Cochrane Database of Systematic Reviews最新文献

{"title":"Pelvic floor muscle therapy for sexual dysfunction in gynaecological cancer survivors.","authors":"Dennis Vaidakis, Anastasia Bagiasta, Vasileios Sioulas, Dimitrios Giannakidis, Athanasios Saitis, Melina Nikolakea, Angeliki C Syristatidi, Michail Papapanou","doi":"10.1002/14651858.CD016162","DOIUrl":"10.1002/14651858.CD016162","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of pelvic floor muscle therapy for sexual dysfunction in gynaecological cancer survivors.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD016162"},"PeriodicalIF":8.8,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721376","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":"Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birthweight infants.","authors":"Chad Andersen, Michael J Stark, Tara Crawford, Robin K Whyte, Axel R Franz, Roger F Soll, Haresh Kirpalani","doi":"10.1002/14651858.CD000512.pub3","DOIUrl":"10.1002/14651858.CD000512.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Infants of very low birthweight frequently receive red blood cell transfusions during their primary hospital stay. Generally, this is guided by predetermined haemoglobin or haematocrit thresholds according to a protocol or as prompted by clinical situations, including critical illness or surgery. Recommendations advocate maintaining higher thresholds in the early weeks when the risk of major morbidity is highest, while permitting lower thresholds after this time. In truth, clinicians worry about the potential effect of chronic anaemia on neurodevelopmental outcomes, as well as the risk of transfusion-related complications in the immature host. Clinical trials have reflected this practice by comparing haemoglobin levels adjusted for critical illness, comparing transfusion algorithms that use fixed differences between haemoglobin thresholds, with both thresholds progressively lowered across postnatal age. This is an update of a review first published in 2011.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the effect of lower (restrictive) compared with higher (liberal) haemoglobin thresholds for transfusion, with or without adjustment for age and critical illness with either fixed or variable transfusion volume, on mortality or later neurodevelopmental outcomes assessed in later infancy at approximately two years postmenstrual age, or the number of transfusions in very low birthweight infants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;Searches were conducted in January 2024 in CENTRAL, MEDLINE, Embase, CINAHL, Epistemonikos, and trial registries. We searched the reference lists of related systematic reviews and trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We selected randomised controlled trials (RCTs) of lower or restrictive haemoglobin/haematocrit thresholds compared with liberal or higher haemoglobin/haematocrit thresholds for transfusion in low birthweight infants within three days of birth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;We used standard Cochrane methods. Our main outcomes were a combined outcome of death or neurodevelopmental impairment, all-cause mortality, and the number of transfusions per infant. We expressed our results using mean difference (MD), standardised mean difference (SMD), risk ratio (RR), and risk difference (RD) with 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;Six trials, enrolling 3451 infants, compared transfusion strategies utilising a lower (restrictive) haemoglobin threshold compared to a higher (liberal) haemoglobin threshold. The transfusion thresholds used in these trials reflected prevailing clinical practice at the time of study design. For comparative purposes, they have been labelled as 'restrictive' and 'liberal'. The trials were similar in design, although each used slightly different transfusion algorithms and intervention thresholds. The three larger trials also conducted later n","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD000512"},"PeriodicalIF":8.8,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721321","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":"School feeding programs for improving the physical and psychological health of school children experiencing socioeconomic disadvantage.","authors":"Elizabeth Kristjansson, Michael Dignam, Anita Rizvi, Muna Osman, Olivia Magwood, Deborah Olarte, Juliana Fw Cohen, Julia Krasevec, Tanya Grover, Patrick R Labelle, Jennifer A Garner, Laura Janzen, Sydney Rossiter, Omar Dewidar, Beverley Shea, Vivian Welch, George A Wells","doi":"10.1002/14651858.CD014794.pub2","DOIUrl":"10.1002/14651858.CD014794.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;School feeding aims to alleviate hunger and enhance child outcomes. Since the first Cochrane systematic review of school meals, there has been a marked increase in studies and reviews of school feeding programs. However, most systematic reviews are geographically limited and use qualitative analysis. We reviewed worldwide papers and performed several meta-analyses, providing a more comprehensive picture of the effectiveness of school feeding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;1. To assess effectiveness of school feeding programs for improving the physical and psychological health of children experiencing socioeconomic disadvantage worldwide. 2. To assess effectiveness of school feeding programs for improving the health of children experiencing socioeconomic disadvantage compared with children who are more advantaged.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched 17 subject-specific and multidisciplinary databases and registries up to November 2023. In November 2024, two Information Specialists ran a top-up search for randomized controlled trials (RCTs). We handsearched references of included studies and relevant reviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included individually randomized, cluster-randomized, and cross-over trials, as well as longitudinal non-randomized studies of interventions (NRSIs). Studies had to compare the provision of free or reduced-price food in schools versus no school feeding, focusing on socioeconomically disadvantaged children. The food had to contain at least 3% of the daily energy requirement and at least 10% of the daily protein requirement for the specified age group(s). Eligible participants were primary or secondary school students aged five to 19 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our critical outcomes were change in: math achievement, reading achievement, attendance, enrollment, height-for-age z-score (HAZ), weight-for-age z-score (WAZ), and overweight/obesity. Our important outcomes were change in: overall academic achievement, fluid intelligence, working memory, behavioral/emotional outcomes, height, weight, and anemia. We planned to study changes between baseline and final outcomes. In one study with extreme contamination, we used the first follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed the risk of bias for RCTs by outcome using the appropriate version of the Cochrane risk of bias tool (RoB 2): RoB 2 for individually randomized trials, for cluster-RCTs, and for cross-over trials. We evaluated the quality of NRSIs using the School-based Measurement & Assessment of Results Tool (SMART), which is adapted from the Newcastle Ottawa Scale.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We used standardized mean differences (SMDs) with 95% confidence intervals (CIs) for educational and cognitive outcomes. We used mean differences (MDs), odds ratios (ORs), or incidence rate ratios (IRRs) for others. All meta-analyses used random-effects generic inverse","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD014794"},"PeriodicalIF":8.8,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12695400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721454","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":"Evan's blue dye test for detection of aspiration in tracheostomized patients.","authors":"Diego Ivaldi, Mariana Andrea Burgos, Sabrina Rico, Lucia B Varela, Samanta Díaz Menai, Camila Micaela Escobar Liquitay, Luis I Garegnani","doi":"10.1002/14651858.CD016277","DOIUrl":"10.1002/14651858.CD016277","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows: To determine the accuracy of Evan's blue dye test (EBDT) and modified Evan's blue dye test (MEBDT) for detecting respiratory aspiration in tracheostomized patients. This could be useful for detecting patients ready to undergo decannulation and for deciding the feeding mode for patients in low-resource settings. Secondary objectives To investigate potential sources of heterogeneity due to different dyeing sources and reference standards.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD016277"},"PeriodicalIF":8.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713551","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":"Prognostic factors associated with progression of open-angle glaucoma in adults.","authors":"Mapa Prabhath Piyasena, Qëndresë Daka, Riaz Qureshi, Gloria Roberti, Manuele Michelessi, Su-Hsun Liu, Tianjing Li, Yemisi Takwoingi, Augusto Azuara-Blanco, Gianni Virgili","doi":"10.1002/14651858.CD015436.pub2","DOIUrl":"10.1002/14651858.CD015436.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Glaucoma is the leading cause of irreversible blindness globally, and the second leading cause of blindness in high-income countries. It is a chronic optic nerve disease that can lead to loss of vision, although it is usually asymptomatic until it progresses (worsens) to an advanced stage. Primary open angle glaucoma (POAG) is the most common type of glaucoma, and it is recognized as a multifactorial disorder. Pseudoexfoliative glaucoma (PXFG) is a common form of secondary open-angle glaucoma and has a higher rate of progression. The understanding of prognostic factors is useful for clinicians to estimate the risk of disease progression and to identify those who are at risk of losing sight early.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To identify risk factors associated with disease progression, defined as worsening or deterioration of functional visual outcomes and/or structural outcomes, amongst adults with POAG and PXFG.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, Ovid MEDLINE, Ovid Embase, and two trial registries on 15 August 2024. The search was supplemented by checking reference lists of eligible articles. We did not apply any restrictions on language or year of publication.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included randomized controlled trials, cohort, and case-control study designs. We excluded any study with less than two years of follow-up and a sample size of &lt; 200. The targeted population consisted of adults ≥ 18 years of age of any sex with glaucoma type restricted to POAG, normal-tension glaucoma (NTG), and PXFG and no previous glaucoma surgery. Two review authors independently screened titles and abstracts, and full-text articles, to determine eligibility. The discrepancies were resolved through discussion with a third reviewer. The time points for the evaluation of outcomes were at a minimum of two years of follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently extracted data from included studies using pre-piloted data extraction forms in Covidence, SRDR+ and Microsoft Excel. We used the Quality in Prognosis Studies (QUIPS) tool to assess the risk of bias in Covidence. We conducted meta-analyses where homogeneous outcomes were reported, using a random-effects, generic inverse variance model. We reported hazard ratios (HR), odds ratio (OR), and risk ratios (RR) separately for each available prognostic factor and outcome, stratified by different time points and multivariable or univariable prognostic estimates, where possible. We evaluated and reported the certainty of evidence using the GRADE guidelines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We screened 16,188 titles and abstracts and retrieved 487 full-text reports from 239 studies for assessment. After full-text screening, we included 123 reports of 22 studies in this review. The 22 studies included 6082 participants. The mean ages of participants ranged from 50 to 78 years across ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD015436"},"PeriodicalIF":8.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12694756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721471","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":"Digital technology for monitoring adherence to inhaled therapies in people with cystic fibrosis.","authors":"Rebecca Calthorpe, Sherie Smith, Nikki Jahnke, Alan R Smyth","doi":"10.1002/14651858.CD013733.pub3","DOIUrl":"10.1002/14651858.CD013733.pub3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Improved understanding and treatment of cystic fibrosis (CF) has led to longer life expectancy, which is accompanied by an increasingly complex regimen of treatments. Suboptimal adherence to the treatment plan, in the context of respiratory disease, is associated with poorer health outcomes. With digital technology being more accessible, it can be used to monitor adherence to inhaled therapies via chipped nebulisers, mobile phone applications and web-based platforms. This technology can allow monitoring of adherence, as well as clinical outcomes, and allow feedback to both the person with CF and their healthcare team.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of using digital technology to monitor adherence to inhaled therapies and health status in adults and children with CF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane CF Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched Embase and three clinical trial registries, and checked the references of included studies. The date of last search was 27 February 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We searched for randomised controlled trials (RCTs) looking at the effects of digital technology for monitoring adherence to inhaled therapies of children and adults with CF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;We assessed available data (at up to three months in one study, and up to 12 months in the second) for adherence to the inhaled treatment, treatment burden, quality of life (QoL) and the change from baseline in forced expiratory volume in one second (FEV&lt;sub&gt;1&lt;/sub&gt;). We assessed the number of pulmonary exacerbations by the end of each study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Using Cochrane's Risk of Bias 2 tool, we assessed the risk of bias within each of the included trials and for each outcome from the randomisation process, deviations from intended interventions, missing outcome data, measurement of the outcome and selection of the reported result.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors screened the search results for studies eligible for inclusion in the review and extracted their data. Due to the difference in the studies' interventions, we analysed the data separately. We assessed the overall certainty of the evidence using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included two studies with 628 participants aged five to 41 years. There was one study in each of two different comparisons.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Nebuliser target inhalation mode versus standard inhalation mode One parallel study was carried out over 10 weeks after a run-in period of four to six weeks. The study compared the effects of a digitally enhanced inhalation mode (target inhalation mode) for nebulised antibiotics compared to standard mode in children attending a regional CF clinic in the UK. The primary outcome ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD013733"},"PeriodicalIF":8.8,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713518","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":"High-flow nasal cannula oxygen therapy for asthma exacerbation.","authors":"Aiko Honda, Yoshitaka Watanabe, Yoshifusa Abe, Sojiro Kusumoto, Takeshi Hasegawa, Hisashi Noma, Erika Ota, Takanori Imai, Noyuri Yamaji, Edward Barroga","doi":"10.1002/14651858.CD016205","DOIUrl":"10.1002/14651858.CD016205","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 effectiveness and safety of high-flow nasal cannula (HFNC) oxygen therapy compared with conventional oxygen therapy for the management of asthma exacerbations in children and adults. We will also explore potential equity implications, including differences in access to and outcomes of HFNC oxygen therapy across diverse healthcare settings and populations.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD016205"},"PeriodicalIF":8.8,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707719","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":"Conservative kidney management versus dialysis for stage 5 chronic kidney disease in older people.","authors":"Jae Won Yang, Patrizia Natale, Sukyeong Kim, Minjy Kim, Min Soo Jeon, Daeho Yi, Yu Ah Hong, Sungjin Chung, Woo Yeong Park, Young Youl Hyun, Soon Hyo Kwon, Sung Joon Shin, Dong Ah Park, Jimin Kim, Jae Hung Jung, Giovanni Fm Strippoli, Jun Young Lee","doi":"10.1002/14651858.CD015151.pub2","DOIUrl":"10.1002/14651858.CD015151.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;The prevalence of kidney failure in people aged 65 years and above is gradually increasing. However, there is insufficient evidence to determine which treatment is better for people with kidney failure, conservative kidney management (CKM) or dialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;We aimed to assess the effects of CKM and dialysis in older people with kidney failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched the Cochrane Kidney and Transplant Register of Studies, MEDLINE, Embase, the WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and regional databases (LILACS, KoreaMed, CADTH), as well as grey literature repositories up to 22 September 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;Randomised and non-randomised studies evaluated CKM compared to dialysis in people aged 65 years and above with kidney failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;The critical outcomes included death (any cause), cardiovascular death, cardiovascular events, and health-related quality of life (HRQoL). The important outcomes included overall adverse events, hospitalisation, malnutrition, sarcopenia, and residual kidney function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Two authors independently performed the risk of bias analysis. We used the 'Risk Of Bias In Non-randomised Studies of Interventions' (ROBINS-I) tool to assess the risk of bias in the included studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Treatment estimates were summarised using random effects pair-wise meta-analysis and expressed as a relative risk (RR), mean difference (MD), or standard mean difference (SMD) with a corresponding 95% confidence interval (CI). Evidence certainty was assessed using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 24 non-randomised studies that involved 26,127 people with kidney failure. These studies compared CKM to dialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Compared to dialysis, CKM had uncertain effects on death (any cause) (23 studies, 24,628 participants: 813 per 1000 with CKM versus 630 per 1000 with dialysis) (RR 1.28, 95% CI 1.17 to 1.41; I² = 89%; very low-certainty evidence) and cardiovascular death (3 studies, 262 participants: 114 per 1000 with CKM versus 66 per 1000 with dialysis) (RR 1.72, 95% CI 0.68 to 4.34; I² = 0%; very low-certainty evidence). For HRQoL, the Physical Component Summary (PCS) score (2 studies, 186 participants) was on average about 1.46 points lower with CKM compared with dialysis (MD -1.46, 95% CI -12.08 to 9.16; I² = 77%; very low-certainty evidence). The Mental Component Summary (MCS) score (2 studies, 186 participants) was about 2.5 points lower with CKM (MD -2.50, 95% CI -7.82 to 2.82; I² = 19%; very low-certainty evidence). We found no randomised controlled trials. The certainty of evidence from non-randomised studies was very low due to a high risk of bias, because of significant imbalances in prognostic factors that could not be ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD015151"},"PeriodicalIF":8.8,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707721","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":"Manual therapy with exercise for neck pain.","authors":"Nejin Chacko, Anita R Gross, Jordan Miller, Pasqualina L Santaguida, Stephen J Burnie, Geoffrey M Gelley, Jean-Philippe Paquin, Mujeeb-Rehman Duranai, Pierre Langevin, Neha Chopra-Tandon, Nga Ting Chak, Jan L Hoving, Pavlos Bobos","doi":"10.1002/14651858.CD011225.pub2","DOIUrl":"10.1002/14651858.CD011225.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Manual therapy and exercise are supported by evidence of effectiveness as single modal interventions for neck pain; however, their combined effect remains unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the benefits and harms of manual therapy with exercise versus placebo or no treatment for acute to chronic neck pain with or without radicular symptoms or cervicogenic headache in adults.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched multiple databases (CENTRAL, MEDLINE, Embase, CINAHL, Index to Chiropractic Literature, trial registries) together with reference checking and handsearching up to 5 March 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included parallel, cross-over, or cluster-randomised controlled trials (RCTs) in adults with neck pain, which compared manual therapy and exercise with placebo or no treatment. We excluded studies in people with myelopathy or headaches not of cervical origin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our outcomes were pain intensity, function or disability, health-related quality of life, participant-reported treatment success, and serious or non-serious adverse events, measured at short-term and long-term follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We used RoB 1 plus an additional six items to assess bias in the included studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We synthesised results for each outcome using meta-analysis or, when not possible, SWiM methods. We used random-effects models to calculate mean differences (MD) or standardised mean differences (SMD) and 95% confidence intervals (CI) for continuous outcomes, and risk ratios (RR) with 95% CI for adverse events. We used GRADE to assess the certainty of evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included nine RCTs (seven parallel, two cross-over) with a total of 694 participants. Studies were conducted in outpatient settings across North America, Europe, Central Asia, East Asia, and the Pacific. Manual therapy with exercise was compared with placebo (two studies) or no treatment (seven studies). Participants were 76% female, with a mean age of 46 years and mean pain severity of 4.75 on a 0 to 10 scale. Six studies (67%) reported receiving institutional or government funding. The disorder classification included chronic (n = 8) and subacute (n = 1) neck pain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;The main biases affecting our findings were selection (44%), performance (100%), detection (100%), and reporting bias (78%). Performance bias is an inherent limitation in manual therapy and exercise RCTs, while detection bias was unavoidable due to reliance on self-reported outcomes. All data reflect short-term follow-up (closest to four weeks). Manual therapy with exercise versus placebo (short-term) Manual therapy with exercise may result in: 1) little or no difference in pain, which was a mean of 3.35 with placebo and showed little to no improvement of 0.91 points (95% CI 1.85 better","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD011225"},"PeriodicalIF":8.8,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12687410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707676","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":"Medical and surgical interventions for neurotrophic keratopathy.","authors":"Zanna Kruoch, Adeline Ym Choo, Andrew Kemp, Marcus Gonzales, Tsz Wing Yim, Paul McCann, Su-Hsun Liu, Darren Shu Jeng Ting, Irene C Kuo","doi":"10.1002/14651858.CD015723.pub2","DOIUrl":"10.1002/14651858.CD015723.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Alterations to the corneal nerves can lead to neurotrophic keratopathy (NK), which is marked by breakdown of the corneal epithelium and impaired healing. If untreated, NK can cause severe corneal damage and significant visual impairment. Etiologies include infection, inflammation, chemical or mechanical trauma, systemic disease (e.g. diabetes mellitus), drug toxicity, contact lens overuse, and ophthalmic, neurosurgical, or otolaryngologic surgery. Treatments are often clinician-dependent and include an array of topical medications and surgical techniques to promote re-epithelialization and preserve vision. There is no consensus on the \"gold standard\" treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To examine the efficacy and safety of medical and surgical interventions when compared with no treatment, placebo, standard care, or an alternative treatment, for people with neurotrophic keratopathy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, PubMed, LILACS, and trial registries on 10 January 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomized controlled trials (RCTs) in which medical or surgical interventions were compared with no treatment, placebo (e.g. ophthalmic vehicle, normal saline), standard care (e.g. artificial tears, bandage contact lens (BCL)), or an alternative treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our outcomes of interest were corneal re-epithelialization, visual acuity, corneal sensitivity, worsening or relapse of the disease, and adverse events as assessed by investigators. We analyzed most outcome data at one to three months post-intervention; we assessed disease progression at six months or longer, and non-serious and serious adverse events at the longest follow-up time point.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;Using Cochrane's risk of bias tool RoB 2, we assessed the risk of bias for outcomes reported in our summary of findings table.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We performed separate comparisons for medical and surgical interventions. In addition to the qualitative synthesis of included studies, where possible, we conducted fixed-effect meta-analyses, calculating risk ratios (RRs) with 95% confidence intervals (CI) for dichotomous outcomes and mean differences (MDs) and 95% CIs for continuous outcomes. We checked continuous data for skewness. 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 included seven parallel-group RCTs with a total of 494 participants (study sample size: 18 to 156 participants; mean age: 25 to 68 years; proportion of female participants: 60% to 77%). Follow-up duration in the studies ranged from 28 days to 18 months. Four studies (57.1%) were multicenter RCTs in the USA and Europe; three studies were conducted in Europe or Asia. Five studies (71.4%) that reported funding sources were industry-sponsored. Six studies compared medical interventions v","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD015723"},"PeriodicalIF":8.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12679690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676604","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}