Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome.
CONCLUSIONS: Laparoscopic ovarian drilling with and without medical ovulation induction may decrease the live birth rate in women with anovulatory PCOS and CC resistance compared with medical ovulation induction alone. But the sensitivity analysis restricted to only RCTs at low risk of selection bias suggests there is uncertainty whether there is a difference between the treatments, due to uncertainty around the estimate. Moderate-quality evidence shows that LOD probably reduces the number of multiple pregnancy. Low-quality evidence suggests that there may be little or no difference between the treatments for the likelihoo...
Source: Cochrane Database of Systematic Reviews - February 11, 2020 Category: General Medicine Authors: Bordewijk EM, Ng KYB, Rakic L, Mol BWJ, Brown J, Crawford TJ, van Wely M Tags: Cochrane Database Syst Rev Source Type: research

Early versus late erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants.
CONCLUSIONS: The use of early EPO did not significantly reduce the 'Use of one or more RBC transfusions' or the 'Number of transfusions per infant" compared with late EPO administration. The finding of a statistically significant increased risk of ROP (any grade) and a similar trend for ROP stage> 3 with early EPO treatment is of great concern. PMID: 32048729 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 11, 2020 Category: General Medicine Authors: Aher SM, Ohlsson A Tags: Cochrane Database Syst Rev Source Type: research

Early erythropoiesis-stimulating agents in preterm or low birth weight infants.
CONCLUSIONS: Early administration of ESAs reduces the use of red blood cell (RBC) transfusions, the volume of RBCs transfused, and donor exposure after study entry. Small reductions are likely to be of limited clinical importance. Donor exposure probably is not avoided, given that all but one study included infants who had received RBC transfusions before trial entry. This update found no significant difference in the rate of ROP (stage ≥ 3) for studies that initiated EPO treatment at less than eight days of age, which has been a topic of concern in earlier versions of this review. Early EPO treatment significantly decr...
Source: Cochrane Database of Systematic Reviews - February 11, 2020 Category: General Medicine Authors: Ohlsson A, Aher SM Tags: Cochrane Database Syst Rev Source Type: research

Water for preventing urinary stones.
CONCLUSIONS: We found no RCT evidence on the role of increased water intake for primary prevention of urinary stones. For secondary prevention, increased water intake achieving a urine volume of at least 2.0 L/day may reduce urinary stone recurrence and prolong time to recurrence for people with a history of urinary stone disease. However, our confidence in these findings is limited. We did not find evidence for adverse events. PMID: 32045491 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 11, 2020 Category: General Medicine Authors: Bao Y, Tu X, Wei Q Tags: Cochrane Database Syst Rev Source Type: research

Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants.
CONCLUSIONS: Ibuprofen is as effective as indomethacin in closing a PDA. Ibuprofen reduces the risk of NEC and transient renal insufficiency. Therefore, of these two drugs, ibuprofen appears to be the drug of choice. The effectiveness of ibuprofen versus paracetamol is assessed in a separate review. Oro-gastric administration of ibuprofen appears as effective as IV administration. To make further recommendations, studies are needed to assess the effectiveness of high-dose versus standard-dose ibuprofen, early versus expectant administration of ibuprofen, echocardiographically-guided versus standard IV ibuprofen, and contin...
Source: Cochrane Database of Systematic Reviews - February 11, 2020 Category: General Medicine Authors: Ohlsson A, Walia R, Shah SS Tags: Cochrane Database Syst Rev Source Type: research

Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services.
CONCLUSIONS: Current research suggests that implementation strategies probably improve the implementation of policies, practices or programmes by childcare services, and may have little or no effect on measures of adverse effects. However such strategies appear to have little to no impact on measures of child diet, physical activity or weight status. PMID: 32036618 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 10, 2020 Category: General Medicine Authors: Wolfenden L, Barnes C, Jones J, Finch M, Wyse RJ, Kingsland M, Tzelepis F, Grady A, Hodder RK, Booth D, Yoong SL Tags: Cochrane Database Syst Rev Source Type: research

Anticoagulant treatment for subsegmental pulmonary embolism.
CONCLUSIONS: There is no evidence from randomised controlled trials to assess the effectiveness and safety of anticoagulation therapy versus control in patients with isolated subsegmental pulmonary embolism (SSPE) or incidental SSPE. Well-conducted research is required before informed practice decisions can be made. PMID: 32030721 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 7, 2020 Category: General Medicine Authors: Yoo HH, Nunes-Nogueira VS, Fortes Villas Boas PJ Tags: Cochrane Database Syst Rev Source Type: research

Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery.
CONCLUSIONS: We found limited evidence that some of the models of enhanced rehabilitation and care used in the included trials may show benefits over usual care for preventing delirium and reducing length of stay for people with dementia who have been treated for hip fracture. However, the certainty of these results is low. Data were available from only a small number of trials, and the certainty for all other results is very low. Determining the optimal strategies to improve outcomes for this growing population of patients should be a research priority. PMID: 32031676 [PubMed - in process] (Source: Cochrane Database ...
Source: Cochrane Database of Systematic Reviews - February 7, 2020 Category: General Medicine Authors: Smith TO, Gilbert AW, Sreekanta A, Sahota O, Griffin XL, Cross JL, Fox C, Lamb SE Tags: Cochrane Database Syst Rev Source Type: research

Percutaneous pinning for treating distal radial fractures in adults.
CONCLUSIONS: Overall, there is insufficient RCT evidence to inform on the role of percutaneous pinning versus cast immobilisation alone or associated treatment decisions such as method of pinning, burying or not of wire ends, wrist position and duration of immobilisation after pinning. Although very low-quality evidence, the serious complications associated with biodegradable materials is noteworthy. We advise waiting on the results of a large ongoing study comparing pinning with plaster cast treatment as these could help inform future research. PMID: 32032439 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 7, 2020 Category: General Medicine Authors: Karantana A, Handoll HH, Sabouni A Tags: Cochrane Database Syst Rev Source Type: research

Acupuncture or acupressure for pain management during labour.
CONCLUSIONS: Acupuncture in comparison to sham acupuncture may increase satisfaction with pain management and reduce use of pharmacological analgesia. Acupressure in comparison to a combined control and usual care may reduce pain intensity. However, for other comparisons of acupuncture and acupressure, we are uncertain about the effects on pain intensity and satisfaction with pain relief due to very low-certainty evidence. Acupuncture may have little to no effect on the rates of caesarean or assisted vaginal birth. Acupressure probably reduces the need for caesarean section in comparison to a sham control. There is a need ...
Source: Cochrane Database of Systematic Reviews - February 7, 2020 Category: General Medicine Authors: Smith CA, Collins CT, Levett KM, Armour M, Dahlen HG, Tan AL, Mesgarpour B Tags: Cochrane Database Syst Rev Source Type: research

Acupuncture for glaucoma.
CONCLUSIONS: At this time, it is impossible to draw reliable conclusions from available data to support the use of acupuncture for treatment of patients with glaucoma. Because of ethical considerations, RCTs comparing acupuncture alone with standard glaucoma treatment or placebo are unlikely to be justified in countries where the standard of care has already been established. PMID: 32032457 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 7, 2020 Category: General Medicine Authors: Law SK, Wang L, Li T Tags: Cochrane Database Syst Rev Source Type: research

First-line combination therapy versus first-line monotherapy for primary hypertension.
CONCLUSIONS: The numbers of included participants, and hence the number of events, were too small to draw any conclusion about the relative efficacy of monotherapy versus combination therapy as initial treatment for primary hypertension. There is a need for large clinical trials that address the review question and report clinically relevant endpoints. PMID: 32026465 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 6, 2020 Category: General Medicine Authors: Garjón J, Saiz LC, Azparren A, Gaminde I, Ariz MJ, Erviti J Tags: Cochrane Database Syst Rev Source Type: research

Anti-vascular endothelial growth factor for neovascular glaucoma.
CONCLUSIONS: Currently available evidence is uncertain regarding the long-term effectiveness of anti-VEGF medications, such as intravitreal ranibizumab or bevacizumab or aflibercept, as an adjunct to conventional treatment in lowering IOP in NVG. More research is needed to investigate the long-term effect of these medications compared with, or in addition to, conventional surgical or medical treatment in lowering IOP in NVG. PMID: 32027392 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 6, 2020 Category: General Medicine Authors: Simha A, Aziz K, Braganza A, Abraham L, Samuel P, Lindsley KB Tags: Cochrane Database Syst Rev Source Type: research

Percutaneous ethanol injection for liver metastases.
CONCLUSIONS: Evidence for the effectiveness of PEI plus TACE versus TACE in people with liver metastases is of very low certainty and is based on one small randomised clinical trial at high risk of bias. Currently, it cannot be determined whether adding PEI to TACE makes a difference in comparison to using TACE alone. Evidence for benefits or harms of PEI compared with no intervention, other ablation methods, or systemic treatments is lacking. PMID: 32017845 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 4, 2020 Category: General Medicine Authors: Swierz MJ, Storman D, Riemsma RP, Wolff R, Mitus JW, Pedziwiatr M, Kleijnen J, Bala MM Tags: Cochrane Database Syst Rev Source Type: research

Telerehabilitation services for stroke.
CONCLUSIONS: While there is now an increasing number of RCTs testing the efficacy of telerehabilitation, it is hard to draw conclusions about the effects as interventions and comparators varied greatly across studies. In addition, there were few adequately powered studies and several studies included in this review were at risk of bias. At this point, there is only low or moderate-level evidence testing whether telerehabilitation is a more effective or similarly effective way to provide rehabilitation. Short-term post-hospital discharge telerehabilitation programmes have not been shown to reduce depressive symptoms, improv...
Source: Cochrane Database of Systematic Reviews - January 31, 2020 Category: General Medicine Authors: Laver KE, Adey-Wakeling Z, Crotty M, Lannin NA, George S, Sherrington C Tags: Cochrane Database Syst Rev Source Type: research

Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer.
CONCLUSIONS: Given the wide-ranging benefits of exercise for people affected by cancer, it was surprising that this review provided no clear evidence of benefit for exercise therapies in women with early breast cancer with AIMSS. This review only yielded seven eligible studies with 400 participants, which is likely to have underpowered the findings. The meta-analysis was challenging due to the considerable heterogeneity amongst the trials, with a wide range of exercise regimens and follow-up periods. Despite these inconclusive findings, exercise needs to be part of routine care for women with breast cancer due to its wide-...
Source: Cochrane Database of Systematic Reviews - January 29, 2020 Category: General Medicine Authors: Roberts KE, Rickett K, Feng S, Vagenas D, Woodward NE Tags: Cochrane Database Syst Rev Source Type: research

Rapid point of care test for detecting urogenital Chlamydia trachomatis infection in nonpregnant women and men at reproductive age.
CONCLUSIONS: Based on the results of this systematic review, the POC test based on antigen detection has suboptimal sensitivity but good specificity. Performance of this test translates, on average, to a 52% chance of mistakenly indicating absence of infection and a 2% chance of mistakenly pointing to the presence of this condition. Because of its deleterious consequences for reproductive health, and considering the current availability of safe and effective interventions to treat C trachomatis infection, the POC screening strategy should not be based on a rapid diagnostic test for antigen detection. Research in this topic...
Source: Cochrane Database of Systematic Reviews - January 29, 2020 Category: General Medicine Authors: Grillo-Ardila CF, Torres M, Gaitán HG Tags: Cochrane Database Syst Rev Source Type: research

Intravenous immunoglobulin for suspected or proven infection in neonates.
Abstract BACKGROUND: Neonates are at higher risk of infection due to immuno-incompetence. Maternal transport of immunoglobulins to the fetus mainly occurs after 32 weeks' gestation, and endogenous synthesis begins several months after birth. Administration of intravenous immunoglobulin (IVIG) provides immunoglobulin G (IgG) that can bind to cell surface receptors, provide opsonic activity, activate complement, promote antibody-dependent cytotoxicity and improve neutrophilic chemo-luminescence. Theoretically, infectious morbidity and mortality could be reduced by the administration of IVIG. OBJECTIVES: To asse...
Source: Cochrane Database of Systematic Reviews - January 29, 2020 Category: General Medicine Authors: Ohlsson A, Lacy JB Tags: Cochrane Database Syst Rev Source Type: research

Intravenous immunoglobulin for preventing infection in preterm and/or low birth weight infants.
Abstract BACKGROUND: Nosocomial infections continue to be a significant cause of morbidity and mortality among preterm and/or low birth weight (LBW) infants. Preterm infants are deficient in immunoglobulin G (IgG); therefore, administration of intravenous immunoglobulin (IVIG) may have the potential of preventing or altering the course of nosocomial infections. OBJECTIVES: To use systematic review/meta-analytical techniques to determine whether IVIG administration (compared with placebo or no intervention) to preterm (
Source: Cochrane Database of Systematic Reviews - January 29, 2020 Category: General Medicine Authors: Ohlsson A, Lacy JB Tags: Cochrane Database Syst Rev Source Type: research

Surgical treatment of fibroids for subfertility.
CONCLUSIONS: There is limited evidence to determine the role of myomectomy for infertility in women with fibroids as only one trial compared myomectomy with no myomectomy. If the decision is made to have a myomectomy, the current evidence does not indicate a superior method (laparoscopy, laparotomy or different electrosurgical systems) to improve rates of live birth, preterm delivery, clinical pregnancy, ongoing pregnancy, miscarriage, or caesarean section. Furthermore, the existing evidence needs to be viewed with caution due to the small number of events, minimal number of studies and very low-quality evidence. PMID...
Source: Cochrane Database of Systematic Reviews - January 29, 2020 Category: General Medicine Authors: Metwally M, Raybould G, Cheong YC, Horne AW Tags: Cochrane Database Syst Rev Source Type: research

Hormone replacement therapy after surgery for epithelial ovarian cancer.
CONCLUSIONS: Hormone replacement therapy may slightly improve overall survival in women who have undergone surgical treatment for EOC, but the certainty of the evidence is low. HRT may make little or no difference to quality of life, incidence of breast cancer, TIA, CVA and MI as the certainty of the evidence has been assessed as very low. There may be little or no effect of HRT use on progression-free survival. The evidence in this review is limited by imprecision and incompleteness of reported relevant outcomes and therefore the results should be interpreted with caution. Future well-designed RCTs are required as this is...
Source: Cochrane Database of Systematic Reviews - January 28, 2020 Category: General Medicine Authors: Saeaib N, Peeyananjarassri K, Liabsuetrakul T, Buhachat R, Myriokefalitaki E Tags: Cochrane Database Syst Rev Source Type: research

Oral Janus kinase inhibitors for maintenance of remission in ulcerative colitis.
CONCLUSIONS: High-certainty evidence suggests that tofacitinib is superior to placebo for maintenance of clinical and endoscopic remission at 52 weeks in participants with moderate-to-severe UC in remission. The optimal dose of tofacitinib for maintenance therapy is unknown. High-certainty evidence suggests that there is no increased risk of AEs with tofacitinib compared to placebo. However, we are uncertain about the effect of tofacitinib on SAEs due to the low number of events. Further studies are required to look at the long-term effectiveness and safety of using tofacitinib and other oral JAK inhibitors as maintenance ...
Source: Cochrane Database of Systematic Reviews - January 27, 2020 Category: General Medicine Authors: Davies SC, Hussein IM, Nguyen TM, Parker CE, Khanna R, Jairath V Tags: Cochrane Database Syst Rev Source Type: research

Low vision rehabilitation for better quality of life in visually impaired adults.
CONCLUSIONS: In this Cochrane Review, no evidence of benefit was found of diverse types of low vision rehabilitation interventions on HRQOL. We found low- and moderate-certainty evidence, respectively, of a small benefit on VRQOL in studies comparing psychological therapies or methods for enhancing vision with active comparators. The type of rehabilitation varied among studies, even within intervention groups, but benefits were detected even if compared to active control groups. Studies were conducted on adults with visual impairment mainly of older age, living in high-income countries and often having AMD. Most of the inc...
Source: Cochrane Database of Systematic Reviews - January 27, 2020 Category: General Medicine Authors: van Nispen RM, Virgili G, Hoeben M, Langelaan M, Klevering J, Keunen JE, van Rens GH Tags: Cochrane Database Syst Rev Source Type: research

Paracetamol (acetaminophen) for prevention or treatment of pain in newborns.
CONCLUSIONS: The paucity and low quality of existing data do not provide sufficient evidence to establish the role of paracetamol in reducing the effects of painful procedures in neonates. Paracetamol given after assisted vaginal birth may increase the response to later painful exposures. Paracetamol may reduce the total need for morphine following major surgery, and for this aspect of paracetamol use, further research is needed. PMID: 31985830 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 27, 2020 Category: General Medicine Authors: Ohlsson A, Shah PS Tags: Cochrane Database Syst Rev Source Type: research

Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants.
CONCLUSIONS: Moderate-quality evidence according to GRADE suggests that paracetamol is as effective as ibuprofen; low-quality evidence suggests paracetamol to be more effective than placebo or no intervention; and low-quality evidence suggests paracetamol as effective as indomethacin in closing a PDA. There was no difference in neurodevelopmental outcome in children exposed to paracetamol compared to ibuprofen; however the quality of evidence is low and comes from only one study. In view of concerns raised regarding neurodevelopmental outcomes following prenatal and postnatal exposure to paracetamol, long-term follow-up to...
Source: Cochrane Database of Systematic Reviews - January 27, 2020 Category: General Medicine Authors: Ohlsson A, Shah PS Tags: Cochrane Database Syst Rev Source Type: research

Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants.
CONCLUSIONS: This review shows that prophylactic use of ibuprofen, compared to placebo or no intervention, probably decreases the incidence of patent ductus arteriosus, the need for rescue treatment with cyclo-oxygenase inhibitors, and for surgical ductal closure. Adverse effects associated with ibuprofen (IV or oral) included increased risks for oliguria, increase in serum creatinine levels, and increased risk of gastrointestinal haemorrhage. There was a reduced risk for intraventricular haemorrhage (grade III - IV) but no evidence of a difference in mortality, chronic lung disease, necrotising enterocolitis, or time to r...
Source: Cochrane Database of Systematic Reviews - January 27, 2020 Category: General Medicine Authors: Ohlsson A, Shah SS Tags: Cochrane Database Syst Rev Source Type: research

Sound reduction management in the neonatal intensive care unit for preterm or very low birth weight infants.
Abstract BACKGROUND: Infants in the neonatal intensive care unit (NICU) are subjected to stress, including sound of high intensity. The sound environment in the NICU is louder than most home or office environments and contains disturbing noises of short duration and at irregular intervals. There are competing auditory signals that frequently challenge preterm infants, staff and parents. The sound levels in NICUs often exceed the maximum acceptable level of 45 decibels (dB), recommended by the American Academy of Pediatrics. Hearing impairment is diagnosed in 2% to 10% of preterm infants versus 0.1% of the general ...
Source: Cochrane Database of Systematic Reviews - January 27, 2020 Category: General Medicine Authors: Almadhoob A, Ohlsson A Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological treatment other than corticosteroids, intravenous immunoglobulin and plasma exchange for Guillain-Barr é syndrome.
CONCLUSIONS: All six RCTs were too small to exclude clinically important benefit or harm from the assessed interventions. The certainty of the evidence was low or very low for all interventions and outcomes. PMID: 31981368 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 25, 2020 Category: General Medicine Authors: Doets AY, Hughes RA, Brassington R, Hadden RD, Pritchard J Tags: Cochrane Database Syst Rev Source Type: research

Interventions for chronic pruritus of unknown origin.
CONCLUSIONS: We found lack of evidence to address our review question: for most of our interventions of interest, we found no eligible studies. The neurokinin 1 receptor (NK1R) antagonist serlopitant was the only intervention that we could assess. One study provided low-certainty evidence suggesting that serlopitant may reduce pruritus intensity when compared with placebo. We are uncertain of the effects of serlopitant on other outcomes, as certainty of the evidence is very low. More studies with larger sample sizes, focused on patients with CPUO, are needed. Healthcare professionals, patients, and other stakeholders may h...
Source: Cochrane Database of Systematic Reviews - January 25, 2020 Category: General Medicine Authors: Andrade A, Kuah CY, Martin-Lopez JE, Chua S, Shpadaruk V, Sanclemente G, Franco JV Tags: Cochrane Database Syst Rev Source Type: research

Cerivastatin for lowering lipids.
CONCLUSIONS: The LDL cholesterol, total cholesterol, and triglyceride lowering effect of cerivastatin was linearly dependent on dose. Cerivastatin log dose-response data were linear over the commonly prescribed dose range. Based on an informal comparison with fluvastatin, atorvastatin and rosuvastatin, cerivastatin was about 250-fold more potent than fluvastatin, 20-fold more potent than atorvastatin and 5.5-fold more potent than rosuvastatin in reducing LDL cholesterol, and 233-fold greater potency than fluvastatin, 18-fold greater potency than atorvastatin and six-fold greater potency than rosuvastatin at reducing total ...
Source: Cochrane Database of Systematic Reviews - January 25, 2020 Category: General Medicine Authors: Adams SP, Tiellet N, Alaeiilkhchi N, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

Yttrium-90 microsphere radioembolisation for unresectable hepatocellular carcinoma.
Abstract BACKGROUND: Hepatocellular carcinoma is the most common liver neoplasm and the sixth most common cancer worldwide. Its incidence has increased dramatically since the mid-2000s. Although surgical resection and liver transplantation are the main curative treatments, only about 20% of people with early hepatocellular carcinoma may benefit from these interventions. Treatment options for unresectable hepatocellular carcinoma include ablative and transarterial interventions - selective yttrium-90 microsphere transarterial radioembolisation - in addition to the drug sorafenib. OBJECTIVES: To determine the b...
Source: Cochrane Database of Systematic Reviews - January 24, 2020 Category: General Medicine Authors: Abdel-Rahman O, Elsayed Z Tags: Cochrane Database Syst Rev Source Type: research

Electrical stimulation for treating pressure ulcers.
CONCLUSIONS: ES probably increases the proportion of pressure ulcers healed and the rate of pressure ulcer healing (moderate certainty evidence), but its effect on time to complete healing is uncertain compared with no ES (very low certainty evidence). It is also uncertain whether ES decreases the surface area of pressure ulcers. The evidence to date is insufficient to support the widespread use of ES for pressure ulcers outside of research. Future research needs to focus on large-scale trials to determine the effect of ES on all key outcomes. PMID: 31962369 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 22, 2020 Category: General Medicine Authors: Arora M, Harvey LA, Glinsky JV, Nier L, Lavrencic L, Kifley A, Cameron ID Tags: Cochrane Database Syst Rev Source Type: research

Probiotics for people with cystic fibrosis.
CONCLUSIONS: Probiotics significantly reduce faecal calprotectin (a marker of intestinal inflammation) in children and adults with CF, however the clinical implications of this require further investigation. Probiotics may make little or no difference to pulmonary exacerbation rates, however, further evidence is required before firm conclusions can be made. Probiotics are associated with a small number of adverse events including vomiting, diarrhoea and allergic reactions. In children and adults with CF, probiotics may be considered by patients and their healthcare providers. Given the variability of probiotic composition ...
Source: Cochrane Database of Systematic Reviews - January 22, 2020 Category: General Medicine Authors: Coffey MJ, Garg M, Homaira N, Jaffe A, Ooi CY Tags: Cochrane Database Syst Rev Source Type: research

Drug therapy for delirium in terminally ill adults.
CONCLUSIONS: We found no high-quality evidence to support or refute the use of drug therapy for delirium symptoms in terminally ill adults. We found low-quality evidence that risperidone or haloperidol may slightly worsen delirium symptoms of mild to moderate severity for terminally ill people compared with placebo. We found moderate- to low-quality evidence that haloperidol and risperidone may slightly increase extrapyramidal adverse events for people with mild- to moderate-severity delirium. Given the small number of studies and participants on which current evidence is based, further research is essential. PMID: 31...
Source: Cochrane Database of Systematic Reviews - January 21, 2020 Category: General Medicine Authors: Finucane AM, Jones L, Leurent B, Sampson EL, Stone P, Tookman A, Candy B Tags: Cochrane Database Syst Rev Source Type: research

Different infusion durations for preventing platinum-induced hearing loss in children with cancer.
CONCLUSIONS: Since only one eligible RCT evaluating the use of a continuous cisplatin infusion versus a one-hour bolus cisplatin infusion was found, and that had methodological limitations, no definitive conclusions can be made. It should be noted that 'no evidence of effect', as identified in this review, is not the same as 'evidence of no effect'. For other (combinations of) infusion durations and other platinum analogues no eligible studies were identified. More high-quality research is needed. PMID: 31961948 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 21, 2020 Category: General Medicine Authors: van As JW, van den Berg H, van Dalen EC Tags: Cochrane Database Syst Rev Source Type: research

Interventions for chronic palmoplantar pustulosis.
CONCLUSIONS: Evidence is lacking for major chronic palmoplantar pustulosis treatments such as superpotent corticosteroids, phototherapy, acitretin, methotrexate, and ciclosporin. Risk of bias and imprecision limit our confidence. Maxacalcitol may be more effective than placebo in achieving clearance in the short term (low-quality evidence), and the risk of adverse effects is probably similar (moderate-quality evidence). Oral alitretinoin is probably no more effective than placebo in reducing severity, with a similar risk of adverse effects (moderate-quality evidence). Regarding biological treatments, we are uncertain of th...
Source: Cochrane Database of Systematic Reviews - January 20, 2020 Category: General Medicine Authors: Obeid G, Do G, Kirby L, Hughes C, Sbidian E, Le Cleach L Tags: Cochrane Database Syst Rev Source Type: research

Early versus delayed postoperative radiotherapy for treatment of low-grade gliomas.
This study found that early postoperative radiotherapy was associated with an increase in time to progression compared to observation (and delayed radiotherapy upon disease progression) for people with LGG but did not significantly improve overall survival (OS). The median progression-free survival (PFS) was 5.3 years in the early radiotherapy group and 3.4 years in the delayed radiotherapy group (hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.45 to 0.77; P
Source: Cochrane Database of Systematic Reviews - January 20, 2020 Category: General Medicine Authors: Dhawan S, Patil CG, Chen C, Venteicher AS Tags: Cochrane Database Syst Rev Source Type: research

Blood transfusions for treating acute chest syndrome in people with sickle cell disease.
CONCLUSIONS: We found only one very small randomised controlled trial; this is not enough to make any reliable conclusion to support the use of blood transfusion. Whilst there appears to be some indication that chronic blood transfusion may play a roll in reducing the incidence of acute chest syndrome in people with sickle cell disease and albeit offering transfusions may be a widely accepted clinical practice, there is currently no reliable evidence to support or refute the perceived benefits of these as treatment options; very limited information about any of the potential harms associated with these interventions or ind...
Source: Cochrane Database of Systematic Reviews - January 16, 2020 Category: General Medicine Authors: Dolatkhah R, Dastgiri S Tags: Cochrane Database Syst Rev Source Type: research

Oxygen therapy in the pre-hospital setting for acute exacerbations of chronic obstructive pulmonary disease.
CONCLUSIONS: The one included study found a reduction in pre/in-hospital mortality for the titrated oxygen arm compared to the high-flow control arm. However, the paucity of evidence somewhat limits the reliability of these findings and generalisability to other settings. There is a need for robust, well-designed RCTs to further investigate the effect of oxygen therapies in the pre-hospital setting for people with AECOPD. PMID: 31934729 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 14, 2020 Category: General Medicine Authors: Kopsaftis Z, Carson-Chahhoud KV, Austin MA, Wood-Baker R Tags: Cochrane Database Syst Rev Source Type: research

Motor neuroprosthesis for promoting recovery of function after stroke.
CONCLUSIONS: Current evidence indicates that MN is no more beneficial than another assistive technology device for improving activities involving limbs measured by Timed Up and Go, balance (moderate-certainty evidence), activities involving limbs measured by walking speed and modified Emory Functional Ambulation Profile, exercise capacity (low-certainty evidence), and participation scale of HRQoL (very low-certainty evidence). Evidence was insufficient to estimate the effect of MN on independence in ADL. In comparison to other assistive devices, MN does not appear to increase the number of falls (moderate-certainty evidenc...
Source: Cochrane Database of Systematic Reviews - January 14, 2020 Category: General Medicine Authors: Mendes LA, Lima IN, Souza T, do Nascimento GC, Resqueti VR, Fregonezi GA Tags: Cochrane Database Syst Rev Source Type: research

Interventions for renal vasculitis in adults.
CONCLUSIONS: Plasma exchange was effective in patients with severe AKI secondary to vasculitis. Pulse cyclophosphamide may result in an increased risk of relapse when compared to continuous oral use but a reduced total dose. Whilst CPA is standard induction treatment, rituximab and MMF were also effective. AZA, methotrexate and leflunomide were effective as maintenance therapy. Further studies are required to more clearly delineate the appropriate place of newer agents within an evidence-based therapeutic strategy. PMID: 31927782 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 13, 2020 Category: General Medicine Authors: Walters GD, Willis NS, Cooper TE, Craig JC Tags: Cochrane Database Syst Rev Source Type: research

Cisplatin versus carboplatin in combination with third-generation drugs for advanced non-small cell lung cancer.
CONCLUSIONS: Advanced NSCL patients treated with carboplatin or cisplatin doublet with third-generation chemotherapy drugs showed equivalent overall survival, one-year survival, and response rate. Regarding adverse events, carboplatin caused more thrombocytopenia, and cisplatin caused more nausea/vomiting. Therefore, in this palliative therapeutic intent, the choice of the platin compound should take into account the expected toxicity profile, patient's comorbidities and preferences. PMID: 31930743 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 13, 2020 Category: General Medicine Authors: Vasconcellos VF, Marta GN, da Silva EM, Gois AF, de Castria TB, Riera R Tags: Cochrane Database Syst Rev Source Type: research

Interim PET-results for prognosis in adults with Hodgkin lymphoma: a systematic review and meta-analysis of prognostic factor studies.
CONCLUSIONS: This review provides moderate-certainty evidence that interim PET scan results predict OS, and very low-certainty evidence that interim PET scan results predict progression-free survival in treated individuals with HL. This evidence is primarily based on unadjusted data. More studies are needed to test the adjusted prognostic ability of interim PET against established prognostic factors. PMID: 31930780 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 13, 2020 Category: General Medicine Authors: Aldin A, Umlauff L, Estcourt LJ, Collins G, Moons KG, Engert A, Kobe C, von Tresckow B, Haque M, Foroutan F, Kreuzberger N, Trivella M, Skoetz N Tags: Cochrane Database Syst Rev Source Type: research

Interventions to slow progression of myopia in children.
CONCLUSIONS: Antimuscarinic topical medication is effective in slowing myopia progression in children. Multifocal lenses, either spectacles or contact lenses, may also confer a small benefit. Orthokeratology contact lenses, although not intended to modify refractive error, were more effective than SVLs in slowing axial elongation. We found only low or very low-certainty evidence to support RGPCLs and sperical aberration SCLs. PMID: 31930781 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 13, 2020 Category: General Medicine Authors: Walline JJ, Lindsley KB, Vedula SS, Cotter SA, Mutti DO, Ng SM, Twelker JD Tags: Cochrane Database Syst Rev Source Type: research

Sclerotherapy versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children and adolescents with chronic liver disease or portal vein thrombosis.
CONCLUSIONS: Randomised clinical trials assessing the benefits or harms of sclerotherapy versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children and adolescents with chronic liver disease or portal vein thrombosis are lacking. Therefore, trials with adequate power and proper design, assessing the benefits and harms of sclerotherapy versus beta-blockers on patient-relevant clinical outcomes such as mortality, failure to control bleeding, and adverse events are needed. Unless such trials are conducted and the results become published, we cannot make any conclusions regarding the benefits or ...
Source: Cochrane Database of Systematic Reviews - January 10, 2020 Category: General Medicine Authors: Gattini D, Cifuentes LI, Torres-Robles R, Gana JC Tags: Cochrane Database Syst Rev Source Type: research

Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis.
CONCLUSIONS: Our review shows that compared to placebo, the biologics infliximab, ixekizumab, risankizumab, bimekizumab, guselkumab, secukinumab and brodalumab were the best choices for achieving PASI 90 in people with moderate-to-severe psoriasis on the basis of moderate- to high-certainty evidence (low-certainty evidence for bimekizumab). This NMA evidence is limited to induction therapy (outcomes were measured from 8 to 24 weeks after randomisation) and is not sufficient for evaluation of longer-term outcomes in this chronic disease. Moreover, we found low numbers of studies for some of the interventions, and the young ...
Source: Cochrane Database of Systematic Reviews - January 9, 2020 Category: General Medicine Authors: Sbidian E, Chaimani A, Afach S, Doney L, Dressler C, Hua C, Mazaud C, Phan C, Hughes C, Riddle D, Naldi L, Garcia-Doval I, Le Cleach L Tags: Cochrane Database Syst Rev Source Type: research

Cognitive behavioural therapy for tinnitus.
CONCLUSIONS: CBT may be effective in reducing the negative impact that tinnitus can have on quality of life. There is, however, an absence of evidence at 6 or 12 months follow-up. There is also some evidence that adverse effects may be rare in adults with tinnitus receiving CBT, but this could be further investigated. CBT for tinnitus may have small additional benefit in reducing symptoms of depression although uncertainty remains due to concerns about the quality of the evidence. Overall, there is limited evidence for CBT for tinnitus improving anxiety, health-related quality of life or negatively biased interpretations o...
Source: Cochrane Database of Systematic Reviews - January 8, 2020 Category: General Medicine Authors: Fuller T, Cima R, Langguth B, Mazurek B, Vlaeyen JW, Hoare DJ Tags: Cochrane Database Syst Rev Source Type: research

Health-improving interventions for obtaining employment in unemployed job seekers.
CONCLUSIONS: Interventions combining therapeutic methods and job-search training probably have a small beneficial effect in increasing employment. Therapeutic interventions may have an effect on re-employment, but we are very uncertain. Therapeutic interventions may not improve health in unemployed job seekers. Large high-quality RCTs targeting short-term or long-term unemployed people are needed to increase the quality of the evidence. A cost-effectiveness assessment is needed of the small beneficial effects. PMID: 31912888 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 8, 2020 Category: General Medicine Authors: Hult M, Lappalainen K, Saaranen TK, Räsänen K, Vanroelen C, Burdorf A Tags: Cochrane Database Syst Rev Source Type: research

Intravesical Bacillus Calmette-Gu érin versus mitomycin C for Ta and T1 bladder cancer.
CONCLUSIONS: Based on our findings, BCG may reduce the risk of recurrence over time although the Confidence Intervals include the possibility of no difference. It may have no effect on either the risk of progression or risk of death from any cause over time. BCG may cause more serious adverse events although the Confidence Intervals once again include the possibility of no difference. We were unable to determine the impact on quality of life. The certainty of the evidence was consistently low, due to concerns that include possible selection bias, performance bias, given the lack of blinding in these studies, and imprecisio...
Source: Cochrane Database of Systematic Reviews - January 8, 2020 Category: General Medicine Authors: Schmidt S, Kunath F, Coles B, Draeger DL, Krabbe LM, Dersch R, Kilian S, Jensen K, Dahm P, Meerpohl JJ Tags: Cochrane Database Syst Rev Source Type: research

Antibiotics versus topical antiseptics for chronic suppurative otitis media.
CONCLUSIONS: Treatment of CSOM with topical antibiotics (quinolones) probably results in an increase in resolution of ear discharge compared with boric acid at up to two weeks. There was limited evidence for the efficacy of other topical antibiotics or topical antiseptics and so we are unable to draw conclusions. Adverse events were not well reported. PMID: 31902139 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - January 6, 2020 Category: General Medicine Authors: Head K, Chong LY, Bhutta MF, Morris PS, Vijayasekaran S, Burton MJ, Schilder AG, Brennan-Jones CG Tags: Cochrane Database Syst Rev Source Type: research