Atypical antipsychotics for disruptive behaviour disorders in children and youths.
CONCLUSIONS: There is some evidence that in the short term risperidone may reduce aggression and conduct problems in children and youths with disruptive behaviour disorders There is also evidence that this intervention is associated with significant weight gain.For aggression, the difference in scores of 6.49 points on the ABC ‒ Irritability subscale (range 0 to 45) may be clinically significant. It is challenging to interpret the clinical significance of the differential findings on two different ABS subscales as it may be difficult to distinguish between reactive and proactive aggression in clinical practice. For condu...
Source: Cochrane Database of Systematic Reviews - August 9, 2017 Category: General Medicine Authors: Loy JH, Merry SN, Hetrick SE, Stasiak K Tags: Cochrane Database Syst Rev Source Type: research

Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.
CONCLUSIONS: This overview summarises evidence from Cochrane reviews on the effects of antenatal and intrapartum interventions on cerebral palsy, and can be used by researchers, funding bodies, policy makers, clinicians and consumers to aid decision-making and evidence translation. We recommend that readers consult the included Cochrane reviews to formally assess other benefits or harms of included interventions, including impacts on risk factors for cerebral palsy (such as the reduction in intraventricular haemorrhage for preterm babies following exposure to antenatal corticosteroids).Magnesium sulphate for women at risk ...
Source: Cochrane Database of Systematic Reviews - August 8, 2017 Category: General Medicine Authors: Shepherd E, Salam RA, Middleton P, Makrides M, McIntyre S, Badawi N, Crowther CA Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure targets for hypertension in older adults.
CONCLUSIONS: At the present time there is insufficient evidence to know whether a higher BP target (less than150 to 160/95 to 105 mmHg) or a lower BP target (less than 140/90 mmHg) is better for older adults with high BP. Additional good-quality trials assessing BP targets in this population are needed. PMID: 28787537 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 8, 2017 Category: General Medicine Authors: Garrison SR, Kolber MR, Korownyk CS, McCracken RK, Heran BS, Allan GM Tags: Cochrane Database Syst Rev Source Type: research

Continuous erythropoiesis receptor activator (CERA) for the anaemia of chronic kidney disease.
CONCLUSIONS: There is low certainty evidence that CERA has little or no effects on patient-centred outcomes compared with placebo, epoetin alfa or beta or darbepoetin alfa for adults with CKD. The effects of CERA among children who have CKD have not studied in RCTs. PMID: 28782299 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 7, 2017 Category: General Medicine Authors: Saglimbene VM, Palmer SC, Ruospo M, Natale P, Craig JC, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization.
CONCLUSIONS: Moderate-quality evidence showed that the use of LMWH in outpatients reduced DVT when immobilization of the lower limb was required, when compared with no prophylaxis or placebo. The quality of the evidence was reduced to moderate because of risk of selection and attrition bias in the included studies. Low-quality evidence showed no clear differences in PE between the LMWH and control groups, but less symptomatic VTE in the LMWH groups. The quality of the evidence was downgraded due to risk of bias and imprecision. PMID: 28780771 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 6, 2017 Category: General Medicine Authors: Zee AA, van Lieshout K, van der Heide M, Janssen L, Janzing HM Tags: Cochrane Database Syst Rev Source Type: research

Antidepressants for chronic non-cancer pain in children and adolescents.
CONCLUSIONS: We identified only a small number of studies with small numbers of participants and insufficient data for analysis.As we could undertake no meta-analysis, we are unable to comment about efficacy or harm from the use of antidepressants to treat chronic non-cancer pain in children and adolescents. Similarly, we cannot comment on our remaining secondary outcomes: Carer Global Impression of Change; requirement for rescue analgesia; sleep duration and quality; acceptability of treatment; physical functioning; and quality of life.There is evidence from adult randomised controlled trials that some antidepressants, su...
Source: Cochrane Database of Systematic Reviews - August 5, 2017 Category: General Medicine Authors: Cooper TE, Heathcote LC, Clinch J, Gold JI, Howard R, Lord SM, Schechter N, Wood C, Wiffen PJ Tags: Cochrane Database Syst Rev Source Type: research

Antiepileptic drugs for chronic non-cancer pain in children and adolescents.
CONCLUSIONS: This review identified only two small studies, with insufficient data for analysis.As we could undertake no meta-analysis, we were unable to comment about efficacy or harm from the use of antiepileptic drugs to treat chronic non-cancer pain in children and adolescents. Similarly, we could not comment on our remaining secondary outcomes: Carer Global Impression of Change; requirement for rescue analgesia; sleep duration and quality; acceptability of treatment; physical functioning; and quality of life.We know from adult randomised controlled trials that some antiepileptics, such as gabapentin and pregabalin, ca...
Source: Cochrane Database of Systematic Reviews - August 5, 2017 Category: General Medicine Authors: Cooper TE, Wiffen PJ, Heathcote LC, Clinch J, Howard R, Krane E, Lord SM, Sethna N, Schechter N, Wood C Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic prophylaxis for operative vaginal delivery.
CONCLUSIONS: One small trial was identified reporting only two outcomes. Evidence from this single trial suggests that antibiotic prophylaxis may lead to little or no difference in endometritis or maternal length of stay. There were no data on any other outcomes to evaluate the impact of antibiotic prophylaxis after operative vaginal delivery. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity. PMID: 28779515 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 5, 2017 Category: General Medicine Authors: Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM Tags: Cochrane Database Syst Rev Source Type: research

Maternal and foetal outcomes following natural vaginal versus caesarean section (c-section) delivery in women with bleeding disorders and carriers.
CONCLUSIONS: The review did not identify any randomised controlled trials investigating the safest mode of delivery and associated maternal and foetal complications during delivery in women with, or carriers of, a bleeding disorder. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials, case studies) to decide upon the optimal mode of delivery to ensure the safety of both mother and foetus.Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised ...
Source: Cochrane Database of Systematic Reviews - August 4, 2017 Category: General Medicine Authors: Karanth L, Kanagasabai S, Abas AB Tags: Cochrane Database Syst Rev Source Type: research

Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.
CONCLUSIONS: Self-management interventions that include a COPD exacerbation action plan are associated with improvements in HRQoL, as measured with the SGRQ, and lower probability of respiratory-related hospital admissions. No excess all-cause mortality risk was observed, but exploratory analysis showed a small, but significantly higher respiratory-related mortality rate for self-management compared to usual care.For future studies, we would like to urge only using action plans together with self-management interventions that meet the requirements of the most recent COPD self-management intervention definition. To increase...
Source: Cochrane Database of Systematic Reviews - August 4, 2017 Category: General Medicine Authors: Lenferink A, Brusse-Keizer M, van der Valk PD, Frith PA, Zwerink M, Monninkhof EM, van der Palen J, Effing TW Tags: Cochrane Database Syst Rev Source Type: research

Sildenafil for pulmonary hypertension in neonates.
CONCLUSIONS: Sildenafil used for treatment of pulmonary hypertension has potential for reducing mortality and improving oxygenation in neonates, especially in resource-limited settings where iNO is not available. However, large-scale randomised trials comparing sildenafil versus active controls (other pulmonary vasodilators) and providing follow-up for survivors are needed to assess the comparative effectiveness and long-term safety of sildenafil versus other pulmonary vasodilators. PMID: 28777888 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 4, 2017 Category: General Medicine Authors: Kelly LE, Ohlsson A, Shah PS Tags: Cochrane Database Syst Rev Source Type: research

Back Schools for chronic non-specific low back pain.
CONCLUSIONS: Due to the low- to very low-quality of the evidence for all treatment comparisons, outcomes, and follow-up periods investigated, it is uncertain if Back School is effective for chronic low back pain. Although the quality of the evidence was mostly very low, the results showed no difference or a trivial effect in favour of Back School. There are myriad potential variants on the Back School approach regarding the employment of different exercises and educational methods. While current evidence does not warrant their use, future variants on Back School may have different effects and will need to be studied in fut...
Source: Cochrane Database of Systematic Reviews - August 3, 2017 Category: General Medicine Authors: Parreira P, Heymans MW, van Tulder MW, Esmail R, Koes BW, Poquet N, Lin CC, Maher CG Tags: Cochrane Database Syst Rev Source Type: research

Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health.
CONCLUSIONS: There are insufficient randomised controlled trial data evaluating the effects of screening for GDM based on different risk profiles and settings on maternal and infant outcomes. Low-quality evidence suggests universal screening compared with risk factor-based screening leads to more women being diagnosed with GDM. Low to very low-quality evidence suggests no clear differences between primary care and secondary care screening, for outcomes: GDM, hypertension, pre-eclampsia, caesarean birth, large-for-gestational age, neonatal complications composite, and hypoglycaemia.Further, high-quality randomised controlle...
Source: Cochrane Database of Systematic Reviews - August 3, 2017 Category: General Medicine Authors: Tieu J, McPhee AJ, Crowther CA, Middleton P, Shepherd E Tags: Cochrane Database Syst Rev Source Type: research

Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease.
CONCLUSIONS: The current level of evidence is insufficient to judge whether prophylactic levosimendan prevents low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. So far, no significant differences have been detected between levosimendan and standard inotrope treatments in this setting.The authors evaluated the quality of evidence as low, using the GRADE approach. Reasons for downgrading were serious risk of bias (performance and detection bias due to unblinded setting of two RCTs), serious risk of inconsistency, and serious to very serious risk of imprecision (...
Source: Cochrane Database of Systematic Reviews - August 2, 2017 Category: General Medicine Authors: Hummel J, Rücker G, Stiller B Tags: Cochrane Database Syst Rev Source Type: research

Schedules for home visits in the early postpartum period.
CONCLUSIONS: Increasing the number of postnatal home visits may promote infant health and maternal satisfaction and more individualised care may improve outcomes for women, although overall findings in different studies were not consistent. The frequency, timing, duration and intensity of such postnatal care visits should be based upon local and individual needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package. PMID: 28770973 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - August 2, 2017 Category: General Medicine Authors: Yonemoto N, Dowswell T, Nagai S, Mori R Tags: Cochrane Database Syst Rev Source Type: research

Paracetamol (acetaminophen) for chronic non-cancer pain in children and adolescents.
CONCLUSIONS: There was no evidence from randomised controlled trials to support or refute the use of paracetamol (acetaminophen) to treat chronic non-cancer pain in children and adolescents. We are unable to comment about efficacy or harm from the use of paracetamol to treat chronic non-cancer pain in children and adolescents.We know from adult randomised controlled trials that paracetamol, can be effective, in certain doses, and in certain pain conditions (not always chronic).This means that no conclusions could be made about efficacy or harm in the use of paracetamol (acetaminophen) to treat chronic non-cancer pain in ch...
Source: Cochrane Database of Systematic Reviews - August 2, 2017 Category: General Medicine Authors: Cooper TE, Fisher E, Anderson B, Wilkinson NM, Williams DG, Eccleston C Tags: Cochrane Database Syst Rev Source Type: research

Non-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents.
CONCLUSIONS: We identified only a small number of studies, with insufficient data for analysis.As we could undertake no meta-analysis, we are unable to comment about efficacy or harm from the use of NSAIDs to treat chronic non-cancer pain in children and adolescents. Similarly, we cannot comment on our remaining secondary outcomes: Carer Global Impression of Change; requirement for rescue analgesia; sleep duration and quality; acceptability of treatment; physical functioning; and quality of life.We know from adult randomised controlled trials that some NSAIDs, such as ibuprofen, naproxen, and aspirin, can be effective in c...
Source: Cochrane Database of Systematic Reviews - August 2, 2017 Category: General Medicine Authors: Eccleston C, Cooper TE, Fisher E, Anderson B, Wilkinson NM Tags: Cochrane Database Syst Rev Source Type: research

Interventions for emergency contraception.
CONCLUSIONS: Levonorgestrel and mid-dose mifepristone (25 mg to 50 mg) were more effective than Yuzpe regimen. Both mid-dose (25 mg to 50 mg) and low-dose mifepristone(less than 25 mg) were probably more effective than levonorgestrel (1.5 mg). Mifepristone low dose (less than 25 mg) was less effective than mid-dose mifepristone. UPA was more effective than levonorgestrel.Levonorgestrel users had fewer side effects than Yuzpe users, and appeared to be more likely to have a menstrual return before the expected date. UPA users were probably more likely to have a menstrual return after the expected date. Menstrual delay was pr...
Source: Cochrane Database of Systematic Reviews - August 2, 2017 Category: General Medicine Authors: Shen J, Che Y, Showell E, Chen K, Cheng L Tags: Cochrane Database Syst Rev Source Type: research

Fluid supplementation for neonatal unconjugated hyperbilirubinaemia.
CONCLUSIONS: There is no evidence that IV fluid supplementation affects important clinical outcomes such as bilirubin encephalopathy, kernicterus, or cerebral palsy in healthy, term newborn infants with unconjugated hyperbilirubinaemia requiring phototherapy. In this review, no infant developed these bilirubin-associated clinical complications. Low- to moderate-quality evidence shows that there are differences in total serum bilirubin levels between fluid-supplemented and control groups at some time points but not at others, the clinical significance of which is uncertain. There is no evidence of a difference between the e...
Source: Cochrane Database of Systematic Reviews - August 1, 2017 Category: General Medicine Authors: Lai NM, Ahmad Kamar A, Choo YM, Kong JY, Ngim CF Tags: Cochrane Database Syst Rev Source Type: research

Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration.
CONCLUSIONS: People with AMD may experience some delay in progression of the disease with multivitamin antioxidant vitamin and mineral supplementation. This finding was largely drawn from one large trial, conducted in a relatively well-nourished American population. We do not know the generalisability of these findings to other populations. Although generally regarded as safe, vitamin supplements may have harmful effects. A systematic review of the evidence on harms of vitamin supplements is needed. Supplements containing lutein and zeaxanthin are heavily marketed for people with age-related macular degeneration but our re...
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Evans JR, Lawrenson JG Tags: Cochrane Database Syst Rev Source Type: research

Mid-urethral sling operations for stress urinary incontinence in women.
CONCLUSIONS: Mid-urethral sling operations have been the most extensively researched surgical treatment for stress urinary incontinence (SUI) in women and have a good safety profile. Irrespective of the routes traversed, they are highly effective in the short and medium term, and accruing evidence demonstrates their effectiveness in the long term. This review illustrates their positive impact on improving the quality of life of women with SUI. However, a brief economic commentary (BEC) identified three studies suggesting that transobturator may be more cost-effective compared with retropubic. Fewer adverse events occur wit...
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA Tags: Cochrane Database Syst Rev Source Type: research

Task-oriented interventions for children with developmental co-ordination disorder.
CONCLUSIONS: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. The conclusions drawn from previous reviews, which unanimously reported beneficial effects of intervention, are inconsistent with our conclusions. This review highlights the need for carefully designed and executed RCTs to investigate the effect of interventions for children with DCD. PMID: 28758189 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Miyahara M, Hillier SL, Pridham L, Nakagawa S Tags: Cochrane Database Syst Rev Source Type: research

Haloperidol for psychosis-induced aggression or agitation (rapid tranquillisation).
CONCLUSIONS: Additional data from new studies does not alter previous conclusions of this review. If no other alternative exists, sole use of intramuscular haloperidol could be life-saving. Where additional drugs are available, sole use of haloperidol for extreme emergency could be considered unethical. Addition of the sedating promethazine has support from better-grade evidence from within randomised trials. Use of an alternative antipsychotic drug is only partially supported by fragmented and poor-grade evidence. Adding a benzodiazepine to haloperidol does not have strong evidence of benefit and carries risk of additiona...
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Ostinelli EG, Brooke-Powney MJ, Li X, Adams CE Tags: Cochrane Database Syst Rev Source Type: research

Low glycaemic index diets for the prevention of cardiovascular disease.
CONCLUSIONS: There is currently no evidence available regarding the effect of low GI diets on cardiovascular disease events. Moreover, there is currently no convincing evidence that low GI diets have a clear beneficial effect on blood lipids or blood pressure parameters. PMID: 28759107 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Clar C, Al-Khudairy L, Loveman E, Kelly SA, Hartley L, Flowers N, Germanò R, Frost G, Rees K Tags: Cochrane Database Syst Rev Source Type: research

Fluid replacement therapy for acute episodes of pain in people with sickle cell disease.
CONCLUSIONS: Treating vaso-occlusive crises is complex and requires multiple interventions. Extra fluids, generally oral or intravenous, are routinely administered during acute painful episodes to people with sickle cell disease regardless of the individual's state of hydration. Reports of their use during these acute painful episodes do not state the efficacy of any single route, type or quantity of fluid compared to another. However, there are no randomised controlled trials that have assessed the safety and efficacy of different routes, types or quantities of fluid. This systematic review identifies the need for a multi...
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Okomo U, Meremikwu MM Tags: Cochrane Database Syst Rev Source Type: research

Anterior vaginal repair for urinary incontinence in women.
CONCLUSIONS: There were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about postoperative complications and morbidity.A Brief Economic Commentary (BEC) identified one study su...
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Glazener CM, Cooper K, Mashayekhi A Tags: Cochrane Database Syst Rev Source Type: research

Pit and fissure sealants for preventing dental decay in permanent teeth.
CONCLUSIONS: Resin-based sealants applied on occlusal surfaces of permanent molars are effective for preventing caries in children and adolescents. Our review found moderate-quality evidence that resin-based sealants reduced caries by between 11% and 51% compared to no sealant, when measured at 24 months. Similar benefit was seen at timepoints up to 48 months; after longer follow-up, the quantity and quality of evidence was reduced. There was insufficient evidence to judge the effectiveness of glass ionomer sealant or the relative effectiveness of different types of sealants. Information on adverse effects was limited but ...
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV Tags: Cochrane Database Syst Rev Source Type: research

Interventions for treating intrahepatic cholestasis in people with sickle cell disease.
CONCLUSIONS: This updated Cochrane Review did not identify any randomised controlled trials assessing interventions for treating intrahepatic cholestasis in people with sickle cell disease. Randomised controlled trials are needed to establish the optimum treatment for this condition. PMID: 28759700 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Martí-Carvajal AJ, Martí-Amarista CE Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological interventions for preventing dry mouth and salivary gland dysfunction following radiotherapy.
Abstract BACKGROUND: Salivary gland dysfunction is an 'umbrella' term for the presence of either xerostomia (subjective sensation of dryness), or salivary gland hypofunction (reduction in saliva production). It is a predictable side effect of radiotherapy to the head and neck region, and is associated with a significant impairment of quality of life. A wide range of pharmacological interventions, with varying mechanisms of action, have been used for the prevention of radiation-induced salivary gland dysfunction. OBJECTIVES: To assess the effects of pharmacological interventions for the prevention of radiation...
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Riley P, Glenny AM, Hua F, Worthington HV Tags: Cochrane Database Syst Rev Source Type: research

Antioxidant vitamin and mineral supplements for preventing age-related macular degeneration.
CONCLUSIONS: Taking vitamin E or beta-carotene supplements will not prevent or delay the onset of AMD. The same probably applies to vitamin C and the multivitamin (Centrum Silver) investigated in the one trial reported to date. There is no evidence with respect to other antioxidant supplements, such as lutein and zeaxanthin. Although generally regarded as safe, vitamin supplements may have harmful effects, and clear evidence of benefit is needed before they can be recommended. People with AMD should see the related Cochrane Review on antioxidant vitamin and mineral supplements for slowing the progression of AMD, written by...
Source: Cochrane Database of Systematic Reviews - July 30, 2017 Category: General Medicine Authors: Evans JR, Lawrenson JG Tags: Cochrane Database Syst Rev Source Type: research

Pathogen-reduced platelets for the prevention of bleeding.
CONCLUSIONS: Findings from this review were based on 12 trials, and of the 1981 participants who received a platelet transfusion only 44 did not have a haematological or oncological diagnosis.In people with haematological or oncological disorders who are thrombocytopenic due to their disease or its treatment, we found high-quality evidence that pathogen-reduced platelet transfusions increase the risk of platelet refractoriness and the platelet transfusion requirement. We found moderate-quality evidence that pathogen-reduced platelet transfusions do not affect all-cause mortality, the risk of clinically significant or sever...
Source: Cochrane Database of Systematic Reviews - July 30, 2017 Category: General Medicine Authors: Estcourt LJ, Malouf R, Hopewell S, Trivella M, Doree C, Stanworth SJ, Murphy MF Tags: Cochrane Database Syst Rev Source Type: research

Treadmill interventions in children under six years of age at risk of neuromotor delay.
CONCLUSIONS: This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and deve...
Source: Cochrane Database of Systematic Reviews - July 29, 2017 Category: General Medicine Authors: Valentín-Gudiol M, Mattern-Baxter K, Girabent-Farrés M, Bagur-Calafat C, Hadders-Algra M, Angulo-Barroso RM Tags: Cochrane Database Syst Rev Source Type: research

Oral versus intravenous fluoropyrimidines for colorectal cancer.
CONCLUSIONS: Results of this review should provide confidence that treatment for CRC with most of the oral fluoropyrimidines commonly used in current clinical practice is similarly efficacious to treatment with IV fluoropyrimidines. Treatment with eniluracil with oral 5-FU was associated with inferior PFS and OS among participants treated with palliative intent for CRC, and eniluracil is no longer being developed. Oral and IV fluoropyrimidines have different patterns of side effects; future research may focus on determining the basis for these differences. PMID: 28752564 [PubMed - as supplied by publisher] (Source: Co...
Source: Cochrane Database of Systematic Reviews - July 28, 2017 Category: General Medicine Authors: Chionh F, Lau D, Yeung Y, Price T, Tebbutt N 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 - July 28, 2017 Category: General Medicine Authors: Showell MG, Mackenzie-Proctor R, Jordan V, Hart RJ Tags: Cochrane Database Syst Rev Source Type: research

Manipulative interventions for reducing pulled elbow in young children.
CONCLUSIONS: There was low-quality evidence from eight small trials that the pronation method may be more effective at first attempt than the supination method for manipulating pulled elbow in young children. For other outcomes, no conclusions could be drawn either because of very low-quality evidence or the outcomes not being reported. We suggest that a high-quality randomised clinical trial comparing hyperpronation and supination-flexion is required to provide definitive evidence. We recommend that this is preceded by a survey among clinicians to establish the extent of clinical equipoise and to optimise the study design...
Source: Cochrane Database of Systematic Reviews - July 28, 2017 Category: General Medicine Authors: Krul M, van der Wouden JC, Kruithof EJ, van Suijlekom-Smit LW, Koes BW Tags: Cochrane Database Syst Rev Source Type: research

Aqueous shunts for glaucoma.
CONCLUSIONS: Information was insufficient to conclude whether there are differences between aqueous shunts and trabeculectomy for glaucoma treatment. While the Baerveldt implant may lower IOP more than the Ahmed implant, the evidence was of moderate-certainty and it is unclear whether the difference in IOP reduction is clinically significant. Overall, methodology and data quality among existing randomized controlled trials of aqueous shunts was heterogeneous across studies, and there are no well-justified or widely accepted generalizations about the superiority of one surgical procedure or device over another. PMID: 2...
Source: Cochrane Database of Systematic Reviews - July 28, 2017 Category: General Medicine Authors: Tseng VL, Coleman AL, Chang MY, Caprioli J Tags: Cochrane Database Syst Rev Source Type: research

Traditional suburethral sling operations for urinary incontinence in women.
CONCLUSIONS: Traditional slings seem to be as effective as minimally invasive slings, but had higher rates of adverse effects. This should be interpreted with some caution however, as the quality of evidence for the studies was variable, follow-up short and populations small, particularly for identifying complication rates. Tradional sling procedures appeared to confer a similar cure rate in comparison to open retropubic colposuspension, but the long-term adverse event profile is still unclear. A brief economic commentary (BEC) identified two studies suggesting that traditional slings may be more cost-effective compared wi...
Source: Cochrane Database of Systematic Reviews - July 26, 2017 Category: General Medicine Authors: Rehman H, Bezerra CA, Bruschini H, Cody JD, Aluko P Tags: Cochrane Database Syst Rev Source Type: research

Procarbazine, lomustine and vincristine for recurrent high-grade glioma.
CONCLUSIONS: Evidence is based on a single large trial analysis as the other trial was small, with inadequate power to detect survival difference. Chemotherapy-naive patients with HGG at first recurrence when treated with PCV or TMZ have similar survival and time-to-progression outcomes. Adverse events are similar and QoL scores are statistically but not clinically significant between TMZ and PCV. Further RCTs should be conducted with adequate power following CONSORT guidelines with emphasis on QoL outcomes. PMID: 28744879 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 26, 2017 Category: General Medicine Authors: Parasramka S, Talari G, Villano JL, Rosenfeld M, Guo J Tags: Cochrane Database Syst Rev Source Type: research

Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth.
CONCLUSIONS: Both planned elective repeat caesarean section and planned induction of labour for women with a prior caesarean birth are associated with benefits and harms. Evidence for these care practices has been drawn from non-randomised studies, which are associated with potential bias. Therefore, any results and conclusions presented must be interpreted with caution. Randomised controlled trials are required to provide the most reliable evidence regarding the benefits and harms of both planned elective repeat caesarean section and planned induction of labour for women with a previous caesarean birth. PMID: 2874489...
Source: Cochrane Database of Systematic Reviews - July 26, 2017 Category: General Medicine Authors: Dodd JM, Crowther CA, Grivell RM, Deussen AR Tags: Cochrane Database Syst Rev Source Type: research

Opioids for chronic non-cancer pain in children and adolescents.
CONCLUSIONS: There was no evidence from randomised controlled trials to support or refute the use of opioids to treat chronic non-cancer pain in children and adolescents. We are unable to comment about efficacy or harm from the use of opioids to treat chronic non-cancer pain in children and adolescents.We know from adult randomised controlled trials that some opioids, such as morphine and codeine, can be effective in certain chronic pain conditions.This means that no conclusions could be made about efficacy or harm in the use of opioids to treat chronic non-cancer pain in children and adolescents. PMID: 28745394 [PubM...
Source: Cochrane Database of Systematic Reviews - July 26, 2017 Category: General Medicine Authors: Cooper TE, Fisher E, Gray AL, Krane E, Sethna N, van Tilburg MA, Zernikow B, Wiffen PJ Tags: Cochrane Database Syst Rev Source Type: research

Flumazenil versus placebo or no intervention for people with cirrhosis and hepatic encephalopathy.
CONCLUSIONS: We found low quality evidence suggesting a short-term beneficial effect of flumazenil on hepatic encephalopathy in people with cirrhosis, but no evidence of an effect on all-cause mortality. Additional evidence from large, high quality randomised clinical trials is needed to evaluate the potential benefits and harms of flumazenil in people with cirrhosis and hepatic encephalopathy. PMID: 28745801 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 26, 2017 Category: General Medicine Authors: Goh ET, Andersen ML, Morgan MY, Gluud LL Tags: Cochrane Database Syst Rev Source Type: research

Immunotherapy for diabetic amyotrophy.
CONCLUSIONS: There is presently no evidence from randomised trials to support a positive or negative effect of any immunotherapy in the treatment in diabetic amyotrophy. PMID: 28746752 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 26, 2017 Category: General Medicine Authors: Chan YC, Lo YL, Chan ES Tags: Cochrane Database Syst Rev Source Type: research

Single-incision sling operations for urinary incontinence in women.
CONCLUSIONS: TVT-Secur is inferior to standard mid-urethral slings for the treatment of women with stress incontinence and has already been withdrawn from clinical use. Not enough evidence has been found on other single-incision slings compared with retropubic or transobturator slings to allow reliable comparisons. A brief economic commentary (BEC) identified two studies which reported no difference in clinical outcomes between single-incision slings and transobturator mid-urethral slings, but single-incision slings may be more cost-effective than transobturator mid-urethral slings based on one-year follow-up. Additional a...
Source: Cochrane Database of Systematic Reviews - July 26, 2017 Category: General Medicine Authors: Nambiar A, Cody JD, Jeffery ST, Aluko P Tags: Cochrane Database Syst Rev Source Type: research

Open retropubic colposuspension for urinary incontinence in women.
CONCLUSIONS: Open retropubic colposuspension is an effective treatment modality for stress urinary incontinence especially in the long term. Within the first year of treatment, the overall continence rate is approximately 85% to 90%. After five years, approximately 70% of women can expect to be dry. Newer minimal access sling procedures look promising in comparison with open colposuspension but their long-term performance is limited and closer monitoring of their adverse event profile must be carried out. Open colposuspension is associated with a higher risk of pelvic organ prolapse compared to sling operations and anterio...
Source: Cochrane Database of Systematic Reviews - July 25, 2017 Category: General Medicine Authors: Lapitan MCM, Cody JD, Mashayekhi A Tags: Cochrane Database Syst Rev Source Type: research

Bladder neck needle suspension for urinary incontinence in women.
CONCLUSIONS: Bladder neck needle suspension surgery is probably not as good as open abdominal retropubic suspension for the treatment of primary and secondary urodynamic stress incontinence because the cure rates were lower in the trials reviewed. However, the reliability of the evidence was limited by poor quality and small trials. There was not enough information to comment on comparisons with suburethral sling operations. Although cure rates were similar after needle suspension compared with after anterior vaginal repair, the data were insufficient to be reliable and inadequate to compare morbidity. A Brief Economic Com...
Source: Cochrane Database of Systematic Reviews - July 25, 2017 Category: General Medicine Authors: Glazener CM, Cooper K, Mashayekhi A Tags: Cochrane Database Syst Rev Source Type: research

Progesterone receptor modulators for endometriosis.
CONCLUSIONS: Among women with endometriosis, moderate-quality evidence shows that mifepristone relieves dysmenorrhoea, and low-quality evidence suggests that this agent relieves dyspareunia, although amenorrhoea and hot flushes are common side effects. Data on dosage were inconclusive, although they suggest that the 2.5 mg dose of mifepristone may be less effective than higher doses. We found insufficient evidence to permit firm conclusions about the safety and effectiveness of other progesterone receptor modulators. PMID: 28742263 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 25, 2017 Category: General Medicine Authors: Fu J, Song H, Zhou M, Zhu H, Wang Y, Chen H, Huang W Tags: Cochrane Database Syst Rev Source Type: research

Urethral injection therapy for urinary incontinence in women.
CONCLUSIONS: The available evidence base remains insufficient to guide practice. In addition, the finding that placebo saline injection was followed by a similar symptomatic improvement to bulking agent injection raises questions about the mechanism of any beneficial effects. One small trial comparing silicone particles with pelvic floor muscle training was suggestive of benefit at three months but it is not known if this was sustained, and the treatment was associated with high levels of postoperative retention and dysuria. Greater symptomatic improvement was observed with surgical treatments, though the advantages need t...
Source: Cochrane Database of Systematic Reviews - July 25, 2017 Category: General Medicine Authors: Kirchin V, Page T, Keegan PE, Atiemo KO, Cody JD, McClinton S, Aluko P Tags: Cochrane Database Syst Rev Source Type: research

Vitamin K antagonists versus low-molecular-weight heparin for the long term treatment of symptomatic venous thromboembolism.
CONCLUSIONS: Moderate-quality evidence shows no clear differences between LMWH and VKA in preventing symptomatic VTE and death after an episode of symptomatic DVT. Low-quality evidence suggests fewer cases of major bleeding with LMWH than with VKA. However, comparison of only high-quality studies for bleeding shows no clear differences between LMWH and VKA. LMWH may represent an alternative for some patients, for example, those residing in geographically inaccessible areas, those who are unable or reluctant to visit the thrombosis service regularly, and those with contraindications to VKA. PMID: 28737834 [PubMed - as ...
Source: Cochrane Database of Systematic Reviews - July 24, 2017 Category: General Medicine Authors: Andras A, Sala Tenna A, Stewart M Tags: Cochrane Database Syst Rev Source Type: research

Non-steroidal anti-inflammatory drugs (NSAIDs) for cancer-related pain in children and adolescents.
CONCLUSIONS: There is no evidence from randomised controlled trials that non-steroidal anti-inflammatory drugs (NSAIDs) reduce cancer-related pain in children and adolescents. This means that no reliance or conclusions can be made about efficacy or harm in the use of NSAIDs to treat chronic cancer-related pain in children and adolescents. PMID: 28737843 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 24, 2017 Category: General Medicine Authors: Cooper TE, Heathcote LC, Anderson B, Grégoire MC, Ljungman G, Eccleston C Tags: Cochrane Database Syst Rev Source Type: research

Calcineurin inhibitor withdrawal or tapering for kidney transplant recipients.
CONCLUSIONS: CNI avoidance increased acute rejection and CNI withdrawal increases acute rejection but reduced graft loss at least over the short-term. Low dose CNI with induction regimens reduced acute rejection and graft loss with no major adverse events, also in the short-term. The use of mTOR-I reduced CMV infections but increased the risk of acute rejection. These conclusions must be tempered by the lack of long-term data in most of the studies, particularly with regards to chronic antibody-mediated rejection, and the suboptimal methodological quality of the included studies. PMID: 28730648 [PubMed - as supplied b...
Source: Cochrane Database of Systematic Reviews - July 21, 2017 Category: General Medicine Authors: Karpe KM, Talaulikar GS, Walters GD Tags: Cochrane Database Syst Rev Source Type: research