Ethosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents.
In this study, the frequency of treatment failures due to intolerable adverse events was significantly different among the treatment groups, with the largest proportion of adverse events in the valproic acid group (48/146, 33%) compared to the ethosuximide (38/154, 25%) and the lamotrigine (29/146, 20%) groups (P
Source: Cochrane Database of Systematic Reviews - January 21, 2021 Category: General Medicine Authors: Brigo F, Igwe SC, Lattanzi S Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic therapy versus no antibiotic therapy for children aged 2 to 59 months with WHO-defined non-severe pneumonia and wheeze.
CONCLUSIONS: We do not currently have enough evidence to support or challenge the continued use of antibiotics for the treatment of non-severe pneumonia. There is a clear need for RCTs to address this question in children aged 2 to 59 months with 2014 WHO-defined non-severe pneumonia and wheeze. PMID: 33469915 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 20, 2021 Category: General Medicine Authors: Lassi ZS, Padhani ZA, Das JK, Salam RA, Bhutta ZA Tags: Cochrane Database Syst Rev Source Type: research

Payment methods for healthcare providers working in outpatient healthcare settings.
CONCLUSIONS: For healthcare providers working in outpatient healthcare settings, P4P or an increase in FFS payment level probably increases the quantity of health service provision (moderate-certainty evidence), and P4P may slightly improve the quality of service provision for targeted conditions (low-certainty evidence). The effects of changes in payment methods on health outcomes is uncertain due to very low-certainty evidence. Information to explore the influence of specific payment method design features, such as the size of incentives and type of performance measures, was insufficient. Furthermore, due to limited and ...
Source: Cochrane Database of Systematic Reviews - January 20, 2021 Category: General Medicine Authors: Jia L, Meng Q, Scott A, Yuan B, Zhang L Tags: Cochrane Database Syst Rev Source Type: research

Hand hygiene for the prevention of infections in neonates.
CONCLUSIONS: We are uncertain as to the superiority of one hand hygiene agent over another because this review included very few studies with very serious study limitations. PMID: 33471367 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 20, 2021 Category: General Medicine Authors: Kuti BP, Ogunlesi TA, Oduwole O, Oringanje C, Udoh EE, Meremikwu MM Tags: Cochrane Database Syst Rev Source Type: research

House modifications for preventing malaria.
CONCLUSIONS: Based on the two trials published to date, there is some evidence that screening may reduce malaria transmission and malaria infection in people living in the house. The four trials awaiting publication are likely to enrich the current evidence base, and we will add these to this review when they become available. PMID: 33471371 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 20, 2021 Category: General Medicine Authors: Furnival-Adams J, Olanga EA, Napier M, Garner P Tags: Cochrane Database Syst Rev Source Type: research

Extended lymph node resection versus standard resection for pancreatic and periampullary adenocarcinoma.
Abstract BACKGROUND: Pancreatic and periampullary adenocarcinomas account for some of the most aggressive malignancies, and the leading causes of cancer-related mortalities. Partial pancreaticoduodenectomy (PD) with negative resection margins is the only potentially curative therapy. The high prevalence of lymph node metastases has led to the hypothesis that wider excision with the removal of more lymphatic tissue could result in an improvement of survival, and higher rates of negative resection margins. OBJECTIVES: To compare overall survival following standard (SLA) versus extended lymph lymphadenectomy (EL...
Source: Cochrane Database of Systematic Reviews - January 20, 2021 Category: General Medicine Authors: Staerkle RF, Vuille-Dit-Bille RN, Soll C, Troller R, Samra J, Puhan MA, Breitenstein S Tags: Cochrane Database Syst Rev Source Type: research

Interventions for treating iron deficiency anaemia in inflammatory bowel disease.
CONCLUSIONS: Intravenous ferric carboxymaltose probably leads to more people having resolution of IDA (iron deficiency anaemia) than intravenous iron sucrose. Oral ferric maltol may lead to more people having resolution of IDA than placebo. We are unable to draw conclusions on which of the other treatments is most effective in IDA with IBD (inflammatory bowel disease) due to low numbers of studies in each comparison area and clinical heterogeneity within the studies. Therefore, there are no other conclusions regarding the treatments that can be made and certainty of all findings are low or very low. Overall, intravenous ir...
Source: Cochrane Database of Systematic Reviews - January 20, 2021 Category: General Medicine Authors: Gordon M, Sinopoulou V, Iheozor-Ejiofor Z, Iqbal T, Allen P, Hoque S, Engineer J, Akobeng AK Tags: Cochrane Database Syst Rev Source Type: research

Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb.
CONCLUSIONS: Complete clot lysis occurred more frequently after thrombolysis (with or without additional clot removal strategies) and PTS incidence was slightly reduced. Bleeding complications also increased with thrombolysis, but this risk has decreased over time with the use of stricter exclusion criteria of studies. Evidence suggests that systemic administration of thrombolytics and CDT have similar effectiveness. Using GRADE, we judged the evidence to be of moderate-certainty, due to many trials having small numbers of participants or events, or both. Future studies are needed to investigate treatment regimes in t...
Source: Cochrane Database of Systematic Reviews - January 19, 2021 Category: General Medicine Authors: Broderick C, Watson L, Armon MP Tags: Cochrane Database Syst Rev Source Type: research

Immediate-release methylphenidate for attention deficit hyperactivity disorder (ADHD) in adults.
CONCLUSIONS: We found no certain evidence that IR methylphenidate compared with placebo or lithium can reduce symptoms of ADHD in adults (low- and very low-certainty evidence). Adults treated with IR methylphenidate are at increased risk of gastrointestinal and metabolic-related harms compared with placebo. Clinicians should consider whether it is appropriate to prescribe IR methylphenidate, given its limited efficacy and increased risk of harms. Future RCTs should explore the long-term efficacy and risks of IR methylphenidate, and the influence of conflicts of interest on reported effects. ...
Source: Cochrane Database of Systematic Reviews - January 18, 2021 Category: General Medicine Authors: Cândido RCF, Menezes de Padua CA, Golder S, Junqueira DR Tags: Cochrane Database Syst Rev Source Type: research

Wheat flour fortification with iron and other micronutrients for reducing anaemia and improving iron status in populations.
CONCLUSIONS: Fortification of wheat flour with iron (in comparison to unfortified flour, or where both groups received the same other micronutrients) may reduce anaemia in the general population above two years of age, but its effects on other outcomes are uncertain. Iron-fortified wheat flour in combination with other micronutrients, in comparison with unfortified flour, probably reduces iron deficiency, but its effects on other outcomes are uncertain. None of the included trials reported data on adverse side effects except for risk of infection or inflammation at the individual level. The effects of this interventio...
Source: Cochrane Database of Systematic Reviews - January 18, 2021 Category: General Medicine Authors: Field MS, Mithra P, Peña-Rosas JP Tags: Cochrane Database Syst Rev Source Type: research

Long-term effects of weight-reducing drugs in people with hypertension.
CONCLUSIONS: In people with elevated blood pressure, orlistat, phentermine/topiramate and naltrexone/bupropion reduced body weight; the magnitude of the effect was greatest with phentermine/topiramate. In the same trials, orlistat and phentermine/topiramate, but not naltrexone/bupropion, reduced blood pressure. One RCT of naltrexone/bupropion versus placebo showed no differences in all-cause mortality or cardiovascular mortality or morbidity after two years. The European Medicines Agency refused marketing authorisation for phentermine/topiramate due to safety concerns, while for lorcaserin the application for European mark...
Source: Cochrane Database of Systematic Reviews - January 17, 2021 Category: General Medicine Authors: Siebenhofer A, Winterholer S, Jeitler K, Horvath K, Berghold A, Krenn C, Semlitsch T Tags: Cochrane Database Syst Rev Source Type: research

Atovaquone-proguanil for treating uncomplicated Plasmodium falciparum malaria.
CONCLUSIONS: Atovaquone-proguanil was effective against uncomplicated P falciparum malaria, although in some instances treatment failure rates were between 5% and 10%. The addition of artesunate to atovaquone-proguanil may reduce treatment failure rates. Artesunate-atovaquone-proguanil and the development of parasite resistance may represent an area for further research. PMID: 33459345 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 15, 2021 Category: General Medicine Authors: Blanshard A, Hine P Tags: Cochrane Database Syst Rev Source Type: research

Indomethacin for symptomatic patent ductus arteriosus in preterm infants.
CONCLUSIONS: High-certainty evidence shows that indomethacin is effective in closing a symptomatic PDA compared to placebo or no treatment in preterm infants. Evidence is insufficient regarding effects of indomethacin on other clinically relevant outcomes and medication-related adverse effects. PMID: 33448032 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 15, 2021 Category: General Medicine Authors: Evans P, O'Reilly D, Flyer JN, Soll R, Mitra S Tags: Cochrane Database Syst Rev Source Type: research

Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.
CONCLUSIONS: This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. It is possible that the findings may change with the inclusion of large ongoing well-organised trials in future updates. The results suggest an improvement in health outcomes if interventions can be targeted at risk fac...
Source: Cochrane Database of Systematic Reviews - January 15, 2021 Category: General Medicine Authors: Smith SM, Wallace E, O'Dowd T, Fortin M Tags: Cochrane Database Syst Rev Source Type: research

Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and rifampicin resistance in adults.
CONCLUSIONS: Xpert Ultra and Xpert MTB/RIF may be helpful in diagnosing extrapulmonary tuberculosis. Sensitivity varies across different extrapulmonary specimens: while for most specimens specificity is high, the tests rarely yield a positive result for people without tuberculosis. For tuberculous meningitis, Xpert Ultra had higher sensitivity and lower specificity than Xpert MTB/RIF against culture. Xpert Ultra and Xpert MTB/RIF had similar sensitivity and specificity for rifampicin resistance. Future research should acknowledge the concern associated with culture as a reference standard in paucibacillary specimens and co...
Source: Cochrane Database of Systematic Reviews - January 15, 2021 Category: General Medicine Authors: Kohli M, Schiller I, Dendukuri N, Yao M, Dheda K, Denkinger CM, Schumacher SG, Steingart KR Tags: Cochrane Database Syst Rev Source Type: research

Prophylactic antibiotics for adults with chronic obstructive pulmonary disease: a network meta-analysis.
CONCLUSIONS: This NMA evaluated the safety and efficacy of different antibiotics used prophylactically for COPD patients. Compared to placebo, prolonged administration of macrolides (ranked first) appeared beneficial in prolonging the time to next exacerbation, improving quality of life, and reducing serious adverse events. No clear benefits were associated with use of quinolones or tetracyclines. In addition, antibiotic resistance was a concern and could not be thoroughly assessed in this review. Given the trade-off between effectiveness, safety, and risk of antibiotic resistance, prophylactic administration of antibiotic...
Source: Cochrane Database of Systematic Reviews - January 15, 2021 Category: General Medicine Authors: Janjua S, Mathioudakis AG, Fortescue R, Walker RA, Sharif S, Threapleton CJ, Dias S Tags: Cochrane Database Syst Rev Source Type: research

Rehabilitation following surgery for flexor tendon injuries of the hand.
CONCLUSIONS: There is a lack of evidence from RCTs on most of the rehabilitation interventions used following surgery for flexor tendon injuries of the hand. The limited and very low-certainty evidence for all 14 comparisons examined in the 17 included studies means that we have very little confidence in the estimates of effect for all outcomes for which data were available for these comparisons. The dearth of evidence identified in this review points to the urgent need for sufficiently powered RCTs that examine key questions relating to the rehabilitation of these injuries. A consensus approach identifying these and estab...
Source: Cochrane Database of Systematic Reviews - January 13, 2021 Category: General Medicine Authors: Peters SE, Jha B, Ross M Tags: Cochrane Database Syst Rev Source Type: research

Gabapentin add-on treatment for drug-resistant focal epilepsy.
CONCLUSIONS: Gabapentin has efficacy as an add-on treatment in people with drug-resistant focal epilepsy, and seems to be fairly well-tolerated. However, the trials reviewed were of relatively short duration and provide no evidence for the long-term efficacy of gabapentin beyond a three-month period. The results cannot be extrapolated to monotherapy or to people with other epilepsy types. Further trials are needed to assess the long-term effects of gabapentin, and to compare gabapentin with other add-on drugs. PMID: 33434292 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 12, 2021 Category: General Medicine Authors: Panebianco M, Al-Bachari S, Hutton JL, Marson AG Tags: Cochrane Database Syst Rev Source Type: research

Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period.
CONCLUSIONS: In women who are not breastfeeding and who sustained perineal trauma, NSAIDs (compared to placebo or paracetamol) may provide greater pain relief for acute postpartum perineal pain and fewer women need additional analgesia, but uncertainty remains, as the evidence is rated as low- or very low-certainty. The risk of bias was unclear for many studies, adverse effects were often not assessed and breastfeeding women were not included. While this review provides some indication of the likely effect, there is uncertainty in our conclusions. The main reasons for downgrading were the inclusion of studies at high risk ...
Source: Cochrane Database of Systematic Reviews - January 11, 2021 Category: General Medicine Authors: Wuytack F, Smith V, Cleary BJ Tags: Cochrane Database Syst Rev Source Type: research

Tyrosine supplementation for phenylketonuria.
CONCLUSIONS: From the available evidence no recommendations can be made about whether tyrosine supplementation should be introduced into routine clinical practice. Further randomised controlled studies are required to provide more evidence. However, given this is not an active area of research, we have no plans to update this review in the future. PMID: 33427303 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 4, 2021 Category: General Medicine Authors: Remmington T, Smith S Tags: Cochrane Database Syst Rev Source Type: research

Intraoperative imaging technology to maximise extent of resection for glioma: a network meta-analysis.
CONCLUSIONS: Intraoperative imaging technologies, specifically 5-ALA and iMRI, may be of benefit in maximising extent of resection in participants with high-grade glioma. However, this is based on low- to very low-certainty evidence. Therefore, the short- and long-term neurological effects are uncertain. Effects of image-guided surgery on overall survival, progression-free survival, and quality of life are unclear. Network and traditional meta-analyses were not possible due to the identified high risk of bias, heterogeneity, and small trials included in this review. A brief economic commentary found limited economic eviden...
Source: Cochrane Database of Systematic Reviews - January 4, 2021 Category: General Medicine Authors: Fountain DM, Bryant A, Barone DG, Waqar M, Hart MG, Bulbeck H, Kernohan A, Watts C, Jenkinson MD Tags: Cochrane Database Syst Rev Source Type: research

Behavioural interventions for smoking cessation: an overview and network meta-analysis.
CONCLUSIONS: Behavioural support for smoking cessation can increase quit rates at six months or longer, with no evidence that support increases harms. This is the case whether or not smoking cessation pharmacotherapy is also provided, but the effect is slightly more pronounced in the absence of pharmacotherapy. Evidence of benefit is strongest for the provision of any form of counselling, and guaranteed financial incentives. Evidence suggested possible benefit but the need of further studies to evaluate: individual tailoring; delivery via text message, email, and audio recording; delivery by lay health advisor; and interve...
Source: Cochrane Database of Systematic Reviews - January 4, 2021 Category: General Medicine Authors: Hartmann-Boyce J, Livingstone-Banks J, Ordóñez-Mena JM, Fanshawe TR, Lindson N, Freeman SC, Sutton AJ, Theodoulou A, Aveyard P Tags: Cochrane Database Syst Rev Source Type: research

Remotely delivered information, training and support for informal caregivers of people with dementia.
CONCLUSIONS: Remotely delivered interventions including support, training or both, with or without information, may slightly reduce caregiver burden and improve caregiver depressive symptoms when compared with provision of information alone, but not when compared with usual treatment, waiting list or attention control. They seem to make little or no difference to health-related quality of life. Caregivers receiving training or support were more likely than those receiving information alone to drop out of the studies, which might limit applicability. The efficacy of these interventions may depend on the nature and availabil...
Source: Cochrane Database of Systematic Reviews - January 4, 2021 Category: General Medicine Authors: González-Fraile E, Ballesteros J, Rueda JR, Santos-Zorrozúa B, Solà I, McCleery J Tags: Cochrane Database Syst Rev Source Type: research

Early full enteral feeding for preterm or low birth weight infants.
CONCLUSIONS: Trials provided insufficient data to determine with any certainty how early full enteral feeding, compared with delayed or progressive introduction of enteral feeds, affects growth in preterm or low birth weight infants. We are uncertain whether early full enteral feeding affects the risk of necrotising enterocolitis because of the risk of bias in the trials (due to lack of masking), inconsistency, and imprecision. PMID: 33368149 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - December 27, 2020 Category: General Medicine Authors: Walsh V, Brown JVE, Copperthwaite BR, Oddie SJ, McGuire W Tags: Cochrane Database Syst Rev Source Type: research

Random drug and alcohol testing for preventing injury in workers.
CONCLUSIONS: In the aviation industry in the USA, the only setting for which the eligible study reported data, there was a statistically significant increase in the rate of positive RAT results following a reduction in the percentage of workers tested, which we deem to be clinically relevant. This result suggests an inverse relationship between the proportion of positive test results and the rate of testing, which is consistent with a deterrent effect for testing. No data were reported on adverse effects related to RDAT. We could not draw definitive conclusions regarding the effectiveness of RDAT for employees in safety-se...
Source: Cochrane Database of Systematic Reviews - December 27, 2020 Category: General Medicine Authors: Els C, Jackson TD, Milen MT, Kunyk D, Wyatt G, Sowah D, Hagtvedt R, Deibert D, Straube S Tags: Cochrane Database Syst Rev Source Type: research

Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.
CONCLUSIONS: Evidence from this updated review supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. Treatment with antenatal corticosteroids reduces the risk of perinatal death, neonatal death and RDS and probably reduces the risk of IVH. This evidence is robust, regardless of resource setting (high, middle or low). Further research should focus on variations in the treatment regimen, effectiveness of the intervention in specific understudied subgroups such as multiple pregnancies and other high-risk obstetric groups, and the risks...
Source: Cochrane Database of Systematic Reviews - December 25, 2020 Category: General Medicine Authors: McGoldrick E, Stewart F, Parker R, Dalziel SR Tags: Cochrane Database Syst Rev Source Type: research

Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia.
CONCLUSIONS: Chlorhexidine mouthwash or gel, as part of OHC, probably reduces the incidence of developing ventilator-associated pneumonia (VAP) in critically ill patients from 26% to about 18%, when compared to placebo or usual care. We did not find a difference in mortality, duration of mechanical ventilation or duration of stay in the intensive care unit, although the evidence was low certainty. OHC including both antiseptics and toothbrushing may be more effective than OHC with antiseptics alone to reduce the incidence of VAP and the length of ICU stay, but, again, the evidence is low certainty. There is insufficient ev...
Source: Cochrane Database of Systematic Reviews - December 24, 2020 Category: General Medicine Authors: Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F Tags: Cochrane Database Syst Rev Source Type: research

Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome.
CONCLUSIONS: This updated review on metformin versus placebo/no treatment before or during IVF/ICSI treatment in women with PCOS found no conclusive evidence that metformin improves live birth rates. In a long GnRH-agonist protocol, we are uncertain whether metformin improves live birth rates, but metformin may increase the clinical pregnancy rate. In a short GnRH-antagonist protocol, metformin may reduce live birth rates, although we are uncertain about the effect of metformin on clinical pregnancy rate. Metformin may reduce the incidence of OHSS but may result in a higher incidence of side effects. We are uncertain of th...
Source: Cochrane Database of Systematic Reviews - December 21, 2020 Category: General Medicine Authors: Tso LO, Costello MF, Albuquerque LET, Andriolo RB, Macedo CR Tags: Cochrane Database Syst Rev Source Type: research

Non-pharmacological care for opioid withdrawal in newborns.
CONCLUSIONS: We are uncertain whether non-pharmacological care for opioid withdrawal in newborns affects important clinical outcomes including length of hospitalization and use of pharmacological treatment based on the six included studies. The outcomes identified for this review were of very low- to low-certainty evidence. Combined analysis was limited by heterogeneity in study design and intervention definitions as well as the number of studies. Many prespecified outcomes were not reported. Although caregivers are encouraged by experts to optimize non-pharmacological care for opioid withdrawal in newborns prior to initia...
Source: Cochrane Database of Systematic Reviews - December 21, 2020 Category: General Medicine Authors: Pahl A, Young L, Buus-Frank ME, Marcellus L, Soll R Tags: Cochrane Database Syst Rev Source Type: research

Care bundles for improving outcomes in patients with COVID-19  or related conditions in intensive care - a rapid scoping review.
CONCLUSIONS: This scoping review has identified 21 studies on care bundle use in critically ill patients in ICU with COVID-19, ARDS, viral influenza or pneumonia and severe respiratory failure. The data for patients with COVID-19 specifically are limited, derived mainly from observational quality improvement or clinical experiential accounts. Research is required, urgently, to further assess care bundle use and optimal components of these bundles in this patient cohort. The care bundles described were also varied, with guidance on ventilator settings described in 10 care bundles, while chest X-ray was part mentioned in one...
Source: Cochrane Database of Systematic Reviews - December 21, 2020 Category: General Medicine Authors: Smith V, Devane D, Nichol A, Roche D Tags: Cochrane Database Syst Rev Source Type: research

Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen.
CONCLUSIONS: The LNG-IUS probably slightly reduces the incidence of benign endometrial polyps and endometrial hyperplasia in women with breast cancer taking tamoxifen. At 12 and 24 months of follow-up, the LNG-IUS probably increases abnormal vaginal bleeding or spotting among women in the treatment group compared to those in the control. Data were lacking on whether the LNG-IUS prevents endometrial cancer in these women. There is no clear evidence from the available RCTs that the LNG-IUS affects the risk of breast cancer recurrence or breast cancer-related deaths. Larger studies are necessary to assess the effects of the L...
Source: Cochrane Database of Systematic Reviews - December 21, 2020 Category: General Medicine Authors: Romero SA, Young K, Hickey M, Su HI Tags: Cochrane Database Syst Rev Source Type: research

Continuous glucose monitoring for the prevention of morbidity and mortality in preterm infants.
CONCLUSIONS: There is insufficient evidence to determine if CGM improves preterm infant mortality or morbidities. Long-term outcomes were not reported. Clinical trials are required to determine the most effective CGM and glycemic management regimens in preterm infants before larger studies can be performed to assess the efficacy of CGM  for reducing mortality, morbidity and long-term neurodevelopmental impairments. The absence of CGM labelled for neonatal use is still a major limit in its use as well as the absence of dedicated neonatal devices. PMID: 33348448 [PubMed - in process] (Source: Co...
Source: Cochrane Database of Systematic Reviews - December 21, 2020 Category: General Medicine Authors: Galderisi A, Bruschettini M, Russo C, Hall R, Trevisanuto D Tags: Cochrane Database Syst Rev Source Type: research

Interventions for frostbite injuries.
CONCLUSIONS: There is a paucity of evidence regarding interventions for frostbite injuries. Very low-quality evidence from a single small trial indicates that iloprost, and iloprost plus rtPA, in combination with buflomedil may reduce the need for amputation in people with severe frostbite compared to buflomedil alone. However, buflomedil has been withdrawn from use. High quality randomised trials are needed to establish firm evidence for the treatment of frostbite injuries. PMID: 33341943 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - December 20, 2020 Category: General Medicine Authors: Lorentzen AK, Davis C, Penninga L Tags: Cochrane Database Syst Rev Source Type: research

Wavefront excimer laser refractive surgery for adults with refractive errors.
CONCLUSIONS: This review suggests that at 12 months and six months postoperatively, there was no important difference between wavefront versus conventional refractive surgery or between wavefront-optimized versus wavefront-guided surgery in the clinical outcomes analyzed. The low certainty of the cumulative evidence reported to date suggests that further randomized comparisons of these surgical approaches would provide more precise estimates of effects but are unlikely to modify our conclusions. Future trials may elect to focus on participant-reported outcomes such as satisfaction with vision before and after surgery and e...
Source: Cochrane Database of Systematic Reviews - December 18, 2020 Category: General Medicine Authors: Li SM, Kang MT, Wang NL, Abariga SA Tags: Cochrane Database Syst Rev Source Type: research

Antenatal interventions for preventing stillbirth, fetal loss and perinatal death: an overview of Cochrane systematic reviews.
CONCLUSIONS: While most interventions were unable to demonstrate a clear effect in reducing stillbirth or perinatal death, several interventions suggested a clear benefit, such as balanced energy/protein supplements, midwife-led models of care, training versus not training traditional birth attendants, and antenatal cardiotocography. Possible benefits were also observed for insecticide-treated anti-malarial nets and community-based intervention packages, whereas a reduced number of antenatal care visits were shown to be harmful. However, there was variation in the effectiveness of interventions across different settings, i...
Source: Cochrane Database of Systematic Reviews - December 18, 2020 Category: General Medicine Authors: Ota E, da Silva Lopes K, Middleton P, Flenady V, Wariki WM, Rahman MO, Tobe-Gai R, Mori R Tags: Cochrane Database Syst Rev Source Type: research

Primary prophylaxis for venous thromboembolism in ambulatory cancer patients receiving chemotherapy.
CONCLUSIONS: In ambulatory cancer patients, primary thromboprophylaxis with direct factor Xa inhibitors may reduce the incidence of symptomatic VTE (low-certainty evidence) and probably increases the risk of major bleeding (moderate-certainty evidence) when compared with placebo. LMWH decreases the incidence of symptomatic VTE (high-certainty evidence), but increases the risk of major bleeding (moderate-certainty evidence) when compared with placebo or no thromboprophylaxis. Evidence for the use of thromboprophylaxis with anticoagulants other than direct factor Xa inhibitors and LMWH is limited. More studies are warranted ...
Source: Cochrane Database of Systematic Reviews - December 18, 2020 Category: General Medicine Authors: Rutjes AW, Porreca E, Candeloro M, Valeriani E, Di Nisio M Tags: Cochrane Database Syst Rev Source Type: research

Corrector therapies (with or without potentiators) for people with cystic fibrosis with class II CFTR gene variants (most commonly F508del).
CONCLUSIONS: There is insufficient evidence that corrector monotherapy has clinically important effects in pwCF with F508del/F508del. Both dual therapies (lumacaftor-ivacaftor, tezacaftor-ivacaftor) result in similar improvements in QoL and respiratory function with lower pulmonary exacerbation rates. Lumacaftor-ivacaftor was associated with an increase in early transient shortness of breath and longer-term increases in blood pressure (not observed for tezacaftor-ivacaftor). Tezacaftor-ivacaftor has a better safety profile, although data are lacking in children under 12 years. In this population, lumacaftor-ivacaftor had a...
Source: Cochrane Database of Systematic Reviews - December 17, 2020 Category: General Medicine Authors: Southern KW, Murphy J, Sinha IP, Nevitt SJ 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 - December 17, 2020 Category: General Medicine Authors: Stanford G, Ryan H, Solis-Moya A Tags: Cochrane Database Syst Rev Source Type: research

Measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review.
CONCLUSIONS: We identified a heterogeneous and complex evidence base of measures implemented in the school setting. This review is an important first step in understanding the available evidence and will inform the development of rapid reviews on this topic. PMID: 33331665 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - December 17, 2020 Category: General Medicine Authors: Krishnaratne S, Pfadenhauer LM, Coenen M, Geffert K, Jung-Sievers C, Klinger C, Kratzer S, Littlecott H, Movsisyan A, Rabe JE, Rehfuess E, Sell K, Strahwald B, Stratil JM, Voss S, Wabnitz K, Burns J Tags: Cochrane Database Syst Rev Source Type: research

Visual cycle modulators versus placebo or observation for the prevention and treatment of geographic atrophy due to age-related macular degeneration.
CONCLUSIONS: There is limited evidence to support the use of visual cycle modulators (emixustat and fenretinide) for the treatment of established geographic atrophy due to AMD. The possible reduction in the incidence of CNV observed with fenretinide, and to a lesser extent, emixustat, requires formal assessment in focused studies. PMID: 33331670 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - December 17, 2020 Category: General Medicine Authors: Yeong JL, Loveman E, Colquitt JL, Royle P, Waugh N, Lois N Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure targets in adults with hypertension.
CONCLUSIONS: For the general population of persons with elevated blood pressure, the benefits of trying to achieve a lower blood pressure target rather than a standard target (≤ 140/90 mm Hg) do not outweigh the harms associated with that intervention. Further research is needed to see if some groups of patients would benefit or be harmed by lower targets. The results of this review are primarily applicable to older people with moderate to high cardiovascular risk. They may not be applicable to other populations. PMID: 33332584 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - December 17, 2020 Category: General Medicine Authors: Arguedas JA, Leiva V, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

Multi-professional simulation-based team training in obstetric emergencies for improving patient outcomes and trainees' performance.
CONCLUSIONS: Simulation-based obstetric team training may help to improve team performance of obstetric teams, and it might contribute to improvement of specific maternal and perinatal outcomes, compared with no training. However, high-certainty evidence is lacking due to serious risk of bias and imprecision, and the effect cannot be generalised for all outcomes. Future studies investigating simulation-based obstetric team training compared to training courses with a different instructional design should carefully consider how and when to measure outcomes. Particular attention should be paid to effect measurement at the le...
Source: Cochrane Database of Systematic Reviews - December 16, 2020 Category: General Medicine Authors: Fransen AF, van de Ven J, Banga FR, Mol BWJ, Oei SG Tags: Cochrane Database Syst Rev Source Type: research

Souvenaid for Alzheimer's disease.
CONCLUSIONS: Two years of treatment with Souvenaid probably does not reduce the risk of progression to dementia in people with prodromal AD. There is no convincing evidence that Souvenaid affects other outcomes important to people with AD in the prodromal stage or mild-to-moderate stages of dementia. Conflicting evidence on combined cognitive-functional outcomes in prodromal AD and mild AD dementia warrants further investigation. Adverse effects of Souvenaid seem to be uncommon, but the evidence synthesised in this review does not permit us to make a definitive statement on the long-term tolerability of Souvenaid. The effe...
Source: Cochrane Database of Systematic Reviews - December 15, 2020 Category: General Medicine Authors: Burckhardt M, Watzke S, Wienke A, Langer G, Fink A Tags: Cochrane Database Syst Rev Source Type: research

Urgent-start peritoneal dialysis versus conventional-start peritoneal dialysis for people with chronic kidney disease.
CONCLUSIONS: In patients with CKD who require dialysis urgently without ready-to-use dialysis access in place, urgent-start PD may increase the risk of dialysate leak and has uncertain effects on catheter blockage, malposition or readjustment, PD dialysate flow problems, infectious complications, exit-site bleeding, technique survival, and patient survival compared with conventional-start PD. PMID: 33320346 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - December 15, 2020 Category: General Medicine Authors: Htay H, Johnson DW, Craig JC, Teixeira-Pinto A, Hawley CM, Cho Y Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy.
CONCLUSIONS: Currently,àavailable evidence does not support the overall superiority of any anticoagulant to another. Compared to UFH, citrate probably reduces major bleeding and prevents clotting and probably has little or no effect on death at 28 days. For other pharmacological anticoagulation methods, there is no available data showing overall superiority to citrate or no pharmacological anticoagulation. Further studies are needed to identify patient populations in which CRRT should commence with no pharmacological anticoagulation or with citrate. PMID: 33314078 [PubMed - in process] (Source: Coc...
Source: Cochrane Database of Systematic Reviews - December 14, 2020 Category: General Medicine Authors: Tsujimoto H, Tsujimoto Y, Nakata Y, Fujii T, Takahashi S, Akazawa M, Kataoka Y Tags: Cochrane Database Syst Rev Source Type: research

Magnesium sulphate for treating acute bronchiolitis in children up to two years of age.
CONCLUSIONS: There is insufficient evidence to establish the efficacy and safety of magnesium sulphate for treating children up to two years of age with acute bronchiolitis. No evidence was available for time to recovery, duration of mechanical ventilation and intensive care unit stay, or pulmonary function. There was no information about adverse events for some comparisons. Well-designed RCTs to assess the effects of magnesium sulphate for children with acute bronchiolitis are needed. Important outcomes, such as time to recovery and adverse events should be measured. PMID: 33316083 [PubMed - in process] (Source: Coch...
Source: Cochrane Database of Systematic Reviews - December 14, 2020 Category: General Medicine Authors: Chandelia S, Kumar D, Chadha N, Jaiswal N Tags: Cochrane Database Syst Rev Source Type: research

Single or combined immune checkpoint inhibitors compared to first-line platinum-based chemotherapy with or without bevacizumab for people with advanced non-small cell lung cancer.
CONCLUSIONS: Authors' conclusions The evidence in this review suggests that single-agent ICI in people with NSCLC and PD-L1 ≥50% probably leads to a higher overall survival rate and may lead to a higher progression-free survival and overall response rate when compared to platinum-based chemotherapy and may also lead to a lower rate of adverse events and higher HRQoL. Combined ICI in people with NSCLC and PD-L1 ≥50% also probably leads to a higher overall survival rate when compared to platinum-based chemotherapy, but its effect on progression-free survival, overall response rate and HRQoL is unknown due to a lack of ...
Source: Cochrane Database of Systematic Reviews - December 14, 2020 Category: General Medicine Authors: Ferrara R, Imbimbo M, Malouf R, Paget-Bailly S, Calais F, Marchal C, Westeel V Tags: Cochrane Database Syst Rev Source Type: research

Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride.
CONCLUSIONS: In white participants, sodium reduction in accordance with the public recommendations resulted in mean arterial pressure (MAP) decrease of about 0.4 mmHg in participants with normal blood pressure and a MAP decrease of about 4 mmHg in participants with hypertension. Weak evidence indicated that these effects may be a little greater in black and Asian participants. The effects of sodium reduction on potential side effects (hormones and lipids) were more consistent than the effect on BP, especially in people with normal BP. PMID: 33314019 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - December 12, 2020 Category: General Medicine Authors: Graudal NA, Hubeck-Graudal T, Jurgens G Tags: Cochrane Database Syst Rev Source Type: research

Abiraterone acetate in combination with androgen deprivation therapy compared to androgen deprivation therapy only for metastatic hormone-sensitive prostate cancer.
CONCLUSIONS: The addition of abiraterone acetate to androgen deprivation therapy improves overall survival but probably not quality of life. Itàprobably also extends disease-specific survival, and delays disease progression compared to androgen deprivation therapy alone. However, the risk of grades III to V adverse events is increased, and probably, so is the risk of discontinuing treatment due to adverse events. PMID: 33314020 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - December 12, 2020 Category: General Medicine Authors: Sathianathen NJ, Oestreich MC, Brown SJ, Gupta S, Konety BR, Dahm P, Kunath F Tags: Cochrane Database Syst Rev Source Type: research

Body weight management in overweight and obese breast cancer survivors.
CONCLUSIONS: Weight loss interventions, particularly multimodal interventions (incorporating diet, exercise and psychosocial support), in overweight or obese breast cancer survivors appear to result in decreases in body weight, BMI and waist circumference and improvement in overall quality of life. There was no increase in adverse events. There is a lack of data to determine the impact of weight loss interventions on survival or breast cancer recurrence. This review is based on studies with marked heterogeneity regarding weight loss interventions. Due to the methods used in included studies, there was a high risk of bias r...
Source: Cochrane Database of Systematic Reviews - December 11, 2020 Category: General Medicine Authors: Shaikh H, Bradhurst P, Ma LX, Tan SYC, Egger SJ, Vardy JL Tags: Cochrane Database Syst Rev Source Type: research