Interventions for orbital lymphangioma.
CONCLUSIONS: Currently, there are no published RCTs of orbital lymphangioma treatments. Without these types of studies, conclusions cannot be drawn regarding the effectiveness of the medical and surgical treatment options for patients with orbital lymphangiomas. The presence of only case reports and case series on orbital lymphangiomas makes it clear that RCTs are needed to address the differences between these options and help guide treatment plans. Such trials would ideally compare outcomes between individuals randomized to one of the following treatment options: observation, sclerotherapy, systemic sirolimus therapy, sy...
Source: Cochrane Database of Systematic Reviews - May 15, 2019 Category: General Medicine Authors: Patel SR, Rosenberg JB, Barmettler A Tags: Cochrane Database Syst Rev Source Type: research

Ready-to-use therapeutic food (RUTF) for home-based nutritional rehabilitation of severe acute malnutrition in children from six months to five years of age.
CONCLUSIONS: Compared to alternative dietary approaches, standard RUTF probably improves recovery and may increase rate of weight gain slightly, but the effects on relapse and mortality are unknown. Standard RUTF meeting total daily nutritional requirements may improve recovery and relapse compared to a similar RUTF given as a supplement to the usual diet, but the effects on mortality and rate of weight gain are not clear. When comparing RUTFs with different formulations, the current evidence does not favour a particular formulation, except for relapse, which is reduced with standard RUTF. Well-designed, adequately powered...
Source: Cochrane Database of Systematic Reviews - May 15, 2019 Category: General Medicine Authors: Schoonees A, Lombard MJ, Musekiwa A, Nel E, Volmink J Tags: Cochrane Database Syst Rev Source Type: research

Self-certification versus physician certification of sick leave for reducing sickness absence and associated costs.
CONCLUSIONS: There is low- to very low-certainty evidence of inconsistent effects of changing the period of self-certification on the duration or frequency of short-term sickness absence periods or the amount of work time lost due to sickness absence. Because the evidence is of low or very low certainty, more and better studies are needed. PMID: 31087323 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 14, 2019 Category: General Medicine Authors: Kausto J, Verbeek JH, Ruotsalainen JH, Halonen JI, Virta LJ, Kankaanpää E Tags: Cochrane Database Syst Rev Source Type: research

Biochemical tests of placental function versus ultrasound assessment of fetal size for stillbirth and small-for-gestational-age infants.
Abstract BACKGROUND: Stillbirth affects 2.6 million pregnancies worldwide each year. Whilst the majority of cases occur in low- and middle-income countries, stillbirth remains an important clinical issue for high-income countries (HICs) - with both the UK and the USA reporting rates above the mean for HICs. In HICs, the most frequently reported association with stillbirth is placental dysfunction. Placental dysfunction may be evident clinically as fetal growth restriction (FGR) and small-for-dates infants. It can be caused by placental abruption or hypertensive disorders of pregnancy and many other disorders and f...
Source: Cochrane Database of Systematic Reviews - May 14, 2019 Category: General Medicine Authors: Heazell AE, Hayes DJ, Whitworth M, Takwoingi Y, Bayliss SE, Davenport C Tags: Cochrane Database Syst Rev Source Type: research

Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses.
CONCLUSIONS: Although our review indicated slight benefit may exist for telephone support interventions on some outcomes (e.g. anxiety and preparedness to care at the end of intervention), for most outcomes, including the primary outcomes, telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care. The findings of the review were mainly based on studies with overall high risk of bias, and few participants. Further high-quality trials, with larger sample sizes are required. PMID: 31087641 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 14, 2019 Category: General Medicine Authors: Corry M, Neenan K, Brabyn S, Sheaf G, Smith V Tags: Cochrane Database Syst Rev Source Type: research

Intrastromal corneal ring segments for treating keratoconus.
CONCLUSIONS: In the absence of eligible RCTs to review, no conclusions can be drawn. PMID: 31087649 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 14, 2019 Category: General Medicine Authors: Zadnik K, Money S, Lindsley K Tags: Cochrane Database Syst Rev Source Type: research

Enteral lactoferrin for the treatment of sepsis and necrotizing enterocolitis in neonates.
CONCLUSIONS: Implications for practice: currently there is no evidence to support or refute the use of enteral lactoferrin, as an adjunct to antibiotic therapy, for the treatment of neonatal sepsis or necrotizing enterocolitis. IMPLICATIONS FOR RESEARCH: given the lack of efficacy of enteral lactoferrin for preventing late-onset sepsis and necrotizing enterocolitis, evaluation of enteral lactoferrin as an adjunctive agent for treatment of sepsis or necrotizing enterocolitis does not appear to be a research priority. PMID: 31077334 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 11, 2019 Category: General Medicine Authors: Pammi M, Abrams SA Tags: Cochrane Database Syst Rev Source Type: research

Fortification of staple foods with vitamin A for vitamin A deficiency.
CONCLUSIONS: Fortifying staple foods with vitamin A alone may make little or no difference to serum retinol concentrations or the risk of subclinical vitamin A deficiency. In comparison with provision of unfortified foods, provision of staple foods fortified with vitamin A plus other micronutrients may not increase serum retinol concentration but probably reduces the risk of subclinical vitamin A deficiency.Compared to no intervention, staple foods fortified with vitamin A plus other micronutrients may increase serum retinol concentration, although it is uncertain whether the intervention reduces the risk of subclinical vi...
Source: Cochrane Database of Systematic Reviews - May 10, 2019 Category: General Medicine Authors: Hombali AS, Solon JA, Venkatesh BT, Nair NS, Peña-Rosas JP Tags: Cochrane Database Syst Rev Source Type: research

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder.
CONCLUSIONS: The available evidence from randomised trials is limited to that comparing immobilisation in external versus internal rotation. Overall, the evidence is insufficient to draw firm conclusions about whether immobilisation in external rotation confers any benefit over immobilisation in internal rotation.Considering that there are several unpublished and ongoing trials evaluating immobilisation in external versus internal rotation, the main priority for research on this question consists of the publication of completed trials and the completion and publication of ongoing trials. Meanwhile, evaluation of other inte...
Source: Cochrane Database of Systematic Reviews - May 10, 2019 Category: General Medicine Authors: Braun C, McRobert CJ Tags: Cochrane Database Syst Rev Source Type: research

Medical interventions for the prevention of platinum-induced hearing loss in children with cancer.
CONCLUSIONS: At the moment there is no evidence from individual studies in children with osteosarcoma or hepatoblastoma treated with different platinum analogues and dosage schedules that underscores the use of amifostine as an otoprotective intervention as compared to no additional treatment. Since pooling of results was not possible and the evidence was of low certainty, no definitive conclusions can be made. Since we found only one RCT evaluating the use of sodium thiosulfate in children with localized hepatoblastoma treated with cisplatin, no definitive conclusions on benefits and harms can be drawn. It should be noted...
Source: Cochrane Database of Systematic Reviews - May 7, 2019 Category: General Medicine Authors: van As JW, van den Berg H, van Dalen EC Tags: Cochrane Database Syst Rev Source Type: research

Stem cell transplantation for ischemic stroke.
CONCLUSIONS: Overall, in participants with ischemic stroke, stem cell transplantation was associated with a reduced neurological impairment, but not with a better functional outcome. No obvious safety concerns were raised. However, these conclusions came mostly from small RCTs with high risk of bias, and the certainty of the evidence ranged from low to very low. More well-designed trials are needed. PMID: 31055832 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 5, 2019 Category: General Medicine Authors: Boncoraglio GB, Ranieri M, Bersano A, Parati EA, Del Giovane C Tags: Cochrane Database Syst Rev Source Type: research

Telephone counselling for smoking cessation.
ann-Boyce J Abstract BACKGROUND: Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES: To evaluate the effect of telephone support to help smokers quit, including proactive or reactive counselling, or the provision of other information to smokers calling a helpline. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' ...
Source: Cochrane Database of Systematic Reviews - May 2, 2019 Category: General Medicine Authors: Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J Tags: Cochrane Database Syst Rev Source Type: research

Preventive lipid-based nutrient supplements given with complementary foods to infants and young children 6 to 23 months of age for health, nutrition, and developmental outcomes.
CONCLUSIONS: The findings of this review suggest that LNS plus complementary feeding compared to no intervention is effective at improving growth outcomes and anaemia without adverse effects among children aged six to 23 months in low- and middle-income countries (LMIC) in Asia and Africa, and more effective if provided over a longer duration of time (over 12 months). Limited evidence also suggests that LNS plus complementary feeding is more effective than FBF and MNP at improving growth outcomes. PMID: 31046132 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 2, 2019 Category: General Medicine Authors: Das JK, Salam RA, Hadi YB, Sadiq Sheikh S, Bhutta AZ, Weise Prinzo Z, Bhutta ZA Tags: Cochrane Database Syst Rev Source Type: research

Positional therapy for obstructive sleep apnoea.
CONCLUSIONS: The review found that CPAP has a greater effect on improving AHI compared with positional therapy in positional OSA, while positional therapy was better than inactive control for improving ESS and AHI. Positional therapy may have better adherence than CPAP. There were no significant differences for other clinically relevant outcomes such as quality of life or cognitive function. All the studies were of short duration. We are unable to comment on the long-term effects of the therapies. This is important, as most of the quality-of-life outcomes will be evident only when the therapies are given over a longer peri...
Source: Cochrane Database of Systematic Reviews - May 1, 2019 Category: General Medicine Authors: Srijithesh PR, Aghoram R, Goel A, Dhanya J Tags: Cochrane Database Syst Rev Source Type: research

Family therapy approaches for anorexia nervosa.
CONCLUSIONS: There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescen...
Source: Cochrane Database of Systematic Reviews - May 1, 2019 Category: General Medicine Authors: Fisher CA, Skocic S, Rutherford KA, Hetrick SE Tags: Cochrane Database Syst Rev Source Type: research

Prostacyclin for pulmonary arterial hypertension.
CONCLUSIONS: This review demonstrates clinical and statistical benefit for intravenous prostacyclin (compared to control) with improved functional class, 6MWD, mortality, symptoms scores, and cardiopulmonary haemodynamics, but at a cost of adverse events. This may be due to a true effect, or may be overestimated due to the inclusion of small, short or open-label studies. There was a statistical and small clinical benefit in function and haemodynamics for inhaled prostacyclin, but the effect is uncertain for mortality. The effect of oral prostacyclins are less certain. Selexipag demonstrated less clinical worsening without ...
Source: Cochrane Database of Systematic Reviews - May 1, 2019 Category: General Medicine Authors: Barnes H, Yeoh HL, Fothergill T, Burns A, Humbert M, Williams T Tags: Cochrane Database Syst Rev Source Type: research

MVA85A vaccine to enhance BCG for preventing tuberculosis.
CONCLUSIONS: MVA85A delivered by intradermal injection in addition to BCG is safe but not effective in reducing the risk of developing tuberculosis. PMID: 31038197 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 30, 2019 Category: General Medicine Authors: Kashangura R, Jullien S, Garner P, Johnson S Tags: Cochrane Database Syst Rev Source Type: research

Plasma interleukin-6 concentration for the diagnosis of sepsis in critically ill adults.
CONCLUSIONS: Our evidence assessment of plasma interleukin-6 concentrations for the diagnosis of sepsis in critically ill adults reveals several limitations. High heterogeneity of collected evidence regarding the main diagnosis, setting, country, positivity threshold, sepsis criteria, year of publication, and the origin of infection, among other factors, along with the potential number of misclassifications, remain significant constraints for its implementation. The 20 conference proceedings assessed as studies awaiting classification may alter the conclusions of the review once they are fully published and evaluated. Furt...
Source: Cochrane Database of Systematic Reviews - April 30, 2019 Category: General Medicine Authors: Molano Franco D, Arevalo-Rodriguez I, Roqué I Figuls M, Montero Oleas NG, Nuvials X, Zamora J Tags: Cochrane Database Syst Rev Source Type: research

Probiotics for the prevention of pediatric antibiotic-associated diarrhea.
Abstract BACKGROUND: Antibiotics alter the microbial balance commonly resulting in antibiotic-associated diarrhea (AAD). Probiotics may prevent AAD via providing gut barrier, restoration of the gut microflora, and other potential mechanisms of action. OBJECTIVES: The primary objectives were to assess the efficacy and safety of probiotics (any specified strain or dose) used for the prevention of AAD in children. SEARCH METHODS: MEDLINE, Embase, CENTRAL, CINAHL, and the Web of Science (inception to 28 May 2018) were searched along with registers including the ISRCTN and Clinicaltrials.gov. We also searched...
Source: Cochrane Database of Systematic Reviews - April 30, 2019 Category: General Medicine Authors: Guo Q, Goldenberg JZ, Humphrey C, El Dib R, Johnston BC Tags: Cochrane Database Syst Rev Source Type: research

Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage.
CONCLUSIONS: Prophylactic oxytocin compared with no uterotonics may reduce blood loss and the need for additional uterotonics. The effect of oxytocin compared to ergot alkaloids is uncertain with regards to blood loss, need for additional uterotonics, and blood transfusion. Oxytocin may increase the risk of a prolonged third stage compared to ergot alkaloids, although whether this translates into increased risk of manual placental removal is uncertain. This potential risk must be weighed against the possible increased risk of side effects associated with ergot alkaloids. Oxytocin-ergometrine may reduce blood loss compared ...
Source: Cochrane Database of Systematic Reviews - April 29, 2019 Category: General Medicine Authors: Salati JA, Leathersich SJ, Williams MJ, Cuthbert A, Tolosa JE Tags: Cochrane Database Syst Rev Source Type: research

Risk-reducing medications for primary breast cancer: a network meta-analysis.
CONCLUSIONS: For women with an above-average risk of developing breast cancer, CPAs can reduce the incidence of this disease. AIs appear to be more effective than SERMs (tamoxifen) in reducing the risk of developing breast cancer. AIs are not associated with an increased risk of endometrial cancer and thromboembolic events. However, long-term data on toxicities from tamoxifen are available while the follow-up toxicity data on unaffected women taking AIs is relatively short. Additional data from direct comparisons are needed to fully address the issues of breast cancer prevention by risk-reducing medications, with special r...
Source: Cochrane Database of Systematic Reviews - April 29, 2019 Category: General Medicine Authors: Mocellin S, Goodwin A, Pasquali S Tags: Cochrane Database Syst Rev Source Type: research

Guided imagery for treating hypertension in pregnancy.
CONCLUSIONS: There is insufficient evidence to inform practice about the use of guided imagery for hypertension in pregnancy.The available evidence for this review topic is sparse, and the effect of guided imagery for treating hypertension during pregnancy (compared with quiet rest) remains unclear. There was low-certainty evidence that guided imagery made little or no difference to the use of antihypertensive drugs, downgraded because of imprecision.The two included trials did not report on any of the primary outcomes of this review. We did not identify any trials comparing guided imagery with no intervention, or with ano...
Source: Cochrane Database of Systematic Reviews - April 27, 2019 Category: General Medicine Authors: Haruna M, Matsuzaki M, Ota E, Shiraishi M, Hanada N, Mori R Tags: Cochrane Database Syst Rev Source Type: research

Interventions for hand eczema.
CONCLUSIONS: Most findings were from single studies with low precision, so they should be interpreted with caution. Topical corticosteroids and UV phototherapy were two of the major standard treatments, but evidence is insufficient to support one specific treatment over another. The effect of topical calcineurin inhibitors is not certain. Alitretinoin is more effective than placebo in controlling symptoms, but advantages over other treatments need evaluating.Well-designed and well-reported, long-term (more than three months), head-to-head studies comparing different treatments are needed. Consensus is required regarding th...
Source: Cochrane Database of Systematic Reviews - April 26, 2019 Category: General Medicine Authors: Christoffers WA, Coenraads PJ, Svensson Å, Diepgen TL, Dickinson-Blok JL, Xia J, Williams HC Tags: Cochrane Database Syst Rev Source Type: research

Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer.
CONCLUSIONS: Among the diagnostic strategies considered, the MRI pathway has the most favourable diagnostic accuracy in clinically significant prostate cancer detection. Compared to systematic biopsy, it increases the number of significant cancer detected while reducing the number of insignificant cancer diagnosed. The certainty in our findings was reduced by study limitations, specifically issues surrounding selection bias, as well as inconsistency. Based on these findings, further improvement of prostate cancer diagnostic pathways should be pursued. PMID: 31022301 [PubMed - as supplied by publisher] (Source: Cochran...
Source: Cochrane Database of Systematic Reviews - April 25, 2019 Category: General Medicine Authors: Drost FH, Osses DF, Nieboer D, Steyerberg EW, Bangma CH, Roobol MJ, Schoots IG Tags: Cochrane Database Syst Rev Source Type: research

Robotic versus open radical cystectomy for bladder cancer in adults.
CONCLUSIONS: Robotic cystectomy and open cystectomy may have similar outcomes with regard to time to recurrence, rates of major complications, quality of life, and positive margin rates (all low-certainty evidence). We are very uncertain whether the robotic approach reduces rates of minor complications (very low-certainty evidence), although it probably reduces the risk of blood transfusions substantially (moderate-certainty evidence) and may reduce hospital stay slightly (low-certainty evidence). We were unable to conduct any of the preplanned subgroup analyses to assess the impact of patient age, pathological stage, body...
Source: Cochrane Database of Systematic Reviews - April 24, 2019 Category: General Medicine Authors: Rai BP, Bondad J, Vasdev N, Adshead J, Lane T, Ahmed K, Khan MS, Dasgupta P, Guru K, Chlosta PL, Aboumarzouk OM Tags: Cochrane Database Syst Rev Source Type: research

Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation.
CONCLUSIONS: The present systematic review of randomized and non-randomized studies found inconsistent results between the two compared interventions regarding their potential to prevent parastomal herniation.In conclusion, there is still a lack of high-quality evidence to support the ideal surgical technique of stoma formation. The available moderate-, low-, and very low-quality evidence, does not support or refute the superiority of one of the studied stoma formation techniques over the other. PMID: 31016723 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 24, 2019 Category: General Medicine Authors: Hardt J, Meerpohl JJ, Metzendorf MI, Kienle P, Post S, Herrle F Tags: Cochrane Database Syst Rev Source Type: research

Anti-GD2 antibody-containing immunotherapy postconsolidation therapy for people with high-risk neuroblastoma treated with autologous haematopoietic stem cell transplantation.
CONCLUSIONS: The evidence base favours dinutuximab-containing immunotherapy compared to standard therapy concerning overall survival and event-free survival in people with high-risk neuroblastoma pre-treated with autologous HSCT. Randomised data on adverse events are lacking, therefore more research is needed before definitive conclusions can be made regarding this outcome. PMID: 31016728 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 24, 2019 Category: General Medicine Authors: Peinemann F, van Dalen EC, Enk H, Tytgat GA Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults.
CONCLUSIONS: Only one study looked at whether toothbrushing with interdental brushing was better than toothbrushing alone, and there was very low-quality evidence for a reduction in gingivitis and plaque at one month. There is also low-quality evidence from seven studies that interdental brushing reduces gingivitis when compared with flossing, but these results were only found at one month. There was insufficient evidence to determine whether interdental brushing reduced or increased levels of plaque when compared to flossing. PMID: 31017680 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 24, 2019 Category: General Medicine Authors: Poklepovic Pericic T, Worthington HV, Johnson TM, Sambunjak D, Imai P, Clarkson JE, Tugwell P Tags: Cochrane Database Syst Rev Source Type: research

Interventions for preventing high altitude illness: Part 3. Miscellaneous and non-pharmacological interventions.
CONCLUSIONS: This Cochrane Review is the final in a series of three providing relevant information to clinicians, and other interested parties, on how to prevent high altitude illness. The assessment of non-pharmacological and miscellaneous interventions suggests that there is heterogeneous and even contradictory evidence related to the effectiveness of these prophylactic strategies. Safety of these interventions remains as an unclear issue due to lack of assessment. Overall, the evidence is limited due to its quality (low to very low), the relative paucity of that evidence and the number of studies pending classification ...
Source: Cochrane Database of Systematic Reviews - April 23, 2019 Category: General Medicine Authors: Molano Franco D, Nieto Estrada VH, Gonzalez Garay AG, Martí-Carvajal AJ, Arevalo-Rodriguez I Tags: Cochrane Database Syst Rev Source Type: research

Interventions for preventing delirium in older people in institutional long-term care.
CONCLUSIONS: Our review identified limited evidence on interventions for preventing delirium in older people in LTC. A software-based intervention to identify medications that could contribute to delirium risk and trigger a pharmacist-led medication review, probably reduces incidence of delirium in older people in institutional LTC. This is based on one large RCT in the US and may not be practical in other countries or settings which do not have comparable information technology services available in care homes. In the educational intervention aimed at identifying risk factors for delirium and developing bespoke solutions ...
Source: Cochrane Database of Systematic Reviews - April 23, 2019 Category: General Medicine Authors: Woodhouse R, Burton JK, Rana N, Pang YL, Lister JE, Siddiqi N Tags: Cochrane Database Syst Rev Source Type: research

Hospital nurse-staffing models and patient- and staff-related outcomes.
CONCLUSIONS: The findings of this review should be treated with caution due to the limited amount and quality of the published research that was included. We have most confidence in our finding that the introduction of advanced or specialist nurses may lead to little or no difference in one patient outcome (i.e. mortality) with greater uncertainty about other patient outcomes (i.e. readmissions, ED attendance, length of stay and pressure ulcer rates). The evidence is of insufficient certainty to draw conclusions about the effectiveness of other types of interventions, including new nurse-staffing models and introduction of...
Source: Cochrane Database of Systematic Reviews - April 23, 2019 Category: General Medicine Authors: Butler M, Schultz TJ, Halligan P, Sheridan A, Kinsman L, Rotter T, Beaumier J, Kelly RG, Drennan J Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Flossing for the management of periodontal diseases and dental caries in adults.
CONCLUSIONS: There is some evidence from twelve studies that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone. There is weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months. No studies reported the effectiveness of flossing plus toothbrushing for preventing dental caries. PMID: 31013348 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 23, 2019 Category: General Medicine Authors: Sambunjak D, Nickerson JW, Poklepovic Pericic T, Johnson TM, Imai P, Tugwell P, Worthington HV Tags: Cochrane Database Syst Rev Source Type: research

Strategies to improve adherence and continuation of shorter-term hormonal methods of contraception.
CONCLUSIONS: Despite the importance of this topic, studies have not been published since the last review in 2013 (nine studies) with only one study added in 2019 that neither changed the results nor improved the certainty of evidence.Overall, the certainty of evidence for strategies to improve adherence and continuation of contraceptives is low. Intensive counseling and reminders (with or without educational information) may be associated with improved continuation of shorter-term hormonal contraceptive methods when compared with usual family planning care. However, this should be interpreted with caution due to the low ce...
Source: Cochrane Database of Systematic Reviews - April 23, 2019 Category: General Medicine Authors: Mack N, Crawford TJ, Guise JM, Chen M, Grey TW, Feldblum PJ, Stockton LL, Gallo MF Tags: Cochrane Database Syst Rev Source Type: research

Types of materials for frontalis sling surgery for congenital ptosis.
CONCLUSIONS: The three trials included in this review evaluated four materials for frontalis sling surgery. Assessment of these three studies does not allow us to identify the optimal material. Future randomized trials should be rigorously designed so as to identify the best treatment for this condition. PMID: 31013353 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 23, 2019 Category: General Medicine Authors: Rosenberg JB, Andersen J, Barmettler A Tags: Cochrane Database Syst Rev Source Type: research

Haloperidol discontinuation for people with schizophrenia.
CONCLUSIONS: This review provides limited evidence derived from small, short-term studies. The longest study was for one year, making it difficult to generalise the results to a life-long disorder. Very low quality evidence shows that discontinuation of haloperidol is associated with an increased risk of relapse and a reduction in the risk of 'global state improvement'. However, participant satisfaction with haloperidol treatment was not different from participant satisfaction with haloperidol discontinuation as measured by leaving the studies early. Due to the very low quality of these results, firm conclusions cannot be ...
Source: Cochrane Database of Systematic Reviews - April 21, 2019 Category: General Medicine Authors: Essali A, Turkmani K, Aboudamaah S, AbouDamaah A, Diaa Aldeen MR, Marwa ME, AlMounayer N Tags: Cochrane Database Syst Rev Source Type: research

Antifibrinolytic therapy for preventing oral bleeding in patients with haemophilia or Von Willebrand disease undergoing minor oral surgery or dental extractions.
CONCLUSIONS: Despite the discovery of a beneficial effect of systemically administered tranexamic acid and EACA in preventing postoperative bleeding in people with haemophilia undergoing dental extraction, the limited number of randomised controlled trials identified, in combination with the small sample sizes and heterogeneity regarding standard therapy and treatment regimens between the two trials, do not allow us to conclude definite efficacy of antifibrinolytic therapy in oral or dental procedures in people with haemophilia. No trials were identified in people with VWD. PMID: 31002742 [PubMed - as supplied by publ...
Source: Cochrane Database of Systematic Reviews - April 19, 2019 Category: General Medicine Authors: van Galen KP, Engelen ET, Mauser-Bunschoten EP, van Es RJ, Schutgens RE Tags: Cochrane Database Syst Rev Source Type: research

Aqueous shunts with mitomycin C versus aqueous shunts alone for glaucoma.
CONCLUSIONS: We found insufficient evidence in this review to suggest MMC provides any postoperative benefit for glaucoma patients who undergo aqueous shunt surgery. Data across all five included trials were sparse and the reporting of study methods required to assess bias was inadequate. Future RCTs of this intervention should report methods in sufficient detail to permit assessment of potential bias and estimate target sample sizes based on clinically meaningful effect sizes. PMID: 30999387 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 19, 2019 Category: General Medicine Authors: Foo VHX, Htoon HM, Welsbie DS, Perera SA Tags: Cochrane Database Syst Rev Source Type: research

Eradication therapy for Burkholderia cepacia complex in people with cystic fibrosis.
CONCLUSIONS: The authors have concluded that there was an extreme lack of evidence in this area of treatment management for people with cystic fibrosis. Without further comprehensive studies, it is difficult to draw conclusions about a safe and effective management strategy for Burkholderia cepacia complex eradication in cystic fibrosis. Thus, while the review could not offer clinicians evidence of an effective eradication protocol for Burkholderia cepacia complex, it has highlighted an urgent need for exploration and research in this area, specifically the need for well-designed multi-centre randomised controlled studies ...
Source: Cochrane Database of Systematic Reviews - April 18, 2019 Category: General Medicine Authors: Regan KH, Bhatt J Tags: Cochrane Database Syst Rev Source Type: research

Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation.
CONCLUSIONS: There is high-certainty evidence that using combination NRT versus single-form NRT, and 4 mg versus 2 mg nicotine gum, can increase the chances of successfully stopping smoking. For patch dose comparisons, evidence was of moderate certainty, due to imprecision. Twenty-one mg patches resulted in higher quit rates than 14 mg (24-hour) patches, and using 25 mg patches resulted in higher quit rates than using 15 mg (16-hour) patches, although in the latter case the CI included one. There was no clear evidence of superiority for 42/44 mg over 21/22 mg (24-hour) patches. Using a fast-acting form of NRT, such as gum ...
Source: Cochrane Database of Systematic Reviews - April 18, 2019 Category: General Medicine Authors: Lindson N, Chepkin SC, Ye W, Fanshawe TR, Bullen C, Hartmann-Boyce J Tags: Cochrane Database Syst Rev Source Type: research

Metformin and second- or third-generation sulphonylurea combination therapy for adults with type 2 diabetes mellitus.
CONCLUSIONS: There is inconclusive evidence whether M+S combination therapy compared with metformin plus another glucose-lowering intervention results in benefit or harm for most patient-important outcomes (mortality, SAEs, macrovascular and microvascular complications) with the exception of hypoglycaemia (more harm for M+S combination). No RCT reported on health-related quality of life. PMID: 30998259 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 18, 2019 Category: General Medicine Authors: Madsen KS, Kähler P, Kähler LKA, Madsbad S, Gnesin F, Metzendorf MI, Richter B, Hemmingsen B Tags: Cochrane Database Syst Rev Source Type: research

Medical treatment for botulism.
CONCLUSIONS: We found low- and moderate-certainty evidence supporting the use of BIG-IV in infant intestinal botulism. A single RCT demonstrated that BIG-IV probably decreases the duration of hospitalization; may decrease the duration of mechanical ventilation; and probably decreases the duration of tube or parenteral feeding. Adverse events were probably no more frequent with immune globulin than with placebo. Our search did not reveal any evidence examining the use of other medical treatments including serum trivalent botulism antitoxin. PMID: 30993666 [PubMed - as supplied by publisher] (Source: Cochrane Database o...
Source: Cochrane Database of Systematic Reviews - April 17, 2019 Category: General Medicine Authors: Chalk CH, Benstead TJ, Pound JD, Keezer MR Tags: Cochrane Database Syst Rev Source Type: research

Yoga as part of a package of care versus non-standard care for schizophrenia.
CONCLUSIONS: In view of the lack of evidence from RCTs, it is currently not possible for us to comment on the use of yoga as part of a package of care versus non-standard care. PMID: 30990224 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 16, 2019 Category: General Medicine Authors: Broderick J, Vancampfort D Tags: Cochrane Database Syst Rev Source Type: research

Screening hysteroscopy in subfertile women and women undergoing assisted reproduction.
CONCLUSIONS: At present, there is no high-quality evidence to support the routine use of hysteroscopy as a screening tool in the general population of subfertile women with a normal ultrasound or hysterosalpingogram in the basic fertility work-up for improving reproductive success rates.In women undergoing IVF, low-quality evidence, including all of the studies reporting these outcomes, suggests that performing a screening hysteroscopy before IVF may increase live birth and clinical pregnancy rates. However, pooled results from the only two trials with a low risk of bias did not show a benefit of screening hysteroscopy bef...
Source: Cochrane Database of Systematic Reviews - April 16, 2019 Category: General Medicine Authors: Kamath MS, Bosteels J, D'Hooghe TM, Seshadri S, Weyers S, Mol BWJ, Broekmans FJ, Sunkara SK Tags: Cochrane Database Syst Rev Source Type: research

Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis.
CONCLUSIONS: Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met. PMID: 30982950 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 15, 2019 Category: General Medicine Authors: Karimi-Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ Tags: Cochrane Database Syst Rev Source Type: research

Robot-assisted surgery in gynaecology.
CONCLUSIONS: Evidence on the effectiveness and safety of RAS compared with CLS for non-malignant disease (hysterectomy and sacrocolpopexy) is of low certainty but suggests that surgical complication rates might be comparable. Evidence on the effectiveness and safety of RAS compared with CLS or open surgery for malignant disease is more uncertain because survival data are lacking. RAS is an operator-dependent expensive technology; therefore evaluating the safety of this technology independently will present challenges. PMID: 30985921 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 15, 2019 Category: General Medicine Authors: Lawrie TA, Liu H, Lu D, Dowswell T, Song H, Wang L, Shi G Tags: Cochrane Database Syst Rev Source Type: research

Hepatic late adverse effects after antineoplastic treatment for childhood cancer.
CONCLUSIONS: The prevalence of hepatic late adverse effects among studies with an adequate outcome definition varied considerably from 1% to 53%. Evidence suggests that radiotherapy involving the liver, higher BMI, chronic viral hepatitis and longer follow-up time or older age at follow-up increase the risk of hepatic late adverse effects. In addition, there may be a suggestion that busulfan, thioguanine, hepatic surgery, higher alcohol intake (>14 units per week), metabolic syndrome, use of statins, non-Hispanic white ethnicity, and older age at cancer diagnosis increase the risk of hepatic late adverse effects. High-q...
Source: Cochrane Database of Systematic Reviews - April 15, 2019 Category: General Medicine Authors: Mulder RL, Bresters D, Van den Hof M, Koot BG, Castellino SM, Loke YKK, Post PN, Postma A, Szőnyi LP, Levitt GA, Bardi E, Skinner R, van Dalen EC Tags: Cochrane Database Syst Rev Source Type: research

Adjuvant therapy with antidepressants for the management of inflammatory bowel disease.
CONCLUSIONS: The results for the outcomes assessed in this review are uncertain and no firm conclusions regarding the efficacy and safety of antidepressants in IBD can be drawn. Future studies should employ RCT designs, with a longer follow-up and develop solutions to address attrition. Inclusion of objective markers of disease activity is strongly recommended as is testing antidepressants from different classes, as at present it is unclear if any antidepressant (or class thereof) has differential efficacy. PMID: 30977111 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 12, 2019 Category: General Medicine Authors: Mikocka-Walus A, Prady SL, Pollok J, Esterman AJ, Gordon AL, Knowles S, Andrews JM Tags: Cochrane Database Syst Rev Source Type: research

First aid glucose administration routes for symptomatic hypoglycaemia.
We reported continuous outcomes as mean differences (MD) with 95% confidence intervals (CIs) and dichotomous outcomes as risk ratios (RR) with 95% CIs. All data on glucose concentrations were converted to mg/dL. We contacted authors of included studies to obtain missing data. MAIN RESULTS: From 6394 references, we included four studies evaluating 77 participants, including two RCTs, studying children and adults with hypoglycaemia, respectively, and two non-RCTs with healthy volunteers. The studies included three different routes of glucose administration (sublingual, buccal and a combination of oral and buccal adminis...
Source: Cochrane Database of Systematic Reviews - April 11, 2019 Category: General Medicine Authors: De Buck E, Borra V, Carlson JN, Zideman DA, Singletary EM, Djärv T Tags: Cochrane Database Syst Rev Source Type: research

Community-based antibiotic delivery for possible serious bacterial infections in neonates in low- and middle-income countries.
CONCLUSIONS: Low-quality data demonstrated that community-based antibiotics reduced neonatal mortality when compared to the standard hospital referral for neonatal PSBI in resource-limited settings. The use of co-interventions, however, prevent disentanglement of the contribution from community-based antibiotics. Moderate-quality evidence showed that simplified, community-based treatment of PSBI using regimens which rely on the combination of oral and injectable antibiotics did not result in increased neonatal mortality when compared to the standard treatment of using only injectable antibiotics. Overall, the evidence sugg...
Source: Cochrane Database of Systematic Reviews - April 11, 2019 Category: General Medicine Authors: Duby J, Lassi ZS, Bhutta ZA Tags: Cochrane Database Syst Rev Source Type: research

Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries.
CONCLUSIONS: Using floss or interdental brushes in addition to toothbrushing may reduce gingivitis or plaque, or both, more than toothbrushing alone. Interdental brushes may be more effective than floss. Available evidence for tooth cleaning sticks and oral irrigators is limited and inconsistent. Outcomes were mostly measured in the short term and participants in most studies had a low level of baseline gingival inflammation. Overall, the evidence was low to very low-certainty, and the effect sizes observed may not be clinically important. Future trials should report participant periodontal status according to the new peri...
Source: Cochrane Database of Systematic Reviews - April 10, 2019 Category: General Medicine Authors: Worthington HV, MacDonald L, Poklepovic Pericic T, Sambunjak D, Johnson TM, Imai P, Clarkson JE Tags: Cochrane Database Syst Rev Source Type: research