Deprescribing versus continuation of chronic proton pump inhibitor use in adults.
CONCLUSIONS: In people with mild GERD, on-demand deprescribing may lead to an increase in GI symptoms (e.g. dyspepsia, regurgitation) and probably a reduction in pill burden. There was a decline in participant satisfaction, although heterogeneity was high. There were insufficient data to make a conclusion regarding long-term benefits and harms of PPI discontinuation, although two trials (one on-demand trial and one abrupt discontinuation trial) reported endoscopic findings in their intervention groups at study end. PMID: 28301676 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 15, 2017 Category: Journals (General) Authors: Boghossian TA, Rashid FJ, Thompson W, Welch V, Moayyedi P, Rojas-Fernandez C, Pottie K, Farrell B Tags: Cochrane Database Syst Rev Source Type: research

Vitamin C supplementation for the primary prevention of cardiovascular disease.
CONCLUSIONS: Currently, there is no evidence to suggest that vitamin C supplementation reduces the risk of CVD in healthy participants and those at increased risk of CVD, but current evidence is limited to one trial of middle-aged and older male physicians from the USA. There is limited low- and very low-quality evidence currently on the effect of vitamin C supplementation and risk of CVD risk factors. PMID: 28301692 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 15, 2017 Category: Journals (General) Authors: Al-Khudairy L, Flowers N, Wheelhouse R, Ghannam O, Hartley L, Stranges S, Rees K Tags: Cochrane Database Syst Rev Source Type: research

Infant formulas containing hydrolysed protein for prevention of allergic disease and food allergy.
CONCLUSIONS: We found no evidence to support short-term or prolonged feeding with a hydrolysed formula compared with exclusive breast feeding for prevention of allergy. Very low-quality evidence indicates that short-term use of an EHF compared with a CMF may prevent infant CMA.In infants at high risk of allergy not exclusively breast fed, very low-quality evidence suggests that prolonged hydrolysed formula feeding compared with CMF feeding reduces infant allergy and infant CMA. Studies have found no difference in childhood allergy and no difference in specific allergy, including infant and childhood asthma, eczema and rhin...
Source: Cochrane Database of Systematic Reviews - March 14, 2017 Category: Journals (General) Authors: Osborn DA, Sinn JK, Jones LJ Tags: Cochrane Database Syst Rev Source Type: research

First trimester ultrasound tests alone or in combination with first trimester serum tests for Down's syndrome screening.
Abstract BACKGROUND: Down's syndrome occurs when a person has three, rather than two copies of chromosome 21; or the specific area of chromosome 21 implicated in causing Down's syndrome. It is the commonest congenital cause of mental disability and also leads to numerous metabolic and structural problems. It can be life-threatening, or lead to considerable ill health, although some individuals have only mild problems and can lead relatively normal lives. Having a baby with Down's syndrome is likely to have a significant impact on family life.Non-invasive screening based on biochemical analysis of maternal serum or...
Source: Cochrane Database of Systematic Reviews - March 14, 2017 Category: Journals (General) Authors: Alldred SK, Takwoingi Y, Guo B, Pennant M, Deeks JJ, Neilson JP, Alfirevic Z Tags: Cochrane Database Syst Rev Source Type: research

First and second trimester serum tests with and without first trimester ultrasound tests for Down's syndrome screening.
CONCLUSIONS: Tests involving first trimester ultrasound with first and second trimester serum markers in combination with maternal age are significantly better than those without ultrasound, or those evaluating first trimester ultrasound in combination with second trimester serum markers, without first trimester serum markers. We cannot make recommendations about a specific strategy on the basis of the small number of studies available. PMID: 28295159 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 14, 2017 Category: Journals (General) Authors: Alldred SK, Takwoingi Y, Guo B, Pennant M, Deeks JJ, Neilson JP, Alfirevic Z Tags: Cochrane Database Syst Rev Source Type: research

Risk scoring for the primary prevention of cardiovascular disease.
CONCLUSIONS: There is uncertainty whether current strategies for providing CVD risk scores affect CVD events. Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm. There were multiple study limitations in the identified studies and substantial heterogeneity in the interventions, outcomes, and analyses, so readers should interpret results with caution. New models for implementing and evaluating CVD risk scores in adequately powered studies are needed to define the role of applying CVD risk scores in primary CVD ...
Source: Cochrane Database of Systematic Reviews - March 13, 2017 Category: Journals (General) Authors: Karmali KN, Persell SD, Perel P, Lloyd-Jones DM, Berendsen MA, Huffman MD Tags: Cochrane Database Syst Rev Source Type: research

Corticosteroids for tuberculous pleurisy.
CONCLUSIONS: Long-term respiratory function is potentially the most important outcome for assessing the effects of adjunctive treatments for people with pleural TB. However, the information on the impact of pleural TB on long-term respiratory function is unknown and could be eclipsed by other risk factors, such as concurrent pulmonary TB, smoking, and HIV. This probably needs to be quantified to help decide whether further trials of corticosteroids for pleural TB would be worthwhile. PMID: 28290161 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 13, 2017 Category: Journals (General) Authors: Ryan H, Yoo J, Darsini P Tags: Cochrane Database Syst Rev Source Type: research

Psychosocial group interventions to improve psychological well-being in adults living with HIV.
CONCLUSIONS: Group-based psychosocial interventions may have a small effect on measures of depression, but the clinical importance of this is unclear. More high quality evidence is needed to assess whether group psychosocial intervention improve psychological well-being in HIV positive adults. PMID: 28291302 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 13, 2017 Category: Journals (General) Authors: van der Heijden I, Abrahams N, Sinclair D Tags: Cochrane Database Syst Rev Source Type: research

Interventions to improve inhaler technique for people with asthma.
CONCLUSIONS: Although interventions to improve inhaler technique may work in some circumstances, the variety of interventions and measurement methods used hampered our ability to perform meta-analyses and led to low to moderate confidence in our findings. Most included studies did not report important improvement in clinical outcomes. Guidelines consistently recommend that clinicians check regularly the inhaler technique of their patients; what is not clear is how clinicians can most effectively intervene if they find a patient's technique to be inadequate, and whether such interventions will have a discernible impact on c...
Source: Cochrane Database of Systematic Reviews - March 12, 2017 Category: Journals (General) Authors: Normansell R, Kew KM, Mathioudakis AG Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological interventions for acute hepatitis C infection: an attempted network meta-analysis.
CONCLUSIONS: Very low quality evidence suggests that interferon-alpha may decrease the incidence of chronic HCV infection as measured by sustained virological response. However, the clinical impact such as improvement in health-related quality of life, reduction in cirrhosis, decompensated liver disease, and liver transplantation has not been reported. It is also not clear whether this finding is applicable in the current clinical setting dominated by the use of pegylated interferons and direct-acting antivirals, although we found no evidence to support that pegylated interferons or ribavirin or both are effective in peopl...
Source: Cochrane Database of Systematic Reviews - March 12, 2017 Category: Journals (General) Authors: Kalafateli M, Buzzetti E, Thorburn D, Davidson BR, Tsochatzis E, Gurusamy KS Tags: Cochrane Database Syst Rev Source Type: research

Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age.
CONCLUSIONS: Vitamin A supplementation is associated with a clinically meaningful reduction in morbidity and mortality in children. Therefore, we suggest maintaining the policy of universal supplementation for children under five years of age in populations at risk of VAD. Further placebo-controlled trials of VAS in children between six months and five years of age would not change the conclusions of this review, although studies that compare different doses and delivery mechanisms are needed. In populations with documented vitamin A deficiency, it would be unethical to conduct placebo-controlled trials. PMID: 2828270...
Source: Cochrane Database of Systematic Reviews - March 10, 2017 Category: Journals (General) Authors: Imdad A, Mayo-Wilson E, Herzer K, Bhutta ZA Tags: Cochrane Database Syst Rev Source Type: research

Frenotomy for tongue-tie in newborn infants.
Abstract BACKGROUND: Tongue-tie, or ankyloglossia, is a condition whereby the lingual frenulum attaches near the tip of the tongue and may be short, tight and thick. Tongue-tie is present in 4% to 11% of newborns. Tongue-tie has been cited as a cause of poor breastfeeding and maternal nipple pain. Frenotomy, which is commonly performed, may correct the restriction to tongue movement and allow more effective breastfeeding with less maternal nipple pain. OBJECTIVES: To determine whether frenotomy is safe and effective in improving ability to feed orally among infants younger than three months of age with tongue...
Source: Cochrane Database of Systematic Reviews - March 10, 2017 Category: Journals (General) Authors: O'Shea JE, Foster JP, O'Donnell CP, Breathnach D, Jacobs SE, Todd DA, Davis PG Tags: Cochrane Database Syst Rev Source Type: research

Management of people with intermediate-stage hepatocellular carcinoma: an attempted network meta-analysis.
CONCLUSIONS: Currently, there is no evidence from randomised clinical trials that people with intermediate-stage hepatocellular carcinoma would benefit from systemic chemotherapy with sorafenib either alone or when transarterial chemoembolisation was used as a cointervention (very low quality evidence). We need high-quality randomised clinical trials designed to measure differences in clinically important outcomes (e.g. all-cause mortality or health-related quality of life). PMID: 28281295 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 9, 2017 Category: Journals (General) Authors: Roccarina D, Majumdar A, Thorburn D, Davidson BR, Tsochatzis E, Gurusamy KS Tags: Cochrane Database Syst Rev Source Type: research

Long chain polyunsaturated fatty acid supplementation in infants born at term.
CONCLUSIONS: Most of the included RCTs reported no beneficial effects or harms of LCPUFA supplementation on neurodevelopmental outcomes of formula-fed full-term infants and no consistent beneficial effects on visual acuity. Routine supplementation of full-term infant milk formula with LCPUFA cannot be recommended at this time. PMID: 28281303 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 9, 2017 Category: Journals (General) Authors: Jasani B, Simmer K, Patole SK, Rao SC Tags: Cochrane Database Syst Rev Source Type: research

Biologics or tofacitinib for people with rheumatoid arthritis unsuccessfully treated with biologics: a systematic review and network meta-analysis.
Abstract BACKGROUND: Biologic disease-modifying anti-rheumatic drugs (DMARDs: referred to as biologics) are effective in treating rheumatoid arthritis (RA), however there are few head-to-head comparison studies. Our systematic review, standard meta-analysis and network meta-analysis (NMA) updates the 2009 Cochrane overview, 'Biologics for rheumatoid arthritis (RA)' and adds new data. This review is focused on biologic or tofacitinib therapy in people with RA who had previously been treated unsuccessfully with biologics. OBJECTIVES: To compare the benefits and harms of biologics (abatacept, adalimumab, anakinr...
Source: Cochrane Database of Systematic Reviews - March 9, 2017 Category: Journals (General) Authors: Singh JA, Hossain A, Tanjong Ghogomu E, Mudano AS, Maxwell LJ, Buchbinder R, Lopez-Olivo MA, Suarez-Almazor ME, Tugwell P, Wells GA Tags: Cochrane Database Syst Rev Source Type: research

Online support groups for women with breast cancer.
CONCLUSIONS: This review did not find the evidence required to show whether participation in online support groups was beneficial for women with breast cancer, because identified trials were small and of low or very low quality. Large, rigorous trials with ethnically and economically diverse participants are needed to provide robust evidence regarding the psychosocial outcomes selected for this review. PMID: 28278559 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 9, 2017 Category: Journals (General) Authors: McCaughan E, Parahoo K, Hueter I, Northouse L, Bradbury I Tags: Cochrane Database Syst Rev Source Type: research

Intravesical Bacillus Calmette-Gu érin with interferon-alpha versus intravesical Bacillus Calmette-Guérin for treating non-muscle-invasive bladder cancer.
CONCLUSIONS: We found low- to very low-quality evidence suggesting no clear differences in recurrence or progression with BCG plus IFN-α compared with BCG alone for people with NMIBC; there was no information to determine the effect on discontinuation of therapy due to adverse events. Low-quality evidence suggests BCG alternating with IFN-α compared with BCG alone may increase time-to-recurrence, however low-quality evidence also suggests no clear differences for time-to-progression or discontinuation of therapy due to adverse events.Additional high-quality, adequately powered trials using standardised instilla...
Source: Cochrane Database of Systematic Reviews - March 7, 2017 Category: Journals (General) Authors: Shepherd AR, Shepherd E, Brook NR Tags: Cochrane Database Syst Rev Source Type: research

Proton pump inhibitors for functional dyspepsia.
CONCLUSIONS: There is evidence that PPIs are effective for the treatment of FD, independent of the dose and duration of treatment compared with placebo. PPIs may be slightly more effective than H2RAs for the treatment of FD; however, the evidence is scarce. The trials evaluating PPIs versus prokinetics are difficult to interpret as they are at risk of bias. Although the effect of these drugs seems to be small, the drugs are well tolerated. PMID: 28271513 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 7, 2017 Category: Journals (General) Authors: Pinto-Sanchez MI, Yuan Y, Bercik P, Moayyedi P Tags: Cochrane Database Syst Rev Source Type: research

Urate oxidase for the prevention and treatment of tumour lysis syndrome in children with cancer.
Abstract BACKGROUND: Tumour lysis syndrome (TLS) is a serious complication of malignancies and can result in renal failure or death. Previous reviews did not find clear evidence of benefit of urate oxidase in children with cancer. This review is the second update of a previously published Cochrane review. OBJECTIVES: To assess the effects and safety of urate oxidase for the prevention and treatment of TLS in children with malignancies. SEARCH METHODS: In March 2016 we searched CENTRAL, MEDLINE, Embase, and CINAHL. In addition, we searched the reference lists of all identified relevant papers, trials regi...
Source: Cochrane Database of Systematic Reviews - March 7, 2017 Category: Journals (General) Authors: Cheuk DK, Chiang AK, Chan GC, Ha SY Tags: Cochrane Database Syst Rev Source Type: research

Interventions for hereditary haemochromatosis: an attempted network meta-analysis.
CONCLUSIONS: There is currently insufficient evidence to determine whether erythrocytapheresis is beneficial or harmful compared with phlebotomy. Phlebotomy has less equipment requirements and remains the treatment of choice in people with hereditary haemochromatosis who require blood letting in some form. However, it should be noted that there is no evidence from randomised clinical trials that blood letting in any form is beneficial in people with hereditary haemochromatosis. Having said this, a trial including no treatment is unlikely to be conducted. Future trials should compare different frequencies of phlebotomy and ...
Source: Cochrane Database of Systematic Reviews - March 7, 2017 Category: Journals (General) Authors: Buzzetti E, Kalafateli M, Thorburn D, Davidson BR, Tsochatzis E, Gurusamy KS Tags: Cochrane Database Syst Rev Source Type: research

External beam radiotherapy for unresectable hepatocellular carcinoma.
Abstract BACKGROUND: Hepatocellular carcinoma is the most common liver neoplasm, the sixth most common cancer worldwide, and the third most common cause of cancer mortality. Moreover, its incidence has increased dramatically in the past decade. While surgical resection and liver transplantation are the main curative treatments, only around 20% of people with early hepatocellular carcinoma may benefit from these therapies. Current treatment options for unresectable hepatocellular carcinoma include various ablative and transarterial therapies in addition to the drug sorafenib. OBJECTIVES: To assess the benefits...
Source: Cochrane Database of Systematic Reviews - March 6, 2017 Category: Journals (General) Authors: Abdel-Rahman O, Elsayed Z Tags: Cochrane Database Syst Rev Source Type: research

Fundal pressure during the second stage of labour.
CONCLUSIONS: There is insufficient evidence to draw conclusions on the beneficial or harmful effects of fundal pressure, either manually or by inflatable belt. Fundal pressure by an inflatable belt during the second stage of labour may shorten duration of second stage for nulliparous women, and lower rates of operative birth. However, existing studies are small and their generalizability is uncertain. There is insufficient evidence regarding safety for the baby. There is no evidence on the use of fundal pressure in specific clinical settings such as inability of the mother to bear down due to exhaustion or unconsciousness....
Source: Cochrane Database of Systematic Reviews - March 6, 2017 Category: Journals (General) Authors: Hofmeyr GJ, Vogel JP, Cuthbert A, Singata M Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological interventions for recurrent abdominal pain in childhood.
CONCLUSIONS: There is currently no convincing evidence to support the use of drugs to treat RAP in children. Well-conducted clinical trials are needed to evaluate any possible benefits and risks of pharmacological interventions. In practice, if a clinician chooses to use a drug as a 'therapeutic trial', they and the patient need to be aware that RAP is a fluctuating condition and any 'response' may reflect the natural history of the condition or a placebo effect, rather than drug efficacy. PMID: 28262913 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 5, 2017 Category: Journals (General) Authors: Martin AE, Newlove-Delgado TV, Abbott RA, Bethel A, Thompson-Coon J, Whear R, Logan S 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 - March 5, 2017 Category: Journals (General) Authors: Hummel J, Rücker G, Stiller B Tags: Cochrane Database Syst Rev Source Type: research

Vitamin E supplementation in people with cystic fibrosis.
CONCLUSIONS: Vitamin E supplementation led to an improvement in vitamin E levels in people with cystic fibrosis, although the studies may have been at risk of bias. No data on other outcomes of interest were available to allow conclusions about any other benefits of this therapy.In future, larger studies are needed, especially in people already being treated with enteric-coated pancreatic enzymes and supplemented with vitamin E, to look at more specific outcome measures such as vitamin E status, lung function and nutritional status. Future studies could also look at the optimal dose of vitamin E required to achieve maximal...
Source: Cochrane Database of Systematic Reviews - March 5, 2017 Category: Journals (General) Authors: Okebukola PO, Kansra S, Barrett J Tags: Cochrane Database Syst Rev Source Type: research

Bed rest with and without hospitalisation in multiple pregnancy for improving perinatal outcomes.
CONCLUSIONS: The evidence to date is insufficient to inform a policy of routine bed rest in hospital or at home for women with a multiple pregnancy. There is a need for large-scale, multicenter randomised controlled trials to evaluate the benefits, adverse effects and costs of bed rest before definitive conclusions can be drawn. PMID: 28262917 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 5, 2017 Category: Journals (General) Authors: da Silva Lopes K, Takemoto Y, Ota E, Tanigaki S, Mori R Tags: Cochrane Database Syst Rev Source Type: research

Washout policies in long-term indwelling urinary catheterisation in adults.
CONCLUSIONS: Data from seven trials that compared different washout policies were limited, and generally, of poor methodological quality or were poorly reported. The evidence was not adequate to conclude if washouts were beneficial or harmful. Further rigorous, high quality trials that are adequately powered to detect benefits from washout being performed as opposed to no washout are needed. Trials comparing different washout solutions, washout volumes, and frequencies or timings are also needed. PMID: 28262925 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - March 5, 2017 Category: Journals (General) Authors: Shepherd AJ, Mackay WG, Hagen S Tags: Cochrane Database Syst Rev Source Type: research

Fixed-dose combination therapy for the prevention of atherosclerotic cardiovascular diseases.
Abstract BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death and disability worldwide, yet ASCVD risk factor control and secondary prevention rates remain low. A fixed-dose combination of blood pressure- and cholesterol-lowering and antiplatelet treatments into a single pill, or polypill, has been proposed as one strategy to reduce the global burden of ASCVD. OBJECTIVES: To determine the effect of fixed-dose combination therapy on all-cause mortality, fatal and non-fatal ASCVD events, and adverse events. We also sought to determine the effect of fixed-dose combination ther...
Source: Cochrane Database of Systematic Reviews - March 5, 2017 Category: Journals (General) Authors: Bahiru E, de Cates AN, Farr MR, Jarvis MC, Palla M, Rees K, Ebrahim S, Huffman MD Tags: Cochrane Database Syst Rev Source Type: research

Iodine supplementation for women during the preconception, pregnancy and postpartum period.
CONCLUSIONS: There were insufficient data to reach any meaningful conclusions on the benefits and harms of routine iodine supplementation in women before, during or after pregnancy. The available evidence suggested that iodine supplementation decreases the likelihood of postpartum hyperthyroidism and increases the likelihood of the adverse effect of digestive intolerance in pregnancy - both considered potential adverse effects. We considered evidence for these outcomes low or very low quality, however, because of study design limitations and wide confidence intervals. In addition, due to the small number of trials and incl...
Source: Cochrane Database of Systematic Reviews - March 4, 2017 Category: Journals (General) Authors: Harding KB, Peña-Rosas JP, Webster AC, Yap CM, Payne BA, Ota E, De-Regil LM Tags: Cochrane Database Syst Rev Source Type: research

Ischaemic preconditioning for the reduction of renal ischaemia reperfusion injury.
CONCLUSIONS: Remote ischaemic preconditioning by cuff inflation appears to be a safe method, and probably leads to little or no difference in serum creatinine, adverse effects, need for dialysis, length of hospital stay, death and in the incidence of acute kidney injury. Overall we had moderate-high certainty evidence however the available data does not confirm the efficacy of remote ischaemic preconditioning in reducing renal ischaemia reperfusion injury in patients undergoing major cardiac and vascular surgery in which renal ischaemia reperfusion injury may occur. PMID: 28258686 [PubMed - as supplied by publisher] (...
Source: Cochrane Database of Systematic Reviews - March 3, 2017 Category: Journals (General) Authors: Menting TP, Wever KE, Ozdemir-van Brunschot DM, Van der Vliet DJ, Rovers MM, Warle MC Tags: Cochrane Database Syst Rev Source Type: research

Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults.
CONCLUSIONS: No firm conclusions can be drawn regarding the efficacy of antibiotic treatment in severe CDI as most studies excluded patients with severe disease. The lack of any 'no treatment' control studies does not allow for any conclusions regarding the need for antibiotic treatment in patients with mild CDI beyond withdrawal of the initiating antibiotic. Nonetheless, moderate quality evidence suggests that vancomycin is superior to metronidazole and fidaxomicin is superior to vancomycin. The differences in effectiveness between these antibiotics were not too large and the advantage of metronidazole is its far lower co...
Source: Cochrane Database of Systematic Reviews - March 2, 2017 Category: Journals (General) Authors: Nelson RL, Suda KJ, Evans CT Tags: Cochrane Database Syst Rev Source Type: research

Non-contraceptive oestrogen-containing preparations for controlling symptoms of premenstrual syndrome.
CONCLUSIONS: We found very low quality evidence to support the effectiveness of continuous oestrogen (transdermal patches or subcutaneous implants) plus progestogen, with a small to moderate effect size. We found very low quality evidence from a study based on 11 women to suggest that luteal-phase oral unopposed oestrogen is probably ineffective and possibly detrimental for controlling the symptoms of PMS. A comparison between 200 µg and 100 µg doses of continuous oestrogen was inconclusive with regard to effectiveness, but suggested that the lower dose was less likely to cause side effects. Uncertainty remains...
Source: Cochrane Database of Systematic Reviews - March 2, 2017 Category: Journals (General) Authors: Naheed B, Kuiper JH, Uthman OA, O'Mahony F, O'Brien PM Tags: Cochrane Database Syst Rev Source Type: research

Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome.
CONCLUSIONS: With the addition of five randomised controlled trials (2927 women) to this updated review, we found no clinically important difference in the incidence of neonatal sepsis between women who birth immediately and those managed expectantly in PPROM prior to 37 weeks' gestation. Early planned birth was associated with an increase in the incidence of neonatal RDS, need for ventilation, neonatal mortality, endometritis, admission to neonatal intensive care, and the likelihood of birth by caesarean section, but a decreased incidence of chorioamnionitis. Women randomised to early birth also had an increased risk of l...
Source: Cochrane Database of Systematic Reviews - March 2, 2017 Category: Journals (General) Authors: Bond DM, Middleton P, Levett KM, van der Ham DP, Crowther CA, Buchanan SL, Morris J Tags: Cochrane Database Syst Rev Source Type: research

Payment methods for outpatient care facilities.
CONCLUSIONS: Our review found that if policymakers intend to apply P4P incentives to pay health facilities providing outpatient services, this intervention will probably lead to a slight improvement in health professionals' use of tests or treatments, particularly for chronic diseases. However, it may lead to little or no improvement in patients' utilisation of health services or health outcomes. When considering using P4P to improve the performance of health facilities, policymakers should carefully consider each component of their P4P design, including the choice of performance measures, the performance target, payment f...
Source: Cochrane Database of Systematic Reviews - March 2, 2017 Category: Journals (General) Authors: Yuan B, He L, Meng Q, Jia L Tags: Cochrane Database Syst Rev Source Type: research

Botulinum toxin for the treatment of strabismus.
CONCLUSIONS: Most published literature on the use of botulinum toxin in the treatment of strabismus consists of retrospective studies, cohort studies or case reviews. Although these provide useful descriptive information, clarification is required as to the effective use of botulinum toxin as an independent treatment modality. Six RCTs on the therapeutic use of botulinum toxin in strabismus, graded as low and very low-certainty evidence, have shown varying responses. These include a lack of evidence for effect of botulinum toxin on reducing visual symptoms in acute sixth nerve palsy, poor response in people with horizontal...
Source: Cochrane Database of Systematic Reviews - March 1, 2017 Category: Journals (General) Authors: Rowe FJ, Noonan CP Tags: Cochrane Database Syst Rev Source Type: research

Support for healthy breastfeeding mothers with healthy term babies.
CONCLUSIONS: When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely m...
Source: Cochrane Database of Systematic Reviews - February 27, 2017 Category: Journals (General) Authors: McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S Tags: Cochrane Database Syst Rev Source Type: research

Breastfeeding education and support for women with twins or higher order multiples.
CONCLUSIONS: We found no evidence from randomised controlled trials about the effectiveness of breastfeeding education and support for women with twins or higher order multiples, or the most effective way to provide education and support . There was no evidence about the best way to deliver the intervention, the timing of care, or the best person to deliver the care. There is a need for well-designed, adequately powered studies of interventions designed for women with twins or higher order multiples to find out what types of education and support are effective in helping these mothers to breastfeed their babies. PMID:...
Source: Cochrane Database of Systematic Reviews - February 27, 2017 Category: Journals (General) Authors: Whitford HM, Wallis SK, Dowswell T, West HM, Renfrew MJ Tags: Cochrane Database Syst Rev Source Type: research

Eplerenone for hypertension.
CONCLUSIONS: Eplerenone 50 to 200 mg/day lowers blood pressure in people with primary hypertension by 9.21 mmHg systolic and 4.18 mmHg diastolic compared to placebo, with no difference of effect between doses of 50 mg/day to 200 mg/day. A dose of 25 mg/day did not produce a statistically significant reduction in systolic or diastolic blood pressure and there is insufficient evidence for doses above 200 mg/day. There is currently no available evidence to determine the effect of eplerenone on clinically meaningful outcomes such as mortality or morbidity in hypertensive patients. The evidence available on side effects is insu...
Source: Cochrane Database of Systematic Reviews - February 27, 2017 Category: Journals (General) Authors: Tam TS, Wu MH, Masson SC, Tsang MP, Stabler SN, Kinkade A, Tung A, Tejani AM Tags: Cochrane Database Syst Rev Source Type: research

N-acetylcarnosine (NAC) drops for age-related cataract.
CONCLUSIONS: There is currently no convincing evidence that NAC reverses cataract, nor prevents progression of cataract (defined as a change in cataract appearance either for the better or for the worse). Future studies should be randomized, double-masked, placebo-controlled trials with standardised quality of life outcomes and validated outcome measures in terms of visual acuity, contrast sensitivity and glare, and large enough to detect adverse effects. PMID: 28245346 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 27, 2017 Category: Journals (General) Authors: Dubois VD, Bastawrous A Tags: Cochrane Database Syst Rev Source Type: research

Autologous serum eye drops for dry eye.
CONCLUSIONS: Overall, investigators reported inconsistency in possible benefits of AS for improving participant-reported symptoms and other objective clinical measures. There might be some benefit in symptoms with AS compared with artificial tears in the short-term, but we found no evidence of an effect after two weeks of treatment. Well-planned, large, high-quality RCTs are warranted to examine participants with dry eye of different severities by using standardized questionnaires to measure participant-reported outcomes, as well as objective clinical tests and objective biomarkers to assess the benefit of AS therapy for d...
Source: Cochrane Database of Systematic Reviews - February 27, 2017 Category: Journals (General) Authors: Pan Q, Angelina A, Marrone M, Stark WJ, Akpek EK Tags: Cochrane Database Syst Rev Source Type: research

Carbamazepine versus phenytoin monotherapy for epilepsy: an individual participant data review.
CONCLUSIONS: We have not found evidence for a statistically significant difference between carbamazepine and phenytoin for the efficacy outcomes examined in this review, but CIs are wide and we cannot exclude the possibility of important differences. There is no evidence in this review that phenytoin is more strongly associated with serious adverse events than carbamazepine. There is some evidence that people with generalised seizures may be less likely to withdraw early from phenytoin than from carbamazepine, but misclassification of seizure type may have impacted upon our results. We recommend caution when interpreting t...
Source: Cochrane Database of Systematic Reviews - February 26, 2017 Category: Journals (General) Authors: Nevitt SJ, Marson AG, Weston J, Tudur Smith C Tags: Cochrane Database Syst Rev Source Type: research

Plasma exchange for Guillain-Barr é syndrome.
CONCLUSIONS: Moderate-quality evidence shows significantly more improvement with plasma exchange than with supportive care alone in adults with Guillain-Barré syndrome, without a significant increase in serious adverse events. According to moderate-quality evidence, there was a small but significant increase in the risk of relapse during the first six to 12 months after onset in people treated with plasma exchange compared with those who were not treated. Despite this, after one year, full recovery of muscle strength was more likely and severe residual weakness less likely with plasma exchange. PMID: 28241090 [...
Source: Cochrane Database of Systematic Reviews - February 26, 2017 Category: Journals (General) Authors: Chevret S, Hughes RA, Annane D Tags: Cochrane Database Syst Rev Source Type: research

Glucose-lowering agents for treating pre-existing and new-onset diabetes in kidney transplant recipients.
Abstract BACKGROUND: Kidney transplantation is the preferred form of kidney replacement therapy for patients with end-stage kidney disease (ESKD) and is often complicated by worsening or new-onset diabetes. Management of hyperglycaemia is important to reduce post-transplant and diabetes-related complications. The safety and efficacy of glucose-lowering agents after kidney transplantation is largely unknown. OBJECTIVES: To evaluate the efficacy and safety of pharmacological interventions for lowering glucose levels in patients who have undergone kidney transplantation and have diabetes. SEARCH METHODS: We...
Source: Cochrane Database of Systematic Reviews - February 26, 2017 Category: Journals (General) Authors: Lo C, Jun M, Badve SV, Pilmore H, White SL, Hawley C, Cass A, Perkovic V, Zoungas S Tags: Cochrane Database Syst Rev Source Type: research

Calcium and phosphorus supplementation of human milk for preterm infants.
CONCLUSIONS: We identified one small trial including only 40 infants that compared supplementation of human milk with calcium and phosphorus versus no supplementation in hospitalised preterm infants. We judged the evidence to be of low quality and found no evidence of differences between groups for clinically important outcomes including growth and fractures. Although serum alkaline phosphatase concentration was reduced in the group receiving supplementation at six weeks postnatal age, this difference is unlikely to be of clinical significance. We conclude that evidence is insufficient to determine whether benefit or harm ...
Source: Cochrane Database of Systematic Reviews - February 25, 2017 Category: Journals (General) Authors: Harding JE, Wilson J, Brown J Tags: Cochrane Database Syst Rev Source Type: research

Different types of dietary advice for women with gestational diabetes mellitus.
CONCLUSIONS: Evidence from 19 trials assessing different types of dietary advice for women with GDM suggests no clear differences for primary outcomes and secondary outcomes assessed using GRADE, except for a possible reduction in caesarean section for women receiving a DASH diet compared with a control diet. Few differences were observed for secondary outcomes.Current evidence is limited by the small number of trials in each comparison, small sample sizes, and variable methodological quality. More evidence is needed to assess the effects of different types of dietary advice for women with GDM. Future trials should be adeq...
Source: Cochrane Database of Systematic Reviews - February 24, 2017 Category: Journals (General) Authors: Han S, Middleton P, Shepherd E, Van Ryswyk E, Crowther CA Tags: Cochrane Database Syst Rev Source Type: research

Molecular assays for the diagnosis of sepsis in neonates.
CONCLUSIONS: Molecular assays have the advantage of producing rapid results and may perform well as 'add-on' tests. PMID: 28236648 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - February 24, 2017 Category: Journals (General) Authors: Pammi M, Flores A, Versalovic J, Leeflang MM Tags: Cochrane Database Syst Rev Source Type: research

Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in low and middle income countries.
CONCLUSIONS: Given the high burden of death among children younger than five years of age in low and middle income countries, and the fact that mortality in infancy is a major contributory cause, it is critical to obtain sound scientific evidence of the effect of vitamin A supplementation during the neonatal period on infant mortality and morbidity. Evidence provided in this review does not indicate a potential beneficial effect of vitamin A supplementation among neonates at birth in reducing mortality during the first six months or 12 months of life. Given this finding and the absence of a clear indication of the biologic...
Source: Cochrane Database of Systematic Reviews - February 23, 2017 Category: Journals (General) Authors: Haider BA, Sharma R, Bhutta ZA Tags: Cochrane Database Syst Rev Source Type: research

Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction.
CONCLUSIONS: There is uncertainty as to the relative effects of endonasal and external DCR. Differences in effect seen in the two trials included in this review may be due to variations in the endonasal technique, but may also be due to other differences between the trials. Future larger RCTs are required to further assess the success and complication rates of endonasal and external DCR. Different techniques of endonasal DCR should also be assessed, as the choice of endonasal technique can influence the outcome. Strict outcome criteria should be adopted to assess functional and anatomical outcomes with a minimal follow-up ...
Source: Cochrane Database of Systematic Reviews - February 23, 2017 Category: Journals (General) Authors: Jawaheer L, MacEwen CJ, Anijeet D Tags: Cochrane Database Syst Rev Source Type: research

Position in the second stage of labour for women with epidural anaesthesia.
CONCLUSIONS: There are insufficient data to say anything conclusive about the effect of position for the second stage of labour for women with epidural analgesia. The GRADE quality assessment of the evidence in this review ranged between moderate to low quality, with downgrading decisions based on design limitations in the studies, inconsistency, and imprecision of effect estimates.Women with an epidural should be encouraged to use whatever position they find comfortable in the second stage of labour.More studies with larger sample sizes will need to be conducted in order for solid conclusions to be made about the effect o...
Source: Cochrane Database of Systematic Reviews - February 23, 2017 Category: Journals (General) Authors: Kibuka M, Thornton JG Tags: Cochrane Database Syst Rev Source Type: research

Bronchoscopic lung volume reduction procedures for chronic obstructive pulmonary disease.
CONCLUSIONS: Results for selected BLVR procedures indicate they can provide significant and clinically meaningful short-term (up to one year) improvements in health outcomes, but this was at the expense of increased adverse events. The currently available evidence is not sufficient to assess the effect of BLVR procedures on mortality. These findings are limited by the lack of long-term follow-up data, limited availability of cost-effectiveness data, significant heterogeneity in results, presence of skew and high CIs, and the open-label character of a number of the studies. PMID: 28230230 [PubMed - as supplied by publi...
Source: Cochrane Database of Systematic Reviews - February 22, 2017 Category: Journals (General) Authors: van Agteren JE, Hnin K, Grosser D, Carson KV, Smith BJ Tags: Cochrane Database Syst Rev Source Type: research