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Preoperative medical therapy before surgery for uterine fibroids.
CONCLUSIONS: A rationale for the use of preoperative medical therapy before surgery for fibroids is to make surgery easier. There is clear evidence that preoperative GnRHa reduces uterine and fibroid volume, and increases preoperative haemoglobin levels, although GnRHa increases the incidence of hot flushes. During hysterectomy, blood loss, operation time and complication rates were also reduced. Evidence suggests that ulipristal acetate may offer similar advantages (reduced fibroid volume and fibroid-related bleeding and increased haemoglobin levels) although replication of these studies is advised before firm conclusions...
Source: Cochrane Database of Systematic Reviews - November 15, 2017 Category: General Medicine Authors: Lethaby A, Puscasiu L, Vollenhoven B Tags: Cochrane Database Syst Rev Source Type: research

Unconditional cash transfers for reducing poverty and vulnerabilities: effect on use of health services and health outcomes in low- and middle-income countries.
CONCLUSIONS: This body of evidence suggests that unconditional cash transfers (UCTs) may not impact a summary measure of health service use in children and adults in LMICs. However, UCTs probably or may improve some health outcomes (i.e. the likelihood of having had any illness, the likelihood of having been food secure, and the level of dietary diversity), one social determinant of health (i.e. the likelihood of attending school), and healthcare expenditure. The evidence on the relative effectiveness of UCTs and CCTs remains very uncertain. PMID: 29139110 [PubMed - as supplied by publisher] (Source: Cochrane Database...
Source: Cochrane Database of Systematic Reviews - November 15, 2017 Category: General Medicine Authors: Pega F, Liu SY, Walter S, Pabayo R, Saith R, Lhachimi SK Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Electrical cardioversion for atrial fibrillation and flutter.
CONCLUSIONS: Electrical cardioversion (rhythm control) led to a non-significant increase in stroke risk but improved three domains of quality of life. PMID: 29140555 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 15, 2017 Category: General Medicine Authors: Mead GE, Elder A, Flapan AD, Cordina J Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Transcendental meditation for the primary prevention of cardiovascular disease.
CONCLUSIONS: Currently, there are few trials with limited outcomes examining the effectiveness of TM for the primary prevention of CVD. Due to the limited evidence to date, we could draw no conclusions as to the effectiveness of TM for the primary prevention of CVD. There was considerable heterogeneity between trials and the included studies were small, short term and at overall serious risk of bias. More and larger long-term, high-quality trials are needed. PMID: 29140556 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 15, 2017 Category: General Medicine Authors: Hartley L, Mavrodaris A, Flowers N, Ernst E, Rees K Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Pharmacological cardioversion for atrial fibrillation and flutter.
CONCLUSIONS: There is no evidence that pharmacological cardioversion of atrial fibrillation to sinus rhythm is superior to rate control. Rhythm control is associated with more adverse effects and increased hospitalisation. It does not reduce the risk of stroke. The conclusions cannot be generalised to all people with atrial fibrillation. Most of the patients included in these studies were relatively older (>60 years) with significant cardiovascular risk factors. PMID: 29140557 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 15, 2017 Category: General Medicine Authors: Cordina J, Mead GE Tags: Cochrane Database Syst Rev Source Type: research

Interventions for the reduction of prescribed opioid use in chronic non-cancer pain.
CONCLUSIONS: There is no evidence for the efficacy or safety of methods for reducing prescribed opioid use in chronic pain. There is a small number of randomised controlled trials investigating opioid reduction, which means our conclusions are limited regarding the benefit of psychological, pharmacological, or other types of interventions for people with chronic pain trying to reduce their opioid consumption. The findings to date are mixed: there were reductions in opioid consumption after intervention, and often in control groups too. PMID: 29130474 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 13, 2017 Category: General Medicine Authors: Eccleston C, Fisher E, Thomas KH, Hearn L, Derry S, Stannard C, Knaggs R, Moore RA Tags: Cochrane Database Syst Rev Source Type: research

Combined diet and exercise interventions for preventing gestational diabetes mellitus.
CONCLUSIONS: Moderate-quality evidence suggests reduced risks of GDM and caesarean section with combined diet and exercise interventions during pregnancy as well as reductions in gestational weight gain, compared with standard care. There were no clear differences in hypertensive disorders of pregnancy, perinatal mortality, large-for-gestational age, perineal trauma, neonatal hypoglycaemia, and childhood adiposity (moderate- tovery low-quality evidence).Using GRADE methodology, the evidence was assessed as moderate to very low quality. Downgrading decisions were predominantly due to design limitations (risk of bias), and i...
Source: Cochrane Database of Systematic Reviews - November 13, 2017 Category: General Medicine Authors: Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P Tags: Cochrane Database Syst Rev Source Type: research

Interventions for treating collagenous colitis.
CONCLUSIONS: Low quality evidence suggests that budesonide may be effective for inducing and maintaining clinical and histological response in patients with collagenous colitis. We are uncertain about the benefits and harms of therapy with bismuth subsalicylate, Boswellia serrata extract, mesalamine with or without cholestramine, prednisolone and probiotics. These agents and other therapies require further study. PMID: 29127772 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 11, 2017 Category: General Medicine Authors: Kafil TS, Nguyen TM, Patton PH, MacDonald JK, Chande N, McDonald JW Tags: Cochrane Database Syst Rev Source Type: research

Ovarian surgery for symptom relief in women with polycystic ovary syndrome.
CONCLUSIONS: There was no clear evidence that LOD improves menstrual regularity or the androgenic symptoms of PCOS, compared to most of the medical treatments used in the included studies. LOD was associated with fewer gastrointestinal side effects compared to metformin and clomiphene.There was also no clear evidence of different effectiveness between types of LOD, except that LOD with four to five punctures per ovary may be more effective than two or fewer punctures. There was little evidence comparing LOD with different types of surgery, although one study concluded that transvaginal hydrolaparoscopy had a lower risk of ...
Source: Cochrane Database of Systematic Reviews - November 10, 2017 Category: General Medicine Authors: Lepine S, Jo J, Metwally M, Cheong YC Tags: Cochrane Database Syst Rev Source Type: research

Genomics-based non-invasive prenatal testing for detection of fetal chromosomal aneuploidy in pregnant women.
CONCLUSIONS: These results show that MPSS and TMPS perform similarly in terms of clinical sensitivity and specificity for the detection of fetal T31, T18, T13 and sex chromosome aneuploidy (SCA). However, no study compared the two approaches head-to-head in the same cohort of patients. The accuracy of gNIPT as a prenatal screening test has been mainly evaluated as a second-tier screening test to identify pregnancies at very low risk of fetal aneuploidies (T21, T18 and T13), thus avoiding invasive procedures. Genomics-based non-invasive prenatal testing methods appear to be sensitive and highly specific for detection of fet...
Source: Cochrane Database of Systematic Reviews - November 10, 2017 Category: General Medicine Authors: Badeau M, Lindsay C, Blais J, Nshimyumukiza L, Takwoingi Y, Langlois S, Légaré F, Giguère Y, Turgeon AF, Witteman W, Rousseau F Tags: Cochrane Database Syst Rev Source Type: research

Mesenchymal stem cells for the prevention and treatment of bronchopulmonary dysplasia in preterm infants.
CONCLUSIONS: There is insufficient evidence to determine the safety and efficacy of MSCs in the treatment or prevention of BPD in premature infants. The results of the ongoing trials addressing this issue are expected in the near future. PMID: 29125893 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 10, 2017 Category: General Medicine Authors: Pierro M, Thébaud B, Soll R Tags: Cochrane Database Syst Rev Source Type: research

Interventions to improve access to cataract surgical services and their impact on equity in low- and middle-income countries.
CONCLUSIONS: Current evidence on the effect on equity of interventions to improve access to cataract services in LMICs is limited. We identified only two studies, both conducted in rural China. Assessment of equity effects will be improved if future studies disaggregate outcomes by relevant social subgroups. To assist with assessing generalisability of findings to other settings, robust data on contextual factors are also needed. PMID: 29119547 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 9, 2017 Category: General Medicine Authors: Ramke J, Petkovic J, Welch V, Blignault I, Gilbert C, Blanchet K, Christensen R, Zwi AB, Tugwell P Tags: Cochrane Database Syst Rev Source Type: research

Dexamethasone as an adjuvant to peripheral nerve block.
CONCLUSIONS: Low- to moderate-quality evidence suggests that when used as an adjuvant to peripheral nerve block in upper limb surgery, both perineural and intravenous dexamethasone may prolong duration of sensory block and are effective in reducing postoperative pain intensity and opioid consumption. There is not enough evidence to determine the effectiveness of dexamethasone as an adjuvant to peripheral nerve block in lower limb surgeries and there is no evidence in children. The results of our review may not apply to participants at risk of dexamethasone-related adverse events for whom clinical trials would probably be u...
Source: Cochrane Database of Systematic Reviews - November 9, 2017 Category: General Medicine Authors: Pehora C, Pearson AM, Kaushal A, Crawford MW, Johnston B Tags: Cochrane Database Syst Rev Source Type: research

Medical and dietary interventions for preventing recurrent urinary stones in children.
CONCLUSIONS: Oral potassium citrate supplementation may reduce recurrent calcium urinary stone formation in children following SWL; however, our confidence in this finding is limited. A substantial number of children stopped the medication due to adverse events. There is no trial evidence on retreatment rates. There is a critical need for additional well-designed trials in children with nephrolithiasis. PMID: 29117629 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 9, 2017 Category: General Medicine Authors: Kern A, Grimsby G, Mayo H, Baker LA Tags: Cochrane Database Syst Rev Source Type: research

Regimens of ultrasound surveillance for twin pregnancies for improving outcomes.
CONCLUSIONS: This review is based on one small study which was underpowered for detection of rare outcomes such as perinatal mortality, stillbirth and neonatal death.There is insufficient evidence from randomised controlled trials to inform best practice for fetal ultrasound surveillance regimens when caring for women with a twin pregnancy. More studies are needed to evaluate the effects of currently used ultrasound surveillance regimens in twin pregnancies. Future research could report on the important maternal and infant outcomes as listed in this review. PMID: 29108135 [PubMed - as supplied by publisher] (Source: C...
Source: Cochrane Database of Systematic Reviews - November 7, 2017 Category: General Medicine Authors: Woolcock JG, Grivell RM, Dodd JM Tags: Cochrane Database Syst Rev Source Type: research

Beta-blockers for preventing aortic dissection in Marfan syndrome.
Abstract BACKGROUND: Marfan syndrome is a hereditary disorder affecting the connective tissue and is caused by a mutation of the fibrillin-1 (FBN1) gene. It affects multiple systems of the body, most notably the cardiovascular, ocular, skeletal, dural and pulmonary systems. Aortic root dilatation is the most frequent cardiovascular manifestation and its complications, including aortic regurgitation, dissection and rupture are the main cause of morbidity and mortality. OBJECTIVES: To assess the long-term efficacy and safety of beta-blocker therapy as compared to placebo, no treatment or surveillance only in pe...
Source: Cochrane Database of Systematic Reviews - November 7, 2017 Category: General Medicine Authors: Koo HK, Lawrence KA, Musini VM Tags: Cochrane Database Syst Rev Source Type: research

Splenectomy versus conservative management for acute sequestration crises in people with sickle cell disease.
CONCLUSIONS: Splenectomy, if full, will prevent further sequestration and if partial, may reduce the recurrence of acute splenic sequestration crises. However, there is a lack of evidence from trials showing that splenectomy improves survival and decreases morbidity in people with sickle cell disease. There is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of splenectomy compared to transfusion programmes, as a means of improving survival and decreasing mortality from acute splenic sequestration in people with sickle cell disease.There are no trials included in ...
Source: Cochrane Database of Systematic Reviews - November 7, 2017 Category: General Medicine Authors: Owusu-Ofori S, Remmington T Tags: Cochrane Database Syst Rev Source Type: research

Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis.
CONCLUSIONS: We found very low quality evidence that was insufficient to support or refute whether periodontal therapy can prevent the recurrence of CVD in the long term in patients with chronic periodontitis. No evidence on primary prevention was found. PMID: 29112241 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 7, 2017 Category: General Medicine Authors: Li C, Lv Z, Shi Z, Zhu Y, Wu Y, Li L, Iheozor-Ejiofor Z Tags: Cochrane Database Syst Rev Source Type: research

Tumour bed boost radiotherapy for women after breast-conserving surgery.
CONCLUSIONS: It appears that local control rates are increased with the boost to the tumour bed, but we found no evidence of a benefit for other oncological outcomes. Subgroup analysis including women older than 40 years of age yielded similarly significant results. Objective percentage of breast retraction assessment appears similar between groups. It appears that the cosmetic outcome is worse with the boost to the tumour bed, but only when measured by a panel, not when assessed by a physician. PMID: 29105051 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 6, 2017 Category: General Medicine Authors: Kindts I, Laenen A, Depuydt T, Weltens C Tags: Cochrane Database Syst Rev Source Type: research

Direct oral anticoagulants versus warfarin for preventing stroke and systemic embolic events among atrial fibrillation patients with chronic kidney disease.
CONCLUSIONS: Our findings indicate that DOAC are as likely as warfarin to prevent all strokes and systemic embolic events without increasing risk of major bleeding events among AF patients with kidney impairment. These findings should encourage physicians to prescribe DOAC in AF patients with CKD without fear of bleeding. The major limitation is that the results of this study chiefly reflect CKD stage G3. Application of the results to CKD stage G4 patients requires additional investigation. Furthermore, we could not assess CKD stage G5 patients. Future reviews should assess participants at more advanced CKD stages. Additio...
Source: Cochrane Database of Systematic Reviews - November 6, 2017 Category: General Medicine Authors: Kimachi M, Furukawa TA, Kimachi K, Goto Y, Fukuma S, Fukuhara S Tags: Cochrane Database Syst Rev Source Type: research

Tests for detecting strabismus in children aged 1 to 6 years in the community.
CONCLUSIONS: There is very limited data in the literature to ascertain the accuracy of tests for detecting strabismus in the community as performed by non-expert screeners. A large prospective study to compare methods would be required to determine which tests have the greatest accuracy. PMID: 29105728 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 6, 2017 Category: General Medicine Authors: Hull S, Tailor V, Balduzzi S, Rahi J, Schmucker C, Virgili G, Dahlmann-Noor A Tags: Cochrane Database Syst Rev Source Type: research

Hypothalamic-pituitary-adrenal (HPA) axis suppression after treatment with glucocorticoid therapy for childhood acute lymphoblastic leukaemia.
CONCLUSIONS: We concluded that adrenal insufficiency commonly occurs in the first days after cessation of glucocorticoid therapy for childhood ALL, but the exact duration is unclear. No data were available on the levels of the hypothalamus and the pituitary; therefore, we could draw no conclusions regarding these outcomes. Clinicians may consider prescribing glucocorticoid replacement therapy during periods of serious stress in the first weeks after cessation of glucocorticoid therapy for childhood ALL to reduce the risk of life-threatening complications. However, additional high-quality research is needed to inform eviden...
Source: Cochrane Database of Systematic Reviews - November 6, 2017 Category: General Medicine Authors: Rensen N, Gemke RJ, van Dalen EC, Rotteveel J, Kaspers GJ Tags: Cochrane Database Syst Rev Source Type: research

Insulin for the treatment of women with gestational diabetes.
CONCLUSIONS: The main comparison in this review is insulin versus oral anti-diabetic pharmacological therapies. Insulin and oral anti-diabetic pharmacological therapies have similar effects on key health outcomes. The quality of the evidence ranged from very low to moderate, with downgrading decisions due to imprecision, risk of bias and inconsistency.For the other comparisons of this review (insulin compared with non-pharmacological interventions, different insulin analogies or different insulin regimens), there is insufficient volume of high-quality evidence to determine differences for key health outcomes.Long-term mate...
Source: Cochrane Database of Systematic Reviews - November 5, 2017 Category: General Medicine Authors: Brown J, Grzeskowiak L, Williamson K, Downie MR, Crowther CA Tags: Cochrane Database Syst Rev Source Type: research

Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications.
CONCLUSIONS: Based on this moderate-quality body of evidence, monofilament sutures may reduce the risk of incisional hernia. Absorbable sutures may also reduce the risk of sinus or fistula tract formation, but this finding is based on low-quality evidence.We had serious concerns about the design or reporting of several of the 55 included trials. The comparator arms in many trials differed by more than one component, making it impossible to attribute differences between groups to any one component. In addition, the patient population included in many of the studies was very heterogeneous. Trials included both emergency...
Source: Cochrane Database of Systematic Reviews - November 3, 2017 Category: General Medicine Authors: Patel SV, Paskar DD, Nelson RL, Vedula SS, Steele SR Tags: Cochrane Database Syst Rev Source Type: research

Chloral hydrate as a sedating agent for neurodiagnostic procedures in children.
CONCLUSIONS: The quality of evidence for the comparisons of oral chloral hydrate against several other methods of sedation was very variable. Oral chloral hydrate appears to have a lower sedation failure rate when compared with oral promethazine for children undergoing paediatric neurodiagnostic procedures. The sedation failure was similar for other comparisons such as oral dexmedetomidine, oral hydroxyzine hydrochloride, and oral midazolam. When compared with intravenous pentobarbital and music therapy, oral chloral hydrate had a higher sedation failure rate. However, it must be noted that the evidence for the outcomes fo...
Source: Cochrane Database of Systematic Reviews - November 3, 2017 Category: General Medicine Authors: Fong CY, Tay CG, Ong LC, Lai NM Tags: Cochrane Database Syst Rev Source Type: research

Vitamin D supplementation for chronic liver diseases in adults.
CONCLUSIONS: We are uncertain as to whether vitamin D supplements in the form of vitamin D3, vitamin D2, 1,25-dihydroxyvitamin D, or 25-dihydroxyvitamin D have important effect on all-cause mortality, liver-related mortality, or on serious or non-serious adverse events because the results were imprecise. There is no evidence on the effect of vitamin D supplementation on liver-related morbidity and health-related quality of life. Our conclusions are based on few trials with an insufficient number of participants and on lack of data on clinically important outcomes. In addition, the analysed trials are at high risk of bias w...
Source: Cochrane Database of Systematic Reviews - November 3, 2017 Category: General Medicine Authors: Bjelakovic G, Nikolova D, Bjelakovic M, Gluud C Tags: Cochrane Database Syst Rev Source Type: research

Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease.
CONCLUSIONS: Women with CIN have a higher baseline risk for prematurity. Excisional and ablative treatment appears to further increases that risk. The frequency and severity of adverse sequelae increases with increasing cone depth and is higher for excision than it is for ablation. However, the results should be interpreted with caution as they were based on low or very low quality (GRADE assessment) observational studies, most of which were retrospective. PMID: 29095502 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 2, 2017 Category: General Medicine Authors: Kyrgiou M, Athanasiou A, Kalliala IEJ, Paraskevaidi M, Mitra A, Martin-Hirsch PP, Arbyn M, Bennett P, Paraskevaidis E Tags: Cochrane Database Syst Rev Source Type: research

Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilisation.
CONCLUSIONS: We found no conclusive evidence indicating that clomiphene citrate or letrozole with or without gonadotropins differed from gonadotropins in GnRH agonist or antagonist protocols with respect to their effects on live-birth or pregnancy rates, either in the general population of women undergoing IVF treatment or in women who were poor responders. Use of clomiphene or letrozole led to a reduction in the amount of gonadotropins required and the incidence of OHSS. However, use of clomiphene citrate or letrozole may be associated with a significant increase in the incidence of cycle cancellations, as well as reducti...
Source: Cochrane Database of Systematic Reviews - November 2, 2017 Category: General Medicine Authors: Kamath MS, Maheshwari A, Bhattacharya S, Lor KY, Gibreel A Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic prophylaxis for episiotomy repair following vaginal birth.
CONCLUSIONS: There was insufficient evidence to assess the clinical benefits or harms of routine antibiotic prophylaxis for episiotomy repair after normal birth. The only trial included in this review had several methodological limitations, with very serious limitations in design, and imprecision of effect estimates. In addition, the trial tested an antibiotic with limited application in current clinical practice. There is a need for a careful and rigorous assessment of the comparative benefits and harms of prophylactic antibiotics on infection morbidity after episiotomy, in well-designed randomised controlled trials, usin...
Source: Cochrane Database of Systematic Reviews - November 2, 2017 Category: General Medicine Authors: Bonet M, Ota E, Chibueze CE, Oladapo OT Tags: Cochrane Database Syst Rev Source Type: research

Glucocorticosteroids for people with alcoholic hepatitis.
CONCLUSIONS: We found no evidence of a difference between glucocorticosteroids and placebo or no intervention on all-cause mortality, health-related quality of life, and serious adverse events during treatment. The risk of bias was high and the quality of evidence was very low or low. Therefore, we are very uncertain about this effect estimate. Due to inadequate reporting, we cannot exclude increases in adverse events. As the confidence intervals were wide, we cannot rule out significant benefits and harms of glucocorticosteroids. Therefore, we need placebo-controlled, randomised clinical trials, designed according to the ...
Source: Cochrane Database of Systematic Reviews - November 2, 2017 Category: General Medicine Authors: Pavlov CS, Varganova DL, Casazza G, Tsochatzis E, Nikolova D, Gluud C Tags: Cochrane Database Syst Rev Source Type: research

Yoga for treatment of urinary incontinence in women.
The objectives are as follows: To assess the effectiveness and safety of yoga for treatment of urinary incontinence in women, compared to no specific treatment, to another active treatment, or to an active treatment without adjuvant yoga, with a focus on patient symptoms and quality of life. PMID: 29081716 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 1, 2017 Category: General Medicine Authors: Wieland LS, Shrestha N, Lassi ZS, Panda S, Chiaramonte D, Skoetz N Tags: Cochrane Database Syst Rev Source Type: research

Prenatal administration of progestogens for preventing spontaneous preterm birth in women with a multiple pregnancy.
CONCLUSIONS: Overall, for women with a multiple pregnancy, the administration of progesterone (either IM or vaginal) does not appear to be associated with a reduction in risk of preterm birth or improved neonatal outcomes.Future research could focus on a comprehensive individual participant data meta-analysis including all of the available data relating to both IM and vaginal progesterone administration in women with a multiple pregnancy, before considering the need to conduct trials in subgroups of high-risk women (for example, women with a multiple pregnancy and a short cervical length identified on ultrasound). PMI...
Source: Cochrane Database of Systematic Reviews - October 31, 2017 Category: General Medicine Authors: Dodd JM, Grivell RM, OBrien CM, Dowswell T, Deussen AR Tags: Cochrane Database Syst Rev Source Type: research

Nerve blocks or no nerve blocks for pain control after elective hip replacement (arthroplasty) surgery in adults.
CONCLUSIONS: Compared to systemic analgesia alone, there is moderate-quality evidence that peripheral nerve blocks reduce postoperative pain, low-quality evidence that patient satisfaction is increased and very low-quality evidence for reductions in acute confusional status, pruritus and hospital length of stay .We found moderate-quality evidence that peripheral nerve blocks reduce pruritus compared with neuraxial blocks.The 11 ongoing studies, once completed, and the three studies awaiting classification may alter the conclusions of the review once assessed. PMID: 29087547 [PubMed - as supplied by publisher] (Source:...
Source: Cochrane Database of Systematic Reviews - October 31, 2017 Category: General Medicine Authors: Guay J, Johnson RL, Kopp S Tags: Cochrane Database Syst Rev Source Type: research

Bisphosphonates and other bone agents for breast cancer.
Abstract BACKGROUND: Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption, and novel targeted therapies such as denosumab inhibit other key bone metabolism pathways. We have studied these agents in both early breast cancer and advanced breast cancer settings. This is an update of the review originally published in 2002 and subsequently updated in 2005 and 2012. OBJECTIVES: To assess the effects of bisphosphonates and other bone agents in addition to anti-cancer treatment: (i) in women with early breast canc...
Source: Cochrane Database of Systematic Reviews - October 30, 2017 Category: General Medicine Authors: O'Carrigan B, Wong MH, Willson ML, Stockler MR, Pavlakis N, Goodwin A Tags: Cochrane Database Syst Rev Source Type: research

Mefloquine for preventing malaria during travel to endemic areas.
CONCLUSIONS: The absolute risk of malaria during short-term travel appears low with all three established antimalarial agents (mefloquine, doxycycline, and atovaquone-proguanil).The choice of antimalarial agent depends on how individual travellers assess the importance of specific adverse effects, pill burden, and cost. Some travellers will prefer mefloquine for its once-weekly regimen, but this should be balanced against the increased frequency of abnormal dreams, anxiety, insomnia, and depressed mood. PMID: 29083100 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 30, 2017 Category: General Medicine Authors: Tickell-Painter M, Maayan N, Saunders R, Pace C, Sinclair D Tags: Cochrane Database Syst Rev Source Type: research

Intracavity lavage and wound irrigation for prevention of surgical site infection.
CONCLUSIONS: The evidence base for intracavity lavage and wound irrigation is generally of low certainty. Therefore where we identified a possible difference in the incidence of SSI (in comparisons of antibacterial and non-antibacterial interventions, and pulsatile versus standard methods) these should be considered in the context of uncertainty, particularly given the possibility of publication bias for the comparison of antibacterial and non-antibacterial interventions. Clinicians should also consider whether the evidence is relevant to the surgical populations under consideration, the varying reporting of other prophyla...
Source: Cochrane Database of Systematic Reviews - October 30, 2017 Category: General Medicine Authors: Norman G, Atkinson RA, Smith TA, Rowlands C, Rithalia AD, Crosbie EJ, Dumville JC Tags: Cochrane Database Syst Rev Source Type: research

Uric acid lowering therapies for preventing or delaying the progression of chronic kidney disease.
CONCLUSIONS: There is limited data which suggests uric acid lowering therapy may prevent progression of chronic kidney disease but the conclusion is very uncertain. Benefits were not observed at all time points and study quality was generally low. Larger studies are required to study the effect of uric acid lowering therapy on CKD progression. Three ongoing studies will hopefully provide much needed high quality data. PMID: 29084343 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 30, 2017 Category: General Medicine Authors: Sampson AL, Singer RF, Walters GD Tags: Cochrane Database Syst Rev Source Type: research

Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews.
CONCLUSIONS: A number of adverse events, including serious adverse events, are associated with the medium- and long-term use of opioids for CNCP. The absolute event rate for any adverse event with opioids in trials using a placebo as comparison was 78%, with an absolute event rate of 7.5% for any serious adverse event. Based on the adverse events identified, clinically relevant benefit would need to be clearly demonstrated before long-term use could be considered in people with CNCP in clinical practice. A number of adverse events that we would have expected to occur with opioid use were not reported in the included Cochra...
Source: Cochrane Database of Systematic Reviews - October 30, 2017 Category: General Medicine Authors: Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, Sharma S, Kolahdooz F, Straube S Tags: Cochrane Database Syst Rev Source Type: research

High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews.
CONCLUSIONS: There is a critical lack of high-quality evidence regarding how well high-dose opioids work for the management of chronic non-cancer pain in adults, and regarding the presence and severity of adverse events. No evidence-based argument can be made on the use of high-dose opioids, i.e. 200 mg morphine equivalent or more daily, in clinical practice. Trials typically used doses below our cut-off; we need to know the efficacy and harm of higher doses, which are often used in clinical practice. PMID: 29084358 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 30, 2017 Category: General Medicine Authors: Els C, Jackson TD, Hagtvedt R, Kunyk D, Sonnenberg B, Lappi VG, Straube S Tags: Cochrane Database Syst Rev Source Type: research

Different methods and settings for glucose monitoring for gestational diabetes during pregnancy.
CONCLUSIONS: Evidence from 11 RCTs assessing different methods or settings for glucose monitoring for GDM suggests no clear differences for the primary outcomes or other secondary outcomes assessed in this review.However, current evidence is limited by the small number of RCTs for the comparisons assessed, small sample sizes, and the variable methodological quality of the RCTs. More evidence is needed to assess the effects of different methods and settings for glucose monitoring for GDM on outcomes for mothers and their children, including use and costs of health care. Future RCTs may consider collecting and reporting on t...
Source: Cochrane Database of Systematic Reviews - October 29, 2017 Category: General Medicine Authors: Raman P, Shepherd E, Dowswell T, Middleton P, Crowther CA Tags: Cochrane Database Syst Rev Source Type: research

Metformin for endometrial hyperplasia.
CONCLUSIONS: At present, evidence is insufficient to support or refute the use of metformin alone or in combination with standard therapy - specifically, megestrol acetate - versus megestrol acetate alone, for treatment of endometrial hyperplasia. Robustly designed and adequately powered randomised controlled trials yielding long-term outcome data are needed to address this clinical question. PMID: 29077194 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 27, 2017 Category: General Medicine Authors: Clement NS, Oliver TR, Shiwani H, Sanner JR, Mulvaney CA, Atiomo W Tags: Cochrane Database Syst Rev Source Type: research

Neurally adjusted ventilatory assist compared to other forms of triggered ventilation for neonatal respiratory support.
CONCLUSIONS: Risks and benefits of NAVA compared to other forms of ventilation for neonates are uncertain. Well-designed trials are required to evaluate this new form of triggered ventilation. PMID: 29077984 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 27, 2017 Category: General Medicine Authors: Rossor TE, Hunt KA, Shetty S, Greenough A Tags: Cochrane Database Syst Rev Source Type: research

Psychological treatments for people with epilepsy.
Abstract BACKGROUND: Given the significant impact epilepsy can have on the health-related quality of life (HRQoL) of individuals with epilepsy and their families, there is great clinical interest in evidence-based psychological treatments, aimed at enhancing psychological well-being in people with epilepsy. A review of the current evidence was needed to assess the effects of psychological treatments for people with epilepsy on HRQoL outcomes, in order to inform future therapeutic recommendations and research designs. OBJECTIVES: To assess the effects of psychological treatments for people with epilepsy on HRQ...
Source: Cochrane Database of Systematic Reviews - October 27, 2017 Category: General Medicine Authors: Michaelis R, Tang V, Wagner JL, Modi AC, LaFrance WC, Goldstein LH, Lundgren T, Reuber M Tags: Cochrane Database Syst Rev Source Type: research

Eslicarbazepine acetate add-on for drug-resistant partial epilepsy.
CONCLUSIONS: ESL reduces seizure frequency when used as an add-on treatment for people with drug-resistant partial epilepsy. The trials included in this review were of short-term duration and focused on adults. One new trial has been included in this update, but the conclusions are unchanged. PMID: 29067682 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 25, 2017 Category: General Medicine Authors: Chang XC, Yuan H, Wang Y, Xu HQ, Hong WK, Zheng RY Tags: Cochrane Database Syst Rev Source Type: research

Early ( < 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants.
Early (
Source: Cochrane Database of Systematic Reviews - October 24, 2017 Category: General Medicine Authors: Doyle LW, Cheong JL, Ehrenkranz RA, Halliday HL Tags: Cochrane Database Syst Rev Source Type: research

Late ( > 7 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants.
CONCLUSIONS: Benefits of late corticosteroid therapy may not outweigh actual or potential adverse effects. This review of postnatal systemic corticosteroid treatment for bronchopulmonary dysplasia initiated after seven days of age suggests that late therapy may reduce neonatal mortality without significantly increasing the risk of adverse long-term neurodevelopmental outcomes. However, the methodological quality of studies determining long-term outcomes is limited in some cases (some studies assessed surviving children only before school age, when some important neurological outcomes cannot be determined with certainty), a...
Source: Cochrane Database of Systematic Reviews - October 24, 2017 Category: General Medicine Authors: Doyle LW, Cheong JL, Ehrenkranz RA, Halliday HL Tags: Cochrane Database Syst Rev Source Type: research

Different communication strategies for disclosing a diagnosis of schizophrenia and related disorders.
CONCLUSIONS: Good communication of diagnosis can affect treatment planning, compliance and patient outcomes, especially in the case of conditions such as schizophrenia, which has the potential to cause serious life disruption for both people with schizophrenia and their carers. Currently, there is no evidence based on findings from RCTs assessing the effects of communication strategies for disclosing the diagnosis of schizophrenia and related disorders. Research is required. PMID: 29064090 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 24, 2017 Category: General Medicine Authors: Farooq S, Johal RK, Ziff C, Naeem F Tags: Cochrane Database Syst Rev Source Type: research

Planned caesarean section versus planned vaginal birth for severe pre-eclampsia.
CONCLUSIONS: There is a lack of robust evidence from randomised controlled trials that can inform practice regarding planned caesarean section versus planned vaginal birth for women with severe pre-eclampsia. There is a need for high-quality randomised controlled trials to assess the short- and long-term effects of caesarean section and vaginal birth for these women and their babies. PMID: 29058762 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 23, 2017 Category: General Medicine Authors: Amorim MM, Souza ASR, Katz L Tags: Cochrane Database Syst Rev Source Type: research

Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children.
CONCLUSIONS: There is no evidence that fluoride supplements taken by women during pregnancy are effective in preventing dental caries in their offspring. PMID: 29059464 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 23, 2017 Category: General Medicine Authors: Takahashi R, Ota E, Hoshi K, Naito T, Toyoshima Y, Yuasa H, Mori R, Nango E Tags: Cochrane Database Syst Rev Source Type: research

Desmopressin for treating nocturia in men.
CONCLUSIONS: Desmopressin may reduce the number of nocturnal voids in an appreciable number of participants compared to placebo in intermediate-term (three to 12 months) follow-up without increase in major adverse events. We found no evidence to compare its effects to behavior modification. The effect on the number of nocturnal voids is likely similar to that of alpha-blockers short-term with very infrequent major adverse events. There appears to be no added benefit in the combined use of desmopressin with an alpha-blocker or an anticholinergic. The findings of this review were limited by short-term follow-up, study limita...
Source: Cochrane Database of Systematic Reviews - October 21, 2017 Category: General Medicine Authors: Han J, Jung JH, Bakker CJ, Ebell MH, Dahm P Tags: Cochrane Database Syst Rev Source Type: research