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Traditional Chinese herbal medicine for vascular dementia.
CONCLUSIONS: We found moderate- to very low-quality evidence of benefit and harm of TCHMs for VaD. Methodological inadequacies need to be addressed by better conducted and reported trials. We identified NaoMaiTai, NaoXinTong and TongXinLuo as warranting special research priority. PMID: 30520514 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 6, 2018 Category: General Medicine Authors: Chan ES, Bautista DT, Zhu Y, You Y, Long JT, Li W, Chen C 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 and arrhythmia risk. PMID: 30521670 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - November 30, 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

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of effects of omega-6 fats on cardiovascular health, mortality, lipids and adiposity to date, using previously unpublished data.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: 3048...
Source: Cochrane Database of Systematic Reviews - November 29, 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

Ezetimibe for the prevention of cardiovascular disease and all-cause mortality events.
CONCLUSIONS: Moderate- to high-quality evidence suggests that ezetimibe has modest beneficial effects on the risk of CVD endpoints, primarily driven by a reduction in non-fatal MI and non-fatal stroke, but it has little or no effect on clinical fatal endpoints. The cardiovascular benefit of ezetimibe might involve the reduction of LDL-C, total cholesterol and triglycerides. There is insufficient evidence to determine whether ezetimibe increases the risk of adverse events due to the low and very low quality of the evidence. The evidence for beneficial effects was mainly obtained from individuals with established atheroscler...
Source: Cochrane Database of Systematic Reviews - November 19, 2018 Category: General Medicine Authors: Zhan S, Tang M, Liu F, Xia P, Shu M, Wu X Tags: Cochrane Database Syst Rev Source Type: research

First-line drugs inhibiting the renin angiotensin system versus other first-line antihypertensive drug classes for hypertension.
CONCLUSIONS: All-cause death is similar for first-line RAS inhibitors and first-line CCBs, thiazides and beta-blockers. There are, however, differences for some morbidity outcomes. First-line thiazides caused less HF and stroke than first-line RAS inhibitors. First-line CCBs increased HF but decreased stroke compared to first-line RAS inhibitors. The magnitude of the increase in HF exceeded the decrease in stroke. Low-quality evidence suggests that first-line RAS inhibitors reduced stroke and total CV events compared to first-line beta-blockers. The small differences in effect on blood pressure between the different classe...
Source: Cochrane Database of Systematic Reviews - November 14, 2018 Category: General Medicine Authors: Chen YJ, Li LJ, Tang WL, Song JY, Qiu R, Li Q, Xue H, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

Acupuncture for hypertension.
CONCLUSIONS: At present, there is no evidence for the sustained BP lowering effect of acupuncture that is required for the management of chronically elevated BP. The short-term effects of acupuncture are uncertain due to the very low quality of evidence. The larger effect shown in non-sham acupuncture controlled trials most likely reflects bias and is not a true effect. Future RCTs must use sham acupuncture controls and assess whether there is a BP lowering effect of acupuncture that lasts at least seven days. PMID: 30480757 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 14, 2018 Category: General Medicine Authors: Yang J, Chen J, Yang M, Yu S, Ying L, Liu GJ, Ren YL, Wright JM, Liang FR Tags: Cochrane Database Syst Rev Source Type: research

Action observation for upper limb rehabilitation after stroke.
CONCLUSIONS: We found evidence that AO is beneficial in improving upper limb motor function and dependence in activities of daily living (ADL) in people with stroke, when compared with any control group; however, we considered the quality of the evidence to be low. We considered the effect of AO on hand function to be large, but it does not appear to be clinically relevant, although we considered the quality of the evidence as moderate. As such, our confidence in the effect estimate is limited because it will likely change with future research. PMID: 30380586 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 31, 2018 Category: General Medicine Authors: Borges LR, Fernandes AB, Melo LP, Guerra RO, Campos TF Tags: Cochrane Database Syst Rev Source Type: research

Swallowing therapy for dysphagia in acute and subacute stroke.
CONCLUSIONS: Moderate- and low-quality evidence suggests that swallowing therapy did not have a significant effect on the outcomes of death or dependency/disability, case fatality at the end of the trial, or penetration aspiration score. However, swallowing therapy may have reduced length of hospital stay, dysphagia, and chest infections, and may have improved swallowing ability. However, these results are based on evidence of variable quality, involving a variety of interventions. Further high-quality trials are needed to test whether specific interventions are effective. PMID: 30376602 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 30, 2018 Category: General Medicine Authors: Bath PM, Lee HS, Everton LF Tags: Cochrane Database Syst Rev Source Type: research

Gamma aminobutyric acid (GABA) receptor agonists for acute stroke.
CONCLUSIONS: This review provides moderate-quality evidence that fails to support the use of GABA receptor agonists (chlormethiazole or diazepam) for the treatment of people with acute stroke. More well-designed RCTs with large samples of participants with total anterior circulation syndrome are required to determine if there are benefits for this subgroup. Somnolence and rhinitis are frequent adverse events related to chlormethiazole. PMID: 30376593 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 30, 2018 Category: General Medicine Authors: Liu J, Zhang J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Interventionist versus expectant care for severe pre-eclampsia between 24 and 34 weeks' gestation.
CONCLUSIONS: This review suggested that an expectant approach to the management of women with severe early onset pre-eclampsia may be associated with decreased morbidity for the baby. However, this evidence was based on data from only six trials. Further large, high-quality trials are needed to confirm or refute these findings, and establish if this approach is safe for the mother. PMID: 30289565 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - October 5, 2018 Category: General Medicine Authors: Churchill D, Duley L, Thornton JG, Moussa M, Ali HS, Walker KF Tags: Cochrane Database Syst Rev Source Type: research

Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke.
CONCLUSIONS: People who receive electromechanical and robot-assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength. However, the results must be interpreted with caution although the quality of the evidence was high, because there were variations between the trials in: the intensity, duration, and amount of training; type of treatment; participant characteristics; and measurements used. PMID: 30175845 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 3, 2018 Category: General Medicine Authors: Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B Tags: Cochrane Database Syst Rev Source Type: research

Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD).
CONCLUSIONS: In studies of adults with CKD G5D treated with dialysis, sevelamer may lower death (all causes) compared to calcium-based binders and incur less treatment-related hypercalcaemia, while we found no clinically important benefits of any phosphate binder on cardiovascular death, myocardial infarction, stroke, fracture or coronary artery calcification. The effects of binders on patient-important outcomes compared to placebo are uncertain. In patients with CKD G2 to G5, the effects of sevelamer, lanthanum, and iron-based phosphate binders on cardiovascular, vascular calcification, and bone outcomes compared to place...
Source: Cochrane Database of Systematic Reviews - August 22, 2018 Category: General Medicine Authors: Ruospo M, Palmer SC, Natale P, Craig JC, Vecchio M, Elder GJ, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

Recanalisation therapies for wake-up stroke.
CONCLUSIONS: There is insufficient evidence from randomised controlled trials for recommendations concerning recanalisation therapies for wake-up stroke. Results from ongoing trials will hopefully establish the efficacy and safety of such therapies. PMID: 30129656 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 21, 2018 Category: General Medicine Authors: Roaldsen MB, Lindekleiv H, Mathiesen EB, Berge E Tags: Cochrane Database Syst Rev Source Type: research

Surgery versus thrombolysis for initial management of acute limb ischaemia.
CONCLUSIONS: There is currently no evidence in favour of either initial thrombolysis or initial surgery as the preferred option in terms of limb salvage, amputation, or death at 30 days, six months, or one year. Low-quality evidence suggests that thrombolysis may be associated with higher risk of haemorrhagic complications and ongoing limb ischaemia (distal embolisation). The higher risk of complications must be balanced against risks of surgery in each individual case. Trial results show no statistical difference in stroke, but the confidence interval is very wide, making it difficult to interpret whether this finding is ...
Source: Cochrane Database of Systematic Reviews - August 10, 2018 Category: General Medicine Authors: Darwood R, Berridge DC, Kessel DO, Robertson I, Forster R Tags: Cochrane Database Syst Rev Source Type: research

Red blood cell transfusion to treat or prevent complications in sickle cell disease: an overview of Cochrane reviews.
CONCLUSIONS: This overview provides support from two high-quality Cochrane Reviews for the use of RBC transfusions in preventing stroke in children and adolescents at high risk of stroke (abnormal TCDs or SCI) and evidence that it may decrease the risk of SCI in children with abnormal TCD velocities. In addition RBC transfusions may reduce the risk of ACS and painful crisis in this population.This overview highlights the lack of high-quality evidence in adults with SCD and the number of reviews that have no evidence for the use of RBC transfusions across a spectrum of SCD complications. Also of concern is the variable and ...
Source: Cochrane Database of Systematic Reviews - August 1, 2018 Category: General Medicine Authors: Fortin PM, Hopewell S, Estcourt LJ Tags: Cochrane Database Syst Rev Source Type: research

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