Cochrane Database of Systematic Reviews最新文献

{"title":"Music therapy for end-of-life care.","authors":"Jose A Calvache, Daniela Collazos Girón, Isabela Bolaños, Joke Bradt, Cheryl Dileo, Markus Klimek","doi":"10.1002/14651858.CD016311","DOIUrl":"10.1002/14651858.CD016311","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 standard care combined with music therapy for the management of physical symptoms and psychosocial outcomes in individuals receiving end-of-life care, compared with (a) standard care alone or (b) standard care plus other non-music interventions To evaluate the relative benefits and harms of different types of music therapy interventions (e.g. music listening, songwriting, or improvisation as part of a structured therapeutic process) for the management of physical symptoms and psychosocial outcomes in individuals receiving end-of-life care.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD016311"},"PeriodicalIF":8.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12679691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676601","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":"Acupuncture for insomnia in people with cancer.","authors":"Qin Ma, Chunyu Liu, Guozhen Zhao, Shiqi Guo, Hancong Li, Bo Zhang, Bo Li, Zhaolun Cai","doi":"10.1002/14651858.CD015177.pub2","DOIUrl":"10.1002/14651858.CD015177.pub2","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Insomnia is a common issue affecting people with cancer. Although acupuncture is widely used as a treatment option for insomnia, its effects on cancer patients require a rigorous and up-to-date evaluation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To evaluate the benefits and harms of acupuncture for insomnia in people with cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, PsycINFO, and five other databases or trial registries in January 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) with a minimum duration of four weeks that evaluated acupuncture (defined as needle insertion at specific acupoints) for treating insomnia in patients with cancer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Our outcomes were insomnia severity measured by the Insomnia Severity Index (ISI), sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI), adverse events, and sleep diary outcomes including sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed the risk of bias using the RoB 2 tool.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;We performed random-effects meta-analysis to calculate risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CIs). We assessed the certainty of evidence with GRADE and interpreted findings for continuous outcomes against minimally important differences (MIDs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included five studies with 402 participants. The participants were predominantly females with breast cancer, and most were people following primary cancer treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;We identified three comparisons with outcomes assessed at the end of the interventions. We rated the certainty of the evidence as very low-to-moderate, mainly due to risk of bias and the imprecision of effect estimates from the small studies. Acupuncture versus sham acupuncture We are very uncertain about all results due to very low-certainty evidence. Compared to sham acupuncture, acupuncture may have little to no effect on post-intervention ISI scores (MD -3.17, 95% CI -10.39 to 4.05; MID -4.7 points; 2 studies, 152 participants; very low-certainty evidence) and PSQI scores (MD -1.16, 95% CI -3.53 to 1.22; MID -3 points; 2 studies, 152 participants; very low-certainty evidence). Acupuncture may increase the risk of adverse events (RR 2.60, 95% CI 0.98 to 6.90; 1 study, 138 participants; very low-certainty evidence), but this result is very uncertain. Regarding sleep diary outcomes, acupuncture compared with sham acupuncture may improve post-intervention SOL (MD -10.02 min, 95% CI -19.09 to -0.94; MID 20 minutes; 2 studies, 152 participants; very low-certainty evidence) and SE (MD 4.90%, 95% CI 1.98 to 7.82; MID 10%; 2 studies, 152 participants; very low-c","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD015177"},"PeriodicalIF":8.8,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12679689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676648","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":"Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD).","authors":"Ole Jakob Storebø, Maja Rosenberg Overby Storm, Johanne Pereira Ribeiro, Maria Skoog, Camilla Groth, Henriette E Callesen, Julie Perrine Schaug, Pernille Darling, Christel-Mie L Huus, Morris Zwi, Richard Kirubakaran, Erik Simonsen, Christian Gluud","doi":"10.1002/14651858.CD009885.pub4","DOIUrl":"10.1002/14651858.CD009885.pub4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed and treated psychiatric disorders in childhood. Typically, children and adolescents with ADHD find it difficult to pay attention and they are hyperactive and impulsive. Methylphenidate is the psychostimulant most often prescribed, but the evidence on benefits and harms is uncertain. This is an update of our comprehensive systematic review on benefits and harms published in 2015.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the beneficial and harmful effects of methylphenidate for children and adolescents with ADHD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, three other databases and two trials registers up to March 2022. In addition, we checked reference lists and requested published and unpublished data from manufacturers of methylphenidate.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Selection criteria: &lt;/strong&gt;We included all randomised clinical trials (RCTs) comparing methylphenidate versus placebo or no intervention in children and adolescents aged 18 years and younger with a diagnosis of ADHD. The search was not limited by publication year or language, but trial inclusion required that 75% or more of participants had a normal intellectual quotient (IQ &gt; 70). We assessed two primary outcomes, ADHD symptoms and serious adverse events, and three secondary outcomes, adverse events considered non-serious, general behaviour, and quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Data collection and analysis: &lt;/strong&gt;Two review authors independently conducted data extraction and risk of bias assessment for each trial. Six review authors including two review authors from the original publication participated in the update in 2022. We used standard Cochrane methodological procedures. Data from parallel-group trials and first-period data from cross-over trials formed the basis of our primary analyses. We undertook separate analyses using end-of-last period data from cross-over trials. We used Trial Sequential Analyses (TSA) to control for type I (5%) and type II (20%) errors, and we assessed and downgraded evidence according to the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results: &lt;/strong&gt;We included 212 trials (16,302 participants randomised); 55 parallel-group trials (8104 participants randomised), and 156 cross-over trials (8033 participants randomised) as well as one trial with a parallel phase (114 participants randomised) and a cross-over phase (165 participants randomised). The mean age of participants was 9.8 years ranging from 3 to 18 years (two trials from 3 to 21 years). The male-female ratio was 3:1. Most trials were carried out in high-income countries, and 86/212 included trials (41%) were funded or partly funded by the pharmaceutical industry. Methylphenidate treatment duration ranged from 1 to 425 days, with a mean duration of 28.8 days. Trials compared methylphenidate with placebo (200 trials) and with no intervention (12 trials). Only ","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD009885"},"PeriodicalIF":8.8,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12676995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667489","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":"Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems.","authors":"Catherine A Cluver, Christa Rohwer, Anke C Rohwer","doi":"10.1002/14651858.CD001059.pub6","DOIUrl":"10.1002/14651858.CD001059.pub6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Calcium supplementation may reduce the risk of developing pre-eclampsia, a common cause of serious maternal and neonatal morbidity and death. However, its effectiveness in preventing hypertensive disorders of pregnancy is uncertain. This updates a review last published in 2018.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To assess the effects of calcium supplementation during pregnancy on hypertensive disorders of pregnancy and related maternal and child outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Search methods: &lt;/strong&gt;We searched CENTRAL, MEDLINE, Embase, four other databases and two trials registries to 7 January 2025, and screened reference lists of retrieved studies and relevant systematic reviews.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Eligibility criteria: &lt;/strong&gt;We included randomised controlled trials (RCTs) that compared calcium supplementation during pregnancy with placebo or standard care only. We compared low and high doses. Trials conducted after 2010 had to be prospectively registered. We assessed trustworthiness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;Critical outcomes were pre-eclampsia for women and perinatal loss for children. Important outcomes for women included maternal death, maternal death or severe morbidity, adverse effects and preterm delivery before 37 weeks. Important outcomes for children were neonatal death or severe morbidity, stillbirth, and neonatal death.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risk of bias: &lt;/strong&gt;We assessed risk of bias in RCTs using version 2 of the Cochrane tool (RoB 2).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis methods: &lt;/strong&gt;Two review authors independently selected trials, extracted data, and assessed bias and trustworthiness. We pooled data using random-effects meta-analysis. We assessed certainty of evidence using GRADE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Included studies: &lt;/strong&gt;We included 10 RCTs with 37,504 participants. All trials provided standard care. Eight compared calcium supplementation to placebo, and two compared low- to high-dose calcium supplementation. We excluded 20 previously included trials; 11 because eligibility criteria changed and nine because they are awaiting classification due to trustworthiness issues.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis of results: &lt;/strong&gt;Calcium supplementation versus placebo Calcium may result in little to no difference in pre-eclampsia (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.67 to 1.04; 6 RCTs, 15,364 women; risk difference (RD) 9/1000 fewer, 95% CI 17 fewer to 2 more; low-certainty evidence). Sensitivity analysis excluding small studies (fewer than 500 participants) indicates little to no difference in pre-eclampsia (RR 0.92, 95% CI 0.79 to 1.05; 4 RCTs, 14,730 women; high-certainty evidence). The evidence is very uncertain about the effect of calcium on maternal death (RR 0.33, 95% CI 0.06 to 1.83; 3 RCTs, 9430 women; very low-certainty evidence) and on adverse effects (RR 2.16, 95% CI 0.43 to 10.78; 2 RCTs, 714 women; very low-certainty evidence). Calcium probably results in little to no difference in the composi","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD001059"},"PeriodicalIF":8.8,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12672055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted 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}