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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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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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisFluid restriction for treatment of symptomatic patent ductus arteriosus in preterm infants.
The ductus arteriosus is a blood vessel connecting the main pulmonary artery and the proximal descending aorta. After birth, the ductus arteriosus usually closes completely. However, sometimes it remains patent in the neonate, which is called patent ductus arteriosus (PDA). If a PDA is clinically symptomatic, it can lead to overcirculation in the lungs, and reduced perfusion to the gut and kidneys. Most clinical practice guidelines suggest fluid restriction as a conservative management strategy for the treatment of symptomatic PDA. Restricting fluid has been shown to reduce the incidence of PDA in older preterm infants. However, aggressive restriction of fluids may affect systemic blood flow in extremely preterm infants. Given the potential adverse effects, it is important to systematically evaluate the evidence on the use of fluid restriction to treat symptomatic PDA to inform clinical decisions. ⋯ No evidence from RCTs is currently available to evaluate the benefits and harms of fluid restriction for the treatment of symptomatic patent ductus arteriosus in preterm infants. We identified no ongoing studies. Evidence from sufficiently powered RCTs evaluating fluid restriction for treatment of symptomatic PDA in preterm neonates is needed to inform clinical decisions.
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Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisFluid restriction for treatment of symptomatic patent ductus arteriosus in preterm infants.
The ductus arteriosus is a blood vessel connecting the main pulmonary artery and the proximal descending aorta. After birth, the ductus arteriosus usually closes completely. However, sometimes it remains patent in the neonate, which is called patent ductus arteriosus (PDA). If a PDA is clinically symptomatic, it can lead to overcirculation in the lungs, and reduced perfusion to the gut and kidneys. Most clinical practice guidelines suggest fluid restriction as a conservative management strategy for the treatment of symptomatic PDA. Restricting fluid has been shown to reduce the incidence of PDA in older preterm infants. However, aggressive restriction of fluids may affect systemic blood flow in extremely preterm infants. Given the potential adverse effects, it is important to systematically evaluate the evidence on the use of fluid restriction to treat symptomatic PDA to inform clinical decisions. ⋯ No evidence from RCTs is currently available to evaluate the benefits and harms of fluid restriction for the treatment of symptomatic patent ductus arteriosus in preterm infants. We identified no ongoing studies. Evidence from sufficiently powered RCTs evaluating fluid restriction for treatment of symptomatic PDA in preterm neonates is needed to inform clinical decisions.
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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.