Interventions for childhood apraxia of speech.
CONCLUSIONS: There is limited evidence that, when delivered intensively, both the NDP-3 and ReST may effect improvement in word accuracy in 4- to 12-year-old children with CAS, measured by the accuracy of production on treated and non-treated words, speech production consistency and the accuracy of connected speech. The study did not measure functional communication. No formal analyses were conducted to compare NDP-3 and ReST by the original study authors, hence one treatment cannot be reliably advocated over the other. We are also unable to say whether either treatment is better than no treatment or treatment as usual. No...
Source: Cochrane Database of Systematic Reviews - May 30, 2018 Category: General Medicine Authors: Morgan AT, Murray E, Liégeois FJ Tags: Cochrane Database Syst Rev Source Type: research

Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction.
CONCLUSIONS: The use of duodenal stent placement in malignant gastric outlet obstruction has the benefits of a quicker resumption of oral intake and a reduced inpatient hospital stay; however, this is balanced by an increase in the recurrence of symptoms and the need for further intervention.It is impossible to draw further conclusions on these and the other measured outcomes, primarily due to the low number of eligible studies and small number of participants which resulted in low-quality evidence. It was not possible to analyse the impact on quality of life each intervention had for these participants. PMID: 2984561...
Source: Cochrane Database of Systematic Reviews - May 30, 2018 Category: General Medicine Authors: Upchurch E, Ragusa M, Cirocchi R Tags: Cochrane Database Syst Rev Source Type: research

Implantable miniature telescope (IMT) for vision loss due to end-stage age-related macular degeneration.
CONCLUSIONS: We found no RCT or quasi-RCT and can draw no conclusion about the effectiveness and safety of the IMT in improving visual acuity in individuals with late or advanced AMD. Since the IMT is typically implanted monocularly based upon which eye has better best-corrected distance visual acuity, randomization between eyes within an individual may not be acceptable. Studies are needed that compare outcomes between individuals randomized to the device versus individuals not implanted, at least during study follow-up, who serve as controls. PMID: 29847689 [PubMed - as supplied by publisher] (Source: Cochrane Datab...
Source: Cochrane Database of Systematic Reviews - May 30, 2018 Category: General Medicine Authors: Gupta A, Lam J, Custis P, Munz S, Fong D, Koster M Tags: Cochrane Database Syst Rev Source Type: research

Neuromuscular electrostimulation for adults with chronic obstructive pulmonary disease.
CONCLUSIONS: NMES, when applied in isolation, increased quadriceps force and endurance, 6MWD and time to symptom limitation exercising at a submaximal intensity, and reduced the severity of leg fatigue on completion of exercise testing. It may increase VO2peak, but the true effect on this outcome measure could be trivial. However, the quality of evidence was low or very low due to risk of bias within the studies, imprecision of the estimates, small number of studies and inconsistency between the studies. Although there were no additional gains in quadriceps force with NMES plus conventional exercise training, there was evi...
Source: Cochrane Database of Systematic Reviews - May 29, 2018 Category: General Medicine Authors: Hill K, Cavalheri V, Mathur S, Roig M, Janaudis-Ferreira T, Robles P, Dolmage TE, Goldstein R Tags: Cochrane Database Syst Rev Source Type: research

Mirtazapine adjunct for people with schizophrenia.
CONCLUSIONS: The available evidence is primarily of very low quality and indicates that mirtazapine adjunct is not clearly associated with an effect for negative symptoms, but there is some indication of a positive effect on overall mental state and akathisia. No effect was found for global state or leaving the study early and data were not available for quality of life or service use. Due to limitations of the quality and applicability of the evidence it is not possible to make any firm conclusions, the role of mirtazapine adjunct in routine clinical practice remains unclear. This underscores the need for new high-quality...
Source: Cochrane Database of Systematic Reviews - May 26, 2018 Category: General Medicine Authors: Perry LA, Ramson D, Stricklin S Tags: Cochrane Database Syst Rev Source Type: research

Time-lapse systems for embryo incubation and assessment in assisted reproduction.
CONCLUSIONS: There is insufficient evidence of differences in live birth, miscarriage, stillbirth or clinical pregnancy to choose between TLS, with or without embryo selection software, and conventional incubation. The studies were at high risk of bias for randomisation and allocation concealment, the result should be interpreted with extreme caution. PMID: 29800485 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 25, 2018 Category: General Medicine Authors: Armstrong S, Bhide P, Jordan V, Pacey A, Farquhar C Tags: Cochrane Database Syst Rev Source Type: research

Education of healthcare professionals for preventing pressure ulcers.
CONCLUSIONS: We are uncertain whether educating healthcare professionals about pressure ulcer prevention makes any difference to pressure ulcer incidence, or to nurses' knowledge of pressure ulcer prevention. This is because the included studies provided very low-certainty evidence. Therefore, further information is required to clarify the impact of education of healthcare professionals on the prevention of pressure ulcers. PMID: 29800486 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 25, 2018 Category: General Medicine Authors: Porter-Armstrong AP, Moore ZE, Bradbury I, McDonough S Tags: Cochrane Database Syst Rev Source Type: research

Respiratory muscle training for cystic fibrosis.
Abstract BACKGROUND: Cystic fibrosis is the most common autosomal recessive disease in white populations, and causes respiratory dysfunction in the majority of individuals. Numerous types of respiratory muscle training to improve respiratory function and health-related quality of life in people with cystic fibrosis have been reported in the literature. Hence a systematic review of the literature is needed to establish the effectiveness of respiratory muscle training (either inspiratory or expiratory muscle training) on clinical outcomes in cystic fibrosis. This is an update of a previously published review. O...
Source: Cochrane Database of Systematic Reviews - May 24, 2018 Category: General Medicine Authors: Hilton N, Solis-Moya A Tags: Cochrane Database Syst Rev Source Type: research

Aromatase inhibitors (letrozole) for subfertile women with polycystic ovary syndrome.
CONCLUSIONS: Letrozole appears to improve live birth and pregnancy rates in subfertile women with anovulatory polycystic ovary syndrome, compared to clomiphene citrate. There is high-quality evidence that OHSS rates are similar with letrozole or clomiphene citrate. There is high-quality evidence of no difference in miscarriage rates or multiple pregnancy rates. There is low-quality evidence of no difference in live birth and pregnancy rates between letrozole and laparoscopic ovarian drilling, although there were few relevant studies. For the 2018 update, we added good-quality trials, upgrading the quality of the evidence. ...
Source: Cochrane Database of Systematic Reviews - May 24, 2018 Category: General Medicine Authors: Franik S, Eltrop SM, Kremer JA, Kiesel L, Farquhar C Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Resorbable versus titanium plates for facial fractures.
CONCLUSIONS: This review illustrates that there are no published randomised controlled clinical trials relevant to this review question. There is currently insufficient evidence for the effectiveness of resorbable fixation systems compared with conventional titanium systems for facial fractures. The findings of this review, based on the results of the aborted trials, do not suggest that resorbable plates are as effective as titanium plates. In future, the results of ongoing clinical trials may provide high level reliable evidence for assisting clinicians and patients for decision making. Trialists should design their studi...
Source: Cochrane Database of Systematic Reviews - May 23, 2018 Category: General Medicine Authors: Dorri M, Oliver R Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Interventions for replacing missing teeth: 1- versus 2-stage implant placement.
CONCLUSIONS: The number of patients included in the trials was too small to draw definitive conclusions. The 1-stage approach might be preferable in partially edentulous patients since it avoids one surgical intervention and shortens treatment times, while a 2-stage submerged approach could be indicated when an implant has not obtained an optimal primary stability or when barriers are used for guided tissue regeneration, or when it is expected that removable temporary prostheses could transmit excessive forces on the penetrating abutments especially in fully edentulous patients. PMID: 29791009 [PubMed - as supplied by...
Source: Cochrane Database of Systematic Reviews - May 23, 2018 Category: General Medicine Authors: Esposito M, Grusovin MG, Chew YS, Coulthard P, Worthington HV Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Treatments for adults with prominent lower front teeth.
CONCLUSIONS: There is insufficient evidence from the two included trials, to conclude that one procedure is better or worse than another. The included trials compared different interventions and were at high risk of bias and therefore no implications for practice can be given. Further high quality randomized controlled trials with long term follow-up are required. PMID: 29791019 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 23, 2018 Category: General Medicine Authors: Minami-Sugaya H, Lentini-Oliveira DA, Carvalho FR, Machado MAC, Marzola C, Saconato H, Prado GF Tags: Cochrane Database Syst Rev Source Type: research

Antiepileptic drugs as prophylaxis for postcraniotomy seizures.
CONCLUSIONS: There is limited, low-quality evidence to suggest that AED treatment administered prophylactically is either effective or not effective in the prevention of postcraniotomy (early or late) seizures. The current evidence base is limited due to the different methodologies employed in the trials and inconsistencies in the reporting of outcomes including deaths and adverse events. Further evidence from good-quality, contemporary trials is required in order to assess the clinical effectiveness of prophylactic AED treatment compared to placebo or no treatment, or other AEDs in preventing postcraniotomy seizures in th...
Source: Cochrane Database of Systematic Reviews - May 23, 2018 Category: General Medicine Authors: Greenhalgh J, Weston J, Dundar Y, Nevitt SJ, Marson AG Tags: Cochrane Database Syst Rev Source Type: research

Oral contraceptives for pain associated with endometriosis.
CONCLUSIONS: Based on the limited evidence from two trials at high risk of bias and limited data for the prespecified outcomes for this review, there is insufficient evidence to make a judgement on the effectiveness of the COCP compared with placebo and the findings cannot be generalised.Based on the limited evidence from one small trial that was at high risk of bias, there is insufficient evidence to make a judgement on the effectiveness of the COCP compared with other medical treatments. Only one comparison was possible, with the medical intervention being goserelin, and the findings cannot be generalised.Further researc...
Source: Cochrane Database of Systematic Reviews - May 22, 2018 Category: General Medicine Authors: Brown J, Crawford TJ, Datta S, Prentice A Tags: Cochrane Database Syst Rev Source Type: research

Blue-light filtering intraocular lenses (IOLs) for protecting macular health.
CONCLUSIONS: This systematic review shows with moderate certainty that there is no clinically meaningful difference in short-term BCVA with the two types of IOLs. Further, based upon available data, these findings suggest that there is no clinically meaningful difference in short-term contrast sensitivity with the two interventions, although there was a low level of certainty for this outcome due to a small number of included studies and their inherent risk of bias. Based upon current, best-available research evidence, it is unclear whether blue-light filtering IOLs preserve macular health or alter risks associated with th...
Source: Cochrane Database of Systematic Reviews - May 22, 2018 Category: General Medicine Authors: Downie LE, Busija L, Keller PR Tags: Cochrane Database Syst Rev Source Type: research

Epidural versus non-epidural or no analgesia for pain management in labour.
Abstract BACKGROUND: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidural versus non-epidural or no analgesia in labour), last published in 2011. OBJECTIVES: To assess the effectiveness and safety of all types of epidural analgesia, including combined-spinal-epidural (CSE) on the mother and the baby, when compared with non-epid...
Source: Cochrane Database of Systematic Reviews - May 21, 2018 Category: General Medicine Authors: Anim-Somuah M, Smyth RM, Cyna AM, Cuthbert A Tags: Cochrane Database Syst Rev Source Type: research

Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under.
CONCLUSIONS: Overall, we found evidence that education improves complementary feeding practices. PMID: 29775501 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - May 18, 2018 Category: General Medicine Authors: Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM Tags: Cochrane Database Syst Rev Source Type: research

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