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[ "We found evidence from one small trial to suggest that parenteral nutrition may result in an increase in weight, serum albumin levels and calorie and protein intake when compared to enteral nutrition (usual food intake). However, the effect of other methods of delivery of nutritional support remains unclear. Results from another small study suggested that the use of energy dense enteral feeds resulted in greater average daily energy intake and subsequently improved weight gain. Three studies looked at glutamine supplementation and did not show a benefit from its use. One study looked at the effect of using olive oil based parenteral feeds rather than those containing standard fats and found that it lead to less weight gain. One study considered the effect of adding fructooligosaccharide to enteral feeds and found that it did not effect the amount of weight gained or how often participants felt nauseated. No studies were identified that compared the nutritional content in either the PN or EN groups of studies. The trials were all of low quality and very different in terms of outcome measures used. In the future, much larger, rigorously conducted trials are needed in order to address this important question." ]

[ "The evidence is current to August 2017. We included 106 studies with a total of 15,027 critically ill participants of any age and any gender. Relevant effects were found for the following drugs: H2 receptor antagonists, antacids, sucralfate, and proton pump inhibitors. H2 receptor antagonists inhibit gastric acid secretion by blocking histamine receptors but can cause a small number of blood platelets (thrombocytopaenia), inflammation of the kidney (interstitial nephritis), and confusion. Antacids neutralise stomach acid but may cause diarrhoea or constipation. Proton pump inhibitors inhibit the final stage of gastric acid production, and it has been found that they may be associated with increased risk of Clostridium difficile diarrhoea. Ulcer protective agents, such as sucralfate, create a barrier between the gastric acid and the gastric mucosa by coating it. They may, however, cause constipation and interfere with the absorption of certain antibacterial agents. In comparison with placebo or no preventive treatment, H2 receptor antagonists, antacids, and sucralfate might be effective in preventing clinically important upper GI bleeding in ICU patients. Hospital-acquired pneumonia was most likely to occur in ICU patients taking either H2 receptor antagonists or sucralfate when compared with patients given placebo or no preventive treatment. Evidence of low certainty suggests that proton pump inhibitors were more effective than H2 receptor antagonists in preventing upper GI bleeding in ICU patients. With proton pump inhibitors, 25 of 1000 people were likely to develop upper GI bleeding, and with H2 receptor antagonists, 73 of 1000 people (95% confidence interval 46 to 115 people) were likely to develop upper GI bleeding. The effect of H2 receptor antagonists versus proton pump inhibitors with respect to the risk for developing hospital-acquired pneumonia was consistent with benefits and harms. Our certainty in the evidence ranged from low to moderate. For effects of different interventions compared with placebo or no prophylaxis, the certainty of evidence was moderate (H2 receptor antagonists) or low (antacids and sucralfate). For effects of H2 receptor antagonists compared with placebo or no preventive treatment on risk of hospital-acquired pneumonia, the certainty of evidence was low. For effects of H2 receptor antagonists compared with proton pump inhibitors on hospital-acquired pneumonia, the certainty of evidence was also low." ]

[ "We found eleven studies with 172 participants to include in the review. All studies compared low-flow oxygen to room air. Ten of the studies were short-term. Four of the studies looked at giving additional oxygen at night. At night, oxygen levels rose during both rapid eye movement (REM) sleep and non-REM sleep in those people breathing low-flow oxygen. Participants breathing oxygen at night also spent less time in REM sleep and took less time to fall asleep. Six of the studies looked at the effect of extra oxygen on exercise. The levels of oxygen and carbon dioxide in the blood of participants increased during or after exercise when they breathed in low-flow oxygen. People were able to exercise for longer if they breathed in low-flow oxygen. There was more regular attendance at school or work in those receiving long-term oxygen. There is little evidence to support or oppose the long-term use of oxygen therapy in people with advanced CF lung disease. In the short term, treatment has shown some improvement in blood oxygen levels in people with CF during sleep and exercise. This increase in oxygen also came with an increase in carbon dioxide levels, which is probably not clinically important. However, caution needs to be exercised in those with advanced lung disease where this may require further monitoring. There should be research into the effects of long-term oxygen treatment on sleep quality and exercise in people with CF. Unfortunately, we do not expect that any such research will be undertaken any time soon, so we do not plan to update this review again until we find any new trials." ]

[ "We found 10 randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) comparing the short-acting insulin analogues insulin lispro, insulin aspart, or insulin glulisine to regular human insulin in 2751 participants. The people in the included trials were monitored (followed) for 24 to 104 weeks. This evidence is up to date as of 31 October 2018. We are uncertain whether short-acting insulin analogues are better than regular human insulin for long-term blood glucose control or for reducing the number of times blood sugar levels drop below normal (hypoglycaemic episodes). The studies were too short to reliably investigate death from any cause. We found no clear effect of insulin analogues on health-related quality of life. We found no information on late diabetes complications, such as problems with the eyes, kidneys, or feet. No study reported on socioeconomic effects, such as costs of the intervention and absence from work. The overall certainty of the included studies was low or very low for most outcomes, mainly because all studies were carried out in an open-labelled fashion (study participants and study personnel knew who was getting which treatment). Several studies also showed inconsistencies in the reporting of methods, and results were imprecise." ]

[ "We found four studies including 4265 pregnant women. Two of the included studies were of high quality, while the other two were of relatively low quality with limitations and biases in design and conduct. The studies were conducted in Sierra Leone, Peru and Uganda. In two studies, the women were also given a daily iron or iron-folate supplement along with antihelminthic treatment. There was no effect of antihelminthic administered in second trimester of pregnancy on maternal anaemia, low birthweight, preterm births or perinatal deaths. There was no impact on maternal anaemia in studies in which iron or iron-folate was also given to pregnant women along with antihelminthic. The impact on infant survival at six months of age could not be evaluated because data were not available. Evidence provided so far from randomised controlled trials is, therefore, insufficient to recommend use of antihelminthics for pregnant women after the first trimester of pregnancy." ]

[ "In this review, we found six trials which enrolled 340 patients who had undergone surgery for borderline ovarian tumours. These trials compared the number of deaths among women who had various forms of treatment or no additional treatment after surgery. In five of the trials, the women had tumours confined to the ovaries and most were followed up for over 10 years. Only one trial enrolled women with tumours that had spread beyond the ovary, and this trial followed patients up for less than three years, which is not long enough to detect any difference between groups receiving different treatments. None of the trials found any demonstrable benefit from any of the additional forms of treatment. However, all six trials were conducted over 15 years ago and since then platinum-based chemotherapy has become widely used to treat advanced ovarian cancer. However, only one of the trials in our review assessed this more modern type of chemotherapy. Further trials of platinum-based chemotherapy and of less toxic treatments are needed, looking at the benefit of reducing the anxiety and distress of further surgery and treatment for relapse. One further trial, which recruited 32 women who had borderline ovarian tumours in both ovaries, compared conservative surgery (taking away the most diseased ovary and removing the tumour from the other ovary) with ultra-conservative surgery (removing the tumours without taking away either ovary). Nearly all the women who had ultra-conservative surgery became pregnant compared with half of those who had conservative surgery. Although about two thirds of the women in the trial developed similar tumours again, most women got pregnant before the disease recurred, all had their recurrences treated by further surgery, none developed invasive ovarian cancer nor died of their tumour. This small study suggests that ultra-conservative surgery by an experienced surgeon with careful follow up for recurrence may be recommended for women with bilateral borderline ovarian tumours who still intend to have children but, ideally, this approach should be evaluated in other independent trials. Despite rigorous searches, we did not find any trial directly comparing conservative surgery with radical surgery (surgery to remove all of the female reproductive organs) or comparing keyhole surgery (laparoscopy) with open surgery (laparotomy) for women with borderline ovarian tumours. None of these trials looked at how the various treatments affected the quality of life (QoL) of the women." ]

[ "The evidence is current to 24 November 2016. We included a single randomised trial with 50 people allocated to the addition of retinoic acid after high-dose chemotherapy followed by autologous haematopoietic stem cell transplantation, and 48 people allocated to the same treatment but without the addition of retinoic acid. The update search did not identify any new studies. Overall survival and event-free survival were no different between the two treatment alternatives. Other outcomes, including those concerning adverse events, were not adequately reported. Additional retinoic acid as part of a postconsolidation therapy after high-dose chemotherapy followed by autologous haematopoietic stem cell transplantation may not improve survival in people with high-risk neuroblastoma, and we lack information on its safety. More research is needed before we can draw solid conclusions. The evidence is based on a single study. The quality of the evidence in this single included study is low." ]

[ "Three small trials of 271 babies were included in this review. The results of these studies show that it is possible to reduce the chance of serious blood infection occurring, but that almost 10 babies need to be given preventive antibiotics to avoid one case of infection. There was no difference in the likelihood of death. There were not enough data on other important effects of the antibiotics or on the possible serious side effects. There was not much similarity between the studies included in this review. Therefore, there is currently not enough evidence to recommend routinely using antibiotics in babies with central venous lines." ]

[ "We identified one new study for this update. The three studies included a a total of 207 participants, which were women with breast cancer. The studies were small in size. We found no evidence of an effect for depression, stress, anxiety, fatigue, and body image. The findings of individual studies suggest that dance/movement therapy may have a beneficial effect on the quality of life, somatization (i.e. distress arising from perceptions of bodily dysfunction) and vigor of women with breast cancer. No adverse effects of dance/movement therapy interventions were reported. The evidence is based on only three small studies and the quality of the evidence is not strong. No conclusions could be drawn regarding the effect of dance/movement therapy on psychological and physical outcomes in cancer patients because of an insufficient number of studies. More research is needed. We did not identify any conflicts of interests in the included studies." ]

[ "We search scientific databases for clinical trials assessing the effect of delayed (more than four days after birth) versus earlier introduction of progressive enteral feeds (where breast or formula milk is fed directly by a tube into the stomach) on the incidence of necrotising enterocolitis, death and general health in very low birth weight infants. The evidence is current to September 2014. We found nine trials with 1106 infants that assessed the effect of delayed rather than early introduction of milk feeds for very preterm or very low birth weight infants. Data from these trials did not provide any evidence that delaying enteral feeding reduces the risk of necrotising enterocolitis. The included trials were generally of reasonable methodological quality but, in common with other trials of feeding interventions in infants, it was not possible to mask carers and clinical assessors to the given treatment." ]

[ "This review identified and assessed seven clinical trials that tested antibiotics in patients sick with leptospirosis. Four of these trials compared intravenous penicillin to a placebo. Three of the trials looked at differences between different antibiotics. All trials had high risk of systematic errors (bias) and of random errors (play of chance). When looked at together, these trials do not answer the basic questions about whether or not antibiotics should be used. Part of the reason for this is that there is a wide range of severity among people ill with the disease. Additional randomised clinical trials are needed. Nonetheless, these trials suggest that antibiotics administered to patients who are sick with leptospirosis may make patients feel better two days earlier than they otherwise would have improved. However, it is also possible that when patients are severely ill, penicillin therapy might increase the risk of death or dialysis in comparison to those who receive no antibiotics. Other antibiotics have not been tested in this way. Despite the lack of evidence, if a clinician chooses to treat leptospirosis with an antibiotic, there does not seem to be any difference between the appropriate use of intravenous penicillin, intravenous cephalosporin, doxycyline, or azithromycin. But, for this they have not been tested to the same extent as intravenous penicillin." ]

[ "Clinical trials to test these hypotheses were performed before currently used criteria for dementia had become generally accepted. The results show improvement after the treatment with vinpocetine versus placebo, but the number of demented patients treated for at least six months was small. The available data does not demonstrate many side effect problems. Although the basic science is interesting, the evidence for beneficial effect of vinpocetine on patients with dementia is inconclusive and does not support clinical use." ]

[ "We found 11 randomised controlled trial (RCTs) from different parts of the world which recruited a total of 3673 participants overall. We judged two of the trials to be of high quality, and we graded the remainder as poor quality. This updated review provides clearer evidence that use of antibiotic eye drops can speed up the resolution of symptoms and infection, and that they are unlikely to be associated with any serious side effects." ]

[ "It is known that treatment with the drug interferon clears hepatitis C virus from the blood in about 15% of patients. This review identified studies comparing ribavirin plus interferon with interferon alone in patients with chronic hepatitis C. This review shows, by combining the results from all trials, that adding ribavirin to interferon increases the number of patients who clear the hepatitis C virus to about 40% as well as the number of patients who demonstrate improved liver histology. Ribavirin and interferon may also reduce the risk of liver-related morbidity or all-cause mortality. However, the number needed to treat to prevent one patient developing morbidity or dying seems very large. Furthermore, combination therapy was associated with increased risk of anaemia and several other adverse reactions. The results gives rise to a dilemma - should we, by adding ribavirin to interferon, increase the risk of haematological, dermatological, gastrointestinal, infectious, and miscellaneous adverse reactions in a situation where it has not yet been clearly demonstrated that the antiviral effect of the intervention is directly linked to the reduction of all-cause mortality? We, therefore, suggest that the combination intervention is applied only with stringent emphasis on the individual patients' well-being. Furthermore, we suggest that all future trials within the area should focus more on adverse reactions and long-term clinical outcomes." ]

[ "Overall, based on 37 studies, which included a total of 4,684,724 women, we did not find enough strong evidence suggesting a potentially higher risk of ovarian cancer in women treated with fertility drugs. A cumulative analysis of 12 case-control studies from the USA revealed increased risk of ovarian cancer in women using fertility drugs, and this risk was higher in nulliparous women (women who have not given birth) when compared to multiparous women (women who have given birth to more than one child). One of the 37 included studies reported a two-fold increase in development of serous borderline ovarian tumour in women after more than four cycles of progesterone; however the number of cases included in this group was very small. One cohort study also suggested an increased risk of borderline ovarian tumour in infertile women treated with clomiphene citrate when compared to infertile women who did not undergo treatment to conceive. Studies showing an increase in the risk of ovarian cancer were of low methodological quality, with short follow-up periods and with lack of adjustment for important confounding factors; therefore the results are too unreliable. However, compared with older studies, recent studies have tended to report both the dose and the number of cycles of infertility drugs and have included more contemporary drug regimens; this has made the final results more reliable. Infertility has been found to be an important risk factor for ovarian cancer. However, the association between infertility drugs and ovarian cancer needs to be addressed with consideration of other factors such as age, body mass index, parity, genetic factors (i.e. family history for ovarian cancer), and aetiology of the infertility, along with longer follow-up times." ]

[ "This review included randomised controlled trials (RCTs) that explored oral stimulation by finger stimulation only in preterm infants. Review authors identified studies to be included by searching electronic databases, clinical trials registers, peer-reviewed journals and published conference proceedings. We included 19 studies of poor quality with small numbers of participants. Study findings suggest that oral stimulation interventions can shorten the transition to oral feeding, reduce length of hospital stay and decrease time spent on parenteral nutrition. No studies looked at longer-term outcomes of the interventions (i.e. beyond six months). Studies have reported no effect on breast feeding outcomes nor on weight gain. These studies were small and most were of low or very low methodological quality. Review authors identified no high-quality studies that could support the efficacy, effectiveness and safety of oral stimulation interventions. Larger, well-designed RCTs are needed to help inform parents and caregivers about the possible benefits and harms of this intervention." ]

[ "We searched several important medical databases in April 2016, as well as trial registers, conference proceedings and reference lists. We found only one relevant medical study in which the children participating were allocated randomly to different treatments. The study compared treatments in which the simple bone cysts were injected with bone marrow or steroid (methylprednisolone acetate). Ninety children with an average age of 9.5 years participated in this study. Results were available for 77 children. Two years after treatment, X-ray examination showed that successful healing of bone cysts was more common in children who had received steroid injections; however, we are very uncertain whether this is a true finding. Low quality evidence two years after treatment showed children in the two treatment groups had similar high levels of function (measured by the Activity Scale for Kids score) and low levels of pain (measured by Oucher score). There was very low quality evidence that there was no difference between the two interventions for adverse events, including pathological fracture after treatment. As the quality of the evidence is low, or very low, we cannot definitively conclude that there are no differences between the treatments, and we do not know whether either treatment gives better results with fewer complications. This review is based on one trial with a small number of participants. Hence, at present there is insufficient evidence to determine the best method for treating simple bone cysts in the long bones of children. More studies with larger numbers of participants and that monitor children for longer follow-up periods are needed." ]

[ "This review provides evidence that group-based parenting programmes improve childhood behaviour problems and the development of positive parenting skills in the short-term, whilst also reducing parental anxiety, stress and depression. Evidence for the longer-term effects of these programmes is unavailable. These group-based parenting programmes achieve good results at a cost of approximately $2500 (£1712 or €2217) per family. These costs are modest when compared with the long-term social, educational and legal costs associated with childhood conduct problems." ]

[ "The aim of this review was to see how effective palliative care interventions in care homes are, and to describe the outcome measures used in the studies. We found only three suitable studies (735 participants), all from the USA. There was little evidence that interventions to improve palliative care for older people in care homes improved outcomes for residents. One study found that palliative care increased bereaved family members' perceptions of the quality of care and another found lower discomfort for residents with dementia who were dying. There were problems with both of these findings. Two studies found that palliative care improved some of the ways in which care was given in the care home, however, we do not know if this resulted in better outcomes for residents. There is a need for more high quality research, particularly outside the USA." ]

[ "This review summarised and meta-analysed the evidence from randomised clinical trials on the effect of prostaglandins for adult liver transplanted patients. We found ten trials randomising 652 patients. Evidence from these trials is inconclusive on the role of prostaglandins regarding outcomes such as death or liver re-transplantation. The risk of acute kidney failure requiring dialysis may be reduced by two thirds if a liver transplant patient receives prostaglandins, although the level of evidence is only moderate due to risks of systematic errors (bias) and random errors (play of chance). No severe adverse events are reported. Therefore, further randomised trials with low risk of bias and sufficient sample sizes are still needed to establish whether prostaglandins should be administered for liver transplanted patients." ]

[ "We searched for evidence from randomised controlled trials in September 2017. We identified eight studies with a total of 2227 women undergoing elective (planned) caesarean section before the onset of labour. Of these women, 1097 underwent cervical dilatation with a double-gloved index finger, or in one study with a Hegar dilator, during surgery, while 1130 did not undergo cervical dilatation during surgery. Low- or very low-quality evidence suggested it was unclear whether cervical dilatation had any impact on postpartum haemorrhage (estimated blood loss greater than 1000 mL), the need for blood transfusion, and other measures of blood loss, postpartum haemorrhage within six weeks, febrile morbidity (infection indicated by increased temperature over a defined time period), endometritis (infection of the lining of the womb), or uterine subinvolution (uterus not returning to its normal size after childbirth). There were no data for cervical trauma. We found a slight improvement with mechanical dilatation for some outcomes that had not been specified in our original protocol, but the evidence for these outcomes was based on one or two studies (mean blood loss, endometrial cavity thickness, retained products of conception, distortion of uterine incision, and healing ratio). Cervical dilatation did not have a clear effect on other secondary outcomes, (again not specified in our original protocol): wound infection, urinary tract infection, operative time, infectious morbidity, and integrity of uterine scar. It is uncertain whether cervical dilatation has any impact on reducing postoperative problems after caesarean section. This means there is insufficient evidence to encourage or discourage the use of mechanical dilatation of the cervix at elective caesarean section for reducing postoperative ill-health." ]

[ "Study characteristics In November 2017 we searched for clinical trials that used cannabis products to treat conditions with chronic neuropathic pain in adults. We found 16 studies involving 1750 people. Studies lasted 2 to 26 weeks. Studies compared different cannabis-based medicines. Ten studies compared an oromucosal (mouth) spray with a plant-derived combination of tetrahydrocannabinol (THC), the principal psychoactive constituent of cannabis, and cannabidiol (CBD), an anti-inflammatory ingredient of cannabis, against a fake medication (placebo). Two studies each compared inhaled herbal cannabis and cannabis plant-derived THC with placebo, and one study compared a man-made cannabinoid mimicking the effects of THC (nabilone) with placebo. One study compared nabilone with a pain killer (dihydrocodeine). We rated the quality of the evidence from studies using four levels: very low, low, moderate, or high. Very low-quality evidence means that we are very uncertain about the results. High-quality evidence means that we are very confident in the results. There was no high-quality evidence. All cannabis-based medicines pooled together were better than placebo for the outcomes substantial and moderate pain relief and global improvement. All cannabis-based medicines pooled together were better than placebo in reducing pain intensity, sleep problems and psychological distress (very low- to moderate-quality evidence). There was no difference between all cannabis-based medicines pooled together and placebo in improving health-related quality of life, stopping the medication because it was not effective, and in the frequency of serious side effects (low-quality evidence). More people reported sleepiness, dizziness and mental problems (e.g. confusion) with all cannabis-based medicines pooled together than with placebo (low-quality evidence). There was moderate-quality evidence that more people dropped out due to side effects with cannabis-based medicines than with placebo. Herbal cannabis was not different from placebo in reducing pain and the number of people who dropped out due to side effects (very low-quality evidence)." ]

[ "We included three studies on a total of 13,885 participants (9640 children and 4245 adults) and 1200 households in Nicaragua and Niger. They examined five programmes by governmental, non-governmental or research organisations that gave recipients cash handouts worth USD 145 to USD 250 (or more, depending on household characteristics) as part of a disaster response (in these cases, to droughts). The studies had some serious methodological limitations, so we considered the evidence to be of very low quality and very uncertain. UCTs appeared to contribute to a very small increase in the proportion of children who received vitamin or iron supplements and a beneficial effect on children's home environment. They may have resulted in a very large reduction in the chance of dying, a moderate reduction in the number of days spent sick in bed, and a large reduction in children's risk of acute malnutrition. UCTs had no clear effect on the proportion of children who received deworming drugs, children's height for age, adults' level of depression, or the quality of parenting behaviour. No adverse effects were identified.The included studies did not examine several important outcomes, including food security and equity impacts. Compared with grants of food, there was no evidence that a UCT influenced the chance of child death or severe acute malnutrition. Compared with the same UCT paid via mobile phone, a UCT paid in-hand led to a moderate increase in household dietary diversity, but there was no evidence for any effect on social determinants of health, health service expenditure, or local markets and infrastructure. Additional research is required to reach clear conclusions regarding the effectiveness and relative effectiveness of UCTs in improving health services use and health outcomes in humanitarian disasters in LMICs." ]

[ "After searching for all relevant studies up to May 2015, we found 13 studies (14 articles) that met our inclusion criteria. However, only three compared different operation types. The others compared aspects of one operation type. One study presented early and late outcomes. What happens to people with Dupuytren’s disease up to five weeks after needle fasciotomy compared with fasciectomy? • Hand function may be slightly better after needle fasciotomy than after fasciectomy (low-quality evidence). • People who have had needle fasciotomy may be more satisfied than those who have had fasciectomy (low-quality evidence). • Fasciectomy probably straightens fingers better than needle fasciotomy in people with advanced disease, but probably no difference is apparent in people with milder disease (low-quality evidence). • A feeling of tingling in the fingers is probably more common after fasciectomy than after needle fasciotomy during the first week after treatment (low-quality evidence). What happens to people with Dupuytren’s disease five years after needle fasciotomy compared with fasciectomy? • Satisfaction may be better after fasciectomy than after needle fasciotomy (low-quality evidence). • Recurrence may be more common after needle fasciotomy than after fasciectomy (low-quality evidence). What happens to people with Dupuytren’s disease up to 36 months after z-plasty closure of a limited fasciectomy compared with use of small ‘firebreak’ skin grafts (a form of dermofasciectomy)? • Little or no difference in outcomes is likely between patients who had z-plasty and those who had small skin grafts, although skin graft procedures take longer to perform (low-quality evidence). What happens to people with Dupuytren’s disease who wear a splint at night after surgery? • Wearing a splint at night after surgery probably does not help to straighten fingers nor to improve hand function, and it may slightly worsen the patient's ability to make a full fist (low-quality evidence). Reporting of complications was variable. We often do not have precise information about side effects and complications, particularly rare but serious side effects. Side effects may include altered feeling in the fingers or reduced ability to make a full fist. Rare complications may include injury to the tendons that pull the fingers into the palm." ]

[ "We searched for all published Cochrane Reviews of MS clinical trials that evaluated the effectiveness of rehabilitation interventions compared with various control groups (no intervention or different type of intervention). We evaluated all relevant reviews, and summarised the findings. We included a total of 15 Cochrane Reviews, which included 168 clinical trials, and a total of 10,396 people with MS. These good-quality reviews evaluated a range of rehabilitation interventions, including: physical activity and exercise therapy, hyperbaric oxygen therapy, whole-body vibration, occupational therapy, cognitive and psychological interventions, nutritional and dietary supplements, vocational rehabilitation, information provision, telerehabilitation, and interventions for the management of spasticity. The findings showed some benefits for people with MS who participated in exercise and physical activity programmes or multidisciplinary rehabilitation programmes (where the intervention is provided by a team of health professionals from different professions). They found improvements in everyday activities, function, and health-related quality of life, compared with those who were not offered rehabilitation. Evidence for other rehabilitation modalities was limited, due to lack of good-quality studies. More research is needed to determine whether various types of rehabilitation modalities are effective in reducing disability in people with MS." ]

[ "We identified a broad range of studies of different types of preparations used at different dosages in both adults and children. The evidence is current up to March 2014. We found no good evidence for or against the effectiveness of OTC medications in acute cough. Nineteen studies reported adverse effects of these medications and described infrequent, mainly minor side effects such as nausea, vomiting, headache and drowsiness. The results of this review have to be interpreted with caution because the number of studies in each category of cough preparations was small. Many studies were poorly reported making assessment of risk of bias difficult. While all studies were placebo-controlled randomised controlled trials only a minority reported their methods of allocation and randomisation and there was lack of reporting of blinding of outcome assessors and whether cough outcome measures were validated. In addition, studies supported by pharmaceutical companies or other providers were more likely to have positive results. Studies were very different from each other in terms of treatment types, treatment duration and outcomes measured, making evaluation of overall effectiveness of OTC cough medicines difficult." ]

[ "The review authors searched the medical literature and were able to find only one small randomised controlled trial. The 14 infants included in the trial had a birthweight over 2000 g and were enrolled at a mean age of 10 hours. They had received ventilatory support and fluid expansion after birth. Infants treated with low dose dopamine (2.5 microg/kg/min) did not differ from the infants receiving placebo (dextrose water) in the number who died before discharge from hospital. Neurodevelopmental disability was similar in both groups, in all infants randomised and in survivors. The timing of assessments was variable. These findings are limited with only one small study in which three of 12 survivors were lost to follow up." ]

[ "The two studies included in this review randomly assigned 305 women being treated with clomiphene citrate to help eggs to develop to additionally receive a medicine (urinary hCG) to trigger their release or to receive no additional treatment. We found no trials comparing other ovulation triggers given with other medicines used for ovulation induction. The evidence is current to November 2013. Giving women on clomiphene citrate additional urinary hCG may not increase their chances of delivering live babies, ovulating or becoming pregnant. Multiple pregnancies, miscarriages and preterm deliveries were not more common with or without an ovulation trigger. No serious adverse events were reported in either study. We cannot be certain whether ovulation triggers are better or worse than no ovulation triggers in women undergoing ovulation induction because not enough women were included in the two trials for definite results to be obtained. Larger trials in women undergoing ovulation induction that compare different ovulation triggers versus no additional treatment are needed." ]

[ "No studies on antibiotics, pneumococcal vaccination and any other non-drug prophylaxis were identified. This review found that intravenous immunoglobulin (IVIG), thymosin, oral transfer factor, Bacillus Calmette-Guerin (BCG) vaccine injection and two kinds of Chinese medicinal herbs (Huangqi granules and TIAOJINING) may help prevent infections in nephrotic children. These studies were methodologically poor. Currently there is no strong evidence for recommending any interventions for preventing infections in nephrotic syndrome. More research is needed." ]

[ "We included 7 trials, with a total of 249 participants, covering 6 treatments in this review. Topical clobetasol propionate and mometasone furoate were effective in treating genital lichen sclerosus. There was no substantial difference in the efficacy of relieving symptoms (e.g. itching and pain) between pimecrolimus cream and clobetasol propionate, but the former was less effective in improving gross appearance. More research is needed for a number of reasons: to decide the strength of steroids that should be used, as well as the frequency and length of application to the skin which gives the best results; to examine other skin treatments; to assess the long-term benefits of topical treatments with regard to relieving symptoms and reducing the risk of developing genital cancers; and to examine the benefits of treatments on the quality of the sex lives of people with this condition." ]

[ "Review authors identified 28 randomized controlled trials involving 3497 critically ill patients with circulatory failure, among whom 1773 died. Patients were followed up to one year. The following drugs, given alone or in combination, were studied in 12 different comparisons: dopamine, norepinephrine, epinephrine, phenylephrine, vasopressin, and terlipressin. In summary, researchers found no significant differences in risk of dying in any comparisons of different drugs given alone or in combination when latest reported death was considered. Disturbances in the rhythm of the heart were observed more frequently in people treated with dopamine than in those treated with norepinephrine. The quality of the evidence was high for the comparison of norepinephrine and dopamine, and was very low to moderate for the other comparisons. Findings were consistent among the few large studies and studies of different quality." ]

[ "Transcutaneous electrical nerve stimulation (TENS) is rarely used for the treatment of dementia but has been studied in a number of randomized controlled trials. Although the available data suggests TENS may be beneficial for some neuropsychological and/or behavioural aspects of dementia insufficient data was available to these reviewers for definitive conclusions to be drawn." ]

[ "The review shows that artemisinin drugs clear malaria parasites from the blood more effectively than standard treatment drugs. In areas where malaria parasites are more resistant to existing drugs, such as South-East Asia, artemisinin drugs are not better at sustained parasite clearance than standard treatment with quinine or mefloquine. Combination treatment using an artemisinin drug together with the longer-acting antimalarial drug mefloquine improves sustained clearance of parasites, but mefloquine is associated with adverse effects. There are few studies on combination treatment with longer-acting antimalarial drugs that are safer than mefloquine. There is no evidence from trials that any of the several artemisinin derivatives is better than the others." ]

[ "We searched scientific databases for randomised controlled trials (clinical trials where people are allocated at random to one of two or more treatments) looking at the effects of dietary fibre intake in healthy adults or those at high risk of developing CVD. We did not include people who already had CVD (e.g. heart attacks and strokes). The evidence is current to January 2015. Twenty three trials fulfilled our inclusion criteria. All of the trials were short term and so could not examine the effect of fibre intake on CVD events. All of the trials examined the effects of fibre intake on lipid levels (lipids are fat-like substances, including cholesterol found in the blood), blood pressure or both. Pooling the results showed a beneficial reduction in total cholesterol and LDL cholesterol (sometimes called 'bad' cholesterol), and diastolic blood pressure with increasing fibre intake. There were no clear patterns for the type of fibre used (soluble or insoluble fibre) or the way in which fibre was provided (via supplements or food stuffs) but their were few studies in each group so results are uncertain. Overall the risk of bias was unclear with few studies judged to be at low risk of bias (so less chance of arriving at the wrong conclusions because of favouritism by the participants or researchers), and for some there was a high risk of bias for some of the quality criteria. The results of this review need to be interpreted cautiously bearing this in mind. There is a need for longer-term well-conducted RCTs to determine the effects of fibre intake on CVD events and to further explore effects by the type of fibre and the way in which increased fibre is provided." ]

[ "The authors found 56 studies; the overall findings show that school-based secondary prevention programmes aimed at reducing aggressive behaviour do appear to produce improvements in behaviour. The improvements can be achieved in both primary and secondary school age groups and in both mixed sex groups and boy-only groups. Further research is needed to investigate if the apparent beneficial programmes effects can be realised outside the experimental setting and in settings other than schools. None of the studies collected data on violent injury, so we can not be certain of the extent to which an improvement in behaviour translates to an actual injury reduction. In addition, more research is needed to determine if the beneficial effects can be maintained over time, and if the benefits can be justified against the costs of implementing such programmes." ]

[ "We searched for evidence on 31 January 2016 and found one small randomised controlled trial (abstract only) that was of poor quality and involved 180 women from Canada.The trial compared two blood sugar ranges, one strict the other more liberal, and reported a very few health outcomes for the pregnant woman and her baby. The trial did not provide any data for this review's main outcomes. For the woman, these related to the development of high blood pressure and protein in the urine during pregnancy, developing type 2 diabetes. For the baby, these outcomes related to death of the baby, increased birthweight, increased risk of birth trauma because of their size, and disability. More women were on insulin in the strictly controlled group (but this result is based on very low quality evidence). No clear differences were reported for caesarian section rates. No other secondary outcome data for women with GDM relevant to this review were reported. No differences were reported for the number of babies that had a birthweight greater than 4000 g or were small-for-gestational age. No other secondary outcomes for the babies relevant to this review were reported.The study did not report on adverse events. This review found that there is not yet enough evidence from randomised controlled trials to determine the best blood sugar range for improving health for pregnant women with GDM and their babies. Four studies are ongoing but not yet complete. More high-quality studies are needed that compare different targets for blood sugar levels and assess both short-term and long-term health outcomes for women and their babies to guide treatment. Studies should include women's experiences and assess health services costs." ]

[ "We found 32 studies that tested the effects of increased police patrols on traffic deaths, injuries, and crashes. There was one randomized controlled trial and no quasi-randomized controlled trials. Almost all of the programs included additional interventions like community information programs, media campaigns, and special training for police officers. Most studies found that increased police patrols reduced traffic crashes and fatalities. Evidence for the effect on traffic injuries was less consistent. The detail provided on the methodology of included studies was almost uniformly poor. When this information was reported, the methodological quality was often weak. Therefore, the available evidence does not firmly establish that increased police patrols reduce the adverse consequences of alcohol-impaired driving. Good quality controlled studies with adequate sample size are needed to evaluate increased patrols. Also needed are studies assessing the cost-effectiveness of this intervention." ]

[ "Six studies involving a total of 610 patients matched the inclusion criteria for this review. Four evaluated three tricyclic antidepressant agents (amitriptyline, nortriptyline and trimipramine) for the treatment of tinnitus. These studies did not find enough evidence to prove the efficacy of these agents in the management of tinnitus. One study evaluated paroxetine, a selective serotonin reuptake inhibitor antidepressant, and one evaluated trazodone, an atypical antidepressant. Neither of these studies showed benefit of paroxetine or trazodone in the treatment of tinnitus. Side effects, though relatively minor, were common in all groups of antidepressants. Further research is required." ]

[ "There are many types of dressings that can be used, which also vary considerably in cost.This review (four studies involving a total of 511 participants) identified no research evidence to suggest that any type of hydrocolloid wound dressing is more effective in healing diabetic foot ulcers than other types of dressing." ]

[ "We examined the research published to 7 August 2017. We found three clinical trials recruiting 366 preterm babies. All three studies reported on preventing severe stages of retinopathy. We found that orally administered beta-blockers may offer short-term benefits such as lower risk of progression to a more severe stage of retinopathy and less need for additional treatment. However, there were no data on long-term vision; and studies did not show an effect of beta-blockers on the most severe stages of retinopathy. On the other hand, serious adverse effects of beta-blockers were reported in one of three studies. The overall quality of evidence for outcomes in this review varied from low to moderate. Thus, our confidence in the results of this review is very limited. We cannot recommend routine use of beta-blockers for prevention or treatment of ROP in preterm infants. Future high-quality studies are necessary to determine whether benefits of beta-blockers outweigh their risks in preventing or treating ROP in preterm infants." ]

[ "Nine studies, involving 8228 women, were included in this review. Most of the women in the studies (91%) had tumours 3 cm or less in size, all had complete removal of the tumour on pathology and 68% had no evidence of cancer in their lymph nodes. Where the breast size was known, 83% had small or medium breasts. The evidence is current up to May 2015. Local recurrence was not different for women having fewer treatments (four fewer local relapses per 1000 (where the true value may be anywhere between 16 fewer to 10 more local relapses per 1000)). Breast appearance was not different for women undergoing fewer treatments (31 fewer fair/poor breast appearance per 1000 (where the true value may be anywhere between 59 fewer to 3 more per 1000 with fair/poor breast appearance)). Survival was not altered by having fewer treatments (13 fewer deaths per 1000 (where the true value could be between 31 fewer to 5 more deaths per 1000)) and there was no significant difference in late skin toxicity (4 more episodes of toxicity per 1000; where the true value may be anywhere between 14 fewer to 36 more episodes of toxicity per 1000) or radiation toxicity. Acute skin toxicity is decreased with fewer treatments (326 fewer events per 1000 (where the true value may be anywhere between 264 fewer to 374 fewer acute skin toxicity events per 1000)). This review indicates that for women who fit these criteria, using fewer radiation treatments after tumour removal gives the same cancer control, with less skin reaction at the time and the likely the same side-effects in the long term. We found high quality evidence for the following outcomes: local recurrence-free survival, breast appearance, toxicity, overall survival and breast cancer-specific survival. We found moderate quality evidence for relapse-free survival, and no data for mastectomy rate (mastectomy may be required because of local recurrence or unacceptable treatment-related toxicity) or costs." ]

[ "We identified nine clinical trials to October 2015, which all investigated some form of caregiver-mediated exercises compared with usual care, no treatment (intervention), or another intervention that was not caregiver-mediated. We included 333 patient-caregiver couples in the review. We found trials in which caregiver-mediated exercises themselves were the studied subject (called CME-core). In addition, we found trials in which the caregiver was the provider of another, already existing intervention. In the latter category, it was difficult to separate the effect of caregiver-mediated exercises from the effect of the other intervention. We found evidence that caregiver-mediated exercises could have a positive effect on patients' standing balance (low-quality evidence) and quality of life (very low-quality evidence) directly after the intervention. In the long term, we found very low-quality evidence for a positive effect on walking distance. For speed of use of the arm and hand, we found low-quality evidence in favour of the control group. We found no significant side effects or beneficial effects on caregiver strain; we judged the quality of this evidence as moderate (after intervention) to very low (long term). Furthermore, we found no significant effects for basic activities of daily living, such as dressing and bathing, after intervention (moderate-quality evidence) or follow-up (low-quality evidence). In addition, we found no significant effects for extended activities of daily living, such as cooking and gardening, after intervention or at follow-up (both low-quality evidence). In the CME-core analysis, we found moderate-quality evidence for a positive effect of caregiver-mediated exercises for basic activities of daily living. It can be concluded that caregiver-mediated exercises may be a promising form of therapy to add to usual care. The number of included trials was small and the level of evidence was of very low to moderate quality. Therefore, results should be interpreted with caution." ]

[ "We identified results from three randomized controlled trials (RCTs; clinical studies where people are randomly put into one of two or more treatment groups) to determine whether glasses were successful in reducing the occurrence of strabismus in far-sighted infants. The trials enrolled infants ages 12 months or younger and measured outcomes between the ages of three and four years. The three trials enrolled 855 infants and included about 79% of the infants in the final analyses of different outcomes. These trials were all conducted in the UK with follow-up periods ranging from one to 3.5 years. The evidence is current up to April 2014. Combining the results of the three trials, we found the risk of strabismus with wearing glasses is uncertain. We identified several potential biases in the way these three trials were conducted. Given the high risk of bias and amount of missing data, it is possible the observed decrease in risk of developing strabismus may be an overestimate of the true effect. The evidence does not currently support the conclusion that glasses prevent strabismus in far-sighted children. More research is required to answer the question. In addition, the prescription of glasses, particularly glasses that correct all of the prescription (full correction), may prevent eyes from developing naturally and normalizing to clear visual acuity. Emmetropization (normalization of vision which usually occurs during the natural growth process) was reported in two trials: one trial suggested that spectacles impede emmetropization, and the second trial reported no difference in the rate of refractive error change. The overall quality of the evidence was very low, particularly due to improper trial design, incomplete outcome data, and the lack of power to provide an accurate estimate of the overall treatment effect of spectacle correction for preventing strabismus." ]

[ "Three trials have compared ropinirole with an inactive placebo in 263 patients in the later stages of Parkinson's disease. Two studies were relatively small, were conducted over the short term (12 weeks), and used relatively low doses of ropinirole (maximum allowed 8 and 10 mg/d) in a twice daily administration regime. For these reasons, the results of these trials have not been included in a statistical overview. The other study was medium term (26 weeks) and used ropinirole doses in line with the current UK licensed maximum (24 mg/d) in a three times a day regime. The conclusions of this review are based on this single trial and thus should be viewed with some caution. No clear difference in the time patients spent in the immobile off state was found between ropinirole and placebo. However, this was probably due to there being too few patients in the trial. Measurements of physical difficulties and problems with activities of daily living (such as bathing, shopping, etc.) were poor in these studies with incomplete information available. Levodopa dose reduction was greater with ropinirole than placebo by 180 mg/d. However, dyskinesia was increased in those who received ropinirole (2.9 times more common with ropinirole than placebo). No other differences in side effects or withdrawals from treatment were found. Ropinirole reduces levodopa dose but at the expense of increased dyskinetic side effects. No clear effect on off time reduction was found in this single trial. Side effects were similar with ropinirole and placebo. These conclusions apply to short and medium term treatment, up to 26 weeks. Further longer term trials are required, with measurements of quality of life and costs, and also studies to compare the newer with the older dopamine agonists." ]

[ "This review aims to examine the effectiveness and safety of these three instruments. The findings showed that UCS results in less blood loss when compared to MES. Operating time was shorter when EBVS was used compared to MES. No marked difference was observed between UCS and EBVS. No difference in complications between all three instruments were reported in the findings. However, it is recognised that more trials are needed to support the evidence provided in this report." ]

[ "This review included seven randomised controlled trials with a total of 266 participants. Four trials studied the effects of non-steroidal anti-inflammatory agents (NSAIDs) in chronic CMO while the other three examined the effect of NSAIDs in acute CMO. This review found two trials which showed that topical NSAID (0.5% ketorolac tromethamine ophthalmic solution) has a positive effect on chronic CMO and a third trial which was supportive of this finding (albeit not statistically significantly so). One study suggested no effect and our review suggests further work is needed for a more conclusive decision regarding use of NSAIDS in chronic CMO. Similarly, the effects of NSAIDs in acute CMO remain unclear and this too needs further investigation." ]

[ "We include 41 full-text peer-reviewed studies of either structured telephone support or home telemonitoring in this review. Twenty-five studies evaluate structured telephone support (eight new studies, plus one previously included study now classified as telemonitoring; total of 9332 participants), 18 evaluated telemonitoring (nine new studies; total of 3860 participants) and two studies evaluated both interventions (included in listed counts). This review demonstrates that supporting people with heart failure at home using information technology can reduce the rates of death and heart failure-related hospitalisation. It can improve people's quality of life and knowledge about heart failure and self care. Most patients, even those who are elderly, learn to use the technology easily and are satisfied with these interventions. We assessed the quality of the evidence for the primary outcomes in this review (all-cause mortality, all-cause hospitalisation and heart failure-related hospitalisation) according to GRADE criteria. We rated it from very low (all-cause hospitalisations) to moderate (all-cause mortality and heart failure-related hospitalisations)." ]

[ "Although complex laboratory studies show that ion generators alter airways function, the few studies which have been conducted in the homes of people with asthma, demonstrate no significant benefit in improving lung function or symptoms." ]

[ "Data from one quasi-randomised trial with 88 infants from 75 families were included in the review. Infants in the early discharge programme with home gavage feeds had a mean hospital stay that was approximately nine days shorter than that of infants in the control group. Infants in the early discharge programme also had lower risk of clinical infection during the home gavage period compared with infants in the control group during the corresponding time in hospital. No significant differences were observed between groups in duration and extent of breast feeding, weight gain, re-admission within the first 12 months post discharge from the home gavage programme or from hospital, scores reflecting parental satisfaction or health service use. Evidence is needed regarding the effects of early home discharge for preterm babies who are stable but still need gavage (tube) feeds." ]

[ "In this review, existing evidence comparing the health outcomes between treated and untreated individuals are summarized. Available data from the limited number of available trials and participants showed no difference between treated and untreated individuals in heart attack, stroke, and death. About 9% of patients treated with drugs discontinued treatment due to adverse effects. Therefore, the benefits and harms of antihypertensive drug therapy in this population need to be investigated by further research." ]

[ "We did a computer search for studies of pills with three phases versus pills with one phase in May 2011. We also wrote to researchers and manufacturers to find other trials. We included randomized trials in any language. The studies had to follow women for at least three treatment cycles. We found 23 trials that looked at three-phase versus one-phase birth control pills. Many studies did not have good methods and the authors did not always report all their methods. The two types of pills did not differ in the numbers of women who got pregnant. About half of the trials found better bleeding patterns with the three-phase pill. The numbers of women who stopped using the pills were about the same for both types of pills. The evidence was not strong enough to say whether the three-phase pill was better than the one-phase pill for pregnancy prevention, bleeding patterns, or continued use. Therefore, we recommend one-phase pills for women starting to use birth control pills. Large trials that are of good quality are needed to see if pills with three phases work better than those with one phase." ]

[ "A former Cochrane review published in 2004 found some evidence of a possible benefit of using oral Chinese herbal medicine (CHM) for eczema; however, the results from only 4 included studies were inconclusive and need to be updated (those four studies have not been included in this update as they investigated a product that has been withdrawn from the market since 2004). As well as updating that review, we have also widened the scope of the review to assess the effects of topical CHM for eczema. We wrote a new protocol to expand the scope of this review. This review included 28 randomised controlled trials (RCTs), with 2306 children and adults, of which 4 compared CHM to placebo, 22 to conventional medications, and 2 to CHM taken by mouth. Most of the included studies reported a higher number of participants who had recovered and significantly improved, with less itching in the CHM groups than the control groups. Where CHM was compared to conventional drugs, although the total effectiveness rate outcome was superior with CHM, it was based on very low quality evidence. One study reported that the quality of life (QoL) score in the CHM group was better than in the placebo group after using a CHM formula taken by mouth for 12 weeks. We assessed most of the studies as at high 'risk of bias' and therefore not of good quality, and there was substantial inconsistency between the studies, so any positive effect in CHM must be treated with caution. One study reported one severe adverse event. Minor adverse events were observed in 24 studies, including temporary elevation of enzymes in 3 cases, which was reversed soon after stopping CHM. Eight included studies received government funding. We could not find conclusive evidence that CHM taken by mouth or applied to the skin was of benefit to children or adults with eczema. Well-designed, adequately powered RCTs are needed to evaluate the efficacy and safety of CHM for eczema." ]

[ "We searched the medical literature until May 2014 and found two relevant studies that included a total of 94 adults with cervical spine facet dislocations. One trial included individuals with spinal cord injuries and the other included individuals without spinal cord injuries. Both studies compared the anterior versus posterior surgical approach. Quality of the evidence The two studies were small and both were at high risk of bias. We therefore judged the quality of the evidence to be very low. Summary of the evidence Neither study found differences between the two approaches in neurological status and pain at one year. One study also found no differences between the two approaches in patient-reported quality of life. Although one study found that the anterior approach resulted in more normal curvature of the neck, the other study reported finding no difference between the two approaches with regard to the alignment of the neck vertebrae. The evidence was insufficient to indicate differences between the two approaches in medical adverse events, rates of instrumentation failure and infection. Although over half (11) of 20 people in the anterior approach group in one study had voice and swallowing disorders, these all resolved by three months. Conclusion The quality of the evidence was very low, meaning that we are very uncertain about the direction and size of effect. Thus we are unable to say whether either an anterior or posterior approach to the surgical management of individuals with dislocations to the cervical spine facet joints is better than the other. We suggest that further research is needed to inform the choice of surgical approach." ]

[ "After searching for all relevant studies (until 14 April 2016), we found one study in which a subgroup of 227 people with AAA received either the beta-blocker metoprolol (medication that reduces blood pressure) or a placebo (dummy treatment). This study's results were imprecise for all causes of death and death from cardiovascular disease or nonfatal cardiovascular events at 30 days or six months after AAA repair. Side effects from the drug were reported for the whole study population and were not available for the subgroup of participants with AAA. We judged this study to be at a generally low risk of bias. We graded the quality of the evidence to low as we only included one small sized study in the review, there were few events reported and the result was consistent with benefit and harm. Larger and longer studies are needed to find out which treatment is most effective. At present, people with AAA are offered a wide range of pharmacological treatment including antiplatelet drugs, antihypertensives and lipid-lowering drugs. Future trials should test available drugs to find the most effective strategy, whether that be one single drug or a combination of treatments. In addition, the acceptability of such interventions needs to be assessed and future studies should measure adverse side effects associated with these drugs and their impact on quality of life." ]

[ "Four trials met the inclusion criteria. They included a total of 104 people; however, three trials did not provide results that we could include in the review. (One trial studied different kinds of foot orthoses, which are in-shoe devices that redistribute force and change gait), and two investigated the effects of adding botulinum toxin injections to various treatments such as stretching, exercises, splints, and footwear.) This review therefore only included the results of one trial, in which 47 children (aged between 5 and 14.5 years) received treatment with either plaster casts alone or plaster casts and injections of botulinum toxin A (BTX) into calf muscles. The study reported how much the children toe walked (based on their parents' observation), any change in ankle range of movement, and relapse (whether the children were still toe walking 12 months after treatment). The included study took place in Sweden and was not funded by anyone with a commercial interest in the results of the study. The evidence was too uncertain to determine whether or not there were differences in outcomes (amount of toe walking observed by parents, range of movement at the ankle, or recurrence of toe walking at 12 months) between children who received plaster casts and injections of BTX into calf muscles, compared to those who received plaster casts alone. There were small numbers of adverse events in both groups, including calf pain and minor skin problems during treatment. The available evidence is too uncertain to determine whether treatment with BTX injections and plaster casts are any more effective than just plaster casts in children with toe walking not associated with a medical condition. The limited evidence found in this review indicates a need for future research on treatments for this condition." ]

[ "We found 15 randomized controlled trials, conducted primarily in North America and Europe, to investigate the effects of methods to lower blood pressure (drug-based in 14 trials; lifestyle change in 1 trial) in 4157 type 1 and 9512 type 2 diabetics, ranging from 16 to 2130 participants in individual trials. The follow-up period ranged from one to nine years for included trials. Of the 15 trials, six were funded in full by one or more drug companies. Seven more studies received drug company support, usually in the form of study medications. The remaining two studies were conducted with support from government-sponsored grants and institutional support. The evidence is current to April 2014. Overall, the included trials provided modest support for lowering blood pressure to prevent diabetic retinopathy, regardless of diabetes type or baseline blood pressure level. However, the evidence did not indicate that lowering blood pressure kept diabetic retinopathy from worsening once it had developed or that it prevented advanced stages of diabetic retinopathy that required laser or other treatment of affected eyes. Treatment to reduce the blood pressure of people with diabetes is warranted for other health reasons, but the available evidence does not justify reduction of blood pressure solely to prevent or slow diabetic retinopathy. Overall, the quality of the evidence was low to moderate based on the reported information. The quality was downgraded mainly because some studies did not report outcomes for all or most participants at follow-up time points, and results from different studies were not highly consistent." ]

[ "No studies comparing vitamin A or other retinoid supplements to placebo (dummy drug containing no vitamin A) were included, but we did find one study comparing beta-carotene supplementation (a precursor of vitamin A) to placebo. A total of 24 people with cystic fibrosis (aged 6.7 to 27.7 years) were put into groups at random and treated either with β-carotene capsules (at a high dose for three months followed by a low dose for a further three months) or with placebo (for six months). No studies on vitamin A supplementation were included in this review. The single included study revealed that high-dose beta-carotene supplementation for three months led to fewer days on which people with CF required antibiotics compared to placebo, but this was not the case in the following three-month section of the study when low-dose beta-carotene supplementation was compared to placebo. Other clinical outcome measures (growth, nutritional status and lung function) showed no statistical significant differences between treatment and placebo groups. No side effects were observed. The other outcomes in this review, such as vitamin A deficiency symptoms, mortality, toxicity and quality of life, were not reported. We could only include one study in this review and that study had several limitations. This is reflected in the assessment of low-quality evidence, judged using the specific evidence grading system (GRADE). So, we feel that the strength of evidence is low. Not all outcome measures were reported after each supplementation dose and results should be viewed with some caution as some beta-carotene from the high-dose period was probably still present in the blood during the low-dose supplementation period. Since no studies on vitamin A supplementation were included in the review, no conclusions can be drawn regarding the routine use of vitamin A supplements. Due to limitations of the included study of beta-carotene supplementation, no definitive conclusions regarding its use can be drawn either. Until further evidence is available, local guidelines should be followed regarding supplementation." ]

[ "We examined the evidence published up to 18 March 2016 and included nine trials with 1337 people that evaluated either dexamethasone, methylprednisolone, or prednisolone given in addition to antituberculous drugs; one trial was of high quality, while the other trials had uncertainties over study quality due to incomplete reporting. The analysis shows that corticosteroids reduce the risk of death by a quarter at two months to two years after treatment was started (high quality evidence). Corticosteroids make little or no difference to the number of people who survive TB meningitis with brain damage causing disability (low quality evidence); because this event is uncommon, even taking the most pessimistic estimate from the analysis of a slight increased risk with corticosteroids means this would not be quantitatively important when compared to the reduction in deaths. One trial followed up participants for five years, by which time there was no difference in the effect on death between the two groups, although the reason for this change over time is unknown. Only one trial evaluated the effects of corticosteroids in human immunodeficiency virus (HIV)-positive people but the number is small so we are not sure if the benefits in terms of fewer deaths are preserved in this group of patients." ]

[ "We identified six randomised controlled trials that reported one or more of the outcomes we thought were important. There may have been flaws in trial conduct that could produce incorrect results. The six trials that provided data for this review included 815 participants (410 participants had subcutaneous closure of incisions and 405 participants did not). In the trials that reported the outcomes, overall 7% of participants developed superficial wound infection, 8% of participants developed superficial separation of wounds, and 8% of participants developed deeper separation of layers in both the groups but there was no clear evidence of a difference in incidence between the subcutaneous closure group and the no subcutaneous closure group. There was no clear evidence of a difference in the length of hospital stay between the groups. We do not know whether these results indicate that there is really no difference between subcutaneous closure and no subcutaneous closure, or that there are problems with study design that make it difficult to identify true differences between the two techniques. So significant benefits or harms of subcutaneous closure cannot be ruled out. Furthermore, no trial assessed the impact of subcutaneous closure on quality of life, long-term patient outcomes (trial follow-up periods varied between one week and two months after surgery) or financial implications to healthcare providers. There is currently no evidence to support or condemn subcutaneous closure after non-childbirth surgery. Further well-designed trials are necessary." ]

[ "This review is up-to-date as of 5 November 2019. The review includes four studies involving 342 adults who had received radiotherapy for the treatment of head and neck cancer. The review looks at three different ways to prevent ORN: - the use of platelet-rich plasma (PRP) in bone after removal of healthy teeth prior to radiotherapy. Plasma is a part of blood that contains special proteins that help the blood to clot, and PRP is concentrated plasma which supports cell growth. Injecting PRP into damaged tissue may stimulate the body to grow new, healthy cells to make it heal more quickly; - taking out teeth because of tooth decay makes the risk of developing ORN greater. Preventing tooth decay in people having radiotherapy is very important. We looked at a study comparing using fluoride gel with a toothpaste with a higher level of fluoride than normal to prevent tooth decay after radiotherapy; - hyperbaric oxygen therapy is breathing oxygen in a pressurized chamber to improve blood supply, which may help heal damaged tissue. Two studies compared the use of hyperbaric oxygen therapy for taking out teeth or placing dental implants with antibiotics. Antibiotics are drugs which stop or slow the growth of bacteria. One study showed no reduction in ORN when using platelet-rich plasma in bone after the removal of healthy teeth. Another study found no difference between fluoride gel and toothpaste with a higher level of fluoride than normal as no cases of ORN were reported. A third study showed that treatment with hyperbaric oxygen therapy caused a reduction in the development of ORN in comparison to patients treated with antibiotics following the removal of teeth. The fourth study found no difference between combined hyperbaric oxygen therapy and antibiotics compared to antibiotics alone. Harmful effects of the different interventions were not reported clearly or were not important. The level of certainty we have in these findings is very low. This was due to high risk of bias, not all studies mentioning important details, and the small number of people studied in the four included trials. We do not have enough evidence to say which intervention works better to stop ORN of the jaws from happening or making it less severe in adults receiving head and neck radiotherapy. We suggest that more, well-conducted, and bigger studies including more people, should be done in this area." ]

[ "This review examines randomised controlled trials which compare aspects of ayurvedic medicine with the use of antipsychotics for people with schizophrenia. All trials took place in India and were for 12 weeks or less. When the ayurvedic herbs brahmyadiyoga and tagara were compared to placebo (2 trials) there was no significant difference between the two groups in acceptability of treatment or overall improvement.  The brahmyadiyoga group did, however, show some improvement when assessed ayurvedically (a combination of assessing aspects of the mind, decision, orientation, memory and habit, and looking for the absence of symptoms of illness). When these two herbs were compared to groups of people taking the antipsychotic, chlorpromazine, again there was no difference in acceptability of treatment, but in one of the two trials there was an improvement in mental state in those taking chlorpromazine. There was also a trial comparing an ayurvedic package (of herbs and other treatment) to chlorpromazine, and although both treatments were acceptable, the rest of the data were not able to be used.  Brahmyadiyoga and tagara tended to have vomiting and nausea as an adverse effect, while chlorpromazine caused people to be sleepy. It may be possible that ayurvedic treatments could be used as adjuncts to antipsychotic medication. A new larger trial comparing ayurvedic herb(s) alone, chlorpromazine alone and both together would answer this question. (Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK www.rethink.org)." ]

[ "This review included six RCTs with a total of 1501 participants that compared cerebrolysin with placebo (inactive medication) added to standard treatment of acute stroke, including thrombolysis. Three of them were large multicentre studies, two were small in size and were judged to be of unclear quality, and one did not include numerical results. The evidence is current up to June 2016. This review of six trials involving 1501 participants showed no beneficial effect of cerebrolysin in terms of death in people with acute ischaemic stroke. There was no difference in the total number of people with adverse events but a concern that cerebrolysin may increase the risk of people having non-fatal serious adverse events compared with placebo. The medication and methodology of the majority of included trials were provided by the manufacturer of cerebrolysin creating a likely conflict of interest. There is moderate-quality evidence currently available that suggests cerebrolysin performs no better than placebo in terms of all-cause death when given to people with acute ischaemic stroke within 48 hours of stroke onset. There is moderate-quality evidence that raises concerns about the increase of serious adverse events with cerebrolysin use in people with acute ischaemic stroke. Further research is likely to have an important impact on our confidence in the estimate of cerebrolysin risks in contributing to serious adverse events in people with acute stroke." ]

[ "The evidence is current to October 2013. We included 19 randomized controlled trials (1940 participants) in this updated review. (We reran the search in February 2015 and found four studies of interest. We will deal with those studies when we next update the review.) Lidocaine was either put into the cuff (the cuff makes sure that the tube stays in place), sprayed onto the person's vocal cords, or used as a gel smeared on the end of the tube. The summarized results of the included studies showed positive results. However, the interpretation of the results should be judged carefully. Though the possible adverse effects of using lidocaine were not reported in the included studies, there are a few case reports about lidocaine toxicity, although this is very rare. For lidocaine therapy versus control, the quality of the evidence for risk of sore throat was low (according to Grading of Recommendations Assessment, Development and Evaluation (GRADE)). This is because most of the trials did not describe how allocation was concealed and the results of the risk of sore throat were inconsistent, the quality of the evidence of the severity of sore throat , measured by the visual-analogue scale, was moderate (according to GRADE)." ]

[ "This is an updated version of the original Cochrane review published in Issue 4, 2010 (Kirthi 2010); no new studies were found. A single oral dose of 1000 mg of aspirin reduced pain from moderate or severe to none by two hours in approximately 1 in 4 people (24%) taking aspirin, compared with about 1 in 10 (11%) taking placebo. Pain was reduced from moderate or severe to no worse than mild pain by two hours in roughly 1 in 2 people (52%) taking aspirin compared with approximately 1 in 3 (32%) taking placebo. Of those who experienced effective headache relief at two hours, more had that relief sustained over 24 hours with aspirin than with placebo. Addition of 10 mg of the antiemetic metoclopramide substantially increased relief of nausea and vomiting compared with aspirin alone, but made little difference to pain. Oral sumatriptan 100 mg was better than aspirin plus metoclopramide for pain-free response at two hours, but otherwise there were no major differences between aspirin with or without metoclopramide and sumatriptan 50 mg or 100 mg. Adverse events with short-term use were mostly mild and transient, occurring slightly more often with aspirin than placebo, and more often with sumatriptan 100 mg than with aspirin." ]

[ "Chronic obstructive pulmonary disease (COPD) is a condition associated with high morbidity, mortality and cost to the community. Patients often report symptomatic improvement with long acting beta-2 agonists (LABAs) and anticholinergic bronchodilator medications (ipratropium). These medications have different mechanisms of action and therefore theoretically could have an additive effect when combined. As these medications are prescribed in COPD as long term therapy, it is important to know what benefit there are, if any, of prescribing ipratropium alone or as combination therapy over LABAs. Seven studies (2652 participants) were included. Salmeterol was more effective than ipratropium on lung function, but there were no major differences seen between the responses to ipratropium and salmeterol on symptoms. When we compared the combination of these two drugs with salmeterol, combination was superior to salmeterol in terms of quality of life, but the differences between these two treatments on other measurements were small and inconsistent. The findings of the review would not support a general recommendation for the use of ipratropium bromide over a beta-2 agonist alone in COPD, but the combination does confer greater benefit in health status. At this stage, people with COPD should use the bronchodilator that gives them the most improvement in their symptoms. Combination therapy should be considered, but the relative effects of this therapy in relation to other forms of inhaled therapy such as inhaled steroids and tiotropium are unknown. Cost considerations also need to be taken into account as there are considerable variations in price of bronchodilators." ]

[ "Ten very different trials involving 874 adults with generally unstable fractures were grouped into six comparisons. No trial used a best-practice method for preventing selection bias. Four trials (239 participants) found implantation of bone scaffolding (autogenous - from the patient - bone graft (one trial); Norian SRS - a bone substitute (two trials); methylmethacrylate cement (one trial)) improved anatomical outcomes compared with plaster cast alone; and two found it improved function. Reported complications of bone scaffolding were transient discomfort resulting from deposits of Norian SRS outside the bone. One deposit required surgical removal. One trial (323 participants) comparing Norian SRS versus plaster cast or external fixation found no difference in functional or anatomical outcomes at one year. External deposits of bone cement and pin track infection were the only significant differences between the two groups. One trial (48 participants) found that autogenous (from the patient) bone graft in the context of external fixation did not significantly change outcome. There was one serious donor-site complication. One trial (21 participants) found some indication of worse outcomes with bone cement compared with percutaneous (through the skin) pinning. Three trials (180 participants) found bone scaffolding (autogenous bone graft (one trial); Norian SRS (one trial); methylmethacrylate cement (one trial)) gave no significant difference in functional outcomes but some indication of better anatomical outcomes compared with external fixation. Most reported complications were associated with external fixation; deposits of Norian SRS outside the bone occurred in one trial. One trial (93 participants treated with plate fixation) comparing allogenic bone material (from other people) versus autogenic bone-graft found slightly improved wrist function for the autograft group but an excess of complications relating to graft harvesting. The review concluded that while bone scaffolding may improve anatomical outcome compared with plaster cast immobilisation alone, there is insufficient evidence to conclude on function and safety; or on outcome for other comparisons." ]

[ "We searched several databases (the Cochrane Library, Embase, MEDLINE, PsycINFO, and Web of Science) to find studies that assessed the impact of restricting access to means of suicide by jumping. We searched the databases up until May 2019. We included studies that assessed jumping means restriction interventions delivered on their own, such as physical barriers, fencing or safety nets on bridges, or those delivered in combination with other suicide prevention interventions, such as crisis telephones and CCTV cameras. We also searched the reference lists of all included studies and relevant systematic reviews to identify additional studies and contacted authors to obtain missing information. Our main outcomes of interest were suicide, attempted suicide or self-harm and cost-effectiveness of interventions. We found 14 relevant studies. Three studies each were from Switzerland and the USA, while two studies each were from the UK, Canada, New Zealand, and Australia respectively. The majority of studies had a before-and-after study design. Due to the observational nature of our included studies, none compared other interventions or control conditions. Jumping means restriction interventions delivered in isolation or in combination with other interventions were found to reduce the number of suicides by jumping. Data on suicide attempts were limited and no study reported self-harm. A cost-effectiveness analysis suggested that the construction of a physical barrier on a bridge would be cost-effective in the long term. The evidence for these assessments was of low quality because of weaknesses in study design and differences in findings between studies, therefore requiring the need for further high-quality studies." ]

[ "The review authors searched scientific databases and Internet resources to identify randomised controlled trials (in which participants were allocated at random to any anticonvulsant drug or placebo or another type of drug or non-pharmacological intervention intended to reduce,the use of cocaine). We assessed also dropout from treatment and frequency of side effects .We included people of any gender, age or ethnicity. The review authors identified 20 studies with 2068 participants, 77% male, with a mean age of 36 years. The mean duration of the trials was 11.8 weeks (range eight to 24 weeks). All but two of the trials were conducted in the USA, all with outpatients. The anticonvulsant drugs studied were carbamazepine, gabapentin, lamotrigine, phenytoin, tiagabine, topiramate and vigabatrin. All studies compared anticonvulsants versus placebo. No significant differences were found between placebo and any anticonvulsant in reducing the number of dropouts from treatment, use of cocaine, craving and severity of dependence, depression or anxiety. Side effects were slightly more frequent in the anticonvulsant groups. No current evidence supports the clinical use of anticonvulsant medications for the treatment of cocaine dependence. The quality of the evidence was moderate for the outcomes dropout and use of cocaine, and was low for the outcomes side effects and craving. The major limitation of the trials was incomplete reporting of the methods used to protect against selection bias, randomly allocate participants to groups and conceal allocation. The evidence is current to June 2014." ]

[ "The review authors searched the medical literature for randomised controlled studies in which people with sickle cell disease or thalassaemia received either zinc supplements or no supplements. We included nine trials in the review (459 participants). In people with thalassaemia, there is no evidence to indicate any benefit of zinc supplements on serum zinc level. However, there was an improvement in height in those who received the supplements. There is mixed evidence on the benefit of using zinc supplements in people with sickle cell disease. For instance, there is evidence that when supplements are given for one year the serum zinc levels increased; however, haemoglobin levels and body mass index did not differ significantly between groups. We also found that people with sickle cell disease who received zinc supplements (at both three months and at one year) had fewer sickle cell crises and infections. However, given that the total number of trials is small, these results should be treated with caution." ]

[ "There were few studies found (searches conducted on 30th April 2013) with few antiepileptic drugs compared. One of the four studies included showed evidence that the antiepileptic drug, sulthiame, may have a positive effect in reducing seizure frequency in BECTS in the short term. There were no significant differences in the number of patients with adverse events apart from a higher risk of rash when carbamazepine was compared to topiramate. The number of patients who discontinued treatment as a result of adverse events was also not significant in the studies reviewed. There is insufficient evidence about whether or not treating with antiepileptic drugs has any effect on seizure freedom in the longer term or on a child’s cognition. The optimum treatment has yet to be identified. More research is needed to look into the effectiveness of treatment versus no treatment on seizure control and intellect, and compare the existing treatments." ]

[ "This review identified one randomised controlled study (involving 883 women) at 26 to 42 weeks' gestation and in early labour who were admitted to a tertiary hospital in USA (between July 1992 and January 1993). Measuring the amount of amniotic fluid when women were admitted did not improve infant outcomes but increased/doubled the caesarean section rate for fetal distress. The use of artificial oxytocin for augmentation of labour was also higher in the group of women who received the test than for those that did not. Because of the limited evidence (one study with a small sample size), we cannot make a meaningful conclusion or recommendations. More studies are needed." ]

[ "We included 10 randomised clinical trials (RCTs), with a total of 1611 participants, that assessed seven medications (epidural and spinal morphine, spinal fentanyl, oral caffeine, rectal indomethacin, intravenous cosyntropin, intravenous aminophylline and intravenous dexamethasone). Epidural morphine and intravenous cosyntropin proved to be effective at reducing the number of participants affected by PDPH of any severity after lumbar puncture compared to placebo. Aminophylline also reduced the number of participants affected by PDPH of any severity after a lumbar puncture compared to no intervention. Dexamethasone increased the risk of PDPH when compared to placebo after spinal anaesthesia for caesarean section. Morphine also increased the number of participants affected by adverse events such as itching, nausea and vomiting. The other interventions (fentanyl, caffeine, indomethacin and dexamethasone) did not show conclusive evidence of effectiveness. Combining data was possible only for subgroups of one study comparing different dosages of caffeine to placebo, because the other RCTs appraised diverse drugs, outcomes or populations. A meta-analysis (combining of data) was not possible because all the included RCTs assessed different drugs, different doses, different outcomes or different baseline participants' characteristics. These conclusions should be interpreted carefully, given the lack of information to evaluate the risk of bias properly, and the small number of participants in the included studies." ]

[ "Previous studies have shown that often patients prefer PCA to traditional methods of pain management, such as a nurse administering an analgesic upon a patient's request. This review demonstrated moderate to low quality evidence that PCA provided slightly better pain control and increased patient satisfaction when compared with non-patient controlled methods. Patients tended to use slightly higher doses of medication with PCA and suffered a higher occurrence of itching, but otherwise side effects were similar between groups." ]

[ "We searched scientific databases for trials that had considered the effectiveness of the surgical treatments of urinary incontinence after prostate surgery in men. The trials had to compare surgical treatment versus no treatment, non-surgical treatment, or another surgical treatment. The evidence is current to April 2014. There are five main types of surgery and, despite some of them being in use since the 1990s, we found only one trial that met the inclusion criteria. There was very low quality evidence that the implantation of an artificial urinary sphincter (a manufactured device to prevent urine leaking out) might be more effective than injectable treatment, but with more adverse effects and higher costs. There was no evidence about the other types of surgery." ]

[ "Review authors identified three randomised studies comparing different diets in 192 children and adults with different types of cancer. Other interventions, such as antimicrobial prophylaxis (i.e. prevention of infection via antimicrobial therapy such as antibiotics) and hygiene practices, and definitions of study outcomes also differed between studies, and very limited information on anticancer treatment was given. All studies had methodological problems. Unfortunately, combining the results of included studies was not possible, but at the moment, no evidence from individual studies suggests that a low bacterial diet prevents infection. Data on survival, time from onset of neutropenia to start of fever, duration of empirical (i.e. start of treatment before determination of a definitive diagnosis) antibiotics and antimycotics (i.e. agents that target fungal infection), diet acceptability and quality of life all were evaluated by only one study; for all outcomes, no statistically significant differences between treatment groups were observed. None of the studies evaluated infection-related mortality. It should be noted that 'no evidence of effect', as identified in this review, is not the same as 'evidence of no effect'. No differences between diets were identified, possibly because few patients were included in these studies. On the basis of currently available evidence, the review authors were not able to give recommendations for clinical practice. Additional high-quality research is needed." ]

[ "We searched for studies that compared biofeedback to either no treatment, sham treatment, or to other active treatments for IBS. We reviewed eight trials that included 300 total participants and assessed the effect of biofeedback on IBS. Each of these studies only included adults, and was carried out in an outpatient setting. The studies ranged from eight weeks to six months in length. The types of biofeedback devices varied, and included heart rate variability, measures of skin temperature or electrical resistance, and the tension of the muscles of the anus. None of the included trials disclosed funding sources. Our primary clinical outcomes were global clinical improvement and quality of life. Regarding overall improvement, three trials compared biofeedback to no treatment and found that biofeedback as part of a relaxation training program led to better symptom control than no treatment (very low-certainty evidence). Two of these trials also compared biofeedback to an attention control and found minimal symptom improvement, but the effects of chance could not be ruled out because the evidence was of very low-certainty. One trial found a greater symptom benefit with heart rate biofeedback compared to hypnotherapy (low-certainty evidence). Of two trials comparing biofeedback to counseling, any apparent effect was minimal and the effect of chance could not be ruled out (very low-certainty evidence). When rectosigmoidal biofeedback was compared to relaxation control, the effect favored the relaxation control. The addition of biofeedback to standard medical therapy was superior to medical therapy alone and to medical therapy plus sham biofeedback (low-certainty evidence for both findings). A single trial looked specifically at overall quality of life. Quality of life improved both for those in the biofeedback group and those in the cognitive therapy group, but there was no overall difference between groups. Only one trial explicitly reported on adverse events. It reported no adverse events in either the biofeedback group or the cognitive therapy group. We used the GRADE criteria to assess the certainty of the evidence for each of these findings. These ranged from low to very low. The evidence is current up to July 2019. We conclude that the existing data on biofeedback for IBS are limited and leave us uncertain about its value in IBS symptom management. The studies currently available all have design limitations that make the results difficult to apply to clinical settings. We do, however, recommend further study in this area, as biofeedback could represent a unique approach for a difficult to manage condition." ]

[ "The purpose of the review was to see whether TENS is effective in relieving pain in labour. The review includes results from 17 studies with a total of 1466 women. Thirteen studies examined TENS applied to the back, two to acupuncture points and two to the cranium (head). Results show that pain scores were similar in women using TENS and in control groups. There was some evidence that women using TENS were less likely to rate their pain as severe but results were not consistent. Many women said they would be willing to use TENS again in a future labour. TENS did not seem have an effect on the length of labour, interventions in labour, or the well-being of mothers and babies. It is not known whether TENS would help women to manage pain at home in early labour. Although it is not clear that it reduces pain, women should have the choice of using TENS in labour if they think it will be helpful." ]

[ "The researchers identified five studies that included a total of 329 patients. Three studies (270 patients) compared low molecular weight heparin to placebo (e.g. a sugar pill), one study (34 patients) compared low molecular weight heparin in addition to standard therapy, and one study (25 patients) compared unfractionated heparin to steroids. The study comparing unfractionated heparin to steroids and the study that compared the addition of low molecular weight heparin to standard therapy to standard therapy alone was judged to be of low quality. The three placebo-controlled studies were judged to be of high quality. In one small study, unfractionated heparin was worse than steroids for inducing clinical improvement (i.e. reduction of symptoms) in people with severe ulcerative colitis. In addition, rectal bleeding was more frequent among people who received unfractionated heparin. In another small study low molecular weight heparin used with standard therapy provided no additional benefit over standard therapy alone in adults with active ulcerative colitis. Low molecular weight heparin administered by injection showed no benefit over placebo for any outcome, including clinical remission (very low quality of evidence), clinical improvement and endoscopic improvement (i.e. healing of inflammation). High dose low molecular weight heparin administered via an extended colon-release tablet demonstrated benefit over placebo for clinical remission, clinical improvement. and endoscopic improvement. This result suggests that high dose low molecular weight heparin administered by extended-release capsules may be effective for the treatment of active ulcerative colitis. However, this result needs to be verified by future clinical trials." ]

[ "We found 27 randomised controlled trials comparing these treatments with each other in a total of 4349 couples with unexplained infertility. The evidence is current to September 2018. Evidence of differences in live birth between expectant management and the other four treatments (OS, IUI, OS-IUI, and IVF/ICSI) was insufficient. If the chance of live birth following expectant management is assumed to be 17%, the chance following OS, IUI, OS-IUI, and IVF would be 9% to 28%, 11% to 33%, 15% to 37%, and 14% to 47%, respectively. Compared to expectant management/IUI, OS may increase the chances of multiple pregnancy, and OS-IUI probably increases the chances of multiple pregnancy. Evidence showing differences between IVF/ICSI and expectant management for multiple pregnancy was insufficient. If the chance of multiple pregnancy following expectant management/IUI is assumed to be 1%, the chance following OS, OS-IUI, and IVF/ICSI would be 1% to 5%, 1% to 5%, and 0% to 6%, respectively. The certainty of evidence overall was low to moderate. The main limitations were imprecision (not enough couples have been studied) and heterogeneity (couples in existing studies had different clinical characteristics)." ]

[ "In this review, treatment with interferon alfa in the acute stage of transfusion-acquired hepatitis C infection improved liver biochemistry and enhanced viral clearance compared to the natural history of the disease. We cannot ascertain, however, the effect of interferon on clinical outcomes due to a lack of data. Because of the effect of therapy on biochemical and virologic outcomes, we recommend the treatment of acute hepatitis C with at least interferon alfa at a dosage of three million units thrice weekly for three months. Future trials should focus on the efficacy of combination therapy with ribavirin and pegylated interferons, which have shown superiority to interferon alfa in chronic hepatitis C." ]

[ "We searched for randomised controlled trials (a type of experiment in which people are randomly allocated to one or more treatment groups) up until November 2017. The search identified 23 studies involving a total of 11,170 caregivers and their children. The ages of the children ranged from birth to 24 months. The caregivers received educational interventions alone while the control group received no intervention, usual care or any other non-educational intervention. The educational methods included printed materials such as leaflets, counselling, teaching sessions, peer support, videos and practical demonstrations. Generally, the education messages were focused on the introduction of semi-solid foods at the appropriate age, the types and amount of complementary foods to be fed to infants, and hygiene. Education reduced the number of caregivers that introduced semi-solid foods to their infants before six months of age by up to 12% (moderate-quality evidence). Hygiene practices of caregivers who received education also showed some improvement compared to those that did not (moderate-quality evidence). In studies conducted in the community, education increased the duration of exclusive breastfeeding, but not in studies conducted in health facilities. There was no convincing evidence of an effect of education on the growth of children (low to very low-quality evidence). We could not combine the results from different studies for diarrhoea, knowledge of caregivers and adequacy of complementary food. However, from the individual reports of the study authors, education led to a reduction in diarrhoea and an improvement in the knowledge of caregivers. It also led to improvement in the quality and quantity of complementary foods fed to infants. Overall, we found evidence that education improves complementary feeding practices." ]

[ "We searched important medical databases such as the Cochrane Central Register of Controlled Trials and MEDLINE. Two review authors independently screened, summarised and analysed the results. This led to the inclusion of seven randomised controlled trials involving with 2564 patients. The evidence provided is current to December 2016. For the comparison of chemotherapy alone and chemotherapy plus radiotherapy with the same number of chemotherapy cycles in both arms, this systematic review found no evidence for a difference regarding OS between the interventions, however, two included trials had potential other high risk of bias due to a high number of patients not receiving radiotherapy as planned beforehand. After excluding these trials in a further analysis, OS was superior in adults receiving chemotherapy plus radiotherapy than in those receiving chemotherapy alone. PFS was also superior in adults receiving chemotherapy plus radiotherapy. Most trials reported adverse events (AEs), but in different ways. Because of insufficient comparable data we focused on adverse events considered of particular interest. For infection- related mortality, second cancer- related mortality and cardiac disease- related mortality, there was no evidence for a difference between treatment groups. For complete response rate (CRR) there was no evidence for a difference between treatment groups either. For the comparison of chemotherapy alone and chemotherapy plus radiotherapy with different numbers of chemotherapy cycles in the arms, OS was reported in one trial only. The use of chemotherapy alone may improve OS compared to chemotherapy plus radiotherapy. There was no evidence for a difference between treatment groups regarding PFS. After excluding one trial with patients not receiving the planned therapy the results showed that chemotherapy plus radiotherapy improved PFS. For infection- related mortality, second cancer- related mortality and cardiac disease- related mortality, there is no evidence for a difference between treatment groups. CR was not reported. For the same number of chemotherapy cycles in both arms, we judged the quality of evidence for OS and PFS as moderate, for AEs and CR as low. For different numbers of chemotherapy cycles in the arms, we considered the quality of evidence for OS, PFS and AEs to be low. This systematic review compared the effects of chemotherapy alone and chemotherapy plus radiotherapy in adults with early stage HL . For the comparison with same numbers of chemotherapy cycles in both arms we found moderate- quality evidence that PFS is superior in patients receiving chemotherapy plus radiotherapy than in those receiving chemotherapy alone. The addition of radiotherapy to chemotherapy has probably little or no difference on OS. A further analysis without the trials with potential other high risk of bias showed that chemotherapy plus radiotherapy improves OS (both analyses moderate- quality evidence). For the comparison of chemotherapy alone and chemotherapy plus radiotherapy with different numbers of chemotherapy cycles between the arms there were no implications for OS and PFS possible, because of the low quality of evidence of the results." ]

[ "This review includes 54 published trials involving 11,898 participants. Data show no apparent additional benefit of altered WBRT dose schedules compared with standard dose schedules. Use of other treatments such as chemotherapy, radiosensitisers, and molecular targeted agents in conjunction with WBRT has not yet been shown to be of benefit. Radiosurgery boost with WBRT does not improve survival among selected people with multiple brain metastases. WBRT when added to radiosurgery improves local and distant brain control. However, neurocognitive outcomes are better for selected people treated with radiosurgery alone as compared with WBRT and radiosurgery. For selected individuals with metastatic non-small-cell lung cancer to brain, survival may not be better with WBRT and optimal supportive care than with optimal supportive care alone. Studies have provided evidence of moderate to high certainty. Altered higher biological WBRT dose-fractionation schemes, as reported in randomised trials, did not confer benefit for overall survival, neurological function, or symptom control compared with standard treatment (3000 cGy in 10 daily fractions, or 2000 cGy in 4 or 5 daily fractions). However, overall survival and neurological function were worse for lower biological WBRT dose-fractionation schemes than for standard dose schedules. The addition of WBRT to radiosurgery improved local and distant brain control (i.e. absence of new intracranial lesions at the site or outside of treated lesions after treatment) among selected people with brain metastases, but investigators reported worse cognitive outcomes and no differences in overall survival. Selected people with multiple brain metastases from non-small-cell lung cancer may show no difference in overall survival when optimal supportive care is given and WBRT is omitted. Use of other treatments (radiosensitisers, chemotherapy, or molecular targeted agents) in conjunction with WBRT remains experimental. Additional trials are needed to evaluate strategies to protect cognitive decline associated with WBRT. As well, future trials should examine people with brain metastases with focus on prognostic features and tumour characteristics." ]

[ "We searched for relevant trials up to 8 July 2016. These studies brought together available trial data from all over the world, with 11 trials and 2343 patients. Trials were carried out between 1966 and 1998. Results showed that fewer people given PORT treatment lived for two years after the operation (53 out of every 100 patients) than those not given PORT after the operation (58 out of every 100 patients). Researchers reported no difference in effects of PORT by types of patients included in trials. Researchers did not routinely collect quality of life information during the trials, and it was unlikely that any benefit of PORT would offset the observed survival disadvantage. Radiotherapy given after successful removal of tumour at operation is not beneficial for patients with non-small cell lung cancer and should not be used as routine treatment; however, further research into new types of radiotherapy for patients at higher risk of recurrence is ongoing. These systematic reviews and meta-analyses use individual participant data, which are considered the gold standard for this type of review. We included all eligible trials, if possible, no matter what language they were published in, or whether or not they were published. This meta-analysis included 88% of all participants in eligible trials. Studies were well designed and conducted and addressed the review question, with consistent effects noted across trials. The impact of any data not included in our analyses is small." ]

[ "In 2009 we identified 14 studies, enrolling 2086 patients, and found that while statins were generally safe and reduced cholesterol levels, they did not prevent death or clinical cardiac events in people treated with dialysis. This latest update analysed a total or 25 studies (8289 patients), and included the results from two new large studies. We found that statins lowered cholesterol in people treated with dialysis but did not prevent death, heart attack, or stroke. Evidence for side-effects was incomplete, and potential harms from statin therapy remain uncertain. Current study data did not address whether statin treatment should be stopped when a person starts dialysis, although the benefits associated with continued treatment are likely to be small. Limited information was available for people treated with peritoneal dialysis, suggesting that more research is needed in this setting." ]

[ "We included six randomised trials with a total of 421 participants. The evidence is current to July 2016. There were two deaths and eight serious adverse events (harmful side effects) reported in the six trials, therefore, we had insufficient data to conclude whether exercise-based cardiac rehabilitation improved outcomes that matter the most to patients, such as death and serious adverse events (e.g. hospitalisation). Exercise-based rehabilitation was not found to have a clinically relevant impact on quality of life for the patient group, but may increase exercise capacity. The quality of the evidence ranged from moderate to very low for all outcomes. It was possible for people in the trials to know to which intervention group they were randomised, the reporting of the results was not complete in many trials, and for some outcomes, the results varied across trials. These considerations limit our confidence in the overall results of the review. Further randomised clinical trials that are conducted with low risks of bias and low risks of the play of chance, in a broader population of patients with AF, are needed to assess the impact of exercise-based interventions." ]

[ "We found two studies including 1073 participants that compared the long-term effectiveness and side effects of tiotropium compared to ipratropium bromide. One trial was 12 weeks long and one was a year long. The people included in the studies had moderate to severe COPD (average forced expiratory volume in one second (FEV1) was 40% the predicted value). Compared to ipratropium bromide, tiotropium treatment led to improved lung function, fewer COPD exacerbations, fewer hospital admissions (including those for exacerbations of COPD) and improved quality of life. Tiotropium appears to be safer with fewer adverse events, but there was no significant difference in deaths with ipratropium bromide when compared to tiotropium. Overall the evidence was of moderate to high quality. Tiotrpium is available in two different inhalers, Respimat and Handihaler. A recent large double-blind trial of the two delivery devices found no substantial difference in mortality using 2.5 µg or 5 µg of tiotropium via Respimat in comparison to 18 µg via Handihaler. Based on this review, tiotropium has more benefits than ipratropium bromide for people with stable moderate to severe COPD. The review was current as of August 2015." ]

[ "We found eight trials involving a total of 22,604 patients. We found that taking formoterol reduced the risk of having an exacerbation that was treated with oral corticosteroids, but none of the other benefits from taking formoterol were statistically significant. Guidelines suggest that long-acting beta-agonists should be given only to patients already taking an inhaled corticosteroid. We could not find enough trials conducted in children to reach a conclusion on the benefits and harms in children, so we do not recommend using the results to make recommendations on treatment of children with asthma." ]

[ "This review suggests that 50 out of 100 patients will be alive at five years, when they are given chemotherapy using a platinum drug in combination with other drugs, before having surgery and/or radiotherapy. This is compared to 45 out of every 100 patients who were given surgery and/or radiotherapy without chemotherapy. This benefit of platinum-based combination chemotherapy was seen in all types of patients and encourages its use for the treatment of invasive bladder cancer. However, chemotherapy based on a single platinum drug did not help patients live longer, and is not recommended." ]

[ "The evidence is current to May 2017. We included eight studies and 334 participants related to five different classes of medicines sometimes recommended for HAI prevention. These medicines included those that mimic the action of serotonin at selected sites (selective 5-hydroxytryptamine(1) receptor agonists), medicines that regulate the action of calcium (N-methyl-D-aspartate (NMDA) antagonist), medicines that promote dilation of the blood vessels (endothelin-1 antagonist), medicines that prevent a neuron (nerve cell) from 'firing' (initiating an action) and convulsions from developing (anticonvulsant medicines), as well as medicines that regulate the body´s sodium and water levels (spironolactone). All studies were undertaken in high altitude mountain areas. The participants ranged between 16 and 65 years of age. Only one study included people at a high risk of this condition due to their history of HAI. Four trials provided the intervention between one to three days prior to the ascent (50%), and three trials less than 24 hours prior (37.5%). The participants in all these studies reached a final altitude of between 3500 and 5895 metres above sea level. Only one of the eight included studies did not provide clear information about the source of funding (12.5%). Twenty-four additional studies were classified as ongoing (12), or awaiting classification (12; unable to obtain full texts). The assessment of the less commonly used pharmacological interventions suggest that there is a scarcity of evidence related to these interventions. For most of the assessed comparisons, we only found evidence from a single study. Clinical benefits and harms related to potential interventions such as sumatriptan are still unclear. The quality of the evidence was rated from low to very low. Several studies had quality shortcomings such as only having small sample sizes and therefore generating uncertain results. For most of the medicines evaluated, additional research is required to clarify their effectiveness and safety." ]

[ "Our searches identified a large body of trial evidence and also a substantial body of work in progress. This revealed that telehealthcare initiatives are unlikely to be of benefit in improving quality of life for the majority of people with relatively mild asthma, but that these interventions may prove useful in preventing exacerbations and hospital admissions in people with more severe asthma. We believe it is important for more research to be done to establish the cost-effectiveness of these interventions." ]

[ "Twenty-five studies met the inclusion criteria (3615 randomly assigned participants). Only 12 of these studies were randomised controlled trials with appropriate allocation concealment. Variability was noted with regard to focus and intensity of the intervention, participant characteristics and length of follow-up. Evidence suggests that early developmental interventions improve cognitive outcomes up to preschool age. Evidence also indicates that early developmental interventions improve motor outcomes during infancy; however, these effects are small. Little evidence was found of an effect on long-term cognitive or motor outcomes (up to school age). The early developmental intervention programmes described in this review had to begin within the first 12 months of life, had to focus on the parent-infant relationship and/or infant development and, although they could begin while the baby was still in hospital, had to include a component that was delivered post discharge from hospital. The early developmental intervention programmes included in this review vary by content and by frequency and focus of the intervention. This review of 25 trials supports early developmental intervention programmes provided to preterm infants post hospital discharge with the goal of improving cognitive development over the short to medium term (up to preschool age). Variability among these early developmental intervention programmes limits the conclusions that can be drawn about their effectiveness." ]

[ "This review compared the benefits and harms of laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy (cutting the muscle between the bile and pancreatic ducts) procedures followed by laparoscopic cholecystectomy to remove stones from the gallbladder and bile duct. By searching scientific databases and trials registers, we found five randomised clinical trials that compared the two approaches, and involved a total of 516 participants. The majority of the participants were females and the age of both men and women ranged from 21 years to 87 years. Only one trial stated they had not received industry sponsorship or other for-profit support. None of the other trials disclosed information about funding. Three trials stated the investigators had no competing interest; the other two trials did not provide information on competing interests. The laparoscopic-endoscopic rendezvous approach could be associated with a lower rate of overall morbidity and clinical post-operative pancreatitis, and a shorter hospital stay. We found no clear differences in overall mortality between the two techniques. Total operative time was longer with the rendezvous approach. We were unable to draw firm conclusions because of the lack of data. Further research is needed to confirm whether the single-stage approach is safer and more efficacious than the two-stage approach, and to address other important issues, such as quality of life and cost analysis. The quality of the evidence was low or very low, because of small numbers of participants, high risk of bias, and inconsistent and imprecise results across trials. The evidence is current to February 2017." ]

[ "Previous studies and systematic reviews suggest that a weaning protocol should be implemented in order to make daily assessments of patients who may be ready for weaning from mechanical ventilation. The ability to breathe spontaneously can be assessed with a spontaneous breathing trial using a T-tube (T-piece) or by reducing the applied airway pressure to provide low levels of pressure support (PS) (5 to 10 cm H2O). After removal of the endotracheal tube (extubation) the patients are monitored for 48 hours. If over this period ventilatory support does not need to be reintroduced, this is taken to indicate successful weaning. For this Cochrane systematic review we searched the medical literature databases until June 2012 and included nine studies with 1208 adult patients who had been on invasive mechanical ventilation for at least 24 hours. The trials compared pressure support (PS) and the use of a T-tube (622 patients randomized to PS and 586 randomized to a T-tube). There was no clear evidence to confirm that PS was superior to a T-tube with regard to the success of weaning, need for reintubation, ICU mortality, and other factors including long-term weaning unit (LWU) length of stay, pneumonia and a rapid shallow breathing index. Among patients who received PS, a greater number of patients had a successful spontaneous breathing trial and the airway tube was removed. For respiratory rate and tidal volume outcomes PS was superior to using a T-tube in two trials. Three studies reported that the weaning duration was shorter during PS, and in one study in which patients submitted to a T-tube the weaning time was shorter. Because of limitations in the design of the studies and imprecision in the effect estimates we have rated the quality of the evidence to be low. We reran the search in December 2013. We will deal with any studies of interest when we update the review." ]

[ "The review of trials found that interferons administered intramuscularly or subcutaneously can lead to a moderate reduction in recurrences and disability in people who have MS with remissions. Interferon-1a administered by the oral route was not effective for prevention of relapses. Side effects were usually influenza-like symptoms, injection site-reactions, pains in the joints and muscles, fatigue and headache." ]

[ "The authors found 23 studies; only five of these measured the effect on injury, the remaining 18 measured the effect on behaviour (by the patrons and/or the servers of the alcohol within the premises). The studies investigated a range of interventions involving server training, health promotion initiatives, a drink driving service, a policy intervention and interventions that targeted the server setting environment. The authors concluded that there is insufficient high quality evidence that interventions in the alcohol server setting are effective in preventing injuries. The evidence for the effectiveness of the interventions on patron alcohol consumption was found to be inconclusive. There is conflicting evidence as to whether server behaviour is improved and it is difficult to predict what effect this might have on actual injury risk. Lack of compliance with interventions seems to be a particular problem; hence mandated interventions or those with associated incentives for compliance, may be more likely to show an effect. The methodology of future evaluations needs to be improved. The focus of research should be broadened to investigate the effectiveness of interventions other than server training, where previous research dominates. When the collection of injury outcome data is not feasible, research is needed to identify the most useful proxy indicators." ]

[ "For women wishing to become pregnant spontaneously, we found one trial (200 women). For women undergoing IVF, we included ten trials (3750 women). All trials evaluated the effects of screening hysteroscopy compared to no hysteroscopy. The evidence is current to September 2018. In women wishing to become pregnant spontaneously, hysteroscopy was associated with a higher chance for an ongoing and clinical pregnancy in one study at high risk of bias. The trial reported no adverse events following hysteroscopy. The miscarriage rate was higher following hysteroscopy. In women undergoing IVF, the included studies suggested that performing a screening hysteroscopy first, improved the chances of live birth or clinical pregnancy. However, adverse events following hysteroscopy were poorly reported, and therefore, we were unable to assess the safety of this intervention. For women at a typical clinic with a 22% live birth rate, performing a screening hysteroscopy would be expected to result in live birth rates between 25% and 32%. There was no increased risk of miscarriage following hysteroscopy. We found no trials with women who were seeking intrauterine insemination. There was very low-quality evidence from one study in women who were trying to become pregnant spontaneously. There was low-quality evidence that a screening hysteroscopy, performed prior to IVF, may increase the chance of live birth or clinical pregnancy, and very low-quality evidence about adverse events following hysteroscopy. The quality of the evidence was reduced because of risk of bias and statistical heterogeneity." ]

[ "The Cochrane Oral Health Group carried out this review of existing studies, which includes evidence current up to 27 September 2013. This review includes one published study in which a total of 185 children and young adults were randomly chosen to have a clinical examination every 12 months or every 24 months. The study measured what effects the two different check-up times had on tooth decay and total time used per person (which could then be used to measure costs to the healthcare system). The limited results did not enable a conclusion to be made about whether or not extending the time to the next dental check-up can reduce tooth decay or costs. The evidence presented is of very low quality due to there only being one study and issues with the way it was conducted." ]

[ "The umbilical cord connects the baby and mother during pregnancy. The cord is cut after birth. The cord stump then dries and falls off, generally within five to 15 days. Infection of the umbilical cord stump (omphalitis), caused by skin bacteria, is a significant cause of illness and death in newborn babies in developing countries. This review evaluated all studies that assessed antiseptics applied topically to the umbilical cord to determine if they reduce the risk of cord infection and death. Thirty-four randomised controlled studies were included involving 69,338 babies. There were 22 different interventions studied. The most commonly studied antiseptics in the included studies were 70% alcohol, triple dye and chlorhexidine. Three studies were conducted in community settings in developing countries; the remainder were conducted in hospital settings, mostly in developed countries. Studies conducted in community settings were large and contributed about 78% of all the participants included in this review. Hospital-based studies were small and had limitations. Studies conducted in community settings evaluated the effectiveness of topical application of chlorhexidine and combined results showed that chlorhexidine reduced risk of death by 23% and the risk of cord infection ranging from 27% to 56%, depending on the severity of infection. Topical application of chlorhexidine may increase cord separation time by about 1.7 days, however, this does not increase subsequent risk of cord infection or death. None of the studies conducted in hospital settings reported data for risk of death or tetanus. No antiseptic was found to be advantageous for the prevention of cord infection compared with dry cord care in hospital settings. Topical triple dye application reduced bacterial colonization with Staphylococcus aureus compared to both dry cord care and alcohol application. There was no advantage of application of alcohol and triple dye for reduction of colonization with streptococcus. Topical alcohol application was advantageous in the reduction of colonization with Enterococcus coli compared with dry cord care and triple dye application. Cord separation time was increased with topical application of alcohol and triple dye compared with dry cord care in hospital settings. There were insufficient studies to determine the efficacy of other antiseptics." ]

[ "This review examines the evidence from studies comparing different types of open surgery for people with groin hernia. We included only randomised studies comparing either 1) methods using synthetic mesh versus methods without mesh or 2) flat mesh methods versus plug and mesh methods. We divided mesh methods into flat mesh, plug and mesh or preperitoneal mesh and non-mesh methods into Shouldice or other non-mesh repair. We found 20 studies comparing mesh with non-mesh repair and two studies comparing flat mesh with plug and mesh. For 13 studies we re-analysed data supplied by the study author, for four studies we received additional results from the study author and for five studies only published information was used. There was strong evidence that fewer hernias recur after mesh repair than following non-mesh repair. There was a suggestion that people had less persisting pain after mesh repair but results were only available for nine out of 20 trials. Open mesh methods were shorter to perform than Shouldice procedures, but took longer than other types of non-mesh repair. We found no clear differences between mesh and non-mesh methods for operative complications and persisting numbness. Overall, people spent less time in hospital and returned to their usual activities quicker after mesh repair but this pattern was not observed for all studies. We did not find clear evidence of differences between flat mesh repair and plug and mesh repair." ]