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

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

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

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

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

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

Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults.
CONCLUSIONS: There is moderate-quality evidence that optimized anaesthesia guided by processed EEG indices could reduce the risk of postoperative delirium in patients aged 60 years or over undergoing non-cardiac surgical and non-neurosurgical procedures. We found moderate-quality evidence that postoperative cognitive dysfunction at three months could be reduced in these patients. The effect on POCD at one week and over one year after surgery is uncertain. There are no data available for patients under 60 years. Further blinded randomized controlled trials are needed to elucidate strategies for the amelioration of postopera...
Source: Cochrane Database of Systematic Reviews - May 15, 2018 Category: General Medicine Authors: Punjasawadwong Y, Chau-In W, Laopaiboon M, Punjasawadwong S, Pin-On P Tags: Cochrane Database Syst Rev Source Type: research

L-ornithine L-aspartate for prevention and treatment of hepatic encephalopathy in people with cirrhosis.
CONCLUSIONS: The results of this review suggest a possible beneficial effect of L-ornithine L-aspartate on mortality, hepatic encephalopathy, and serious adverse events in comparisons with placebo or no-intervention, but, because the quality of the evidence is very low, we are very uncertain about these findings. There was very low quality evidence of a possible beneficial effect of L-ornithine L-aspartate on hepatic encephalopathy, when compared with probiotics, but no other benefits were demonstrated in comparison with other active agents. Additional access to data from completed, but unpublished trials, and new randomis...
Source: Cochrane Database of Systematic Reviews - May 15, 2018 Category: General Medicine Authors: Goh ET, Stokes CS, Sidhu SS, Vilstrup H, Gluud LL, Morgan MY Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Nursing record systems: effects on nursing practice and healthcare outcomes.
CONCLUSIONS: We found some limited evidence of effects on practice attributable to changes in record systems. It is clear from the literature that it is possible to set up the randomised trials or other quasi-experimental designs needed to produce evidence for practice. Qualitative nursing research to explore the relationship between practice and information use could be used as a precursor to the design and testing of nursing information systems. PMID: 29763508 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 15, 2018 Category: General Medicine Authors: Urquhart C, Currell R, Grant MJ, Hardiker NR Tags: Cochrane Database Syst Rev Source Type: research

Trihexyphenidyl for dystonia in cerebral palsy.
CONCLUSIONS: At present, there is insufficient evidence regarding the effectiveness of trihexyphenidyl for people with cerebral palsy for the outcomes of: change in dystonia, adverse effects, increased upper limb function and improved participation in activities of daily living. The study did not measure pain or quality of life. There is a need for larger randomised, controlled, multicentre trials that also examine the effect on pain and quality of life in order to determine the effectiveness of trihexyphenidyl for people with cerebral palsy. PMID: 29763510 [PubMed - as supplied by publisher] (Source: Cochrane Databas...
Source: Cochrane Database of Systematic Reviews - May 15, 2018 Category: General Medicine Authors: Harvey AR, Baker LB, Reddihough DS, Scheinberg A, Williams K Tags: Cochrane Database Syst Rev Source Type: research

Hormone replacement therapy for women previously treated for endometrial cancer.
CONCLUSIONS: Currently, there is insufficient high-quality evidence to inform women considering HRT after treatment for endometrial cancer. The available evidence (both the single RCT and non-randomised evidence) does not suggest significant harm, if HRT is used after surgical treatment for early-stage endometrial cancer. There is no information available regarding use of HRT in higher-stage endometrial cancer (FIGO stage II and above). The use of HRT after endometrial cancer treatment should be individualised, taking account of the woman's symptoms and preferences, and the uncertainty of evidence for and against HRT use. ...
Source: Cochrane Database of Systematic Reviews - May 15, 2018 Category: General Medicine Authors: Edey KA, Rundle S, Hickey M Tags: Cochrane Database Syst Rev Source Type: research

Glucocorticosteroids for infants with biliary atresia following Kasai portoenterostomy.
CONCLUSIONS: The two meta-analysed randomised clinical trials present insufficient evidence to determine the effects of using glucocorticosteroids versus placebo after Kasai portoenterostomy in infants with biliary atresia on any of the primary or secondary review outcomes. There is insufficient evidence to support glucocorticosteroid use in the postoperative management of infants with biliary atresia for long-term outcomes of all-cause mortality or liver transplantation. It is also unclear if glucocorticosteroids are able to reduce the numbers of infants who did not clear their jaundice by six months. Further randomised, ...
Source: Cochrane Database of Systematic Reviews - May 14, 2018 Category: General Medicine Authors: Tyraskis A, Parsons C, Davenport M Tags: Cochrane Database Syst Rev Source Type: research

Antidepressants for insomnia in adults.
Abstract BACKGROUND: Insomnia disorder is a subjective condition of unsatisfactory sleep (e.g. sleep onset, maintenance, early waking, impairment of daytime functioning). Insomnia disorder impairs quality of life and is associated with an increased risk of physical and mental health problems including anxiety, depression, drug and alcohol abuse, and increased health service use. hypnotic medications (e.g. benzodiazepines and 'Z' drugs) are licensed for sleep promotion, but can induce tolerance and dependence, although many people remain on long-term treatment. Antidepressant use for insomnia is widespread, but non...
Source: Cochrane Database of Systematic Reviews - May 14, 2018 Category: General Medicine Authors: Everitt H, Baldwin DS, Stuart B, Lipinska G, Mayers A, Malizia AL, Manson CC, Wilson S Tags: Cochrane Database Syst Rev Source Type: research

Psychological therapies for treatment-resistant depression in adults.
CONCLUSIONS: Moderate-quality evidence shows that psychotherapy added to usual care (with antidepressants) is beneficial for depressive symptoms and for response and remission rates over the short term for patients with TRD. Medium- and long-term effects seem similarly beneficial, although most evidence was derived from a single large trial. Psychotherapy added to usual care seems as acceptable as usual care alone.Further evidence is needed on the effectiveness of different types of psychotherapies for patients with TRD. No evidence currently shows whether switching to a psychotherapy is more beneficial for this patient gr...
Source: Cochrane Database of Systematic Reviews - May 14, 2018 Category: General Medicine Authors: Ijaz S, Davies P, Williams CJ, Kessler D, Lewis G, Wiles N Tags: Cochrane Database Syst Rev Source Type: research

Comparison of a therapeutic-only versus prophylactic platelet transfusion policy for people with congenital or acquired bone marrow failure disorders.
CONCLUSIONS: We found no evidence to determine the safety and efficacy of therapeutic platelet transfusion compared with prophylactic platelet transfusion for people with long-term bone marrow failure disorders. This review underscores the urgency of prioritising research in this area. People with bone marrow failure depend on long-term platelet transfusion support, but the only trial that assessed a therapeutic strategy was halted. There is a need for good-quality studies comparing a therapeutic platelet transfusion strategy with a prophylactic platelet transfusion strategy; such trials should include outcomes that are im...
Source: Cochrane Database of Systematic Reviews - May 14, 2018 Category: General Medicine Authors: Malouf R, Ashraf A, Hadjinicolaou AV, Doree C, Hopewell S, Estcourt LJ Tags: Cochrane Database Syst Rev Source Type: research

Withdrawal of immunosuppressant or biologic therapy for patients with quiescent Crohn's disease.
CONCLUSIONS: The effects of withdrawal of immunosuppressant therapy in people with quiescent Crohn's disease are uncertain. Low quality evidence suggests that continuing azathioprine monotherapy may be superior to withdrawal for avoiding clinical relapse, while very low quality evidence suggests that there may be no difference in clinical relapse rates between discontinuing azathioprine from a combination therapy regimen, compared to continuing combination therapy. It is unclear whether withdrawal of azathioprine, initially administered alone or in combination, impacts on the development of CD-related complications, advers...
Source: Cochrane Database of Systematic Reviews - May 12, 2018 Category: General Medicine Authors: Boyapati RK, Torres J, Palmela C, Parker CE, Silverberg OM, Upadhyaya SD, Nguyen TM, Colombel JF Tags: Cochrane Database Syst Rev Source Type: research

Non-pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.
CONCLUSIONS: Based on the findings of moderate quality evidence, this review found that some non-pharmacological interventions such as acupuncture and extracorporeal shockwave therapy are likely to result in a decrease in prostatitis symptoms and may not be associated with a greater incidence of adverse event. The QoE for most other comparisons was predominantly low. Future clinical trials should include a full report of their methods including adequate masking, consistent assessment of all patient-important outcomes including potential treatment-related adverse events and appropriate sample sizes. PMID: 29757454 [Pub...
Source: Cochrane Database of Systematic Reviews - May 12, 2018 Category: General Medicine Authors: Franco JV, Turk T, Jung JH, Xiao YT, Iakhno S, Garrote V, Vietto V Tags: Cochrane Database Syst Rev Source Type: research

Increasing antipsychotic dose versus switching antipsychotic for non response in schizophrenia.
CONCLUSIONS: There is extremely limited evidence and no clear conclusions can be drawn. There is an urgent need for further trials in order to determine the optimal treatment strategy for people with schizophrenia who do not respond to their initial antipsychotic treatment. PMID: 29749607 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 11, 2018 Category: General Medicine Authors: Samara MT, Klupp E, Helfer B, Rothe PH, Schneider-Thoma J, Leucht S Tags: Cochrane Database Syst Rev Source Type: research

Increasing antipsychotic dose for non response in schizophrenia.
CONCLUSIONS: Current data do not show any clear differences between increasing or maintaining the antipsychotic dose for people with schizophrenia who do not respond to their initial antipsychotic treatment. Adverse effect reporting was limited and poor. There is an urgent need for further trials in order to determine the optional treatment strategy in such cases. PMID: 29750432 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 11, 2018 Category: General Medicine Authors: Samara MT, Klupp E, Helfer B, Rothe PH, Schneider-Thoma J, Leucht S Tags: Cochrane Database Syst Rev Source Type: research

Cyclamen europaeum extract for acute sinusitis.
CONCLUSIONS: The effectiveness of Cyclamen europaeum for people with acute sinusitis is unknown. Although no serious side effects were observed, 50% of participants who received Cyclamen europaeum reported adverse events compared with 24% of those who received placebo. PMID: 29750825 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 11, 2018 Category: General Medicine Authors: Zalmanovici Trestioreanu A, Barua A, Pertzov B Tags: Cochrane Database Syst Rev Source Type: research

Melatonin for the promotion of sleep in adults in the intensive care unit.
CONCLUSIONS: We found insufficient evidence to determine whether administration of melatonin would improve the quality and quantity of sleep in ICU patients. We identified sparse data, and noted differences in study methodology, in ICU sedation protocols, and in methods used to measure and report sleep. We identified five ongoing studies from database and clinical trial register searches. Inclusion of data from these studies in future review updates would provide more certainty for the review outcomes. PMID: 29746721 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 10, 2018 Category: General Medicine Authors: Lewis SR, Pritchard MW, Schofield-Robinson OJ, Alderson P, Smith AF Tags: Cochrane Database Syst Rev Source Type: research

Stiripentol add-on therapy for focal refractory epilepsy.
CONCLUSIONS: Since the last version of this review was published, we have found no new studies. Hence, we have made no changes to the conclusions of this update as presented in the initial review. We can draw no conclusions to support the use of stiripentol as add-on treatment for focal refractory epilepsy. Additional large, randomised, well-conducted trials are needed. PMID: 29747241 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 10, 2018 Category: General Medicine Authors: Brigo F, Igwe SC, Bragazzi NL Tags: Cochrane Database Syst Rev Source Type: research

Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors.
CONCLUSIONS: There is high-certainty evidence that HPV vaccines protect against cervical precancer in adolescent girls and young women aged 15 to 26. The effect is higher for lesions associated with HPV16/18 than for lesions irrespective of HPV type. The effect is greater in those who are negative for hrHPV or HPV16/18 DNA at enrolment than those unselected for HPV DNA status. There is moderate-certainty evidence that HPV vaccines reduce CIN2+ in older women who are HPV16/18 negative, but not when they are unselected by HPV DNA status.We did not find an increased risk of serious adverse effects. Although the number of deat...
Source: Cochrane Database of Systematic Reviews - May 9, 2018 Category: General Medicine Authors: Arbyn M, Xu L, Simoens C, Martin-Hirsch PP Tags: Cochrane Database Syst Rev Source Type: research

Induction of labour for improving birth outcomes for women at or beyond term.
CONCLUSIONS: A policy of labour induction at or beyond term compared with expectant management is associated with fewer perinatal deaths and fewer caesarean sections; but more operative vaginal births. NICU admissions were lower and fewer babies had low Apgar scores with induction. No important differences were seen for most of the other maternal and infant outcomes.Most of the important outcomes assessed using GRADE had a rating of moderate or low-quality evidence - with downgrading decisions generally due to study limitations such as lack of blinding (a condition inherent in comparisons between a policy of acting and of ...
Source: Cochrane Database of Systematic Reviews - May 9, 2018 Category: General Medicine Authors: Middleton P, Shepherd E, Crowther CA Tags: Cochrane Database Syst Rev Source Type: research

Grommets (ventilation tubes) for recurrent acute otitis media in children.
CONCLUSIONS: Current evidence on the effectiveness of grommets in children with rAOM is limited to five RCTs with unclear or high risk of bias, which were conducted prior to the introduction of pneumococcal vaccination. Low to very low-quality evidence suggests that children receiving grommets are less likely to have AOM recurrences compared to those managed by active monitoring and placebo medication, but the magnitude of the effect is modest with around one fewer episode at six months and a less noticeable effect by 12 months. The low to very low quality of the evidence means that these numbers need to be interpreted wit...
Source: Cochrane Database of Systematic Reviews - May 9, 2018 Category: General Medicine Authors: Venekamp RP, Mick P, Schilder AG, Nunez DA Tags: Cochrane Database Syst Rev Source Type: research

Abdominal drainage to prevent intra-peritoneal abscess after open appendectomy for complicated appendicitis.
CONCLUSIONS: The quality of the current evidence is very low. The effect of abdominal drainage on the prevention of intra-peritoneal abscess or wound infection after open appendectomy is uncertain for patients with complicated appendicitis. The increased rates for overall complication rate and hospital stay for the drainage group compared to no drainage group is also subject to great uncertainty. Thus, there is no evidence for any clinical improvement by using abdominal drainage in patients undergoing open appendectomy for complicated appendicitis. The increased risk of mortality with drainage comes from eight deaths obser...
Source: Cochrane Database of Systematic Reviews - May 9, 2018 Category: General Medicine Authors: Li Z, Zhao L, Cheng Y, Cheng N, Deng Y Tags: Cochrane Database Syst Rev Source Type: research

Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD).
Abstract BACKGROUND: The rising prevalence of autism spectrum disorders (ASD) increases the need for evidence-based behavioral treatments to lessen the impact of symptoms on children's functioning. At present, there are no curative or psychopharmacological therapies to effectively treat all symptoms of the disorders. Early intensive behavioral intervention (EIBI) is a treatment based on the principles of applied behavior analysis. Delivered for multiple years at an intensity of 20 to 40 hours per week, it is one of the more well-established treatments for ASD. This is an update of a Cochrane review last published ...
Source: Cochrane Database of Systematic Reviews - May 9, 2018 Category: General Medicine Authors: Reichow B, Hume K, Barton EE, Boyd BA Tags: Cochrane Database Syst Rev Source Type: research

Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents - assessment of adverse events in non-randomised studies.
CONCLUSIONS: Our findings suggest that methylphenidate may be associated with a number of serious adverse events as well as a large number of non-serious adverse events in children and adolescents, which often lead to withdrawal of methylphenidate. Our certainty in the evidence is very low, and accordingly, it is not possible to accurately estimate the actual risk of adverse events. It might be higher than reported here.Given the possible association between methylphenidate and the adverse events identified, it may be important to identify people who are most susceptible to adverse events. To do this we must undertake larg...
Source: Cochrane Database of Systematic Reviews - May 9, 2018 Category: General Medicine Authors: Storebø OJ, Pedersen N, Ramstad E, Kielsholm ML, Nielsen SS, Krogh HB, Moreira-Maia CR, Magnusson FL, Holmskov M, Gerner T, Skoog M, Rosendal S, Groth C, Gillies D, Buch Rasmussen K, Gauci D, Zwi M, Kirubakaran R, Håkonsen SJ, Aagaard L, Simonsen E, Glu Tags: Cochrane Database Syst Rev Source Type: research

Interventions for improving adherence to iron chelation therapy in people with sickle cell disease or thalassaemia.
CONCLUSIONS: The medication comparisons included in this review had higher than average adherence rates not accounted for by differences in medication administration or side effects.Participants may have been selected based on higher adherence to trial medications at baseline. Also, within the clinical trial context, there is increased attention and involvement of clinicians, thus high adherence rates may be an artefact of trial participation.Real-world, pragmatic trials in community and clinic settings are needed that examine both confirmed or unconfirmed adherence strategies that may increase adherence to iron chelation ...
Source: Cochrane Database of Systematic Reviews - May 8, 2018 Category: General Medicine Authors: Fortin PM, Fisher SA, Madgwick KV, Trivella M, Hopewell S, Doree C, Estcourt LJ Tags: Cochrane Database Syst Rev Source Type: research

Face-to-face interventions for informing or educating parents about early childhood vaccination.
CONCLUSIONS: There is low- to moderate-certainty evidence suggesting that face-to-face information or education may improve or slightly improve children's vaccination status, parents' knowledge, and parents' intention to vaccinate.Face-to-face interventions may be more effective in populations where lack of awareness or understanding of vaccination is identified as a barrier (e.g. where people are unaware of new or optional vaccines). The effect of the intervention in a population where concerns about vaccines or vaccine hesitancy is the primary barrier is less clear. Reliable and validated scales for measuring more comple...
Source: Cochrane Database of Systematic Reviews - May 8, 2018 Category: General Medicine Authors: Kaufman J, Ryan R, Walsh L, Horey D, Leask J, Robinson P, Hill S Tags: Cochrane Database Syst Rev Source Type: research

Interventions for improving modifiable risk factor control in the secondary prevention of stroke.
CONCLUSIONS: We found that organisational interventions may be associated with an improvement in achieving blood pressure target but we did not find any clear evidence that these interventions improve other modifiable risk factors (lipid profile, HbA1c, medication adherence) or reduce the incidence of recurrent cardiovascular events. Interventions, including patient education alone, did not lead to improvements in modifiable risk factor control or the prevention of recurrent cardiovascular events. PMID: 29734470 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 7, 2018 Category: General Medicine Authors: Bridgwood B, Lager KE, Mistri AK, Khunti K, Wilson AD, Modi P Tags: Cochrane Database Syst Rev Source Type: research

Treatment for hepatitis C virus-associated mixed cryoglobulinaemia.
CONCLUSIONS: To treat HCV-associated mixed cryoglobulinaemia, it may be beneficial to eliminate HCV infection by using antiviral treatment and to stop the immune response by using rituximab. For skin vasculitis and for some laboratory findings, it may be appropriate to combine antiviral treatment with deletion of B-cell clonal expansions by using of rituximab. The applicability of evidence reviewed here is limited by the absence of any studies with direct-acting antivirals, which are urgently needed to guide therapy. PMID: 29734473 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 7, 2018 Category: General Medicine Authors: Montero N, Favà A, Rodriguez E, Barrios C, Cruzado JM, Pascual J, Soler MJ Tags: Cochrane Database Syst Rev Source Type: research

Acupuncture for hip osteoarthritis.
Abstract BACKGROUND: Hip osteoarthritis (OA) is a major cause of pain and functional limitation. Few hip OA treatments have been evaluated for safety and effectiveness. Acupuncture is a traditional Chinese medical therapy which aims to treat disease by inserting very thin needles at specific points on the body. OBJECTIVES: To assess the benefits and harms of acupuncture in patients with hip OA. SEARCH METHODS: We searched Cochrane CENTRAL, MEDLINE, and Embase all through March 2018. SELECTION CRITERIA: We included randomized controlled trials (RCTs) that compared acupuncture with sham acupuncture, a...
Source: Cochrane Database of Systematic Reviews - May 5, 2018 Category: General Medicine Authors: Manheimer E, Cheng K, Wieland LS, Shen X, Lao L, Guo M, Berman BM Tags: Cochrane Database Syst Rev Source Type: research

Lower versus higher oxygen concentrations titrated to target oxygen saturations during resuscitation of preterm infants at birth.
Abstract BACKGROUND: Initial resuscitation with air is well tolerated by most infants born at term. However, the optimal fractional inspired oxygen concentration (FiO2 - proportion of the breathed air that is oxygen) targeted to oxygen saturation (SpO2 - an estimate of the amount of oxygen in the blood) for infants born preterm is unclear. OBJECTIVES: To determine whether lower or higher initial oxygen concentrations, when titrated according to oxygen saturation targets during the resuscitation of preterm infants at birth, lead to improved short- and long-term mortality and morbidity. SEARCH METHODS: We ...
Source: Cochrane Database of Systematic Reviews - May 4, 2018 Category: General Medicine Authors: Lui K, Jones LJ, Foster JP, Davis PG, Ching SK, Oei JL, Osborn DA Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological interventions for apathy in Alzheimer's disease.
CONCLUSIONS: Methylphenidate may demonstrate a benefit for apathy and may have slight benefits for cognition and functional performance in people with AD, but this finding is associated with low-quality evidence. Our meta-analysis is limited by the small number of studies within each drug class, risk of bias, publication bias, imprecision and inconsistency between studies. Additional studies should be encouraged targeting people with AD with clinically significant apathy which investigate apathy as a primary outcome measure, and which have a longer duration and a larger sample size. This could increase the quality of evide...
Source: Cochrane Database of Systematic Reviews - May 4, 2018 Category: General Medicine Authors: Ruthirakuhan MT, Herrmann N, Abraham EH, Chan S, Lanctôt KL Tags: Cochrane Database Syst Rev Source Type: research

Clonazepam add-on therapy for refractory epilepsy in adults and children.
CONCLUSIONS: There is no evidence from double-blind randomised controlled trials for or against the use of clonazepam as an add-on therapy for adults and children with refractory focal or generalised onset epileptic seizures. PMID: 29717488 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 2, 2018 Category: General Medicine Authors: Song L, Liu F, Liu Y, Zhang R, Ji H, Jia Y Tags: Cochrane Database Syst Rev Source Type: research

Interventions for preventing occupational irritant hand dermatitis.
CONCLUSIONS: Moisturisers used alone or in combination with barrier creams may result in a clinically important protective effect, either in the long- or short-term, for the primary prevention of OIHD. Barrier creams alone may have slight protective effect, but this does not appear to be clinically important. The results for all of these comparisons were imprecise, and the low quality of the evidence means that our confidence in the effect estimates is limited. For skin protection education, the results varied substantially across the trials, the effect was imprecise, and the pooled risk reduction was not large enough to b...
Source: Cochrane Database of Systematic Reviews - April 30, 2018 Category: General Medicine Authors: Bauer A, Rönsch H, Elsner P, Dittmar D, Bennett C, Schuttelaar MA, Lukács J, John SM, Williams HC Tags: Cochrane Database Syst Rev Source Type: research

Interventions for investigating and identifying the causes of stillbirth.
CONCLUSIONS: There is currently a lack of RCT evidence regarding the effectiveness of interventions for investigating and identifying the causes of stillbirth. Seeking to determine the causes of stillbirth is an essential component of quality maternity care, but it remains unclear what impact these interventions have on the psychosocial outcomes of parents and families, the rates of diagnosis of the causes of stillbirth, and the care and management of subsequent pregnancies following stillbirth. Due to the absence of trials, this review is unable to inform clinical practice regarding the investigation of stillbirths, and t...
Source: Cochrane Database of Systematic Reviews - April 30, 2018 Category: General Medicine Authors: Wojcieszek AM, Shepherd E, Middleton P, Gardener G, Ellwood DA, McClure EM, Gold KJ, Khong TY, Silver RM, Erwich JJH, Flenady V Tags: Cochrane Database Syst Rev Source Type: research

Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia.
CONCLUSIONS: We found no evidence from RCTs or non-randomised studies on which to base an assessment of the correct platelet transfusion threshold prior to insertion of a lumbar puncture needle or epidural catheter. There are no ongoing registered RCTs assessing the effects of different platelet transfusion thresholds prior to the insertion of a lumbar puncture or epidural anaesthesia in people with thrombocytopenia. Any future study would need to be very large to detect a difference in the risk of bleeding. A study would need to be designed with at least 47,030 participants to be able to detect an increase in the number o...
Source: Cochrane Database of Systematic Reviews - April 30, 2018 Category: General Medicine Authors: Estcourt LJ, Malouf R, Hopewell S, Doree C, Van Veen J Tags: Cochrane Database Syst Rev Source Type: research

Follicular flushing during oocyte retrieval in assisted reproductive techniques.
CONCLUSIONS: This review suggests that follicular flushing probably has little or no effect on live birth rates compared with aspiration alone. None of the included trials reported on effects of follicular aspiration and flushing on the miscarriage rate. Data suggest little or no difference between follicular flushing and aspiration alone with respect to oocyte yield, total embryo number, or number of cryopreserved embryos. In addition, follicular flushing probably makes little or no difference in the clinical pregnancy rate. Evidence was insufficient to allow any firm conclusions with respect to adverse events or safety. ...
Source: Cochrane Database of Systematic Reviews - April 26, 2018 Category: General Medicine Authors: Georgiou EX, Melo P, Brown J, Granne IE Tags: Cochrane Database Syst Rev Source Type: research

Smectite for acute infectious diarrhoea in children.
CONCLUSIONS: Based on low-certainty evidence, smectite used as an adjuvant to rehydration therapy may reduce the duration of diarrhoea in children with acute infectious diarrhoea by a day; may increase cure rate by day 3; and may reduce stool output, but has no effect on hospitalization rates or need for intravenous therapy. PMID: 29693719 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 25, 2018 Category: General Medicine Authors: Pérez-Gaxiola G, Cuello-García CA, Florez ID, Pérez-Pico VM Tags: Cochrane Database Syst Rev Source Type: research

Uterotonic agents for preventing postpartum haemorrhage: a network meta-analysis.
CONCLUSIONS: Ergometrine plus oxytocin combination, carbetocin, and misoprostol plus oxytocin combination were more effective for preventing PPH ≥ 500 mL than the current standard oxytocin. Ergometrine plus oxytocin combination was more effective for preventing PPH ≥ 1000 mL than oxytocin. Misoprostol plus oxytocin combination evidence is less consistent and may relate to different routes and doses of misoprostol used in the studies. Carbetocin had the most favourable side-effect profile amongst the top three options; however, most carbetocin trials were small and at high risk of bias.Amongst the 11 ongoing studies l...
Source: Cochrane Database of Systematic Reviews - April 25, 2018 Category: General Medicine Authors: Gallos ID, Williams HM, Price MJ, Merriel A, Gee H, Lissauer D, Moorthy V, Tobias A, Deeks JJ, Widmer M, Tunçalp Ö, Gülmezoglu AM, Hofmeyr GJ, Coomarasamy A Tags: Cochrane Database Syst Rev Source Type: research

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children.
CONCLUSIONS: We conclude that there is moderate-quality evidence that regional anaesthesia may reduce the risk of developing PPP after three to 18 months after thoracotomy and three to 12 months after caesarean section. There is low-quality evidence that regional anaesthesia may reduce the risk of developing PPP three to 12 months after breast cancer surgery. There is moderate evidence that intravenous infusion of local anaesthetics may reduce the risk of developing PPP three to six months after breast cancer surgery.Our conclusions are considerably weakened by the small size and number of studies, by performance bias, nul...
Source: Cochrane Database of Systematic Reviews - April 25, 2018 Category: General Medicine Authors: Weinstein EJ, Levene JL, Cohen MS, Andreae DA, Chao JY, Johnson M, Hall CB, Andreae MH Tags: Cochrane Database Syst Rev Source Type: research

Cyclodestructive procedures for non-refractory glaucoma.
CONCLUSIONS: There is insufficient evidence to evaluate the relative effectiveness and safety of cyclodestructive procedures for the primary procedural management of non-refractory glaucoma. Results from the one included trial did not compare cyclophotocoagulation to other procedural interventions and yielded uncertainty about any difference in outcomes when comparing low-energy versus high-energy diode TSCPC. Overall, the effect of laser treatment on IOP control was modest and the number of eyes experiencing vision loss was limited. More research is needed specific to the management of non-refractory glaucoma. PMID: ...
Source: Cochrane Database of Systematic Reviews - April 25, 2018 Category: General Medicine Authors: Michelessi M, Bicket AK, Lindsley K Tags: Cochrane Database Syst Rev Source Type: research

Rufinamide add-on therapy for refractory epilepsy.
CONCLUSIONS: In people with drug-resistant focal epilepsy, rufinamide when used as an add-on treatment was effective in reducing seizure frequency. However, the trials reviewed were of relatively short duration and provided no evidence for the long-term use of rufinamide. In the short term, rufinamide as an add-on was associated with several adverse events. This review focused on the use of rufinamide in drug-resistant focal epilepsy and the results cannot be generalised to add-on treatment for generalised epilepsies. Likewise, no inference can be made about the effects of rufinamide when used as monotherapy. PMID: 29...
Source: Cochrane Database of Systematic Reviews - April 25, 2018 Category: General Medicine Authors: Panebianco M, Prabhakar H, Marson AG Tags: Cochrane Database Syst Rev Source Type: research

Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism.
CONCLUSIONS: We reviewed RCTs that implemented a variety of system-wide strategies aimed at improving thromboprophylaxis in hospitalized patients. We found increased prescription of prophylaxis associated with alerts and multifaceted interventions, and increased prescription of appropriate prophylaxis associated with alerts. While multifaceted interventions were found to be less effective than alerts, a multifaceted intervention with an alert was more effective than one without an alert. Alerts, particularly computer alerts, were associated with a reduction in symptomatic VTE at three months, although there were not enough...
Source: Cochrane Database of Systematic Reviews - April 24, 2018 Category: General Medicine Authors: Kahn SR, Morrison DR, Diendéré G, Piché A, Filion KB, Klil-Drori AJ, Douketis JD, Emed J, Roussin A, Tagalakis V, Morris M, Geerts W Tags: Cochrane Database Syst Rev Source Type: research

Antidepressants for the treatment of people with co-occurring depression and alcohol dependence.
CONCLUSIONS: We found low-quality evidence supporting the clinical use of antidepressants in the treatment of people with co-occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In...
Source: Cochrane Database of Systematic Reviews - April 24, 2018 Category: General Medicine Authors: Agabio R, Trogu E, Pani PP Tags: Cochrane Database Syst Rev Source Type: research

Antidepressants for the treatment of depression in people with cancer.
CONCLUSIONS: Despite the impact of depression on people with cancer, the available studies were very few and of low quality. This review found very low certainty evidence for the effects of these drugs compared with placebo. On the basis of these results, clear implications for practice cannot be deduced. The use of antidepressants in people with cancer should be considered on an individual basis and, considering the lack of head-to-head data, the choice of which agent to prescribe may be based on the data on antidepressant efficacy in the general population of individuals with major depression, also taking into account th...
Source: Cochrane Database of Systematic Reviews - April 23, 2018 Category: General Medicine Authors: Ostuzzi G, Matcham F, Dauchy S, Barbui C, Hotopf M Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological interventions for the prevention of insufficiency fractures and avascular necrosis associated with pelvic radiotherapy in adults.
CONCLUSIONS: The evidence relating to interventions to prevent insufficiency fractures and avascular necrosis associated with pelvic radiotherapy in adults is of very low certainty. This review highlights the need for prospective clinical trials using interventions prior to and during radiotherapy to prevent radiation-related bone morbidity, insufficiency fractures and avascular necrosis. Future trials could involve prospective assessment of bone health including BMD and bone turnover markers prior to pelvic radiotherapy. The interventions for investigation could begin as radiotherapy commences and remain ongoing for 12 to...
Source: Cochrane Database of Systematic Reviews - April 23, 2018 Category: General Medicine Authors: van den Blink QU, Garcez K, Henson CC, Davidson SE, Higham CE Tags: Cochrane Database Syst Rev Source Type: research

Oral and sublingual immunotherapy for egg allergy.
CONCLUSIONS: Frequent and increasing exposure to egg over one to two years in people who are allergic to egg builds tolerance, with almost everyone becoming more tolerant compared with a minority in the control group and almost half of people being totally tolerant of egg by the end of treatment compared with 1 in 10 people who avoid egg. However, nearly all who received treatment experienced adverse events, mainly allergy-related. We found that 1 in 12 children had serious allergic reactions requiring adrenaline, and some people gave up oral immunotherapy. It appears that oral immunotherapy for egg allergy is effective, b...
Source: Cochrane Database of Systematic Reviews - April 20, 2018 Category: General Medicine Authors: Romantsik O, Tosca MA, Zappettini S, Calevo MG Tags: Cochrane Database Syst Rev Source Type: research