Datasets:

---

GEM

/

cochrane-simplification

like 4

Follow

GEM benchmark 92

[ "We searched for evidence in July 2017 and identified only one study published in 1989. The study included 393 women undergoing either vacuum or forceps delivery comparing those receiving the antibiotic cefotetan with those women who received no treatment. There were no differences between the two groups of women in terms of age, previous pregnancies and other important characteristics. The only two outcomes reported in the trial were infection of the uterus (endometritis) and length of hospital stay. The trial reported that seven women had an infection of the uterus (endometritis) in the group that did not receive any antibiotics. No woman in the antibiotic group was reported to have an infection. Giving antibiotics had no effect on length of hospital stay for the mother for either group. The quality of the evidence for these two outcomes was assessed as being low: the evidence comes from a single trial, which included a very small number of women and reported on only two outcomes. Evidence from this single trial suggests that antibiotic prophylaxis may lead to little or no difference in endometritis or maternal length of stay. There were no data on any other outcomes to evaluate the impact of antibiotics for preventing infection after operative vaginal delivery. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to provide evidence on whether it is a useful intervention." ]

[ "This review did not find any high quality research evidence showing that HBOT is beneficial for wound healing. Two poor quality studies suggested benefits associated with HBOT. The first, in patients with crush injuries, showed improved wound healing and fewer adverse outcomes. The second reported improved survival of split skin grafts in people with burn wounds. Two trials reported no benefits associated with HBOT for either skin grafting or free flap surgery. Further, better quality research is needed to determine the effects of HBOT on wound healing." ]

[ "No clear evidence from available RCTs suggests that any of the measures used to protect the kidneys during the perioperative period are beneficial. These findings held true in 14 studies of patients with pre-existing renal damage and in 24 studies that were considered of good methodological quality. The primary outcomes of these studies were mortality and acute renal injury. Reported mortality in studies with low risk of bias was not different between intervention and control groups (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.52 to 1.97) or for acute renal injury (OR 1.05, 95% CI 0.55 to 2.03). The summary of findings revealed a similar picture. So we conclude that evidence suggests that none of the interventions used currently are helpful in protecting the kidneys during the perioperative period, nor do they cause increased harm." ]

[ "This review included six studies involving over 1345 TBAs, more than 32,000 women and approximately 57,000 births and examined the effect of TBA training, or additional training, on TBA behaviour and on pregnancy outcomes. We conclude that while there are a few more studies meeting the inclusion criteria and the results are promising for some outcomes, more evidence is needed to establish the potential of TBA training to improve peri-neonatal mortality. A lack of contrast in training in the intervention and control clusters and an insufficient number of studies may have contributed to the lack of observed differences in maternal deaths and deaths of their babies (early neonatal deaths)." ]

[ "A review of studies concluded that helmets reduce the risk of head injury by around 69% and death by around 42%. There is, so far, insufficient evidence to compare the effectiveness of different types of helmet. Some studies have suggested that helmets may protect against facial injury and that they have no effect on neck injury, but more research is required for a conclusive answer. The review supports the view that helmet use should be actively encouraged worldwide for rider safety." ]

[ "The review located 12 relevant randomised controlled studies looking at the effect of stretching before or after physical activity on muscle soreness. Eleven studies were small with between 10 to 30 people being allocated stretching exercises. In contrast, one study was large with 2337 participants, 1220 of whom were in the stretching group. Ten studies were conducted in laboratories using standardised exercises. The only two studies, which included the only large study, were so-called field-based studies. These examined the effect of stretching on muscle soreness associated with self-selected physical activity. The studies were of low to moderate quality. Some of the studies examined the effects of stretching before physical activity, some examined the effects of stretching after physical activity, and some examined effects of stretching both before and after physical activity. The studies produced very consistent findings. They showed there was little or no effect of stretching on the muscle soreness experienced in the week after the physical activity." ]

[ "We included one small study on 25 people with chronic lung disease. Of those 25, only eight people had bronchiectasis. Other individuals had chronic bronchitis of diffuse panbronchiolitis and were at risk for bronchiectasis. However, we must remember when interpreting the results that not all study participants had bronchiectasis. Overall, the small study reported improvement in sputum production and dyspnoea (shortness of breath) in adults with chronic lung disease (chronic bronchitis, bronchiectasis or diffuse panbronchiolitis) who received inhaled indomethacin compared with placebo. Researchers observed no significant improvement in lung function (forced expiratory volume in one second (FEV1) and vital capacity (VC)) and reported no adverse events. Conclusions The small scale of this study and collective analysis of data from the three disease states made it difficult for review authors to draw solid conclusions on the benefit of using NSAIDs to treat adults with bronchiectasis. Review authors identified no studies examining the use of NSAIDs in children with bronchiectasis." ]

[ "We searched for all relevant research, found six studies and assessed the quality of each study. We pooled their results where possible to draw our overall conclusions. Some of the original researchers provided additional information beyond that in their published studies. However, most of the research was conducted more than 10 years ago and only the published work was available to us. We found that all six studies examined the therapy approach of practising perceptual activities (e.g. puzzles and tasks that involve processing sensory information) with stroke patients. No study examined whether the therapy provided benefits past six month in terms of the level of independence in undertaking everyday activities. On the basis of existing research evidence, the benefit or harm of therapy for adults who experience difficulty processing sensory information after stroke or brain injury remains unknown. People with perceptual problems should continue to be offered rehabilitation as recommended in guidelines intended for healthcare practitioners. Future studies should be large enough to be conclusive and should look at the longer-term effects of therapy, including independence in doing everyday activities, emotions, outcome for family caregivers and potential harmful effects." ]

[ "A review of the literature was undertaken to determine how effective rectal 5-ASA (e.g. enemas, suppositories or foam) is for treating distal UC. Thirty-eight studies met the criteria for inclusion in the review. Pooled results from these studies show that rectal 5-ASA is superior to placebo (fake suppositories, enemas or foam) for improving symptoms, improving the appearance of the bowel lining at colonoscopy, and improving the appearance of biopsies of the bowel examined microscopically. Rectal 5-ASA is also superior to rectal steroids for improving symptoms. Side effects were generally mild in nature and included abdominal pain or distention, nausea and anal discomfort or irritation. From these results, it was concluded that rectal 5-ASA should be a first-line treatment for patients with mild to moderately active distal UC." ]

[ "Twenty-one randomised controlled studies with a total of 3286 participants were included. The data were combined in an analysis to get an overall result. All types of antispasmodics were given at the beginning of established labour. They decreased the first stage of labour, the time from beginning of labour until the baby is about to be born, by 49 to 98 minutes, as well as the total duration of labour, from the beginning of labour until the delivery of the afterbirth, by 49 to 121 minutes. The drugs did not affect the number of women requiring emergency caesarean sections and did not have serious side effects for either mother or her baby. The most commonly reported adverse events for the mothers were fast heart rates and mouth dryness, but since both maternal and neonatal adverse events were poorly reported, more information is needed to make conclusions about the safety of these drugs during labour. The included studies were mostly of poor quality and good studies are needed to assess what happens when these drugs are given to women whose labour is already prolonged." ]

[ "After searching for relevant studies, we found two studies with a combined total of 288 participants to be included in this review of evidence. One study compared two forms of the anticoagulant heparin. Low molecular weight heparin offered no significant improvement over unfractionated heparin in the prevention of DVT. Furthermore neither drug caused bleeding. However, in this study both the participants and study personnel were aware of which treatment was being administered. This may have biased the results. It is unclear if other bias was introduced in the study because the process of randomly allocating treatment was not adequately described. The second study concluded that heparin was not more effective in preventing a PE than placebo whether the amputation was above or below the knee. Bleeding occurred in less than 10% of each treatment group but the study authors did not report specific numbers and therefore this could not be analysed. This study did not report the methods used to conceal how treatment was allocated but it was judged to be free from other sources of bias. This review found that there are too few trials to determine the most effective strategy in preventing VTE in people undergoing amputation of the lower limb. No study looked at mechanical forms of preventing VTE, such as compression devices, and therefore it is not possible to make any conclusions about these. Further good quality and large-scale studies are required." ]

[ "Studies in animals have shown that lowering the body temperature can help to protect the brain cells in circumstances when the blood supply to the cells is compromised. Similarly, studies in humans who have been resuscitated after their heart stopped beating have shown that lowering their body temperature helps to reduce brain damage. The purpose of this updated version of a previous review of the same title was to determine whether cooling patients who were having brain surgery reduced death and serious disability, or was associated with increased risk of harm. A detailed search of the available literature up until May 2014 identified four eligible studies that included a total of 1219 participants. Their results were combined to answer these questions. No evidence was found that cooling patients who are having brain operations reduced the risk of death or severe disability, or produced significant harm." ]

[ "However, there is some concern about the reliability of the evidence due to not all trials reporting allergy outcomes and trials not reporting the outcome for all infants. Reactions to foods and allergies (including asthma, eczema and hay fever) are common and may be increasing. Many infants become sensitised to foods, including infant formula, through their gastrointestinal tract, a process that may be affected by the composition of the intestinal bacteria. Attempts to promote the growth of normal gastrointestinal bacteria and prevent sensitisation to foods have included the addition of prebiotic to infant formula. Prebiotics are nondigestible food components that help by selectively stimulating the growth or activity of 'healthy' bacteria in the colon. This review found some evidence that a prebiotic supplement added to infant feeds may prevent eczema in infants up to two years of age. It is unclear whether the use of prebiotic should be restricted to infants at high risk of allergy or may have an effect in low risk populations; or whether it may have an effect on other allergic diseases including asthma. However, further research is needed to confirm the findings before routine use of prebiotics can be recommended for prevention of allergy." ]

[ "We identified 10 studies (nine trials and one follow-up study) up to December 2014. In total, the studies involved over 1100 primary care doctors and around 492,000 patients. The intervention was different in each study. Six of the studies involved training clinicians (mostly primary care doctors) in communication skills that are needed to facilitate shared decision making. In three studies, as well as training doctors in these skills, patients were also given written information about antibiotics for acute respiratory infections. All included trials received funding from government sources. No studies declared a conflict of interest. Interventions that aim to facilitate shared decision making significantly reduce antibiotic prescribing for acute respiratory infections in primary care, without a decrease in patients' satisfaction with the consultation, or an increase in repeat consultations for the same illness. There was not enough information to decide whether shared decision making affects other clinically adverse secondary outcomes, measures of clinician and patient involvement in sharing decision making, or antibiotic resistance. We rated the quality of the evidence as moderate or low for all outcomes." ]

[ "We identified five RCTs with a total of 827 participants. Seven hundred thirty participants (384 received continuous sutures and 346 interrupted sutures) provided data for this review. Participants had abdominal or groin operations. The only outcomes reported were, superficial surgical site infection, superficial wound breakdown and length of hospital stay. No other important outcomes, including quality of life, long-term patient outcomes and use of healthcare resources, were reported. Approximately 6% of participants developed superficial surgical site infection, but there was no significant difference between the two groups in the proportion of participants who developed these. Approximately 4% of participants developed superficial wound breakdown. The proportion of participants with this problem in the continuous suture group was approximately one-tenth of that in the interrupted suture group. Most wound breakdowns occurred in two trials that used absorbable sutures for continuous suturing and non-absorbable sutures for interrupted suturing. Non-absorbable sutures are removed seven to nine days after surgery, but absorbable sutures are not removed, and so support the wound for longer - which may account for the difference in distribution of this problem between groups. There was no significant difference between groups for length of hospital stay. Superficial wound breakdown is reduced by continuous subcuticular suturing. However, the trials that contributed to this result had suture removal in only one group (interrupted sutures), which may have led to this observation. The number of participants included in this review was small and follow-up after surgery was short. The overall quality of evidence was very low. Levels of bias across the studies were mostly high or unclear, so there may have been flaws in trial organisation that could produce erroneous results. Further well-designed trials at low risk of bias are necessary." ]

[ "This review identified six studies (271 participants) comparing PGE1 with or without ACEi/ARB versus ACEi/ARB, no treatment or Xueshuantong (a Chinese medicinal herb). The results suggest that PGE1 may have a positive effect on DKD by reducing urinary albumin excretion rate (UAER), microalbuminuria and proteinuria. No serious adverse events or allergic responses were reported. All studies were methodologically poor and there is no strong evidence for recommending PGE1 for preventing the progression of DKD as a routine therapeutic measure. More high-quality research is needed." ]

[ "This review found 100 studies that assessed the effect of higher versus lower intake of PUFAs in infants through searches of medical databases up to September 2015. However, only nine of these studies enrolling 2704 infants reported allergy outcomes (measures). Of these nine studies, we considered only one to be high quality. Five studies reported all allergy as an outcome measure; four studies reported asthma; all nine studies reported dermatitis/eczema; two studies reported allergic rhinitis and four studies reported food allergy. PUFA supplementation in infancy did not affect the risk of infant (aged up to two years of age) or childhood (aged up to 10 years of age) allergy, asthma, dermatitis/eczema and food allergy. There was a reduction in the risk of allergic rhinitis during infancy, however, there was no effect on the risk of childhood allergic rhinitis. There is insufficient evidence to determine an effect on allergic rhinitis. We graded the evidence for no effect on infant incidence, childhood incidence and childhood prevalence of all allergy as very low; the reduction in infant incidence of allergic rhinitis as very low; and the evidence for no effect on infant incidence, childhood incidence and childhood prevalence of all other allergic outcomes as very low to low. Further high quality studies are needed before we can determine an effect of higher PUFA intake in infants on the risk of allergic disease." ]

[ "Warfarin is commonly prescribed to prevent blot clots in patients with medical conditions such as atrial fibrillation, heart valve replacement or previous blood clots. Warfarin is an effective treatment which has been used for many years but needs to be closely monitored, especially at the beginning of treatment, as there is a wide variation in response to dose. Monitoring of the response to dose is done using an International Normalized Ratio (INR) and it is important that patients remain within a narrow range (typically 2 to 3 INR) due to the need to balance the goal of preventing blood clots with the risk of causing excessive bleeding. This review included 12 randomised controlled trials comparing different warfarin doses given to patients beginning warfarin treatment. Most of the studies had a high risk of bias so the results were interpreted with caution. Those trials that were included compared loading doses in several different situations. The review authors divided the trials into four categories, 5 mg versus 10 mg initial doses (four studies), 5 mg versus other doses (two studies), 5 mg or 10 mg versus age adjusted doses (two studies), 5 mg or 10 mg versus genotype adjusted doses (four studies). The review authors concluded that there is still considerable uncertainty between the use of a 5 mg and a 10 mg loading dose for the initiation of warfarin. In the elderly, there is some evidence that lower initiation doses or age adjusted doses are more appropriate. However, there is insufficient evidence to warrant genotype adjusted dosing. We also found no data to suggest that any one method was safer than another." ]

[ "We searched the medical literature up to May 2016 and found one randomised controlled trial (RCT) and one prospective cohort study to include in this review. These studies involved 493 participants in total. The RCT conducted at a dental hospital in the UK included 77 adolescent male and female participants, and the cohort study conducted at a private dental clinic in the USA involved 416 men aged 24 to 84 years. Available evidence is insufficient to show whether or not asymptomatic disease-free impacted wisdom teeth should be removed. One study at serious risk of bias provided very low quality evidence suggesting that the presence of asymptomatic disease-free impacted wisdom teeth is associated with increased risk of periodontitis (infection of the gums) affecting the adjacent second molar (teeth directly in front of the wisdom teeth) in the long term. In the same study, no evidence was found to suggest that the presence of asymptomatic disease-free impacted wisdom teeth increases the risk of caries affecting the adjacent second molar. Another study, also at high risk of bias, found no evidence to suggest that removal of asymptomatic disease-free impacted wisdom teeth has an effect on crowding in the dental arch. The included studies did not measure our primary outcome - health-related quality of life. Nor did they measure our secondary outcomes - costs, other adverse events associated with retention of asymptomatic disease-free impacted wisdom teeth (pericoronitis, root resorption, cyst formation, tumour formation, inflammation/infection) and adverse effects associated with their removal (alveolar osteitis/postoperative infection, nerve injury, damage to adjacent teeth during surgery, bleeding, osteonecrosis related to medication/radiotherapy, inflammation/infection). Evidence provided by the two studies included in this review is of low to very low quality, so we cannot rely on these findings. High-quality research is urgently needed to support clinical practice in this area. In light of the lack of available evidence, patient values should be considered and clinical expertise used when treatment decisions are made with patients who have asymptomatic disease-free impacted wisdom teeth. If the decision is made to retain asymptomatic disease-free impacted wisdom teeth, clinical assessment at regular intervals is advisable to prevent undesirable outcomes." ]

[ "We included 32 studies involving a total of 748 participants aged above 18 with acute, postacute or chronic ischaemic or haemorrhagic stroke. The mean age in the experimental groups ranged from 43 years up to 70 years and from 45 years up to 75 years in the control groups. The level of participants' impairment ranged from severe to moderate. The majority of studies were conducted in an inpatient setting. Different stimulation types (anodal, cathodal, dual) of tDCS with different stimulation durations and dosages were administered and compared with sham tDCS or an active control intervention. Sham tDCS means that the stimulation is switched off covertly in the first minute of the intervention. This review found that tDCS might enhance ADLs, but it is still uncertain if arm and leg function, muscle strength and cognitive abilities may be improved. Proportions of adverse events and people discontinuing the treatment were comparable between groups. Included studies differed in terms of type, location and duration of stimulation, amount of current delivered, electrode size and positioning as well as type and location of stroke. Future research is needed in this area to foster the evidence base of these findings, especially regarding arm and leg function, muscle strength and cognitive abilities (including spatial neglect). The quality of evidence for tDCS for improving ADLs was very low to moderate. It was low for upper extremity function and low for adverse events and people discontinuing the treatment." ]

[ "This review identified 13 studies (2032 participants). Methenamine hippurate may be effective in preventing UTI in patients without renal tract abnormalities particularly when used for short term prophylaxis. It does not appear to be effective for long term prophylaxis in patients who have neuropathic bladder. There were few adverse effects.Additional well controlled randomised controlled trials are necessary in particular to clarify effectiveness for longer term prophylaxis in those without neuropathic bladder." ]

[ "This review analyzed the effects of furosemide on preterm babies receiving indomethacin to close the ductus arteriosus. The review of trials found not enough evidence to recommend routine use of furosemide in preterm infants who receive indomethacin for closing a ductus arteriosus." ]

[ "Sixty-one studies presented data on 15,077 women with a wide range of risk factors for developing breast cancer, who underwent RRM. Risk-reducing mastectomy could include either surgically removing both breasts to prevent breast cancer (bilateral risk-reducing mastectomy or BRRM), or removing the disease-free breast in women who have had breast cancer in one breast to reduce the incidence of breast cancer in the other breast (contralateral risk-reducing mastectomy or CRRM). The evidence is current to July 2016. The BRRM studies reported that it reduced the incidence of breast cancer or the number of deaths or both, but many of the studies have methodological limitations. After BRRM, most women are satisfied with their decision, but reported less satisfaction with cosmetic results, body image, and sexual feelings. One of the complications of RRM was the need for additional unanticipated surgeries, particularly in women undergoing reconstruction after RRM. However, most women also experienced reduced worry of developing and dying from breast cancer along with diminished satisfaction with body image and sexual feelings In women who have had cancer in one breast, removing the other breast (CRRM) may reduce the incidence of cancer in that other breast, but there is insufficient evidence that this improves survival because of the continuing risk of recurrence or metastases from the original cancer. While published observational studies demonstrated that BRRM was effective in reducing both the incidence of, and death from, breast cancer, more rigorous prospective studies are suggested. BRRM should be considered only among those at high risk of disease, for example, carriers of mutations in the breast cancer genes, BRCA1 and BRCA2. CRRM was shown to reduce the incidence of contralateral breast cancer (CBC), but there is insufficient evidence that CRRM improves survival, and studies that control for multiple variables that can affect results are recommended. It is possible that selection bias in terms of healthier, younger women being recommended for or choosing CRRM produces better overall survival numbers for CRRM. Just over half of the studies were found to have a low risk of selection bias, that is, studies adjusting for systematic differences in prognosis or treatment responsiveness between the groups, and similarly, 60% had a low risk of detection bias, that is, studies considered systematic differences in the ways the outcomes were measured and detected. The primary cause for both selection bias and detection bias was not controlling for all major confounding factors, e.g., risk factors or having bilateral risk-reducing salpingo-oophorectomy (BRRSO - surgery to remove fallopian tubes and ovaries) in the subject and control groups. Performance bias (validation of the risk-reducing mastectomy) was not problematic, as most studies were based on surgical reports; three relied on self-reports and eight were unclear because of multiple sources of data and/or broad timeframe. Attrition bias was at high risk or unclear in approximately 13% of the studies. The mean or median follow-up period reported was from 1 - 22 years. Given the number of women who may be over-treated with BRRM/CRRM, it is critical that women and clinicians understand the true risk for each individual woman before considering surgery. Additionally, thought should be given to other options to reduce breast cancer risk, such as BRRSO and chemoprevention, when considering RRM." ]

[ "In some studies, health professionals were simply given information about their performance and how this compared to professional standards or targets. In other studies, health professionals were also given a specific target that they personally were expected to reach, or were given an action plan with suggestions or advice about how to improve their performance. What happens when health professionals are given audit and feedback? The effect of using audit and feedback varied widely across the included studies. Overall, the review shows that: The effect of audit and feedback on professional behaviour and on patient outcomes ranges from little or no effect to a substantial effect. The quality of the evidence is moderate. Audit and feedback may be most effective when: 1. the health professionals are not performing well to start out with; 2. the person responsible for the audit and feedback is a supervisor or colleague; 3. it is provided more than once; 4. it is given both verbally and in writing; 5. it includes clear targets and an action plan. In addition, the effect of audit and feedback may be influenced by the type of behaviour it is targeting. It is uncertain whether audit and feedback is more effective when combined with other interventions." ]

[ "We included 425 research reports described in 551 articles, which had studied the subsequent full publication of 307,028 abstracts from a variety of biomedical and social sciences. Fifty-four reports included data from abstracts describing randomized or controlled trials. Of the 425 reports, 376 were published in English, and 49 in other languages. 1. Less than half of all studies, and about two-thirds of randomized trials, initially presented as summaries or abstracts at meetings, are published as journal articles in the 10 years after presentation. 2. Studies with positive results are more likely to be published. 3. Studies with larger sample sizes are more likely to be published. 4. Studies with abstracts presented orally are more likely to be published than those presented as posters. 5. Studies accepted for presentation at a meeting are more likely to be published than those not accepted. 6. Studies describing basic science are more likely to be published that those describing clinical research. 7. Studies describing randomized trials are more likely to be published than those describing other types of studies. 8. Studies that took place in multiple centers are more likely to be published than those at a single center. 9. Studies classified as ‘high quality’ are more likely to be published than ‘low quality’ studies. 10. Studies with authors from an academic setting are more likely to be published than those with authors from other settings. 11. Studies considered by the report authors to have a high impact are more likely to be published than other studies. 12. Studies with funding source reported are more likely to be published than those not reporting funding. 13. Studies originating in North America or Europe are more likely to be published than those originating elsewhere. 14. Studies from English-speaking countries are more likely to be published than studies originating elsewhere. We have confidence in our findings. We considered five criteria to constitute a risk of bias in the included reports, including methods to identify and match full publications to abstracts, and methods to determine whether a factor was associated with full publication. Overall, 7.5% (32/425) of the reports were scored as having an overall high risk of bias, 83.1% (353/425) had at least one criterion at high risk of bias, and 6.1% (26/425) had all criteria at low risk of bias. Our search updated our 2007 review and is current to February 2016. After the considerable work involved in including more than 300 additional studies from the February 2016 searches, we chose not to update the search again because additional searches are unlikely to change our overall conclusions in any important way." ]

[ "We found one eligible study of 55 participants from the UK. All participants in the study had a history of contact lens wear. The study randomly assigned people with AK to one of two medical treatment options: chlorhexidine eye drops or polyhexamethylene biguanide (PHMB) eye drops. Participants in the study were treated for 51 to 145 days. In the one study identified, similar results were seen between the chlorhexidine and PHMB groups in terms of resolution of infection, changes in vision, or need for surgery. However, the number of participants in the study was small and the results uncertain; thus, we cannot be confident that there are really no differences between these treatments. No serious side effect was observed with either treatment in the study. Although the study was well-designed with no suggestion of bias, the results must be interpreted carefully because of the small number of participants." ]

[ "In May 2017 we searched for all clinical trials that investigated the effectiveness of trihexyphenidyl for people with dystonic cerebral palsy. We included one Australian trial that involved 16 children (10 boys, 6 girls) with cerebral palsy and dystonia. They had an average age of nine years. The children were divided into two different groups. Both groups took 12 weeks of trihexyphenidyl and 12 weeks of a placebo (something that looks the same as trihexyphenidyl but with no active ingredient), with a 4-week break in between during which they received neither. The only difference between the groups was that one group started with trihexyphenidyl and then had placebo, and the other group started with placebo and then had trihexyphenidyl. We found no evidence that trihexyphenidyl was effective for reducing dystonia or improving upper arm function in children with cerebral palsy and dystonia. Trihexyphenidyl may be associated with an increased risk of side effects (agitation, constipation, dry mouth and poor sleep). There was some evidence that trihexyphenidyl may improve individual goals set by the child and family around improved participation in activities of daily living. The study did not measure pain or quality of life. We rated the quality of the evidence as low because the one study included a small number of children and there are no other studies to support the findings. Therefore, we are uncertain about the effectiveness of trihexyphenidyl in reducing dystonia or improving arm function and participation in everyday activities of people with cerebral palsy and dystonia." ]

[ "This review of trials found that using mechanical devices might be better than no treatment but the evidence is weak. There was not enough evidence to recommend any specific type of device or to show whether mechanical devices are better than other forms of treatment such as pelvic floor muscle training." ]

[ "We included four studies with a total of 152 adult participants. These studies were conducted in several countries (Norway, the United Kingdom and Canada). All of them compared debridement to no debridement after endoscopic sinus surgery. The minimum follow-up time in the studies ranged from 3 to 12 months. Only one study reported health-related quality of life scores and only one reported disease severity scores. However, all four studies reported scores for the appearance of the sinonasal cavities viewed through an endoscope. Adverse effects of this procedure and rates of revision surgery were not reported in any of these studies. Health-related quality of life and disease severity scores were not significantly different between those patients who underwent debridement and those who did not. All four studies demonstrated better post-surgical endoscopic appearance in the debridement group, although the size of improvement was not statistically significant. A lower rate of intranasal scarring was noted in the patient group that underwent debridement. Nonetheless, the overall evidence for all of these outcomes is of low quality. We identified several problems or potential problems in these studies. The most important was that in each study a different protocol was used for the number of debridement interventions performed per patient and the time interval between each such intervention. In addition, the numbers of patients in the study groups were relatively small. We therefore determined the overall quality of the evidence to be low for all outcomes. The evidence in this review is up to date to May 2018." ]

[ "This review included 19 studies involving over 310,000 women. Seven trials were conducted in Africa, six in Indonesia, two in Bangladesh, and one each in Nepal, China, India, UK and USA. Most of the trials were conducted in populations considered to be vitamin A deficient (except USA and UK). The overall risk of bias was low to unclear in most of the trials, and the body of evidence was moderate to high quality. The findings indicate that routine supplementation with vitamin A (either alone or in combination with other supplements) during pregnancy did not reduce mother or newborn baby deaths. There is good evidence that antenatal vitamin A supplementation does reduce maternal anaemia in women who live in areas where vitamin A deficiency is common or who are HIV-positive. The trials published so far did not report any side effects or adverse events. The available evidence suggests a reduction in maternal infection but these data are not of a high quality and further trials would be needed to confirm or refute this. Taking vitamin A supplements during pregnancy does not help to prevent maternal deaths (related to pregnancy) or perinatal or newborn baby deaths. Taking vitamin A supplements during pregnancy does not help to prevent other problems that can occur such as stillbirth, preterm birth, low birthweight of babies or newborn babies with anaemia. However, the risk of maternal anaemia, maternal infection and maternal night blindness is reduced." ]

[ "In January 2016, we found seven studies that assessed liposomal bupivacaine nerve block. Three studies were listed as completed but had not reported results. This left four studies involving 299 participants for this review. Two studies investigated liposomal bupivacaine given between two of the layers of abdominal muscles to block the nerves supplying sensation to that area (known as a transversus abdominus plane (TAP) block); one study investigated liposomal bupivacaine given around the nerves that supply sensation to the penis (dorsal penile nerve block); and one study investigated the ankle (ankle block). We did not identify any studies that reported our primary outcome cumulative pain score between 0 and 72 hours or pain-centred secondary outcomes. Two studies reported cumulative opioid (a strong painkiller) use with inconsistent results. We looked for results about side effects but none were reported, however no participants dropped out of the studies due to side effects. Overall, the lack of evidence, due to the small number of trials each reporting different outcomes, prevented a full assessment of the role of liposomal bupivacaine administered as a nerve block for the management of pain after surgery in adults. Due to the small number of trials, and small number of participants in these trials, the quality of evidence was very low. As such, further research is required to evaluate the role of liposomal bupivacaine as a nerve block to treat pain after surgery." ]

[ "We have found two trials comparing these devices and including 67 participants in total. The studies compared different devices, so we could not pool the information from the two studies. However, one study showed that long intravenous lines last for longer than short intravenous lines (thus reducing the number of procedures which a participant has to undergo for a course of antibiotics). Patient satisfaction was higher with long intravenous lines compared to short intravenous lines. The study comparing two different types of long intravenous line did not show that one type was clearly better than another. Neither study was large enough to show differences in complications for the different devices. Neither study reported on important outcomes, such as the number of attempts required to insert the device. We recommend further research to compare different types of percutaneous long intravenous line." ]

[ "We identified seven trials with a combined total of 542 participants comparing percutaneous transluminal angioplasty (PTA) alone versus PTA with stent placement (current until June 2018). One trial randomised limbs to PTA alone or PTA with stent placement, and the remaining studies randomised participants. Full analysis of five trials shows that the technical success rate of re-opening the narrowed artery was higher in the stent group than in the PTA group. However, we noted no clear differences in patency (opened vessel remaining open) of the treated vessel at six months. The complication rate of the procedure, the number of major amputations at 12 months, and the number of deaths at 12 months also did not differ greatly between treatment groups. The overall certainty of evidence provided by the trials included in this review was moderate. Trials differed in their methods. Two studies reported poorly on the methods used to generate random numbers and to allocate participants to different groups. All studies were unblinded. All included studies were rated as direct in their relevance to the review question. Overall, we downgraded the certainty of evidence for all outcomes by one level to moderate due to inconsistency of results across studies and the small numbers of studies and participants. PTA with stent placement is better than PTA alone for restoring vessel patency immediately; however we found no clear difference in short-term patency at six months between the two groups. Trials show no clear differences between groups in complications at or around the time of the procedure, major amputation, and death. Currently available data suggest that high-certainty evidence is insufficient to show that PTA with stent placement is superior to PTA alone for treatment of infrapopliteal arterial lesions. Further studies should standardise the use of blood-thinning drugs (antiplatelets/anticoagulants) before and after both interventions to improve the comparability of the two treatments." ]

[ "The evidence is current to 7 July 2015. Our review identified nine clinical trials that compared the effectiveness and safety of fulvestrant against other standard treatments for advanced hormone-sensitive breast cancer and pooled the data from these trials to analyse all the data together. Three different endocrine therapies were analysed as comparator drugs against fulvestrant. Two of these drugs were the aromatase inhibitors anastrozole and exemestane, which lower oestrogen levels in postmenopausal women, and the third was tamoxifen, which works by blocking oestrogen. Four of the studies were in the first-line setting, meaning that fulvestrant was tested against these endocrine therapies as the initial treatment for advanced disease. Five of the studies tested fulvestrant in the second-line or more setting, meaning after the women had progressed on a prior initial treatment for advanced disease. Two studies examined fulvestrant in combination with anastrozole against anastrozole alone, and the other seven studies compared fulvestrant alone with other comparator drugs. We found that fulvestrant was at least as effective as the other three standard endocrine therapies used in the treatment of advanced hormone-sensitive breast cancer and is possibly more effective at the new standard dose of 500 mg, rather than the lower dose of 250 mg, which was previously used and tested in all but one of the included studies. We also found that combining fulvestrant with an aromatase inhibitor did not improve effectiveness, and neither was effectiveness influenced by whether fulvestrant was used as the first treatment upon diagnosis of advanced disease or after another endocrine therapy. This was evident in the pooled data analysis for both survival time without progression of cancer and the rate of tumour shrinkage or stabilisation due to fulvestrant as compared with the other endocrine therapies. In addition, fulvestrant-treated women did not experience worse side effects than those receiving the comparator endocrine therapies, and quality of life was equivalent in both fulvestrant-treated women and women treated with the other endocrine therapies. Fulvestrant can therefore be considered an effective and safe treatment for postmenopausal women with advanced hormone-sensitive breast cancer, when treatment with endocrine therapy is indicated. All studies were of high quality." ]

[ "Seven small studies of variable quality were reviewed. The studies tested the effect of maintenance treatment with probiotics (e.g. Lactobacilli GG, Escherichia coli strain Nissle 1917, VSL#3, Saccharomyces boulardii) among patients with Crohn's disease in remission. Remission was induced by medical or surgical treatment. The studies lasted for 6 months to a year. The studies did not demonstrate any benefit for probiotic treatment. Probiotics were generally well tolerated and few side effects were reported. Reported side effects include bloating, diarrhoea, constipation, nausea and epigastric pain. Currently, there is no evidence to support the use of probiotics for the maintenance treatment of Crohn's disease. It is possible that larger studies might show that this approach to treatment is effective." ]

[ "This review included three trials that randomly assigned 175 women with the placenta remaining undelivered more than 15 minutes after delivery to either a placebo or the tocolytic nitroglycerin. Both groups received oxytocin to stimulate contractions of the uterus. Combined administration of nitroglycerin and oxytocin did not reduce the need for manual removal of placenta, blood loss, nor the incidence of severe postpartum haemorrhage. Nitroglycerin administration did not cause headache but resulted in a mild drop in blood pressure and a related increase in heart rate. Two out of the three trials had low risk of bias but this result needs confirmation in larger trials with adequate sample sizes to verify the role of nitroglycerin and other tocolytic drugs in managing different subtypes of retained placenta. The trials in this review did not specify the type of retained placenta. We have included an explanation of some of the scientific terms that are used in this review in a glossary (see Appendix 1)." ]

[ "Twelve randomised clinical trials fulfilled the inclusion criteria of this review. Primary analysis of the data based on criteria described beforehand (intention-to-treat model assigning unfavourable outcome for missing data) showed that hepatitis B vaccination has an unclear effect on the risk of developing hepatitis B infection. Analysis of data of available participants in the various trials showed that as compared to not vaccinating, hepatitis B vaccination reduces the risk of developing hepatitis B infection; by 88% for hepatitis B surface antigen marker and 62% for anti-core antibody marker. One should note, that these findings are based on only four randomised clinical trials of poor methodological quality involving 1230 participants. When compared with other vaccines or placebo, hepatitis B vaccination results in comparable risk of developing adverse events. This includes serious adverse events such as admission to hospital and convulsions, as well as less serious events such as fever, local redness, and pain. This shows that the risk of developing these adverse events is not more than with other vaccinations. There was not enough data to draw definite conclusions on the effect of hepatitis B vaccination on compliance and cost-effectiveness." ]

[ "We systematically reviewed ten studies assessing the efficacy of antidepressants, for a total of 885 participants. The evidence is current to 3 July 2017. Due to the small number of people in the studies, and issues with how the studies reported what was done, there is uncertainty over whether antidepressants were better than placebo in terms of depressive symptoms after 6 to 12 weeks of treatment. We did not have enough evidence to determine how well antidepressants were tolerated in comparison with placebo. Our results did not show whether any particular antidepressant was better than any other in terms of both beneficial and harmful effects. To better inform clinical practice, we need large studies which randomly assign people to different treatments. Currently, we cannot draw reliable conclusions about the effects of antidepressants on depression in people with cancer. The certainty of the evidence was very low because of a lack of information about how the studies were designed, low numbers of people in the analysis of results, and differences between the characteristics of the studies and their results. Despite the impact of depression on people with cancer, the available studies were very few and of low quality. This review found very low certainty evidence for the effects of these drugs compared with placebo." ]

[ "The aim of this review was to determine if these interventions are effective in the management of conduct disorder and delinquency in children and adolescents, aged 10-17. Current evidence suggests that family and parenting interventions for juvenile delinquents and their families have beneficial effects on reducing time spent in institutions. This has an obvious benefit to the participant and their family and may result in a cost saving for society. These interventions may also reduce rates of later arrest, but at present these results need to be interpreted with caution, because of diversity in the results of studies." ]

[ "Studies included in this review are current to March 2016. We included 10 studies involving 545 participants for evaluation of the diagnostic accuracy of ultrasound for confirmation of gastric tube placement. Most studies showed good performance for correct placement of the tube. However, few data were available for incorrect placement of the tube and the possible complications of a misplaced tube. Among the included studies, only 43 participants had a misplaced tube. None of the studies reported complications during ultrasound use. Three methods of ultrasound were reported: neck approach, upper abdominal (tummy) approach and a combination of both. No included studies indicated that ultrasound had sufficient accuracy as a single test for the confirmation of gastric tube placement for feeding. In contrast, ultrasound combined with other tests (e.g. saline flush visualization (pushing salt solution through the tube and seeing it inside the stomach by ultrasound)) might be useful for the confirmation of tubes used for gastric drainage. Generally, the studies were of low or unclear methodological quality. We considered only three (30%) of the 10 included studies to be representative of patients in practice because they performed ultrasound after they confirmed correct position by other methods. The studies reported a variety of results for incorrect tube placement. Larger studies are needed to investigate whether ultrasound could replace X-rays for confirming gastric tube placement, as well as whether ultrasound could decrease severe complications, such as pneumonia, from a misplaced tube." ]

[ "Cochrane authors performed a comprehensive literature search of the standard medical databases to 8 April 2019 in consultation with the Cochrane Gynaecology and Fertility Group Information Specialist, for randomised clinical trials (RCTs: clinical studies where people are randomly put into one of two or more treatment groups) investigating the effect of thyroid hormones (levothyroxine) for women diagnosed with ATD or mildly underactive thyroid who were planning to undergo assisted reproduction. Two authors independently selected studies, evaluated them, extracted data and attempted to contact the authors where data were missing. We found four RCTs (with 820 women) that met our inclusion requirements. The thyroid hormones were administered in a range of doses to women diagnosed with mildly underactive thyroid or presence of thyroid antibodies (ATD). In women with mild thyroid hormone imbalance and unknown thyroid autoimmunity status, we were uncertain whether thyroxine replacement had an effect on live birth or miscarriage rates (very low-quality evidence from one study involving 70 women). In women with mildly underactive thyroids (with or without ATD), the evidence suggested that thyroxine replacement may have improved live birth rates (low-quality evidence from one study involving 64 women) and it may have led to similar miscarriage rates (low-quality evidence from one study involving 64 women). The evidence suggested that women with mildly underactive thyroid (with or without ATD) would have a 25% chance of a live birth with placebo or no treatment, and 27% to 100% with thyroxine. In women with ATD and normal thyroid function, treatment with thyroxine replacement compared with placebo or no treatment may have led to similar live birth rates (low-quality evidence from two studies involving 686 women) and miscarriage rates (low quality evidence from two studies involving 686 women). The evidence suggested that women with ATD and normal thyroid function would have a 31% chance of a live birth with placebo or no treatment, and 26% to 40% with thyroxine. Side effects were rarely reported. One study reported none out of 32 preterm births in the thyroxine replacement group and one out of 32 preterm births in the control group in women diagnosed with mildly underactive thyroid (with or without ATD). One study reported 21 out of 300 preterm births in the thyroxine replacement group and 19 out of 300 preterm births in the control group in women diagnosed with ATD and normal thyroid function. None of the studies reported on other maternal pregnancy complications, foetal complications or side effects of thyroxine. The evidence was of very low to low quality. We downgraded the evidence as it was based on single, small trials with widely variable results." ]

[ "We only found one reasonably good but small trial. It did not show that compliance therapy really effected compliance with medication, psychotic symptoms, or quality of life but it was always too small really to show this for certain. The study did, however, suggest that the compliance therapy may help people spend shorter times in hospital across a two year period, when compared with standard care. There is a need for more studies and we have proposed a design that could be conducted within the confines of routine care for outcomes of interest to everyone involved." ]

[ "This review included one low quality trial of a specialist nurse counselling intervention compared with routine outpatient clinic follow up. No data were reported on remission outcomes. Counselling by a specialist nurse might improve mental health related quality of life for some IBD patients in the short term. However, the poor quality of the one included study does not allow for any definitive conclusions regarding the impact of the nurse-led counselling program. Better designed studies are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease." ]

[ "Researchers and organizations often use evidence from randomized controlled trials (RCTs) to determine the efficacy of a treatment or intervention under ideal conditions, while studies of observational designs are used to measure the effectiveness of an intervention in non-experimental, 'real world' scenarios. Sometimes, the results of RCTs and observational studies addressing the same question may have different results. This review explores the questions of whether these differences in results are related to the study design itself, or other study characteristics. This review summarizes the results of methodological reviews that compare the outcomes of observational studies with randomized trials addressing the same question, as well as methodological reviews that compare the outcomes of different types of observational studies. The main objectives of the review are to assess the impact of study design--to include RCTs versus observational study designs (e.g. cohort versus case-control designs) on the effect measures estimated, and to explore methodological variables that might explain any differences. We searched multiple electronic databases and reference lists of relevant articles to identify systematic reviews that were designed as methodological reviews to compare quantitative effect size estimates measuring efficacy or effectiveness of interventions of trials with observational studies or different designs of observational studies. We assessed the risks of bias of the included reviews. Our results provide little evidence for significant effect estimate differences between observational studies and RCTs, regardless of specific observational study design, heterogeneity, inclusion of pharmacological studies, or use of propensity score adjustment. Factors other than study design per se need to be considered when exploring reasons for a lack of agreement between results of RCTs and observational studies." ]

[ "In one trial involving 200 women, uterine massage was given every 10 minutes for 60 minutes after delivery of the placenta effectively reduced blood loss, and the need for additional uterotonics, by some 80%. The numbers of women losing more than 500 mL of blood were too small for meaningful comparison. Two women in the control group and none in the uterine massage group needed blood transfusions. The second trial involved 1964 women who were assigned to receive oxytocin, uterine massage or both after delivery of the baby and before delivery of the placenta. There was no added benefit for uterine massage when oxytocin was used. The results of this review are inconclusive. The methodological quality of the two included trials was high but it is possible that there were differences in the procedures used in the study sites. Disadvantages of uterine massage include the use of staff time, and discomfort caused to women. The findings should not change the recommended practice. It is likely that any reduction in blood loss was limited with the use of oxytocin in these trials. Uterine massage may also have increased apparent blood loss by pressing pooled blood out from the uterine cavity. There is a need for more trials, especially in settings where uterotonics are not available. Uterine massage could be a simple inexpensive intervention if proved effective." ]

[ "This review assessed the analgesic efficacy and adverse effects that single dose oral dextropropoxyphene taken alone or in combination with paracetamol had in treating moderate to severe postoperative pain. The combination of dextropropoxyphene 65 mg with paracetamol 650 mg showed similar efficacy to that of tramadol 100 mg for single dose studies in postoperative pain but with a lower incidence of side effects. This review also highlighted that Ibuprofen 400 mg was yet more effective than both tramadol 100 mg and dextropropoxyphene 65 mg." ]

[ "Our review included 11 clinical trials that randomized 1838 participants (current until December 2015). The trials included thigh and leg arteries above and below the knee. The trials were carried out in Europe and the USA, and all used DEBs that contained paclitaxel. Four companies manufactured the DEB devices: Bard, Bavaria Medizin, Biotronik, and Medtronic. Most participants were followed for 12 or more months (called follow-up). At six and 12 months of follow-up, DEBs were associated with improved primary vessel patency, which is an indicator of whether a vessel is still patent without any further interventions (blood flowing well), late lumen loss, which is the difference in millimeters between the angioplastied segment and how narrow it is on follow-up, target lesion revascularization, which is an indicator of whether a person received more than one treatment to the same artery during the period covered by the study, and binary restenosis, which occurs when a treated artery becomes narrowed again after being previously treated. Unfortunately, early anatomic (structural) advantages of DEBs were not accompanied by improvements in quality of life, functional walking ability, or in the occurrence of amputation or death. When we specifically examined arteries below the knee and people who had very advanced PAD, we found no clinical or angiographic advantage for DEBs at 12 months of follow-up compared with uncoated balloon angioplasty. In summary, DEBs have several anatomic advantages over uncoated balloons for the treatment of lower limb PAD for up to 12 months after undergoing the procedure. However, more data are needed to assess the long-term results of this treatment option adequately. All the trials had differences in the way in which they inserted the balloons, and in the type and duration of additional antiplatelet (anticlotting) therapy, leading to downgrading of the quality of the evidence. The quality of the evidence presented was moderate for target lesion revascularization and change in Rutherford category (a way of classifying PAD), and high for amputation, primary vessel patency, binary restenosis, death, and change in ankle-brachial index (which is used to predict the severity of PAD)." ]

[ "These conclusions are based on 24 randomised controlled trials with 6915 participants who were treated as outpatients in all but one trial that involved adolescent inpatients. The majority of participants were men, median age 42 years. Most studies were conducted in Europe; two studies were conducted in the United States and one study in each of South Korea,Australia and Brazil. The effects of acamprosate did not differ in industry-sponsored and non-profit funded trials. Three trials compared acamprosate and naltrexone and did not indicate a superiority of one or the other drug on return to any drinking, return to heavy drinking and cumulative abstinence duration." ]

[ "We included 67 studies including randomised controlled trials and observational studies with a mixed risk of bias. A total number of participants is not included as the total would be made up of a varied set of observations: participant people and observations on participants and countries (the object of some studies). Any total figure would therefore be misleading. Respiratory virus spread can be reduced by hygienic measures (such as handwashing), especially around younger children. Frequent handwashing can also reduce transmission from children to other household members. Implementing barriers to transmission, such as isolation, and hygienic measures (wearing masks, gloves and gowns) can be effective in containing respiratory virus epidemics or in hospital wards. We found no evidence that the more expensive, irritating and uncomfortable N95 respirators were superior to simple surgical masks. It is unclear if adding virucidals or antiseptics to normal handwashing with soap is more effective. There is insufficient evidence to support screening at entry ports and social distancing (spatial separation of at least one metre between those infected and those non-infected) as a method to reduce spread during epidemics." ]

[ "We included 23 studies that compared the effectiveness of combined treatment with beta-agonists and anticholinergics versus treatment with beta-agonists alone. A total of 2724 adult participants were enrolled in the studies. Salbutamol (also called albuterol) was the most common beta-agonist investigated and ipratropium bromide was the most common anticholinergic assessed. We found that most studies did not report sources of funding (14 studies); one study was supported by a hospital; another received support from a pharmaceutical company, but indicated that there was no involvement from the company in conducting or reporting research. Two studies were part-funded and four were funded by pharmaceutical companies. Patients with severe asthma who received combined treatment of beta-agonists and anticholinergics were less likely to be admitted to hospital. An estimated 65 fewer patients per 1000 would require hospital admission after receiving combined inhaled therapy in the emergency department. Among patients with mild -to-moderate asthma, combined inhaled therapy was less effective in preventing admission to hospital compared with people with severe asthma. Patients receiving combined treatment were less likely to return to the emergency department with worsening asthma symptoms and had better outcomes in most lung function tests. On the other hand, 103 more participants per 1000 who receive combined inhaled therapy would experience side effects compared to people who receive beta-agonists alone. Quality of the evidence that combination inhaled therapy can improve health outcomes compared to treatment with beta-agonists alone ranged from very low to moderate. Our confidence about the effects of combination inhaled therapy on hospital admissions, peak expiratory flow, percent change in peak expiratory flow from baseline, and relapse was moderate because of the overall risk of bias among included studies. Factors associated with inconsistency and imprecision were additional aspects that reduced the quality of the evidence for forced expiratory volume in one second, and percent predicted peak expiratory flow." ]

[ "This review includes 53 randomized trials with a total of 8548 participants. Oral 5-ASA was found to be more effective than placebo (fake drug). Although oral 5-ASA drugs are effective for treating active ulcerative colitis, they are no more effective than SASP therapy. Patients taking 5-ASA are less likely to experience side effects than patients taking SASP. Side effects associated with 5-ASA are generally mild in nature, and common side effects include gastrointestinal symptoms (e.g. flatulence, abdominal pain, nausea, and diarrhea), headache and worsening ulcerative colitis. Male infertility is associated with SASP and not with 5-ASA, so 5-ASA may be preferred for patients concerned about fertility. 5-ASA compounds are more expensive than SASP, so SASP may be the preferred option where cost is an important factor. 5-ASA dosed once daily appears to be as effective and safe as conventionally dosed (two or three times daily) 5-ASA. There do not appear to be any differences in effectiveness or safety among the various 5-ASA formulations. A daily dosage of 2.4 g appears to be a safe and effective therapy for patients with mild to moderately active ulcerative colitis. Patients with moderate disease may benefit from an initial dose of 4.8 g/day." ]

[ "We examined research published up to 14 February 2017. We looked for studies of boys and girls from age one to 18 years who sometime before had problems with kidney stones and who were assigned to a different diet or a medicine (or both) to stop the stones from coming back for at least 12 months. We were most interested in whether the stones returned, how many side effects there were and if children had to have more treatments for kidney stones. We only found one small study with 125 children (72 boys and 53 girls) who had been treated with waves similar to those that carry sound, so-called shock waves to treat their kidney stones. These children formed kidney stones for unknown reasons and had otherwise normal kidneys. Fifty-two children had no more stones and 44 children still had small stone pieces left when they started the study. One group was given a medicine by mouth called potassium citrate; the other group was given no special medicine. The children were on this study for about two years. The study reported on the findings in 96 children; 48 in each group. Based on this study, we found that this medicine may result in stones coming back less often. However, we are not sure about this finding because the study was not of good quality and small. One in eight patients stopped the medicine because of side effects. We did not find any information on how often children had to be treated for stones again. The evidence quality for stones coming back less often was low and that for side effects very low. We found no evidence on how often children had to be treated for stones again." ]

[ "We found four studies that included a total of 690 adults who had been in the ICU. Patients were randomized to receive exercises and assistance to move early in their stay in the ICU or to usual care. All participants had been on a breathing machine at some point during their time in the ICU. Three studies included adults with critical illness involving severe disease of the lungs or severe body response to infection and one study involved adults who had undergone cardiac surgery. One study was funded by the Intensive Care Foundation, Royal Brisbane and Women's Hospital, Australia and the investigator was supported by a Postgraduate Award from Singapore. We were unable to determine whether early movement or exercise of critically ill people in the ICU improves their ability to do daily activities, muscle strength, or quality of life. There were mixed results on the effect of early movement or exercise on physical function. One study found that on some measures of physical function, participants who received the intervention could get out of bed earlier and walk greater distances. However, the same study found no differences in the number of daily activities they could do when leaving ICU. Early movement or exercise appears safe as the number of adverse events was very low. There was no difference between groups in time spent in hospital, muscle strength or death rates. Overall there was low-quality evidence from these studies. The main reasons were that only a small number of studies have examined this intervention. Most studies included only a small number of participants, and participants and study staff were aware of group assignment. In addition, in two studies, staff assessing outcomes were aware of group assignment. There were also differences in participant diagnoses, interventions and the way that outcomes were measured. The four studies awaiting classification, and the three ongoing studies may alter the conclusions of the review once these results are available. Evidence in this review is current to August 2017." ]

[ "This review included nine randomised controlled trials involving 1118 women and assessed six of these studies (involving 394 women) comparing umbilical vein injection of normal saline with or without oxytocin. Other comparisons did not provide the required information. With umbilical vein injection of saline solution plus oxytocin versus umbilical vein injection of saline solution there was no evidence of a difference in the amount of blood lost, duration of the third stage of labour or need for manual removal of a retained placenta. routine use of umbilical injection after childbirth to deliver any infusion, though the combined results of the small number of relevant studies showed no evidence of effect and further research is needed to make a conclusion. There is a need for training in the technique and a possible higher cost of materials." ]

[ "This review assesses data from randomised trials of the three classes of drugs commonly used as add-on (adjuvant) treatment to levodopa therapy in people with PD who have motor complications. Forty-four randomised trials, involving 8436 participants were identified as suitable for this review. The review confirms reports from individual trials that, compared to placebo, add-on therapy (on a background of levodopa) significantly reduces patient off-time, reduces the required levodopa dose and improves overall disability scores (measured on the Unified Parkinson's Disease Rating Scale - UPDRS). However, dyskinesia and other side-effects such as constipation, hallucinations and vomiting are increased with adjuvant therapy. Indirect comparisons of the three drug classes (dopamine agonists, COMTIs and MAOBIs) suggest that dopamine agonists may provide more effective symptomatic control than COMTI and MAOBI therapy. COMTI and MAOBI have comparable efficacy. There was no significant evidence of differences in efficacy between individual drugs within the drug classes, other than tolcapone appearing more effective than entacapone. However these observations are based on indirect comparisons between trials, so could be due to other factors, e.g. differences in the types of people included in the trials, and so should to be interpreted with caution. This review highlights the need for large randomised studies that directly compare the different drug classes with patient-rated overall quality of life and health economic measures as the primary outcomes." ]

[ "Glutamine is a non-essential amino acid which is abundant in the healthy human body. There are studies reporting that muscle and plasma glutamine levels are reduced in patients with critical illness, or following major surgery, suggesting that the body's demand for glutamine is increased in these situations. In the past decade, several clinical trials have examined the effects of glutamine supplementation in patients with critical illness or receiving surgery, and a systematic review of this clinical evidence suggested that giving glutamine to these patients may reduce infection and mortality rates. However, two recent large-scale clinical trials, published in 2011 and 2013, did not find any beneficial effects of glutamine supplementation in patients with critical illness. In this review, we searched the available literature until May 2013 and included studies which compared the outcomes with glutamine supplementation and without in adults with a critical illness or undergoing elective major surgery. We included 57 articles from 53 randomized controlled studies in this review. These 53 studies enrolled a total of 4671 patients with critical illness or undergoing elective major surgery. The risk of mortality, length of intensive care unit stay and the incidence of side effects were not significantly different between those given glutamine and those who were not. However, our findings showed that the risk of infectious complications in patients who were given glutamine was 79% of the risk for those who were not. In other words, 12 patients need to be supplemented with glutamine to prevent one case of infection. This result needs to be interpreted cautiously as the quality of evidence for infectious complications was moderate. The funnel plot for this outcome suggested that smaller studies with outcomes favouring non-supplemented patients have not been published, and further research is likely to have an impact on the estimate of effect for this outcome. The findings from this review also suggested that the average length of hospital stay in critically ill or surgical patients supplemented with glutamine was 3.46 days shorter than for patients without glutamine supplementation. This result should also be treated with care as there was substantial heterogeneity between these studies. We found in this review that the mean number of days on mechanical ventilation was 0.69 days shorter in patients with glutamine supplementation than for patients without glutamine supplementation." ]

[ "This review found 15 randomised studies that compared HFNC with other non-invasive ways of supporting babies' breathing. The studies differed in the interventions that were compared, the gas flows used and the reasons for respiratory support. When HFNC was used as first-line respiratory support after birth compared to CPAP (4 studies, 439 infants), there were no differences in the rates of death or chronic lung disease (CLD). HFNC use resulted in longer duration of respiratory support, but there were no differences in other outcomes. One study (75 infants) showed no differences between HFNC and NIPPV as breathing support after birth. When HFNC were used after a period of mechanical ventilation (total 6 studies, 934 infants), there were no differences between HFNC and CPAP in the rates of death or CLD. There was no difference in the rate of treatment failure or reintubation. Infants randomised to HFNC had less trauma to the infant's nose. There was a small reduction in the rate of pneumothorax in infants treated with HFNC. We found no difference between the effect of HFNC compared with CPAP in preterm infants in different gestational age subgroups, though there were only small numbers of extremely preterm and late preterm infants. One trial (28 infants) found similar rates of reintubation for humidified and non-humidified HFNC, and two other trials (100 infants) found no difference between different models of equipment used to deliver humidified HFNC. For infants weaning from non-invasive respiratory support (CPAP), two studies (149 infants) found that preterm infants randomised to HFNC had a reduced duration of hospitalisation compared with infants who remained on CPAP. HFNC use has similar rates of efficacy to other forms of non-invasive respiratory support in preterm infants for preventing treatment failure, death and CLD. Most evidence is available for the use of HFNC as post-extubation support. Following extubation, use of HFNC is associated with less nasal trauma, and may be associated with reduced pneumothorax compared with nasal CPAP. Further adequately powered randomised controlled trials should be undertaken in preterm infants comparing HFNC with other forms of primary non-invasive support after birth and for weaning from non-invasive support. Further evidence is also required for evaluating the safety and efficacy of HFNC in extremely preterm and mildly preterm subgroups, and for comparing different HFNC devices." ]

[ "Evidence from poor quality, small trials, suggests that superficial and partial thickness burns heal more quickly with silicon-coated nylon, silver containing dressings and biosynthetic dressings than with silver sulphadiazine cream. Burns treated with hydrogel dressings healed more quickly than those treated with usual care." ]

[ "Exercise is moderately more effective than no therapy for reducing symptoms of depression. Exercise is no more effective than antidepressants for reducing symptoms of depression, although this conclusion is based on a small number of studies. Exercise is no more effective than psychological therapies for reducing symptoms of depression, although this conclusion is based on small number of studies. The reviewers also note that when only high-quality studies were included, the difference between exercise and no therapy is less conclusive. Attendance rates for exercise treatments ranged from 50% to 100%. The evidence about whether exercise for depression improves quality of life is inconclusive. The reviewers recommend that future research should look in more detail at what types of exercise could most benefit people with depression, and the number and duration of sessions which are of most benefit. Further larger trials are needed to find out whether exercise is as effective as antidepressants or psychological treatments." ]

[ "We included nine studies in this review which involved 134 participants with TBI. Only five studies, including 105 people provided usable results. These studies tested the effects of a range of treatments, including medicines (baclofen or botulinum toxin A), casting, physiotherapy, splints, a table that moves people from the lying position to standing and electrical stimulation (where electrical impulses are delivered to the muscles). Studies inadequately reporting results had tested the effect of medicines (baclofen or tizanidine). Of the five studies with results, three were funded by governments, charities or health services and two were funded by a drug manufacturer and medical technology company. The other four studies without useable results were funded by drug manufacturer or medical technology companies. This evidence is current to June 2017. Interpreting the results of the studies was difficult because of a lack of information and concerns about the quality of the evidence. For spasticity, some studies concluded that the treatment they tested made an improvement, and others found no difference between treatments. The most common side effect was minor skin damage in people who received casting. We believe it would be misleading to provide any further description of study results given the quality of the evidence was very low for all measurements. The quality of this evidence was very low; we only had five studies with results and none of the studies were large or comparable with one another. We also had concerns about how they were conducted or analysed. Because of this, we cannot draw any firm conclusions about the benefits and harms of different treatments for spasticity in people with TBI." ]

[ "Five poor quality trials were included in this review. These involved a total of 260 participants who were randomly assigned to having their humerus fractures fixed with either a plate or a nail. Both nailing and plating had similar fracture union rates. Compared with plating, nailing was associated with an increased risk of shoulder impingement involving shoulder pain and restrictions in shoulder range of movement. Usually because of impingement, nails had to be removed more frequently than plates. The limited available evidence did not show important differences between the two surgical methods in the other outcomes reported by one or more trials. These outcomes included nerve injury, infection, healing time, operating time, blood loss and return to pre-injury occupation." ]

[ "We reviewed the evidence about the effect of bronchodilators in infants with bronchiolitis. We found 30 trials that included a total of 1922 infants, in several countries. The evidence is current up to January 2014. We analyzed studies done in outpatient and inpatient settings separately. All bronchodilators were included in the review except for epinephrine because it is reviewed in another Cochrane review. Albuterol (otherwise known as salbutamol) is commonly used in studies, so we also reviewed this bronchodilator as a subgroup. We found no effect of bronchodilators on oxygen saturation. Infants hospitalized for bronchiolitis showed no significant benefit of bronchodilator treatment. This review also found that bronchodilators do not reduce the need for hospitalization, do not shorten the length of stay in hospital and do not shorten the length of the illness at home. Reviewing the subgroup of studies using albuterol (salbutamol), we found no effect of this bronchodilator on oxygen saturation or clinical scores. Side effects of bronchodilators include rapid heart beat, decrease in oxygen and shakiness. Given these side effects, little evidence that they are effective and the expense associated with these treatments, bronchodilators are not helpful in the management of bronchiolitis. This review is limited by the small number of studies that use the same measures and methods. For example, only 22 studies included only infants wheezing for the first time. Older studies included children who had wheezed before and may have had asthma. Thus these older studies favor the use of bronchodilators. Newer studies that excluded infants with prior wheezing and had a better study design do not show a benefit of bronchodilators. This review is also limited by the small number of infants included in each study. Lastly, clinical scores used to measure the effect of the bronchodilators in some studies may vary from one observer to the next, making this measure unreliable. Studies that include more infants, use better measures and have a stronger study design are needed to define the effectiveness of these medications." ]

[ "Review authors, working with the Cochrane Oral Health Group, carried out a thorough search up to 15 December 2015 for studies that randomly allocated participants to different treatments for BRONJ (or to a 'placebo' condition that has no active treatment). This type of study design is known as a 'randomised controlled trial'. We only found one relevant completed study and two ongoing studies. The completed study compared people with BRONJ being treated with surgery, antibiotics and mouth rinses to people receiving the same 'standard care' with an add-on treatment called hyperbaric oxygen therapy, which is thought to increase bone renewal. There were 49 participants, most of whom had cancer. The study found that the participants in intervention group were more likely than the standard care group participants to have an improvement in their osteonecrosis at three months, but there was no clear difference between the groups when they were evaluated at six, 12 and 18 months and last contact. There was no clear difference between the groups at any time point for complete healing. These results are not reliable as the quality of the evidence is very low. The study did not assess whether there were any side effects of the treatment. The study had several important flaws: for example, there was a very small number of participants, some participants changed groups during the study and there was a loss of participants during the study. There is insufficient evidence to conclude whether hyperbaric oxygen therapy is a useful add-on to standard care in the treatment of BRONJ. There are two ongoing trials of teriparatide, a hormonal treatment for BRONJ. We found no randomised controlled trials of any other treatments for BRONJ. As there is a lack of good quality scientific evidence to decide how best to treat BRONJ, high quality trials are needed." ]

[ "We included two studies, recruiting a total of 413 patients. One study looked at 201 children between six months and six years who had ventilation tubes inserted to treat glue ear or recurrent infections. Children were divided into two groups: one group was allowed to swim and bathe freely, the other group was instructed to wear ear plugs while swimming or bathing. Another study looked at 212 children between three months and 12 years who had ventilation tubes inserted (we do not know precisely what for). These children were divided into two groups: one group was allowed to swim and bathe freely, the other group was instructed not to swim and told to avoid putting their head under water when bathing. Children in both studies were followed for about one year to see how many ear infections they had and if there were any other problems. We do not have any reason to be concerned about who funded these studies. The main result we looked for was the effect that keeping ears dry had on ear infections, specifically ear discharge. One study showed that there was a small reduction in the likelihood of getting an ear infection in children who protected their ears from water with ear plugs when swimming or bathing. The effect of wearing ear plugs was to reduce the number of infections a child would have every year (on average) from 1.2 to 0.84. We think the results from this study are quite reliable. Another study showed that there was no difference in the likelihood of children getting ear infections whether they were told to avoid swimming and putting their head under water, or whether they took no precautions at all. We are uncertain whether the results from this study are reliable. Neither study showed any other important differences between the children who got their ears wet and those who kept them dry. There was no effect on how long the tubes stayed in place or on hearing (although these results were only measured in one study). No harm to any participant was reported in either study. The evidence is current to September 2015. We graded the quality of evidence for the use of ear plugs as low, which means that \"further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate\". We have graded the quality of evidence relating to water avoidance as very low (\"we are very uncertain about the estimate\"). The difference that wearing ear plugs makes appears to be very small and a child would have to wear them on average for almost three years to prevent one infection resulting in ear discharge. It may be that telling children to avoid swimming and putting their head under water makes no difference to whether or not they get ear infections, but this is very uncertain. Current expert guidelines for clinicians therefore recommend against routinely using water precautions because the limited clinical benefit is outweighed by the associated cost, inconvenience and anxiety. Future high-quality studies could be undertaken but may not be thought necessary. It is uncertain whether further trials in this area would change the findings of this review or have an impact on practice. Any future high-quality research should focus on determining whether particular groups of children benefit more from water precautions than others, as well as on developing clinical guidelines and their implementation." ]

[ "Women who want to preserve the length of their vagina after radiotherapy should consider dilation. There are limited data from observational studies that suggest regular stretching of the vagina, once radiotherapy treatment is completed, might reduce the risk of scaring by a small amount. There is no evidence to support dilation therapy during radiotherapy. There are also case reports and one case series suggesting that dilation months or years after radiotherapy might help restore vaginal length. Randomised trial design has not, and may never, obtain high-quality evidence to assess vaginal dilation therapy. The available studies suggest, but cannot prove, that dilation works. However, this only applies once the radiotherapy has finished. There is an association between vaginal dilation after radiotherapy and less vaginal stenosis, but this is not proof that the benefit is due to dilation. The link between dilation and less stenosis could either be due to a beneficial effect of dilation or because women with stenosis (or who self report stenosis) are less able to use the dilator." ]

[ "We included eight studies (490 adult participants). Seven studies (437 participants) investigated topical antifungals (nasal sprays or irrigations) and one study (53 participants) investigated systemic antifungals (tablets). All studies compared antifungals to placebo or no treatment. Most studies were well conducted and there was a mix of patients with chronic rhinosinusitis both with, and without, nasal polyps. At the end of at least four weeks treatment, none of the studies found that patients using antifungals (topical or systemic) had a better quality of life or less severe symptoms than patients who used placebo or had no treatment. Not many participants in the studies reported having adverse effects. Topical antifungals may lead to more nasal irritation compared with placebo. It is uncertain if patients taking topical antifungals have more headaches or nosebleeds than with placebo. For systemic antifungals, it is uncertain if patients using antifungals have more problems with their liver (hepatic toxicity) than with placebo. Systemic antifungals may lead to fewer patients with gastrointestinal disturbances compared to placebo. We found no studies that compared antifungal treatment with other treatments for chronic rhinosinusitis. We assessed the quality of the evidence as either low (further research is very likely to have an important impact on our confidence in the result) or very low (any estimate of the result is very uncertain), as some of the results are only from one or two studies, which do not have a lot of participants. Moreover, the different studies reported outcomes using different measurement scales making it difficult to draw conclusions. Due to the very low quality of the evidence, it is uncertain whether or not the use of topical or systemic antifungals has an impact on patient outcomes in adults with chronic rhinosinusitis compared with placebo or no treatment. More trials are needed to assess well-defined patient populations (such as the AFRS subgroup) and to evaluate other antifungals that have not been assessed in randomised controlled trials." ]

[ "We included randomized trials that recruited adults with ischemic stroke, at any time after onset. We included any kind of stem cell or method of administration. We identified seven randomized trials, involving 401 participants. Overall, stem cell transplantation was associated with a reduced neurological impairment, but not with a better functional outcome. No safety concerns were raised. The certainty of the evidence ranged from low to very low because of the risk of bias in the included studies, the lack of precision of the results, and different designs. More well-designed randomized controlled trials are needed." ]

[ "We found a total of 27 Cochrane ART reviews of high quality that could be included for this overview. These reviews aimed to report on OHSS in cycles of IVF or ICSI. We did not include reviews of intrauterine insemination and ovulation induction. The evidence is current to 12 December 2016. Of the 27 reviews included in this overview, 10 reviews had not been updated in the past three years. Seven reviews described interventions that provided a beneficial effect in reducing OHSS rates, and we categorised one additional review as 'promising'. Of the effective interventions, all except one had no detrimental effect on pregnancy outcomes. Evidence of at least moderate quality evidence indicates that clinicians should consider the following interventions in ART cycles to reduce OHSS rates. • Metformin treatment before and during an ART cycle in women with PCOS (moderate-quality evidence). • Gonadotrophin-releasing hormone (GnRH) antagonist protocol in ART cycles (moderate-quality evidence). • GnRH agonist (GnRHa) trigger in donor oocyte or 'freeze-all' programmes (moderate-quality evidence). Evidence of low or very low quality evidence suggests that clinicians should consider the following interventions in ART cycles to reduce OHSS rates. • Clomiphene citrate for controlled ovarian stimulation in ART cycles (low-quality evidence). • Cabergoline around the time of human chorionic gonadotrophin (hCG) administration or oocyte pickup in ART cycles (low-quality evidence). • Intravenous fluids (blood plasma expanders) around the time of hCG administration or egg pickup in ART cycles (very low-quality evidence). • Progesterone for luteal phase support in ART cycles (low-quality evidence). A promising intervention that needs to be researched further is coasting (withholding gonadotrophins) for reduction of OHSS. On the basis of this overview, we must conclude that evidence is currently insufficient to support the widespread practice of freezing all embryos and replacing them at a later time when OHSS has dissolved. Clinicians can use the evidence summarised in this overview to choose the best treatment regimen for individual patients - a regimen that not only reduces the chance of developing OHSS but does not compromise pregnancy outcomes. However, results of this overview are limited by the lack of recent primary studies or updated reviews. Furthermore, this overview can be used by policymakers in developing local and regional protocols or guidelines and can reveal knowledge gaps for future research." ]

[ "Evidence from this review of 630 people in two trials suggests that, in patients with polycythaemia vera and with no clear indication or contraindication to aspirin therapy, low-dose aspirin may reduce the risk of thrombotic and all-cause mortality. No data were provided on mortality from bleeding episodes. No studies in participants with essential thrombocythaemia and with antiplatelet therapy other than aspirin have been published." ]

[ "We searched for evidence that OWSC could be used to identify which patients with inoperable MBO would recover with conservative management. We also wanted to know if OWSC increased the likelihood of recovery from MBO, reduced hospital stay or improved prognosis. Finally, we wished to know what side effects OWSC might cause for patients with MBO. We conducted the search in June 2017 and found one study. It only recruited nine participants and did not fully report on the outcomes of using OWSC in MBO. We found insufficient evidence that OWSC can identify which patients with MBO will recover with conservative management. We found insufficient evidence that patients with MBO benefit from OWSC in terms of length of hospital stay, recovery time or survival. No conclusions could be made about side effects from OWSC. 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. We rated the quality of the evidence as very low due to the lack of studies reporting on the benefits of using OWSC in MBO and the only study we found reporting on side effects recruited very few participants (nine). The low quality of the evidence means that we are very uncertain about the use of OWSC in the management of MBO and cannot confirm its benefits or harms in patients with this condition." ]

[ ". We searched for trials in July 2015 and April 2017, using the Cochrane Schizophrenia Group's register of trials. The review includes 14 studies investigating the use of cholinergic drugs compared with placebo. All studies randomised small numbers of participants (five to 60 people) with schizophrenia or other chronic mental illnesses who had also developed antipsychotic-induced tardive dyskinesia. . We found the effects of both older and newer cholinergic drugs to be unclear as too few and too small studies are available and do not yield great evidence and leave many questions unanswered. . The available evidence is weak, limited, and small scale. It is not possible to recommend these drugs as a treatment for tardive dyskinesia based on our findings. To fully investigate whether the use of cholinergic drugs have any positive effects for people with tardive dyskinesia, there would have to be well-designed, larger, longer-term studies, particularly on new cholinergic drugs currently being used for treating Alzheimer’s disease. Ben Gray, Senior Peer Researcher, McPin Foundation. http://mcpin.org/" ]

[ "The aim of this review was to assess the effectiveness of using the telephone to deliver interventions to improve the health of PLHIV compared to standard care. A comprehensive search of various scientific databases and other resources found 11 relevant studies. All of the studies were performed in the United States, and so the results may not apply to other countries, particularly developing countries. Some studies were aimed at any HIV positive person in the area in which the study was carried out, and others focused on specific groups of people, such as young substance using PLHIV, or older PLHIV. There were a lot of differences in the types of telephone interventions used in each study. There was some evidence that telephone interventions can improve medication adherence, reduce risky sexual behaviour, and reduce symptoms of depression in PLHIV. However, there were also a number of studies that suggested that telephone interventions were no more effective than usual care alone. We need more studies conducted in different settings to assess the effectiveness of telephone interventions for improving the health of PLHIV." ]

[ "We conducted a comprehensive search of medical literature up to 5 July 2013 to find randomized controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) and quasi-randomized controlled trials (e.g. allocation by hospital record number or date of birth) comparing computer-assisted surgery (CAS) of the ACL or PCL with conventional operating techniques not involving CAS in adults. We found five studies for inclusion in this review. These studies involved 366 participants, mainly female (70%), aged 14 to 53 years. All five trials involved ACL reconstruction. We were uncertain about the reliability of study findings due to poor reporting of trial methods and, sometimes, results. Our assessment of the quality of the evidence available for individual outcomes ranged from 'moderate' quality (which means further research may change the estimate) to 'very low' quality (which means we are very uncertain about the estimate). The trials provided some moderate quality evidence that there was no difference between computer-assisted surgery and conventional surgery for patient-reported knee function. There was low quality evidence of no difference between the two groups in self-reported function score and very low quality evidence of no difference in a score measuring activity levels. There was low quality evidence of no difference between the two treatment groups in the number of people assessed by clinicians as having a normal or nearly normal knee function at the final follow-up time. No adverse post-surgical events were reported in two trials; this outcome was not reported by the other three trials. CAS took longer to do than conventional surgery (from 9 to 27 minutes longer). Overall, the currently available evidence does not indicate that CAS in knee ligament reconstruction improves outcome compared with conventional surgery." ]

[ "We included two randomized controlled trials with a total of 2560 participants set in Australia and Tanzania. One trial compared a combined strategy of face washing plus tetracycline (an antibiotic) ointment with tetracycline ointment alone for up to one year. The second trial compared four intervention groups for three months in children who already had follicular trachoma: a combined strategy of face washing plus tetracycline eye drops, face washing alone, tetracycline eye drops alone, and no treatment. The evidence is current to January 2015. Both trials reported the number of children with active trachoma as an outcome measure; one trial also reported the number of children with severe trachoma and the percentage of clean faces after one year. One trial reported that face washing was effective in increasing facial cleanliness and in reducing severe trachoma at one year; the second trial did not show that eye washing alone or in combination with tetracycline eye drops reduced follicular trachoma amongst children who had follicular trachoma at time of enrollment. The two included trials were of uncertain risk of bias due to not reporting many aspects of the trial designs." ]

[ "We identified 49 randomised controlled trials (over 140,000 school children) of interventions aiming to prevent children who had never smoked from becoming smokers. At longer than one year, there was a significant effect of the interventions in preventing young people from starting smoking. Programmes that used a social competence approach and those that combined a social competence with a social influence approach were found to be more effective than other programmes. However, at one year or less there was no overall effect, except for programmes which taught young people to be socially competent and to resist social influences. A smaller group of trials reported on the smoking status of all people in the class, whether or not they smoked at the start of the study. In these trials with follow-up of one year or less there was an overall small but significant effect favouring the controls. This continued after a year; for trials with follow-up longer than one year, those in the intervention groups smoked more than those in the control groups. When trials at low risk of bias from randomisation, or from losing participants, were examined separately, the conclusions remained the same. Programmes led by adults may be more effective than those led by young people. There is no evidence that delivering extra sessions makes the intervention more effective." ]

[ "Randomised controlled studies compare treatments to find out if they are truly effective. We searched for randomised studies comparing non-invasive ventilation to routine care for adults with acute cardiogenic pulmonary oedema. We compared studies treating people with non-invasive ventilation versus medical care. Medical care includes therapies such as providing extra oxygen and water pills to patients. The evidence upon which this review is based is current to September 2018. We sought to address if non-invasive ventilation in adults with acute cardiogenic pulmonary oedema reduces rates of deaths, the need for a breathing tube, and heart attacks. We found 24 studies with 2664 participants comparing non-invasive ventilation to medical care alone. Non-invasive ventilation may decrease the chances of dying in hospital. The quality of results for studies reporting death in hospital was low. Studies were poorly conducted, and results were not similar across studies. In addition, non-invasive ventilation probably reduces the chances of needing a breathing tube. The quality of results for studies reporting breathing tube rates was moderate. Studies evaluating breathing tube rates were poorly conducted. Non-invasive ventilation probably has little or no effect on getting a heart attack. The quality of results for studies reporting heart attack rates was moderate, and studies had inconsistent results for this outcome. We are unsure if the length of hospital stay is improved with non-invasive ventilation. The quality of results for studies reporting hospital length of stay was very low, which was due to poor study conduct and inconsistent results. Finally, non-invasive ventilation may make little or no difference to adverse events (complications), compared to medical care. The quality of results for studies reporting adverse events was low. Studies evaluating adverse events were poorly conducted and had inconsistent results." ]

[ "We looked for studies which compared steroid injections in the ear with placebo in patients with Ménière's disease or syndrome. Only one study satisfied the prespecified inclusion criteria for this review. This study demonstrated a benefit of this treatment for patients with Ménière's disease; at 24 months the patients in the treatment group had far fewer episodes of vertigo. The results of this review are encouraging, however as it is based solely on the results of a single study, further research is required." ]

[ "The review of trials found that there was conflicting evidence about the benefit of therapists teaching men to contract their pelvic floor muscles for either prevention or treatment of urine leakage after radical prostate surgery for cancer. However, information from one large trial suggested that men do not benefit from seeing a therapist to receive pelvic floor muscle training after transurethral resection (TURP) for benign prostatic enlargement. Overall, there was insufficient evidence to demonstrate a beneficial effect from pelvic floor muscle training. Of three external compression devices tested, one penile clamp seemed to be better than the others. This one penile clamp needed to be used cautiously because of safety risks. In future updates it may be worth considering two separate reviews, looking separately at 'treatment' and 'prevention' trials. More research that is of better quality is also needed to assess conservative management." ]

[ "The review findings indicate that listening to music during planned caesarean section under regional anaesthesia may improve pulse rates and birth satisfaction scores, although the effect sizes were not large enough to indicate a clinically beneficial effect. The review authors identified one controlled trial that randomly assigned 76 women who listened to their preferred music through earphones, or to standard care, but data were available for only 64 women. The music was provided from the beginning of anaesthesia to the end of surgery. The women's heart rates were reduced by some seven beats/minute when measured at the end of contact with the newborn during the intra-operative period and after the surgeon had completed skin suture. Birth satisfaction scores were increased by a mean of 3.4 points on a 35-point scale when women listened to music. Respiration rates were no different for the two groups and neither were levels of anxiety, which decreased at the end of contact with the newborn and again after closing the skin, with no clear difference with or without music. The trial was from Taiwan and reporting of trial methodology was poor." ]

[ "Two randomised controlled trials were included in this review involving a total of 271 women with twin pregnancies at 37 weeks' gestation. One of the two trials (involving 235 women) was of high quality, and the quality of the second trial (involving 36 women) was unclear. There were no differences shown between the group of women who had an elective birth at 37 weeks' gestation and the group of women who waited for labour to start spontaneously for the outcomes: birth by caesarean section, perinatal (fetal or neonatal) death or serious perinatal morbidity, or maternal death or serious maternal morbidity. No other differences between the two groups of women were shown for other pregnancy and birth complications or for complications for the infant. Elective birth at 37 weeks' gestation compared with ongoing expectant management for women with uncomplicated twin pregnancies does not appear be associated with an increased risk of harms." ]

[ "We found one small trial undertaken in 28 children aged 1 to 16 years with confirmed peanut allergy. The study did not include children who had moderate to severe asthma or who had had severe anaphylaxis (a severe allergic reaction that may result in death) because of their peanut allergy. The authors randomised children to intervention or placebo in a 2:1 ratio. Intervention arm children received peanut flour whereas control arm participants received oat flour. The 48-week trial showed that treatment with peanut OIT enabled children receiving OIT to substantially increase the amount of peanut flour they ate in comparison with those in the placebo arm without having an allergic reaction.  However, almost half of the children (nine out of 19) receiving OIT had an allergic reaction due to the OIT which required antihistamines, and two had more serious reactions to the treatment which required adrenaline (epinephrine). Although promising, based on the findings of this one small trial, we cannot recommend that peanut OIT be used routinely for people with peanut allergy. There is a need for further larger studies investigating safer OIT regimens and establishing the long-term effectiveness of OIT after treatment is stopped." ]

[ "The review of trials found that a few days of using acetazolamide can improve the level of oxygen in the blood of people with COPD. It is not clear if this leads to better outcomes, so more research is needed. Not enough data were reported on the safety of the drug." ]

[ "The review of trials found that a letter of invitation, mailed educational material, a phone call and some combined actions (such as a letter of invitation plus a phone call and training activities plus reminders) all seem to increase numbers of women participating. However it is not known which of these work better. Other interventions (such as a home visit) have not been proven to work." ]

[ "We examined research up to 17 February 2015. We included research studies that had women over 16 years of age attending any healthcare setting. Our search generated 12,369 studies and we eventually included 13 studies that met the criteria described above. In all, 14,959 women had agreed to be in those studies. Studies were in different healthcare settings (antenatal clinics, women's health/maternity services, emergency departments, and primary care centres). They were conducted in mainly urban settings, in high-income countries with domestic violence legislation and developed support services to which healthcare professionals could refer. Each of the included studies was funded by an external source. The majority of the funding came from government departments and research councils, with a small number of grants/support coming from trusts and universities. Eight studies with 10,074 women looked at whether healthcare professionals asked about abuse, discussed it, and/or documented abuse in participating women's records. There was a twofold increase in the number of women identified in this way compared to the comparison group. The quality of this evidence was moderate. We looked at smaller groups within the overall group, and found, for example, that pregnant women were four times as likely to be identified by a screening intervention as pregnant women in a comparison group. We did not see an increase in referral behaviours of healthcare professionals but only two studies measured referrals in the same way and there were some shortcomings to these studies. We could not tell if screening increased uptake of specialist services and no studies examined if it is cost-effective to screen. We also looked to see if different methods were better at picking up abuse, for example, you might expect that women would be more willing to disclose to a computer, but we did not find one method to be better than another. We found an absence overall of studies examining the recurrence of violence (only two studies looked at this, and saw no effect) and women's health (only one study looked at this, and found no difference 18 months later). Finally, many studies included some short-term assessment of adverse outcomes, but reported none. There is a mismatch between the increased numbers of women picked up through screening by healthcare professionals and the high numbers of women attending healthcare settings actually affected by domestic violence. We would need more evidence to show screening actually increases referring and women's engagement with support services, and/or reduces violence and positively impacts on their health and wellbeing. On this basis, we concluded that there is insufficient evidence to recommend asking all women about abuse in healthcare settings. It may be more effective at this time to train healthcare professionals to ask women who show signs of abuse or those in high-risk groups, and provide them with a supportive response and information, and plan with them for their safety." ]

[ "The purpose of this systematic review was to examine the effectiveness and safety of curcumin therapy for the maintenance of remission in patients with ulcerative colitis (UC), a chronic inflammatory condition of the colon. Currently available agents for the management of this condition have been reported to result side effects, particularly when used for prolonged periods. This review includes one randomized trial with a total of 89 participants. All patients received treatment with sulfasalazine or mesalamine (drugs containing 5-aminosalicylic acid). Fewer patients in the curcumin group relapsed at six months compared to patients who received placebo (e.g. fake drug). However, this result was not statistically significant. Patients in the curcumin group had significantly lower disease activity index and endoscopic index scores at six months than patients in the placebo group. No serious side effects were reported. A total of nine mild side effects were reported in seven patients. These side effects included a sensation of abdominal bulging, nausea, a brief increase in blood pressure, and a brief increase in the number of stools. The results of this systematic review suggest that curcumin may be a safe and effective therapy for maintenance of remission in ulcerative colitis when given as additional therapy with mesalamine or sulfasalazine. Further research is needed to confirm any possible benefit of curcumin for maintenance therapy in ulcerative colitis." ]

[ "We included seven trials with 1497 women who had HER2-positive metastatic breast cancer in this review. They were assigned by chance to receive trastuzumab with or without chemotherapy (taxane, anthracycline or capecitabine in four studies), hormonal therapy (aromatase inhibitors including letrozole or anastrozole in two studies) or targeted therapy (lapatinib in one study). Women treated with trastuzumab were followed up until disease progression in five studies and beyond disease progression in two studies. The length of trastuzumab administration varied between 8.7 and 30 months, and follow-up averaged two years after starting trastuzumab. All studies found that trastuzumab extends time to disease progression, with gains varying between two and 11 months, and in five studies it extended time to death by between five and eight months. However, some patients develop severe heart toxicity (congestive heart failure) during treatment. While trastuzumab reduces breast cancer mortality by one-fifth, the risk of heart toxicity is between three and four times more likely. If 1000 women were given standard therapy alone (with no trastuzumab) about 300 would survive and 10 would have heart toxicities. With the addition of trastuzumab to this treatment, an additional 73 would have their lives prolonged, and an additional 25 would have severe heart toxicity. Omitting the anthracycline-trastuzumab arms (which would not be regarded as standard of care) 21 patients would have severe heart toxicity (11 more than the chemotherapy alone group). These heart toxicities are often reversible if the treatment is stopped once heart disease is discovered. Women with advanced disease might choose to accept this risk. On balance, this review shows that with trastuzumab the time to disease progression and survival benefits outweigh the risk of heart harm. Trastuzumab does not increase the risk of haematological toxicities, such as neutropenic fever and anaemia; however, it seems to raise the risk of neutropenia. There were insufficient data on the impact of trastuzumab on quality of life, treatment-related deaths and brain metastases to reach a conclusion for these outcomes. We rated the overall quality of the evidence as moderate, with the main weaknesses being the fact that all studies included were open-label (not blinded), which may have affected the outcome assessments for time to disease progression and toxicities, and that two studies have not published their results for mortality. Furthermore, the recruitment in three out of seven studies was stopped early and in three trials more than 50% of patients in the control groups were permitted to switch to the trastuzumab arms at disease progression, making it more difficult to understand the real net benefit of trastuzumab on mortality. The evidence to support the use of trastuzumab beyond disease progression is limited. It is important to highlight that, although trastuzumab is used for women with HER2-positive early breast cancer, the women enrolled in these metastatic trials were not previously treated with trastuzumab. The effectiveness of trastuzumab for women relapsing after adjuvant trastuzumab is still an open issue, although it is likely that it is offered to the majority of them." ]

[ "The researchers identified 14 studies that included a total of 1805 participants. Nine studies (779 participants) compared budesonide to conventional corticosteroids, three studies (535 participants) compared budesonide to a placebo (e.g. a sugar pill), and two studies (491 participants) compared budesonide to mesalamine (an anti-inflammatory drug composed of 5-aminosalicylic acid). Ten studies were judged to be of high quality. Four studies were judged to be of low quality. Budesonide was superior to placebo for induction of remission. An increase in side effects was not seen with budesonide compared to placebo. Withdrawals due to disease worsening were similar in budesonide and placebo groups. Budesonide patients were more likely than placebo patients to experience adrenal suppression a condition in which the adrenal glands do not produce adequate amounts of steroid hormones. Budesonide was significantly less effective than conventional steroids for induction of remission in people with Crohn's disease. However, fewer side effects occurred in those treated with budesonide compared to conventional steroids and budesonide was better than conventional steroids in preserving adrenal function. One study (n = 182) found budesonide to be superior to mesalamine for induction of remission in patients with Crohn's disease whereas another study found no difference in remission rates. The current evidence does not allow for a firm conclusion on the relative efficacy of budesonide compared to 5-aminosalicylic products. Budesonide is more effective than placebo for induction of remission in Crohn's disease. Although budesonide is less effective than conventional steroids for induction of remission the likelihood of side effects and adrenal suppression is lower than with conventional steroids." ]

[ "Our systematic review identified 15 randomised studies with 1550 patients comparing CRRT with IRRT. We did not find any difference between CRRT and IRRT with respect to mortality, renal recovery, and risk of haemodynamic instability or hypotension episodes." ]

[ "Although four randomised controlled trials met the inclusion criteria, one was excluded because of poor methodology. The three remaining trials compared testosterone treatment with placebo in a total of 109 middle-aged to elderly people, predominantly men. The participants had symptoms of lower limb atherosclerosis, predominantly intermittent claudication. The trials were published from 1967 to 1971 and all took place in Denmark. Testosterone did not provide any clear improvement in the symptoms reported by the participants, walking distance or other objective tests for peripheral arterial disease including leg muscle blood flow. The dose of testosterone in the trials varied between 300 mg taken by mouth every two weeks for three months to a lower (100 mg) oral dose taken more often and 200 mg given by intramuscular injection, first weekly then every two weeks for six months. Side effects were poorly reported except for subjective sexual functioning, which did seem to improve with testosterone treatment. No trials investigated oestrogens in women with lower limb atherosclerosis. Trials by the Women's Health Initiative (published in 2004) have shown that oestrogen and progestin does not confer any protection against peripheral arterial disease in healthy postmenopausal women or reduce the risk of coronary events in postmenopausal women with coronary heart disease." ]

[ "We included two randomized controlled studies (clinical trials where people are randomly put into one of two or more treatment groups) with 297 men comparing PUL to sham surgery (participants are made to believe they received treatment, while in reality they did not) or transurethral resection of prostate (TURP: removing the excess prostate growth using a camera and an electrically activated resecting loop inserted via the penis). The average age of the participants was 65.6 years. Compared to sham surgery up to three months, PUL may improve urinary symptoms and likely improves quality of life without additional unwanted side effects after surgery. In the short term, there were no additional surgeries because PUL did not work. PUL likely does not make erections or ejaculation worse. Compared to TURP up to 24 months, PUL may be less effective in relieving urinary symptoms, but result in similar quality of life. PUL may preserve ejaculation, but may have less unwanted effects on erections than TURP. However, we are either very uncertain or have no evidence about serious unwanted side effects or the need for additional treatment after surgery. Findings of this review are up-to-date until 31 January, 2019. The certainty of evidence for most outcomes was low. This means that the true effect may be substantially different from what this review shows." ]

[ "Only one small randomized trial of 54 men was included in this review. Based on the results of this trial, which used non-valid ways to measure symptom improvements, allopurinol cannot be recommended. Further studies of allopurinol treatment, enrolling larger numbers of men and using standard and validated measures to measure symptom improvements, are necessary to determine whether allopurinol is an effective treatment for chronic prostatitis." ]

[ "We performed a comprehensive literature search for randomized controlled trials and found one study that addressed our question. This study was a randomized trial of adults undergoing surgery to remove their bladder. They received either 12 mg alvimopan of up to 15 doses over seven days (143 patients) or placebo (137 patients). This study was conducted at centres that did many of these operations (at least 50 per year), had experienced surgeons and also used other measures such as asking patients to get out of bed soon after surgery to hasten bowel recovery. We found that patients who receive alvimopan short-term probably tolerate solid food faster, are discharged from the hospital more quickly and have fewer major adverse events. We did not find any differences with regards to these patients' need to be readmitted to hospital, their risk of heart problems or their need for narcotic pain medications. Patients taking alvimopan were less likely to have a tube placed back into their stomach. The quality of evidence was rated as at least moderate as per GRADE for all primary outcomes. This means that our estimates of how well alvimopan works is likely close to how well it really works although there is a possibility that it may be different." ]

[ "This review is up-to-date to May 2014. We included 26 trials involving 17,011 participants: 24 trials assessed lowering blood pressure, one trial tested raising blood pressure, and two trials assessed what to do with drugs taken before stroke. All studies took place in hospitals that were used to treating people with stroke. Not all trials contributed information to all outcomes, and we have used data that were available in publications. There is insufficient evidence to say that lowering blood pressure saves lives or reduces disability in people with acute stroke. Immediately restarting blood pressure-lowering drugs taken before the stroke may increase disability. More research is needed to identify those people who are most likely to benefit from altering blood pressure in acute stroke, the time window in which the treatment is likely to be of benefit, what types of stroke are likely to respond favourably, and the environment in which such treatment may be best given in routine practice." ]

[ "We identified two randomized controlled trials involving a total of 147 participants (current until January 2016). Due to differences in the techniques and outcomes measured, we were unable to combine the data from these studies. In one study, participants were randomized to receive either subintimal angioplasty (SIA) with stenting or remote endarterectomy (RE) (a surgical procedure to unblock the artery) with stenting. This study showed significantly better vessel patency (no obstruction) with RE compared to SIA. Three-year follow-up results showed clinical improvement measured by a Rutherford classification improvement in 64% of participants in the SIA group compared to 80% of participants in the RE group. Postexercise ankle brachial index improvements (0.2) were reported in 70% of SIA participants compared to 82% of RE participants. The technical success rate was 93% for SIA participants and 96% for RE participants. Primary patency was 56.8% in SIA compared to 76.5% in RE at 24 months, and 47.7% in SIA and 62.7% in RE at 36 months. Assisted primary patency was 52.3% in SIA compared to 70.6% in RE at 36 months. Secondary patency favored RE at 36 months. Limb salvage at three years' follow-up was 95% in the SIA group and 98% in the RE group. There were no deaths during or around the time of the procedure, but complications occurred in two SIA participants and three RE participants. The other study, which compared the SIA OUTBACK device with a manual re-entry technique, reported that technical success was achieved in all cases but did not report on clinical improvement. The primary 6-month patency rate was 100% in the OUTBACK group (26 of 26 participants) compared to 96.2% in the manual re-entry group (25 of 26 participants). The primary 12-month patency rate was 92.3% in the OUTBACK group (24 of 26 participants) compared to 84.6% in manual group (22 of 26 participants). Patency rates at 24 and 36 months were not reported. Limb salvage rates at 36 months were not reported. No complications were reported. Both studies were at an overall low risk of methodological bias, but the quality of the evidence is low due to small study size and the small number of studies. Moreover, the two included trials differed from each other in the techniques and control used, preventing the combining of trial results. Since we included only two small studies, we doubt the completeness and applicability of the evidence presented in this review. Further studies are needed to reach a definitive conclusion." ]

[ "In this review we have included results from 27 randomised trials with more than 12,000 women. All of the trials examined telephone support versus usual care (no additional telephone support). In two trials women received automated text messages. We did not identify any trials comparing different types of telephone support (for example, text messaging versus one-to-one calls). All but one of the trials were carried out in high-resource settings. The majority of studies examined support provided via telephone conversations between women and health professionals although a small number of trials included telephone support from peers. Many of the results described in the review are based on findings from only one or two studies. Overall, results were inconsistent and inconclusive. Telephone support may increase women's overall satisfaction with their care during pregnancy and the postnatal period; although results for both periods were from only two studies. There was no consistent evidence confirming that telephone support reduces anxiety during pregnancy or after the birth of the baby. Evidence from two trials showed that women who received support had lower average depression scores in the postnatal period but without clear evidence that women who were supported were less likely to have a diagnosis of depression. Results from trials encouraging breastfeeding through telephone support were also inconsistent, although there was some evidence that telephone support may increase the duration of breastfeeding. There was no strong evidence that women receiving telephone support were less likely to be smoking at the end of pregnancy or during the postnatal period. For infant outcomes, such as preterm birth and infant birthweight, overall, there was little evidence. Where evidence was available, there were no clear differences between groups. There remains uncertainty regarding the benefit of telephone support and despite some encouraging findings, there is insufficient evidence to recommend routine telephone support for women accessing maternity services." ]

[ "Information and communication technologies (ICTs) are technologies that help gather, store, process and share information electronically.  Examples of ICTs are electronic medical records, medical journals and databases on the internet, videoconferencing for doctor appointments, or systems on the internet to give feedback to doctors so they can improve the care they provide.  ICTs have the potential to improve health care and the health of patients.  But even though computers are being used more and more in hospitals, not all health care professionals use ICTs.   For this reason, there are many strategies to try and promote the use of ICTs.  Strategies can include training groups of health care professionals to use a specific ICT, or teaching someone one-on-one to use an ICT, or simply providing training materials. A review of the effects of different strategies to promote the use of ICTs was conducted.  After searching for all relevant studies, 10 studies were found.  The evidence shows that some ways, such as group training, or one-on-one training sessions, or providing training materials, may improve the use of ICTs.  But overall, it is still uncertain whether some strategies are effective.  More research is needed." ]

[ "Eleven studies involving a total of 2093 participants were included. The evidence was dominated by one large multicentre trial of 1319 participants. The methods of two studies were flawed such that their results were likely to be biased. The remaining studies were at a lower risk of bias. The trials evaluated five different comparisons of interventions. Only the two comparisons tested by more than one trial are reported here. These were reamed versus unreamed intramedullary nailing (six trials) and Ender nail versus interlocking nail (two trials). The review found no evidence of a significant difference between reamed and unreamed intramedullary nailing in re-operations for complications, nor in various complications such as nonunion (where the bone fails to heal). However, reamed nailing was more associated with a lower implant failure, such as broken screws, than unreamed nailing. Moreover, there was some weak evidence that reamed nailing may be associated with fewer major re-operations for non-union when used for closed fractures (where the skin remains intact) compared with open (where the skin is broken) fractures. The review also found that the Ender nail resulted in more re-operations and deformity (malunion) than an interlocking nail. The review concluded that there is insufficient evidence to draw definitive conclusions on the best type of, or technique for, intramedullary nailing for tibial shaft fractures in adults." ]

[ "From literature searches updated to 5 January 2016, 10 randomised controlled trials that enrolled 1644 infants were included. We are not aware of any financial support from the industry for the included studies. In this update of the review there was no significant reduction in the rate of chronic lung disease at 36 weeks' postmenstrual age. A significant reduction in the combined outcome of death or chronic lung disease at 36 weeks' postmenstrual age among all randomised neonates and among survivors was noted. Even though the results were significant, the upper confidence interval was infinity (i.e. we would have to treat every baby with inhaled steroid to prevent one baby dying or developing chronic lung disease at 36 weeks' postmenstrual age). This would not be acceptable in clinical practice. A lower rate of reintubation (the need for the insertion of a tube into the airway) was noted in the steroid group compared with the control group in one large study. There were no statistically significant differences in short- and long-term complications between groups. The results of the long-term follow-up of one large study is awaited. In general the quality of the studies was good." ]

[ "We systematically analysed the published trials comparing the usefulness of FG as a small-vessel sealing agent. Eighteen randomised controlled trials on 1252 people were retrieved following bibliographic searches on standard medical databases. There were significant clinical and methodological differences among the included trials. The use of FG following breast and axillary surgery did not reduce the incidence of postoperative seroma, mean volume of seroma, wound infections, postoperative complications and the length of hospital stays. FG reduced the total volume of drained seroma and the duration of persistent seroma requiring frequent aspirations. This review showed no overall benefit of using FG. Although this conclusion is based on the combined analysis of 18 trials, the majority of these were of poor quality due to flaws in trial methods. Therefore, this conclusion should be taken cautiously and a major, multicentre, high-quality randomised controlled trial on people undergoing breast and axillary surgery for breast cancer is required to corroborate this conclusion." ]

[ "Cabergoline has been compared with inactive placebo in two smaller and shorter (6 - 12 weeks) studies and one larger, medium term trial (24 weeks). These trials included 268 patients with Parkinson's disease and motor complications. The average reduction in the time patients spent in the immobile off state was 1.1 hours greater with cabergoline compared with placebo, although this was not statistically significant. Inadequate data on dyskinesia was collected to allow a conclusion to be drawn. A small but significant advantage of cabergoline over placebo was seen in one study for activities of daily living and physical functioning. No such advantage was seen in one other study due to small numbers of patients and the comparatively low doses of cabergoline used. Levodopa dose reduction was greater with cabergoline by 145 mg per day. There was a trend towards more side effects with cabergoline but towards fewer withdrawals from cabergoline treatment. In the management of the motor complications seen in Parkinson's disease, cabergoline can be used to reduce levodopa dose and modestly improve motor function and activities of daily living with an acceptable side effect profile. This is based on, at best, medium term evidence. Further long term trials are required to compare the newer with the older dopamine agonists, particularly in terms of quality of life and cost." ]