Interventions for primary vesicoureteric reflux.
CONCLUSIONS: Compared with no treatment, the use of long-term, low-dose antibiotics may make little or no difference to the number of repeat symptomatic and febrile UTIs in children with VUR (low certainty evidence). Considerable variation in the study designs and subsequent findings prevented drawing firm conclusions on efficacy of antibiotic treatment.The added benefit of surgical or endoscopic correction of VUR over antibiotic treatment alone remains unclear since few studies comparing the same treatment and with relevant clinical outcomes were available for analysis. PMID: 30784039 [PubMed - as supplied by publish...
Source: Cochrane Database of Systematic Reviews - February 20, 2019 Category: General Medicine Authors: Williams G, Hodson EM, Craig JC Tags: Cochrane Database Syst Rev Source Type: research

Competitions for smoking cessation.
CONCLUSIONS: At present, it is impossible to draw any firm conclusions about the effectiveness, or a lack of it, of smoking cessation competitions. This is due to a lack of well-designed comparative studies. Smoking cessation competitions have not been shown to enhance long-term cessation rates. The limited evidence suggesting that population-based Quit & Win contests at local and regional level might deliver quit rates above baseline community rates has not been tested adequately using rigorous study designs. It is also unclear whether the value or frequency of possible cash reward schedules influence the success of c...
Source: Cochrane Database of Systematic Reviews - February 20, 2019 Category: General Medicine Authors: Fanshawe TR, Hartmann-Boyce J, Perera R, Lindson N Tags: Cochrane Database Syst Rev Source Type: research

Systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults.
CONCLUSIONS: There are few studies assessing the effects of systemic corticosteroids on cancer-related dyspnoea in adults with cancer. We judged the evidence to be of very low quality that neither supported nor refuted corticosteroid use in this population. Further high-quality studies are needed to determine if corticosteroids are efficacious in this setting. PMID: 30784058 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 20, 2019 Category: General Medicine Authors: Haywood A, Duc J, Good P, Khan S, Rickett K, Vayne-Bossert P, Hardy JR Tags: Cochrane Database Syst Rev Source Type: research

Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews.
Abstract BACKGROUND: Chronic pain, considered to be pain lasting more than three months, is a common and often difficult to treat condition that can significantly impact upon function and quality of life. Treatment typically includes pharmacological and non-pharmacological approaches. Transcutaneous electrical nerve stimulation (TENS) is an adjunct non-pharmacological treatment commonly recommended by clinicians and often used by people with pain. OBJECTIVES: To provide an overview of evidence from Cochrane Reviews of the effectiveness of TENS to reduce pain in adults with chronic pain (excluding headache or ...
Source: Cochrane Database of Systematic Reviews - February 19, 2019 Category: General Medicine Authors: Gibson W, Wand BM, Meads C, Catley MJ, O'Connell NE Tags: Cochrane Database Syst Rev Source Type: research

Surgical interventions for the prevention or treatment of lymphoedema after breast cancer treatment.
CONCLUSIONS: There is low-certainty evidence that lymphaticovenular anastomosis is effective in preventing the development of lymphoedema after breast cancer treatment based on the findings from two studies. One study providing very low-certainty evidence found that vascularised lymph node transfer is an efficacious option in the treatment of established stage 2 lymphoedema related to breast cancer. Important secondary outcomes in this review were rarely reported in the included studies. More high-quality RCTs are required to further elucidate the effectiveness of surgical interventions in the prevention and treatment of l...
Source: Cochrane Database of Systematic Reviews - February 19, 2019 Category: General Medicine Authors: Markkula SP, Leung N, Allen VB, Furniss D Tags: Cochrane Database Syst Rev Source Type: research

Effectiveness of provision of animal-source foods for supporting optimal growth and development in children 6 to 59 months of age.
CONCLUSIONS: Given the limited quality of the evidence, we are uncertain of the effects of the provision of animal-source food versus cereal products or no intervention on the growth or development of children. More adequately powered trials with deliberately selected animal-source foods are needed. PMID: 30779870 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 19, 2019 Category: General Medicine Authors: Eaton JC, Rothpletz-Puglia P, Dreker MR, Iannotti L, Lutter C, Kaganda J, Rayco-Solon P Tags: Cochrane Database Syst Rev Source Type: research

Sequencing of anthracyclines and taxanes in neoadjuvant and adjuvant therapy for early breast cancer.
CONCLUSIONS: In the neoadjuvant setting, there is high- to low-certainty evidence of equivalent outcomes for the sequence in which taxanes are delivered. In the adjuvant setting, none of the studies reported on overall survival or disease-free survival. In most institutions, standard practice would be to deliver anthracycline followed by taxane, and currently available data do not support a change in this practice. We wait for the full-text publication of a relevant neoadjuvant study for women with HER2-negative breast cancer for inclusion in an update of this review. PMID: 30776132 [PubMed - as supplied by publisher]...
Source: Cochrane Database of Systematic Reviews - February 18, 2019 Category: General Medicine Authors: Zaheed M, Wilcken N, Willson ML, O'Connell DL, Goodwin A Tags: Cochrane Database Syst Rev Source Type: research

Transcatheter arterial chemoembolisation followed by three-dimensional conformal radiotherapy versus transcatheter arterial chemoembolisation alone for primary hepatocellular carcinoma in adults.
CONCLUSIONS: TACE followed by 3-DCRT may be associated with lower all-cause mortality and increased tumour response, despite the increased toxicity expressed by a higher rise of total bilirubin. Our review findings should be considered with caution because of the methodological weaknesses in the included trials, resulting in low- to very low-certainty evidence. Data on serious adverse events and health-related quality of life are lacking. We are also very much uncertain in the results of the reported non-serious adverse events. High-quality trials are needed to assess further the role of TACE followed by 3-DCRT for unresec...
Source: Cochrane Database of Systematic Reviews - February 16, 2019 Category: General Medicine Authors: Lu L, Zeng J, Wen Z, Tang C, Xu N Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic treatment for newborns with congenital syphilis.
CONCLUSIONS: At present, the evidence on the effectiveness and safety of antibiotic treatment for newborns with confirmed, highly probable or possible congenital syphilis is sparse, implying that we are uncertain about the estimated effect. One trial compared benzathine penicillin with no intervention for infants with possible congenital syphilis. Low-quality evidence suggested penicillin administration possibly reduce the proportion of neonates with clinical manifestations of congenital syphilis, penicillin administration increased the serological cure at the third month. These findings support the clinical use of penicil...
Source: Cochrane Database of Systematic Reviews - February 15, 2019 Category: General Medicine Authors: Walker GJ, Walker D, Molano Franco D, Grillo-Ardila CF Tags: Cochrane Database Syst Rev Source Type: research

Late erythropoiesis-stimulating agents to prevent red blood cell transfusion in preterm or low birth weight infants.
Abstract BACKGROUND: Preterm infants have low plasma levels of erythropoietin (EPO), providing a rationale for the use of erythropoiesis-stimulating agents (ESAs) to prevent or treat anaemia. Darbepoetin (Darbe) and EPO are currently available ESAs. OBJECTIVES: To assess the effectiveness and safety of late initiation of ESAs, between eight and 28 days after birth, in reducing the use of red blood cell (RBC) transfusions in preterm or low birth weight infants. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 20...
Source: Cochrane Database of Systematic Reviews - February 15, 2019 Category: General Medicine Authors: Aher SM, Ohlsson A Tags: Cochrane Database Syst Rev Source Type: research

Relapse prevention interventions for smoking cessation.
CONCLUSIONS: Behavioural interventions that teach people to recognise situations that are high risk for relapse along with strategies to cope with them provided no worthwhile benefit in preventing relapse in assisted abstainers, although unexplained statistical heterogeneity means we are only moderately certain of this. In people who have successfully quit smoking using pharmacotherapy, there were mixed results regarding extending pharmacotherapy for longer than is standard. Extended treatment with varenicline helped to prevent relapse; evidence for the effect estimate was of moderate certainty, limited by unexplained stat...
Source: Cochrane Database of Systematic Reviews - February 13, 2019 Category: General Medicine Authors: Livingstone-Banks J, Norris E, Hartmann-Boyce J, West R, Jarvis M, Hajek P Tags: Cochrane Database Syst Rev Source Type: research

Calcium antagonists for acute ischemic stroke.
CONCLUSIONS: We found no evidence to support the use of calcium antagonists in people with acute ischemic stroke. PMID: 30758052 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 13, 2019 Category: General Medicine Authors: Zhang J, Liu J, Li D, Zhang C, Liu M Tags: Cochrane Database Syst Rev Source Type: research

Desmopressin acetate (DDAVP) for preventing and treating acute bleeds during pregnancy in women with congenital bleeding disorders.
CONCLUSIONS: No randomised controlled trials were identified investigating the relative effectiveness of DDAVP for bleeding during pregnancy in women with congenital bleeding disorders. In the absence of high-quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials) to decide whether or not to treat women with congenital bleeding disorders with DDAVP.Given the ethical considerations, future randomised controlled trials are unlikely. However, other high-quality controlled studies (such as risk allocation designs, sequential design, parallel cohort design) to ...
Source: Cochrane Database of Systematic Reviews - February 13, 2019 Category: General Medicine Authors: Karanth L, Barua A, Kanagasabai S, Nair NS Tags: Cochrane Database Syst Rev Source Type: research

Aquablation of the prostate for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia.
CONCLUSIONS: Based on short-term (up to 12 months) follow-up, the effect of Aquablation on urological symptoms is probably similar to that of TURP (moderate-certainty evidence). The effect on quality of life may also be similar (low-certainty evidence). We are very uncertain whether patients undergoing Aquablation are at higher or lower risk for major adverse events (very low-certainty evidence). We are very uncertain whether Aquablation may result in little to no difference in erectile function but offer a small improvement in preservation of ejaculatory function (both very low-certainty evidence). These conclusions are b...
Source: Cochrane Database of Systematic Reviews - February 13, 2019 Category: General Medicine Authors: Hwang EC, Jung JH, Borofsky M, Kim MH, Dahm P Tags: Cochrane Database Syst Rev Source Type: research

Active versus expectant management for women in the third stage of labour.
CONCLUSIONS: Although the data appeared to show that active management reduced the risk of severe primary PPH greater than 1000 mL at the time of birth, we are uncertain of this finding because of the very low-quality evidence. Active management may reduce the incidence of maternal anaemia (Hb less than 9 g/dL) following birth, but harms such as postnatal hypertension, pain and return to hospital due to bleeding were identified.In women at low risk of excessive bleeding, it is uncertain whether there was a difference between active and expectant management for severe PPH or maternal Hb less than 9 g/dL (at 24 to 72 hours)....
Source: Cochrane Database of Systematic Reviews - February 13, 2019 Category: General Medicine Authors: Begley CM, Gyte GM, Devane D, McGuire W, Weeks A, Biesty LM Tags: Cochrane Database Syst Rev Source Type: research

Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator.
CONCLUSIONS: Due to a lack of evidence, we were unable to definitively assess the impact of exercise-based cardiac rehabilitation on all-cause mortality, serious adverse events and health-related quality of life in adults with an ICD. However, our findings do provide very low-quality evidence that patients following exercise-based cardiac rehabilitation experience a higher exercise capacity compared with the no exercise control. Further high-quality randomised trials are needed in order to assess the impact of exercise-based cardiac rehabilitation in this population on all-cause mortality, serious adverse events, health-re...
Source: Cochrane Database of Systematic Reviews - February 12, 2019 Category: General Medicine Authors: Nielsen KM, Zwisler AD, Taylor RS, Svendsen JH, Lindschou J, Anderson L, Jakobsen JC, Berg SK Tags: Cochrane Database Syst Rev Source Type: research

N-acetylcysteine as an adjuvant therapy for Helicobacter pylori eradication.
CONCLUSIONS: We are uncertain whether the addition of NAC to antibiotics improves H pylori eradication rates compared with the addition of placebo or no NAC. Due to the clinical, statistical and methodological heterogeneity found in included studies, and the uncertainty observed when analysing therapy subgroups, any possible beneficial effect of NAC should be regarded cautiously.We are uncertain whether NAC is associated with a higher risk of gastrointestinal or allergic adverse events compared with placebo or no NAC. There were no reports of toxic adverse events amongst the included studies.Further large, well-designed, r...
Source: Cochrane Database of Systematic Reviews - February 12, 2019 Category: General Medicine Authors: Fontes LES, Martimbianco ALC, Zanin C, Riera R Tags: Cochrane Database Syst Rev Source Type: research

Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa).
CONCLUSIONS: Nerve-sparing radical hysterectomy may lessen the risk of postoperative bladder dysfunction compared to the standard technique, but the certainty of this evidence is low. The very low-certainty evidence for disease-free survival and lack of information for overall survival indicate that the oncological safety of nerve-sparing radical hysterectomy for women with early stage cervical cancer remains unclear. Further large, high-quality RCTs are required to determine, if clinically meaningful differences of survival exist between these two surgical treatments. PMID: 30746689 [PubMed - as supplied by publisher...
Source: Cochrane Database of Systematic Reviews - February 12, 2019 Category: General Medicine Authors: Kietpeerakool C, Aue-Aungkul A, Galaal K, Ngamjarus C, Lumbiganon P Tags: Cochrane Database Syst Rev Source Type: research

Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders.
CONCLUSIONS: The evidence on the effect of iodine fortification of foods, beverages, condiments, or seasonings other than salt on reducing goitre, improving physical development measures, and any adverse effects is uncertain. However, our findings suggest that the intervention likely increases urinary iodine concentration. Additional, adequately powered, high-quality studies on the effects of iodine fortification of foods on these, and other important outcomes, as well as its efficacy and safety, are required. PMID: 30746700 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 12, 2019 Category: General Medicine Authors: Santos JAR, Christoforou A, Trieu K, McKenzie BL, Downs S, Billot L, Webster J, Li M Tags: Cochrane Database Syst Rev Source Type: research

Exercise training for advanced lung cancer.
CONCLUSIONS: Exercise training may improve or avoid the decline in exercise capacity and disease-specific global HRQoL for adults with advanced lung cancer. We found no significant effects of exercise training on dyspnoea, fatigue, feelings of anxiety and depression, or lung function. The findings of this review should be viewed with caution because of the heterogeneity between studies, the small sample sizes, and the high risk of bias of included studies. Larger, high-quality RCTs are needed to confirm and expand knowledge on the effects of exercise training in this population. PMID: 30741408 [PubMed - as supplied by...
Source: Cochrane Database of Systematic Reviews - February 11, 2019 Category: General Medicine Authors: Peddle-McIntyre CJ, Singh F, Thomas R, Newton RU, Galvão DA, Cavalheri V Tags: Cochrane Database Syst Rev Source Type: research

Combined hormonal contraceptives for heavy menstrual bleeding.
CONCLUSIONS: Moderate-quality evidence suggests that the combined oral contraceptive pill over six months reduces HMB in women with unacceptable HMB from 12% to 77% (compared to 3% in women taking placebo). When compared with other medical options for HMB, COCP was less effective than the LNG IUS. Limited evidence suggested that COCP and CVR had similar effects. There was insufficient evidence to determine comparative efficacy of combined hormonal contraceptives with NSAIDs, or long course progestogens. PMID: 30742315 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 11, 2019 Category: General Medicine Authors: Lethaby A, Wise MR, Weterings MA, Bofill Rodriguez M, Brown J Tags: Cochrane Database Syst Rev Source Type: research

Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents.
Abstract BACKGROUND: This is an updated version of the Cochrane Review previously published in 2017.Absence seizures (AS) are brief epileptic seizures which present in childhood and adolescence. Depending on clinical features and electroencephalogram (EEG) findings they are divided into typical, atypical absences, and absences with special features. Typical absences are characterised by sudden loss of awareness and an EEG typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently used to treat absence seizures. This review aims to determine t...
Source: Cochrane Database of Systematic Reviews - February 8, 2019 Category: General Medicine Authors: Brigo F, Igwe SC, Lattanzi S Tags: Cochrane Database Syst Rev Source Type: research

Dietary interventions for induction and maintenance of remission in inflammatory bowel disease.
CONCLUSIONS: The effects of dietary interventions on CD and UC are uncertain. Thus no firm conclusions regarding the benefits and harms of dietary interventions in CD and UC can be drawn. There is need for consensus on the composition of dietary interventions in IBD and more RCTs are required to evaluate these interventions. Currently, there are at least five ongoing studies (estimated enrollment of 498 participants). This review will be updated when the results of these studies are available. PMID: 30736095 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 8, 2019 Category: General Medicine Authors: Limketkai BN, Iheozor-Ejiofor Z, Gjuladin-Hellon T, Parian A, Matarese LE, Bracewell K, MacDonald JK, Gordon M, Mullin GE Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Hand and ultrasonic instrumentation for orthograde root canal treatment of permanent teeth.
CONCLUSIONS: This review illustrates the current lack of published or ongoing randomised controlled trials and the unavailability of high level evidence, based on clinically relevant outcomes, for the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment.Future randomised controlled trials might focus more closely on evaluating the effectiveness of combinations of these interventions with an emphasis on not only clinically relevant but also patient-centred outcomes. PMID: 30730577 [PubMed - as supplied by publisher] (Source: Cochrane Databas...
Source: Cochrane Database of Systematic Reviews - February 7, 2019 Category: General Medicine Authors: Pedrazzi V, Oliveira-Neto JM, Sequeira-Byron P, Fedorowicz Z, Nasser M Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Ozone therapy for the treatment of dental caries.
CONCLUSIONS: Given the high risk of bias in the available studies and lack of consistency between different outcome measures, there is no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. There is a fundamental need for more evidence of appropriate rigour and quality before the use of ozone can be accepted into mainstream primary dental care or can be considered a viable alternative to current methods for the management and treatment of dental caries. PMID: 30731019 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 7, 2019 Category: General Medicine Authors: Rickard GD, Richardson RJ, Johnson TM, McColl DC, Hooper L Tags: Cochrane Database Syst Rev Source Type: research

Antibiotics for induction and maintenance of remission in Crohn's disease.
CONCLUSIONS: Moderate to high quality evidence suggests that any benefit provided by antibiotics in active CD is likely to be modest and may not be clinically meaningful. High quality evidence suggests that there is no increased risk of adverse events with antibiotics compared to placebo. The effect of antibiotics on the risk of serious adverse events is uncertain. The effect of antibiotics on maintenance of remission in CD is uncertain. Thus, no firm conclusions regarding the efficacy and safety of antibiotics for maintenance of remission in CD can be drawn. More research is needed to determine the efficacy and safety of ...
Source: Cochrane Database of Systematic Reviews - February 7, 2019 Category: General Medicine Authors: Townsend CM, Parker CE, MacDonald JK, Nguyen TM, Jairath V, Feagan BG, Khanna R Tags: Cochrane Database Syst Rev Source Type: research

Thoracic endovascular repair (TEVAR) versus open surgery for blunt traumatic thoracic aortic injury.
CONCLUSIONS: We found no RCTs conducted to determine whether use of TEVAR for the treatment of BTAI is associated with reduced mortality and morbidity when compared to conventional open repair. Hence, we are unable to provide any evidence to guide the treatment option for this life-threatening condition. To perform a randomised controlled trial to clarify the optimal management of BTAI would be highly challenging due to the natural history of the condition. Despite the lack of RCT evidence, clinicians are moving forward with endovascular treatment of BTAI on the basis of meta-analyses of cohort studies and large clinical s...
Source: Cochrane Database of Systematic Reviews - February 6, 2019 Category: General Medicine Authors: Pang D, Hildebrand D, Bachoo P Tags: Cochrane Database Syst Rev Source Type: research

Ureteral stent versus no ureteral stent for ureteroscopy in the management of renal and ureteral calculi.
CONCLUSIONS: Findings of this review illustrate the trade-offs of risks and benefits faced by urologists and their patients when it comes to decision-making about stent placement after uncomplicated ureteroscopy for stone disease. We noted that both desirable and undesirable effects were small in absolute terms, with findings based mostly on low and very low CoE. The main issues reducing our confidence in research findings were study limitations (mostly risk of performance and detection bias) and imprecision. We were unable to conduct any of the preplanned subgroup analyses, in particular those based on stone size, stone l...
Source: Cochrane Database of Systematic Reviews - February 6, 2019 Category: General Medicine Authors: Ordonez M, Hwang EC, Borofsky M, Bakker CJ, Gandhi S, Dahm P Tags: Cochrane Database Syst Rev Source Type: research

Interventions for treating traumatised permanent front teeth: avulsed (knocked out) and replanted.
CONCLUSIONS: Based on the results of the included studies, there is insufficient evidence to support or refute the effectiveness of different interventions for avulsed and replanted permanent front teeth. The overall quality of existing evidence was very low, and therefore great caution should be exercised when generalising the results of the included trials. There is urgent need for further well-designed randomised controlled trials. PMID: 30720860 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 5, 2019 Category: General Medicine Authors: Day PF, Duggal M, Nazzal H Tags: Cochrane Database Syst Rev Source Type: research

Interventions for intra-operative pain relief during postpartum mini-laparotomy tubal ligation.
CONCLUSIONS: An intraperitoneal instillation of lidocaine during postpartum mini-laparotomy tubal ligation before fallopian tubes were tied may offer better intraperitoneal pain control, although the evidence regarding adverse effects is uncertain. We found no clear difference in intraperitoneal pain between women who received a combination of an injection of morphine, and intraperitoneal instillation of lidocaine and those who received an intraperitoneal instillation of lidocaine alone. These results must be interpreted with caution, since the evidence overall was low to very low-certainty. PMID: 30706442 [PubMed - a...
Source: Cochrane Database of Systematic Reviews - February 1, 2019 Category: General Medicine Authors: Werawatakul Y, Sothornwit J, Laopaiboon M, Lumbiganon P, Kietpeerakool C Tags: Cochrane Database Syst Rev Source Type: research

Interventions for treating urinary incontinence after stroke in adults.
CONCLUSIONS: There is insufficient evidence to guide continence care of adults in the rehabilitative phase after stroke. As few trials tested the same intervention, conclusions are drawn from few, usually small, trials. CIs were wide, making it difficult to ascertain if there were clinically important differences. Only four trials had adequate allocation concealment and many were limited by poor reporting, making it impossible to judge the extent to which they were prone to bias. More appropriately powered, multicentre trials of interventions are required to provide robust evidence for interventions to improve urinary inco...
Source: Cochrane Database of Systematic Reviews - February 1, 2019 Category: General Medicine Authors: Thomas LH, Coupe J, Cross LD, Tan AL, Watkins CL Tags: Cochrane Database Syst Rev Source Type: research

Interventions to promote patient utilisation of cardiac rehabilitation.
CONCLUSIONS: Interventions may increase cardiac rehabilitation enrolment, adherence and completion; however the quality of evidence was low to moderate due to heterogeneity of the interventions used, among other factors. Effects on enrolment were larger in studies targeting healthcare providers, training nurses, or allied healthcare providers to intervene face-to-face; effects on adherence were larger in studies that tested remote interventions. More research is needed, particularly to discover the best ways to increase programme completion. PMID: 30706942 [PubMed - as supplied by publisher] (Source: Cochrane Database...
Source: Cochrane Database of Systematic Reviews - February 1, 2019 Category: General Medicine Authors: Santiago de Araújo Pio C, Chaves GS, Davies P, Taylor RS, Grace SL Tags: Cochrane Database Syst Rev Source Type: research

Needle aspiration versus intercostal tube drainage for pneumothorax in the newborn.
CONCLUSIONS: There is insufficient evidence to establish the efficacy and safety of needle aspiration and intercostal tube drainage in the management of neonatal pneumothorax. The two included trials showed no differences in mortality; however the information size is low. Needle aspiration reduces the need for intercostal tube drainage placement. Limited or no evidence is available on other clinically relevant outcomes. PMID: 30707441 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 1, 2019 Category: General Medicine Authors: Bruschettini M, Romantsik O, Zappettini S, O'Donnell CP, Calevo MG Tags: Cochrane Database Syst Rev Source Type: research

Continuous positive airway pressure (CPAP) for acute bronchiolitis in children.
CONCLUSIONS: Limited, low-quality evidence suggests that breathing improved (a decreased respiratory rate) in children with bronchiolitis who received CPAP; this finding is unchanged from the 2015 review. Further evidence for this outcome was provided by the inclusion of a low-quality study for the 2018 update. Due to the limited available evidence, the effect of CPAP in children with acute bronchiolitis is uncertain for other outcomes. Larger, adequately powered trials are needed to evaluate the effect of CPAP for children with acute bronchiolitis. PMID: 30701528 [PubMed - as supplied by publisher] (Source: Cochrane ...
Source: Cochrane Database of Systematic Reviews - January 31, 2019 Category: General Medicine Authors: Jat KR, Mathew JL Tags: Cochrane Database Syst Rev Source Type: research

Phosphodiesterase 5 inhibitors for pulmonary hypertension.
CONCLUSIONS: PDE5 inhibitors appear to have clear beneficial effects in group 1 PAH. Sildenafil, tadalafil and vardenafil are all efficacious in this clinical setting, and clinicians should consider the side-effect profile for each individual when choosing which PDE5 inhibitor to prescribe.While there appears to be some benefit for the use of PDE5 inhibitors in PH-left-heart disease, it is not clear based on the mostly small, short-term studies, which type of left-heart disease stands to benefit. These data suggest possible harm in valvular heart disease. There is no clear benefit for PDE5 inhibitors in pulmonary hypertens...
Source: Cochrane Database of Systematic Reviews - January 31, 2019 Category: General Medicine Authors: Barnes H, Brown Z, Burns A, Williams T Tags: Cochrane Database Syst Rev Source Type: research

Aerobic physical exercise for adult patients with haematological malignancies.
CONCLUSIONS: Eighteen, mostly small RCTs did not identify evidence for a difference in terms of mortality. Physical exercise added to standard care might improve fatigue and depression. Currently, there is inconclusive evidence regarding QoL, physical functioning, anxiety and SAEs .We need further trials with more participants and longer follow-up periods to evaluate the effects of exercise intervention for people suffering from haematological malignancies. To enhance comparability of study data, development and implementation of core sets of measuring devices would be helpful. PMID: 30702150 [PubMed - as supplied by ...
Source: Cochrane Database of Systematic Reviews - January 31, 2019 Category: General Medicine Authors: Knips L, Bergenthal N, Streckmann F, Monsef I, Elter T, Skoetz N Tags: Cochrane Database Syst Rev Source Type: research

Risk assessment tools for the prevention of pressure ulcers.
CONCLUSIONS: We identified two studies which evaluated the effect of risk assessment on pressure ulcer incidence. Based on evidence from one study, we are uncertain whether risk assessment using the Braden tool makes any difference to pressure ulcer incidence, compared with training and risk assessment using clinical judgement, or risk assessment using clinical judgement alone. Risk assessment using the Waterlow tool, or the Ramstadius tool may make little or no difference to pressure ulcer incidence, or severity, compared with clinical judgement. The low, or very low certainty of evidence available from the included studi...
Source: Cochrane Database of Systematic Reviews - January 31, 2019 Category: General Medicine Authors: Moore ZE, Patton D Tags: Cochrane Database Syst Rev Source Type: research

Exercise for preventing falls in older people living in the community.
CONCLUSIONS: Exercise programmes reduce the rate of falls and the number of people experiencing falls in older people living in the community (high-certainty evidence). The effects of such exercise programmes are uncertain for other non-falls outcomes. Where reported, adverse events were predominantly non-serious.Exercise programmes that reduce falls primarily involve balance and functional exercises, while programmes that probably reduce falls include multiple exercise categories (typically balance and functional exercises plus resistance exercises). Tai Chi may also prevent falls but we are uncertain of the effect of res...
Source: Cochrane Database of Systematic Reviews - January 31, 2019 Category: General Medicine Authors: Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE Tags: Cochrane Database Syst Rev Source Type: research

Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women.
CONCLUSIONS: Intermittent iron supplementation may reduce anaemia and may improve iron stores among menstruating women in populations with different anaemia and malaria backgrounds. In comparison with daily supplementation, the provision of iron supplements intermittently is probably as effective in preventing or controlling anaemia. More information is needed on morbidity (including malaria outcomes), side effects, work performance, economic productivity, depression, and adherence to the intervention. The quality of this evidence base ranged from very low to moderate quality, suggesting that we are uncertain about these e...
Source: Cochrane Database of Systematic Reviews - January 31, 2019 Category: General Medicine Authors: Fernández-Gaxiola AC, De-Regil LM Tags: Cochrane Database Syst Rev Source Type: research

General health checks in adults for reducing morbidity and mortality from disease.
CONCLUSIONS: General health checks are unlikely to be beneficial. PMID: 30699470 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 31, 2019 Category: General Medicine Authors: Krogsbøll LT, Jørgensen KJ, Gøtzsche PC Tags: Cochrane Database Syst Rev Source Type: research

Mesenchymal stromal cells as treatment or prophylaxis for acute or chronic graft-versus-host disease in haematopoietic stem cell transplant (HSCT) recipients with a haematological condition.
CONCLUSIONS: MSCs are an area of intense research activity, and an increasing number of trials have been undertaken or are planned. Despite a number of reports of positive outcomes from the use of MSCs for treating acute GvHD, the evidence to date from RCTs has not supported the conclusion that they are an effective therapy. There is low-quality evidence that MSCs may reduce the risk of cGvHD. New trial evidence will be incorporated into future updates of this review, which may better establish a role for MSCs in the prevention or treatment of GvHD. PMID: 30697701 [PubMed - as supplied by publisher] (Source: Cochrane ...
Source: Cochrane Database of Systematic Reviews - January 30, 2019 Category: General Medicine Authors: Fisher SA, Cutler A, Doree C, Brunskill SJ, Stanworth SJ, Navarrete C, Girdlestone J Tags: Cochrane Database Syst Rev Source Type: research

Interventions to reduce shoulder pain following gynaecological laparoscopic procedures.
CONCLUSIONS: There is low to moderate-quality evidence that the following interventions are associated with a reduction in the incidence or severity, or both, of STP, or a reduction in analgesia requirements for women undergoing gynaecological laparoscopy: a specific technique for releasing the pneumoperitoneum; intraperitoneal fluid instillation; an intraperitoneal drain; and local anaesthetic applied to the peritoneal cavity (not subdiaphragmatic).There is low to moderate-quality evidence that subdiaphragmatic intraperitoneal local anaesthetic and warmed and humidified insufflating gas may not make a difference to the in...
Source: Cochrane Database of Systematic Reviews - January 30, 2019 Category: General Medicine Authors: Kaloo P, Armstrong S, Kaloo C, Jordan V Tags: Cochrane Database Syst Rev Source Type: research

Exercise-based cardiac rehabilitation for adults with heart failure.
CONCLUSIONS: This updated Cochrane Review provides additional randomised evidence (11 trials) to support the conclusions of the previous version (2014) of this Cochane Review. Compared to no exercise control, CR appears to have no impact on mortality in the short term (
Source: Cochrane Database of Systematic Reviews - January 29, 2019 Category: General Medicine Authors: Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJ, Dalal H, Rees K, Singh SJ, Taylor RS Tags: Cochrane Database Syst Rev Source Type: research

Pharmacotherapies for cannabis dependence.
CONCLUSIONS: There is incomplete evidence for all of the pharmacotherapies investigated, and for many outcomes the quality of the evidence was low or very low. Findings indicate that SSRI antidepressants, mixed action antidepressants, bupropion, buspirone and atomoxetine are probably of little value in the treatment of cannabis dependence. Given the limited evidence of efficacy, THC preparations should be considered still experimental, with some positive effects on withdrawal symptoms and craving. The evidence base for the anticonvulsant gabapentin, oxytocin, and N-acetylcysteine is weak, but these medications are also wor...
Source: Cochrane Database of Systematic Reviews - January 28, 2019 Category: General Medicine Authors: Nielsen S, Gowing L, Sabioni P, Le Foll B Tags: Cochrane Database Syst Rev Source Type: research

Topiramate for juvenile myoclonic epilepsy.
CONCLUSIONS: We have found no new studies since the last version of this review was published in 2017. This review does not provide sufficient evidence to support topiramate for the treatment of people with JME. Based on the current limited available data, topiramate seems to be better tolerated than valproate, but has no clear benefits over valproate in terms of efficacy. Well-designed, double-blind RCTs with large samples are required to test the efficacy and tolerability of topiramate in people with JME. PMID: 30687937 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 28, 2019 Category: General Medicine Authors: Liu J, Wang LN, Wang YP Tags: Cochrane Database Syst Rev Source Type: research

School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review.
CONCLUSIONS: School-based asthma self-management interventions probably reduce hospital admission and may slightly reduce ED attendance, although their impact on school attendance could not be measured reliably. They may also reduce the number of days where children experience asthma symptoms, and probably lead to small improvements in asthma-related quality of life. Many of the studies tested the intervention in younger children from socially disadvantaged populations. Interventions that had a theoretical framework, engaged parents and were run outside of children's free time were associated with successful implementation...
Source: Cochrane Database of Systematic Reviews - January 28, 2019 Category: General Medicine Authors: Harris KM, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J Tags: Cochrane Database Syst Rev Source Type: research

Drug-eluting balloon angioplasty versus uncoated balloon angioplasty for the treatment of in-stent restenosis of the femoropopliteal arteries.
CONCLUSIONS: Based on a meta-analysis of three trials with 263 participants, evidence suggests an advantage for DEBs compared with uncoated balloon angioplasty for anatomical endpoints such as target lesion revascularization (TLR) and binary restenosis, and for one clinical endpoint - improvement in Rutherford category post intervention for up to 24 months. However, the certainty of evidence for all these outcomes is very low due to the small number of included studies and participants and the high risk of bias in study design. Adequately powered and carefully constructed randomized controlled trials are needed to adequate...
Source: Cochrane Database of Systematic Reviews - January 26, 2019 Category: General Medicine Authors: Kayssi A, Al-Jundi W, Papia G, Kucey DS, Forbes T, Rajan DK, Neville R, Dueck AD Tags: Cochrane Database Syst Rev Source Type: research

Antibiotics for treating urogenital Chlamydia trachomatis infection in men and non-pregnant women.
CONCLUSIONS: In men, regimens with azithromycin are probably less effective than doxycycline for microbiological failure, however, there might be little or no difference for clinical failure. For women, we are uncertain whether azithromycin compared to doxycycline increases the risk of microbiological failure. Azithromycin probably slightly reduces adverse events compared to doxycycline in men and women together but may have little difference in men alone. We are uncertain whether doxycycline compared to ofloxacin reduces microbiological failure in men or women alone, or men and women together, nor if it reduces clinical f...
Source: Cochrane Database of Systematic Reviews - January 25, 2019 Category: General Medicine Authors: Páez-Canro C, Alzate JP, González LM, Rubio-Romero JA, Lethaby A, Gaitán HG Tags: Cochrane Database Syst Rev Source Type: research

Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews.
CONCLUSIONS: There is little evidence to support the use of one airway clearance technique over another. People with cystic fibrosis should choose the airway clearance technique that best meets their needs, after considering comfort, convenience, flexibility, practicality, cost, or some other factor. More long-term, high-quality randomised controlled trials comparing airway clearance techniques among people with cystic fibrosis are needed. PMID: 30676656 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 24, 2019 Category: General Medicine Authors: Wilson LM, Morrison L, Robinson KA Tags: Cochrane Database Syst Rev Source Type: research

Immunonutrition for acute respiratory distress syndrome (ARDS) in adults.
CONCLUSIONS: This meta-analysis of 10 studies of varying quality examined effects of omega-3 fatty acids and/or antioxidants in adults with ARDS. This intervention may produce little or no difference in all-cause mortality between groups. We are uncertain whether immunonutrition with omega-3 fatty acids and antioxidants improves the duration of ventilator days and ICU length of stay or oxygenation at day 4 due to the very low quality of evidence. Adverse events associated with immunonutrition are also uncertain, as confidence intervals include the potential for increased cardiac, gastrointestinal, and total adverse events....
Source: Cochrane Database of Systematic Reviews - January 24, 2019 Category: General Medicine Authors: Dushianthan A, Cusack R, Burgess VA, Grocott MP, Calder PC Tags: Cochrane Database Syst Rev Source Type: research