Interventions to increase tuberculosis case detection at primary healthcare or community-level services.
CONCLUSIONS: The available evidence demonstrates that when used in appropriate settings, active case-finding approaches may result in increase in tuberculosis case detection in the short term. The effect of active case finding on treatment outcome needs to be further evaluated in sufficiently powered studies. PMID: 29182800 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 28, 2017 Category: General Medicine Authors: Mhimbira FA, Cuevas LE, Dacombe R, Mkopi A, Sinclair D Tags: Cochrane Database Syst Rev Source Type: research

Probiotics for vulvovaginal candidiasis in non-pregnant women.
CONCLUSIONS: Low and very low quality evidence shows that, compared with conventional treatment, the use of probiotics as an adjuvant therapy could increases the rate of short-term clinical and mycological cure and decrease the relapse rate at one month but this did not translate into a higher frequency of long-term clinical or mycological cure. Probiotics use does not seem to increase the frequency of serious or non-serious adverse events. There is a need for well-designed RCTs with standardized methodologies, longer follow-up and larger sample size. PMID: 29168557 [PubMed - as supplied by publisher] (Source: Cochran...
Source: Cochrane Database of Systematic Reviews - November 23, 2017 Category: General Medicine Authors: Xie HY, Feng D, Wei DM, Mei L, Chen H, Wang X, Fang F Tags: Cochrane Database Syst Rev Source Type: research

Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age.
CONCLUSIONS: Point-of-use fortification of foods with MNPs containing iron reduces anaemia and iron deficiency in preschool- and school-age children. However, information on mortality, morbidity, developmental outcomes and adverse effects is still scarce. PMID: 29168569 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 23, 2017 Category: General Medicine Authors: De-Regil LM, Jefferds MED, Peña-Rosas JP Tags: Cochrane Database Syst Rev Source Type: research

Prophylactic platelet transfusions prior to surgery for people with a low platelet count.
The objectives are as follows: To determine the clinical effectiveness and safety of prophylactic platelet transfusions prior to surgery for people with a low platelet count or platelet dysfunction (inherited or acquired). PMID: 29151812 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 22, 2017 Category: General Medicine Authors: Estcourt LJ, Malouf R, Doree C, Trivella M, Hopewell S, Birchall J Tags: Cochrane Database Syst Rev Source Type: research

Silodosin for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia.
CONCLUSIONS: Silodosin may reduce urologic symptom scores in an appreciable number of men compared to placebo. Quality of life and treatment withdrawals for any reason appears similar. Its efficacy appears similar to that of other alpha blockers (tamsulosin, naftopidil and alfuzosin) but the rate of sexual side effects is likely higher. Our certainty in the estimates of effect was lowered due to study limitations, inconsistency and imprecision. PMID: 29161773 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 22, 2017 Category: General Medicine Authors: Jung JH, Kim J, MacDonald R, Reddy B, Kim MH, Dahm P Tags: Cochrane Database Syst Rev Source Type: research

Methylphenidate for children and adolescents with autism spectrum disorder.
We report parent-rated outcomes separately. Risk of bias: we considered three trials to be at high risk of bias due to selective reporting and all trials to be at unclear risk of bias for blinding of participants and assessors, due to the potential for recognising the side effects of methylphenidate. We judged all trials to be at low or unclear risk of bias for other items. Primary outcomes: the meta-analysis suggested that high-dose methylphenidate (0.43 mg/kg/dose to 0.60 mg/kg/dose) had a significant and clinically relevant benefit on hyperactivity, as rated by teachers (SMD -0.78, 95% confidence interval (CI) -1.13 to ...
Source: Cochrane Database of Systematic Reviews - November 21, 2017 Category: General Medicine Authors: Sturman N, Deckx L, van Driel ML Tags: Cochrane Database Syst Rev Source Type: research

Mass media interventions for smoking cessation in adults.
CONCLUSIONS: There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality. One state-wide tobacco control programme (Massachusetts) showed positive results up to eight years after the campaign. Another (California) showed positive results during the period of adequate funding and implementation and in final evaluation since the beginning of the programme. Six of nine studies carried out in communities or regions showed some positive e...
Source: Cochrane Database of Systematic Reviews - November 21, 2017 Category: General Medicine Authors: Bala MM, Strzeszynski L, Topor-Madry R Tags: Cochrane Database Syst Rev Source Type: research

Proton pump inhibitors for functional dyspepsia.
CONCLUSIONS: There is evidence that PPIs are effective for the treatment of FD, independent of the dose and duration of treatment compared with placebo. PPIs may be slightly more effective than prokinetics for the treatment of FD; however, the evidence is scarce. The trials evaluating PPIs versus prokinetics are difficult to interpret as they are at risk of bias. Although the effect of these drugs seems to be small, the drugs are well tolerated. PMID: 29161458 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 21, 2017 Category: General Medicine Authors: Pinto-Sanchez MI, Yuan Y, Hassan A, Bercik P, Moayyedi P Tags: Cochrane Database Syst Rev Source Type: research

Neuromuscular electrical stimulation for the prevention of venous thromboembolism.
CONCLUSIONS: Low-quality evidence shows no clear difference in the risk of DVT between NMES and alternative methods of prophylaxis but suggest that NMES may be associated with lower risk of DVT compared with no prophylaxis (moderate-quality evidence) and higher risk of DVT compared with low-dose heparin (low-quality evidence). The best available evidence about the effectiveness of NMES in the prevention of VTE is not adequately robust to allow definitive conclusions. Adequately powered high-quality randomised controlled trials are required to provide adequately robust evidence. PMID: 29161465 [PubMed - as supplied by ...
Source: Cochrane Database of Systematic Reviews - November 21, 2017 Category: General Medicine Authors: Hajibandeh S, Hajibandeh S, Antoniou GA, Scurr JR, Torella F Tags: Cochrane Database Syst Rev Source Type: research

Enzyme replacement therapy for infantile-onset Pompe disease.
CONCLUSIONS: The search found no trials comparing the effectiveness and safety of enzyme replacement therapy to another intervention, no intervention or placebo. One small randomized controlled trial provided no robust evidence for which dosing schedule of alglucosidase alfa was more effective to treat infantile-onset Pompe disease. It is not deemed ethical to proceed with new placebo-controlled trials, therefore a randomized controlled trial with a large sample size comparing different dosing schedules of enzyme replacement therapy is needed. The main clinical outcomes (i.e. cardiac function, invasive ventilation, surviva...
Source: Cochrane Database of Systematic Reviews - November 20, 2017 Category: General Medicine Authors: Chen M, Zhang L, Quan S Tags: Cochrane Database Syst Rev Source Type: research

Virtual reality for stroke rehabilitation.
CONCLUSIONS: We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the ty...
Source: Cochrane Database of Systematic Reviews - November 20, 2017 Category: General Medicine Authors: Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M Tags: Cochrane Database Syst Rev Source Type: research

Tobacco cessation interventions for young people.
CONCLUSIONS: There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers. PMID: 29148565 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - November 17, 2017 Category: General Medicine Authors: Fanshawe TR, Halliwell W, Lindson N, Aveyard P, Livingstone-Banks J, Hartmann-Boyce J Tags: Cochrane Database Syst Rev Source Type: research

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis.
CONCLUSIONS: Many factors influence the care that SBAs are able to provide to mothers during childbirth. These include access to training and supervision; staff numbers and workloads; salaries and living conditions; and access to well-equipped, well-organised healthcare facilities with water, electricity, and transport. Other factors that may play a role include the existence of teamwork and of trust, collaboration, and communication between health workers and with mothers. Skilled birth attendants reported many problems tied to all of these factors. PMID: 29148566 [PubMed - as supplied by publisher] (Source: Cochrane...
Source: Cochrane Database of Systematic Reviews - November 17, 2017 Category: General Medicine Authors: Munabi-Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H Tags: Cochrane Database Syst Rev Source Type: research

Cuffed versus uncuffed endotracheal tubes for general anaesthesia in children aged eight years and under.
CONCLUSIONS: Implications for practiceWe are unable to draw definitive conclusions about the comparative effects of cuffed or non-cuffed endotracheal tubes in children undergoing general anaesthesia. Our confidence is limited by risks of bias, imprecision and indirectness. The lower requirement for exchange of tubes with cuffed ETTs was very low-quality evidence, and the requirement for less medical gas used and consequent lower cost was low-quality evidence. In some cases, tracheal re-intubation is required to guarantee an open airway when adequate oxygenation is difficult after removal of the tube, for a variety of reaso...
Source: Cochrane Database of Systematic Reviews - November 17, 2017 Category: General Medicine Authors: De Orange FA, Andrade RG, Lemos A, Borges PS, Figueiroa JN, Kovatsis PG Tags: Cochrane Database Syst Rev Source Type: research

Interventions for Old World cutaneous leishmaniasis.
CONCLUSIONS: There was very low-certainty evidence to support the effectiveness of itraconazole and paromomycin ointment for OWCL in terms of cure (i.e. microbiological or histopathological cure and percentage of participants completely cured). Both of these interventions incited more adverse effects, which were mild in nature, than their comparisons, but we could draw no conclusions regarding safety due to the very low certainty of the evidence for this outcome.We downgraded the key outcomes in these two comparisons due to high risk of bias, inconsistency between the results, and imprecision. There is a need for large, we...
Source: Cochrane Database of Systematic Reviews - November 17, 2017 Category: General Medicine Authors: Heras-Mosteiro J, Monge-Maillo B, Pinart M, Lopez Pereira P, Garcia-Carrasco E, Campuzano Cuadrado P, Royuela A, Mendez Roman I, López-Vélez R Tags: Cochrane Database Syst Rev Source Type: research

Music therapy for depression.
CONCLUSIONS: Findings of the present meta-analysis indicate that music therapy provides short-term beneficial effects for people with depression. Music therapy added to treatment as usual (TAU) seems to improve depressive symptoms compared with TAU alone. Additionally, music therapy plus TAU is not associated with more or fewer adverse events than TAU alone. Music therapy also shows efficacy in decreasing anxiety levels and improving functioning of depressed individuals.Future trials based on adequate design and larger samples of children and adolescents are needed to consolidate our findings. Researchers should consider i...
Source: Cochrane Database of Systematic Reviews - November 16, 2017 Category: General Medicine Authors: Aalbers S, Fusar-Poli L, Freeman RE, Spreen M, Ket JC, Vink AC, Maratos A, Crawford M, Chen XJ, Gold C Tags: Cochrane Database Syst Rev Source Type: research

Zuclopenthixol dihydrochloride for schizophrenia.
CONCLUSIONS: Zuclopenthixol dihydrochloride appears to cause more EPSEs than clozapine, risperidone or perphenazine, but there was no difference in EPSEs when compared to placebo or chlorpromazine. Similar numbers required hypnotics/sedatives when zuclopenthixol dihydrochloride was compared to sulpiride, and similar numbers of reported side-effects were found when its isomers were compared. The other comparisons did not report adverse-effect data.Reported data indicate zuclopenthixol dihydrochloride demonstrates no difference in mental or global states compared to placebo, chlorpromazine, chlorprothixene, clozapine, halope...
Source: Cochrane Database of Systematic Reviews - November 16, 2017 Category: General Medicine Authors: Bryan EJ, Purcell MA, Kumar 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 - November 16, 2017 Category: General Medicine Authors: Ohlsson A, Aher SM Tags: Cochrane Database Syst Rev Source Type: research

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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