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+This review looked at studies which compared usual care for asthma to more intensive educational programmes and the results showed a statistically significant reduction in the treatment groups needing subsequent emergency department visits or hospital admissions. We were not able to determine the most effective type, duration or intensity of education that should be offered to children to offer the best asthma outcomes.
+In July 2018 we searched for randomised clinical trials where ketamine was injected before, during, or after operation in adults having an operation under general anaesthesia. Important outcomes were opioid use and pain at 24 and 48 hours after the operation, time to first request for a painkiller, and ketamine-related side effects. We found 130 eligible studies with 8341 participants. Compared to people given control treatment, those given intravenous ketamine used less opioid painkiller (by about 1 part in 10), and had less pain (by about 2 parts in 10; moderate- or high-quality evidence). Ketamine may be more effective in operations that are likely to cause more intense pain. People given ketamine requested painkillers 54 minutes later than those who did not receive ketamine (moderate-quality evidence). Ketamine reduced the risk of postoperative nausea and vomiting by a small amount (high-quality evidence). Ketamine produced no increased risk of central nervous system side effects (hallucination, nightmares or double vision) (high-quality evidence). Future research should assess ketamine's effect after operations that are accompanied by intense pain such as thoracotomy, back surgery, or amputations. Additionally, assessing ketamine's effects among particular patient groups, for example, the elderly or individuals with a history of substance abuse would be of interest. 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 found the quality of evidence for most outcomes to be moderate. Many of the studies were small, which was the main reason for downgrading the evidence from high to moderate. We tested the results by operation type, timing of ketamine injection, and by looking at larger studies, and those with more pain were consistent, and provided confidence in the results. There was sufficient evidence to allow conclusions about ketamine's effect on pain, painkiller consumption and side effects after operation.
+This review looked at vaccinations targeted at the asexual (blood) phase of the parasite's life, when the parasites are in red blood cells. One vaccine for this phase, MSP/RESA (also known as Combination B), has been tested in field trials in Papua New Guinea. It reduced the density of parasites in the blood, but it did not prevent malaria attacks. Blood-stage vaccines are being actively pursued in further research.
+Four studies, which involved 125 participants, were included in this review. The majority of participants had suffered a broken tibia that had not healed as quickly as expected or at all. The results of this review suggest that there may be a benefit on bone healing from electromagnetic field stimulation. However, the available evidence was not good enough to be certain of this and it may not apply to current practice. Electromagnetic field stimulation appears to be safe. The two complications reported were minor involving irritation of the skin.
+A total of 1831 participants received drain (915 patients) versus 'no drain' (916 patients) in 12 trials included in this review. The decision of whether the patients received drain or not was determined by a method similar to toss of a coin. Only two trials including 199 patients were of low risk of bias (free from errors in study design that can result in wrong conclusions, leading to overestimation of benefits and to underestimation of harms of the drainage or no drainage). Nine of the 12 trials included patients who underwent planned operations. The average age of participants in the trials ranged between 48 years and 63 years in the 10 trials that provided this information. The proportion of females ranged between 55.0% and 79.0% in the 11 trials that provided this information. There was no significant or clinically important differences in the short-term mortality, serious complications, quality of life, length of hospital stay, operating time, return to normal activity, or return to work in the trials that reported these outcomes. The proportion of patients who were discharged as day-procedure laparoscopic cholecystectomy seemed significantly lower in the drain group than in the 'no drain' group in one trial of high risk of bias involving 68 participants. Currently, there is no evidence to support the use of drain after laparoscopic cholecystectomy. Further well-designed randomised clinical trials are necessary.
+This systematic review identified a total of 49 trials that included 3639 participants with DPN. Ten of the trials were new at this first update of the review. We evaluated the effects of various herbal formulations (including single herbs, Chinese proprietary medicines and mixtures of different herbs) for treating people with DPN. All the identified clinical trials were performed and published in China. The trials reported on global symptom improvement (including improvement in numbness or pain) and changes in nerve conduction velocity. The positive results described from the 49 studies of low quality are of questionable significance. There was inadequate reporting on adverse events in the included trials. Most of the trials did not mention whether they monitored for adverse effects. Only two trials reported adverse events but an adverse event occurred in the control group in one trial and it was unclear in which group they occurred in the other trial. Conclusions about the safety of herbal medicines cannot therefore be drawn from this review due to inadequate reporting. Most of the trials were of very low methodological quality and the interpretation of any positive findings for the efficacy of the included Chinese herbal medicines for treating DPN should be made with caution. Based on this systematic review, there is no evidence to support the objective effectiveness and safety of Chinese herbal medicines for DPN. No well-designed, randomised placebo controlled trial with objective outcome measures has been conducted.
+Five studies involving 1382 patients were included in this review. All the included studies involved advanced (T3 or T4) prostate cancer. No study was of adequate size and duration. Few events were reported and they did not assess disease-specific survival or metastatic disease. Only one study evaluated biochemical outcomes. Studies primarily reported on adverse events. There are no data for the relative effectiveness of IAS versus CAS for overall survival, prostate cancer specific survival, disease progression, or quality of life. Limited information suggests IAS may have slightly reduced adverse events. In Hering 2000, IAS (18/25 versus 18/18) appears to be slightly more favorable than CAS in controlling impotence. Overall, IAS was also as effective as CAS for potency, but was superior during the interval of cycles (96%). More research is needed.
+We did computer searches for randomised trials of IUDs inserted right after abortion or miscarriage. We also wrote to researchers to find more studies. Trials could compare types of IUDs or times for insertion. We found 12 studies to include. Four trials randomised women to an IUD inserted right away or at a later time. One had no major difference. Three recent trials (of levonorgestrel intrauterine system or CuT380A) showed use was greater at six months for an IUD inserted right away compared to one inserted later. Another trial assigned women to the levonorgestrel IUD or Nova T; more women with the Nova T stopped use due to pregnancy. A subanalysis showed more IUDs came out when inserted right after abortion or miscarriage rather than later. Seven trials looked at inserting the IUD right away. From two large trials, the TCu 220C was better than the Lippes Loop and the Copper 7 for preventing pregnancy and staying in. The IUD was more likely to come out on its own when inserted after a mid-pregnancy abortion than after an earlier one. In other work, when the Lippes Loop had copper arms added, fewer women got pregnant and the IUD stayed in more often. Moderate level evidence shows that inserting an IUD right after an abortion or miscarriage is safe and practical. However, the IUD is more likely to come out when inserted right away rather than at a later time. Women are more likely to use an IUD at six months if they had it inserted right away compared to some weeks after the abortion or miscarriage.
+We included one trial with 91 adult patients, of whom only 42 were analysed. The trial involved five one-hour meditation intervention sessions between admission and discharge of participants newly diagnosed with acute myeloid or lymphoid leukaemia. There was no information about the age of the participants included in the study. All participants in the trial were hospitalised for initial induction chemotherapy. As the abstract of the publication did not provide numbers, it is not possible to describe the results in more detail. Participants practising meditation reported better physical health and levels of depression could be decreased. Most of our pre-defined outcomes (overall survival, anxiety, fatigue, quality of sleep, and adverse events) were not reported at all. We judge the quality of the evidence for the outcomes quality of life and depression as 'very low', due to high risk of bias (only 42 out 91 participants were evaluated) and very imprecise results. There were not enough data available to determine the effectiveness of meditation practice on haematologically-diseased patients, thus the role of meditation in the treatment of haematological malignancies remains unclear. More high-quality and larger randomised controlled trials are needed to validate possible positive effects of meditation practice for haematologically-diseased patients. The evidence is up-to-date as of August, 2015.
+The number of participants in these three trials was small and is a limitation of this review. The quality of the included studies varied, which also limits confidence in the results. There have been no trials of this type undertaken in adults, and none of the trials commented on adverse events following immunisation, such as fever or injection site reactions.
+Antibiotics can be used individually, or combined, and administered for different durations. To identify the best antibiotic(s), or dose pattern, for preventing development of MRSA infection after surgery, we investigated studies that compared different antibiotics with each other, or with no treatment, to prevent MRSA SSIs. We included only randomised controlled trials (RCTs), and set no limits regarding language, or date, of publication, or trial size. Two review authors identified studies and extracted data independently. We identified 12 RCTs, with 4704 participants. Eleven trials compared 16 preventative (prophylactic) antibiotic treatments, and one compared antibiotic prophylaxis with no prophylaxis. Generally, MRSA status of the participants prior to surgery was not known. Four studies reported deaths (14/1401 participants): approximately 1% of participants died from any cause after surgery, but there were no significant differences between treatment groups. Four trials reported on serious antibiotic-related adverse events - there were none in 561 participants. None of the trials reported quality of life, length of hospital stay or use of healthcare resources. Overall, 221 SSIs due to any bacterium developed in 4032 people (6%), and 46 MRSA SSIs developed in 4704 people (1%). There were no significant differences in development of SSIs between the 15 comparisons of one antibiotic treatment against another. When antibiotic prophylaxis with co-amoxiclav was compared with no antibiotic prophylaxis, a significantly lower proportion of people developed SSIs after receiving co-amoxiclav (74% reduction in all SSIs, and 95% reduction in MRSA SSIs). Two trials reported that 19 participants developed MRSA infection in wounds (SSIs), chest, or bloodstream, but there were no significant differences in the proportion of people who developed them between the two comparisons. Prophylaxis with co-amoxiclav decreases the proportion of people developing MRSA infections compared with no antibiotic prophylaxis in people without cancer undergoing surgery for feeding tube insertion into the stomach using endoscopy, although this may be due to decreasing overall infection thereby preventing wounds from becoming secondarily infected with MRSA. There is currently no other evidence that either a combination of prophylactic antibiotics, or increased duration of antibiotic treatment, benefits people undergoing surgery in terms of reducing MRSA infections. Well-designed RCTs are necessary to assess different antibiotic treatments for preventing MRSA infections after surgery.
+We included two randomised controlled studies with 116 women in the review. These studies compared planned home versus hospital management for women with preterm, prelabour rupture of the membranes (PPROM). In both studies there were strict criteria for deciding whether women could be included; for example, women had to live within a certain distance of emergency facilities, and there had to be no signs that mothers and babies had infection or other problems. There was a period of monitoring in hospital for women in both groups. Results suggested that there were few differences in mothers' and babies' health for women cared for at home or in hospital including infant death, serious illness, or admission to intensive care baby units. There was some evidence that women managed in hospital were more likely to be delivered by caesarean section. Women cared for at home were likely to spend less time in hospital (spending approximately 10 fewer days as inpatients) and were more satisfied with their care. In addition, home care was associated with reduced costs. Overall, the number of women included in the two studies was too small to allow adequate assessment of outcomes.
+We identified 19 randomized controlled trials and included 11, but only eight contributed data. The most commonly studied methods of skin closure were non-absorbable staples compared with absorbable subcutaneous sutures. Staples were associated with similar outcomes in terms of wound infection, pain and appearance compared with sutures. Non-absorbable staples had an increased risk of skin separation and, therefore, reclosure. Skin separation was defined differently across trials and removal of staples varied from about day three to day seven postoperatively. There is not enough evidence from the included studies to say which method of closing the caesarean skin incision is superior. Too few trials compared different kinds of sutures. The use of prophylactic antibiotics to reduce infection was not reported in most trials.
+This review assessed the effectiveness of green tea, black tea or black/green tea extracts in healthy adults and those at high risk of CVD. We found 11 randomised controlled trials, four of which examined black tea interventions and seven examined green tea interventions. There were variations in the dosage and form (drink, tablets or capsules) of the black and green tea interventions, and the duration of the interventions ranged from three months to six months. Adverse events were reported in five of the included trials. These included a diagnosis of prostate cancer, hospitalisation for influenza, appendicitis and retinal detachment; these are unlikely to be associated with the intervention. The results showed black and green tea to have a beneficial effect on lipid levels and blood pressure, but these results were based on only a small number of trials that were at risk of bias. Analysis conducted over both tea types showed beneficial effects of tea on LDL-cholesterol and blood pressure but again this was based on only a few trials that were at risk of bias. To date the small number of studies included suggest some benefits of green and black tea on blood pressure and lipid levels but more longer-term trials at low risk of bias are needed to confirm this.
+The review found two small studies which did not provide adequate evidence as to whether azathioprine could be offered to reduce oral steroid treatment. There is a need for well-designed trials addressing this question before recommendations can be made.
+A number of studies have been carried out to investigate the effects of exercise both during and after treatment. The current review was carried out to evaluate the effect of physical exercise on fatigue related to cancer. Fifty-six studies, involving a total of 4068 participants, were included in this review. Results suggest that physical exercise such as aerobic walking and aerobic cycling can help to reduce fatigue both during and after treatment for cancer. The benefits of exercise on fatigue were observed specifically for people with breast cancer and prostate cancer.
+We found five eligible trials by the date of this updated review (search date March 2017). These trials included 3427 patients adult patients (16 to 65 years of age). For this updated review there are new data available resulting in a benefit in terms of overall survival (OS) for people with early unfavourable and advanced HL receiving BEACOPP escalated for first-line treatment. Furthermore, the analysis shows a better chance of avoiding recurrence of the tumour in patients who received chemotherapy including BEACOPP escalated. We analysed the following harms potentially caused by both regimens. There is no evidence for a difference for treatment-related mortality. There is evidence for a higher risk of secondary acute myeloid leukaemia (AML) or myelodysplastic syndromes (MDS) in patients receiving BEACOPP escalated, but the total number of secondary malignancies does not show evidence for a difference between both treatment groups. However, the observation time of the studies included in the review is too short to be expected to demonstrate differences with respect to second solid tumours. We are very uncertain how many female patients will be infertile due to chemotherapy and which arm might be favoured, as the evaluated sample is very small. No data for male patients and risk for infertility was provided. Treatment with BEACOPP escalated caused a higher risk of adverse events such as anaemia, neutropenia, thrombocytopenia and infections. Quality of life was not reported by any of the included trials. One trial stated it would assess quality of life, however, there were no results reported. We assessed the quality of the evidence as high relating to overall survival, as moderate for progression-free survival and as low for secondary AML or MDS, secondary malignancies and treatment-related mortality and adverse events. The quality of evidence is very low for infertility.
+The search date was 25 March 2014. Fifteen randomised controlled trials including 1835 cancer patients met the inclusion criteria. We found four types of interventions. In the first, psycho-educational interventions, participants learned about physical side effects, stress and coping and they took part in group discussions. In the second type of physical intervention participants took part in exercises such as walking. In the third type of intervention, participants received medical interventions ranging from cancer drugs to surgery. The fourth kind concerned multidisciplinary interventions in which vocational counselling, patient education, patient counselling, biofeedback-assisted behavioral training and/or physical exercises were combined.We did not find any studies on vocational interventions aimed at work-related issues. Key results Results suggest that multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to more cancer patients returning to work than when they received care as usual. Quality of life was similar. When studies compared psycho-educational, physical and medical interventions with care as usual they found that similar numbers of people returned to work in all groups. Quality of the evidence We found low quality evidence of similar return-to-work rates for psycho-educational interventions compared to care as usual. We also found low quality evidence showing that physical training was not more effective than care as usual in improving return-to-work. We also found low quality evidence that less radical cancer treatments had similar return-to-work rates as more radical treatments. Moderate quality evidence showed multidisciplinary interventions involving physical, psycho-educational and/or vocational components led to higher return-to-work rates than care as usual.
+We compared the admission CTG with intermittent auscultation of the FHR performed on the woman's admission to the labour ward. We searched for evidence to 30 November 2016 but found no new studies for this updated review (previously published in 2012). This review includes four studies and there is one study that is not yet complete. The included studies (carried out in the UK and Ireland) involved more than 13,000 women with low-risk pregnancies. Three trials were funded by the hospitals were the trials took place and one trial was funded by the Scottish government. Women allocated to admission CTG were probably more likely to have a caesarean section than women allocated to intermittent auscultation (moderate quality evidence). There was no difference in the number of instrumental vaginal births (low quality evidence) or in numbers of babies who died during or shortly after labour (moderate quality evidence) between women in the two groups. Admission CTG was associated with an increase in the use of continuous EFM (with an electrode placed on the baby’s scalp) (low quality evidence) and fetal blood sampling (a small blood sample taken from a baby's scalp) during labour. There were no differences in other outcomes measured such as artificial rupture of the membranes, augmentation of labour, use of an epidural, damage to the baby's brain due to lack of oxygen (very low quality evidence), or the baby having fits or seizures just after birth (low quality evidence). No studies reported if the babies developed any severe problems in brain or central nervous system growth and development after one year of age. Although many hospitals carry out CTGs on women when they are admitted to hospital in labour, we found no evidence that this benefits women with low-risk pregnancies. We found that admission CTGs may increase numbers of women having a caesarean section by about 20%. The included studies did not include enough women to show if admission CTGs or intermittent auscultation were better at keeping babies safe. However, studies to show which is better at keeping babies safe would have to be very large. Based on this review, low-risk pregnant women who have an admission CTG could be more likely to have a caesarean section. The benefits to these women of having an admission CTG are not certain. All of the included studies took place in developed Western European countries. The review findings might not be useful to people in very different countries or where different ways of FHR monitoring are used. However, countries that use admission CTGs should start to question why, because there are not clear benefits to using admission CTGs, and they could be causing women harm by making them more likely to have a caesarean section.
+The evidence is current to March 2015. We included 32 randomised controlled trials of a wide variety of different commercially available culture media in women undergoing IVF or ICSI. Sixteen studies randomised women (total 3666), three randomised cycles (total 1018) and twelve randomised oocytes (over 15,230). Most studies (22/32) failed to report their source of funding. No two studies compared the same culture media. Only seven studies reported our primary outcome of live birth or ongoing pregnancy, and they found no good evidence of a difference between the media compared. A single study found low-quality evidence that for day three embryo transfer, Quinn's Advantage may be associated with higher rates than G5, but this study was available only as an abstract and the methods used were not clearly reported. With regard to adverse effects, three studies reported multiple pregnancies and six studies reported miscarriage. None of them found any evidence of a difference between the culture media used. None of the studies reported on the health of offspring. We conclude that there is insufficient evidence to support or refute the use of any specific culture medium. Properly designed and executed randomised trials are necessary. There was very low-quality evidence for nearly all comparisons, the main limitations being imprecision and poor reporting of study methods.
+The present systematic review set out to assess the effectiveness of various methods of communicating a first diagnosis of confirmed breast cancer. The review was particularly interested in how this would impact on what the patient remembered, the satisfaction with the information received, the coping strategies used as a result of the information given and the impact of receiving the information on the patient's quality of life. The review authors made a thorough search of the medical literature looking for controlled trials in which women receiving a first diagnosis of breast cancer were randomised to the intervention group. They retrieved 23 original reports of trials for further review but ultimately no trial could be included. A number of the trials focused on communication at the first treatment consultation rather than the method of delivering the diagnosis. In an area that is ethically sensitive, the authors suggest that a review which focuses on the various methods of communication at the first consultation visit may provide useful information as to which methods are more effective and beneficial for this patient group.
+This Cochrane review included all studies of psychotherapy for non-cardiac chest pain. Seventeen trials met the inclusion criteria, and included a total of 1006 participants. The review found that cognitive-behavioural treatments are probably effective (in terms of reduced chest pain frequency) in the short term, for the treatment of non-cardiac related chest pain. No adverse effects of the psychotherapy were found. Hypnotherapy is also a possible alternative. A limitation of this review is the high variability of the studies included, reflected in a wide range of outcome measures, although there was an overall fairly low risk of bias.
+The evidence is current to July 2014. Among the 30 studies reviewed there were 17 different comparisons, including 4344 participants ranging in age between 4 and 85 years. The duration of treatment ranged from one to eight weeks. Ten out of 30 studies were funded by the drug manufacturer (8 totally and 2 partially funded); 20 studies did not report any source of funding. There was inconsistency in the way the effect of treatment was measured and reported. Overall risk of bias was low. Topical antihistamines and mast cell stabilisers, alone or in combination, are safe and effective for reducing symptoms of seasonal and perennial allergic conjunctivitis. We found insufficient evidence to discern which topical antihistamines and mast cell stabilisers are the most effective.
+This review found that there is not enough published research evaluating programmes aiming to prevent Indigenous youth from starting to use tobacco. Information from the two included studies in this review (1505 participants in total, in Native American communities) does not allow a conclusion to be drawn as to whether tobacco prevention programmes in Indigenous populations prevent Indigenous youth from smoking or using smokeless tobacco. The review highlights the absence of data and need for more research.
+We searched for evidence on 30 May 2016 and identified one controlled trial, with an unclear risk of bias, that randomised 72 women with sickle cell anaemia (haemoglobin SS) before 28 weeks of gestation to one of the two blood transfusion policies. The trial indicated no difference in severe ill health and death of the mother or newborn. There was no difference in the risk of delayed blood transfusion reaction. The trial suggested giving blood at frequent intervals reduced the risk of pain crisis, with a large degree of uncertainty about the size of the effect, compared with giving blood only when medically indicated. Blood transfusion was delivered at a ratio of four to one for prophylactic versus selective blood transfusion, respectively. Overall, the quality of evidence for outcomes that are important to the woman is very low. The available evidence on this subject is insufficient to advocate for a change in clinical practice and policy. More research needs to be conducted.
+We identified 67 randomised clinical trials involving a total of 6197 participants that met our inclusion criteria. However, we were only able to include 5771 participants from 64 trials since investigators either did not include the remaining participants in the analysis or did not report any outcomes of interest. Source of funding: 24 trials (35.8%) were funded by parties with no financial interest in obtaining positive results for the treatment being evaluated. The remaining trials received funding from either parties who would gain financially from the results of the study or did not report the funding. All the trials were at high risk of bias, that is, investigators may have overestimated the benefits or underestimated the harms of one method or the other because of the way that the studies were conducted. Many trials included few participants, and there was a good chance of arriving at the wrong conclusions because of this. The overall quality of evidence was low or very low. There was no evidence of differences in most of the comparisons, and where there was, these differences were in single trials, mostly of small sample size. Such evidence is unreliable. So, we mention only the evidence that was available in more than one trial. Of the primary outcomes, the only one where there was evidence of difference was in the number of adverse events, which was higher with radiofrequency dissecting sealer than with clamp-crush method. Among the secondary outcomes, the only evidence of difference was in the following: Blood transfusion (percentage): higher in the low central venous pressure group than in the acute normovolemic haemodilution (diluting the blood by giving fluids during operation) plus low central venous pressure group. Blood transfusion amount: lower in the fibrin sealant group (a type of glue applied to the cut surface of the liver) than in the control. Blood transfusion (fresh frozen plasma − a component of blood): higher in the oxidised cellulose (another type of glue applied to the cut surface of the liver) group than in the fibrin sealant group. Blood loss, total hospital stay, and operating time: lower with the low central venous pressure group than control. For other comparisons, the evidence for difference was based on single small trials, or there was no evidence of differences. None of the trials reported health-related quality of life or time needed to return to work. There is no evidence to suggest that using special equipment for liver resection is of any benefit.
+The review of trials found that several treatments improve the symptoms of chronic palmoplantar pustulosis, although no treatment was shown to suppress the condition completely. Oral retinoid therapy (acitretin) appears to be helpful at relieving symptoms, particularly if combined with PUVA. Ciclosporin and tetracycline antibiotics can also provide some relief. Topical treatments were generally less helpful. As yet there is no ideal treatment for chronic palmoplantar pustulosis, though oral retinoids, particularly when combined with psoralens and ultraviolet radiation (PUVA), may help
+We searched the available scientific literature to find all the trials that had addressed these questions. We found 9 trials studying the blood pressure-lowering ability of 5 different loop diuretics (furosemide, cicletanine, piretanide, indacrinone and etozolin) in 460 participants. The blood pressure-lowering effect was modest, with systolic pressure lowered by 8 mmHg and diastolic pressure by 4 mmHg. No loop diuretic drug appears to be any better or worse than others in terms of blood pressure-lowering ability. Due to lack of reporting and the short duration of included trials, this review could not provide an estimate of the harms associated with loop diuretics.
+We identified 58 trials, of which 48 randomised clinical trials involving 2849 people undergoing laparoscopic cholecystectomy contributed data to one or more of the outcomes. Most participants in the trials were low anaesthetic risk people undergoing planned laparoscopic cholecystectomy. The choice of whether the participants received local anaesthetic agents (or not) was determined by a method similar to the toss of a coin so that the treatments compared were conducted in people who were as similar as possible. There were no deaths in either group in eight trials (446 participants) that reported deaths. The studies reported very few or no serious complications in the groups. There were no local anaesthetic-related complications in nearly 1000 participants who received intra-abdominal local anaesthetic administration in the different trials that reported complications. None of the trials reported quality of life, the time taken to return to normal activity, or the time taken to return to work. The small differences in hospital stay between the two groups were imprecise. Pain scores were lower in the participants who received intra-abdominal local anaesthetic administration compared with those who received controls at four to eight hours and at nine to 24 hours as measured by the visual analogue scale (a chart that rates the amount of pain on a scale of 1 to 10). Most of the trials were of high risk of bias, that means that there is possibility of arriving at wrong conclusions overestimating benefits or underestimating harms of one method or the other because of the way that the study was conducted. Overall, the quality of evidence was very low. Serious adverse event rates were low in studies evaluating local anaesthetic intra-abdominal administration (very low quality evidence). There is very low quality evidence that local anaesthetic intra-abdominal administration reduces pain in low anaesthetic risk people undergoing planned laparoscopic cholecystectomy. However, the clinical importance of this reduction in pain is likely to be small. Further trials are necessary. Such trials should include outcomes such as quality of life, the time taken to return to normal activity, and the time taken to return to work, which are important for the person undergoing laparoscopic cholecystectomy and the people who provide funds for the treatment.
+Standard diagnosis of malaria in the past has depended on blood microscopy, but this requires a technician and a laboratory, and is often not feasible for basic health services in many areas. Sometimes in research studies, another technique called polymerase chain reaction (PCR) is used, but again this requires equipment and trained staff, and cannot be used routinely. Technological advances have led to rapid diagnostic tests (RDTs) for malaria. These detect parasite-specific antigens in the blood, are simple to use, and can give results as a simple positive or negative result, within 15 minutes. This review evaluates the accuracy of RDTs compared with microscopy and PCR for detecting Plasmodium falciparum parasites in the blood. It includes 74 studies, giving a total of 111 RDT evaluations (of which 104 compared RDTs with microscopy), reporting a total of 60,396 RDT results. Results are presented by type of test, classified by the malaria antigen that they are designed to detect (either histidine-rich protein-2 (HRP-2), or plasmodium lactate dehydrogenase (pLDH)). The results indicate that RDTs can be very accurate compared to microscopy and PCR. The performance of RDT types varied but the differences were not large. HRP-2-based tests tended to be more sensitive (ie they identified more true cases of malaria) and less specific (ie they wrongly identified more malaria that was not present) than pLDH-based tests. Choice will depend on prevalence of malaria, and we provide data in this review to assist these decisions, although policy makers will also take into account other factors relating to cost and test stability.
+We identified five studies conducted in the UK that tested whether methods to change consultation length for family doctors provides any benefit. The studies were conducted in single or multiple practices, and the number of appointments ranged from 200 to 2957 consultations. Four studies compared a change in appointment times from 5 to 15 minutes, and one study compared short versus long consultations with or without treatment for patients with no diagnosis. All studies tested short-term changes in the consultation time allocated to each patient. Our confidence in the results of these studies is very low. Consequently, we are not certain whether changing appointment slots leads to an actual increase of the length of the consultation, number of referrals and investigations requested by the doctor, and number of medications prescribed. Likewise, it is unclear whether patients are more satisfied with the health care they receive when appointments are longer. None of the studies reported on the resources associated with lengthening appointments. There is currently not enough evidence to say whether altering the amount of time that doctors consult with patients provides benefits or not.
+The comprehensive search strategy developed by the Cochrane HIV/AIDS Review Group was used to identify trials that compared the safety and efficacy in suppressing the viral load of low dose versus high dose stavudine in the context of treating HIV-1 with combination antiretroviral therapy. The searches covered the period 1996 to 2014.The search identified 3952 trials and only three met the inclusion criteria, all the included trials were conducted in developed countries, the number of participants ranged from 24 to 92 and the majority were male. The efficacy of suppressing the viral load was found to be the same in all the trials whether high dose or low dose of stavudine was used. McComsey 2008 and Milinkovic 2007 demonstrated a reduction in bone mineral density (BMD), reduction in limb fat and an increase in triglycerides in the high dose arms. While there was no demonstration of a difference in efficacy of viral load suppression between high dose and low dose stavudine in the included trials, participants included in these trials were already treated with antiretroviral therapy and had suppressed viral load. The fact that participants already had suppression of the viral load and the studies were small, meant it would be difficult to demonstrate the differences in viral load suppression between the two groups. The studies did not indicate that any participants discontinued treatment due to adverse events. This review identified only trials that tested the safety and efficacy in suppressing the viral load of low dose compared to high dose stavudine. These trials were small, conducted in developed countries and included participants with suppressed viral loads that had been on antiretroviral treatment for a long time. Individual results from the trials have not identified a clear advantage in viral load suppression or safety between low and high dose stavudine.Studies that evaluate the safety and efficacy in viral load suppression need to be conducted particularly in developing countries where stavudine is still being used and probably needed to either sustain treatment programs or where alternatives are limited.
+We included 10 trials in this review, which included a total of 1658 participants with acute respiratory distress syndrome. Low-quality evidence suggests that recruitment manoeuvres improve ICU survival but not 28-day or hospital survival. Recruitment manoeuvres have no effect on the risk of air leakage from the lungs. We found the evidence for most outcomes to be of low to moderate quality, primarily because of the design of included trials. Many trials used the recruitment manoeuvre in conjunction with other ventilation techniques or strategies, and this might have influenced outcomes. Caution should be applied when conclusions are drawn about the effectiveness of the recruitment manoeuvre alone.
+Systematically, we searched the literature on psychological interventions to find valid studies that looked at the effects of providing mainly psychological interventions for adults with asthma. The studies found examined many different therapies and measured different physical and psychological outcomes; for these reasons, their results could not be easily combined. However, meta-analyses could be performed to determine the effect of Cognitive Behavioural Therapy (CBT) on quality of life, bio-feedback on PEF, and relaxation therapy on PEF and FEV1 and medication use. The available studies were completed with small numbers of people and the way the studies were conducted could be improved. More research with larger numbers of people and improved design needs to be done before it is known whether psychological interventions are effective in improving health outcomes for adults with asthma.
+We did not find substantial differences between antidepressants and benzodiazepines in terms of efficacy and tolerability. There was not enough information to compare any differences in adverse effects. However, our findings are limited in the following ways: few studies contributed to each analysis, some studies were funded by pharmaceutical companies, and only short-term outcomes were assessed. The quality of the available evidence was mainly low, meaning that further research would be very likely to have an important impact on these results. Studies with larger sample sizes and fewer risks of bias should be carried out, with head-to-head comparisons. Longer-term outcomes need to be addressed to establish whether the effect is transient or durable. Trials should better report any harms experienced by participants during the trial. In addition, a network meta-analysis of psychopharmacological treatment in panic disorder will likely shed further light on this compelling issue, also being able to provide more information with regard to comparative efficacy.
+This review compares 29 randomised controlled trials that used surgical by-pass, endoscopic metal stents or endoscopic plastic stents in patients with malignant bile duct obstruction. All included studies contained groups where cancer of the pancreas was the most common cause of bile duct obstruction. This review shows that endoscopic stents are preferable to surgery in palliation of malignant distal bile duct obstruction due to pancreatic cancer. The choice of metal or plastic stents depends on the expected survival of the patient; metal stents only differ from plastic stents in the risk of recurrent bile duct obstruction. Polyethylene stents and stainless-steel alloy stents (Wallstent) are the most studied stents.
+The evidence is current to January 2016. We found five eligible studies - four comparing ultrasound with palpation and one comparing ultrasound with Doppler auditory assistance. We included in the review children aged one month to 18 years. We found that ultrasound increased the rate of successful cannulation at the first attempt and reduced the formation of haematomas. Ultrasound also increased the success rate within two attempts. It is likely that ultrasound is more useful for infants and small children than for older children. It is also likely that ultrasound is more useful if the practitioner is experienced in its use. We noted variation in the risk of bias of included studies. We rated the quality of evidence as moderate mainly because the number of studies was limited. For the same reason, we could not confirm the effect of age and expertise in ultrasound usage. Our evidence suggests that ultrasound is superior to other techniques for arterial catheter insertion, particularly in babies and young children.
+The evidence we present is current to May 2014. We found four studies that evaluated the restriction or banning of alcohol advertising via any format. One was a small randomised controlled trial (RCT) that evaluated drinking behaviour in 80 young men in the Netherlands exposed to movies with either a high or low alcohol content combined with a commercial with either a neutral content (interpreted as a ban on alcohol advertising) or a high alcohol content. The other three studies were interrupted time series (ITS) studies. ITS studies are studies in which changes, usually in the general public, are measured at various points before, during and after an intervention such as a change in policy. Two of the three ITS studies evaluated what happened after an advertising ban was introduced by two different Canadian provincial governments. The third ITS study evaluated what happened after a ban was lifted after being in place for 50 years in another Canadian province. Each study evaluated a different category of ban (either partial or full). None of the above studies were funded by the alcohol or advertising industries. The data arising from the included studies did not show a clear effect either for or against the banning or restriction of alcohol advertising. In the RCT, young men who watched movies with a low-alcohol content drank less than men who watched movies with a high-alcohol content. Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less. The trial was one and a half hours, so we do not know how long beyond the trial these effects lasted. The trial did not report on any harmful outcomes. The results from the three ITS studies were inconsistent. We statistically combined the results of the two studies that assessed what happened after a ban was introduced. This showed an overall increase in beer consumption in the general population following the introduction of the ban, but the results were uncertain and could also be consistent with no difference or an overall decrease in alcohol consumption. The third ITS study, which evaluated the lifting of a total ban on all forms of alcohol advertising to a ban on spirits advertising only, also found uncertain results. None of the studies reported on any harms arising from the bans. Overall we judged the quality of evidence to be very low in the RCT. This was based on the fact that there were problems with the study methodology, the population included men only and the results were not very accurate. In the ITS studies, the quality was also judged to be very low due to problems with the study methodology and the results not being precise. The review cannot recommend for or against banning alcohol advertising. Governments that are considering implementing alcohol advertising bans would be advised to implement the ban in a research environment and monitor the effects over time to build the evidence base.
+The review authors searched the medical literature. They found eight small controlled randomized studies looking at short-term growth (weight, length, and head circumference gain) in preterm infants fed with varying amounts of medium chain fats. The pattern of growth in infants fed exclusively with high MCT or low MCT formula for at least one week did not differ (five studies with 182 infants). These infants had a mean gestational age between 29 and 32 weeks, mean birth weights between 1 kg and 1.5 kg, and were aged one to six weeks. One study found a high degree of gastrointestinal intolerance with high MCT content and another did not. Development of necrotizing enterocolitis was not different. No studies addressed long-term growth or neurodevelopmental outcomes.
+We searched for evidence on 6 July 2016 and only found one randomised controlled trial (which reported data from a total of 34 women). Data were available for 17 women who received transcervical amnioinfusion and 17 women who did not. All of the women received paracetamol and antibiotics and they also had a special type of catheter inserted into the cervix to measure information about their contractions (i.e. how often the contractions occur, how long they lasted and how strong they were). infection of the mother's womb after the birth(low-quality evidence);infection of the baby(low-quality evidence);caesarean section(low-quality evidence);duration of antibiotic treatment; norduration of hospital stay. Themother's temperature at delivery, which was not a pre-defined outcome for our review, was lower in the women who received amnioinfusion, by 0.38 °C (with a likely range of 0.74 lower to 0.02 lower). The outcomedeath or severe illness in the babywas not reported, nor did the study report on the number of babies with alow Apgar scoreafter they were born (a low Apgar score could indicate that the baby is in need of medical attention). Similarly, the majority of other outcomes listed in this review were not reported in the included study. We did not identify any studies that looked at introducing the solution through the mother's abdomen (transabdominal route). There is not enough evidence to support the use of amnioinfusion for chorioamnionitis in clinical practice. We suggest that the reduction in temperature may have been in part due to a direct cooling effect of the infused fluid, and that further research is justified to determine whether such a cooling effect may be beneficial for the baby. Further randomised controlled trials are needed in this area. Future trials should compare transabdominal or transcervical amnioinfusion with no amnioinfusion for women with pregnancy fluid and sac infection (chorioamnionitis) and report on important outcomes listed in this review.
+In this review, we searched medical literature databases to identify studies which evaluated how well the Mini-Cog is able to distinguish between individuals who have dementia and those who do not have dementia when compared to in-depth evaluation by dementia specialists. Our review focussed on those studies that were conducted in community based settings. We identified three unique randomised controlled studies that evaluated the Mini-Cog. In these studies the accuracy of the Mini-Cog varied and importantly there were some potential limitations within the studies which may have led to an overestimation of the accuracy of the Mini-Cog. Based on the information that we obtained from our review, we felt that further research into the accuracy of the Mini-Cog was required before it could be recommended for routine use for identifying dementia in community settings.
+Reviewers found 19 studies, which enrolled 2521 patients. Most patients were male (57.2%), middle-aged (mean age 35.3 years) Caucasians (84.5%). These studies compared amphetamines to placebo (something that looks like an amphetamine but with no active ingredient), and three studies also compared amphetamines with other drugs such as guanfacine, modafinil, and paroxetine. In this review, we assessed the effects of three different kinds of amphetamines: dexamphetamine (from 10.2 to 21.8 mg/d), lisdexamfetamine (from 30 to 70 mg/d), and mixed amphetamine salts (MAS) (from 12.5 to 80 mg/d). Treatment length ranged from one to 20 weeks. Eighteen studies were conducted in the USA and one study in Canada and the USA. Ten studies were conducted at multiple sites. Study funding was reported in all but two studies. Sixteen studies were funded by the manufacturer, and one was funded by government agencies. All amphetamines reduced the severity of ADHD symptoms as rated by patients. Lisdexamfetamine and MAS also reduced the severity of ADHD symptoms as rated by clinicians, but dexamphetamine did not. Overall, amphetamines did not make people more likely to stay in treatment and were associated with higher risk of treatment ending early as the result of adverse events. We found no evidence suggesting that higher doses worked better than lower ones. We did not find any difference in effectiveness between amphetamines that act for longer periods of time versus those that act for shorter periods of time. Therefore, it appears that short-term treatment with amphetamines reduces the severity of ADHD symptoms, but studies assessing the effects of amphetamines for longer periods of time are needed. We found no differences in effectiveness between amphetamines and guanfacine, modafinil, or paroxetine. The quality of the evidence was low to very low for all outcomes for several reasons, namely, it was possible for patients to know the treatment they were taking; the number of studies and included patients was low, leading to imprecise results for many outcomes; the studies had problems in their design; and, for some outcomes, results varied across trials.
+We searched scientific databases for studies comparing vitamin D supplementation with placebo (a dummy treatment) or active medicines for the treatment of chronic painful conditions in adults. The evidence is current to February 2015. There is a small amount of evidence supporting this link but it is not of high quality and may not be reliable. This update of a review sought high quality evidence from randomised controlled trials (studies where participants are randomly allocated to receive one of several treatments) on vitamin D for chronic painful conditions. We found no consistent pattern that vitamin D treatment was better than placebo for any chronic painful condition, but the studies had methodological shortcomings (low quality evidence). More research is needed to determine if vitamin D is a useful pain treatment in any particular chronic painful condition. That research should examine whether any effect is restricted to people who are vitamin D deficient. It should also examine how much vitamin D is required, and for how long, before beneficial effects occur.
+This review examined the effects of interventions targeting health professionals or the way care is organised, with the aim of improving the management of people with diabetes in primary care, outpatient and community settings. The review found that multifaceted professional interventions (for example combinations of postgraduate education, reminders, audit and feedback, local consensus processes, and peer review) could enhance the performance of care providers. Organisational interventions that increased structured recall, such as central computerised tracking systems or nurses who regularly contacted patients, could also lead to improved care for patients with diabetes. The effectiveness of these interventions on patient outcomes (glycaemic control, cardiovascular risk factors, wellbeing) is less clear.
+We searched for randomized trials of birth control methods until August 2015. Randomized trials are clinical studies in which people are randomly put into one of two or more treatment groups. Women in these studies were 25 years old or younger. The birth control methods could be either hormonal or a non-hormonal device placed in the uterus. The hormonal methods included pills, vaginal rings, or implants. The methods that are placed in the uterus include the intrauterine device (IUD) without hormones and the intrauterine system that has the hormone levonorgestrel (LNG-IUS). IUDs and the LNG-IUS are sometimes called intrauterine contraception (IUC). We found five trials that enrolled had a total of 1503 women. Some studies looked at different types of IUC, while others compared pills versus a vaginal ring, skin patch, or IUC. No study showed any major difference between the groups in pregnancy or continued use. Some of the trials were too small to find a difference. Women kept using IUC at least as long as pills in one study. IUC may be useful for women in this age group. Studies of different birth control with more women would help determine which methods work the best for young women. Overall, the quality of the results was moderate to low.
+The review of trials found that immunotherapy can reduce asthma symptoms, the need for medications and the risk of severe asthma attacks after future exposure to the allergen. It is possibly as effective as inhaled steroids. However, there is an increased risk of a lump at the injection site, rash, wheezing, breathlessness and very rarely a fatal allergic reaction.
+Several studies have suggested that mechanical breathing can also cause lung damage and bleeding. A new lung protective way of mechanical ventilation was tested in large studies. In this third update of the Cochrane review we searched the databases until September 2012 but we did not find any new study which was eligible for inclusion. The total number of studies remained unchanged, six trials involving 1297 people. This systematic review shows that a gentler form of mechanical breathing (so-called protective ventilation) can decrease deaths in the short term, by 26% on average, but the effects in the long term are uncertain or unknown.
+The evidence is current to June 2014. We included studies with participants from all age groups except neonates (infants less than 28 days old) who received injectable or gas techniques of anaesthesia during surgery for brain tumour. We reran the searches for all databases in March 2016 and found two studies that are awaiting classification. We will deal with them when we update this review. We found 15 eligible studies with 1833 participants. These studies compared one injectable drug (propofol) with two gaseous drugs (sevoflurane and isoflurane). Although isoflurane was associated with slower awakening (about three and a half minutes) compared with propofol, researchers found no important differences between propofol and sevoflurane. In terms of adverse effects, propofol was less likely to cause nausea and vomiting than either gas anaesthetic (about half as likely) but was more likely to be associated with changes in blood pressure. Overall, we found that isoflurane is associated with slower awakening, but we have found no evidence of important differences between sevoflurane and propofol. We found evidence of low quality for our main outcome of quick wakefulness, and the effect of injectable anaesthetic technique in people undergoing brain tumour surgery is uncertain. Further research and well-designed studies are needed.
+We found four trials suitable for analysing the effectiveness of blood pressure lowering for preventing development of cognitive impairment and dementia. However, for several reasons, including the differing methodologies of the trials, the number of drop-outs from the trials, and active treatment of subjects in the control groups, we were unable to assess definitively the effectiveness of antihypertensive treatments for preventing cognitive impairment and dementia in people with no evidence of previous cerebrovascular disease.
+This review sought to determine whether PTCRA leads to improved patient outcomes compared to balloon angioplasty. It was important to do this review as it is not known whether or not PTCRA provides greater benefits to patients compared to balloon angioplasty. The review analysed data from 12 studies, which showed that there is limited evidence to support the routine use of PTCRA for in-stent re-stenosis; however, only for those people who were not suitable for surgery. For those with complex lesions, PTCRA may provide some benefit in comparison to balloon angioplasty. The review also showed that patients receiving PTCRA were more likely to have perforations during the procedure compared to patients receiving balloon angioplasty. This review was limited by the small number of studies and deficiency of data reported in some of the studies.
+We identified three randomised controlled trials involving 333 children up to 24 months of age hospitalised with bronchiolitis. All three studies compared nebulised rhDNase with placebo. Any additional treatments were given to both groups. Overall, the studies did not show that nebulised rhDNase shortened the duration of hospital admission, or improved the severity of symptoms. No serious side effects were reported by any of the studies. One study showed that in patients suffering from atelectasis, a severe complication of bronchiolitis wherein the lung does not expand completely, nebulised rhDNase treatment resulted in a distinct improvement within two days. To confirm this beneficial effect, further clinical studies in patients with severe bronchiolitis are needed. Currently, the use of this treatment in young children hospitalised with bronchiolitis is not recommended.
+This update found two studies comparing the cut-down artery access with the percutaneous technique (current to October 2016). One was a small study with 30 participants, the other a larger more robust study with 151 participants. The large study was found to be of high quality with little risk of bias. The smaller study did not report on the methods of randomisation, how the randomisation was concealed and the pre-selected outcomes of interest. Combined, the studies had 181 participants; 116 underwent the cut-down technique and 65 the percutaneous technique. Both studies compared rates of death, major complications, wound infections, bleeding complications, and length of the operation. Overall, we did not find any difference in the rates of death (moderate-quality evidence), major complications (moderate-quality evidence); or bleeding complications between the percutaneous and cut-down techniques (high-quality evidence). No one developed a wound infection (moderate-quality evidence). The surgery took less time (moderate-quality evidence) in the percutaneous group compared with the cut-down group. Only one study reported if the aneurysm wall was successfully reinforced (checked by a CT scan, moderate-quality evidence), on complications at six months, (moderate-quality evidence); and on how long participants spent in an intensive treatment unit (ITU). We did not find any difference between the cut-down and percutaneous groups. This review shows moderate-quality evidence of no difference between the percutaneous approach compared with cut-down femoral artery access group for short-term mortality, aneurysm exclusion (sealing of the aneurysms), major complications, wound infection and long-term (six months) complications; and high-quality evidence for no difference in bleeding complications. There was a difference in operating time, with moderate-quality evidence showing that the percutaneous approach was faster than the cut-down femoral artery access technique. We downgraded the quality of the evidence to moderate due to the small number of studies, overall event rates and imprecision (differences around the level of effect).
+In April 2013, we did computer searches for randomized trials that compared the sponge with the diaphragm. For the original review, we looked at reference lists and book chapters to find trials. We also wrote to researchers to look for more trials. We found two trials. In a large USA trial, the sponge did not work as well as the diaphragm in preventing pregnancy. For every 100 women who used the sponge for a year, about 17 got pregnant. Of those who used the diaphragm, 13 became pregnant. A U.K. trial found similar results. For each 100 women who used the sponge for a year, about 25 got pregnant. Of the diaphragm users, 11 became pregnant. We have not found any new trials since the initial review. About 30% more women stopped using the sponge than the diaphragm. Allergy to the sponge was a problem for some women. However, discomfort caused about the same numbers of women to stop using their birth control method.
+In August 2014 we searched four literature databases. Six randomised controlled trials (RCTs), in which patients were randomly assigned to the intervention or a comparison group (control group), were eligible for inclusion. Each trial assessed different interventions, so results were not combined. The largest trial investigated the medical drug memantine in 508 patients with a metastatic brain tumour. Another trial investigated donepezil in 198 patients with a primary or secondary brain tumour. The other trials were smaller and investigated modafinil and methylphenidate. We found one psychological intervention for preventing cognitive deficits during brain radiation. There is one ongoing medical drug trial recruiting participants. There were many non-randomised and non-controlled trials that offer promising results for further exploration using an RCT method. Findings into the efficacy of memantine offer supportive evidence for preventing cognitive deficits in patients with a secondary brain tumour receiving brain irradiation. Findings into the efficacy of donepezil offer some support for its use in the amelioration of cognitive deficits in patients with a primary or secondary tumour previously treated with radiation. The remaining studies did not have a sufficient number of participants to provide reliable results. The drugs used had few side effects (adverse events), although these were not reported well. Recruitment and retention of trial participants for these medical drug studies is difficult. We found limitations in the evidence across studies, most medical drug randomised controlled trials had a low risk of bias, whereas the psychological interventions were at a high risk of bias.
+The Cochrane Oral Health Group carried out this review, and the evidence is current as of 9 October 2013. There are two studies included, both published in 1996, which compared low-level laser treatment to placebo or fake treatment for partial loss of sensation following surgery to the lower jaw. There were 15 participants in one study and 16 in the other, their ages ranging from 17 to 55 years. All had suffered accidental damage to nerves of the lower jaw and tongue causing some loss of sensation following surgery. Low-level laser therapy was the only treatment to be evaluated in the included studies and this was compared to fake or placebo laser therapy. No studies were found that evaluated other surgical, medical or counselling treatments. There was some evidence of an improvement when participants reported whether or not sensation was better in the lip and chin areas with low-level laser therapy. This is based on the results of a single, small study, so the results should be interpreted with caution. No studies reported on the effects of the treatment on other outcomes such as pain, difficulty eating or speaking or taste. No studies reported on quality of life or harm. The overall quality of the evidence is very low as a result of limitations in the conduct and reporting of the two included studies and the low number of participants, and evidence from participants with only partial sensory loss.
+The hormones oestrogen and progesterone have established physiological roles in maintaining pregnancy. It has been suggested that supplementation of these hormones could help prevent miscarriage before 24 weeks of pregnancy, particularly in women who have low levels of the hormones, in assisted reproductive technology programs, or who have a history of repeated miscarriages. In our review of randomised controlled trials published in major scientific databases, we only identified two trials that met our inclusion criteria. The two trials involved small numbers of women. One involved 161 women with diabetes who took oral placebo or oral diethylstilboestrol and ethisterone in increasing doses from before the end of the 16th week until birth. The other trial involved 120 women with pregnancy assisted by in vitro fertilisation and embryo transfer who continued treatment until the completed 12th week of gestation. From the little evidence available, the two trials found no evidence that combined oestrogen and progestogen can prevent miscarriage (progestogen is a major class of hormones which includes progesterone) when compared with placebo or usual care. The first of the two studies indicated an increased risk for the mothers who used hormonal therapy during pregnancy of developing cancer later in life. Diethylstilboestrol is no longer in use and poses serious adverse effects while ethisterone contains androgenic properties thought to be responsible for genital abnormalities and has been replaced by progesterone. Overall, we acknowledge the lack of trials, especially large-scale trials, and therefore suggest further research is needed in this area before supporting or disproving the use of combined oestrogen and progesterone for the prevention of miscarriages.
+However, most systematic reviews of antidepressant treatment have included trials conducted in secondary care settings. There has been doubt about the effectiveness of antidepressants in primary care, and hence the impetus to do this review. Through extensive searches of the literature we found 14 studies conducted in adults (not the elderly) in primary care setting, in which tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) were compared against a placebo control group in the treatment of depression. The results showed that both TCAs and SSRIs were effective for depression. Most of the studies were supported by funds from pharmaceutical companies and were of short duration. There appeared to be more adverse effects with TCAs than with SSRIs, however rates of withdrawal from study medication due to adverse effects were very similar between the two antidepressant classes. Adverse effects not leading to medication cessation seemed to be more common with TCAs than SSRIs.
+This is an updated version of the original Cochrane review published in Issue 10, 2010 (Rabbie 2010); no new studies were found. A single oral dose of ibuprofen 200 mg or 400 mg is effective in relieving pain in migraine headaches. Pain will be reduced from moderate or severe to no pain by two hours in just over 1 in 4 people (26%) taking ibuprofen 400 mg, compared with about 1 in 10 (12%) taking placebo. It will be reduced from moderate or severe to no worse than mild pain by two hours in roughly 1 in 2 people (57%) taking ibuprofen compared with approximately 1 in 4 (25%) taking placebo. Of those who experience effective headache relief at two hours, more have that relief sustained over 24 hours with ibuprofen than with placebo. A 200-mg dose is slightly less effective, while soluble formulations give more rapid responses. A single 400-mg dose of ibuprofen has efficacy similar to that shown for a single dose of 1000 mg aspirin in a separate Cochrane review (Kirthi 2013). Adverse events are mostly mild and transient, occurring in the same proportion of participants treated with ibuprofen and placebo. Very few individuals had serious adverse events or needed to withdraw from these studies because of adverse events. There is no information for ibuprofen combined with a self-administered antiemetic, and little information comparing ibuprofen with other medications. There were no significant differences between ibuprofen 400 mg and rofecoxib 25 mg (now withdrawn) for 2-hour headache relief, 24-hour sustained headache relief, or use of rescue medication.
+This review included 43 randomized controlled trials (3497 people with dry eye) that compared OTC artificial tears with other OTC artificial tears, with no treatment, or with placebo. We considered participant symptoms to be the primary outcome for this review. We recorded other commonly performed dry eye tests as secondary outcomes (e.g. vision, tear stability). We measured primary and secondary outcomes at two and four weeks, although we also considered other time points in this review. We searched for trials up to December 2015. This review analyzed many OTC artificial tear formulations, and most of the literature indicates uncertainty as to which OTC artificial tear works best. The literature also shows that OTC artificial tears may be effective at treating dry eye symptoms and that OTC artificial tears are generally safe, although not without side effects. We also identified an additional 18 potentially eligible trials that were registered, but did not provide any results or publications. These trials may have enrolled 2079 total participants for whom no data are available. Without the results of these trials, the effects of the OTC artificial tears that they evaluated are unknown. The overall quality of the evidence was low for the various OTC artificial tear formulations compared in this review. This finding indicates that future published research may have an important impact on the conclusions currently provided in this review.
+This review attempted to assess the best ART regimen for HIV-infected people in low- and middle-income countries following treatment failure; however, the review found limited studies addressing this topic. One randomised trial and one abstract of an observational study evaluated whether or not to maintain lamivudine in second-line regimens; both suggested no difference in outcomes. There were no studies comparing boosted PI-containing second-line regimens in patients failing an NNRTI-based first-line regimen, nor any evaluating NRTI combinations after first-line with non-thymidine analog combinations. While such trials are difficult to conduct for a variety of reasons, randomised controlled trails comparing second-line therapies are needed, especially in resource-limited settings.
+We included 133 studies (844,206 participants) which investigated the accuracy of the seven tests above, plus 69 other common tests and 32 test combinations, in detection of difficult airways. For difficult laryngoscopy, the average sensitivity (percentage of correctly identified difficult airways) ranged from 22% (mouth opening test) to 63% (upper lip bite test). The average specificity (percentage of correctly classified patients without difficult airways) ranged from 80% (modified Mallampati test) to 95% (Wilson risk score). The upper lip bite test had the highest sensitivity of all tests considered. For difficult tube insertion, the average sensitivity ranged from 24% (thyromental distance) to 51% (modified Mallampati test) and the average specificity ranged from 87% (modified Mallampati test) to 93% (mouth opening test). The modified Mallampati test had the highest sensitivity of all tests considered. For difficult face mask ventilation (another indication of a difficult airway), there were only enough data to calculate average sensitivity of 17% and specificity 90% for the modified Mallampati test. Overall, the evidence from the studies was of moderate to high quality. The likelihood of the studies providing reliable results was generally high, although in half of them, the intubating physician knew the result of the preceding test, which may have influenced results, but this is the normal situation in routine clinical care. The characteristics of patients, tests, and conditions were comparable to those seen in a wide range of everyday clinical settings. The results of this review should apply to standard preoperative airway assessments in apparently normal hospital patients worldwide. The bedside screening tests examined in this review are not well suited for the purpose of detecting unanticipated difficult airways because they missed a large number of people who had a difficult airway.
+A number of randomized controlled trials have been done to see whether probiotics are beneficial in acute infectious diarrhoea. We have searched for as many of these trials as possible and collected together the data in a systematic way to try to discover whether or not probiotics are beneficial in acute diarrhoea. We identified 63 trials, which included a total of 8014 people - mainly infants and children. Probiotics were not associated with any adverse effects. Nearly all studies reported a shortened duration of diarrhoea and reduced stool frequency in people who received probiotics compared to the controls. Overall, probiotics reduced the duration of diarrhoea by around 25 hours, the risk of diarrhoea lasting four or more days by 59% and resulted in about one fewer diarrhoeal stool on day 2 after the intervention. However, there was very marked variability in the study findings and so these estimates are approximate. We concluded that these results were very encouraging but more research is needed to identify exactly which probiotics should be used for which groups of people, and also to assess the cost effectiveness of this treatment.
+This review includes one small pilot study with 52 participants. The study compared nidotherapy with standard care versus standard care alone and lasted 18 months. Findings suggest some limited evidence that those who received nidotherapy might experience a slight improvement in social functioning or personal relationships, mental state and may spend less time as inpatients in hospital over the course of 12 months, but there is no information concerning the appropriateness of this for the individual. However, these limited findings need to be treated with considerable caution. The degree of any possible improvements that come from taking part in nidotherapy remain unclear due to the single study’s small sample size, incomplete evidence and risk of bias. No evidence is available on the effect of nidotherapy on general functioning, quality of life, taking medication, satisfaction with treatment, employment status or adverse effects. Further research is required to fill this gap in knowledge about the effectiveness, benefits and possible hazards of nidotherapy. Until such a time, people with mental health problems, health professionals, managers and policymakers should consider this new therapy an experimental one. This summary has been written by a consumer Ben Gray (Benjamin Gray, Service User and Service User Expert, Rethink Mental Illness. Email: [email protected]).
+We searched scientific databases for studies that looked at the effects of pregabalin in adults with fibromyalgia who had moderate or severe pain. The treatment had to last at least eight weeks. The evidence is current to March 2016. Eight studies satisfied the inclusion criteria, including three new studies for this update. Five studies randomised 3283 participants to immediate treatment with pregabalin or placebo. Two studies identified 687 out of 1492 participants who had a good pain response and could take the medicine, and then randomised them to continued treatment with pregabalin or placebo. Study quality was good. One other had no useful data. High quality evidence showed that 1 in 10 people with moderate or severe fibromyalgia pain reported a large fall in pain by a third to a half over 12 to 26 weeks. This is an outcome that people with fibromyalgia consider to be useful. The dose of pregabalin was 300 to 600 mg daily. Side effects occurred in 8 or 9 people in 10, often while adjusting to the medicine. Particular side effects were dizziness (affecting 1 in 4 participants), drowsiness (1 in 7), weight gain (1 in 18), and peripheral oedema (1 in 19) (high quality evidence). Serious side effects were no more common with pregabalin than with placebo, affecting 1 or 2 in 100. About 1 in 10 more participants taking pregabalin withdrew from the study because of side effects, and 1 in 17 fewer withdrew because the medicine was not working. The evidence was mostly of high quality, which means we are very confident that the true effect lies close to that of the estimate of the effect in this review. Concern about how information was handled when people left the studies was offset by other information showing that results were not impacted by this to any important degree.
+This review included one randomised controlled study involving 135 women with mild pre-eclampsia (high blood pressure and/or protein in the urine). There was not enough evidence from this study to determine the effects of magnesium sulphate on babies born at term. Women receiving magnesium sulphate were more likely to feel warm and flushed in this study than women who received a placebo, but they were not more likely to stop treatment due to side effects. The rates of haemorrhage after birth and rates of caesarean birth were similar for women who received magnesium sulphate and those who received a placebo. More studies are needed to establish whether magnesium sulphate given to the mother at term is protective for the baby's brain. The babies in these trials should be followed up over a long period so that we can monitor the effects of magnesium on child development. We are awaiting further information from another six studies so that they can be assessed.
+This review of four studies found that published studies evaluating smoking cessation interventions specifically aiming to reduce and/or stop the use of tobacco in Indigenous people are significantly lacking. The limited evidence reported in this review does indicate some benefit in these interventions to help Indigenous people stop smoking. However, the change in attitudes after one study was negative with fewer people 'ready to quit' after the smoking cessation intervention was completed. Consideration needs to be given to cultural differences and traditions when tailoring interventions for Indigenous people. Modified or innovative interventions and careful outcomes research are needed to improve the usefulness of smoking cessation interventions aimed at Indigenous populations.
+We identified 13 studies comparing patients treated with and without the use of a PAC that studied a total of 5686 patients. These were studies of patients undergoing routine major surgery (eight) and studies of patients who were critically ill and admitted to ICUs (five). We analysed the studies for any trial related risks and performed appropriate statistical analysis to minimize any risk of bias or errors. The quality of evidence is high from this review and further research is very unlikely to change our confidence in the estimate of effect except for cost analysis. Our review found that there were no differences in the number of deaths during hospital stay, days spent in general ICUs, and days spent in hospital between patients who did and did not have a PAC inserted. Two US studies were analysed for hospital cost associated with or without a PAC and showed no difference in the cost. Neither group of patients studied showed any evidence of benefit or harm from using a PAC. The catheter is a monitoring tool that helps in diagnosis and is not a treatment modality. Insertion of PACs to help make treatment decisions in ICU patients should be individualized and should be done by experts in the field after adequate training in the interpretation of data. Studies need to be conducted to identify subgroups of ICU patients who can benefit, when the device is used in combination with standardized treatment plans, in reversing shock states and improving organ function.
+This review of trials found evidence that venepuncture, when done by a trained practitioner, caused less pain than heel lance. The use of a sweet tasting solution given to the baby prior to the event reduced pain further. The evidence included outcome measures using pain scales, how long the baby cried and how the mother rated their baby's pain.
+This review looked at randomised controlled trials of re-stitching broken down wounds compared with non-stitching. Two small studies were identified. One study, involving 17 women, showed a marginal tendency to improved healing in the women who were re-stitched, however, this evidence was not conclusive. In the other study involving 35 women, more women had resumed intercourse in the re-suturing group at two months. As the studies were small and of poor quality, it is not possible to draw conclusions about the best way to manage wound breakdown after childbirth. Therefore, there is an urgent need to conduct further studies to compare fully the benefits and risks of both treatments.
+This updated review assessed the therapeutic effects and safety of Chinese medicinal herbs as an alternative and adjunctive therapy to other commonly used drugs for influenza. Eighteen studies involving 2521 participants were included in the review. 'Ganmao' capsules were found to be more effective than amantadine in decreasing influenza symptoms and aiding recovery in one study (in which adverse reactions were mentioned in the amantadine group although no data were reported). There were no significant differences between 'E Shu You' and ribavirin in treating influenza, nor in the occurrence of adverse reactions. The remaining 17 Chinese herbal trials showed a similar effect to antiviral drugs in preventing or treating influenza. However, since these included studies were of poor quality, the evidence does not support or reject the use of any Chinese herbal preparations for influenza. High-quality trials are required.
+We found eight studies involving 580 participants that tested the three different treatments. Studies also compared drug dosages and methods of administration. The quality of evidence is limited by small study size and high risk of bias. Thrombolytic therapy was probably better than placebo at restoring catheter function but there was no optimal dose or administration method. Physical disruption of a fibrin sheath may be equally effective as pharmaceutical thrombolytic agent for immediate management of catheter dysfunction. Catheter patency at two weeks is probably better following fibrin sheath stripping or catheter exchange compared to thrombolytic agent. Catheter exchange may be better than sheath disruption for long-term catheter survival and the use of both techniques together is probably best. There is currently insufficient evidence favouring any technique in terms of either dialysis adequacy or reduced risk of adverse events. Further research is required to adequately address the question of the most effective technique for haemodialysis catheter dysfunction.
+This review investigated the value of adding one or more chemotherapy drugs to a chemotherapy regimen. We found that the addition of chemotherapy drug/s to a regimen caused greater shrinkage of the tumour seen with imaging but increased toxicity. There is insufficient evidence to determine if there is an impact on time to disease progression and overall survival.
+Ten studies, including over 1800 patients, were analysed to determine if patients sent to a nursing led inpatient unit benefited or at least fared no worse than patients in a unit providing usual care. Compared to usual care, patients in nursing led inpatients units functioned better and experienced greater well-being; more patients were discharged home and not to an institution after about 3 months (but not after 6 months); fewer were readmitted back into hospital soon after discharge; but they stayed in hospital longer. The number of deaths during stay in hospital and 3 to 6 months after discharge was similar between the units (but there was a trend for more deaths early while in nursing led inpatients units that needs to be researched further). It is still not known whether nursing led inpatient units save money - studies in the United Kingdom found them more expensive than usual care units but studies in the United States found them cheaper.
+We searched for study reports and found 11 randomised controlled trials including 443 participants overall that assessed the safety and benefit of therapeutic ultrasound for people with carpal tunnel syndrome. The risk of bias of studies was low in some studies and unclear or high in others. There is only poor quality evidence from very limited data to suggest that therapeutic ultrasound may be more effective than placebo for either short- or long-term symptom improvement in people with carpal tunnel syndrome. There is insufficient evidence to support the greater benefit of one type of therapeutic ultrasound regimen over another or to support the use of therapeutic ultrasound as a treatment with greater efficacy compared with other non-surgical interventions for carpal tunnel syndrome, such as splinting, exercises, and oral drugs. Few studies measured adverse effects to therapeutic ultrasound. More research is needed to find out how effective and safe therapeutic ultrasound is for people with carpal tunnel syndrome, particularly in the long term.
+Studies have shown that interventions for reducing either total serum cholesterol or low density lipoprotein cholesterol levels reduce the risk of coronary heart disease (CHD) and stroke events in people with a history of CHD. However, for stroke patients the relation between the level of serum cholesterol and cholesterol subfractions with the risk of future stroke or cardiovascular events is unclear. This review, which includes eight studies involving approximately 10,000 participants, shows statin therapy, but not other lipid-lowering measures, reduces the risk of subsequent major vascular events and a marginal benefit in decreasing stroke events, but not all-cause mortality in those with a history of ischaemic cerebrovascular disease.
+We searched up until 30th November 2016, and found 11 relevant studies for this review. The numbers of participants varied between the included studies. All of the studies involved adults, although some studies also included younger people (14+ or 15+). Campaigns involved TV, radio, print media and billboard advertising. Studies differed in setting, duration, content of the intervention, length of observation, measures of smoking behaviour and the way of showing results. Two campaigns reported definite decreases in smoking prevalence, and some positive effects were observed in another three. Three large-scale campaigns reported lower tobacco consumption. Three studies showed some positive effect in abstinence or quit rates. One study did not show significant decreases but did demonstrate an effect of the intervention on smokers and ex-smokers combined. Tobacco control programmes that include mass media campaigns may change smoking behaviour in adults, but the evidence comes from studies of variable quality and scale and often occur in an environment where there are other influences on smoking, making it hard to isolate the effects of the media campaign itself. No consistent patterns by age, education, ethnicity or gender were found. There were problems with the design and conduct of all of the studies, which clouded the evidence. It would help if future studies could include comparator communities where there are no mass media interventions taking place to get a better estimate of the effect of the mass media campaign.
+We found 24 studies that involved 2166 women. Our evidence is current to January 2016. We found that women in 11 studies had completed surgery, chemotherapy and radiotherapy; women in three studies were currently undergoing chemotherapy; and women in five studies were currently undergoing radiotherapy. Women in the remaining five studies were either undergoing treatment or were not. Studies used a variety of questionnaires to assess quality of life, depression, fatigue and/or sleep disturbances. We found that yoga was more effective than no therapy in improving quality of life and reducing fatigue and sleep disturbances. We also found that yoga was better for reducing depression, anxiety and fatigue in women when compared with psychosocial or educational interventions such as counselling. We are fairly certain that these observed results are probably true. Yoga might be as effective as exercise in improving quality of life and reducing fatigue; we do not have enough data to be sure. Studies have poorly reported risks of yoga. However, we found no evidence of serious risks of yoga among women with a diagnosis of breast cancer. No studies have assessed effects of yoga in women given a diagnosis of breast cancer more than five years ago. Our findings indicate that women with a diagnosis of breast cancer can use yoga as supportive therapy for improving their quality of life and mental health, in addition to standard cancer treatments.
+We looked for studies involving adults with gliomas that compared current practice of doing scans at specific time points with other approaches. We found only one study meeting our criteria. This was from a cancer centre in the USA, looking at glioblastoma patients (those with the most aggressive gliomas) who had been treated between 2006 and 2016. The study involved 125 people and split them into those scanned within two days of surgery (early scan) with those who were not. They showed that doing the early scan made no change to the chance of being alive at one and two years after diagnosis. This might have been because the early scans were not used to change treatments, which mainly were to receive standard radiotherapy and temozolomide, and we could not tell if the patients' surgeon(s) were different or had different approaches to care. We judged this suggestion of little change in survival time with or without early scanning to be very uncertain. The number of people included over 10 years was small, and the decision whether or not to have a scan after surgery was based on surgeon's choice. It was not clear whether the surgeon(s) involved or their approaches to care differed, nor whether a person's care might have been changed in light of early imaging. The other search did not find any studies looking at the value of different imaging approaches. We still do not know whether doing scans regularly at specific times after glioma diagnosis changes how well patients do. The limited evidence, suggesting early scans after operations do not affect survival, is unreliable and more research is needed, especially as early scans may also help surgeons improve their practice, and decide whether to repeat the operation earlier than they might otherwise have chosen to do. The best timings and reasons for scanning brain gliomas in adults are not known. Lessons might be learned from studies involving children, and by looking at large collections of clinical trials. It is also important to study the potential costs and benefits of different strategies.
+In November 2015, the Information Specialist of the Cochrane Schizophrenia group searched their specialised register for relevant clinical trials. The search identified four reports. We inspected these reports and found they referred to three trials, randomising people with schizophrenia to receive chlorpromazine or metiapine. Main results Our review now includes three studies with 161 participants. The studies revealed no real differences between chlorpromazine and metiapine for improvement in global state or incidence of parkinsonism (an umbrella term for symptoms such as tremor (shaking), bradykinesia (slow movement), rigidity (stiffness), and postural instability (difficulty in balancing). No data were reported for our other main areas of interest: mental state, service use, satisfaction with treatment, behaviour or cost of care. Conclusions We cannot draw firm conclusions from the data provided. The number of studies and number of participants in each study is small, all studies are also short term. Therefore, we rated the reported evidence as very low quality. However, metiapine is not a highly prescribed or used antipsychotic medicine, so although our evidence is poor, it probably will remain the best available evidence as it is unlikely new trials comparing metiapine with chlorpromazine will be conducted in the future.
+This review examines the results of published studies which have looked at the effect of using medication following surgery for Crohn's disease as a mean of preventing the return (recurrence) of inflammation. Where possible, the results of studies were combined to compare the results of different treatments. A number of medications appeared to reduce the recurrence of inflammation, including metronidazole, mesalamine, azathioprine, 6-mercaptopurine and infliximab. Given that some of these medications have significant side-effects, the decision to use them requires a careful balancing of the risks and benefits for each individual patient
+We found seven studies that examined five talking therapies among 825 people with drug problems. Cognitive-behavioural coping skills training (CBCST) is a talking therapy that focuses on changing the way people think and act. The twelve-step programme is based on theories from Alcoholics Anonymous and aims to motivate the person to develop a desire to stop using drugs or alcohol. Motivational interviewing (MI) helps people to explore and resolve doubts about changing their behaviour. It can be delivered in group, individual and intensive formats. Brief motivational interviewing (BMI) is a shorter MI that takes 45 minutes to three hours. Brief interventions are based on MI but they take only five to 30 minutes and are often delivered by a non-specialist. Six of the studies were funded by the National Institutes for Health or by the Health Research Board; one study did not report its funding source. We found that the talking therapies led to no differences, or only small differences, for the outcomes assessed. These included abstinence, reduced drinking, and substance use. One study found that there may be no difference between CBCST and the twelve-step programme. Three studies found that there may be no difference between brief intervention and usual treatment. Three studies found that there may be no difference between MI and usual treatment or education only. One study found that BMI is probably better at reducing alcohol use than usual treatment (needle exchange), but found no differences in other outcomes. One study found that intensive MI may be somewhat better than standard MI at reducing severity of alcohol use disorder among women, but not among men and found no differences in other outcomes. It remains uncertain whether talking therapies reduce alcohol and drug use in people who also have problems with other drugs. High-quality studies are missing and are needed. The quality of the evidence was moderate for brief and intensive motivational interviewing, but low for brief interventions and standard motivational interviewing, and very low for CBCST versus twelve-step programme.
+This review includes 23 trials, with 1586 participants. The trials compared quinine or quinine-based medicines against inactive treatment (placebo) or other active treatments. We found no new studies when we searched the medical literature again and updated the review in 2014. The risk of bias in the included trials varied considerably. All 23 trials claimed to be randomised, but many failed to clearly describe how participants were assigned to treatments. There is low quality evidence that quinine (200 mg to 500 mg daily) significantly reduces cramp number and cramp days and moderate quality evidence that quinine reduces cramp intensity. There is moderate quality evidence that there are more minor adverse events with quinine compared to placebo but no increase in major adverse events. However, there are reliable reports from other sources that an overdose of quinine can cause serious harm including death. Low or moderate quality evidence shows there is no significant difference when comparing quinine to vitamin E or to a quinine-vitamin E mixture. There is evidence from one trial that theophylline combined with quinine improves cramps more than quinine alone. In a single trial there was no significant difference when comparing quinine to xylocaine injections. More research is needed to clarify the best dose and duration of treatment, as well as alternatives to quinine for cramps. The evidence is current to October 2014.
+We searched for all high quality published studies evaluating the effectiveness of magnesium to prevent muscle cramps and found four studies in older adults and three studies in pregnant women. There were no studies of people who cramp while exercising and no studies on people who cramp because of underlying medical problems. The four studies in older adults (a total of 322 participants including controls in cross-over studies) collectively suggest that magnesium is unlikely to provide a meaningful benefit in reducing the frequency or severity of cramps in that population. We consider this evidence to be of moderate quality. In contrast, the three studies in pregnant women (202 participants) are collectively inconclusive since one study found benefit in reducing both cramp frequency and cramp pain while the other two found no benefit. More research on magnesium in pregnant women is needed; however, older adult cramp sufferers appear unlikely to benefit from this therapy. While we could not determine the rate of unwanted side effects, the study withdrawal rates and adverse event discussions suggest the treatment is well tolerated.
+We included one trial that studied the effects of a six-month, home-based training program that combined exercises to increase muscle strength with aerobic exercise training (exercise that increases breathing and heart rate). The aerobic exercise training used in the trial was recumbent cycling training (seated cycling, with back support). The study included 14 people with SMA type 3, all of whom were able to walk. The participants were between 10 years and 48 years old and had SMA type 3 of mild-to-moderate severity. The nature of the intervention made it impossible to hide the treatment group from participants or personnel, which is an important limitation when measurements rely on participant assessments or effort. The included study was supported by the United States Department of Defense and the SMA Foundation. Participants performed strength training as prescribed, but only half of them completed the full aerobic exercise program. The effects of physical exercise training in people with SMA type 3 remain unclear, as the evidence is very uncertain.
+This review of two trials with 149 patients found no conclusive evidence to support surgical treatment for people with degeneration, radiculopathy or myelopathy. Possible limitations of this review include the the lack of large trials and the risk of bias associated with these studies. Further research is very likely to change the estimate of effects and our confidence in the results. Future large-scale randomised trials with better methods are needed to provide clear evidence on the balance between risk and benefit from surgery for individuals with cervical degeneration with radiculopathy or myelopathy.
+Nine studies were found and analysed to determine whether telephone consultation was safe and effective. In general, at least half of the calls were handled by telephone only (without the need for face-to-face visits). It was found that telephone consultation appears to decrease the number of immediate visits to doctors and does not appear to increase visits to emergency departments. It is still unclear though, whether it is just delaying visits to a later time. Telephone consultation also appears to be safe and people were just as satisfied using the telephone as going to see someone face-to-face. There are still questions about its effectiveness and more research into the use, cost, safety and satisfaction of telephone consultation is needed.
+We found a total of 84 randomised controlled trials (studies where participants were randomly divided into one of two or more treatment or control groups) that compared MI with either no intervention or with a different approach. Seventy of these trials focused on higher risk individuals or settings. We were mainly interested in trials with a follow-up period of 4 or more months, and the typical follow-up period was 12 months. We also evaluated the quality of the studies' designs and their applicability to our research, finding that these studies provided moderate to low quality evidence. In 66 trials, the MI consisted of a single, individual session. In 12 studies, young people attended multiple individual sessions or mixtures of both individual sessions and group sessions. Six trials used group MI sessions only. The length of MI sessions varied, but in 57 studies it was one hour or less. The shortest MI intervention was 10 to 15 minutes, and the longest had five dedicated MI sessions over a 19-hour period. Settings for the trials varied: 58 of the 84 studies took place in college (mainly university but also four vocational) settings. The remaining trials took place in healthcare locations, a youth centre, local companies, a job-related training centre, an army recruitment setting, UK drug agencies and youth prisons. The total number of young adults was 22,872, aged on average from 15 to 24 years old. The proportion of males in the trials with both males and females ranged from 22% to 90%. The ethnicity of the young adults was typically mixed, but 52 of the 67 studies that reported ethnicity involved mostly white people. At four or more months follow-up, we found only small or borderline effects showing that MI reduced the quantity of alcohol consumed, frequency of alcohol consumption, alcohol problems and peak blood alcohol concentration (BAC). We didn't find any effects for binge drinking, average BAC, drink-driving or other alcohol-related risky behaviour. We found no relationship between the length of MI and its effectiveness. Also, there were no clear subgroup differences in effects when we examined the type of comparison group (assessment only control or alternative intervention, the setting (college/university vs other settings), or risk status (higher risk students vs all/low-risk students). None of the studies reported harms related to MI. Although we found some significant effects for MI, our reading of these results is that the strength of the effects was slight and therefore unlikely to confer any advantage in practice. Overall, there is only low or moderate quality evidence for the effects found in this review. Many of the studies did not adequately describe how young people were allocated to the study groups or how they concealed the group allocation to participants and personnel. Study drop-outs were also an issue in many studies. These problems with study quality could result in inflated estimates of MI effects, so we cannot rule out the possibility that any slight effects observed in this review are overstated. The US National Institutes of Health provided funding for half (42/84) of the studies included in this review. Twenty-nine studies provided no information about funding, and only eight papers had a clear conflict of interest statement.
+We found 29 studies involving 2210 people with asthma. Studies lasted between 2 and 26 weeks. Studies reported inhaler technique on a range of different checklists. We grouped studies into three types: studies testing enhanced face-to-face training session(s), studies using multi-media to deliver inhaler training (e.g. a video, computer app or game) and studies testing devices that give people visual or audio feedback about technique. Studies tested different types of training and used different measures to gauge success, meaning that we could not bring data together. This was particularly true when we tried to assess effects on asthma attacks, adverse events, visits to a healthcare provider and absences from work or school. Both face-to-face and multi-media inhaler training improved inhaler technique in most studies, although results varied depending on how and when each technique was assessed. Some studies reported the number of people who had correct or 'good enough' technique. More people had correct or 'good enough' technique after face-to-face training and with feedback devices. But the benefit of multi-media training for adults was uncertain. Interventions that provide inhaler training may bring some benefit for quality of life and asthma control among adults and children, but results were varied and studies were small. Children may receive some benefit but results tended to be less clear for children because fewer and smaller studies have included children as participants. For studies like these, it is not possible to blind people to their assigned group. This may bias how people behave or respond to questionnaires, which reduced our confidence in the findings. We were uncertain about other results because studies did not provide enough data to show clear benefit. We cannot say for sure what is the best way to help people learn how to use their inhaler properly. It is important that patients understand how their inhaler works, so they should ask their doctor or nurse for help. We also use Cochrane Reviews to make suggestions for future research. We suggest that trials should last longer than six months and should report adherence information. The most useful information reported was the number of people who had 'good enough' inhaler technique, so we urge future trials to report this as well.
+This review of three small trials, involving 226 participants, found that there was not enough evidence to decide if mannitol improves survival or prevents disability after stroke. The treatment can cause a number of adverse effects, but no serious adverse events were reported in the trials included in this review. More research is needed.
+Penicillamine is a penicillin derived compound. Studies showed that this could be used to treat rheumatoid arthritis originally in 1950. It was frequently used in the past, but its use has declined with the increasing use of other disease modifying anti-rheumatic drugs (DMARDs), such as methotrexate. The purpose of this summary was to find out if penicillamine is helpful in the treatment of rheumatoid arthritis. Penicillamine was seen to be beneficial for all ranges of dosages for disease activity on tender joint pain, physician global assessment and sed rate. No major differences were observed between placebo and low dose penicillamine (<500 mg/day). For higher dosages, patients on penicillamine were twice as likely to withdraw than those receiving placebo 500 to <1000 mg/day. D-penicillamine appears be have a clinical and statistical benefit on the disease activity of patients with rheumatoid arthritis. Its benefit is similar to that of other such drugs, such as disease modifying anti-rheumatic drugs (DMARDs). More adverse reactions are seen in patients being treated with D-penicillamine.
+We have performed a systematic review of the potential benefits of Chinese herbal medicines in patients being treated with chemotherapy for colorectal cancer. We identified four relevant studies, which included a total of 342 patients, with adequately reported data. We conclude that, from the limited information available, there is some evidence of benefit from decoctions of Huangqi compounds. Compared with patients treated by chemotherapy alone, patients treated with chemotherapy and Huangqi decoctions were less likely to experience nausea and vomiting or low white cell counts. There was some evidence to suggest that the decoctions also stimulated cells of the immune system, but did not affect the levels of antibodies in the blood. We could find no evidence of harm arising from the use of Huangqi decoctions. Our results suggest that further, larger-scale, trials of the use of Huangqi decoctions in the prevention of chemotherapy-related side-effects are needed.
+We identified three clinical studies conducted in the USA and Canada. These studies included 866 participants with RP aged between four and 55 years, who were followed for an average of four years after administration of treatment. One study compared a fish oil extract (docosahexaenoic acid (DHA, 400 mg per day)), to placebo (pretend medicine); the second study compared vitamin A (15000 IU per day) to vitamin E (400 IU per day) and to very low levels of vitamins (vitamin A trace + vitamin E trace); and the third study compared DHA (1200 mg per day) + vitamin A (15000 IU per day) to vitamin A alone (15000 IU per day). The evidence is current to August 2013. All these studies measured the following outcomes: worsening in visual field, worsening in visual acuity (sharpness), and worsening in electroretinography results. Generally, comparison of participants who received vitamin A with or without fish oils (DHA) with participants who received placebo, did not show any difference for these outcomes, which means that the use of high-dose vitamin A or fish oils does not significantly slow progressive visual loss in people with RP. None of the studies reported any systemic adverse events from vitamin A or fish oil. However, the long-term adverse effects of high-dose vitamin A and fish oil are not known. The trials appear to have been well designed and well conducted, so we determined the quality was good for all included studies.
+We searched the available literature up to 30 April 2014. We included three randomised controlled trials with 414 participants who had IA and who were at risk of losing their jobs. These trials first evaluated how the work environment could be adapted and then provided counselling, advice or education for work problems. One trial gave two 1.5-hour sessions over five months. Another trial gave two consultation and multidisciplinary treatments during three months. The third trial gave six to eight individual or group sessions over six months. The included trials compared the effects of interventions to usual care (two trials) or to written information only (one trial). Two of the included trials measured the effect of the intervention on job loss (382 participants) when the third measured effect on work absenteeism and work functioning (32 participants). When considered together, the evidence from the three trials was of very low quality. Two trials found different results on job loss measured at two years' follow-up: one trial on job counselling found a large reduction in people who lost their job and the other trial found similar effects in both groups. Another trial did not find a considerable effect on absenteeism at six months' follow-up but found a moderate improvement in work functioning. Because of positive results from one RCT with long term follow-up, we see potential for job loss prevention interventions in helping workers with inflammatory arthritis to stay at work. The certainty of these results is limited by the very low quality evidence of the three RCTs overall.
+Review authors searched the literature for controlled studies evaluating the efficacy and safety of arginine supplementation. Adding extra arginine to a preterm infant's feed reduced the risk of NEC in three good quality studies that included 285 infants born at less than 34 weeks' gestation. Six infants had to be treated, for one to benefit from treatment. Researchers reported no significant side effects directly attributable to too much arginine in the first 28 days, and one study reported no long-term (36 months) developmental delays. Possible effects of supplementing arginine include lower blood pressure and changes in blood glucose control. Arginine supplementation may reduce the incidence and severity of NEC in preterm infants. Results are limited, as studies included only a few patients. A large study that includes infants from multiple centres is needed to verify these findings.
+A critical systematic review of the literature found four well-conducted, randomised, placebo-controlled intervention studies, involving 1943 participants treated for 15 or 21 days. The results suggest that there may be a modest effect with INCS in the resolution or improvement of symptoms. Only minor adverse events such as epistaxis, headache and nasal itching were reported. Given the small number of studies included in this review, it is recommended that further randomised controlled trials be conducted. The evidence is up to date as of May 2013.
+The review of trials found that low dose continuous infusions, or low dose intermittent administration, of vancomycin reduce the risk of a baby getting sepsis in the neonatal intensive care unit. There is not enough evidence to show if this approach increases antibiotic resistance in nurseries.
+There are many kinds of dressings and topical agents available but few have been evaluated in trials. This review did not find any evidence that any one dressing or topical agent speeds up the healing of surgical wounds healing by secondary intention more than another, although gauze may be associated with greater pain or discomfort for the patient.
+We included 11 studies with a total of 1482 women. These trials looked at many methods: pills, an implant, the injectable 'Depo,' and a hormonal intrauterine device (IUD). Some older reports did not have much data. Most trials showed no major difference due to hormonal birth control use. Two of eight trials noted less breastfeeding among women using hormonal birth control. One was a combined pill with few results and the other a hormonal IUD. In one study, the implant group infants gained more weight than those in the no-method group but less weight than infants in the 'Depo' group. Two trials noted that a combined pill had a negative effect on breast milk volume or content. One report did not have much data. The other showed lower volume for combined pill users than for women taking pills with only progestin. We found little information on any specific birth control method, with usually two studies per method. Results were not consistent across all trials. The data were of moderate quality overall. The results of better quality showed little effect on breastfeeding or infant growth.
+This review looked for studies of their effectiveness in reducing the number of times that drivers drive through red lights and the number of crashes. Very little research has been done and much of it has not allowed for the statistical problems that occur when recording this kind of information. However, five studies in Australia, Singapore and the USA all found that use of red-light cameras cut the number of crashes in which there were injuries. In the best conducted of these studies, the reduction was nearly 30%. More research is needed to determine best practice for red-light camera programmes, including how camera sites are selected, signing policies, publicity programmes and penalties.
+This review of four studies with a total of 494 participants (current until June 2015) found that in patients with acute thromboembolism aged 18 years or older, considerable uncertainty surrounds the use of a 10-mg or a 5-mg loading dose for initiation of warfarin to achieve an INR of 2.0 to 3.0 on the fifth day of therapy. A benefit of 10-mg warfarin compared with 5-mg warfarin was observed for the proportion of patients with VTE who had achieved a therapeutic INR by day five but the quality of the evidence was moderate due to the differences among analyzed studies. In addition, no differences were observed between 5-mg and 10-mg nomograms for recurrent venous thromboembolism, major and minor bleeding, and length of hospital stay. Studies with high-quality evidence regarding the efficacy of 5-mg and 10-mg warfarin nomograms are needed. Quality of the evidence The quality of the evidence was moderate for therapeutic INR and major bleeding, low for recurrent VTE and length of hospital stay, and very low for minor bleeding. The main reason for downgrading the quality of the evidence was differences between the studies in types of study participants and length of follow-up.
+We searched for randomised controlled trials (a type of study in which participants are assigned to one of two or more treatment groups using a random method) that compared any model of enhanced care and rehabilitation for people with dementia after hip fracture versus the usual care provided in the trial setting. The latest search was performed on 16 October 2019. We identified seven trials that studied a total of 555 people with dementia following hip fracture. Five trials compared an enhanced interdisciplinary rehabilitation and care programme where the various healthcare professionals worked collaboratively across hospital and community settings or just in hospital, to usual hospital care. Two trials compared care in-hospital led by a geriatrician versus care led by an orthopaedic surgeon. People with dementia who receive enhanced care and rehabilitation in hospital after a hip fracture may be less likely to develop delirium. When care is led by a geriatrician, they may have stays in hospital that are three to four days shorter than if care is led by an orthopaedic surgeon. There was no information on the effect of any of the care models on quality of life, and we could not be certain about their effects on other important outcomes such as an individual's ability to manage their daily activities, regaining mobility, cognitive function, pain, death rates, or the likelihood of the person returning to the same place they had been living before the fracture. The main issues with the evidence were that most of the studies were small and their results may have been subject to bias. Most of the results of the review are very uncertain. None of the care models had been designed specifically for people with dementia. All of the data included in the review came from people with dementia who had been included in larger trials for all older people with hip fractures, although people with dementia may have particular needs. There may be some benefits from the care models studied, but the currently available research is insufficient to determine the best ways to care for people with dementia after a hip fracture operation.
+This review aimed to examine whether specialist paediatric home-based nursing services for children with acute and chronic illnesses reduce the number of hospital admissions and length of stay, enhance health care in the community and reduce stress for families at the time of their child's illness. It is an update of our original review published in 2006. We found seven relevant randomised controlled trials (RCTs) of total of 840 children aged from birth to 18 years with acute and/or chronic illnesses receiving either specialist home-based nursing services or conventional health care. The outcomes included use of health care services, physical and mental health, satisfaction, adverse health outcomes and costs. We decided not to combine the results of these RCTs because of the variety in types of services provided, types of participants and the outcome measures used. The results of individual RCTs show improved satisfaction with home-based care with no adverse impact on physical health outcomes for children. There is some evidence that specialist home-based nursing services reduce the length of hospital stay; however, there is no evidence that it leads to a reduction in use of hospital services. Further trials are required, measuring health, satisfaction, service use and long-term costs.
+We carried out electronic searches for randomised controlled trials comparing ICM with non-ICM or standard care in 2009, 2012, and 2015. We included 40 trials involving 7524 people. The trials took place in Australia, Canada, China, Europe, and the USA. When ICM was compared to standard care, those in the ICM group were more likely to stay with the service, have improved general functioning, get a job, not be homeless, and have shorter stays in hospital (especially when they had had very long stays in hospital previously). When ICM was compared to non-ICM, the only clear difference was that those in the ICM group were more likely to be kept in care. None of the evidence for the main outcomes of interest was high quality; at best the evidence was of moderate quality. In addition, the healthcare and social support systems of the countries where the studies took place were quite different, so it was difficult to make valid overall conclusions. Furthermore, we were unable to use much of the data on quality of life and patient and carer satisfaction because the trials used many different scales to measure these outcomes, some of which were not validated.  The development of an overall scale and its validation would be very beneficial in producing services that people favour. (Plain language summary initially prepared for this review by Janey Antoniou of RETHINK, UK (rethink.org))
+The trials compared box model training versus no training (16 trials; 464 participants) or versus different types of box model training (14 trials; 382 participants) (some trials and participants were included in both comparisons as the trials compared different methods of box training versus no training). The primary outcomes investigated in this review were time taken to perform task, error score, accuracy score, and a composite (total summed) performance score. Box model training appears to decrease the time required to perform a laparoscopic task, improve the accuracy, decrease the errors, and improves the overall performance. This suggests that the box model training improves technical skills of surgical trainees with no previous experience in laparoscopic surgery. There does not appear to be any significant differences in different methods of box model training. The impact of the improved surgical skills on patients or healthcare funders in terms of improved health or decreased costs is unknown. All but one of the trials were of high risk of bias (defects in study design that can lead to arriving at incorrect conclusions with overestimation of benefits and underestimation of harms). Furthermore, our results are prone to risks of random errors. Overall, the quality of evidence was very low. Further well-designed trials with less risk of bias because of poor study design or because of chance are necessary.
+Two trials on glucocorticosteroids for primary sclerosing cholangitis were identified. One trial compared biliary lavage with hydrocortisone versus saline. This trial was stopped due to adverse events. The other trial compared oral administration of budesonide versus prednisone. No statistically significant effects were found on mortality, serum activity of alkaline phosphatases, serum bilirubin, and adverse events for any of the evaluated intervention regimens.
+The authors identified 11 eligible trials that investigated the timing and route of nutritional support in head-injured patients. These trials included a total of 534 patients. However, of the many of the trials had methodological weaknesses. The authors found that early feeding may be associated with fewer infections and a trend towards better outcomes in terms of survival and disability. However, the trials were small so any improvements detected were on a small scale. Also the focus of many of the trials was on nutritional outcomes, and many did not report the effect on death and disability. The authors were unable to obtain data for death and disability for all of the included trials so they feel there may be a possibility of bias. Further trials of nutritional support following head injury are required. These trials should report death and disability as well nutritional outcomes. They should also be large enough to detect clinically important treatment effects.
+The studies included people in workplaces, colleges or health clinics and internet users. Everyone typed information about their drinking into a computer or mobile device - which then gave half the people advice about how much they drank and the effect this has on health. This group also received suggestions about how to cut down on drinking. The other group could sometimes read general health information. Between one month and one year later, everyone was asked to confirm how much they were drinking. Drinking levels in both groups were compared to each other at these time points. Many (56%) studies were funded by government or research foundation funds. Some (11%) were funded by personal awards such as PhD fellowships. The rest did not report sources of funding. We included 57 studies comparing the drinking of people getting advice about alcohol from computers or mobile devices with those who did not after one to 12 months. Of these, 41 studies (42 comparisons, 19,241 participants) focused on the actual amounts that people reported drinking each week. Most people reported drinking less if they received advice about alcohol from a computer or mobile device compared to people who did not get this advice. Evidence shows that the amount of alcohol people cut down may be about 1.5 pints (800 mL) of beer or a third of a bottle of wine (250 mL) each week. Other measures supported the effectiveness of digital alcohol interventions, although the size of the effect tended to be smaller than for overall alcohol consumption. Positive differences in measures of drinking were seen at 1, 6 and 12 months after the advice. There was not enough information to help us decide if advice was better from computers, telephones or the internet to reduce risky drinking. We do not know which pieces of advice were the most important to help people reduce problem drinking. However, advice from trusted people such as doctors seemed helpful, as did recommendations that people think about specific ways they could overcome problems that might prevent them from drinking less and suggestions about things to do instead of drinking. We included five studies which compared the drinking of people who got advice from computers or mobile devices with advice from face-to-face conversations with doctors or nurses; there may be little or no difference between these to reduce heavy drinking. No studies reported whether any harm came from the interventions. Personalised advice using computers or mobile devices may help people reduce heavy drinking better than doing nothing or providing only general health information. Personalised advice through computers or mobile devices may make little or no difference to reduce drinking compared to face-to-face conversation. Evidence was moderate-to-low quality.
+We found consistent evidence for a possible advantage of benzodiazepines in the improvement of panic symptoms and in the number of participants dropping out of treatment. Furthermore, benzodiazepines may improve social functioning more than placebo. However, there may be more dropouts due to side effects and more participants who experience at least one side effect when treated with benzodiazepines. We found several severe limitations in the design of the included studies. For example, it seems that at least in some studies participants and physicians were able to guess to which treatment arm the participants were allocated, thus it is possible that some trials were not really blinded. These limitations may have led to an overestimation of the treatment effect. Another major limitation is that our included studies were only short-term studies and did not reflect the risks of dependency and withdrawal symptoms. Furthermore, it is unclear if the effect is maintained after the end of treatment. High-quality long-term studies should be carried out to establish whether the benefits of treatment can be maintained and to put the benefits in context of withdrawal effects and the risk of dependency. However, it is unlikely that the general conclusions regarding the short-term efficacy and the dependency potential of benzodiazepines will change. Comparisons with other active treatment including psychotherapy, for example in multiple-treatment meta-analyses, may thus be more suitable to inform clinical practise.
+We searched scientific databases for randomised controlled trials (clinical trials where people are allocated at random to one of two or more treatments) looking at the effects of tai chi on adults at high risk of developing CVD. We did not included people who had already had CVD (e.g. heart attacks and strokes). The evidence is current to December 2013. We found 13 trials, none of them were large enough or of long enough duration to examine the effects of tai chi on reducing cardiovascular deaths or non-fatal endpoints. There were variations in the duration and style of tai chi and the follow-up of the interventions ranged from three to 12 months. Due to the small number of short-term studies and the variability between them, we were unable to determine conclusively whether or not tai chi was beneficial at reducing cardiovascular risk in healthy adults and adults at increased risk of CVD, although beneficial effects for CVD risk factors were seen in some studies. None of the included studies reported on adverse events. Longer-term, high-quality trials are needed in order to determine the effectiveness of tai chi for CVD prevention. The results of this review should be treated with caution as the studies were small, of short duration and there was some risk of bias (where there was a risk of arriving at the wrong conclusions because of favouritism by the participants or researchers).
+We identified 27 trials; 23 in the USA and one each in Australia, India, the Netherlands, and Norway. The focus varied amongst the studies. Fifteen trials focused on substance use prevention: six focused only on tobacco prevention; one focused on alcohol; one on general substance abuse; three on tobacco, alcohol and marijuana; two on alcohol and tobacco; and two on tobacco and cardiovascular health. Two trials focused on HIV and unsafe sex prevention. Ten trials focused on family functioning, child development and modifying adolescent behaviour. Duration of follow-up after the intervention was very varied, ranging from 6 months to over 15 years for the studies which intervened with mothers of very young children. Nine trials provided data to compare a family tobacco intervention to no intervention on future smoking behaviour for those who did not smoke at the start of the study. We could not include data from a further eight trials. The results showed a significant benefit of family-based interventions over the control comparison on preventing experimentation with or taking up regular smoking. Our estimate suggested that family interventions could reduce the number of adolescents who tried smoking at all by between 16 and 32%. Two trials provided data to compare a combined family plus school intervention to a school intervention and also favoured the family-based intervention. The estimate suggested that the addition of a family intervention might reduce the onset of smoking by between 4 and 25%. We could not include data from a further five trials. Our interpretation is that the common feature of the effective interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting). This is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting. Because most of the randomised controlled trials included in the review did not report their methods in sufficient detail to be confident that the results were not biased, we judged the quality of the evidence to be moderate, which means that the estimate of effect is uncertain. There is moderate quality evidence that family-based interventions can prevent children and adolescents from starting to smoke. Intensive programs may be more likely to be successful than those of lower intensity. There is also evidence to suggest that adding a family-based component to a school intervention may be effective. As the interventions and settings in the review differed considerably, it is important that family-based programmes continue to be evaluated.
+In August 2016, we found three relevant studies with 451 participants. The trial size varied from 51 to 280 participants. The duration of the included studies ranged from seven to 14 days. Two studies compared dexamethasone to placebo. The third study compared a number of additional medicines in various combinations, including metoclopramide, chlorpromazine, tropisetron, and dexamethasone. The current evidence is based on a small number of studies with a small number of participants. 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 made the following conclusions from the available evidence: 1) we found very low-quality evidence of the effects of steroids on nausea and vomiting in cancer patients; 2) there was no evidence about how steroids work in different types of cancer; and 3) there were few reported side effects, and the drugs were generally well tolerated. More high quality studies are needed to determine if steroids are effective anti-nausea agents.
+In February 2015, we searched for studies examining the effect of antibiotics to prevent LRTI in children aged 12 years and under with an increased risk of contracting such infections. We included 10 studies; three examined the effectiveness of antibiotics in 1345 children with HIV, four in 429 children with cystic fibrosis, one in 219 children with sickle cell disease, one in 160 children undergoing treatment for cancer, and one in 40 children who were underweight at birth with underlying breathing problems. The study duration was between 18.9 and 24.7 months for children with HIV, between six and 36 months in children with cystic fibrosis, 15 months in one study of children with sickle cell disease, 13 to 24 months in one study of children with cancer, and seven days in low birth weight newborns with underlying respiratory problems. Of three studies that included children with HIV, one was funded by an International Aid Agency, another by government and the third by a charity. Of four studies that included children with cystic fibrosis, three were funded by charities and one by government. The one study that included children with sickle cell disease was funded by government and the study that included children with cancer was funded by government, industry and charity. The funding source for the study that included newborns with underlying respiratory disorders was not specified. In children with HIV, antibiotics did not reduce the likelihood of contracting tuberculosis. Overall there was no improvement in death rates, but there was a marked reduction in hospital admission with antibiotic use in one study. In children with cystic fibrosis, antibiotics did not reduce the likelihood of infection with Pseudomonas bacteria, but there was a reduction in flare-ups, where bacterial infection makes it harder for the child to breathe. In one study of children with sickle cell disease, antibiotics reduced the likelihood of contracting blood infections. In one study of children with cancers, antibiotics reduced the likelihood of contracting Pneumocystis infection in the lungs. In low birth weight newborns with respiratory disorders, antibiotics did not reduce the likelihood of lung infections. In children with HIV, we rated the overall quality of the evidence for two studies that examined the effect of antibiotics for preventing tuberculosis as moderate because of differences in how the antibiotics were administered. We rated the quality of the evidence for antibiotic use in reducing deaths as moderate because of differences in the types of antibiotics used. Due to lack of data, we could not rate the quality of the evidence for hospital admissions. In children with cystic fibrosis, we rated the overall quality of the evidence for two studies that examined the effect of antibiotics in reducing the likelihood of Pseudomonas infection as moderate because of differences in the types of antibiotics used. We rated the quality of the evidence for the effect of antibiotics in reducing 'flare-ups' as high. In children with cancer, we rated the quality of the evidence for the effect of antibiotics in reducing the likelihood of Pneumocystis infection as moderate because of the likelihood of indirectness of the study results. Due to lack of data, we could not rate the quality of the evidence for the effect of antibiotics in reducing the likelihood of blood infections in children with sickle cell disease, or in reducing the likelihood of lung infections in low birth weight newborns with respiratory disorders; the two studies had low probability and high probability of bias respectively.
+We searched for all relevant studies up to September 2016. We identified nine clinical trials with 519 participants, of which three trials (196 participants) compared nitrous oxide (laughing gas) with carbon dioxide, five trials (177 participants) compared helium with carbon dioxide, and one trial (146 participants) compared room air with carbon dioxide. Studies were conducted in the USA, Australia, China, Finland, and Netherlands. The age of the participants in the trials ranged from 19 to 62 years. We are uncertain as to whether there are differences in the number of people with heart or lung complications or surgical complications between nitrous oxide and carbon dioxide. We are uncertain as to whether there are any differences in heart or lung complications, surgical complications, or pain scores between helium and carbon dioxide. There were no serious side effects related to the use of carbon dioxide, nitrous oxide, or room air, but generally serious side effects are rare events and it would take larger studies with many more participants to be sure that these gases are equally safe. There were three serious side effects when helium was used. Room air seemed to be associated with lower total hospital costs compared with carbon dioxide for insufflation of the abdominal cavity. Because of the few participants included in the review, the safety of using nitrous oxide, helium, or room air is unknown. There is no evidence for any clinical improvement by using nitrous oxide, helium, or room air instead of carbon dioxide. Overall, the quality of the evidence for the results is very low. Thus, future well-designed trials examining complications, harms, quality of life, and pain are urgently needed.
+Searching all electronic databases to 21 March 2016 revealed 14 studies investigating two or more different corticosteroid regimens in preterm infants. The investigated regimens differed in the used cumulative dose, timing of initiation and duration of therapy. Those studies comparing a high versus a lower-dosage regimen showed an increased risk of BPD and adverse neurodevelopmental outcome for infants receiving a lower cumulative dose. Those studies investigating an early versus later administration of steroids did not show any difference in outcome. Furthermore, pulse regimens showed inferior results for the outcome BPD compared with continuous treatment. An individualized dosage regimen showed no differences compared to the standard tapering course. Most of the studies had important methodological weaknesses, preventing any recommendations on the optimal corticosteroid dosage regimen for preterm infants at risk of BPD. More studies are urgently needed.
+This is an update of a review published in 2003 and previously updated in 2009 and 2012. For this latest update, the search was rerun on 17 October 2013, and no new studies were found. Rheumatic fever is a late complication of a type of throat infection caused by streptococcal bacteria. It is an immune system disease that can lead to inflammatory disease of the heart (carditis), joints, brain and skin. Carditis can cause heart failure and death. Various anti-inflammatory drugs have been used to treat carditis, including corticosteroids, aspirin and immunoglobulins (immune therapy using antibodies). No new trials were identified in this update. This review includes eight trials with 996 participants. Evidence shows little effect of corticosteroids over aspirin in preventing cardiac disease after one year (six studies, 907 participants, risk ratio 0.87, 95% confidence interval 0.66 to 1.15). Several steroidal agents such as corticotrophin, cortisone, hydrocortisone and dexamethasone were compared with aspirin before 1966, and prednisone and immunoglobulins were compared with placebo in studies from 1990 and 2001, respectively. Most studies did not report on adverse events, but those that did reported complications due to corticosteroids including weight gain, enlarged facial features and acne. Trials were generally old (six of the eight trials were conducted between 1955 and 1965), small and of poor quality and had high risk of bias. For this reason, results should be interpreted with caution.
+We included six studies involving 12,294 participants of different ages and both sexes in this review. The trials were conducted in The Gambia, Mali, Tanzania, Niger and Ethiopia. Two studies looked at insecticide spray, one looked at insecticide spray and provision of latrines, one study looked at provision of latrines, and two studies looked at health education with one of them having health education combined with water supply. Prevalence of active trachoma, prevalence of Chlamydia trachomatis and fly count measures were the main outcomes assessed. Two studies conducted in the same area found insecticide spray effective in reducing active trachoma but one study in a different setting found the spray ineffective. A separate study found health education on personal and environmental hygiene to be effective in reducing active trachoma, however, another study found that a modest health education programme combined with a modest water supply was not effective in reducing active trachoma. One study on latrine provision found no impact on trachoma. However, more research is needed.
+This review aimed to find out whether CBT is effective for CBT, both as a standalone treatment and in combination with other treatments, and whether it is more effective than other treatments used for CFS. The review included 15 studies, with a total of 1043 CFS participants. The review showed that people attending for CBT were more likely to have reduced fatigue symptoms at the end of treatment than people who received usual care or were on a waiting list for therapy, with 40% of people in the CBT group showing clinical improvement, in contrast with 26% in usual care. At follow-up, 1-7 months after treatment ended, people who had completed their course of CBT continued to have lower fatigue levels, but when including people who had dropped out of treatment, there was no difference between CBT and usual care. The review also compared CBT against other types of psychological therapy, including relaxation techniques, counselling and support/education, and found that people attending for CBT was more likely to have reduced fatigue symptoms at the end of treatment than those attending for other psychological therapies. Physical functioning, depression, anxiety and psychological distress symptoms were also more reduced when compared with other psychological therapies. However at follow-up, the results were inconsistent and the studies did not fit well together, making it difficult to draw any conclusions. Very few studies reported on the acceptability of CBT and no studies examined side effects. Only two studies compared the effectiveness of CBT against other treatments, both exercise therapy, and just one study compared a combination of CBT and other treatments with usual care. More studies should be carried out to establish whether CBT is more helpful than other treatments for CFS, and whether CBT in combination with other treatments is more helpful than single treatment approaches.
+The review included one study which recruited 46 people with sickle cell disease aged between seven and 21 years; of these 39 people in the study were randomly selected to take vitamin D tablets or placebo tablets for six weeks and then followed up for six months. The study reported results from 37 people. People taking a vitamin D supplement had higher levels of vitamin D in their blood when it was measured after eight, 16 and 24 weeks. There were no differences in the number of people reporting side effects, such as tingling in the lips or hands between the vitamin D group and the placebo group. The vitamin D group had fewer days of pain compared to the placebo group. The study also reported on health-related quality of life (physical functioning scores). After eight weeks the vitamin D group had a slightly worse score than the placebo group, but the difference was much greater after 16 and 24 weeks. Given these results from this small single study with moderate to low quality of the evidence, we do not think the results of our review are of sufficient quality to guide clinical practice. Until further evidence becomes available, clinicians should consider relevant existing guidelines for vitamin D supplementation (e.g. the Endocrine Society Clinical Practice Guidelines), and recommendations for calcium and vitamin D intake (from e.g. the USA Institute of Medicine). High-quality studies looking at the effects of supplementing vitamin D in children and adults with sickle cell disease are needed. We do not think there are risks of bias in the way people were put into the different groups and we do not think anyone (either the participant or the doctor) could guess which group they were in once the study started. Even though the adverse events were not reported in the original report, the study author provided the information upon request. More people dropped out of the placebo group (68.4%) than the vitamin D group (5%), and two people assigned to vitamin D group but not included in the analysis. We considered there was a high risk of bias in the way the study reported results. The evidence is only applicable to people with sickle cell disease when they are in a steady state, i.e. at least 30 days from blood transfusion and at least 14 days from any acute sickle complication. The quality of evidence for the outcomes ranged from moderate to low. We considered the quality of the evidence for vitamin D blood levels to be moderate, and for adverse events, days of pain and health-related quality of life, the quality of the evidence was low.
+We found one study with 26 children aged 4 to 12 years with CAS. The children had mild to severe CAS without a known cause. Children were allocated randomly (using a method like coin tossing) to one of two treatments: the Nuffield Dyspraxia Programme - Third Edition (NDP-3); and the Rapid Syllable Transition treatment (ReST). Both therapies were delivered intensively in one-hour sessions, four days a week for three weeks. The treatments were delivered by speech pathology students in a university clinic. Outcomes were assessed before therapy, immediately after therapy, at one month and four months post-therapy. Our review looked at one-month post-therapy outcomes only. The included study was funded by the Australian Research Council; the University of Sydney International Development Fund; Douglas & Lola Douglas Scholarship on Child and Adolescent Health; Nadia Verrall Memorial Scholarship; and a James Kentley Memorial Fellowship. Further studies replicating these findings would strengthen available evidence. The study provides limited evidence that the NDP-3 may improve the accuracy of production on treated items and the accuracy of connected speech. There is limited evidence that the NDP-3 has a negligible effect on speech production consistency, and the ReST a negligible effect on accuracy of production on non-treated words. The study did not measure functional communication. The included study was a randomised controlled trial with an overall low risk of bias. We downgraded the quality of the evidence by one level to moderate, due to imprecision, given that only one RCT was identified. There is limited evidence that the NDP-3 or ReST may be helpful for children with CAS of unknown origin, aged 4 to 12 years, without other co-occurring conditions. We were not able to find out whether one of these treatment was better than the other, or whether either was better than no treatment or treatment as usual. There is currently no available evidence for other treatments. Further RCTs — including studies comparing treatments to a no-treatment (wait-list) control group — would strengthen the evidence base. Further research is also needed for children with CAS and other disorders or diagnoses.
+We found four studies with a total of 268 participants. These studies were conducted in Brazil, the UK, and the US. The evidence is current to 22 February 2016. Only one of the four studies compared the effect of antibiotic treatment for 12 months with placebo on visual acuity and found similar changes in both groups. Three studies examined the effect of antibiotics on reducing the number of recurring episodes of the disease. Two of these three studies were conducted in Brazil in adults infected with the more aggressive South American strains of the parasite, which can cause frequently recurring eye symptoms. The studies from Brazil found that the long-term antibiotics over 14 and 12 months, respectively, reduced the number of recurrent episodes of retinochoroiditis. The other study did not find that short-term (eight weeks) treatment with antibiotics made any difference. Two studies reported an improvement in intraocular inflammation in antibiotic-treated compared with untreated participants, and one study reported no changes. Two studies investigated side effects of giving antibiotics such as decreased white blood cells, loss of appetite, rashes and other allergic reactions and found only weak evidence that antibiotics increase the risk of side effects. There were problems with the design, conduct, and analyses of all of the studies, which could have biased the results. There was a lack of evidence about whether antibiotics (short or long term) prevent vision loss. More trials are needed, including trials of newer antibiotics.
+The main results were for the comparisons of various types of intramedullary nails with the sliding hip screw. Twenty-two trials, involving 3749 participants, tested the Gamma nail. Five trials, involving 623 participants, tested the intramedullary hip screw (IMHS). Three trials, involving 394 participants, tested the proximal femoral nail. Other trials involved newer varieties of intramedullary nails. Most older trials showed a tendency for the nails to be associated with an increased risk of fracture of the thigh bone both during and after the operation. More recent trials testing newer varieties of nails seemed to avoid this specific problem to some extent. The review found that using intramedullary nails resulted in one extra reoperation in every 50 people. Mortality and, where data were available, other long-term outcomes were similar between the implants. The review concluded that current evidence supports the continued use of the sliding hip screw for fixing the more common types of extracapsular hip fractures. This may not be the case for some of the more recently developed designs of intramedullary nails or for specific fracture types, but further research is required to confirm this.
+We found only one relevant study. It included only 47 cases: 27 had an operation to relieve bowel obstruction and the 20 who did not have an operation were given a drug called Octreotide to control the amount of vomiting that often results from bowel obstruction. Among the 27 women who had an operation, six women could not have their bowel obstruction corrected because the cancer had spread too far, six women had serious complications of surgery and three died of these complications.  Nevertheless, the authors of the study reported that women who had the operation survived longer, on average, than those who did not, even after allowing for their underlying better health. It was unclear how much of the difference in survival could be ascribed to the differences in treatment and how much to the better health of women undergoing surgery. Unfortunately the study did not assess their QoL or level of pain. The study reported the numbers of women who could start eating again after their treatment (surgery or Octreotide) but it didn't analyse this allowing for the underlying difference in health of women in the two groups, so it is impossible to interpret these results. We were therefore unable to reach definite conclusions about the relative benefits and harms of the two forms of treatment and we were unable to identify sub-groups of women who are likely to benefit from one treatment or the other.
+There is no good evidence from this review that statins improve menstrual regularity, spontaneous ovulation rate, hirsutism or acne, either alone or in combination with the combined oral contraceptive pill. There is also no good evidence that statins have a beneficial effect on hirsutism or acne (pimples) associated with PCOS. In women with PCOS, statins are effective in reducing serum androgen levels and decreasing bad cholesterol (LDL), but statins are not effective in reducing fasting insulin or insulin resistance. There is no good evidence available on the long-term use of statins (alone or in combination) for the management of PCOS.
+the searches were updated to March 2018. We found no randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) for inclusion, so there is an absence of evidence that tranexamic acid, vaginal packing (with or without formalin-soaked packs), interventional radiology techniques or other interventions are as effective or safe as radiotherapy for palliative control of bleeding from the vagina in advanced cervical cancer. There is a need for randomised controlled trials or good-quality non-randomised comparative studies to determine the effectiveness and safety of these interventions when compared with radiotherapy in terms of symptom control, quality of life and side events. no studies fulfilled the inclusion criteria and so there is no good-certainty evidence.
+Three randomised controlled trials (RCTs) enrolling patients with newly diagnosed glioblastoma multiforme (GBM - a form of HGG) have studied chemotherapy with temozolomide during and after radiotherapy. This was compared with radiotherapy only. Those who received temozolomide had an improved survival and delayed progression of the disease. The short-term adverse events associated with temozolomide are low but can be severe, while the long-term effects are unknown. No RCTs investigated the use of temozolomide in HGGs other than GBM. In recurrent GBM, temozolomide delayed progression but did not improve overall survival. In the elderly population (age over 60 years), temozolomide alone appears to be a suitable alternative to radiotherapy alone for primary therapy of GBM. Either treatment has similar overall survival, progression-free survival and quality of life, but there are possibly more adverse events with temozolomide. All these trials enrolled highly selected patients with good prognostic features that are not entirely representative of all patients with HGG limiting the general applicability of these results.
+It is difficult to draw any conclusions about the effects of these types of interventions as the review only found two relevant studies. In addition, the evidence that the review did identify was of low quality. Training: The available evidence suggests that in-service district manager training: ·       may lead to more knowledge about planning processes ·       may lead to better monitoring and evaluation skills None of the studies assessed the effects of district manager training on people’s health, on their access to or use of health care, or on the quality or efficiency of care. Contracting-in: The available evidence suggests that private contracts with international NGOs for district health systems management: ·       may not affect people’s illness reporting, diarrhea incidence or infant death ·       may increase the likelihood that a health facility is open 24 hours ·       may increase the availability of medical equipment and supplies ·       may increase people’s use of antenatal care and public facilities None of the studies assessed the effects of contracting-in district management on the quality or efficiency of health care, on job vacancy rates, or on district manager knowledge and skills.
+We searched scientific databases for studies comparing surgical treatment with nonsurgical treatment in adults or children with flail chest. We included three studies in this review, which involved 123 people. In these studies, people with flail chest were randomly allocated into the surgery or no surgery study groups. The results show that surgery to repair the broken ribs reduces pneumonia, chest deformity, tracheostomy, duration of mechanical ventilation and length of ICU stay. There was no difference in deaths between people treated with surgery or no surgery. Since only six people died across the three studies, due to a variety of causes, more research is needed in order to know for certain which treatment is better for reducing deaths. These three small studies have shown that surgical treatment is preferable to nonsurgical treatment in reducing pneumonia, chest deformity, tracheostomy, mechanical ventilation and length of stay in the ICU. More research is needed in order to know which treatment is better for reducing deaths. Three more studies are being undertaken by researchers in the USA and Canada at the moment, and the results will be incorporated into the review in the future.
+We looked for high quality randomised trials (RCTs) and before-and-after studies with cerivastatin in different dose sizes . The trials were between three and twelve weeks long. People of any age and gender, either with or without heart disease were in these trials. Participants could be of any age and gender, with or without cardiovascular disease. We found fifty trials with 13,018 participants who had their lipid levels measured. 12,877 participants had their LDL cholesterol measured. People taking 0.025 to 0.8 mg of cerivastatin per day lowered their LDL cholesterol by 12% to 42%. The higher the dose, the lower the levels of three measures of cholesterol. HDL cholesterol increased by 5%. For lowering LDL cholesterol, cerivastatin is 250-times stronger than fluvastatin, 20-times stronger than atorvastatin and 5.5 times stronger than rosuvastatin. Only 11 of the 19 RCTs reported the number of people who dropped out of the studies because of adverse effects. The level of drop outs due to adverse effects were similar in the people who took cerivastatin and placebo. There is a high level of trust around the results  for total cholesterol and LDL cholesterol and very low to moderate for triglycerides. We have a low level of trust in the evidence around drop outs because many (8 out of 19 trials) did not report drop outs due to adverse effects.
+We performed a search off all available literature on 8 August 2016 to find all randomised controlled studies. 28 studies including 6851 patients were included in this analysis. Five studies included children undergoing cardiac surgery. Adult studies included patients undergoing major vascular surgery (three studies), cardiac surgery (nine studies), coronary bypass surgery (10 studies) and partial kidney resection (one study). The overall quality of the studies was acceptable. Twenty studies were funded without economical interest. One study was funded from a source with commercial interest. The other seven studies did not report funding. Remote ischaemic preconditioning performed with a blood pressure cuff appears to be safe as only two of 15 studies reported adverse effects (6/1999 in the remote ischaemic preconditioning group and 1/1994 in the control group). However remote ischaemic preconditioning by vascular clamping may cause vascular complications. Kidney injury in patients undergoing (surgical) procedures in which kidney injury may occur, was not reduced by remote Ischaemic preconditioning measured at day one, two or three after surgery. The need for dialysis, hospital stay and death were not reduced by remote ischaemic preconditioning. Although remote ischaemic preconditioning by cuff inflation is safe, available data do not confirm the efficacy of remote ischaemic preconditioning in reducing kidney injury.
+The evidence is current to May 2014. We found 12 randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) with 703 people with stroke. Of these 12 trials, eight trials recruited only people with fatigue and were primarily intended to treat fatigue, no trial was primarily intended to prevent fatigue and the other four trials were not primarily intended to treat or prevent fatigue but reported fatigue as an outcome. There was insufficient evidence to support the use of any intervention to treat or prevent fatigue in people with stroke. The general study quality was low. The available data were limited as each identified intervention was only investigated in a single trial. In addition, some trials were small and used poor study designs. Therefore, further trials of better quality are needed.
+The objective of this review was to determine the effectiveness and safety of interventions for this serious condition. Two studies enrolling 52 infants that assessed the use of a combination of insulin and sugar to reduce the blood levels of potassium were identified. This combination reduced the duration of high blood levels of potassium and the risk for bleeds in the brains of the infants. One study that enrolled 19 patients reported on the use of albuterol (a medication that helps to move potassium from the blood to the body cells). Albuterol lowered the blood levels of potassium both at four and at eight hours after the treatment had started. Because of the few infants enrolled in the studies to date, no firm recommendations for the treatment of too high blood levels of potassium in neonates can be made. Further research is needed.
+We included trials of IVIg compared to no treatment, dummy treatment, PE, immunoabsorption (in which specific antibodies are removed from blood) or other immune treatments. We also considered trials of IVIg added to another treatment. We found 12 trials. Some of these compared more than two treatments. - Seven trials compared IVIg with PE (in 623 participants with severe GBS). - One compared PE alone to PE followed by IVIg (in 249 participants). - Three compared IVIg with supportive care (in a total of 75 children). - One compared a two-day to a five-day IVIg treatment plan (in 51 children). - One compared IVIg with immunoabsorption (in 48 participants). - One compared IVIg plus immunoabsorption with immunoabsorption (in 34 participants). For this review, we chose change in a disability scale after four weeks’ treatment as the main measure of the effect of IVIg. Five of the trials comparing IVIg and PE measured change in disability. IVIg and PE produced a similar amount of improvement in disability in the 536 trial participants. This evidence was of moderate quality. Harmful effects were no more frequent with PE or IVIg, but people were more likely to finish a course of IVIg. In one trial involving 249 participants who received PE or PE followed by IVIg, there was slightly more improvement from PE and IVIg together. The effect was probably not large enough to be noticeable but the results do not rule out the possibility. This evidence was of moderate quality. Three studies in children suggested that IVIg speeds up recovery compared with supportive care. Only one used the disability scale. They provided low quality evidence. In one small trial in children, the effect on disability appeared similar with a standard dose over two days rather than five days. Giving IVIg after immunoabsorption provided no extra benefit over immunoabsorption alone. No conclusions can be drawn from the trial comparing IVIg with immunoabsorption. The risk of bias in the included studies was variable. More research is needed to find the best dose of IVIg in adults and children, and one trial of giving a second dose to people who otherwise would be expected to do badly is in progress. The evidence is current to December 2013.
+We identified 28 randomized clinical trials. Eight trials with 4918 participants reported on risk of death, and 15 trials with 7219 participants reported on surgical site infections within 14 to 30 days of surgery. Four trials reported serious adverse events, three trials respiratory insufficiency, nine trials length of stay during the associated hospital admission and one trial quality of life. All trials were conducted without direct industry funding. The number of participants in each trial ranged from 38 to 2012. The mean age of participants was 50 years (range 15 to 92 years) and 63% were women. Types of surgery included abdominal surgery (eight trials), caesarean section (four trials), breast surgery (one trial), orthopaedic surgery (two trials) and various other surgical procedures (four trials). A high percentage of inspired oxygen was not statistically associated with increased risk of death, or with a decrease in surgical site infections, in all trials that measured these outcomes, in trials of highest quality and in those with longest follow-up. An increased risk of adverse events could not be proved right or wrong for a high percentage of inspired oxygen during anaesthesia and surgery. Only five of the included trials had low risk of bias. The trials randomly assigned 9330 participants, of whom only 7537 participants provided data for this review. The number of participants required to detect or reject a 20% relative risk reduction in deaths was not reached; therefore the observed results were uncertain.
+This review included evidence available up to 14 April 2016. In total 25 studies (3663 children) were eligible for inclusion. Two studies did not report on any of the outcomes of interest, leaving 23 studies (3258 children). Overall, we assessed most studies as being at low to moderate risk of bias. In the 23 studies many different antibiotics were used and the children were of different ages and had suffered from glue ear for various lengths of time. They looked at the benefits at various time points after the treatment was given. The most important outcomes that we measured were the difference in the proportion of children who no longer had glue ear two to three months after the treatment was started and adverse effects of antibiotics (diarrhoea, vomiting or skin rash). We found moderate quality evidence (six trials including 484 children) that children treated with oral antibiotics are more likely to have glue ear resolved two to three months after the treatment was started than those allocated to control treatment. The number of children needed to treat for one beneficial outcome (NNTB) was five. However, there is evidence (albeit of low quality; five trials, 742 children) indicating that children treated with oral antibiotics are more likely to experience diarrhoea, vomiting or skin rash than those allocated to control treatment. The number of children needed to treat for one harmful outcome (NNTH) was 20. In respect of the secondary outcome of having glue ear resolved at any time point, we found low to moderate quality evidence from five of our analyses where we combined data from studies (meta-analyses), which included between two and 14 studies, of a beneficial effect of antibiotics, with a NNTB ranging from three to seven. Time periods ranged from 10 to 14 days to six months. In terms of other secondary outcomes, only two trials (849 children) reported on hearing levels at two to four weeks and found conflicting results. None of the trials reported data on speech, language and cognitive development or quality of life. Low quality evidence did not show that oral antibiotics were associated with fewer ventilation tube (grommet) insertions (two trials, 121 children) or in adverse consequences for the tympanic membrane (ear drum) (one trial, 103 children). Low quality evidence indicated that children treated with oral antibiotics were less likely to have acute otitis media (ear infection) episodes within four to eight weeks (five trials, 1086 children; NNTB 18) and within six months after treatment was started (two trials, 199 children; NNTB 5). It should however be noted that the beneficial effect of oral antibiotics on ear infection episodes within four to eight weeks was no longer significant when studies with high risk of bias were excluded. Moderate quality evidence is available that children with glue ear do benefit from oral antibiotics in terms of resolving glue ear at various time points and reducing acute otitis media episodes during follow-up compared with control treatment. Low quality evidence is available that children treated with oral antibiotics are more likely to experience diarrhoea, vomiting and skin rash than those receiving the control treatment. Currently only two trials have assessed the impact of oral antibiotics on hearing and these showed conflicting results (low quality evidence). Low quality evidence did not show that oral antibiotics were associated with fewer ventilation tube insertions or in adverse consequences for the tympanic membrane.
+Based on 12 studies, including from eight to 160 people with type 1 and type 2 diabetes for at least an average four-month period, restricted protein intake appeared to slow progression of diabetic kidney disease, but not by much on average. However, individual variation existed, therefore a low-protein diet may benefit some individuals. A low-protein diet can be difficult to adhere to, especially over the long term. Reducing the amount of animal protein is the usual method but some evidence suggests that a shift from red meat to white meat and fish or vegetables may give similar results. We found no data on the effects of low-protein diet on health-related quality of life and costs.
+Studies eligible for inclusion in this review were controlled trials, in which one group of people received treatment (such as MD rehabilitation) and was compared with a similar group that received a different treatment. We found 19 relevant studies, which involved a total of 3480 people. We searched the medical literature worldwide on 14 September 2015. We used the Van Tulder system to rate the strength of the evidence as it distinguished better between trials of different quality than the standard GRADE system on criteria that are important in the context of rehabilitation. For mild brain injury, information and advice were usually more appropriate than intensive rehabilitation. As a whole, studies suggest that patients with moderate to severe brain injury who received more intensive rehabilitation showed earlier improvement, and that earlier rehabilitation was better than delayed treatment. Strong evidence supports the provision of cognitive rehabilitation in a therapeutic 'milieu', that is, an environment in which patients receive predominantly group-based rehabilitation alongside a peer group of others who are facing similar challenges. Trial-based literature provided little evidence related to other aspects of MD rehabilitation, so the review authors recommend that additional research should be done. Rehabilitation for brain injury is such an individualised and long-term process that research studies do not necessarily facilitate general conclusions. Overall the included studies were of good quality; 12 of 19 studies were judged to be of high quality according to the van Tulder scoring system. The other studies were at risk of bias because of elements of their design, for example, in one study, treatment depended on the availability of a bed in the rehabilitation unit. Bed availability is a haphazard way of allocating treatment to patients, and this makes results of the study prone to bias.
+The latest search was done on 30th May 2016. No new studies were identified. Only one study is included in the review. One trial (involving 176 women) was analysed which provided information on the rate of exclusive breastfeeding on discharge from hospital. We found that there was low-quality evidence that keeping mother and infant together in the same room after birth until they are discharged from the hospital increased the rate of exclusive breastfeeding at four days after birth. There was no difference between the groups in the proportion of infants receiving any breastfeeding at six months of age. We found little evidence to support or refute the practice of rooming-in after birth. A randomised controlled trial is needed and it should report all important outcomes, including breastfeeding duration.
+This review of eight trials, involving 660 participants, indicated that sanchi improved short-term outcome. However, the evidence from the small sample size and inferior quality of the studies does not support its routine use for acute ischaemic stroke. Well-designed trials are required.
+The seven identified studies included too few patients to answer the questions. Four studies evaluated which is the best time to place implants. One study evaluated whether bone grafting is advantageous at implant placement and two studies evaluated which are the best grafting techniques. There is currently too little evidence to draw any reliable conclusions, however, the aesthetic outcome could be slightly better when placing implants early after tooth extraction, though early placed implants might be at a higher risk of failure. There is not enough evidence supporting or refusing the need of bone augmentation when extracted teeth are immediately replaced with dental implants, nor it is known whether any augmentation procedure is better than the others. Bone substitutes (anorganic bovine bone) can be used instead of self generated (autogenous) bone graft.
+Two different types of MPAC have been used in clinical trials and the drugs are known as PBT1 and PBT2. The trial of PBT1 compared with placebo (in 36 patients) showed no statistically significant difference in cognition or memory between the active treatment and placebo groups at 36 weeks. We therefore conclude that there is no current evidence that treatment with clioquinol (PBT1) has any significant effect on cognition and in particular memory (as measured by the ADAS-Cog scale) in patients with Alzheimer's dementia. This drug has now been withdrawn from development. The trial of PBT2 showed it was safe after 12 weeks of treatment but demonstrated no overall significant effect on cognition or memory.
+We included 36 studies with 2999 people. Trials were conducted for 14 weeks on average, with some as long as 12 months. Most trials involved adults, and two trials specifically included children. Nineteen trials included those with group 1 pulmonary arterial hypertension (inherited, unknown, due to connective tissue diseases). People who were given PDE5 inhibitors were compared with those not given PDE5 inhibitors. This review shows that when given PDE5 inhibitors, on average people walked 48 meters further in six minutes (8 trials, 880 people). They also improved their functional class (reducing the physical limitations associated with PH), and were less likely to die (high-certainty evidence). They were also more likely to have side effects, including headache, flushing and muscle aches. Five trials included people with pulmonary hypertension due to left-heart disease. This review shows that when given PDE5 inhibitors, these people were on average able to walk 34 metres further in six minutes (3 trials, 284 people; low-certainty evidence). However, there was no difference in survival, compared to those who were not given PDE5 inhibitors. Five trials included people with pulmonary hypertension due to lung disease (mostly chronic obstructive pulmonary disease and some idiopathic pulmonary fibrosis). When given PDE5 inhibitors, they were able to walk 27 meters further in six minutes (low-certainty evidence), but with no difference in survival, compared to those who were not given PDE5 inhibitors. Three trials included people with pulmonary hypertension due to blood clots; there was no significant difference in outcomes for those who used PDE5 inhibitors compared to those who did not. There was good-quality evidence for those with pulmonary arterial hypertension, giving us some confidence that the results are correct. The evidence for those with pulmonary hypertension due to heart disease was less certain. The quality of evidence in this group was low because there were few trials, small numbers of people taking part, and the trials were quite different from each other, making it difficult to draw firm conclusions.
+We searched the literature up until April 2016 and identified 22 randomized controlled trials for inclusion in the review. These trials involved a total of 2193 participants who were given regional anaesthesia for hand, wrist, forearm or elbow surgery. The trials used methods that were generally adequate and did not affect the validity of the findings. Nine trials compared double versus single injections. These found that people in the double-injection group had a 45% reduction in their chance of needing additional anaesthesia. The effect was more certain in the four trials where the nerves were located using the more precise method of neurostimulation. In the nine trials comparing multiple with single injections, and the 12 trials comparing multiple with double injections, there were significant reductions in the chance of needing additional anaesthesia in the multiple-injection groups (75% and 73% reductions when compared to single and double injections respectively). In addition, people in the multiple-injection group were 47% less likely to experience pain from the surgical tourniquet compared to the double-injection group. There were no other statistically significant differences in complications or patient discomfort between the two groups for any of the three comparisons. Single and double injections took less time to perform than multiple injections, but this did not reduce the total time required for adequate surgical anaesthesia to be established. Overall, there is high-quality evidence showing that multiple injections of anaesthetic close to three or four nerves in the armpit provide more complete anaesthesia for hand and forearm surgery than one or two injections. There was, however, not enough evidence to determine if there was a significant difference in the other outcomes, including safety.
+The review of trials found that the inhaled steroid, beclomethasone causes an average decrease in growth of about one and a half centimetres a year. However, it is not known whether there is any catch-up growth once the treatment is stopped. More research is needed.
+The aim of this review was to compare the effectiveness of CAPD and APD. Only three small randomised controlled trials (RCTs) (139 patients) were identified after an extensive literature search, and we found no difference between CAPD and APD for clinically important outcomes. APD may however be considered advantageous in select group of patients such as in the younger PD population and those in employment or education due to its psychosocial advantages. These outcomes were only reported in one trial. Large, long-term RCTs are needed in this area.
+A meta-analysis of data from 37 randomised trials including over 9000 patients was conducted. For early-stage patients, CRT resulted in longer survival and longer HD-free survival than either RT or CT alone. Second malignancy (SM) risk was lower with CRT than with RT (no difference in between CRT and CT was demonstrated). For advanced stages, no difference in survival between CRT and CT was established. With CRT, HD-free survival was longer but SM risk was higher.
+The findings of this systematic review suggest that proper management of a type of strong painkiller (opioids) in well-selected patients with no history of substance addiction or abuse can lead to long-term pain relief for some patients with a very small (though not zero) risk of developing addiction, abuse, or other serious side effects. However, the evidence supporting these conclusions is weak, and longer-term studies are needed to identify the patients who are most likely to benefit from treatment.
+In March 2017, we searched for randomised controlled trials, which compared the use of anabolic steroids with other treatments for pressure ulcers. We found only one trial involving a total of 212 participants. This trial compared the effects of an anabolic steroid (oxandrolone capsules) with a placebo (dummy treatment containing no active medicine) on pressure ulcer healing in people with spinal cord injuries. The participants were mostly male (98.2%) with a mean age of 58.4 years in the oxandrolone group, which was comparable with the participants in the placebo group (male: 100%; mean age: 57.3 years). The trial was conducted over 24 weeks with a further follow-up for eight weeks. The trial was ended early as the trial authors deemed that the interim results suggested that there was unlikely to be a benefit from treatment with oxandrolone. Because of the limited data available from one trial, we remain uncertain whether anabolic steroids have beneficial effects on pressure ulcer healing, whether the treatment causes increased serious adverse events and if the treatment may increase the risk of non-serious adverse events. Overall, the evidence from this study was judged to be of very low quality. More, better-designed studies are necessary to provide evidence as to whether anabolic steroids are beneficial or not in treating pressure ulcers. This plain language summary is up to date as of March 2017.
+We found that there was not much evidence on the effects of using email to give people information on disease prevention and health promotion. We found only six trials with 8372 participants in total. All of the trials had elements of bias. Four studies compared email to standard mail as a method of communication, and found that using email instead of mail did not make any difference to patient or caregiver understanding, or the uptake of preventive screening. Two studies compared email with usual care, and found that using email instead of usual methods of information delivery did make any difference to patient or caregiver understanding and support, or patient health status and well-being. We were unable to properly assess email's impact on patient or caregiver behaviours/actions as the results were mixed. As there is a lack of good quality evidence for whether email can be used by healthcare professionals to provide information to patients or caregivers on how to stay healthy and avoid disease, we need to think about how to get good measurable information on this. Future studies should follow advice on good ways of carrying out and presenting research. It would be useful if they could look at the costs of using email and take into account ongoing changes in technology.
+We included 11 studies in this review, with a total of 855 participants. Nine studies looked at post-treatment postural restrictions (using a neck brace/head movement restrictions/instructions to sleep upright) following the Epley manoeuvre. There was a statistically significant difference found when these restrictions were compared to a control treatment of the Epley manoeuvre alone. Although there was a difference between the groups, adding postural restrictions conferred only a small additional benefit since the Epley manoeuvre was effective alone in just under 80% of patients. Four of the studies reported minor complications such as neck stiffness, horizontal BPPV (a subtype of BPPV which is similar to posterior canal BPPV, but has some distinct differences in terms of the signs and symptoms), dizziness and disequilibrium (the feeling of unsteadiness on ones feet) in some patients. Additionally, two studies looked into the application of oscillation/vibration to the mastoid region during the Epley manoeuvre compared to control; the intervention produced no difference in outcome between these groups. One study that also researched post-treatment postural restrictions looked into extra steps in the Epley manoeuvre. Compared to the control treatment there were no significant differences in outcomes. No serious adverse effects were reported in any of the studies in the review. The results should be interpreted carefully and further trials are needed.
+Four randomised controlled trials, involving a total of 231 patients with chronic rhinosinusitis with nasal polyps, are included in this review. The number of patients in each study ranged from 34 to 109. The studies took place in ENT departments in several European countries. All patients were adults and most of the studies enrolled more men than women. In all studies the patients were randomly assigned to either surgery or medical treatment (such as antibiotics or steroid tablets or injections) in addition to topical steroids given as nasal sprays or drops. Both the type of surgery performed and the medical treatments used varied widely between the studies, and did not allow all of the studies to be looked at together. Rather, we considered the treatment groups in the four studies as three separate pairs of comparisons instead of simply 'surgical' versus 'medical' treatments. The main outcome measures were patient-reported disease-specific symptom scores and health-related quality of life scores, as well as generic health-related quality of life scores. There were no important differences between groups in either the patient-reported disease-specific symptom scores or the health-related quality of life scores. Two studies (one comparing ESS plus topical steroid versus antibiotics plus high-dose topical steroid, the other ESS versus systemic steroids) did not find a difference in general health-related quality of life scores. Two studies reported changes in polyp size (when looked at with an endoscope) using a score. One study (ESS versus systemic steroids) reported a significantly better score in the surgery group than in the steroids group at 12 months. In the other study (ESS plus topical steroid versus antibiotics plus high-dose topical steroid) no difference was found between the groups. There were no reported differences between the different medical and surgical treatment groups in any study for any other objective (clinician-based) measurements. Complication rates were not reported in all studies, but nosebleeds (epistaxis) were the most commonly described complication with both medical and surgical treatment; severe complications were reported rarely in either group. The evidence does not show that one treatment is better than another in terms of patient-reported symptom scores and quality of life measurements. One positive finding (polyps size scores) from amongst the several studies examining a number of different comparisons must be treated with appropriate caution, in particular when the clinical significance of the measure is uncertain. There is not enough evidence to draw firm conclusions regarding the most appropriate treatment for this condition. Chronic rhinosinusitis with nasal polyps has significant implications for quality of life and the use of healthcare services. Further research to investigate this problem is justified. Overall, we found this evidence to be of low or very low quality. We have low confidence in the estimates of these studies; further research will very likely change these estimates. There were serious limitations in how the studies were carried out or reported (or both), and the number of participants involved was small. In addition, some of the treatment regimens used in the trials are no longer current standards of therapy for patients with chronic rhinosinusitis with nasal polyps. This evidence is up to date to 20 February 2014.
+We included eight trials (709 participants); seven were from middle-income countries of Asia, Africa, Europe, and Latin America where zinc deficiency is likely to be a public health problem. The effect of fortification of foods with zinc on incidence of zinc deficiency is uncertain. Fortification of foods with zinc may slightly improve the blood zinc levels of populations if zinc is the only micronutrient used for fortification. Zinc added to food in combination with other micronutrients may make little or no difference to blood zinc levels. The fortification of foods with zinc may make little or no difference on incidence of underweight or stunting. The effects of fortification of foods with zinc on other outcomes, including wasting and weight/height, are unknown. Fortification of foods with zinc does not seem to have any adverse effect on indicators of iron or copper status. Most studies included in this review involved a small number of participants and were judged to be at low or unclear risk of bias. There were also some inconsistencies in the results across different studies.
+The evidence is current to December 2013. We included 11 studies involving 3060 randomly assigned participants at advanced stages of prostate cancer. The follow-up period of participants ranged from six months to six years. In seven studies, authors reported possible conflicts of interest. In three studies, no conflicts of interest were declared. In one study, authors reported that they had received an educational grant from the sponsor, who had no role in any aspect of analysis or data interpretation. Use of non-steroidal antiandrogens decreased overall survival and increased clinical progression and treatment failure. Subgroup analyses showed that non-steroidal antiandrogens, compared with castration, were less favourable for overall survival, for clinical progression and for treatment failure in men with metastatic disease. Participants receiving antiandrogens were also more likely to stop treatment as the result of side effects. The risk of suffering breast pain, enlargement of breast tissue or symptoms of physical weakness was also increased with non-steroidal antiandrogens. The risks of feeling intense heat with sweating and rapid heartbeat and of bleeding, the need to get up in the night to urinate, loss of sexual interest, extreme tiredness and the need to urinate more often than usual were increased with castration. No difference was noted for other side effects. The effect of non-steroidal antiandrogens on cancer-specific survival and biochemical progression remained unclear. Included studies were poorly conducted, and the quality of evidence was rated as moderate. This means that further research is likely to have an important impact on our confidence in the accuracy of results.
+Screening with mammography uses X-ray imaging to find breast cancer before a lump can be felt. The goal is to treat cancer earlier, when a cure is more likely. The review includes seven trials that involved 600,000 women in the age range 39 to 74 years who were randomly assigned to receive screening mammograms or not. The studies which provided the most reliable information showed that screening did not reduce breast cancer mortality. Studies that were potentially more biased (less carefully done) found that screening reduced breast cancer mortality. However, screening will result in some women getting a cancer diagnosis even though their cancer would not have led to death or sickness. Currently, it is not possible to tell which women these are, and they are therefore likely to have breasts or lumps removed and to receive radiotherapy unnecessarily. If we assume that screening reduces breast cancer mortality by 15% after 13 years of follow-up and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings. Women invited to screening should be fully informed of both the benefits and harms. To help ensure that the requirements for informed choice for women contemplating whether or not to attend a screening programme can be met, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk. Because of substantial advances in treatment and greater breast cancer awareness since the trials were carried out, it is likely that the absolute effect of screening today is smaller than in the trials. Recent observational studies show more overdiagnosis than in the trials and very little or no reduction in the incidence of advanced cancers with screening.
+This review included four randomised controlled trials, with a total of 522 women. One study investigated the use of 20,000 units hCG priming compared to 10,000 units. The remaining studies investigated 10,000 units hCG priming compared to no priming. The main outcomes were live birth rate and miscarriage rate per woman randomised. Evidence published up to 29 August 2016 was examined. Only one study reported the main outcome of live birth per woman randomised; two studies reported clinical pregnancy. We found no certain evidence of a difference between 10,000 units hCG priming and no priming. However, there was some low quality evidence to suggest that hCG may be associated with a reduction in pregnancy rates; 22% of women who received no priming achieved pregnancy, while between 7% and 23% of women who received hCG priming did so. Two studies reported miscarriage rate per woman randomised, and found no evidence of a difference between 10,000 units hCG priming and no priming. No studies reported on adverse events (other than miscarriage) or drug reactions. Overall, there was insufficient evidence to draw any definite conclusions on the use of hCG priming in IVM. Further randomised trials are necessary, in particular, focusing on women with PCOS. The quality of the evidence was low, the main limitations being imprecision (random error) and lack of blinding (the process in which participant and assessor are prevented from knowing which intervention has been received).
+Animal studies (performed both in the laboratory and on living animals) suggest that estrogen alone might protect the brain as women get older. After the menopause, levels of estrogens decline in women and estrogen therapy has been claimed to maintain or enhance cognitive function in postmenopausal women. This review found no evidence of a benefit of any types of estrogen on overall cognitive functioning in older postmenopausal women when given either as short term or longer term (up to five years) therapy. There was also no evidence of a beneficial effect of combined estrogen and progestagen therapy overall. There was insufficient evidence to determine whether any type of hormone replacement therapy had beneficial or harmful effects on specific types of cognitive ability, such as verbal or visual memory.
+We found two studies involving 880 participants that compared the benefits and harms of once-daily inhaled ICS/LABA combined in one inhaler versus inhaled LAMA for treatment of adults with COPD. These studies lasted 12 weeks. Participants were men and women aged 40 or older who had COPD with various degrees of severity. No consistent differences were found between the two different types of inhalers included in this review. Researchers reported no major differences in death rate, numbers of COPD exacerbations, lung inflammation, or other serious unwanted events.  People receiving both inhalers showed similar improvements in quality of life, symptoms, and lung function tests. Overall, we assessed the evidence presented in this review to be of very low quality, which means we have very little confidence in the findings. The main reasons for such judgement include the small number of identified studies and the fact that these studies were not focused on the outcomes of interest for this review. Also, both studies had a short observation time, which means that most of the undesired events may have occurred after the observation period was over. From this review, we did not find evidence strong enough to demonstrate major differences between inhalers or to establish that these inhalers have the same effect.
+Our systematic review of randomised controlled trials assesses the effects of drug treatment or psychotherapy when used on their own or in combination. We found five eligible trials, including three of psychotherapy (cognitive behavioural therapy (CBT) and exposure and response prevention (ERP)) and two of medication (the serotonin reuptake inhibitors (SRIs) fluoxetine and clomipramine). In the only placebo-controlled medication trial included in our review, people with BDD treated with fluoxetine were more likely to respond (56%, 19 out of 34) than those allocated placebo (18%, 6 out of 33). Symptoms became less severe after treatment with both medication and psychotherapy. Adverse events were mild to moderate in severity and none of the people in the active treatment groups were reported to have dropped out of the studies because of treatment-emergent adverse events. There is preliminary evidence from one trial of CBT that the effects of CBT may persist once treatment has ended. Treatment response in the medication trials was not effected by the degree to which people had insight into their condition. Although few controlled trials have been done, and those that have been conducted were small, indicating that our findings should be used with caution unless confirmed by larger studies (some of which are ongoing), the results suggest that treatment with both medication or psychotherapy can be effective in treating the symptoms of body dysmorphic disorder.
+Three trials examining the use of cotrimoxazole in preventing opportunistic infections were included in the review. When compared to rechallenge, desensitization appeared to result in fewer treatment stoppages and side effects in HIV-infected adult patients who had a previous mild or moderate reaction to cotrimoxazole. However, more data are needed for these results to be conclusive. It is important to note that reintroduction of cotrimoxazole was usually successful using either desensitization or rechallenge, with 44.4% to 79.4% of patients still on cotrimoxazole after six months in the three studies. Furthermore, in the studies reviewed, no strategy resulted in severe hypersensitivity reactions. Severe limitations of this review included the absence of data in paediatric populations and the minimal data from resource-poor populations.
+We have selected for inclusion in this review randomised controlled trials of continuous intravenous drip of midazolam as a sedative in babies aged 28 days or younger. We included three clinical trials in this review. Using different scales to measure level of sedation, each study showed that midazolam was effective in providing sedation to babies. However, the validity of the sedation scales used in these studies has not been proven in babies; therefore, we cannot be certain that midazolam is, in fact, an effective sedative for babies. Moreover, one study showed that babies who received midazolam had a significantly higher risk of death or brain injury, and combined results of two studies showed that midazolam use may prolong length of stay in the NICU. One of the studies included in this review received support from industry, and for the other two studies, industry provided all study drugs. We assessed the quality of the evidence on the outcomes of mortality during hospital stay, length of stay in the NICU, pain, and neurological outcomes at 28 days of life and found the evidence to be of moderate quality, as there was not enough evidence available. Therefore, we conclude there is not enough evidence to support the use of midazolam as a sedative for babies undergoing intensive care. Additional research is needed to address the safety and effectiveness of midazolam in this population.
+In this review, we investigated the benefits and safety of antibiotics for treatment of NTS versus placebo or no antibiotic treatment. We found that in otherwise healthy people, treatment with antibiotics did not have any benefit over treatment with no antibiotics. Furthermore, treatment with antibiotics made it more likely that patients would continue to excrete the same organisms for up to one month after treatment. We are unable to comment on the use of antibiotics in very young people, very old people and people who are unable to fight off infection because the trials we identified did not include these patients.
+We performed a thorough literature search for studies reporting the use of IL-6 levels for detection of sepsis up to January 2019. We found 23 studies enrolling 4192 severely ill adults. Our assessment of the evidence reveals the complexity of the research topic, represented in the high variability of information reported by the studies. We found the characteristics of assessed patients to vary considerably between studies in terms of age, gender, setting, initial diagnosis, indicative value for sepsis, and source of infection, among other factors. This variability in the collected data prevented a formal numerical synthesis of the findings. Using the available data to perform an approximated estimation of the consequences, we found that 700 out of 1000 patients under suspicion of sepsis might be correctly classified, but 130 out of 1000 patients would be wrongly considered as having sepsis, while 170 out of 1000 patients might be incorrectly considered as not having sepsis. These errors would result in a serious increase in the risk of further morbidity and death due to delays of adequate treatment. This information should be interpreted with caution due to limitations in the collected data. We judged the included studies to have important limitations in their validity, hence they are at high risk of providing distorted results (i.e. to be at high risk of bias).
+We conducted a review of all available, relevant evidence about the impact of dressings on the prevention of surgical site infections in surgical wounds healing by primary intention. This review examined data from 29 randomised controlled trials (which provide the most reliable evidence). These investigated the use of dressings in surgery that had a low risk of surgical site infection (clean surgery) and surgery with a higher risk (potentially contaminated surgery). We found no clear evidence to suggest that one dressing type was better than any other at reducing the risk of surgical site infection, nor that covering wounds with any dressing at all reduced the risk of surgical site infection. Additionally, there was no clear evidence that any dressing type improves scarring, pain control, patient acceptability or ease of removal. Currently decision makers may opt to make decisions about whether and how to dress a wound based on patient and clinician preferences and dressing costs. It is important to note that many trials in this review were small and the evidence was of low or very low certainty meaning that current information is uncertain. Assessed as up to date September 2016.
+This review identified two randomised controlled studies. One study examined the effect of selenium supplements taken by women from the first trimester to birth in preventing postnatal depression. This study had a high risk of bias because of women withdrawing or not completing their self-scoring system for depression (Edinburgh Postnatal Depression Scale). It may also have been difficult to ensure that the women took their supplements because of concerns that exist about taking supplements during pregnancy. More high-quality studies would be required to confirm any benefit in preventing postnatal depression using selenium. This review also identified one randomised controlled study that compared docosahexanoic and eicosapentaenoic acid to placebo in women at risk of postpartum depression. This study found that neither docosahexanoic acid nor eicosapentaenoic acid prevented postpartum depression. Overall, there is not enough evidence at this stage to recommend selenium, docosahexanoic acid, eicosapentaenoic acid or any other dietary supplement for the prevention of postnatal depression. Unfortunately there were no other studies of other dietary supplements that met our selection criteria. Other dietary supplements need to be studied in trials where depressed women are excluded from entry to determine if supplements prevent postnatal depression.
+The evidence is current to December 2015. We found 11 studies: 7 evaluated different infusion durations (803 participants), and 4 evaluated different peak doses (5280 participants). Participants had different types of cancer. For the use of different anthracycline infusion durations, the authors found that an anthracycline infusion duration of six hours or longer reduces the risk of clinical heart failure (for example shortness of breath or leg oedema), and it seems to reduce the risk of subclinical heart failure (that is heart damage diagnosed for example by an echocardiography in people without symptoms). Only a small amount of data was available for children and individuals with leukaemia, since most studies evaluating different anthracycline infusion durations were performed in adults with solid tumours. Based on the currently available evidence, we are not able to favour either a doxorubicin peak dose of less than 60 mg/m2 or 60 mg/m2 or more. There was not enough high-quality evidence available for the use of other anthracycline peak doses to be able to draw conclusions. No data were available for children and individuals with leukaemia. Further high-quality research is needed. All studies had problems relating to quality of the evidence.
+We included 37 studies with 3110 participants. In each trial, patients were randomly divided into two groups: one group remained at normal body temperature of 36.5 to 38 °C, and the other group was cooled to a maximum of 35 °C for at least 12 hours. We did not combine results of these studies to assess whether hypothermia improves patient outcome. This was because the results had large differences which we could not explain. We identified some differences in the ways in which the studies were carried out and the participants that study authors had recruited, but we did not assess whether this could explain the differences in results. We did not have enough good quality evidence that was sufficiently similar to be confident that treating people who have had a severe brain injury with hypothermia will reduce the incidence of death or severe disability, or increase the incidence of pneumonia. Many of the studies were not well reported and we were unable to assess whether differences between the quality of the studies may also have affected our results. We used the GRADE approach to judge the quality of evidence. We judged the evidence for death or severe disability to be very low quality, and the evidence for pneumonia to be low quality.
+This review looks at whether family therapy is an effective intervention in treating people of any age with depression. Family therapy for depression is widely used, especially in the United Kingdom and the United States. The small number of randomised controlled trials included in the review were very heterogeneous, and therefore difficult to synthesise. Family therapy seems more effective than no treatment or being placed on a waiting list, but it remains unclear how effective this intervention is in comparison to other interventions. Further randomised controlled trials are needed.
+Duxil is described as having several properties which may be beneficial for dementia. This review looked for randomized trials comparing Duxil with control in patients with dementia. Three trials were identified. Though there was significant beneficial effect of Duxil on the improvement of cognitive function, due to the low methodological quality of included trials, small number of trials and probable publication bias, this review did not provide sufficient evidence to support the routine use of Duxil for the treatment of patients with dementia. More large, high-quality randomized trials are needed.
+This Cochrane review aims to determine whether drain tube insertion reduces complication rates or is associated with any risks or harms. We analysed seven randomised controlled trials including 960 participants that compared drain insertion with no drainage after axillary lymphadenectomy for the treatment of breast cancer. We found that the chance of getting a seroma if a drain was inserted was less than if no drain was inserted (0.46 times less likely), and that the number of aspirations required (using a needle to drain seroma fluid in the outpatient clinic) was lower (on average, 0.79 fewer per participant). These benefits must be balanced against a longer average hospital stay of 1.47 days in the drained population, although increasingly patients can be discharged with their drain in place, to be removed at a later date. Risk of infection, volume of fluid aspirated and rates of lymphoedema (arm swelling) or haematoma (bruising) did not differ between drained and undrained participants.
+Eight studies with 390,769 participants, mainly observational, were included in this systematic review. The aim of the studies reviewed was to determine an association of the intake of total flavonoids, and eight main flavonoid subclasses, with colorectal neoplasms including CRC and adenomas. The majority of the studies were of medium to high methodological quality. The evidence that intake of dietary flavonoids reduces the risk of colorectal neoplasms was conflicting, and could partly be explained due to difficulties in quantifying the intake of flavonoids. Therefore, the association of dietary flavonoids and prevention of colorectal neoplasms remains unproven.
+We found seven randomised clinical trials that compared a treatment duration of 72 weeks with 48 weeks in 1369 participants. The quality of all trials was low. Mortality and liver-related morbidity were not reported in any of the included trials. Sustained virological response (that is, undetectable hepatitis C virus RNA after six months from the end of an entire course of treatment) was increased when the decision to prolong treatment was taken based on viral load after 12 weeks of treatment (RR 1.43, 95% CI 1.07 to 1.92) as well as when the decision to prolong treatment was taken based on the results of the viral load after four weeks of treatment (RR 1.27, 95% CI 1.07 to 1.50). The calculated number needed to treat to achieve an increase in sustained virological response proportions was nine (meaning that among nine participants treated for 72 weeks instead of 48 weeks, only one more will achieve a sustained virological response compared to the participants treated for 48 weeks). The higher sustained virological response after 72 weeks of treatment was caused by a reduction in the number of patients in this group who experienced a virological relapse after treatment. Adherence to treatment was not different between the two groups. Serious adverse events were mentioned in only one trial, and they were not different in the two treatment groups. The findings may be influenced by both risks of systematic errors (bias) and the risk of random errors (play of chance). Further large-scale, randomised trials with reporting of patient relevant outcomes are warranted.
+We included two studies with a total of 34 patients in this review. Both studies evaluated the diagnostic performance of EUS. This evidence is current to 5 November 2015. Of the two studies, one study was conducted as well as such a study could be conducted. The methodological quality of the other study was poor. The two included studies showed that in those people with pancreatic cancer in whom CT alone showed their cancer was capable of being fully surgically removed, 61% (61 out of 100) would prove to have cancer that was too fully spread to make this possible when a laparotomy was attempted. Due to the small sample size, there is significant uncertainty in the utility of EUS in people with pancreatic cancer found to have resectable disease on CT scan. There is no evidence to suggest that it should be performed routinely in people with pancreatic cancer found to have resectable disease on CT scan.
+This review focuses on chronic blepharitis and stratifies anterior and posterior blepharitis. There were 34 studies (2169 participants with blepharitis) included in the review, 20 of which included participants with anterior blepharitis and 14 of which included participants with posterior blepharitis. For anterior blepharitis, topical antibiotics provided some symptomatic relief and were effective in clearing bacteria from the eyelid margins. There was no difference between the types of topical antibiotics used. Topical steroids also provided some symptomatic relief; however, they were ineffective in eliminating bacteria. Lid hygiene, including warm compresses and lid scrubs, showed some symptomatic relief in both anterior and posterior blepharitis. Overall, there was no strong evidence for any of the treatments in terms of curing chronic blepharitis. Further research should be done to evaluate the effectiveness of treatments for blepharitis, with particular attention paid to adequate diagnosis and classification of the disease.
+We found one randomised controlled trial with a total of 23 participants for inclusion in this review. The study took place at two centres in the USA. Six of the 23 patients did not complete the study (dropped out). Participants who completed the study were outpatients, their age range was four to 60 years and 76% were men and 24% women. The study did not measure any of the outcomes important to patients (symptom improvement - respiratory distress/dyspnoea and voice quality, quality of life improvement and recurrence-free interval). It did measure the reduction in the volume of disease (assessed with an endoscope). We found insufficient evidence from the included study that photodynamic therapy has a benefit on its own or in combination with surgery in recurrent respiratory papillomatosis. There was no clear evidence that effects observed in the treatment group were different to those in the control group. Adverse effects reported included airway swelling in a child with severe disease a few hours after photodynamic therapy, which required insertion of a breathing tube and a prolonged stay in hospital. The overall quality of the evidence is very low: there was no blinding of treatment and a high rate of drop-out. This evidence is up to date to January 2014.
+We collected the most recent evidence (to July 2016) and conducted a meta-analysis according to the most appropriate methods for diagnostic tests. We included 42 studies with 4220 participants in the review. The analyses measured sensitivity (how well a test identified people with endoleak correctly) and specificity (how well a test identified people without endoleak correctly). The summary accuracy estimates were sensitivity 82% (95% confidence interval 66% to 91%) and specificity 93% (95% confidence interval 87% to 96%) for ultrasonography without contrast; and sensitivity 94% (95% confidence interval 85% to 98%) and specificity 95% (95% confidence interval 90% to 98%) for ultrasonography with contrast. Use of contrast improved the sensitivity of ultrasound significantly. Based on these results, we would expect 94% of people with endoleaks will be correctly identified by contrast-enhanced ultrasound. Studies that evaluated contrast-enhanced ultrasound used better methods than the studies that evaluated ultrasound alone.
+In this review we looked at the effectiveness of injections of small amounts of sterile water given into four spots on the woman’s lower back in labour. The review included seven studies with 766 participants; four used intracutaneous injections, two subcutaneous, and one both. All studies compared the injections of sterile water with injections of saline, whilst none compared the injection of sterile water with women using their own skills to manage pain in labour. Nor did the studies compare with other forms of pain management in labour, as this information is in other Cochrane reviews. We found no good quality evidence that these simple water injections could provide a significant level of pain relief compared with simple saline injection for any type of pain experienced during labour. Women did report transient pain at the injection site. More research is needed on this possible form of pain management in labour.
+We identified 12 relevant randomised controlled trials comparing glue versus suture for fixation of the mesh, with a total of 1932 participants. Glue fixation is superior to suture for the outcomes of chronic pain, duration of operation, haematoma and recovery time to daily activities. Glue fixation is not associated with an increased risk of infection, hernia recurrence, seroma (a collection of fluid that builds up under the surface of the skin after surgery), persisting numbness (loss of sensation or feeling), quality of life, and postoperative length of stay. We do not know the role of glue fixation in people with recurrent hernia, femoral hernia or complicated hernia. Meanwhile no conclusions could be drawn on which type of glue should be used because of lack of trials. Eight out of 12 trials showed high risk of bias in at least one of the investigated domains. Two studies were quasi-randomised controlled trials. Nearly half of the included trials either did not provide adequate information or had high risk of bias regarding blinding processes. The risk of bias for incomplete outcome data of all the included studies is low to high. Two trials did not report on some important outcomes. One study was funded by the manufacturer producing the fibrin sealant. As the quality of the evidence (GRADE) for the outcomes is moderate to low and the results of chronic pain is not robust, the findings should be interpreted with caution. However, the evidence is still sufficient to conclude that glue fixation of mesh for the Lichtenstein procedure is comparable, if not superior, to fixation with suture. Glue may be a sensible alternative to suture for mesh fixation in Lichtenstein repair.
+Most journals try to improve articles before publication by editing them to make them fit a 'house-style', and by other processes such as proof-reading. We refer to all these processes as technical editing. We identified 32 studies of the effects of technical editing from a systematic review. There is some evidence that the overall 'package' of technical editing raises the quality of articles (suggested by 'before-and-after' studies) and that structuring abstracts makes them more useful, although longer. However, there has been little rigorous research to show which processes can improve accuracy or readability the most, or if any have harmful effects or disadvantages. Over one third of references cited in articles in medical journals have some inaccuracies and one-fifth of quotations to references in these articles are not accurate
+In this review we set out to estimate how well codeine worked, how many people had side effects, and how severe those side effects were - for example, whether they were so severe that participants stopped taking their oral codeine. We included 15 studies with 721 participants. The studies we found had methodological shortcomings: they were small and of short duration. They also reported results in different ways, so that it was not possible to combine results. In seven of the eight studies that compared codeine with placebo, codeine was better than placebo. In studies that compared codeine with another drug, the results were similar. Codeine at doses of 30 mg to 120 mg, alone or in combination with paracetamol, does seem to provide a good level of pain relief for some people with cancer pain. We cannot be certain about how many people will get this benefit, and we do not know whether, or by how much, adding paracetamol increases its effect. Codeine increases nausea, vomiting, and constipation, and may cause drowsiness or dizziness if used for more than a week. Some people will stop taking codeine because of the side effects. More trials comparing codeine with other treatments and using patient-centred outcomes are needed. The role of codeine in mild cancer pain, in addition to moderate to severe cancer pain, should be investigated.
+The review included 12 trials (563 people with HbSS, HbSC or HbSβthal aged six to 35 years). Participants were assigned randomly to either educational programs, no program and in some cases to a non-educational program, e.g. art therapy. Interventions ranged from a total of one hour to weekly sessions for eight weeks and post-intervention assessments ranged from the end of the intervention period to 12 months after completion. Educational programs and other interventions have resulted in improvements in patient knowledge or understanding of sickle cell disease, and a decrease in depression. Effects on patients' knowledge were maintained for longer than for caregivers. The effects are shown to be small but may result from the fact that most studies had very small numbers of participants and there was much variation between studies. The interventions studied showed no effect on patients' utilization of health services, relationships between families, caregiver or patient skills, coping or health-related quality of life of the patient. No comparative data were reported for patients or caregivers (or both) recognising signs and symptoms leading to self-management. No trials assessed the adherence to treatment. Trials varied in the interventions being studied as well as how the different outcomes were measured. The quality of evidence was low for the outcome positive coping and moderate for the outcomes child knowledge, healthcare utilization and depression. This suggests that further research is likely to have an important impact on our confidence in the effect of the treatment. Further research using randomized controlled trials with more people (including different populations) are needed to improve our understanding of which interventions are likely to be useful.
+Evidence taken from studies examining the effectiveness of brivaracetam was of moderate quality. This means that we can be fairly certain that study findings showing that brivaracetam is effective in reducing the frequency of seizures in drug-resistant epilepsy are accurate. Evidence regarding the tolerability of brivaracetam, for example, the number of people who withdrew from these studies and the number of people who experienced side effects, however, was of low quality. This means that we cannot be sure that trial findings are completely accurate, and that more research is needed to fully investigate the tolerability of brivaracetam. All study participants were adults, and most had focal epilepsy. As a result, the review cannot inform us about how effective brivaracetam is in children or in individuals with other types of epilepsy, for example, generalised epilepsy, which is epilepsy that involves the whole brain. Evidence is current to October 2018.
+We included 38 studies in our review. Most of the studies were from high-income countries and explored mothers' perceptions of vaccine communication. Some of the studies also included the views of fathers, grandmothers and other caregivers. In general, parents wanted more information than they were getting (high confidence). For some parents, a lack of information led to worry and regret about their vaccination decision (moderate confidence). Parents wanted balanced information about both the benefits and risks of vaccination (high confidence), presented in a clear and simple manner (moderate confidence) and tailored to their situation (low confidence). Parents wanted vaccination information to be available outside of the health services (low confidence). They wanted this information in good time before each vaccination appointment and not while their child was being vaccinated (moderate confidence). Parents viewed health workers as an important source of information and had specific expectations of their interactions with them (high confidence). Poor communication and negative relationships with health workers sometimes impacted on vaccination decisions (moderate confidence). Parents generally found it difficult to know which vaccination information source to trust and found it difficult to find information that they felt was unbiased and balanced (high confidence). The amount of information parents wanted and the sources they felt they could trust seem to be linked to their acceptance of vaccination, with parents who were more hesitant wanting more information (low to moderate confidence). How up-to-date is this review? We searched for studies published before 30 August 2016.
+There was a limited amount of very low-quality evidence to suggest that people might do better when receiving focal psychodynamic therapy compared to no treatment or treatment as usual. With one exception, we found little difference between specific psychological therapies. Most therapies appeared as acceptable as any other approach, except for dietary advice which had a 100% non-completion rate in one small trial. Because of the risk of bias and limitations of studies, notably small sample sizes, we can draw no specific conclusions about the effects of specific individual psychological therapies for anorexia nervosa in adults or older adolescents. We need more large multicentre randomised controlled trials of commonly-used psychological therapies in older adolescents and adults with anorexia nervosa.
+We found three randomized controlled trials (RCTs) involving 516 participants that compared tamponade agents. All participants underwent surgery to treat RD associated with PVR. The Silicone Study compared the use of silicone oil to either sulfur hexafluoride (SF6) gas or perfluropropane (C3F8) gas in two RCTs. Both gases and silicone oil are less dense than water, so that they float upwards or towards the top of the eye while a patient is sitting or standing. This is sometimes but not always beneficial, so a denser-than-water silicone oil called heavy silicone oil has been investigated, primarily outside the US. The Heavy Silicone Oil Study compared the use of heavy silicone oil to standard silicone oil in participants with RD involving the lower parts of the retina. The evidence was current to June 2013. When silicone oil was compared to SF6 gas, eyes randomized to receive silicone oil more often achieved a visual acuity of 5/200 or better at one year, and more often achieved macular attachment at one year but with no difference at two years. When silicone oil was compared with C3F8 gas, there were no significant differences between the groups with respect to visual acuity or macular attachment at one year. When heavy silicone oil was compared to standard silicone oil, there were no significant differences between the groups with respect to retinal re-attachment or visual acuity at one year. Heavy silicone oil did not demonstrate any significant benefit over standard silicone oil. Adverse events were only reported for the Heavy Silicone Oil Study; however, only the total number of adverse events was reported, and the numbers for each group were not specified: of the 94 participants, there were four deaths, 26 recurrent RDs, 22 patients with glaucoma, four patients with cataract, and two patients with capsular fibrosis (scarring behind a lens implant). The overall quality of these studies was moderately satisfactory. Although all trials employed proper randomization methods for participants, the masking of participants was unclear in all of the three RCTs, and masking of outcome assessors was not performed in two RCTs.
+We searched for evidence on 12 January 2016 and found five randomised studies, involving 1819 women. Two of the studies were large, high-quality studies, in women with gestational hypertension, mild pre-eclampsia or deteriorating existing hypertension at 34 to 37 weeks (704 women) or with gestational hypertension or mild pre-eclampsia at 36 to 41 weeks (756 women). Fewer women who received planned early delivery experienced severe adverse outcomes (1459 women, high-quality evidence). There was not enough information to draw any conclusions about the effects on the number of babies born with poor health, with a high level of variability between the two studies (1459 infants, low-quality evidence). There was no clear difference between planned early delivery and delayed delivery for the number of caesarean sections (four studies, 1728 women, moderate-quality evidence), or the duration of the mother’s hospital stay after the birth of the baby (two studies, 925 women, moderate-quality evidence) (or for the baby (one study, 756 infants, moderate-quality evidence)). More babies who were delivered early had breathing problems (respiratory distress syndrome, three studies, 1511 infants), or were admitted to the neonatal unit (four studies, 1585 infants). Fewer women who delivered early developed HELLP syndrome (three studies, 1628 women) or severe kidney problems (one study, 100 women). Two studies compared women who had labour induced at 34 to 36 weeks and at 34 to 37 weeks with a comparison group who were monitored until 37 weeks, when induction was begun if labour had not started spontaneously. Three studies compared induction of labour at term or closer to term, at 37 completed weeks and at 36 to 41 weeks, with women who were monitored until 41 weeks when induction was begun if labour had not started spontaneously. Other inclusion and exclusion criteria also differed between the five studies. No studies attempted to blind the women or their clinicians to which group they were in. Women and staff were aware of the intervention and this may have affected aspects of care and decision-making. Most of the evidence was of moderate quality, so we can be moderately certain about the findings. Overall, if a woman’s baby was delivered immediately after 34 weeks, there was less risk of a complication for the mother and no clear difference in the overall rate of complications for the baby, but information was limited. These findings are applicable to general obstetric practice when high blood pressure disorders during pregnancy are considered together. Further studies are needed to look at the different types of hypertensive disorders individually.
+This review includes six randomised controlled trials. Two compare the regular use of clotting factor concentrates to prevent joint bleeds with their use 'on demand'. Four compare different regimens of regular use in children and adults with hemophilia. It was clearly evident that preventative therapy, as intravenous infusion of factor concentrate repeated more times a week and started early in childhood was able to reduce joint deterioration as compared to treatment administered after bleeding occurred. This favourable effect is due to a consistent reduction in total bleeds and hemarthrosis (bleeding into joints) and leads to a significant improvement in quality of life. Preventative therapy is linked to an increased factor usage and cost of treatment. We found weaker evidence (due to lack of data) to show preventative therapy reduced joint deterioration when treatment is started after joint damage has been established. Further studies are needed to establish the best preventative regimen, i.e. for example starting time, dosage frequency, minimally effective dose.
+This review aims to evaluate these treatments to assess their effectiveness especially for later stages. The review identified 13 trials involving 1824 participants. However, data presentable for the review were only available in 10 trials with 732 participants. The data were difficult to collate because of the quality of the study methods and the reporting of the results; outcome measures differed between trials and they were mainly small-sized trials. No significant differences in overall survival were seen between studies aimed at inducing remission. Adverse events reported were mostly due to infections and reductions in blood cell counts. The more recent studies were focused on using less intensive treatment regimens as they could provide similar responses with lower risk of adverse effects.
+We identified two completed randomized controlled studies, involving 447 RhD-negative women. The findings suggest that intramuscular and intravenous anti-D in the 28th week of pregnancy are equally effective in preventing RhD antibody formation (alloimmunization) during the pregnancy. None of the women developed antibodies against the RhD antigen. The small number of studies, low number of participants and methodological limitations mean that we do not have sufficient information to guide practice. The choice of intramuscular or intravenous route of administration will depend on available preparations, the dose to be administered and the woman's preference.
+This review assessed if these medications would be useful in patients with diabetes. We included eight trials with 21,379 patients and a mean duration of follow-up ranging from 365 to 913 days. Specific data for patients with diabetes were only available in full for one of these trials and partial data were available for two trials. Analysis of the available data demonstrated that adenosine-diphosphate receptor antagonists (such as clopidogrel, prasugrel, ticagrelor, ticlopidine) were not more effective than other blood thinning drugs or placebo for death from any cause, death related to cardiovascular disease, heart attacks or strokes. There was no available information on the effects of adenosine-diphosphate receptor antagonists on health-related quality of life, adverse effects specially for people with diabetes, or costs. The use of adenosine-diphosphate receptor antagonists in patients with diabetes needs to be guided by the information available from trials which included patients with and without diabetes. All future trials on adenosine-diphosphate receptor antagonists should include data which relate specifically to patients with diabetes in order to inform evidence-based clinical guidelines.
+This review includes 10 trials (191 people with cystic fibrosis) - seven single-treatment sessions and a two-week trial, a six-week trial and a three-month trial. Six single-treatment trials, the two-week trial and the three-month trial compared non-invasive ventilation with other airway clearance techniques. Two single-treatment trials and the six-week trial looked at non-invasive ventilation for overnight breathing support compared to oxygen or normal room air. One single-treatment trial compared non-invasive ventilation with no additional treatment during an exercise test. Single-treatment trials of non-invasive ventilation for airway clearance showed that this may be easier with non-invasive ventilation and people with cystic fibrosis may prefer it to other methods. We could not find evidence that non-invasive ventilation increased the amount of mucus coughed up, but it did improve some measures of lung function, at least in the short term. The two-week trial did not demonstrate clear benefits between groups. The original three-month trial report stated an improvement in lung clearance index. One person in one of these trials reported pain on respiratory muscle testing. The three trials comparing overnight support from non-invasive ventilation measured lung function, quality of life and carbon dioxide levels; they showed it is effective, safe and acceptable. We found no clear differences between non-invasive ventilation and oxygen or room air, except for exercise performance which improved with non-invasive ventilation compared to room air after six weeks. Two trials reported side effects. In the first trial, one person found the mask uncomfortable. In the second trial, one person in the room air group had collapsed lungs and two people could not tolerate increased pressure when breathing in. The trial comparing the effects of non-invasive ventilation to no treatment on exercise capacity found no clear differences between groups. Non-invasive ventilation may help alongside other airway clearance techniques, particularly when people with cystic fibrosis have difficulty coughing up mucus and during sleep. Long-term trials are needed with enough people to show the clinical effects of non-invasive ventilation on airway clearance, during sleep and exercise training in severe disease. The benefits of non-invasive ventilation have largely been demonstrated in single-treatment sessions with only small numbers of people. There is limited evidence of some longer-term improvement in lung function in one trial. Our results from the trials of overnight breathing support differed from those in the original analyses, this is likely due to the small numbers of participants and some statistical issues. We judged only the six-week trial to be free from any bias. In the remaining trials, we thought there were low or unclear chances of the results being affected because data were either reported only partially or not at all. We were not sure if the way in which participants were put into the different treatment groups would affect the results of the trials.
+The evidence is current to August 2012. We found seven studies that reported the effects of NIPPV at home. Five of these studies looked at the effects after using NIPPV compared to regular treatment (without NIPPV) for at least three months. Two studies looked for a longer period of time, for at least 12 months. The mean age of all participants included in our meta-analysis was 67 years. All studies included men and women, but 77% of participants were men. We used data from 245 people for our meta-analysis. NIPPV during the night for 3 and 12 months in people with COPD who had raised levels of carbon dioxide had no clinically or statistically significant effect on gas exchange, six-minute walking distance, health-related quality of life, lung function, respiratory muscle strength and sleep efficiency. This means we found little or no difference in the outcomes. Because some trials had very small numbers of participants, our confidence in the quality of evidence is moderate when looking at the effects on gas exchange. All seven trials measured this outcome. Other outcomes were not always measured or available leading to a lower quality of evidence for the other outcomes such as six-minute walking distance, health-related quality of life, lung function, respiratory muscle function and sleep efficiency.
+We found four trials that assessed induction of labour at 37 to 40 weeks for women when it was suspected that their baby was large. A total of 1190 pregnant, non-diabetic women were involved. We searched for evidence on 31 October 2015. The studies were of moderate or good quality although it was not possible to blind the women and staff providing care to which group women had been assigned. This may have introduced bias. The number of births where the baby's shoulder became stuck (shoulder dystocia) or a bone was fractured (usually the clavicle, which heals well without consequences) were reduced in the induction of labour group. The evidence was assessed as moderate quality for shoulder dystocia and high quality for fracture. No clear differences between groups were reported for damage to the network of nerves that send signals from the spine to the shoulder, arm and hand (brachial plexus injury) of the baby (low-quality evidence due to very few events occurring) or signs of not enough oxygen during birth. A policy of labour induction reduced the average birthweight of babies by 178 g. The trials did not show any differences in the number of women who had caesarean sections or instrumental births. There is limited evidence that more women in the induction of labour group had severe damage to the perineum. We conclude that there appear to be benefits, but there may also be some disadvantages of induction of labour shortly before term. The option of having an induction should be discussed with parents when their baby is suspected to be extra large. Although some parents and doctors may feel the existing evidence is sufficient to justify inducing labour, others may disagree. Further high-quality studies are needed in order to find out what is the best time to induce labour towards the end of pregnancy, and how to improve the accuracy in diagnosing macrosomia. A visual summary of some of the results from this review can be found here (screen view version) and (printable version here).
+In the 56 trials that provided data for the analyses, a total of 95,286 participants were randomly assigned to vitamin D versus no treatment or placebo. More than half of the trials were considered to have low risk of bias. All trials were conducted in high-income countries. The age of participants ranged from 18 to 107 years. The mean proportion of women was 77%. Vitamin D was administered for an average of 4.4 years. This plain language summary is as current as of February 2012. This review suggests that vitamin D3 may reduce mortality, showing that about 150 participants need to be treated over five years for one additional life to be saved. We found comparable effects of vitamin D3 in studies that included only women compared with studies including both women and men. Vitamin D3 also seemed to decrease cancer mortality, showing a reduction in mortality of 4 per 1000 persons treated for five to seven years. We also observed adverse effects to vitamin D such as renal stone formation (seen for vitamin D3 combined with calcium) and elevated blood levels of calcium (seen for both alfacalcidol and calcitriol). In conclusion, we found some evidence that vitamin D3 seems to decrease mortality in elderly people not dependent on help or living in institutional care. A large number of study participants left the trial before completion, and this raises concerns regarding the validity of the results. More randomised clinical trials are needed on the effects of vitamin D3 on mortality in younger, healthy persons, as well as in elderly community-dwelling and institutionalised persons without apparent vitamin D deficiency.
+This review of drugs for weight loss among adults with type 2 diabetes revealed weight loss of between 2.0 and 5.1 kg for fluoxetine, orlistat and sibutramine at follow-up of up to 57 weeks. The long-term effects remain uncertain. Adverse events were common in all three drugs: gastrointestinal side effects with orlistat; tremor, somnolence, and sweating with fluoxetine; and palpitations with sibutramine. There were few studies examining other drugs used for weight loss in populations with diabetes.
+The evidence is current to July 2015. We found five trials assessing vigabatrin or carbamazepine monotherapy for newly diagnosed epilepsy, which recruited a total of 734 participants between six months and 65 years of age. Results of this review show no significant differences between vigabatrin and carbamazepine in terms of time to treatment withdrawal and time to achieve six-month remission after dose stabilisation from randomisation, but they reveal some clinical disadvantage with vigabatrin on time to first seizure. Taking vigabatrin was more likely to result in weight gain. A safety concern was the high prevalence of visual field defects, as reported in a systematic review of observational studies (Maguire 2010). One study was assessed as good quality and the other four as poor quality.
+We searched several medical databases and identified four randomised controlled trials that met our inclusion criteria. Two of the four studies terminated early due to low recruitment (14 participants included) and did not release any results. We were therefore unable to include them in our statistical analysis. The two published analysed trials included 600 participants with multiple myeloma and non-Hodgkin lymphoma. In both studies, the experimental group received G-CSF plus plerixafor subcutaneously, and the control group received G-CSF plus placebo. Both trials were sponsored by Genzyme, the manufacturer of plerixafor. We were able to conduct a meta-analysis of the data of the two studies for the outcomes mortality at 12 months, successful stem cell collection, and adverse events. We found no evidence for a difference between the plerixafor and placebo group for the outcomes mortality at 12 months and adverse events during stem cell mobilisation period. The meta-analysis showed an advantage for those participants randomised to plerixafor for the outcome successful stem cell collection. Furthermore, in both studies the time to collect a defined number of stem cells was significantly shorter in the plerixafor group compared to the placebo group. In the study that enrolled people with multiple myeloma, 95.9% of the participants in the plerixafor arm and 88.3% in the placebo arm underwent transplantation. In the study that examined people with non-Hodgkin lymphoma, 90% of the participants in the plerixafor group and only 55.4% in the placebo group could be transplanted. It seems that especially people with non-Hodgkin lymphoma benefit from the addition of plerixafor in terms of successful transplantation, but there was no evidence for a difference for time to neutrophil and platelet engraftment in transplanted participants. None of the trials reported on quality of life or progression-free survival. The quality of the evidence was high for adverse events and successful stem cell collection and moderate for mortality at 12 months. The main limitation was a wide confidence interval.
+Twenty-three small trials, involving 1806 women, were found. The results of these trials consistently showed that the use of vaginal weights is better than having no treatment. When vaginal weights were compared to other treatments, such as pelvic floor muscle training without the weights, and electrical stimulation of the pelvic floor, no clear differences between the treatments were evident. This may have been because the numbers of participants in the trials were small, and larger numbers may be required for any differences in the effectiveness of treatments to become clear. Some women find vaginal weights unpleasant or difficult to use, so this treatment may not be useful for all women. Many women with stress urinary incontinence will not be cured by these treatments, and so it is important for trials to assess quality of life during and after treatment, but few of these trials did. Most of the trials were of fairly short duration, so it is difficult to say what happens to women with stress urinary incontinence in the longer term.
+This is an update of the original review first published in 2013. We searched scientific databases in February 2016 and found 11 randomised clinical trials including 2246 adults with atrial fibrillation who were taking oral anticoagulant medication. The trials we found compared education, decision aids, and self-monitoring plus education to usual care, over any length of time. Few studies had comparable groups and data. There was uncertainty about the effect of self-monitoring plus education on the percentage of time the INR was within the therapeutic range because the proportion or time in the therapeutic range was similar between individuals who received self-monitoring plus education and those who did not. There were small and positive effects on anxiety and depression in individuals who received education compared to those who received usual care. There were small and negative effects on decision conflict in individuals who received decision aids compared to those who received usual care. The evidence should be interpreted with caution as the quality of the evidence ranged from very low to low across different outcomes because of the limitations of individual studies. It is likely that further high-quality trials may affect these reported results.
+This review set out to determine the effectiveness and safety of vaginal prostaglandins for third trimester cervical ripening and induction of labour (the cervix softens, shortens and opens, the uterus starts to contract regularly). Eight different comparisons were made, different vaginal prostaglandins were compared with placebos or no treatment, or other vaginal prostaglandins (PGE2, PGF2a, except misoprostol) and different preparations and dosages were compared. We identified 70 studies involving a total of 11,487 women. Vaginal prostaglandins increase the likelihood of vaginal birth within 24 hours, but they can also stimulate the uterus to contract too much and this may cause the baby's heart to slow, however they did not increase the caesarean section rate and may reduce it. Overall, the trials do not show any effect (improvement or worsening) of many important outcomes. Prostaglandin E2 tablets, gels, or pessaries including sustained release preparations appear to be as good as each other or the differences between them are small and have not yet been detected in the trials. Lower-dose regimens, as defined in the review, appeared to be as good as higher-dose regimens (eight trials, 1615 women). Very limited data were available in the included trials on time in labour and patient satisfaction. Few studies have addressed issues relating to the safety of using vaginal prostaglandins for induction of labour as outpatients.
+This updated review randomly assigned 247 preterm infants (in five trials), to an intervention of cot-nursing using a heated water-filled mattress. The control babies received routine care in an air heated incubator. One trial had three-arms, including cot-nursing in a room heated with a manually controlled space heater. In the included trials infants in the incubator groups were nursed naked apart from wearing a nappy, except in one trial in which the infants also wore a cotton jacket and booties. Three comparisons were undertaken: the overall comparison of cot-nursing versus incubator care, and two subgroup comparisons: cot-nursing with heated water-filled mattress versus incubator care, and cot-nursing using warming of the nursery versus incubator care. The results of the review showed no evidence of effect of cot-nursing versus incubator care on weight gain in the overall analysis, or in the subgroup analysis comparing cot-nursing using a heated water-filled mattress with incubator care. However, cot-nursing with warming of the nursery during week one when compared to incubator care revealed poorer weight gain. The primary outcomes related to temperature control (mean body temperature and episodes of cold stress) indicated on overall analysis no effect of cot-nursing compared to incubator care. Episodes of hyperthermia in the cot-nursing group were reported more frequently in one trial. The secondary outcomes of oxygen consumption, breast feeding at hospital discharge, episodes of nosocomial sepsis, maternal perceptions of infant's condition, maternal stress and anxiety and death prior to hospital discharge revealed there was no effect of cot-nursing compared to incubator care. There was, however, a strong trend towards less death prior to hospital discharge. This was largely related to the results were obtained from the trials undertaken in Turkey and Ethiopia and thus may not be applicable to neonatal nurseries in developed countries. Nevertheless the implications of these findings deserve consideration, particularly in the context of a developing country.
+The evidence in this review is up-to-date as of February 2017. Authors with Cochrane Oral Health found three relevant studies, involving 146 participants who had eye teeth displaced in the roof of the mouth, either on one or both sides. The majority of participants were female and the average age in the studies ranged from 14 to 17 years. Two studies were designed in a way that made them likely to be biased. We combined results from three studies and found that one technique did not seem to have an advantage over the other for ensuring the movement of the tooth into the correct position without the need for repeat surgery. Five out of 141 participants analysed were surgical failures, one of which was due to the complication of detachment of the gold chain during surgery. One study reported complications after surgery and found one participant in the closed group had a post-operative infection requiring antibiotics and another participant in the closed group experienced pain during alignment of the canine as the gold chain penetrated through the gum tissue of the palate. We were unable to combine results from studies for any other outcomes, but individual studies did not show evidence of a difference between the two techniques for pain, discomfort, appearance, gum health, length of treatment time or cost (low to very low quality evidence). Overall, we assessed the quality of the evidence as low, which means we cannot be certain of the findings. It does not seem that one surgical technique is better than the other for moving displaced eye teeth into the correct position, or for other outcomes, but this finding is uncertain because the quality of the evidence is low. This suggests the need for more high-quality studies. Three studies are currently in process. When they are completed, we will include them in an update of this review and may be able to reach firmer conclusions.
+The review identified three randomised controlled studies (involving 244 women) that compared the use of prostaglandins with placebo. Currently there is limited, very low-quality evidence relating to the effectiveness and the safety using prostaglandins for the management of retained placenta. Use of prostaglandins resulted in less need for manual removal of placenta, severe postpartum haemorrhage and need for blood transfusion but none of the differences reached statistical significance. Much larger, adequately powered studies are needed to confirm that these clinically important beneficial effects are not just chance findings. Similarly, no differences were detected between prostaglandins and placebo in mean blood loss or the mean time from injection to placental removal (minutes). The prostaglandin was administered by intravenous infusion (E2 analogue sulprostone) in one study including 50 women and was orally or sublingually administered (E1 analogue misoprostol) in the other two studies including 194 women. Shivering was more frequent in women receiving the prostaglandin but there were no clear differences in vomiting, headache, maternal pain or nausea compared with placebo. The trials were small and of poor methodological quality. The quality of evidence is very low due to study limitations, inconsistency and imprecise results (few women and outcome events with wide confidence intervals). Two studies were stopped early due to an apparent benefit.
+Six studies of moderate quality were identified for inclusion. The source of distending pressure was a negative pressure chamber in two studies, face mask continuous positive airway pressure (CPAP) in two studies, nasal CPAP in one study and negative pressure for less severe illness and endotracheal CPAP when more severe in another study. The studies were small, and four of the six were conducted before surfactant therapy was available. The review of trials found that outcomes for babies were improved. Fewer required IPPV and fewer died, and with these two outcomes combined, fewer babies died or required IPPV. It was also found that CDP can increase the rate of pneumothorax (air outside the lung within the chest cavity). Some meaningful benefits were found when continuous distending pressure (CDP) was used for respiratory distress syndrome in preterm babies.
+Existing reviews have not found evidence that one dressing type is more effective than other types in healing foot ulcers in people with diabetes. This review (157 participants) confirms that currently there is no research evidence to suggest that foam wound dressings are more effective in healing diabetic foot ulcers than other types of dressing. Current decisions on choice of wound dressing if any, should be based where possible, on dressing costs and selecting the most useful management properties offered by each dressing type, for example, the management of wound discharge.
+We performed a search in March 2014 and found three relevant randomised trials. Two comparing endoscopic versus surgical interventions (111 patients with durations of two and three years), while the third compared surgery to conservative treatment (i.e. no intervention) (32 patients with a duration of 16 months). We found that surgery achieved pain relief in a higher proportion of participants than endoscopy. Surgery also had other advantages like improved quality of life for the first two years after intervention, although this difference disappeared with time. Similarly, surgery reduced the risk of developing malabsorption due to failure of the pancreas, but with longer follow-up this advantage became smaller. The studies seemingly showed no difference between endoscopy and surgery in complications after interventions. We also compared surgery with conservative treatment. The results of one trial suggested that surgery early in the condition achieved better pain relief and preservation of pancreatic function. For endoscopy versus surgery, the quality of the evidence for pain relief, quality of life and pancreatic function was moderate (according to GRADE). For both complications and mortality this was low, since the two trials were too small to make reliable conclusions. The quality of evidence regarding surgery versus conservative treatment was low, since the trial was small, which precluded drawing reliable conclusions regarding all outcomes.
+We identified only one randomised controlled trial. This trial was at high risk of bias, i.e. there were flaws in the way it was conducted that could have given incorrect results.This trial included 857 people undergoing minor skin operations performed at a General Practitioner (GP) surgery. No steri-strips were used in this trial, as the wounds were stitched. The people running the trial used a method similar to the toss of a coin to decide which group participants went into. One group of 415 people was advised to remove the dressing 12 hours after surgery and then to bathe normally, while the other group of 442 people was advised to keep the dressing on for at least 48 hours and then to bathe normally. The only outcome of interest reported in this trial was wound infection. The authors reported no statistically significant difference in the proportion of people who developed wound infection in the two groups (8.5% in the early bathing group and 8.8% in the delayed bathing group). There is currently no conclusive evidence available from randomised trials about the benefits, or harms, with regard to wound complications of early or delayed post-operative showering or bathing. We recommend further randomised controlled trials to compare early versus delayed post-operative showering or bathing.
+We found one randomised controlled trial (RCT) addressing each question. We did not find any new trials for this update. A 1982 US study compared daily prednisone tablets for 12 weeks with no treatment. Thirty-five people took part. Fourteen participants received prednisone (10 male and four female, with a median age of 46.5 years) and 14 did not receive prednisone (nine male and five female, with a median age of 50 years). Those taking part and the trialists were aware of which treatment the participants received (i.e. they were not 'blinded'), which carries a risk of bias. The second study compared two six-month corticosteroid treatment regimens: daily standard-dose prednisolone tablets, and high-dose dexamethasone tablets for four days each month. Multiple European centres did the trial, which reported its findings in 2010. Forty-one people took part but one person withdrew after one day because they did not want to continue and the diagnosis was wrong. Of those who continued, 24 (18 men and six women, average age 59.9 years) received monthly dexamethasone and 16 (10 men and six women, average age 60.8 years) received daily prednisolone. There was no commercial support for either study. Funding for both came from an academic centre or charitable funds. Neither included study reported our preferred primary outcome, which was a disability score. After 12 weeks, in the trial of prednisone compared to no treatment, 12 of 19 participants on prednisone improved compared with five of 16 participants not on prednisone, based on measurement of disease severity by neurologists. Thus, improvement was about twice as common with prednisone. The small numbers in the trial and its limitations meant that even with this difference we are very uncertain about the size of any effect of prednisone. The trial authors did not report side effects in detail, but one person who received prednisone died. Corticosteroids are commonly used for CIDP in practice, based on favourable reports from non-randomised studies. Corticosteroids are well known to cause side effects, especially when people take large doses for a long time. In the RCT comparing two corticosteroid regimens, 10 of 24 people on monthly dexamethasone and six of 16 people on daily prednisolone were well and off treatment after a year, which indicates effects that are probably similar. Changes in grip strength and scores of muscle strength were also probably similar between the treatment groups. Monthly dexamethasone and daily prednisolone had similar side effects to one another, except that with high-dose monthly dexamethasone, sleeplessness may be less common and a moon-shaped facial appearance is probably less common. The benefit and harm from prednisone in CIDP is uncertain. The quality of evidence is very low because only one small randomised trial with a high risk of bias is available. Monthly dexamethasone and daily prednisolone may be of similar benefit in CIDP, but monthly dexamethasone may have fewer side effects. The evidence is up to date to 8 November 2016.
+We found a total of six studies including 2100 participants: four studies including 792 people could be pooled for the main results, and two other studies were looked at separately because their designs were very different (n = 1213 and n = 95). People in the four pooled studies in general took regular medications and we excluded those with severe asthma or other lung diseases. We looked at two other studies with very different designs to the main four separately: one compared a practice where people with asthma were given the option of a telephone check-up or a practice visit where they came to the clinic as usual, and one looked specifically at using technology to monitor people while cutting down their oral steroids dose. We last looked for studies on 24 November 2015. We cannot say whether or not people who had a check-up over the phone or internet were more or less likely to need oral corticosteroids for an asthma attack than those seen face-to-face, and we were uncertain of the result for several reasons. Too few people had asthma attacks that needed treatment in the Emergency Department or hospital, or an unscheduled visit to see their doctor to tell if remote check-ups were as good as face-to-face consultations. There didn't appear to be a difference in asthma control or quality of life, but we were able to rule out the possibility that remote check-ups are not as good as face-to-face consultations on these measures. The evidence was all considered to be of low or moderate quality. The study that tested the possible benefit of giving people the option of a telephone check-up showed that this increased the number of people reviewed, but did not show an overall benefit on asthma outcomes.
+The number of joints with pain was not measured in these studies. We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. No short-term adverse effects of exercise therapy were found in the studies that make up this review. What is exercise therapy and what is JIA? Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and is an important cause of short-term and long-term disability. In JIA the cause of the arthritis is unknown. It generally begins in children younger than age 16 years. It always lasts for at least six weeks. A physician will rule out other conditions that may be causing the symptoms before diagnosing JIA. Several types of exercise therapy are described in this review, for example, physical training programs such as strength training for improving muscle strength and endurance exercise for improving overall fitness (either land based or in a pool). Best estimate of what happens to children with JIA and exercise Ability to function: a child's ability to function changed less than 1 more point on a scale of 0 to 3. Other studies state that a change of 0.13 on the score of the Childhood Health Assessment Questionnaire (CHAQ) is a clinically important improvement from the perspective of children and their parents. This level of change has not been found in this review Quality of life: a child's quality of life changed between 2.5 and 4 more points on a scale of 1 to 50. There may be little or no difference with exercise. It is possible that these differences are the result of chance. Adverse effects: no short-term effects have been reported after exercise therapy for children with JIA.
+Evidence gathered for this review is current to September 2018. We found 19 randomised studies that compared antibiotics versus placebo in a total of 2663 COPD patients with a wide range of flare-up severity. Analyses show that currently used antibiotics reduced treatment failures (no improvement in symptoms, despite treatment, within 7 to 28 days, depending on the study) compared with placebo in outpatients with mild to moderate flare-ups, as well as in patients admitted to an intensive care unit for very severe flare-ups with respiratory failure. However, antibiotics did not reduce treatment failures among hospitalised patients with severe flare-ups, although we are less certain about this result because the effect estimate also suggested findings similar to those seen in outpatients, but the confidence interval crossed 1.0. Use of antibiotics led to reduced mortality only in patients admitted to an intensive care unit, but not in patients with mild to moderate (outpatients) or severe (inpatients) flare-ups, although deaths were rare in these latter groups. Antibiotics did not reduce length of hospital stay for hospitalised patients. Patients treated with antibiotics experienced diarrhoea more often than those given placebo, but the difference was not statistically significant. Reviewers could not compare the severity of underlying COPD across trials because trial authors inconsistently reported lung function and other parameters. The quality of evidence for review outcomes was low to moderate. Although trial results show that antibiotics were effective across outcomes for patients with very severe flare-ups and respiratory failure who needed treatment in an intensive care unit, researchers report inconsistent effects in patients with mild to severe flare-ups. Future high-quality studies should examine clinical signs or blood tests at the time of presentation that are useful for identifying patients who can benefit from antibiotic therapy.
+We evaluated nine randomised studies assessing the effects of whole grain diets compared to diets with refined grains or a usual diet on levels of cholesterol in the blood or blood pressure (major risk factors for cardiovascular disease including heart attacks or stroke). The evidence is current to August 2016. The diets were followed for at least 12 weeks, but most studies had some methodological limitations, numbers of participants were small, and the overall quality of the evidence was low. We found no studies reporting on the effect of whole grains on deaths from cardiovascular disease or cardiovascular events. All nine included studies reported the effects of whole grain diets on levels of cholesterol in the blood or blood pressure. We found no effects on blood cholesterol or blood pressure in favour of whole grain diets. Four studies were funded by independent national and government funding bodies, while the remaining studies reported funding or partial funding by organisations with commercial interests in cereals. There is insufficient evidence from randomised controlled trials to date to recommend consumption of whole grain diets to reduce the risk of cardiovascular disease, or lower blood cholesterol, or blood pressure.
+Thirty-eight studies with a total of 1,896 participants were included in the review. Many of the trials were potentially biased. Three studies examined rehabilitation interventions that started during the immobilisation period after non-surgical treatment. There is some very limited evidence of short term benefit of one type of brace compared with immobilisation with a cast or orthosis. There was no evidence for hypnosis. Thirty studies investigated rehabilitation interventions that started during the immobilisation period after surgical treatment. Ten of these compared the use of a removable type of immobilisation combined with exercise with cast immobilisation alone. There is some evidence from these that using a removable brace or splint so that gentle ankle exercises can be performed during the immobilisation period may enhance the return to normal activities, reduce pain and improve ankle movement. However, the incidence of adverse events (such as problems with the surgical wound) may also be increased. Starting walking early may also slightly improve ankle movement. One small and biased study showed that neurostimulation, an electrotherapy modality, may be beneficial in the short-term. There was little and inconclusive evidence on what type of support or immobilisation was the best. Five studies investigated different rehabilitation interventions that started after the immobilisation period. There is no evidence of improved function for stretching or manual therapy when either of these are added to an exercise programme, or for an exercise programme when this is compared with usual care. One small and potentially biased study found reduced ankle swelling after non-thermal compared with thermal pulsed shortwave diathermy.
+We identified four studies that evaluated interventions designed to improve adherence to ART among children and adolescents age 18 years and younger. These studies showed that home-based nursing, peer support for adolescents and LPV/r-containing regimens have the potential to improve ART adherence, but more evidence is needed. Medication diaries do not appear to have an effect on adherence. There is a need for well-designed evaluations of interventions to improve paediatric adherence to ART.
+Five studies looking at a total of 696 participants were included. Because fewer than 200 participants were treated with any one dose of fenoprofen within each study, results must be treated with caution. A good level of pain relief was experienced by better than one in two (over half; 57%) of those with moderate or severe postoperative pain after a single dose of fenoprofen 200 mg, compared to about 1 in 7 (14%) with placebo. This level of pain relief is comparable to that experienced with ibuprofen 400 mg. The frequency of adverse events did not differ between fenoprofen 200 mg and placebo in these studies.
+Six trials were included. Four trials compared pelvic floor muscle training (PFMT) with no intervention, and two trials compared pelvic floor muscle training plus surgery to surgery alone. PFMT compared to no intervention was found in individual trials to improve prolapse symptoms, but data could not be combined. Data on prolapse severity was combined from two trials and results indicated that PFMT increases the chance of improvement in prolapse stage by 17% compared to no treatment. Pelvic floor muscle function appeared to be improved in women who received PFMT in the two trials which measured this. Bladder symptoms were improved with PFMT in two out of three trials measuring this; bowel symptoms were measured in one trial, and an improvement with PFMT was found. The two trials which looked at the benefit of PFMT in addition to surgery, were small but of good quality. Findings were contradictory: women benefited from PFMT, in terms of urinary symptoms and pelvic floor muscle strength, in one trial but not the other. The evidence from the trials suggests there is some benefit from conservative treatment of prolapse, specifically for PFMT as compared to no intervention. More randomised controlled trials are still needed to look at different regimens of PFMT, the cost in relation to benefit, and the long-term effects. The combination of PFMT and surgery requires to be evaluated in a large randomised trial. There is a dearth of trials addressing lifestyle changes as a treatment for prolapse, and trials aimed at prevention of prolapse. Trials of one type of conservative intervention versus another, and combinations of conservative interventions, are also lacking.
+Quinolone antibiotic drops (considered to be the 'gold standard' topical antibiotics) are better than no drug treatment or antiseptics at drying the ear. The effects of non-quinolone antibiotics (without steroids) when compared to antiseptics are less clear. Studies were also inconclusive regarding any differences between quinolone and non-quinolone antibiotics, although indirect evidence suggests a benefit of quinolones cannot be ruled out. Less is known about longer-term outcomes (producing a dry ear in the long term, preventing complications, healing the eardrum, and improving hearing), or about treating complicated CSOM. The evidence in these trials about safety is also weak. More research is needed to assess whether there may be fewer adverse events with topical quinolones than with alternative topical treatments.
+This review looks at how accurate First Rank Symptoms (FRS) are at diagnosing schizophrenia. FRS are symptoms that people with psychosis may experience, for example hallucinations, hearing voices and thinking that other people can hear their thoughts. We found 21 studies, with 6253 participants, that looked at how good FRS are at diagnosing schizophrenia when compared to a diagnosis made by a psychiatrist. These studies showed that for people who actually have schizophrenia, FRS would only correctly diagnose just over half of them as schizophrenic. For people who do not have schizophrenia, almost 20% would be incorrectly diagnosed with schizophrenia. Therefore, if a person is experiencing a FRS, schizophrenia is a possible diagnosis, but there is also a chance that it is another mental health disorder. We do not recommend that FRS alone can be used to diagnose schizophrenia. However, FRS could be useful to triage patients who need to be assessed by a psychiatrist.
+The main finding of this review is that there is currently only limited research evidence about the effect of educational and psychological approaches when used alongside medicines for the treatment of childhood eczema. Included studies provided a range of interventions, from a single 15-minute consultation to a comprehensive series of sessions delivered to groups of parents over a period of 12 hours. Details of the interventions used and the educational theory base are generally poorly described. Outcome measures varied between studies. Although it is not possible to draw definitive conclusions from this review, several studies using educational interventions demonstrated improvements in eczema severity and quality of life for both children and families. In particular, two studies showed promise. One large study (n = 992) using a multi-disciplinary group education intervention in a hospital setting showed modest improvements in disease severity and quality of life. The single study using psychological approaches indicated that relaxation methods reduced the severity of eczema when compared to discussion only. There is a need for further research into this subject, and priority should be given to comparing the relative cost effectiveness of health professionals educating parents either in teams or by nurses alone. There is also a need for comparison with stand-alone self-help. The most appropriate timeframe for evaluating the effect of interventions should be considered.
+There was some evidence that HBOT improved outcome in LRTI affecting bone and soft tissues of the head and neck, for radiation proctitis (inflammation of the lower part of the large intestine caused by radiotherapy treatment) and to prevent the development of osteoradionecrosis (bone death caused by radiotherapy treatment) following tooth extraction in an irradiated field. There was no such evidence of any important clinical effect on tissues in the nervous system. The evidence was generally of moderate quality and limited by small numbers of participants, poor reporting of methods and results, and uncertainty as to the exact degree of improvement with HBOT. The application of HBOT to selected participants and tissues may be justified. Studies of radiation injury suggest that other tissues are also likely to respond (e.g. bladder). Further research is required to establish which people may respond and the best timing of such therapy. A study of costs would also be useful.
+We reviewed the literature to evaluate the preventive effect of blunt needles compared to sharp needles on needle stick injuries among surgical staff. We searched multiple medical databases (to May 2011). We included studies if they were randomised controlled trials (RCTs) of blunt versus sharp suture needles for preventing needle stick injuries among surgical staff. We located 10 RCTs with 2961 operations in which blunt needles were compared to sharp needles. Six studies focused on abdominal operations, two on vaginal repair and two on hip replacement. On average, a surgeon that used sharp needles sustained one glove perforation per three operations. The use of blunt needles reduced the risk of glove perforations by 54% (95% confidence interval 46% to 62%) compared to sharp needles. The use of blunt needles in six operations will thus prevent one glove perforation. In four studies the use of blunt needles also reduced the number of self-reported needle stick injuries by 69% (95% confidence interval 14% to 68%). Even though surgeons reported that the force needed for the blunt needles was higher, their use of the needles was still rated as acceptable in five out of six studies. We concluded that there is high quality evidence that the use of blunt needles appreciably reduces the risk of contracting infectious diseases for surgeons and their assistants over a range of operations by reducing the number of needle stick injuries. It is unlikely that future research will change this conclusion.
+Antipsychotic drugs are the main treatment for schizophrenia, they help people cope with symptoms such as hearing voices, seeing things and having strange beliefs. Guidelines state that there is no difference in effectiveness between antipsychotics, but low-potency antipsychotic drugs are often seen as less effective than high-potency drugs, and they also seem to differ in side-effects. The classification into high-potency and low-potency medication means that low-potency antipsychotic drugs need higher doses for treating the symptoms of schizophrenia. Side-effects that are common to most high-potency antipsychotic drugs include the movement disorders such as uncontrollable movements of the face, arms, or legs; tremors; problems with balance or walking; restlessness; seizures; joint pain whereas low-potency drugs are more likely to cause sedation, fever and loss of muscle strength. Research has not evaluated and compared high-potency drugs with low-potency antipsychotic drugs. The aim of the review was therefore to compare trifluoperazine (a high-potency antipsychotic) with low-potency antipsychotics for people with schizophrenia. Examples of low-potency drugs are chlorpromazine, chlorprothixene, thioridazine and levomepromazine. The review is based on a search carried out in 2010 and included seven studies with a total of 422 people. It compared trifluoperazine with low-potency antipsychotic drugs. Overall, information was poorly reported and the quality of the studies was low; authors rated the quality of evidence for the main outcomes of interested as being either moderate, low or very low quality. Results do not show a superiority of trifluoperazine compared with low-potency antipsychotics. However, at least one movement disorder (muscle stiffness) was significantly more with trifluoperazine. For people with schizophrenia it is important to know that trifluoperazine and low-potency antipsychotics are approximately equal for dealing with symptoms such as hearing voices or seeing things. They differ slightly in their side-effects, with trifluoperazine leading to at least one movement disorder (muscle stiffness). However, no clear superiority of trifluoperazine versus low-potency antipsychotics was found. Due to the limited number of studies, participants and low quality of information, these results have to be interpreted with caution. This plain language summary has been written by a consumer Benjamin Gray, Service User and Service User Expert, Rethink Mental Illness.
+We searched for all available evidence up to January 2016. We found nine eligible randomised controlled trials (including a total of 593 infants) that examined whether feeding preterm infants in response to their own feeding and satiation cues (sometimes called 'demand' feeding) is better than feeding set volumes of milk at predefined intervals. These trials compared responsive with scheduled interval regimens in preterm infants in the transition phase from intragastric tube to oral feeding. Although the trials were generally small and most had some methodological weaknesses, analysis suggests that responsive feeding results in slightly slower rates of weight gain and reduces the time taken for infants to transition from enteral tube to oral feeding. The quality of this evidence is low, and the importance of this finding is uncertain as the trials did not find a strong or consistent effect on the length of hospitalisation. None of the included trials reported any parent, caregiver, or staff views. This Cochrane review does not provide strong or consistent evidence that responsive feeding improves outcomes for preterm infants or their families. Responsive feeding might help infants transition more quickly to oral feeding, but more randomised controlled trials would be needed to confirm this finding.
+We looked at studies where treatments to lower homocysteine were used in people with PAD and hyperhomocysteinaemia. Two trials with 161 participants with PAD were included in this review. One trial showed a significant  improvement in the ankle brachial index (ABI) in participants treated daily with 400 μg folic acid or 5-methyltetrahydrofolate (5-MTHF). A second trial showed that there was no difference in ABI in participants who received a multivitamin B supplement compared with placebo. None of the other predefined primary outcomes (mortality and rate of limb loss) were assessed in these studies. More research about the effect of homocysteine lowering therapy on the clinical progression of disease in people with PAD and hyperhomocysteinaemia is needed.
+Our review identified two studies examining the effects of different methods of remuneration on the behaviour of 821 dentists from 503 dental practices, involving 4771 patients. Both were conducted in the United Kingdom. One study investigated the impact of a fee-for-service payment and an educational intervention on the placement of fissure sealants in permanent molar teeth. The second study compared the impact of capitation payments and fee-for-service payments on primary care dentists’ clinical activity and the levels of dental decay that were experienced across the two payment systems. The first study found an increase in clinical activity related to fee-for-service payments. In the second study, dentists working under capitation arrangements restored carious teeth at a later stage in the disease process than fee-for-service controls. In the capitation arm, the dentists tended to see their patients less frequently and tended to carry out fewer fillings and extractions, but tended to give more preventive advice. There was insufficient information regarding cost-effectiveness of the different remuneration methods. Financial incentives within remuneration systems may produce changes to clinical activity undertaken by primary care dentists. However, the number of included studies is limited and the quality of the evidence is low/very low for all outcomes.
+Many women of childbearing age may have mild to moderate zinc deficiency. Low zinc concentrations may cause preterm birth or they may even prolong labour. It is also possible that zinc deficiency may affect infant growth as well. This review of 21 randomised controlled trials, involving over 17,000 women and their babies, found that although zinc supplementation has a small effect on reducing preterm births, it does not help to prevent low birthweight babies compared with not giving zinc supplements before 27 weeks of pregnancy. One trial did not contribute data. The overall risk of bias was unclear in half of the studies. No clear differences were seen for development of pregnancy hypertension or pre-eclampsia. The 14% relative reduction in preterm birth for zinc compared with placebo was primarily represented by trials of women with low incomes. In some trials all women were also given iron, folate or vitamins or combinations of these. UNICEF is already promoting antenatal use of multiple-micronutrient supplementation, including zinc, to all pregnant women in developing countries. Finding ways to improve women's overall nutritional status, particularly in low-income areas, will do more to improve the health of mothers and babies than supplementing pregnant women with zinc alone. In low- to middle- income countries, addressing anaemia and infections, such as malaria and hookworm, is also necessary.
+We searched evidence up to October 2017 and included 10 clinical trials with 1656 participants. The trials lasted between three months and five years. All trials used at least one laboratory method for diagnosis. Four trials compared vaginal suppository (solid medicine inserted directly into the vagina) or tablet of clotrimazole (antifungal medicine) plus vaginal capsules of probiotics with vaginal suppository or tablet of clotrimazole alone. Three trials compared vaginal suppository of miconazole (antifungal medicine) plus vaginal capsules of probiotics with vaginal suppository of miconazole alone. Two trials compared oral fluconazole (antifungal medicine) plus oral capsules of probiotics with oral fluconazole plus oral capsules of placebo (pretend treatment). One trial compared oral fluconazole and vaginal fenticonazole (antifungal medicines) with oral fluconazole plus vaginal fenticonazole plus probiotic. Compared with conventional antifungal drugs used alone, probiotics as adjuvant therapy could enhance their effect in improving the rate of short-term (within five to 10 days) clinical cure, short-term mycological cure (no abnormal laboratory results) and relapse at one month (recurrence of problems), but does not seem to influence the rate of long-term (within one to three months) clinical cure, long-term mycological cure, serious and non-serious side events. However, because of the low quality of evidence available, there is insufficient evidence for the use of probiotics as adjuvants to conventional antifungal medicines or used alone for the treatment of VVC in non-pregnant women. The quality of the evidence was low or very low in this review, so we have very little confidence in the results.
+In this review of the literature, up to August 2017, we identified seven randomised trials involving 696 women that compared the use of progestogens in the treatment of threatened miscarriage with either placebo or no treatment. We found that the use of a progestogen probably reduces the rate of spontaneous miscarriage and this was supported by moderate-quality evidence. Five trials, involving 588 women, reported on the effectiveness of progestogens given for threatened miscarriage in reducing the rate of preterm delivery and showed little or no effect, with low-quality evidence. Two trials, involving 337 women, reported on the effect of treatment with progestogens given for threatened miscarriage on the rate of occurrence of congenital abnormalities in the newborns. The evidence on congenital abnormalities is uncertain, because the quality of the evidence for this outcome was based on only two small trials with very few events and was found to be of very low quality. The evidence suggests that progesterone probably reduces the rate of spontaneous miscarriage but may make little or no difference to the number of preterm deliveries. The evidence for congenital abnormalities is uncertain because the quality of the evidence for this outcome was based on only two small trials with very few events and was found to be of very low quality.
+We found five studies. The searches were done in April 2014. Three studies were done in the USA, one study in the UK and one study in Japan. A total of 4786 people (9503 eyes) were included in these studies. Most participants had PDR. We found that moderate vision loss at 12 months was similar in eyes treated with laser and eyes that were not treated, but similar assessments made at a later date showed that eyes treated with laser were less likely to have suffered moderate vision loss. Treatment with laser reduced the risk of severe visual loss by over 50% at 12 months. There was a similar effect on the progression of DR. None of the studies reported patient-relevant outcomes such as pain or loss of driving licence. We did not find very many studies and those we found were done quite a long time ago when standards of trial conduct and reporting were lower. We judged the quality of the evidence to be low, with the exception of the results for severe visual loss, which we judged to be moderate quality evidence.
+We searched scientific databases for clinical trials looking at the treatment of adults with acute respiratory failure following abdominal surgery. The trials compared NPPV with usual care(oxygen therapy through a face mask). We included two trials involving 269 participants.The participants were mostly men (67%) and on average 65 years of age. One trial was conducted in several intensive care units (ICU). Both trials included adults with acute respiratory failure after upper abdominal surgery. The evidence is current to May 2015. This review examined mortality, rate of tracheal intubation, length of stay in the ICU, length of hospital stay, complications after NPPV, and changes in the levels of gases within the blood (arterial blood gases). Compared with oxygen therapy, NPPV decreased the rate of tracheal intubation. Out of every 1000 adults who developed acute respiratory failure after upper abdominal surgery, 181 adults treated with oxygen therapy would need to be intubated compared with 54 adults treated with NPPV. When compared to oxygen therapy, NPPV tended to reduce mortality. However, since the number of participants included in the two trials was small, more studies are needed. The use of NPPV also reduced the length of stay in the ICU by almost two days when compared to oxygen therapy. However, the mean length of stay in the hospital was similar in the two groups. When compared to oxygen therapy, NPPV improved blood gas levels one hour after the intervention. There was insufficient evidence to be certain that CPAP or NPPV had an effect on anastomotic (e.g. where two pieces of intestine are joined together) leakage, pneumonia related complications and sepsis (blood poisoning) or infections. However, adults treated with NPPV had lower rates these complications than adults treated with oxygen. There was low quality evidence for hospital mortality, low quality of evidence for rate of tracheal intubation, and very low quality of evidence for ICU length of stay. The findings of this review showed that NPPV is an effective and safe treatment for adults with acute respiratory failure after upper abdominal surgery. However, due to the low quality of the evidence, more good quality studies are needed to confirm these findings.
+This review found that there is not enough evidence from the four included randomised controlled trials, involving 388 women and their babies, to determine the most effective and safe analgesic agent or technique for women who are undergoing a forceps delivery. Three of the four trials compared diazepam with alternative agents (ketamine, vinydan-ether, or "other" anaesthesic agent) to provide general anaesthesia during forceps delivery. A number of different methods were used to measure pain relief and the results could not be combined. The data from one trial could not be included in the review. Women who received diazepam were more likely to judge their pain relief as effective compared with women who received vinydan-ether in one small trial. In another small trial, however, no difference in pain relief was shown when diazepam was compared with ketamine. In the trial that compared spinal analgesia with pudendal nerve block, women receiving spinal analgesia were more likely to report their pain relief as adequate and were less likely to report severe pain. None of the four trials reported on serious complications or death for the mother or baby. The included trials had a high or unclear risk of bias and were not of a high quality. Each of the four included trials was conducted prior to 1980 and assessed agents or methods that are not commonly used in clinical practice today. Therefore, more studies are needed to establish what drug, or technique, is most effective and safe in reducing pain for the mother. These studies should also assess safety for the baby.
+We reviewed 15 studies that compared the effects of yoga with usual treatment or a 'sham' yoga in 1048 participants. We found that yoga probably improves quality of life and asthma symptoms to some extent. However, our confidence in the results is low as most of the studies were flawed in various ways. The effects of yoga on lung function were inconsistent, and we found a small amount of evidence indicating that yoga can reduce medication usage. Information on unwanted side effects was very limited; more studies are needed to assess this. High-quality studies involving large numbers of participants are required for us to be able to draw a firm conclusion about the effects of yoga for asthma.
+This review included 10 trials (249 participants). One of these trials (24 participants) is completed but has not yet been published. Seven trials compared treatments with placebo (inactive treatment): three of intravenous immunoglobulin (IVIg), two of interferon beta-1a (IFN beta-1a), and one each of oxandrolone, methotrexate (MTX), and arimoclomol (not yet published). A further two trials compared MTX with combined immunosuppressive therapy (MTX with anti-T lymphocyte immunoglobulin (ATG) (an agent that destroys white blood cells) and MTX with azathioprine). In these two trials, participants and investigators knew which treatment participants were receiving, which could have biased the results. For our primary outcome, which was muscle strength, we were only able to combine the results for the two trials of IFN beta-1a therapy versus placebo. This treatment did not appear to offer a benefit in terms of muscle strength. MTX also did not stop or retard loss of muscle strength when compared to placebo. We considered the evidence from these trials to be of moderate quality because the trials were too small to rule out a possible benefit for these drugs. For the other trials, the evidence was of very low quality. Three trials compared IVIg (combined in one trial with prednisone) to a placebo, but we were unable to perform meta-analysis because the available data were not suitable. One trial of ATG combined with MTX versus MTX alone provided very low-quality evidence of an effect on muscle strength in favour of MTX plus ATG at 12 months. The other comparisons, of MTX versus placebo, oxandrolone versus placebo, azathioprine combined with MTX versus MTX, and arimoclomol versus placebo were reported in single trials that did not provide enough data for analysis of the effect on muscle strength. Due to their small size and short duration, the trials we studied were generally unable to give definitive answers as to whether the treatments tested were effective or ineffective. All of the interventions we studied had some adverse effects and are known to cause potentially serious adverse events. We need larger trials of longer duration, using robust ways of measuring the effects of treatments that are meaningful to people with IBM. Agreeing on common trial measurements will also make it easier to compare trial results and assess potential treatments. The evidence is current to October 2014.
+This review identified nine RCTs, with a total of 3144 participants, and compared treatment with linezolid against treatment with vancomycin for skin and soft tissue infections. No new trials were identified for this first update. Linezolid was found to be more effective than vancomycin for treating these infections. There were fewer skin complications in the group that were treated with linezolid. There were no differences between the two groups in the number of reported deaths, and those treated with linezolid had shorter lengths of hospital stay than those treated with vancomycin. The daily cost of outpatient therapy was less with oral linezolid than with intravenous vancomycin, although for inpatient treatment, linezolid was more expensive than vancomycin. Well-designed trials will be required in future to confirm these results, as the trials from which these conclusions were drawn were of poor methodological quality, at high risk of bias, and were funded by the pharmaceutical company that makes linezolid.
+We included eight randomised controlled trials with a total of 512 participants in this review. The included trials revealed vast differences in sample size as well as clinical and methodological quality. We could identify no relevant differences in terms of main complications, long-term survival, or death due to complications after the operation, but operating time, intraoperative blood loss, and need for blood transfusion seem to be less frequent in the group treated with the pylorus-preserving Whipple operation. Our conclusion is that, at present, no relevant difference is evident between the two surgical procedures for the treatment of pancreatic or periampullary cancer. The quality of the body of evidence is still low since all trials revealed some shortcomings in terms of methodological quality or reporting.
+This review looked at all high quality trials comparing the use of calcium channel blockers with a control, in head-injured patients of any age. The authors also looked at trials involving patients suffering from subarachnoid haemorrhage (that is, bleeding into the space between the brain and the skull) caused by an injury, as a subgroup. The authors found six eligible trials involving 1862 patients. The results indicate that there is insufficient evidence to support the use of calcium channel blockers. The authors conclude that there is some evidence that a calcium channel blocker called nimodipine may be beneficial for some patients with subarachnoid haemorrhage. However, there is also an indication of certain adverse reactions amongst patients treated with nimodipine which may mean that the drug is harmful for some individuals. The authors recommend that the promising results in patients with subarachnoid haemorrhage are replicated in a larger well designed trial, before any firm conclusions about the effectiveness of the drug can be drawn. In future trials, data on outcomes other than death and severe disability, such as quality of life of the survivors and the economic utility of the drug, should be measured; such outcomes have not been considered in existing research.
+After reviewing the studies and their available data, we could not be certain that one approach had superiority over another, and we could not establish whether the two treatments had similar effects on outcomes. We found no adverse effects associated with either treatment. Currently, no definitive evidence allows us to conclude that chest compressions should be the initial therapy for patients with OHCA over immediate electric shock treatment. However, we believe that the amount and quality of research in this area currently are not sufficient to allow strong conclusions. To further our understanding of the efficacy of these two different strategies, further rigorous randomized controlled trials are required.
+This review of ten randomised controlled trials suggests there is insufficient evidence to support the routine use of any one particular intervention in the management of women who are poor responders. More research is needed with good quality trials looking at relevant outcomes such as live birth rates rather than treatment-associated outcomes such as positive pregnancy rates or number of eggs. Research is also recommended in adverse outcomes and costs of these treatments.
+Studies were conducted in Europe, Asia and North America with packages of family intervention varying among studies, although there were no clear differences in study design. Results indicated that family intervention may reduce the risk of relapse and improve compliance with medication. However data were often inadequately reported and therefore unusable. As this package of care is widely employed, there should be further research to properly clarify several of the short-term and long-term outcomes.
+Our review included three clinical trials that randomized 263 participants (most recent search - November 28, 2017). Trials included leg arteries at and above the knee and were carried out in Europe; all used DEBs that contained the chemical known as "paclitaxel." Two companies manufactured the DEBs: Eurocor and Medtronic. Most study participants were followed for six or more months; this is called "follow-up." Results showed that DEBs were not better for participants than uncoated balloon angioplasty with regard to the need for amputation. At 24 months of follow-up, DEBs were associated with fewer target lesion revascularizations, which refers to the need to perform a procedure on a stent that had already been treated with a DEB or an uncoated balloon angioplasty for in-stent restenosis. DEBs were also found to have better binary restenosis rates, which refers to the percentage of treated stents that develop new stenosis after they have been treated with a DEB or an uncoated balloon angioplasty. Finally, more people who were treated with DEBs described improvement in their leg symptoms, as measured by a change in their Rutherford category. DEBs were not found to be better for participants than uncoated balloon angioplasty with regard to patient death. The certainty of the evidence presented was very low because we identified only three studies with small numbers of participants, and because many participants in those studies were lost to follow-up. Furthermore, risk of performance and attrition bias was significant, as was risk of other biases, due to lack of accounting for the type of stent treated and the need for bailout stenting.
+Evidence is current to November 2016. Male and female children diagnosed with Kawasaki disease were included in this review. We selected only randomised clinical trials. Trials compared the use of steroids against not using steroids. This review involves seven trials and 922 participants. Steroids appear to reduce the risk of heart problems after Kawasaki disease without causing any important side effects. They also reduce the length of symptoms (fever and rash), length of hospital stay, and blood markers associated with being unwell. Certain groups, including those based in Asia, those with higher risk scores, and those receiving longer steroid treatment, may have greater benefit from steroid use, especially with decreasing rates of heart problems, but more tests are needed to answer these questions. More tests are also needed to obtain a more accurate marker of the risk of serious side effects and to determine if there is a lower chance of death when using steroids. Evidence presented in this review suggests that treatment with a long course of steroids should be considered for all children diagnosed with Kawasaki disease until further studies are performed. Evidence quality was graded according to the GRADE system. Evidence was considered high quality for serious adverse events, mortality and time for laboratory parameters to normalise. Evidence was considered moderate quality for the risk of future heart problems, duration of clinical symptoms (fever, rash) and length of hospital stay. This means that we are reasonably confident that the true effect is close to that estimated in this work.
+We searched electronic databases and identified randomised controlled trials (RCTs, where participants are randomly allocated to one of two or more treatment groups) and one cluster randomised trial (where prisons rather than participants were used as the unit of randomisation), in which participants had been allocated to a receive PIP versus a control group, and which reported results using at least one standard measure of outcome (i.e. an instrument which has been tested to ensure that it reliably measures the outcome under investigation). Evidence is current to 13 January 2014. We identified eight studies with 846 randomised participants comparing either PIP with a no-treatment control group (four studies) or comparing PIP with other types of treatment (four studies). The studies comparing PIP with a no-treatment control group contributed data to 19 meta-analyses of the primary outcomes of parental mental health (depression), parent-infant interaction outcomes of maternal sensitivity (i.e. the extent to which the caregiver responds in a timely and attuned manner), child involvement and parent positive engagement, and infant outcomes of infant attachment category (the infant's ability to seek and maintain closeness to primary caregiver - infant attachment is classified as follows: 'secure' infant attachment is a positive outcome, which indicates that the infant is able to be comforted when distressed and is able to use the parent as a secure base from which to explore the environment. Infants who are insecurely attached are either 'avoidant' (i.e. appear not to need comforting when they are distressed and attempt to manage the distress themselves); or 'resistant' (i.e. unable to be comforted when distressed and alternate between resistance and anger). Children who are defined as ‘disorganised’ are unable to produce a coherent strategy in the face of distress and produce behaviour that is a mixture of approach and avoidance to the caregiver); and the secondary outcomes of infant behaviour and infant cognitive development (i.e. intellectual development, including thinking, problem solving and communicating). In our analyses, parents who received PIP were more likely to have an infant who was securely emotionally attached to the parent after the intervention; this a favourable outcome but there is very low quality evidence to support it. The studies comparing PIP with another model of treatment contributed data to 15 meta-analysis assessments of primary outcomes, including parental mental health, parent-infant interaction (maternal sensitivity); infant attachment and infant behaviour, or secondary infant outcomes such as infant cognitive development. None of these comparisons showed differences that favoured either PIP or the alternative intervention. None of the comparisons of PIP with either a control or comparison treatment group showed adverse changes for any outcome. We conclude that although PIP appears to be a promising method of improving infant attachment security, there is no evidence about its benefits in terms of other outcomes, and no evidence to show that it is more effective than other types of treatment for parents and infants. Further research is needed. The included studies were unclear about important quality criteria, had limitations in terms of their design or methods, or we judged that there was risk of bias in the trial. This lower quality evidence gives us less confidence in the observed effects.
+This updated Cochrane review included 11 studies involving 753 participants. The studies compared maternal (mother) and neonatal (foetal) outcomes when pregnant women received extra oxygen versus room air. Oxygen was given to the women in different ways (at any flow rate or concentration via any oxygen delivery device). Overall, the results of this updated review reach the same conclusions as the original published review. None of the 11 included trials reported maternal desaturation. No differences were noted in routine measures of foetal wellbeing (Apgar scores) when mothers who received extra oxygen were compared with those who did not. The pregnant women receiving extra oxygen in comparison with room air had significantly higher oxygen saturation (three trials) and partial pressure of oxygen in arterial blood (five trials), as well as a significantly higher partial pressure of oxygen in both the umbilical artery and the umbilical vein (eight and 11 trials, respectively). Two trials reported higher markers of free radicals (perhaps indicating stress from excess oxygen) in mothers and foetuses when extra oxygen was given, but this is of no clinical significance Overall, we found no convincing evidence that giving oxygen in this situation is either beneficial or harmful for either the mother or the foetus. None of the 11 studies focused on maternal changes in oxygen saturation (defined as maternal saturation less than 90%). We graded the quality of evidence as low for the primary outcome (Apgar scores), and very low for the secondary outcomes (maternal oxygen saturation; partial pressure of oxygen in arterial blood, the umbilical artery and the umbilical vein). The reasons for our grading were risk of bias and inconsistency of the results.
+We assessed twelve studies involving 2196 participants who were taking self-administered medications for at least one month. The studies involved different types of packaging, and different medications for various health problems. We found that reminder packaging increased the proportion of people taking their medications when measured by pill count; however, this effect was not large. We also found some evidence that reminder packaging may be beneficial in improving clinical outcomes such as blood pressure. Reminder packing for certain individuals may represent a simple method for improving the adherence to medications; further research is needed to improve the design and targeting of these devices.
+In experimental studies many drugs have shown some promise in decreasing liver damage caused by the occluded blood supply. We identified a total of 15 randomised trials evaluating 11 different pharmacological interventions (methylprednisolone, multivitamin antioxidant infusion, vitamin E infusion, amrinone, prostaglandin E1, pentoxifylline, mannitol, trimetazidine, dextrose, allopurinol, and OKY 046). All trials had risk of bias ('systematic errors') and risk of play of chance ('random errors'). There was no significant difference between the groups in mortality, liver failure, or post-operative complications. The trimetazidine group had a significantly shorter hospital stay, and the vitamin E group had a significantly shorter intensive therapy unit stay than the respective controls. There was no significant difference in any of the clinically relevant outcomes in the remaining comparisons. Methylprednisolone improved the enzyme markers of liver function and trimetazidine, methylprednisolone, and dextrose reduced the enzyme markers of liver injury compared to controls. However, there is a high risk of type I (erroneously concluding that an intervention is beneficial when it is actually not beneficial) and type II errors (erroneously concluding that an intervention is not beneficial when it is actually beneficial) because of the few trials included, the small sample size in each trial, and the risks of bias. Three pharmacological drugs - trimetazidine, methylprednisolone, and dextrose - have potential for a protective role against liver injury in elective liver surgery involving blood supply occlusion. However, based on the current evidence it is recommended that the use of these agents should be restricted to well-designed trials in patients undergoing resection.
+The evidence is current to March 2017. We included 61 studies; 46 on prevalence, six for both prevalence and risk factors, and nine studies that did not meet all the requirements for this review, but evaluated risk factors (non-eligible studies). Participants in the studies had been treated before the age of 21 years with chemotherapy (i.e. cisplatin, carboplatin, ifosfamide), radiation, or surgery involving the kidneys, or a combination of these treatments. The studies took place at least one year after the participants had finished their treatment. The 52 studies that evaluated prevalence of adverse kidney effects included 13,327 participants, of whom 4499 underwent kidney function tests. The studies were very different from each other, in the types of participants and treatments, length of follow-up and how they measured treatment results, and their methods were of variable quality. The percentage of CCS with kidney problems ranged from 0% to 84%. Reported risk factors were often inconsistent among studies. The prevalence of chronic kidney disease ranged from 2.4% to 32% in 244 participants (7/52 studies). Thirty-six out of 52 studies, including at least 432 participants, carried out a kidney function test called glomerular filtration rate (GFR). An abnormal GFR was found to be present in 0% to 73.7% of participants. One eligible study found an increased risk of abnormal GFR in participants who had been treated with total body irradiation (TBI) and received certain types of antibiotics (aminoglycosides and vancomycin). Four non-eligible studies reported an increased risk of abnormal GFR for participants treated with surgery of the kidney and ifosfamide. Some studies also reported that cisplatin and long follow-up duration were risk factors. Twenty-two out of 52 studies, including 851 participants, assessed an abnormal amount of proteins in the urine, which they found in 3.5% to 84% of participants. Risk factors, evaluated by three non-eligible studies, included cisplatin, ifosfamide, TBI, and a combination of surgery and radiation involving the kidney. However, the results of these studies did not agree, and we could not analyse their results together because they used different definitions. Eleven out of 52 studies looked at a low level of phosphate in the blood (hypophosphataemia), or problems with the reabsorption of phosphate by the kidneys in 246 participants. Prevalence of hypophosphataemia ranged between 0% and 36.8% in 287 participants. The studies found problems with the reabsorption of phosphate by the kidneys in 0% to 62.5% of participants. One non-eligible study investigated risk factors, but could not find any association with hypophosphataemia. Four out of 52 studies, including 128 CCS, evaluated a low level of magnesium in the blood (hypomagnesaemia). Prevalence ranged between 13.2% and 28.6%. Two non-eligible studies identified cisplatin as risk factor for hypomagnesaemia. Other reported risk factors were carboplatin, surgery of the kidney, and follow-up time. However, studies were contradictory. The prevalence of high blood pressure ranged from 0% to 50% in 2464 participants (30/52 studies). Risk factors reported by one eligible study were older age at screening and radiation involving the kidney. A high body mass index was reported as a risk factor by three non-eligible studies. Other reported risk factors included follow-up time, and radiation involving the kidney or TBI. However, studies were contradictory. All studies showed problems that could affect our confidence in their results. More, and especially higher-quality research is needed to gain better insight into kidney adverse effects and related risk factors.
+Two trials (182 participants) and two phytomedicines Niprisan® (also known as Nicosan®) and Ciklavit® were included. This review found that Niprisan® may help to reduce episodes of sickle cell disease crises associated with severe pain. Ciklavit®, which has been reported to reduce painful crises in people with sickle cell disease, deserves further study before recommendations can be made regarding its use. The trial of Ciklavit® also reported a possible adverse effect on the level of anaemia. Both formulations reported no serious adverse symptoms or derangement of liver or kidney function in the participants. More detailed and larger trials of these medicines will need to be carried out before we can make any recommendations about their use. Further research should also assess long-term outcome measures. We judged the quality of the evidence from this review to be of low to very low quality, depending on the outcome measured.
+We searched important medical databases such as the Cochrane Central Register of Controlled Trials and MEDLINE. Two review authors independently screened, summarised and analysed the results. This lead to the inclusion of three randomised controlled trials (RCTs) with 1999 participants. Currently, only data for 1480 of these participants have been published and were included in this systematic review. Participants were randomised to receive either standard therapy (chemotherapy followed by radiotherapy) or PET-adapted therapy (chemotherapy only). The median age of participants was 32 years and 52% were male. The evidence provided is current to September 2014. We are unable to draw conclusions about the effect of PET-adapted therapy on OS as there was insufficient data available (4 deaths in 1480 participants). However, PFS was shorter following PET-adapted therapy than with standard treatment. Based on our data, we can assume that of 1000 individuals receiving PET-adapted treatment over 4 years, 222 individuals would experience disease progression or death compared with 100 of 1000 individuals receiving standard treatment. Only one trial reported on short-term adverse events and the findings were uncertain and do not provide reliable evidence. The studies did not provide any information on the outcomes of QoL, response to therapy or treatment-related mortality. We judged the quality of evidence for the outcomes of OS and adverse events as very low. We considered the quality of evidence for PFS to be moderate. To date, no robust data on OS are available. This systematic review shows that individuals with early-stage HL have a shorter PFS after PET-adapted therapy compared with those who receive standard therapy. More RCTs with longer follow ups may lead to more information on adverse events, treatment-related mortality and QoL, and could evaluate whether the PFS advantage seen with standard therapy will translate into a benefit in terms of OS.
+In April 2014, we looked for randomized trials of how the body handles carbohydrates when using birth control methods with hormones. Outcomes were blood glucose or insulin levels. Birth control methods could contain estrogen and progestin or just progestin. The type could be pills, shots (injections), implants (matchstick-size rods put under the skin), the vaginal ring, or an intrauterine device (IUD). The studies had to compare two types of birth control or one type versus a placebo or 'dummy' method. We included 31 trials. None had a placebo. Of 34 pairs of birth control methods compared, eight showed some difference by study groups. Twelve trials studied pills with desogestrel. The few differences were not consistent. Three trials looked at the etonogestrel ring. One showed the ring group had lower insulin than the pill group. Eight trials looked at the progestin norethisterone. A group using norethisterone pills had less glucose change than those taking other pills. In another study, a group using the injectable ‘depo’ (depot medroxyprogesterone acetate) had higher glucose and insulin than the group using another injectable. Of five new trials, two used different estrogen types. In one study, a group taking a pill with ethinyl valerate had lower glucose than a group taking a standard pill. Two other trials compared taking pills for several cycles without stopping (extended use) versus usual use. In one using a dienogest pill, the extended-use group had more glucose change. A small trial used two levonorgestrel pills, and looked at obese and normal weight women. The outcomes did not differ much between those groups. In women without diabetes, hormone contraceptives have little effect on the body's carbohydrate use. Few studies compared the same types of birth control. Therefore, we cannot make strong statements. Many trials had small numbers of women, and many women dropped out. Older trials often did not report all the study methods. Many trials did not include overweight women.
+This summary of an update of a Cochrane review presents what we know from research about the effect of exercise for people with OA of the hip. After searching for all relevant studies up to February 2013, we included five new studies since the last version of the review, giving 10 studies (549 participants) with mostly mild-to-moderate symptomatic hip OA, alone or with knee OA. Except for one study where participants enrolled in a tai chi programme, all other participants underwent land-based exercise programmes consisting of traditional muscle strengthening, functional training and aerobic fitness programmes, either individually supervised or as part of a group, compared with people who did not exercise. Pain on a scale of 0 to 100 points (lower scores mean reduced pain): - People who completed an exercise programme rated their pain to be 8 points lower (4 to 11 points lower) at end of treatment (8% absolute improvement) compared with people who did not exercise. - People who completed an exercise programme rated their pain as 21 points. - People who did not exercise rated their pain as 29 points. Physical function on a scale of 0 to 100 points (lower score means better physical function): - People who completed an exercise programme rated their physical function to be 7 points lower (1 to 12 points lower) at end of treatment (7% absolute improvement) compared with people who did not exercise. - People who completed an exercise programme rated their physical function as 22 points. - People who did not exercise rated their physical function as 29 points. Quality of life (higher score means better quality of life): - Overall, people with hip OA participating in the studies had a similar quality of life compared with the general population (normative scores of average 50 points), and quality of life was not further improved by participation in an exercise programme: 0 points higher. - People who completed an exercise programme rated their quality of life as 50 points on a population norm-based scale. - People who did not exercise rated their quality of life as 50 points on a population norm-based scale. Withdrawals - three more people out of 100 dropped out of the exercise programme (1% absolute increase). - Six out of 100 people in exercise programmes dropped out. - Three out of 100 people who did not exercise dropped out. This review showed that there is high-quality evidence that in people with hip OA, exercise reduced pain slightly and improved physical function slightly. Further research is unlikely to change the estimate of these results. Low-quality evidence indicated that exercise may not improve quality of life. Further research is likely to change the estimate of these results. Moderate-quality evidence showed that exercise probably does not increase study drop-outs. Further research may change the estimate. We do not have precise information about side effects such as injuries or falls during exercise, but we would expect these to be rare, and no injuries were reported in the studies.
+To date, there is no effective treatment for MS, however, a number of studies suggest that exercise interventions aimed to improve daily functioning of patients with MS are effective. Nine randomized controlled trials of exercise therapy for MS patients were included in this review six of which used no therapy as the comparator. There was strong evidence in favor of exercise therapy, compared to no therapy, regarding muscle function and mobility while no evidence was found of improved fatigue, in one study only. No one specifically targeted exercise program was more successful than others. No deleterious effects were described in the included studies.
+Only one trial including 75 participants (average age: 43 years; females: 65% of participants) provided information for this review. In this trial, 35 participants underwent early laparoscopic cholecystectomy (less than 24 hours after diagnosis) and 40 participants underwent delayed laparoscopic cholecystectomy after an average waiting period of approximately four months. The treatment that the participants underwent was determined by a method similar to the toss of a coin. This trial was at high risk of bias (systematic errors or errors in study design which may influence the conclusions). There were no deaths in the early group (0 out of 35) (0%) and there was one death (1 out of 40) (2.5%) in the delayed laparoscopic cholecystectomy group. This difference between the groups was not significantly different. There were no serious complications related to the surgery in either group. During the waiting period, 9 out of 40 participants (22.5%) developed gallstone-related serious complications. Five participants in the delayed group revisited the hospital because of recurrent gallbladder pain. In total, 14 participants required hospital admissions for the above symptoms. All of these participants were from the delayed group. All the participants in the early group were operated on within 24 hours. The proportion of participants who developed serious complications was significantly lower in the early group than the proportion of participants in the delayed laparoscopic cholecystectomy group. Quality of life and return to work were not reported in this trial. There was no significant difference in the proportion of participants who required conversion to open removal of the gallbladder. The hospital stay was significantly shorter (by about one day) in the early group than the delayed group. The operating time was significantly shorter (by about 15 minutes) in the early group than the delayed group. Based on evidence from only one high-bias risk trial, it appears that early laparoscopic cholecystectomy performed within 24 hours of diagnosis of biliary colic decreases serious complications, hospital stay, and operating time compared with delayed laparoscopic cholecystectomy with an average waiting time of four months. Further well designed, randomised clinical trials are necessary to confirm or refute these findings.
+We conducted a comprehensive search for studies on this topic. We collected data from all studies addressing this question and summarised them to determine whether antibiotics could prevent infection after surgery, whether this treatment has any adverse effects, whether it reduces the number of days that patients need to be in the hospital and whether it improves overall health status. We found 11 studies. Overall, long-term antibiotics reduce the risk of SSI, and there is uncertainty regarding the effects of receiving one dose of antibiotics preoperatively versus short term antibiotics. There was no investigation of side effects of antibiotics in these studies, but in the studies where side effects were investigated, no side effects were found. None of the other effects of interest to clinicians or patients were measured in the studies, and information was insufficient to show whether any single antibiotic is better than any other.
+This review identified one small randomised controlled trials, involving 42 women. There were no significant differences in outcomes for mother or baby when pre-term birth at 36 weeks was planned, compared with later birth. However, it was such a small trial that it does not rule out important benefits or harms from early birth. There was also small overall difference in gestational age at birth between the two groups in the trial, possibly because of the high rate of spontaneous preterm birth with this condition. Further trials are needed.
+In this review we set out to examine all the evidence on how well paracetamol (alone or with morphine-like drugs) worked in adults and children with cancer pain. We also wanted to know how many people had side effects, and how severe those side effects were, for example, whether they caused people to stop taking their medicines. In March 2017, we found three studies with 122 participants. All compared paracetamol plus opioid with the same dose of opioid alone. The studies were small, and were of poor quality. They used different study designs and different ways of showing their pain results. Outcomes of importance to people with cancer pain were not reported. We found no evidence that taking paracetamol alone made any difference to the level of pain experienced. We found no evidence that taking paracetamol together with a morphine-like drug was better than the morphine-like drug alone. Paracetamol did not appear to improve quality of life. No conclusions could be reached about side effects. The amount of information and the differences in how studies were reported meant that no conclusions could be made. The quality of the evidence was very low. Very low-quality evidence means that we are very uncertain about the impact of paracetamol for treating cancer pain. We do not know whether using paracetamol alone, or in combination with an opioid such as codeine or morphine, is worthwhile.
+Clozapine is an antipsychotic medication used in the treatment of schizophrenia, a mental health problem that can cause symptoms such as hallucinations and delusions and social withdrawal. Clozapine may be useful in those for whom other medications have not worked very well. One of the common side-effects of clozapine is having too much saliva in the mouth (hypersalivation). This can be embarrassing in public and problematic, especially at night. This review is about ways of reducing this problem and includes 15 trials containing 964 people, most of which were done in hospitals in China. Treatments included medications that had previously been useful for this problem or were thought to work in theory. The medications used were from a group of drugs called antimuscarinics, traditional Chinese medicines or others. The trials were short (all four weeks or less). From these trials the antimuscarinics; astemizole, diphenhydramine and propantheline, were shown to be better than placebo at reducing hypersalivation. Another medication called oryzanol and a Chinese traditional medicine called Suo quo wan were found to have benefit over doxepin, an antimuscarinic. However, because of the shortness of the trials, poor reporting and the limitations of design, it is difficult to draw any firm conclusions from these results.    (Plain language summary prepared for this review by Janey Antoniou of RETHINK, UK, www.rethink.org)
+We searched electronic databases for randomized controlled trials (where participants are assigned at random to either a treatment or a control arm) published up to 3 February 2017 that investigated respiratory muscle training in people with MS. In addition, we contacted experts in the field to identify additional studies. We found six trials involving 195 participants with MS. Training consisted of two or three sets of 10 to 15 repetitions, twice a day for at least three days a week, and interventions lasted for six weeks to three months. Follow-up ranged from no follow-up to six months. Two of the included trials investigated inspiratory muscle training with a threshold device (i.e. a portable breathing device that increases airflow resistance while inhaling or exhaling). Three trials investigated expiratory muscle training with a threshold device, and one trial investigated breathing exercises. We found benefits with inspiratory muscle training for improving predicted maximal inspiratory pressure, but not for improving measured maximal inspiratory pressure. We did not find any effects for maximal expiratory pressure. Only one study measured quality of life, but it did not find any effects; two trials measured fatigue and also failed to find a difference between the treatment and control groups. Eighteen participants (˜ 10%) dropped out, and no trials reported any serious adverse events. The six trials that were eligible for inclusion in this review were small, so statistical power was low, making analyses less precise. In addition, studies were heterogeneous in terms of the type of respiratory muscle training, dosing/intensity, and the severity of MS. In addition, we could not analyze the effects of training on, for example, cough efficacy, pneumonia, and quality of life, as the included trials did not report on these outcomes even though they are important for patients, caregivers and healthcare professionals. Altogether, this review provides low-quality evidence that resistive inspiratory muscle training improves predicted inspiratory muscle strength in people with MS. We did not find any effects for resistive expiratory muscle training. More high-quality research in respiratory muscle training in MS is needed.
+Current evidence from one randomised controlled trial indicates that betamethasone does not reduce the risk of neonatal thrombocytopenia and neonatal bleeding in ITP during pregnancy when compared to no medication. We could not identify evidence on other medical treatments for ITP during pregnancy. This review included one controlled trial in which 38 women (41 pregnancies) were randomised, with only 26 women (28 pregnancies) being analysed. There was also a severe imbalance between comparison groups. Giving the mother betamethasone (1.5 mg/day) did not result in a difference in the neonatal platelet count at birth and at the first week of life. The study reported that the maternal platelet count of peripheral blood did not change significantly during the study period for both the betamethasone and no treatment groups. Maternal postpartum haemorrhage and neonatal intracranial haemorrhage were not studied. Nor were maternal clinical and pregnancy outcomes reported. The researchers used no treatment in the control group, which may have increased the risk of performance bias in the trial.
+We included two randomised controlled trials (RCTs) which involved a total of 111 participants in this review. Both trials were conducted in single medical centres in Iran and compared the outcomes, at least three months post-suture removal (for a minimum of 12 months in the newer study, and for a range of 6.8 to 36.4 months in the older study), of participants with keratoconus who had received DALK to those who had received penetrating keratoplasty. The evidence is current to October 2013. The results suggested that graft rejection is more likely to occur following penetrating keratoplasty, however likelihood of graft failure was similar in both groups, as were visual and structural results. DALK was unable to be completed as planned in four cases and in a further three cases complications during dissection required further intervention. Other adverse events, of varying severity, were reported in both intervention groups. For both types of surgery, these included postoperative astigmatism (when the cornea is no longer perfectly curved), raised pressure in the eye following steroid use, and a failure of the epithelium, the front layer of the eye, to heal properly. In recipients of DALK, one participant had interface neovascularisation (a growth of blood vessels where the host and donor cornea come together) and one had wrinkling of Descemet's membrane, a structural element of the cornea. In the penetrating keratoplasty groups, one participant required graft resuturing and one had an atonic pupil, a condition in which the pupil dilates and is non-reactive. The included studies reported adverse events thoroughly. The evidence remains weak, as the quality of evidence is rated very low to moderate. Large trials comparing the outcomes of DALK and penetrating keratoplasty for the treatment of keratoconus, are needed. These should be randomised single-masked trials, in which graft recipients are unaware of their group allocation. Because of the nature of the surgery, it is not likely to be possible to conduct double-masked trials as practitioners who are qualified to undertake outcomes assessments would be able to see which graft a participant had received. Future trials should include regular, long-term follow-up and consistent methods must be used.
+We included studies comparing the effects of iron compared with no iron when given at least five days per week to menstruating women. We identified 67 trials recruiting 8506 women eligible for inclusion in the review. Most trials lasted between one and three months. The most commonly used iron form was ferrous sulphate. We found evidence that iron supplements reduce the prevalence of anaemia and iron deficiency, and raise levels of haemoglobin in the blood and in iron stores. Iron supplementation clearly increases the risk of side effects, for example, constipation and abdominal pain. We found high quality evidence that iron improves haemoglobin and produces changes in bowel function, but moderate quality evidence that iron reduces the prevalence of anaemia and iron deficiency. Evidence of the effects of iron on other outcomes, such as abdominal pain, is of low quality. There are no data on the effects of iron on mortality in this population group. Further definitive studies are needed to identify whether taking iron supplements orally for at least five days a week has an impact on key, health-related outcomes.
+We searched the literature on January 13, 2016. We identified five randomised controlled trials with a total of 1,726 patients comparing the combination of IRI and fluoropyrimidine with IRI alone. The search in January 2016 resulted in an additional ongoing trial, the results of which have not been incorporated in this review. This review compared IRI and fluoropyrimidine with IRI alone in terms of overall survival, progression-free survival, toxicity, response rates and quality of life. There is no evidence to suggest any superiority of the combination of IRI and fluoropyrimidine over IRI alone, but our results on overall survival are limited by the number of studies available to date. Longer progression-free survival was seen from adding fluoropyrimidines to IRI. Based on current evidence, both the combination regimens and IRI alone seem equally effective for treating advanced or metastatic patients. Patients in the intervention arm were less likely to develop grade 3 or 4 diarrhea and grade 1 or 2 alopecia, and more likely to have grade 3 or 4 neutropenia, compared to patients receiving IRI alone. There was moderate quality evidence from these studies suggesting longer progression-free survival from adding fluoropyrimidines to IRI. However, findings need to be confirmed by larger, high-quality randomised clinical trials.
+The choice of abdominal surgical incision is determined largely by access. However, a transverse incision may be superior to a midline incision in terms of recovery and complications. All randomised controlled trials comparing these incisions were identified. Outcomes included analgesic use, pulmonary function, complication rates and hospital stay. Marked variability in methodology made comparison difficult and potential biases in all of the studies suggests results should be treated with caution. Nevertheless a trend was seen toward less analgesic requirement, less effect on pulmonary function and lower wound dehiscence and incisional hernia rates with a transverse incision. However, the lower pain and reduced effect on pulmonary function were not translated into other clinical advantages as recovery times and other complication rates (except cosmetic appearance) were similar.
+The search is current to July of 2016. Five studies were conducted in Europe and four in North America. Sample sizes ranged from 33 to 351. The mean age across trials ranged between 32.0 and 43.7 years. The majority of studies included mixed samples of male and female participants. The authors had no concerns about funding sources of any included studies. Overall, we found that multidisciplinary treatments may be better than usual care for people with LBP for a duration of six to 12 weeks. Individuals receiving multidisciplinary treatment had less pain, less disability, increased likelihood of return-to-work and fewer sick leave days at 12-month follow-up. However, when comparing multidisciplinary treatments to other treatments (e.g. brief clinical intervention including education and advice on exercise), we found that multidisciplinary treatments may be no better than other treatments. Although we examined adverse events as a secondary outcome, none of the included studies reported this outcome. The quality of the evidence for this review was generally low to very low. This was mainly due to small sample sizes and other study limitations. Moreover, we grouped together studies with differing interventions and comparisons. For example, some of the multidisciplinary interventions were quite intense (e.g. > 30 hours of treatment), whereas others were designed to be brief (e.g. < three hours). This variability across studies makes it more challenging to interpret the findings. In sum, there is a need for additional, large, high-quality randomised controlled trials before we can make definitive recommendations for clinical practice.
+We searched medical databases to 13 July 2017. Two review authors independently screened, summarized and analyzed the findings. This led to the inclusion of 18 clinical trials. We found low quality evidence that bisphosphonates provided no clinically relevant difference in pain response (three studies involving 876 men) compared to placebo (pretend treatment) or no additional treatment. Bisphosphonates reduced pain in 40 more men per 1000 men (19 fewer to 114 more). We found moderate quality evidence that bisphosphonates probably resulted in 58 fewer skeletal-related events per 1000 (85 fewer to 27 fewer). Bisphosphonates showed no clear difference in the number of men who died or the number of men with decreased use of pain killers. We observed moderate quality evidence that bisphosphonates probably increased the number of men with nausea. Bisphosphonates resulted in seven more men with nausea per 1000 men (0 fewer to 14 more). We found moderate quality evidence that bisphosphonates probably increased the number of men with kidney problems. In this case, bisphosphonates resulted in 22 more men with renal complications per 1000 men (4 more to 50 more). For osteonecrosis of the jaw (where the jaw bone weakens and dies), we found very low quality evidence that bisphosphonates showed no clear difference. We observed moderate quality evidence that bisphosphonates probably decreased the number of men affected by disease progression (where the disease got worse). This means that bisphosphonates resulted in 36 fewer men with disease progression per 1000 men (71 fewer to 7 fewer). We found no useable data on quality of life. We judged the quality of evidence as moderate to very low.
+With this assumption, we assessed the role of high-dose therapy followed by autologous stem cell transplantation in the treatment of follicular lymphoma in adults. We included five trials with 1093 patients in the main analyses. As a result, the meta-analyses for previously untreated patients (four trials) show no statistical significant differences in terms of survival, treatment-related mortality or secondary malignancies between the patients treated with high-dose therapy followed by autologous stem cell transplantation and those treated with chemotherapy only. However, progression-free survival (tumour control), was significantly improved by the high-dose chemotherapy and stem cell transplantation. Adverse events are more common in patients treated with high-dose therapy followed by autologous stem cell transplantation. There is an advantage of the high-dose chemotherapy and stem cell transplantation for patients with a relapse of the disease, both in survival and in tumour control (one trial). No data on adverse events are reported in this trial.
+In Feburary 2016, the Information Specialist of the Cochrane Schizophrenia Group ran an electronic search for trials that randomised people with schizophrenia to receive either WDD, placebo/no treatment or antipsychotic drugs. We screened all records found in this search and included those that met our inclusion criteria and reported useful data. Fifteen trials (with a total of 1437 participants) provided useable, but limited, data. Results showed that WDD may have some beneficial effects on short-term global outcomes and mental state of people with schizophrenia compared to placebo or no treatment but did not show a benefit when compared to antipsychotics - although WDD did cause fewer adverse effects. When WDD was combined with an antipsychotic, there were observed benefits for WDD on improving global state and reducing the side effects caused by antipsychotics. Results of this review suggest WDD may be helpful for people with schizophrenia, but these results are based on low to moderate evidence and there is not enough high-quality evidence to make firm conclusions. Better-designed large studies are needed to fully and fairly test the effects of WDD for people with schizophrenia.
+We searched for studies on 5 October 2017. We were interested in 'randomised controlled trials' (RCTs), which are studies in which participants are assigned randomly to the interventions being compared. We found 12 RCTs with 799 participants, all of whom had upper or lower full arch fixed braces, or both. The studies evaluated different initial arch wires, but they were poorly conducted or reported, or both, and their results are likely to be biased. The studies varied in a number of other aspects of orthodontic treatment, compared different types of initial arch wires and reported different outcomes at different times. None of the studies reported both potential benefits (straightening) and harms (pain or side effects such as tooth root shortening). We found moderate-quality evidence that coaxial superelastic nickel-titanium (NiTi) can produce greater tooth movement over 12 weeks than single-strand superelastic NiTi. We found moderate-quality evidence that there is no difference in pain at day 1 between multistrand stainless steel versus superelastic NiTi arch wires. There is insufficient evidence from our included studies to know if any other particular initial arch wire material is better or worse than another, or if they function equally well, with regard to speed of straightening, pain or tooth shortening in people undergoing orthodontic treatment. There was moderate-quality evidence that coaxial superelastic NiTi can produce greater tooth movement than single-strand superelastic NiTi, and that there is no real difference in pain whether whether arch wires are made with multistrand stainless steel or superelastic NiTi. The quality of the evidence for all other comparisons and outcomes was low or very low. Overall, the evidence about initial arch wires in orthodontic treatment is very limited, with comparisons often assessed by one small study with problems in its design. The findings are imprecise and unreliable so more research is needed.
+We looked for all available evidence on this topic, finding just two studies. One of these included 306 people with dementia and an average age of 86 years, living in 16 nursing homes in France. The second study is still in progress and did not provide results for the review. The study did not assess areas important to us, such as the number of injuries sustained by staff or residents. It did, however, measure the impact of staff training on residents' level of aggression three months after the end of the training. Some measures of physical and verbal aggression showed reductions, but not all. The reliability of evidence available in the one included trial is very low and did not address important questions such as injury. Therefore, we cannot say whether de-escalation techniques are effective. The evidence is current to September 2017.
+We included randomised controlled trials which compared skin care products, procedures, methods for using skin care products and frequencies of using a skin care product. The participants had to be over 18 years of age. We found thirteen, mostly small, trials, involving 1316 participants. All participants were incontinent for urine, stool, or both and lived in nursing homes or were hospitalised. The trials tested skin care products, procedures, and frequencies of using a skin care product. Two trials showed that soap and water performed poorly in the prevention and treatment of IAD. A skin cleanser or a washcloth with cleansing, moisturising and protecting properties may be more effective than soap and water. The findings from the other trials suggest that using a skin care product is more effective than withholding a skin care product. We found no evidence that one skin care product performed better than another. The trials did not report on adverse effects. The quality of the evidence was low. Eleven trials had small numbers of participants and were of short duration. The overall risk of bias was high. The trials included in this review tested skin care products, procedures and frequencies of using a skin care product. Very limited evidence exists on the effects of interventions for preventing and treating IAD in adults. Larger, long-term and well performed trials are required. Furthermore, we recommend the development of a list of outcomes which are important for patients and will guide researchers in their study. This list should include well developed tools to measure the items in order to obtain accurate results. The review authors searched for studies that had been published up to 28 September 2016.
+We included seven studies that involved a total of 333 people; two were conducted in Europe and five in the USA. Three studies took place in hospitals, one each in a student health centre and a children's clinic, but the setting was unclear in two studies. Three different antiviral drugs were studied: acyclovir, valomaciclovir and valacyclovir, as well as dosage, comparison treatment (fake or no treatment), and how long people were treated and followed up. One study did not report study funding, but the other six studies appeared to have some industry support. None declared conflicts of interest, but one included two authors from a drug company. We wanted to investigate several outcomes: time to recovery; medication side effects; duration of: fever, sore throat, swollen lymph nodes, enlarged spleen and liver; development of glandular fever complications; how long it took to eliminate the virus from the throat; health-related quality of life; days off school or work; and economic outcomes. We found improvements in participants who received antiviral for two outcomes. There was an improvement of five days in time taken to recover among people who received antiviral treatment, but this result was not very precise, and the way it was measured was not clearly defined. Other studies show that glandular fever symptoms can take a month or more to get better, and tiredness may occur in about one in every 10 of patients six months later. This improvement may be of limited clinical significance. Most studies that examined adverse effects did not find any differences between people who received antivirals and those who did not. Time taken to resolve lymph node swelling improved to nine days when antivirals were used. However, studies that reported on this, measured lymph node swelling in different ways so we cannot be sure about the accuracy of the result. Evidence quality was rated as very low for all results, which means that we cannot know the exact effect of using antivirals for glandular fever. Better studies are needed so we can draw firm conclusions.
+Four studies investigated a total of 2250 people. Trials lasted between 24 and 52 weeks. Overall, risk of bias of the evaluated studies was high. Our analysis of these intermediate term trials comparing insulin detemir with insulin glargine showed that these two insulins were equally effective in achieving and maintaining glycaemic control (glycosylated haemoglobin A1c (HbA1c)). There were no differences in overall, nocturnal and severe hypoglycaemia when comparing insulin detemir to insulin glargine. Insulin detemir was associated with significantly less weight gain (one study showing a difference of 0.9 kg). Treatment with insulin glargine resulted in a lower daily basal insulin dose and a lower number of injection site reactions (1.8% of patients treated with insulin detemir compared to 0.4% of patients treated with insulin glargine had injection side reactions). There was no difference in the variability of fasting glucose levels or the variability of glucose values of 24-hour profiles between the two treatment groups. From the retrieved trials it was not possible to draw conclusions on the effects of these two insulins on quality of life, their costs or on the number of fatalities. Only one trial reported results on health-related quality of life and showed no significant differences between treatment groups. Our analyses suggest that there is no clinically relevant difference in the efficacy or the safety between the use of insulin detemir and insulin glargine for treating type 2 diabetes mellitus. However, to achieve the same glycaemic control insulin detemir was often injected twice-daily in a higher dose but with less weight gain, while insulin glargine was only injected once-daily, with somewhat fewer injection site reactions.
+This review evaluated the published evidence for the use of SNS for patients with faecal incontinence or constipation from six trials of SNS for faecal incontinence (219 participants) and two trials of SNS for constipation (61 participants). Two of the faecal incontinence trials had a 'parallel group design', which means that one group of participants received SNS and the other control group did not receive SNS throughout the trial. The remaining six trials had a 'crossover design', in which the participants experienced equal periods with stimulation 'off' then 'on', or vice versa. The level of stimulation was such that participants could not tell whether the system was 'on' or 'off'. In the two 'parallel group' trials, 53 and 15 participants with faecal incontinence who were in the SNS group experienced fewer episodes of faecal incontinence compared to the control group at 3 and 12 months. In the first crossover trial, 24 participants who completed the trial chose the period of stimulation they had preferred while still unaware whether this was 'on' or 'off'. Nineteen participants who preferred the 'on' period experienced 59% fewer episodes of FI per week during the 'on' period, and 5 participants who preferred the 'off' period experienced 118% more episodes of FI per week. In the second crossover trial, the participants did not experience episodes of FI during either the 'on' or the 'off' periods. In the third trial, participants experienced 83% fewer episodes of faecal incontinence during the 'on' compared with the 'off' period. In the fourth crossover trial participants experienced 88% fewer episodes of faecal incontinence during the 'on' period compared with the 'off' period. —adverse effects:Not all trials reported adverse effects after SNS. The two 'parallel group' trials reported only minor complications, in 10% of SNS participants in the first study, and in 3 participants in the second study. In the first crossover study 7 out of 34 participants were excluded from crossover due mainly to complications. Four out of 27 participants with an implanted system in this study experienced a problem that led to the device being removed. The participants in the fourth crossover trial experienced some complications with the SNS implanted electrode such as pain (one person), misplacement of the tined lead (one person) and haematoma (swelling containing blood) (three people). In one trial assessing SNS for constipation, two participants reported an increase of 150% in the frequency of passing stools per week, and time with abdominal pain and swelling went down from 79% during the 'off' period to 33% during the 'on' period. However, in the much larger second trial assessing SNS for constipation, in 59 participants SNS did not improve frequency of bowel movements. The limited evidence suggests that SNS can improve continence in some people with faecal incontinence. SNS did not improve symptoms in patients with constipation. Larger, good-quality trials are needed to provide more reliable evidence on the effectiveness of SNS for these two conditions.
+The evidence in this review, which was carried out together with Cochrane Oral Health, is up-to-date as of 15 February 2017. We included two studies that evaluated 190 participants. Both trials were conducted in the UK and both compared bonded molar tubes with molar bands. From the limited data of two studies at low risk of bias, it would appear that bonded molar tubes are associated with a higher failure rate than with molar bands.
+We conducted a meta-analysis according to the most recent methods for diagnostic tests. The last literature search was performed in January 2015. We included 66 studies (of 7747 patients) in the review. We found that EUS can distinguish between superficial (T1 - T2) and advanced (T3 - T4) primary tumors with a sensitivity and a specificity greater than 85%. This performance is maintained for the discrimination between T1 and T2 superficial tumors. However, EUS diagnostic accuracy is lower when it comes to distinguishing between the different types of early tumors (T1a versus T1b) and between tumors with versus those without lymph node disease. Overall, EUS provides physicians with some helpful information on the stage of gastric cancer. Nevertheless, in the light of the variability of the results reported in the international medical literature, its limitations in terms of performance must be kept in mind in order to make the most out of the diagnostic potential of this tool. Finally, more work is needed to assess whether some technical improvements and the combination with other staging instruments may increase our ability to correctly stage the disease and thus optimize patient treatment.
+This review aims to investigate the current literature available and provides an overview of the evidence demonstrated in recent clinical trials on the subject. The review authors identified a total of six trials involving 492 participants. Two hundred and thirty-nine people underwent planned laparoscopic cholecystectomy as day-surgery and 253 participants stayed in the hospital overnight after the procedure. All the trials were at high risk of bias (methodological deficiencies that might make it possible to arrive at wrong conclusions by overestimating the benefit or underestimating the harm of the day-surgery or overnight stay procedure). We looked at outcomes that are considered to be important from the perspective of the participant and also the healthcare provider. These outcomes include death, serious complication, quality of life following procedure, pain, how long it took for people to return to normal activity and to return to work, hospital readmissions, and failed discharges (failure to be discharged as planned). There was no significant difference in the proportion who died or the complication rate between the group who underwent day-surgery and those who stayed overnight. Quality of life did not differ significantly between the two groups. There was no significant difference in the time taken for people to return to normal activity or to return to work. There was also no significant difference in the hospital readmission or failed discharge rates. The results suggest that day-surgery is safe for patients. It is important to note that all trials were at risk of bias and the data were sparse, resulting in a considerable chance of arriving at wrong conclusions due to systematic errors (overestimating benefits or underestimating harms of day-surgery or overnight stay) and random errors (play of chance). More randomised trials are needed to investigate the impact of day-surgery and overnight stay on the quality of life and other outcomes of people undergoing laparoscopic cholecystectomy.
+We searched scientific databases for studies that looked at the effects of high-concentration capsaicin in adults who had moderate or severe neuropathic pain. The treatment had to have effects measured for at least 8 weeks. The evidence is current to June 2016. Eight studies satisfied our inclusion criteria, including two new studies for this update. The studies were well conducted. In seven studies, involving 2442 participants, we found that the treatment gave good levels of pain relief to a small number of participants with some types of neuropathic pain (pain after shingles, and nerve injury pain associated with HIV infection), and probably also in another type (painful feet because of damaged nerves caused by diabetes). About 4 in 10 people had at least moderate pain relief with capsaicin compared with 3 in 10 with control. The control was a treatment that looked the same but did not contain high levels of capsaicin, with either nothing added, or very small amounts of capsaicin added. In one small study (46 participants) in people with persistent pain after hernia surgery, it did not seem better than control. In all people who have this treatment there can be short-lived localised skin problems such as redness, burning, or pain. Serious problems seem to be uncommon, and were no more frequent in these trials with high-concentration capsaicin than with control using very low-concentration capsaicin or placebo. Slightly more people treated with control rather than capsaicin dropped out of the studies because of lack of benefit, but there was no difference between the groups for drop-outs because of side effects. We judged the quality of the evidence as moderate or very low for pain relief outcomes, mainly because only a small number of studies and moderate number of participants provided information for each outcome. We judged the quality of the evidence as moderate for harmful effects. Moderate quality means that further research may change the result. Very low quality means we are very uncertain about the results.
+This review identified three randomised controlled trials (6343 participants randomised), which compared carotid surgery with no carotid surgery (i.e. best medical therapy plus surgery versus best medical therapy alone) in participants with carotid stenosis and recent transient ischaemic attacks (TIA) or minor ischaemic strokes in the territory of that artery. The trials were carried out in Europe, USA, and Canada and included some centres in Israel, South Africa, and Australia. The gender ratio of participants was 2.6:1 (72% men and 28% women); 90% of participants were younger than 75 years old. The results of the three trials were initially conflicting because they differed in how they measured carotid stenosis and how they defined the outcomes. To address this discrepancy, we reassessed the patient data using the same methods and definitions, so results could be compared. The results of the review are current up to July 2016. Results showed that older male participants with 70% to 99% stenosis, without occlusion, and recent (within two weeks) TIA or stroke, had the most benefit from surgery, assuming they were well enough for surgery, and their surgeons had a record of low complication rates (less than 7% risk of stroke and death). Carotid endarterectomy also benefited participants with 50% to 99% carotid stenosis and symptoms. For participants whose carotid artery was nearly occluded, benefit was uncertain in the long term. Surgery tended to harm participants with less than 30% stenosis. The second European Carotid Surgery Trial, which is currently recruiting participants, is exploring whether a lipid lowering agent (statin) might be a better choice than carotid endarterectomy to prevent ischaemic stroke in ipsilateral carotid stenosis, which may benefit those who did not benefit from surgery in these trials. We found the evidence to be high quality for near occlusion and less than 30% carotid stenosis; and moderate quality for 50% to 99% carotid stenosis for any stroke or operative death, as well as ipsilateral ischaemic stroke and any operative stroke or death outcome.
+The evidence is current to 9 November 2018. In this update, we included 10 retrospective cohort studies with a total of 864 participants, and one randomized controlled trial (RCT: a study in which participants are randomly allocated to the treatment groups), including 60 participants. The target population was individuals, regardless of age, who received a temporary or permanent enterostomy for any reason in either the elective (planned) or the emergency setting. The results found inconclusive results between the two techniques for the risk of parastomal herniation (11 studies, 924 participants), stomal prolapse (1 study, 145 participants), ileus or stenosis (1 study, 60 participants), and skin irritation (1 study, 60 participants). Neither technique was found to be better than the other for any of the stoma-related outcomes of interest. None of the studies measured other stoma-related problems, or death. We downgraded the quality of the evidence to moderate, low, or very low, because of high risk of bias, small sample sizes, few events, and diversity across studies. Based on the current knowledge presented in this review, there is no evidence to support the use of one stoma formation technique over the other. Further research is likely to have an important impact on our confidence in the estimate of effect.
+The aim of this review is to assess the effectiveness of supportive therapy compared to other specific therapies or treatment as usual. This update is based on a search run in 2012; the review now includes 24 randomised studies with a total of 2126 people. The studies compared supportive therapy either with standard care alone or a range of other therapies such as CBT, family therapy and psychoeducation. The participants continued to receive their antipsychotic medication and any other treatment they would normally receive during the trials. Overall, the quality of evidence from these studies was very low. There is not enough information or data to identify any real therapeutic difference between supportive therapy and standard care. There are several outcomes, including hospitalisation, satisfaction with treatment and general mental state, indicating advantages for other psychological therapies over supportive therapy. However, these findings are limited because they are based on only a few small studies where the quality of evidence is very low. There was very limited information to compare supportive therapy with family therapy and psychoeducation as most studies in this review focused on other psychological therapies, such as CBT. Apart from one study presenting data on death, there was no information on the adverse effects of supportive therapy. In summary, there does not seem to be much difference between supportive therapy, standard care and other therapies. Future research would benefit from larger studies where supportive therapy is the main treatment. Ben Gray, Senior Peer Researcher, McPin Foundation: http://mcpin.org/
+In this review we set out to examine the evidence on how well NSAIDs worked (alone or with morphine-like drugs) in adults with cancer pain. We also wanted to know how many people had side effects, and how severe they were. In April 2017, we found 11 studies with 949 participants. They compared NSAID with NSAID, or NSAID with opioid drug (morphine or codeine). No studies looked at using NSAID together with an opioid-like morphine, which is how they are often used. The studies were small and of poor quality. They used different designs and different ways of showing their pain results. Outcomes important to people with cancer pain were often not reported. Many different NSAIDs were tested, and it was not possible to make sensible comparisons. With an NSAID, initially moderate or severe cancer pain was reduced to no worse than mild pain after one or two weeks in 1 in 4 (26%) to 1 in 2 (51%) people in four studies. Side-effect reporting was poor. Two serious side effects were reported with NSAIDs, and 22 deaths, but these were not related to pain treatment. Common side effects were thirst/dry mouth (1 in 7; 15%), loss of appetite (1 in 7; 14%), sleepiness (1 in 10; 11%), and heartburn (1 in 10; 11%). One in four people stopped taking NSAIDs because the drug did not work, and 1 in 20 stopped because of side effects. The quality of the evidence was very low. Very low-quality evidence means that we are very uncertain about the impact of an NSAID alone for treating cancer pain. We do not know whether using NSAIDs together with an opioid such as codeine or morphine is worthwhile.
+The review included two studies that lasted seven days with a total of 287 people. One study involved 253 people (aged approximately 22 years) with sickle cell disease and compared tinzaparin with placebo and people were selected for one treatment or the other randomly. The other study was smaller with 34 participants (aged approximately 27 years) and compared dalteparin versus placebo. Tinzaparin reduced the number of days spent in hospital and reduced the pain (and the intensity of the pain) more rapidly. Two minor bleedings were reported in the tinzaparin group versus none in the placebo group. The data regarding the effectiveness of dalteparin were very limited and only addressed pain intensity, being more reduced by treatment with dalteparin than by placebo. These data are not sufficient to support the conclusion that low-molecular-weight heparins are effective in the treatment of vaso-occlusive crises in people with sickle cell disease. Additional studies with different types of low-molecular-weight heparin used in different forms of sickle cell disease, are necessary to confirm or dismiss the results of this single study. Vaso-occlusive crises can be extremely debilitating and can have a significant impact on quality of life; therefore it is important to know whether low-molecular-weight heparins might serve as a useful treatment option with few side effects. The quality of the evidence for the majority of outcomes was very low, this had mainly to do with risk of bias of the studies (e.g. method of blinding unclear) or with small sample size of the studies.
+We did not find any completed randomised trials testing these drugs in people with carotid artery dissection. However, there is one ongoing trial. We found only poor quality non-randomised studies that compared anticoagulants with aspirin. There was no evidence that anticoagulants were better than aspirin. Aspirin is likely to be similarly effective and safe as anticoagulants in such patients. More research is needed.
+This review identified 26 trials (involving 2066 participants) comparing silver-containing dressings or creams against dressings or creams that did not contain silver. Twenty of the trials were on burn wounds, while the other trials were on a mixture of wound types. Most studies were small and of poor quality. After examining them all, the authors concluded that there is not enough evidence to support the use of silver-containing dressings or creams, as generally these treatments did not promote wound healing or prevent wound infections. Some evidence from a number of small, poor-quality studies suggested that one silver-containing compound (silver sulphadiazine) has no effect on infection, and actually slows down healing in patients with partial-thickness burns.
+We looked at studies involving adults aged over 18 years who were treated in intensive care units for ventilator-associated pneumonia and needed antibiotic treatment. We analysed 12 studies with 3571 participants. All included studies looked at the use of one antibiotic treatment plan versus another, but these varied among studies. There was potential for bias because some studies did not report outcomes for all participants, and funding for many was provided by pharmaceutical companies and study authors were affiliated with these companies. We used statistical techniques to evaluate our results. For single versus multiple antibiotics, we found no difference in rates of death or cure, or adverse events. For our comparison of combination therapies with optional adjunctives we were only able to analyse clinical cure for one the antibiotics Tigecycline and imipenem-cilastatin for which imipenem-cilastatin was found to have higher clinica cure. We also looked at carbapenem (antibiotics used to treat infections caused by multidrug-resistant bacteria) versus non-carbapenem treatment; we found no difference in death rate or adverse effects, but we found that carbapenems are associated with an increase in clinical cure. We assessed evidence quality as moderate for most outcomes, and very low for clinical cure when single-antibiotic treatment was compared with multiple antibiotic therapy. We also found that evidence quality was low for adverse events when carbapenem was compared with non-carbapenem treatment. We did not find differences between single and combination therapy, lending support to use of a single-antibiotic treatment plan for people with ventilator-associated pneumonia. This may not be applicable to all patients because studies did not identify patients who are at risk of exposure to harmful types of bacteria. We could not evaluate the best single-antibiotic choice to treat people with ventilator-associated pneumonia because there were too few studies, but carbapenems may achieve better cure rates than other tested antibiotics.
+This review found 29 studies that evaluated policies that restrict reimbursement of specific prescriptions drugs. Where drugs have cheaper, effective alternatives and they target symptoms, this review found that reimbursement restriction polices can ensure better use of the medications with reduced costs and without an increase in the use of other health services, as would be expected if there were negative health effects of the restriction policies. Evaluation is required if alternative drugs are not effective substitutes. Removing restrictions for drugs that prevent complications of disease can result in an intended increase in their use as well as cost savings. When restrictions to reimbursement policies are designed using the best available evidence on the health impact of the medications, they support equitable access to the drugs that best support health by supporting the sustainability of publically subsidized drug plans. A summary of this review for policy-makers is availablehere
+Authors from Cochrane Oral Health carried out this review and the evidence is up to date to 10 November 2017. We included research where individual patients received oral hygiene advice from a dental care professional on a one-to-one basis in a dental clinic setting with a minimum of 8 weeks follow-up. In total, within the identified 19 studies, oral hygiene advice was provided by a hygienist in eight studies, dentist in four studies, dental nurse in one study, dentist or hygienist in one study, dental nurse and hygienist in one study, and dental nurse oral hygiene advice to the control group with further self-administration of the intervention in one study. It was unclear in three of the studies which member of the dental team carried out the intervention. Over half of the studies (10 of the 19) were conducted in a hospital setting, with only five studies conducted in a general dental practice setting (where oral hygiene advice is largely delivered). Overall we found insufficient evidence to recommend any specific method of one- to-one oral hygiene advice as being more effective than another in maintaining or improving oral health. The studies we found varied considerably in how the oral hygiene advice was delivered, by whom and what outcomes were looked at. Due to this it was difficult to readily compare these studies and further well designed studies should be conducted to give a more accurate conclusion as to the most effective method of maintaining or improving oral health through one-to-one oral hygiene advice delivered by a dental care professional in a dental setting. We judged the quality of the evidence to be very low due to problems with the design of the studies.
+The studies tested people who had adhesive capsulitis for about 6 months. They were given no treatment, fake treatments, steroid injections or oral steroids. Oral steroids, such as prednisolone or cortisone were given for about 3 to 4 weeks, and sometimes again for another 3 to 4 weeks if people still had pain and stiffness. All people had physiotherapy or an exercise programme while taking the steroids. Benefits of oral steroids  In people with adhesive capsulitis, at 3 weeks, oral steroids may work more than fake pills ­48 out of 100 people who took fake pills said they were better  ­96 out of 100 people who took steroids said they were better may decrease pain and disability more than fake pills ­pain may decrease by 2.7 more points on a scale of 0 to 10 with steroids  ­disability may decrease by 18 more points on a scale of 0 to 100 with steroids may increase the ability to move the shoulder more than fake pills ­shoulder movement increased by 23 degrees  But these benefits did not last as long as 6 weeks so there is not enough evidence to be certain of the results beyond 3 weeks. Oral steroids may also improve pain earlier and quicker than no treatment at all. But after 5 months there were no benefits of oral steroids over no treatment. There is also not enough evidence to be certain of the results. Harms of oral steroids  In people with adhesive capsulitis who have no serious other problems, taking oral steroids for a short time may not cause serious side effects. But there is not enough evidence to be certain. Other research about steroids taken over longer periods of time shows that harms could include high cholesterol and high blood pressure.
+For this review we searched widely for clinical trials of rTMS in people with ALS and found three studies, which involved 50 participants in total. All three compared rTMS with sham (inactive) rTMS. None of the three studies reported on disability or limitation in activity as assessed by a specific ALS scale (ALSFRS-R) at six months follow-up, which was what we chose as our primary measure of the effectiveness of rTMS. Other outcome measures were only available from 12 participants in one poor quality trial, in which there was no difference between rTMS and sham rTMS in ALSFRS-R or a test of muscle strength at 12 months’ follow-up. None of the studies reported any adverse effects with rTMS. The trials in this review had small numbers of participants and some problems of design, so larger, well-designed trials should be considered, to determine the efficacy and safety of rTMS in ALS. However, the potential benefit should be balanced against the impact of taking part in trials for people with ALS.
+Three new studies were included in this update of the review published in 2005 making a total of 10 randomised controlled trials with a total of 1049 participants. All studies involved different comparisons, none had a placebo group. Different doses and formulations of corticosteroids plus azathioprine showed no significant differences in disease control, although azathioprine reduced the amount of prednisone required for disease control. There were no significant differences in healing or disease-free intervals in participants taking azathioprine compared with mycophenolate mofetil, or in disease response comparing tetracycline plus nicotinamide with prednisolone. One small study using Chinese traditional medicine, 'Jingui Shenqi Pill' (JSP), plus prednisone did not show any benefit in favour of adding this traditional Chinese herbal remedy. Most of the deaths were in participants taking high doses of oral corticosteroids. The review of trials concluded that lower doses of oral steroids and strong steroid creams seem safe and effective. However, the use of steroid creams in extensive disease may be limited by side-effects and the practicality of applying creams to large areas of the skin. Milder regimens of topical steroids are safe and effective in moderate BP. More research is needed on treatments for BP, in particular, the effectiveness of adding plasma exchange, azathioprine or mycophenolate mofetil to corticosteroids, and the treatment with tetracyclines and nicotinamide.
+Traditional Chinese herbal medicine is a common practice in the East, and some clinical trials show a benefit of herbal medicines for symptomatic treatment of this condition. This systematic review identified and included 75 randomised clinical trials evaluating the effects of various herbal preparations (including single herbs or mixtures of different herbs) for treating people with irritable bowel syndrome. The review shows that some herbal medicines improve global symptoms such as abdominal pain, diarrhoea and/or constipation. However, the methodological quality of the majority of clinical trials evaluating these herbs was generally poor. There is evidence indicating that small, poor quality trials with positive findings are more likely to be associated with exaggerated effects. Although the included trials did not report serious adverse effects from using herbal medicines more research is needed to determine the safety of herbal medicines. In conclusion, herbal medicines might be promising for the treatment of irritable bowel syndrome. However, it is premature to recommend herbal medicines for routine use in irritable bowel syndrome. Testing the herbs in larger, well-designed trials is needed in order to establish sound evidence for their use.
+We ran computer searches until 1 September 2014 to find relevant studies in any language. For the initial review, we also wrote to researchers to find other trials. We assessed the quality of the research methods in the studies. We used the Pearl Index to estimate the effect. The Pearl Index is the number of pregnancies for every 100 years of pill use. We found 22 studies from the past 40 years. They included a total of 12,400 women in Europe, Asia, and the Americas. Fifteen trials studied different doses of the hormone levonorgestrel and seven looked at other hormones. These studies showed that using some hormones right before or after sex did prevent pregnancy. Levonorgestrel seemed to work well, and was safe and accepted by thousands of women in several large trials. The most common side effects were menstrual bleeding problems. However, such bleeding issues were not always related to how often women took the pills or the total dose of the drug. Most studies were old and many reports were not complete. However, the data had moderate quality because of the many women in these studies, the low pregnancy rates, and the consistent results. We do not know for sure whether using levonorgestrel repeatedly around the time of sex is a good and safe method of birth control. More high-quality research is needed to answer the question.
+The evidence on which this review is based was correct as of 28 October 2013. This is an update to an existing review, which included one study. Fifteen studies were included in this review involving data from 561 participants. The studies were conducted in Europe, India, China, South Korea and the USA. Most took place in university settings or training hospitals and one in a specialist orthodontic practice. Most studies contained a similar number of males and females, however there were more females than males in five studies and only females in two. The age range varied from adolescents and young adults to adults up to the age of 54 years. All participants in the studies needed a course of orthodontic treatment with additional anchorage control. None of the studies reported adverse effects. When surgically implanted anchorage devices were compared to conventional anchorage devices, they were better in providing stabilisation for preventing unwanted movement in teeth during orthodontic treatment. There was limited information on patient-reported outcomes such as pain and how acceptable the devices were found to be. No information was reported on adverse events. The quality of the evidence for the important outcomes in this review ranged from moderate to low quality. The main shortcomings of all of the studies were related to issues with their design and the way they were carried out, with insufficient and low quality reporting of the study methods and outcomes.
+We looked at 50 studies published before June 2012 concerning statin treatment in over 45,000 people with CKD who did not need dialysis treatment. We found that statins reduced the risk of death and major heart-related events by 20%. Statin treatment was also found to be effective in reducing cardiac disease and death in people who have CKD but not heart disease. In these people, statin treatment reduced risks of heart attack by half. Statins have some potential harmful effects on liver and muscle function, and some cancers. We found that these issues were not analysed well in the studies we evaluated, and these effects are not well understood. Although use of statins did not clearly reduce risks of kidney disease progression, they can be recommended to reduce risks of death and heart-related events in people with early stages of kidney disease. However, the potential side-effects are uncertain, and need further study.
+Overall, these trials did not find clear evidence of a benefit of the drugs tested in the treatment of pain. This was apart from the two on cerebral palsy where pain relief occurred with the use of baclofen delivered via a catheter into the spinal cord. However the procedure to deliver this medication resulted in most side effect reported in these trials; this was swelling at the site of the catheter, and in one study it reported that this occurred in around half of the children (8/17). Five children also leaked spinal fluid from the catheter resulting in headache and nausea and, for two children, a prolonged hospital stay. The trials were limited by the quality of their methods and most did not set out to measure the benefit of the drug in reducing pain as a main focus. In conclusion, the evidence on pain treatment in children and young people with life-limiting health conditions is very limited, and only evaluated in participants with certain diseases and not for drug treatments primarily used to treat pain. The trials that were identified evaluated the drugs in small samples of children. There remains a need for more research to help guide doctors in their decisions on how to treat pain in these children and young people.
+Clinical studies have had conflicting findings, so we conducted a systematic review and pooled all the available data to assess the effects of latrepirdine. We looked for studies to help us answer this question by conducting a literature search in June 2014. We combined data from seven studies with a total of 1697 patients with AD. We were unable to conclude whether latrepirdine has any beneficial effect on cognition and function in people with AD due to variations in the results between studies and because the effects we estimated were too imprecise. However, the evidence suggests that latrepirdine may have a positive effect in treating behavioural symptoms, and that it is not associated with adverse effects in people with AD. Although seven studies have been done, data from only six studies were available and most of the studies were not fully reported. We contacted the investigators for additional data but received no response.
+This review included seven studies (specifically randomised controlled trials), involving 735 people. The studies compared RIC with sham RIC or medical management in people with ischaemic stroke or at risk of ischaemic stroke. Three trials (involving 371 people) were eligible for our analysis of RIC for preventing ischaemic stroke, and another four trials (involving 364 people) were eligible for our analysis of RIC for treating ischaemic stroke. The included trials were carried out in China, Denmark, and the UK. The results of this review are current up to January 2018. In people with narrowing of arteries in the brain, RIC may reduce the risk of recurrent stroke. In people being treated with stenting (the insertion of a metal or plastic tube) for narrowed arteries in the neck, RIC may reduce the size of new brain injuries caused by reduced blood flow. However, its effect on clinical outcomes (stroke and death) was unclear. Adverse events were significantly more common in the RIC group but were not reported to be severe. Among people with acute ischaemic stroke (where it had only been several hours from symptom onset) who received clot-dissolving medicines, we found that RIC may increase the risk of death or dependency (needing help from others). We found no significant differences in the size of the final stroke. In people with acute ischaemic stroke and chronic blood vessel disease of the brain, RIC did not affect measures of nerve function, mood, or thinking ability. There is low-quality evidence which suggests that RIC may help prevent recurrent stroke in people with narrowed arteries in the brain, and may increase death or dependency in people with acute ischaemic stroke who received clot dissolving medication. The evidence is less clear for reducing the volume of the stroke (size of brain lesion caused by low blood flow). Further research is likely to have an important impact on our confidence in these findings.
+We found six randomised trials (trials in which each infant had an equal chance of being chosen to receive either treatment), involving 204 preterm infants. The search is up to date to February 2018. Low-quality evidence showed that the addition of extra protein to breast milk increased short-term rates of weight gain (five trials), length gain (four trials), and head growth (four trials). Low-quality evidence from one trial did not show a clear difference in the rate of growth of skin fold thickness (measure of fat under the skin) between the supplemented and unsupplemented groups. Very low-quality evidence from one trial reported that infants who received additional protein stayed in hospital longer, while very low-quality evidence from four trials observed higher blood urea nitrogen concentrations (measure of kidney function and protein breakdown) in these infants, compared to those who received no additional protein. Very low-quality evidence from one trial suggested that adding extra protein to expressed breast milk did not clearly increase the risk of necrotising enterocolitis (inflammation of the intestine) or feeding intolerance, or clearly alter serum albumin concentrations (a measure of blood protein levels). No data were available on the effects of adding extra protein to human milk on long-term growth, body fat, obesity, high blood sugar, or brain development. Adding extra protein to human milk for preterm infants may increase short-term growth. However, its effect on length of hospital stay, feeding intolerance, and necrotizing enterocolitis is uncertain, due to data limitations and very low-quality evidence. There were no data about effects on later health and development, or effects in low resource settings. Since protein supplementation of human milk is now usually done as a component of multi-nutrient fortifiers, future studies should compare different amounts of protein in multi-component fortifiers, and be designed to determine the effects on length of hospital stay, safety, long-term growth, body fat, obesity, high blood sugar, and brain development.
+Medical journals and clinical practice guidelines are common channels to distribute scientific information to healthcare providers, as they allow a wide distribution at relatively low costs. Delivery of printed educational materials is meant to improve healthcare professionals' awareness, knowledge, attitudes, and skills, and ultimately improve professional practice and patients' health outcomes. Results of this review suggest that printed educational materials slightly improve healthcare professional practice compared to no intervention, but a lack of results prevent any conclusion on their impact on patient outcomes.
+Searches identified 5271 bibliographic records. Screening the records independently by two review authors identified 23 relevant randomised controlled trials (RCTs). The trials were mostly conducted in the USA (21 trials) and in health-care (e.g. family planning) clinics (14 trials), with only four in educational settings. Trial participants had mixed socio-economic and demographic characteristics and most were sexually experienced. The interventions mostly provided information about STIs and taught safer sex skills (e.g. communication with partners), occasionally supplemented with provision of resources (e.g. free sexual health services). Interventions varied considerably in duration, contact time, provider, behavioural aims and outcomes. A variety of STIs were addressed including HIV and chlamydia, but not explicitly HPV. The most common behavioural outcome (measured in 19 trials) was condom use for vaginal intercourse. Sexual partners, sexual abstinence and STIs were reported in four, two and 12 trials respectively. In terms of statistically significant effects, some interventions improved condom-related behaviour and reduced the number of sexual partners, but none affected the frequency of sexual episodes. Effects of interventions on STIs were limited. None of the interventions appeared to be harmful. The methods used in the trials were not always well described making it difficult to tell whether their results may have been biased. In conclusion, although some behavioural interventions improve condom-related behaviour, trials have been predominantly in USA healthcare settings, did not specifically address HPV and were too different to enable a most effective type of intervention to be identified.
+. The review authors searched for randomised trials in 2013 and found 20 relevant studies with 2337 participants. Half of the studies were carried out in China. These trials randomised people to receive either brief psychoeducation sessions (these ranged from one-day psychoeducation to eight sessions of psychoeducation over a period of one year) or routine care. Based on information from a limited number of studies, brief psychoeducation does seem to reduce relapse and encourage people to take their medication. Those receiving brief psychoeducation also have more favourable results for mental state and social functioning. Although initial results are encouraging, most information and data for the main outcomes of interest, were rated as low or very low quality, and the number of trials providing useful data is small. Until further large, high-quality studies become available, the usefulness of brief psychoeducation remains debatable. Ben Gray, Senior Peer Researcher, McPin Foundation.http://mcpin.org/
+We included 11 studies involving 9839 participants comparing the benefits and harms of LAMA+LABA and LABA+ICS for the treatment of people with COPD. Although risk of serious side effects and death were not affected by the choice of treatment, compared to LABA+ICS, LAMA+LABA was associated with a lower risk of flare-ups, fewer episodes of pneumonia, larger improvement in how well the lungs work, and improved quality of life. Since most of the analysed studies were sponsored by pharmaceutical companies, we had to interpret the results carefully. However, we judged the included studies to be generally conducted in an acceptable manner. These data were supported by low or moderate quality evidence from trials in people with mainly moderate to severe COPD who were studied for less than one year.
+We did not include any new trials in this update. We included three randomised controlled trials (studies in which participants are allocated by chance to receive a treatment) involving a total of 91 children with croup aged from 6 months to 4 years. Studies ran for between 7 and 16 months; two were conducted in the USA and one in Spain. In one study children with mild croup received either heliox with 30% oxygen; in another study children with moderate croup received oral dexamethasone (a type of corticosteroid) and either heliox or no treatment; and in the third study children with moderate to severe croup received injected dexamethasone and either heliox or 100% oxygen with adrenaline. Heliox may be no more effective than 30% oxygen for children with mild croup; as effective as 100% oxygen given with one or two doses of adrenaline; and slightly more effective than no treatment for children with moderate to severe croup. None of the studies reported adverse events. The quality of the evidence was low as the trials included few children, and in one trial children, their families, and the physicians knew which treatment was given.
+Eight studies including several thousand patients described 29 different questions and physical exam tests that have been used to look for spinal fractures.  Most of the 29 were not accurate.  The best four questions asked about use of steroids (which can cause weak bones), the patient’s age (age above 74 increases the risk of fractures) and recent trauma such as a fall.  Using a combination of the best questions appears to improve the accuracy.  For example, women above age 74 are more likely to have a fracture when they come to the physician complaining of back pain.  In the emergency room, the best indication of a spinal fracture was a bruise or scrape on the painful area of the back. Fractures are rare and generally do not require emergency treatment, even if red flags exist clinicians and patients can watch and wait.  During the waiting period, patients should avoid treatments like exercise and manipulation that are not recommended for spinal fractures. The worst effects of low quality red flag screening are overtreatment and undertreatment.  If the tests are not accurate, patients without a fracture may get an x-ray or CT scan that they don’t need—unnecessary exposure to x-rays, extra worry for the patient and extra cost.  At the other extreme (and much less common), it might be possible to miss a real fracture, and cause the patient to have extra time without the best treatment. Most of the studies were of low or moderate quality, so more research is needed to identify the best combination of questions and examination methods.
+The uncertainty as to which option is best prompted this review of the current evidence. We found very little good quality evidence and were unable to achieve all our objectives for this review. The results of a single study suggest that dilatation and urethrotomy offer equivalent outcomes, but they are associated with a high rate of recurrence of the stricture requiring repeated procedures over a relatively short period of time. Preliminary data reported in abstract form suggested that urethroplasty was more effective than urethrotomy for the specific circumstance of urethral trauma following fracture of the pelvic bones. We found no data concerning well-being or the quality of life amongst men treated for urethral stricture disease. The main conclusion of the review is that the current lack of quality evidence means that further trials are needed to establish which intervention is most effective and most cost-effective for treatment of urethral stricture disease in men.
+This review of randomised controlled trials found no significant difference in the number of asthma attacks of moderate severity between people taking inhaled corticosteroids every day and those taking them 'as needed'. However, there was not enough information to conclude to that the two approaches were equivalent. We found that people taking inhaled corticosteroids everyday had slightly better asthma control with better lung function, less use of reliever medication and more symptom-free days than those taking inhaled corticosteroids intermittently. We also observed that compared to intermittent inhaled corticosteroids, children grew slightly less with daily inhaled budesonide and beclomethasone (inhaled corticosteroids are known to affect growth), underlying the importance of using the safest and lowest effective dose of inhaled corticosteroids. We did not observe any significant group difference in the rate of withdrawals or adverse effects. These results do not provide firm conclusions, although the improvement in asthma control, lung function and airway inflammation would provide slightly greater support for the use of inhaled corticosteroids every day as compared to taking them only when symptoms get worse. Physicians and patients are advised to weigh the risks and benefits of each treatment option carefully and monitor the response of individual patients to adjust therapy as needed.
+We found 17 studies involving 1639 people who had chronic kidney disease that looked into whether diet changes or advice improved their health. Studies included men and women with mainly moderate or severe kidney disease. Diets involved increasing fruit and vegetable intake, increasing poultry and fish, higher nut and olive oil use, and some increases in cereals and legumes (e.g. beans), and less red meat, sugar, and salt. We looked particularly at three key outcomes: the risk of death, the risk of advanced kidney disease requiring dialysis, and quality of life. There were four studies involving people who have had a kidney transplant and three studies involving people treated with dialysis. After combining the available studies, it was uncertain whether making healthy diet changes prevented heart complications as most studies did not measure these. Diet changes may improve life quality. We did see that some risk factors for future disease, such as blood pressure and cholesterol, were lower following diet counselling or healthier eating. The quality of the included studies was often very low meaning we could not be sure that future studies would find similar results. We are very uncertain whether dietary changes improve well-being for people with kidney disease because the available research studies were not designed to learn about these. Diet changes may lower blood pressure and cholesterol, but the longer term impact of these effects on well-being is not proven. This means we still need large and good-quality research studies to help understand the impact of diet on the health of people with kidney disease.
+Humidified air as steam inhalation or mist is thought to help the patient by lightening respiratory tract secretions and relieving the symptoms of respiratory distress. We searched and reviewed studies that used humidified air alone or in combination with drugs to relieve the symptoms of the infection in children less than three years of age. We found only one study (156 children) that met our criteria for analysis. The study compared nebulised salbutamol and mist in a tent (humidified air). The results showed that nebulised salbutamol was effective in relieving respiratory distress in acute bronchiolitis in young children while mist therapy was not effective. The study did not report on adverse effects for either intervention. Although the study was of high quality, some issues regarding patient allocation to the various treatment groups were not very satisfactory. There is currently not enough evidence to state that steam inhalation or mist is useful in young children with bronchiolitis. More well-designed trials of the effectiveness of humidified oxygen, mist therapy or steam inhalation compared with other treatments for acute bronchiolitis are needed.
+Two independent authors searched scientific databases for studies in which a statin or a placebo (a pretend treatment) was given for at least six months. We included people with a probable or possible diagnosis of Alzheimer's disease according to standard clinical criteria. The findings were current to January 2014. We identified four studies involving 1154 participants (age range 50 to 90 years). The studies used standard tests to assess the severity of Alzheimer's disease. From these trials, including two large trials, we found no evidence that statins help in the treatment of cognitive decline in dementia. The quality of evidence is felt to be high as two large randomised controlled trials have been included along with two smaller ones.
+The purpose of this review was to assess the evidence regarding the effectiveness of interventions for improving ankle flexibility in people with neuromuscular disease. Four studies were included in the review involving a total of 149 participants. Two studies showed that wearing a night splint was no more effective than not wearing a night splint for increasing ankle flexibility in 26 people who had Charcot-Marie-Tooth disease type 1A. One study showed corticosteroids (prednisone) did not significantly improve ankle flexibility in 103 boys with Duchenne muscular dystrophy and the other study showed that while orthopaedic surgery initially increased ankle flexibility in 20 young boys with Duchenne muscular dystrophy this was not sustained in the long term. This review shows that, currently, there is limited evidence supporting any intervention for improving ankle flexibility in patients with Charcot-Marie-Tooth disease type 1A and Duchenne muscular dystrophy. More research is needed.
+This review included 25 studies (involving 5218 women). Although many studies were not of high quality, and most of the women were low risk, they did show that the first stage of labour may be approximately one hour and twenty minutes shorter for women who are upright or walk around. As every contraction is potentially painful, and prolonged labour can be an overwhelming and exhausting process resulting in an increased need for medical intervention, this is a meaningful outcome for women. Indeed other important outcomes for women who were upright and mobile compared with lying down in bed included a reduction in the risk of caesarean birth, less use of epidural as a method of pain relief, and less chance of their babies being admitted to the neonatal unit. More research of better quality is still needed to validate these results for all women in labour. However, based on the results of this review we recommend that wherever possible, women should be encouraged and supported to use upright and mobile positions of their choice during first stage labour, as this may enhance the progress of their labour and may lead to better outcomes for themselves and their babies.
+From our systematic search we identified two trials. One trial compared surgery to remove the first rib (transaxillary first rib resection) with surgery in which the surgeon freed the nerves from surrounding tissues (neuroplasty) without removing a rib, in 55 people with the disputed type of TOS. The participants had not responded to non-surgical treatments. Average follow-up was 37 months. A second trial analyzed 19 people who underwent double-blinded provision of a single injection of BTX (muscle relaxant) into the scalene muscles of the neck, and 18 people in the placebo group who received no active injection, with follow-up at six weeks, three months and, critically for the purpose of this review, six months. There is very low quality evidence that removal of a rib reduced pain from 'disputed' TOS more than a neuroplasty procedure. We identified issues in study design that could have affected the outcome of the trial. There were no adverse effects in either group. There were no trials of surgery versus no treatment. The trial comparing the intervention of BTX injection with placebo provided moderate evidence that this procedure does not significantly reduce pain or disability scores long term, although there were no adverse events associated with the procedure over placebo. This systematic review demonstrated that there is not enough evidence that the established interventions for TOS are helpful in relieving pain. Until high quality, randomized clinical trials comparing the various interventions for TOS are performed, the decision whether to treat and the choice of appropriate treatment will have to be based on the preferences of the individual and health care provider. The evidence is current to June 2014.
+Other Cochrane reviews show benefit from nerve decompression surgery and steroids. This review of other non-surgical treatments found some evidence of short-term benefit from oral steroids, splinting/hand braces, ultrasound, yoga and carpal bone mobilisation (movement of the bones and tissues in the wrist), and insulin and steroid injections for people who also had diabetes. Evidence on ergonomic keyboards and vitamin B6 is unclear, while trials so far have not shown benefit from diuretics, non-steroidal anti-inflammatory drugs, magnets, laser acupuncture, exercise or chiropractic.
+The review authors searched the medical literature up to 13 November 2014 and included two randomized controlled trials (GENEVA and SCORE) that had evaluated steroids in 708 participants with CRVO-ME. Both trials included participants with similar baseline characteristics with respect to age, gender, and co-morbidities. GENEVA was conducted in 24 countries across the world and SCORE was conducted in the US. Both trials compared two different doses of steroid, but the investigators of the two trials used different steroidal agents and different methods of delivery (implant versus injection). Both trials received full or partial sponsorship from the manufacturer of the drugs. Neither trial provided sufficient evidence to determine whether steroids had improved visual acuity after six months of treatment. Due to the limited evidence, we are unable to determine reliably whether steroid implants improved vision in eyes with CRVO-ME. Although the SCORE trial showed that more eyes in the steroid injection groups had improvement in vision compared with eyes in the observation group, participants treated with steroids and those not treated with steroids both lost vision on average at eight months. The GENEVA investigators reported no difference in vision outcomes between participants treated with steroids and those not treated with steroids after six months of treatment; however the GENEVA study was not limited to participants with only CRVO-ME and included participants with other retinal disease. Both trials showed that patients treated with steroids were at increased risk for high eye pressure - requiring additional medications to lower the eye pressure - and developing cataracts. The overall quality of the evidence was low due to clinical differences between studies, incomplete information available to assess outcomes, and lack of masking which may lead to biased study results.
+This review was conducted to assess the effectiveness of intranasal corticosteroids for improving nasal airway obstruction in children aged 0 to 12 years with moderate to severe adenoidal hypertrophy. Evidence derived from five of the six randomised controlled trials included in this review suggests that intranasal steroids may significantly improve symptoms of nasal obstruction in children with adenoidal hypertrophy and that this improvement may be associated with the reduction of adenoid size. One study did not find a significant improvement in nasal obstruction symptoms. Further large and high-quality randomised controlled trials are warranted.
+We searched for evidence in July 2017 and identified one small randomised controlled study (involving 24 women) for inclusion in this review. The women were at 30 weeks of gestation or more, diagnosed with severe pre-eclampsia, and being cared for in an intensive care unit. They were randomly assigned to an epidural block plus their other medications or a drug to treat their high blood pressure plus their other medications. After six hours of treatment they all underwent a caesarean section. The included study did not report on any of the important outcomes of interest in this review such as death of the mother, death of her baby (before or after being born), serious illness for the mother or her baby, the mother developing eclampsia or seizures, or side effects of the intervention. The study authors did report difference in the infant Apgar scores between the two groups The study authors also reported a clear drop in the diastolic blood pressure in the epidural group compared to the other group. Systolic and mean blood pressures were similar in the two groups of women. However, the study did not report on any other mother or baby outcomes of interest in this review. There is not enough evidence from randomised controlled trials to evaluate the use of epidural therapy in severe pre-eclampsia to improve outcomes for the mother or her baby. High-quality trials are needed to evaluate the efficacy, safety and cost of epidural therapy in severe pre-eclampsia. Future studies could report on important outcomes such as those listed in this review.
+Sixteen randomised clinical trials compared glucocorticosteroids with placebo or no intervention in people with alcoholic hepatitis. Fifteen trials provided data for analysis (927 participants received glucocorticosteroids and 934 participants received placebo or no intervention). Glucocorticosteroids were administered orally or as an injection for a median of 28 days (range 3 days to 12 weeks). The trial participants were between 25 and 70 years old, 65% were men, and had different stages of alcoholic liver disease. Trial participants were followed up to the moment of discharge from the hospital, or until they died (a median of 63 days), or for at least one year. Not all trials reported the follow-up of participants. The trials were conducted in France, India, the UK, and the USA. Two trials administered pentoxifylline (a medicine used for diseases of the blood vessels) to both glucocorticosteroids and placebo intervention groups. Based on the information that we collected from the published trial reports, only one of the trials seems not to be industry-funded, and the remaining 15 trials did not report clearly whether they were partly or completely funded by the industry. The overall reliability of the evidence was low for health-related quality of life and very low for death due to any cause up to three months following entry in the trial; serious side effects during treatment; liver-related death up to three months following entry in the trial; number of participants with any complications up to three months following entry in the trial, and number of participants non-serious side effects up to three months' follow-up after the end of treatment. All trials but one were at overall high risk of bias, which means that there is possibility of drawing wrong conclusions, exaggerating benefits, or underestimating harms of glucocorticosteroids because of the way the trials were conducted and analysed. We could not determine whether glucocorticosteroids had a positive or negative effect on people with alcoholic liver disease. Despite available data on outcomes which included mortality, health-related quality of life, and serious complications, we were unable to draw firm conclusions mainly because available data were still insufficient to produce robust results, trials were small, and the included participants differed in severity of disease. Therefore, we have very little confidence in our conclusions.
+We identified four studies, up to October 2013, which involved 245 people after stroke. A wide range of interventions was used, including driving simulation, training on devices to improve speed of processing information, scanning and movement. All studies compared the effectiveness of the driving intervention on improving whether drivers passed or failed on a driving assessment. There was no evidence that a driving intervention was more effective than no intervention. One trial found that training on a driving simulator resulted in improved performance on a test of recognising road signs immediately after training. Results should be interpreted with caution, as this was a single study. Further trials involving large numbers of participants, grouped according to their impairments and stroke type are required.
+We found eight studies that included 582 people with COPD who experienced a flare-up that required extra treatment in hospital. These studies compared oral or injected corticosteroid treatment given for seven or fewer days versus treatment for longer than seven days. Most of the people in these studies were in their late sixties and had severe or very severe symptoms of COPD; more men than women took part. The last search for studies to be included in the review was conducted in March 2017. No differences were observed between shorter and longer courses of treatment. People treated for seven or fewer days did not have a higher rate of treatment failure or longer time to their next exacerbation; the number of people who avoided treatment failure ranged from 51 fewer to 34 more per 1000 treated (average 22 fewer people per 1000). Time in hospital and lung function (blowing tests) at the end of treatment were not different. No differences in side effects or death were noted between treatments. Information on quality of life, which is an important outcome for people with COPD, is limited, as only one study measured it. The eight studies included in this review were generally well designed, and the quality of the evidence was rated as moderate because of imprecision in results; more research, especially involving people with less severe COPD, is needed.
+Only one small study including 13 patients with bone marrow failure was included in this review. The study was funded by two government agencies and one charity. We are aware of three ongoing studies which have not yet been completed. The evidence is current to 26th May 2015. The one included study was too small to demonstrate any difference in all-cause mortality (death due to any cause) or number of red cell transfusions received between a restrictive compared to a liberal red blood cell transfusion policy. At the current time, there is a lack of evidence to recommend a restrictive transfusion strategy over a liberal one. Trials with good methodology are needed to determine the best transfusion policy for patients with long -term bone marrow failure disorders. The evidence for the findings was of very low quality. This was because very small numbers of participants were included in the study. Only 13 patients were recruited to the trial rather than the planned 200 participants due to problems with recruitment.
+This review found two eligible studies. The first study evaluated a game based on the TV show Family Feud and taught about infection control. The second study evaluated the use of a "Snakes and Ladders" board game in continuing medical education on stroke prevention and management. The two studies did not consistently show a beneficial effect on knowledge. We are therefore very uncertain whether games improve health care professional practice or patient care.
+This systematic review investigated the efficacy and tolerability of lithium compared to antidepressants for the long-term treatment of unipolar affective disorder. Eight randomised studies (reporting on 475 participants) were included in the review. We found no reliable evidence of any robust differences between lithium and antidepressants but nor could we reliably exclude the possibility of clinically significant differences. In this review some studies included a mixed group of participants with either bipolar or unipolar disorder. The review suggests that, while lithium may be of benefit in preventing relapse in unipolar affective disorder, there remains uncertainty about the treatment effect in comparison with antidepressants. Interpretation of this review should consider that the number of participants in the studies was small and the included studies had methodological shortcomings.
+We found only two randomised controlled trials in which the effects of amifostine were compared with placebo. The two randomised clinical trials investigated 130 patients treated with high dose radioactive iodine for thyroid cancer. Altogether data from the two trials suggest that amifostine has no obvious protective effects on the salivary glands in these patients. Two patients in one study collapsed after initiation of amifostine therapy and had to be treated by withdrawing the infusion and volume substitution. Both patients recovered without sequelae. Until better data become available, the use of sour candy or lemon juice to increase salivation might be more appropriate during radioactive iodine treatment for patients with differentiated thyroid cancer. Patients should be well informed of the importance of hydration, acid stimulation and glandular massage after radioactive iodine treatment. In addition, early recognition and treatment of xerostomia may improve outcomes.
+The evidence is current to January 2018. We found three studies involving 45 children aged between 29 months and six years. Two studies were randomised controlled trials: experiments in which children were allocated to treatment (i.e. parent-mediated) and control (treatment as usual or clinician-mediated, or both) groups using a random method such as a computer-generated list of random numbers. The other study reported that randomisation took place but did not specify how this was done. Two studies compared parent-mediated intervention to treatment as usual. One of these lasted for 13 weeks, and parents in the intervention group received nine, weekly group sessions and four individual sessions in the home. The total intervention time was approximately 26.5 hours. A second study lasted for six months, and parents received weekly, 1.5- to 2-hour clinic or home-based, individualised, parent-child sessions. The total intervention time was approximately 48 hours. A third study compared a parent- and clinician-mediated intervention to a clinician-only-mediated intervention. In this study the parents in the intervention group took part in a two- to three-hour interactive workshop plus three individualised sessions (two clinic-based and one home-based) every week for 12 weeks. The control group received the same individualised sessions, but a clinician delivered them (i.e. there was no parental involvement). The total intervention time was approximately 19 hours. A grant from the Hospital for Sick Children Foundation (Toronto, Ontario, Canada) funded one study. Another received partial funding from the National Institute of Child Health and Human Development and the Department of Education in the USA. The remaining study did not specify any funding sources. Two of the three studies found no differences in children's language ability after parent training. However, these same two studies found that children in the intervention group used more words that had been specifically targeted, postintervention; this was not maintained 12 months later. The study that gave parents the largest amount of intervention reported gains on general measures of overall language ability for children in the intervention group. One study did not find any changes in levels of parental stress immediately or up to 12 months postintervention in either group. All three studies noted changes in how parents talked to and interacted with their children immediately postintervention, and most strategies were retained by the intervention group 12 months later. One study reported increases in the socialisation skills of children who received the intervention. No study reported language attrition in either group postintervention. We rated the quality of the evidence in this review as very low, as only three studies fulfilled the criteria for inclusion, and all had small sizes and serious methodological limitations. There is currently insufficient evidence to determine the effect of parent-mediated interventions for improving the communication and language development in young children with Down syndrome.
+We searched for randomised clinical trials (experiments in which participants are randomly allocated to an experimental compared with a control intervention) examining the effect of exercise-based cardiac rehabilitation compared with no exercise after heart valve surgery for heart valve disease (from any cause) in adults (18 years or older). Our literature searches were undertaken up to March 2015. We found two randomised clinical trials published in 1987 and 2004 that included a total of 148 participants. Due to the limited amount of data, we were not able to determine the effect of exercise-based rehabilitation on mortality, serious adverse events, health-related quality of life, ability to return to work, New York Heart Association class, left ventricular ejection fraction, or cost. However, exercise-based rehabilitation did appear to increase exercise capacity at up to 12 months follow-up, although this should be interpreted with caution as the included trials had a high risk of systematic error (bias). Further randomised clinical trials are needed to definitely understand the effect of physical exercise in adults after heart valve surgery. Given that the included studies are relatively old, and included narrowly-selected trial populations, the evidence is likely to be of limited applicability to clinical practice. Both trials had a high risk of bias (systematic errors) and the quality of the evidence was low. Due to the scarcity of the evidence there is also a high risk that the results may be subject to random errors (play of chance). Therefore, further high-quality randomised clinical trials are needed to assess the effects of exercise-based interventions.
+Being ill and near to the end of life can raise questions such as "Why me? Why now?". The experience may start or increase thoughts of a spiritual or religious nature. Some research has found that having spiritual or religious awareness, or both, may help a person cope with disease and dying. We conducted our review through searches for studies that were randomised controlled trials. We only included such studies if they evaluated an intervention that involved a spiritual or religious aspect, such as prayer and meditation, and aimed to support adults in the terminal phase of a disease. We found five studies. In total, the studies involved 1130 participants. Two studies evaluated meditation. Three evaluated the work of a palliative care team that involved physicians, nurses and chaplains. Studies compared those who received the intervention with those who did not. Studies evaluated the interventions in various ways including whether it helped in any way a person's quality of life. There was inconclusive evidence that meditation and palliative care teams that involve a chaplain or spiritual counsellor help patients feel emotionally supported. The findings of the review are limited. This is because none of the studies measured whether the intervention helped the person cope with the disease process, and also it is unclear whether all participants receiving the palliative care team interventions were offered support from a chaplain. All the studies were undertaken in one country, making it difficult to draw conclusions as to whether the intervention would work elsewhere.
+We included six trials involving 137 participants. The duration of treatment in the included trials ranged from a single session to five consecutive sessions of tDCS. From the six trials involving 137 participants, we found there was insufficient evidence to determine how much of an effect there is from tDCS in enhancing rehabilitation outcomes regarding reduction in off time (when the symptoms are not controlled by the medication) and on time with dyskinesia (time that symptoms are controlled but the person still experiences involuntary muscle movements) , and for improving health- related quality of life, disability, and impairment in patients with IPD. However, tDCS may improve impairment regarding motor symptoms in patients with IPD. We found no study examining the effects of tDCS for improving activities of daily living. Proportions of adverse events and people discontinuing the study were comparable between groups. All findings are based on evidence of very low quality. That means that we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.
+In September 2015, we found a limited number of small trials, all of which had design flaws. We did not find evidence that LASB was better than placebo in reducing pain, or that it provided additional pain relief when added to rehabilitation. While a number of small studies compared LASB to other treatments, most did not find that LASB was better. One small study found that injecting the thoracic (upper back) sympathetic nerves with local anaesthetic and steroid was better than injecting the same drugs just under the skin at one-year follow-up, but the study may have been prone to bias. Only six studies reported on the type and amount of side effects. These studies reported only minor side effects, but since some studies did not report this information we can draw no firm conclusions about the safety of LASB. The evidence was mostly of low or very low quality. Overall, the evidence is limited, conflicting, and of low quality. While we cannot draw strong conclusions, the existing evidence is not encouraging.
+We identified 14 trials, which included 2488 participants with mild, moderate, or severe one-sided Bell's palsy of unknown cause. Participants were aged from 14 to 84 years. The trials compared: - antivirals plus corticosteroids to corticosteroids alone or in combination with placebo; - antivirals alone or in combination with placebo to placebo or no treatment; - antivirals alone or in combination with placebo to corticosteroid treatment alone or in combination with placebo; or - antivirals plus corticosteroids to placebo or no treatment. For the majority of the studies, no information on funding was given. The remaining were mostly partly public funded, and one trial was funded by a pharmaceutical company. Eleven studies had high or uncertain risk of bias from various factors that can systematically affect trial results. We chose to base our conclusions only on data from three studies at a lower risk of bias. The review showed that there may be no clear difference in rates of incomplete recovery from Bell's palsy after treatment with the combination of antivirals and corticosteroids, compared to corticosteroids alone. This finding was of low certainty and was based on data from three trials involving 766 people with Bell's palsy of various degrees of severity. We excluded data from 10 trials with multiple potential sources of bias. However, we can be moderately confident that the combined therapy reduced the number of people left with long-term effects of Bell's palsy (excessive tearing of the eyes or an abnormal facial movement) compared to corticosteroid treatment alone. Data from two studies (98 participants) showed that in people with severe Bell's palsy (complete or almost complete facial paralysis), combined antivirals and corticosteroids had no clear effect on recovery compared with corticosteroid treatment alone. Corticosteroids alone were more effective than antivirals alone on rates of incomplete recovery (667 participants, 2 trials); antivirals and corticosteroids combined were more effective than placebo or no treatment (658 participants, 2 trials); and there was no clear benefit from antivirals alone over placebo (658 participants, 2 trials). Although, based on data from two trials (656 participants), we found no clear difference in the occurrence of side effects between people receiving both antivirals and corticosteroids, compared to those receiving corticosteroids alone, this evidence is too uncertain for us to draw conclusions. Large studies in people with Bell's palsy comparing additional antiviral agents may be indicated in the future.
+We searched electronic databases and other resources for randomised controlled trials (RCTs) comparing LHRH agonists with chemotherapy or placebo in women with relapsed EOC.Two RCTs were identified. Since the comparisons differed, they were reported separately. Available evidence did not show improvement in overall survival and progression-free survival at six and12 months with hormonal (LHRH) therapy. Also, major side effects (haematological and neurological) did not statistically differ between the two treatment groups, but were incompletely reported. Quality of life data were not reported in either study. Currently, the quality of evidence is very low regarding the effectiveness and safety of LHRH agonists in women who relapse within six months of initial platinum chemotherapy treatment.
+In a search updated to February 2016, review authors identified a total of 17 studies for inclusion in the review. Most of the results reported in this review were obtained from 10 studies of moderate to high quality, which compared inhaled nitric oxide (iNO) versus standard therapy without iNO. Six studies compared iNO started when babies were less sick against waiting to see if they deteriorated, then treating them later. These studies were smaller, and only one was a high-quality trial. Inhaled nitric oxide is safe and can help some full-term babies with respiratory failure who have not responded to other methods of support. Inhaled nitric oxide increases levels of oxygen in babies' blood, and babies are more likely to survive without needing ECMO, a highly invasive therapy with many complications. Unfortunately, benefits of iNO are not clear in babies whose respiratory failure is due to a diaphragmatic hernia. Inhaled nitric oxide has shown no short-term or long-term adverse effects. No signs suggest that iNO given earlier is more beneficial or results in more babies treated, and the number who die or who need ECMO is not significantly reduced.
+In one study (82 people), back supports added to back school (patient education about recovering from back pain) were helpful in reducing the number of days of sick leave but not in preventing back pain. Back supports plus usual medical care reduced the number of days of low-back pain and improved function, but did not reduce sick leave (one study, 360 people). Treatment:  In four studies (1170 people), there was little or no difference between patients with acute or chronic back pain who used back supports and those who received no treatment in short-term pain reduction or overall improvement. There is conflicting evidence (two studies, 550 people) about whether back supports are better than nothing in helping low-back pain patients return to work faster, however in three studies (410 patients), they were better than nothing in helping individuals with subacute and chronic low-back pain recover function in the short term. In three studies (954 people), there was little or no difference in short-term pain reduction, overall improvement and return-to-work between those who used back supports and those who received manipulation, physiotherapy, or electrical stimulation. One study (164 people) reported mixed results on whether back supports improved function more than massage and in another study (19 people), use of a lumbar corset with back support was more effective in reducing pain in the short-term than a corset alone. Conclusions from this review should be viewed with caution due to the low quality of many of the studies. In the future, researchers should report side effects from wearing back supports and measure how many hours per day the supports are actually worn.
+We included 57 studies with 16,784 catheters and 11 types of antimicrobial impregnation. The total number of participants was not clear as some studies did not provide this information, and some participants may have had more than one CVC in the course of their treatment. The participants were mostly adults aged 18 and over in ICUs, cancer units or other healthcare settings in which CVCs were used for intravenous treatment or nutrition. All studies were completed when the participants left the unit or hospital, and no study followed up participants in the long-term. Twenty-six out of 57 studies were funded fully or partially by the catheter manufacturers or distributors, two studies were government-funded, and two received no funding. Funding sources were not stated in the remaining 27 studies. Compared to those participants given non-impregnated catheters, participants with impregnated catheters had 2% lower rates of bloodstream infections that were definitely catheter-related (CRBSI) (average absolute reduction in CRBSI: 2%). There was also a 9% lower chance of finding bacteria on these impregnated catheters (catheter colonization) (average absolute reduction in catheter colonization: 9%). However, the benefits of these catheters in reducing catheter colonization varied according to study setting, with significant benefits observed only in studies conducted in the ICUs. There were no clinically significant differences in the overall rates of bloodstream infections (clinically-diagnosed sepsis) or in death, although these outcomes were assessed in fewer studies than CRBSI and catheter colonization. Impregnated catheters appeared no more likely than non-impregnated catheters to cause adverse effects such as bleeding, clots, pain or redness at the insertion site. The amount of information in this review contributed to high-quality evidence for the major outcomes of CRBSI, all-cause mortality and adverse effects. However, for clinically-diagnosed sepsis we considered the quality of the evidence to be moderate, as we suspected that there had been selective non-publication of certain trials. We considered the quality of evidence to be moderate for catheter colonization too, due to major inconsistencies in the direction of the results amongst the included studies. While impregnated catheters are effective in reducing CRBSI and catheter colonization, particularly in ICUs, they may not be effective across all settings. Furthermore, our review shows that these impregnated catheters do not appear to reduce all bloodstream infections and numbers of deaths. The discrepancy between the findings for CRBSI, catheter colonization and overall bloodstream infections might be related to the limitations of the catheter and blood cultures that were used in most studies for detecting catheter-related infections. Future research should include overall bloodstream infections and death as key outcomes, and include some advanced methods for detecting micro-organisms on the catheters and in the bloodstream to evaluate the presence of catheter-related infections more accurately.
+Nutritional methods (interventions) to improve infant and young children's growth have not been comprehensively or systematically assessed for urban slums. We included 15 studies in the review, involving 9261 children less than five years old and 3664 pregnant women. About 73% of children were less than one year old. The interventions provided maternal education; nutrient supplementation of mothers, infants, and children; improving nutrition systems; or a combination of these but not dietary modification. The reliability of the studies was very low to moderate overall because studies were not designed to cope with research problems linked to urban slum communities, such as high mobility and high loss of participants to follow-up. This meant that the effectiveness of the intervention could not be properly assessed at later dates. We assessed the effect of interventions taking both statistical and clinical significance into account. Where intervention outcomes were statistically insignificant, we conclude there was 'unclear effect'. There was no effect of giving mothers nutrient supplementation on birth weight and length, there were inconclusive results for nutrient supplementation in infants and children on improving children's height or stunting status, there was a positive impact on birth weight of maternal education interventions where there was a positive difference in birth weight of 478 g in infants exposed to the intervention, and inconclusive results of improving health systems that support nutrition on children's stunting status and a positive effect on height. There were no reported side effects from these interventions. The review showed the need to better understand urban slum environments and their people as evidence showed that interventions included in this review were successful in other locations outside of urban poor areas. More evidence is needed of the effects of multi-sectorial interventions, combining nutrition-specific and sensitive methods and programmes, as well as the effects of 'up-stream' practices and policies of governmental, non-governmental organisations (NGOs), and the business sector to improve low birth weight and stunting in poor urban environments.
+We evaluated the evidence from 12 randomised controlled trials that either compared different types of foam dressings, or compared foam dressings with other types of wound dressings. We found no evidence to suggest that polyurethane foam dressings are significantly better or worse than hydrocellular foam dressings in venous leg ulcer healing. Similarly, we found no evidence to suggest that foam dressings are significantly better or worse than other types of dressings (paraffin-impregnated gauze dressings, hydrocapillary dressings, hydrocolloid dressings, knitted viscose dressings, or protease-modulating matrix dressings), for the healing of venous leg ulcers. We found insufficient evidence to draw any conclusions regarding: adverse events, quality of life, costs, pain, or dressing performance. Overall, the current evidence is of low or unclear methodological quality. This limits the making of any specific recommendations regarding the use of foam dressings. Further, good quality evidence is required before definitive conclusions can be made regarding the role of foam dressings in the management of venous leg ulcers.
+This review does not include any studies that assessed the tolerability and safety of the withdrawn COX-2 inhibitors rofecoxib, valdecoxib, or lumiracoxib.This review identified two studies that included a total of 381 participants with IBD who were experiencing rheumatological manifestations. One study (159 participants) compared etoricoxib (60 to 120 mg/day) to placebo (e.g. a sugar pill) in people with IBD (ulcerative colitis or Crohn's disease) who were in remission (i.e. no disease symptoms) or had active disease (i.e. had symptoms). The other study (222 participants) compared 2 weeks of treatment with celecoxib (200 mg twice daily) to placebo in people with ulcerative colitis who were in remission. The study that compared etoricoxib to placebo found no clear evidence of a difference in the proportion of patients who experienced exacerbation of IBD after 12 weeks of treatment. Although this study documented side effects experienced by the participants these side effects were not reported in the study manuscript. The study that compared celecoxib to placebo found no clear evidence of a difference in the proportion of patients who experienced exacerbation of ulcerative colitis after two weeks of treatment. The proportion of patients who experienced side effects was similar in the celecoxib and placebo groups (21% and 17%, respectively). No patients in either group died or experienced serious side effects. Eleven percent of patients in the celecoxib and placebo groups experienced GI side effects including increased stool frequency, rectal bleeding, and inflamed mucosa. No patients experienced any cardiovascular side effects (i.e. heart attack or stroke). Renal toxicity (i.e. the poisonous effect of a substance on the kidneys) or thrombotic side effects (i.e. the formation of a blood clot inside a blood vessel) were not reported. The results of the two included studies in this review suggest that celecoxib and etoricoxib do not exacerbate IBD symptoms. However, it should be noted that both studies assessed relatively small numbers of patients and were of short duration. Futhermore, the overall quality of the evidence from the studies was rated as low due to lack of precision of the results. No firm conclusions on the tolerability and safety of celecoxib and etoricoxib can be drawn from these studies. Further studies are needed to determine the tolerability and safety of celecoxib and etoricoxib in patients with rheumatological manifestations of inflammatory bowel disease.
+In August 2016 we searched for randomised controlled trials involving the use of any antimicrobial treatment on foot ulcers or other open wounds of the foot in people with diabetes. We found 22 trials involving a total of over 2310 adult participants (one trial did not report the number of participants). Participant numbers in each trial ranged from 4 to 317 and follow-up times during and after treatment ranged from 4 to 24 weeks. Some trials included participants with ulcers that were infected, while other trials included participants with ulcers that were uninfected. The trials compared a variety of different antimicrobial dressings, solutions, gels, creams, or ointments. Many of the trials did not report important data, which means the reliability of the results is uncertain. The results of five trials involving 945 participants suggest that use of some type of antimicrobial dressing may increase the number of ulcers healed in medium-term follow-up (4 to 24 weeks) when compared with a non-antimicrobial dressing (low certainty evidence). Due to limited information, we were unable to assess the effectiveness of treatments in either preventing or resolving wound infection. Four trials involving 937 participants compared systemic antibiotics (given by mouth or via injection, distributed to the whole body by the bloodstream) with antimicrobial treatments applied directly to the wound. These trials did not provide data on healing or infection, but it appeared that there was no difference in the side effects experienced by participants whose ulcers were treated systemically or topically (moderate certainty evidence). Overall, the certainty of the evidence provided by the trials was too low for us to be certain of the benefits and harms of topical antimicrobial treatments for treating foot ulcers in people with diabetes. More, larger, and better-designed randomised controlled trials should be carried out in this area.
+We included six studies that investigated zinc supplements to prevent pneumonia. The studies were conducted in Bangladesh, India, Peru and South Africa and involved 5193 children aged from two to 59 months. Children received either zinc or a similar-looking treatment that did not contain zinc. In two studies, children were also given vitamin A. All included studies were funded. Of these, three explicitly mentioned that funding agencies had no role in the design and results of the study. Zinc supplementation was significantly associated with reducing the incidence and prevalence of pneumonia among children aged from two to 59 months. On subgroup analysis, we found that a more stringent diagnosis (radiological examination) increased the reduction in pneumonia incidence. Overall, evidence quality was assessed as low on GRADE assessment.
+We included 10 trials (33,179 children) where vitamin A deficiency or malnutrition was prevalent (31,379 in the community and 1800 in a hospital setting). Studies measured different aspects (for example, what constituted 'acute LRTI', the time to symptom resolution, etc.). There may have been other treatments (especially of malnourished children) which could have led to bias. Most studies showed no significant benefit of vitamin A supplements on the incidence or prevalence of symptoms of acute LRTIs. Although no included studies addressed adverse effects of vitamin A, the use of vitamin A should be carefully monitored. We do not recommend giving vitamin A to all children to prevent acute LRTIs because a few studies unexpectedly found that vitamin A increased the chance of infections or worsened symptoms in otherwise healthy children. Some evidence shows benefit for vitamin supplements given to children with low serum retinol or with a poor nutritional status. Limitations of our review include trials conducted within very specific populations and poor methodological quality of some of the included trials.
+This systematic review shows that orally administered theophylline improves lung function and levels of oxygen and carbon dioxide in the blood. However, there is limited data on its effect on symptoms, exercise capacity or quality of life. Despite being associated with increased side effects, particularly nausea, participants preferred theophylline over placebo.
+We included 10 randomized controlled trials (studies that allocate people randomly by chance to receive treatment) that compared oral immunotherapy to placebo (a fake treatment not containing egg) or an egg-avoidance diet for people with egg allergy. The 10 studies included a total of 439 children (249 in the oral immunotherapy group (treatment containing egg) and 190 in the control group (no egg)) who were aged from 1 year to 18 years. The evidence showed that treating egg allergy by giving a small, increasing amount of egg may help most children with egg allergy to tolerate a partial serving of egg, so long as they continued to consume a daily amount of egg protein. Side effects were frequent during oral immunotherapy treatment, but were usually mild-to-moderate. Nevertheless, 21 of 249 children treated with oral immunotherapy for egg allergy required medicine because of a serious reaction. The studies did not report information about quality of life of children and their families during oral immunotherapy treatment. The trials involved small numbers and there were problems with the way they were done, therefore further research is needed.
+We searched scientific databases and found four randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) including 579 adults, which met our inclusion criteria. This review includes evidence identified up to April 2015. All-cause mortality (death from any cause) was no different in people who received the ILR. Loop recorders do not seem to change quality of life, although people with ILR had a significantly higher rate of diagnosis compared to participants in the standard assessment group. Moreover, data seem to show a trend towards a reduction in syncope recurrences after diagnosis in people implanted with ILR. Finally, costs were higher in the group of participants in which the ILR was implanted but the cost per diagnosis and the cost to diagnose an arrhythmia were much lower for participants randomised to ILR implant. There was low quality evidence that ILR does not change mortality if compared to a standard diagnostic assessment of people with syncope. There was moderate quality evidence that ILR increases the rate of diagnosis if compared to a standard diagnostic assessment. Future research is needed in order to clarify if ILRs can improve quality of life and reduce syncope recurrences and costs. All the included studies were funded: two of them by scientific societies, the remaining were partially supported by the ILR's manufacturers.
+The aim of this review is to compare these two types of treatment. We found four small studies were identified after an extensive literature search. Due to limited information about the design of the studies, and the small number of patients enrolled, the results should be interpreted with caution. Meta-analysis showed lower rates of recurrence in the surgery group, however there was insufficient evidence to draw a strong conclusion. Postoperative complications such as infection and fever, as well as cost and time to work resumption were less in the aspiration and sclerotherapy group; however the recurrence rate was higher. Cure at short-term follow-up was similar between the groups, however there is significant uncertainty in this result which may be as a result of the age of one of the studies and the different agent used compared to the other studies.
+We wanted to find out which out of these possible treatments was most effective. We found only one randomised controlled trial (RCT) that assessed nebulised recombinant human deoxyribonuclease (rhDNase) which helps in breaking down the mucous and has been shown to be useful in aiding airway clearance in cystic fibrosis compared to placebo (no active treatment) in children with both tracheomalacia and a concurrent respiratory infection. This trial showed no evidence of benefit in terms of the number of children who were cough-free two weeks after treatment. Also, there was less coughing reported, both during the day and at night, in the group who did not receive the intervention - however these differences were not statistically significant. With the lack of evidence, the routine use of any therapies for intrinsic tracheomalacia cannot be recommended given the cost of nebulised rhDNase and the likely harmful effect. The decision to subject a child to any surgical or medical based therapies will have to be made on an individual basis, with careful consideration of the risk-benefit ratio for each individual situation. It is unlikely that any RCT on surgically based management will ever be available for children with severe life-threatening illness associated with tracheomalacia. For those with less severe disease, RCTs on interventions such as antibiotics and chest physiotherapy are needed.
+We rated the quality of current research as low to moderate. Fourteen out of the 21 studies focused on cognitive behavioural therapy, which is a specific form of talking therapy based on the idea that thoughts and thinking can influence emotions and behaviours. Cognitive behavioural therapy was more effective than usual care in reducing the severity of MUPS. For other types of therapy, we found only one or two studies giving insufficient evidence for conclusions. Cognitive behavioural therapy was no more effective than enhanced care provided by the person's doctor. No studies of physical therapy met the criteria to be included in the review. Talking therapies were acceptable to people and few people dropped out of the trials; however, this may not reflect real clinical practice as the study participants were people with somatoform disorders or MUPS who were willing to try talking therapies. In clinical practice, a high proportion of people may not be willing to accept these treatments. The review authors suggest that future high-quality trials should be carried out to find out more about which groups of people benefit most from cognitive behavioural therapy and how it can be most effectively delivered. They also suggest that more studies are needed of other talking therapies, and a particular focus should be on high-quality studies of physical therapies.
+The evidence is current to December 2016. We found 63 randomized controlled trials (RCTs) with participants undergoing open chest, heart, breast, abdominal, vascular, gynaecological and other surgery, but not orthopaedic surgery. RCTs are studies where people are allocated by chance to one or the other of different treatments being studied. The studies included only adults, and were mostly conducted in Europe and North America, with some from China, Egypt and Brazil. The types of surgery included surgery with a high event rate of persistent pain after surgery, such as breast surgery, limb amputation and opening the chest, and surgery with a lower risk but high numbers of procedures, such as caesarean section. We were able to pool results from 39 RCTs enrolling a total of 3027 participants for our inclusive analysis. Follow-up was for 1293 participants at three months, 1365 participants at six months, 326 participants at 12 months, and 43 participants at 20 or more months after surgery. The RCTs did not report surgical and anaesthetic complications consistently and little information was available on these. The studies were mostly funded by the institutions conducting the studies. Regional anaesthesia reduced the number of people who experienced persistent pain after undergoing non-orthopaedic surgery. For open chest surgery, giving an epidural halved the odds of a person having persistent postoperative pain at three to 18 months after surgery (7 RCTs, 499 participants, moderate-quality evidence). Seven people needed to be treated in this way for one to benefit. For the prevention of persistent pain three to 12 months after breast cancer surgery, seven people needed regional anaesthesia for one to benefit (18 RCTs, 1297 participants, low-quality evidence). Infusion of local anaesthetic into a vein was shown to reduce the risk of persistent pain three to six months after breast surgery (2 RCTs, 97 participants, moderate-quality evidence), with three people needing to be treated for one to benefit. Regional anaesthesia reduced the odds by more than half of a woman experiencing persistent pain after caesarean section (4 RCTs, 551 participants, moderate-quality evidence). The number of women treated for one to benefit was 19. Continuous local anaesthetic infusion of the site where bone tissue was obtained from the hip bone did not clearly reduce the number of people with persistent pain at three to 55 months (3 RCTs, 123 participants, low-quality evidence). We could not synthesize evidence for limb amputation, hernia repair, cardiac or abdominal surgery because of differences in how treatment was given or how results were reported. We found consistent evidence supporting the use of regional anaesthesia in adults to prevent persistent pain after a number of types of surgery. However, we observed variations in the effect sizes, and at different times after surgery. Some studies could not be blinded to the treatment received and our results are affected by the small number of studies and participants, and the loss to follow-up of participants over time. The evidence was therefore of low or moderate quality.
+Available studies tested the effects of antipsychotic, antidepressant and mood stabiliser treatment in BPD. In addition, the dietary supplement omega-3 fatty acid (commonly derived from fish) which is supposed to have mood stabilising effects was tested. Twenty-eight studies covering 1742 study participants were included. The findings tended to suggest a benefit from using second-generation antipsychotics, mood stabilisers, and omega-3 fatty acids, but most effect estimates were based on single study effects so repeat studies would be useful. Moreover, the long-term use of these drugs has not been assessed. The small amount of available information for individual comparisons indicated marginal effects for first-generation antipsychotics and antidepressants. The data also indicated that there may be an increase in self-harming behaviour in patients treated with olanzapine. In general, attention must be paid to adverse effects. Most trials did not provide detailed data of adverse effects and thus could not be considered within this review. We assumed their effects were similar to those experienced by patients with other conditions. Available data of the studies included here suggested adverse effects included weight gain, sedation and change of haemogram parameters with olanzapine treatment, and weight loss with topiramate. Very few beneficial effects were identified for first-generation antipsychotics and antidepressants. However, they may be helpful in the presence of comorbid problems that are not part of BPD core pathology, but can often be found in BPD patients. There are only few study results per drug comparison, with small numbers of included participants. Thus, current findings of trials and this review are not robust and can easily be changed by future research endeavours. In addition, the studies may not adequately reflect several characteristics of clinical settings (among others, patients' characteristics and duration of interventions and observation periods).
+We included seven studies that presented information on 217 people who completed the studies of 349 who started in the trials. Two studies were new for this update. The studies, published between 1979 and 2014, were conducted in the USA (3 studies), the UK (2 studies), and one each in Canada and Finland. The studies included people with long-term catheters. People were allocated randomly to have catheter washouts or not, and the effects compared. We also included studies that compared different types of washout solutions. Four studies reported on possible harmful effects of washout use, such as blood in the washout solution, changes in blood pressure and bladder spasms. The included studies were funded by Novobay Pharmaceuticals Inc (Linsenmeyer 2014); Alberta Heritage Foundation for Medical Research and the Canadian Nurses Foundation (Moore 2009); National institute of Aging, National Institutes of Health (Muncie 1989); Paralyzed Veterans of America Spinal Cord Research Foundation (Waites 2006). Three studies did not report funding sources. There was not enough good research evidence to determine if catheter washouts were useful. The included trials were generally small with methodological flaws. This included limited details on how participants were randomly allocated into groups and how both participants and researchers were blinded to these groups. Evidence quality was low to very low. New trials are needed to definitively answer this research question.
+The evidence is up to date to March 2019. We include 30 studies, describing 18,682 participants after treatment for childhood cancer. We found a lot of variation between studies in cancer diagnosis, cancer treatment, age of participants, the questionnaires used to assess fatigue, and the size of the study. Eighteen studies reported a prevalence of severe fatigue, which ranged from 0% to 61.7%. Four studies reported a prevalence of severe fatigue in the patient's brothers and sisters or in population-based controls. Prevalence rates in these control groups ranged from 3.1% to 10.3%. In these four studies, survivors were more often fatigued than controls. This difference was only significant in two studies. When we looked at the prevalence of severe fatigue in survivors of lymphoma and leukaemia (types of blood cancers), we found that they ranged from 1.8% to 35.9%. Two studies reported on severe fatigue in brain cancer survivors, with rates of 21.13% and 14.6%. One study in bone cancer survivors reported no cases of severe fatigue. For survivors aged 18 and younger, prevalence rates ranged from 6.7% to 12.5%. By contrast, in studies including participants aged 16 years and over (but mostly over 18), prevalence rates ranged from 4.4% to 61.7%. Twenty-two studies assessed one or more possible risk factors for fatigue. Our review shows that depression might increase fatigue. The age at cancer diagnosis and the education level of the survivor did not seem to influence fatigue. Only one study provided information about the course of fatigue over time, and found that over the course of 2.7 years 32 of the 102 participants (31.4%) reported persistent severe fatigue. All included studies had problems with the quality of the evidence, and we found many differences between studies for several characteristics. The evidence to address our review question is therefore weak. The occurrence of severe fatigue after treatment for childhood cancer remains uncertain. This is also the case for the course of severe fatigue after completion of cancer treatment and the risk factors that might be responsible for developing fatigue.
+This review includes 36 studies involving 6914 patients treated in ICUs to investigate whether the administration of antibiotics prevents the development of infections. Antibiotics were administered in two different ways. In some studies antibiotics were applied both directly to the oropharynx via a nasogastric tube (topical) and intravenously (systemic). In other studies they were applied only topically. Our results show that when patients received the combination of topical plus systemic antibiotics there were less infections and deaths. When patients received only topical treatment there were less infections but the number of deaths was not changed. Although this treatment seems to work it is not widely used in clinical practice because there is concern about the possible development of antibiotic resistance (that is, bacteria become unresponsive to drugs).
+We reviewed whether interventions aimed at preventing and reducing the use of PR in geriatric long-term care settings are effective. We identified five small-sized randomised controlled studies suitable for inclusion. All studies examined educational interventions targeted at nursing staff. Four studies investigated residents in nursing homes and one in group dwelling units. The methodological quality of all studies was limited. Results of the studies were inconsistent. One study with higher methodological quality showed no reduction in PR use. Three other studies with lower methodological quality found their intervention to be effective. Thus, current evidence on interventions for the reduction or prevention of PR use in long-term geriatric care does not support a clear conclusion. Ongoing and unpublished research might alter the results of the review.
+We found four randomised controlled trials (RCTs), but useable data were available for only two of these. The trials compared adjuvant treatment with systemic glucocorticoids during ovarian stimulation for IVF cycles versus no placebo. The evidence is current to October 2016. Key results Two RCTs were included in our analyses (310 women). For the outcome of live birth, data were available for only 212 women, as the larger study had data available from only one study centre. There was no conclusive evidence of a difference in the primary outcome of live birth rate and the secondary outcome of clinical pregnancy rate. Our findings suggest that if the chance of live birth with placebo is assumed to be 15%, the chance following supplementation would be between 7% and 31%, and that if the chance of clinical pregnancy with placebo is assumed to be 24%, the chance following treatment with supplementation would be between 23% and 47%. There was also insufficient evidence to determine whether there was any difference between the groups in the multiple-pregnancy rate or miscarriage rate. Neither of the studies reported ovarian hyperstimulation syndrome (OHSS) or side-effects. Thus, the safety and effectiveness of glucocorticoid administration in women undergoing controlled ovarian hyperstimulation for IVF/ICSI cycles (until the day of oocyte retrieval) is unclear due to the small number of studies and low event rates. Whilst glucocorticoids possibly increase the clinical pregnancy rate, there may be little or no impact on the live birth rate. The evidence was rated as low or very low quality for all outcomes, mainly due to imprecision, with low sample sizes and few events.
+This review looked at using of rhGH to improve lung function, growth and quality of life for children and young adults with CF. It includes eight trials with 291 individuals with CF being selected for one treatment or the other randomly. The individuals in the trials were five to 23 years old, but most had not yet reached puberty. Six trials lasted for one year and two trials for six months. Treatment with rhGH was compared to no treatment in seven trials and to a placebo (a liquid that did not contain any growth hormone) in one trial. The trial that used a placebo compared it to two different doses of rhGH treatment. Results showed a modest improvement in height, weight and lean body mass between six and 12 months. However, there was no consistent evidence that rhGH treatment improves lung function, muscle strength, or quality of life. The trials were small and we did not find any evidence on changes in glucose metabolism or the long-term risk of diabetes due to the treatment. Given these results, we are not able to identify any clear benefit of therapy and believe that more research from well-designed, adequately powered clinical trials is needed. We did not have enough information to decide if overall the trials were biased in a way that might affect the results. All the measured outcomes were clearly reported in the trials, but the trials were small, and did not have enough participants to show a difference that may not have been due to chance. We also had concerns that outcomes which were based on personal judgement, such as quality of life scores, might be affected because those taking part in seven of the trials were able to tell which group they were in.
+The review is based on 26 studies that included 1,695 participants with occupational asthma. Sensitizers caused nearly all cases. We focused on the interventions of removal from exposure and reduction of exposure, which were compared with continued exposure. Outcomes were changes in asthma symptoms, lung function, and non-specific bronchial hyperreactivity between baseline and follow-up. What are the main results of the review? Both removal from exposure and reduction of exposure may improve asthma symptoms when compared to continued exposure. Removal from exposure, but not reduction of exposure, may improve lung function when compared to continued exposure. Removal from exposure may improve symptoms and lung function more than reduction of exposure among patients exposed to low molecular weight agents, but removal may also increase the risk of unemployment. Consequently, the benefit of a better improvement has to be weighed against the potential for a higher risk of job loss. Further research is needed to determine the effectiveness of interventions at reducing the impact of occupational asthma. How up-to-date is this review? We searched for studies that had been published through 31July 2019.
+We found six trials with 1758 participants. Of these, five studies looked at on-demand deprescribing and one trial looked at abruptly stopping PPIs. Participants were aged 48 to 57 years, except for one trial (average age of 73 years). The majority of participants had moderate heart burn and acid reflux with milder forms of esophagitis (inflammation of the food pipe that may lead to damage). We found that deprescribing methods led to worse symptoms control while considerably reducing pill use. Deprescribing PPIs may lead to side effects such as inflammation of the esophagus. Very few data were available to make a conclusion regarding long-term benefits and harms of PPI reduction or discontinuation. Overall, the quality of evidence for this review ranged from very low to moderate. Trials were inconsistent with how they reported symptom control. There were also limitations in how the studies were conducted (e.g. participants and investigators may have known which medicine they received), which lowered the quality of evidence. Other contributing factors included small sample sizes for most trials and inconsistent results between studies.
+The main objective of this review is to investigate the effectiveness of social skills programmes, compared to standard care or discussion groups, for people with schizophrenia. Based on searches carried out in 2006 and 2011, this review includes 13 trials with a total of 975 participants. Authors chose seven main outcomes of interest, all data for these outcomes were rated to be very low quality. The review found significant differences in favour of social skills programmes compared to standard care on all measures of social functioning. Rates of relapse were lower for social skills compared to standard care and there was a significant difference in favour of social skills on people’s mental state. Quality of life was also improved in the social skills programme compared to standard care. However, when social skills programmes were compared to discussion groups, there were no significant differences in people’s social functioning, relapse rates, mental state or quality of life. Compared to standard care, social skills programmes may improve the social skills of people with schizophrenia and reduce relapse rates. However, at the moment evidence is very limited with data only of very low quality available. Cultural differences might also limit the relevance of current results, as most reported studies were conducted in China. Whether social skills programmes or training can improve the social functioning of people with schizophrenia in different settings remains unclear and should be further investigated in a large multi-centre randomised controlled trial. Ben Gray, Senior Peer Researcher, McPin Foundation.http://mcpin.org/
+This is a summary of a Cochrane review that shows interventions for the management of tophi. After searching for all relevant studies in May 2013, we found only one study (pooled results from two randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups)) that randomised 225 people to pegloticase (every two weeks (biweekly) or monthly) or placebo, in the management of chronic gout; 145 participants had tophi and 131 contributed outcome data. Resolution of tophi - 33 more people out of 100 had resolution of one or more tophi after six months' treatment with pegloticase biweekly compared with placebo (33% absolute improvement). - 14 more people out of 100 had resolution of one or more tophi after six months' treatment with pegloticase monthly compared with placebo (14% absolute improvement). - 40 people out of 100 in the biweekly pegloticase group had resolution of one or more tophi. - 21 people out of 100 in the monthly pegloticase group had resolution of one or more tophi. - 7 people out of 100 in the placebo group had resolution of one or more tophi. Other outcomes were for all participants, and not separated out for those people with tophi. Therefore, we have not reported them in this review. However, we reported on withdrawal due to adverse events for the total population. Most withdrawals were due to adverse reactions to drug infusion. Withdrawal due to adverse events - 16 more people out of 100 withdrew from treatment with biweekly pegloticase compared with placebo (16% more withdrawals). - 17 more people out of 100 withdrew from treatment with monthly pegloticase compared to placebo (17% more withdrawals). - 18 people out of 100 withdrew from treatment with biweekly pegloticase due to adverse events. - 19 people out of 100 withdrew from treatment with monthly pegloticase due to adverse events. - 2 people out of 100 withdrew from treatment with placebo due to adverse events. Moderate-quality evidence indicated that pegloticase biweekly or monthly probably resolves one or more tophi. However, this has to be weighed up against high withdrawal rates from treatment due to adverse events, mostly due to an increase in infusion reactions. Pain reduction, quality of life, serum urate normalisation and function were not reported separately in people with tophi. The evidence was downgraded due to imprecise results. Further research may change these results. We do not know if other interventions, including surgery, are effective, as we found no randomised controlled trials that assessed other interventions.
+We searched the medical literature through January 2016 and found three randomized controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) (with 2095 newborn infants). Treatment was started either in the first 24 hours following birth (two small studies) or following commencement of oral feeding (enteral) (one large well-controlled study). In this large study, infants generally received breast milk, whereas they received formula milk in the other two studies. Giving immunoglobulin (IgG alone or IgG plus IgA combination) did not reduce the incidence of NEC, need for surgery related to NEC or death from NEC, either during or after the study period. Immunoglobulins could possibly cause breakdown of red blood cells (called haemolysis) (red blood cells are common cells in the blood that delivery oxygen to organs), but no clinically important haemolysis was apparent. There were no other reported side effects. There was low-very low evidence for all the major outcomes. The major factor that affected the quality of evidence was the lack of precision in the result estimates, as the calculated plausible range of the effects (the 95% confidence intervals) were wide.
+Womb (uterine/endometrial) cancer is a fairly common disease affecting approximately 1 in 70 women. A hysterectomy is usually curative because most cancers have a low risk of spreading (metastasising) to other sites which may result in a later recurrence. Microscopic examination of the hysterectomy specimen can tell doctors if there is a high risk of the cancer returning and this allows women to decide if they want further preventative treatment (adjuvant therapy) to reduce the risk. Chemotherapy can increase cure rates for other types of high-risk cancer after initial surgery and this review examines the effectiveness of chemotherapy for primary womb cancer after hysterectomy. Data from nine high quality randomised clinical trials involving up to 2197 women were subjected to systematic statistical modelling. This shows that chemotherapy reduces the risk of recurrent disease, lengthens the duration women have before a metastasis is diagnosed and improves survival rates. There are many ways to examine the data. The subset analysis that excluded old fashioned drug regimens suggests that chemotherapy reduces the risk of being dead at any nominated time by a quarter. The number of women who would need to have need chemotherapy to prevent one death depends on the type of cancer. In these trials, one woman was cured for every 25 women treated with high dose platinum based chemotherapy after hysterectomy. This is an absolute risk reduction of 4%. Chemotherapy is associated with a greater survival advantage than radiotherapy and has added value when used with radiotherapy. It also appears to reduce the absolute risk of developing a recurrence outside the pelvis by about 5%. This would benefit one woman in every 20 treated. However, chemotherapy has side effects, risks and temporarily reduces a woman's quality of life. In many cases, the small reduction in the cancer recurrence risk may not be worth the side effects of adjuvant treatment.
+We included 35 studies from around the world. These studies showed that clients' experiences of these types of programmes were mixed. Some felt that these programmes provided them with feelings of support and connectedness, as they felt that someone was taking the time to send them messages (moderate confidence in the evidence). Others also described sharing the messages with their friends and family (moderate confidence). However, clients also pointed to problems when using these programmes. Some clients had poor access to cell networks and to the internet (high confidence). Others had no phone, had lost or broken their phone, could not afford airtime, or had changed their phone number (moderate confidence). Some clients, particularly women and teenagers, had their access to phones controlled by others (moderate confidence). The cost of messages could also be a problem, and many thought that messages should be free of charge (high confidence). Languages issues as well as clients' skills in reading, writing, and using mobile phones could also be a problem (moderate confidence). Clients dealing with stigmatised or personal health conditions such as HIV, family planning, or abortion care were concerned about privacy and confidentiality (high confidence). Some suggested strategies to deal with these issues, such as using neutral language and tailoring the content, timing, and frequency of messages (high confidence). Clients wanted messages at a time and frequency that was convenient for them (moderate confidence). They had preferences for different delivery channels (e.g. short message service (SMS) or interactive voice response) (moderate confidence). They also had preferences about message content, including new knowledge, reminders, solutions, and suggestions about health issues (moderate confidence). Clients' views about who sent the digital health communication could influence their views of the programme, and many people wanted a sender that they knew and trusted (moderate confidence). We searched for studies published before July 2017.
+For a tapered dose treatment to reduce withdrawal symptoms, illicit opioids are replaced by methadone or another agent using decreasing doses up to 30 days under medical supervision. The review authors searched the medical literature and identified 23 controlled trials involving 2467 adult opioid users in various countries. Trial participants were randomised to receive methadone or another pharmacological treatment. The other treatments were adrenergic agonists such as lofexidine, partial opioid agonists such as buprenorphine, opioid agonists such as LAAM (levo-α-acetyl-methadol) and the anxiolytics chlordiazepoxide and buspirone. In the two studies that compared methadone with placebo, withdrawal symptoms were more severe and more people dropped out in the placebo group. The studies included in this review confirmed that slow tapering with temporary substitution of long- acting opioids, could reduce withdrawal severity. Nevertheless, the majority of patients relapsed to heroin use. The medications used in the included studies were similar in terms of overall effectiveness, although symptoms experienced by participants differed according to the medication used and the program adopted. The programs varied widely with regard to the assessment of outcome measures. Seventeen of the included trials were conducted in inpatient settings.
+The review of trials shows that this sort of withdrawal treatment is quicker than withdrawal managed with reducing doses of methadone or clonidine plus symptomatic medications. The intensity of withdrawal experienced with anaesthesia-based approaches is similar to that experienced with approaches using only minimal sedation, but there is a significantly increased risk of serious adverse events with anaesthesia-assisted approaches. The lack of additional benefit, and increased risk of harm, suggest that this form of treatment should not be pursued.
+We included fourteen randomised controlled trials. When compared to other typical antipsychotics molindone shows no difference in effectiveness and is no more or less likely than typical drugs to cause movement disorders, it does however cause significantly more weight loss. At present there is no evidence to suggest that it may have an atypical profile.
+We included 20 studies with a total of 2125 participants covering 23 different treatments. Triple-combination cream was significantly more effective at lightening melasma when compared to hydroquinone alone or to dual combinations such as tretinoin and hydroquinone, tretinoin and fluocinolone acetonide, or hydroquinone and fluocinolone acetonide. Tretinoin was more effective at lightening melasma compared to placebo, as was the skin-whitening complex Thiospot. However, many studies were of a poor quality with a only small number of participants. The side-effects reported most frequently by both participants and clinicians were dry, red, and sore skin. No serious side-effects were seen. More evidence is needed on other treatments which are widely used, including the role of sunscreens which were recommended in almost all studies. There is a need for high-quality studies comparing the treatments for this difficult to manage condition. For example, studies should have a minimum follow-up period of 6 months and should clearly categorise participant groups such as age, type of melasma, and duration of the condition at the start of the trial so that these differences can be considered when assessing results. Addtionally, study outcomes should include participants' views in a standardised manner because they may perceive the degree of skin lightening differently to the trial investigators.
+This is a summary of a Cochrane review that looked at the effect of using one of these drugs, 5-Fluorouracil (5-FU). We gathered evidence from 12 trials involving 1319 participants. The evidence is current to July 2013. For patients who have never had eye surgery before, 5-FU injections after surgery can slightly reduce the pressure in the eye after one year and also the risk of having more surgery in the first year. For patients having both cataract surgery and glaucoma surgery at the same time, no difference has been detected between injections and no injections. Some people are at higher risk of having problems following trabeculectomy, for instance people that have had previous surgery on the eye. For this group, the 5-FU injections can reduce the pressure in the eye a little and also reduce the risk of having more surgery in the first year. Only one study has investigated the effect of using lower than normal doses in the injections. No benefit was found when compared to a control group who had no injections. If 5-Fluorouracil was applied to the eye during the surgery, there was less chance of having to have more surgery within the year and the pressure in the eye was also reduced slightly at one year. Complications such as damage to cells at the front of the eye or a leak from the wound seem more common when 5-FU is used. The methodological quality of the trials was not high in general. In many of the studies that contributed to the evidence about 5-FU after glaucoma surgery the researchers were aware of whether the participant had received the dummy injection or the 5-FU injection. This may have introduced bias into the results. Importantly the only study contributing information about low dose 5-FU was of low methodological quality so our conclusions on low dose 5-FU must be cautious. The studies that contributed evidence about 5-FU during surgery was largely very good, the studies were designed and reported to a standard we would expect of modern trials. We concluded that the main benefit is for people at high risk of problems. There may be a smaller benefit for people at low risk of problems if 5-FU is given either as injections after surgery or during the operation. However, 5-FU was found to increase the risk of serious complications and so may not be worthwhile for the small benefit gained.
+Pooling of the data from the 55 trials with 16,154 people showed that there was no consistent long-term benefit in the rate of decline in breathing capacity. Death rates were unchanged. Inhaled steroids were beneficial in slowing down the rate of decline in quality of life and reducing the frequency of exacerbations. Inhaled steroids increased the risk of side effects including thrush (candida) infection in the mouth and hoarseness, and the rate of pneumonia. In deciding whether to use this treatment, consumers and health professionals should weigh up the benefits (reduced rate of exacerbations, reduced decline in quality of life and possible reduction in the rate of decline of breathing capacity) against the side effects (mouth thrush, hoarseness and increased risk of developing pneumonia).
+We found 80 randomised controlled trials (RCTs), which included a total of 5820 women and compared 20 different types of NSAIDs with placebo (an inactive pill), paracetamol or each other. Most of the studies were commercially funded (59%), and a further 31% did not state their source of funding. The review found that NSAIDs appear to be very effective in relieving period pain. The evidence suggests that if 18% of women taking placebo achieve moderate or excellent pain relief, between 45% and 53% taking NSAIDs will do so. NSAIDs appear to work better than paracetamol, but it is unclear whether any one NSAID is safer or more effective than others. NSAIDs commonly cause adverse effects (side effects), including indigestion, headaches and drowsiness. The evidence suggests that if 10% of women taking placebo experience side effects, between 11% and 14% of women taking NSAIDs will do so. Based on two studies that made head-to-head comparisons, there was no evidence that newer types of NSAID (known as COX-2-specific inhibitors) are more effective for the treatment of dysmenorrhoea than traditional NSAIDs (known as non-selective inhibitors), nor that there is a difference between them with regard to adverse effects. We rated the quality of the evidence as low for most comparisons, mainly due to poor reporting of study methods.
+In this Cochrane review, we assess the benefits and harms of high versus low levels of PEEP in patients with ALI and ARDS. The undertaking of this review was both relevant and necessary because the optimal level of PEEP in these patients is still controversial, and available evidence indicates no difference in mortality. We included seven studies involving a total of 2565 participants and found that high levels of PEEP, as compared with low levels, did not produce a reduction in hospital mortality, although we did see a trend towards decreased mortality. We also found evidence of clinical heterogeneity among the included studies (clinical heterogeneity concerns differences in participants, interventions, and outcomes that might have an impact on results from the use of PEEP). The studies included were of moderate to good quality. We did not find a significant difference with respect to barotrauma—defined as the presence of pneumothorax on chest radiography or a chest tube insertion for known or suspected pneumothorax. We furthermore ascertained that high levels of PEEP improved participants' oxygenation up to the first, third, and seventh days. The number of ventilator-free days showed no significant difference between the two groups (the term ventilator-free days refers to the number of days between successful weaning from mechanical ventilation and day 28 after study enrolment), and available data were insufficient to allow pooling of lengths of stay in the intensive care unit. Additional trials will be required to determine which patients should receive high PEEP levels and the best means of applying this intervention.
+This review examined the effects of HES on kidney function compared to other fluid therapies in critically ill patients. Forty-two randomised clinical trials (11,399 patients) comparing HES to another fluid therapy qualified for this review. Overall, the use of HES products was associated with a 59% increased risk of kidney failure, and a 32% increased risk of dialysis. No significant differences in effect were seen depending on the patient population studied, the type of HES solution, or the dose used. Due to the potential risks associated with HES products, alternative fluid therapies should be used.
+We analysed evidence from nine studies conducted in China that compared Rheum officinale with no treatment or treatment with captopril, an ACEi. We looked at reported changes in two important blood markers - serum creatinine and blood urea nitrogen - that indicate progression of CKD. We found no high quality evidence to indicate that treatment with Rheum officinale can improve CKD or delay its progression. Rheum officinale was not found to cause any serious health problems in patients with CKD. Well-designed randomised controlled studies are needed to provide robust, high quality evidence to assess if there are benefits from Rheum officinale for people with CKD.
+We searched electronic databases of published research studies, looking for all studies of IQCODE in a hospital setting. We searched from the first available papers in scientific databases up to and including January 2013. We found 13 relevant studies which had results suitable to be combined in a single analysis. Of these papers, six (1352 participants) described studies conducted in “specialist” services such as memory clinics or wards. Three papers (566 participants) described studies conducted in general older adult services and four studies (827 participants) included both specialist and general services. Summarising the available papers, we found that IQCODE was useful for 'ruling out' possible dementia in the general hospital setting. This means if a person has a low score on IQCODE testing they probably do not have dementia. IQCODE was less useful in specialist memory clinics and psychiatry wards. We also found that a short version of the IQCODE gave similar results to the traditional longer version. As part of our assessment we looked at whether the design of the available studies was suitable for the study question. We found several instances where the design of the study could be improved. For example, seven of the thirteen studies only included a selection of all the people attending the service who could have been assessed with IQCODE. We also looked at how well researchers reported the conduct and results of their studies. Again, there were many instances where the reporting could be improved. A common issue was not describing the severity of memory and thinking problems in those thought to have dementia, only reported in three of the included studies. In summary, IQCODE may be a useful tool for assessing adults for possible dementia. There are still a number of unanswered questions around how useful IQCODE may be in hospital settings. For example, before we start using IQCODE routinely we need to describe if it is practical and acceptable to hospital staff, to patients and to their carers. The review was performed by a team based in research centres in the UK (Glasgow, Leicester, Oxford). We had no external funding specific to this study and we have no conflicts of interest that may have influenced our assessment of the research data.
+We included three relevant studies in the review, which investigated different types of MD rehabilitation interventions after botulinum toxin injections into the arms of 91 adults with previous stroke. There was low quality evidence for intensive forced use of the affected arm in improving spasticity, and very low quality evidence for elbow splinting with occupational therapy. We did not identify any studies of MD rehabilitation in children with post-stroke spasticity or after other injected medications. The review findings are limited by the small number of studies that are methodologically flawed. More research is needed into what rehabilitation modalities and treatments are most effective for spasticity management following stroke.
+We found only four randomised clinical trials that compared different prophylactic regimens in 136 participants. None of the trials compared the same prophylaxis regimen. In each individual trial no significant differences were detected with regard to patients' survival after transplantation, HBV recurrence, or the recurrence of liver disease. All trials were too small to detect a difference, if it existed. Prevention of HBV recurrence following liver transplantation is currently non-evidence based. Practice is to administer a combination of HBIg and an antiviral drug. Randomised clinical trials are needed to examine this practice.
+We identified 15 publications (10 studies) looking at 1019 patients who were followed between three months to 10 years. We found many of the publications had poor quality of reporting and had small numbers of participants. However, there does seem to be evidence from this review that the drug sulphonylurea (like glibenclamide or glyburide, gliclazide) could make patients insulin dependent sooner and it does not control blood sugar as well as insulin. Therefore, this suggests that this drug should not be a first line treatment for patients with LADA. In addition, insulin combined with vitamin D, or Chinese herbs may maintain natural insulin production better than insulin alone. Similarly, glutamic acid decarboxylase (GAD65) may maintain natural insulin production. However, there was no conclusive evidence that any of the other remaining treatment methods were better than each other. Studies on oral agents or insulin reported no adverse events in terms of severe hypoglycaemic attacks. This review represents very early days of our understanding of the best way to treat LADA. It is limited by the poor reporting quality of the studies, small sample sizes, no clear single definition of LADA and many of the studies being carried out in different ethnic groups (China, Japan, Cuba, UK, Sweden) with different clinical care systems.  None of the publications reported on complications of diabetes, health-related quality of life, costs or health service utilisation. All but one of the publications reported there were no deaths.  In summary, this review demonstrates that insulin treatment may be preferable compared to sulphonylurea treatment but there is little evidence regarding other forms of treatment. Future studies are needed, should have a clear definition of LADA, investigate patient-important outcomes and use a common method of measuring stimulated C-peptide (a marker of natural insulin production reflecting improved beta-cell function of the pancreas).
+70 studies were included in this review, with 44,958 students overall. We were interested mainly in studies with a follow-up period of four or more months to assess whether any effects were sustained beyond the immediate short term. In 43 of the trials, the social norms intervention was targeted at higher-risk students. 55 trials were conducted in the USA, with others form Australia, Brazil, New Zealand, Sweden and the United Kingdom. Delivery of social norms information included mailed feedback, web/computer feedback, individual face-to-face feedback, group face-to-face feedback and general social norms marketing campaigns across college campuses. Over the longer-term, after four or more months of follow-up, there was only a small effect of social norms information on binge drinking, drinking quantity, and peak BAC. For these outcomes, effects were not any different across the different delivery modes.Only small effects were found for web feedback and individual face-to-face feedback on frequency of alcohol consumed. Only a small effect of individual face-to-face feedback on alcohol related problems, but no effects were found for mailed or web feedback. Similarly, no effects were found for group face-to-face feedback or for marketing campaigns on frequency of alcohol consumed and typical BAC. Our reading of these results is that, although we found some significant effects of social norms information, the strength of the effects over the longer-term is very small and therefore this information is unlikely to provide any advantage in practice. Overall, only low or moderate quality evidence was noted for the effects reported in this review. Problems with study quality could result in estimates of social norms effects that are too high, so we cannot rule out the chance that the effects observed in this review may be overstated. The U.S. National Institutes of Health provided funding for just under half (33/70) of the studies included in this review. Eighteen studies provided no information about funding, and only 13 papers had a clear conflict of interest statement.
+This Cochrane review is current to 29 April 2016. We searched the available evidence and included three studies, which had 492 people who had received a THA. Two of these studies investigated providing people with equipment, such as raised toilet seats and rails, and restricting their body movements (one of these studies also provided people with physiotherapy). One study investigated teaching participants about doing certain activities of daily living in a safe way to promote self-care without the risk of dislocating the new hip. The interventions were different and thus we did not combine the results. One study compared outcomes for participants randomised to the provision of hip precautions, equipment and functional restrictions versus no provision of hip precautions or equipment or functional restrictions. This is the main comparator in the review. Health-related quality of life (lower scores mean better quality of life) We cannot tell from our results whether the intervention has an important effect on health-related quality of life (no numerical results provided) because the sample size was small and the study design flawed. Function We cannot tell from our results whether the intervention has an important effect on functional outcomes (no numerical results provided) because the sample size was small and the study design flawed. Complications and adverse events There were no dislocations or adverse events. Outcomes of interest not measured Pain, treatment success and re-operation rate were not measured. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of the evidence. Due to issues relating to the small number of participants, size of studies and study conduct, including poorly blinding assessors to group allocation, we rated the quality of the evidence as 'very low'. Further research is highly likely to change the conclusions drawn from these results. We are uncertain whether the interventions improved outcomes.
+Endometriosis is the presence of endometrial tissue outside the uterus, usually in the pelvis, that can lead to infertility and pelvic pain. It is managed with surgery, hormonal medications, or a combination of both. The progestogen levonorgestrel is one such hormonal medication. The aim of this review was to assess whether the use of a hormone-releasing intrauterine device was beneficial for managing associated painful symptoms and for preventing recurrence of endometriosis following surgery. Although preliminary findings are encouraging, at this stage there is only limited evidence from three randomised trials of a beneficial role with the use of the LNG-IUD in reducing the recurrence of painful periods following surgery for endometriosis. The strength of the evidence was graded as moderate reflecting our belief that future evidence will most likely not change these findings.
+Six studies involved availability interventions, of which four changed the relative proportion of less-healthy to healthier options, and two changed the absolute number of different options available. In statistical analyses that combined results from multiple studies, it was found that reducing the number of available options for a particular range or category of food(s) reduced selection of those food products (from analysing 154 participants) and possibly reduced consumption of those products (from 150 participants). However, the certainty of the evidence for these effects was low. Eighteen studies involved proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. One study found that this reduced selection of food (from analysing 41 participants), whilst in a statistical analysis combining results from multiple studies, it was found that placing food farther away reduced consumption of those food products (from analysing 1098 participants). However, the certainty of the evidence for these effects was very low and low, respectively. Key messages Mindful of its limitations, the current evidence suggests that changing the number of available food options or changing where foods are positioned could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes to food environments. However, more high-quality studies in real-world settings are needed to make this finding more certain. How up-to-date is this review? The evidence is current to 23 July 2018.
+This review evaluated the effects of antiretroviral post-exposure prophylaxis (PEP) for preventing HIV infection following occupational exposure. No randomized controlled trials were identified. Only one case-control study provides evidence for using zidovudine monotherapy. The study found that, in the occupational setting, HIV transmission was significantly associated with deep injury, visible blood on the sharp instrument, procedures involving a needle placed in the source patient's blood vessel, and terminal illness in the source patient. After taking these into account, it was found that those who became infected with HIV had significantly lower odds of having taken zidovudine after exposure, compared to those who did not seroconvert. There is no direct evidence to support the use of multi-drug antiretroviral regimens following occupational exposure to HIV. However, due to the success of combination therapies in treating HIV-infected individuals, a combination of drugs should be used for PEP. Eight reports from other studies confirmed the findings that adverse events were higher with a three-drug regimen; however, discontinuation rates were not significantly different. A four-week regimen of post-exposure prophylaxis should be initiated as soon as possible after exposure, depending on the risk of seroconversion. Healthcare workers should be counseled about expected adverse events and given strategies for managing these events. They should also be advised that PEP is not 100% effective in preventing HIV seroconversion.
+Our search found 42 trials of treatments which met our criteria, but only 35 provided data in a form that could be used. The two main types of psychological treatment are called cognitive behavioural therapy (CBT) and behaviour therapy. Both focus on helping people to change behaviour that maintains or worsens pain, disability, distress and catastrophic thinking; CBT also directly addresses the thoughts and feelings that are a problem for people with persistent pain. The effects of these two treatments on pain, disability, mood and catastrophic thinking were tested immediately after the treatment, and six months later. Small to moderate benefits, more for disability, mood and catastrophic thinking than for pain, were found in trials which compared CBT with no treatment. Some of these were still positive six months later. Behaviour therapy showed few and only brief benefits. Psychological therapies can help people with chronic pain reduce negative mood (depression and anxiety), disability, catastrophic thinking, and in some cases, pain. Although the overall effect is positive, we do not know enough about exactly which type of treatment is best for which person.
+We searched research papers and government reports and had direct communication with individuals working in salt reduction in their respective countries. The evidence is current as of 5 January 2015, when we last searched electronic databases. Initiatives in 15 countries met the inclusion criteria. Ten of these countries provided sufficient data for quantitative analysis, gathered from studies that included 64,798 participants. Initiatives ranged from one activity (e.g. in Japan, which at the time of writing had a public information campaign) to many activities (e.g. in the United Kingdom, which provided five activities including on-package nutrition information, restrictions on marketing to children and food product reformulation). Of the 15 countries that met inclusion criteria, seven provided information about funding source, of which six reported non-industry funding. The other eight countries did not report a funding source for one or more data point(s). Five of the 10 countries included in the quantitative analysis (China, Finland, France, Ireland and England) showed a decrease in salt intake after the intervention. Two of the 10 countries (Canada, Switzerland) showed an increase in salt intake after the intervention, however, in both countries the only data available were from several years prior to the intervention starting. Because the initiatives were very different, we cannot present an overall finding of whether these types of initiatives work. When we focused on the subset of seven countries whose salt reduction initiatives included multiple components and were not focused solely on educating the public, we found that more than half (four of seven) showed a decrease in salt intake from pre-intervention to post-intervention. When we examined the nine initiatives that analysed men and women separately, we found that amongst men, more than half (five of nine) showed a decrease in salt intake after the intervention. Amongst women, the pattern of findings was less clear, with three of nine interventions showing a decrease, two showing an increase and four showing no change in salt intake. Low-bias study designs, such as randomised controlled trials, typically are not suitable for evaluating complex initiatives such as these; therefore, we rated all of the studies included in this review as having low methodological quality. Large nationally representative samples of the population and careful measurement of dietary sodium intake were strengths of several studies. However, because of study design limitations, the trustworthiness of study results is not clear. Overall, our results show that national government initiatives have the potential to achieve population-wide reductions in salt intake, especially amongst men, and particularly if they employ more than one strategy and include structural activities such as food product reformulation (i.e. food companies putting less salt in food products). The wide variation of results across the studies we found presents a challenge in interpreting the current evidence and this warrants more research to help us understand this.
+We searched scientific databases for clinical trials comparing any drug with placebo (a dummy treatment), other drugs or no treatment in people of any age with sleep bruxism. The evidence is current to August 2014. A total of 18 studies were identified and seven were included in the review. Each individual study involved a very small number of participants (7-16) and four of them were of moderate methodological quality. Amitriptyline (three studies), bromocriptine (one study), clonidine (one study), propranolol (one study), levodopa (Prolopa®) (one study) and tryptophan (one study) were compared with placebo. Amitriptyline and L-tryptophan did not reduce activity of the jaw muscles, measured using electromyography. Bromocriptine,clonidine, propanolol and levodopa did not significantly reduce the number of bruxism episodes per hour when compared to placebo. This systematic review concluded that there is not enough evidence in the literature to show that drugs can reduce sleep bruxism.
+The evidence is current up to April 2018. We included in this review 10 studies with 1015 adult participants. These studies were conducted in intensive care units and compared standard nutrition (the usual nutrition given to patients with ARDS) versus nutrition supplemented with omega-3 fatty acids or placebo (a substance with no active effect), and compared either with or without antioxidants. Antioxidants are molecules that can inhibit or slow down oxidation - a reaction that can cause inflammation and damage cells. It is unclear whether use of omega-3 fatty acids and antioxidants as part of nutritional intake in patients with ARDS improves long-term survival. It is uncertain whether omega-3 fatty acids and antioxidants reduce length of ICU stay and the number of days spent on a ventilator, or if they improve oxygenation. It is also unclear if this type of nutrition causes increased harm. Findings of this review are limited by lack of standardization among the included studies in terms of methods, types of nutritional supplements given, and reporting of outcome measures. We rated the quality of evidence as low to very low.
+Clinical drug trials or studies are usually conducted to assess how well the drug works but also whether it causes any harm (side effects or adverse effects). Adverse effects can be detected by the trial doctor examining participants or taking some blood samples or doing other kinds of tests. The trial staff can also ask participants about how they are feeling after taking the trial drug. However, the way participants are asked about their health can vary from trial to trial, or even within a trial. In some trials, participants may be asked a simple open question such as 'how have you been feeling?', while in other trials, participants may be asked about whether they have had any of a long list of possible symptoms (such as 'have you had a headache, stomach ache, or sore muscles?'). There has been concern that these different kinds of questions and how they are phrased will impact on what participants report about their health during a trial. This might then affect the trial's results and what we know about the side effects of drugs. We did this review to look at studies that compared different types of participant questioning methods in order to investigate these issues. We found 33 studies comparing mainly open questions with checklist-type questions, but also some ratings scales and participant interviews. While the studies were all very different in terms of the types of disease, drugs, and patients studied, we found in general that, as would be expected, when a more specific type of question was asked (like a checklist), participants reported more symptoms. What is interesting is that, in those studies that looked more closely at the types of symptoms reported, it seems that an open question picks up the more severe or bothersome symptoms compared to a checklist-type question. However, some studies found that even quite severe or bothersome symptoms were not reported when a participant is asked an open question and these severe symptoms will only be reported with the more specific question. This makes it difficult to say whether one method is better than any other and the different questioning methods may, in fact, be complementary and therefore should be used together. It is also difficult to say what a specific question should include, as it might take too long for a participant to have to answer a very long list. While more research is needed to resolve the remaining uncertainties, it is very important for trials to be clear about which kind of questioning was used when they publish their results. This will help readers understand the trial's findings about the side effects and make it easier to make accurate comparisons between trials.
+We judged the quality of the evidence from this review to be very low as the only included study was not randomised, and information about supervision measures to prevent SUDEP was not available for 40% of the people with epilepsy who did not experience SUDEP. We found very limited, low-quality evidence that supervision at night prevents SUDEP. Further research is needed to identify if other treatments, such as seizure detection devices, safety pillows, and drug interventions working on serotonin, adenosine, and opiate levels in the brain are effective in preventing SUDEP in people with epilepsy.
+We searched the literature for studies comparing at least two sessions of autogenic drainage with other breathing techniques and devices which help to clear the lungs of mucus. We included seven studies in the review involving 208 people with cystic fibrosis, aged between seven and 63 years of age. People were selected for one physiotherapy treatment or the other randomly. The number of people in the studies ranged from 17 to 75, and had a wide range of disease severity. The studies lasted from four days to two years in total. We did not find any clear evidence that autogenic drainage was better than the other techniques for lung function or quality of life in either the short-term or long-term studies. This was also true for our other outcome measures such as hospital admissions, additional antibiotic treatment, exercise tolerance and oxygen saturation, but in one study autogenic drainage was the preferred technique compared to postural drainage and percussion. Exercise was identified as a comparator for airway clearance by the authors of this review but no included studies used it in this way, even though it is often used as an alternative therapy by people with cystic fibrosis. Overall, the quality of the evidence from the studies was judged to be mainly low or very low. The main problems for this being the small numbers of participants in each study, the unclear reporting of results in the studies and the study design used. In one study, which was classed as having a high risk of bias due to incomplete results, those taking part had to change physiotherapy technique halfway through the study and there were many who dropped out and did not comply with the postural drainage and percussion treatment arm. Five of the seven studies used research staff to assess results who did not know which technique each person was using and this improved the quality of the evidence and reduced any bias.
+This review aimed to find out whether psychological therapies are effective for GAD, and whether cognitive behavioural therapy (CBT) is more effective than other psychological therapy approaches, including psychodynamic and supportive therapies. The review included 25 studies, with a total of 1305 participants. All the studies used a CBT approach, and compared CBT against treatment as usual or waiting list (13 studies), or against another psychological therapy (12 studies). The review showed that people attending for psychological therapy based on a CBT approach were more likely to have reduced anxiety at the end of treatment than people who received treatment as usual or were on a waiting list for therapy. CBT was also very effective in reducing secondary symptoms of worry and depression. People who attended for group CBT and older people were more likely to drop out of therapy. None of the studies comparing CBT with treatment as usual or waiting list looked at the long-term effectiveness of CBT. It is not clear whether people attending for CBT sessions were more likely to have reduced anxiety than people attending for psychodynamic therapy or supportive therapy, because only one study compared CBT with psychodynamic therapy, and the six studies that compared CBT with supportive therapy showed differing results. None of the studies included in the review reported on the possible side effects or acceptability of psychological therapies. More studies should be carried out to establish whether psychodynamic and supportive therapies are effective for GAD, and whether CBT is more helpful than other psychological therapy approaches in treating GAD.
+We searched for evidence on 6 July 2017 and identified a total of 13 trials that enrolled a total of 2556 women with a history of recurrent miscarriages. These trials found that giving progestogen medication to women with recurrent miscarriages early in their pregnancy may help lower the rates of miscarriage in that pregnancy from 27.5% to 20.1%. We believe that these findings are based on evidence of only moderate quality, so we cannot be certain about the results. We did not find that giving the progestogen medication by mouth, as a shot (injection), or in the vagina, was any better than any of the other ways. We also found that the trials showed that giving progestogen to women with prior recurrent miscarriages made the chances of having a live baby in the current pregnancy slightly higher. We are uncertain about the effect on the rate of preterm birth because the evidence is very low-quality. We did not find evidence of improvement in other outcomes such as newborn death, stillbirth, low birthweight, or newborn birth defects for women given progestogens. We found evidence from randomized controlled trials that giving progestogen medication may prevent miscarriage for women with recurrent previous miscarriages.
+Researchers from the Cochrane Collaboration examined the evidence published up to January 2015 and included 14 studies with 1298 pregnant women in this Cochrane review. The 1298 pregnant women received either CM or MIB techniques in adjunct to other comprehensive care options; women in the control group received usual care that included pharmacological treatment such as methadone maintenance, counselling, prenatal care, STD counselling and testing, transportation, and/or childcare. Nine studies used CM techniques vs. usual care, while five studies involved MIB techniques vs. usual care. All of the studies were completed in the United States of America and most participants were African American. Most studies used the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-R) criteria to determine drug dependence. There were no differences in retention or abstinence between CM or MIB techniques and usual care. There were also no differences in birth outcomes between the groups. Overall, there is low to moderate quality of evidence from the included studies. Allocation methods were often described in very limited manner. Furthermore, many studies lacked attrition information which could have impacted results. While further information related to these methods could be helpful, future randomized trials using psychosocial interventions are unlikely to show a benefit. In addition, there was significant heterogeneity in terms of methods for measuring outcomes.
+Our search yielded 31 eligible studies comparing the transradial approach to the transfemoral approach in people undergoing diagnostic or therapeutic (or both) coronary catheterisation procedures in different settings, whether urgent (during heart attacks (myocardial infarctions)) or elective (planned procedure). The trials were carried out in many countries and regions, including Canada, China, Europe, Japan, and USA. We also identified two ongoing studies. The evidence was current to October 2017. Transradial access was associated with a reduction in the composite outcome (comprising two or more combined outcomes) of net adverse clinical events (NACE), including death from cardiac causes, myocardial infarction (injury of the heart muscle), stroke (insult to the brain), need to reintervene on the same site of coronary artery stenosis (narrowing), and bleeding during the first 30 days following intervention. When assessing individual outcomes, the risk of myocardial infarction and stroke was similar between groups. Transradial access reduced death from cardiac causes, death from all causes during the first 30 days following intervention, bleeding, and local complications at the access site. The transradial approach shortened the length of stay in hospital, but was associated with a higher radiation exposure and more technical failures requiring an alternate vascular access route. We rated the quality of the evidence for short-term myocardial infarction and all-cause death as high. We rated short-term NACE, cardiac death, and success of the procedure as moderate quality evidence. Evidence for bleeding and access site complications was low quality.
+We examined the research published up to January 2016. We found only two suitable studies (189 people), both from the US. We also found six studies that were underway but the results were not yet published. One study found that having a small team of doctors and nurses trained in palliative care made little difference to how people with advanced dementia were treated while in hospital. But, having this special team meant that more people had a palliative care plan when they were discharged from hospital. The other study measured if giving written information to relatives explaining the different methods that can be used to feed people with advanced dementia helped either the relatives or the person. This study found that giving relatives this information made it a little easier for relatives to make decisions about what methods would be used to feed the person with dementia. We only found two studies and the two palliative care methods in these studies were very different. We cannot be very certain about how accurate either of these results reported here are, partly because only a small number of people took part in the studies. So from these studies, it is hard to be sure whether palliative care makes a difference to people with advanced dementia. Little research has been done about people with advanced dementia, often because of ethical concerns. However, although it is hard to do research with people with dementia, more well-designed studies are required to work out how palliative care can be used best in this special population.
+This review examined the current evidence on the best way to administer chemotherapy and radiotherapy following breast-conserving surgery. We were able to include three randomised trials. Two of these, with 853 women, assessed radiotherapy and chemotherapy given at the same time versus chemotherapy given first followed by radiotherapy. The third trial randomised 244 women to radiotherapy followed by chemotherapy versus chemotherapy followed by radiotherapy. The evidence produced by these three well-conducted trials suggests that recurrence of a woman's cancer and her chances of dying from breast cancer are similar regardless of the order of the treatments, provided that both radiotherapy and chemotherapy are commenced within seven months of the surgery. The trials provided limited information regarding adverse events, side effects or quality of life associated with the different sequences of treatment. The limited evidence available does suggest that the frequency and severity of side effects of chemotherapy and radiotherapy are similar regardless of which sequence is used. However, it should be noted that the women in these trials were treated, on average, in the early 2000s. As a result, the trials do not assess the modern types of radiotherapy, and new types of chemotherapy (such as taxanes) or other drugs (such as Herceptin). We will add relevant trials that include these more recent treatments to future updates of this review.
+We included nine randomised controlled trials which compared the efficacy and safety of 8 to 24 weeks of chromium supplementation and placebo in overweight or obese adults (i.e. with a body mass index between 25 and 29.9 kg/m2 defining being overweight and a body mass index of 30kg/m2 or more defining obesity). A total of 622 participants took part in the studies, 346 participants received chromium picolinate and 276 received placebo. The evidence is current to December 2012. When the results obtained from the doses of chromium picolinate investigated (200 µg, 400 µg, 500 µg, 1000 µg) were pooled, study participants lost around 1 kg of body weight more than participants receiving placebo. We were unable to find good evidence that this potential weight loss effect increased with increasing dose of chromium picolinate. Only three of nine studies provided information on adverse events, so we were unable to determine whether chromium picolinate supplements are safe and whether any potential harms may increase with dose. In addition, the length of studies included was rather short (maximum of 24 weeks), so we were unable to determine any long-term effects of supplementation. No study reported whether supplementation was associated with increases in deaths from any cause or illnesses (such as myocardial infarction or stroke), or the health-related quality of life or socioeconomic effects of supplementation. The overall quality of evidence was considered low and we have inadequate information from which to draw conclusions about the efficacy and safety of chromium picolinate supplementation in overweight or obese adults.
+In November 2015 we searched for as many studies as possible that both had a randomised controlled design and looked at the use of an antibiotic or antiseptic in participants with surgical wounds healing by secondary intention. We found 11 studies which included a total of 886 participants.These all looked at different comparisons. Several different types of wounds were included. Studies looked at wounds after diabetic foot amputation, pilonidal sinus surgery, treatment of various types of abscess, surgery for haemorrhoids, complications after caesarean section and healing of openings created by operations such as colostomy. Most studies compared a range of different types of antibacterial treatments to treatments without antibacterial activity, but four compared different antibacterial treatments. Although some of the trials suggested that one treatment may be better than another, this evidence was limited by the size of the studies and the ways they were carried out and reported. All of the studies had low numbers of participants and in some cases these numbers were very small. Many of the studies did not report important information about how they were carried out, so it was difficult to tell whether the results presented were likely to be true. More, better quality, research is needed to find out the effects of antimicrobial treatments on surgical wounds which are healing by secondary intention. Assessed as up to date November 2015.
+We compare the safety and accuracy of various modifications and included five randomised studies with 1049 women. For amniocentesis, studies evaluated drugs that relax the uterus (tocolytics), progesterone prophylaxis, or compared the difference in safety for different puncture sites. For CVS, one study included tocolysis prior to procedure and the other evaluated the role of continuous vacuum for aspiration of the placental tissue. None of these modifications had clinically important effects on procedure safety. Overall, we found no evidence of sufficient quality to change current clinical practice. Studies of high quality with adequate safety outcomes and power to detect important clinical differences would be clearly welcome.
+We conducted the literature search in March and May 2018. We included 10 studies; four studies provided data for meta-analyses. Six studies were conducted in upper-middle-income countries (China, Mexico, South Africa), one study was conducted in a lower-middle-income country (Bangladesh), and three studies were conducted in a high-income country (Canada). Seven studies examined the effects of wheat flour fortified with folic acid alone (3 studies) or with other micronutrients (4 studies). Three studies assessed the effects of maize flour fortified with folic acid alone (1 study) or with other micronutrients (two studies). Fortification of wheat flour with folic acid may reduce the likelihood of neural tube defects (i.e. total neural tube defects and two specific types of neural tube defects, spina bifida and encephalocoele (a type of neural tube defect that affects the brain and the membranes that cover it through an opening in the skull). Fortification of wheat or maize flour with folic acid (i.e. alone or with other vitamins and minerals) may increase folate status. There was limited evidence of the effects of folic acid-fortified wheat flour on haemoglobin levels or anaemia. The effects of folic acid fortification of wheat or maize flour on other main outcomes assessed in this review is not known. No studies reported on the occurrence of adverse effects. Limitations of this review were the small number of studies and participants, and the low-certainty of evidence due to how included studies were designed and reported.
+This review includes two trials with 1,124,483 babies (210 with cystic fibrosis). The trials compared newborn screening to clinical diagnosis. We were only able to analyse data from one of the trials. This trial showed that severe malnutrition was less common among screened babies. Screened babies had better chest radiograph scores at diagnosis, but these scores became worse over time. The screened babies become colonised with Pseudomonas aeruginosa earlier. Costs for screening were less than costs for traditional diagnosis.
+The evidence is current to October 2013. We found and analyzed five randomized trials including 7134 adult participants with type 2 diabetes and high blood pressure, 40-80 years old, who received treatment aimed to lower blood pressure to a standard compared to a lower blood pressure target and followed for 2 to 5 years to detect differences in mortality and adverse events. Four out of five studies were funded by the drug manufacturer, which had a potential of impacting the results. One study was sponsored by the National Heart, Lung, and Blood Institute (NHLBI) from the United States. The only significant benefit in the group assigned to 'lower' systolic blood pressure was a small reduction in the incidence of stroke, but with a significantly larger increase in the number of other serious adverse events. The effect of systolic blood pressure targets on mortality was compatible with both a reduction and increase in risk. There was no benefit associated with a 'lower' diastolic blood pressure target. The evidence from randomized trials available at the present time is of low quality and does not support blood pressure targets lower than the standard in people with raised blood pressure and diabetes. Further research is likely to change these results and future studies should report all outcomes that are important to patients, such as mortality and adverse events.
+The studies included in this review compared non-removable pressure-relieving interventions (foot casts) with other ways of relieving pressure on the ulcer site to improve healing. The comparisons included dressings alone, temporary therapeutic shoes, removable pressure-relieving devices and surgical intervention. The review found that the non-removable interventions were more effective than any of the other external pressure-relieving methods. Non-removable casts used with Achilles tendon lengthening were more successful in one forefoot ulcer study than using a non-removable cast alone.
+We identified five eligible studies that described six interventions. These included two studies of computerised cognitive skills practice, two cognitive coping skills training programmes, one meditation intervention and one exercise intervention. All five studies included a total of 235 women who had been treated for breast cancer. The findings suggest that cognitive skills practice and cognitive coping skills training may be useful in improving patient reports and formal assessments of cognition, as well as quality of life. There was insufficient evidence to know if meditation and exercise interventions had any effect on cognition. The quality of the evidence was low. There were problems with study designs and, so, we need to be cautious about our conclusions. There is not enough good quality evidence to know if any interventions improve cognitive impairment or maintain cognitive functioning among people who have received systemic treatment for cancer. There are several ongoing trials in the field, which may provide the necessary evidence in the future.
+A search for randomised controlled trials that could be relevant to this review was carried out on 6 June 2015, and another search was carried out 8 October 2018. This was achieved by searching the Specialised Register of Cochrane Schizophrenia. The 2015 search found six possible trials and we carefully checked these to see if we could include them in the review. The 2018 search found no new trials. Five trials, randomising a total of 343 participants met the review requirements for inclusion. These trials randomly allocated participants to receive either chlorpromazine or piperacetazine. Data were reported for participants' global and mental state after treatment, incidence of adverse effects and numbers leaving the trial early. However, we did not find any data concerning service use, functioning of participants or economic costs of these treatments. The overall results showed chlorpromazine and piperacetazine may have similar clinical efficacy and side effect profiles. However, these results are based on very low-quality data. The number of included studies and the sample size of participants included in this review is small, and the quality of data very low, so the results of this review are not conclusive and must be used with caution. Further research would be needed before decisions can be made regarding which drug is more effective.
+This systematic review of five randomised trial shows higher rates of clinical relief of obstruction in emergency surgery. Colonic stent has not been shown to be as effective as emergency surgery in malignant colorectal obstructions. However, use of colonic stent is associated with comparable mortality and morbidity with advantage of shorter hospital stay and procedure time and less blood loss. Further randomised controlled trials with larger sample size and robust trial design are required on this topic.
+We found nine randomised controlled trials (RCTs) which compared the use of volume expanders (albumin, HES and mannitol) for preventing moderate or severe OHSS. Control groups received no treatment or placebo. The studies included 1867 women at high risk of OHSS. The evidence is current to September 2015. Evidence suggests that plasma expanders (human albumin, HES and mannitol) reduce rates of moderate and severe OHSS in women at high risk. If the rate of OHSS without treatment is 12%, it will be about 9% (6% to 12%) with the use of intravenous albumin. If the rate of OHSS without treatment is 16%, it will be about 5% (2% to 10%) with the use of HES, and if the rate without treatment is 52%, it will be about 29% (19% to 41%) with mannitol. Adverse events appear to be uncommon, but were too poorly reported to reach firm conclusions. No studies reported live birth, but there was evidence that human albumin reduces pregnancy rates. While there was no evidence that HES, or mannitol had any influence on pregnancy rates, the evidence of effectiveness was based on very few trials, and better evidence is needed before they should be considered for routine use in clinical practice. The evidence was very low to moderate quality for all comparisons. The main limitations were imprecision, poor reporting of study methods, and failure to blind outcome assessment.
+We included 10 randomised controlled trials involving 484 people in our review. Sodium tetradecyl sulfate (STS), polidocanol (POL), and heparsal (20% saline mixed with heparin 100 units/mL) cleared the veins more effectively than an injection of normal saline. There was no evidence that one agent was better than any other sclerosant, that patients were more satisfied with one agent than another, and which dose of an agent was best. There was some evidence that POL was less painful than heparsal and STS, and that STS was more painful than heparsal. At higher doses, some of the agents appeared to cause more pain and side effects such as mild brown discoloration, a flare or blush next to the injected vein, or itching; however, we do not have enough evidence to determine the optimal concentration to use. The trials were designed in very different ways and used various agents, which meant we were unable to combine the studies to help form firm conclusions. The amount of available evidence was limited and the overall methodological quality of the research was poor, as was the quality of reporting.
+We searched for all studies that tested whether therapies were effective and safe at treating high potassium published up to 18 August 2015. We found seven studies that investigated drug therapies for treating hyperkalaemia in adults which together included results from 241 participants. Most studies tested the therapies in male and female adults with kidney problems who were medically stable. We did not find any studies that looked at the serious medical complications of high potassium such as death. We found that salbutamol and insulin-dextrose were effective in reducing potassium levels in the blood. We found that salbutamol was effective whether it was given intravenously or by nebuliser. Those treatments appeared to be more effective than other treatments such as sodium bicarbonate and aminophylline. None of the studies found any serious adverse reactions to the medications. Overall, the quality of evidence was assessed as poor because the studies were small in size and the methods for how the studies were performed were not well described. None of the studies looked at the serious problems caused by hyperkalaemia and this limited the strength of the evidence.
+We included 39 studies, including 3,945 participants undergoing HD through a CVC. The studies compared CVC sealing solutions with heparin to antimicrobial lock solutions. Fifteen studies used only antibiotic lock solutions, 21 used non-antibiotic lock solutions, and 4 used both (antibiotic and non-antibiotic) lock solutions. Studies measured the incidence of CRIs and catheter thrombosis, or both. Overall quality of the studies was low for CRIs and very low for thrombosis. There was no information on funding sources for most of the studies. In general antimicrobial lock solutions are likely superior to standard solutions in preventing CRIs among patients undergoing HD through a CVC, but non-antibiotic solutions did not prove to reduce CRI. They are no worse than heparin at preventing thrombosis. Other adverse effects were not reported in most studies. Our confidence in these results is low due to the quality of the studies. Some antimicrobial (antibiotic and the combination of antibiotic-non antibiotic) lock solutions decrease the incidence of CRIs compared to heparin. Their effect on CVC permeability remains unclear. The quality of the studies is low and very low, respectively; therefore, more studies are needed to confirm the benefits and harms of antimicrobial lock solutions.
+This review looked at the benefits and harms of pre-emptive treatment with antiviral agents in preventing CMV disease in solid organ transplant recipients. We identified six studies (288 participants) that compared pre-emptive treatment with placebo or usual care. Pre-emptive treatment significantly reduced the risk of CMV disease. There were also eight studies (784 participants) that compared pre-emptive treatment with antiviral prophylaxis. There were no significant differences in the risks of CMV disease or death between pre-emptive therapy and prophylaxis. However, variation in results among studies meant that there is some uncertainty about these results. Low white blood cell counts were much less common with pre-emptive treatment. More studies comparing pre-emptive treatment with antiviral prophylaxis are still required to provide greater certainty about the relative effectiveness of pre-emptive therapy compared with prophylaxis.
+We decided to investigate whether there is enough evidence from medical trials to show whether sweet potato works as a treatment for diabetes. This review of randomised controlled trials found only three studies (with a total of 140 participants) that evaluated the effects of sweet potato for type 2 diabetes mellitus compared with a fake medicine (placebo). All these trials were of very low quality. Two studies with 122 participants showed improved long-term metabolic control of blood sugar levels as measured by glycosylated haemoglobin A1c (HbA1c) which was moderately lowered by 0.3% in participants who were given 4 g sweet potato tablets a day for three to five months. The duration of treatment ranged from six weeks to five months. No study investigated diabetic complications, death from any cause, health-related quality of life, well-being, functional outcomes or costs. Adverse effects were mostly mild, and included abdominal distension and pain. There are many varieties of sweet potatoes and sweet potato preparations. More trials are needed to assess the quality of the various sweet potato preparations as well as to evaluate further the use of different varieties of sweet potato in the diet of diabetic people.
+While 19 studies comparing the active cycle of breathing technique with other airway clearance therapies are included in the review, only five studies (192 participants) reported data that we could include in the analysis. Each of the five studies compared different techniques: the active cycle of breathing technique was compared with autogenic drainage, airway oscillating devices, high-frequency chest compression devices, positive expiratory pressure, and conventional chest physiotherapy. Most studies lasted a single day, but there were two studies that lasted between one and three years. Participants ranged in age from six to 63 years and most (63%) were male. We found that the active cycle of breathing technique was comparable with other treatments in outcomes such as quality of life, personal preference, exercise tolerance, lung function, sputum weight, oxygen saturation, and the number of pulmonary exacerbations. We were not able to show that any single technique was better than another. Longer studies are needed to better assess the effects of the active cycle of breathing technique on outcomes important for people with cystic fibrosis such as quality of life and personal preference. Many of the studies did not provide enough details of their methods to determine if there were any biases that might have affected the results. Many studies did not report how they decided who would get which treatment and how they made sure that the people who were putting people into the different treatment groups and those who were assessing the results did not know which group each individual was in. Most of the included studies had a cross-over design (where people have one treatment and then switch to the second), and many of these did not report the length of time in between different treatments. As it is possible that the first treatment might affect the results of the next treatment, we only included results from the first treatment period. Many of the studies did not report separate results for just the first treatment period, so we did not include their results in our review. All participants knew which treatment group they were in (it is not possible to disguise different physiotherapy techniques). This could have affected the results for some of the self-reported outcomes, such as quality of life, personal preference, or exercise tolerance, but is unlikely to have affected the more objective outcomes, such as lung function. Most of the studies followed those taking part for less than one month and did this for most of the participants for the entire study period. In two out of the three longer studies more than 10% of the people taking part dropped out. The study results could be affected if the people who dropped out of the studies were not evenly spread across the different treatment groups. Over half of the studies checked that participants were using the airway clearance therapy they were supposed to. Most of the studies reported on all their planned outcomes. The findings of the review were limited as not many studies made the same comparisons; also, there were not many long-term studies and the studies we included did not report enough data.
+This review identified eight randomized controlled trials involving 733 women. Low quality evidence showed increases in ongoing pregnancy and clinical pregnancy rates with the use of the brief co-incubation protocol. More studies are needed to assess whether brief co-incubation would contribute to a higher live-birth rate and a lower miscarriage rate compared to the standard overnight insemination protocol.
+The review authors identified five randomised studies reported from 1980 to 1992. These trials recruited a total of 694 newborn infants with acute respiratory failure mainly caused by hyaline membrane disease. A long inspiratory time was associated with a significant increase in air leak from the lungs (NNT 8). There was no significant difference in the incidence of BPD but an increase in mortality before hospital discharge reached borderline statistical significance. Caution should be exercised in applying these results to modern neonatal intensive care because these studies were conducted before the introduction of antenatal steroids, postnatal surfactant and the use of synchronised modes of ventilatory support. Whilst there is increasing use of non-invasive ventilation such as nasal continuous positive airway pressure to avoid ventilator-induced lung injury, mechanical ventilation will continue to have a role in extremely immature infants and those with hyaline membrane disease complicated by apnea.
+Our systematic review identified 33 relevant studies, almost all of which were of low methodological quality (a major limitation of the review). We found that telephone follow-up has been applied in many patient groups. There is great variety in the ways the telephone follow-up has been performed. Many different outcomes have been measured. Some studies found effects in favour of the telephone follow-up intervention, but overall studies identified no statistically significant differences between the telephone follow-up and control groups. For as far as the results of studies could be pooled together, we could draw no firm conclusions about the effects of telephone follow-up. No studies identified adverse effects of the intervention.
+This review identified methods that encouraged people to stay in trials. We searched scientific databases for randomised studies (where people are allocated to one of two or more possible treatments in a random manner) or quasi-randomised studies (where allocation is not really random, e.g. based on date of birth, order in which they attended clinic) that compared methods of increasing retention in trials. We included trials of participants from any age, gender, ethnic, cultural, language and geographic groups. The methods that appeared to work were offering or giving a small amount of money for return of a completed questionnaire and enclosing a small amount of money with a questionnaire with the promise of a further small amount of money for return of a filled in questionnaire. The effect of other ways to keep people in trials is still not clear and more research is needed to see if these really do work. Such methods are shorter questionnaires, sending questionnaires by recorded delivery, using a trial design where people know which treatment they will receive, sending specially designed letters with a reply self addressed stamped envelope followed by a number of reminders, offering a donation to charity or entry into a prize draw, sending a reminder to the study site about participants to follow-up, sending questionnaires close to the time the patient was last followed-up, managing peoples' follow-up, conducting follow-up by telephone and changing the order of questionnaire questions. The methods that we identified were tested in trials run in many different disease areas and settings and, in some cases, were tested in only one trial. Therefore, more studies are needed to help decide whether our findings could be used in other research fields.
+We included eight randomized studies that involved a total of 829 participants 18 years of age and older. All participants had elective surgeries and needed general anaesthesia. Researchers directly compared cLMA against pLMA for providing artificial breathing during surgery. We identified six cross-over studies that are awaiting classification; one is completed but has not been published, and five other studies are gathering data related to the first treatment period that are not yet available. Five studies did not report any funding sources. Of the remaining three studies, one reported that the Laryngeal Mask Company sponsored some data but was not involved in study design, data analysis, and manuscript preparation. The Joseph Drown Foundation, in Los Angeles, Califiornia, in the USA, partially supported another study. One of the authors of the final study had received research funds from Intavent Ltd, manufacturer of both types of laryngeal mask airway, but Intavent Ltd did not sponsor this study. We are unsure whether these devices exhibit important differences in providing adequate oxygenation and ventilation because there was not enough data to enable us to draw any firm conclusions. ProSeal laryngeal mask airway may provides a better seal because it leaks at higher pressure, but Classic laryngeal mask airway may be quicker to insert. However, these findings are not important clinically. We assessed all of the included studies as providing low-quality evidence because anaesthetists knew which device was being used on which participants (although this was probably unavoidable), and because it was unclear whether the investigator who collected the data was unaware of the intervention. This fact created the potential for bias.
+This evidence is current to June 2016. Nineteen studies met our inclusion criteria, including 13 studies of probiotics and four studies of fibre interventions. We also found one study of a diet low in substances known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) and one study of a fructose-restricted diet. All of the studies compared dietary interventions to a placebo or control. The trials were carried out in eight countries and included a total of 1453 participants, aged between five and 18 years. Most children were recruited from outpatient clinics. Most interventions lasted four to six weeks. Probiotics We found evidence from 13 studies suggesting that probiotics might be effective in improving pain in the shorter term. Most studies did not report on other areas such as quality of daily life. No harmful effects were reported, other than dry mouth in one study. We judged this evidence to be of moderate or low quality because some studies were small, showed varying results, or were at risk of bias. Fibre supplements We found no clear evidence of improvement of pain from four studies of fibre supplements. Most studies did not report on other areas such as quality of daily life. No harmful effects were reported. There were few studies of fibre supplements, and some of these studies were at risk of bias. We judged this evidence to be of low quality. Low FODMAP diets We found only one study evaluating the effectiveness of low FODMAP diets in children with RAP. Fructose-restricted diets We found only one study evaluating the effectiveness of fructose-restricted diets in children with RAP. We found some evidence suggesting that probiotics may be helpful in relieving pain in children with RAP in the short term. Clinicians may therefore consider probiotic interventions as part of the management strategy for RAP. Further trials are needed to find out how effective probiotics are over longer periods of time and which probiotics might work best. We did not find convincing evidence that fibre supplements are effective in improving pain in children with RAP. Future larger, high-quality studies are needed to test the effectiveness of fibre and low FODMAP diet treatments.
+We reviewed studies comparing people who saw or heard a mass media intervention about mental health problems with people who had not seen or heard any intervention, or who had seen an intervention which contained nothing about mental ill health or stigma. We aimed to find out what effects mass media interventions may have on reducing stigma towards people with mental health problems. We found 22 studies involving 4490 people.  Five of these studies had data about discrimination and 19 had data about prejudice. We found that mass media interventions may reduce, increase, or have no effect on discrimination. We found that mass media interventions may reduce prejudice. The amount of the reduction can be considered as small to medium, and is similar to reducing the level of prejudice from that associated with schizophrenia to that associated with major depression. The quality of the evidence about discrimination and prejudice was low, so we cannot be very certain about these findings. Only three studies gave any information about financial costs and two about adverse affects, and there were limitations in how they assessed these, so we cannot draw conclusions about these aspects.
+We include 85 studies in our synthesis. Forty-six studies explored the views and experiences of women who were pregnant or who had recently given birth. 17 studies explored the views and experiences of healthcare providers, including lay or community health workers, and 22 studies included the views of both women and healthcare providers. The studies took place in eight high-income countries, 18 middle-income countries and 12 low-income countries, in rural and urban locations. Our findings suggest that women use antenatal care if they find it is a positive experience that fits with their beliefs and values, is easy for them to access, affordable, and treats them as an individual. They want care that helps them to feel that they and their baby are safe, and that is provided by kind, caring, culturally sensitive, flexible, and respectful staff that have time to give them support and reassurance about the health and well-being of them and their babies. They also value tests and treatments that are offered when they need them, and information and advice that is relevant to them. Our findings also suggest that healthcare staff want to be able to offer this kind of care. They would like to work in antenatal services that are properly funded, and that give them proper support, pay, training and education. They believe this will help them to have enough time to treat each pregnant woman as an individual, and to have the knowledge, skills resources and equipment to do their job well. The review authors searched for studies that had been published up to February 2019.
+This review of 16 trials, involving 3361 patients, has found that the outcome after subarachnoid haemorrhage, in terms of survival and being independent in activities of daily living, is improved by treatment with calcium channel blockers (antagonists). If the largest trial is excluded from the analysis, the results are no longer statistically significant, and therefore the evidence is not beyond all doubt. However, given the high likelihood of benefits and the modest risks associated with this treatment, the review authors conclude that calcium antagonists, in the form of oral nimodipine 60 mg every four hours, are useful in patients with subarachnoid haemorrhage from a ruptured aneurysm. Magnesium is another calcium antagonist with promising results, but larger trials with this drug are needed before we can be certain about a beneficial effect.
+This systematic review focused on randomised studies comparing the effectiveness of myeloablative therapy with conventional therapy in children with high-risk neuroblastoma. The authors found three studies including 739 patients. These studies provide evidence that myeloablative therapy improves event-free survival (that is, the time until a certain event, for example tumour progression, the development of a second tumour, or death from any cause occurs). For overall survival (that is, the time until a patient dies from any cause, so not only from the tumour or its treatment, but for example, also from a car accident) there is no evidence of a better outcome in patients treated with myeloablative therapy. Side effects such as renal (kidney) effects, interstitial pneumonitis (a type of lung disease) and veno-occlusive disease (a condition in which some of the small veins in the liver are obstructed) were more common in patients treated with myeloablative therapy than conventional chemotherapy. It should be noted that this systematic review only allows a conclusion on the concept of myeloablative therapy; no conclusions regarding the best treatment strategy with regard to, for example, types of chemotherapeutic agents and the use of radiation therapy, could be made. More high quality research is needed. It should be noted that recently the age cut-off for high-risk disease was changed from one year to 18 months. As a result it is possible that patients with what is now classified as intermediate-risk disease were included in the high-risk groups. Consequently the relevance of the results of these studies to the current practice can be questioned. Survival rates may be overestimated due to the inclusion of patients with intermediate-risk disease.
+The review authors searched the medical literature in order to clarify the role of the combination of TACE followed by 3-DCRT for the treatment of primary hepatocellular carcinoma, and to compare their benefits and harms with TACE alone. We collected and analysed data from randomised clinical trials (clinical studies where people are randomly put into one of two or more treatment groups) of people with primary hepatocellular carcinoma who were able to receive TACE or 3-DCRT. Evidence is current to May 2018. The review included eight trials with 632 participants. All trials were at high risk of bias. TACE followed by 3-DCRT appeared to be superior to TACE in improving death from any cause and tumour response, despite an increased toxicity expressed by a higher rise of total bilirubin (measured by a blood test to see how well the liver is working). No trials reported serious side effects. One trial reported health-related quality of life (a measure of a person's satisfaction with their life and health), but this was ill-defined. The review findings were uncertain because the included trials had methodological weaknesses. More high-quality randomised clinical trials are needed to confirm or complete the review findings.
+Studies have shown that these babies have higher energy expenditure and lower energy intake compared with babies without CLD/BPD. Increasing energy intake for these babies beyond standard levels may therefore seem beneficial. However, setting high targets for energy intake for these babies may not be achievable. Furthermore, methods of increasing energy intake such as increasing the milk volume or concentration or giving intravenous nutrition may lead to complications of their own. We planned to examine whether increasing energy intake for these babies improves their breathing status, their growth and development, and reduces their risk of death without producing significant complications. Having found no suitable study to date that answers these questions, we are currently unable to provide any evidence on whether increasing the energy intake for babies with (or developing) CLD/BPD is overall beneficial.
+This Cochrane systematic review compared landmark techniques versus ultrasound guidance. The evidence is current to´January 2013. We included in the review 13 studies enrolling 2341 participants (and involving 2360 procedures). The studies were varied, and their quality was not high. We reran the search in August 2014. We will deal with any studies of interest when we update the review. Nevertheless, ultrasound offered some benefits, as it reduced the risk of arterial puncture and severe bruising in subclavian vein catheterization. Fewer data were available for femoral vein catheterization, but success rates seemed to be higher with ultrasound. No evidence showed a significant difference in complication rates or in time taken to cannulate at either site. On the basis of available data, we conclude that two-dimensional ultrasound offers small advantages in safety and quality when compared with an anatomical landmark technique for subclavian vein (reduced arterial puncture and haematoma formation) or femoral vein (reduced success on the first attempt) cannulation for central vein catheterization, but these findings do not necessarily hold for all groups of ultrasound users or for patients at high risk for complications. The results for Doppler ultrasound techniques versus anatomical landmark techniques are uncertain.
+Studies conducted more than 20 years ago suggested that physostigmine could improve memory in people with or without dementia. Investigation of this property has been limited by the very short half-life of physostigmine. Various forms of administering the drug have been tried to overcome this problem, most recently a controlled-release (CR) oral formulation, and a skin patch. An additional limiting factor has been a high incidence of adverse effects, including nausea, vomiting and diarrhoea. Physostigmine appears to have no advantage over some newer anticholinesterase drugs. The short half-life remains a serious disadvantage and requires complex forms of administration. There is no reason to recommend further research into this drug.
+The duration of fibrates ranged from 12 months to 8 years. We included 13 trials in this review with a total of 16,112 participants with a history of coronary heart disease or stroke. This review includes evidence identified up to October 2014. Our analysis showed that when compared primarily to placebo, fibrates can be effective for prevention of composite outcome of non-fatal stroke, non-fatal heart attack (myocardial infarction), and death due to circulatory disease. However, this beneficial effect relies on the inclusion on data from clofibrates, a drug that was discontinued in 2002 because of safety concerns. In other words, there is no good evidence to support the use of currently available fibrates in the prevention of future heart attacks, strokes, and circulatory disease death in people with existing circulatory disease. In combination with clofibrate data, quality of evidence was moderate for the composite (non-fatal stroke, non-fatal myocardial infarction (MI), and vascular death) and MI (non-fatal or fatal) outcomes and low for stroke (ischaemic or haemorrhagic, non-fatal or fatal) and death from vascular or any cause during the treatment and scheduled follow-up period. The quality of evidence without clofibrate data was moderate for MI (non-fatal or fatal) outcome and low for the composite (non-fatal stroke, non-fatal MI, and vascular death), stroke (ischaemic or haemorrhagic, non-fatal or fatal), and death from vascular or any cause outcomes during the treatment and scheduled follow-up period.
+TA decreased blood loss greater than 400 mL or greater than 500 mL and this effect was more apparent with vaginal births. The studies had methodological shortcomings. Blood loss greater than 1000 mL decreased with the use of TA in six trials (2093 women), however, the difference was most obvious in caesarean section (two trials, 1400 women) and not in vaginal birth in which there were few such outcomes (one trial, 439 women). Mean blood loss decreased with the use of TA by 77 mL, overall (five studies, 1186 women) and with both vaginal and caesarean section births. This finding was based on studies with methodological limitations. The studies were too small to detect the effect of TA on maternal death or blood clots. Mild side effects, which include diarrhoea, nausea and vomiting, were more common in women who received TA versus placebo or no intervention. No differences in blood loss and side effects were found when two different doses of TA were evaluated. Further larger studies are needed to investigate the effects of TA on maternal deaths and formation of clots in the blood (thromboembolism).
+We identified 12 trials (2494 participants: 1586 children and 908 elderly). We looked for trials that compared amantadine or rimantadine with no intervention, placebos or control drugs in children and the elderly. The most recent searches were completed in October 2014. We looked at several outcomes, including influenza A, fever duration, cough, headache, nausea/vomiting, dizziness and stimulation/insomnia. Although amantadine was effective in preventing influenza A in children, it would be necessary to use it in up to 17 children over a period of 14 to 18 weeks to prevent one case of influenza A. Furthermore, the safety of the drug was not well established. The quality of the evidence was low. The effectiveness of both antivirals was limited to a benefit from rimantadine in the reduction of fever by day three of treatment in children. The quality of the evidence was moderate. This benefit does not seem to justify a recommendation for using rimantadine to treat all children with influenza A. Rimantadine did not show a prophylactic (preventative) effect in the elderly. The quality of evidence was very low. The quality of the evidence combined with a lack of knowledge about the safety of amantadine and the limited benefits of rimantadine, do not indicate that amantadine and rimantadine compared to control (placebo or paracetamol) could be useful in preventing, treating and shortening the duration of influenza A in children and the elderly.
+Nine randomised controlled trials met the inclusion criteria of this review, and included a total of 1512 women. The women in seven studies were trying to get pregnant from IUI, and from intercourse in two studies. Most women had a type of subfertility known as unexplained subfertility, which means that after having all routine tests done there is no obvious explanation for why the couple has not become pregnant so far. Eight trials compared intentional endometrial injury with no injury/placebo procedure; of these two trials also compared intentional endometrial injury in the cycle prior to IUI with intentional endometrial injury in the IUI cycle. One trial compared higher vs. lower degree of intentional endometrial injury. The evidence is current to 31 October 2015. The results from the included studies suggest a beneficial effect of endometrial injury on the chance of getting pregnant, but the studies are associated with many significant limitations. Therefore, it is not possible to say with any confidence whether endometrial injury can increase the probability of pregnancy. We are uncertain whether endometrial injury increases the probability of a live birth or a pregnancy beyond 12 weeks. The endometrial injury procedure is a common procedure and is known to cause a degree of temporary pain or discomfort. Only one included study reported on whether the women experienced pain during the procedure, and the average pain experienced was six out of 10 on a visual scale from zero to 10. Endometrial injury does not seem to have an effect on miscarriage, ectopic pregnancy or multiple pregnancy. No studies reported bleeding after the procedure. The quality of the evidence was low or very low as assessed using GRADE criteria. In general, the studies included in this review were not very well designed and did not recruit a high enough number of women to provide meaningful results. This means the results must be treated cautiously, and further studies are needed to confirm the findings. There remains uncertainty about whether or not the endometrial injury procedure increases the probability of having a baby.
+This review was carried out through Cochrane Oral Health. We searched scientific databases for relevant studies, up to 15 November 2017. We included four studies, with a total of 3905 participants randomly assigned to treatment or usual care. Participants were long-term-care elderly residents in nursing homes who did not have pneumonia at the beginning of the studies. Some of the participants had dementia or systemic diseases. All studies focused on the comparison between 'professional' mouth care and 'usual' mouth care. None of the studies evaluated oral care versus no oral care. We identified four studies, all of which compared professional mouth care to usual mouth care in nursing home residents. From the limited evidence, we could not tell whether professional oral mouth care was better or worse than usual mouth care for preventing pneumonia. The evidence for death from any cause was inconclusive, but the studies did suggest that professional mouth care may reduce the number of deaths caused by pneumonia, compared to usual mouth care, when measured after 24 months. Only one study measured negative effects of the interventions, and reported that there were no serious events. The most common non-serious events reported were damage to the mouth and tooth staining. The quality of the evidence is low or very low, because of the small number of studies and problems with their design. Therefore, we cannot rely on the findings, and further research is required.
+Five studies including 149 participants were identified. These studies assessed budesonide versus placebo (e.g. a sugar pill), mesalazine versus mesalazine plus cholestyramine and beclometasone dipropionate versus mesalazine and Pepto-Bismol® versus placebo. The study which compared mesalazine to mesalazine plus cholestyramine and the study which compared beclometasone dipropionate to mesalazine were judged to be of low quality. The study which compared Pepto-Bismol® bismuth subsalicylate to a placebo was judged as low quality due to a very small sample size (5 participants) and limited data. The other three studies were judged to be high quality. A pooled analysis of two studies (57 participants) showed that budesonide (9 mg/day for 6 to 8 weeks) was superior to placebo for improvement of diarrhea and improvement of microscopic inflammation of the bowel. Improvement in diarrhea was noted in 88% of budesonide participants compared to 38% of placebo participants. Improvement in microscopic inflammation was reported in 78% of budesonide participants compared to 33% of placebo participants. Forty-one participants were enrolled in the study that compared mesalazine (2.4. g/day) to mesalazine plus cholestyramine (4 g/day). Improvement in diarrhea was noted in 85% of participants in the mesalazine group compared to 86% of participants in the mesalazine plus cholestyramine group. Five patients were enrolled in the trial studying Pepto-Bismol® (nine 262 mg tablets daily for 8 weeks versus placebo). There were no differences in improvement of diarrhea or in improvement of microscopic inflammation of the bowel. Forty-six participants were enrolled in the trial studying beclometasone dipropionate (5 mg/day or 10 mg/day) versus mesalazine (2.4 g/day). Although participants receiving beclometasone dipropionate (84%) and mesalazine (86%) had improved diarrhea at 8 weeks, this improvement was not maintained at 12 months (26% and 20%, respectively). Side effects reported in the budesonide studies include nausea, vomiting, neck pain, abdominal pain, excessive sweating and headache. Side effects reported in the mesalazine plus cholestyramine study included nausea and skin rash. Side effects in the beclometasone dipropionate trial included nausea, sleepiness and change of mood. No side effects were reported in the Pepto-Bismol® study. Low quality evidence suggests that budesonide may be an effective therapy for the treatment of lymphocytic colitis. Low quality evidence also suggests that mesalazine with or without cholestyramine and beclometasone dipropionate may be effective for treatment of lymphocytic colitis. No conclusions can be made regarding bismuth subsalicylate due to the very small number of participants in the study. In the future, researchers should consider further large placebo-controlled trials of budesonide to confirm the suggested benefit and safety of this therapy. Bismuth subsalicylate, which has less potential for toxicity than budesonide, also warrants further study. The effectiveness and safety of mesalazine with or without cholestyramine, and beclometasone dipropionate need to be investigated in a large placebo-controlled studies.
+Two studies reported costs of self-monitoring: One study compared the costs of self-monitoring of blood glucose with self-monitoring of urine glucose based on nine measurements per week and with the prices in US dollars for self-monitoring in 1990. They concluded that total costs in the first year of self-monitoring of blood glucose, with the purchase of a reflectance meter were 12 times more expensive than self-monitoring of urine glucose ($481 or 361 EURO [11/2011 conversion] versus $40 or 30 EURO [11/2011 conversion]). Another study reported a full economical evaluation of the costs and effects of self-monitoring. At the end of the trial, costs for the intervention were £89 (104 EURO [11/2011 conversion]) for standardized usual care (control group), £181 (212 EURO [11/2011 conversion]) for the less intensive self-monitoring group and £173 (203 EURO [11/2011 conversion]) for the more intensive self-monitoring group. We did not find good evidence for an effect on general health-related quality of life, general well-being, patient satisfaction, or on the decrease of the number of hypoglycaemic episodes. However, hypoglycaemic episodes were more often reported in the self-monitoring blood glucose groups than in the control groups (four studies). Because patients in the self-monitoring blood glucose groups can use their device to confirm both periods of asymptomatic and symptomatic hypoglycaemic episodes, this is according to expectations.
+We considered 11 studies, but were unable to draw any firm conclusions from the evidence available. Although several studies looked at treatments to reduce drug or alcohol misuse in people with antisocial personality disorder, few studies focused on treating the disorder itself. Only three studies reported outcome measures that were originally defined in the review protocol as being of particular importance in this disorder (reconviction and aggression). Nonetheless, there was some evidence that a type of treatment known as contingency management (which provides rewards for progress in treatment) could help people with antisocial personality disorder to reduce their misuse of drugs or alcohol. Further research is urgently needed to clarify which psychological treatments are effective for people with this disorder. This research is best carried out using carefully designed clinical trials. Such trials should focus on the key features of antisocial personality disorder. To be informative, they need to be carried out with samples of participants of sufficient size.
+To find out whether antibiotics work for the common cold we identified studies that compared one group of people taking an antibiotic with another group of people taking a medication that looked similar but contained no antibiotic (a placebo). We found six studies of the common cold, with 1047 participants and five studies of acute purulent rhinitis, with 791 participants. Many of the studies had flaws which might have biased the results, especially because many of the participants probably had chest or sinus infections that the researchers did not know about. Results suggest that antibiotics do not work for either the common cold or for acute purulent rhinitis and many people are affected by antibiotic side effects.
+The evidence is current to January 2019. We included five studies (162 participants); three were conducted in hospital dermatology departments. Participants were 12 to 77 years old (100 males; 62 females). One study was funded by a pharmaceutical company. The severity of the condition ranged from mild to severe. Streptococcus bacteria were found in the throats of 14% of people. We classed outcomes measured within eight weeks of the start of treatment as short-term, and those measured at least one year after the start of treatment as long-term. The antibiotic trials in guttate psoriasis patients were all short-term in duration; the antibiotic trial in chronic plaque psoriasis was 48 weeks long. Three studies included participants with guttate psoriasis, and assessed the short-term effects of antibiotics: penicillin (20 participants), or erythromycin compared to no treatment (43 participants), and rifampicin compared to placebo (20 participants). Two studies included participants with chronic plaque psoriasis. One study assessed azithromycin (antibiotic) versus vitamin C at 48 weeks (50 participants); one assessed tonsillectomy versus no intervention at eight weeks and 24 months (29 participants). These results are backed by very low-quality evidence, so we are not certain of their accuracy. Each result is based on only one study. No studies measured our main outcome of interest, the time taken for the skin to be clear or almost clear of lesions, or the risk of relapsing at least once during long-term follow-up. No side effects were seen when penicillin was compared with no treatment in people with guttate psoriasis. Side effects were not measured for the comparisons of rifampicin versus placebo, or erythromycin versus no treatment. In participants with chronic plaque psoriasis, one trial assessed azithromycin versus vitamin C, and 10 participants in the azithromycin group complained of nausea or mild stomach upset. A trial of tonsillectomy versus no treatment reported one case of minor bleeding in the tonsillectomy group. Two studies in participants with chronic plaque psoriasis measured the number of participants achieving a 75% reduction on the Psoriasis Area and Severity Index (PASI 75). In one, 18/30 participants in the azithromycin group reached PASI 75 versus none in the vitamin C group. In the other, 3/15 in the tonsillectomy group reached PASI 75 versus none in the no treatment group. The guttate psoriasis trials did not assess this outcome. We are uncertain whether the number of participants with guttate psoriasis achieving clear or almost clear skin differs between those given penicillin and those receiving no treatment. Only one participant with chronic plaque psoriasis achieved almost clear skin in the tonsillectomy group compared to none in the no treatment group. The other three trials did not measure this outcome. Many of our main outcomes were not assessed. Those that were assessed were based on very low-quality evidence, meaning we are not sure of their accuracy. The studies were very small, and had a high risk of bias because participants and trial assessors were aware of treatment allocation. More studies are needed to see if antibiotic treatment of Streptococcal infection shortens the duration of acute guttate psoriasis, stopping it from turning into a long-term condition (chronic plaque psoriasis).
+Our systematic search identified 12 studies enrolling 933 people with MS. Research shows that vitamin D has no effect on recurrence of relapse, worsening of disability measured by the Expanded Disability Status Scale (EDSS), or new MRI gadolinium-enhancing T1 lesions. Its effects on health-related quality of life and fatigue are unclear. Our confidence in these results is very low because vitamin D has been evaluated in only a few small trials that we judged as having high risk of bias. Vitamin D supplementation appears to be safe for people with MS included in our review, but available data are limited. For people with MS, vitamin D supplementation appears to have no effect on relevant clinical outcomes or new MRI lesions. Vitamin D supplementation at the doses and treatment durations used in the included trials appears to be safe, although available data are limited. Seven trials are ongoing; they will likely provide further evidence for a future update of this review. This evidence is up-to-date as of October 2017.
+In this updated review we set out to estimate how well morphine worked, how many people had side effects, and how severe those side effects were – for example, whether they were so severe that participants stopped taking their oral morphine. We found 62 studies with 4241 participants. The studies were often small, compared many different preparations, and used different study designs. This made it difficult to work out whether any one tablet or preparation of oral morphine was better than any other. There did not seem to be much difference between them. More than 9 in 10 participants had pain that went from moderate or severe before taking morphine to pain that was no worse than mild when taking morphine. More than 6 in 10 participants were very satisfied with the morphine treatment, or considered the result to be very good or excellent. Only about 1 person in 20 stopped taking morphine because of side effects. Morphine is associated with some unwanted effects, mainly constipation, and nausea and vomiting. At one level these are good results. On another level, the quality of studies is generally poor and we could wish for more consistency in study design, and especially in study reporting, which should include the outcome of pain reduced to tolerable levels – no worse than mild pain – so that people with cancer are not bothered by pain.
+This Cochrane Review is current to August 2017. We included 14 randomised controlled trials involving 1260 participants, totalling 1361 trigger fingers. Two studies compared open surgery versus steroid injections, five studies compared percutaneous surgery versus steroid injection, one study compared open surgery versus steroid injection plus hyaluronic acid injection, one study compared percutaneous surgery plus steroid injection versus steroid injection, five studies compared percutaneous surgery versus open surgery, one study compared endoscopic surgery versus open surgery and one study compared three types of skin incision to open surgery. The majority of participants were female (about 70%); they were aged between 16 and 88 years; and the mean follow-up of participants after the procedure was eight weeks to 23 months. Due to space constraints, the reporting of all results was limited to the main comparison — open surgery versus steroid injection — because open surgery is the oldest and the most widely used treatment method and considered as standard surgery, whereas steroid injection is the least invasive control treatment method as reported in the studies in this review and is often used as first-line treatment in clinical practice. Based on two trial (270 participants), compared with the steroid injection procedure: Resolution of trigger finger (lessening of symptoms with no recurrence): • 92 out of 100 people had resolution of symptoms with open surgery. • 61 out of 100 people had resolution of symptoms with steroid injection. Incidence of pain, assessed as the presence or absence of pain after the procedure was performed (at one week): • 49% more people had pain with open surgery (33% to 66% more). • 68 out of 100 people had pain with open surgery. • 19 out of 100 people had pain with steroid injection. Recurrence of the trigger finger (from six to 12 months): • 29% fewer people had recurrence of symptoms with open surgery (60% fewer to 3% more). • 7 out of 100 people had recurrence of symptoms with open surgery. • 39 out of 100 people had recurrence of symptoms with steroid injection. Adverse events: Adverse events including infections, tendon injuries, cutaneous discomfort, flare or fat necrosis at the procedure site, or neovascular events were uncommon in either treatment group. No study reported hand function or participant-reported treatment success or satisfaction. Very low quality evidence from two trials means we are uncertain whether open surgery improve resolution of trigger finger in comparison with steroid injection, due the risk of bias in the design of the studies, inconsistencies between studies and the small number of participants in studies. Low-quality evidence from two trials shows that open surgery may result in fewer recurrences of trigger finger compared with steroid injection procedure, although it increases the incidence of pain during the first week after the procedure. Evidence was downgraded to 'low' due to the risk of bias in the design and the small number of participants. No studies measured functional improvement or participant satisfaction in the comparison between open surgery and steroid injection. We are uncertain whether there is a difference in the risk of adverse events or neurovascular injury between treatments, as few events occurred in the studies. Only low and very low-quality evidence was found for other comparisons so we are uncertain if percutaneous surgery has any benefits over steroid injection, or if open surgery is better than steroid plus hyaluronic acid, or if one type of surgery is better than another.
+We searched the scientific literature up to March 2014 for studies of adults over 18 years of age with a diagnosis of anaplastic oligodendrogliomas, anaplastic oligoastrocytomas or anaplastic astrocytomas. After surgery, the participants had to have received radiotherapy alone, chemotherapy alone or radiotherapy plus chemotherapy. In the first review on this topic in 2009, we found two trials to include. In this update, we identified another trial for inclusion, and updates from the two previously included trials were taken into consideration. Three randomized controlled trials, which included 931 participants, assessed the role of chemotherapy alone or in addition to radiotherapy, or radiotherapy alone. One study was able to demonstrate a significant survival benefit for the addition of chemotherapy to radiotherapy after surgery, compared with radiotherapy alone. In addition, during examination of these brain tumour biopsy specimens, they found specific chromosome deletions and mutations in two studies, which helped to identify a group of participants with better survival outcomes. Furthermore, in one study, these specific chromosome deletions and mutations predicted which group of participants derived benefit from the addition of chemotherapy to radiotherapy after surgery. Evidence for giving radiotherapy and chemotherapy was of good quality, but sparse.
+We included five studies in the review. These studies each included 25 to 62 children between one and 11 years of age with mild to moderate OSA treated at specialised sleep outpatient clinics. The included studies used two different types of anti-inflammatory medications. Seventy-five children were randomised to receive either intranasal corticosteroid nasal spray or placebo. One hundred and three children were randomised to either montelukast tablet or placebo. Three studies were supported by drug manufacturers. We are uncertain about the difference in the number of breathing pauses, episodes of shallow breathing, episodes with a lack of blood oxygen, or sleep disruption between children receiving corticosteroid nasal spray compared to placebo (2 studies involving 75 children). Children receiving montelukast tablets had fewer breathing pauses, fewer episodes of shallow breathing, and less sleep disruption compared to those treated with placebo (2 studies involving 103 children). However, we are uncertain about the difference in the number of episodes with a lack of blood oxygen between the montelukast and placebo group. Unintended effects were assessed in all trials, but were rare and of minor nature (e.g. nosebleeds). Serious unintended effects were not reported. The certainty of the evidence for corticosteroid nasal spray for the treatment of OSA was low for the primary outcome due to the wide range of the beneficial effect with some inconsistency of the effect between the two included studies. We excluded one study from the analysis due to serious concerns about the quality of the study results. The evidence for the use of montelukast tablets in the treatment of OSA was of moderate certainty for the primary outcome. There were concerns about the design and conduct of one study and some inconsistency of the effect between the two included studies. The evidence is current to October 2019.
+In this review, we investigated whether systemic treatments can prevent thrombosis. We identified six studies; two studies investigated low molecular weight heparins, one antithrombin supplementation and one cryoprecipitate and/or fresh frozen plasma supplementation; one study compared antithrombin supplementation with low molecular weight heparin and antithrombin supplementation, and another investigated warfarin. The addition of low molecular weight heparins to antithrombin supplementation did result in a lower number of symptomatic thromboses. This was statistically significant. We could not detect an effect of systemic preventive treatments in comparison with no treatment, and no difference was noted in the number of participants who suffered from major or minor bleeding. However, the overall number of participants was very small; a similar study with a larger population of participants might yield different results.
+The available evidence does not fully establish CSF drainage as a method of protection. The review authors made a thorough search of the medical literature and identified three randomised trials involving a total of 287 participants operated on for high-risk thoracoabdominal aortic aneurysms. All of the studies used CSF drainage in addition to other measures of spinal cord protection. In the first trial of 98 patients, neurological deficits in the lower extremities occurred in about one third of patients with or without drainage. The deficit was observed within 24 hours of the operation in 21 (68%), and from three to 22 days in 10 (32%). The second trial of 33 patients reported that a combination of CSF drainage and papaverine in the region of the spinal cord (intrathecally) reduced the rate of postoperative neurological deficit compared to controls. In the third trial involving 145 patients, drainage was begun during the operation and continued for 48 hours after surgery. Paraplegia or paraparesis occurred less with CSF drainage (2.7% of patients with drainage versus 12.2% in the control group).
+This review included 13 small randomised controlled trials (RCT), with a total of 662 participants. Most of these were of poor methodological quality. For treating CPP, the clearance rate between the NB-UVB and oral PUVA groups were inconsistent in three RCTs. In one, there was no difference between the groups, and in the other two, the clearance rate was in favour of oral PUVA. The evidence from the comparison of NB-UVB with bath PUVA in terms of clearance rate was also inconsistent: Pooled data from two left-right body comparison RCTs found no significant difference between the two groups, while another RCT favoured bath PUVA. Two RCTs found NB-UVB plus retinoid (re-NB-UVB) and PUVA plus retinoid (re-PUVA) had similar effects for treating people with CPP or guttate psoriasis. One RCT found no significant differences between NB-UVB and selective BB-UVB for clearing CPP or in the number of withdrawals due to side-effects. In participants with PPP, one RCT found there were no statistically significant differences between NB-UVB treated sides and topical PUVA treated sides in terms of clearance rate. In summary, NB-UVB may be preferred to oral or bath PUVA because it is more convenient to use. NB-UVB seemed to be equal to selective BB-UVB for clearing CPP. Evidence regarding NB-UVB and conventional BB-UVB is limited. The long-term safety of NB-UVB needs to be confirmed. The efficacy of NB-UVB for clearing PPP needs to be confirmed in future studies.
+There was some evidence from trials suggesting that these treatments are helpful. If patients who have tried and failed other simpler treatments, such as changing their diet or using medications, are selected then biofeedback using computer equipment or rectal balloon is more beneficial than exercises alone. Exercises and electrical stimulation used in the anus may be more helpful than vaginal exercises for women with faecal incontinence after childbirth. About half of the 21 trials were at low risk of bias. They compared different combinations of treatments and different outcome measures, making comparison between them difficult. However, a small number of the larger recent trials provide better evidence.
+Five trials suggested that it might be better to use a catheter after surgery than not to use one as fewer people needed to be re-catheterised if a catheter was used at first. Information from six trials suggested that fewer people needed to be re-catheterised for urinary retention if a suprapubic catheter was used instead of a urethral one. People in up to 11 trials had fewer urinary tract infections if the catheters were removed sooner rather than later.   Although 39 trials were included in the review in total, the evidence in general was poor and came from small studies, which often did not provide enough information to draw firm conclusions. Much larger trials with many more participants must be conducted.
+Ten studies are included (3340 participants). Most studies compared aripiprazole versus placebo, but some researchers compared aripiprazole versus haloperidol (two studies) and versus lithium (one study). Two studies examined the effect of adding aripiprazole to another treatment (valproate or lithium) and compared this combination versus placebo combined with these other treatments. We assessed the overall risk of bias in the ten studies as unclear. The main measure of effect was the mean change on the Young Mania Rating Scale from the start to the end of the trial; this tool is used by clinicians to assess the severity of mania. After three weeks of treatment, aripiprazole was better than placebo at reducing the severity of mania when used on its own or when added to other mood stabilisers. The effect was modest. However, aripiprazole caused more inner restlessness (akathisia), nausea, and constipation than placebo. Aripiprazole was similarly effective in reducing the symptoms of mania when compared with other drug treatments (haloperidol and lithium). Aripiprazole caused fewer movement disorders and less raised prolactin (a hormone secreted by the pituitary gland) than haloperidol. People taking aripiprazole were more likely to remain on treatment than those taking haloperidol but were no more or less likely than those taking placebo or lithium. The main reason for the difference in dropouts between aripiprazole and haloperidol groups was the adverse effects associated with haloperidol. In summary, aripiprazole is an effective treatment for mania when compared with placebo. This finding is based on studies that included mixed populations (i.e. children, adolescents and adults). For the adult population, studies have directly compared aripiprazole versus haloperidol, lithium and placebo, but evidence obtained for treatment of the child and adolescent population is available only from placebo-controlled studies. Given the lack of evidence obtained by comparing aripiprazole versus other drugs, its exact place in therapy is unclear. Further studies focused on particular populations are needed to determine whether this treatment is equally effective in different age groups.
+In this review we investigated the effect of lock treatments on CVC-related infections. We identified three studies: two investigating the effect of urokinase lock treatments in addition to antibiotics and one study investigating the effect of ethanol locks in addition to antibiotics. We could detect no effect of urokinase or ethanol locks. However, the groups were very small. A similar study with a larger participant population might have different results.
+Electronic bibliographic databases were searched up to 11 July 2010. Fifteen randomised controlled trials (1660 participants) looking at the effectiveness of patient education strategies for neck disorders were included. Of the 15 selected trials, only one trial depicting moderate quality evidence favoured the educational video for acute WAD. The remaining trials showed that patient education trials did not demonstrate evidence of benefit or favoured the comparison treatment being exercise for pain. Other outcomes were less frequently reported and did not yield results that diverged from those associated with pain. Participants who received advice to stay active reported little or no difference in pain compared with those who received no treatment, treatments focusing on rest, treatments focusing on exercise, physiotherapy and cognitive behavioural therapy. Additionally, stress-management therapies, when compared with no treatment, did not seem to have an effect on pain intensity in patients with mechanical neck disorders. Finally, self-care strategies (ergonomics, exercise, self-care, relaxation) do not seem to have an effect on pain when compared with no treatment. No adverse events were reported in the trials. In summary, the review authors concluded that there is no strong evidence for the effectiveness of educational interventions in various neck disorders.
+That CJD and vCJD are very rare diseases creates challenges for researchers aiming to conduct rigorous quantitative studies in this area. Although we searched widely to identify all relevant research evaluating the effects of interventions to communicate with (notify and support) people at risk, we did not identify any studies that met the criteria for inclusion in this Cochrane review. However, systematic searches did identify a number of pieces of relevant research and literature that provided evidence about policy implementation and consumer experiences in situations of iatrogenic exposure to risk. This research formed the basis of a thematic synthesis. The synthesis identified several activities that aim to improve the experiences of people at risk of CJD and vCJD. It indicates that communication may be best considered as a longitudinal multicomponent programme occurring over time, ensuring that notification is coordinated and considers impact; that support is in place and is offered over time; that communication is flexible, tailored and responsive to need; and that supporting activities, such as widespread education of the healthcare workforce, the public and the media, and monitoring of access to health care for those at risk, are in place. The thematic synthesis also indicates that poor communication practices may have negative impacts or cause harm, such as discrimination in accessing health care. In the absence of rigorous evaluative studies the results of this thematic synthesis can be used to inform policy and practice decisions for communicating with people at risk.
+We included one randomised controlled clinical trial with moderate risk of bias that tested a combination of oxycodone and naloxone against placebo capsules, taken twice daily in participants whodid not respond to more usual medications. Researchers used the International RLS severity scale to find out if patients were improved after 12 weeks of treatment. Particpants receiving the combined oxycodone and naloxone reported improvement in RLS symptoms, Quality of life, and sleep quality; 42% of the drug group were symptom-free. Discussion The study was well designed overall, but was at a high risk of bias due to the high percentage of participants who withdrew from treatment (attrition bias). Eighty-four percent of the drug group developed adverse events, which were mostly related to the gastrointestinal system, headache, fatigue, and sleepiness (somnolence); 9.8% left the study because of the adverse events. Conclusion The use of opioids for the treatment of RLS in patients resistant to conventional treatment is supported by low-quality evidence. Prescription of these medications should be based on clinical experience, and caution used due to the potential for abuse, dependency, and adverse events. No patient on opioids complained that their symptoms worsened.
+Fifteen trials, involving 1022 adults with potentially or evidently unstable fractures, were included. While all trials compared external fixation versus plaster cast immobilisation, there was considerable variation in their characteristics especially in terms of patient characteristics and the method of external fixation. Weak methodology, such as using inadequate methods of randomisation and outcome assessment, means that the possibility of serious bias can not be excluded. The review found that external fixation reduced fracture redisplacement that prompted further treatment and generally improved final anatomical outcome. It appears to improve function too but this needs to be confirmed. The complications, such a pin tract infection, associated with external fixation were many but were generally minor. Serious complications occurred in both groups. The review concludes that there is some evidence to support the use of external fixation for these fractures.
+It is uncertain whether the number of major urological complications were different in those patients whose stent was removed early (less than 15 days post-operatively), when compared with those removed later (more than 15 days post-operatively). The number of patients suffering from a urinary tract infection may be less in the early removal group - especially if the stent was not exposed to the external environment. The studies identified for this review were generally of poor quality. It is uncertain whether a bladder indwelling ureteric stent that is removed early following kidney transplantation reduces the risk of complications, however it may prevent urine tract infections.
+We searched medical and dental sources for studies up to 21 January 2015. We identified five relevant studies. They were at high risk of bias because the participants knew which treatment they received and so did the people who treated them. Four studies compared crowns with fillings. Two of them compared metal crowns fitted using the conventional method with fillings and two compared metal crowns fitted using the Hall Technique with fillings. One of the studies also compared the Hall Technique with 'non-restorative caries treatment' (not using either a filling or crown but opening the cavity to make it possible to clean with a toothbrush, sealing with fluoride varnish and encouraging toothbrushing). The final study compared crowns made of two different materials (stainless steel versus stainless steel with a white covering). We looked at what happened for each treatment at the time of the dental appointment or within 24 hours of treatment, in the short term (less than 12 months) and long term (12 months to 48 months). Teeth restored with preformed crowns are less likely to develop problems (e.g. abscess) or cause pain in the long term, compared to fillings. Crowns fitted using the Hall Technique (no injections or tooth trimming) gave less discomfort at the time of the appointment, when compared with fillings. Crowns may increase the risk of gingival bleeding but this result was unclear. Only one small study compared crowns with non-restorative caries treatment and one small study compared metal and white crowns, and we could draw no reliable conclusions from these. Some of our outcomes of interest were not measured in any of the studies: these included time to restoration failure or retreatment, patient satisfaction and costs. There is moderate quality evidence that crowns are more effective than fillings for managing decay in primary molar teeth. There is moderate quality evidence that crowns fitted using the Hall Technique are less likely to cause abscesses and pain than fillings. The evidence comparing preformed crowns with non-restorative caries management, and comparing preformed metal crowns with preformed white crowns, is very low quality so we do not know which is better. Crowns placed on primary molar teeth with decay, or that have had pulp treatment, are likely to reduce the risk of major failure or pain in the long term compared to fillings. Crowns fitted using the Hall Technique may reduce discomfort at the time of treatment compared to fillings.
+The review includes 28 studies with 788 people (from infants to adults) with CF with mild to severe lung disease. The studies compared PEP to other methods of chest physiotherapy; the length of treatment ranged from a single session to two years of treatment. Generally, the efficacy of PEP is similar to other methods of chest physiotherapy such as postural drainage with percussion, active cycle of breathing techniques, autogenic drainage, oscillatory PEP devices such as the flutter and acapella, thoracic oscillating devices such as the 'Vest', and bilevel positive airway pressure (BiPaP) (typically used for ventilatory support, but by changing the inspiratory and expiratory pressures on the device and combining it with huffing, BiPaP has been used for airway clearance). We found no difference between PEP and other forms of chest physiotherapy in lung function, the amount of mucus cleared from the airways or its related effects on the health of people with CF. However, the rate of flare ups of respiratory symptoms decreased in people using PEP compared to other forms of physiotherapy such as a vibrating PEP device or a vibrating vest. There was some evidence that people with CF may prefer PEP to other chest physiotherapy methods. There was no evidence of PEP causing harm, except in one study where infants performing either PEP or percussion in various positions which use gravity to help drain secretions, experienced some gastro-oesophageal reflux (regurgitation of food) in head-down positions; this was more severe in the group using postural drainage with percussion. In all the other trials PEP was performed in a sitting position. In 10 of the 28 studies studied single PEP treatment sessions. The results from these studies are very limited as they could not report on the number of respiratory infections and lung function did not change with just one treatment. Two one-year studies compared PEP to postural drainage and percussion; in the study with children, PEP improved their lung function, while in the adult study, lung function declined slightly with both PEP and postural drainage and percussion. Also, the method of performing PEP was different in the two age groups. Although PEP seems to have an advantage in reducing flare ups (based on the combined results of a few studies), different physiotherapy techniques and devices may be more or less effective at varying times and in different individuals during baseline function and chest flare ups. Each person should talk to their clinician to help choose which method of airway clearance is best for them and which they will adhere to, so as to provide the best quality of life and long-term outcomes. Some studies were of low quality. These studies highlight the difficulty in comparing studies using PEP compared to other forms of chest physiotherapy. Factors such as age and severity of lung disease in the participants may affect the results as well as the method of performing each treatment. Overall, the evidence provided by this review for whether PEP reduces flare ups compared to other forms of chest physiotherapy was moderate to high quality, but evidence for other outcomes was of very low to moderate quality, as results were limited.
+The literature was searched up to 28 January 2019. Four studies involving 1485 patients compared certolizumab pegol with placebo (a dummy drug). All studies included patients with active Crohn’s disease. Most patients were adults over 18 years of age, except for six patients aged 16 or 17 years old. All studies were funded by the drug manufacturer. In a combined analysis of the four studies, patients with active Crohn’s disease who received certolizumab pegol at a dose ranging from 100 mg to 400 mg every 2 to 4 weeks, responded to the treatment and achieved remission at 8 weeks more often than patients taking placebo. No remarkable difference in the rate of serious side effects was observed between certolizumab pegol and placebo. Serious side effects included worsening Crohn's disease, infections, and malignancy (i.e. cancer). Moderate certainty evidence suggests that certolizumab pegol is beneficial in terms of achieving remission in people with moderate to severe Crohn's disease. Because of a low number of serious side effects, the certainty of evidence about harms of certolizumab pegol was moderate. Moderate certainty evidence suggests that certolizumab pegol is effective for induction of clinical remission and clinical response in people with active Crohn's disease. It is uncertain whether the risk of serious side effects differs between certolizumab pegol and placebo. Future studies are needed to evaluate the long-term benefits and harms of certolizumab pegol in people with Crohn's disease.
+We found 31 studies involving 23,762 people with heart failure and chronic kidney disease. Patients were given either a heart failure medicine compared to standard care or a placebo. The treatment they received was decided by random chance. Although there were many different treatments studied, unfortunately, few of them looked at the same type of medicine. As well, there were many different ways that researchers measured what happened when patients took these medicines. As a result, we could not combine the studies together and clarify the benefits and harms of each treatment. Existing studies cannot really tell us whether medicines used to treat heart failure in the general population are effective or safe for people who have both heart failure and chronic kidney disease. We are not able to recommend which heart failure medicines are best for people with heart failure and chronic kidney disease. We need more information from large clinical studies. Most of the heart failure studies did not report treatment effects separately based on levels of kidney function. Obtaining this information from existing studies may be helpful to learn more about how to treat heart failure in people with chronic kidney disease.
+The aim of this review was to compare the effectiveness of IT compared with ET. We included three randomised controlled studies (1945 women). The methodological quality of the studies was considered to be moderate. When comparing internal registration of contractions with external registration of contractions during induced or augmented labour, there were no differences in any of the outcomes for mother or child: adverse neonatal outcomes, instrumental deliveries, caesarean section, use of analgesia or time to delivery. No increased risk for infection was reported when an intrauterine catheter was used in these studies. There is insufficient evidence to recommend the use of one form of tocodynamometry over another for women where intravenous oxytocin is administered for induction or augmentation of labour.
+This review included two clinical trials, involving a total of 54 participants, that compared directly the effects of physical exercise and a control intervention (evidence current until May 2016). One study reported no difference between the exercise and control groups whereas the second reported a reduction in symptoms in the exercise group. At the end of the study, an improvement in venous blood return was observed in the exercise group compared with the control group. The included studies did not report on new cases of venous leg ulcers. No difference between the exercise and control groups was observed with regard to participants' quality of life, the range of motion of the ankle joint or overall muscle strength. The overall finding of an improvement in venous blood return in the exercise group favours the idea that physical exercise improves blood flow conditions in people with CVI, but we found the risk of bias due to blinding or randomisation to be high for both studies. We therefore consider that there is currently not enough information to determine whether physical exercise is effective in the management of CVI. Quality of the evidence We judged the overall quality of evidence as very low: the two included studies were small (54 participants in total) and were at high risk of bias based on their methods of blinding or randomisation.
+To evaluate the efficacy, effectiveness and safety of HA products, in knee OA, we have conducted a systematic review using Cochrane methodology. The analyses support the contention that the HA class of products is superior to placebo. There is considerable between-product, between-variable and time-dependent variability in the clinical response. The clinical effect for some products against placebo on some variables at some time points is in the moderate to large effect size range. In general, sample size restrictions preclude any definitive comment on the safety of the HA class of products, however, within the constraints of the trial designs employed, no major safety issues were detected. The analyses suggest that viscosupplements are comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events, and that HA products have more prolonged effects than IA corticosteroids. Overall, the aforementioned analyses support the use of the HA class of products in the treatment of knee OA.
+The review identified 10 randomised controlled trials involving 4052 women. Seven of these trials looked at a drug called misoprostol, which is a prostaglandin and so works by increasing muscle contractions. Overall, the trials suggest that misoprostol does not work as well as oxytocin infusion, and it has more side effects. However, oxytocin needs to be kept in a refrigerator, and so in settings where refrigeration and infusions are not readily available, misoprostol can be used. Other clinical trials looked into using other types of drugs or squeezing the main artery that supplies blood to the woman. The number of women included in these studies was too small for any useful conclusions regarding their effectiveness and safety.
+This systemic review was done to analyze whether adding cysteine (or related compounds) to intravenous nutrition affects growth and other outcomes in newborn infants. Five trials studied the effects of adding cysteine to intravenous nutrition that did not contain cysteine. Addition of cysteine significantly improved the babies' ability to build body proteins (analyzed in four studies); however, it did not improve growth (analyzed in one study); no other outcomes were available. One large randomized trial studied the effect of adding another chemical, N-acetyl-cysteine, to intravenous nutrition that already contained cysteine. This study showed no benefit and no toxicity of this intervention. We conclude that present data are insufficient to justify routine addition of cysteine to the intravenous nutrition of newborn infants that does not contain cysteine. Available evidence does not support routine addition of N-acetylcysteine to intravenous nutrition of newborn infants containing cysteine.
+We included 77 randomised clinical trials that involved a total of 6287 participants. Of these, 41 trials (3829 participants) provided information for one or more outcomes for this review. Thirty-five trials only included participants with NASH; five included only people with diabetes mellitus; and 14 included only people who did not have diabetes mellitus. The average follow-up period in the trials ranged from one month to two years in the trials that reported this information. We excluded trials in which participants with NAFLD had undergone liver transplantation before the trial. As well as conducting standard Cochrane analysis, we also planned to conduct network meta-analysis (a technique that enables comparison of different treatments that are not directly compared to each other in the trials). However, the nature of available information meant we could not determine if the network meta-analysis results were reliable. Specific outcomes we looked for were numbers of deaths, adverse events, and assessment of health-related quality of life. Twelve trials did not receive any additional funding or were funded by sources with no vested interest in the results; 26 were funded by drug companies that could potentially benefit from trial results; and the funding source was not available from 39 trials. Included trials compared drug treatments such as bile acids, antioxidants, phosphodiesterase type 4 inhibitor, glucocorticosteroid inhibitor, anti-cholesterol drugs and anti-diabetes drugs with a fake treatment (placebo) or no treatment. There were no deaths in either group (87 participants, 1 trial). None of the participants developed serious adverse events in the trial which reported the percentage of people with serious adverse events (87 participants, 1 trial). There was no evidence of difference in the number of serious adverse events between antioxidants and no intervention (254 participants, 2 trials). There was no evidence of difference in deaths at maximal follow-up (659 participants, 4 trials), percentage of people with serious adverse events (404 participants, 3 trials), or the number of serious adverse events (404 participants, 3 trials) between bile acids and no intervention. None of the trials reported health-related quality of life. There were no deaths in either group (74 participants, 1 trial). None of the participants developed serious adverse events in the two trials which reported the percentage of people with serious adverse events (194 participants, 2 trials). There was no evidence of difference in the number of serious adverse events between thiazolidinediones and no intervention (357 participants, 3 trials). None of the trials reported health-related quality of life. We found no evidence of benefit from any of the compared interventions in people with fatty liver disease. There is significant uncertainty in this issue, and we need further high quality randomised clinical trials with sufficiently large group of participants. Evidence quality was very low overall, and there was a high risk of bias. This means there is a possibility of making conclusions that wrongly interpret benefits or harms of treatments because of the ways the studies were conducted.
+The evidence is current to January 2013. We included 15 studies containing a total of 1282 participants with MCI. The majority of studies (n = 9) were published between 2010 and 2013. The remaining six studies were published between 2004 and 2009. All of the included studies were conducted in Europe. Study sizes varied and ranged from 15 to 231 participants.The mean (range) age of the youngest sample was 64 years (45 to 76) and the mean (standard deviation) age of the oldest sample was 73.4 (6.6) years. Our findings are based on studies with poor reporting, with a majority of studies at unclear risk of bias due to insufficient details given on how participants were selected and how the clinical diagnosis of dementia was established. According to the assessment of how the CSF tests were conducted and analysed, eight of 15 studies were of poor methodological quality. Below is a summary of key findings for the tests: CSF t-tau test for conversion from MCI to Alzheimer’s disease dementia The sensitivity values in seven individual studies ranged from 51% to 90% while the specificity values ranged from 48% to 88%. The statistical analysis of those studies showed that, at the fixed specificity of 72%, the estimated sensitivity was 77%, and, at the prevalence of 37%, the positive predictive value was 62% and the negative predictive value was 84%. Based on these results, on average 62 out of 100 people with MCI and a positive index test result would convert to Alzheimer's disease dementia but 38 would not; on average, 84 out of 100 people with MCI and with a negative index test result would not convert to Alzheimer's disease dementia, but 16 would. CSF p-tau test for conversion from MCI to Alzheimer’s disease dementia The sensitivity values in six individual studies ranged from 40% to 100% while the specificity values ranged from 22% to 86%. The statistical analysis of those studies showed that, at the fixed specificity of 48%, the estimated sensitivity was 81%, and, at the prevalence of 37%, the positive predictive value was 48% and the negative predictive value was 81%. Based on these results, on average 48 out of 100 people with MCI and with a positive index test result would convert to Alzheimer's disease dementia, but 52 would not; on average, 81 out of 100 people with MCI with a negative index test result would not convert to Alzheimer's disease dementia, but 19 would. We found that the cerebrospinal fluid (CSF) diagnostic test, as a single test, lacks the accuracy to identify those people with mild cognitive impairment (MCI) who would develop Alzheimer’s disease dementia or other forms of dementia over a period of time. The data suggested that a negative CSF test, in people with MCI, almost indicates the absence of Alzheimer's disease as the cause of their clinical symptoms. However, a positive CSF test does not confirm the presence of Alzheimer's disease as the aetiology (cause) of their clinical symptoms. There were methodological problems in the included studies that did not allow for a clear answer to the review question. The main limitations of the review were poor reporting in the included studies, lack of a widely accepted threshold of the CSF diagnostic tests in people with MCI, variability in length of follow-up, and the marked variation in CSF tests’ accuracy between the included studies.
+The evidence is current to May 2016 and was provided by three small randomized controlled trials involving 170 males who had their prostate removed. These studies took place in hospitals in Korea and Turkey. We looked for differences in pain and postoperative nausea and vomiting (PONV) and changes in pressure inside the eyes between patients receiving anaesthetic via the veins or by inhalation. Study funding sources Studies were funded by the institution, or the funding sources were not stated. Key results Postoperative pain was no different between the two types of anaesthesia. Anaesthesia delivered through the veins reduced PONV at one to six hours after prostate surgery compared with anaesthesia provided via inhalation. One study showed that anaesthesia delivered through the veins prevented an increase in pressure inside the eyes during surgery compared with inhalational anaesthesia. We cannot conclude whether this means that anaesthesia provided via the veins reduces ocular complications, as no patients in this small study developed these complications. Quality of the evidence The quality of the evidence was considered low, as included studies were small and provided an unclear description of methods. All participants in these studies were men who were undergoing robotic assisted laparoscopic removal of the prostate. An ongoing trial includes men and women undergoing abdominal robotic surgery, also with a focus on the quality of recovery. Additional studies are needed.
+We updated the review that was previously published in 2009. We examined the research published up to July 2015 and found seven new studies. All in all, this updated review included a total of 14 observational studies that assessed 1,601,515 pregnancies. Observational studies are generally regarded as less rigorous than randomised controlled clinical trials. The funding source was from academic or governmental institutions in 10 studies and was not reported in 4 studies. We found no associations between mothers' use of topical steroids of any potency and type of delivery, birth defects, premature births, or low Apgar score. There is some evidence indicating a relation between low birth weight and maternal use of potent or very potent topical steroids, especially when high doses are used in pregnancy, and this may warrant more research. On the other hand, maternal use of mild or moderate topical corticosteroids is not related to low birth weight. We even found that mild or moderately potent topical steroids protect against death of the baby, but this was not seen when the mothers used potent or very potent topical steroids. This finding needs further examination. The overall quality of evidence is low because all available studies were observational. The high quality study design of the randomised controlled trial that allocates participants to receive either topical corticosteroids or no treatment is not generally feasible in pregnant women due to ethical concerns about possible exposure of the foetus to an experimental treatment. Where we further downgraded the quality of the evidence to 'very low', it was because we had detected variation in the results from the studies that we found, which means that we have low confidence in our estimates of the effects for our outcomes.
+We found four studies in which antibiotics alone had been compared with antibiotics plus corticosteroids for the treatment of bacterial keratitis. These studies were conducted in the USA, Canada, India, and South Africa, and included a total of 612 eyes of 611 participants. The largest study included 500 participants followed for one year. The three smaller studies followed participants for two to three months. The evidence is current to July 2014. None of the four studies reported an important difference between topical corticosteroid therapy and placebo or control treatment for reduction in ulcer size, change in visual acuity, adverse events, or quality of life. One study reported that healing or cure time in the steroid group was slower than the placebo group (for every 100 people cured in the control group, only 47 were cured in the steroid group during the same time period), but the largest study did not report any difference (for every 100 people cured in the control group, 92 were cured in the steroid group during the same time interval). For adverse events, none of the studies found a difference between the two groups, except that one study reported that more eyes in the control group developed intraocular pressure (IOP) elevation. We did not find any information on economic outcomes. Generally, the quality of the evidence based on the four studies we identified was moderate due to the proportions of participants who were not included in the final study analyses and the inconsistency of outcomes assessed across the four studies. In addition, three studies enrolled too few participants (30 to 42) to reach scientifically valid conclusions.
+We included four trials with 450 participants randomised to either percutaneous vascular intervention or clot-dissolving drugs given by injection. The evidence is current as of September 2017. Compared with clot-dissolving drugs, percutaneous vascular interventions did not increase the chance of making a good recovery by the end of the trial. There was no significant increase in the risk of dying or of suffering a brain bleed. New, larger trials are needed, particularly because of the rapid development of new techniques and devices for percutaneous vascular interventions. We judged the quality of the evidence to be low because of the limited amount of trial information available.
+We included studies that assessed the effects of centre-based day care for children younger than five years of age in high-income countries. To isolate the effects of day care, we excluded interventions that involved medical, psychological or non–child-focused co-interventions. Electronic searches identified 34,890 citations that were screened for inclusion in the review. Only one study (120 families, 143 children), based in London, England, matched all inclusion criteria and was included in the review. Evidence is current to April 2014. Currently very limited evidence is available on the effects of centre-based day care on the cognitive and psychosocial development of children, parental employment or household income, or on long-term outcomes for children. Only one randomised controlled trial (RCT) was included in this review. In addition, a large proportion of families in the non-intervention group secured day care services for themselves. The quality of the evidence included in this review is very low, so the results must be interpreted with caution. Although RCTs do not allow conclusive judgements as regards the role of centre-based day care in the development of children and the economic situation of parents, this does not imply that these services are not important in high-income countries. The need for effectiveness studies of centre-based day care without co-interventions is significant. This review is one of a pair of reviews; researchers and practitioners may find evidence from the low- and middle-income country review to be informative also (Brown 2014).
+The researchers found that 11 out of the 30 histologic scoring indices that exist have been partially validated. The Nancy Index and the Robarts Histopathology Index have undergone the most validation compared to the other nine indices. However, none of the currently available histologic scoring indices have been fully validated. In order to determine the ideal index to measure histologic healing in UC, more research is required. The ideal index would need to be fully validated.
+We searched medical databases and trials registries in December 2014. We wanted to include studies in which receiving one surgical treatment or another surgical treatment was decided by chance. This research method, termed a randomised controlled trial (RCT), is the best way to ensure that any measured improvement is caused by the treatment itself and no other factors. We found three RCTs involving 213 adults (with results available from 173) that compared nailing versus plating for treating distal tibial fractures. Overall the studies included around twice as many males as females and the average age of the study participants was just over 40 years. We found no trials comparing surgery with non-surgical treatment. We found no clear differences between the nailing and plating groups in terms of patient-reported functional outcomes, re-operations for adverse outcomes, troublesome non-healing of the bone or deformity, pain, wound problems such as infection, or the numbers of individuals with healed fractures. Only three trials were identified and the sample sizes were small, so the results are imprecise. Moreover, the results of one trial were very likely to be biased due to flawed methodology. We therefore judged the overall quality of evidence to be very low, which means that we are very unsure of these results. Overall, the evidence is of very low quality and is insufficient to draw definite conclusions about the best method of surgery, including nailing versus plating, for treating breaks of the lower end of the shin bone in adults. Future updates of this review are likely to include evidence from currently ongoing research comparing nailing versus plating. Although other RCTs are needed to address key clinical questions on surgical methods for treating these fractures, these studies should be preceded by research to determine which questions should be prioritised.
+this review is up-to-date to August 2017. We included 11 trials involving 38,742 participants: eight trials assessed the effect of blood pressure drugs, and three trials compared different blood pressure targets. Ten studies were hospital-based and one trial was performed in a general practitioner setting. Not all trials contributed information to all outcomes. blood pressure drugs lowered the risk of recurrent stroke in patients with a stroke or TIA, whereas there is insufficient evidence to conclude whether they reduce the risk of other blood vessel diseases and dementia. There is also insufficient evidence to conclude which blood pressure target is best for patients with a stroke or TIA. overall, the quality of the trials in this review was moderate. However, we found similar results in an analysis using only high-quality trials. More research is needed to investigate whether blood pressure drugs also prevent dementia, and what blood pressure targets are best for patients with a stroke or TIA.
+The review found that beta-sitosterol treatments were well tolerated and improved urinary symptoms and flow measures in men with mild to moderate BPH. More research into long-term effects of beta-sitosterols is needed.
+There was no statistically significant difference in the number of people who died during treatment with salmeterol compared with placebo or salbutamol. Because so few people die of asthma, huge trials or observational studies are normally required to detect a difference in death rates from asthma. There were more non-fatal serious adverse events in people taking salmeterol compared to those on placebo; for every 188 people treated with salmeterol for 28 weeks, one extra non-fatal event occurred in comparison with placebo. There was no significant differences in serious adverse events in people on salmeterol compared to regular salbutamol. In order to obtain individual patient data on asthma deaths, we looked separately at mortality in two large trials on over 51,000 patients who were not taking inhaled corticosteroids, and found that there was an increase in the number of asthma-related deaths among people on salmeterol. We conclude that, for patients whose asthma is not well-controlled on moderate doses of inhaled corticosteroids, additional salmeterol can improve symptoms but this may be at the expense of an increased risk of serious adverse events and asthma related mortality. Salmeterol should not be used as a substitute for inhaled corticosteroids, and adherence with inhaled steroids should be kept under review if separate inhalers are used. Salmeterol should not be taken by people who are not taking regular inhaled steroids due to the increased risk of asthma-related death.
+This review found two small trials that compared the use of thyroid hormones to no treatment in infants with breathing problems in the first hours after birth. No benefit was found from use of these hormones on severity of breathing problems or complications that occurred as a result of these breathing problems. The effect on longer term development was not reported.
+We included 29 RCTs comparing non-absorbable disaccharides with inactive placebo or no intervention and nine RCTs comparing lactulose with lactitol. Seven of the included RCTs evaluated the prevention of hepatic encephalopathy and 31 evaluated the treatment of hepatic encephalopathy. Sixteen of the treatment RCTs included people with overt hepatic encephalopathy while 15 included people with minimal hepatic encephalopathy. The duration of treatment varied depending on the type of hepatic encephalopathy from five days to one year. People who received non-absorbable disaccharides were less likely to die than people given a placebo or no treatment. They were also less likely to develop serious complications of their liver disease such as liver failure, bleeding, and infections. The non-absorbable disaccharides were also effective in preventing the development of hepatic encephalopathy and increased the number of participants who recovered from hepatic encephalopathy. There was some evidence from a small number of trials that lactulose has a beneficial effect on the quality of life, but we were unable to include the data in an overall analysis. The non-absorbable disaccharides were associated with adverse events including diarrhoea, nausea, bloating, and flatulence. None of the RCTs comparing lactulose versus lactitol reported quality of life. The analyses showed no differences between the two interventions for the remaining outcomes. In the comparison of non-absorbable disaccharides versus placebo/no intervention, we found moderate quality evidence of benefit for the outcomes of death, hepatic encephalopathy, and serious complications. The evidence for the remaining outcomes was of very low quality.
+In 2019, there are 65 research studies (involving 3598 people) that looked at whether medicines can prevent bone fractures after kidney transplant. The most common medicine in the studies was a bisphosphonate which slows bone breakdown. Bisphosphonates were given at around the time of kidney transplantation (generally just before or within a few weeks) and continued for about one year on average. Other treatment options in the studies were vitamin D, calcitonin, denosumab, teriparatide, or cinacalcet. Bisphosphonate treatment given after a transplant possibly prevents fractures and bone pain, however the range where the actual effect of treatment might be (the "margin of error") indicates that treatment might make little or no difference. Bisphosphonates possibly lower the chances of a rejection of the transplant kidney but because of problems with the research studies, we can't be very certain that this is true. Bisphosphonates caused low blood calcium levels for some people. There was low or very low confidence in the information about all the other possible treatments for bone fractures after a kidney transplant, as the studies were often too small. There was only one study for medicines in children so we don't know whether these drugs are useful and safe for younger people. It is still unclear whether bisphosphonate therapy makes any difference to bone fractures or are safe for both adults and children with a kidney transplant.
+Alcohol withdrawal syndrome (AWS) is a set of symptoms experienced when one reduces or stops alcohol consumption after prolonged periods of alcohol intake. Some studies show that AWS coincides with low levels of magnesium in the blood. Since magnesium may play a role in dampening the excitability of the central nervous system, some researchers believe that low levels of magnesium may make the central nervous system 'hyper-excitable' and may cause AWS symptoms, which include sleeplessness, tremors, anxiety, headache, excessive sweating and reduced appetite. Many AWS treatment protocols therefore recommend magnesium supplementation. The goal of our review was to determine whether magnesium supplementation prevents or treats AWS in adults. Our review of four trials covering 317 participants determined that there is not enough evidence about the benefits or harms of using magnesium supplements to prevent or treat AWS in adults.
+We included 15 studies in which adults with short-duration sinus infection, whether or not confirmed by imaging, randomly received antibiotics, or a dummy drug or no treatment, in ambulatory care settings. The studies included a total of 3057 adults whose average age was 36 years; about 60% were female. Participants were followed until they were cured. Trial duration ranged from 8 to 28 days. Seven studies received financial support from government or academic institutions; six received grants from the pharmaceutical industry; and five did not state sources of support. Without antibiotics, almost half of all participants were cured after one week, and two out of three were cured after 14 days. Five (diagnosis based on symptoms described to a doctor) to 11 (diagnosis confirmed by x-ray) more people per 100 were cured faster with antibiotics. A computed tomography (CT) scan could better predict who would benefit from antibiotics, but routine use would cause health problems related to radiation exposure. Ten more people per 100 were relieved faster of thick, yellow discharge from the nose with antibiotics compared to a dummy drug or no treatment. Thirteen more people per 100 experienced side effects (mostly concerning stomach or intestines) with antibiotics compared to a dummy drug or no treatment. Compared with people who initially started antibiotics, five more people per 100 in the dummy drug or no treatment group had to start antibiotics because their condition worsened. Serious complications (e.g. brain abscess) were rare. We found that antibiotics are not a first-choice treatment for adults with short-duration sinus infection. We found no evidence relating to adults with severe sinusitis or with reduced immunity, or to children. We found high-quality evidence when the diagnosis was based on symptoms described to a doctor. We downgraded evidence quality to moderate when diagnosis was confirmed by x-ray or CT scan because the number of participants was small, which makes the estimates less reliable.
+We collected data from eight randomized controlled trials addressing this issue and enrolling a total of 2515 patients. We found that D2 lymphadenectomy can reduce the number of deaths due to disease progression as compared to D1 lymphadenectomy. However, D2 lymphadenectomy was also associated with a higher rate of postoperative mortality. In addition, available evidence does not support the superiority of D3 versus D2 lymphadenectomy. In conclusion, our findings support the use of D2 lymphadenectomy in patients with resectable carcinoma of the stomach, although the increased incidence of postoperative mortality reduces its therapeutic effect. The quality of the evidence was moderate due to an intermediate level of result heterogeneity across the included trials.
+In this review of the medical literature oral naltrexone, with or without psychotherapy, was no better than placebo or no pharmacological treatments with regard to retention in treatment, use of the primary substance of abuse or side effects. The only outcome that was clearly in favour of naltrexone was a reduction of re incarcerations by about a half but these results were from only two studies. In single studies naltrexone was not superior to benzodiazepines or buprenorphine for retention, abstinence or side effects. The review authors identified a total of 13 randomised controlled studies that involved 1158 opioid addicts treated as outpatients following detoxification. Less than a third of participants were retained in treatment over the duration of the included studies. The mean duration was six months (range one to 10 months). None of included studies considered deaths from fatal overdoses in people treated with naltrexone.
+We found two studies, which were both part of the same multicentre trial and included people with dementia and people with or without dementia and Parkinson's disease. We included data on people with dementia only. The first of the two studies looked at the immediate effects of two viscosities of liquids compared to regular thin liquids on aspiration (entry of food or fluid into the lungs) in 351 people with dementia. This study also compared drinking regular thin liquids using a chin down head posture as well as drinking regular thin liquids without any changes to head position; the main outcome was fluid entering the lungs. Using a subgroup of 260 people with dementia from the first study, the second study compared the effect of the same liquid viscosities with a chin down head posture. The effectiveness of these interventions on the incidence of pneumonia and adverse effects of these interventions was examined over a three-month period. Honey thick viscosity liquids, which clinically are similar to descriptions of 'very thick liquids', had a more positive immediate impact on preventing fluid entering the lungs when examined during videofluoroscopy (specialised swallow x-ray) examination. However, during the three-month follow-up period there were a greater number of incidents of pneumonia in the group of people with dementia receiving these honey thick liquids, than those receiving nectar thick liquids and those receiving regular thin liquids with a chin down posture. There were no deaths classified as 'definitely related' to the type of liquids that the person with dementia was receiving. There were a number of methodological flaws in both studies in this review and these were acknowledged by the authors. While thickening fluids may have an immediate positive effect on swallow function, clinicians should consider the effects of this intervention on the person with dementia in the longer-term. People with dementia on thickened fluids require long-term follow-up. The overall risk of bias of included studies is high. The quality of evidence is low. Further well-designed research is needed.
+Six trials were included, with a total of 788 women undergoing an IVF treatment. The evidence is current to 31st July 2013. The largest trial in the review (with 396 women) has not yet reported full results. The evidence suggested that for a woman with a 53% chance of live birth using standard IVF, the chance using natural cycle IVF ranges from 34% to 53%. No significant difference was found in rates of clinical pregnancy, ongoing pregnancy, multiple pregnancy, incidence of ovarian hyperstimulation syndrome, gestational abnormalities or cancellations of treatment. However findings were imprecise for all outcomes and further evidence from larger studies is awaited. There was evidence from single studies that a lower number of oocytes was retrieved in the natural cycle group. Findings on cost-effectiveness were inconsistent. Quality ratings for the evidence ranged from very low to moderate, the main limitation being imprecision due to insufficient data. When the review authors checked the effect of using an alternative method of analysis the findings suggested higher rates of clinical pregnancy with standard IVF than with natural cycle IVF.
+We included a total of 811 participants from 12 studies in the final analysis of this review. The number of participants in each study ranged from 10 to 206, and mean age ranged from 61 to 74 years. The programme lasted for six weeks to one year. Included studies adopted different styles and numerous forms of Tai Chi. The most commonly reported form is the simplified 24-form Yang-style Tai Chi. No unwanted events or side effects were reported throughout the study period. Quality of evidence of all outcomes of interest ranged from very low to moderate. After training was completed, levels of shortness of breath in Tai Chi and control (i.e. usual care) groups were similar. Participants in the Tai Chi group walked farther, by 29.64 metres in six minutes, and had better pulmonary function, than those who received usual care. However, changes in quality of life were not apparent. When the effect of Tai Chi used in addition to another intervention (i.e. breathing exercise or exercise) was examined, we did not find that Tai Chi offered additional benefit in terms of shortness of breath or functional and psychosocial well-being. Currently, only one study has investigated the beneficial effects of Tai Chi on muscle strength and balance; investigators provided insufficient information to allow comment on the data in this review. Future studies addressing these topics are warranted.
+We identified 72 studies involving 2470 people after stroke. A wide range of virtual reality programs were used, with most aimed to improve either arm function or walking ability. The evidence is current to April 2017. Twenty-two trials tested whether the use of virtual reality compared with conventional therapy resulted in an improved ability to use one's arm and found that the use of virtual reality did not result in better function (low-quality evidence). When virtual reality was used in addition to usual care or rehabilitation to increase the amount of time the person spent in therapy there were improvements in the functioning of the arm (low-quality evidence). Six trials tested whether the use of virtual reality compared with conventional therapy resulted in improved walking speed. There was no evidence that virtual reality was more effective in this case (low-quality evidence). Ten trials found that there was some evidence that virtual reality resulted in a slightly better ability to manage everyday activities such as showering and dressing (moderate-quality evidence). However, these positive effects were found soon after the end of the treatment and it is not clear whether the effects are long lasting. Results should be interpreted with caution as, while there are a large number of studies, the studies are generally small and not of high quality. A small number of people using virtual reality reported pain, headaches, or dizziness. No serious adverse events were reported. The quality of the evidence was generally of low or moderate quality. The quality of the evidence for each outcome was limited due to small numbers of study participants, inconsistent results across studies, and poor reporting of study details.
+We examined the research published up to 6 March 2013 and we identified five randomised controlled trials (1330 people) that met the inclusion criteria. The trials were performed in low- and middle-income countries located in geographically diverse areas but there was a lack of studies conducted in Asia. We found no studies that examined the effect of including fluoroquinolones in a standard six month TB treatment regimen on treatment failure. We do not know whether adding fluoroquinolones or substituting fluoroquinolones for ethambutol in a standard six month TB treatment regimen reduces treatment failure, relapse, death, or adverse events. Substituting fluoroquinolones for isoniazid in a standard six month TB treatment regimen may have little or no difference upon death and adverse events. Currently, there are nine randomised controlled trials ongoing. HIV-positive participants were relatively well-represented in the included trials but none of the included trials stratified outcomes by HIV status. Also, the primary outcomes of all the included trials were reached before initiation of antiretroviral treatment. Evidence is generally lacking on the safety and efficacy of fluoroquinolone additions or substitutions in children (< 18 years) and in pregnant and lactating women.