Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisDiagnostic test accuracy of self-administered cognitive assessment tools for dementia.
Dementia is a chronic and progressive clinical syndrome that can present with a range of cognitive and behavioural symptoms. Global prevalence is projected to increase due to ageing populations, particularly in resource-limited settings, with significant associated health and social care costs. There is a critical need for accurate cognitive assessment as part of the diagnostic workup for dementia. Although self-administered cognitive assessment tools are not diagnostic, they can be used to assess cognition. The role of these tests is uncertain, and their diagnostic test accuracy remains unclear, but they may be useful tools in circumstances where face-to-face assessment may be difficult. ⋯ There is insufficient evidence to recommend the use of any single self-administered cognitive assessment tool. The tools had test accuracy scores that are similar to the range seen with standard pencil and paper cognitive screening tests conducted by clinicians. Further research on the optimal test and threshold score, and how that may be impacted by setting, language, and educational level is needed.
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Editorial note (19 December 2024; amended 31 January 2025): Larun L, Brurberg KG, Odgaard‐Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD003200. DOI: 10.1002/14651858.CD003200.pub8. Accessed 18 December 2024. This Editorial Note is for the above article, published online on 2 October 2019 on the Cochrane Library (https://www.cochranelibrary.com/), and has been issued by the Publisher, John Wiley & Sons Ltd, in agreement with the Cochrane Collaboration. The Editorial note has been agreed to inform readers that Cochrane is ceasing the production of a full update of this Cochrane review. A pilot project for engaging interest holders in the development of this Cochrane review was initiated on 2 October 2019 (see Editorial Note below) and has now been disbanded. Cochrane maintains its decision to publish this Cochrane review in 2019, which includes studies from searches up to 9 May 2014. Editorial note (2 October 2019): A statement from the Editor in Chief about this review and its planned update is available at https://www.cochrane.org/news/cfs ⋯ Exercise therapy probably has a positive effect on fatigue in adults with CFS compared to usual care or passive therapies. The evidence regarding adverse effects is uncertain. Due to limited evidence it is difficult to draw conclusions about the comparative effectiveness of CBT, adaptive pacing or other interventions. All studies were conducted with outpatients diagnosed with 1994 criteria of the Centers for Disease Control and Prevention or the Oxford criteria, or both. Patients diagnosed using other criteria may experience different effects.
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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisNon-steroidal anti-inflammatory drugs for treating symptomatic uncomplicated urinary tract infections in non-pregnant adult women.
Almost half of all women will have at least one symptomatic urinary tract infection (UTI) in their lifetime. Although usually self-remitting, 74% of women contacting a health professional are prescribed an antibiotic, and in rare instances, they may progress to more severe infections. Therefore, the standard of care for the treatment of symptomatic uncomplicated UTIs is oral antibiotic therapy, which aims to achieve symptom resolution and prevent the development of complications such as pyelonephritis. Given that a number of UTIs are self-remitting, non-antibiotic treatments that may help reduce the severity or duration of symptoms or reduce the need for antibiotics may be of benefit. ⋯ The use of NSAIDs for symptomatic management of uncomplicated UTIs probably results in less short-term resolution of symptoms and greater use of rescue antibiotics by day 30 compared to primary antibiotic treatment. Future studies should consider the various confounders such as degree of symptoms, microbiology, type and resistance patterns of bacteria involved and number of UTI episodes in the months prior to commencement of treatment.
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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisCycled light in the intensive care unit for preterm and low birth weight infants.
Preterm and low birth weight infants are at an early stage of development, and do not receive adequate maternal circadian signals. They are often cared for over prolonged periods of hospitalisation in neonatal intensive care units (NICU), where environmental circadian stimuli are lacking. Exposure to artificial light-dark cycles may stimulate the development of the circadian system and improve clinical outcomes. However, it remains uncertain whether cycled light (CL) is preferable to near darkness (ND) or continuous bright light (CBL) in fostering development and maturation, and reducing adverse neonatal health outcomes. This is an update of an earlier Cochrane review, last published in 2016. ⋯ Despite identifying 20 studies, we remain uncertain about the effect of CL compared to ND or CBL on all outcomes of interest in this review. In addition, a few critical outcomes were not reported by any of the included studies. The evidence remains uncertain about whether CL is the right choice in the NICU. The physician should always weigh the benefits and risks, based on the effects of the different options in the specific setting.
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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisAcupuncture for hypoxic ischemic encephalopathy in neonates.
Peripartum asphyxia affects three to five per 1000 live births, with moderate or severe hypoxic ischemic encephalopathy (HIE) occurring in 0.5 to 1 per 1000 live births, and is associated with high mortality and morbidity. Therapeutic hypothermia is an effective treatment, but alternative therapies such as acupuncture are also used. ⋯ There is limited availability of studies addressing this specific population. The included studies did not assess mortality, long-term neurodevelopmental outcomes, or adverse effects of acupuncture. We are unable to draw any conclusions about the benefits and harms of acupuncture for HIE in neonates. In light of the current limitations, clinicians are urged to approach the use of acupuncture in neonates with HIE cautiously, as there is no evidence to support its routine application. The available trials assessed surrogate outcomes that have a relatively small impact on newborns, and failed to report important outcomes such as mortality and long-term neurodevelopmental outcomes. Other available trials were performed on older infants who had experienced neonatal HIE. Given the lack of available evidence, well-designed randomized controlled trials with relevant outcomes such as mortality and neurodevelopmental outcomes are essential to evaluate the efficacy and safety of acupuncture for HIE in neonates.