":"Miya St John, Elizabeth Murray, Frederique J Liégeois, Angela T Morgan","doi":"10.1002/14651858.CD016149","DOIUrl":"10.1002/14651858.CD016149","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To examine the effectiveness of speech and language interventions for children and adolescents with Childhood Apraxia of Speech (CAS) as delivered by speech and language pathologists/therapists or by other personnel under the direction of a speech and language pathologist/therapist.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"2 ","pages":"CD016149"},"PeriodicalIF":8.8,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12888076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149327","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}