Treatments for breast engorgement during lactation.
CONCLUSIONS: Although some interventions may be promising for the treatment of breast engorgement, such as cabbage leaves, cold gel packs, herbal compresses, and massage, the certainty of evidence is low and we cannot draw robust conclusions about their true effects. Future trials should aim to include larger sample sizes, using women - not individual breasts - as units of analysis. PMID: 32944940 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - September 18, 2020 Category: General Medicine Authors: Zakarija-Grkovic I, Stewart F Tags: Cochrane Database Syst Rev Source Type: research

Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking aerosol-generating procedures (AGPs) on patients without suspected or confirmed COVID-19 infection.
CONCLUSIONS: We identified no studies for inclusion in this review, nor any ongoing studies. The absence of completed studies is not surprising given the relatively recent emergence of COVID-19 infection. However, we are disappointed that this important clinical question is not being addressed by ongoing studies. PMID: 32936947 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - September 16, 2020 Category: General Medicine Authors: Burton MJ, Clarkson JE, Goulao B, Glenny AM, McBain AJ, Schilder AG, Webster KE, Worthington HV Tags: Cochrane Database Syst Rev Source Type: research

Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to improve patient outcomes and to protect healthcare workers treating them.
CONCLUSIONS: We identified no studies for inclusion in this review. This is not surprising given the relatively recent emergence of COVID-19 infection. It is promising that the question posed in this review is being addressed by a number of RCTs and other studies. We are concerned that few of the ongoing studies specifically state that they will evaluate adverse events such as changes in the sense of smell or to the oral and nasal microbiota, and any consequences thereof. Very few interventions have large and dramatic effect sizes. If a positive treatment effect is demonstrated when studies are available for...
Source: Cochrane Database of Systematic Reviews - September 16, 2020 Category: General Medicine Authors: Burton MJ, Clarkson JE, Goulao B, Glenny AM, McBain AJ, Schilder AG, Webster KE, Worthington HV Tags: Cochrane Database Syst Rev Source Type: research

Use of antimicrobial mouthwashes (gargling) and nasal sprays by healthcare workers to protect them when treating patients with suspected or confirmed COVID-19 infection.
CONCLUSIONS: We identified no studies for inclusion in this review. This is not surprising given the relatively recent emergence of COVID-19 infection. It is promising that the question posed in this review is being addressed by two RCTs and a non-randomised study. We are concerned that only one of the ongoing studies specifically states that it will evaluate adverse events and it is not clear if this will include changes in the sense of smell or to the oral and nasal microbiota, and any consequences thereof. Very few interventions have large and dramatic effect sizes. If a positive treatment effect is demonstrat...
Source: Cochrane Database of Systematic Reviews - September 16, 2020 Category: General Medicine Authors: Burton MJ, Clarkson JE, Goulao B, Glenny AM, McBain AJ, Schilder AG, Webster KE, Worthington HV Tags: Cochrane Database Syst Rev Source Type: research

Aural toilet (ear cleaning) for chronic suppurative otitis media.
CONCLUSIONS: We are very uncertain whether or not treatment with aural toileting is effective in resolving ear discharge in people with CSOM, due to a lack of data and the poor quality of the available evidence. We also remain uncertain about other outcomes, including adverse events, as these were not well reported. Similarly, we are very uncertain whether daily suction clearance, followed by antibiotic ear drops administered at a clinic, is better than a single episode of suction clearance followed by self-administration of topical antibiotic ear drops. PMID: 32926406 [PubMed - as supplied by publisher] (Source: Coch...
Source: Cochrane Database of Systematic Reviews - September 14, 2020 Category: General Medicine Authors: Bhutta MF, Head K, Chong LY, Daw J, Schilder AG, Burton MJ, Brennan-Jones CG Tags: Cochrane Database Syst Rev Source Type: research

Sublingual immunotherapy for asthma.
CONCLUSIONS: Despite continued study in the field, the evidence for important outcomes such as exacerbations and quality of life remains too limited to draw clinically useful conclusions about the efficacy of SLIT for people with asthma. Trials mostly recruited mixed populations with mild and intermittent asthma and/or rhinitis and focused on non-validated symptom and medication scores. The review findings suggest that SLIT may be a safe option for people with well-controlled mild-to-moderate asthma and rhinitis who are likely to be at low risk of serious harm, but the role of SLIT for people with uncontrolled asthma requi...
Source: Cochrane Database of Systematic Reviews - September 14, 2020 Category: General Medicine Authors: Fortescue R, Kew KM, Leung MST Tags: Cochrane Database Syst Rev Source Type: research

Systemic treatments for eczema: a network meta-analysis.
CONCLUSIONS: Our findings indicate that dupilumab is the most effective biological treatment for eczema. Compared to placebo, dupilumab reduces eczema signs and symptoms in the short term for people with moderate to severe atopic eczema. Short-term safety outcomes from clinical trials did not reveal new safety concerns with dupilumab. Overall, evidence for the efficacy of most other immunosuppressive treatments for moderate to severe atopic eczema is of low or very low certainty. Given the lack of data comparing conventional with newer biological treatments for the primary outcomes, there remains high uncertainty for ...
Source: Cochrane Database of Systematic Reviews - September 14, 2020 Category: General Medicine Authors: Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N Tags: Cochrane Database Syst Rev Source Type: research

Carotid endarterectomy for symptomatic carotid stenosis.
CONCLUSIONS: Carotid endarterectomy reduced the risk of recurrent stroke for people with significant stenosis. Endarterectomy might be of some benefit for participants with 50% to 69% symptomatic stenosis (moderate-quality evidence) and highly beneficial for those with 70% to 99% stenosis (moderate-quality evidence). PMID: 32918282 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - September 12, 2020 Category: General Medicine Authors: Rerkasem A, Orrapin S, Howard DP, Rerkasem K Tags: Cochrane Database Syst Rev Source Type: research

Taxation of the fat content of foods for reducing their consumption and preventing obesity or other adverse health outcomes.
Abstract BACKGROUND: Overweight and obesity are increasing worldwide and are considered to be a major public health issue of the 21st century. Introducing taxation of the fat content in foods is considered a potentially powerful policy tool to reduce consumption of foods high in fat or saturated fat, or both. OBJECTIVES: To assess the effects of taxation of the fat content in food on consumption of total fat and saturated fat, energy intake, overweight, obesity, and other adverse health outcomes in the general population. SEARCH METHODS: We searched CENTRAL, Cochrane Database of Systematic Reviews, MEDLI...
Source: Cochrane Database of Systematic Reviews - September 11, 2020 Category: General Medicine Authors: Lhachimi SK, Pega F, Heise TL, Fenton C, Gartlehner G, Griebler U, Sommer I, Bombana M, Katikireddi SV Tags: Cochrane Database Syst Rev Source Type: research

Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children.
CONCLUSIONS: The ESR test does not appear to be sufficiently accurate to be helpful in differentiating children with cystitis from children with pyelonephritis. A low CRP value (
Source: Cochrane Database of Systematic Reviews - September 10, 2020 Category: General Medicine Authors: Shaikh KJ, Osio VA, Leeflang MM, Shaikh N Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.
CONCLUSIONS: We found there is probably little to no difference in total mortality and cardiovascular mortality between people with hypertension and cardiovascular disease treated to a lower compared to a standard blood pressure target. There may also be little to no difference in serious adverse events or total cardiovascular events. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on withdrawals due to adverse effects, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (135/85 mmHg or le...
Source: Cochrane Database of Systematic Reviews - September 9, 2020 Category: General Medicine Authors: Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L Tags: Cochrane Database Syst Rev Source Type: research

Psychological and social interventions for the prevention of mental disorders in people living in low- and middle-income countries affected by humanitarian crises.
CONCLUSIONS: Of the seven prevention studies included in this review, none assessed whether prevention interventions reduced the incidence of mental disorders and there may be no evidence for any differences in acceptability. Additionally, for both child and adolescent populations and adult populations, a very small number of RCTs with low quality evidence on the review's secondary outcomes (changes in symptomatology at endpoint) did not suggest any beneficial effect for the studied prevention interventions. Confidence in the findings is hampered by the scarcity of prevention studies eligible for inclusion in the review, b...
Source: Cochrane Database of Systematic Reviews - September 8, 2020 Category: General Medicine Authors: Papola D, Purgato M, Gastaldon C, Bovo C, van Ommeren M, Barbui C, Tol WA Tags: Cochrane Database Syst Rev Source Type: research

Preimplantation genetic testing for aneuploidies (abnormal number of chromosomes) in in vitro fertilisation.
CONCLUSIONS: There is insufficient good-quality evidence of a difference in cumulative live birth rate, live birth rate after the first embryo transfer, or miscarriage rate between IVF with and IVF without PGT-A as currently performed. No data were available on ongoing pregnancy rates. The effect of PGT-A on clinical pregnancy rate is uncertain. Women need to be aware that it is uncertain whether PGT-A with the use of genome-wide analyses is an effective addition to IVF, especially in view of the invasiveness and costs involved in PGT-A. PGT-A using FISH for the genetic analysis is probably harmful. The currently available...
Source: Cochrane Database of Systematic Reviews - September 8, 2020 Category: General Medicine Authors: Cornelisse S, Zagers M, Kostova E, Fleischer K, van Wely M, Mastenbroek S Tags: Cochrane Database Syst Rev Source Type: research

Carbohydrate supplementation of human milk to promote growth in preterm infants.
CONCLUSIONS: We found insufficient evidence on the short- and long-term effects of carbohydrate supplementation of human milk in preterm infants. The only trial included in this review presented very low-quality evidence, and study authors provided uncertain information about study methods and analysis. The evidence may be limited in its applicability because researchers included a small sample of preterm infants from a single centre. However, the outcomes assessed are common to all preterm infants, and this trial demonstrates the feasibility of prebiotic carbohydrate supplementation in upper-middle-income countries. Futur...
Source: Cochrane Database of Systematic Reviews - September 8, 2020 Category: General Medicine Authors: Amissah EA, Brown J, Harding JE Tags: Cochrane Database Syst Rev Source Type: research

Education and training for preventing and minimizing workplace aggression directed toward healthcare workers.
CONCLUSIONS: Education combined with training may not have an effect on workplace aggression directed toward healthcare workers, even though education and training may increase personal knowledge and positive attitudes. Better quality studies that focus on specific settings of healthcare work where exposure to patient aggression is high are needed. Moreover, as most studies have assessed episodes of aggression toward nurses, future studies should include other types of healthcare workers who are also victims of aggression in the same settings, such as orderlies (healthcare assistants). Studies should es...
Source: Cochrane Database of Systematic Reviews - September 8, 2020 Category: General Medicine Authors: Geoffrion S, Hills DJ, Ross HM, Pich J, Hill AT, Dalsbø TK, Riahi S, Martínez-Jarreta B, Guay S Tags: Cochrane Database Syst Rev Source Type: research

Vitamin E supplementation in people with cystic fibrosis.
CONCLUSIONS: Vitamin E supplementation may lead to an improvement in vitamin E levels in people with cystic fibrosis, although evidence we assessed was low quality. No data on other outcomes of interest were available to allow conclusions about any other benefits of this therapy. In future, larger studies are needed, especially in people already being treated with enteric-coated pancreatic enzymes and supplemented with vitamin E, to look at more specific outcome measures such as vitamin E status, lung function and nutritional status. Future studies could also look at the optimal dose of vitamin E required to achieve maxima...
Source: Cochrane Database of Systematic Reviews - September 6, 2020 Category: General Medicine Authors: Okebukola PO, Kansra S, Barrett J Tags: Cochrane Database Syst Rev Source Type: research

Tafenoquine for preventing relapse in people with Plasmodium vivax malaria.
CONCLUSIONS: TQ 300 mg single dose prevents relapses after clinically parasitologically confirmed P vivax malaria compared to no antihypnozoite treatment, and with no difference detected in studies comparing it to PQ to date. However, the inability to differentiate a true relapse from a recurrence in the available studies may affect these estimates. The drug is untested in children and in people with G6PD deficiency. Single-dose treatment is an important practical advantage compared to using PQ for the same purpose without an overall increase in adverse events in non-pregnant, non-G6PD-deficient adults. PMID: 32892362...
Source: Cochrane Database of Systematic Reviews - September 6, 2020 Category: General Medicine Authors: Rodrigo C, Rajapakse S, Fernando D Tags: Cochrane Database Syst Rev Source Type: research

Time course for blood pressure lowering of beta-blockers with partial agonist activity.
CONCLUSIONS: There is insufficient evidence to draw general conclusions about the degree of variation in hourly BP-lowering efficacy of BBPAA over a 24-hour period, in adults with essential hypertension. Very low-certainty evidence showed that BBPAA acebutalol, pindolol, and bopindolol lowered BP more during the day and evening than at night. However, the number of studies and participants included in this review was very small, further limiting the certainty of the evidence. We need further and larger trials, with accurate recording of time of drug intake, and with reporting of standard deviation of BP and HR at each hour...
Source: Cochrane Database of Systematic Reviews - September 5, 2020 Category: General Medicine Authors: Zhang XY, Soufi S, Dormuth C, Musini VM Tags: Cochrane Database Syst Rev Source Type: research

An overview of systematic reviews on mental health promotion, prevention, and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons.
CONCLUSIONS: Gaps exist in the evidence on mental health interventions for refugees, asylum seekers, and internally displaced persons. Most reviews do not specify that internally displaced persons are included in the selection criteria, even though they make up the majority of involuntary migrants worldwide. Reviews specific to mental health promotion and prevention of common mental disorders are missing, and there is more evidence available for adults or mixed populations than for children. The literature is focused on post-traumatic stress disorder and trauma-related symptoms, with less attention for depression and anxie...
Source: Cochrane Database of Systematic Reviews - September 4, 2020 Category: General Medicine Authors: Uphoff E, Robertson L, Cabieses B, Villalón FJ, Purgato M, Churchill R, Barbui C Tags: Cochrane Database Syst Rev Source Type: research

Psychological interventions for antisocial personality disorder.
CONCLUSIONS: There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour. Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the ad...
Source: Cochrane Database of Systematic Reviews - September 3, 2020 Category: General Medicine Authors: Gibbon S, Khalifa NR, Cheung NH, Völlm BA, McCarthy L Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological interventions for antisocial personality disorder.
CONCLUSIONS: The evidence summarised in this review is insufficient to draw any conclusion about the use of pharmacological interventions in the treatment of antisocial personality disorder. The evidence comes from single, unreplicated studies of mostly older medications. The studies also have methodological issues that severely limit the confidence we can draw from their results. Future studies should recruit participants on the basis of having AsPD, and use relevant outcome measures, including reconviction. PMID: 32880105 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - September 3, 2020 Category: General Medicine Authors: Khalifa NR, Gibbon S, Völlm BA, Cheung NH, McCarthy L Tags: Cochrane Database Syst Rev Source Type: research

Hydrosurgical debridement versus conventional surgical debridement for acute partial-thickness burns.
CONCLUSIONS: This review contains one randomised trial of hydrosurgery versus conventional debridement in a paediatric population with low percentage of total body surface area burn injuries. Based on the available trial data, there may be little or no difference between hydrosurgery and conventional debridement in terms of time to complete healing, postoperative infection, operative time, and scar outcomes at six months. These results are based on very low-certainty evidence. Further research evaluating these outcomes as well as health-related quality of life, resource use, and other adverse event outcomes is require...
Source: Cochrane Database of Systematic Reviews - September 3, 2020 Category: General Medicine Authors: Wormald JC, Wade RG, Dunne JA, Collins DP, Jain A Tags: Cochrane Database Syst Rev Source Type: research

Environmental and behavioural interventions for reducing physical activity limitation and preventing falls in older people with visual impairment.
CONCLUSIONS: There is no evidence of effect for most of the environmental or behavioral interventions studied for reducing physical activity limitation and preventing falls in visually impaired older people. The certainty of evidence is generally low due to poor methodological quality and heterogeneous outcome measurements. Researchers should form a consensus to adopt standard ways of measuring physical activity and falls reliably in older people with visual impairments. Fall prevention trials should plan to use objectively measured or self-reported physical activity as outcome measures of reduced activity limitation. Futu...
Source: Cochrane Database of Systematic Reviews - September 3, 2020 Category: General Medicine Authors: E JY, Li T, McInally L, Thomson K, Shahani U, Gray L, Howe TE, Skelton DA Tags: Cochrane Database Syst Rev Source Type: research

Hyaluronic acid in embryo transfer media for assisted reproductive technologies.
CONCLUSIONS: Moderate-quality evidence shows improved clinical pregnancy and live birth rates with the addition of HA as an adherence compound in embryo transfer media in ART. Low-quality evidence suggests that adding HA may slightly decrease miscarriage rates, but when only studies at low risk of bias were included in the analysis, the results were inconclusive. HA had no clear effect on the rate of total adverse events. The increase in multiple pregnancy rates may be due to combining an adherence compound and transferring more than one embryo. Further studies of adherence compounds with single embryo transfer need to be ...
Source: Cochrane Database of Systematic Reviews - September 2, 2020 Category: General Medicine Authors: Heymann D, Vidal L, Or Y, Shoham Z Tags: Cochrane Database Syst Rev Source Type: research

Pharmacotherapy for hyperuricaemia in hypertensive patients.
CONCLUSIONS: In this updated Cochrane Review, the current RCT data are insufficient to know whether UA-lowering therapy lowers BP. More studies are needed. PMID: 32877573 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - September 2, 2020 Category: General Medicine Authors: Gois PHF, Souza ERM Tags: Cochrane Database Syst Rev Source Type: research

Oxygen targets in the intensive care unit during mechanical ventilation for acute respiratory distress syndrome: a rapid review.
CONCLUSIONS: We are very uncertain as to whether a higher or lower oxygen target is more beneficial in patients with ARDS and receiving mechanical ventilation in an intensive care setting. We identified only one RCT with a total of 205 participants exploring this question, and rated the risk of bias as high and the certainty of the findings as very low. Further well-conducted studies are urgently needed to increase the certainty of the findings reported here. This review should be updated when more evidence is available. PMID: 32870512 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - September 1, 2020 Category: General Medicine Authors: Cumpstey AF, Oldman AH, Smith AF, Martin D, Grocott MP Tags: Cochrane Database Syst Rev Source Type: research

Complementary and alternative therapies for post-caesarean pain.
CONCLUSIONS: Some CAM therapies may help reduce post-CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer-term effects on pain. Since pain control is the most relevant outcome for post-CS women and their clinicians, it is important that future studies of CAM for post-CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. Measuring pain as a dichotomous variable would improve the certainty of evidence and it is easy to understand for ...
Source: Cochrane Database of Systematic Reviews - September 1, 2020 Category: General Medicine Authors: Zimpel SA, Torloni MR, Porfírio GJ, Flumignan RL, da Silva EM Tags: Cochrane Database Syst Rev Source Type: research

Citicoline for treating people with acute ischemic stroke.
CONCLUSIONS: This review assessed the clinical benefits and harms of citicoline compared with placebo or any other standard treatment for people with acute ischemic stroke. The findings of the review suggest there may be little to no difference between citicoline and its controls regarding all-cause mortality, disability or dependence in daily activities, severe adverse events, functional recovery and the assessment of the neurological function, based on low-certainty evidence. None of the included trials assessed quality of life and the safety profile of citicoline remains unknown. The available evidence is of low quality...
Source: Cochrane Database of Systematic Reviews - August 29, 2020 Category: General Medicine Authors: Martí-Carvajal AJ, Valli C, Martí-Amarista CE, Solà I, Martí-Fàbregas J, Bonfill Cosp X Tags: Cochrane Database Syst Rev Source Type: research

Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis.
CONCLUSIONS: There is high-certainty evidence that 5-ASA is superior to placebo for maintenance therapy in UC. There is high-certainty evidence that 5-ASA is inferior compared to SASP. There is probably little or no difference between 5-ASA and placebo, and 5-ASA and SASP in commonly reported AEs such as flatulence, abdominal pain, nausea, diarrhea, headache, and dyspepsia. Oral 5-ASA administered once daily has a similar benefit and harm profile as conventional dosing for maintenance of remission in quiescent UC. PMID: 32856298 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 28, 2020 Category: General Medicine Authors: Murray A, Nguyen TM, Parker CE, Feagan BG, MacDonald JK Tags: Cochrane Database Syst Rev Source Type: research

Antioxidants for female subfertility.
Abstract BACKGROUND: A couple may be considered to have fertility problems if they have been trying to conceive for over a year with no success. This may affect up to a quarter of all couples planning a child. It is estimated that for 40% to 50% of couples, subfertility may result from factors affecting women. Antioxidants are thought to reduce the oxidative stress brought on by these conditions. Currently, limited evidence suggests that antioxidants improve fertility, and trials have explored this area with varied results. This review assesses the evidence for the effectiveness of different antioxidants in female...
Source: Cochrane Database of Systematic Reviews - August 27, 2020 Category: General Medicine Authors: Showell MG, Mackenzie-Proctor R, Jordan V, Hart RJ Tags: Cochrane Database Syst Rev Source Type: research

Home versus inpatient induction of labour for improving birth outcomes.
CONCLUSIONS: Data on the effectiveness, safety and women's experiences of home versus inpatient induction of labour are limited and of very low-certainty. Given that serious adverse events are likely to be extremely rare, the safety data are more likely to come from very large observational cohort studies rather than relatively small RCTs. PMID: 32852803 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 27, 2020 Category: General Medicine Authors: Alfirevic Z, Gyte GM, Nogueira Pileggi V, Plachcinski R, Osoti AO, Finucane EM Tags: Cochrane Database Syst Rev Source Type: research

Interventions for American cutaneous and mucocutaneous leishmaniasis.
CONCLUSIONS: Evidence certainty was mostly moderate or low, due to methodological shortcomings, which precluded conclusive results. Overall, both IMMA and oral miltefosine probably result in an increase in cure rates, and nausea and vomiting are probably more common with miltefosine than with IMMA. Future trials should investigate interventions for mucosal leishmaniasis and evaluate recurrence rates of cutaneous leishmaniasis and its progression to mucosal disease. PMID: 32853410 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 27, 2020 Category: General Medicine Authors: Pinart M, Rueda JR, Romero GA, Pinzón-Flórez CE, Osorio-Arango K, Silveira Maia-Elkhoury AN, Reveiz L, Elias VM, Tweed JA Tags: Cochrane Database Syst Rev Source Type: research

Xpert MTB/RIF and Xpert MTB/RIF Ultra assays for active tuberculosis and rifampicin resistance in children.
CONCLUSIONS: We found Xpert MTB/RIF sensitivity to vary by specimen type, with gastric aspirate specimens having the highest sensitivity followed by sputum and stool, and nasopharyngeal specimens the lowest; specificity in all specimens was> 98%. Compared with Xpert MTB/RIF, Xpert Ultra sensitivity in sputum was higher and specificity slightly lower. Xpert MTB/RIF was accurate for detection of rifampicin resistance. Xpert MTB/RIF was sensitive for diagnosing lymph node tuberculosis. For children with presumed tuberculous meningitis, treatment decisions should be based on the entirety of clinical information and treatmen...
Source: Cochrane Database of Systematic Reviews - August 27, 2020 Category: General Medicine Authors: Kay AW, González Fernández L, Takwoingi Y, Eisenhut M, Detjen AK, Steingart KR, Mandalakas AM Tags: Cochrane Database Syst Rev Source Type: research

Radiotherapy for neovascular age-related macular degeneration.
CONCLUSIONS: The evidence is uncertain regarding the use of radiotherapy for neovascular AMD. Most studies took place before the routine use of anti-VEGF, and before the development of modern radiotherapy techniques such as stereotactic radiotherapy. Visual outcomes with epimacular brachytherapy are likely to be worse, with an increased risk of adverse events,  probably related to vitrectomy. The role of stereotactic radiotherapy combined with anti-VEGF is currently uncertain. Further research on radiotherapy for neovascular AMD may not be justified until current ongoing st...
Source: Cochrane Database of Systematic Reviews - August 26, 2020 Category: General Medicine Authors: Evans JR, Igwe C, Jackson TL, Chong V Tags: Cochrane Database Syst Rev Source Type: research

Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection.
CONCLUSIONS: This review identifies early-stage evaluations of point-of-care tests for detecting SARS-CoV-2 infection, largely based on remnant laboratory samples. The findings currently have limited applicability, as we are uncertain whether tests will perform in the same way in clinical practice, and according to symptoms of COVID-19, duration of symptoms, or in asymptomatic people. Rapid tests have the potential to be used to inform triage of RT-PCR use, allowing earlier detection of those testing positive, but the evidence currently is not strong enough to determine how useful they are in clinical practice. Prospective...
Source: Cochrane Database of Systematic Reviews - August 26, 2020 Category: General Medicine Authors: Dinnes J, Deeks JJ, Adriano A, Berhane S, Davenport C, Dittrich S, Emperador D, Takwoingi Y, Cunningham J, Beese S, Dretzke J, Ferrante di Ruffano L, Harris IM, Price MJ, Taylor-Phillips S, Hooft L, Leeflang MM, Spijker R, Van den Bruel A, Cochrane COVID- Tags: Cochrane Database Syst Rev Source Type: research

Proton pump inhibitors for chronic obstructive pulmonary disease.
This study recruited participants with a mean age of 75 years, and excluded people with symptoms or history of GERD. No placebo was used in the usual care arm. Among the primary and secondary outcomes of this review, the study only reported data on COPD exacerbations and acute respiratory infections (the common cold). As we only included one study, we could not conduct a meta-analysis. The included study reported that 12 of the 50 people on lansoprazole had at least one exacerbation over a year, compared to 26 out of 50 on usual care (risk ratio 0.46, 95% CI 0.26 to 0.81). The frequency of COPD exacerbations per person in ...
Source: Cochrane Database of Systematic Reviews - August 25, 2020 Category: General Medicine Authors: Kikuchi S, Imai H, Tani Y, Tajiri T, Watanabe N Tags: Cochrane Database Syst Rev Source Type: research

Fat supplementation of human milk for promoting growth in preterm infants.
CONCLUSIONS: The one included trial suggests no evidence of an effect of fat supplementation of human milk on short-term growth and feeding intolerance in preterm infants. However, the very low-quality evidence, small sample size, few events, and low precision diminishes our confidence that these results reflect the true effect of fat supplementation of human milk in preterm infants, and no long-term outcomes were reported. Further high-quality research should evaluate the effect on short and long-term growth, neurodevelopmental and cardio-metabolic outcomes in the context of the development of multicomponent fortifiers. O...
Source: Cochrane Database of Systematic Reviews - August 25, 2020 Category: General Medicine Authors: Amissah EA, Brown J, Harding JE Tags: Cochrane Database Syst Rev Source Type: research

Surgical interventions for primary congenital glaucoma.
CONCLUSIONS: The evidence suggests that there may be little to no evidence of difference between CTT and routine conventional trabeculotomy, or between viscotrabeculotomy and routine conventional trabeculotomy. A 360-degree circumferential trabeculotomy may show greater surgical success than conventional trabeculotomy. Considering the rarity of the disease, future research would benefit from a multicenter, possibly international trial, involving parents of children with PCG and with a follow-up of at least one year. PMID: 32816311 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 22, 2020 Category: General Medicine Authors: Gagrani M, Garg I, Ghate D Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic therapy for pelvic inflammatory disease.
CONCLUSIONS: We are uncertain whether one treatment was safer or more effective than any other for the cure of mild-moderate or severe PID Based on a single study at a low risk of bias, a macrolide (azithromycin) probably improves the rates of cure of mild-moderate PID, compared to tetracycline (doxycycline). PMID: 32820536 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 20, 2020 Category: General Medicine Authors: Savaris RF, Fuhrich DG, Maissiat J, Duarte RV, Ross J Tags: Cochrane Database Syst Rev Source Type: research

Primaquine alternative dosing schedules for preventing malaria relapse in people with Plasmodium vivax.
CONCLUSIONS: Trials available to date do not detect a difference in recurrence between the following regimens: 1) 0.5 mg/kg/day for seven days versus standard 0.25 mg/kg/day for 14 days; 2) high-standard 0.5 mg/kg/day for 14 days versus standard 0.25 mg/kg/day for 14 days; 3) 0.75 mg/kg/week for eight weeks versus high-standard 0.5 mg/kg/day for 14 days; 4) 1 mg/kg/day for seven days versus high-standard 0.5 mg/kg/day for 14 days. There were no differences detected in adverse events for Comparisons 1, 2 or 3, but there may be more serious adverse events with the high seven-day course in Comparison 4. The shorter regimen of...
Source: Cochrane Database of Systematic Reviews - August 19, 2020 Category: General Medicine Authors: Milligan R, Daher A, Villanueva G, Bergman H, Graves PM Tags: Cochrane Database Syst Rev Source Type: research

Aromatherapy for dementia.
CONCLUSIONS: We have not found any convincing evidence that aromatherapy (or exposure to fragrant plant oils) is beneficial for people with dementia although there are many limitations to the data. Conduct or reporting problems in half of the included studies meant that they could not contribute to the conclusions. Results from the other studies were inconsistent. Harms were very poorly reported in the included studies. In order for clear conclusions to be drawn, better design and reporting and consistency of outcome measurement in future trials would be needed. PMID: 32813272 [PubMed - in process] (Source: Cochrane D...
Source: Cochrane Database of Systematic Reviews - August 19, 2020 Category: General Medicine Authors: Ball EL, Owen-Booth B, Gray A, Shenkin SD, Hewitt J, McCleery J Tags: Cochrane Database Syst Rev Source Type: research

Stem cell-based interventions for the prevention of morbidity and mortality following hypoxic-ischaemic encephalopathy in newborn infants.
CONCLUSIONS: There is currently no evidence from randomised trials that assesses the benefit or harms of stem cell-based interventions for the prevention of morbidity and mortality following hypoxic-ischaemic encephalopathy in newborn infants. PMID: 32813884 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 19, 2020 Category: General Medicine Authors: Bruschettini M, Romantsik O, Moreira A, Ley D, Thébaud B Tags: Cochrane Database Syst Rev Source Type: research

Retzius-sparing versus standard robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer.
CONCLUSIONS: Findings of this review indicate that RS-RALP may result in better continence outcomes than standard RALP up to six months after surgery. Continence outcomes at 12 months may be similar. Downsides of RS-RALP may be higher positive margin rates. We are very uncertain about the effect on BCRFS and potency outcomes. Longer-term oncologic and functional outcomes are lacking, and no preplanned subgroup analyses could be performed to explore the observed heterogeneity. Surgeons should discuss these trade-offs and the limitations of the evidence with their patients when considering this approach. ...
Source: Cochrane Database of Systematic Reviews - August 18, 2020 Category: General Medicine Authors: Rosenberg JE, Jung JH, Edgerton Z, Lee H, Lee S, Bakker CJ, Dahm P Tags: Cochrane Database Syst Rev Source Type: research

Mobile technologies to support healthcare provider to healthcare provider communication and management of care.
CONCLUSIONS: Our confidence in the effect estimates is limited. Interventions including a mobile technology component to support healthcare provider to healthcare provider communication and management of care may reduce the time between presentation and management of the health condition when primary care providers or emergency physicians use them to consult with specialists, and may increase the likelihood of receiving a clinical examination among participants with diabetes and those who required an ultrasound. They may decrease the number of people attending primary care who are referred to secondary or tertiary care in ...
Source: Cochrane Database of Systematic Reviews - August 18, 2020 Category: General Medicine Authors: Gonçalves-Bradley DC, J Maria AR, Ricci-Cabello I, Villanueva G, Fønhus MS, Glenton C, Lewin S, Henschke N, Buckley BS, Mehl GL, Tamrat T, Shepperd S Tags: Cochrane Database Syst Rev Source Type: research

Multiple versus fewer antiplatelet agents for preventing early recurrence after ischaemic stroke or transient ischaemic attack.
Abstract BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide. Antiplatelet agents are considered to be the cornerstone for secondary prevention of stroke, but the role of using multiple antiplatelet agents early after stroke or transient ischaemic attack (TIA) to improve outcomes has not been established. OBJECTIVES: To determine the effectiveness and safety of initiating, within 72 hours after an ischaemic stroke or TIA, multiple antiplatelet agents versus fewer antiplatelet agents to prevent stroke recurrence. The analysis explores the evidence for different drug combinations. SE...
Source: Cochrane Database of Systematic Reviews - August 17, 2020 Category: General Medicine Authors: Naqvi IA, Kamal AK, Rehman H Tags: Cochrane Database Syst Rev Source Type: research

Personally tailored activities for improving psychosocial outcomes for people with dementia in community settings.
CONCLUSIONS: Offering personally tailored activities to people with dementia living in the community may be one approach for reducing challenging behaviour and may also slightly improve the quality of life of people with dementia. Given the low certainty of the evidence, these results should be interpreted with caution. For depression and affect of people with dementia, as well as caregivers' quality of life and burden, we found no clear benefits of personally tailored activities. PMID: 32786083 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 15, 2020 Category: General Medicine Authors: Möhler R, Renom A, Renom H, Meyer G Tags: Cochrane Database Syst Rev Source Type: research

Erythropoietin plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery.
CONCLUSIONS: Moderate-quality evidence suggests that preoperative rHuEPO + iron therapy for anaemic adults prior to non-cardiac surgery reduces the need for RBC transfusion and, when given at higher doses, increases the haemoglobin concentration preoperatively. The administration of rHuEPO + iron treatment did not decrease the mean number of units of RBC transfused per patient. There were no important differences in the risk of adverse events or mortality within 30 days, nor in length of hospital stay. Further, well-designed, adequately powered RCTs are required to estimate the impact of this combined treatment more precis...
Source: Cochrane Database of Systematic Reviews - August 13, 2020 Category: General Medicine Authors: Kaufner L, von Heymann C, Henkelmann A, Pace NL, Weibel S, Kranke P, Meerpohl JJ, Gill R Tags: Cochrane Database Syst Rev Source Type: research

Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis.
CONCLUSIONS: There is high-certainty evidence that 5-ASA is superior to placebo, and moderate-certainty evidence that 5-ASA is not more effective than SASP. Considering relative costs, a clinical advantage to using oral 5-ASA in place of SASP appears unlikely. High-certainty evidence suggests 5-ASA dosed once daily appears to be as efficacious as conventionally-dosed 5-ASA. There may be little or no difference in efficacy or safety among the various 5-ASA formulations. PMID: 32786164 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 12, 2020 Category: General Medicine Authors: Murray A, Nguyen TM, Parker CE, Feagan BG, MacDonald JK Tags: Cochrane Database Syst Rev Source Type: research

Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis.
CONCLUSIONS: This systematic review provides moderate-quality evidence showing that ET, compared with CMT, in people with recent symptomatic severe intracranial atherosclerotic stenosis probably does not prevent recurrent stroke and appears to carry an increased hazard. The impact of delayed ET intervention (more than three weeks after a qualifying event) is unclear and may warrant further study. PMID: 32789891 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 11, 2020 Category: General Medicine Authors: Wang T, Luo J, Wang X, Yang K, Jadhav V, Gao P, Ma Y, Zhao N, Jiao L Tags: Cochrane Database Syst Rev Source Type: research

Pancreatic enzyme replacement therapy for people with cystic fibrosis.
CONCLUSIONS: There is limited evidence of benefit from enteric-coated microspheres when compared to non-enteric coated pancreatic enzyme preparations up to one month. In the only comparison where we could combine any data, the fact that these were cross-over trials is likely to underestimate the level of inconsistency between the results of the trials due to over-inflation of CIs from the individual trials.There is no evidence on the long-term effectiveness and risks associated with PERT. There is also no evidence on the relative dosages of enzymes needed for people with different levels of severity of pancreatic insuffici...
Source: Cochrane Database of Systematic Reviews - August 5, 2020 Category: General Medicine Authors: Somaraju URR, Solis-Moya A Tags: Cochrane Database Syst Rev Source Type: research