Vitamin D as an adjunct to antibiotics for the treatment of acute childhood pneumonia.
CONCLUSIONS: We are uncertain as to whether vitamin D has an important effect on outcomes because the results were imprecise. No major adverse events were reported. We assessed the quality of the evidence as very low to low. Several trials are ongoing and may provide additional information. PMID: 30024634 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 19, 2018 Category: General Medicine Authors: Das RR, Singh M, Naik SS Tags: Cochrane Database Syst Rev Source Type: research

Interventions for increasing the use of shared decision making by healthcare professionals.
CONCLUSIONS: It is uncertain whether any interventions for increasing the use of SDM by healthcare professionals are effective because the certainty of the evidence is low or very low. PMID: 30025154 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 19, 2018 Category: General Medicine Authors: Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner-Banzhoff N Tags: Cochrane Database Syst Rev Source Type: research

Continuation versus discontinuation of antiplatelet therapy for bleeding and ischaemic events in adults undergoing non-cardiac surgery.
CONCLUSIONS: We found low-certainty evidence that either continuation or discontinuation of antiplatelet therapy before non-cardiac surgery may make little or no difference to mortality, bleeding requiring surgical intervention, or ischaemic events. We found moderate-certainty evidence that either continuation or discontinuation of antiplatelet therapy before non-cardiac surgery probably makes little or no difference to bleeding requiring transfusion. Evidence was limited to few studies with few participants, and with few events. The three ongoing studies may alter the conclusions of the review once published and assessed....
Source: Cochrane Database of Systematic Reviews - July 18, 2018 Category: General Medicine Authors: Lewis SR, Pritchard MW, Schofield-Robinson OJ, Alderson P, Smith AF Tags: Cochrane Database Syst Rev Source Type: research

De-escalation techniques for managing non-psychosis induced aggression in adults.
CONCLUSIONS: The limited evidence means that uncertainty remains around the effectiveness of de-escalation and the relative efficacy of different techniques. High-quality research on the effectiveness of this intervention is therefore urgently needed. PMID: 30019748 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 18, 2018 Category: General Medicine Authors: Spencer S, Johnson P, Smith IC Tags: Cochrane Database Syst Rev Source Type: research

Omega-6 fats for the primary and secondary prevention of cardiovascular disease.
CONCLUSIONS: This is the most extensive systematic assessment of effects of omega-6 fats on cardiovascular health, mortality, lipids and adiposity to date, using previously unpublished data. We found no evidence that increasing omega-6 fats reduces cardiovascular outcomes other than MI, where 53 people may need to increase omega-6 fat intake to prevent 1 person from experiencing MI. Although benefits of omega-6 fats remain to be proven, increasing omega-6 fats may be of benefit in people at high risk of MI. Increased omega-6 fats reduce serum total cholesterol but not other blood fat fractions or adiposity. PMID: 3001...
Source: Cochrane Database of Systematic Reviews - July 18, 2018 Category: General Medicine Authors: Hooper L, Al-Khudairy L, Abdelhamid AS, Rees K, Brainard JS, Brown TJ, Ajabnoor SM, O'Brien AT, Winstanley LE, Donaldson DH, Song F, Deane KH Tags: Cochrane Database Syst Rev Source Type: research

Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease.
CONCLUSIONS: This is the most extensive systematic assessment of effects of omega-3 fats on cardiovascular health to date. Moderate- and high-quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials). Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias. Low-quality evidence suggests ALA may slightly reduce CVD event risk, CHD mortality and arrhythmia. PMID: 30019766 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 18, 2018 Category: General Medicine Authors: Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KH, AlAbdulghafoor FK, Summerbell CD, Worthington HV, Song F, Hooper L Tags: Cochrane Database Syst Rev Source Type: research

Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease.
CONCLUSIONS: This is the most extensive systematic review of RCTs conducted to date to assess effects of increasing PUFA on cardiovascular disease, mortality, lipids or adiposity. Increasing PUFA intake probably slightly reduces risk of coronary heart disease and cardiovascular disease events, may slightly reduce risk of coronary heart disease mortality and stroke (though not ruling out harms), but has little or no effect on all-cause or cardiovascular disease mortality. The mechanism may be via lipid reduction, but increasing PUFA probably slightly increases weight. PMID: 30019767 [PubMed - as supplied by publisher] ...
Source: Cochrane Database of Systematic Reviews - July 18, 2018 Category: General Medicine Authors: Abdelhamid AS, Martin N, Bridges C, Brainard JS, Wang X, Brown TJ, Hanson S, Jimoh OF, Ajabnoor SM, Deane KH, Song F, Hooper L Tags: Cochrane Database Syst Rev Source Type: research

Environmental and behavioural modifications for improving food and fluid intake in people with dementia.
CONCLUSIONS: Due to the quantity and quality of the evidence currently available, we cannot identify any specific environmental or behavioural modifications for improving food and fluid intake in people with dementia. PMID: 30021248 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 18, 2018 Category: General Medicine Authors: Herke M, Fink A, Langer G, Wustmann T, Watzke S, Hanff AM, Burckhardt M Tags: Cochrane Database Syst Rev Source Type: research

Vaginal preparation with antiseptic solution before cesarean section for preventing postoperative infections.
CONCLUSIONS: Vaginal preparation with povidone-iodine or chlorhexidine solution compared to saline or not cleansing immediately before cesarean delivery probably reduces the risk of post-cesarean endometritis. Subgroup analysis could not rule out larger reductions in endometritis with antiseptics in women who were in labor or in women whose membranes had ruptured when antiseptics were used.The quality of the evidence using GRADE was moderate for all reported outcomes. We downgraded the outcome of post-cesarean endometritis and composite of wound complications or endometritis for risk of bias and postoperative fever and pos...
Source: Cochrane Database of Systematic Reviews - July 17, 2018 Category: General Medicine Authors: Haas DM, Morgan S, Contreras K, Enders S Tags: Cochrane Database Syst Rev Source Type: research

Nurses as substitutes for doctors in primary care.
CONCLUSIONS: This review shows that for some ongoing and urgent physical complaints and for chronic conditions, trained nurses, such as nurse practitioners, practice nurses, and registered nurses, probably provide equal or possibly even better quality of care compared to primary care doctors, and probably achieve equal or better health outcomes for patients. Nurses probably achieve higher levels of patient satisfaction, compared to primary care doctors. Furthermore, consultation length is probably longer when nurses deliver care and the frequency of attended return visits is probably slightly higher for nurses, compared to...
Source: Cochrane Database of Systematic Reviews - July 16, 2018 Category: General Medicine Authors: Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJ Tags: Cochrane Database Syst Rev Source Type: research

Parent training interventions for parents with intellectual disability.
CONCLUSIONS: There is some very low-quality evidence that some parents, mainly mothers, with intellectual disabilities are able to provide adequate parenting if they are given appropriate training and support to learn the parenting skills they need. However, there are few studies exploring how interventions might work, for whom and in what circumstances. In particular, there have been few studies that include fathers with intellectual disabilities, or that explore the views of parents themselves.There is a need for larger RCTs of parenting interventions, with longer follow-up, before conclusions can be drawn about the effe...
Source: Cochrane Database of Systematic Reviews - July 13, 2018 Category: General Medicine Authors: Coren E, Ramsbotham K, Gschwandtner M Tags: Cochrane Database Syst Rev Source Type: research

Antiplatelet and anticoagulant agents for primary prevention of thrombosis in individuals with antiphospholipid antibodies.
CONCLUSIONS: There is insufficient evidence to demonstrate benefit or harm of using anticoagulants with or without ASA versus ASA alone in people with aPL antibodies and a history of recurrent pregnancy loss and with no such history; ASA versus placebo in people with aPL antibodies; and ASA with LMWH versus placebo or IVIG, and ASA with high-dose LMWH versus ASA with low-dose LMWH or UFH, in women with aPL antibodies and a history of recurrent pregnancy loss, for the primary prevention of thrombotic events. In a mixed population of people with a history of previous pregnancy loss and without such a history treated with ant...
Source: Cochrane Database of Systematic Reviews - July 13, 2018 Category: General Medicine Authors: Bala MM, Paszek E, Lesniak W, Wloch-Kopec D, Jasinska K, Undas A Tags: Cochrane Database Syst Rev Source Type: research

Calcium channel blockers for preventing cardiomyopathy due to iron overload in people with transfusion-dependent beta thalassaemia.
CONCLUSIONS: The available evidence does not clearly suggest that the use of calcium channel blockers is associated with a reduction in myocardial iron in people with transfusion-dependent beta thalassaemia, although a potential for this was seen. There is a need for more long-term, multicentre trials to assess the efficacy and safety of calcium channel blockers for myocardial iron overload, especially in younger children. Future trials should be designed to compare commonly used iron chelation drugs with the addition of calcium channel blockers to investigate the potential interplay of these treatments. In addition, the r...
Source: Cochrane Database of Systematic Reviews - July 12, 2018 Category: General Medicine Authors: Sadaf A, Hasan B, Das JK, Colan S, Alvi N Tags: Cochrane Database Syst Rev Source Type: research

Nivolumab for adults with Hodgkin's lymphoma (a rapid review using the software RobotReviewer).
CONCLUSIONS: To date, data on OS, quality of life, PFS, response rate, or short- and long-term AEs are available from small uncontrolled trials only. The three trials included heavily pretreated participants, which had previously undergone regimens of BV or ASCT. For these participants, median OS was not reached after follow-up times of at least 16 months (more than 50% of participants with a limited life expectancy were alive at this timepoint). Only one cohort out of three only reported quality of life, with limited follow-up data so that meaningful conclusions were not possible. Serious adverse events occurred rarely. C...
Source: Cochrane Database of Systematic Reviews - July 12, 2018 Category: General Medicine Authors: Goldkuhle M, Dimaki M, Gartlehner G, Monsef I, Dahm P, Glossmann JP, Engert A, von Tresckow B, Skoetz N Tags: Cochrane Database Syst Rev Source Type: research

Anticoagulation for perioperative thromboprophylaxis in people with cancer.
CONCLUSIONS: We found no difference between perioperative thromboprophylaxis with LMWH versus UFH and LMWH compared with fondaparinux in their effects on mortality, thromboembolic outcomes, major bleeding, or minor bleeding in people with cancer. There was a lower incidence of wound hematoma with LMWH compared to UFH. PMID: 29993117 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 11, 2018 Category: General Medicine Authors: Matar CF, Kahale LA, Hakoum MB, Tsolakian IG, Etxeandia-Ikobaltzeta I, Yosuico VE, Terrenato I, Sperati F, Barba M, Schünemann H, Akl EA Tags: Cochrane Database Syst Rev Source Type: research

Mirror therapy for improving motor function after stroke.
CONCLUSIONS: The results indicate evidence for the effectiveness of mirror therapy for improving upper extremity motor function, motor impairment, activities of daily living, and pain, at least as an adjunct to conventional rehabilitation for people after stroke. Major limitations are small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality. PMID: 29993119 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 11, 2018 Category: General Medicine Authors: Thieme H, Morkisch N, Mehrholz J, Pohl M, Behrens J, Borgetto B, Dohle C Tags: Cochrane Database Syst Rev Source Type: research

Clobazam monotherapy for focal or generalized seizures.
CONCLUSIONS: We found no advantage for clobazam over carbamazepine for retention at 12 months in drug-naive children and a slight advantage of clobazam over phenytoin for retention at six months in adolescents and adults with neurocysticercosis in a single clinical trial each. At present, the available evidence is insufficient to inform clinical practice. PMID: 29995989 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 11, 2018 Category: General Medicine Authors: Arya R, Giridharan N, Anand V, Garg SK Tags: Cochrane Database Syst Rev Source Type: research

Injectable local anaesthetic agents for dental anaesthesia.
CONCLUSIONS: For success (absence of pain), low-quality evidence suggests that 4% articaine, 1:100,000 epinephrine was superior to 2% lidocaine, 1:100,000 epinephrine for root treating of posterior teeth with irreversible pulpitis, and 2% lidocaine, 1:100,000 epinephrine was superior to 4% prilocaine plain when surgical procedures/periodontal treatment was provided. Moderate-quality evidence shows that 2% lidocaine, 1:100,000 epinephrine was superior to 3% prilocaine, 0.03 IU felypressin when surgical procedures were performed.Adverse events were rare. Moderate-quality evidence shows no difference in pain on injection when...
Source: Cochrane Database of Systematic Reviews - July 10, 2018 Category: General Medicine Authors: St George G, Morgan A, Meechan J, Moles DR, Needleman I, Ng YL, Petrie A Tags: Cochrane Database Syst Rev Source Type: research

Interventions for the treatment of brain radionecrosis after radiotherapy or radiosurgery.
CONCLUSIONS: There is a lack of good certainty evidence to help quantify the risks and benefits of interventions for the treatment of brain radionecrosis after radiotherapy or radiosurgery. In an RCT of 14 patients, bevacizumab showed radiological response which was associated with minimal improvement in cognition or symptom severity. Although it was a randomised trial by design, the small sample size limits the quality of data. A trial of edaravone plus corticosteroids versus corticosteroids alone reported greater reduction in the surrounding oedema with combination treatment but no effect on the enhancing radionecrosis l...
Source: Cochrane Database of Systematic Reviews - July 9, 2018 Category: General Medicine Authors: Chung C, Bryant A, Brown PD Tags: Cochrane Database Syst Rev Source Type: research

Intraoperative use of low volume ventilation to decrease postoperative mortality, mechanical ventilation, lengths of stay and lung injury in adults without acute lung injury.
CONCLUSIONS: We found moderate-quality evidence that low tidal volumes (defined as less than 10 mL/kg) decreases pneumonia and the need for postoperative ventilatory support (invasive and non-invasive). We found no difference in the risk of barotrauma (pneumothorax), but the number of participants included does not allow us to make definitive statement on this. The four studies in 'Studies awaiting classification' may alter the conclusions of the review once assessed. PMID: 29985541 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 9, 2018 Category: General Medicine Authors: Guay J, Ochroch EA, Kopp S Tags: Cochrane Database Syst Rev Source Type: research

Interventions for recurrent corneal erosions.
CONCLUSIONS: Well-designed, masked, randomised controlled trials using standardised methods are needed to establish the benefits of new and existing prophylactic and treatment regimes for recurrent corneal erosion. Studies included in this review have been of insufficient size and quality to provide firm evidence to inform the development of management guidelines. International consensus is also needed to progress research efforts towards evaluation of the major effective treatments for recurrent corneal erosions. PMID: 29985545 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 9, 2018 Category: General Medicine Authors: Watson SL, Leung V Tags: Cochrane Database Syst Rev Source Type: research

Ketorolac for postoperative pain in children.
CONCLUSIONS: Due to the lack of data for our primary outcomes, and the very low-quality evidence for secondary outcomes, the efficacy and safety of ketorolac in treating postoperative pain in children were both uncertain. The evidence was insufficient to support or reject its use. PMID: 29981164 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 7, 2018 Category: General Medicine Authors: McNicol ED, Rowe E, Cooper TE Tags: Cochrane Database Syst Rev Source Type: research

Remote ischaemic conditioning for preventing and treating ischaemic stroke.
CONCLUSIONS: We found low-quality evidence that RIC may reduce the risk of recurrent stroke in participants with intracerebral artery stenosis and reduce stroke severity in participants undergoing carotid stenting, but it may increase death or dependence in participants with acute ischaemic stroke who are undergoing intravenous thrombolysis. However, there is considerable uncertainty about these conclusions because of the small number of studies and low quality of the evidence. PMID: 29974450 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 5, 2018 Category: General Medicine Authors: Zhao W, Zhang J, Sadowsky MG, Meng R, Ding Y, Ji X Tags: Cochrane Database Syst Rev Source Type: research

Effects of total fat intake on bodyweight in children.
CONCLUSIONS: We were unable to reach firm conclusions. Limited evidence from three trials that randomised children to dietary counselling or education to lower total fat intake (30% or less TE) versus usual or modified fat intake, but with no intention to reduce weight, showed small reductions in body mass index, total- and LDL-cholesterol at some time points with lower fat intake compared to controls. There were no consistent effects on weight, high-density lipoprotein (HDL) cholesterol or height. Associations in cohort studies that related total fat intake to later measures of body fatness in children were inconsistent a...
Source: Cochrane Database of Systematic Reviews - July 5, 2018 Category: General Medicine Authors: Naude CE, Visser ME, Nguyen KA, Durao S, Schoonees A Tags: Cochrane Database Syst Rev Source Type: research

Different infusion durations for preventing platinum-induced hearing loss in children with cancer.
CONCLUSIONS: Since only one eligible RCT evaluating the use of a continuous cisplatin infusion versus a one-hour bolus cisplatin infusion was found, and that had methodological limitations, no definitive conclusions can be made. It should be noted that 'no evidence of effect', as identified in this review, is not the same as 'evidence of no effect'. For other (combinations of) infusion durations and other platinum analogues no eligible studies were identified. More high-quality research is needed. PMID: 29975402 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 5, 2018 Category: General Medicine Authors: van As JW, van den Berg H, van Dalen EC Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Techniques to ascertain correct endotracheal tube placement in neonates.
CONCLUSIONS: There is insufficient evidence to determine the most effective technique for the assessment of correct ETT placement either in the delivery room or the neonatal intensive care unit. Randomised clinical trials comparing either of these techniques with chest radiography are warranted. PMID: 29975802 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - July 5, 2018 Category: General Medicine Authors: Schmölzer GM, Roehr CCC Tags: Cochrane Database Syst Rev Source Type: research

Psychological therapies for the treatment of mental disorders in low- and middle-income countries affected by humanitarian crises.
CONCLUSIONS: There is low quality evidence that psychological therapies have large or moderate effects in reducing PTSD, depressive, and anxiety symptoms in adults living in humanitarian settings in LMICs. By one to four month and six month follow-up assessments treatment effects were smaller. Fewer trials were focused on children and adolescents and they provide very low quality evidence of a beneficial effect of psychological therapies in reducing PTSD symptoms at endpoint. Confidence in these findings is influenced by the risk of bias in the studies and by substantial levels of heterogeneity. More research evidence is n...
Source: Cochrane Database of Systematic Reviews - July 5, 2018 Category: General Medicine Authors: Purgato M, Gastaldon C, Papola D, van Ommeren M, Barbui C, Tol WA Tags: Cochrane Database Syst Rev Source Type: research

Acute tocolysis for uterine tachysystole or suspected fetal distress.
CONCLUSIONS: There is insufficient evidence to determine the effects of tocolytics for uterine tachysystole or suspected fetal distress during labour. The clinical significance for some of the improvements in measures of fetal well-being with tocolytics is unclear. The sample sizes were too small to detect effects on neonatal morbidity, mortality or serious adverse effects. The majority of studies are from high-income countries in facilities with access to caesarean section, which may limit the generalisability of the results to lower-resource settings, or settings where caesarean section is not available.Further well-desi...
Source: Cochrane Database of Systematic Reviews - July 4, 2018 Category: General Medicine Authors: Leathersich SJ, Vogel JP, Tran TS, Hofmeyr GJ Tags: Cochrane Database Syst Rev Source Type: research

Negative pressure wound therapy for open traumatic wounds.
CONCLUSIONS: There is moderate-certainty evidence for no clear difference between NPWT and standard care on the proportion of wounds healed at six weeks for open fracture wounds. There is moderate-certainty evidence that NPWT is not a cost-effective treatment for open fracture wounds. Moderate-certainty evidence means that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. It is uncertain whether there is a difference in risk of wound infection, adverse events, time to closure or coverage surgery, pain or health-related quality of life between...
Source: Cochrane Database of Systematic Reviews - July 3, 2018 Category: General Medicine Authors: Iheozor-Ejiofor Z, Newton K, Dumville JC, Costa ML, Norman G, Bruce J Tags: Cochrane Database Syst Rev Source Type: research

Antifibrinolytic therapy for preventing oral bleeding in people on anticoagulants undergoing minor oral surgery or dental extractions.
CONCLUSIONS: Based on the results of this Cochrane Review, there seems to be a beneficial effect of locally applied TXA in preventing oral bleeding in people on continuous treatment with VKAs undergoing minor oral surgery or dental extractions. However, the small number of identified randomised controlled trials, the relatively small number of participants included in the trials and the differences in standard therapy and treatment regimens between trials, do not allow us to conclude definite efficacy of antifibrinolytic therapy in this population.We were unable to identify any eligible trials in people on continuous treat...
Source: Cochrane Database of Systematic Reviews - July 2, 2018 Category: General Medicine Authors: Engelen ET, Schutgens RE, Mauser-Bunschoten EP, van Es RJ, van Galen KP Tags: Cochrane Database Syst Rev Source Type: research

Interventions for treating acute high altitude illness.
CONCLUSIONS: There is limited available evidence to determine the effects of non-pharmacological and pharmacological interventions in treating acute high altitude illness. Low-quality evidence suggests that dexamethasone and acetazolamide might reduce AMS score compared to placebo. However, the clinical benefits and harms related to these potential interventions remain unclear. Overall, the evidence is of limited practical significance in the clinical field. High-quality research in this field is needed, since most trials were poorly conducted and reported. PMID: 29959871 [PubMed - as supplied by publisher] (Source: C...
Source: Cochrane Database of Systematic Reviews - June 30, 2018 Category: General Medicine Authors: Simancas-Racines D, Arevalo-Rodriguez I, Osorio D, Franco JV, Xu Y, Hidalgo R Tags: Cochrane Database Syst Rev Source Type: research

Immunosuppressive treatment for proliferative lupus nephritis.
CONCLUSIONS: In this review update, studies assessing treatment for proliferative lupus nephritis were not designed to assess death (all causes) or ESKD. MMF may lead to increased complete disease remission compared with IV cyclophosphamide, with an acceptable adverse event profile, although evidence certainty was low and included the possibility of no difference. Calcineurin combined with lower dose MMF may improve induction of disease remission compared with IV cyclophosphamide, but the comparative safety profile of these therapies is uncertain. Azathioprine may increase disease relapse as maintenance therapy compared wi...
Source: Cochrane Database of Systematic Reviews - June 29, 2018 Category: General Medicine Authors: Tunnicliffe DJ, Palmer SC, Henderson L, Masson P, Craig JC, Tong A, Singh-Grewal D, Flanc RS, Roberts MA, Webster AC, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

HPV vaccination: balancing facts.
PMID: 29957861 [PubMed - in process] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 29, 2018 Category: General Medicine Authors: Morrison J, Lasserson T Tags: Cochrane Database Syst Rev Source Type: research

Cholinesterase inhibitors for the treatment of delirium in non-ICU settings.
CONCLUSIONS: There is insufficient evidence to support or refute the use of cholinesterase inhibitors for the treatment of delirium in non-ICU settings. No clear benefits or harms associated with cholinesterase inhibitors were observed when compared with placebo due to the lack of data. More trials are required. PMID: 29952000 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 28, 2018 Category: General Medicine Authors: Yu A, Wu S, Zhang Z, Dening T, Zhao S, Pinner G, Xia J, Yang D Tags: Cochrane Database Syst Rev Source Type: research

Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction.
CONCLUSIONS: There is evidence that MRA treatment reduces heart failure hospitalisation in heart failure with preserverd ejection fraction, however the effects on mortality related outcomes and quality of life remain unclear. The available evidence for beta-blockers, ACEI, ARB and ARNI is limited and it remains uncertain whether these treatments have a role in the treatment of HFpEF in the absence of an alternative indication for their use. This comprehensive review highlights a persistent gap in the evidence that is currently being addressed through several large ongoing clinical trials. PMID: 29952095 [PubMed - as s...
Source: Cochrane Database of Systematic Reviews - June 28, 2018 Category: General Medicine Authors: Martin N, Manoharan K, Thomas J, Davies C, Lumbers RT Tags: Cochrane Database Syst Rev Source Type: research

Lamotrigine versus carbamazepine monotherapy for epilepsy: an individual participant data review.
CONCLUSIONS: Moderate quality evidence indicates that treatment failure for any reason related to treatment or due to adverse events occurs significantly earlier on carbamazepine than lamotrigine, but the results for time to first seizure suggested that carbamazepine may be superior in terms of seizure control. The choice between these first-line treatments must be made with careful consideration. We recommend that future trials should be designed to the highest quality possible with consideration of masking, choice of population, classification of seizure type, duration of follow-up, choice of outcomes and analysis, and p...
Source: Cochrane Database of Systematic Reviews - June 28, 2018 Category: General Medicine Authors: Nevitt SJ, Tudur Smith C, Weston J, Marson AG Tags: Cochrane Database Syst Rev Source Type: research

Interventions for chronic non-hypovolaemic hypotonic hyponatraemia.
CONCLUSIONS: In people with chronic hyponatraemia, vasopressin receptor antagonists modestly raise serum sodium concentration at the cost of a 3% increased risk of it being rapid. To date there is very low certainty evidence for patient-important outcomes; the effects on mortality and health-related quality of life are unclear and do not rule out appreciable benefit or harm; there does not appear to be an important effect on cognitive function, but hospital stay may be slightly shorter, although available data are limited. Treatment decisions must weigh the value of an increase in serum sodium concentration against its sho...
Source: Cochrane Database of Systematic Reviews - June 28, 2018 Category: General Medicine Authors: Nagler EV, Haller MC, Van Biesen W, Vanholder R, Craig JC, Webster AC Tags: Cochrane Database Syst Rev Source Type: research

Influenza vaccine for chronic obstructive pulmonary disease (COPD).
CONCLUSIONS: It appeared, from the limited number of RCTs we were able to include, all of which were more than a decade old, that inactivated vaccine reduced exacerbations in people with COPD. The size of effect was similar to that seen in large observational studies, and was due to a reduction in exacerbations occurring three or more weeks after vaccination, and due to influenza. There was a mild increase in transient local adverse effects with vaccination, but no evidence of an increase in early exacerbations. Addition of live attenuated virus to the inactivated vaccine was not shown to confer additional benefit. PM...
Source: Cochrane Database of Systematic Reviews - June 26, 2018 Category: General Medicine Authors: Kopsaftis Z, Wood-Baker R, Poole P Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological treatment for attention deficit hyperactivity disorder (ADHD) in children with comorbid tic disorders.
CONCLUSIONS: Following an updated search of potentially relevant studies, we found no new studies that matched our inclusion criteria and thus our conclusions have not changed.Methylphenidate, clonidine, guanfacine, desipramine, and atomoxetine appear to reduce ADHD symptoms in children with tics though the quality of the available evidence was low to very low. Although stimulants have not been shown to worsen tics in most people with tic disorders, they may, nonetheless, exacerbate tics in individual cases. In these instances, treatment with alpha agonists or atomoxetine may be an alternative. Although there is ...
Source: Cochrane Database of Systematic Reviews - June 26, 2018 Category: General Medicine Authors: Osland ST, Steeves TD, Pringsheim T Tags: Cochrane Database Syst Rev Source Type: research

Antibiotics for exacerbations of asthma.
CONCLUSIONS: We found limited evidence that antibiotics given at the time of an asthma exacerbation may improve symptoms and PEFR at follow-up compared with standard care or placebo. However, findings were inconsistent across the six heterogeneous studies included, two of the studies were conducted over 30 years ago and most of the participants included in this review were recruited from emergency departments, limiting the applicability of findings to this population. Therefore we have limited confidence in the results. We found insufficient evidence about several patient-important outcomes (e.g. hospital admission) to for...
Source: Cochrane Database of Systematic Reviews - June 25, 2018 Category: General Medicine Authors: Normansell R, Sayer B, Waterson S, Dennett EJ, Del Forno M, Dunleavy A Tags: Cochrane Database Syst Rev Source Type: research

Automated monitoring compared to standard care for the early detection of sepsis in critically ill patients.
CONCLUSIONS: It is unclear what effect automated systems for monitoring sepsis have on any of the outcomes included in this review. Very low-quality evidence is only available on automated alerts, which is only one component of automated monitoring systems. It is uncertain whether such systems can replace regular, careful review of the patient's condition by experienced healthcare staff. PMID: 29938790 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 25, 2018 Category: General Medicine Authors: Warttig S, Alderson P, Evans DJ, Lewis SR, Kourbeti IS, Smith AF Tags: Cochrane Database Syst Rev Source Type: research

Botulinum toxins for the prevention of migraine in adults.
CONCLUSIONS: In chronic migraine, botulinum toxin type A may reduce the number of migraine days per month by 2 days compared with placebo treatment. Non-serious adverse events were probably experienced by 60/100 participants in the treated group compared with 47/100 in the placebo group. For people with episodic migraine, we remain uncertain whether or not this treatment is effective because the quality of this limited evidence is very low. Better reporting of outcome measures in published trials would provide a more complete evidence base on which to draw conclusions. PMID: 29939406 [PubMed - as supplied by publisher...
Source: Cochrane Database of Systematic Reviews - June 25, 2018 Category: General Medicine Authors: Herd CP, Tomlinson CL, Rick C, Scotton WJ, Edwards J, Ives N, Clarke CE, Sinclair A Tags: Cochrane Database Syst Rev Source Type: research

Early planned removal versus expectant management of peripherally inserted central catheters to prevent infection in newborn infants.
CONCLUSIONS: There are no trial data to guide practice regarding early planned removal versus expectant management of PICCs in newborn infants. A simple and pragmatic randomised controlled trial is needed to resolve the uncertainty about optimal management in this common and important clinical dilemma. PMID: 29940073 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 25, 2018 Category: General Medicine Authors: Gordon A, Greenhalgh M, McGuire W Tags: Cochrane Database Syst Rev Source Type: research

Descemet's membrane endothelial keratoplasty (DMEK) versus Descemet's stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure.
CONCLUSIONS: This review included studies conducted on people with corneal endothelium failure due to FED for whom both DMEK and DSAEK can be considered, and found low-certainty evidence that DMEK provides some advantage in terms of final BCVA, at the cost of more graft dislocations needing 're-bubbling' (very low-certainty of evidence). PMID: 29940078 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 25, 2018 Category: General Medicine Authors: Stuart AJ, Romano V, Virgili G, Shortt AJ Tags: Cochrane Database Syst Rev Source Type: research

Fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery.
CONCLUSIONS: Based on the current available evidence, fibrin sealants may have little or no effect on postoperative pancreatic fistula in people undergoing distal pancreatectomy. The effects of fibrin sealants on the prevention of postoperative pancreatic fistula are uncertain in people undergoing pancreaticoduodenectomy. PMID: 29934987 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 23, 2018 Category: General Medicine Authors: Gong J, He S, Cheng Y, Cheng N, Gong J, Zeng Z Tags: Cochrane Database Syst Rev Source Type: research

Protein supplementation of human milk for promoting growth in preterm infants.
CONCLUSIONS: Low-quality evidence showed that protein supplementation of human milk, fed to preterm infants, increased short-term growth. However, the small sample sizes, low precision, and very low-quality evidence regarding duration of hospital stay, feeding intolerance, and necrotising enterocolitis precluded any conclusions about these outcomes. There were no data on outcomes after hospital discharge. Our findings may not be generalisable to low-resource settings, as none of the included studies were conducted in these settings.Since protein supplementation of human milk is now usually done as a component of multi-nutr...
Source: Cochrane Database of Systematic Reviews - June 22, 2018 Category: General Medicine Authors: Amissah EA, Brown J, Harding JE Tags: Cochrane Database Syst Rev Source Type: research

Saline irrigation for allergic rhinitis.
CONCLUSIONS: Saline irrigation may reduce patient-reported disease severity compared with no saline irrigation at up to three months in both adults and children with allergic rhinitis, with no reported adverse effects. No data were available for any outcomes beyond three months. The overall quality of evidence was low or very low. The included studies were generally small and used a range of different outcome measures to report disease severity scores, with unclear validation. This review did not include direct comparisons of saline types (e.g. different volume, tonicity).Since saline irrigation could provide a cheap, safe...
Source: Cochrane Database of Systematic Reviews - June 22, 2018 Category: General Medicine Authors: Head K, Snidvongs K, Glew S, Scadding G, Schilder AG, Philpott C, Hopkins C Tags: Cochrane Database Syst Rev Source Type: research

Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults.
CONCLUSIONS: There is low-quality evidence relating to the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD; some trials reported small benefits while others found no effect. There is low-quality evidence that these interventions do not result in harm. On the basis of this review, there is currently uncertainty around the effectiveness of these interventions. We identified six ongoing trials being conducted in a range of contexts including low-income settings with potential to generate more precise estimates of the effect of primary prevention ...
Source: Cochrane Database of Systematic Reviews - June 22, 2018 Category: General Medicine Authors: Palmer MJ, Barnard S, Perel P, Free C Tags: Cochrane Database Syst Rev Source Type: research

Prophylactic abdominal drainage for pancreatic surgery.
CONCLUSIONS: It was unclear whether routine abdominal drainage had any effect on the reduction of mortality at 30 days, or postoperative complications after pancreatic surgery. Moderate-quality evidence suggested that routine abdominal drainage probably slightly reduced mortality at 90 days. Low-quality evidence suggested that use of an active drain compared to the use of a passive drain may slightly reduce the length of hospital stay after pancreatic surgery, and early removal may be superior to late removal for people with low risk of postoperative pancreatic fistula. PMID: 29928755 [PubMed - as supplied by publishe...
Source: Cochrane Database of Systematic Reviews - June 21, 2018 Category: General Medicine Authors: Zhang W, He S, Cheng Y, Xia J, Lai M, Cheng N, Liu Z Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological therapies for management of opium withdrawal.
CONCLUSIONS: Results did not support using any specific pharmacological approach for the management of opium withdrawal due to generally very low-quality evidence and small or no differences between treatments. However, it seems that opium withdrawal symptoms are significant, especially at days 2 to 4 after discontinuation of opium. All of the assessed medications might be useful in alleviating symptoms. Those who receive clonidine might experience hypotension. PMID: 29929212 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - June 21, 2018 Category: General Medicine Authors: Rahimi-Movaghar A, Gholami J, Amato L, Hoseinie L, Yousefi-Nooraie R, Amin-Esmaeili M Tags: Cochrane Database Syst Rev Source Type: research