Transplacental versus direct fetal corticosteroid treatment for accelerating fetal lung maturation where there is a risk of preterm birth.
CONCLUSIONS: The available clinical studies carried out so far on animals and human have shown that direct intramuscular injection of corticosteroid into the fetus under ultrasound guidance is feasible, but data on health outcomes are lacking. Uncertainty therefore persists as to which method could provide better efficacy and safety. Randomised controlled trials are required focusing on the benefits and harms of transplacental versus direct fetal corticosteroid treatment. Until the uncertainties have been addressed, it is advisable to stay with the current standard of antenatal transplacental maternally-administered cortic...
Source: Cochrane Database of Systematic Reviews - June 14, 2018 Category: General Medicine Authors: Utama DP, Crowther CA Tags: Cochrane Database Syst Rev Source Type: research

Controlled hypotension versus normotensive resuscitation strategy for people with ruptured abdominal aortic aneurysm.
CONCLUSIONS: We found no RCTs that compared controlled hypotension and normotensive resuscitation strategies in the management of haemorrhagic shock in patients with ruptured abdominal aortic aneurysm that assessed mortality, presence of coagulopathy, intensive care unit length of stay, and the presence of myocardial infarct and renal failure. High quality studies that evaluate the best strategy for managing haemorrhagic shock in ruptured abdominal aortic aneurysms are required. PMID: 29897100 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 13, 2018 Category: General Medicine Authors: Moreno DH, Cacione DG, Baptista-Silva JC Tags: Cochrane Database Syst Rev Source Type: research

Iridotomy to slow progression of visual field loss in angle-closure glaucoma.
CONCLUSIONS: The available studies that directly compared iridotomy to no iridotomy have not yet published full trial reports. At present, we cannot draw reliable conclusions based on randomized controlled trials as to whether iridotomy slows progression of visual field loss at one year compared to no iridotomy. Full publication of the results from the studies may clarify the benefits of iridotomy. PMID: 29897635 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 13, 2018 Category: General Medicine Authors: Le JT, Rouse B, Gazzard G Tags: Cochrane Database Syst Rev Source Type: research

Fluphenazine (oral) versus placebo for schizophrenia.
CONCLUSIONS: The findings in this review confirm much that clinicians and recipients of care already know, but they provide quantification to support clinical impression. Fluphenazine's global position as an effective treatment for psychoses is not threatened by the outcome of this review. However, fluphenazine is an imperfect treatment and if accessible, other inexpensive drugs less associated with adverse effects may be an equally effective choice for people with schizophrenia. PMID: 29893410 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 12, 2018 Category: General Medicine Authors: Matar HE, Almerie MQ, Sampson SJ Tags: Cochrane Database Syst Rev Source Type: research

Interventions for preventing distal intestinal obstruction syndrome (DIOS) in cystic fibrosis.
Abstract BACKGROUND: Cystic fibrosis (CF) is the most common, life-limiting, genetically inherited disease. It affects multiple organs, particularly the respiratory system. However, gastrointestinal problems such as constipation and distal intestinal obstruction syndrome (DIOS) are also important and well-recognised complications in CF. They share similar symptoms e.g. bloating, abdominal pain, but are distinct conditions. Constipation occurs when there is gradual faecal impaction of the colon, but DIOS occurs when there is an accumulation of faeces and sticky mucus, forming a mass in the distal part of the small ...
Source: Cochrane Database of Systematic Reviews - June 12, 2018 Category: General Medicine Authors: Green J, Gilchrist FJ, Carroll W Tags: Cochrane Database Syst Rev Source Type: research

Dual antibiotics for bronchiectasis.
Abstract BACKGROUND: Bronchiectasis is a chronic respiratory disease characterised by abnormal and irreversible dilatation of the smaller airways and associated with a mortality rate greater than twice that of the general population. Antibiotics serve as front-line therapy for managing bacterial load, but their use is weighed against the development of antibiotic resistance. Dual antibiotic therapy has the potential to suppress infection from multiple strains of bacteria, leading to more successful treatment of exacerbations, reduced symptoms, and improved quality of life. Further evidence is required on the effic...
Source: Cochrane Database of Systematic Reviews - June 11, 2018 Category: General Medicine Authors: Felix LM, Grundy S, Milan SJ, Armstrong R, Harrison H, Lynes D, Spencer S Tags: Cochrane Database Syst Rev Source Type: research

Extracorporeal shock wave therapy for the healing and management of venous leg ulcers.
CONCLUSIONS: We found no RCTs assessing the effectiveness of extracorporeal shock wave therapy in the healing and management of venous leg ulceration. The lack of high-quality evidence in this area highlights a gap in research and may serve to justify the need for further research and evidence to provide guidance concerning the use of this treatment option for this condition. Future trials should be of clear design and include concomitant use of the current best practice treatment, multilayer compression therapy. Recruitment should aspire to best represent patients seen in clinical practice and patient-related outcome meas...
Source: Cochrane Database of Systematic Reviews - June 11, 2018 Category: General Medicine Authors: Cooper B, Bachoo P Tags: Cochrane Database Syst Rev Source Type: research

Couple therapy for depression.
CONCLUSIONS: Although there is suggestion that couple therapy is as effective as individual psychotherapy in improving depressive symptoms and more effective in improving relations in distressed couples, the low or very low quality of the evidence seriously limits the possibility of drawing firm conclusions. Very few data were available for comparisons with no/minimal treatment and drug therapy. Future trials of high quality should test in large samples with a long follow-up of the effects of couple therapy in comparison to other interventions in discordant couples with a depressed partner, considering the role of relation...
Source: Cochrane Database of Systematic Reviews - June 8, 2018 Category: General Medicine Authors: Barbato A, D'Avanzo B, Parabiaghi A Tags: Cochrane Database Syst Rev Source Type: research

Enteral versus parenteral nutrition and enteral versus a combination of enteral and parenteral nutrition for adults in the intensive care unit.
CONCLUSIONS: We found insufficient evidence to determine whether EN is better or worse than PN, or than combined EN and PN for mortality in hospital, at 90 days and at 180 days, and on the number of ventilator-free days and adverse events. We found fewer deaths at 30 days when studies gave combined EN and PN, and reduced sepsis for EN rather than PN. We found no studies that reported number of ICU-free days up to day 28. Certainty of the evidence for all outcomes is either low or very low. The 11 studies awaiting classification may alter the conclusions of the review once assessed. PMID: 29883514 [PubMed - as supplied...
Source: Cochrane Database of Systematic Reviews - June 8, 2018 Category: General Medicine Authors: Lewis SR, Schofield-Robinson OJ, Alderson P, Smith AF Tags: Cochrane Database Syst Rev Source Type: research

Prophylactic use of ergot alkaloids in the third stage of labour.
CONCLUSIONS: Prophylactic IM or IV injections of ergot alkaloids may be effective in reducing blood loss, reducing PPH (estimated blood loss of at least 500 mL), and increasing maternal haemoglobin. Ergot alkaloids may also decrease the use of therapeutic uterotonics, but adverse effects may include elevated blood pressure and pain after birth requiring analgesia. There were no differences between groups in terms of other adverse effects (vomiting, nausea, headache or eclamptic fit). There is a lack of evidence on the effects of ergot alkaloids on severe PPH, and retained or manual removal of placenta. There is also a lack...
Source: Cochrane Database of Systematic Reviews - June 7, 2018 Category: General Medicine Authors: Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM Tags: Cochrane Database Syst Rev Source Type: research

Ribavirin for treating Crimean Congo haemorrhagic fever.
CONCLUSIONS: We do not know if ribavirin is effective for treating Crimean Congo haemorrhagic fever. Non-randomized studies are often cited as evidence of an effect, but the risk of bias in these studies is high. PMID: 29869797 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 5, 2018 Category: General Medicine Authors: Johnson S, Henschke N, Maayan N, Mills I, Buckley BS, Kakourou A, Marshall R Tags: Cochrane Database Syst Rev Source Type: research

Mu-opioid antagonists for opioid-induced bowel dysfunction in people with cancer and people receiving palliative care.
CONCLUSIONS: In this update, the conclusions for naldemedine are new. There is moderate-quality evidence to suggest that, taken orally, naldemedine improves bowel function over two weeks in people with cancer and OIBD but increases the risk of adverse events. The conclusions on naloxone and methylnaltrexone have not changed. The trials on naloxone did not assess laxation at 24 hours or over two weeks. There is moderate-quality evidence that methylnaltrexone improves bowel function in people receiving palliative care in the short term and over two weeks, and low-quality evidence that it does not increase adverse events. The...
Source: Cochrane Database of Systematic Reviews - June 5, 2018 Category: General Medicine Authors: Candy B, Jones L, Vickerstaff V, Larkin PJ, Stone P Tags: Cochrane Database Syst Rev Source Type: research

Parenteral opioids for maternal pain management in labour.
CONCLUSIONS: Though most evidence is of low- or very-low quality, for healthy women with an uncomplicated pregnancy who are giving birth at 37 to 42 weeks, parenteral opioids appear to provide some relief from pain in labour but are associated with drowsiness, nausea, and vomiting in the woman. Effects on the newborn are unclear. Maternal satisfaction with opioid analgesia was largely unreported. The review needs to be examined alongside related Cochrane reviews. More research is needed to determine which analgesic intervention is most effective, and provides greatest satisfaction to women with acceptable adverse effects f...
Source: Cochrane Database of Systematic Reviews - June 5, 2018 Category: General Medicine Authors: Smith LA, Burns E, Cuthbert A Tags: Cochrane Database Syst Rev Source Type: research

Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates.
CONCLUSIONS: Moderate to very low quality evidence suggests that videolaryngoscopy increases the success of intubation in the first attempt but does not decrease the time to intubation or the number of attempts for intubation. However, these studies were conducted with trainees performing the intubations and these results highlight the potential usefulness of the videolaryngoscopy as a teaching tool. Well-designed, adequately powered RCTs are necessary to confirm efficacy and address safety and cost-effectiveness of videolaryngoscopy for endotracheal intubation in neonates by trainees and those proficient in direct laryngo...
Source: Cochrane Database of Systematic Reviews - June 4, 2018 Category: General Medicine Authors: Lingappan K, Arnold JL, Fernandes CJ, Pammi M Tags: Cochrane Database Syst Rev Source Type: research

Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units.
CONCLUSIONS: This review shows that antacids, sucralfate, and H2 receptor antagonists might be more effective in preventing upper GI bleeding in ICU patients compared with placebo or no prophylaxis. The effect estimates of any treatment versus no prophylaxis on nosocomial pneumonia were consistent with benefits and harms. Evidence of low certainty suggests that proton pump inhibitors might be more effective than H2 receptor antagonists. Therefore, patient-relevant benefits and especially harms of H2 receptor antagonists compared with proton pump inhibitors need to be assessed by larger, high-quality RCTs to confirm the res...
Source: Cochrane Database of Systematic Reviews - June 4, 2018 Category: General Medicine Authors: Toews I, George AT, Peter JV, Kirubakaran R, Fontes LES, Ezekiel JPB, Meerpohl JJ Tags: Cochrane Database Syst Rev Source Type: research

Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery in adults.
CONCLUSIONS: We are uncertain whether IV perioperative lidocaine, when compared to placebo or no treatment, has a beneficial impact on pain scores in the early postoperative phase, and on gastrointestinal recovery, postoperative nausea, and opioid consumption. The quality of evidence was limited due to inconsistency, imprecision, and study quality. Lidocaine probably has no clinically relevant effect on pain scores later than 24 hours. Few studies have systematically assessed the incidence of adverse effects. There is a lack of evidence about the effects of IV lidocaine compared with epidural anaesthesia in terms of the op...
Source: Cochrane Database of Systematic Reviews - June 4, 2018 Category: General Medicine Authors: Weibel S, Jelting Y, Pace NL, Helf A, Eberhart LH, Hahnenkamp K, Hollmann MW, Poepping DM, Schnabel A, Kranke P Tags: Cochrane Database Syst Rev Source Type: research

Prescribed hypocaloric nutrition support for critically-ill adults.
CONCLUSIONS: The included studies had substantial clinical heterogeneity. We found very low-quality evidence about the effects of prescribed hypocaloric nutrition support on mortality in hospital, in the ICU and at 30 days, as well as in length of hospital and ICU stay, infectious complications and the length of mechanical ventilation. For these outcomes there is uncertainty about the effects of prescribed hypocaloric nutrition, since the range of estimates includes both appreciable benefits and harms.Given these limitations, results must be interpreted with caution in the clinical field, considering the unclear balance of...
Source: Cochrane Database of Systematic Reviews - June 4, 2018 Category: General Medicine Authors: Perman MI, Ciapponi A, Franco JV, Loudet C, Crivelli A, Garrote V, Perman G Tags: Cochrane Database Syst Rev Source Type: research

Continuous versus intermittent antibiotics for bronchiectasis.
CONCLUSIONS: No randomised controlled trials have compared the effectiveness and risks of continuous antibiotic therapy versus intermittent antibiotic therapy for bronchiectasis. High-quality clinical trials are needed to establish which of these interventions is more effective for reducing the frequency and duration of exacerbations, antibiotic resistance and the occurrence of serious adverse events. PMID: 29860722 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 3, 2018 Category: General Medicine Authors: Donovan T, Felix LM, Chalmers JD, Milan SJ, Mathioudakis AG, Spencer S Tags: Cochrane Database Syst Rev Source Type: research

Medical and surgical interventions for the treatment of urinary stones in children.
CONCLUSIONS: Based on mostly very low-quality evidence for most comparisons and outcomes, we are uncertain about the effect of nearly all medical and surgical interventions to treat stone disease in children.Common reasons why we downgraded our assessments of the quality of evidence were: study limitations (risk of bias), indirectness, and imprecision. These issues make it difficult to draw clinical inferences. It is important that affected individuals, clinicians, and policy-makers are aware of these limitations of the evidence. There is a critical need for better quality trials assessing patient-important outcomes in chi...
Source: Cochrane Database of Systematic Reviews - June 2, 2018 Category: General Medicine Authors: Barreto L, Jung JH, Abdelrahim A, Ahmed M, Dawkins GPC, Kazmierski M Tags: Cochrane Database Syst Rev Source Type: research

Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma.
CONCLUSIONS: There is insufficient evidence to identify whether IM corticosteroids are more effective in reducing relapse compared to oral corticosteroids among children or adults discharged from an ED or equivalent acute care setting for acute asthma. While we found no statistical differences, patients receiving IM corticosteroids reported fewer adverse events. Additional studies comparing the effectiveness of IM versus oral corticosteroids could provide further evidence clarity. Furthermore, there is a need for studies comparing different IM corticosteroids (e.g. IM dexamethasone versus IM methylprednisone) and different...
Source: Cochrane Database of Systematic Reviews - June 2, 2018 Category: General Medicine Authors: Kirkland SW, Cross E, Campbell S, Villa-Roel C, Rowe BH Tags: Cochrane Database Syst Rev Source Type: research

Anticoagulation for people with cancer and central venous catheters.
CONCLUSIONS: The evidence was not conclusive for the effect of LMWH on mortality, the effect of VKA on mortality and catheter-related VTE, and the effect of LMWH compared to VKA on mortality and catheter-related VTE. We found moderate-certainty evidence that LMWH reduces catheter-related VTE compared to no LMWH. People with cancer with CVCs considering anticoagulation should balance the possible benefit of reduced thromboembolic complications with the possible harms and burden of anticoagulants. PMID: 29856471 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 1, 2018 Category: General Medicine Authors: Kahale LA, Tsolakian IG, Hakoum MB, Matar CF, Barba M, Yosuico VE, Terrenato I, Sperati F, Schünemann H, Akl EA Tags: Cochrane Database Syst Rev Source Type: research

Vaccines for preventing typhoid fever.
CONCLUSIONS: The licensed Ty21a and Vi polysaccharide vaccines are efficacious in adults and children older than two years in endemic countries. The Vi-rEPA vaccine is just as efficacious, although data is only available for children. The new Vi-TT vaccine (PedaTyph) requires further evaluation to determine if it provides protection against typhoid fever. At the time of writing, there were only efficacy data from a human challenge setting in adults on the Vi-TT vaccine (Tybar), which clearly justify the ongoing field trials to evaluate vaccine efficacy. PMID: 29851031 [PubMed - as supplied by publisher] (Source: Cochr...
Source: Cochrane Database of Systematic Reviews - May 31, 2018 Category: General Medicine Authors: Milligan R, Paul M, Richardson M, Neuberger A Tags: Cochrane Database Syst Rev Source Type: research

Interventions for necrotizing soft tissue infections in adults.
CONCLUSIONS: We found very little evidence on the effects of medical and surgical treatments for NSTI. We cannot draw conclusions regarding the relative effects of any of the interventions on 30-day mortality or serious adverse events due to the very low quality of the evidence.The quality of the evidence is limited by the very small number of trials, the small sample sizes, and the risks of bias in the included trials. It is important for future trials to clearly define their inclusion criteria, which will help with the applicability of future trial results to a real-life population.Management of NSTI participants (critic...
Source: Cochrane Database of Systematic Reviews - May 31, 2018 Category: General Medicine Authors: Hua C, Bosc R, Sbidian E, De Prost N, Hughes C, Jabre P, Chosidow O, Le Cleach L Tags: Cochrane Database Syst Rev Source Type: research

Nicotine replacement therapy versus control for smoking cessation.
CONCLUSIONS: There is high-quality evidence that all of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect. The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial ...
Source: Cochrane Database of Systematic Reviews - May 31, 2018 Category: General Medicine Authors: Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T Tags: Cochrane Database Syst Rev Source Type: research

Pulp treatment for extensive decay in primary teeth.
CONCLUSIONS: Pulp treatment for extensive decay in primary teeth is generally successful. Many included trials had no clinical or radiological failures in either trial arm, and the overall proportion of failures was low. Any future trials in this area would require a very large sample size and follow up of a minimum of one year.The evidence suggests MTA may be the most efficacious medicament to heal the root pulp after pulpotomy of a deciduous tooth. As MTA is relatively expensive, future research could be undertaken to confirm if Biodentine, enamel matrix derivative, laser treatment or Ankaferd Blood Stopper are acceptabl...
Source: Cochrane Database of Systematic Reviews - May 31, 2018 Category: General Medicine Authors: Smaïl-Faugeron V, Glenny AM, Courson F, Durieux P, Muller-Bolla M, Fron Chabouis H Tags: Cochrane Database Syst Rev Source Type: research

Primary cryotherapy for localised or locally advanced prostate cancer.
CONCLUSIONS: Based on very low quality evidence, primary whole gland cryotherapy has uncertain effects on oncologic outcomes, QoL, and major adverse events compared to external beam radiotherapy. Reasons for downgrading the QoE included serious study limitations, indirectness due to the use of lower doses of radiation in the comparison group than currently recommended, and serious or very serious imprecision. PMID: 29845595 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 30, 2018 Category: General Medicine Authors: Jung JH, Risk MC, Goldfarb R, Reddy B, Coles B, Dahm P Tags: Cochrane Database Syst Rev Source Type: research

Interventions to increase influenza vaccination rates of those 60 years and older in the community.
Conclusions are unchanged from the 2014 review. PMID: 29845606 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 30, 2018 Category: General Medicine Authors: Thomas RE, Lorenzetti DL Tags: Cochrane Database Syst Rev Source Type: research

Interventions for childhood apraxia of speech.
CONCLUSIONS: There is limited evidence that, when delivered intensively, both the NDP-3 and ReST may effect improvement in word accuracy in 4- to 12-year-old children with CAS, measured by the accuracy of production on treated and non-treated words, speech production consistency and the accuracy of connected speech. The study did not measure functional communication. No formal analyses were conducted to compare NDP-3 and ReST by the original study authors, hence one treatment cannot be reliably advocated over the other. We are also unable to say whether either treatment is better than no treatment or treatment as usual. No...
Source: Cochrane Database of Systematic Reviews - May 30, 2018 Category: General Medicine Authors: Morgan AT, Murray E, Liégeois FJ Tags: Cochrane Database Syst Rev Source Type: research

Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction.
CONCLUSIONS: The use of duodenal stent placement in malignant gastric outlet obstruction has the benefits of a quicker resumption of oral intake and a reduced inpatient hospital stay; however, this is balanced by an increase in the recurrence of symptoms and the need for further intervention.It is impossible to draw further conclusions on these and the other measured outcomes, primarily due to the low number of eligible studies and small number of participants which resulted in low-quality evidence. It was not possible to analyse the impact on quality of life each intervention had for these participants. PMID: 2984561...
Source: Cochrane Database of Systematic Reviews - May 30, 2018 Category: General Medicine Authors: Upchurch E, Ragusa M, Cirocchi R Tags: Cochrane Database Syst Rev Source Type: research

Implantable miniature telescope (IMT) for vision loss due to end-stage age-related macular degeneration.
CONCLUSIONS: We found no RCT or quasi-RCT and can draw no conclusion about the effectiveness and safety of the IMT in improving visual acuity in individuals with late or advanced AMD. Since the IMT is typically implanted monocularly based upon which eye has better best-corrected distance visual acuity, randomization between eyes within an individual may not be acceptable. Studies are needed that compare outcomes between individuals randomized to the device versus individuals not implanted, at least during study follow-up, who serve as controls. PMID: 29847689 [PubMed - as supplied by publisher] (Source: Cochrane Datab...
Source: Cochrane Database of Systematic Reviews - May 30, 2018 Category: General Medicine Authors: Gupta A, Lam J, Custis P, Munz S, Fong D, Koster M Tags: Cochrane Database Syst Rev Source Type: research

Neuromuscular electrostimulation for adults with chronic obstructive pulmonary disease.
CONCLUSIONS: NMES, when applied in isolation, increased quadriceps force and endurance, 6MWD and time to symptom limitation exercising at a submaximal intensity, and reduced the severity of leg fatigue on completion of exercise testing. It may increase VO2peak, but the true effect on this outcome measure could be trivial. However, the quality of evidence was low or very low due to risk of bias within the studies, imprecision of the estimates, small number of studies and inconsistency between the studies. Although there were no additional gains in quadriceps force with NMES plus conventional exercise training, there was evi...
Source: Cochrane Database of Systematic Reviews - May 29, 2018 Category: General Medicine Authors: Hill K, Cavalheri V, Mathur S, Roig M, Janaudis-Ferreira T, Robles P, Dolmage TE, Goldstein R Tags: Cochrane Database Syst Rev Source Type: research

Mirtazapine adjunct for people with schizophrenia.
CONCLUSIONS: The available evidence is primarily of very low quality and indicates that mirtazapine adjunct is not clearly associated with an effect for negative symptoms, but there is some indication of a positive effect on overall mental state and akathisia. No effect was found for global state or leaving the study early and data were not available for quality of life or service use. Due to limitations of the quality and applicability of the evidence it is not possible to make any firm conclusions, the role of mirtazapine adjunct in routine clinical practice remains unclear. This underscores the need for new high-quality...
Source: Cochrane Database of Systematic Reviews - May 26, 2018 Category: General Medicine Authors: Perry LA, Ramson D, Stricklin S Tags: Cochrane Database Syst Rev Source Type: research

Time-lapse systems for embryo incubation and assessment in assisted reproduction.
CONCLUSIONS: There is insufficient evidence of differences in live birth, miscarriage, stillbirth or clinical pregnancy to choose between TLS, with or without embryo selection software, and conventional incubation. The studies were at high risk of bias for randomisation and allocation concealment, the result should be interpreted with extreme caution. PMID: 29800485 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 25, 2018 Category: General Medicine Authors: Armstrong S, Bhide P, Jordan V, Pacey A, Farquhar C Tags: Cochrane Database Syst Rev Source Type: research

Education of healthcare professionals for preventing pressure ulcers.
CONCLUSIONS: We are uncertain whether educating healthcare professionals about pressure ulcer prevention makes any difference to pressure ulcer incidence, or to nurses' knowledge of pressure ulcer prevention. This is because the included studies provided very low-certainty evidence. Therefore, further information is required to clarify the impact of education of healthcare professionals on the prevention of pressure ulcers. PMID: 29800486 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 25, 2018 Category: General Medicine Authors: Porter-Armstrong AP, Moore ZE, Bradbury I, McDonough S Tags: Cochrane Database Syst Rev Source Type: research

Respiratory muscle training for cystic fibrosis.
Abstract BACKGROUND: Cystic fibrosis is the most common autosomal recessive disease in white populations, and causes respiratory dysfunction in the majority of individuals. Numerous types of respiratory muscle training to improve respiratory function and health-related quality of life in people with cystic fibrosis have been reported in the literature. Hence a systematic review of the literature is needed to establish the effectiveness of respiratory muscle training (either inspiratory or expiratory muscle training) on clinical outcomes in cystic fibrosis. This is an update of a previously published review. O...
Source: Cochrane Database of Systematic Reviews - May 24, 2018 Category: General Medicine Authors: Hilton N, Solis-Moya A Tags: Cochrane Database Syst Rev Source Type: research

Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome.
CONCLUSIONS: Letrozole appears to improve live birth and pregnancy rates in subfertile women with anovulatory polycystic ovary syndrome, compared to clomiphene citrate. There is high-quality evidence that OHSS rates are similar with letrozole or clomiphene citrate. There is high-quality evidence of no difference in miscarriage rates or multiple pregnancy rates. There is low-quality evidence of no difference in live birth and pregnancy rates between letrozole and laparoscopic ovarian drilling, although there were few relevant studies. For the 2018 update, we added good-quality trials, upgrading the quality of the evidence. ...
Source: Cochrane Database of Systematic Reviews - May 24, 2018 Category: General Medicine Authors: Franik S, Eltrop SM, Kremer JA, Kiesel L, Farquhar C Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Resorbable versus titanium plates for facial fractures.
CONCLUSIONS: This review illustrates that there are no published randomised controlled clinical trials relevant to this review question. There is currently insufficient evidence for the effectiveness of resorbable fixation systems compared with conventional titanium systems for facial fractures. The findings of this review, based on the results of the aborted trials, do not suggest that resorbable plates are as effective as titanium plates. In future, the results of ongoing clinical trials may provide high level reliable evidence for assisting clinicians and patients for decision making. Trialists should design their studi...
Source: Cochrane Database of Systematic Reviews - May 23, 2018 Category: General Medicine Authors: Dorri M, Oliver R Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Interventions for replacing missing teeth: 1- versus 2-stage implant placement.
CONCLUSIONS: The number of patients included in the trials was too small to draw definitive conclusions. The 1-stage approach might be preferable in partially edentulous patients since it avoids one surgical intervention and shortens treatment times, while a 2-stage submerged approach could be indicated when an implant has not obtained an optimal primary stability or when barriers are used for guided tissue regeneration, or when it is expected that removable temporary prostheses could transmit excessive forces on the penetrating abutments especially in fully edentulous patients. PMID: 29791009 [PubMed - as supplied by...
Source: Cochrane Database of Systematic Reviews - May 23, 2018 Category: General Medicine Authors: Esposito M, Grusovin MG, Chew YS, Coulthard P, Worthington HV Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Treatments for adults with prominent lower front teeth.
CONCLUSIONS: There is insufficient evidence from the two included trials, to conclude that one procedure is better or worse than another. The included trials compared different interventions and were at high risk of bias and therefore no implications for practice can be given. Further high quality randomized controlled trials with long term follow-up are required. PMID: 29791019 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 23, 2018 Category: General Medicine Authors: Minami-Sugaya H, Lentini-Oliveira DA, Carvalho FR, Machado MAC, Marzola C, Saconato H, Prado GF Tags: Cochrane Database Syst Rev Source Type: research

Antiepileptic drugs as prophylaxis for postcraniotomy seizures.
CONCLUSIONS: There is limited, low-quality evidence to suggest that AED treatment administered prophylactically is either effective or not effective in the prevention of postcraniotomy (early or late) seizures. The current evidence base is limited due to the different methodologies employed in the trials and inconsistencies in the reporting of outcomes including deaths and adverse events. Further evidence from good-quality, contemporary trials is required in order to assess the clinical effectiveness of prophylactic AED treatment compared to placebo or no treatment, or other AEDs in preventing postcraniotomy seizures in th...
Source: Cochrane Database of Systematic Reviews - May 23, 2018 Category: General Medicine Authors: Greenhalgh J, Weston J, Dundar Y, Nevitt SJ, Marson AG Tags: Cochrane Database Syst Rev Source Type: research

Oral contraceptives for pain associated with endometriosis.
CONCLUSIONS: Based on the limited evidence from two trials at high risk of bias and limited data for the prespecified outcomes for this review, there is insufficient evidence to make a judgement on the effectiveness of the COCP compared with placebo and the findings cannot be generalised.Based on the limited evidence from one small trial that was at high risk of bias, there is insufficient evidence to make a judgement on the effectiveness of the COCP compared with other medical treatments. Only one comparison was possible, with the medical intervention being goserelin, and the findings cannot be generalised.Further researc...
Source: Cochrane Database of Systematic Reviews - May 22, 2018 Category: General Medicine Authors: Brown J, Crawford TJ, Datta S, Prentice A Tags: Cochrane Database Syst Rev Source Type: research

Blue-light filtering intraocular lenses (IOLs) for protecting macular health.
CONCLUSIONS: This systematic review shows with moderate certainty that there is no clinically meaningful difference in short-term BCVA with the two types of IOLs. Further, based upon available data, these findings suggest that there is no clinically meaningful difference in short-term contrast sensitivity with the two interventions, although there was a low level of certainty for this outcome due to a small number of included studies and their inherent risk of bias. Based upon current, best-available research evidence, it is unclear whether blue-light filtering IOLs preserve macular health or alter risks associated with th...
Source: Cochrane Database of Systematic Reviews - May 22, 2018 Category: General Medicine Authors: Downie LE, Busija L, Keller PR Tags: Cochrane Database Syst Rev Source Type: research

Epidural versus non-epidural or no analgesia for pain management in labour.
Abstract BACKGROUND: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non-epidural or no analgesia in labour), last published in 2011. OBJECTIVES: To assess the effectiveness and safety of all types of epidural analgesia, including combined-spinal-epidural (CSE) on the mother and the baby, when compared with non-epid...
Source: Cochrane Database of Systematic Reviews - May 21, 2018 Category: General Medicine Authors: Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A Tags: Cochrane Database Syst Rev Source Type: research

Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under.
CONCLUSIONS: Overall, we found evidence that education improves complementary feeding practices. PMID: 29775501 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 18, 2018 Category: General Medicine Authors: Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM Tags: Cochrane Database Syst Rev Source Type: research

Automated mandatory bolus versus basal infusion for maintenance of epidural analgesia in labour.
CONCLUSIONS: There is predominantly moderate-certainty evidence that AMB is similar to BI for maintaining epidural analgesia for labour for all measured outcomes and may have the benefit of decreasing the risk of breakthrough pain and improving maternal satisfaction while decreasing the amount of local anaesthetic needed. PMID: 29770432 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 17, 2018 Category: General Medicine Authors: Sng BL, Zeng Y, de Souza NNA, Leong WL, Oh TT, Siddiqui FJ, Assam PN, Han NR, Chan ES, Sia AT Tags: Cochrane Database Syst Rev Source Type: research

Interventions for increasing fruit and vegetable consumption in children aged five years and under.
CONCLUSIONS: Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or l...
Source: Cochrane Database of Systematic Reviews - May 17, 2018 Category: General Medicine Authors: Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton-McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L Tags: Cochrane Database Syst Rev Source Type: research

Inhaled corticosteroids for bronchiectasis.
CONCLUSIONS: This updated review indicates that there is insufficient evidence to support the routine use of ICS in adults with stable state bronchiectasis. Further, we cannot draw any conclusion for the use of ICS in adults during an acute exacerbation or in children (for any state), as there were no studies. PMID: 29766487 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 16, 2018 Category: General Medicine Authors: Kapur N, Petsky HL, Bell S, Kolbe J, Chang AB Tags: Cochrane Database Syst Rev Source Type: research

Immersion in water during labour and birth.
CONCLUSIONS: In healthy women at low risk of complications there is moderate to low-quality evidence that water immersion during the first stage of labour probably has little effect on mode of birth or perineal trauma, but may reduce the use of regional analgesia. The evidence for immersion during the second stage of labour is limited and does not show clear differences on maternal or neonatal outcomes intensive care. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring or giving birth in water. Available evidence is limited by clinical variability and heterogeneity across trials, ...
Source: Cochrane Database of Systematic Reviews - May 16, 2018 Category: General Medicine Authors: Cluett ER, Burns E, Cuthbert A Tags: Cochrane Database Syst Rev Source Type: research

Pain relief for women undergoing oocyte retrieval for assisted reproduction.
CONCLUSIONS: The evidence does not support one particular method or technique over another in providing effective conscious sedation and analgesia for pain relief during and after oocyte retrieval. Simultaneous use of sedation combined with analgesia such as the opiates, further enhanced by paracervical block or acupuncture techniques, resulted in better pain relief than occurred with one modality alone. Evidence was insufficient to show conclusively whether any of the interventions influenced pregnancy rates. All techniques reviewed were associated with a high degree of patient satisfaction. Women's preferences and resour...
Source: Cochrane Database of Systematic Reviews - May 15, 2018 Category: General Medicine Authors: Kwan I, Wang R, Pearce E, Bhattacharya S Tags: Cochrane Database Syst Rev Source Type: research

Airway physical examination tests for detection of difficult airway management in apparently normal adult patients.
The objective of this review was to characterize and compare the diagnostic accuracy of the Mallampati classification and other commonly used airway examination tests for assessing the physical status of the airway in adult patients with no apparent anatomical airway abnormalities. We performed this individually for each of the four descriptors of the difficult airway: difficult face mask ventilation, difficult laryngoscopy, difficult tracheal intubation, and failed intubation. SEARCH METHODS: We searched major electronic databases including CENTRAL, MEDLINE, Embase, ISI Web of Science, CINAHL, as well as regional, su...
Source: Cochrane Database of Systematic Reviews - May 15, 2018 Category: General Medicine Authors: Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, Herkner H Tags: Cochrane Database Syst Rev Source Type: research