Cochrane Db Syst Rev
-
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.
-
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: Primary objective To assess the effects of peer-supported interventions on quality of life and self-management compared with control (i.e. usual care, no intervention, or other supportive or psychosocial interventions) in people with spinal cord injury (SCI). Secondary objective To assess the effects of peer-supported interventions on health service utilisation, secondary health conditions, mood disorders, and social participation compared with control (i.e. usual care, no intervention, or other supportive or psychosocial interventions) in people with SCI, as well as to assess the adverse outcomes of peer-supported interventions in people with SCI.
-
Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisHigher blood pressure targets for hypertension in older adults.
This is an update of the original Cochrane review, published in 2017. Eight out of 10 major antihypertensive trials in adults, 65 years of age or older, attempted to achieve a target systolic blood pressure (BP) of < 160 mmHg. Collectively, these trials demonstrated cardiovascular benefit for treatment, compared to no treatment, for older adults with BP > 160 mmHg. However, an even lower BP target of < 140 mmHg is commonly applied to all age groups. Yet the risk and benefit of antihypertensive therapy can be expected to vary across populations, and some observational evidence suggests that older adults who are frail might have better health outcomes with less aggressive BP lowering. Current clinical practice guidelines are inconsistent in target BP recommendations for older adults, with systolic BP targets ranging from < 130 mmHg to < 150 mmHg. The 2017 review did not find compelling evidence of a reduction in any of the primary outcomes, including all-cause mortality, stroke, or total serious cardiovascular adverse events, comparing a lower BP target to a higher BP target in older adults with hypertension. It is important to update this review to explore if new evidence exists to determine whether older adults might do just as well, better, or worse with less aggressive pharmacotherapy for hypertension. ⋯ When comparing a higher BP target, in the range of < 150 to 160/95 to 105 mmHg, to a lower BP target of 140/90 or lower, over two to four years of follow-up, there is high-certainty evidence that the lower BP target reduces stroke, and moderate-certainty evidence that the lower BP target likely reduces serious cardiovascular events. The effect on all-cause mortality is unclear (low-certainty evidence), and the lower BP target likely does not increase withdrawals due to adverse effects (moderate-certainty evidence). Although additional research is warranted in those who are 80 years of age and older, and those who are frail (in whom risks and benefits may differ), conventional BP targets may be appropriate for the majority of older adults.
-
Cochrane Db Syst Rev · Dec 2024
Review Meta AnalysisHigher blood pressure targets for hypertension in older adults.
This is an update of the original Cochrane review, published in 2017. Eight out of 10 major antihypertensive trials in adults, 65 years of age or older, attempted to achieve a target systolic blood pressure (BP) of < 160 mmHg. Collectively, these trials demonstrated cardiovascular benefit for treatment, compared to no treatment, for older adults with BP > 160 mmHg. However, an even lower BP target of < 140 mmHg is commonly applied to all age groups. Yet the risk and benefit of antihypertensive therapy can be expected to vary across populations, and some observational evidence suggests that older adults who are frail might have better health outcomes with less aggressive BP lowering. Current clinical practice guidelines are inconsistent in target BP recommendations for older adults, with systolic BP targets ranging from < 130 mmHg to < 150 mmHg. The 2017 review did not find compelling evidence of a reduction in any of the primary outcomes, including all-cause mortality, stroke, or total serious cardiovascular adverse events, comparing a lower BP target to a higher BP target in older adults with hypertension. It is important to update this review to explore if new evidence exists to determine whether older adults might do just as well, better, or worse with less aggressive pharmacotherapy for hypertension. ⋯ When comparing a higher BP target, in the range of < 150 to 160/95 to 105 mmHg, to a lower BP target of 140/90 or lower, over two to four years of follow-up, there is high-certainty evidence that the lower BP target reduces stroke, and moderate-certainty evidence that the lower BP target likely reduces serious cardiovascular events. The effect on all-cause mortality is unclear (low-certainty evidence), and the lower BP target likely does not increase withdrawals due to adverse effects (moderate-certainty evidence). Although additional research is warranted in those who are 80 years of age and older, and those who are frail (in whom risks and benefits may differ), conventional BP targets may be appropriate for the majority of older adults.
-
Cochrane Db Syst Rev · Dec 2024
Financial incentives for family members of hospitalized neonates for improving family presence.
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of financial incentives for improving family engagement on family members of neonates receiving hospitalized care.