Selective progesterone receptor modulators (SPRMs) for uterine fibroids.
CONCLUSIONS: Short-term use of SPRMs resulted in improved quality of life, reduced menstrual bleeding and higher rates of amenorrhoea than were seen with placebo. Thus, SPRMs may provide effective treatment for women with symptomatic fibroids. Evidence derived from one RCT showed no difference between leuprolide acetate and SPRM with respect to improved quality of life and bleeding symptoms. Evidence was insufficient to show whether effectiveness was different between SPRMs and leuprolide. Investigators more frequently observed SPRM-associated endometrial changes in women treated with SPRMs than in those treated with place...
Source: Cochrane Database of Systematic Reviews - April 26, 2017 Category: Journals (General) Authors: Murji A, Whitaker L, Chow TL, Sobel ML Tags: Cochrane Database Syst Rev Source Type: research

Platelet count, spleen length, and platelet count-to-spleen length ratio for the diagnosis of oesophageal varices in people with chronic liver disease or portal vein thrombosis.
Abstract BACKGROUND: Current guidelines recommend screening of people with oesophageal varices via oesophago-gastro-duodenoscopy at the time of diagnosis of hepatic cirrhosis. This requires that people repeatedly undergo unpleasant invasive procedures with their attendant risks, although half of these people have no identifiable oesophageal varices 10 years after the initial diagnosis of cirrhosis. Platelet count, spleen length, and platelet count-to-spleen length ratio are non-invasive tests proposed as triage tests for the diagnosis of oesophageal varices. OBJECTIVES: Primary objectives To determine the dia...
Source: Cochrane Database of Systematic Reviews - April 26, 2017 Category: Journals (General) Authors: Colli A, Gana JC, Yap J, Adams-Webber T, Rashkovan N, Ling SC, Casazza G Tags: Cochrane Database Syst Rev Source Type: research

Exercise therapy for chronic fatigue syndrome.
CONCLUSIONS: Patients with CFS may generally benefit and feel less fatigued following exercise therapy, and no evidence suggests that exercise therapy may worsen outcomes. A positive effect with respect to sleep, physical function and self-perceived general health has been observed, but no conclusions for the outcomes of pain, quality of life, anxiety, depression, drop-out rate and health service resources were possible. The effectiveness of exercise therapy seems greater than that of pacing but similar to that of CBT. Randomised trials with low risk of bias are needed to investigate the type, duration and intensity of the...
Source: Cochrane Database of Systematic Reviews - April 25, 2017 Category: Journals (General) Authors: Larun L, Brurberg KG, Odgaard-Jensen J, Price JR Tags: Cochrane Database Syst Rev Source Type: research

Effect of cocoa on blood pressure.
Abstract BACKGROUND: High blood pressure is an important risk factor for cardiovascular disease, contributing to about 50% of cardiovascular events worldwide and 37% of cardiovascular-related deaths in Western populations. Epidemiological studies suggest that cocoa-rich products reduce the risk of cardiovascular disease. Flavanols found in cocoa have been shown to increase the formation of endothelial nitric oxide which promotes vasodilation and therefore blood pressure reduction. Here we update previous meta-analyses on the effect of cocoa on blood pressure. OBJECTIVES: To assess the effects on blood pressur...
Source: Cochrane Database of Systematic Reviews - April 25, 2017 Category: Journals (General) Authors: Ried K, Fakler P, Stocks NP Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis.
CONCLUSIONS: We found that nebulised antibiotics, alone or in combination with oral antibiotics, were better than no treatment for early infection with Pseudomonas aeruginosa. Eradication may be sustained for up to two years. There is insufficient evidence to determine whether antibiotic strategies for the eradication of early Pseudomonas aeruginosa decrease mortality or morbidity, improve quality of life, or are associated with adverse effects compared to placebo or standard treatment. Four trials comparing two active treatments have failed to show differences in rates of eradication of Pseudomonas aeruginosa. There have ...
Source: Cochrane Database of Systematic Reviews - April 25, 2017 Category: Journals (General) Authors: Langton Hewer SC, Smyth AR Tags: Cochrane Database Syst Rev Source Type: research

Treatment with disease-modifying drugs for people with a first clinical attack suggestive of multiple sclerosis.
CONCLUSIONS: Very low-quality evidence suggests a small and uncertain benefit with early treatment compared with placebo in reducing disability-worsening and relapses. The advantage of early treatment compared with delayed on disability-worsening was heterogeneous depending on the actual drug used and based on very low-quality evidence. Low-quality evidence suggests that the chances of relapse are less with early treatment compared with delayed. Early treatment reduced the hazard of conversion to CDMS compared either with placebo, no treatment or delayed treatment, both in short- and long-term follow-up. Low-quality eviden...
Source: Cochrane Database of Systematic Reviews - April 25, 2017 Category: Journals (General) Authors: Filippini G, Del Giovane C, Clerico M, Beiki O, Mattoscio M, Piazza F, Fredrikson S, Tramacere I, Scalfari A, Salanti G Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic therapy for pelvic inflammatory disease.
CONCLUSIONS: We found no conclusive evidence that one regimen of antibiotics was safer or more effective than any other for the cure of PID, and there was no clear evidence for the use of nitroimidazoles (metronidazole) compared to use of other drugs with activity over anaerobes. Moderate-quality evidence from a single study at low risk of bias suggested that a macrolide (azithromycin) may be more effective than a tetracycline (doxycycline) for curing mild-moderate PID. Our review considered only the drugs that are currently used and mentioned by the CDC. PMID: 28436019 [PubMed - as supplied by publisher] (Source: Coc...
Source: Cochrane Database of Systematic Reviews - April 24, 2017 Category: Journals (General) Authors: Savaris RF, Fuhrich DG, Duarte RV, Franik S, Ross J Tags: Cochrane Database Syst Rev Source Type: research

Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews.
CONCLUSIONS: The quality of the evidence examining physical activity and exercise for chronic pain is low. This is largely due to small sample sizes and potentially underpowered studies. A number of studies had adequately long interventions, but planned follow-up was limited to less than one year in all but six reviews.There were some favourable effects in reduction in pain severity and improved physical function, though these were mostly of small-to-moderate effect, and were not consistent across the reviews. There were variable effects for psychological function and quality of life.The available evidence suggests physica...
Source: Cochrane Database of Systematic Reviews - April 24, 2017 Category: Journals (General) Authors: Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH Tags: Cochrane Database Syst Rev Source Type: research

Topiramate monotherapy for juvenile myoclonic epilepsy.
CONCLUSIONS: Since the last version of this review we found no new studies. This review does not provide sufficient evidence to support topiramate for the treatment of people with JME. Based on the current limited available data, topiramate seems to be better tolerated than valproate, but there were no more benefits of efficacy in topiramate compared with valproate. In the future, well-designed, double-blind RCTs with large samples are required to test the efficacy and tolerability of topiramate in people with JME. PMID: 28434203 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 23, 2017 Category: Journals (General) Authors: Liu J, Wang LN, Wang YP Tags: Cochrane Database Syst Rev Source Type: research

Dietary interventions for adults with chronic kidney disease.
CONCLUSIONS: Dietary interventions have uncertain effects on mortality, cardiovascular events and ESKD among people with CKD as these outcomes were rarely measured or reported. Dietary interventions may increase health-related quality of life, eGFR, and serum albumin, and lower blood pressure and serum cholesterol levels.Based on stakeholder prioritisation of dietary research in the setting of CKD and preliminary evidence of beneficial effects on risks factors for clinical outcomes, large-scale pragmatic RCTs to test the effects of dietary interventions on patient outcomes are required. PMID: 28434208 [PubMed - as sup...
Source: Cochrane Database of Systematic Reviews - April 23, 2017 Category: Journals (General) Authors: Palmer SC, Maggo JK, Campbell KL, Craig JC, Johnson DW, Sutanto B, Ruospo M, Tong A, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

Immediate versus delayed postpartum insertion of contraceptive implant for contraception.
CONCLUSIONS: Evidence from this review indicates that the rate of initiation of contraceptive implant at the first postpartum check-up visit was higher with immediate postpartum insertion than with delayed insertion. There appeared to be little or no difference between the groups in the continuation rate of contraceptive implant use at 6 months. It was unclear whether there was any difference between the groups in continuation of contraceptive use at 12 months or in the unintended pregnancy rate at 12 months. PMID: 28432791 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 22, 2017 Category: Journals (General) Authors: Sothornwit J, Werawatakul Y, Kaewrudee S, Lumbiganon P, Laopaiboon M Tags: Cochrane Database Syst Rev Source Type: research

Nitric oxide donors (nitrates), L-arginine, or nitric oxide synthase inhibitors for acute stroke.
CONCLUSIONS: There is currently insufficient evidence to recommend the use of NO donors, L-arginine or NOS-I in acute stroke, and only one drug (GTN) has been assessed. In people with acute stroke, GTN reduces blood pressure, increases heart rate and headache, but does not alter clinical outcome (all based on high-quality evidence). PMID: 28429459 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 21, 2017 Category: Journals (General) Authors: Bath PM, Krishnan K, Appleton JP Tags: Cochrane Database Syst Rev Source Type: research

Surgery for limited-stage small-cell lung cancer.
CONCLUSIONS: Evidence from currently available RCTs does not support a role for surgical resection in the management of limited-stage small-cell lung cancer; however our conclusions are limited by the quality of the available evidence and the lack of contemporary data. The results of the trials included in this review may not be generalisable to patients with clinical stage 1 small-cell lung cancer carefully staged using contemporary staging methods. Although some guidelines currently recommend surgical resection in clinical stage 1 small-cell lung cancer, prospective randomised controlled trials are needed to determine if...
Source: Cochrane Database of Systematic Reviews - April 21, 2017 Category: Journals (General) Authors: Barnes H, See K, Barnett S, Manser R Tags: Cochrane Database Syst Rev Source Type: research

Iodine-131-meta-iodobenzylguanidine therapy for patients with newly diagnosed high-risk neuroblastoma.
CONCLUSIONS: We identified no RCTs or CCTs comparing the effectiveness of treatment including (131)I-MIBG therapy versus treatment not including (131)I-MIBG therapy in patients with newly diagnosed HR NBL. We found two small observational studies including chilren. They had high risk of bias, and not all relevant outcome results were available. Based on the currently available evidence, we cannot make recommendations for the use of (131)I-MIBG therapy in patients with newly diagnosed HR NBL in clinical practice. More high-quality research is needed. PMID: 28429876 [PubMed - as supplied by publisher] (Source: Cochrane ...
Source: Cochrane Database of Systematic Reviews - April 21, 2017 Category: Journals (General) Authors: Kraal KC, van Dalen EC, Tytgat GA, Van Eck-Smit BL Tags: Cochrane Database Syst Rev Source Type: research

Cerebrolysin for acute ischaemic stroke.
CONCLUSIONS: The findings of this Cochrane Review do not demonstrate clinical benefits of cerebrolysin for treating acute ischaemic stroke. We found moderate-quality evidence of an increase in non-fatal SAEs with cerebrolysin use but not in total SAEs. PMID: 28430363 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 21, 2017 Category: Journals (General) Authors: Ziganshina LE, Abakumova T, Vernay L Tags: Cochrane Database Syst Rev Source Type: research

Unfractionated heparin versus low molecular weight heparins for avoiding heparin-induced thrombocytopenia in postoperative patients.
CONCLUSIONS: This updated review demonstrated low-quality evidence of a lower incidence of HIT, and HIT complicated by venous thromboembolism, in postoperative patients undergoing thromboprophylaxis with LMWH compared with UFH. Similarily, the risk of HIT in people undergoing major surgical procedures was lower when treated with LMWH compared to UFH (low-quality evidence). The quality of the evidence was downgraded due to concerns about the risk of bias in the included studies and imprecision of the study results. These findings may support current clinical use of LMWH over UFH as front-line heparin therapy. However, our c...
Source: Cochrane Database of Systematic Reviews - April 21, 2017 Category: Journals (General) Authors: Junqueira DR, Zorzela LM, Perini E Tags: Cochrane Database Syst Rev Source Type: research

Serum C-reactive protein, procalcitonin, and lactate dehydrogenase for the diagnosis of pancreatic necrosis.
CONCLUSIONS: The paucity of data and methodological deficiencies in the studies meant that it was not possible to arrive at any conclusions regarding the diagnostic test accuracy of the index test because of the uncertainty of the results. Further well-designed diagnostic test accuracy studies with prespecified index test thresholds of CRP, procalcitonin, LDH; appropriate follow-up (for at least two weeks to ensure that the person does not have pancreatic necrosis, as early scans may not indicate pancreatic necrosis); and clearly defined reference standards (of surgical or radiological confirmation of pancreatic necrosis) ...
Source: Cochrane Database of Systematic Reviews - April 21, 2017 Category: Journals (General) Authors: Komolafe O, Pereira SP, Davidson BR, Gurusamy KS Tags: Cochrane Database Syst Rev Source Type: research

Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis.
CONCLUSIONS: As about a quarter of people with acute pancreatitis fail to be diagnosed as having acute pancreatitis with the evaluated tests, one should have a low threshold to admit the patient and treat them for acute pancreatitis if the symptoms are suggestive of acute pancreatitis, even if these tests are normal. About 1 in 10 patients without acute pancreatitis may be wrongly diagnosed as having acute pancreatitis with these tests, therefore it is important to consider other conditions that require urgent surgical intervention, such as perforated viscus, even if these tests are abnormal.The diagnostic performance of t...
Source: Cochrane Database of Systematic Reviews - April 21, 2017 Category: Journals (General) Authors: Rompianesi G, Hann A, Komolafe O, Pereira SP, Davidson BR, Gurusamy KS Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological interventions for acute pancreatitis.
CONCLUSIONS: Very low-quality evidence suggests that none of the pharmacological treatments studied decrease short-term mortality in people with acute pancreatitis. However, the confidence intervals were wide and consistent with an increase or decrease in short-term mortality due to the interventions. We did not find consistent clinical benefits with any intervention. Because of the limitations in the prognostic scoring systems and because damage to organs may occur in acute pancreatitis before they are clinically manifest, future trials should consider including pancreatitis of all severity but power the study to measure ...
Source: Cochrane Database of Systematic Reviews - April 21, 2017 Category: Journals (General) Authors: Moggia E, Koti R, Belgaumkar AP, Fazio F, Pereira SP, Davidson BR, Gurusamy KS Tags: Cochrane Database Syst Rev Source Type: research

Hydroxyurea (hydroxycarbamide) for sickle cell disease.
CONCLUSIONS: There is evidence to suggest that hydroxyurea is effective in decreasing the frequency of pain episodes and other acute complications in adults and children with sickle cell anaemia of HbSS or HbSβºthal genotypes and in preventing life-threatening neurological events in those with sickle cell anaemia at risk of primary stroke by maintaining transcranial doppler velocities. However, there is still insufficient evidence on the long-term benefits of hydroxyurea, particularly in preventing chronic complications of SCD, recommending a standard dose or dose escalation to maximum tolerated dose. There is al...
Source: Cochrane Database of Systematic Reviews - April 20, 2017 Category: Journals (General) Authors: Nevitt SJ, Jones AP, Howard J Tags: Cochrane Database Syst Rev Source Type: research

Assessment and support during early labour for improving birth outcomes.
CONCLUSIONS: Assessment and support in early labour does not have a clear impact on rate of caesarean section or instrumental vaginal birth, or whether the baby was born before arrival at hospital or in an unplanned home birth. However, evidence suggested that interventions may have an impact on reducing the use of epidural anaesthesia, labour augmentation and on increasing maternal satisfaction with giving birth. Evidence about the effectiveness of early labour assessment versus immediate admission was very limited and more research is needed in this area. PMID: 28426160 [PubMed - as supplied by publisher] (Source: C...
Source: Cochrane Database of Systematic Reviews - April 20, 2017 Category: Journals (General) Authors: Kobayashi S, Hanada N, Matsuzaki M, Takehara K, Ota E, Sasaki H, Nagata C, Mori R Tags: Cochrane Database Syst Rev Source Type: research

Lay-led and peer support interventions for adolescents with asthma.
CONCLUSIONS: Although weak evidence suggests that lay-led and peer support interventions could lead to a small improvement in asthma-related quality of life for adolescents, benefits for asthma control, exacerbations and medication adherence remain unproven. Current evidence is insufficient to reveal whether routine use of lay-led or peer support programmes is beneficial for adolescents receiving asthma care.Ongoing and future research may help to identify target populations for lay-led and peer support interventions, along with attributes that constitute a successful programme. PMID: 28421600 [PubMed - as supplied by...
Source: Cochrane Database of Systematic Reviews - April 19, 2017 Category: Journals (General) Authors: Kew KM, Carr R, Crossingham I Tags: Cochrane Database Syst Rev Source Type: research

Prophylactic anti-staphylococcal antibiotics for cystic fibrosis.
CONCLUSIONS: Anti-staphylococcal antibiotic prophylaxis leads to fewer children having isolates of Staphylococcus aureus, when commenced early in infancy and continued up to six years of age. The clinical importance of this finding is uncertain. Further research may establish whether the trend towards more children with CF with Pseudomonas aeruginosa, after four to six years of prophylaxis, is a chance finding and whether choice of antibiotic or duration of treatment might influence this. PMID: 28417451 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 18, 2017 Category: Journals (General) Authors: Smyth AR, Rosenfeld M Tags: Cochrane Database Syst Rev Source Type: research

Interventions to improve adherence to inhaled steroids for asthma.
CONCLUSIONS: Pooled results suggest that a variety of interventions can improve adherence. The clinical relevance of this improvement, highlighted by uncertain and inconsistent impact on clinical outcomes such as quality of life and asthma control, is less clear. We have low to moderate confidence in these findings owing to concerns about risk of bias and inconsistency. Future studies would benefit from predefining an evidence-based 'cut-off' for acceptable adherence and using objective adherence measures and validated tools and questionnaires. When possible, covert monitoring and some form of blinding or active control ma...
Source: Cochrane Database of Systematic Reviews - April 18, 2017 Category: Journals (General) Authors: Normansell R, Kew KM, Stovold E Tags: Cochrane Database Syst Rev Source Type: research

Vitamin E for Alzheimer's dementia and mild cognitive impairment.
CONCLUSIONS: We found no evidence that the alpha-tocopherol form of vitamin E given to people with MCI prevents progression to dementia, or that it improves cognitive function in people with MCI or dementia due to AD. However, there is moderate quality evidence from a single study that it may slow functional decline in AD. Vitamin E was not associated with an increased risk of serious adverse events or mortality in the trials in this review. These conclusions have changed since the previous update, however they are still based on small numbers of trials and participants and further research is quite likely to affect the re...
Source: Cochrane Database of Systematic Reviews - April 18, 2017 Category: Journals (General) Authors: Farina N, Llewellyn D, Isaac MGEKN, Tabet N Tags: Cochrane Database Syst Rev Source Type: research

Simulated presence therapy for dementia.
CONCLUSIONS: We were unable to draw any conclusions about the efficacy of SPT for treating behavioural and psychological symptoms and improving quality of life of people with dementia. New high-quality studies are needed to investigate the effect of SPT. PMID: 28418586 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 18, 2017 Category: Journals (General) Authors: Abraha I, Rimland JM, Lozano-Montoya I, Dell'Aquila G, Vélez-Díaz-Pallarés M, Trotta FM, Cruz-Jentoft AJ, Cherubini A Tags: Cochrane Database Syst Rev Source Type: research

Routine oro/nasopharyngeal suction versus no suction at birth.
CONCLUSIONS: The currently available evidence does not support or refute the benefits or harms of routine oro/nasopharyngeal suction over no suction. Further high-quality studies are required in preterm infants or term newborn infants with thick meconium amniotic fluid. Studies should investigate long-term effects such as neurodevelopmental outcomes. PMID: 28419406 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 18, 2017 Category: Journals (General) Authors: Foster JP, Dawson JA, Davis PG, Dahlen HG Tags: Cochrane Database Syst Rev Source Type: research

Ultrasonography for confirmation of gastric tube placement.
CONCLUSIONS: Of 10 studies that assessed the diagnostic accuracy of gastric tube placement, few studies had a low risk of bias. Based on limited evidence, ultrasound does not have sufficient accuracy as a single test to confirm gastric tube placement. However, in settings where X-ray is not readily available, ultrasound may be useful to detect misplaced gastric tubes. Larger studies are needed to determine the possibility of adverse events when ultrasound is used to confirm tube placement. PMID: 28414415 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 17, 2017 Category: Journals (General) Authors: Tsujimoto H, Tsujimoto Y, Nakata Y, Akazawa M, Kataoka Y Tags: Cochrane Database Syst Rev Source Type: research

Imaging modalities for characterising focal pancreatic lesions.
CONCLUSIONS: We were unable to arrive at any firm conclusions because of the differences in the way that study authors classified focal pancreatic lesions into cancerous, precancerous, and benign lesions; the inclusion of few studies with wide confidence intervals for each comparison; poor methodological quality in the studies; and heterogeneity in the estimates within comparisons. PMID: 28415140 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 17, 2017 Category: Journals (General) Authors: Best LM, Rawji V, Pereira SP, Davidson BR, Gurusamy KS Tags: Cochrane Database Syst Rev Source Type: research

Topiramate for essential tremor.
CONCLUSIONS: This systematic review highlighted the presence of limited data and very low to low quality evidence to support the apparent efficacy and the occurrence of treatment-limiting AEs in people with ET treated with topiramate. Further research to assess topiramate efficacy and safety on ET is needed. PMID: 28409827 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 14, 2017 Category: Journals (General) Authors: Bruno E, Nicoletti A, Quattrocchi G, Allegra R, Filippini G, Colosimo C, Zappia M Tags: Cochrane Database Syst Rev Source Type: research

Magnesium for treating sickle cell disease.
CONCLUSIONS: Moderate to low quality evidence showed neither intravenous magnesium and oral magnesium therapy has an effect on reducing painful crisis, length of hospital stay and changing quality of life in treating sickle cell disease. Therefore, no definitive conclusions can be made regarding its clinical benefit. Further randomized controlled studies, perhaps multicentre, are necessary to establish whether intravenous and oral magnesium therapies have any effect on improving the health of people with sickle cell disease. PMID: 28409830 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 14, 2017 Category: Journals (General) Authors: Than NN, Soe HH, Palaniappan SK, Abas AB, De Franceschi L Tags: Cochrane Database Syst Rev Source Type: research

Pharmacotherapy for hyperuricemia in hypertensive patients.
CONCLUSIONS: In this updated systematic review, the RCT data available at present are insufficient to know whether UA-lowering therapy also lowers BP. More studies are needed. PMID: 28406263 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 13, 2017 Category: Journals (General) Authors: Gois PH, Souza ER Tags: Cochrane Database Syst Rev Source Type: research

Autologous hematopoietic stem cell transplantation following high-dose chemotherapy for nonrhabdomyosarcoma soft tissue sarcomas.
CONCLUSIONS: The limited data of a single RCT with an unclear risk of bias and moderate to high quality evidence showed no survival advantage for HDCT. If this treatment is offered it should only be given after careful consideration on an individual person basis and possibly only as part of a well-designed RCT. PMID: 28407197 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 13, 2017 Category: Journals (General) Authors: Peinemann F, Enk H, Smith LA Tags: Cochrane Database Syst Rev Source Type: research

Chlorpromazine dose for people with schizophrenia.
CONCLUSIONS: The dosage of chlorpromazine has changed drastically over the past 50 years with lower doses now being the preferred of choice. However, this change was gradual and arose not due to trial-based evidence, but due to clinical experience and consensus. Chlorpromazine is one of the most widely used antipsychotic drugs yet appropriate use of lower levels has come about after many years of trial and error with much higher doses. In the absence of high-grade evaluative studies, clinicians have had no alternative but to learn from experience. However, such an approach can lack scientific rigor and does not allow for p...
Source: Cochrane Database of Systematic Reviews - April 13, 2017 Category: Journals (General) Authors: Dudley K, Liu X, De Haan S Tags: Cochrane Database Syst Rev Source Type: research

Multiple-micronutrient supplementation for women during pregnancy.
Abstract BACKGROUND: Multiple-micronutrient (MMN) deficiencies often coexist among women of reproductive age in low- to middle-income countries. They are exacerbated in pregnancy due to the increased demands, leading to potentially adverse effects on the mother and developing fetus. Though supplementation with MMNs has been recommended earlier because of the evidence of impact on pregnancy outcomes, a consensus is yet to be reached regarding the replacement of iron and folic acid supplementation with MMNs. Since the last update of this Cochrane review, evidence from a few large trials has recently been made availa...
Source: Cochrane Database of Systematic Reviews - April 13, 2017 Category: Journals (General) Authors: Haider BA, Bhutta ZA Tags: Cochrane Database Syst Rev Source Type: research

Patient-controlled analgesia with remifentanil versus alternative parenteral methods for pain management in labour.
CONCLUSIONS: Based on the current systematic review, there is mostly low-quality evidence to inform practice and future research may significantly alter the current situation. The quality of evidence is mainly limited by poor quality of the studies, inconsistency, and imprecision. More research is needed on maternal and neonatal safety outcomes (maternal apnoea and respiratory depression, Apgar score) and on the optimal mode and regimen of remifentanil administration to provide highest efficacy with reasonable adverse effects for mothers and their newborns. PMID: 28407220 [PubMed - as supplied by publisher] (Source: C...
Source: Cochrane Database of Systematic Reviews - April 13, 2017 Category: Journals (General) Authors: Weibel S, Jelting Y, Afshari A, Pace NL, Eberhart LH, Jokinen J, Artmann T, Kranke P Tags: Cochrane Database Syst Rev Source Type: research

Asthma education for school staff.
CONCLUSIONS: Asthma education for school staff increases asthma knowledge and preparedness, but studies vary and all available evidence is of low quality. Studies have not yet captured whether this improvement in knowledge has led to appreciable benefits over the short term or the longer term for the safety and health of children with asthma in school. Randomised evidence does not contribute to our knowledge of content or attributes of interventions that lead to the best outcomes, or of resources required for successful implementation.Complete reporting of the content and resources of educational interventions is essential...
Source: Cochrane Database of Systematic Reviews - April 12, 2017 Category: Journals (General) Authors: Kew KM, Carr R, Donovan T, Gordon M Tags: Cochrane Database Syst Rev Source Type: research

Decision aids for people facing health treatment or screening decisions.
CONCLUSIONS: Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is need...
Source: Cochrane Database of Systematic Reviews - April 12, 2017 Category: Journals (General) Authors: Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L Tags: Cochrane Database Syst Rev Source Type: research

Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants.
CONCLUSIONS: In extremely preterm infants, targeting lower (85% to 89%) SpO₂ compared to higher (91% to 95%) SpO₂ had no significant effect on the composite outcome of death or major disability or on major disability alone, including blindness, but increased the average risk of mortality by 28 per 1000 infants treated. The trade-offs between the benefits and harms of the different oxygen saturation target ranges may need to be assessed within local settings (e.g. alarm limit settings, staffing, baseline outcome risks) when deciding on oxygen saturation targeting policies. PMID: 28398697 [PubMed - as supplied by pu...
Source: Cochrane Database of Systematic Reviews - April 11, 2017 Category: Journals (General) Authors: Askie LM, Darlow BA, Davis PG, Finer N, Stenson B, Vento M, Whyte R Tags: Cochrane Database Syst Rev Source Type: research

Arginine supplementation for prevention of necrotising enterocolitis in preterm infants.
CONCLUSIONS: Administration of arginine to preterm infants may prevent development of NEC. Because information was provided by three small trials that included 285 participants, the data are insufficient at present to support a practice recommendation. A multi-centre randomised controlled study that is focused on the incidence of NEC, particularly at more severe stages (2 and 3), is needed. PMID: 28399330 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 11, 2017 Category: Journals (General) Authors: Shah PS, Shah VS, Kelly LE Tags: Cochrane Database Syst Rev Source Type: research

Limited versus full sternotomy for aortic valve replacement.
CONCLUSIONS: The evidence in this review was assessed as generally low to moderate quality. The study sample sizes were small and underpowered to demonstrate differences in outcomes with low event rates. Clinical heterogeneity both between and within studies is a relatively fixed feature of surgical trials, and this also contributed to the need for caution in interpreting results.Considering these limitations, there was uncertainty of the effect on mortality or extracorporeal support times with upper hemi-sternotomy for aortic valve replacement compared to full median sternotomy. The evidence to support a reduction in tota...
Source: Cochrane Database of Systematic Reviews - April 10, 2017 Category: Journals (General) Authors: Kirmani BH, Jones SG, Malaisrie SC, Chung DA, Williams RJ Tags: Cochrane Database Syst Rev Source Type: research

Personalised asthma action plans for adults with asthma.
CONCLUSIONS: Analysis of available studies was limited by variable reporting of primary and secondary outcomes; therefore, it is difficult to draw firm conclusions related to the effectiveness of PAAPs in the management of adult asthma. We found no evidence from randomised controlled trials of additional benefit or harm associated with use of PAAP versus no PAAP, or PAAP plus education versus education alone, but we considered the quality of the evidence to be low or very low, meaning that we cannot be confident in the magnitude or direction of reported treatment effects. In the context of this caveat, we found no observab...
Source: Cochrane Database of Systematic Reviews - April 10, 2017 Category: Journals (General) Authors: Gatheral TL, Rushton A, Evans DJ, Mulvaney CA, Halcovitch NR, Whiteley G, Eccles FJ, Spencer S Tags: Cochrane Database Syst Rev Source Type: research

Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride.
Abstract BACKGROUND: In spite of more than 100 years of investigations the question of whether a reduced sodium intake improves health is still unsolved. OBJECTIVES: To estimate the effects of low sodium intake versus high sodium intake on systolic and diastolic blood pressure (SBP and DBP), plasma or serum levels of renin, aldosterone, catecholamines, cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides. SEARCH METHODS: The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to March 2016: the Cochrane ...
Source: Cochrane Database of Systematic Reviews - April 9, 2017 Category: Journals (General) Authors: Graudal NA, Hubeck-Graudal T, Jurgens G Tags: Cochrane Database Syst Rev Source Type: research

Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients.
CONCLUSIONS: In this update, we identified limited data from RCTs and quasi-RCTs which evaluated strategies to prevent peritonitis and exit-site/tunnel infections. This review demonstrates that pre/peri-operative intravenous vancomycin may reduce the risk of early peritonitis and that antifungal prophylaxis with oral nystatin or fluconazole reduces the risk of fungal peritonitis following an antibiotic course. However, no other antimicrobial interventions have proven efficacy. In particular, the use of nasal antibiotic to eradicate Staphylococcus aureus, had an uncertain effect on the risk of peritonitis and raises questio...
Source: Cochrane Database of Systematic Reviews - April 8, 2017 Category: Journals (General) Authors: Campbell D, Mudge DW, Craig JC, Johnson DW, Tong A, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

Amylase in drain fluid for the diagnosis of pancreatic leak in post-pancreatic resection.
CONCLUSIONS: Because of the paucity of data and methodological deficiencies in the studies, we are uncertain whether drain fluid amylase should be used as a method for testing for pancreatic leak in an unselected population after pancreatic resection; and we judge that the optimal cut-off of drain fluid amylase for making the diagnosis of pancreatic leak is also not clear. Further well-designed diagnostic test accuracy studies with pre-specified index test threshold of drain fluid amylase (at three times more on postoperative day 5 or another suitable pre-specified threshold), appropriate follow-up (for at least six to eig...
Source: Cochrane Database of Systematic Reviews - April 7, 2017 Category: Journals (General) Authors: Davidson TB, Yaghoobi M, Davidson BR, Gurusamy KS Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Interventions for fatigue and weight loss in adults with advanced progressive illness.
CONCLUSIONS: There is a lack of robust evidence for interventions to manage fatigue and/or unintentional weight loss in the advanced stage of progressive illnesses such as advanced cancer, heart failure, lung failure, cystic fibrosis, multiple sclerosis, motor neuron disease, Parkinson's disease, dementia and AIDS. The evidence contained within this overview provides some insight into interventions which may prove of benefit within this population such as exercise, some pharmacological treatments and support for self management.Researchers could improve the methodological quality of future studies by blinding of outcome as...
Source: Cochrane Database of Systematic Reviews - April 7, 2017 Category: Journals (General) Authors: Payne C, Wiffen PJ, Martin S Tags: Cochrane Database Syst Rev Source Type: research

Chlorpromazine versus clotiapine for schizophrenia.
CONCLUSIONS: Clinically important changes in global and mental state were not reported. Only one trial reported the average change in overall mental state; results favour clotiapine but these limited data are very difficult to trust due to methodological limitations of the study. The comparative effectiveness of chlorpromazine compared to clotiapine on change in global state remains unanswered. Results in this review suggest chlorpromazine and clotiapine cause similar adverse effects, although again, the quality of evidence for this is poor, making firm conclusions difficult. PMID: 28387925 [PubMed - as supplied by pu...
Source: Cochrane Database of Systematic Reviews - April 7, 2017 Category: Journals (General) Authors: Mazhari S, Esmailian S, Shah-Esmaeili A, Goughari AS, Bazrafshan A, Zare M Tags: Cochrane Database Syst Rev Source Type: research

Needle gauge and tip designs for preventing post-dural puncture headache (PDPH).
CONCLUSIONS: There is moderate-quality evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. The studies did not report very clearly on aspects related to randomization, such as random sequence generation and allocation concealment, making it difficult to interpret the risk of bias in the included studies. The moderate quality of the evidence for traumatic versus atraumatic needles suggests that further research is likely to have an important impact on our confidence in the estimate of effect. PMID: 28388808 [PubMed -...
Source: Cochrane Database of Systematic Reviews - April 7, 2017 Category: Journals (General) Authors: Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N, Ciapponi A, Arevalo JJ, Boogaard S, Roqué I Figuls M Tags: Cochrane Database Syst Rev Source Type: research

Repeated lumbar or ventricular punctures in newborns with intraventricular haemorrhage.
CONCLUSIONS: There was no evidence that repeated removal of CSF via lumbar puncture, ventricular puncture or from a ventricular reservoir produces any benefit over conservative management in neonates with or at risk for developing PHH in terms of reduction of disability, death, or need for placement of a permanent shunt. PMID: 28384379 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - April 6, 2017 Category: Journals (General) Authors: Whitelaw A, Lee-Kelland R Tags: Cochrane Database Syst Rev Source Type: research

Infant pacifiers for reduction in risk of sudden infant death syndrome.
Abstract BACKGROUND: Sudden infant death syndrome (SIDS) has been most recently defined as the sudden unexpected death of an infant less than one year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including the performance of a complete autopsy and a review of the circumstances of death and clinical history. Despite the success of several prevention campaigns, SIDS remains a leading cause of infant mortality. In 1994, a 'triple risk model' for SIDS was proposed that described SIDS as an event that results from the intersection of...
Source: Cochrane Database of Systematic Reviews - April 5, 2017 Category: Journals (General) Authors: Psaila K, Foster JP, Pulbrook N, Jeffery HE Tags: Cochrane Database Syst Rev Source Type: research