Pub Date : 2026-01-20DOI: 10.1002/14651858.CD015371.pub2
Daphne Kos, Ashley Boers, Ciara O'Meara, Geertruida E Bekkering, Leen De Coninck, Marja Koen, Jennifer Freeman, Sinéad M Hynes, Isaline Cjm Eijssen
<p><strong>Rationale: </strong>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.</p><p><strong>Objectives: </strong>To assess the benefits and harms of occupational therapy interventions for improving daily functioning, participation and quality of life in people with multiple sclerosis.</p><p><strong>Search methods: </strong>We searched seven electronic bibliographic databases until November 2024. We also searched grey literature and trial registers.</p><p><strong>Eligibility criteria: </strong>We included randomised and non-randomised controlled trials that compared OT for adults with MS versus no intervention, usual care or active control.</p><p><strong>Outcomes: </strong>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).</p><p><strong>Risk of bias: </strong>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).</p><p><strong>Synthesis methods: </strong>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.</p><p><strong>Included studies: </strong>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.</p><p><strong>Synthesis of results: </strong>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
原理：职业治疗（OT）使个体能够从事有意义的日常活动，被认为是多发性硬化症（MS）患者护理的一个有价值的组成部分。然而，OT对MS的具体影响尚不清楚。目的：评估职业治疗干预对改善多发性硬化症患者日常功能、参与和生活质量的利弊。检索方法：截止到2024年11月检索了7个电子书目数据库。我们还检索了灰色文献和试验登记。入选标准：我们纳入了随机和非随机对照试验，比较了治疗成人多发性硬化症与不干预、常规治疗或积极对照。结果：主要结果为日常功能、生活质量和不良反应。重要的结果是参与、自我效能、自我管理、情绪、恢复力和对照顾者的影响。我们感兴趣的时间点是干预后、中期（干预结束后6个月）和长期（6个月后最长的随访）。偏倚风险：我们评估了结果摘要表中报告的结果的偏倚风险（RoB）。我们使用Cochrane工具robins -2（用于随机对照试验）和robins - 1（用于非随机对照试验）。综合方法：我们使用荟萃分析（随机效应模型，逆方差）综合结果。效应测量为平均差（MD）或标准化平均差（SMD）。在无法进行meta分析的情况下，我们使用不进行meta分析的综合指南对结果进行叙述性综合。我们使用GRADE来评估证据的确定性。纳入的研究：我们纳入了20项研究（1628名受试者），其中3项是非随机的。其中19项研究是在高收入国家进行的。这些研究包括患有多发性硬化症的成年人（年龄在18岁到70岁之间），他们有低到中度的残疾。10项研究评估了疲劳管理方案，9项研究检查了日常功能（如技能培训）的OT干预措施，1项研究针对社会参与。干预后：与主动对照组相比，OT干预可能在日常功能方面提供较小的益处（SMD 0.22, 95% CI -0.02至0.46;I²= 17%；7项研究，364名受试者；低确定性），与不干预相比，有中等的益处（SMD 0.56, 95% CI -0.26至1.37;I²= 68%；2项研究，164名受试者；低确定性）。与常规护理相比，可能有很大的影响，但证据非常不确定（SMD 1.19, 95% CI 0.29至2.09;I²= 62%；2项研究，120名参与者；非常低的确定性）。中期：与主动对照组相比，OT可能对日常功能几乎没有影响（SMD 0.11, 95% CI -0.13至0.35;I²= 0%；4项研究，264名受试者；低确定性），但与常规护理相比可能有很大影响（SMD 0.99, 95% CI 0.57至1.41；I²不适用；1项研究，98名受试者；低确定性）。与主动控制或常规护理相比，OT对日常功能的长期影响非常不确定。没有关于OT与无干预的中期或长期数据的报道。干预后：与积极对照相比，OT可能对精神健康相关生活质量（HR-QoL）有较小的改善（SMD 0.33, 95% CI -0.01至0.66;I²= 42%；5项研究，296名受试者；低确定性），但对身体HR-QoL几乎没有改善（SMD 0.17, 95% CI -0.09至0.42;I²= 12%；5项研究，295名受试者；低确定性）。与常规护理相比，对身体HR-QoL （SMD 0.69, 95% CI -1.18至2.56;I²= 91%；2项研究，166名受试者；极低确定性）和精神HR-QoL （SMD 0.44, 95% CI -1.27至2.16;I²= 91%；2项研究；极低确定性）的中度影响非常不确定。与无干预相比，OT可适度改善精神HR-QoL （SMD 0.68, 95% CI -0.09 ~ 1.45; I²= 0%；3项研究，192名受试者；极低确定性），尽管证据非常不确定；可能对身体的HR-QoL影响很小或没有影响（SMD 0.12, 95% CI -0.62至0.86;I²= 0%；3项研究，192名参与者；非常低的确定性），但证据非常不确定。中期：与主动对照相比，OT对精神HR-QoL可能有小的益处，但证据非常不确定（SMD 0.21, 95% CI -0.08至0.49;I²= 20%；4项研究，270名参与者；非常低的确定性）。可能对身体的HR-QoL影响很小或没有影响（SMD 0.19, 95% CI -0.05 ~ 0.43; I²= 0%；4项研究，268名参与者；低确定性）。与常规护理相比，对身体（SMD 0.26, 95% CI -0.33 ~ 0.86; I²= 81%；2项研究，242名受试者；极低确定性）和精神HR-QoL （SMD 0.18, 95% CI -0.63 ~ 0.98; I²= 90%；2项研究，242名受试者；极低确定性）的影响非常不确定。与不干预相比，OT的中期效果尚无结果。OT对生活质量的长期影响非常不确定。 没有研究系统地报告了不良反应的频率或类型。与主动控制相比，职业治疗可能对干预后的参与几乎没有影响。其他比较和时间点的结果不可用或只能提供非常低确定性的证据。作者的结论是：无论采用何种比较干预，职业治疗均可改善干预后患者的日常功能和心理健康相关生活质量。在日常功能（与常规护理相比）和与精神健康相关的生活质量（与主动控制相比）方面，这些潜在益处可能会在中期持续存在。长期影响尚不确定。很少有证据表明，与主动比较者相比，职业治疗可能对身体健康相关的生活质量影响很小或没有影响。我们没有发现关于职业治疗不良反应的证据。我们的综合效应需要谨慎解释，因为干预的异质性和我们排除了多学科研究，没有单独的数据用于职业治疗，限制了我们对证据的确定性。未来的研究需要有可靠的设计和系统的结果评估，以得出关于多发性硬化症患者职业治疗效果的确切结论。资助：Elizabeth Casson Trust Research Grant_2022（英国）；卫生研究委员会（爱尔兰）和HSC公共卫生机构（授予ESI-2021-001）通过证据合成/科克伦爱尔兰注册：协议DOI 10.1002/14651858.CD015371。
{"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":"<p><strong>Rationale: </strong>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.</p><p><strong>Objectives: </strong>To assess the benefits and harms of occupational therapy interventions for improving daily functioning, participation and quality of life in people with multiple sclerosis.</p><p><strong>Search methods: </strong>We searched seven electronic bibliographic databases until November 2024. We also searched grey literature and trial registers.</p><p><strong>Eligibility criteria: </strong>We included randomised and non-randomised controlled trials that compared OT for adults with MS versus no intervention, usual care or active control.</p><p><strong>Outcomes: </strong>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).</p><p><strong>Risk of bias: </strong>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).</p><p><strong>Synthesis methods: </strong>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.</p><p><strong>Included studies: </strong>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.</p><p><strong>Synthesis of results: </strong>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}
Pub Date : 2026-01-19DOI: 10.1002/14651858.CD012182.pub3
Gülay Ateş, Patrick Welsch, Petra Klose, Tudor Phillips, Britta Lambers, Winfried Häuser, Lukas Radbruch
<p><strong>Rationale: </strong>Estimates of the population prevalence of chronic pain with neuropathic components range from 6% to 10%. Current pharmacological treatments for neuropathic pain help only a minority. New treatments are needed. Cannabis is increasingly promoted in the media as a treatment for chronic pain. This is an update of a review first published in 2018.</p><p><strong>Objectives: </strong>To assess the benefits and harms of cannabis-based medicines (herbal, plant-based, synthetic) compared to placebo or conventional drugs for chronic neuropathic pain conditions in adults.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, and three trial registries, together with reference checking. The latest search date was 29 January 2025.</p><p><strong>Eligibility criteria: </strong>We selected randomised, double-blind controlled trials of medical cannabis, plant-derived and synthetic cannabinoids, against placebo or any other active treatment for chronic neuropathic pain conditions in adults, with a treatment duration of at least two weeks. We excluded studies whose double-blind duration was less than two weeks and studies which did not explicitly state that the pain was of a neuropathic nature.</p><p><strong>Outcomes: </strong>Critical outcomes were the number of participants reporting pain relief of at least 50%, a Patient Global Impression of Change (PGIC) rating of 'much' or 'very much' improved, serious adverse events, and withdrawals due to adverse events.</p><p><strong>Risk of bias: </strong>We assessed the risk of bias (RoB) for seven outcomes reported in three summary of findings tables using the Cochrane RoB 1 tool.</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis with a random-effects model by calculating absolute risk differences (RD) and standardised mean differences (SMD) with 95% confidence intervals (CI) for dichotomous outcomes and continuous outcomes, respectively. We used GRADE to assess the certainty of evidence for prespecified outcomes.</p><p><strong>Included studies: </strong>We included six new studies involving 450 participants, along with 15 studies involving 1737 participants from the 2018 review, for a total of 21 studies with 2187 participants. The studies ranged from two to 26 weeks in duration. Sample sizes ranged from 18 to 339 participants. Participants' mean age ranged from 34 to 61 years, and the proportion of women ranged from 0% to 90%. Five studies included participants with central neuropathic pain, 14 studies included participants with peripheral neuropathic pain, and two studies included both types. Seven studies administered tetrahydrocannabinol (THC)-dominant medicines; nine studies, balanced THC and cannabidiol (CBD) medicines; and five studies, CBD-dominant medicines. Twenty studies compared cannabis-based medicine to placebo, and one study's comparator was dihydrocodeine. We judged the overall risk of bias to be low
{"title":"Cannabis-based medicines for chronic neuropathic pain in adults.","authors":"Gülay Ateş, Patrick Welsch, Petra Klose, Tudor Phillips, Britta Lambers, Winfried Häuser, Lukas Radbruch","doi":"10.1002/14651858.CD012182.pub3","DOIUrl":"10.1002/14651858.CD012182.pub3","url":null,"abstract":"<p><strong>Rationale: </strong>Estimates of the population prevalence of chronic pain with neuropathic components range from 6% to 10%. Current pharmacological treatments for neuropathic pain help only a minority. New treatments are needed. Cannabis is increasingly promoted in the media as a treatment for chronic pain. This is an update of a review first published in 2018.</p><p><strong>Objectives: </strong>To assess the benefits and harms of cannabis-based medicines (herbal, plant-based, synthetic) compared to placebo or conventional drugs for chronic neuropathic pain conditions in adults.</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, and three trial registries, together with reference checking. The latest search date was 29 January 2025.</p><p><strong>Eligibility criteria: </strong>We selected randomised, double-blind controlled trials of medical cannabis, plant-derived and synthetic cannabinoids, against placebo or any other active treatment for chronic neuropathic pain conditions in adults, with a treatment duration of at least two weeks. We excluded studies whose double-blind duration was less than two weeks and studies which did not explicitly state that the pain was of a neuropathic nature.</p><p><strong>Outcomes: </strong>Critical outcomes were the number of participants reporting pain relief of at least 50%, a Patient Global Impression of Change (PGIC) rating of 'much' or 'very much' improved, serious adverse events, and withdrawals due to adverse events.</p><p><strong>Risk of bias: </strong>We assessed the risk of bias (RoB) for seven outcomes reported in three summary of findings tables using the Cochrane RoB 1 tool.</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis with a random-effects model by calculating absolute risk differences (RD) and standardised mean differences (SMD) with 95% confidence intervals (CI) for dichotomous outcomes and continuous outcomes, respectively. We used GRADE to assess the certainty of evidence for prespecified outcomes.</p><p><strong>Included studies: </strong>We included six new studies involving 450 participants, along with 15 studies involving 1737 participants from the 2018 review, for a total of 21 studies with 2187 participants. The studies ranged from two to 26 weeks in duration. Sample sizes ranged from 18 to 339 participants. Participants' mean age ranged from 34 to 61 years, and the proportion of women ranged from 0% to 90%. Five studies included participants with central neuropathic pain, 14 studies included participants with peripheral neuropathic pain, and two studies included both types. Seven studies administered tetrahydrocannabinol (THC)-dominant medicines; nine studies, balanced THC and cannabidiol (CBD) medicines; and five studies, CBD-dominant medicines. Twenty studies compared cannabis-based medicine to placebo, and one study's comparator was dihydrocodeine. We judged the overall risk of bias to be low ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD012182"},"PeriodicalIF":8.8,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12812441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997099","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 : 2026-01-19DOI: 10.1002/14651858.CD016213
Arturo J Martí-Carvajal, Mark J Dayer, Diana Monge Martín, Mario A Gemmato-Valecillos, Gabriella Comunián-Carrasco, Ricardo Riera Lizardo, Eduardo Alegría-Barrero, Ivan Perez-Neri, Irshad Bajeer, Bhone Myint Kyaw, Mona Abdalla, Raquel Esther Gonzalez Hormostay, Cristina Elena Martí-Amarista, Gursimer Jeet, José M Palacios-González, Fernando-María Caballero-Martínez
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the clinical benefits and harms of percutaneous coronary intervention plus guideline-directed medical therapy compared with guideline-directed medical therapy alone for stable coronary artery disease in adults.
{"title":"Percutaneous coronary intervention plus guideline-directed medical therapy (GDMT) versus GDMT alone in adults with stable coronary artery disease.","authors":"Arturo J Martí-Carvajal, Mark J Dayer, Diana Monge Martín, Mario A Gemmato-Valecillos, Gabriella Comunián-Carrasco, Ricardo Riera Lizardo, Eduardo Alegría-Barrero, Ivan Perez-Neri, Irshad Bajeer, Bhone Myint Kyaw, Mona Abdalla, Raquel Esther Gonzalez Hormostay, Cristina Elena Martí-Amarista, Gursimer Jeet, José M Palacios-González, Fernando-María Caballero-Martínez","doi":"10.1002/14651858.CD016213","DOIUrl":"10.1002/14651858.CD016213","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the clinical benefits and harms of percutaneous coronary intervention plus guideline-directed medical therapy compared with guideline-directed medical therapy alone for stable coronary artery disease in adults.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016213"},"PeriodicalIF":8.8,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12814346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997162","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 : 2026-01-16DOI: 10.1002/14651858.CD014654
Florence Lamarche, Flavie Brousseau-La Rosa, Pierre-Henri Heitz, Nadim A Beruni, Nicola P Bondonno, Germaine Wong, Amelie Bernier-Jean
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of regular, structured exercise training in adults with chronic kidney disease not requiring dialysis, focusing on patient-important outcomes such as death, cardiovascular events, fatigue, functional capacity, and depression.
{"title":"Exercise training for adults with chronic kidney disease not requiring dialysis.","authors":"Florence Lamarche, Flavie Brousseau-La Rosa, Pierre-Henri Heitz, Nadim A Beruni, Nicola P Bondonno, Germaine Wong, Amelie Bernier-Jean","doi":"10.1002/14651858.CD014654","DOIUrl":"10.1002/14651858.CD014654","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 regular, structured exercise training in adults with chronic kidney disease not requiring dialysis, focusing on patient-important outcomes such as death, cardiovascular events, fatigue, functional capacity, and depression.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD014654"},"PeriodicalIF":8.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12809872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988491","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 : 2026-01-16DOI: 10.1002/14651858.CD001939.pub5
Luise Aamann, Neha Deshpande, Gitte Dam, Iñigo Les, Giulio Marchesini, Mette Borre, Niels Kristian Aagaard, Hendrik Vilstrup, Lise Lotte Gluud
<p><strong>Rationale: </strong>Hepatic encephalopathy is a brain dysfunction characterised by neurological and psychiatric changes due to liver insufficiency or portal-systemic shunting. The severity ranges from minor symptoms to coma. The previous version of this updated review meta-analysed data from 16 randomised clinical trials on branched-chain amino acids (BCAAs) versus control interventions, and found that BCAAs did not affect mortality but had a beneficial effect on hepatic encephalopathy. As data on critical outcomes were insufficient and new trials were published, we updated the review again.</p><p><strong>Objectives: </strong>To assess the beneficial and harmful effects of BCAAs versus any control intervention for people with cirrhosis and hepatic encephalopathy.</p><p><strong>Search methods: </strong>We identified trials through manual and electronic searches in the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Latin American and Caribbean Health Science Information database (LILACS), Science Citation Index Expanded, and Conference Proceedings Citation Index - Science. We also searched other resources and contacted experts for additional published and unpublished trials. The latest search date was 12 December 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised clinical trials, irrespective of bias control, language, outcomes reported, or publication status, that compared any form of branched-chain amino acid with no intervention, placebo, diets, non-absorbable disaccharides, antibiotics, or any other intervention with a potential effect on hepatic encephalopathy, in children and adults with overt or minimal hepatic encephalopathy associated with acute or chronic liver disease.</p><p><strong>Outcomes: </strong>The critical outcomes were all-cause mortality, hepatic encephalopathy (number of people without improved manifestations of hepatic encephalopathy), and serious adverse events (including nausea and diarrhoea). The important outcomes were quality of life and markers of nutritional status, including serum albumin and nitrogen balance. We evaluated outcomes at the longest available follow-up duration. The longest follow-up was also our primary time point for analysis.</p><p><strong>Risk of bias: </strong>We assessed the risk of bias (RoB) of the critical and important outcomes using the Cochrane RoB 2 tool.</p><p><strong>Synthesis methods: </strong>We used standard Cochrane methodology. We performed meta-analyses, based on intention-to-treat, with risk ratios (RRs) for dichotomous outcomes, standardised mean differences (SMDs) for continuous outcomes in trials using different scales, and mean differences (MDs) for continuous outcomes when trials used the same scales, all with 95% confidence intervals (CI). We conducted the main analysis using a random-effects model. We assessed the overall certainty of the evidence per outcome with
理由：肝性脑病是一种以肝功能不全或门静脉-全身分流引起的神经和精神改变为特征的脑功能障碍。严重程度从轻微症状到昏迷不等。这篇更新的综述的上一版本荟萃分析了来自16项关于支链氨基酸（BCAAs）与对照干预的随机临床试验的数据，发现BCAAs不影响死亡率，但对肝性脑病有有益作用。由于关键结果的数据不足，又有新的试验发表，我们再次更新了综述。目的：评估BCAAs与任何对照干预对肝硬化肝性脑病患者的有益和有害影响。检索方法：我们通过人工和电子检索在Cochrane肝胆对照试验注册库、Cochrane中央对照试验注册库、MEDLINE、Embase、拉丁美洲和加勒比健康科学信息数据库（LILACS）、科学引文索引扩展和会议论文集引文索引-科学中确定试验。我们还检索了其他资源，并联系了其他已发表和未发表试验的专家。最近一次搜索日期是2024年12月12日。入选标准：我们纳入了随机临床试验，无论偏倚对照、语言、报道的结局或发表状态如何，这些试验比较了任何形式的支链氨基酸与无干预、安慰剂、饮食、不可吸收双糖、抗生素或任何其他对肝性脑病有潜在影响的干预，适用于伴有急性或慢性肝病的明显或轻微肝性脑病的儿童和成人。结局：关键结局是全因死亡率、肝性脑病（肝性脑病无改善表现的人数）和严重不良事件（包括恶心和腹泻）。重要的结果是生活质量和营养状况指标，包括血清白蛋白和氮平衡。我们评估了最长随访时间的结果。最长的随访时间也是我们分析的主要时间点。偏倚风险：我们使用Cochrane RoB 2工具评估了关键和重要结局的偏倚风险（RoB）。综合方法：采用标准Cochrane方法学。我们进行了meta分析，基于意向治疗，使用不同量表的二分类结果的风险比（rr），使用不同量表的连续结果的标准化平均差异（SMDs），以及使用相同量表的连续结果的平均差异（MDs），均有95%的置信区间（CI）。我们使用随机效应模型进行主要分析。我们用GRADE方法评估了每个结果证据的总体确定性，包括五个组成部分（偏倚风险、间隔性、异质性、使用最小背景化方法的不精确性和传播偏倚）。纳入研究：我们在本次综述更新中增加了两项新的随机临床试验。因此，在1984年至2023年间发表的18项试验包括934名成年人（平均年龄47至64岁）。我们没有发现儿童试验。参与者有显性肝性脑病（13项试验）和隐性肝性脑病（5项试验）。10项试验评估了口服BCAA补充剂，8项试验评估了静脉注射BCAA。对照组不接受干预或安慰剂（2项试验）、饮食（11项试验）、乳果糖（3项试验）或新霉素（2项试验）。大多数参与者有肝硬化（至少97%）。一项试验包括急性肝炎患者。随访时间从4天到2年（104周）。10项试验在欧洲进行，4项在亚洲进行，2项在美国进行，巴西和澳大利亚各进行一次。三个试验以干预的形式得到了营利性组织的支持。结果综合：与对照干预相比，BCAAs可能对全因死亡率影响很小或没有影响，但证据非常不确定（RR 0.89, 95% CI 0.71至1.12；17项研究，867名受试者；极低确定性证据）。我们没有发现小规模研究效应的证据。所有试验都报道了支链氨基酸对肝性脑病的影响。证据表明，支链氨基酸可减少肝性脑病（RR 0.79, 95% CI 0.64 - 0.96； 18项研究，934名受试者；低确定性证据）。这两种结果的随访时间从4天到2年不等。恶心和腹泻被认为是严重的不良事件，BCAAs组477名参与者中有58名（12%）发生，对照组干预组538名参与者中有16名（3%）发生。关于支链氨基酸对恶心和腹泻的影响，证据非常不确定（RR 2.05, 95% CI 0.40 - 10.58； 6项研究，1015名受试者；极低确定性证据）。 三个试验提供了关于生活质量的数据，但由于使用了记录分数的方法，我们无法对数据进行meta分析。三个试验的所有参与者都有肝硬化，但有些人在基线时没有肝性脑病。当分析仅限于肝性脑病患者时，没有一项试验发现BCAAs对全球36项简短健康调查（SF-36）评分或任何子量表有有益或有害的影响。BCAAs可能对白蛋白浓度影响很小或没有影响（范围12至56周）（MD 0.60, 95% CI -0.90至2.09;I²= 0%；3项研究，176名受试者；非常低确定性证据），但证据不确定。BCAAs对氮平衡的影响（4天至2年）的证据非常不确定（SMD 0.82, 95% CI -1.01至2.64；3项研究，108名参与者；非常低确定性的证据）。由于存在偏倚、间接和不精确的风险，我们降低了证据的确定性。目前正在进行三项试验。作者结论：我们在分析中增加了两个新的试验。有证据表明，支链氨基酸可减少肝性脑病，但证据的确定性较低。由于证据的确定性非常低，我们不知道与对照组相比，支链氨基酸是否对全因死亡率、恶心和腹泻、白蛋白和氮平衡有任何影响。我们无法对生活质量数据进行meta分析。目前还缺乏针对儿童的试验。我们缺乏比较支链氨基酸与不可吸收双糖、利福昔明或其他抗生素等干预措施的随机临床试验。资助：无资助注册：协议（1997）：Gluud C, Koretz RL。支链氨基酸治疗肝性脑病（Cochrane综述方案）。Cochrane图书馆，1997，第1期。原评审（2003）：doi.org/10.1002/14651858.CD001939评审更新（2015年2月）：doi.org/10.1002/14651858.CD001939.pub2评审更新（2015年9月）doi.org/10.1002/14651858.CD001939.pub3评审更新（2017年）：doi.org/10.1002/14651858.CD001939.pub4。
{"title":"Branched-chain amino acids for people with cirrhosis and hepatic encephalopathy.","authors":"Luise Aamann, Neha Deshpande, Gitte Dam, Iñigo Les, Giulio Marchesini, Mette Borre, Niels Kristian Aagaard, Hendrik Vilstrup, Lise Lotte Gluud","doi":"10.1002/14651858.CD001939.pub5","DOIUrl":"10.1002/14651858.CD001939.pub5","url":null,"abstract":"<p><strong>Rationale: </strong>Hepatic encephalopathy is a brain dysfunction characterised by neurological and psychiatric changes due to liver insufficiency or portal-systemic shunting. The severity ranges from minor symptoms to coma. The previous version of this updated review meta-analysed data from 16 randomised clinical trials on branched-chain amino acids (BCAAs) versus control interventions, and found that BCAAs did not affect mortality but had a beneficial effect on hepatic encephalopathy. As data on critical outcomes were insufficient and new trials were published, we updated the review again.</p><p><strong>Objectives: </strong>To assess the beneficial and harmful effects of BCAAs versus any control intervention for people with cirrhosis and hepatic encephalopathy.</p><p><strong>Search methods: </strong>We identified trials through manual and electronic searches in the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Latin American and Caribbean Health Science Information database (LILACS), Science Citation Index Expanded, and Conference Proceedings Citation Index - Science. We also searched other resources and contacted experts for additional published and unpublished trials. The latest search date was 12 December 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised clinical trials, irrespective of bias control, language, outcomes reported, or publication status, that compared any form of branched-chain amino acid with no intervention, placebo, diets, non-absorbable disaccharides, antibiotics, or any other intervention with a potential effect on hepatic encephalopathy, in children and adults with overt or minimal hepatic encephalopathy associated with acute or chronic liver disease.</p><p><strong>Outcomes: </strong>The critical outcomes were all-cause mortality, hepatic encephalopathy (number of people without improved manifestations of hepatic encephalopathy), and serious adverse events (including nausea and diarrhoea). The important outcomes were quality of life and markers of nutritional status, including serum albumin and nitrogen balance. We evaluated outcomes at the longest available follow-up duration. The longest follow-up was also our primary time point for analysis.</p><p><strong>Risk of bias: </strong>We assessed the risk of bias (RoB) of the critical and important outcomes using the Cochrane RoB 2 tool.</p><p><strong>Synthesis methods: </strong>We used standard Cochrane methodology. We performed meta-analyses, based on intention-to-treat, with risk ratios (RRs) for dichotomous outcomes, standardised mean differences (SMDs) for continuous outcomes in trials using different scales, and mean differences (MDs) for continuous outcomes when trials used the same scales, all with 95% confidence intervals (CI). We conducted the main analysis using a random-effects model. We assessed the overall certainty of the evidence per outcome with","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD001939"},"PeriodicalIF":8.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12809873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988431","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 : 2026-01-15DOI: 10.1002/14651858.CD016298
Ersilia Lucenteforte, Sueko M Ng, Rosella Saulle, Geraldine Hoad, Robert Schillinger, Gianni Virgili
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the comparative efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) agents and their biosimilars for people with neovascular age-related macular degeneration (nAMD), and provide a relative ranking of interventions using network meta-analysis (NMA) methods, considering differences in treatment intensity.
{"title":"Anti-vascular endothelial growth factor (anti-VEGF) agents for neovascular age-related macular degeneration (nAMD): a network meta-analysis.","authors":"Ersilia Lucenteforte, Sueko M Ng, Rosella Saulle, Geraldine Hoad, Robert Schillinger, Gianni Virgili","doi":"10.1002/14651858.CD016298","DOIUrl":"10.1002/14651858.CD016298","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the comparative efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) agents and their biosimilars for people with neovascular age-related macular degeneration (nAMD), and provide a relative ranking of interventions using network meta-analysis (NMA) methods, considering differences in treatment intensity.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016298"},"PeriodicalIF":8.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12805632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984587","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 : 2026-01-15DOI: 10.1002/14651858.CD016316
Hideto Yasuda, Yutaro Shinzato, Mari Abe, Shinya Miura, Manabu Tomida, Mari Saito, Yusuke Terasaka
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of midline catheters versus PICCs for intravenous therapy in adults.
{"title":"Midline catheters versus peripherally inserted central catheters for intravenous therapy in adults.","authors":"Hideto Yasuda, Yutaro Shinzato, Mari Abe, Shinya Miura, Manabu Tomida, Mari Saito, Yusuke Terasaka","doi":"10.1002/14651858.CD016316","DOIUrl":"10.1002/14651858.CD016316","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 midline catheters versus PICCs for intravenous therapy in adults.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016316"},"PeriodicalIF":8.8,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12805634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984564","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: To assess the benefits and harms of surgical interventions for treating vesicovaginal fistula in women.
目的：这是Cochrane综述（干预）的一个方案。目的如下：评估手术干预治疗女性膀胱阴道瘘的利弊。
{"title":"Surgical interventions for treating vesicovaginal fistula in women.","authors":"Yoshiyuki Okada, Tomomi Matsushita, Takeshi Hasegawa, Hisashi Noma, Erika Ota, Bob Achila, Yasukuni Yoshimura","doi":"10.1002/14651858.CD015413","DOIUrl":"10.1002/14651858.CD015413","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 surgical interventions for treating vesicovaginal fistula in women.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD015413"},"PeriodicalIF":8.8,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12797282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145958615","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 objectives To evaluate the benefits and harms of physiology-guided PCI compared to angiography-guided PCI for cardiovascular events in individuals with CCS and ACS. Secondary objectives To assess potential differences in the effectiveness and safety of physiology-guided PCI according to patient characteristics, including sex and age, from the perspective of equity.
{"title":"Physiology- versus angiography-guided percutaneous coronary intervention for people with coronary artery disease.","authors":"Satoshi Higuchi, Noyuri Yamaji, Hisashi Noma, Marie Ito, Yuya Yokota, Erika Ota, Takeshi Hasegawa","doi":"10.1002/14651858.CD016318","DOIUrl":"10.1002/14651858.CD016318","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objectives To evaluate the benefits and harms of physiology-guided PCI compared to angiography-guided PCI for cardiovascular events in individuals with CCS and ACS. Secondary objectives To assess potential differences in the effectiveness and safety of physiology-guided PCI according to patient characteristics, including sex and age, from the perspective of equity.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"1 ","pages":"CD016318"},"PeriodicalIF":8.8,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12794143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951003","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 : 2026-01-09DOI: 10.1002/14651858.CD006589.pub5
Michael Itzkovich, Ami Neuberger, Itai Harris, Dafna Yahav, Mical Paul, Mayan Gilboa
<p><strong>Rationale: </strong>Iron deficiency anaemia is a common nutritional disorder among children in malaria-endemic regions and is associated with adverse developmental and health outcomes. However, concerns have been raised that iron supplementation might increase the risk of malaria by enhancing parasite growth, particularly in areas lacking adequate malaria prevention and treatment services.</p><p><strong>Objectives: </strong>To evaluate the effects and safety of iron supplementation, with or without folic acid, in children living in areas with hyperendemic or holoendemic malaria transmission, where malaria is intense and occurs year-round.</p><p><strong>Search methods: </strong>We searched CENTRAL (Wiley), MEDLINE (Ovid), Embase (Ovid), and Global Index Medicus (WHO) up to 30 April 2024. We also searched two trial registries, ClinicalTrials.gov and WHO ICTRP, to 30 April 2024. We conducted a top-up search on 20 May 2025. We contacted trial investigators and scanned references of included trials and reviews for relevant studies.</p><p><strong>Eligibility criteria: </strong>We included individual and cluster-randomised controlled trials (RCTs) conducted in malaria-endemic regions that enrolled children under 18 years of age. We included trials that compared: (1) oral iron alone versus placebo or no treatment; (2) oral iron plus folic acid versus placebo or no treatment; (3) oral iron (with or without folic acid) versus placebo or no treatment, grouped by malaria prevention and management services for the outcome of clinical malaria only; and (4) oral iron plus antimalarial treatment versus placebo or no treatment. Iron or fortified interventions had to provide ≥ 80% of age-appropriate Recommended Dietary Allowance (RDA). Antihelminthics and micronutrients other than iron and folic acid had to be administered equally to both groups.</p><p><strong>Outcomes: </strong>The critical outcomes were clinical malaria, severe malaria, and death from any cause. Important outcomes included hospitalisations and clinic visits.</p><p><strong>Risk of bias: </strong>We assessed risk of bias in the included trials using the Cochrane RoB 1 tool.</p><p><strong>Synthesis methods: </strong>We used fixed-effect meta-analysis (Mantel-Haenszel or generic inverse variance) and adjusted for clustering in cluster-RCTs. For haemoglobin and anaemia outcomes, we applied a random-effects model due to anticipated heterogeneity. We assessed the certainty of evidence using GRADE and explored heterogeneity through subgroup analysis.</p><p><strong>Included studies: </strong>Forty trials (33,785 children) met the inclusion criteria.</p><p><strong>Synthesis of results: </strong>Iron versus placebo/no treatment Iron results in little or no difference in the risk of clinical malaria (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.87 to 1.00; 16 trials, 7843 children; high-certainty evidence) and reduces the risk of severe malaria slightly (RR 0.90, 95% CI 0.81 to 0.98; 5 tr
理由：缺铁性贫血是疟疾流行地区儿童中一种常见的营养失调，与不良的发育和健康结果有关。然而，有人担心，补充铁可能会促进寄生虫生长，从而增加疟疾的风险，特别是在缺乏适当疟疾预防和治疗服务的地区。目的：评价在疟疾高流行区或全流行区（疟疾严重且全年发生）生活的儿童中，加或不加叶酸补铁的效果和安全性。检索方法：检索截至2024年4月30日的CENTRAL （Wiley）、MEDLINE （Ovid）、Embase （Ovid）和Global Index Medicus （WHO）。我们还检索了两个试验注册库ClinicalTrials.gov和WHO ICTRP，截止到2024年4月30日。我们于2025年5月20日进行了补充搜索。我们联系了试验研究者，并扫描了纳入试验的参考文献和相关研究的综述。入选标准：我们纳入了在疟疾流行地区进行的纳入18岁以下儿童的个体和集群随机对照试验（rct）。我们纳入了以下比较的试验：(1)单独口服铁与安慰剂或不治疗；(2)口服铁+叶酸与安慰剂或不治疗的比较；(3)口服铁（含或不含叶酸）与安慰剂或不治疗，按疟疾预防和管理服务分组，仅针对临床疟疾的结果；(4)口服铁加抗疟治疗与安慰剂或不治疗的对比。铁或强化干预必须提供≥80%的适合年龄的推荐膳食摄入量（RDA）。除铁和叶酸外，抗蠕虫剂和微量营养素必须同等地给予两组。结局：关键结局是临床疟疾、严重疟疾和任何原因导致的死亡。重要结果包括住院和门诊就诊。偏倚风险：我们使用Cochrane RoB 1工具评估纳入试验的偏倚风险。综合方法：我们采用固定效应荟萃分析（Mantel-Haenszel或通用逆方差），并在聚类随机对照试验中对聚类进行调整。对于血红蛋白和贫血的结果，由于预期的异质性，我们采用了随机效应模型。我们使用GRADE评估证据的确定性，并通过亚组分析探讨异质性。纳入研究：40项试验（33,785名儿童）符合纳入标准。结果综合：铁与安慰剂/不治疗相比，铁导致临床疟疾风险的差异很小或没有差异(风险比（RR） 0.93, 95%可信区间（CI） 0.87至1.00；16项试验，7843名儿童；高确定性证据)并略微降低严重疟疾的风险（相对危险度0.90,95%可信区间0.81至0.98；5项试验，3421名儿童；高确定性证据）。铁可能导致死亡率（RR 1.15, 95% CI 0.76至1.74；20项试验，8809名儿童；低确定性证据）和住院或门诊就诊（RR 0.99, 95% CI 0.95至1.04；10项试验，14,011名儿童；低确定性证据）的差异很小或没有差异。铁+叶酸与安慰剂/不治疗相比，这种比较的证据主要来自一个大型试验（Pemba）和四个较小的试验（19456名儿童）。没有临床疟疾的报告。铁加叶酸可能导致需要入院治疗的严重疟疾几乎没有差异（RR 1.11, 95% CI 0.96至1.28；2项试验，17,575名儿童；低确定性证据）；全因死亡率（RR 1.13, 95% CI 0.90 ~ 1.42； 5项试验，18,034名儿童；低确定性证据）；住院率（RR 1.08, 95% CI 0.96 - 1.22； 1项试验，15956名儿童；低确定性证据）。铁（含或不含叶酸）与安慰剂/无治疗；我们还根据疟疾预防和管理服务的存在与否对试验进行了分组，分析了19项试验（25,531名儿童）。在提供服务的地区，铁（含或不含叶酸）可略微减少临床疟疾（相对风险比0.91,95%可信区间0.84至0.97；12项试验，5777名儿童；低确定性证据）。在没有服务的地区，铁（含或不含叶酸）可能使临床疟疾略有增加（相对危险度1.15,95%可信区间1.02至1.30；7项试验，19,754名儿童；低确定性证据）。总体而言，当不按疟疾预防和管理服务进行分组时，补充铁（含或不含叶酸）可能对临床疟疾几乎没有影响（RR 0.96, 95% CI 0.91至1.03；19项试验，25,531名儿童；低确定性证据）。铁加抗疟预防与安慰剂/不治疗相比，在抗疟预防中加入铁可显著降低临床疟疾发病率（RR 0.54, 95% CI 0.43 - 0.67； 3项试验，728名儿童；高确定性证据）；可能导致住院和门诊就诊的大量减少（RR 0.85, 95% CI 0.81 - 0）。 89年;2项试验，5976个月龄；moderate-certainty证据);可能不会降低全因死亡率（RR 1.05, 95% CI 0.52 - 2.11； 3项试验，728名儿童；低确定性证据）。在这个比较中没有严重疟疾的报告。作者的结论：铁治疗对临床疟疾的风险几乎没有影响（高确定性证据）。在资源有限的地方，只要有效地提供疟疾预防或管理服务，就可以在不筛查贫血或缺铁的情况下施用铁。在预防和治疗疟疾的资源有限的地方，铁可能增加临床疟疾的风险（低确定性证据）。这些结论与本综述（2016）上一版本报道的结论一致。资助：Cochrane传染病组（CIDG）的编辑基地由英国国际发展部资助，目的是造福发展中国家。Dafna Yahav （DY）获得了由英国国际发展部资助的研究项目联盟的资助，完成了2014年的更新。Ami Neuberger （AN）获得了世界卫生组织营养促进健康与发展部的资助，用于2016年的更新。注册：协议（2007）DOI: 10.1002/14651858。原评审（2009）DOI: 10.002 /14651858.CD006589。pub2综述更新（2011）DOI: https://doi.org/10.1002/14651858.CD006589.pub3综述更新（2016）DOI: 10.1002/14651858.CD006589.pub4。
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