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Management of faecal incontinence and constipation in adults with central neurological diseases.
CONCLUSIONS: There is still remarkably little research on this common and, to patients, very significant issue of bowel management. The available evidence is almost uniformly of low methodological quality. The clinical significance of some of the research findings presented here is difficult to interpret, not least because each intervention has only been addressed in individual trials, against control rather than compared against each other, and the interventions are very different from each other.There was very limited evidence from individual trials in favour of a bulk-forming laxative (psyllium), an isosmotic macrogol l...
Source: Cochrane Database of Systematic Reviews - December 18, 2013 Category: Journals (General) Authors: Coggrave M, Norton C Tags: Cochrane Database Syst Rev Source Type: research

Cooling for cerebral protection during brain surgery.
CONCLUSIONS: We found no evidence that the use of induced hypothermia was associated with a significant reduction in mortality or severe neurological disability, or an increase in harm in patients undergoing neurosurgery. PMID: 25626888 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - February 3, 2015 Category: Journals (General) Authors: Galvin IM, Levy R, Boyd JG, Day AG, Wallace MC Tags: Cochrane Database Syst Rev Source Type: research

WITHDRAWN: Pharmacological cardioversion for atrial fibrillation and flutter.
CONCLUSIONS: There is no evidence that pharmacological cardioversion of atrial fibrillation to sinus rhythm is superior to rate control. Rhythm control is associated with more adverse effects and increased hospitalisation. It does not reduce the risk of stroke. The conclusions cannot be generalised to all people with atrial fibrillation. Most of the patients included in these studies were relatively older (>60 years) with significant cardiovascular risk factors. PMID: 29140557 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 15, 2017 Category: General Medicine Authors: Cordina J, Mead GE Tags: Cochrane Database Syst Rev Source Type: research

Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular events.
CONCLUSIONS: The available evidence demonstrates that the use of clopidogrel plus aspirin in people at high risk of cardiovascular disease and people with established cardiovascular disease without a coronary stent is associated with a reduction in the risk of myocardial infarction and ischaemic stroke, and an increased risk of major and minor bleeding compared with aspirin alone. According to GRADE criteria, the quality of evidence was moderate for all outcomes except all-cause mortality (low quality evidence) and adverse events (very low quality evidence). PMID: 29240976 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 14, 2017 Category: General Medicine Authors: Squizzato A, Bellesini M, Takeda A, Middeldorp S, Donadini MP Tags: Cochrane Database Syst Rev Source Type: research

Withdrawal of antihypertensive drugs in older people.
CONCLUSIONS: There is no evidence of an effect of discontinuing compared with continuing antihypertensives used for hypertension or primary prevention of cardiovascular disease in older adults on all-cause mortality and myocardial infarction. The evidence was low to very low certainty mainly due to small studies and low event rates. These limitations mean that we cannot make any firm conclusions about the effect of deprescribing antihypertensives on these outcomes. Future research should focus on populations with the greatest uncertainty of the benefit:risk ratio for use of antihypertensive medications, such as those with ...
Source: Cochrane Database of Systematic Reviews - June 9, 2020 Category: General Medicine Authors: Reeve E, Jordan V, Thompson W, Sawan M, Todd A, Gammie TM, Hopper I, Hilmer SN, Gnjidic D Tags: Cochrane Database Syst Rev Source Type: research

High versus low blood pressure targets for cardiac surgery while on cardiopulmonary bypass
CONCLUSIONS: A high blood pressure target may result in little to no difference in patient outcomes including acute kidney injury and mortality. Given the wide CIs, further studies are needed to confirm the efficacy of a higher blood pressure target among those who undergo cardiac surgery with CPB.PMID:36448514 | DOI:10.1002/14651858.CD013494.pub2
Source: Cochrane Database of Systematic Reviews - November 30, 2022 Category: General Medicine Authors: Yuki Kotani Yuki Kataoka Junichi Izawa Shoko Fujioka Takuo Yoshida Junji Kumasawa Joey Sw Kwong Source Type: research

Remote ischaemic preconditioning versus no remote ischaemic preconditioning for vascular and endovascular surgical procedures
CONCLUSIONS: Overall, compared with no RIPC, RIPC probably leads to little or no difference in perioperative mortality, myocardial infarction, renal impairment, stroke, hospital stay, and operating time, and may lead to little or no difference in limb loss in people undergoing elective major vascular and endovascular surgery. Adequately powered and designed randomised studies are needed, focusing in particular on the clinical endpoints and patient-centred outcomes.PMID:36645250 | DOI:10.1002/14651858.CD008472.pub3
Source: Cochrane Database of Systematic Reviews - January 16, 2023 Category: General Medicine Authors: Fuxiang Liang Shidong Liu Guangzu Liu Hongxu Liu Bing Song Liang Yao Qi Wang Source Type: research

Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation.
CONCLUSIONS: Factor Xa inhibitors significantly reduced the number of strokes and systemic embolic events compared with warfarin in patients with AF. Factor Xa inhibitors also seem to reduce the number of major bleedings and ICHs compared with warfarin, though the evidence for a reduction of major bleedings is somewhat less robust. There is currently no conclusive evidence to determine which factor Xa inhibitor is more effective and safer for long-term anticoagulant treatment of patients with AF as head-to-head studies of the different factor Xa inhibitors have not yet been performed. PMID: 23925867 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 8, 2013 Category: Journals (General) Authors: Bruins Slot KM, Berge E Tags: Cochrane Database Syst Rev Source Type: research

Anticoagulation versus placebo for heart failure in sinus rhythm.
CONCLUSIONS: Based on the two major randomised trials (HELAS 2006; WASH 2004), there is no convincing evidence that oral anticoagulant therapy modifies mortality or vascular events in patients with heart failure and sinus rhythm. Although oral anticoagulation is indicated in certain groups of patients with heart failure (for example those with atrial fibrillation), the available data does not support the routine use of anticoagulation in heart failure patients who remain in sinus rhythm. PMID: 24683002 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 28, 2014 Category: Journals (General) Authors: Lip GY, Shantsila E Tags: Cochrane Database Syst Rev Source Type: research

Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation.
CONCLUSIONS: Treatment with factor Xa inhibitors significantly reduced the number of strokes and systemic embolic events compared with warfarin in people with AF. The absolute effect of factor Xa inhibitors compared with warfarin treatment was, however, rather small. Factor Xa inhibitors also reduced the number of ICHs, all-cause deaths and major bleedings compared with warfarin, although the evidence for a reduction in the latter is less robust. PMID: 29509959 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 6, 2018 Category: General Medicine Authors: Bruins Slot KM, Berge E Tags: Cochrane Database Syst Rev Source Type: research

Interventions to increase patient and family involvement in escalation of care for acute life-threatening illness in community health and hospital settings.
CONCLUSIONS: Our review identified that interactional patient-facing interventions and multi-component programmes (including staff) to increase patient and family involvement in escalation of care for acute life-threatening illness may improve patient and family knowledge about danger signs and care-seeking responses, and probably have few adverse effects on patient's anxiety levels when compared to usual care. Multi-component interventions probably have little impact on mortality rates. Further high-quality trials are required using multi-component interventions and a focus on relational elements of care. Cognitive and be...
Source: Cochrane Database of Systematic Reviews - December 8, 2020 Category: General Medicine Authors: Mackintosh NJ, Davis RE, Easter A, Rayment-Jones H, Sevdalis N, Wilson S, Adams M, Sandall J Tags: Cochrane Database Syst Rev Source Type: research

Endovascular versus open surgical repair for complicated chronic Type B aortic dissection
CONCLUSIONS: Due to lack of RCTs or CCTs investigating the effectiveness and safety of TEVAR compared to OSR for patients with complicated CBAD, we are unable to provide any evidence to inform decision-making on the optimal intervention for these patients. High-quality RCTs or CCTs addressing this objective are necessary. However, conducting such studies will be challenging for this life-threatening disease.PMID:34905228 | DOI:10.1002/14651858.CD012992.pub2
Source: Cochrane Database of Systematic Reviews - December 14, 2021 Category: General Medicine Authors: Fionnuala Jordan Brian FitzGibbon Edel P Kavanagh Peter McHugh Dave Veerasingam Sherif Sultan Niamh Hynes Source Type: research

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