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cochrane-google-pe-corpus/en/CD000026.pub2.en.xml

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+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Routine versus selective antifungal administration for control of fungal infections in patients with cancer</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Prevention of fungal infections in patients with cancer with antifungal drugs</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Cancer patients receiving chemotherapy or a bone marrow transplant are at risk of fungal infections. These can be life-threatening, especially when they spread throughout the body. Those patients with low white cell counts (neutropenia) are particularly at risk. Antifungal drugs are often given as a routine preventive measure, or when people who are at risk have a fever. The review found that intravenous amphotericin B could reduce the number of deaths. Three of the drugs, amphotericin B, fluconazole and itraconazole, reduced fungal infections.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Systemic fungal infection is considered to be an important cause of morbidity and mortality in cancer patients, particularly those with neutropenia. Antifungal drugs are often given prophylactically, or empirically to patients with persistent fever.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess whether commonly used antifungal drugs decrease mortality in cancer patients with neutropenia.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched PubMed from 1966 to 7 July 2014 and the reference lists of identified articles.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised clinical trials of amphotericin B, fluconazole, ketoconazole, miconazole, itraconazole or voriconazole compared with placebo or no treatment in cancer patients with neutropenia.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>The two review authors independently assessed trial eligibility and risk of bias, and abstracted data.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Thirty-two trials involving 4287 patients were included. Prophylactic or empirical treatment with amphotericin B significantly decreased total mortality (relative risk (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.96), whereas the estimated RRs for fluconazole, ketoconazole, miconazole, and itraconazole were close to 1.00. No eligible trials were found with voriconazole. Amphotericin B and fluconazole decreased mortality ascribed to fungal infection (RR 0.45, 95% CI 0.26 to 0.76 and RR 0.42, 95% CI 0.24 to 0.73, respectively). The incidence of invasive fungal infection decreased significantly with administration of amphotericin B (RR 0.41, 95% CI 0.24 to 0.73), fluconazole (RR 0.39, 95% CI 0.27 to 0.57) and itraconazole (RR 0.53, 95% CI 0.29 to 0.97), but not with ketoconazole or miconazole. Effect estimates were similar for those 13 trials that had adequate allocation concealment and were blinded. The reporting of harms was far too variable from trial to trial to allow a meaningful overview. For the 2011 and 2014 updates no additional trials were identified for inclusion.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Intravenous amphotericin B was the only antifungal agent that reduced total mortality. It should therefore be preferred when prophylactic or empirical antifungal therapy is introduced in cancer patients with neutropenia.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000039.pub3.en.xml

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+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Interventions for deliberately altering blood pressure in acute stroke</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Drug interventions for deliberately altering blood pressure in acute stroke</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Background: </B>In people who have just had a stroke (a sudden brain attack due to either blockage or rupture of an artery in the brain), very high and very low blood pressures may be harmful. Therefore, drugs that raise low blood pressure or lower high blood pressure might be beneficial. Up to 50% of people admitted with acute stroke are taking blood pressure tablets on hospital admission and it is not clear whether these medications should be continued or discontinued in the acute situation. This review looked at those trials that deliberately altered blood pressure or compared continuing or stopping blood pressure-lowering tablets taken before stroke.</P>
+<P>
+<B>Study characteristics: </B>This review is up-to-date to May 2014. We included 26 trials involving 17,011 participants: 24 trials assessed lowering blood pressure, one trial tested raising blood pressure, and two trials assessed what to do with drugs taken before stroke. All studies took place in hospitals that were used to treating people with stroke. Not all trials contributed information to all outcomes, and we have used data that were available in publications.</P>
+<P>
+<B>Key results: </B>There is insufficient evidence to say that lowering blood pressure saves lives or reduces disability in people with acute stroke. Immediately restarting blood pressure-lowering drugs taken before the stroke may increase disability.</P>
+<P>
+<B>Conclusion:</B> More research is needed to identify those people who are most likely to benefit from altering blood pressure in acute stroke, the time window in which the treatment is likely to be of benefit, what types of stroke are likely to respond favourably, and the environment in which such treatment may be best given in routine practice.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>It is unclear whether blood pressure should be altered actively during the acute phase of stroke. This is an update of a Cochrane review first published in 1997, and previously updated in 2001 and 2008.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the clinical effectiveness of altering blood pressure in people with acute stroke, and the effect of different vasoactive drugs on blood pressure in acute stroke.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Stroke Group Trials Register (last searched in February 2014), the Cochrane Database of Systematic reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL) (<I>The Cochrane Library</I> 2014, Issue 2), MEDLINE (Ovid) (1966 to May 2014), EMBASE (Ovid) (1974 to May 2014), Science Citation Index (ISI, Web of Science, 1981 to May 2014) and the Stroke Trials Registry (searched May 2014).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials of interventions that aimed to alter blood pressure compared with control in participants within one week of acute ischaemic or haemorrhagic stroke.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors independently applied the inclusion criteria, assessed trial quality and extracted data. The review authors cross-checked data and resolved discrepancies by discussion to reach consensus. We obtained published and unpublished data where available.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We included 26 trials involving 17,011 participants (8497 participants were assigned active therapy and 8514 participants received placebo/control). Not all trials contributed to each outcome. Most data came from trials that had a wide time window for recruitment; four trials gave treatment within six hours and one trial within eight hours. The trials tested alpha-2 adrenergic agonists (A2AA), angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor antagonists (ARA), calcium channel blockers (CCBs), nitric oxide (NO) donors, thiazide-like diuretics, and target-driven blood pressure lowering. One trial tested phenylephrine.</P>
+<P>At 24 hours after randomisation oral ACEIs reduced systolic blood pressure (SBP, mean difference (MD) -8 mmHg, 95% confidence interval (CI) -17 to 1) and diastolic blood pressure (DBP, MD -3 mmHg, 95% CI -9 to 2), sublingual ACEIs reduced SBP (MD -12.00 mm Hg, 95% CI -26 to 2) and DBP (MD -2, 95%CI -10 to 6), oral ARA reduced SBP (MD -1 mm Hg, 95% CI -3 to 2) and DBP (MD -1 mm Hg, 95% CI -3 to 1), oral beta blockers reduced SBP (MD -14 mm Hg; 95% CI -27 to -1) and DBP (MD -1 mm Hg, 95% CI -9 to 7), intravenous (iv) beta blockers reduced SBP (MD -5 mm Hg, 95% CI -18 to 8) and DBP (-5 mm Hg, 95% CI -13 to 3), oral CCBs reduced SBP (MD -13 mmHg, 95% CI -43 to 17) and DBP (MD -6 mmHg, 95% CI -14 to 2), iv CCBs reduced SBP (MD -32 mmHg, 95% CI -65 to 1) and DBP (MD -13, 95% CI -31 to 6), NO donors reduced SBP (MD -12 mmHg, 95% CI -19 to -5) and DBP (MD -3, 95% CI -4 to -2) while phenylephrine, non-significantly increased SBP (MD 21 mmHg, 95% CI -13 to 55) and DBP (MD 1 mmHg, 95% CI -15 to 16).</P>
+<P>Blood pressure lowering did not reduce death or dependency either by drug class (OR 0.98, 95% CI 0.92 to 1.05), stroke type (OR 0.98, 95% CI 0.92 to 1.05) or time to treatment (OR 0.98, 95% CI 0.92 to 1.05). Treatment within six hours of stroke appeared effective in reducing death or dependency (OR 0.86, 95% CI 0.76 to 0.99) but not death (OR 0.70, 95% CI 0.38 to 1.26) at the end of the trial. Although death or dependency did not differ between people who continued pre-stroke antihypertensive treatment versus those who stopped it temporarily (worse outcome with continuing treatment, OR 1.06, 95% CI 0.91 to 1.24), disability scores at the end of the trial were worse in participants randomised to continue treatment (Barthel Index, MD -3.2, 95% CI -5.8, -0.6).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There is insufficient evidence that lowering blood pressure during the acute phase of stroke improves functional outcome. It is reasonable to withhold blood pressure-lowering drugs until patients are medically and neurologically stable, and have suitable oral or enteral access, after which drugs can than be reintroduced. In people with acute stroke, CCBs, ACEI, ARA, beta blockers and NO donors each lower blood pressure while phenylephrine probably increases blood pressure. Further trials are needed to identify which people are most likely to benefit from early treatment, in particular whether treatment started very early is beneficial.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000103.pub2.en.xml

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+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Haemodilution for acute ischaemic stroke</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Haemodilution for acute ischaemic stroke</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Question</B>
+</P>
+<P>We wanted to compare the effectiveness of haemodilution (diluting the blood) treatment, started within 72 hours of stroke onset, versus control or no treatment in people with ischaemic stroke to assess the impact on death or dependence.</P>
+<P>
+<B>Background</B>
+</P>
+<P>Stroke is the second leading cause of death worldwide. Symptoms of stroke include face drooping, arm weakness and difficulty with speech. Most strokes are caused by a blood clot that interrupts blood flow to a part of the brain. If blood flow is not restored quickly, the brain cells will die. Haemodilution improves the flow properties of the blood so that, theoretically, oxygen and nutrient supply to the brain is improved and brain cells threatened to die could survive. This treatment reduces brain infarct (the area of dead cells) size in animals with experimental stroke. Haemodilution can be achieved by blood-letting (removing blood), by giving fluids as an infusion or by a combination of both. The fluids used may be salt solutions but colloid solutions, which consist of large insoluble molecule meant to retain fluid intravascularly, are more effective as haemodilution agents. In many countries, haemodilution has been used in clinical treatment of people with acute stroke since the 1970s. Since then, a large number of clinical studies on haemodilution in acute stroke have been published. The goal of this review was to determine if blood dilution could prevent death in people with stroke due to blood clots.</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>We identified 21 trials involving 4174 adult, male and female participants with presumed acute ischaemic stroke. The evidence is current to February 2014. Many trials followed participants for at least three to six months. Interventions included isovolaemic regimens (replacing a portion of blood volume with fluid) and hypervolaemic regimens (increasing the total volume of blood by adding fluid) using different types of solutions.</P>
+<P>
+<B>Key results</B>
+</P>
+<P>This review showed that, when all the studies are taken together, there is no clear evidence of benefit from haemodilution. There is also no clear evidence that any particular mode of haemodilution, with or without blood-letting, using various types of haemodiluting agents, etc, is beneficial. There were no significant serious side effects of this treatment. It is concluded that there is no clear scientific support for the use of haemodilution in the routine treatment of people with acute ischaemic stroke.</P>
+<P>
+<B>Quality of the evidence</B>
+</P>
+<P>The overall quality of the evidence was moderate as individual trials were of varying quality. There was little variation among trials.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Ischaemic stroke interrupts the flow of blood to part of the brain. Haemodilution is thought to improve the flow of blood to the affected areas of the brain and thus reduce infarct size. </P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of haemodilution in acute ischaemic stroke.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Stroke Group Trials Register (February 2014), the Cochrane Central Register of Controlled Trials (Issue 1, 2014), MEDLINE (January 2008 to October 2013) and EMBASE (January 2008 to October 2013). We also searched trials registers, scanned reference lists and contacted authors. For the previous version of the review, the authors contacted manufacturers and investigators in the field.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised trials of haemodilution treatment in people with acute ischaemic stroke. We included only trials in which treatment was started within 72 hours of stroke onset.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors assessed trial quality and one review author extracted the data.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We included 21 trials involving 4174 participants. Nine trials used a combination of venesection and plasma volume expander. Twelve trials used plasma volume expander alone. The plasma volume expander was plasma alone in one trial, dextran 40 in 12 trials, hydroxyethyl starch (HES) in five trials and albumin in three trials. Two trials tested haemodilution in combination with another therapy. Evaluation was blinded in 14 trials. Five trials probably included some participants with intracerebral haemorrhage. Haemodilution did not significantly reduce deaths within the first four weeks (risk ratio (RR) 1.10; 95% confidence interval (CI) 0.90 to 1.34). Similarly, haemodilution did not influence deaths within three to six months (RR 1.05; 95% CI 0.93 to 1.20), or death and dependency or institutionalisation (RR 0.96; 95% CI 0.85 to 1.07). The results were similar in confounded and unconfounded trials, and in trials of isovolaemic and hypervolaemic haemodilution. No statistically significant benefits were documented for any particular type of haemodiluting agents, but the statistical power to detect effects of HES was weak. Six trials reported venous thromboembolic events. There was a tendency towards reduction in deep venous thrombosis or pulmonary embolism or both at three to six months' follow-up (RR 0.68; 95% CI 0.37 to 1.24). There was no statistically significant increased risk of serious cardiac events among haemodiluted participants.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>The overall results of this review showed no clear evidence of benefit of haemodilution therapy for acute ischaemic stroke.</P>
+<P>These results are compatible with no persuasive beneficial evidence of haemodilution therapy for acute ischaemic stroke. This therapy has not been proven to improve survival or functional outcome.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000112.pub3.en.xml

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+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Immunotherapy for recurrent miscarriage</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Immunotherapy for recurrent miscarriage</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Immunotherapy does not lower the risk of future miscarriage in women who repeatedly miscarry.</P>
+<P>
+<B>Background<BR/>
+</B>Recurrent miscarriage is three or more consecutive early miscarriages. One theory is that for some women, this might be caused by an immune system response to the embryo or fetus. Therapies that try to immunize the woman against the 'foreign' cells of a future pregnancy have been tried. Immunotherapies have included white blood cells (leukocytes) from the woman's partner or a donor, products derived from early embryos (trophoblast membranes), or antibodies derived from blood (immunoglobulin).</P>
+<P>
+<B>Review question<BR/>
+</B>We sought to determine whether immunological treatments would improve the chance of live births in women with a history of recurrent miscarriage.<BR/>
+<BR/>
+<B>Study characteristics<BR/>
+</B>We included 20 randomized controlled trials involving 1137 women, which took place from 1985 and 2004 in 11 countries. The trials examined four different forms of immunotherapy: immunization using white blood cells from the woman's partner (12 trials, 641 women), white blood cells from a third-party donor (three trials, 156 women), products derived from early embryos (one trial, 37 women), or antibodies derived from blood (intravenous immunoglobulin) (eight trials 303 women).</P>
+<P>
+<B>Quality of the evidence and conclusions<BR/>
+</B>Overall, we considered the risk of bias for the majority of included studies to be low.</P>
+<P>The review of trials found that none of these treatments provided a significant beneficial effect over placebo in improving the live birth rate or lowered the risk of future miscarriage in women who have recurrent miscarriages.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Because immunological aberrations might be the cause of miscarriage in some women, several immunotherapies have been used to treat women with otherwise unexplained recurrent pregnancy loss. </P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>The objective of this review was to assess the effects of any immunotherapy, including paternal leukocyte immunization and intravenous immunoglobulin on the live birth rate in women with previous unexplained recurrent miscarriages.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 February 2014) and reference lists of retrieved studies.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomized trials of immunotherapies used to treat women with three or more prior miscarriages and no more than one live birth after, in whom all recognized non-immunologic causes of recurrent miscarriage had been ruled out and no simultaneous treatment was given.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>The review author and the two co-authors independently extracted data and assessed study quality for all studies considered for this review. </P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Twenty trials of high quality were included. The various forms of immunotherapy did not show significant differences between treatment and control groups in terms of subsequent live births: paternal cell immunization (12 trials, 641 women), Peto odds ratio (Peto OR) 1.23, 95% confidence interval (CI) 0.89 to 1.70; third-party donor cell immunization (three trials, 156 women), Peto OR 1.39, 95% CI 0.68 to 2.82; trophoblast membrane infusion (one trial, 37 women), Peto OR 0.40, 95% CI 0.11 to 1.45; or intravenous immunoglobulin, (eight trials, 303 women), Peto OR 0.98, 95% CI 0.61 to 1.58.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Paternal cell immunization, third-party donor leukocytes, trophoblast membranes, and intravenous immunoglobulin provide no significant beneficial effect over placebo in improving the live birth rate.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000126.pub4.en.xml

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+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Local versus general anaesthesia for carotid endarterectomy</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Local versus general anaesthesia for carotid endarterectomy</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>About 20% of strokes result from narrowing of the carotid artery, which is the main artery supplying blood to the brain. Blood clots can form at the point of narrowing. If a blood clot breaks off into the bloodstream, it can be carried into the brain, block the blood supply there and cause a stroke. A surgical operation known as carotid endarterectomy removes the inner lining and blood clot in the carotid artery and can lower the risk of stroke. However, even with very careful surgery, approximately one in 20 patients will suffer a stroke caused by the operation itself. The use of local anaesthesia rather than general anaesthesia might lower the risk of a stroke happening during or after surgery. This review includes 14 randomised trials, involving 4596 operations, comparing the use of local anaesthetic to general anaesthetic for carotid endarterectomy. There was no statistically significant difference between the anaesthetic techniques in the percentage of patients who had a stroke or died within 30 days of surgery. This systematic review provides evidence to suggest that patients and surgeons can choose either anaesthetic technique, depending on the clinical situation and their own preferences.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Carotid endarterectomy may significantly reduce the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant perioperative risks that may be reduced by performing the operation under local rather than general anaesthetic. This is an update of a Cochrane Review first published in 1996, and previously updated in 2004 and 2008.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To determine whether carotid endarterectomy under local anaesthetic: (1) reduces the risk of perioperative stroke and death compared with general anaesthetic; (2) reduces the complication rate (other than stroke) following carotid endarterectomy; and (3) is acceptable to patients and surgeons.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Stroke Group Trials Register (September 2013), MEDLINE (1966 to September 2013), EMBASE (1980 to September 2013) and Index to Scientific and Technical Proceedings (ISTP) (1980 to September 2013). We also handsearched relevant journals, and searched the reference lists of articles identified.<BR/>
+</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised trials comparing the use of local anaesthetic to general anaesthetic for carotid endarterectomy were considered for inclusion.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Three review authors independently assessed trial quality and extracted data. We calculated a pooled Peto odds ratio (OR) and corresponding 95% confidence interval (CI) for the following outcomes that occurred within 30 days of surgery: stroke, death, stroke or death, myocardial infarction, local haemorrhage, cranial nerve injuries, and shunted arteries.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We included 14 randomised trials involving 4596 operations, of which 3526 were from the single largest trial (GALA). In general, reporting of methodology in the included studies was poor. All studies were unable to blind patients and surgical teams to randomised treatment allocation and for most studies the blinding of outcome assessors was unclear. There was no statistically significant difference in the incidence of stroke within 30 days of surgery between the local anaesthesia group and the general anaesthesia group. The incidence of strokes in the local anaesthesia group was 3.2% compared to 3.5% in the general anaesthesia group (Peto OR 0.92, 95% CI 0.67 to 1.28). There was no statistically significant difference in the proportion of patients who had a stroke or died within 30 days of surgery. In the local anaesthesia group 3.6% of patients had a stroke or died compared to 4.2% of patients in the general anaesthesia group (Peto OR 0.85, 95% CI 0.63 to 1.16). There was a non-significant trend towards lower operative mortality with local anaesthetic. In the local anaesthesia group 0.9% of patients died within 30 days of surgery compared to 1.5% of patients in the general anaesthesia group (Peto OR 0.62, 95% CI 0.36 to 1.07). However, neither the GALA trial or the pooled analysis were adequately powered to reliably detect an effect on mortality.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>The proportion of patients who had a stroke or died within 30 days of surgery did not differ significantly between the two types of anaesthetic techniques used during carotid endarterectomy. This systematic review provides evidence to suggest that patients and surgeons can choose either anaesthetic technique, depending on the clinical situation and their own preferences.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000163.pub2.en.xml

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+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Closure versus non-closure of the peritoneum at caesarean section: long- and short-term outcome</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Not stitching the peritoneum after caesarean section takes less theatre time and therefore has less cost, but information on possible long-term disadvantages are limited.</P>
+<P>There are many ways of performing a caesarean section and the techniques used depend on a number factors including the clinical situation and the preference of the operator. The peritoneum is a thin membrane of cells supported by a thin layer of connective tissue, and during caesarean section these peritoneal surfaces have to be cut through in order to reach the uterus and for the baby to be born. Following a caesarean section, it has been standard practice to close the peritoneum by stitching (suturing) the two layers of tissue that line the abdomen and cover the internal organs, to restore the anatomy. It has however been suggested that peritoneal adhesions may be more likely rather than less likely when the peritoneum is sutured, possibly as a result of a tissue reaction to the suture material. This review of trials sought to address whether to routinely suture these thin layers of tissue or not after delivering a baby by caesarean section. Twenty-nine randomised controlled trials were identified, with differences in their methodological quality; 21 trials involving over 17,000 women contributing data to the review. Several minutes were saved when the peritoneum was not stitched, and with a shorter period of hospital stay in most of the women. Postoperative adhesion formation was assessed in only four trials with 282 women, and no difference was found when leaving both layers of peritoneum unclosed was compared with closure of both. Longer-term outcomes were not adequately assessed, particularly adhesion formation, subfertility and ease of other surgeries in later life. Although the methodological quality of trials was variable, the results were in general consistent between the trials of better and poorer quality. Further studies are needed to further assess all these outcomes.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or routinely performed.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative and immediate- and long-term postoperative outcomes.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 November 2013).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials comparing leaving the visceral or parietal peritoneum, or both, unsutured at caesarean section with a technique which involves suturing the peritoneum in women undergoing elective or emergency caesarean section.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked it for accuracy.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>A total of 29 trials were included in this review and 21 trials (17,276 women) provided data that could be included in an analysis. The quality of the trials was variable.</P>
+<P>
+<B>1. Non-closure of visceral and parietal peritoneum versus closure of both parietal layers</B>
+</P>
+<P>Sixteen trials involving 15,480 women, were included and analysed, when both parietal peritoneum was left unclosed versus when both peritoneal surfaces were closed. Postoperative adhesion formation was assessed in only four trials with 282 women, and no difference was found between groups (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.76 to 1.29). There was significant reduction in the operative time (mean difference (MD) -5.81 minutes, 95% CI -7.68 to -3.93). The duration of hospital stay in a total of 13 trials involving 14,906 women, was also reduced (MD -0.26, 95% CI -0.47 to -0.05) days. In a trial involving 112 women, reduced chronic pelvic pain was found in the peritoneal non-closure group.</P>
+<P>
+<B>2. Non-closure of visceral peritoneum only versus closure of both peritoneal surfaces</B>
+</P>
+<P>Three trials involving 889 women were analysed. There was an increase in adhesion formation (two trials involving 157 women, RR 2.49, 95% CI 1.49 to 4.16) which was limited to one trial with high risk of bias.There was reduction in operative time, postoperative days in hospital and wound infection. There was no significant reduction in postoperative pyrexia.</P>
+<P>
+<B>3. Non-closure of parietal peritoneum only versus closure of both peritoneal layers</B>
+</P>
+<P>The two identified trials involved 573 women. Neither study reported on postoperative adhesion formation. There was reduction in operative time and postoperative pain with no difference in the incidence of postoperative pyrexia, endometritis, postoperative duration of hospital stay and wound infection. In only one study, postoperative day one wound pain assessed by the numerical rating scale, (MD -1.60, 95% CI -1.97 to -1.23) and chronic abdominal pain d by the visual analogue score (MD -1.10, 95% CI -1.39 to -0.81) was reduced in the non-closure group.</P>
+<P>
+<B>4. Non-closure versus closure of visceral peritoneum when parietal peritoneum is closed.</B>
+</P>
+<P>There was reduction in all the major urinary symptoms of frequency, urgency and stress incontinence when the visceral peritoneum is left unsutured.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There was a reduction in operative time across all the subgroups. There was also a reduction in the period of hospitalisation post-caesarean section except in the subgroup where parietal peritoneum only was not sutured where there was no difference in the period of hospitalisation. The evidence on adhesion formation was limited and inconsistent. There is currently insufficient evidence of benefit to justify the additional time and use of suture material necessary for peritoneal closure. More robust evidence on long-term pain, adhesion formation and infertility is needed.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000166.en.xml

@@ -0,0 +1,35 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE>Planned caesarean section for term breech delivery</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Planned caesarean section for term breech delivery</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Planned caesarean section was safer for singleton term breech babies than planned vaginal birth, managed according to a clinical protocol, but was associated with more complications for mothers.</P>
+<P>Most babies are born head first but some lie in the womb with their buttocks or feet coming first (breech). The review of three studies (2396 participants) showed that planned caesarean section was safer for the singleton breech baby at term than planned vaginal birth, managed according to a clinical protocol. However, mothers suffered more short-term complications and there was limited information about the potential for problems with future pregnancies.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Poor outcomes after breech birth might be the result of underlying conditions causing breech presentation or due to factors associated with the delivery.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of planned caesarean section for singleton breech presentation at term on measures of pregnancy outcome.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2011).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised trials comparing planned caesarean section for singleton breech presentation at term with planned vaginal birth.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>We assessed trial eligibility and quality. We extracted and analysed data using routine Cochrane Collaboration methodology.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Three trials (2396 participants) were included in the review. Caesarean delivery occurred in 550/1227 (45%) of those women allocated to a vaginal delivery protocol. Perinatal or neonatal death (excluding fatal anomalies) or serious neonatal morbidity was reduced with planned caesarean section (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.19 to 0.56). This reduction was less for countries with high national perinatal mortality rates. Perinatal or neonatal death (excluding fatal anomalies) was also reduced with planned caesarean section (RR 0.29, 95% CI 0.10 to 0.86). The proportional reductions were similar for countries with low and high national perinatal mortality rates. Planned caesarean section was associated with modestly increased short-term maternal morbidity (RR 1.29, 95% CI 1.03 to 1.61). At three months after delivery, women allocated to the planned caesarean section group reported less urinary incontinence (RR 0.62, 95% CI 0.41 to 0.93); more abdominal pain (RR 1.89, 95% CI 1.29 to 2.79); and less perineal pain (RR 0.32, 95% CI 0.18 to 0.58).</P>
+<P>At two years, there were no differences in the combined outcome 'death or neurodevelopmental delay'. Maternal outcomes at two years were also similar. In countries with low perinatal mortality rates, the protocol of planned caesarean section was associated with lower healthcare costs, expressed in 2002 Canadian dollars (one trial; mean difference -$877.00, 95% CI -894.89 to -859.11).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Planned caesarean section compared with planned vaginal birth reduced perinatal or neonatal death or serious neonatal morbidity, at the expense of somewhat increased maternal morbidity. The option of external cephalic version is dealt with in separate reviews. The data from this review cannot be generalised to settings where caesarean section is not readily available, or to methods of breech delivery that differ materially from the clinical delivery protocols used in the trials reviewed. The review will help to inform individualised decision-making regarding breech delivery. Research on strategies to improve the safety of breech delivery is needed.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000169.pub3.en.xml

@@ -0,0 +1,43 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Drugs for preventing malaria in pregnant women in endemic areas: any drug regimen versus placebo or no treatment</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>The effect of taking antimalarial drugs routinely to prevent malaria in pregnancy</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Pregnancy increases the risk of malaria and this is associated with poor health outcomes for both the mother and the infant, especially during the first or second pregnancy. For this reason, women are encouraged to try and prevent malaria infection during pregnancy by sleeping under mosquito bed-nets, and by taking drugs effective against malaria throughout pregnancy as chemoprevention.</P>
+<P>This Cochrane Review looked at all drug regimens compared to placebo. The review authors sought to summarise and quantify the overall effects of chemoprevention. Seventeen trials were included, all conducted between 1957 and 2008, and all but two in countries of Africa.</P>
+<P>For women in their first or second pregnancy, malaria chemoprevention prevents moderate to severe anaemia (<I>high quality evidence</I>); and prevents malaria parasites being detected in the blood (<I>high quality evidence</I>). It may also prevent malaria illness. We don't know if it prevents maternal deaths, as this would require very large studies to detect an effect.</P>
+<P>In their infants, malaria chemoprevention improves the average birthweight (<I>moderate quality evidence</I>), and reduces the number of low birthweight infants (<I>moderate quality evidence</I>). We are not sure if chemoprevention reduces mortality of babies in the first week, month and year, as again studies would need to be very large to show these effects.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Pregnancy increases the risk of malaria and this is associated with poor health outcomes for both the mother and the infant, especially during the first or second pregnancy. To reduce these effects, the World Health Organization recommends that pregnant women living in malaria endemic areas sleep under insecticide-treated bednets, are treated for malaria illness and anaemia, and receive chemoprevention with an effective antimalarial drug during the second and third trimesters.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of malaria chemoprevention given to pregnant women living in malaria endemic areas on substantive maternal and infant health outcomes. We also summarised the effects of intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) alone, and preventive regimens for <I>Plasmodium vivax.</I>
+</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, and reference lists up to 1 June 2014.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomized controlled trials (RCTs) and quasi-RCTs of any antimalarial drug regimen for preventing malaria in pregnant women living in malaria-endemic areas compared to placebo or no intervention. In the mother, we sought outcomes that included mortality, severe anaemia, and severe malaria; anaemia, haemoglobin values, and malaria episodes; indicators of malaria infection, and adverse events. In the baby, we sought foetal loss, perinatal, neonatal and infant mortality; preterm birth and birthweight measures; and indicators of malaria infection. We included regimens that were known to be effective against the malaria parasite at the time but may no longer be used because of parasite drug resistance.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors applied inclusion criteria, assessed risk of bias and extracted data. Dichotomous outcomes were compared using risk ratios (RR), and continuous outcomes using mean differences (MD); both are presented with 95% confidence intervals (CI). We assessed the quality of evidence using the GRADE approach.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Seventeen trials enrolling 14,481 pregnant women met our inclusion criteria. These trials were conducted between 1957 and 2008, in Nigeria (three trials), The Gambia (three trials), Kenya (three trials), Mozambique (two trials), Uganda (two trials), Cameroon (one trial), Burkina Faso (one trial), and Thailand (two trials). Six different antimalarials were evaluated against placebo or no intervention; chloroquine (given weekly), pyrimethamine (weekly or monthly), proguanil (daily), pyrimethamine-dapsone (weekly or fortnightly), and mefloquine (weekly), or intermittent preventive therapy with SP (given twice, three times or monthly). Trials recruited women in their first or second pregnancy (eight trials); only multigravid women (one trial); or all women (eight trials). Only six trials had adequate allocation concealment.</P>
+<P>For women in their first or second pregnancy, malaria chemoprevention reduces the risk of moderate to severe anaemia by around 40% (RR 0.60, 95% CI 0.47 to 0.75; three trials, 2503 participants, <I>high quality evidence</I>), and the risk of any anaemia by around 17% (RR 0.83, 95% CI 0.74 to 0.93; five trials,, 3662 participants, <I>high quality evidence</I>). Malaria chemoprevention reduces the risk of antenatal parasitaemia by around 61% (RR 0.39, 95% CI 0.26 to 0.58; seven trials, 3663 participants, <I>high quality evidence</I>), and two trials reported a reduction in febrile illness (<I>low quality evidence</I>). There were only 16 maternal deaths and these trials were underpowered to detect an effect on maternal mortality (<I>very low quality evidence</I>).</P>
+<P>For infants of women in their first and second pregnancies, malaria chemoprevention probably increases mean birthweight by around 93 g (MD 92.72 g, 95% CI 62.05 to 123.39; nine trials, 3936 participants, <I>moderate quality evidence</I>), reduces low birthweight by around 27% (RR 0.73, 95% CI 0.61 to 0.87; eight trials, 3619 participants, <I>moderate quality evidence</I>), and reduces placental parasitaemia by around 46% (RR 0.54, 95% CI 0.43 to 0.69; seven trials, 2830 participants, <I>high quality evidence</I>). Fewer trials evaluated spontaneous abortions, still births, perinatal deaths, or neonatal deaths, and these analyses were underpowered to detect clinically important differences.</P>
+<P>In multigravid women, chemoprevention has similar effects on antenatal parasitaemia (RR 0.38, 95% CI 0.28 to 0.50; three trials, 977 participants, <I>high quality evidence</I>)but there are too few trials to evaluate effects on other outcomes.</P>
+<P>In trials giving chemoprevention to all pregnant women irrespective of parity, the average effects of chemoprevention measured in all women indicated it may prevent severe anaemia (defined by authors, but at least &lt; 8 g/L: RR 0.19, 95% CI 0.05 to 0.75; two trials, 1327 participants, <I>low quality evidence), </I>but consistent benefits have not been shown for other outcomes. </P>
+<P>In an analysis confined only to intermittent preventive therapy with SP, the estimates of effect and the quality of the evidence were similar.</P>
+<P>A summary of a single trial in Thailand of prophylaxis against <I>P. vivax </I>showed chloroquine prevented vivax infection (RR 0.01, 95% CI 0.00 to 0.20; one trial, 942 participants).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Routine chemoprevention to prevent malaria and its consequences has been extensively tested in RCTs, with clinically important benefits on anaemia and parasitaemia in the mother, and on birthweight in infants.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000190.pub3.en.xml

@@ -0,0 +1,52 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting)</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting)</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Question</B>
+</P>
+<P>We wanted to compare the effect of routine shunting versus selective or no shunting during carotid endarterectomy, and to assess the effect of different methods for selection of people for shunting.</P>
+<P>
+<B>Background</B>
+</P>
+<P>About 20% of strokes result from narrowing of the carotid artery (the main artery supplying blood to the brain). Carotid endarterectomy is an operation to remove this narrowing and therefore reduce the risk of stroke. However, there is a 5% to 10% risk of the operation itself causing a stroke. The use of a silicon tube, or shunt, as a temporary bypass can reduce the length of time that blood flow to the brain is interrupted during the operation. This may reduce the risk of perioperative stroke but could also result in arterial wall damage and therefore increase the risk of stroke. Shunt surgery falls into three categories. Firstly, in routine shunting, the surgeon inserts a shunt in every patient. Secondly, in selective shunting, the surgeon only uses a shunt in patients with an inadequate blood supply to the brain following clamping; various cerebral monitoring techniques, such as ultrasound for predicting who needs a shunt, have been used in this policy. Thirdly, in no shunting, surgeons do not employ shunts at all.</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>We identified six studies up to August 2013, for inclusion in the review. These studies included a total of 1270 participants. Three of the trials compared routine shunting with no shunting, one trial compared routine shunting versus selective shunting, and another two trials compared different methods of monitoring in selective shunting. We have not yet identified any trials that compared selective shunting with no shunting. All the included trials assessed the use of shunting in people undergoing endarterectomy under general anaesthetic. The age of the participants ranged from 40 to 89 years, and overall, there were more male than female participants. Where reported, participants were followed up for no longer than 30 days.</P>
+<P>
+<B>Key results</B>
+</P>
+<P>There is still no evidence for the use of a carotid shunt during carotid endarterectomy. This review suggests a benefit from the use of a shunt, but the overall results were not statistically significant. More trials are needed.</P>
+<P>
+<B>Quality of the evidence</B>
+</P>
+<P>There were significant problems with the quality of the randomised trials and, overall, the reporting of study methodology was poor.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Temporary interruption of cerebral blood flow during carotid endarterectomy can be avoided by using a shunt across the clamped section of the carotid artery. This may improve outcome. This is an update of a Cochrane review originally published in 1996 and previously updated in 2009.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effect of routine versus selective or no shunting during carotid endarterectomy, and to assess the best method for selecting people for shunting.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Stroke Group Trials Register (last searched August 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (<I>The Cochrane Library</I>, 2013, Issue 8), MEDLINE (1966 to August 2013), EMBASE (1980 to August 2013) and Index to Scientific and Technical Proceedings (1980 to August 2013). We handsearched journals and conference proceedings, checked reference lists, and contacted experts in the field.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised and quasi-randomised trials of routine shunting compared with no shunting or selective shunting, and trials that compared different shunting policies in people undergoing carotid endarterectomy.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Three review authors independently performed the searches and applied the inclusion criteria. For this update, we identified two new relevant randomised controlled trials.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We included six trials involving 1270 participants in the review: three trials involving 686 participants compared routine shunting with no shunting, one trial involving 200 participants compared routine shunting with selective shunting, one trial involving 253 participants compared selective shunting with and without near-infrared refractory spectroscopy monitoring, and the other trial involving 131 participants compared shunting with a combination of electroencephalographic and carotid pressure measurement with shunting by carotid pressure measurement alone. In general, reporting of methodology in the included studies was poor. For most studies, the blinding of outcome assessors and the report of prespecified outcomes were unclear. For routine versus no shunting, there was no significant difference in the rate of all stroke, ipsilateral stroke or death up to 30 days after surgery, although data were limited. No significant difference was found between the groups in terms of postoperative neurological deficit between selective shunting with and without near-infrared refractory spectroscopy monitoring, However, this analysis was inadequately powered to reliably detect the effect. There was no significant difference between the risk of ipsilateral stroke in participants selected for shunting with the combination of electroencephalographic and carotid pressure assessment compared with pressure assessment alone, although again the data were limited.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>This review concluded that the data available were too limited to either support or refute the use of routine or selective shunting in carotid endarterectomy. Large scale randomised trials of routine shunting versus selective shunting are required. No method of monitoring in selective shunting has been shown to produce better outcomes.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000197.pub3.en.xml

@@ -0,0 +1,33 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Organised inpatient (stroke unit) care for stroke</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Organised inpatient (stroke unit) care</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Organised stroke unit care is a form of care provided in hospital by nurses, doctors and therapists who specialise in looking after stroke patients and work as a co-ordinated team. This review of 28 trials, involving 5855 participants, showed that patients who receive this care are more likely to survive their stroke, return home and become independent in looking after themselves. A variety of different types of stroke unit have been developed. The best results appear to come from those which are based in a dedicated ward.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Organised stroke unit care is provided by multidisciplinary teams that exclusively manage stroke patients in a ward dedicated to stroke patients, with a mobile stroke team or within a generic disability service (mixed rehabilitation ward).</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effect of stroke unit care compared with alternative forms of care for people following a stroke.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the trials registers of the Cochrane Stroke Group (January 2013) and the Cochrane Effective Practice and Organisation of Care (EPOC) Group (January 2013), MEDLINE (2008 to September 2012), EMBASE (2008 to September 2012) and CINAHL (1982 to September 2012). In an effort to identify further published, unpublished and ongoing trials, we searched 17 trial registers (January 2013), performed citation tracking of included studies, checked reference lists of relevant articles and contacted trialists.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled clinical trials comparing organised inpatient stroke unit care with an alternative service. After formal risk of bias assessment, we have now excluded previously included quasi-randomised trials.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors initially assessed eligibility and trial quality. We checked descriptive details and trial data with the co-ordinators of the original trials.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We included 28 trials, involving 5855 participants, comparing stroke unit care with an alternative service. More-organised care was consistently associated with improved outcomes. Twenty-one trials (3994 participants) compared stroke unit care with care provided in general wards. Stroke unit care showed reductions in the odds of death recorded at final (median one year) follow-up (odds ratio (OR) 0.81, 95% Confidence Interval (CI) 0.69 to 0.94; P = 0.005), the odds of death or institutionalised care (OR 0.78, 95% CI 0.68 to 0.89; P = 0.0003) and the odds of death or dependency (OR 0.79, 95% CI 0.68 to 0.90; P = 0.0007). Sensitivity analyses indicated that the observed benefits remained when the analysis was restricted to securely randomised trials that used unequivocally blinded outcome assessment with a fixed period of follow-up. Outcomes were independent of patient age, sex, initial stroke severity or stroke type, and appeared to be better in stroke units based in a discrete ward. There was no indication that organised stroke unit care resulted in a longer hospital stay.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Stroke patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent, and living at home one year after the stroke. The benefits were most apparent in units based in a discrete ward. We observed no systematic increase in the length of inpatient stay.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000213.pub3.en.xml

@@ -0,0 +1,53 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE>Thrombolysis for acute ischaemic stroke</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Clot-dissolving drugs for treating ischaemic stroke in the early stages</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Question</B>
+</P>
+<P>We wanted to compare the safety and efficacy of clot-dissolving (thrombolytic) drugs versus placebo or no treatment in the early stages of ischaemic stroke to see if clot-dissolving drugs improve outcome after stroke.</P>
+<P>
+<B>Background</B>
+</P>
+<P>Most strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with clot-dissolving (thrombolytic) drugs can restore blood flow before major brain damage has occurred and could mean that people are more likely to make a good recovery from their stroke. Thrombolytic drugs can also, however, cause serious bleeding in the brain, which can be fatal. Thrombolytic therapy has now been evaluated in many randomised trials in acute ischaemic stroke. The thrombolytic drug alteplase has been licensed for use within three hours of stroke in the USA and Canada, and within 4.5 hours in most European countries. The numbers of people receiving this treatment successively are increasing.</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>We identified 27 trials with a total of 10,187 participants in searches conducted up to November 2013. Most data come from trials testing one drug (recombinant tissue Plasminogen Activator, rt-PA) given into a vein up to six hours after acute ischaemic stroke, but several other drugs were also tested and at different times to treatment after stroke and given into an artery in the brain rather than into a vein in the arm. All trials compared a clot-dissolving drug with a placebo (control) group. Most trials included participants with moderate to severe stroke. All trials took place in hospitals that were used to treating people with stroke. Differences between trials mean that not all trials contribute information to all outcomes, but we have used all available data. Most trials included participants after a computed tomography (CT) brain scan had excluded a brain haemorrhage as the cause of symptoms (a few trials used magnetic resonance brain scanning instead).</P>
+<P>
+<B>Key results</B>
+</P>
+<P>There is general agreement between the earlier trials and the one recent trial added in this update (IST-3) for all main outcomes, and between the 12 trials that tested rt-PA and the 15 trials that tested other clot-dissolving drugs. The main difference between IST-3 and earlier trials was that IST-3 had many participants above 80 years. Clot-dissolving treatment can reduce the risk of long-term dependency on others for daily activities, in spite of there being an increased risk of bleeding in the brain which also increased the risk of early death. Once the early bleeding risk had passed, at three or six months after stroke, people given clot-dissolving drugs were more likely to have recovered from their stroke and to be independent, especially if they had been treated within the first three hours after stroke. Older people benefited as much as younger people. Giving aspirin at the same time as clot-busting drugs increased the risk of bleeding and should be avoided. Further analyses of individual patient data factors such as findings on brain scanning before treatment, and of different ways of giving the treatment, may give more information than the summary data that we used here. Meantime, people who think that they are experiencing a stroke should get to hospital quickly, be assessed by a stroke doctor, have a brain scan and receive clot-dissolving treatment as fast as possible. They should not hesitate by thinking that they will be 'too old' for treatment. The treatment is very effective if started within three hours of stroke and definitely improves outcome if given up to 4.5 hours after stroke, but later than that the effects are less clear and are still being tested in trials. More information is needed from trials in people with mild stroke to see if the benefit of clot-dissolving drugs outweighs the risk of haemorrhage.</P>
+<P>
+<B>Quality of the evidence</B>
+</P>
+<P>The evidence comes mostly from well-conducted randomised trials run by stroke experts. Some trials (8/27) were run by companies that make the clot-dissolving drugs, but most trials (19/27, including most participants) were funded by Government or charity sources independently of drug companies. These results apply to a wide range of people with a wide range of severities of stroke and other medical conditions.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Most strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with thrombolytic drugs can restore blood flow before major brain damage has occurred and improve recovery after stroke in some people. Thrombolytic drugs, however, can also cause serious bleeding in the brain, which can be fatal. One drug, recombinant tissue plasminogen activator (rt-PA), is licensed for use in selected patients within 4.5 hours of stroke in Europe and within three hours in the USA. There is an upper age limit of 80 years in some countries, and a limitation to mainly non-severe stroke in others. Forty per cent more data are available since this review was last updated in 2009.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To determine whether, and in what circumstances, thrombolytic therapy might be an effective and safe treatment for acute ischaemic stroke.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Stroke Group Trials Register (last searched November 2013), MEDLINE (1966 to November 2013) and EMBASE (1980 to November 2013). We also handsearched conference proceedings and journals, searched reference lists and contacted pharmaceutical companies and trialists.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised trials of any thrombolytic agent compared with control in people with definite ischaemic stroke.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors applied the inclusion criteria, extracted data and assessed trial quality. We verified the extracted data with investigators of all major trials, obtaining additional unpublished data if available.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We included 27 trials, involving 10,187 participants, testing urokinase, streptokinase, rt-PA, recombinant pro-urokinase or desmoteplase. Four trials used intra-arterial administration, while the rest used the intravenous route. Most data come from trials that started treatment up to six hours after stroke. About 44% of the trials (about 70% of the participants) were testing intravenous rt-PA. In earlier studies very few of the participants (0.5%) were aged over 80 years; in this update, 16% of participants are over 80 years of age due to the inclusion of IST-3 (53% of participants in this trial were aged over 80 years). Trials published more recently utilised computerised randomisation, so there are less likely to be baseline imbalances than in previous versions of the review. More than 50% of trials fulfilled criteria for high-grade concealment; there were few losses to follow-up for the main outcomes.</P>
+<P>Thrombolytic therapy, mostly administered up to six hours after ischaemic stroke, significantly reduced the proportion of participants who were dead or dependent (modified Rankin 3 to 6) at three to six months after stroke (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.78 to 0.93). Thrombolytic therapy increased the risk of symptomatic intracranial haemorrhage (OR 3.75, 95% CI 3.11 to 4.51), early death (OR 1.69, 95% CI 1.44 to 1.98; 13 trials, 7458 participants) and death by three to six months after stroke (OR 1.18, 95% CI 1.06 to 1.30). Early death after thrombolysis was mostly attributable to intracranial haemorrhage. Treatment within three hours of stroke was more effective in reducing death or dependency (OR 0.66, 95% CI 0.56 to 0.79) without any increase in death (OR 0.99, 95% CI 0.82 to 1.21; 11 trials, 2187 participants). There was heterogeneity between the trials. Contemporaneous antithrombotic drugs increased the risk of death. Trials testing rt-PA showed a significant reduction in death or dependency with treatment up to six hours (OR 0.84, 95% CI 0.77 to 0.93, P = 0.0006; 8 trials, 6729 participants) with significant heterogeneity; treatment within three hours was more beneficial (OR 0.65, 95% CI 0.54 to 0.80, P &lt; 0.0001; 6 trials, 1779 participants) without heterogeneity. Participants aged over 80 years benefited equally to those aged under 80 years, particularly if treated within three hours of stroke.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Thrombolytic therapy given up to six hours after stroke reduces the proportion of dead or dependent people. Those treated within the first three hours derive substantially more benefit than with later treatment. This overall benefit was apparent despite an increase in symptomatic intracranial haemorrhage, deaths at seven to 10 days, and deaths at final follow-up (except for trials testing rt-PA, which had no effect on death at final follow-up). Further trials are needed to identify the latest time window, whether people with mild stroke benefit from thrombolysis, to find ways of reducing symptomatic intracranial haemorrhage and deaths, and to identify the environment in which thrombolysis may best be given in routine practice.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000222.pub3.en.xml

@@ -0,0 +1,58 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Ursodeoxycholic acid for cystic fibrosis-related liver disease</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Ursodeoxycholic acid for liver disease related to cystic fibrosis</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Review question</B>
+</P>
+<P>Does ursodeoxycholic acid improve measures of liver function, reduce the risk of developing chronic liver disease and improve outcomes in general in people with cystic fibrosis?</P>
+<P>
+<B>Background</B>
+</P>
+<P>Problems with the consistency of bile (thickened) and how it flows cause liver disease in up to 20% of young people with cystic fibrosis. Bile ducts can become blocked and cause cirrhosis in one or more parts of the liver. Ursodeoxycholic acid is a naturally occurring bile acid which is taken as either a tablet or liquid to try and prevent liver disease in people with cystic fibrosis. The best response seems to be from a total dose of 20 mg/kg/day in two to three separate doses and given initially for several months but possibly indefinitely. Originally it was used to treat gallstones, but over the last few years it has been used to treat and prevent the progression of cystic fibrosis-related liver disease.</P>
+<P>
+<B>Search date</B>
+</P>
+<P>We last searched for evidence on 29 May 2014.</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>We searched for trials of ursodeoxycholic acid lasting for at least three months and were able to include three trials. A a further three trials did not have enough information for us to decide if they were relevant. There are 118 participants aged between four and 32 years in this review. The dose of the drug given in the trials ranged from 10 to 20 mg/kg/day. Two trials compared ursodeoxycholic acid to tablets with no medicine in them (placebo) and the third trial compared ursodeoxycholic acid to 'usual' treatment. The complex design of two trials meant data could not be analysed for all the participants. The trials lasted for up to 12 months, but no longer; however, one trial did report some follow-up data after nine years.</P>
+<P>
+<B>Key results</B>
+</P>
+<P>Not many of the outcomes we listed in our review were assessed; only weight gain, skinfold thickness and biliary excretion. There were no real differences between treatments for any of these outcomes. Long-term outcomes that we think are important, such as death or the need for liver transplant, were only reported in the follow-up of one trial and the information did not tell us if the people who died or needed a liver transplant had received ursodeoxycholic acid or placebo.</P>
+<P>Current research shows that side effects of this treatment are rare, but there is not enough information about using it in the long-term to justify routinely giving it to people with cystic fibrosis. As there is no other treatment to prevent liver disease, more research on ursodeoxycholic acid is needed.</P>
+<P>
+<B>Quality of the evidence</B>
+</P>
+<P>The trials seemed to be well organised and well run, but there was not always enough information to judge them properly. While, on the whole, we do not think that any factors linked to how the trials were run would influence the results greatly, we did have some concerns that in one trial the group taking ursodeoxycholic acid were generally not as healthy at the start of the trial as the group taking placebo. Also, in another trial there were some people who withdrew and were not included in the final analysis, but no reasons for this were given.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Abnormal biliary secretion leads to the thickening of bile and the formation of plugs within the bile ducts; the consequent obstruction and abnormal bile flow ultimately results in the development of cystic fibrosis-related liver disease. This condition peaks in adolescence with up to 20% of adolescents with cystic fibrosis developing chronic liver disease. Early changes in the liver may ultimately result in end-stage liver disease with people needing transplantation. One therapeutic option currently used is ursodeoxycholic acid.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To analyse evidence that ursodeoxycholic acid improves indices of liver function, reduces the risk of developing chronic liver disease and improves outcomes in general in cystic fibrosis.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane CF and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. We also contacted drug companies.</P>
+<P>Date of the most recent search of the Group's trials register: 29 May 2014.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials of the use of ursodeoxycholic acid for at least three months compared with placebo or no additional treatment in people with cystic fibrosis.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two authors independently assessed trial eligibility and quality.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Ten trials have been identified, of which three trials involving 118 participants were included; the dose of ursodeoxycholic acid ranged from 10 to 20 mg/kg/day for up to 12 months. The complex design used in two trials meant that data could only be analysed for subsets of participants. There was no significant difference in weight change, mean difference -0.90 kg (95% confidence interval -1.94 to 0.14) based on 30 participants from two trials. Improvement in biliary excretion was reported in only one trial and no significant change after treatment was shown. There were no data available for analysis for long-term outcomes such as death or need for liver transplantation.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There are few trials assessing the effectiveness of ursodeoxycholic acid. There is insufficient evidence to justify its routine use in cystic fibrosis.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000238.pub2.en.xml

@@ -0,0 +1,53 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Ambulatory oxygen for people with chronic obstructive pulmonary disease who are not hypoxaemic at rest</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Portable oxygen for chronic obstructive pulmonary disease</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Background</B>
+<BR/>Some people with chronic obstructive pulmonary disease (COPD) have low oxygen levels in their blood when they are resting or when moving. Low oxygen levels are known as hypoxaemia. These patients can carry around an oxygen supply (oxygen in small cylinders, portable liquid oxygen systems or battery-powered oxygen concentrators) so that they have oxygen to breathe to make simple tasks such as getting dressed, leaving the house, doing chores or even walking around their own home easier, and to help them to breathe. This portable oxygen device is referred to as 'ambulatory oxygen.'</P>
+<P>
+<B>Review question</B>
+<BR/>We conducted this review to find out the long-term benefit of ambulatory oxygen therapy for people who are not severely hypoxaemic at rest.</P>
+<P>
+<B>Study characteristics</B>
+<BR/>We looked at randomised controlled trials that compared ambulatory oxygen versus a placebo (normal air). We found four studies on 331 people with a mean age of 71 years. Two of the included studies were from Australia, one from New Zealand and one from Canada. The method of oxygen delivery and the dose of oxygen varied, although equipment in all instances consisted of light-weight or portable cylinders with flow ranging from 3 L/min to 6 L/min. Final follow-up was reported as 12 weeks for three studies and two weeks for the Nonoyama study.</P>
+<P>
+<B>Key results</B>
+<BR/>We found that ambulatory oxygen therapy reduced breathlessness and decreased the number of patients who felt tired. However, the distance that people could walk in five to six minutes and survival (death rate) did not change.</P>
+<P>
+<B>Quality of the evidence</B>
+<BR/>The overall quality of evidence from the studies in this review was moderate. The way the studies were conducted (methods) was not fully reported in all cases. Most studies were lacking the pre-published study plan (protocol).<BR/>
+</P>
+<P>
+<B>Bottom line</B>
+<BR/>From this review, it is not possible to know whether ambulatory oxygen therapy should be provided during exercise or for day-to-day activities for patients with COPD who are not severely hypoxaemic at rest.<BR/>
+</P>
+<P>This Cochrane plain language summary is up-to-date as of November 2012.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>People with chronic obstructive pulmonary disease (COPD) often become transiently hypoxaemic (low oxygen levels in blood) on exercise, necessitating oxygen therapy to improve breathlessness and exercise capacity and to reduce disability. Ambulatory oxygen therapy refers to provision of oxygen therapy during exercise and activities of daily living. Ambulatory oxygen therapy is often used by patients on long-term oxygen therapy (LTOT) during exercise or by non-LTOT users with or without resting hypoxaemia when they show evidence of exercise de-saturation and demonstrate improvement in exercise capacity with supplemental oxygen.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To determine the longer-term efficacy of ambulatory oxygen therapy only in patients with COPD who do not meet the criteria for LTOT, with respect to improvement in exercise capacity, mortality, quality of life and other relevant measures of improvement.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>The Cochrane Airways Group Specialised Register, including MEDLINE, EMBASE and CINAHL, was searched. Online clinical trial registers, including Controlled Clinical Trials (www.controlled-trials.com), government registries (clinicaltrials.gov) and World Health Organization (WHO) registries (www.who.int/trialsearch), were screened for ongoing and recently completed studies. Bibliographies of included studies were searched for additional trials that may meet the inclusion criteria and were not retrieved by the above search strategy. Authors of identified trials were contacted to provide other published and unpublished studies. Searches were current as of November 2012.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials (RCTs) that compare ambulatory oxygen therapy provided through portable oxygen cylinders/battery-powered devices or liquid oxygen canisters versus placebo air cylinders, usual medical care or co-intervention in study participants with COPD who did not meet criteria for LTOT.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>We used standard methods as expected by The Cochrane Collaboration.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Four studies met the inclusion criteria (331 participants), with two studies producing a statistically and clinically significant benefit in favour of the intervention for dyspnoea post exercise.The quality of life domain for all four included studies produced a statistically significant benefit for the subcategories of dyspnoea and fatigue, in favour of the oxygen group (dyspnoea mean difference (MD) 0.28, 95% confidence interval (CI) 0.10 to 0.45; P value 0.002; fatigue MD 0.17, 95% CI 0.04 to 0.31; P value 0.009). No evidence of any effect was reported for survival, and limited benefits were observed for exercise capacity (as measured by step test and distance walk test), with one study showing a statistically significant improvement in the number of steps taken in the oxygen group for group N-of-1 studies only. No other statistically significant benefits were observed for exercise capacity among the other trials or individual N-of-1 studies.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>In patients with COPD with moderate hypoxia, current evidence on ambulatory oxygen therapy reveals improvements in dyspnoea post exercise and in the dyspnoea and fatigue domain of quality of life. However, evidence for the clinical utility and effectiveness of ambulatory oxygen in improving mortality and exercise capacity was not evident in this review. Methodologically rigorous RCTs with sufficient power to detect a difference are required to investigate the role of ambulatory oxygen in the management of COPD.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000239.pub2.en.xml

@@ -0,0 +1,33 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Amphotericin B versus fluconazole for controlling fungal infections in neutropenic cancer patients</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Prevention of fungal infections in cancer patients with amphotericin B or fluconazole</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Cancer patients treated with chemotherapy or who receive a bone marrow transplant have an increased risk of acquiring fungal infections. Such infections can be life-threatening. Antifungal drugs are therefore often given prophylactically to such patients, or when they have a fever. The review could not detect a difference in effect between amphotericin B and fluconazole but several of the trials were designed or analysed in a way that disfavoured amphotericin B, which is the only antifungal drug that has been shown to have an effect on mortality.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Systemic fungal infection is considered to be an important cause of morbidity and mortality in cancer patients, particularly those with neutropenia. Antifungal drugs are often given prophylactically, or empirically to patients with persistent fever.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To compare the effect of fluconazole and amphotericin B on morbidity and mortality in patients with cancer complicated by neutropenia.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched PubMed from 1966 to 7 July 2014 and the reference lists of identified articles.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised clinical trials comparing fluconazole with amphotericin B.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>The two review authors independently assessed trial eligibility and risk of bias, and abstracted data.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Seventeen trials (3798 patients, 381 deaths) were included. In two large three-armed trials, results for amphotericin B were combined with results for nystatin in a 'polyene' group. Because nystatin is an ineffective drug in these circumstances, this approach creates a bias in favour of fluconazole. Furthermore, most patients were randomised to oral amphotericin B, which is poorly absorbed and poorly documented. There was overlap among the 'polyene' trials but we were unable to obtain any information from the trial authors or from Pfizer, the manufacturer of fluconazole, to clarify these issues. There were no significant differences in effect between fluconazole and amphotericin B, but the confidence intervals were wide. More patients dropped out of the study when they received amphotericin B, but as none of the trials were blinded decisions on premature interruption of therapy could have been biased. Furthermore, amphotericin B was not given under optimal circumstances, with premedication to reduce infusion-related toxicity, slow infusion, and with fluid, potassium and magnesium supplements to prevent nephrotoxicity. The major harms were hepatic impairment and gastrointestinal adverse effects with fluconazole and infusion-related toxicity, renal impairment and gastrointestinal adverse effects with amphotericin B. For the 2011 and 2014 updates no additional trials were identified for inclusion.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Amphotericin B has been disfavoured in several of the trials through their design or analysis, or both. Since intravenous amphotericin B is the only antifungal agent for which an effect on mortality has been shown, and since it is considerably cheaper than fluconazole, it should be the preferred agent.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000245.pub3.en.xml

@@ -0,0 +1,35 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Antibiotics for acute bronchitis</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Antibiotic treatment for people with a clinical diagnosis of acute bronchitis</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Acute bronchitis is a clinical diagnosis for an acute cough, which may or may not be productive of mucus or sputum. It occurs when the tubes (bronchi) within the lungs become inflamed and may be caused by viruses or bacteria. Symptoms generally last for two weeks but the associated cough can last for up to eight weeks. Recently, there has been controversy over the term acute bronchitis as it covers a range of clinical presentations that may overlap with other diagnoses such as upper or lower respiratory tract infections. For this reason, some have suggested using the term 'acute lower respiratory tract infection when pneumonia is not suspected' as this is more specific. Antibiotics are commonly prescribed to treat this condition though other treatments providing symptom relief are commonly used. Antibiotics can have adverse effects such as nausea and diarrhea but can cause more serious reactions related to anaphylaxis in those allergic to them. In healthy communities, there is little evidence of bacterial infection in people with bronchitis and there is no practical test to distinguish between bacterial and viral bronchitis. Within this context the use of antibiotics to treat acute bronchitis is controversial but common. Concerns that prescribing unnecessary antibiotics increases antibiotic resistance exists.</P>
+<P>We included 17 trials with 3936 participants diagnosed with acute bronchitis and randomly assigned to receive any antibiotic treatment or a placebo or no treatment. Co-treatments with other medications to relieve symptoms were allowed if they were given to all patients. We excluded patients with pre-existing underlying pulmonary disease such as chronic bronchitis or chronic obstructive pulmonary disease. The quality of trials was generally good, particularly for more recent studies. There was limited evidence to support the use of antibiotics for acute bronchitis and a large study involving 1038 patients from 12 countries included in this update has confirmed this finding. Some people treated with antibiotics recovered a bit more quickly with reductions in cough-related outcomes though the difference was of doubtful clinical significance as it amounted to a difference of half a day over an 8 to 10 day period. There was a statistically significant but small increase in adverse side effects in patients treated with antibiotics. The most commonly reported side effects included nausea, vomiting or diarrhea, headaches, skin rash and vaginitis.The available evidence suggests that there is no benefit in using antibiotics for acute bronchitis in otherwise healthy individuals though more research is needed on the effect in frail, elderly people with multimorbidities who may not have been included in the existing trials. The use of antibiotics needs to be considered in the context of the potential side effects, medicalisation for a self-limiting condition and costs of antibiotic use, particularly the potential harms at population level associated with increasing antibiotic resistance.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>The benefits and risks of antibiotics for acute bronchitis remain unclear despite it being one of the most common illnesses seen in primary care. </P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of antibiotics in improving outcomes and assess adverse effects of antibiotic therapy for patients with a clinical diagnosis of acute bronchitis.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched CENTRAL 2013, Issue 12, MEDLINE (1966 to January week 1, 2014), EMBASE (1974 to January 2014) and LILACS (1982 to January 2014).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials (RCTs) comparing any antibiotic therapy with placebo or no treatment in acute bronchitis or acute productive cough, in patients without underlying pulmonary disease.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>At least two review authors extracted data and assessed trial quality.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Seventeen trials with 5099 participants were included in the primary analysis. The quality of trials was generally good. There was limited evidence to support the use of antibiotics in acute bronchitis. At follow-up, there was no difference in participants described as being clinically improved between antibiotic and placebo groups (11 studies with 3841 participants, risk ratio (RR) 1.07, 95% confidence interval (CI) 0.99 to 1.15; number needed to treat for an additional beneficial outcome (NNTB) 22. Participants given antibiotics were less likely to have a cough (four studies with 275 participants, RR 0.64, 95% CI 0.49 to 0.85; NNTB 6); have a night cough (four studies with 538 participants, RR 0.67, 95% CI 0.54 to 0.83; NNTB 7) and a shorter mean cough duration (seven studies with 2776 participants, mean difference (MD) -0.46 days, 95% CI -0.87 to -0.04). The differences in presence of a productive cough at follow-up and MD of productive cough did not reach statistical significance.</P>
+<P>Antibiotic-treated patients were more likely to be improved according to clinician's global assessment (six studies with 891 participants, RR 0.61, 95% CI 0.48 to 0.79; NNTB 25); were less likely to have an abnormal lung exam (five studies with 613 participants, RR 0.54, 95% CI 0.41 to 0.70; NNTB 6); have a reduction in days feeling ill (five studies with 809 participants, MD -0.64 days, 95% CI -1.16 to -0.13) and a reduction in days with limited activity (six studies with 767 participants MD -0.49 days, 95% CI -0.94 to -0.04). The differences in proportions with activity limitations at follow-up did not reach statistical significance. There was a significant trend towards an increase in adverse effects in the antibiotic group (12 studies with 3496 participants) (RR 1.20, 95% CI 1.05 to 1.36; NNT for an additional adverse effect 24).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There is limited evidence to support the use of antibiotics in acute bronchitis. Antibiotics may have a modest beneficial effect in some patients such as frail, elderly people with multimorbidity who may not have been included in trials to date. However, the magnitude of this benefit needs to be considered in the broader context of potential side effects, medicalisation for a self-limiting condition, increased resistance to respiratory pathogens and cost of antibiotic treatment.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000246.pub2.en.xml

@@ -0,0 +1,38 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Prophylactic antibiotics for inhibiting preterm labour with intact membranes</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Prophylactic antibiotics for inhibiting preterm labour in women whose membranes are still intact</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>We found no benefit for the use of antibiotics for women going into labour too early, with their membranes still intact.</P>
+<P>Maternal infection in the cervix or uterus may trigger preterm labour even if the infection does not cause symptoms (low grade infection). Preterm babies can have a range of complications, which often require admission to a neonatal intensive care unit, for example, because of breathing problems. Complications of being born early may result in death or longer-term disability such as chronic lung disease or cerebral palsy. Our systematic review of randomised trials, which included a total of 14 studies randomising 7837 women in preterm labour at a mean gestational age of 30 to 32 weeks compared routine administration of antibiotics before membrane rupture with placebo or no treatment for women without signs of infection. While antibiotics reduced the number of women who developed infections, they did not improve outcomes for the infant in terms of birth before 36 to 37 weeks, perinatal deaths or admission to neonatal intensive care or special care with serious illness. The review also found that antibiotic therapy was associated with an increase in neonatal deaths, functional impairment and cerebral palsy at seven years of age. The results of this review supports not giving antibiotics to women in threatened preterm labour with intact membranes who did not have clear signs of infection.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>The aetiology of preterm birth is complex and there is evidence that subclinical genital tract infection influences preterm labour in some women but the role of prophylactic antibiotic treatment in the management of preterm labour is controversial. Since rupture of the membranes is an important factor in the progression of preterm labour, it is important to see if the routine administration of antibiotics confers any benefit or causes harm, prior to membrane rupture.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of prophylactic antibiotics administered to women in preterm labour with intact membranes, on maternal and neonatal outcomes. </P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2013).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised trials that compared antibiotic treatment with placebo or no treatment for women in preterm labour (between 20 and 36 weeks' gestation) with intact membranes.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors independently assessed trial eligibility, and undertook quality assessment and data extraction. We contacted study authors for additional information. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for data measured on a continuous scale with their respective 95% confidence intervals (CI). The number needed to treat to benefit (NNTB) and the number needed to treat to harm (NNTH) was calculated where appropriate.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>In this update (2013), with the addition of three trials (305 women), the large ORACLE II 2001 trial continues to dominate the results of this review. This review now includes a total of 14 studies randomising 7837 women. No significant difference was shown in perinatal or infant mortality for infants of women allocated to any prophylactic antibiotics compared with no antibiotics. However, an increase in neonatal deaths was shown for infants of women receiving any prophylactic antibiotics when compared with placebo (RR 1.57, 95% CI 1.03 to 2.40; NNTH 149, 95% CI 2500 to 61). No reduction in preterm birth or other clinically important short-term outcomes for the infant were shown.</P>
+<P>Long-term child outcomes to seven years of age were available for infants in the UK enrolled in the ORACLE II trial. Comparing any antibiotics with placebo, a marginally non-statistically significant increase was shown in any functional impairment (RR 1.10, 95% CI 0.99 to 1.23) and cerebral palsy (CP) (RR 1.82, 95% CI 0.99 to 3.34). In subgroup analysis, CP was statistically significantly increased for infants of women allocated to macrolide and beta-lactam antibiotics combined compared with placebo (RR 2.83, 95% CI 1.02 to 7.88; NNTH 35, 95% CI 333 to 9).</P>
+<P>Further, exposure to any macrolide antibiotics (including erythromycin alone or erythromycin plus co-amoxiclav) versus no macrolide antibiotics (including placebo and co-amoxiclav alone) was shown to increase neonatal death (RR 1.52, 95% CI 1.05 to 2.19; NNTH 139, 95% CI 1429 to 61), any functional impairment (RR 1.11, 95% CI 1.01 to 1.20; NNTH 24, 95% CI 263 to 13) and CP (RR 1.90, 95% CI 1.20 to 3.01; NNTH 64, 95% CI 286 to 29). Exposure to any beta-lactam (beta-lactam alone or in combination with macrolide antibiotics) versus no beta-lactam antibiotics resulted in more neonatal deaths (RR 1.51, 95% CI 1.06 to 2.15; NNTH 143, 95% CI 1250 to 63) and CP (RR 1.67, 95% CI 1.06 to 2.61; NNTH 79, 95% CI 909 to 33), however no difference was shown in functional impairment.</P>
+<P>Maternal infection was reduced with the use of any prophylactic antibiotics compared with placebo (RR 0.74, 95% CI 0.63 to 0.86; NNTB 34, 95% CI 24 to 63) and any beta-lactam compared with no beta-lactam antibiotics (RR 0.80, 95% CI 0.69 to 0.92; NNTB 47, 95% CI 31 to 119). However, caution should be exercised with this finding due to the possibility of bias shown by funnel plot asymmetry. Any beta-lactam compared with no beta-lactam antibiotics was associated with an increase in maternal adverse drug reaction (RR 1.61, 95% CI 1.02 to 2.54; NNTH 17, 95% CI 526 to 7).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>This review did not demonstrate any benefit in important neonatal outcomes with the use of prophylactic antibiotics for women in preterm labour with intact membranes, although maternal infection may be reduced. Of concern, is the finding of short- and longer-term harm for children of mothers exposed to antibiotics. The evidence supports not giving antibiotics routinely to women in preterm labour with intact membranes in the absence of overt signs of infection.</P>
+<P>Further research is required to develop sensitive markers of subclinical infection for women in preterm labour with intact membranes, as this is a group that might benefit from future novel interventions, including new modalities of antibiotic therapy. The results of this review demonstrate the need for future trials in the area of preterm birth to include assessment of long-term neurodevelopmental outcome.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000284.pub3.en.xml

@@ -0,0 +1,37 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Chlorpromazine versus placebo for schizophrenia</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Chlorpromazine versus placebo for schizophrenia</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>For previous plain language summary please see <A HREF="03">Appendix 3</A>.</P>
+<P>People with schizophrenia often hear voices or see things (hallucinations) and have strange beliefs (delusions). The main treatment for these symptoms of schizophrenia is antipsychotic drugs. Chlorpromazine was one of the first drugs discovered to be effective in the treatment of schizophrenia during the 1950s. It remains one of the most commonly used and inexpensive treatments even today. However, being an older drug (‘typical’ or first generation) it also has serious side effects, such as blurred vision, a dry mouth, tremors or uncontrollable shaking, depression, muscle stiffness and restlessness.</P>
+<P>An update search was carried out in 2012 and the review now includes 55 studies that assess the effects of chlorpromazine in treating schizophrenia compared with no active treatment (‘dummy’ treatment or placebo). Evidence was, in the main, rated by the review authors as low quality. There is some evidence to suggest that chlorpromazine reduces relapse and improves people’s mental health, symptoms and functioning. However, the side effects of chlorpromazine are severe and debilitating. Chlorpromazine causes sleepiness and sedation. It also causes movement disorders (such as tremors and uncontrollable shaking), considerable weight gain and lowering of blood pressure with accompanying dizziness.</P>
+<P>Chlorpromazine is low-cost and widely available. Despite its many side effects, chlorpromazine is likely to remain a benchmark drug and one of the most widely used treatments for schizophrenia worldwide.</P>
+<P>It should be noted that the quality of evidence from the 55 included studies was low and in addition to this, 315 studies were excluded because of flaws in the reporting of information or data and in research design and methods. Larger, better conducted and reported trials should focus on important outcomes such as quality of life, levels of satisfaction, relapse, hospital discharge or admission and number of violent incidents.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Chlorpromazine, formulated in the 1950s, remains a benchmark treatment for people with schizophrenia.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To review the effects of chlorpromazine compared with placebo, for the treatment of schizophrenia.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Schizophrenia Group’s Trials Register (15 May 2012). We also searched references of all identified studies for further trial citations. We contacted pharmaceutical companies and authors of trials for additional information.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>We included all randomised controlled trials (RCTs) comparing chlorpromazine with placebo for people with schizophrenia and non-affective serious/chronic mental illness irrespective of mode of diagnosis. Primary outcomes of interest were death, violent behaviours, overall improvement, relapse and satisfaction with care.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>We independently inspected citations and abstracts, ordered papers, re-inspected and quality assessed these. We analysed dichotomous data using risk ratio (RR) and estimated the 95% confidence interval (CI) around this. We excluded continuous data if more than 50% of participants were lost to follow-up. Where continuous data were included, we analysed this data using mean difference (MD) with a 95% confidence interval. We used a fixed-effect model.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We inspected over 1100 electronic records. The review currently includes 315 excluded studies and 55 included studies. The quality of the evidence is very low. We found chlorpromazine reduced the number of participants experiencing a relapse compared with placebo during six months to two years follow-up (n = 512, 3 RCTs, RR 0.65 CI 0.47 to 0.90), but data were heterogeneous. No difference was found in relapse rates in the short, medium or long term over two years, although data were also heterogeneous. We found chlorpromazine provided a global improvement in a person's symptoms and functioning (n = 1164, 14 RCTs, RR 0.71 CI 0.58 to 0.86). Fewer people allocated to chlorpromazine left trials early ( n = 1831, 27 RCTs, RR 0.64 CI 0.53 to 0.78) compared with placebo. There are many adverse effects. Chlorpromazine is clearly sedating (n = 1627, 23 RCTs, RR 2.79 CI 2.25 to 3.45), it increases a person's chances of experiencing acute movement disorders (n = 942, 5 RCTs, RR 3.47 CI 1.50 to 8.03) and parkinsonism (n = 1468, 15 RCTs, RR 2.11 CI 1.59 to 2.80). Akathisia did not occur more often in the chlorpromazine group than placebo. Chlorpromazine clearly causes a lowering of blood pressure with accompanying dizziness (n = 1488, 18 RCTs, RR 2.38 CI 1.74 to 3.25) and considerable weight gain (n = 165, 5 RCTs, RR 4.92 CI 2.32 to 10.43).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>The results of this review confirm much that clinicians and recipients of care already know but aim to provide quantification to support clinical impression. Chlorpromazine's global position as a 'benchmark' treatment for psychoses is not threatened by the findings of this review. Chlorpromazine, in common use for half a century, is a well-established but imperfect treatment. Judicious use of this best available evidence should lead to improved evidence-based decision making by clinicians, carers and patients.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000332.pub3.en.xml

@@ -0,0 +1,46 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Erythropoiesis-stimulating agents for anemia in rheumatoid arthritis</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Erythropoiesis-stimulating agents for anemia in rheumatoid arthritis</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Researchers in the Cochrane Collaboration conducted a review of the effect of erythropoiesis-stimulating agents for anemia in patients with rheumatoid arthritis.  After searching for all relevant studies, they found three studies covering 133 people. Their findings are summarised below:</P>
+<P>The review shows that in people with anemia and rheumatoid arthritis:</P>
+<P>- it is uncertain whether erythropoiesis-stimulating agents improve quality of life or hemoglobin levels.<BR/>- it is unknown whether erythropoiesis-stimulating agents improve fatigue, as this was not measured by the studies.</P>
+<P>We do not have precise information about side effects and complications. This is particularly true for rare but serious side effects, which may include thromboembolic complications. </P>
+<P>
+<B>What is anemia in rheumatoid arthritis and what are erythropoiesis-stimulating agents? </B>
+<BR/>
+</P>
+<P>When you have rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints. This makes them swollen, stiff and painful. The small joints of the hands and feet are usually affected first.  As the disease progresses, other complications may appear, including anemia (low hemoglobin level). Hemoglobin is a protein in red blood cells that carries oxygen.  Anemia is a condition in which the body does not have enough healthy red blood cells.  Erythropoietin is a hormone produced in the kidney, which increases the production of red blood cells. Erythropoiesis-stimulating agents work to increase red blood cell production. </P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Rheumatoid arthritis (RA) is a chronic and systemic inflammatory disorder that mainly affects the small joints of the hands and feet. Erythropoiesis-stimulating agents have been used to treat anemia, one of the extra-articular manifestations of RA. Although anemia is less of a problem now because of the reduction in inflammation due to disease-modifying antirheumatic drugs (DMARDs), it could still be an issue in countries where DMARDs are not yet accessible.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>We assessed the clinical benefits and harms of erythropoiesis-stimulating agents for anemia in rheumatoid arthritis.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in <I>The Cochrane Library</I> (issue 7 2012), Ovid MEDLINE and Ovid MEDLINE(R) In-Process &amp; Other Non-Indexed Citations (1948 to 7 August 2012), OVID EMBASE (1980 to 7 August 2012), LILACS (1982 to 7 August 2012), the Clinical Trials Search Portal of the World Health Organization, reference lists of the retrieved publications and review articles. We did not apply any language restrictions.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>We included randomized controlled trials (RCTs) in patients aged 16 years or over, with a diagnosis of rheumatoid arthritis affected by anemia. We considered health-related quality of life, fatigue and safety as the primary outcomes.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two authors independently performed trial selection, risk of bias assessment, and data extraction. We estimated difference in means with 95% confidence intervals (CIs) for continuous outcomes. We estimated risk ratios with 95% CIs for binary outcomes. 
+</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We included three RCTs with a total of 133 participants. All trials compared human recombinant erythropoietin (EPO), for different durations (8, 12 and 52 weeks), versus placebo. All RCTs assessed health-related quality of life. All trials had high or unclear risk of bias for most domains, and were sponsored by the pharmaceutical industry. Two trials administered EPO by a subcutaneous route while the other used an intravenous route. </P>
+<P>We decided not to pool results from trials, due to inconsistencies in the reporting of results.</P>
+<P>Health-related quality of life: subcutaneous EPO – one trial with 70 patients at 52 weeks showed a statistically significant difference in improvement of patient global assessment (median and interquartile range 3.5 (1.0 to 6.0) compared with placebo 4.5 (2.0 to 7.5) (P = 0.027) on a VAS scale (0 to 10)). The other shorter term trials (12 weeks with subcutaneous EPO and eight weeks with intravenous administration) did not find statistically significant differences between treatment and control groups in health-related quality of life outcomes.</P>
+<P>Change in hemoglobin: both trials of subcutaneous EPO showed a statistically significant difference in increasing hemoglobin levels; (i) at  52 weeks (one trial, 70 patients), intervention hemoglobin level (median 134, interquartile range 110 to 158 g/litre) compared with the placebo group level (median 112, interquartile range; 86 to 128 g/litre) (P = 0.0001); (ii) at  12 weeks (one trial, 24 patients) compared with placebo (difference in means 8.00, 95% CI 7.43 to 8.57). Intravenous EPO at eight weeks showed no statistically significant difference in increasing hematocrit level for EPO versus placebo (difference in means 4.69, 95% CI -0.17 to 9.55; P = 0.06).</P>
+<P>Information on withdrawals due to adverse events was not reported in two trials, and one trial found no serious adverse events leading to withdrawals. None of the trials reported withdrawals due to high blood pressure, or to lack of efficacy or to fatigue.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>We found conflicting evidence for erythropoiesis-stimulating agents to increase quality of life and hemoglobin level by treating anemia in patients with rheumatoid arthritis. However, this conclusion is based on randomized controlled trials with a high risk of bias, and relies on trials assessing human recombinant erythropoietin (EPO). The safety profile of EPO is unclear. Future trials assessing erythropoiesis-stimulating agents for anemia in rheumatoid arthritis should be conducted by independent researchers and reported according to the CONSORT statements. Trials should be based on Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) and The Patient-Centered Outcomes Research Institute (PCORI) approaches for combining both clinician and patient perspectives.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000366.pub3.en.xml

@@ -0,0 +1,40 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Inositol in preterm infants at risk for or having respiratory distress syndrome</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Supplementing preterm babies who have respiratory distress with the nutrient inositol may reduce death and disability</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Review question</P>
+<P>Does the administration of supplementary inositol reduce adverse outcomes in preterm infants with or without respiratory distress syndrome (RDS)?</P>
+<P>Background</P>
+<P>Inositol is an essential nutrient for cells, with high concentrations in breast milk (particularly in the breast milk of mothers whose babies have been born early). A drop in inositol levels in babies with respiratory distress syndrome (RDS) can be a sign that their illness will be severe.</P>
+<P>Study characteristics</P>
+<P>Four published randomised controlled trials met our inclusion criteria.</P>
+<P>Results</P>
+<P>We found that the initial evidence regarding inositol supplementation in preterm babies with RDS is promising. Supplementation lowered rates of death and bleeding in the brain, with an important reduction in eye problems as well. Inositol did not have serious adverse effects. Further research is warranted to confirm these preliminary findings. Such research is currently ongoing in the USA.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Inositol is an essential nutrient required by human cells in culture for growth and survival. Inositol promotes maturation of several components of surfactant and may play a critical role in fetal and early neonatal life.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effectiveness and safety of supplementary inositol in preterm infants with or without respiratory distress syndrome (RDS) in reducing adverse neonatal outcomes.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>The Cochrane Central Register of Controlled Trials (CENTRAL) in <I>The Cochrane Library</I>, MEDLINE, EMBASE, CINAHL, Clinicaltrials.gov and Controlled-trials.com were searched in September 2014. The reference lists of identified randomised controlled trials (RCTs), personal files and Web of Science were searched.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>All RCTs of inositol supplementation of preterm infants compared with a control group that received a placebo or no intervention were included. Outcomes of interest were neonatal death, infant death, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC) and sepsis.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Data on neonatal outcomes were abstracted independently by the three review authors and any discrepancy was resolved through consensus. Outcomes were reported as relative risk (RR), risk difference (RD) and number needed to treat to benefit (NNTB) or to harm (NNTH).</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Four published RCTs and one ongoing RCT were identified. Study quality varied and interim analyses had occurred in all trials of repeat doses of inositol that provided data for the outcomes of interest in this review. In these trials neonatal death was found to be significantly reduced (3 trials, 355 neonates; typical RR 0.53, 95% CI 0.31 to 0.91; typical RD -0.09, 95% CI -0.17 to -0.03; NNTB 11, 95% CI 6 to 33). Infant deaths were reduced (3 trials, 355 infants; typical RR 0.55, 95% CI 0.40 to 0.77; typical RD -0.18, 95% CI -0.27 to -0.08; NNTB 6, 95% CI 4 to 13). ROP stage ≥ 3 was significantly reduced (2 trials, 262 infants; typical RR 0.09, 95% CI 0.01 to 0.67; typical RD -0.08, 95% CI -0.13 to -0.03; NNTB 13, 95% CI 8 to 33) and IVH grade &gt; II was significantly decreased (3 trials, 355 infants; typical RR 0.53, 95% CI 0.31 to 0.90; typical RD -0.09, 95% CI -0.16 to -0.02; NNTB 11, 95% CI 6 to 50). Neither sepsis nor NEC differed significantly between groups. One study (74 infants) that administered a single dose of inositol (60 or 120 mg/kg) found no significant differences in adverse outcomes using RR, but an increased RD for BPD at 36 weeks postmenstrual age (RD 0.23, 95% CI 0.03 to 0.43; NNTH 4, 95% CI 2 to 33). This result should be interpreted with caution as only one dose of inositol was given and only the RD, but not the RR, was significant. One ongoing large study of repeat doses of inositol in preterm infants was identified.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Inositol supplementation results in statistically significant and clinically important reductions in important short-term adverse neonatal outcomes. A large size multi-centre randomised controlled trial is currently ongoing and the trial will likely confirm or refute the findings from this systematic review.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000387.pub2.en.xml

@@ -0,0 +1,17 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Interventions for treating chronic pelvic pain in women</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE/>
+    <SUMMARY_BODY/>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND/>
+    <ABS_OBJECTIVES/>
+    <ABS_SEARCH_STRATEGY/>
+    <ABS_SELECTION_CRITERIA/>
+    <ABS_DATA_COLLECTION/>
+    <ABS_RESULTS/>
+    <ABS_CONCLUSIONS/>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000406.pub4.en.xml

@@ -0,0 +1,55 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Oral calorie supplements for cystic fibrosis</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Use of oral supplements to increase calorie intake in people with cystic fibrosis</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>We reviewed the evidence for the use of oral supplements to increase calorie intake in people with cystic fibrosis.</P>
+<P>
+<B>Background</B>
+</P>
+<P>Cystic fibrosis affects many organs, including the digestive system, and can lead to food not being absorbed as it should be, which in turn leads to growth problems. Children with cystic fibrosis need more energy than other children, but they often have reduced appetites. Poor diet has been linked to poor outcomes in cystic fibrosis. Milks or juices containing additional calories are often added to the diets of children with cystic fibrosis to increase their total daily calorie intake and help them gain weight. However, these supplements are expensive and may not achieve the desired effect if patients take them as a substitute for calories consumed from food rather than as an additional component. In toddlers or young children use of supplements may risk compromising the development of normal eating behaviour.</P>
+<P>
+<B>Search date</B>
+</P>
+<P>We last searched for evidence on 03 July 2014.</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>This review includes three randomised controlled trials with a total of 131 volunteers and two of them only included children. Two of the trials compared supplements to dietary advice and one compared supplements to no advice. The trials lasted between three months and one year.</P>
+<P>
+<B>Key results</B>
+</P>
+<P>There were no major differences between people receiving supplements or just dietary advice for any nutritional or growth measurements. This was also true for measures of body composition, lung function, adverse effects on the digestive system or people's levels of activity. Advice and monitoring appear to be enough to manage the diet of moderately malnourished children.</P>
+<P>Future trials should look into the use of calorie supplements for acute weight loss or long-term care for adults with cystic fibrosis.</P>
+<P>
+<B>Quality of the evidence</B>
+</P>
+<P>One of the trials appeared to be well run and the risk of bias was low for all the aspects of trial design that we assessed; so we do not think any bias will influence the results in a negative way. In both the other two trials, we were not sure if the people taking part could guess which treatment group they were in. In one of these two trials, we further thought it was likely that the person recruiting them to the trial knew which group the participant would be in. In the second of these trials, the volunteers in the group receiving supplements appeared to be generally in better clinical condition at the start of the trial than those who didn't receive any supplements or advice. These factors affect our confidence in the results from these trials.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Poor nutrition occurs frequently in people with cystic fibrosis (CF) and is associated with other adverse outcomes. Oral calorie supplements are used to increase total daily calorie intake and improve weight gain. However, they are expensive and there are concerns they may reduce the amount of food eaten and not improve overall energy intake.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To establish whether in people with CF, oral calorie supplements: increase daily calorie intake; and improve overall nutritional intake, nutritional indices, lung function, survival and quality of life. To assess adverse effects associated with using these supplements.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane CF Trials Register comprising references from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. We contacted companies marketing oral calorie supplements.</P>
+<P>Last search: 03 July 2014.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised or quasi-randomised controlled trials comparing use of oral calorie supplements for at least one month to increase calorie intake with no specific intervention or additional nutritional advice in people with CF.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>We independently selected the included trials, assessed risk of bias and extracted data. We contacted the authors of included trials and obtained additional information for two trials.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We identified 21 trials and included three, reporting results from 131 participants lasting between three months and one year. Two trials compared supplements to additional nutritional advice and one to no intervention. Two of the included trials recruited only children. In one trial the risk of bias was low across all domains, in a second trial the risk of bias was largely unclear and in the third mainly low. Blinding of participants was unclear in two of the trials. Also, in one trial the clinical condition of groups appeared to be unevenly balanced at baseline and in another trial there were concerns surrounding allocation concealment. There were no significant differences between people receiving supplements or dietary advice alone for change in weight, height, body mass index, z score or other indices of nutrition or growth. Changes in weight (kg) at three, six and twelve months respectively were: MD 0.32 (95% CI -0.09 to 0.72); MD 0.47 (95% CI -0.07 to 1.02 ); and MD 0.16 (-0.68 to 1.00). Total calorie intake was greater in people taking supplements at 12 months, MD 265.70 (95% CI 42.94 to 488.46). There were no significant differences between the groups for anthropometric measures of body composition, lung function, gastrointestinal adverse effects or activity levels.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Oral calorie supplements do not confer any additional benefit in the nutritional management of moderately malnourished children with CF over and above the use of dietary advice and monitoring alone. While nutritional supplements may be used, they should not be regarded as essential. Further randomised controlled trials are needed to establish the role of short-term oral protein energy supplements in people with CF and acute weight loss and also for the long-term nutritional management of adults with CF or advanced lung disease, or both.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000503.pub3.en.xml

@@ -0,0 +1,34 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Most babies born before 37 weeks of pregnancy (preterm babies) are not developed enough to take all the water and nutrients they need by mouth. As a result, they are unable to regulate their intake of water. Inadequate water intake can cause the baby to become dehydrated. Excessive water intake can cause heart and lung problems or intestinal damage. Systematic review of trials related to this issue leads to the conclusion that careful restriction of water for preterm babies, to amounts that meet their physical needs without causing dehydration, reduces the risk of certain complications. More research on this topic is needed.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Most premature infants are physiologically not sufficiently mature to orally ingest all of their required water and nutrients. Therefore, premature infants rely on their caregivers to regulate their volume of water intake. Thus, the caregiver must determine the amount of water to be given each day to such infants.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To determine the effect of water intake on postnatal weight loss and the risks of dehydration, patent ductus arteriosus, necrotizing enterocolitis, bronchopulmonary dysplasia, intracranial hemorrhage, and death in premature infants.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>Randomized clinical trials (RCTs) identified in previous versions of this review were re-examined and, in each case, retained. Additional trials were sought that compared the outcomes of interest in groups of premature infants who were given different levels of water intake according to an experimental protocol. Such trials were sought in a list of trials provided by the Cochrane Neonatal Review Group, with a PubMed search and in the authors' personal files.</P>
+<P>This search was updated in 2014.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Only RCTs of varying water intake in premature infants were included. The review was limited to trials that included infants whose water intake was provided mainly or entirely by intravascular infusion.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>The standard methods of The Cochrane Collaboration were used. Study selection and data abstraction were performed independently by each review author. The adverse event rates were calculated for the restricted and liberal water intake groups for each dichotomous outcome, and the relative risk and risk difference were computed. In addition, the maximal weight loss results were recorded and the weighted mean difference was computed.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>The analysis of the five studies taken together indicated that restricted water intake significantly increased postnatal weight loss and significantly reduced the risks of patent ductus arteriosus and necrotizing enterocolitis. With restricted water intake, there were trends toward increased risk of dehydration and reduced risks of bronchopulmonary dysplasia, intracranial hemorrhage, and death but these trends were not statistically significant.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Based on this analysis, the most prudent prescription for water intake to premature infants would seem to be careful restriction of water intake so that physiological needs are met without allowing significant dehydration. This practice could be expected to decrease the risks of patent ductus arteriosus and necrotizing enterocolitis without significantly increasing the risk of adverse consequences.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000530.pub3.en.xml

@@ -0,0 +1,41 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Echinacea for preventing and treating the common cold</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Echinacea for preventing and treating the common cold</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Preparations of the plant <I>Echinacea</I> are widely used in some European countries and in North America for common colds. <I>Echinacea</I> preparations available on the market differ greatly as different types (species) and parts (herb, root or both) of the plant are used, different manufacturing methods (drying, alcoholic extraction or pressing out the juice from fresh plants) are used and sometimes also other herbs are added.</P>
+<P>We reviewed 24 controlled clinical trials with 4631 participants investigating the effectiveness of several different <I>Echinacea</I> preparations for preventing and treating common colds or induced rhinovirus infections. Our review shows that a variety of products prepared from different <I>Echinacea</I> species, different plant parts and in a different form have been compared to placebo in randomized trials. Due to the significant differences in the preparations tested, it was difficult to draw strong conclusions. Five trials were rated as having a low risk of bias in all five categories of the Cochrane 'Risk of bias' tool. Five more trials were rated as low risk of bias, having an unclear risk of bias in only one category. Eight trials were rated as having a high risk of bias in at least one category and the remaining six as having an unclear risk of bias.</P>
+<P>The majority of trials investigated whether taking <I>Echinacea</I> preparations after the onset of cold symptoms shortens the duration, compared with placebo. Although it seems possible that some <I>Echinacea</I> products are more effective than a placebo for treating colds, the overall evidence for clinically relevant treatment effects is weak. In general, trials investigating <I>Echinacea</I> for preventing colds did not show statistically significant reductions in illness occurrence. However, nearly all prevention trials pointed in the direction of small preventive effects. The number of patients dropping out or reporting adverse effects did not differ significantly between treatment and control groups in prevention and treatment trials. However, in prevention trials there was a trend towards a larger number of patients dropping out due to adverse events in the treatment groups.</P>
+<P>The evidence is current to July 2013.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>
+<I>Echinacea </I>plant preparations (family <I>Asteraceae</I>) are widely used in Europe and North America for common colds. Most consumers and physicians are not aware that products available under the term <I>Echinacea</I> differ appreciably in their composition, mainly due to the use of variable plant material, extraction methods and the addition of other components.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess whether there is evidence that <I>Echinacea</I> preparations are effective and safe compared to placebo in the prevention and treatment of the common cold.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched CENTRAL 2013, Issue 5, MEDLINE (1946 to May week 5, 2013), EMBASE (1991 to June 2013), CINAHL (1981 to June 2013), AMED (1985 to February 2012), LILACS (1981 to June 2013), Web of Science (1955 to June 2013), CAMBASE (no time limits), the Centre for Complementary Medicine Research (1988 to September 2007), WHO ICTRP and clinicaltrials.gov (last searched 5 June 2013), screened references and asked experts in the field about published and unpublished studies.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomized controlled trials (RCTs) comparing mono-preparations of <I>Echinacea</I> with placebo.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>At least two review authors independently assessed eligibility and trial quality and extracted data. The primary efficacy outcome was the number of individuals with at least one cold in prevention trials and the duration of colds in treatment trials. For all included trials the primary safety and acceptability outcome was the number of participants dropping out due to adverse events. We assessed trial quality using the Cochrane 'Risk of bias' tool.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Twenty-four double-blind trials with 4631 participants including a total of 33 comparisons of <I>Echinacea</I> preparations and placebo met the inclusion criteria. A variety of different <I>Echinacea</I> preparations based on different species and parts of plant were used. Evidence from seven trials was available for preparations based on the aerial parts of <I>Echinacea purpurea. </I>
+</P>
+<P>Ten trials were considered to have a low risk of bias, six to have an unclear risk of bias and eight to have a high risk of bias. Ten trials with 13 comparisons investigated prevention and 15 trials with 20 comparisons investigated treatment of colds (one trial addressed both prevention and treatment).</P>
+<P>Due to the strong clinical heterogeneity of the studies we refrained from pooling for the main analysis. None of the 12 prevention comparisons reporting the number of patients with at least one cold episode found a statistically significant difference. However a <I>post hoc </I>pooling of their results, suggests a relative risk reduction of 10% to 20%. Of the six treatment trials reporting data on the duration of colds, only two showed a significant effect of <I>Echinacea </I>over placebo. The number of patients dropping out or reporting adverse effects did not differ significantly between treatment and control groups in prevention and treatment trials. However, in prevention trials there was a trend towards a larger number of patients dropping out due to adverse events in the treatment groups.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>
+<I>Echinacea </I>products have not here been shown to provide benefits for treating colds, although, it is possible there is a weak benefit from some <I>Echinacea </I>products<I>: </I>the results of individual prophylaxis trials consistently show positive (if non-significant) trends, although potential effects are of questionable clinical relevance.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000544.pub3.en.xml

@@ -0,0 +1,33 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Oral 5-ASA compounds for maintaining remission in ulcerative colitis</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Sulfasalazine (SASP) has been used for treating ulcerative colitis for decades. SASP is made up of 5-aminosalicylic acid (5-ASA) linked to a sulfur molecule. Up to a third of patients treated with SASP have reported side effects, which are thought to be related to the sulfur part of the molecule. Common side effects associated with SASP include nausea, indigestion, headache, vomiting and abdominal pain. 5-ASA drugs were developed to avoid the side effects associated with SASP. This review includes 38 randomized trials with a total of 8127 participants. Oral 5-ASA was found to be more effective than placebo (fake drug) for maintaining remission. Although oral 5-ASA preparations are effective for maintaining remission in ulcerative colitis, they are no more effective than sulfasalazine (SASP) therapy. People who have become well can remain so by continuing to take either medication. There is no evidence that side effects are more frequent with one or the other medication. However, the side effects of 5-ASA may be notably less than those associated with SASP therapy. Common side effects associated with 5-ASA included flatulence, abdominal pain, nausea, diarrhea, headache, dyspepsia (indigestion), and nasopharyngitis (inflammation of the nasal passages). Most of the trials comparing 5-ASA with SASP enrolled patients who were known to tolerate SASP. This may have reduced SASP-related side effects in these trials. Male infertility is associated with SASP and not with 5-ASA, so 5-ASA may be preferred for patients concerned about fertility. 5-ASA therapy is more expensive than SASP, so SASP may be the preferred option where cost is an important factor. Oral 5-ASA administered once daily is as effective and safe as conventional dosing (two or three times daily) for maintaining remission in ulcerative colitis. There does not appear to be any difference in efficacy or safety between the various formulations of 5-ASA. Patients with extensive ulcerative colitis or with frequent relapses may benefit from a higher dose of maintenance therapy. High dose therapy appears to be as safe as low dose and is not associated with a higher incidence of side effects.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Oral 5-aminosalicylic (5-ASA) preparations were intended to avoid the adverse effects of sulfasalazine (SASP) while maintaining its therapeutic benefits. Previously, it was found that 5-ASA drugs were more effective than placebo but had a statistically significant therapeutic inferiority relative to SASP. This updated review includes more recent studies and evaluates the effectiveness, dose-responsiveness, and safety of 5-ASA preparations used for maintenance of remission in quiescent ulcerative colitis.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>The primary objectives were to assess the efficacy, dose-responsiveness and safety of oral 5-ASA compared to placebo, SASP, or 5-ASA comparators for maintenance of remission in quiescent ulcerative colitis. A secondary objective was to compare the efficacy and safety of once daily dosing of oral 5-ASA with conventional (two or three times daily) dosing regimens.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>A literature search for relevant studies (inception to January 20, 2012) was performed using MEDLINE, EMBASE and the Cochrane Library. Review articles and conference proceedings were also searched to identify additional studies.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Studies were accepted for analysis if they were randomized controlled trials with a minimum treatment duration of six months. Studies of oral 5-ASA therapy for treatment of patients with quiescent ulcerative colitis compared with placebo, SASP or other 5-ASA formulations were considered for inclusion. Studies that compared once daily 5-ASA treatment with conventional dosing of 5-ASA and 5-ASA dose ranging studies were also considered for inclusion.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>The primary outcome was the failure to maintain clinical or endoscopic remission. Secondary outcomes included adherence, adverse events, withdrawals due to adverse events, and withdrawals or exclusions after entry. Trials were separated into five comparison groups: 5-ASA versus placebo, 5-ASA versus sulfasalazine, once daily dosing versus conventional dosing, 5-ASA versus comparator 5-ASA formulation, and 5-ASA dose-ranging. Placebo-controlled trials were subgrouped by dosage. Once daily versus conventional dosing studies were subgrouped by formulation. 5-ASA-controlled trials were subgrouped by common 5-ASA comparators (e.g. Asacol and Salofalk). Dose-ranging studies were subgrouped by 5-ASA formulation. We calculated the relative risk (RR) and 95% confidence intervals (95% CI) for each outcome. Data were analyzed on an intention to treat basis.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Thirty-eight studies (8127 patients) were included. The majority of included studies were rated as low risk of bias. Eight studies were rated at high risk of bias. Six of these studies were single-blind and two studies were open-label. However, the two open-label studies and four of the single-blind studies utilized investigator performed endoscopy as an endpoint, which may protect against bias. 5-ASA was significantly superior to placebo for maintenance of clinical or endoscopic remission. Forty-one per cent of 5-ASA patients relapsed compared to 58% of placebo patients (7 studies, 1298 patients; RR 0.69, 95% CI 0.62 to 0.77). There was a trend towards greater efficacy with higher doses of 5-ASA with a statistically significant benefit for the 1 to 1.9 g/day (RR 0.65; 95% CI 0.56 to 0.76) and the <U>&gt;</U> 2 g/day subgroups (RR 0.73, 95% CI 0.60 to 0.89). SASP was significantly superior to 5-ASA for maintenance of remission. Forty-eight per cent of 5-ASA patients relapsed compared to 43% of SASP patients (12 studies, 1655 patients; RR 1.14, 95% CI 1.03 to 1.27). A GRADE analysis indicated that the overall quality of the evidence for the primary outcome for the placebo and SASP-controlled studies was high. No statistically significant differences in efficacy or adherence were found between once daily and conventionally dosed 5-ASA. Twenty-nine per cent of once daily patients relapsed over 12 months compared to 31% of conventionally dosed patients (7 studies, 2826 patients; RR 0.92, 95% CI 0.83 to 1.03). Fourteen per cent of patients in the once daily group failed to adhere to their medication regimen compared to 11% of patients in the conventional dosing group (5 studies, 1161 patients; RR 1.21, 95% CI 0.90 to 1.63). There does not appear to be any difference in efficacy among the various 5-ASA formulations. Thirty-eight per cent of patients in the 5-ASA group relapsed compared to 37% of patients in the 5-ASA comparator group (5 studies, 457 patients; RR 1.01, 95% CI 0.80 to 1.28). A pooled analysis of two studies showed no statistically significant difference in efficacy between Balsalazide 6 g and 3 g/day. Twenty-three per cent of patients in the 6 g/day group relapsed compared to 33% of patients in the 3 g/day group (216 patients; RR 0.72; 95% CI 0.46 to 1.13). One study found Balsalazide 4 g to be superior to 2 g/day. Thirty-seven per cent of patients in the 4 g/day Balsalazide group relapsed compared to 55% of patients in the 2 g/day group (133 patients; RR 0.66; 95% CI 0.45 to 0.97). One study found a statistically significant difference between Salofalk granules 3 g and 1.5 g/day. Twenty-five per cent of patients in the Salofalk 3 g/day group relapsed compared to 39% of patients in the 1.5 g/day group (429 patients; RR 0.65; 95% CI 0.49 to 0.86). Common adverse events included flatulence, abdominal pain, nausea, diarrhea, headache, dyspepsia, and nasopharyngitis. There were no statistically significant differences in the incidence of adverse events between 5-ASA and placebo, 5-ASA and SASP, once daily and conventionally dosed 5-ASA, 5-ASA and comparator 5-ASA formulations and 5-ASA dose ranging studies. The trials that compared 5-ASA and SASP may have been biased in favour of SASP because most trials enrolled patients known to be tolerant to SASP which may have minimized SASP-related adverse events.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>5-ASA was superior to placebo for maintenance therapy in ulcerative colitis. However, 5-ASA had a statistically significant therapeutic inferiority relative to SASP. Oral 5-ASA administered once daily is as effective and safe as conventional dosing for maintenance of remission in quiescent ulcerative colitis. There does not appear to be any difference in efficacy or safety between the various formulations of 5-ASA. Patients with extensive ulcerative colitis or with frequent relapses may benefit from a higher dose of maintenance therapy. High dose therapy appears to be as safe as low dose and is not associated with a higher incidence of adverse events.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000937.pub2.en.xml

@@ -0,0 +1,38 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Magnesium supplementation in pregnancy</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>There is not enough high quality evidence to show that dietary magnesium supplementation during pregnancy is beneficial</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Many women, especially those from disadvantaged backgrounds, have intakes of magnesium below recommended levels. Magnesium supplementation during pregnancy may be able to reduce growth restriction of the fetus and pre-eclampsia (high blood pressure and protein in the urine during pregnancy), and increase birthweight. This review aimed to assess the effects of magnesium supplementation during pregnancy on maternal, neonatal and paediatric outcomes.</P>
+<P>We included 10 randomised trials involving 9090 women and their babies in this review. These trials were of a low to moderate quality overall. No difference in the risk of perinatal mortality (stillbirth and death of babies prior to hospital discharge) was found when we compared the group of babies born to mothers who received magnesium during their pregnancy and the group of babies born to mothers who did not receive magnesium. Magnesium supplementation did not reduce the risk of babies being born small for their gestational age, and did not reduce the risk of pre-eclampsia for the mothers.</P>
+<P>We found no convincing evidence that magnesium supplementation during pregnancy is beneficial.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Magnesium is an essential mineral required for regulation of body temperature, nucleic acid and protein synthesis and in maintaining nerve and muscle cell electrical potentials. Many women, especially those from disadvantaged backgrounds, have low intakes of magnesium. Magnesium supplementation during pregnancy may be able to reduce fetal growth restriction and pre-eclampsia, and increase birthweight.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of magnesium supplementation during pregnancy on maternal, neonatal/infant and paediatric outcomes.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised and quasi-randomised trials assessing the effects of dietary magnesium supplementation during pregnancy were included. The primary outcomes were perinatal mortality (including stillbirth and neonatal death prior to hospital discharge), small-for-gestational age, maternal mortality and pre-eclampsia.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Ten trials involving 9090 women and their babies were included; one trial had a cluster design (with randomisation by study centre). All 10 trials randomly allocated women to either an oral magnesium supplement or a control group; in eight trials a placebo was used, and in two trials no treatment was given to the control group. In the 10 included trials, the compositions of the magnesium supplements, gestational ages at commencement, and doses administered varied, including: magnesium oxide, 1000 mg daily from ≤ four months post-conception (one trial); magnesium citrate, 365 mg daily from ≤ 18 weeks until hospitalisation after 38 weeks (one trial), and 340 mg daily from nine to 27 weeks' gestation (one trial); magnesium gluconate, 2 to 3 g from 28 weeks' gestation until birth (one trial), and 4 g daily from 23 weeks' gestation (one trial); magnesium aspartate, 15 mmol daily (three trials, commencing from either six to 21 weeks' gestation until birth, ≤ 16 weeks' gestation until birth, or &lt; 12 weeks until birth), or 365 mg daily from 13 to 24 weeks until birth (one trial); and magnesium stearate, 128 mg elemental magnesium from 10 to 35 weeks until birth (one trial). </P>
+<P>In the analysis of all trials, oral magnesium supplementation compared to no magnesium was associated with no significant difference in perinatal mortality (stillbirth and neonatal death prior to discharge) (risk ratio (RR) 1.10; 95% confidence interval (CI) 0.72 to 1.67; five trials, 5903 infants), small-for-gestational age (RR 0.76; 95% CI 0.54 to 1.07; three trials, 1291 infants), or pre-eclampsia (RR 0.87; 95% CI 0.58 to 1.32; three trials, 1042 women). None of the included trials reported on maternal mortality.</P>
+<P>Considering secondary outcomes, while no increased risk of stillbirth was observed, a possible increased risk of neonatal death prior to hospital discharge was shown for infants born to mothers who had received magnesium (RR 2.21; 95% CI 1.02 to 4.75; four trials, 5373 infants). One trial contributed over 70% of the participants to the analysis for this outcome; the trial authors suggested that the large number of severe congenital anomalies in the supplemented group (unlikely attributable to magnesium) and the deaths of two sets of twins (with birthweights &lt; 750 g) in the supplemented group likely accounted for the increased risk of death observed, and thus this result should be interpreted with caution. Furthermore, when the deaths due to severe congenital abnormalities in this trial were excluded from the meta-analysis, no increased risk of neonatal death was seen for the magnesium supplemented group. Magnesium supplementation was associated with significantly fewer babies with an Apgar score less than seven at five minutes (RR 0.34; 95% CI 0.15 to 0.80; four trials, 1083 infants), with meconium-stained liquor (RR 0.79; 95% CI 0.63 to 0.99; one trial, 4082 infants), late fetal heart decelerations (RR 0.68; 95% CI 0.53 to 0.88; one trial, 4082 infants), and mild hypoxic-ischaemic encephalopathy (RR 0.38; 95% CI 0.15 to 0.98; one trial, 4082 infants). Women receiving magnesium were significantly less likely to require hospitalisation during pregnancy (RR 0.65, 95% CI 0.48 to 0.86; three trials, 1158 women).</P>
+<P>Of the 10 trials included in the review, only two were judged to be of high quality overall. When an analysis was restricted to these two trials none of the review's primary outcomes (perinatal mortality, small-for-gestational age, pre-eclampsia) were significantly different between the magnesium supplemented and control groups.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There is not enough high-quality evidence to show that dietary magnesium supplementation during pregnancy is beneficial.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000951.pub2.en.xml

@@ -0,0 +1,72 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Folic acid or folinic acid for reducing side effects of methotrexate for people with rheumatoid arthritis</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Researchers in The Cochrane Collaboration conducted a review of the effect of folic acid or folinic acid for people taking methotrexate for rheumatoid arthritis. After searching for all relevant studies, six studies with up to 624 people were included in the review. Their findings are summarized below.</P>
+<P>
+<B>In people with rheumatoid arthritis who take methotrexate (MTX): </B>
+</P>
+<P>- Taking either folic or folinic acid probably improves some side effects of MTX such as nausea and abdominal pain</P>
+<P>- Taking either folic or folinic acid probably reduces the chance of developing abnormal liver blood tests</P>
+<P>- Taking either folic or folinic acid probably helps people continue on their MTX treatment</P>
+<P>- Taking either folic or folinic acid may improve some side effects of MTX such as mouth sores</P>
+<P>- We are unable to ascertain whether or not taking folic or folinic acid with MTX prevents neutropenia (problems with producing white blood cells)</P>
+<P>- Taking folic or folinic acid with MTX probably has no effect on how well MTX is able to treat rheumatoid arthritis.</P>
+<P>
+<B>What are folic acid and folinic acids and why do people take them with MTX? </B>
+</P>
+<P>Folic acid and folinic acid are forms of vitamin B9. The human body needs folate to perform many functions, including cell division, growth, and the production of new red blood cells. Folinic acid is chemically different to folic acid but both work in a similar way. If a person does not have enough folic acid or folinic acid, it is called a folate deficiency. MTX (a medication that is commonly prescribed to treat rheumatoid arthritis) works by blocking some of the effects of folic acid. A folate deficiency may cause side effects such as mouth sores, stomach problems such as nausea or abdominal pain, liver problems or problems with producing blood cells. These side effects are sometimes bad enough that they cause people to stop taking MTX (discontinue treatment).</P>
+<P>
+<B>Best estimate of what happens to people who take folic acid or folinic acid while on MTX<BR/>
+</B>
+</P>
+<P>Stomach problems such as nausea, vomiting or abdominal pain:</P>
+<P>- 9 fewer people out of 100 experienced stomach problems such as nausea up to 6 to 12 months after starting folic acid or folinic acid with their MTX (9.0% absolute improvement);</P>
+<P>- 35 people out of 100 experienced stomach problems such as nausea when they took MTX alone for their rheumatoid arthritis;</P>
+<P>- 26 people out of 100 experienced stomach problems such as nausea when they took folic acid or folinic acid with their MTX.</P>
+<P>Liver problems (as measured by abnormal liver blood tests):</P>
+<P>- 16 fewer people out of 100 had liver problems up to 6 to 12 months after they starting folic acid or folinic acid with their MTX (16.0% absolute improvement);</P>
+<P>- 21 people out of 100 experienced abnormal liver blood tests when they took MTX alone for their rheumatoid arthritis;</P>
+<P>- 5 people out of 100 experienced abnormal liver blood tests when they took folic acid or folinic acid with their MTX.</P>
+<P>Ability to continue on MTX treatment:</P>
+<P>- 15 fewer people out of 100 who took folic acid or folinic acid dropped out of the studies for any reason (15.2% absolute improvement);</P>
+<P>- 25 people out of 100 who took a placebo (fake folic acid or folinic acid) with their MTX dropped out of the studies for any reason;</P>
+<P>- 10 people out of 100 who took folic acid or folinic acid with their MTX dropped out of the studies for any reason.</P>
+<P>Mouth sores or ulcers:</P>
+<P>- 6 fewer people out of 100 who took folic acid or folinic acid with their MTX developed mouth sores (6.2% absolute improvement);</P>
+<P>- 22 people out of 100 who took a placebo (fake folic acid) with their MTX developed mouth sores or ulcers;</P>
+<P>- 16 people out of 100 who took folic acid or folinic acid with their MTX developed mouth sores or ulcers.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Methotrexate (MTX) is a disease modifying antirheumatic drug (DMARD) used as a first line agent for treating rheumatoid arthritis (RA). Pharmacologically, it is classified as an antimetabolite due to its antagonistic effect on folic acid metabolism. Many patients treated with MTX experience mucosal, gastrointestinal, hepatic or haematologic side effects. Supplementation with folic or folinic acid during treatment with MTX may ameliorate these side effects.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To identify trials of supplementation with folic acid or folinic acid during MTX therapy for rheumatoid arthritis and to assess the benefits and harms of folic acid and folinic acid (a) in reducing the mucosal, gastrointestinal (GI), hepatic and haematologic side effects of MTX, and (b) whether or not folic or folinic acid supplementation has any effect on MTX benefit.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We originally performed MEDLINE searches, from January 1966 to June 1999. During the update of this review, we searched additional databases and used a sensitive search strategy designed to retrieve all trials on folic acid or folinic acid for rheumatoid arthritis from 1999 up to 2 March 2012.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>We selected all double-blind, randomised, placebo-controlled clinical trials (RCTs) in which adult patients with rheumatoid arthritis were treated with MTX (at a dose equal to or less than 25 mg/week) concurrently with folate supplementation. In this update of the review we only included trials using 'low dose' folic or folinic acid (a starting dose of ≤ 7 mg weekly).</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Data were extracted from the trials, and the trials were independently assessed for risk of bias using a predetermined set of criteria. </P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Six trials with 624 patients were eligible for inclusion. Most studies had low or unclear risk of bias for key domains. The quality of the evidence was rated as 'moderate' for each outcome as assessed by GRADE, with the exception of haematologic side effects which were rated as 'low'. There was no significant heterogeneity between trials, including where folic acid and folinic acid studies were pooled.</P>
+<P>For patients supplemented with any form of exogenous folate (either folic or folinic acid) whilst on MTX therapy for rheumatoid arthritis, a 26% relative (9% absolute) risk reduction was seen for the incidence of GI side effects such as nausea, vomiting or abdominal pain (RR 0.74, 95% CI 0.59 to 0.92; P = 0.008). Folic and folinic acid also appear to be protective against abnormal serum transaminase elevation caused by MTX, with a 76.9% relative (16% absolute) risk reduction (RR 0.23, 95% CI 0.15 to 0.34; P &lt; 0.00001), as well as reducing patient withdrawal from MTX for any reason (60.8% relative (15.2% absolute) risk reduction, RR<B> </B>0.39, 95% CI 0.28 to 0.53; P &lt; 0.00001).</P>
+<P>We analysed the effect of folic or folinic acid on the incidence of stomatitis / mouth sores, and whilst showing a trend towards reduction in risk, the results were not statistically significant (RR 0.72, 95% CI 0.49 to 1.06)</P>
+<P>It was not possible to draw meaningful conclusions on the effect of folic or folinic acid on haematologic side effects of methotrexate due to small numbers of events and poor reporting of this outcome in included trials.</P>
+<P>It does not appear that supplementation with either folic or folinic acid has a statistically significant effect on the efficacy of MTX in treating RA (as measured by RA disease activity parameters such as tender and swollen joint counts, or physician's global assessment scores).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>The results support a protective effect of supplementation with either folic or folinic acid for patients with rheumatoid arthritis during treatment with MTX.</P>
+<P>There was a clincally important significant reduction shown in the incidence of GI side effects, hepatic dysfunction (asmeasured by elevated serum transaminase levels) as well as a clincally important significant reduction in discontinuation of MTX treatment for any reason. A trend towards a reduction in stomatitis was demonstrated however this did not reach statistical significance.</P>
+<P>This updated review with its focus on lower doses of folic acid and folinic acid and updated assessment of risk of bias aimed to give a more precise and more clinically relevant estimate of the benefit of folate supplementation for patients with rheumatoid arthritis receiving methotrexate.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000963.pub3.en.xml

@@ -0,0 +1,50 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Multidisciplinary biopsychosocial rehabilitation for chronic low back pain</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Multidisciplinary treatment for back pain</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Review question</B>
+</P>
+<P>Is treatment involving a team of therapists from several different clinical professions helpful for people with long-term back pain?</P>
+<P>
+<B>Background</B>
+</P>
+<P>Low back pain (LBP) is a condition that causes a great deal of pain and suffering across the world and also accounts for large costs to society due to healthcare spending and missed work. Previous research has shown that LBP that has persisted for several months or years is often associated with psychological and social problems. Multidisciplinary treatments target physical as well as psychological and social aspects of LBP and involve a team of healthcare providers with different professional backgrounds and training.</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>We collected all the published studies up to February 2014; there were 41 studies (with 6858 participants) that compared multidisciplinary treatment to other treatments. Most studies compared a multidisciplinary treatment to usual care (such as care by a general practitioner) or to treatments that only addressed physical factors (such as exercise or physiotherapy). All the people in the studies had LBP for more than three months and most had received some other sort of treatment previously.</P>
+<P>
+<B>Key results</B>
+</P>
+<P>There was moderate quality evidence that multidisciplinary treatment results in larger improvements in pain and daily function than usual care or treatments aimed only at physical factors. The difference was not very large, about 1 point on a 10 point scale for pain, but this may be important for people whose symptoms have not responded to other treatments. There was also moderate evidence that multidisciplinary treatment doubled the likelihood that people were able to work in the next 6 to 12 months compared to treatments aimed at physical factors.</P>
+<P>While these programs seem to be more effective than alternatives, the effects needs to be balanced with their costs in terms of money, resources and time. Multidisciplinary treatment programs are often quite intensive and expensive, so they are probably most appropriate for people with quite severe or complex problems.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Low back pain (LBP) is responsible for considerable personal suffering worldwide. Those with persistent disabling symptoms also contribute to substantial costs to society via healthcare expenditure and reduced work productivity. While there are many treatment options, none are universally endorsed. The idea that chronic LBP is a condition best understood with reference to an interaction of physical, psychological and social influences, the 'biopsychosocial model', has received increasing acceptance. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To review the evidence on the effectiveness of MBR for patients with chronic LBP. The focus was on comparisons with usual care and with physical treatments measuring outcomes of pain, disability and work status, particularly in the long term.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the CENTRAL, MEDLINE, EMBASE, PsycINFO and CINAHL databases in January and March 2014 together with carrying out handsearches of the reference lists of included and related studies, forward citation tracking of included studies and screening of studies excluded in the previous version of this review.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>All studies identified in the searches were screened independently by two review authors; disagreements regarding inclusion were resolved by consensus. The inclusion criteria were published randomised controlled trials (RCTs) that included adults with non-specific LBP of longer than 12 weeks duration; the index intervention targeted at least two of physical, psychological and social or work-related factors; and the index intervention was delivered by clinicians from at least two different professional backgrounds.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors extracted and checked information to describe the included studies, assessed risk of bias and performed the analyses. We used the Cochrane risk of bias tool to describe the methodological quality. The primary outcomes were pain, disability and work status, divided into the short, medium and long term. Secondary outcomes were psychological functioning (for example depression, anxiety, catastrophising), healthcare service utilisation, quality of life and adverse events. We categorised the control interventions as usual care, physical treatment, surgery, or wait list for surgery in separate meta-analyses. The first two comparisons formed our primary focus. We performed meta-analyses using random-effects models and assessed the quality of evidence using the GRADE method. We performed sensitivity analyses to assess the influence of the methodological quality, and subgroup analyses to investigate the influence of baseline symptom severity and intervention intensity.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>From 6168 studies identified in the searches, 41 RCTs with a total of 6858 participants were included. Methodological quality ratings ranged from 1 to 9 out 12, and 13 of the 41 included studies were assessed as low risk of bias. Pooled estimates from 16 RCTs provided moderate to low quality evidence that MBR is more effective than usual care in reducing pain and disability, with standardised mean differences (SMDs) in the long term of 0.21 (95% CI 0.04 to 0.37) and 0.23 (95% CI 0.06 to 0.4) respectively. The range across all time points equated to approximately 0.5 to 1.4 units on a 0 to 10 numerical rating scale for pain and 1.4 to 2.5 points on the Roland Morris disability scale (0 to 24). There was moderate to low quality evidence of no difference on work outcomes (odds ratio (OR) at long term 1.04, 95% CI 0.73 to 1.47). Pooled estimates from 19 RCTs provided moderate to low quality evidence that MBR was more effective than physical treatment for pain and disability with SMDs in the long term of 0.51 (95% CI -0.01 to 1.04) and 0.68 (95% CI 0.16 to 1.19) respectively. Across all time points this translated to approximately 0.6 to 1.2 units on the pain scale and 1.2 to 4.0 points on the Roland Morris scale. There was moderate to low quality evidence of an effect on work outcomes (OR at long term 1.87, 95% CI 1.39 to 2.53). There was insufficient evidence to assess whether MBR interventions were associated with more adverse events than usual care or physical interventions.</P>
+<P>Sensitivity analyses did not suggest that the pooled estimates were unduly influenced by the results from low quality studies. Subgroup analyses were inconclusive regarding the influence of baseline symptom severity and intervention intensity.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Patients with chronic LBP receiving MBR are likely to experience less pain and disability than those receiving usual care or a physical treatment. MBR also has a positive influence on work status compared to physical treatment. Effects are of a modest magnitude and should be balanced against the time and resource requirements of MBR programs. More intensive interventions were not responsible for effects that were substantially different to those of less intensive interventions. While we were not able to determine if symptom intensity at presentation influenced the likelihood of success, it seems appropriate that only those people with indicators of significant psychosocial impact are referred to MBR.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000969.pub2.en.xml

@@ -0,0 +1,35 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Amphotericin B lipid soluble formulations versus amphotericin B in cancer patients with neutropenia</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Prevention of fungal infections in patients with cancer with amphotericin B</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Patients with cancer who are treated with chemotherapy or receive a bone marrow transplant have an increased risk of acquiring fungal infections. Such infections can be life-threatening. Antifungal drugs are therefore often given prophylactically to such patients, or when they have a fever. The review found that lipid formulations of amphotericin B had fewer adverse effects (less nephrotoxicity and fewer dropouts) than conventional amphotericin B. However, it is not clear whether there are any advantages of these formulations if conventional amphotericin B is administered under optimal circumstances.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Patients with cancer who are treated with chemotherapy or receive a bone marrow transplant have an increased risk of acquiring fungal infections. Such infections can be life-threatening. Antifungal drugs are therefore often given prophylactically to such patients, or when they have a fever. </P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To compare the benefits and harms of lipid soluble formulations of amphotericin B with conventional amphotericin B in cancer patients with neutropenia.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched PubMed from 1966 to 7 July 2014 and the reference lists of identified articles.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised clinical trials comparing lipid soluble formulations of amphotericin B with conventional amphotericin B.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>The two review authors independently assessed trial eligibility and risk of bias and abstracted data.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We found 13 trials (1960 patients). Lipid-based amphotericin B was not more effective than conventional amphotericin B on mortality (relative risk (RR) 0.5; 95% confidence interval (CI) 0.64 to 1.14) but decreased invasive fungal infection (RR 0.65; 95% CI 0.44 to 0.97), nephrotoxicity defined as a 100% increase in serum creatinine (RR 0.45; 95% CI 0.37 to 0.54), and number of dropouts (RR 0.78; 95% CI 0.62 to 0.97).</P>
+<P>For the drug used in most patients, AmBisome (4 trials, 1214 patients), there was no significant difference in mortality (RR 0.77; 95% CI 0.54 to 1.10) whereas it tended to be more effective than conventional amphotericin B on invasive fungal infection (RR 0.63; 95% CI 0.39 to 1.01, P value 0.053).</P>
+<P>AmBisome, amphotericin B in Intralipid (6 trials, 379 patients), amphotericin B colloidal dispersion (ABCD) (2 trials, 262 patients), and amphotericin B lipid complex (ABLC) (1 trial, 105 patients) all decreased the occurrence of nephrotoxicity, but conventional amphotericin B was rarely administered under optimal circumstances.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>It is not clear whether there are any advantages of lipid-based formulations if conventional amphotericin B is administered under optimal circumstances, and their high cost prohibits routine use in most settings. There is a need for large trials comparing lipid-based formulations of amphotericin B with conventional amphotericin B given in the same dose, with routine premedication for prevention of infusion-related toxicity, and with supplementation with fluid, potassium, and magnesium for prevention of nephrotoxicity.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD000990.pub3.en.xml

@@ -0,0 +1,39 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Exercise for intermittent claudication</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Exercise for reducing intermittent claudication symptoms</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Intermittent claudication is a cramping leg pain that develops when walking and is relieved with rest. It is caused by inadequate blood flow to the leg muscles because of atherosclerosis (fatty deposits restricting blood flow through the arteries). People with mild-to-moderate claudication are advised to keep walking, stop smoking and reduce cardiovascular risk factors. Other treatments include antiplatelet therapy, pentoxifylline or cilostazol, angioplasty (inserting a balloon into the artery to open it up) and bypass surgery.</P>
+<P>The review authors identified 30 controlled trials that randomised 1816 adults with stable leg pain to exercise, usual care or placebo, or other interventions. Outcomes were measured at times ranging from two weeks to two years. The types of exercise varied from strength training to polestriding and upper or lower limb exercises; in general supervised sessions were at least twice a week. Quality of the included trials was moderate,<B> </B>mainly due to an absence of relevant information. Compared with usual care, exercise therapy improved maximal walking time on a treadmill by almost five minutes (4.51; range 3.0 to 5.9 minutes). Pain-free walking distance was increased overall by 82.29 metres (range 71.86 to 92.72 metres) and the maximum distance that participants could walk by 108.99 metres (range 38.20 to 179.78 metres) in six trials. Improvements were seen for up to two years. Exercise did not improve ankle to brachial blood pressure index. No data were given on non-fatal cardiovascular events; data on deaths and need for amputation were inconclusive due to limited data.</P>
+<P>Comparisons of exercise with antiplatelet therapy, pentoxifylline, iloprost, vitamin E and pneumatic foot and calf compression were limited because of small numbers of trials and participants.</P>
+<P>The present review shows that exercise programmes clearly improve walking time and distance for people considered fit for exercise regimens. This benefit appears to be sustained over two years.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Exercise programmes are a relatively inexpensive, low-risk option compared with other more invasive therapies for leg pain on walking (intermittent claudication (IC)). This is an update of a review first published in 1998.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>The prime objective of this review was to determine whether an exercise programme in people with intermittent claudication was effective in alleviating symptoms and increasing walking treadmill distances and walking times. Secondary objectives were to determine whether exercise was effective in preventing deterioration of underlying disease, reducing cardiovascular events and improving quality of life.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>For this update<I> </I>the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched September 2013) and CENTRAL (2013, Issue 8). </P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials of an exercise regimen versus control or versus medical therapy in people with IC due to peripheral arterial disease. Any exercise programme or regimen used in the treatment of intermittent claudication was included, such as walking, skipping and running. Inclusion of trials was not affected by the duration, frequency or intensity of the exercise programme. Outcome measures collected included treadmill walking distance (time to onset of pain or pain-free walking distance and maximum walking time or maximal walking distance), ankle brachial index (ABI), quality of life, morbidity or amputation; if none of these were reported the trial was not included in this review.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors independently extracted data and assessed trial quality.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Eleven additional studies were included in this update making a total of 30 trials which met the inclusion criteria, involving a total of 1816 participants with stable leg pain. The follow-up period ranged from two weeks to two years. The types of exercise varied from strength training to polestriding and upper or lower limb exercises; generally supervised sessions were at least twice a week. Most trials used a treadmill walking test for one of the outcome measures. Quality of the included trials was moderate,<B> </B>mainly due to an absence of relevant information. The majority of trials were small with 20 to 49 participants. Twenty trials compared exercise with usual care or placebo, the remainder of the trials compared exercise to medication (pentoxifylline, iloprost, antiplatelet agents and vitamin E) or pneumatic calf compression; people with various medical conditions or other pre-existing limitations to their exercise capacity were generally excluded.</P>
+<P>Overall, when taking the first time point reported in each of the studies, exercise significantly improved maximal walking time when compared with usual care or placebo: mean difference (MD) 4.51 minutes (95% confidence interval (CI) 3.11 to 5.92) with an overall improvement in walking ability of approximately 50% to 200%. Walking distances were also significantly improved: pain-free walking distance MD 82.29 metres (95% CI 71.86 to 92.72) and maximum walking distance MD 108.99 metres (95% CI 38.20 to 179.78). Improvements were seen for up to two years, and subgroup analyses were performed at three, six and 12 months where possible. Exercise did not improve the ABI (MD 0.05, 95% CI 0.00 to 0.09). The effect of exercise, when compared with placebo or usual care, was inconclusive on mortality, amputation and peak exercise calf blood flow due to limited data. No data were given on non-fatal cardiovascular events.</P>
+<P>Quality of life measured using the Short Form (SF)-36 was reported at three and six months. At three months, physical function, vitality and role physical all significantly improved with exercise, however this was a limited finding as this measure was only reported in two trials. At six months five trials reported outcomes of a significantly improved physical summary score and mental summary score secondary to exercise. Only two trials reported improvements in other domains, physical function and general health.</P>
+<P>Evidence was generally limited for exercise compared with antiplatelet therapy, pentoxifylline, iloprost, vitamin E and pneumatic foot and calf compression due to small numbers of trials and participants.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Exercise programmes are of significant benefit compared with placebo or usual care in improving walking time and distance in people with leg pain from IC who were considered to be fit for exercise intervention.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001036.en.xml

@@ -0,0 +1,36 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Collection devices for obtaining cervical cytology samples</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>This review is no longer appropriate for update as liquid based cytology has superceded smear technology.</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Cervical screening (pap smear) is an effective way of detecting pre-cancerous abnormalities of the cervix (cervical intraepithelial neoplasia). Tests can be affected by the tester's skill and the design of the device used. Inadequate smears can produce incorrect results, causing stress and inconvenience to women having to undergo repeat screening. This review of trials found that the commonly used Ayre spatula is not as effective in collecting cells as the extended tip spatula. The most effective appears to be a combination of the cytobrush with an extended tip spatula.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>
+<B>This review is no longer appropriate for update as liquid based cytology has superceded smear technology.</B>
+</P>
+<P>The large variation in disease detection rated with cervical smears may be partly due to differences in the sampling devices and the techniques of sampling.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess whether the design of the cervical smear device affects rates of inadequate smears and the detection of disease; and whether the presence of endocervical cells in the smear affects disease detection.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Gynaecological Cancer Group<BR/>trials register and MEDLINE up to July 1997. We also handsearched 16<BR/>journals.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised and quasi-randomised trials and non-randomised comparative studies comparing cervical smear collection devices in women attending for primary screening, colposcopy following an abnormal smear or colposcopy after treatment.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two reviewers independently abstracted data. Study quality was assessed.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Thirty-six trials and six observational comparative studies were included. The Ayre spatula was shown to be less effective compared with extended tip spatulas for collecting endocervical cells in eight trials (odds ratio 2.25, 95% confidence interval 2.06 to 2.44).<BR/>Use of a spatula with the cytobrush was more effective than spatula alone at collecting endocervical cells (odds ratio 3.33, 95% confidence interval 3.05 to 3.63) and the same effect was present for adequate smear rates (odds ratio 1.51 95% confidence interval 1.19-1.92). Extended tip spatulas were also superior for the detection of dyskaryosis in seven trials (odds ratio 1.21, 95% confidence interval 1.10 to 1.33). Based on data from two trials and three observational studies, smears that contained endocervical cells were more likely to detect dyskaryosis, particularly in severe disease. The proportion of smears with endocervical cells present increased with increasing severity of the disease.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Extended tip spatulas of various designs appear to be better for collecting endocervical cells than the commonly used Ayre spatula. The most effective combination appears to be the cytobrush with an extended tip spatula. The rate of detection of endocervical cells appears to be a valid and convenient surrogate for the ability to detect dyskaryosis and for adequate smear rates. The ability of the extended tip spatula with the cytobrush compared with the extended tip spatula alone to detect disease, needs to be evaluated in a trial.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001040.pub2.en.xml

@@ -0,0 +1,36 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Adjuvant progestagens for endometrial cancer</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>No evidence to support use of adjuvant progestagens to prevent recurrence of endometrial cancer after surgery</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Endometrial (womb) cancer is the most common genital tract cancer in developed countries. Progestagen (a hormone) therapy is sometimes used following initial surgery to reduce the risk of recurrence. However, progestagens have been found to reduce one of the protective factors against heart disease and may also make tumours more resistant to radiotherapy. This review found no evidence to support the use of progestagen as an addition to surgery for newly diagnosed endometrial cancer. Progestagen can, however, prevent or delay recurrence of cancer in some patients.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Endometrial cancer is the most common genital tract carcinoma among women in developed countries, with most women presenting with stage 1 disease. Adjuvant progestagen therapy has been advocated following primary surgery to reduce the risk of recurrence of disease.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To evaluate the effectiveness and safety of adjuvant progestagen therapy for the treatment of endometrial cancer.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Gynaecological Cancer Group Trials Specilaised Register, Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2009. MEDLINE and EMBASE up to April 2009.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials (RCTs) of progestagen therapy in women who have had surgery for endometrial cancer.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors independently abstracted data and assessed risk of bias. Risk ratios (RRs) comparing survival in women who did and did not receive progestagen were pooled in random effects meta-analyses. .<B>
+<I> </I>
+</B>
+</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Seven trials assessing 4556 women were identified. Three trials included women with stage one disease only, whereas four included women with more advanced disease. Meta-analysis of four trials showed that there was no significant difference in the risk of death at five years between adjuvant progestagen therapy and no further treatment (RR = 1.00, 95% CI 0.85 to 1.18). This conclusion is also robust to single trial analyses at 4 and 7 years and in one trial across all points in time using a hazard ratio (HR). There was also no significant difference between progestagen therapy and control in terms of the risk of death from endometrial cancer, cardiovascular disease and intercurrent disease. Relapse of disease appeared to be reduced by progestagen therapy in one trial (HR = 0.71, 95% CI 0.52 to 0.97 and 5 year RR = 0.74, 95% CI 0.58 to 0.96), but there was no evidence of a difference in disease recurrence in another trial at 7 years (RR = 1.34, 95% CI 0.79 to 2.27).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There is no evidence to support the use of adjuvant progestagen therapy in the primary treatment of endometrial cancer. There have now been several RCTs which have failed to establish a role for adjuvant progestagen therapy after primary treatment for endometrial cancer and therefore, further trials in this field are probably not justified.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001059.pub4.en.xml

@@ -0,0 +1,46 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Evidence from randomised controlled trials shows that calcium supplements help prevent pre-eclampsia and preterm birth and lower the risk of a woman dying or having serious problems related to high blood pressure in pregnancy. This is particularly for women on low calcium diets.</P>
+<P>Pre-eclampsia is evident as high blood pressure and protein in the urine. It is a major cause of death in pregnant women and newborn babies worldwide. Preterm birth (birth before 37 weeks) is often caused by high blood pressure and is the leading cause of newborn deaths, particularly in low-income countries. The review of 24 trials found good quality evidence that calcium supplementation with high doses (at least 1 g daily) during pregnancy (13 studies involving 15,730 women) is a safe and relatively cheap way of reducing the risk of pre-eclampsia, especially in women from communities with low dietary calcium and those at increased risk of pre-eclampsia. Women receiving calcium supplements were also less likely to die or have serious problems related to pre-eclampsia. Babies were less likely to be born preterm. No adverse effects have been found but further research is needed into the ideal dosage of supplementation. Limited evidence from 10 trials (2234 women) suggested that a relatively low dose may be effective although co-interventions such as vitamin D, linoleic acid or antioxidants were given in six of the included trials.</P>
+<P>In settings of low dietary calcium where high-dose supplementation is not feasible, the option of lower dose supplements (500 to 600 mg/day) might be considered in preference to no supplementation.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Pre-eclampsia and eclampsia are common causes of serious morbidity and death. Calcium supplementation may reduce the risk of pre-eclampsia, and may help to prevent preterm birth.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of calcium supplementation during pregnancy on hypertensive disorders of pregnancy and related maternal and child outcomes.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 March 2013) and contacted study authors for more data where possible. We updated the search in May 2014 and added the results to the 'Awaiting Classification' section of the review.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials (RCTs) comparing high-dose (at least 1 g daily of calcium) or low-dose calcium supplementation during pregnancy with placebo or no calcium.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>We assessed eligibility and trial quality, extracted and double-entered data.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>
+<I>High-dose calcium supplementation (</I>≥<I>1 g/day)</I>
+</P>
+<P>We included 14 studies in the review, however one study contributed no data. We included 13 high-quality studies in our meta-analyses (15,730 women). The average risk of high blood pressure (BP) was reduced with calcium supplementation compared with placebo (12 trials, 15,470 women: risk ratio (RR) 0.65, 95% confidence interval (CI) 0.53 to 0.81; I² = 74%). There was also a significant reduction in the risk of pre-eclampsia associated with calcium supplementation (13 trials, 15,730 women: RR 0.45, 95% CI 0.31 to 0.65; I² = 70%). The effect was greatest for women with low calcium diets (eight trials, 10,678 women: average RR 0.36, 95% CI 0.20 to 0.65; I² = 76%) and women at high risk of pre-eclampsia (five trials, 587 women: average RR 0.22, 95% CI 0.12 to 0.42; I² = 0%). These data should be interpreted with caution because of the possibility of small-study effect or publication bias.</P>
+<P>The composite outcome maternal death or serious morbidity was reduced (four trials, 9732 women; RR 0.80, 95% CI 0.65 to 0.97; I² = 0%). Maternal deaths were not significantly different (one trial of 8312 women: calcium group one death versus placebo group six deaths). There was an anomalous increase in the risk of HELLP (haemolysis, elevated liver enzymes and low platelets) syndrome (two trials, 12,901 women: RR 2.67, 95% CI 1.05 to 6.82; I² = 0%) in the calcium group, however, the absolute number of events was low (16 versus six).</P>
+<P>The average risk of preterm birth was reduced in the calcium group (11 trials, 15,275 women: RR 0.76, 95% CI 0.60 to 0.97; I² = 60%) and amongst women at high risk of developing pre-eclampsia (four trials, 568 women: average RR 0.45, 95% CI 0.24 to 0.83; I² = 60%), but no significant reduction in neonatal high care admission. There was no overall effect on the risk of stillbirth or infant death before discharge from hospital (11 trials 15,665 babies: RR 0.90, 95% CI 0.74 to 1.09; I² = 0%).</P>
+<P>One study showed a reduction in childhood systolic BP greater than 95th percentile among children exposed to calcium supplementation in utero (514 children: RR 0.59, 95% CI 0.39 to 0.91). In a subset of these children, dental caries at 12 years old was also reduced (195 children, RR 0.73, 95% CI 0.62 to 0.87).</P>
+<P>
+<I>Low-dose calcium supplementation (&lt; 1 g/day)</I>
+</P>
+<P>We included 10 trials (2234 women) that evaluated low-dose supplementation with calcium alone (4) or in association with vitamin D (3), linoleic acid (2), or antioxidants (1). Most studies recruited women at high risk for pre-eclampsia, and were at high risk of bias, thus the results should be interpreted with caution. Supplementation with low doses of calcium significantly reduced the risk of pre-eclampsia (RR 0.38, 95% CI 0.28 to 0.52; I² = 0%). There was also a reduction in hypertension, low birthweight and neonatal intensive care unit admission.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Calcium supplementation (≥ 1 g/day) is associated with a significant reduction in the risk of pre-eclampsia, particularly for women with low calcium diets. The treatment effect may be overestimated due to small-study effects or publication bias. It also reduces preterm birth and the occurrence of the composite outcome 'maternal death or serious morbidity'. We considered these benefits to outweigh the increased risk of HELLP syndrome, which was small in absolute numbers. The World Health Organization recommends calcium 1.5 g to 2 g daily for pregnant women with low dietary calcium intake.</P>
+<P>The limited evidence on low-dose calcium supplementation suggests a reduction in pre-eclampsia, but needs to be confirmed by larger, high-quality trials. Pending such results, in settings of low dietary calcium where high-dose supplementation is not feasible, the option of lower-dose supplements (500 to 600 mg/day) might be considered in preference to no supplementation.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001060.pub2.en.xml

@@ -0,0 +1,36 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Magnesium sulphate for preventing preterm birth in threatened preterm labour</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Magnesium sulphate for preventing preterm birth in threatened preterm labour</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Even short-term postponement of birth when labour begins early (before 37 weeks) can help improve outcomes for babies, as the woman can take corticosteroid drugs to help develop the baby's lungs in a short time. Magnesium sulphate is one of the drugs that has been used to try to stop the uterus contracting in women who go into labour too soon.</P>
+<P>This review of 37 trials including 3571 women and their infants did not find that magnesium sulphate, given to women who go into labour too soon, prevented babies being born too soon or reduced the risks of the baby developing serious health problems. However, antenatal magnesium sulphate is effective in helping women who develop pre-eclampsia (high blood pressure and protein in the urine) and for helping to protect babies' brains.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Magnesium sulphate has been used in some settings as a tocolytic agent to inhibit uterine activity in women in preterm labour with the aim of preventing preterm birth.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of magnesium sulphate therapy given to women in threatened preterm labour with the aim of preventing preterm birth and its sequelae.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (last searched 31 January 2014).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials of magnesium sulphate as the only tocolytic, administered by any route, compared with either placebo, no treatment or alternative tocolytic therapy (not magnesium sulphate) to women considered to be in preterm labour.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>At least two review authors assessed trial eligibility and risk of bias and undertook data extraction independently.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>The 37 included trials (total of 3571 women and over 3600 babies) were generally of moderate to high risk of bias. Antenatal magnesium sulphate was compared with either placebo, no treatment, or a range of alternative tocolytic agents.</P>
+<P>For the primary outcome of giving birth within 48 hours after trial entry, no significant differences were seen between women who received magnesium sulphate and women who did not (whether placebo/no alternative tocolytic drug, betamimetics, calcium channel blockers, cox inhibitors, prostaglandin inhibitors, or human chorionic gonadotropin) (19 trials, 1913 women). Similarly for the primary outcome of serious infant outcome, there were no significant differences between the infants exposed to magnesium sulphate and those not (whether placebo/no alternative tocolytic drug, betamimetics, calcium channel blockers, cox inhibitors, prostaglandin inhibitors, human chorionic gonadotropin or various tocolytic drugs) (18 trials; 2187 babies). No trials reported the outcome of extremely preterm birth. In the seven trials that reported serious maternal outcomes, no events were recorded.</P>
+<P>In the group treated with magnesium sulphate compared with women receiving antenatal placebo or no alternative tocolytic drug, a borderline increased risk of total death (fetal, neonatal, infant) was seen (risk ratio (RR) 4.56, 95% confidence interval (CI) 1.00 to 20.86; two trials, 257 babies); none of the comparisons between magnesium sulphate and other classes of tocolytic drugs showed differences for this outcome (10 trials, 991 babies). The outcomes of neonatal and/or infant deaths and of fetal deaths did not show differences between magnesium sulphate and no magnesium sulphate, whether compared with placebo/no alternative tocolytic drug, or any specific class of tocolytic drug. For most of the other secondary outcomes, there were no significant differences between magnesium sulphate and the control groups for risk of preterm birth (except for a significantly lower risk with magnesium sulphate when compared with barbiturates in one trial of 65 women), gestational age at birth, interval between trial entry and birth, other neonatal morbidities, or neurodevelopmental outcomes. Duration of neonatal intensive care unit stay was significantly increased in the magnesium sulphate group compared with the calcium channel blocker group, but not when compared with cox inhibitors or prostaglandin inhibitors. No maternal deaths were reported in the four trials reporting this outcome. Significant differences between magnesium sulphate and controls were not seen for maternal adverse events severe enough to stop treatment, except for a significant benefit of magnesium sulphate compared with betamimetics in a single trial.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Magnesium sulphate is ineffective at delaying birth or preventing preterm birth, has no apparent advantages for a range of neonatal and maternal outcomes as a tocolytic agent and its use for this indication may be associated with an increased risk of total fetal, neonatal or infant mortality (in contrast to its use in appropriate groups of women for maternal, fetal, neonatal and infant neuroprotection where beneficial effects have been demonstrated).</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001099.pub3.en.xml

@@ -0,0 +1,34 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Fibrinolytic agents for peripheral arterial occlusion</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Drugs to break down blood clots for people with sudden onset peripheral arterial occlusion</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Acute reduction in blood flow to a limb can be caused by a blood clot blocking an artery or a vascular graft. If not treated promptly this condition, known as peripheral arterial occlusion, can result in amputation or be life threatening. Infusion of clot-busting drugs can restore blood flow by dissolving the clot (thrombolysis). This review found some evidence from five randomized controlled trials, involving a total of 687 patients that suggested local infusion of a drug into the affected artery is more effective than infusion into a vein, and is also associated with a lower risk of unwanted bleeding. No particular drug was more effective in preventing limb loss or death than another. The drugs investigated were streptokinase, urokinase, recombinant tissue plasminogen activator and pro-urokinase. More research is needed to confirm these findings. All of the findings of this review came from small studies that involved people with peripheral arterial ischaemia of differing severity.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Peripheral arterial thrombolysis is used in the management of peripheral arterial ischaemia. Streptokinase was originally used but safety concerns led to a search for other agents. Urokinase and recombinant tissue plasminogen activator (rt-PA) have increasingly become established as first line agents for peripheral arterial thrombolysis. Potential advantages of these agents include improved safety, greater efficacy and a more rapid response. Recently drugs such as pro-urokinase, recombinant staphylokinase and alfimperase have been introduced. This is an update of a review first published in 2010.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To determine which fibrinolytic agents are most effective in peripheral arterial ischaemia.<BR/>
+</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>For this update<I> </I>the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched March 2013) and CENTRAL (2013, Issue 3) for randomised controlled trials (RCTs) comparing fibrinolytic agents to treat peripheral arterial ischaemia.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>RCTs comparing fibrinolytic agents to treat peripheral arterial occlusion.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Data were analysed for the outcomes vessel patency, time to lysis, limb salvage, amputation, death, complications including major haemorrhage, stroke, and distal embolization.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Five RCTs involving a total of 687 participants with a range of clinical indications were included. No new studies were included in this update. In one three-pronged study, vessel patency was greater with intra-arterial recombinant tissue plasminogen activator (rt-PA) than with intra-arterial streptokinase (P &lt; 0.04) or intravenous rt-PA (P &lt; 0.01). In participants with peripheral arterial occlusion there was no statistically significant difference in limb salvage at 30 days with either urokinase or rt-PA, though this may reflect the small numbers in the studies. Incidences of haemorrhagic complications varied with fibrinolytic regime but there was no statistically significant difference between intra-arterial urokinase and intra-arterial rt-PA. In the three-pronged study intravenous rt-PA and intra-arterial streptokinase were associated with a significantly higher risk of haemorrhagic complications than with intra-arterial rt-PA (P &lt; 0.05).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There is some evidence to suggest that intra-arterial rt-PA is more effective than intra-arterial streptokinase or intravenous rt-PA in improving vessel patency in people with peripheral arterial occlusion. There was no evidence that rt-PA was more effective than urokinase for patients with peripheral arterial occlusion and some evidence that initial lysis may be more rapid with rt-PA, depending on the regime. Incidences of haemorrhagic complications were not statistically significantly greater with rt-PA than with other regimes. However, all of the findings come from small studies and a general paucity of results means that it is not possible to draw clear conclusions.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001118.pub3.en.xml

@@ -0,0 +1,53 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Print-based self-help interventions for smoking cessation</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Do printed self-help materials containing information about how to give up smoking help people to quit</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Background</B>
+</P>
+<P>We reviewed the evidence that printed materials giving structured advice about how to stop smoking help people to quit. We looked for trials of any type of printed self-help material which gave structured support and advice about quitting. We also included materials in audio or video format but we did not include internet programmes or other formats. Trials had to include people who smoked, but they did not need to be currently trying to give up. We were interested in the number of people who were not smoking at least 6 months from the time when materials were provided. Some trials mailed materials on more than one occasion. Some trials gathered information about smoking history and habits in order to provide materials which were individually tailored to the characteristics of the smoker (tailored materials). In some trials, there was no face-to-face contact, and the materials were the only support. Other trials gave everyone advice and were designed to test whether there was any additional benefit from providing written materials.</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>This evidence is current to April 2014. We identified 74 studies. Most of them took place in North America or Europe and were conducted in adults. Most studies did not require that people wanted to quit smoking in order to join. Although some studies were judged to be at possible risk of bias, mainly because the papers did not report the methods in detail, this did not affect the overall conclusions from the review.</P>
+<P>
+<B>Key results</B>
+</P>
+<P>Based on 11 studies with over 21,000 participants, there was evidence of a small benefit of printed non-tailored structured self-help materials when provided without any other contact. The likelihood of quitting was increased by about 20%. If self help was compared to even a brief pamphlet about smoking (6 studies), there was no evidence of additional benefit from structured materials. When self-help materials were provided in addition to brief face-to-face contact (5 studies) or advice (11 studies), there was no longer any evidence of additional benefit compared to the effect of contact or advice alone.</P>
+<P>We found 31 trials which provided written materials that were individually tailored. Some studies compared these to no materials and some to non-tailored materials. There was evidence based on 9 studies with over 13,000 participants that tailored materials were of more benefit than no materials. There was also weaker evidence from an additional 22 studies that tailored materials were of more benefit than non-tailored materials.</P>
+<P>
+<B>Conclusions</B>
+</P>
+<P>The size of benefit from self-help materials is small, with only about 1 additional successful quitter expected from 100 people receiving materials with no other support. Studies of this type often sent materials to people who were not trying to quit, and the number of successful quitters was low. Most studies also took place in countries where more intensive support was available for people wanting to quit (for example, counselling). People were more likely to make successful quit attempts when they had face-to-face support, but in these studies giving materials did not help increase success further. People who choose to use materials may find them helpful, especially if more intensive support is not available to them, but people who want to quit should be encouraged to seek more intensive support if it is available.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Many smokers give up smoking on their own, but materials giving advice and information may help them and increase the number who quit successfully.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>The aims of this review were to determine: the effectiveness of different forms of print-based self-help materials, compared with no treatment and with other minimal contact strategies; the effectiveness of adjuncts to print-based self help, such as computer-generated feedback, telephone hotlines and pharmacotherapy; and the effectiveness of approaches tailored to the individual compared with non-tailored materials.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Tobacco Addiction Group trials register. Date of the most recent search April 2014.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>We included randomized trials of smoking cessation with follow-up of at least six months, where at least one arm tested a print-based self-help intervention. We defined self help as structured programming for smokers trying to quit without intensive contact with a therapist.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>We extracted data in duplicate on the participants, the nature of the self-help materials, the amount of face-to-face contact given to intervention and to control conditions, outcome measures, method of randomization, and completeness of follow-up.</P>
+<P>The main outcome measure was abstinence from smoking after at least six months follow-up in people smoking at baseline. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates when available. Where appropriate, we performed meta-analysis using a fixed-effect model.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We identified 74 trials which met the inclusion criteria. Many study reports did not include sufficient detail to judge risk of bias for some domains. Twenty-eight studies (38%) were judged at high risk of bias for one or more domains but the overall risk of bias across all included studies was judged to be moderate, and unlikely to alter the conclusions.</P>
+<P>Thirty-four trials evaluated the effect of standard, non-tailored self-help materials. Pooling 11 of these trials in which there was no face-to-face contact and provision of structured self-help materials was compared to no intervention gave an estimate of benefit that just reached statistical significance (n = 13,241, risk ratio [RR] 1.19, 95% confidence interval [CI] 1.04 to 1.37). This analysis excluded two trials with strongly positive outcomes that introduced significant heterogeneity. Six further trials without face-to-face contact in which the control group received alternative written materials did not show evidence for an effect of the smoking self-help materials (n = 7023, RR 0.88, 95% CI 0.74 to 1.04). When these two subgroups were pooled, there was no longer evidence for a benefit of standard structured materials (n = 20,264, RR 1.06, 95% CI 0.95 to 1.18). We failed to find evidence of benefit from providing standard self-help materials when there was brief contact with all participants (5 trials, n = 3866, RR 1.17, 95% CI 0.96 to 1.42), or face-to-face advice for all participants (11 trials, n = 5365, RR 0.97, 95% CI 0.80 to 1.18).</P>
+<P>Thirty-one trials offered materials tailored for the characteristics of individual smokers, with controls receiving either no materials, or stage matched or non-tailored materials. Most of the trials used more than one mailing. Pooling these showed a benefit of tailored materials (n = 40,890, RR 1.28, 95% CI 1.18 to 1.37) with moderate heterogeneity (I² = 32%). The evidence is strongest for the subgroup of nine trials in which tailored materials were compared to no intervention (n = 13,437, RR 1.35, 95% CI 1.19 to 1.53), but also supports tailored materials as more helpful than standard materials. Part of this effect could be due to the additional contact or assessment required to obtain individual data, since the subgroup of 10 trials where the number of contacts was matched did not detect an effect (n = 11,024, RR 1.06, 95% CI 0.94 to 1.20). In two trials including a direct comparison between tailored materials and brief advice from a health care provider, there was no evidence of a difference, but confidence intervals were wide (n = 2992, RR 1.13, 95% CI 0.86 to 1.49).</P>
+<P>Only four studies evaluated self-help materials as an adjunct to nicotine replacement therapy, with no evidence of additional benefit (n = 2291, RR 1.05, 95% CI 0.88 to 1.25). A small number of other trials failed to detect benefits from using additional materials or targeted materials, or to find differences between different self-help programmes.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Standard, print-based self-help materials increase quit rates compared to no intervention, but the effect is likely to be small. We did not find evidence that they have an additional benefit when used alongside other interventions such as advice from a healthcare professional, or nicotine replacement therapy. There is evidence that materials that are tailored for individual smokers are more effective than non-tailored materials, although the absolute size of effect is still small. Available evidence tested self-help interventions in high income countries; further research is needed to investigate their effect in contexts where more intensive support is not available.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001146.pub4.en.xml

@@ -0,0 +1,33 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Early (&lt; 8 days) postnatal corticosteroids for preventing chronic lung disease in preterm infants</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Early (up to seven days) postnatal corticosteroids for preventing chronic lung disease in preterm infants</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Corticosteroids can reduce lung inflammation in newborns with chronic lung disease, but there are major adverse effects of the drugs. Chronic lung disease is a major problem for newborn babies in neonatal intensive care units. Persistent inflammation of the lungs is the most likely cause. Corticosteroid drugs have been used to either prevent or treat chronic lung disease because of their strong anti-inflammatory effects. This review of trials found that the benefits of giving corticosteroids to infants up to seven days of age may not outweigh the known adverse effects. The beneficial effects were a shorter time on the ventilator and less chronic lung disease, but the adverse effects included high blood pressure, bleeding from the stomach or bowel, perforation of the bowel, an excess of glucose in the bloodstream and an increased risk of cerebral palsy at follow-up. Use of early corticosteroids, especially dexamethasone, to treat or prevent chronic lung disease should be curtailed until more research has been performed.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Chronic lung disease remains a major problem in neonatal intensive care units. Persistent inflammation in the lungs is the most likely underlying pathogenesis. Corticosteroids have been used to either prevent or treat chronic lung disease because of their potent anti-inflammatory effects.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To examine the relative benefits and adverse effects of postnatal corticosteroids commenced within the first seven days of life to preterm infants at risk of developing chronic lung disease.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We sought randomised controlled trials (RCTs) of postnatal corticosteroid therapy from the Cochrane Central Register of Controlled Trials (CENTRAL, 2013, Issue 8), MEDLINE (1966 to August 2013), handsearching paediatric and perinatal journals, and by examining previous review articles and information received from practising neonatologists. We contacted authors of all studies, where possible, to confirm details of reported follow-up studies, or to obtain any information about long-term follow-up where none had been reported.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>We selected RCTs of postnatal corticosteroid treatment within the first seven days of life (early) in high-risk preterm infants for this review. Most studies evaluated the use of dexamethasone but we also included studies that assessed hydrocortisone, even if it was used primarily to manage hypotension.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>We extracted and analysed data regarding clinical outcomes that included mortality, chronic lung disease, death or chronic lung disease, failure to extubate, complications during the primary hospitalisation, and long-term health outcomes.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Twenty-nine RCTs enrolling a total of 3750 participants were eligible for inclusion in this review. The overall risk for bias was probably low as all were randomised controlled trials, and most trials have used rigorous methods. There were significant benefits for the following outcomes: lower rates of failure to extubate and decreased risks of chronic lung disease at both 28 days and 36 weeks' postmenstrual age, death or chronic lung disease at 28 days and 36 weeks' postmenstrual age, patent ductus arteriosus and ROP, including severe ROP. There were no significant differences in the rates of neonatal or subsequent mortality, infection, severe intraventricular haemorrhage, periventricular leukomalacia, necrotising enterocolitis or pulmonary haemorrhage. Gastrointestinal bleeding and intestinal perforation were important adverse effects. The risks of hyperglycaemia, hypertension, hypertrophic cardiomyopathy and growth failure were also increased. In the 12 trials that reported late outcomes, several adverse neurological effects were found at follow-up examinations, including developmental delay (not defined), cerebral palsy and abnormal neurological examination. However, major neurosensory disability was not significantly increased, either overall in the seven studies where this outcome could be determined, or in the two individual studies where the rates of cerebral palsy or abnormal neurological examination were significantly increased. Moreover, the rates of the combined outcomes of death or cerebral palsy, or of death or major neurosensory disability, were not significantly increased. Dexamethasone was used in most studies (n = 20); only nine studies used hydrocortisone. In subgroup analyses by type of corticosteroid, most of the beneficial and harmful effects were attributable to dexamethasone; hydrocortisone had little effect on any outcomes except for an increase in intestinal perforation and a borderline reduction in patent ductus arteriosus.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>The benefits of early postnatal corticosteroid treatment (≤ 7 days), particularly dexamethasone, may not outweigh the adverse effects of this treatment. Although early corticosteroid treatment facilitates extubation and reduces the risk of chronic lung disease and patent ductus arteriosus, it causes short-term adverse effects including gastrointestinal bleeding, intestinal perforation, hyperglycaemia, hypertension, hypertrophic cardiomyopathy and growth failure. Long-term follow-up studies report an increased risk of abnormal neurological examination and cerebral palsy. However, the methodological quality of the studies determining long-term outcomes is limited in some cases; the surviving children have been assessed predominantly before school age, and no study has been sufficiently powered to detect important adverse long-term neurosensory outcomes. There is a compelling need for the long-term follow-up and reporting of late outcomes, especially neurological and developmental outcomes, among surviving infants who participated in all randomised trials of early postnatal corticosteroid treatment. Hydrocortisone in the doses and regimens used in the reported RCTs has few beneficial or harmful effects and cannot be recommended for the prevention of chronic lung disease.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001181.pub4.en.xml

@@ -0,0 +1,36 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Antimicrobial prophylaxis for colorectal surgery</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Antibiotics administered to patients prior to colorectal surgery</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>When people undergo surgical operations of their abdomen they are at risk of infection which will often be cured by an antibiotic. However, it might be better to give this before the operation to prevent the infection (prophylaxis or prophylactic use), rather than wait until an infection occurs before giving it. This review looks at the evidence for giving an antibiotic before surgery takes place. </P>
+<P>The review found 260 studies which had recruited over 43 thousand people undergoing abdominal surgery. The studies had some limitations in relation to the number of people who remained in the studies and the possibility that the results were affected because some of the researchers in the studies knew which people had received antibiotics before surgery. However, when the results were analysed effect of prophylactic antibiotics was consistently beneficial meaning that these limitations were unlikely to have had a major impact on the nature of the overall results. Abdominal surgical wound infection in patients having operations on the large intestine occurs in about 40% of patients if antibiotics are not given. This risk can be greatly diminished by the administration of antibiotics prophylactically before surgery. . The antibiotic(s) given usuallly needs to cover different types of bacteria some of which need oxygen (aerobic bacteria) and others which do not need oxygen (anaerobic bacteria).. They are usually given via a canula injected into a vein, though there is evidence that a combination of oral and intravenous antibiotics may provide more protection. This last finding raises a problem in that current clinical practice is to avoid mechanical cleansing of the colon because it is not thought to be necessary before surgery (and not popular with patients). Studies that found a benefit to oral antibiotics were done at a time when mechanical cleansing of the colon was routinely done. In the light of current practice regarding mechanical cleansing before surgery of the colon, the benefit of oral antibiotics is uncertain.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Research shows that administration of prophylactic antibiotics before colorectal surgery prevents postoperative surgical wound infection. The best antibiotic choice, timing of administration and route of administration remain undetermined.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To establish the effectiveness of antimicrobial prophylaxis for the prevention of surgical wound infection in patients undergoing colorectal surgery. Specifically to determine:</P>
+<P>1. whether antimicrobial prophylaxis reduces the risk of surgical wound infection;<BR/>2. the target spectrum of bacteria (aerobic or anaerobic bacteria, or both);<BR/>3. the best timing and duration of antibiotic administration;<BR/>4. the most effective route of antibiotic administration (intravenous, oral or both);<BR/>5. whether any antibiotic is clearly more effective than the currently recommended gold standard specified in published guidelines;<BR/>6. whether antibiotics should be given before or after surgery.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>For the original review published in 2009 we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in <I>The Cochrane Library</I>, MEDLINE (Ovid) and EMBASE (Ovid). For the update of this review we rewrote the search strategies and extended the search to cover from 1954 for MEDLINE and 1974 for EMBASE up to 7 January 2013. We searched CENTRAL on the same date (Issue 12, 2012).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials of prophylactic antibiotic use in elective and emergency colorectal surgery, with surgical wound infection as an outcome.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Data were abstracted and reviewed by one review author and checked by another only for the single, dichotomous outcome of surgical wound infection. Quality of evidence was assessed using GRADE methods.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>This updated review includes 260 trials and 68 different antibiotics, including 24 cephalosporins and 43,451 participants. Many studies had multiple variables that separated the two study groups; these could not be compared to other studies that tested one antibiotic and had a single variable separating the two groups. We did not consider the risk of bias arising from attrition and lack of blinding of outcome assessors to affect the results for surgical wound infection.</P>
+<P>Meta-analyses demonstrated a statistically significant difference in postoperative surgical wound infection when prophylactic antibiotics were compared to placebo/no treatment (risk ratio (RR) 0.34, 95% confidence interval (CI) 0.28 to 0.41, high quality evidence). This translates to a reduction in risk from 39% to 13% with prophylactic antibiotics. The slightly higher risk of wound infection with short-term compared with long-term duration antibiotic did not reach statistical significance (RR 1.10, 95% CI 0.93 to 1.30). Similarly risk of would infection was slightly higher with single-dose antibiotics when compared with multiple dose antibiotics, but the results are compatible with benefit and harm (RR 1.30, 95% CI 0.81 to 2.10). Additional aerobic coverage and additional anaerobic coverage both showed statistically significant improvements in surgical wound infection rates (RR 0.44, 95% CI 0.29 to 0.68 and RR 0.47, 95% CI 0.31 to 0.71, respectively), as did combined oral and intravenous antibiotic prophylaxis when compared to intravenous alone (RR 0.56, 95% CI 0.43 to 0.74), or oral alone (RR 0.56, 95% CI 0.40 to 0.76). Comparison of an antibiotic with anaerobic specificity to one with aerobic specificity showed no significant advantage for either one (RR 0.84, 95% CI 0.30 to 2.36). Two small studies compared giving antibiotics before or after surgery and no significant difference in this timing was found (RR 0.67, 95% CI 0.21 to 2.15). Established gold-standard regimens recommended in major guidelines were no less effective than any other antibiotic choice.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>This review has found high quality evidence that antibiotics covering aerobic and anaerobic bacteria delivered orally or intravenously (or both) prior to elective colorectal surgery reduce the risk of surgical wound infection. Our review shows that antibiotics delivered within this framework can reduce the risk of postoperative surgical wound infection by as much as 75%. It is not known whether oral antibiotics would still have these effects when the colon is not empty. This aspect of antibiotic dosing has not been tested. Further research is required to establish the optimal timing and duration of dosing, and the frequency of longer-term adverse effects such as <I>Clostridium difficile</I> pseudomembranous colitis.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001191.pub3.en.xml

@@ -0,0 +1,61 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE>Rivastigmine for Alzheimer's disease</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Rivastigmine for people with Alzheimer's disease</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Review question</B>
+</P>
+<P>We reviewed evidence comparing the effectiveness and safety of rivastigmine with placebo in people with Alzheimer's disease.<BR/>
+<B>
+<BR/>Background</B>
+</P>
+<P>Alzheimer's disease is the commonest cause of dementia affecting older people. As the disease progresses, people lose the ability to remember, communicate, think clearly and perform the usual daily activities. Their behaviour or personality may also change. In severe Alzheimer's disease, the patients lose the ability to care for themselves and require full time care.</P>
+<P>Currently, there is no cure available for Alzheimer's disease, but a few pharmacological interventions are available to alleviate symptoms.</P>
+<P>The symptoms are caused by the loss of a type of nerve cell in the brain called cholinergic neurons. Rivastigmine, an acetylcholine inhibitor, works by increasing the levels of a brain chemical called acetylcholine which allows the nerve cells to communicate. This may improve the symptoms of dementia. Rivastigmine can be taken orally, either as capsules or a liquid, or by applying a patch on the skin. Its effectiveness in improving the symptoms of Alzheimer's disease and safety were evaluated in this review.</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>This review included double-blinded randomised controlled trials, and the evidence was searched for up to March 2015 using the standard Cochrane methods. The review included studies conducted for at least 12 weeks that compared the safety and effectiveness of rivastigmine compared with placebo. Thirteen studies that met these criteria were found. Most of these studies involved people with mild to moderate Alzheimer's disease with an average age of around 75 years.</P>
+<P>
+<B>Key results</B>
+</P>
+<P>Results from seven trials showed that patients on rivastigmine (6 to 12 mg/day by mouth, or 9.5 mg/day by skin patch) were better for three outcomes than those on placebo, after six months of treatment. The differences were quite small for cognitive function (2 points, using the ADAS-Cog which has a range of 70 points) and activities of daily living (standardised mean difference (SMD) of 0.20, which is considered a small effect). Patients on rivastigmine were more likely to show overall improvement compared with those on placebo (odds ratio of 1.47, 95% confidence interval (CI) of 1.25 to 1.72) . However, there was no difference for behavioural changes (reported by three trials) or impact on carers (reported by one trial). Patients on rivastigmine were also about twice as likely to experience adverse events, although this risk might have been slightly less for patients using patches compared with capsules. It was possible that certain types of adverse events were less in people using patches than taking capsules (nausea, vomiting, weight loss, dizziness).</P>
+<P>In summary, rivastigmine may be of benefit to people with Alzheimer's disease. It is possible that the using a patch is associated with reduced side effects compared to using oral capsules.</P>
+<P>
+<B>Quality of evidence</B>
+</P>
+<P>The quality of the evidence for most of the outcomes reviewed was moderate. The main factors affecting our confidence in the results included relatively high number of patients dropping out in some of the trials (the rates of dropout in the rivastigmine arms were higher). There were also concerns about the applicability of the evidence for the long term treatment of Alzheimer's disease since data from double-blinded randomised controlled trials were only available for up to 12 months. All the data included in the main analysis of this review came from studies either sponsored or funded by the drug manufacturer (Novartis Pharma).<BR/>
+</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Alzheimer's disease is the commonest cause of dementia affecting older people. One of the therapeutic strategies aimed at ameliorating the clinical manifestations of Alzheimer's disease is to enhance cholinergic neurotransmission in the brain by the use of cholinesterase inhibitors to delay the breakdown of acetylcholine released into synaptic clefts. Tacrine, the first of the cholinesterase inhibitors to undergo extensive trials for this purpose, was associated with significant adverse effects including hepatotoxicity. Other cholinesterase inhibitors, including rivastigmine, with superior properties in terms of specificity of action and lower risk of adverse effects have since been introduced. Rivastigmine has received approval for use in 60 countries including all member states of the European Union and the USA.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To determine the clinical efficacy and safety of rivastigmine for patients with dementia of Alzheimer's type.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, on 2 March 2015 using the terms: Rivastigmine OR  exelon OR ENA OR "SDZ ENA 713". ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases (Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS), numerous trial registries and grey literature sources.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>We included all unconfounded, double-blind, randomised, controlled trials in which treatment with rivastigmine was administered to patients with dementia of the Alzheimer's type for 12 weeks or more and its effects compared with those of placebo in a parallel group of patients, or where two formulations of rivastigmine were compared.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>One review author (JSB) applied the study selection criteria, assessed the quality of studies and extracted data.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>A total of 13 trials met the inclusion criteria of the review. The trials had a duration of between 12 and 52 weeks. The older trials tested a capsule form with a dose of up to 12 mg/day. Trials reported since 2007 have tested continuous dose transdermal patch formulations delivering 4.6, 9.5 and 17.7 mg/day. 
+</P>
+<P>Our main analysis compared the safety and efficacy of rivastigmine 6 to 12 mg/day orally or 9.5 mg/day transdermally with placebo.</P>
+<P>Seven trials contributed data from 3450 patients to this analysis. Data from another two studies were not included because of a lack of information and methodological concerns. All the included trials were multicentre trials and recruited patients with mild to moderate Alzheimer's disease with a mean age of about 75 years. All had low risk of bias for randomisation and allocation but the risk of bias due to attrition was unclear in four studies, low in one study and high in two studies.</P>
+<P>After 26 weeks of treatment rivastigmine compared to placebo was associated with better outcomes for cognitive function measured with the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) score (mean difference (MD) -1.79; 95% confidence interval (CI) -2.21 to -1.37, n = 3232, 6 studies) and the Mini-Mental State Examination (MMSE) score (MD 0.74; 95% CI 0.52 to 0.97, n = 3205, 6 studies), activities of daily living (SMD 0.20; 95% CI 0.13 to 0.27, n = 3230, 6 studies) and clinician rated global impression of changes, with a smaller proportion of patients treated with rivastigmine experiencing no change or a deterioration (OR 0.68; 95% CI 0.58 to 0.80, n = 3338, 7 studies).</P>
+<P>Three studies reported behavioural change, and there were no differences compared to placebo (standardised mean difference (SMD) -0.04; 95% CI -0.14 to 0.06, n = 1529, 3 studies). Only one study measured the impact on caregivers using the Neuropsychiatric Inventory-Caregiver Distress (NPI-D) scale and this found no difference between the groups (MD 0.10; 95% CI -0.91 to 1.11, n = 529, 1 study). Overall, participants who received rivastigmine were about twice as likely to withdraw from the trials (odds ratio (OR) 2.01, 95% CI 1.71 to 2.37, n = 3569, 7 studies) or to experience an adverse event during the trials (OR 2.16, 95% CI 1.82 to 2.57, n = 3587, 7 studies).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Rivastigmine (6 to 12 mg daily orally or 9.5 mg daily transdermally) appears to be beneficial for people with mild to moderate Alzheimer's disease. In comparisons with placebo, better outcomes were observed for rate of decline of cognitive function and activities of daily living, although the effects were small and of uncertain clinical importance. There was also a benefit from rivastigmine on the outcome of clinician's global assessment. There were no differences between the rivastigmine group and placebo group in behavioural change or impact on carers. At these doses the transdermal patch may have fewer side effects than the capsules but has comparable efficacy. The quality of evidence is only moderate for all of the outcomes reviewed because of a risk of bias due to dropouts. All the studies with usable data were industry funded or sponsored. This review has not examined economic data.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001213.en.xml

@@ -0,0 +1,34 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Interventions for guttate psoriasis</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Treatments for guttate psoriasis</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Psoriasis is a skin disease that causes scaly pink patches. Guttate psoriasis is a particular form of the disease that usually affects children and young adults. It can happen on its own, or as a complication of ordinary (chronic plaque) psoriasis. Often, it follows a bacterial throat infection or tonsillitis. Antibiotics and tonsillectomy as treatments for guttate psoriasis are covered by another review. This review could find no evidence, from trials, about the effects of any other commonly used treatments for guttate psoriasis.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Guttate psoriasis is a distinctive acute form of psoriasis which characteristically occurs in children and young adults. Very little specific evidence-based guidance is available in standard texts to help make rational decisions about treatment options.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effectiveness of treatments for guttate psoriasis.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Clinical Trials Register (Cochrane Library, Issue 3, 1999), Medline (1966- September 1999), Embase (1988-September 1999), Salford Database of Psoriasis Trials (to November 1999) and European Dermato-Epidemiology Network (EDEN) Psoriasis Trials Database (to November 1999) for terms GUTTATE and PSORIASIS. We also searched 100 unselected RCTs of psoriasis therapy and all 112 RCTs of phototherapy for psoriasis in the Salford Database of Psoriasis Trials for separate stratification for guttate psoriasis. </P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised trials in which patients with acute guttate psoriasis were randomised to different treatments, except those trials examining antistreptococcal interventions which are addressed in a separate Cochrane review.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two reviewers independently assessed trial eligibility and quality.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>No published report could be found to support or to challenge current commonly used methods of management.</P>
+<P>Only one trial which met the selection criteria was identified. In this small study of 21 hospitalised patients with guttate psoriasis, intravenous infusion of an n-3 fatty acid rich lipid emulsion was compared with placebo emulsion containing n-6 fatty acids. The n-3 preparation appeared to be of some benefit for patients with guttate psoriasis. </P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There is currently no firm evidence on which to base treatment of acute guttate psoriasis. Studies comparing standard treatment modalities, including phototherapy and topical regimens, are required to enable informed decisions on treatment choices to be made.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001219.en.xml

@@ -0,0 +1,35 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Corticosteroids may reduce bowel obstruction for people with advanced gastrointestinal or ovarian cancer. Malignant bowel obstruction is fairly common in people with gastrointestinal (gut) cancer or ovarian cancer. It can lead to pain, vomiting, nausea, or complete constipation. Corticosteroids may lower inflammation and so help to reduce the obstruction especially if surgery is not considered to be suitable. The review found that corticosteroids may reduce bowel obstruction for people with these cancers, with a low rate of adverse effects. The treatment does not appear to affect survival rates compared to the placebo.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>This is an update of the review published in Issue 3, 1999. Gastrointestinal and ovarian cancers are common cancers. The incidence of associated malignant bowel obstruction in patients with advanced cancers of these types is not known, and the best management of these patients is controversial. Inappropriate management may result in uncontrolled (faeculant) vomiting, pain and distress. Management of the symptoms can include palliative surgery, nasogastric tube suction together with intravenous fluids, or pharmacological means, such as corticosteroids. There is uncertainty regarding both the efficacy and possible harmful effects of corticosteroids, and also the most effective type, dose/dosing regime, route and period of administration.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To locate, appraise and summarise evidence from scientific studies on intestinal obstruction due to advanced gynaecological and gastrointestinal cancer, in order to assess efficacy of corticosteroids.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>A comprehensive list of all studies was provided by an extensive search of the electronic databases, relevant journals, reference lists, the grey literature, contact with investigators and other search strategies outlined in the methods. Date of last search conducted in February 2006.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>As the review concentrates on the 'best evidence' available of the role of corticosteroids in malignant bowel obstruction due to advanced gynaecological and gastrointestinal cancer the inclusion criteria were kept fairly broad so as to include all studies relevant to the question.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Data extraction forms were used to collect data from the studies included in the review. The data was checked by a secondary searcher to reduce error.</P>
+<P>A qualitative analysis was performed of the dichotomous data of resolution of obstruction and death at one month, obtained from the randomised controlled trials of corticosteroids versus placebo. Both fixed and random effect models were used. Number-needed-to-treat-to-benefit (NNT) was derived from the odds ratio. Kaplan-Meier survival curves from individual patient data were also analysed. Studies of lower methodological quality were assessed in a qualitative manner.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>No new included or excluded trials were found for this update beyond the three unpublished, randomised, placebo, double blind controlled trials and seven published (prospective and retrospective) trials which were previously considered eligible.</P>
+<P>Using only the randomised trials (89 patients), there is a trend, which is not statistically significant, for the resolution of bowel obstruction using corticosteroids. There is no statistically significant difference in mortality at one month, nor in the Kaplan-Meier curves, which describe the survival of patients on corticosteroids or placebo. Number needed to treat is six (three, infinity) i.e. six patients need to be treated with corticosteroids to resolve one episode of bowel obstruction. The results are robust to fixed and random effects models and to 'best' and 'worst case' scenarios on the missing data from patients. The morbidity associated with corticosteroids appears to be very low, though the quality of the data limits this conclusion. No other outcomes were available from the published data or from the authors.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There is a trend for evidence that corticosteroids of dose range six to 16 mg dexamethasone given intravenously may bring about the resolution of bowel obstruction. Equally, the incidence of side effects in all the included studies is extremely low. Corticosteroids do not seem to affect the length of survival of these patients. Since the last version of this review, no new studies have been conducted. No new studies have been identified for this update and the conclusions are not altered.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001236.pub2.en.xml

@@ -0,0 +1,34 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Routine perineal shaving on admission in labour</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Routinely shaving women in the area around the vagina on admission to hospital in labour</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Women may have their pubic hairs shaved with a razor (perineal shaving) when they are admitted to hospital to give childbirth. This is done in the belief that shaving reduces the risk of infection if the perineum tears or a episiotomy is performed and that it makes suturing easier and helps with instrumental deliveries. Shaving is a routine procedure in some countries. Three controlled trials that involved a total of 1039 women were reported on between 1922 and 2005. They each used an antiseptic skin preparation and compared perineal shaving with cutting vulval hairs. The overall quality of evidence ranged from very low (for the outcomes postpartum maternal febrile morbidity and neonatal infection) to low (for the outcomes wound infection and maternal satisfaction). When the findings of the trials were combined, no differences were found, with and without shaving, on the number of mothers who experiencing high body temperatures after the birth. One trial also looked at perineal wound infection, the incidence of open wounds and maternal satisfaction immediately after a perineal repair had been completed and found no difference between groups. Most of the side-effects attributable to shaving occurred later, as described by one of the trials. These included irritation, redness, multiple superficial scratches from the razor and burning and itching of the vulva. One trial assessed maternal satisfaction and found no difference between groups. Other outcomes such as pain, embarrassment or discomfort during hair regrowth, were not reported. The present review found no evidence of any clinical benefit with perineal shaving. Not routinely shaving women before labour appeared safe.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Pubic or perineal shaving is a procedure performed before birth in order to lessen the risk of infection if there is a spontaneous perineal tear or if an episiotomy is performed.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of routine perineal shaving before birth on maternal and neonatal outcomes, according to the best available evidence.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (12 June 2014).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>All controlled trials (including quasi-randomised) that compare perineal shaving versus no perineal shaving.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors independently assessed all potential studies for inclusion, assessed risk of bias and extracted the data using a predesigned form. Data were checked for accuracy.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Three randomised controlled trials (1039 women) published between 1922 and 2005 fulfilled the prespecified criteria. In the earliest trial, 389 women were alternately allocated to receive either skin preparation and perineal shaving or clipping of vulval hair only. In the second trial, which included 150 participants, perineal shaving was compared with the cutting of long hairs for procedures only. In the third and most recent trial, 500 women were randomly allocated to shaving of perineal area or cutting of perineal hair. The primary outcome for all three trials was maternal febrile morbidity; no differences were found (risk ratio (RR) 1.14, 95% confidence interval (CI) 0.73 to 1.76). No differences were found in terms of perineal wound infection (RR 1.47, 95% CI 0.80 to 2.70) and perineal wound dehiscence (RR 0.33, 95% CI 0.01 to 8.00) in the most recent trial involving 500 women, which was the only trial to assess these outcomes. In the smallest trial, fewer women who had not been shaved had Gram-negative bacterial colonisation compared with women who had been shaved (RR 0.83, 95% CI 0.70 to 0.98). There were no instances of neonatal infection in either group in the one trial that reported this outcome. There were no differences in maternal satisfaction between groups in the larger trial reporting this outcome (mean difference (MD) 0.00, 95% CI -0.13 to 0.13). No trial reported on perineal trauma. One trial reported on side-effects and these included irritation, redness, burning and itching.</P>
+<P>The overall quality of evidence ranged from very low (for the outcomes postpartum maternal febrile morbidity and neonatal infection) to low (for the outcome maternal satisfaction and wound infection).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>There is insufficient evidence to recommend perineal shaving for women on admission in labour.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001239.pub5.en.xml

@@ -0,0 +1,48 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE>Intravenous immunoglobulin for suspected or proven infection in neonates</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Intravenous immunoglobulin for suspected or proven infection in neonates</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Background </B>
+</P>
+<P>Infants may acquire infection while in the womb or in the hospital after birth, especially if they require intensive care. Such infections may cause serious illness or death. Maternal transport of immunoglobulins (substances in the blood that can fight infection) to the fetus mainly occurs after 32 weeks' gestation, and infants do not begin to produce their own immunoglobulins until several months after birth. Theoretically, the adverse effects of infection could be reduced by the administration of intravenous immunoglobulin.</P>
+<P>
+<B>Our review question </B>
+</P>
+<P>In newborn infants with suspected or proven infections<B>,</B> does the injection of immunoglobulin into the veins reduce death or illness?</P>
+<P>
+<B>What the studies showed</B>
+</P>
+<P>In addition to many small studies<B>,</B> a very large trial that enrolled 3493 infants has been published. It is clear from the available studies that intravenous immunoglobulin administration does not prevent death or illness during hospital stay, and death or major disability at two years of age.</P>
+<P>
+<B>Overall</B>
+</P>
+<P>The use of intravenous immunoglobulin to treat suspected or proven infection in neonates is not recommended. No further research is recommended.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Neonates are at higher risk of infection due to immuno-incompetence. Maternal transport of immunoglobulins to the fetus mainly occurs after 32 weeks' gestation, and endogenous synthesis begins several months after birth. Administration of intravenous immunoglobulin (IVIG) provides immunoglobulin G (IgG) that can bind to cell surface receptors, provide opsonic activity, activate complement, promote antibody-dependent cytotoxicity and improve neutrophilic chemo-luminescence. Theoretically, infectious morbidity and mortality could be reduced by the administration of IVIG.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of IVIG on mortality and morbidity caused by suspected or proven infection at study entry in neonates. To assess in a subgroup analysis the effects of IgM-enriched IVIG on mortality from suspected infection.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>For this update, MEDLINE, EMBASE, <I>The Cochrane Library</I>, CINAHL, trial registries, Web of Science, reference lists of identified studies, meta-analyses and personal files were searched in 2013. No language restrictions were applied.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised or quasi-randomised controlled trials involving newborn infants (&lt; 28 days old); IVIG for treatment of suspected or proven bacterial or fungal infection compared with placebo or no intervention; and where one of the following outcomes was reported, mortality, length of hospital stay or psychomotor development at follow-up.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Statistical analyses included typical risk ratio (RR), risk difference (RD), weighted mean difference (WMD), number needed to treat for an additional beneficial outcome (NNTB) or an additional harmful outcome (NNTH), all with 95% confidence intervals (CIs), and the I<SUP>2</SUP> statistic to examine for statistical heterogeneity.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>The updated search identified one published study that was previously ongoing. A total of 9 studies evaluating 3973 infants were included in this review. Mortality during hospital stay in infants with clinically suspected infection was not significantly different after IVIG treatment (9 studies (n = 2527); typical RR 0.95, 95% CI 0.80 to 1.13; typical RD -0.01, 95% CI - 0.04 to 0.02; I<SUP>2</SUP> = 23% for RR and 29% for RD). Death or major disability at 2 years corrected age was not significantly different in infants with suspected infection after IVIG treatment (1 study (n = 1985); RR 0.98, 95% CI 0.88 to 1.09; RD -0.01, 95% CI -0.05 to 0.03). Mortality during hospital stay was not significantly different after IVIG treatment in infants with proven infection at trial entry (1 trial (n = 1446); RR 0.95, 95% CI 0.74 to 1.21; RD -0.01, 95% CI -0.04 to 0.03). Death or major disability at 2 years corrected age was not significantly different after IVIG treatment in infants with proven infection at trial entry (1 trial (n = 1393); RR 1.03, 95% CI 0.91 to 1.18; RD 0.01, 95% CI -0.04 to 0.06). Mortality during hospital stay in infants with clinically suspected or proven infection at trial entry was not significantly different after IVIG treatment (1 study (n = 3493); RR 1.00, 95% CI 0.86 to 1.16; RD 0.00, 95% CI - 0.02 to 0.03). Death or major disability at 2 years corrected age was not significantly different after IVIG treatment in infants with suspected or proven infection at trial entry (1 study (n = 3493); RR 1.00, 95% CI 0.92 to 1.09; RD -0.00, 95% CI -0.03 to 0.03). Length of hospital stay was not reduced for infants with suspected or proven infection at trial entry (1 study (n = 3493); mean difference (MD) 0.00 days, 95% CI -0.61 to 0.61). No significant difference in mortality during hospital stay after administration of IgM-enriched IVIG for suspected infection at trial entry was reported in 4 studies (n = 266) (typical RR 0.68, 95% CI 0.39 to 1.20; RD -0.06, 95% CI -0.14 to 0.02; I<SUP>2</SUP> = 17% for RR and 53% for RD).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>The undisputable results of the INIS trial, which enrolled 3493 infants, and our meta-analyses (n = 3973) showed no reduction in mortality during hospital stay, or death or major disability at two years of age in infants with suspected or proven infection. Although based on a small sample size (n = 266), this update provides additional evidence that IgM-enriched IVIG does not significantly reduce mortality during hospital stay in infants with suspected infection. Routine administration of IVIG or IgM-enriched IVIG to prevent mortality in infants with suspected or proven neonatal infection is not recommended. No further research is recommended.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001255.pub5.en.xml

@@ -0,0 +1,49 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Hip protectors for preventing hip fractures in older people</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Hip protectors for preventing hip fractures in older people</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>What are hip protectors?</B>
+</P>
+<P>Older people living in nursing care facilities or older adults living at home are at high risk of falling and a hip fracture may occur after a fall. Hip protectors are plastic shields (hard) or foam pads (soft), usually fitted in pockets in specially designed underwear. They are worn to cushion a sideways fall on the hip.</P>
+<P>
+<B>Do they prevent hip fractures?</B>
+</P>
+<P>We conducted a review of the effect<I> </I>of hip protectors to prevent hip fractures. We searched for all relevant studies up to December 2012. We found 19 studies with about 17,000 people who were around 80 years old.</P>
+<P>Overall, there was moderate quality evidence from these studies for the following results.</P>
+<P>In older people living in nursing care facilities, providing a hip protector<BR/>- probably decreases the chance of a hip fracture slightly<BR/>- may increase the small chance of a pelvic fracture slightly<BR/>- probably has little or no effect on other fractures or falls</P>
+<P>In older people living at home, providing a hip protector<BR/>- probably has little or no effect on hip fractures</P>
+<P>When wearing the hip protectors very few people had side effects, such as skin irritation. However, people often did not wear the hip protectors when they were provided. Better understanding is needed of the personal and design factors that may influence acceptance and adherence.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Older people living in nursing care facilities or older adults living at home are at high risk of falling and a hip fracture may occur after a fall. Hip protectors have been advocated as a means to reduce the risk of hip fracture. Hip protectors are plastic shields (hard) or foam pads (soft), usually fitted in pockets in specially designed underwear. </P>
+<P>This is an update of a Cochrane review first published in 1999, and updated several times, most recently in 2010.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To determine if the provision of external hip protectors (sometimes referred to as hip pads or hip protector pads) reduces the risk of fracturing the hip in older people.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (<I>The Cochrane Library </I>2012<I>, </I>Issue 12)<I>,</I> MEDLINE (1950 to week 3 November 2012), MEDLINE In-Process (18 December 2012), EMBASE (1988 to 2012 Week 50), CINAHL (1982 to December 2012), BioMed Central (January 2010), trial registers and reference lists of relevant articles.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>All randomised or quasi-randomised controlled trials comparing an intervention group provided with hip protectors with a control group not provided with hip protectors.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors independently assessed risk of bias and extracted data. We sought additional information from trialists. Data were pooled using fixed-effect or random-effects models as appropriate.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>This review includes 19 studies, nine of which were cluster randomised. These included approximately 17,000 people (mean age range 78 to 86 years). Most studies were overall at low risk of bias for fracture outcomes. Trials tested hard or soft hip protectors enclosed in special underwear in 18 studies.</P>
+<P>Pooling of data from 14 studies (11,808 participants) conducted in nursing or residential care settings found moderate quality evidence for a small reduction in hip fracture risk (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.67 to 1.00); the absolute effect is 11 fewer people (95% CI, from 20 fewer to 0) per 1000 having a hip fracture when provided with hip protectors.</P>
+<P>There is moderate quality evidence when pooling data from five trials in the community (5614 participants) that shows little or no effect in hip fracture risk (RR 1.15, 95% CI 0.84 to 1.58); the absolute effect is two more people (95% CI 2 fewer to 6 more) per 1000 people having a hip fracture when provided with hip protectors.</P>
+<P>There is probably little to no effect on falls (rate ratio 1.02, 95% CI 0.9 to 1.16) or fractures other than of the hip or pelvis (rate ratio 0.87, 95% CI 0.71 to 1.07). However, the risk ratio for pelvic fractures is RR 1.27 (95% CI 0.78 to 2.08); this is an absolute effect of one more person (95% CI 1 fewer to 5 more) per 1000 having a pelvic fracture when provided with hip protectors.</P>
+<P>The incidence of adverse events while wearing hip protectors, including skin irritation, ranged from 0% to 5%. Adherence, particularly in the long term, was poor.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Hip protectors probably reduce the risk of hip fractures if made available to older people in nursing care or residential care settings, without increasing the frequency of falls. However, hip protectors may slightly increase the small risk of pelvic fractures. Poor acceptance and adherence by older people offered hip protectors is a barrier to their use. Better understanding is needed of the personal and design factors that may influence acceptance and adherence.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001258.pub3.en.xml

@@ -0,0 +1,37 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Carbamazepine for schizophrenia</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Carbamazepine for schizophrenia</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>People with schizophrenia will often hear voices or see things (hallucinations) and have strange beliefs (delusions). They may also experience apathy, tiredness, lack of drive and disorganised thoughts and behaviour. These symptoms make schizophrenia a severe illness that affects many people throughout their life.</P>
+<P>The main treatment for schizophrenia is antipsychotic medication. However, although this medication is successful in treating the majority of people, 5% to 15% will continue to suffer from debilitating symptoms. For these people, several treatment options are available: changing the dose of medication; switching to another antipsychotic drug; or taking additional drugs that are not antipsychotics. Carbamazepine is a drug first used to treat epilepsy in the 1950s. It is also used as a mood stabiliser when people change between ‘high’ and ‘low’ moods (for example bi-polar affective disorder). Side effects of carbamazepine include: poor coordination, headaches and drowsiness.</P>
+<P>This review focuses on the effectiveness of carbamazepine for people with schizophrenia. A search of the Cochrane Schizophrenia Group's trials register was carried out July 2012. Ten studies were found with 283 people. Carbamazepine was compared with no active medication (‘dummy’ or placebo treatment), versus an antipsychotic or when taken in addition to an antipsychotic. However, all of the 10 studies were small and information in them was of a poor standard. There is therefore a lack of evidence whether carbamazepine reduces symptoms and side effects in people with schizophrenia or similar mental health problems. Larger well-designed trials are necessary to provide stronger evidence before carbamazepine can be recommended as a treatment for people with schizophrenia.</P>
+<P>This plain language summary has been written by a consumer Ben Gray: Service User and Service User Expert. Rethink Mental Illness.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Many people with schizophrenia do not achieve a satisfactory treatment response with just antipsychotic drug treatment and various adjunct medications are used to promote additional response. The antiepileptic carbamazepine is one such drug.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To examine whether carbamazepine or oxcarbazepine alone is an effective treatment for schizophrenia and schizoaffective psychoses and whether carbamazepine or oxcarbazepine augmentation of neuroleptic medication is an effective treatment for the same illnesses.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>For the original version we searched The Cochrane Schizophrenia Group's Register of Trials (December 2001), <I>The Cochrane Library</I> (Issue 3, 2001), MEDLINE (1966-2001), EMBASE (1980-2001), Biological Abstracts (1980-2001), PsycLIT (1886-2001) and PSYNDEX (1974-2001). For the most recent update we searched the Cochrane Schizophrenia Group's Register of Trials in July 2012. We also inspected references of all identified studies for further trials and contacted relevant pharmaceutical companies and authors for additional data.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>We included all randomised controlled trials (RCTs) comparing carbamazepine or compounds of the carbamazepine family with placebo or no intervention, whether as sole treatment or as an adjunct to antipsychotic medication for the treatment of schizophrenia and/or schizoaffective psychoses.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>We extracted data independently. For homogenous dichotomous data we calculated fixed-effect, risk ratio (RR), with 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). We assessed the risk of bias for included studies and created a 'Summary of findings' table using GRADE.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>The updated search did not reveal any further studies that met our inclusion criteria. The number of included studies therefore remains at 10 with the number of participants randomised still 283.</P>
+<P>One study comparing carbamazepine with placebo as the sole treatment for schizophrenia was abandoned early due to high relapse rate with 26 out of 31 participants relapsing by three months. No effect of carbamazepine was evident with no difference in relapse between the two groups (1 RCT n = 31, RR 1.07 CI 0.78 to 1.45). Another study compared carbamazepine with antipsychotics as the sole treatment for schizophrenia. No differences in terms of mental state were found when comparing 50% reduction in Brief Psychiatric Rating Scale (BPRS) scores (1 RCT n = 38, RR 1.23 CI 0.78 to 1.92). A favourable effect for carbamazepine was found when more people who received the antipsychotic (perphenazine) had parkinsonism (1 RCT n = 38, RR 0.03 CI 0.00 to 0.043). Eight studies compared adjunctive carbamazepine versus adjunctive placebo, we were able use GRADE for quality of evidence for these results. Adding carbamazepine to antipsychotic treatment was as acceptable as adding placebo with no difference between the numbers leaving the study early from each group (8 RCTs n = 182, RR 0.47 CI 0.16 to 1.35, <I>very low quality evidence</I>). Carbamazepine augmentation was superior compared with antipsychotics alone in terms of overall global improvement, but participant numbers were low (2 RCTs n = 38, RR 0.57 CI 0.37 to 0.88). There were no differences for the mental state outcome of 50% reduction in BPRS scores (6 RCTs n = 147, RR 0.86 CI 0.67 to 1.12, <I>low quality evidence</I>). Less people in the carbamazepine augmentation group had movement disorders than those taking haloperidol alone (1 RCT n = 20, RR 0.38 CI 0.14 to 1.02). No data were available for the effects of carbamazepine on subgroups of people with schizophrenia and aggressive behaviour, negative symptoms or EEG abnormalities or with schizoaffective disorder.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Based on currently available randomised trial-derived evidence, carbamazepine cannot be recommended for routine clinical use for treatment or augmentation of antipsychotic treatment of schizophrenia. At present large, simple well-designed and reported trials are justified - especially if focusing on people with violent episodes and people with schizoaffective disorders or those with both schizophrenia and EEG abnormalities.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001266.pub4.en.xml

@@ -0,0 +1,56 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Bronchodilators for bronchiolitis</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Bronchodilators for bronchiolitis for infants with first-time wheezing</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>What is bronchiolitis?</B>
+</P>
+<P>Bronchiolitis is an acute, highly contagious, viral infection of the lungs that is common in infants 0 to 12 months of age. It occurs every year in the winter months. It causes the small airways in the lungs to become inflamed and fill with debris. The airways are narrowed and this leads to blocking of the free passage of air. The infant has a harsh cough, runny nose and usually a fever. S/he can become breathless, wheezy and short of oxygen.</P>
+<P>
+<B>Why review bronchodilators?</B>
+</P>
+<P>Bronchodilators are drugs often used as aerosols to widen the air passages by relaxing the bronchial muscle. They are effective in helping older children and adults with asthma. However, unlike asthmatics, infants with bronchiolitis are usually wheezing for the first time. They are wheezing for a different reason, that is to say, because their airways are clogged with debris. Therefore, infants with bronchiolitis are less likely to respond to bronchodilators.</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>We reviewed the evidence about the effect of bronchodilators in infants with bronchiolitis. We found 30 trials that included a total of 1922 infants, in several countries. The evidence is current up to January 2014. We analyzed studies done in outpatient and inpatient settings separately. All bronchodilators were included in the review except for epinephrine because it is reviewed in another Cochrane review. Albuterol (otherwise known as salbutamol) is commonly used in studies, so we also reviewed this bronchodilator as a subgroup.</P>
+<P>
+<B>Key results</B>
+</P>
+<P>We found no effect of bronchodilators on oxygen saturation. Infants hospitalized for bronchiolitis showed no significant benefit of bronchodilator treatment. This review also found that bronchodilators do not reduce the need for hospitalization, do not shorten the length of stay in hospital and do not shorten the length of the illness at home. Reviewing the subgroup of studies using albuterol (salbutamol), we found no effect of this bronchodilator on oxygen saturation or clinical scores. Side effects of bronchodilators include rapid heart beat, decrease in oxygen and shakiness. Given these side effects, little evidence that they are effective and the expense associated with these treatments, bronchodilators are not helpful in the management of bronchiolitis.</P>
+<P>
+<B>Quality of the evidence</B>
+</P>
+<P>This review is limited by the small number of studies that use the same measures and methods. For example, only 22 studies included only infants wheezing for the first time. Older studies included children who had wheezed before and may have had asthma. Thus these older studies favor the use of bronchodilators. Newer studies that excluded infants with prior wheezing and had a better study design do not show a benefit of bronchodilators. This review is also limited by the small number of infants included in each study. Lastly, clinical scores used to measure the effect of the bronchodilators in some studies may vary from one observer to the next, making this measure unreliable. Studies that include more infants, use better measures and have a stronger study design are needed to define the effectiveness of these medications.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Bronchiolitis is an acute, viral lower respiratory tract infection affecting infants and is sometimes treated with bronchodilators.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To assess the effects of bronchodilators on clinical outcomes in infants (0 to 12 months) with acute bronchiolitis.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched CENTRAL 2013, Issue 12, MEDLINE (1966 to January Week 2, 2014) and EMBASE (1998 to January 2014).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomized controlled trials (RCTs) comparing bronchodilators (other than epinephrine) with placebo for bronchiolitis.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two authors assessed trial quality and extracted data. We obtained unpublished data from trial authors.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We included 30 trials (35 data sets) representing 1992 infants with bronchiolitis. In 11 inpatient and 10 outpatient studies, oxygen saturation did not improve with bronchodilators (mean difference (MD) -0.43, 95% confidence interval (CI) -0.92 to 0.06, n = 1242). Outpatient bronchodilator treatment did not reduce the rate of hospitalization (11.9% in bronchodilator group versus 15.9% in placebo group, odds ratio (OR) 0.75, 95% CI 0.46 to 1.21, n = 710). Inpatient bronchodilator treatment did not reduce the duration of hospitalization (MD 0.06, 95% CI -0.27 to 0.39, n = 349).</P>
+<P>Effect estimates for inpatients (MD -0.62, 95% CI -1.40 to 0.16) were slightly larger than for outpatients (MD -0.25, 95% CI -0.61 to 0.11) for oximetry. Oximetry outcomes showed significant heterogeneity (I<SUP>2 </SUP>statistic = 81%). Including only studies with low risk of bias had little impact on the overall effect size of oximetry (MD -0.38, 95% CI -0.75 to 0.00) but results were close to statistical significance.</P>
+<P>In eight inpatient studies, there was no change in average clinical score (standardized MD (SMD) -0.14, 95% CI -0.41 to 0.12) with bronchodilators. In nine outpatient studies, the average clinical score decreased slightly with bronchodilators (SMD -0.42, 95% CI -0.79 to -0.06), a statistically significant finding of questionable clinical importance. The clinical score outcome showed significant heterogeneity (I<SUP>2 </SUP>statistic = 73%). Including only studies with low risk of bias reduced the heterogeneity but had little impact on the overall effect size of average clinical score (SMD -0.22, 95% CI -0.41 to -0.03).</P>
+<P>Sub-analyses limited to nebulized albuterol or salbutamol among outpatients (nine studies) showed no effect on oxygen saturation (MD -0.19, 95% CI -0.59 to 0.21, n = 572), average clinical score (SMD -0.36, 95% CI -0.83 to 0.11, n = 532) or hospital admission after treatment (OR 0.77, 95% CI 0.44 to 1.33, n = 404).</P>
+<P>Adverse effects included tachycardia, oxygen desaturation and tremors.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Bronchodilators such as albuterol or salbutamol do not improve oxygen saturation, do not reduce hospital admission after outpatient treatment, do not shorten the duration of hospitalization and do not reduce the time to resolution of illness at home. Given the adverse side effects and the expense associated with these treatments, bronchodilators are not effective in the routine management of bronchiolitis. This meta-analysis continues to be limited by the small sample sizes and the lack of standardized study design and validated outcomes across the studies. Future trials with large sample sizes, standardized methodology across clinical sites and consistent assessment methods are needed to answer completely the question of efficacy.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001269.pub5.en.xml

@@ -0,0 +1,66 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Vaccines for preventing influenza in healthy adults</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Vaccines to prevent influenza in healthy adults</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Review question</B>
+</P>
+<P>We evaluated the effect of immunisation with influenza vaccines on preventing influenza A or B infections (efficacy), influenza-like illness (ILI) and its consequences (effectiveness), and determined whether exposure to influenza vaccines is associated with serious or severe harms. The target populations were healthy adults, including pregnant women and newborns.</P>
+<P>
+<B>Background</B>
+</P>
+<P>Over 200 viruses cause influenza and ILI, producing the same symptoms (fever, headache, aches, pains, cough and runny noses). Without laboratory tests, doctors cannot distinguish between them as both last for days and rarely lead to death or serious illness. At best, vaccines may only be effective against influenza A and B, which represent about 10% of all circulating viruses. Annually, the World Health Organization estimates which viral strains should be included in the next season's vaccinations.</P>
+<P>Inactivated vaccine is prepared by treating influenza viruses with a specific chemical agent that “kills” the virus. Final preparations can contain either the complete viruses (whole vaccine) or the active part of them (split or subunit vaccines). These kind of vaccines are normally intramuscularly administered (parenteral route)</P>
+<P>Live attenuated vaccines is prepared by growing the influenza viruses through a series of cell cultures or animal embryos. With each passage, the viruses lose their ability to replicate in human cells but can still stimulate the immune system. Live attenuated vaccine are administered as aerosol in the nostrils (intranasal route).</P>
+<P>The virus strains contained in the vaccine are usually those that are expected to circulate in the following epidemic seasons (two type A and one B strains), accordingly to the recommendations of the World Health Organization (seasonal vaccine).</P>
+<P>Pandemic vaccine contains only the virus strain that is responsible of the pandemic (i.e. the type A H1N1 for the 2009/2010 pandemic).</P>
+<P>
+<B>Study characteristics</B>
+</P>
+<P>The evidence is current to May 2013. In this update, 90 reports of 116 studies compared the effect of influenza vaccine with placebo or no intervention. Sixty-nine reports were clinical trials (over 70,000 people), 27 were comparative cohort studies (about eight million people) and 20 were case-control studies (nearly 25,000 people). Of the 116 studies, 23 (three case-control and 20 cohort studies) were performed during pregnancy (about 1.6 million mother-child couples).</P>
+<P>
+<B>Key results</B>
+</P>
+<P>The preventive effect of parenteral inactivated influenza vaccine on healthy adults is small: at least 40 people would need vaccination to avoid one ILI case (95% confidence interval (CI) 26 to 128) and 71 people would need vaccination to prevent one case of influenza (95% CI 64 to 80). Vaccination shows no appreciable effect on working days lost or hospitalisation.</P>
+<P>The protection against ILI that is given by the administration of inactivated influenza vaccine to pregnant women is uncertain or at least very limited; the effect on their newborns is not statistically significant.</P>
+<P>The effectiveness of live aerosol vaccines on healthy adults is similar to inactivated vaccines: 46 people (95% CI 29 to 115) would need immunisation to avoid one ILI case.</P>
+<P>The administration of seasonal inactivated influenza vaccine is not associated with the onset of multiple sclerosis, optic neuritis (inflammation of the optic nerve of the eye) or immune thrombocytopaenic purpura (a disease that affects blood platelets). The administration of pandemic monovalent H1N1 inactivated vaccine is not associated with Guillain-Barré syndrome (a disease that affects the nerves of the limbs and body).</P>
+<P>Evidence suggests that the administration of both seasonal and 2009 pandemic vaccines during pregnancy has no significant effect on abortion or neonatal death.</P>
+<P>
+<B>Quality of the evidence</B>
+</P>
+<P>The real impact of biases could not be determined for about 70% of the included studies (e.g. insufficient reporting details, very different scores among the items evaluated). About 20% of the included studies (mainly cohorts) had a high risk of bias. Just under 10% had good methodological quality.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Different types of influenza vaccines are currently produced worldwide. Vaccination of pregnant women is recommended internationally, while healthy adults are targeted in North America.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To identify, retrieve and assess all studies evaluating the effects (efficacy, effectiveness and harm) of vaccines against influenza in healthy adults, including pregnant women.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (<I>The Cochrane Library</I> 2013, Issue 2), MEDLINE (January 1966 to May 2013) and EMBASE (1990 to May 2013).</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials (RCTs) or quasi-RCTs comparing influenza vaccines with placebo or no intervention in naturally occurring influenza in healthy individuals aged 16 to 65 years. We also included comparative studies assessing serious and rare harms.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors independently assessed trial quality and extracted data.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>We included 90 reports containing 116 data sets; among these 69 were clinical trials of over 70,000 people, 27 were comparative cohort studies (about eight million people) and 20 were case-control studies (nearly 25,000 people). We retrieved 23 reports of the effectiveness and safety of vaccine administration in pregnant women (about 1.6 million mother-child couples).</P>
+<P>The overall effectiveness of parenteral inactivated vaccine against influenza-like illness (ILI) is limited, corresponding to a number needed to vaccinate (NNV) of 40 (95% confidence interval (CI) 26 to 128). The overall efficacy of inactivated vaccines in preventing confirmed influenza has a NNV of 71 (95% CI 64 to 80). The difference between these two values depends on the different incidence of ILI and confirmed influenza among the study populations: 15.6% of unvaccinated participants versus 9.9% of vaccinated participants developed ILI symptoms, whilst only 2.4% and 1.1%, respectively, developed laboratory-confirmed influenza.</P>
+<P>No RCTs assessing vaccination in pregnant women were found. The only evidence available comes from observational studies with modest methodological quality. On this basis, vaccination shows very limited effects: NNV 92 (95% CI 63 to 201) against ILI in pregnant women and NNV 27 (95% CI 18 to 185) against laboratory-confirmed influenza in newborns from vaccinated women.</P>
+<P>Live aerosol vaccines have an overall effectiveness corresponding to a NNV 46 (95% CI 29 to 115).</P>
+<P>The performance of one-dose or two-dose whole virion pandemic vaccines was higher, showing a NNV of 16 (95% CI 14 to 20) against ILI and a NNV of 35 (95% CI 33 to 47) against influenza, while a limited impact on hospitalisation was found (NNV 94, 95% CI 70 to 1022).</P>
+<P>Vaccination had a modest effect on time off work and had no effect on hospital admissions or complication rates. Inactivated vaccines caused local harms. No evidence of association with serious adverse events was found, but the harms evidence base was limited.</P>
+<P>The overall risk of bias in the included trials is unclear because it was not possible to assess the real impact of bias.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Influenza vaccines have a very modest effect in reducing influenza symptoms and working days lost in the general population, including pregnant women. No evidence of association between influenza vaccination and serious adverse events was found in the comparative studies considered in the review. This review includes 90 studies, 24 of which (26.7%) were funded totally or partially by industry. Out of the 48 RCTs, 17 were industry-funded (35.4%). </P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001298.pub4.en.xml

@@ -0,0 +1,49 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Fluid and pharmacological agents for adhesion prevention after gynaecological surgery</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Use of fluids and pharmacological agents (medicinal drugs) to prevent the formation of adhesions (scar tissue) after surgery of the female pelvis</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Review question: </B>This Cochrane systematic review evaluated all fluid and pharmacological agents that aim to prevent adhesion formation after gynaecological surgery (gels were defined as fluid agents).</P>
+<P>
+<B>Background:</B> Adhesions are defined as internal scar tissue that may form as part of the body's healing process after surgery. They can also be caused by pelvic infection and endometriosis. Adhesions join together tissues and organs that are not normally connected. They are common after gynaecological surgery and can cause pelvic pain, infertility and bowel obstruction. Women with adhesions may need further surgery, which is more difficult and can lead to additional complications. The fluid agents are placed inside the pelvic cavity (which contains all female reproductive organs) during surgery and physically prevent raw, healing tissues from touching. These fluids can be broken down into hydroflotation agents or gels; hydroflotation agents are fluids placed in large volumes (usually around a litre); gels are directly applied to the internal surgical site. Pharmacological agents act by changing part of the healing process.</P>
+<P>
+<B>Study characteristics:</B> We included 29 randomised controlled trials in the review (3227 participants). Of these, results of 18 trials were pooled (2740 participants). Results from the remaining 11 trials could not be used in the meta-analysis because investigators did not use a way of measuring adhesions that would allow findings to be pooled with other data, or because important statistical information was not reported. We searched all evidence up to April 2014.</P>
+<P>
+<B>Key results: </B>Only one study evaluated pelvic pain and provided no evidence that the adhesion prevention agent made a difference. No evidence suggests that any of the investigated agents affected live birth rate. Regarding adhesions, participants given a fluid agent during surgery were less likely to form adhesions than participants who did not receive a fluid agent. When fluids and gels were compared with each other, gels appeared to perform better than fluids. No pharmacological agents showed good evidence of causing a significant effect on adhesions. No studies looked at differences in quality of life. All studies apart from one stated that investigators were going to assess serious adverse outcomes associated with the agents, and no adverse effects were reported.</P>
+<P>For gels, results suggest that for a woman with a 77% risk of developing adhesions without treatment, the risk of developing adhesions after a gel is used would be between 26% and 65%. For a woman with an 83% risk of worsening of adhesions after no treatment at initial surgery, the chance when a gel is used would be between 16% and 73%. Similarly, for hydroflotation fluids in a woman with an 84% chance of developing adhesions with no treatment, the risk of developing adhesions when hydroflotation fluid is used would be between 53% and 73%.</P>
+<P>Fluids and gels appear to be effective in reducing adhesions, but more information is needed to determine whether this affects pelvic pain, live birth rate, quality of life and long-term complications such as bowel obstruction. Further large, high-quality studies should be conducted in which investigators use the standard way of measuring adhesions as developed by the American Fertility Society (the modified AFS score).<BR/>
+</P>
+<P>
+<B>Quality of the evidence: </B>The quality of the evidence ranged from low to high. The main reasons for downgrading of evidence were imprecision (small sample sizes and wide confidence intervals) and poor reporting of study methods.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Adhesions are fibrin bands that are a common consequence of gynaecological surgery. They are caused by various conditions including pelvic inflammatory disease and endometriosis. Adhesions are associated with considerable co-morbidity, including pelvic pain, subfertility and small bowel obstruction. Patients may require further surgery—a fact that has financial implications.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To evaluate the role of fluid and pharmacological agents used as adjuvants in preventing formation of adhesions after gynaecological surgery.<BR/>
+</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>The following databases were searched up to April 2014: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. Studies involving hydroflotation, gel and such pharmacological agents as steroids, noxytioline, heparin, promethazine, <I>N,O</I>-carboxymethyl chitosan and gonadotrophin-releasing hormone agonists were evaluated.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomised controlled trials investigating the use of fluid and pharmacological agents to prevent adhesions after gynaecological surgery. Gels were defined as fluid agents.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Three review authors independently assessed trials for eligibility, extracted data and evaluated risk of bias. Results were expressed as odds ratios (ORs), mean differences (MDs) or standard mean differences (SMDs) as appropriate, with 95% confidence intervals (CIs).</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Twenty-nine trials were included (3227 participants), and nine were excluded. One study examined pelvic pain and found no evidence of a difference between use of hydroflotation agents and no treatment. We found no evidence that any of the antiadhesion agents significantly affected the live birth rate. When gels were compared with no treatment or with hydroflotation agents at second-look laparoscopy (SLL), fewer participants who received a gel showed a worsening adhesion score when compared with those who received no treatment (OR 0.16, 95% CI 0.04 to 0.57, P value 0.005, two studies, 58 women, I<SUP>2</SUP> = 0%, moderate-quality evidence) and with those given hydroflotation agents (OR 0.28, 95% CI 0.12 to 0.66, P value 0.003, two studies, 342 women, I<SUP>2</SUP> = 0%, high-quality evidence). Participants who received steroids were less likely to have a worsening adhesion score (OR 0.27, 95% CI 0.12 to 0.58, P value 0.0008, two studies, 182 women, I<SUP>2</SUP> = 0%, low-quality evidence). Participants were less likely to have adhesions at SLL if they received a hydroflotation agent or gel than if they received no treatment (OR 0.34, 95% CI 0.22 to 0.55, P value &lt; 0.00001, four studies, 566 participants, I<SUP>2</SUP> = 0%, high-quality evidence; OR 0.25, 95% CI 0.11 to 0.56, P value 0.0006, four studies, 134 women, I<SUP>2</SUP> = 0%, high-quality evidence, respectively). When gels were compared with hydroflotation agents, participants who received a gel were less likely to have adhesions at SLL than those who received a hydroflotation agent (OR 0.36, 95% CI 0.19 to 0.67, P value 0.001, two studies, 342 women, I<SUP>2</SUP> = 0%, high-quality evidence). No studies evaluated quality of life. In all studies apart from one, investigators stated that they were going to assess serious adverse outcomes associated with treatment agents, and no adverse effects were reported.</P>
+<P>Results suggest that for a woman with a 77% risk of developing adhesions without treatment, the risk of developing adhesions after use of a gel would be between 26% and 65%. For a woman with an 83% risk of worsening of adhesions after no treatment at initial surgery, the chance when a gel is used would be between 16% and 73%. Similarly, for hydroflotation fluids for a woman with an 84% chance of developing adhesions with no treatment, the risk of developing adhesions when hydroflotation fluid is used would be between 53% and 73%.</P>
+<P>Several of the included studies could not be included in a meta-analysis: The findings of these studies broadly agreed with the findings of the meta-analyses.</P>
+<P>The quality of the evidence, which was assessed using the GRADE approach, ranged from low to high. The main reasons for downgrading of evidence included imprecision (small sample sizes and wide confidence intervals) and poor reporting of study methods.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>Gels and hydroflotation agents appear to be effective adhesion prevention agents for use during gynaecological surgery, but no evidence indicates that they improve fertility outcomes or pelvic pain, and further research is required in this area. Future studies should measure outcomes in a uniform manner, using the modified American Fertility Society (mAFS) score. Statistical findings should be reported in full.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001364.pub5.en.xml

@@ -0,0 +1,17 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE>Zinc for the common cold</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE/>
+    <SUMMARY_BODY/>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND/>
+    <ABS_OBJECTIVES/>
+    <ABS_SEARCH_STRATEGY/>
+    <ABS_SELECTION_CRITERIA/>
+    <ABS_DATA_COLLECTION/>
+    <ABS_RESULTS/>
+    <ABS_CONCLUSIONS/>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001367.pub3.en.xml

@@ -0,0 +1,34 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title"> Duration of treatment with vitamin K antagonists in symptomatic venous thromboembolism</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Length of treatment with vitamin K antagonists and prevention of recurrence in patients with venous thromboembolism</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>Venous thromboembolism (VTE) occurs when a blood clot is formed in a deep vein, or when it detaches itself and lodges in the lung vessels. These clots can be fatal if blood flow to the heart is blocked. Vitamin K antagonists (VKA) are given to people who have experienced a VTE, to prevent recurrence. The major complication of this treatment is bleeding. The continuing risk of bleeding with drug use and uncertainty regarding the extent of the risk of recurrence make it important to look at the proper duration of treatment with VKA for these patients. The review authors searched the literature and were able to combine data from 11 randomized controlled clinical trials (3716 participants) comparing different durations of treatment with VKA in patients with a symptomatic VTE. Participants receiving prolonged treatment had around five times lower risk of recurrence of VTE. On the other hand, they had about three times higher risk of bleeding complications. Prolonged treatment did not reduce the risk of death. Prolonged use of VKA strongly reduced the risk of recurrent clots as long as they were used, but benefit decreased over time and the risk of major bleeding remained.<B> </B>
+</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Currently, the most frequently used secondary treatment for patients with venous thromboembolism (VTE) consists of vitamin K antagonists (VKA) targeted at an international normalized ratio (INR) of 2.5 (range 2.0 to 3.0). However, based on the continuing risk of bleeding and uncertainty regarding the risk of recurrent VTE, discussion on the proper duration of treatment with VKA for these patients is ongoing. Several studies have compared the risks and benefits of different durations of VKA in patients with VTE. This is the third update of a review first published in 2000.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>To evaluate the efficacy and safety of different durations of treatment with vitamin K antagonists in patients with symptomatic venous thromboembolism.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>For this update,<I> </I>the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched October 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) 2013, Issue 9.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>Randomized controlled clinical trials comparing different durations of treatment with vitamin K antagonists in patients with symptomatic venous thromboembolism.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Three review authors (SM, MP, and BH) extracted the data and assessed the quality of the trials independently.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Eleven studies with a total of 3716 participants were included. A consistent and strong reduction in the risk of recurrent venous thromboembolic events was observed during prolonged treatment with VKA (risk ratio (RR) 0.20, 95% confidence interval (CI) 0.11 to 0.38) independent of the period elapsed since the index thrombotic event. A statistically significant "rebound" phenomenon (ie, an excess of recurrences shortly after cessation of prolonged treatment) was not found (RR 1.28, 95% CI 0.97 to 1.70). In addition, a substantial increase in bleeding complications was observed for patients receiving prolonged treatment during the entire period after randomization (RR 2.60, 95% CI 1.51 to 4.49). No reduction in mortality was noted during the entire study period (RR 0.89, 95% CI 0.66 to 1.21, P = 0.46).</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>In conclusion, this review shows that treatment with VKA strongly reduces the risk of recurrent VTE for as long as they are used. However, the absolute risk of recurrent VTE declines over time, although the risk for major bleeding remains. Thus, the efficacy of VKA administration decreases over time since the index event.</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>

cochrane-google-pe-corpus/en/CD001385.pub2.en.xml

@@ -0,0 +1,38 @@
+<?xml version="1.0"?>
+<DOC>
+  <TITLE LABEL="Review Title">Long-acting beta2-agonists for chronic asthma in adults and children where background therapy contains varied or no inhaled corticosteroid</TITLE>
+  <SUMMARY>
+    <SUMMARY_TITLE>Long-acting beta2-agonists for chronic asthma in adults and children where background therapy contains varied or no inhaled corticosteroid</SUMMARY_TITLE>
+    <SUMMARY_BODY>
+<P>
+<B>Note added in July 2014:</B> Since the original version of this review, guidance around LABA has changed. International asthma guidelines now only recommend the use of LABA in conjunction with ICS. The US Food and Drug Agency (FDA) has issued a warning that LABA should not be used to treat asthma without concurrent ICS.<B> </B>The review will continue to be available for people to read on the Cochrane Library, but we will not update the review again. It is no longer considered safe to take LABA on their own without taking inhaled steroids due to harms which can occur.</P>
+<P>
+<B>Plain language summary published in 2006:</B> In this review of studies in which patients were either not on inhaled corticosteroids, or in which some patients but not all were on inhaled corticosteroids, treatment with regular long-acting beta-2 agonists such as salmeterol (Serevent) or formoterol (Foradil, Oxis) in chronic asthma resulted in fewer asthma symptoms by day or night, less relief bronchodilator medication requirement, better lung function, a lower risk of acute worsening of asthma and better quality of life, but most of the evidence comes from groups in which at least some used inhaled corticosteroid therapy. There is less information on asthma control in patients who did not use a regular 'preventer medication' or in children under twelve years, but the same generally positive effects on symptoms and lung function seem to apply. We have also been particularly focused on serious adverse events, given previous concerns about potential risks, especially of death, from regular beta-2 agonist use. A significant increase in asthma related deaths or life threatening experiences has been found in a recently published surveillance study, with an increased risk of around one event over 6 months for every thousand patients treated. This increase was mainly in African-Americans and those not on inhaled corticosteroids, although these observations were drawn from analyses conducted after the event (post-hoc) and as such lack the validity of pre-defined distinctions.</P>
+</SUMMARY_BODY>
+  </SUMMARY>
+  <ABSTRACT>
+    <ABS_BACKGROUND>
+<P>Asthma is a common respiratory disease among both adults and children and short acting inhaled beta-2 agonists are used widely for 'reliever' bronchodilator therapy. Long acting beta-2 agonists (LABA) were introduced as prospective 'symptom controllers' in addition to inhaled corticosteroid 'preventer' therapy (ICS). </P>
+<P>We originally analysed studies comparing the use of LABA with placebo in mixed populations in which only some were taking ICS and in populations not using ICS therapy. However international guidelines no longer recommend the use of LABA in people who are not taking ICS for their asthma. We are therefore no longer updating this review.</P>
+</ABS_BACKGROUND>
+    <ABS_OBJECTIVES>
+<P>This review aimed to determine the benefit or detriment on the primary outcome of asthma control with the regular use of LABA compared with placebo, in mixed populations in which only some were taking ICS and in populations not using ICS therapy.</P>
+</ABS_OBJECTIVES>
+    <ABS_SEARCH_STRATEGY>
+<P>We carried out searches using the Cochrane Airways Group trial register, most recently in October 2005. We searched bibliographies of identified RCTs for additional relevant RCTs and contacted authors of identified RCTs for other published and unpublished studies.</P>
+</ABS_SEARCH_STRATEGY>
+    <ABS_SELECTION_CRITERIA>
+<P>All randomised studies of at least four weeks duration, comparing a LABA given twice daily with a placebo, in chronic asthma. Selection criteria to this updated review have been altered to accommodate recently published Cochrane reviews on combination and addition of LABA to ICS therapy. Studies in which all individuals were uniformly taking ICS were excluded from this review.</P>
+</ABS_SELECTION_CRITERIA>
+    <ABS_DATA_COLLECTION>
+<P>Two review authors performed data extraction and study quality assessment independently. We contacted authors of studies for missing data.</P>
+</ABS_DATA_COLLECTION>
+    <ABS_RESULTS>
+<P>Sixty-seven studies (representing 68 experimental comparisons) randomising 42,333 participants met the inclusion criteria. Salmeterol was used as long-acting agent in 50 studies and formoterol fumarate in 17. The treatment period was four to nine weeks in 29 studies, and 12 to 52 weeks in 38 studies. Twenty-four studies did not permit the use of ICS, and forty permitted either inhaled corticosteroid or cromones (in three studies this was unclear). In these studies between 22% and 92% were taking ICS, with a median of 62%. There were significant advantages to LABA treatment compared to placebo for a variety of measurements of airway calibre including morning peak expiratory flow (PEF), evening PEF and FEV1. They were associated with significantly fewer symptoms, less use of rescue medication and higher quality of life scores. This was true whether patients were taking LABA in combination with ICS or not. Findings from SMART (a recently published surveillance study) indicated significant increases in asthma related deaths, respiratory related deaths and combined asthma related deaths and life threatening experiences. The absolute increase in asthma-related mortality was consistent with an increase of around one per 1250 patients treated with LABA for six months, but the confidence intervals are wide (from 700 to 10,000). Post-hoc exploratory subgroups suggested that African-Americans and those not on inhaled corticosteroids were at particular risk for the primary end-point of death or life-threatening asthma event. There was also a suggestion of an increase in exacerbation rate in children. Pharmacologically predicted side effects such as headache, throat irritation, tremor and nervousness were more frequent with LABA treatment.</P>
+</ABS_RESULTS>
+    <ABS_CONCLUSIONS>
+<P>LABA are effective in the control of chronic asthma in the "real-life" subject groups included. However there are potential safety issues which call into question the safety of LABA, particularly people with asthma who are not taking ICS, and it is not clear why African-Americans were found to have significant differences in comparison to Caucasians for combined respiratory-related death and life threatening experiences, but not for asthma-related death.</P>
+<P>Since the original version of this review, the US Food and Drug Agency (FDA) has added a warning that LABA should not be used to treat asthma without concurrent ICS. International guidelines only recommend the use of LABA in conjunction with ICS. Readers should consult the overviews which summarise the results of Cochrane reviews on the safety of LABAs in adults and children (Cates 2012; Cates 2014).</P>
+</ABS_CONCLUSIONS>
+  </ABSTRACT>
+</DOC>