Cochrane Database of Systematic Reviews最新文献

{"title":"Robotic-assisted thoracoscopic surgery lobectomy versus open or video-assisted thoracoscopic surgery lobectomy for early-stage non-small cell lung cancer.","authors":"Eduardo I Leão, Aline Rocha, Ana Carolina Pereira Nunes Pinto, Diego Adão, Humberto Saconato","doi":"10.1002/14651858.CD016158","DOIUrl":"10.1002/14651858.CD016158","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Objective 1: to assess the effects of robotic-assisted thoracoscopic surgery lobectomy versus conventional open lobectomy or video-assisted thoracoscopic surgery lobectomy in people with early-stage non-small cell lung cancer (NSCLC). Objective 2: to appraise full economic evaluations comparing robotic-assisted thoracoscopic surgery with open lobectomy or video-assisted thoracoscopic surgery lobectomy for early-stage NSCLC by extracting data on resource use, costs, utilities, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) from societal and healthcare perspectives.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD016158"},"PeriodicalIF":8.8,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145653803","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":"Rapid, point-of-care antigen tests for diagnosis of SARS-CoV-2 infection.","authors":"Jacqueline Dinnes, Sarah Berhane, Jennifer Walsh, Paul Reidy, Aaron Doherty, Bethany Hillier, Katie Scandrett, Dineshani Hettiarachchi, Fahmida Islam, Yasith Mathangasinghe, Nicholas Nyaaba, Melissa Taylor, Praveen Weeratunga, Dakshitha Wickramasinghe, Susanna S van Wyk, Jane Cunningham, Clare Davenport, Sabine Dittrich, Devy Emperador, Lotty Hooft, Mariska Mg Leeflang, Matthew Df McInnes, René Spijker, Jan Y Verbakel, Yemisi Takwoingi, Sian Taylor-Phillips, Ann Van den Bruel, Jonathan J Deeks","doi":"10.1002/14651858.CD013705.pub4","DOIUrl":"10.1002/14651858.CD013705.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Accurate rapid diagnostic tests for SARS-CoV-2 infection could help manage the COVID-19 pandemic by potentially increasing access to testing and speed detection of infection, as well as informing clinical and public health management decisions to reduce transmission. Previous iterations of this review provided clear and conclusive evidence of superior test performance in those experiencing possible signs and symptoms of Covid-19. However, test performance in asymptomatic individuals and sensitivity by setting and indication for testing remains unclear. This is the fourth iteration of this review, first published in 2020.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the diagnostic accuracy of rapid, point-of-care antigen tests (Ag-RDTs) for diagnosis of SARS-CoV-2 infection in asymptomatic population groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the COVID-19 Open Access Project living evidence database from the University of Bern (which includes daily updates from MEDLINE and Embase and preprints from medRxiv and bioRxiv) on 17 February 2022. We included independent evaluations from national reference laboratories, FIND and the Diagnostics Global Health website. We did not apply language restrictions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included test accuracy studies of any design that evaluated commercially produced, rapid antigen tests in asymptomatic people tested because of known or suspected contact with SARS-CoV-2 infection, known SARS-CoV-2 infection or known absence of infection, or those who were being screened for infection. We included evaluations of single applications of a test (one test result reported per person). Reference standards for presence or absence of infection were any laboratory-based molecular test (primarily reverse transcription polymerase chain reaction (RT-PCR)).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard screening procedures with three reviewers. Two reviewers independently carried out quality assessment (using the QUADAS-2 tool) and extracted study results. Other study characteristics were extracted by one review author and checked by a second. We present sensitivity and specificity with 95% confidence intervals (CIs) for each test, and pooled data using the bivariate model. We investigated heterogeneity by including indicator variables in the random-effects logistic regression models. We tabulated results by test manufacturer and compliance with manufacturer instructions for use and according to symptom status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 146 study cohorts (described in 130 study reports). The main results relate to 164 evaluations of single test applications including 144,250 unique samples (7104 with confirmed SARS-CoV-2) obtained from asymptomatic or mainly asymptomatic populations. Studies were mainly conducted in Europe (85/146, 58%), and evaluated 41 different commercial antigen assays (test kit). Only six ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD013705"},"PeriodicalIF":8.8,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12661640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630595","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":"Human stem cells for decompensated cirrhosis in adults.","authors":"Htar Htar Aung, Cho Naing, Han Ni, Saint Nway Aye, Norah Htet Htet, Siang Tong Kew, Chavdar S Pavlov","doi":"10.1002/14651858.CD015173.pub2","DOIUrl":"10.1002/14651858.CD015173.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Liver cirrhosis and its complications increase the risk of death associated with end-stage liver disease. Liver transplantation is an option, but the procedure may have significant morbidity and mortality risks, in addition to the shortage of liver donors. Human stem cell interventions are expected to be able to remodel injured liver tissue and to maintain liver function in people with decompensated cirrhosis. So far, results of randomised clinical trials on the effects of human stem cells in adults with decompensated cirrhosis have been inconsistent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of human stem cell intervention in adults with decompensated cirrhosis, regardless of ethnicity, sex, types of stem cell, route of stem cell injection, and administered dose.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Hepato-Biliary Group (CHBG) Controlled Trials Register, CENTRAL, MEDLINE, five other databases and four trials registers, in addition to reference checking, citation searching, and contacting study authors to identify the trials for inclusion. Last date of search - 4 October 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Randomised clinical trials comparing any stem cell type versus placebo, conventional, or no active treatment for people (≥ 18 years old) with decompensated cirrhosis. We included trials with any route of administration, frequency, and number of stem cells administered in people with decompensated cirrhosis and irrespective of the reported outcomes of interest to our review, language, year, format, and status of publication. We excluded quasi-randomised studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were all-cause mortality, serious adverse events, and quality of life. Our important outcomes were complications, non-serious adverse events, and liver function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed the risk of bias (RoB) in the outcome results of interest to our review, using the RoB 2 tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We conducted our meta-analyses, including outcome results, irrespective of our risk of bias judgements. Our primary analyses, on which we based our conclusions, included outcome data at the longest follow-up. We presented the results of dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean difference or standardised mean difference (SMD), with 95% confidence intervals (CI). We used the random-effects model for our primary analyses. We used the Restricted Maximum Likelihood (REML) estimator to estimate the differences in the random-effects model with the inverse-variance method, which includes a measure of the degree of heterogeneity in the study weights. We employed the Hartung-Knapp-Sidik-Jonkman (HKSJ) method to compute a CI for the meta-analysis effect estimate in situations with at least three trials and an estimate of heterogeneity greater than zero. In the case of pooled","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD015173"},"PeriodicalIF":8.8,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12661637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630688","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":"Long-term hormone therapy for perimenopausal and postmenopausal women.","authors":"Magdalena Bofill Rodriguez, Li Ning Yong, Sanja Mirkov, Christine Bekos, Anne Lethaby, Cindy Farquhar","doi":"10.1002/14651858.CD004143.pub6","DOIUrl":"10.1002/14651858.CD004143.pub6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hormone therapy is widely provided to control menopausal symptoms and has been used for the management and prevention of cardiovascular disease, osteoporosis and dementia in older women. This is an updated version of a Cochrane review first published in 2005.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the long-term effects of prolonged use (at least one year) of hormone therapy on mortality, cardiovascular outcomes, cancer, gallbladder disease, fractures and cognition in perimenopausal and postmenopausal women.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We used the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, three other databases and two trial registers, together with reference checking, citation searching and contact with study authors to identify the studies included in the review. The latest search date was 26 September 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised, double-blind trials in which peri- or postmenopausal women took hormone therapy or placebo for at least one year. We included various oestrogen formulations, with or without progestogens. We focused on studies assessing hormone therapy's effects on long-term clinical outcomes, including death, coronary events and cancer. Hormone therapy's efficacy in managing menopausal symptoms was beyond the scope of this review, and is assessed in other Cochrane reviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently selected studies, assessed risk of bias and extracted data. We calculated risk ratios (RRs) for dichotomous data and mean differences (MDs) for continuous data, along with 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 24 studies - with two newly added in this update - involving 45,660 participants. We derived nearly 70% of the data from two well-conducted studies: the Heart and Estrogen/progestin Replacement Study (HERS 1998) and the large, multi-component Women's Health Initiative research programme, which included two hormone therapy arms (WHI 1998). Across all the studies, most participants were postmenopausal American women with one or more comorbidities. The mean participant age in most studies was over 60 years. Only one included study focused on perimenopausal women. We present full results for all included studies with available data in the main review. The results presented below are drawn from WHI 1998, in which the combined hormone therapy arm and the oestrogen-only arm were run concurrently, with women assigned to the appropriate trial based on their uterus status. One study with 16,608 postmenopausal women with an intact uterus compared combined continuous hormone therapy (conjugated equine oestrogen and medroxyprogesterone acetate) to placebo, and measured outcomes at an average of 5.6 years of follow-up. Based on this study, combined continuous hormo","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD004143"},"PeriodicalIF":8.8,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12658958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630684","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":"Decongestants and antihistamines for acute otitis media in children.","authors":"Petter Darlison, Luca Moresco, Barbara Nussbaumer-Streit, Matteo Bruschettini, Marie Gisselsson-Solen","doi":"10.1002/14651858.CD015839.pub2","DOIUrl":"10.1002/14651858.CD015839.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Acute otitis media (AOM) is one of the most common bacterial infections in children worldwide, and the most common reason for prescribing antibiotics. Although serious complications (e.g. mastoiditis or meningitis) are rare, the infection causes acute pain and can lead to hearing impairment. Since AOM often resolves spontaneously, current treatment guidelines recommend an approach of watchful waiting (no initial antibiotics). However, decongestants and antihistamines, administered orally or nasally, might reduce inflammation and mucosal oedema in the middle ear and help resolve AOM in children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of decongestants and antihistamines in treating acute otitis media in children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, CINAHL, the World Health Organization (WHO) trials portal, and ClinicalTrials.gov in February 2025. We checked reference lists of relevant articles for additional studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) with children (from any setting) with AOM. Eligible comparisons were decongestants versus no intervention or placebo, antihistamines versus no intervention or placebo, decongestants plus antihistamines versus no intervention or placebo, decongestants versus antihistamines, one decongestant versus another, and one antihistamine versus another. The route of administration could be oral or nasal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were presence of AOM within seven days from starting treatment, severe complications (e.g. mastoiditis, meningitis, sinus thrombosis, facial paralysis, labyrinthitis), any adverse events (e.g. drowsiness), otalgia (yes/no) within seven days from starting treatment, and otalgia (score) within seven days from starting treatment. Our important outcomes included the presence of otitis media with effusion (OME) within 10 to 14 days from starting treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Two review authors used the Cochrane risk of bias tool (RoB 2) to independently assess risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We used standard Cochrane methods. We evaluated the benefits and harms using a random-effects model, calculating risk ratios (RRs) and risk differences (RDs) with 95% confidence intervals (CIs) for dichotomous outcomes, and mean differences (MDs) or standardised mean differences (SMDs) for continuous outcomes. Where the results could not be pooled due to the nature of the data, we described them narratively. We assessed the certainty of evidence using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We identified 15 studies (3066 participants) conducted in the USA (11 studies), Denmark (2 studies), Canada (1 study), and the UK (1 study), and published between 1965 and 2003. In 12 studies, the children's ages ranged from three months to 15 years. One study also includ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD015839"},"PeriodicalIF":8.8,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12658955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630364","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 treating urinary incontinence in older women: a network meta-analysis.","authors":"Giovana Vesentini, Nicole O'Connor, Mélanie Le Berre, Ashraf F Nabhan, Adrian Wagg, Sheila A Wallace, Chantale Dumoulin","doi":"10.1002/14651858.CD015376.pub2","DOIUrl":"10.1002/14651858.CD015376.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Urinary incontinence is highly prevalent among women 60 years and over, impacting their quality of life. The condition is often overlooked and untreated. Various treatments are available, but their benefits and harms in older women remain uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To compare the benefits and harms of conservative, pharmacological, and surgical treatments for urinary incontinence in terms of 'cure', 'cure or improvement', and serious adverse events (SAEs) in women 60 years and over using network meta-analyses (NMA), and to rank interventions within a single treatment network.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Incontinence Specialized Register, comprising trials from CENTRAL, MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, MEDLINE Daily, and two major international clinical trial registries, on 23 March 2025. We handsearched journals, conference proceedings, and reference lists of relevant articles. We placed no limitations on the searches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomized controlled trials (RCTs) that examined the benefits and harms of conservative, pharmacological, and/or surgical treatments in women 60 years and over with urinary incontinence. Our primary outcomes were 'cure' and 'cure or improvement' of urinary incontinence symptoms. Secondary outcomes included the number of women with SAEs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;At least two review authors independently assessed trials for eligibility and risk of bias using Cochrane's risk of bias 2 (RoB 2) tool. A third author resolved any disagreements. We followed the guidance on undertaking NMA in Chapter 11 of the Cochrane Handbook for Systematic Reviews of Interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 43 RCTs involving 8506 participants, a mean of 198 per study (range 14 to 1438). Conservative treatments predominated (20/43, 46.5%) in the studies, followed by pharmacological (17/43, 39.5%), surgical (4/43, 9.3%), and mixed (2/43, 4.7%) treatments. The RCTs had variable risks of bias, often presenting 'some concerns' or 'high risk,' with poor reporting on randomization, blinding, and protocol details. Conservative and pharmacological treatments were often at a high risk of bias for all outcomes (cure, cure or improvement, and SAEs). For the 'cure' outcome, we excluded three studies to address network disconnections; hence, comparisons focused on conservative and pharmacological treatments. Results indicated that all treatments might be better than control, with physical therapies - mainly pelvic floor muscle training with or without complementary therapies or education - showing the best performance for 'cure': physical therapies combined with complementary therapies (odds ratio (OR) 17.79, 95% confidence interval (CI) 2.97 to 106.46; 1 study, 71 participants), physical therapies (OR 7.20, 95% CI 2.59 to 20.03; 4 studies, 310 particip","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD015376"},"PeriodicalIF":8.8,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12658956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630651","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":"Governance arrangements for rehabilitation services in health systems: an overview of systematic reviews.","authors":"Melissa Atkinson-Graham, Silvano Mior, Nora Bakaa, Theodore Konstantinidis, Jessica Wong, Chiara Arienti, Irene Battel, Paolo Capodaglio, Claudio Cordani, Simon Décary, Wouter De Groote, Matteo Johann Del Furia, Antony Duttine, Eshetu Haileselassie Engeda, Walter R Frontera, Carlotte Kiekens, Francesca Gimigliano, Sara Liguori, Silvia Minozzi, Qhayiya Mudau, Marco Paoletta, Rebecca Ryan, Carla Sabariego, Alex Todhunter-Brown, Dima Touhami, Stefano Negrini, Pierre Côté","doi":"10.1002/14651858.CD016309","DOIUrl":"10.1002/14651858.CD016309","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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 governance arrangements, defined in the EPOC taxonomy as the rules or processes that affect the way in which powers are exercised, particularly regarding authority, accountability, openness, participation, and coherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This overview aimed to synthesize the current evidence on governance 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched the Epistemonokos 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 selected non-randomized studies of interventions (NRSIs) that evaluated the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to governance 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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We found no Cochrane or non-Cochrane systematic reviews of RCTs or NRSIs pertaining to rehabilitation and relevant to the EPOC pillar of governance arrangements. As a result, we are unable to offer a broad synthesis of the existing evidence or to signpost relevant reviews on health policy and systems interventions related to this pillar for end-users. We did describe relevant research gaps and priorities for future primary HPSR in the rehabilitation field.&lt;/p&gt;&lt;p&gt;&lt;","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD016309"},"PeriodicalIF":8.8,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12658954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630390","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":"Nucleoplasty for cervical radicular pain due to disc herniation.","authors":"Judith D de Rooij, Arianne P Verhagen, B S Harhangi, Michael G Fehlings, J George Groeneweg, Wichor M Bramer, Frank J Huygen, Miranda W Langendam","doi":"10.1002/14651858.CD011852.pub2","DOIUrl":"10.1002/14651858.CD011852.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cervical radicular pain due to disc herniation presents with pain in the neck and one arm, with muscle weakness with or without numbness or tingling in the fingers or hands. Conservative treatment includes rest, analgesics, non-steroidal anti-inflammatory drugs, exercises and cervical collar. When conservative treatment fails, surgery is considered. Surgery can carry risks, and freedom from pain is not guaranteed. Recently, nucleoplasty, a new treatment for contained disc herniations, was developed. Nucleoplasty is a minimally invasive outpatient procedure that relieves nerve pressure by removing small portions of the disc's gel-like nucleus, with no reported neurological complications.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effect of nucleoplasty on pain, function, quality of life, recovery, adverse events and withdrawals due to adverse events compared to placebo, no treatment, conservative treatment, minimally invasive interventions or surgery for people with cervical radicular pain due to disc herniation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We used CENTRAL, MEDLINE, seven other databases and two trial registers, together with reference checking, citation searching and contact with study authors and experts in the field to identify the studies that are included in the review. The latest search date was 24 February 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) that investigated nucleoplasty compared to placebo/sham treatment, no treatment, conservative treatment, minimally-invasive interventions or surgery for people with cervical radicular pain due to disc herniation. Major outcomes were pain in the arm and neck, neck-related function, recovery, quality of life, adverse events and withdrawals due to adverse events. The primary time point was short-term follow-up (up to three months).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently screened the references. We used the original Cochrane risk of bias tool for RCTs to assess the risk of bias of the included studies. We used GRADE to assess the certainty of the evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included four RCTs (259 participants). We judged all four studies to have an overall high risk of bias, due either to a high risk of detection or attrition bias. Three of four studies were at high risk of detection bias for unblinded outcome assessors. Nucleoplasty versus no treatment or placebo We did not find any RCT for this comparison. Nucleoplasty versus conservative treatment (1 study, 120 participants) Low-certainty evidence, downgraded for risk of bias and imprecision, showed that nucleoplasty may result in a large reduction in pain (0 to 100 scale, 0 = no pain) at short-term follow-up. The mean change from baseline in pain was 30.45 points lower with conservative treatment and 53.16 points lower with nucleoplasty (mean difference (MD) 22.71 points lower","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD011852"},"PeriodicalIF":8.8,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12648664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602677","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 quitting vaping.","authors":"Ailsa R Butler, Nicola Lindson, Jonathan Livingstone-Banks, Caitlin Notley, Tari Turner, Nancy A Rigotti, Thomas R Fanshawe, Rachna Begh, Angela Difeng Wu, Leonie Brose, Monserrat Conde, Erikas Simonavičius, Jamie Hartmann-Boyce","doi":"10.1002/14651858.CD016058.pub3","DOIUrl":"10.1002/14651858.CD016058.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;There is limited guidance on how to stop using nicotine-containing vapes (otherwise known as e-cigarettes) and ensure long-term abstinence, whilst minimising the risk of tobacco smoking and other unintended consequences. Treatments could include pharmacological interventions, behavioural interventions, or both.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To conduct a living systematic review assessing the benefits and harms of interventions to help people stop vaping compared to each other, placebo or no intervention. To assess how these interventions affect the use of combustible tobacco, and whether effects vary based on participant characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, PsycINFO, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from 1 January 2004 to 1 July 2025. We also searched the references of eligible studies and abstracts from the Society for Research on Nicotine and Tobacco conferences, and contacted study authors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) recruiting people of any age using nicotine-containing vapes, regardless of tobacco smoking status. Studies had to test an intervention designed to support people to quit vaping, and plan to measure at least one of our outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical outcomes: vaping cessation at six months or longer; change in combustible tobacco use at six months or longer; number of participants reporting serious adverse events (SAEs) at one week or longer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used Cochrane's RoB 1 tool to assess risk of bias in the included studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We followed standard Cochrane methods. We grouped studies by comparisons and outcomes, and calculated individual study and pooled effects, as appropriate. We used random-effects Mantel-Haenszel methods to calculate risk ratios (RRs) with 95% confidence intervals (CIs) and random-effects inverse variance methods to calculate mean differences (MDs) and 95% CIs. We used GRADE to assess the certainty of evidence for our critical outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;Fifteen studies (six new to this updated version) involving 5800 participants are included. Fourteen studies included some participants who had previously smoked tobacco; in seven studies, participants were not smoking at baseline. Twelve studies only included participants aged 18 or older (five exclusively included people between 18 and 29); two included some participants under 18 years; and one included 13- to 17-year-olds only. Fourteen studies were conducted in the USA and one in Italy. We judged five studies at low, six at high, and four at unclear risk of bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Pharmacological interventions Studies assessed our critical outcomes in relation to combination nicotine replacement therapy (NRT), cytisine,","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD016058"},"PeriodicalIF":8.8,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602744","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":"Cyproterone acetate for hirsutism.","authors":"Mushi J Matjila, Paul Andre Le Roux, Zephne M van der Spuy","doi":"10.1002/14651858.CD001125.pub2","DOIUrl":"10.1002/14651858.CD001125.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hirsutism (excessive and unwanted hair growth) is a distressing and relatively common endocrine problem in women that may prove difficult to manage. Cyproterone acetate (CPA), an antiandrogen, is frequently used to treat hirsutism, usually in combination with ethinylestradiol. This is an update of a Cochrane review first published in 2003.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of cyproterone acetate (CPA) alone, or in combination with ethinylestradiol, and other medication in reducing hair growth and improving the endocrine profile in women with hirsutism secondary to ovarian hyperandrogenism as well as idiopathic hirsutism.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Gynaecology and Fertility specialised register, CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL to 20 December 2022. We also searched the reference lists of relevant papers and clinical trial registries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomised controlled trials (RCT) examining women of reproductive age with either idiopathic hirsutism or hirsutism secondary to ovarian hyperandrogenism. Hirsutism was defined as a Ferriman Gallwey (FG) score greater than 7.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We included 23 studies. Only one study had more than 100 women included in the analysis. The primary outcomes were the objective and subjective assessment of clinical parameters (FG scores, linear hair growth and hair shaft diameter, women's feedback and frequency of hair removal). Secondary outcomes included endocrine parameters, side effects and withdrawals during therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;Cyproterone acetate greater than 2 mg plus ethinylestradiol compared to cyproterone acetate 2 mg or less plus ethinylestradiol (dose comparison) After six months of treatment, we are uncertain of any difference in effect on FG scores (mean difference (MD) 0.63, 95% confidence interval (CI) -1.02 to 2.28; I&lt;sup&gt;2&lt;/sup&gt; = 0%; 2 RCTs, 145 women; very low-certainty evidence). There was likely little to no difference in free testosterone (MD 0.35 pmol/L, 95% CI -0.61 to 1.31; 1 RCT, 113 women; moderate-certainty evidence). Cyproterone acetate alone (no ethinylestradiol) compared to other interventions alone (no ethinylestradiol) There was little or no difference for CPA compared with gonadotropin-releasing hormone (GnRH) analogues on total testosterone at three months (MD 0.17 nmol/L, 95% CI -0.15 to 0.49). There was little or no evidence of an effect for CPA compared with GnRH agonist on androstenedione at three months (MD 0.66 nmol/L, 95% CI -0.44 to 1.76). Both results from one RCT (20 women; very low-certainty evidence). Cyproterone acetate plus ethinylestradiol compared to other interventions alone (no ethinylestradiol) There was little to no difference in effect for CPA plus ethinylestradiol on FG scores at six months compared with finasteride (MD 4.70, 95% CI -1.86 t","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"11 ","pages":"CD001125"},"PeriodicalIF":8.8,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12645544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145602621","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}