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  • What are the benefits and risks of different materials used for retrograde
           filling in people who need this treatment in order to save a tooth'

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      Authors: Li H;Guo Z;Li C;Ma X;Wang Y;Zhou X;Johnson TM;Huang D
      Abstract: Updated
      Authors :  Li H, Guo Z, Li C, Ma X, Wang Y, Zhou X, Johnson TM, Huang D Key messages - Due to a lack of robust evidence, the benefits and risks of different materials used for retrograde filling in root canal therapy are unclear.- The evidence is not robust enough to determine which material is best to use in retrograde filling.- We need future studies to strengthen the evidence. What is retrograde filling in root canal therapy' The living part of the tooth, also known as the tooth pulp, can become permanently swollen because of damage or bacterial infection due to tooth decay. To deal with this problem, the dentist has to drill a hole on the top of the crown of the tooth to access the inner space of the tooth, the root canal system. The dentist will then remove the infected tissue and bacteria by a combination of mechanical cleaning and irrigation.After this is done, the dentist fills the space with an inactive packing material and seals the opening. This treatment is known as root canal therapy. Although results are generally good, a small number of failures can happen. This can be because the root canal system is complex and it is not always easy to completely eliminate all bacteria. These can spread and the infection around the root can last indefinitely.When root canal therapy fails, a retreatment called retrograde filling is a good alternative to save the tooth. During retrograde filling the dentist cuts a flap in the gum and creates a hole in the bone to get access to the bottom tip of the root of the tooth. After cutting off the tip, followed by thorough preparation, the apex is sealed (the apical seal), and the hole made by the dentist filled with a dental material. This sealing process is considered the most important factor in achieving success in a retrograde root filling. What materials can be used for retrograde filling' Many materials have been developed to seal the root tip, for example, mineral trioxide aggregate (MTA), intermediate restorative material (IRM), super ethoxybenzoic acid (Super-EBA), dentine-bonded resin composite, glass ionomer cement, amalgam, and root repair material (RRM). However, there is no agreement on which material is best. What did we want to find out' We wanted to find out which material works better for retrograde filling in root canal therapy, and whether they are associated with any unwanted (adverse) effects. What did we do' We searched for studies that compared different materials used for retrograde filling in root canal therapy. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes. What did we find' We found eight studies with a minimum duration of 12 months that involved 1399 people (1471 teeth) over 17 years of age undergoing retrograde filling using different types of filling material.The evidence:- is not robust enough to determine which material is best to use in retrograde filling.No studies investigated the unwanted effects of any of the materials. What are the limitations of the evidence' The main limitations of the evidence are that studies:- were very small;- were conducted in ways that may have introduced errors into their results; and- there were not enough studies to be certain about the results.Due to these limitations, we have little confidence in the evidence. How up to date is this evidence' The evidence is up to date to April 2021.
      PubDate: Thu, 14 Oct 2021 00:00:00 +020
       
  • Humour-based interventions for people with schizophrenia

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      Authors: Tsujimoto Y;Nakamura Y;Banno M;Kohmura K;Tsujimoto H;Kataoka Y
      Abstract: New
      Authors :  Tsujimoto Y, Nakamura Y, Banno M, Kohmura K, Tsujimoto H, Kataoka Y Review question Are humour-based interventions effective in treating people with schizophrenia' Background Schizophrenia is a serious mental illness. It is a disorder of thought, namely firm fixed false beliefs despite there being evidence to the contrary, loss of reality ties, and altered perception. These symptoms are further classified as (i) positive symptoms, such as speech without order, illusions or mistaken and persistent ideas; and (ii) negative symptoms, a lack of emotion or restricted quantity of speech; and decline in cognitive function, including attention, memory, and behavior control. The standard treatment for schizophrenia is antipsychotic medications. Treatment with humour-based interventions, such as watching humorous movies, funny videos, or comedies, has been proposed as an add-on treatment that promotes health and wellness by stimulating a playful discovery, expression, or appreciation of the irrationality or inconsistency of life's situations. Searching for evidence We ran an electronic search in February 2021 for trials that randomised people with schizophrenia to receive humour-based interventions in addition to usual care, or to receive usual care only, another psychological intervention or a control condition. We found eight records and checked them for suitability to include in our review. Evidence found Three trials met the review requirements and two low-quality trials (total number of participants = 96) provided useable data. Compared with active control, humour-based interventions may not improve positive symptoms and anxiety, but may improve depressive symptoms. However, when compared with standard care, humour-based intervention may not improve the depressive symptoms. Current evidence is very limited and is of low to very low quality. We are uncertain as to whether humour-based interventions may lead to clinically-important improvement in mental state or quality of life in people with schizophrenia. Conclusions There is insufficient research evidence to support the use of humour-based interventions in people with schizophrenia.
      PubDate: Wed, 13 Oct 2021 00:00:00 +020
       
  • Is local or general anaesthesia better during surgery to widen the main
           blood vessel to the brain when it becomes narrowed (carotid
           endarterectomy)'

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      Authors: Rerkasem A;Orrapin S;Howard DPJ;Nantakool S;Rerkasem K
      Abstract: Updated
      Authors :  Rerkasem A, Orrapin S, Howard DPJ, Nantakool S, Rerkasem K Key messages - Current evidence does not show any clear difference between local anaesthesia (where the patient remains awake) and general anaesthesia for the risk of stroke, death, or other unwanted effects for people having surgery to widen a narrowed carotid artery (carotid endarterectomy).- Future studies should recruit more people, analyse and publish information from all of them, and make sure that the researchers assessing the outcomes do not know which type of anaesthetic people had. What is a carotid endarterectomy' A stroke happens when blood stops flowing to any part of your brain. The carotid artery is the main vessel supplying blood to the brain. This artery can become narrowed due to fatty deposits that build up over time. Around 1 in 5 strokes is caused by narrowing of the carotid artery. Blood clots can form at the point of narrowing. If a blood clot breaks off into the bloodstream, it can be carried into the brain, where it blocks the blood supply and causes a stroke.A surgical operation – carotid endarterectomy – removes the inner lining, fatty deposits and any blood clots in the carotid artery and can lower the risk of stroke. However, even with very careful surgery, approximately 1 in 20 people will suffer a stroke caused by the operation itself.Anaesthetics are medicines that prevent people feeling pain. Surgeons can use either a local anaesthetic, where an area of the body is numbed, or general anaesthetic, where a person is put to sleep. The use of a local anaesthetic rather than a general anaesthetic might lower the risk of a stroke during or after carotid endarterectomy surgery. What did we want to find out' We wanted to find out if using local anaesthetic for carotid endarterectomy:- lowers the risk of stroke and death around the time of the operation;
      - lowers the rate of other unwanted effects; and
      - is more acceptable to individuals and surgeonswhen compared to general anaesthetic. What did we do' We searched for studies that compared local and general anaesthetics in people who had a carotid endarterectomy. We compared and summarised their results, and rated our confidence in the evidence, based on factors such as study methods and sizes. What did we find' We found 16 studies involving 4839 people. The biggest study included 3526 people and the smallest study had 20 people. The studies were conducted around the world. More men than women were included in the studies, and their average age was 67 years. Main results Local anaesthetic makes little to no difference in risk of stroke within 30 days of surgery compared to general anaesthetic.Local anaesthetic may not reduce risk of death within 30 days of surgery compared to general anaesthetic.Since neither type of anaesthesia has clear benefits over the other, the choice of which to use can be made on the basis of the clinical situation, and the preferences of the surgeon and patient. Main limitations of the evidence We have either little, or moderate, confidence in these results. The quality of the evidence was reduced because, in most studies, it was possible that researchers collecting information about the outcomes of surgery knew which type of anaesthetic people had been given; this could have influenced their assessments. Also, information from some people who were meant to be included in the studies was left out, which also reduces the quality of the evidence. How up to date is this evidence' The evidence is current to February 2021.
      PubDate: Wed, 13 Oct 2021 00:00:00 +020
       
  • Can music interventions benefit people with cancer'

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      Authors: Bradt J;Dileo C;Myers-Coffman K;Biondo J
      Abstract: Updated
      Authors :  Bradt J, Dileo C, Myers-Coffman K, Biondo J The issue
      Cancer may result in extensive emotional, physical and social suffering. Music therapy and music medicine interventions have been used to alleviate symptoms and treatment side effects and address psychosocial needs in people with cancer. In music medicine interventions, patients simply listen to pre-recorded music that is offered by a medical professional. Music therapy requires the implementation of a music intervention by a trained music therapist, the presence of a therapeutic process and the use of personally tailored music experiences. The aim of the review
      This review is an update of a previous Cochrane review from 2016, which included 52 studies. For this review update, we searched for additional trials studying the effect of music interventions on psychological and physical outcomes in people with cancer. We searched for studies up to April 2020. What are the main findings'
      We identified 29 new studies, so the evidence in this review update now rests on 81 studies with 5576 participants. Of the 81 studies, 74 trials included adults and 7 included children.The findings suggest that music therapy and music medicine interventions may have a beneficial effect on anxiety, depression, hope, pain, fatigue, heart rate and blood pressure in adults with cancer. Music therapy but not music medicine interventions may improve adult patients' quality of life and levels of fatigue. We did not find evidence that music interventions improve mood, distress or physical functioning, but only a few trials studied these outcomes. We could not draw any conclusions about the effect of music interventions on immunologic functioning, resilience, spiritual well-being or communication outcomes in adults because there were not enough trials looking at these aspects. Due to the small number of trials, we could not draw conclusions for children. Therefore, more research is needed.Overall, the treatment benefits of music therapy interventions were more consistent across trials than those of music medicine interventions, leading to greater confidence in the treatment impact of music therapy interventions delivered by a trained music therapist.No adverse effects of music interventions were reported. Quality of the evidence
      Most trials were at high risk of bias, so these results need to be interpreted with caution. We did not identify any conflicts of interests in the included studies. What are the conclusions'
      We conclude that music interventions may have beneficial effects on anxiety, depression, hope, pain, and fatigue in adults with cancer. Furthermore, music may have a small positive effect on heart rate and blood pressure. Reduction of anxiety, depression, fatigue and pain are important outcomes for people with cancer, as they have an impact on health and overall quality of life.
      PubDate: Tue, 12 Oct 2021 00:00:00 +020
       
  • Strategies to help adults with a breathing tube to communicate

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      Authors: Rose L;Sutt A-L;Amaral AC;Fergusson DA;Smith OM;Dale CM
      Abstract: New
      Authors :  Rose L, Sutt A-L, Amaral AC, Fergusson DA, Smith OM, Dale CM What is the issue' Patients needing a machine to support breathing cannot speak due to a tube delivering gas to the lungs bypassing their voice box. Patients mouth words, gesture, and use facial expressions. However, these are very difficult to understand. Weakened muscles and difficulty concentrating, which are common in critical illness, makes using aids such as writing equipment or communication boards difficult. Consistent evidence on which communication aids are effective is lacking. Why is this important' Difficulty communicating places people at increased risk of harm, causes distress to patients and family, and causes stress for healthcare staff. What evidence did we find' We searched for studies (to 30 July 2020) exploring aids used to help people with a breathing tube to communicate. We found 11 studies involving 1931 participants admitted to intensive care units. We also looked for studies involving people needing a breathing tube and living at home or in long-term care, but found none. Eight studies used communication boards or apps. Three studies used aids that help a patient to speak with the breathing tube in place. All studies compared the communication aid to routine communication practices. For six studies, routine practice did not include use of any type of communication aid. For the remaining five studies, usual care comprised a range of communication aids routinely used in the participating intensive care units including a communication board, paper notepad, and routine timing of the use of speech aids. We are unsure about whether the early use of aids to help with speaking may increase the number of people who can say words that can be understood or shorten the time to be able to speak. The evidence was of very low quality.Similarly, compared to routine care in which an aid is not used, we are uncertain about the effects of communication boards on patient satisfaction. We are not sure about the effect on psychological distress and quality of life due to uncertainty in the evidence. Communication aids that help people to speak may have little or no effect on intensive care unit length of stay (low-quality evidence). We are uncertain of possible harms  with use of communication aids as only three studies reported this, and all measured different adverse events, and two were very small studies. What does this mean' We are unsure whether using speaking aids in intensive care might increase the number of people who can say words that can be understood. Use of communication boards may increase patient satisfaction, but we are not sure of these findings because of very low-quality evidence. This means further studies are likely to change our understanding of the effects of communication aids. More studies are needed to understand the effects of communication aids, particularly effects on psychological well-being and people's ability to communicate.
      PubDate: Tue, 12 Oct 2021 00:00:00 +020
       
  • Treatment for telangiectasias and reticular veins

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      Authors: Nakano LCU;Cacione DG;Baptista-Silva JCC;Flumignan RLG
      Abstract: New
      Authors :  Nakano LCU, Cacione DG, Baptista-Silva JCC, Flumignan RLG What are telangiectasias and reticular veins' Telangiectasias (spider veins) are small dilated blood vessels near the skin surface measuring less than 1.0 mm in diameter. Reticular veins have a diameter of less than 3.0 mm and are deeper in the skin. The cause is unknown, and they can be solely cosmetic, or can result in pain, burning or itching. Telangiectasias and reticular veins on the legs are very common, increase with age, and have been found in 41% of women over the age of 50 years. Risk factors include family history, pregnancy, local trauma, obesity and hormonal factors How are telangiectasias and reticular veins treated' There are several treatments, such as sclerotherapy, laser, intense pulsed light, microphlebectomy and thermoablation, but none is established as preferable. Unwanted side effects of treatments include hyperpigmentation (skin darkening), matting (new telangiectasis after treatment), allergy and pain. It is therefore important to know the effects of these treatments to help doctors and patients decide which is the best option for them. What did we do' We searched for studies where patients were randomly selected to receive one treatment for spider veins compared to a sham treatment, or to another type of treatment. We then compared the results and summarised the evidence from all the studies. Finally, we assessed how certain we are of the evidence. We considered factors such as the way studies were conducted, study sizes, and consistency of findings across studies. Based on our assessments, we categorised the evidence as being of very low, low, moderate or high certainty. What did we find' We found 35 studies with a combined total of 3632 participants (searched to 16 March 2021). Some studies compared one treatment on one leg to another treatment on the other leg. Studies used a variety of different treatments and none of them reported on all of our outcomes. Not all available treatments were investigated: no studies investigated intensive pulsed light, thermocoagulation or microphlebectomy.Sclerosing agents improved telangiectasias and reticular veins resolution when compared to sham treatment, but resulted in more unwanted side effects (hyperpigmentation and matting). There was no benefit seen in one sclerosing agent compared to another, or compared to laser, for improving telangiectasias. There may be differences between treatments in adverse events and pain. Compared to other agents, polidocanol may result in less pain. Sodium tetradecyl sulphate (STS) may cause more hyperpigmentation, matting and probably more pain; foam may result in more matting; laser treatment may cause less hyperpigmentation. Combined laser plus sclerotherapy may result in better resolution compared to only sclerotherapy, but may cause more pain. How reliable are these results' We are not very confident in these results. We downgraded the certainty of the evidence by one or two levels (from high to moderate or low). This was because of the differences in the designs of the studies, which meant that only small numbers of studies and participants provided information for each treatment comparison. Conclusion Further well-designed studies are needed to improve our confidence in the comparisons identified in this review, for other treatments available, and for other important outcomes, such as recurrence, time to resolution and long-term side effects.
      PubDate: Tue, 12 Oct 2021 00:00:00 +020
       
  • Ultrasound to guide arterial (other than femoral) punctures and
           cannulation in adults

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      Authors: Flumignan RLG;Trevisani VFM;Lopes RD;Baptista-Silva JCC;Flumignan CDQ;Nakano LCU
      Abstract: New
      Authors :  Flumignan RLG, Trevisani VFM, Lopes RD, Baptista-Silva JCC, Flumignan CDQ, Nakano LCU Research question What is the effectiveness and safety of ultrasound technologies to guide arterial (other than femoral) punctures and cannulation in adults' Background Despite the availability of devices that help health professionals to access arteries, unwanted events such as pneumothorax (air outside the lung and inside the thorax), haemothorax (blood outside the lung and inside the thorax), haematoma (blooding in skin and other tissues), amputation, and death may happen. Additional techniques such as ultrasound may be useful for improving these results, but their effects for arterial access in adults remain under debate. Study characteristics Review authors identified 48 studies that evaluated the effects of different types of ultrasound guidance for adults who underwent arterial puncture or cannulation. Studies were conducted in hospitals and mainly for diagnostic purposes (smaller devices). Review authors identified the studies included in this review through electronic literature searches conducted up to May 2021. Key results Real-time visual ultrasound guidance improved first attempt success rate, overall success rate, and time needed for a successful procedure for up to one month, mainly in radial artery, compared to palpation or non-visual ultrasound guidance. In addition, real-time visual ultrasound guidance probably decreased major haematomas compared to palpation. However, we are uncertain about the effects on major haematomas and on pain for other comparisons due to very low-certainty evidence and unreported outcomes. We are also uncertain about the effects on pseudoaneurysm and QoL for axillary and dorsalis pedis arteries catheterisation. Quality of evidence We found very low- to moderate-certainty evidence comparing real-time visual ultrasound guidance versus palpation, and comparing one ultrasound guidance type versus another.
      PubDate: Tue, 12 Oct 2021 00:00:00 +020
       
  • Using patient questionnaires for improving clinical management and
           outcomes

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      Authors: Gibbons C;Porter I;Gonçalves-Bradley DC;Stoilov S;Ricci-Cabello I;Tsangaris E;Gangannagaripalli J;Davey A;Gibbons EJ;Kotzeva A;Evans J;van der Wees PJ;Kontopantelis E;Greenhalgh J;Bower P;Alonso J;Valderas JM
      Abstract: New
      Authors :  Gibbons C, Porter I, Gonçalves-Bradley DC, Stoilov S, Ricci-Cabello I, Tsangaris E, Gangannagaripalli J, Davey A, Gibbons EJ, Kotzeva A, Evans J, van der Wees PJ, Kontopantelis E, Greenhalgh J, Bower P, Alonso J, Valderas JM What is the aim of this review' The aim of this Cochrane Review was to find out whether healthcare workers who receive information from questionnaires completed by their patients give better health care and whether their patients have better health. We collected and analysed all relevant studies. Key messages Patient questionnaire responses fed back to health workers and patients may result in moderate benefits for patient-provider communication and small benefits for patients' quality of life. Healthcare workers probably make and record more diagnoses and take more notes. The intervention probably makes little or no difference for patient's general perceptions of their health, social functioning, and pain. There appears to be no impact on physical and mental functioning, and fatigue. Our confidence in these results is limited by the quality and number of included studies for each outcome. What was studied in the review' When receiving health care, patients are not always asked about how they feel, either about their physical, mental or social health. This can be a problem as knowing how the patient is feeling might help to make decisions about diagnosis and the course of the treatment. One possible solution is to ask the patients to complete questionnaires about their health, and then give that information to the healthcare workers and to patients. What are the main results of the review' We found 116 studies (49,785 participants), all of which were from high-income countries. We found that feeding back patient questionnaire responses to healthcare workers and patients probably slightly improves quality of life and increases communication between patients and their doctors, but probably does not make a lot of difference to social functioning. We are not sure of the impact on physical and mental functioning or fatigue of feeding back patient questionnaire responses as the certainty of this evidence was assessed as very low. The intervention probably increases diagnosis and note-taking. We did not find studies reporting on adverse effects defined as distress following or related to Patient-reported outcomes measures (PROM) completion. How up-to-date is this review' The review authors searched for studies that had been published up to October 2020.
      PubDate: Tue, 12 Oct 2021 00:00:00 +020
       
  • Identifying carrier status for thalassaemia, sickle cell disease, cystic
           fibrosis, or Tay-Sachs disease in non-pregnant women and their partners

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      Authors: Hussein N;Henneman L;Kai J;Qureshi N
      Abstract: Updated
      Authors :  Hussein N, Henneman L, Kai J, Qureshi N Review question We looked for evidence to show whether identifying people who are carriers for thalassaemia, sickle cell disease, cystic fibrosis, or Tay-Sachs disease, before pregnancy leads to improving reproductive choice and pregnancy outcomes. Background Across the world, about 6% of children are born with a birth defect of genetic or partially genetic origin.  Many of these conditions can be passed down from parent to child. There are tests to identify the genetic risk of the most common genetic conditions (thalassaemia, sickle cell disease, cystic fibrosis, or Tay-Sachs disease) before pregnancy. In these conditions, called autosomal recessive conditions, the parents of affected children are 'carriers' of the condition, which means they do not usually have symptoms. All 'carrier' couples will have a 25% chance of having an affected child. Risk assessment for these genetic conditions before getting pregnant would benefit potential parents who may be carriers. This information would give the at-risk couple the opportunity to make fully informed decisions about family planning. However, genetic risk assessment before pregnancy may potentially have a negative psychological impact. This is an updated version of the original review. Search date We last looked for evidence on 04 August 2021. Study characteristics We did not find any trials that we could include in this review. In an earlier version of this review, we had already found the protocol for a trial that has now published its results, but we have excluded the trial in this version of the review because it did not look at the right topic after all. Key results Although no trials were identified in which people taking part would have equal chances of being in either group, there are several studies which are not so strictly designed which support current policy recommendations for genetic risk assessment prior to pregnancy in routine clinical practice. We recommend considering potential observational studies in future reviews as well as looking at ‘expanded carrier screening’ before pregnancy and not just screening for one condition. Any future trials need to consider legal, ethical and cultural barriers to implementing genetic risk assessment before pregnancy.
      PubDate: Mon, 11 Oct 2021 00:00:00 +020
       
  • What are the main benefits and risks of drugs for reducing blood pressure
           in the treatment of people with thickening of the heart muscle caused by
           high blood pressure'

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      Authors: Leache L;Gutiérrez-Valencia M;Finizola RM;Infante E;Finizola B;Pardo Pardo J;Flores Y;Granero R;Arai KJ
      Abstract: New
      Authors :  Leache L, Gutiérrez-Valencia M, Finizola RM, Infante E, Finizola B, Pardo Pardo J, Flores Y, Granero R, Arai KJ Key messages Given the lack of robust evidence, the benefits and risks of adding additional drugs for reducing blood pressure to treat people with thickening of the heart muscle and high blood pressure are unclear. It is unclear if adding drugs for reducing blood pressure causes more serious harms in patients than placebo (dummy treatment) or no treatment; however, it may increase treatment discontinuation due to unwanted effects.There is a need for future studies to better understand the benefits and harms of adding drugs for reducing blood pressure in people with thickening of the heart muscle caused by high blood pressure. What is thickening of the heart muscle' Thickening of the heart muscle is a condition where the muscle gets bigger and affects the function of the heart. This can happen when the heart has worked too hard over time and is mainly caused by high blood pressure. People with thickening of the heart muscle can experience shortness of breath, fatigue, chest pain, heart palpitations, and dizziness or fainting. How is thickening of the heart muscle treated' Thickening of the heart muscle can be treated with drugs for reducing blood pressure. What did we want to find out' We wanted to find out if adding drugs for reducing blood pressure was better than placebo or no drug treatment at preventing illness and death in people with thickening of the heart muscle and high blood pressure. We also wanted to learn if the addition of drugs for reducing blood pressure was associated with any unwanted or harmful effects. What did we do' We searched for studies that investigated the addition of drugs for reducing blood pressure compared with placebo or no drug treatment.We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as methods and sizes of participant groups. What did we find' We found 3 studies that involved 930 people with thickening of the heart muscle and high blood pressure. The largest study was in 692 people, and the smallest study was in 15 people. Study participants were of both genders and on average between 66 and 75 years old. Participants were followed for between three and four years. The studies were conducted in several countries in Europe, Asia, and North and South America. One study received pharmaceutical industry funding. It is uncertain if adding drugs for reducing blood pressure has an effect on death, development of heart and blood vessel diseases, or on hospitalisation for heart failure. It is unclear if adding drugs for reducing blood pressure causes more serious harms than placebo or no drug treatment, but it may increase treatment discontinuations due to unwanted effects. It is unclear if adding drugs for reducing blood pressure has an effect on heart muscle mass. What are the limitations of the evidence' Our confidence in the evidence is lacking because of the small number of identified studies. The available evidence is based on a small percentage of people with thickening of the heart muscle and high blood pressure identified from larger populations in the included studies. Further evidence may change our results. How up-to-date is the evidence' The evidence is current to September 2020.
      PubDate: Sun, 10 Oct 2021 00:00:00 +020
       
  • Are oral blood thinners safe and effective for people being treated for
           cancer'

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      Authors: Kahale LA;Matar CF;Tsolakian I;Hakoum MB;Barba M;Yosuico VED;Terrenato I;Sperati F;Schünemann H;Akl EA
      Abstract: Updated
      Authors :  Kahale LA, Matar CF, Tsolakian I, Hakoum MB, Barba M, Yosuico VED, Terrenato I, Sperati F, Schünemann H, Akl EA Key messages - It is reasonable to give direct oral anticoagulants (a type of blood thinning medicine) to people being treated for cancer, especially if they have an increased risk of blood clots, because the benefit of reduction in blood clots appears to outweigh the risk of major bleeding.- For a different type of blood thinner, vitamin K antagonists (warfarin), the risk of major bleeding might outweigh the benefit of a reduction in formation of blood clots in the legs and lungs.- More research is needed on the effects of blood thinners in people with different types and stages of cancers. What are blood thinners Blood thinners are medicines that help prevent blood from clotting. People at a high risk of getting blood clots can take blood thinners to reduce their chances of developing serious conditions such as heart attacks and strokes.Why might blood-thinning treatment be helpful for people with cancer'People with cancer undergoing systemic treatment (any medication that travels through your body in the bloodstream to find, damage or destroy cancer cells, including chemotherapy, radiotherapy, immunotherapy and target therapy) are at increased risk of blood clots. While blood thinners can decrease the risk of getting blood clots, they can also increase the risk of serious and fatal bleeding. Therefore, it is important to understand the benefits and harms of using blood thinners in these people to allow them and their doctors to make informed decisions. What did we want to find out' We wanted to find out if giving preventative, oral (by mouth) blood thinners was better than no preventative treatment for people being treated for cancer. We focused on people with cancer who were not admitted to hospital for their cancer treatment.We were interested in the effects of blood thinners on:- death;- formation of blood clots in veins (venous thromboembolism). Venous thromboembolism includes deep vein thrombosis (DVT) where a clot lodges in the lower leg, thigh or pelvis, and pulmonary embolism where a clot lodges in the lungs;- major and minor bleeding. What did we do' We searched for studies that examined the benefits and harms of blood thinners for people being treated for cancer who otherwise had no signs, symptoms or conditions that suggested blood thinning was definitely needed.We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes. What did we find' We found 10 studies that involved 2934 people with cancer. The biggest study had 841 people and the smallest had 24 people. The studies used two types of blood thinner:- the vitamin K antagonist, warfarin; or- direct [ER1] oral anticoagulants (specifically, apixaban and rivaroxaban). Main results Compared to no preventative treatment, warfarin, the vitamin K antagonist medicine:- probably reduces death at 6 months and at 12 months slightly (22 and 29 fewer deaths, respectively, per 1000 people);- may have little to no effect on formation of blood clots, but we are very uncertain about the results;- probably increases major bleeding and minor bleeding at 12 months (107 more major bleeds and 167 more minor bleeds per 1000 people).Compared to no preventative treatment, direct oral anticoagulant medicines:- probably reduce death at 3 to 6 months slightly (11 fewer deaths per 1000 people);- probably reduce blood clots in the lungs and legs slightly (24 fewer in the lungs and 19 fewer in the legs per 1000 people);- probably do not increase major bleeding (9 more major bleeds per 1000 people);- may increase minor bleeding (55 more minor bleeds per 1000 people). This suggests that:with a vitamin K antagonist, the risk of major bleeding might outweigh the benefit of any reduction in the risk of blood clots in the legs and lungs;with direct oral anticoagulants, the benefit of reduction in the risk of blood clots in the legs and lungs outweighs the risk of major bleeding. What are the limitations of the evidence' We are moderately confident in the evidence for death, major bleeding and minor bleeding. In eight of the studies, the methods used may have affected the results.We are not confident in the evidence for blood clots in people who were given vitamin K antagonist medicine because the evidence came from one study only. This study gave the medicine in a fixed rather than variable dose, which is not current best practice. How up to date is this evidence' This review updates our previous review. The evidence is up to date to June 2021.Editorial note: this is a living systematic review. Living systematic reviews offer a new approach to review updating in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the 'What's new' section on the Cochrane Database of Systematic Reviews for the current status of this review.
      PubDate: Fri, 08 Oct 2021 00:00:00 +020
       
  • Ketamine and other glutamate receptor modulators for bipolar depression

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      Authors: Dean RL;Marquardt T;Hurducas C;Spyridi S;Barnes A;Smith R;Cowen PJ;McShane R;Hawton K;Malhi GS;Geddes J;Cipriani A
      Abstract: Updated
      Authors :  Dean RL, Marquardt T, Hurducas C, Spyridi S, Barnes A, Smith R, Cowen PJ, McShane R, Hawton K, Malhi GS, Geddes J, Cipriani A Why is this review important' Bipolar disorder is one of the most severe mental health conditions characterised by episodes of mania (abnormally high mood or irritability amongst other symptoms for a short time), or hypomania (the same symptoms lasting for a shorter time) and major depression (low mood). The depressive phase of the illness is linked with a greatly increased risk of self-harm and suicide. Current treatments for depression in bipolar disorder are not always effective and can be slow to work. Among the most promising new and alternative treatments are drugs called glutamate receptor modulators. These drugs work in a different way to the drugs usually used, such as antidepressants. This is an update of a review published in 2015. As more clinical studies have been published since then, it is important to update this review with the most recent evidence. Who will be interested in this review' - People with bipolar disorder, their friends and families.- General practitioners, psychiatrists, psychologists, and pharmacists.- Professionals working in adult mental health services. What questions does this review aim to answer' 1. Are ketamine and other glutamate receptor modulators better at treating bipolar depression than placebo (dummy pill) or other antidepressants'
      2. Do patients prescribed ketamine or other glutamate receptor modulators experience fewer side effects than people who take placebo or other antidepressants' Which studies were included in the review' We searched medical databases to find all relevant studies completed up to 30 July 2020. These studies had to be randomised controlled trials (where people in the study are randomly assigned to receive either the drug being tested or a different drug or placebo to compare the results). To be included in the review, studies had to compare ketamine or other glutamate receptor modulators with placebo or other medicines in adults with bipolar depression. We included 10 studies (647 participants). The studies investigated five different glutamate receptor modulator drugs: ketamine (three trials), memantine (two trials), cytidine (one trial), N-acetylcysteine (three trials), and riluzole (one trial). Nine studies compared glutamate receptor modulators with placebo, and one study compared ketamine with another drug. Most of the trials in the review included participants who were also receiving another medication (either lithium, valproate, or lamotrigine). We rated the certainty of the evidence 'very low' to 'low' across different comparisons, meaning that we cannot be confident that the results are a close representation of the truth. What does the evidence from the review tell us' The effectiveness of glutamate receptor modulators was measured primarily as the number of patients whose symptoms of depression were reduced by 50% with treatment. A single dose of ketamine injected into a vein proved to be better than placebo, but this was based on very limited evidence (two studies with 33 participants), and its effect only lasted for up to 24 hours. No differences were found in side effects between ketamine and placebo, despite common reports of trance-like states or dissociation (a dream-like state in which body and mind are experienced separately). The small number of participants included in this review means that we cannot say for certain whether ketamine or glutamate receptor modulators work better than other antidepressants. No differences were found between memantine, cytidine, N-acetylcysteine and placebo for numbers of people who responded to treatment or who experienced side effects, and no data were available for riluzole. What should happen next' Ketamine may or may not be an effective medication as an add-on treatment to mood stabilisers in people with bipolar depression, but because the amount of data was small, we are unable to draw any firm conclusions. The data suggests that ketamine may work very quickly in bipolar depression, but that the effects only last for a short amount of time. All trials examined the effectiveness of ketamine when injected, which is less practical than other options such as taking a pill. Future research should focus on longer-term use of ketamine compared with placebo and other drugs, so that we can draw confident conclusions about which treatments are more effective. More research is needed on the long-term side effects, as some studies have shown that long-term ketamine use is linked to memory problems.
      PubDate: Fri, 08 Oct 2021 00:00:00 +020
       
  • Healthcare strategies for identifying possible or definite clinical
           familial hypercholesterolaemia in primary care and other community
           settings

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      Authors: Qureshi N;Da Silva MLR;Abdul-Hamid H;Weng SF;Kai J;Leonardi-Bee J
      Abstract: New
      Authors :  Qureshi N, Da Silva MLR, Abdul-Hamid H, Weng SF, Kai J, Leonardi-Bee J Background One of the most common inherited conditions is familial hypercholesterolaemia, people with this condition have raised cholesterol from birth. This condition can result in the arteries being narrowed by excess cholesterol sticking to their walls and can lead to heart disease at an early age. However, treatment with cholesterol-lowering tablets markedly reduces this risk.As well as raised cholesterol in the blood, family history of heart disease and the presence of fatty lumps under the skin could indicate familial hypercholesterolaemia.It is important that community-based health professionals, such as general practitioners and community pharmacists, can identify those at risk of possible or probable familial hypercholesterolaemia and refer them to a specialist. Specialists can confirm a diagnosis of familial hypercholesterolaemia through examination and a genetic test.This review explores the impact of these healthcare strategies in primary care and other community settings to systematically identify people with possible and definite clinical familial hypercholesterolaemia. Search date 13 September 2021.

      Study characteristics We did not find any studies that we could include in this review. Key results There were no studies eligible for inclusion in the review. Quality of evidence There were no studies included in the review. Conclusions Currently, there is a lack of evidence regarding the most appropriate healthcare strategy to identify possible or definite clinical familial hypercholesterolaemia in primary care and other community settings. Better-designed studies, with diagnosis of definite familial hypercholesterolaemia confirmed by genetic tests, are needed to clearly answer this question.
      PubDate: Thu, 07 Oct 2021 00:00:00 +020
       
  • Prophylactic antibiotics for preventing gram-positive infections
           associated with long-term central venous catheters in adults and children
           receiving treatment for cancer

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      Authors: van den Bosch C;van Woensel J;van de Wetering MD
      Abstract: Updated
      Authors :  van den Bosch C, van Woensel J, van de Wetering MD The issue
      People undergoing anti-cancer treatment (chemotherapy) often have a catheter (tube) inserted into a large vein, through which their chemotherapy is given. This is known as a central venous catheter (CVC). As chemotherapy is usually administered over several months to years, long-term CVCs are used. Despite sterile insertion and care afterwards, these CVCs often become infected by a type of bacteria called gram-positive bacteria. Giving antibiotics as a preventive (prophylactic antibiotics) before the catheter is inserted, or using the antibiotics as a lock or flush solution, or both, may prevent these infections. A lock/flush solution is instilled in the catheter when it is not in use. This solution often contains heparin, saline, or both, to prevent a clot forming in the catheter.  The aim of the review
      The aim of this review was to determine whether giving antibiotics before catheter insertion or as a lock/flush solution can prevent gram-positive CVC-related infections. What are the main findings'
      We searched databases to identify randomised controlled trials (RCTs - clinical studies where people are randomly put into one of two or more treatment groups). We identified 12 relevant studies, which included a total of 1244 adults and children with cancer.We included six studies (756 people) that compared giving antibiotics before the insertion of the CVC against not giving antibiotics. We found that giving an antibiotic before CVC insertion did not prevent infections. The studies authors' did not describe side-effects. We included six studies (488 people) that compared an antibiotic solution with a heparin-only solution to flush/lock a CVC. We found that an antibiotic lock/flush solution reduced the number of CVC-related infections. People in one study reported an unpleasant taste after flushing, and one study found there were fewer CVC obstructions (e.g. a clot) in people who received the combined antibiotic and anticoagulant solution.  Certainty of the evidence
      We have moderate confidence in the evidence for giving antibiotics prior to CVC insertion and antibiotic lock/flush solutions since the studies were done in different people, used different types of catheters and antibiotics, and measured their results in different ways.  What are the conclusions'
      We did not observe any benefit of giving antibiotics before the insertion of long-term CVCs to prevent gram-positive CVC-related infections. Flushing/locking long-term CVCs with an antibiotic appeared to reduce gram-positive CVC-related infections in people with cancer. It must be noted that the use of an antibiotic flush/lock solution may increase microbial antibiotic resistance, therefore it should be reserved for high-risk people or if baseline CVC-related infection rates are high. This review updates our previous review. The evidence is up to date to 19 November 2020.
      PubDate: Thu, 07 Oct 2021 00:00:00 +020
       
  • Synthetic human growth hormone for treating X-linked hypophosphatemia (or
           vitamin D-resistant rickets) in children

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      Authors: Smith S;Remmington T
      Abstract: Updated
      Authors :  Smith S, Remmington T Review question Can human growth hormone lead to improved clinical outcomes (such as increased growth and bone mineral density, as well as better kidney and hormone function) without side effects in children with X-linked hypophosphataemia' Background X-linked hypophosphataemia is a genetic disorder which causes abnormal levels of phosphate in the body. This can lead to short stature and rickets. Standard treatment of X-linked hypophosphatemia can heal rickets, but does not always raise the level of phosphates in the blood or return growth levels to normal. It is unclear whether combining human growth hormone therapy with standard treatment improves the phosphate levels, growth rates and bone mineral density. Search date The evidence is current to: 12 January 2021 Study characteristics We included two small studies with a total of 20 children aged between 2.5 and nine years old in this review.  There were equal numbers of boys and girls. Both trials were randomised so that participants had an equal chance of being put in the growth hormone group or the control group (children in the control group either got no additional treatment or a placebo (sham) treatment). One (parallel) trial compared children given the growth hormone to children who did not have any treatment for three years. The second trial was a cross-over trial, so to start with one group of children were given human growth hormone therapy and the second group were given a placebo for a year and then the groups were given the opposite treatment for a further year. Results The parallel trial found no difference in height scores after treatment with growth hormone compared to no additional treatment. No serious side effects were seen in either of the trials. In the cross-over trial, human growth hormone therapy improved the height standard deviation score (z score), and temporarily increased blood phosphate levels. We found no conclusive evidence that shows that human growth hormone treatment works for this condition. There have not been enough studies of human growth hormone treatment for this condition and more research is needed. This is an updated version of a previously published review. Quality of the evidence We mostly graded the certainty of the evidence as low or very low. This was because the trials were very small and only included a few children. We were also concerned that there might have been some bias in the results because of the design of the smaller cross-over trial.
      PubDate: Thu, 07 Oct 2021 00:00:00 +020
       
  • How accurate are computerised tomography (CT) scans for detecting liver
           cancer'

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      Authors: Nadarevic T;Giljaca V;Colli A;Fraquelli M;Casazza G;Miletic D;Štimac D
      Abstract: New
      Authors :  Nadarevic T, Giljaca V, Colli A, Fraquelli M, Casazza G, Miletic D, Štimac D Key messages In people with chronic liver disease, · computerised tomography (CT: cross-sectional scans inside the body) probably misses liver cancer in 22.5% of people who would not receive timely or appropriate treatment, and also, CT incorrectly finds liver cancer in 8.7% of people who would receive unnecessary treatment.· CT probably misses liver cancer in 28.6% of people with liver cancer who could have surgery to remove part of their liver, and CT incorrectly finds liver cancer in 7.7% of people who undergo inappropriate surgery.· The studies were too different from each other to allow us to draw firm conclusions based on the evidence. Why is it important to diagnose liver cancer accurately' Liver cancer, or ‘hepatocellular carcinoma’ occurs mostly in people with chronic liver disease, regardless of the cause. It is the sixth most common cancer in the world and the fourth most common cause of death due to cancer. It is difficult to diagnose because early symptoms are similar to those of liver disease. People with blood test or ultrasound results that suggest liver cancer may go on to have further tests, such as scans that produce images of the liver, or biopsy where a small piece of the liver is removed and examined. If liver cancer is detected early, people may be treated with surgery to remove part of the liver (a liver resection) or with a liver transplant. If the liver cancer is more advanced, people may need chemotherapy. If liver cancer is missed, people will not receive appropriate treatment. However, incorrectly diagnosing liver cancer when it is not present means that people may undergo unnecessary testing or treatment. What is computed tomography and how might it diagnose liver cancer' Computed tomography (CT) produces images that show a cross-section or ‘slice’ of the bones, blood vessels and tissues inside the body. The images consist of a series of X-rays that are directed and combined by a computer. CT scans can detect the presence of abnormalities in the liver that might be cancer. Current guidelines recommend using either CT or another type of imaging, magnetic resonance imaging (MRI), to confirm the presence of liver cancer in people who might have liver cancer, and to judge the size and spread (stage) of the cancer. What did we want to find out' We wanted to find out if CT is accurate enough to diagnose liver cancer in adults with chronic liver disease. We were interested firstly, in liver cancers of any size and stage and secondly, in liver cancers that were suitable for resection. What did we do' We searched for studies that assessed the accuracy of CT scans compared to the best available tests to confirm liver cancer in adults with chronic liver disease. The best available tests are examination of the liver, or part of the liver under a microscope. What did we find' We found a total of 21 studies with 3101 people.Based on the studies, around 520 (52%) out of 1000 adults with chronic liver disease have confirmed liver cancer. Of these 1000 people, CT may:· correctly detect liver cancer in 403 people· miss liver cancer in 117 people· incorrectly detect liver cancer in 42 cancer-free people· correctly detect no liver cancer in 438 people.Based on the studies, around 350 (35%) out of 1000 adults with chronic liver disease have confirmed resectable liver cancer. Of these 1000 people, CT may:· correctly detect resectable liver cancer in 250 people· miss resectable liver cancer in 100 people· incorrectly detect resectable liver cancer in 50 people; and· correctly detect no resectable liver cancer in 600 people. What are the limitations of the evidence' Our confidence in the evidence is limited because the studies used different methods to select study participants and used different definitions for the presence of liver disease. This means CT scans could be more or less accurate than suggested by the evidence. How up to date is this evidence' The evidence is up to date to 4 May 2021.
      PubDate: Wed, 06 Oct 2021 00:00:00 +020
       
  • Does testing for cancer in people with unprovoked blood clots in the legs
           and lungs reduce cancer- and blood clot-related death and illness'

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      Authors: Robertson L;Broderick C;Yeoh SE;Stansby G
      Abstract: Updated
      Authors :  Robertson L, Broderick C, Yeoh SE, Stansby G Key message This review found that there are too few trials to determine whether testing for undiagnosed cancer in people with a first unprovoked venous thromboembolism (VTE) is effective in reducing cancer- and VTE-related deaths and illness. Further good-quality and large-scale studies are required. Why is this question important' Venous thromboembolism (VTE) refers to blood clots in leg veins (known as deep venous thrombosis (DVT)), which can travel to the lungs (causing pulmonary embolism (PE)). PE can often be fatal. Signs of DVT include pain and swelling of the leg while signs of PE include breathlessness and chest pain. Risk factors for VTE include surgery, prolonged bed rest, trauma, family history, pregnancy, and blood deficiencies. Sometimes a VTE happens for no apparent reason (it is unprovoked). In such people, undetected cancer may be the cause of the VTE. This has raised the question of whether people with an unprovoked VTE should be investigated for underlying cancer. This is important as the management of VTE in people with and without cancer differs. A cancer diagnosis would ensure people receive the optimal treatment to reduce the risk of another VTE. A diagnosis could also lead to the cancer being treated earlier, at a more curable stage. What did we do' We searched for randomised controlled studies that assessed whether testing for undiagnosed cancer in people with a first unprovoked VTE (DVT or PE) was effective in reducing cancer and VTE-related illness and death. In randomised controlled studies the treatments or tests people receive are decided at random and these usually give the most reliable evidence about treatment effects. What did we find' We found four studies with 1644 participants. Two studies compared extensive cancer tests with tests carried out at the physician's discretion and two studies compared cancer tests plus scanning with cancer tests alone. Combining the results of the two studies showed that extensive testing had no effect on the number of cancer-related deaths. Additionally, extensive testing did not identify more people with cancer. However, extensive testing did identify cancers at an earlier stage (approximately 10 months earlier) and cancers were less advanced in people in the extensive testing group than in people in the group with tests carried out at the physician's discretion. Neither study looked at the number of deaths due to any cause, deaths and illness associated with VTE, side effects of cancer tests, side effects of VTE treatment or participant satisfaction. Two studies that compared tests plus scanning with tests alone showed that adding computed tomography scanning had little or no effect on the number of deaths, cancer-related deaths, illness associated with VTE; nor did it identify more people with cancer, or show a clear difference in time to diagnosis or stages of cancer diagnosed. Neither study looked at deaths associated with VTE, side effects of cancer tests, side effects of VTE treatment, participant satisfaction or quality of life. How certain are we in the evidence' When comparing extensive tests versus tests at the physician's discretion, the certainty of the evidence was low due to bias caused by two of the studies stopping early. When comparing tests plus PET/CT scanning with tests alone, the certainty of the evidence ranged from low to moderate due to issues with how the studies were designed, imprecision caused by a low number of events and bias due to lack of blinding of people assessing the effects. How up to date is this evidence' This Cochrane review updates our previous evidence. The evidence is current to May 2021.
      PubDate: Fri, 01 Oct 2021 00:00:00 +020
       
  • Autologous blood or PRP injection for lateral elbow pain

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      Authors: Karjalainen TV;Silagy M;O'Bryan E;Johnston RV;Cyril S;Buchbinder R
      Abstract: New
      Authors :  Karjalainen TV, Silagy M, O'Bryan E, Johnston RV, Cyril S, Buchbinder R Background Lateral elbow pain, also known as tennis elbow or lateral epicondylitis, is a degenerative (age-related structural change of tissue) tendon disease at the site where forearm extensor muscles attach to the outer part of the elbow. It is a common cause of elbow pain and disability, typically in middle-aged people.Autologous blood and platelet-rich plasma (PRP) injections have been suggested to improve tendon healing. Autologous blood is derived from the person's own venous blood sample (blood taken from a vein), and PRP is a concentrate of plasma and platelets isolated from autologous blood.This study aimed to review evidence regarding the benefits and harms of autologous blood or PRP injection for treatment of lateral elbow pain. Study characteristics We searched MEDLINE, CENTRAL, Embase, Clinicaltrials.gov, and WHO trials registries, unrestricted by date or language, on 18 September 2020.We included 32 trials with 2337 participants. Mean age varied between 36 years and 53 years, and mean duration of symptoms ranged from 1 month to 22 months. Of 21 studies that reported gender, 56% of participants were female. Among the included studies, three studies were funded by manufacturers of the PRP centrifugation system; two studies were provided PRP kits; and one study received funding from PRP kit manufacturers. Key findings Comparison with placebo at three months revealed the following. Pain (lower scores mean less pain) (8 studies, 523 participants; moderate-certainty evidence). Pain improved by 2% (3% worse to 6% better), or by 0.16 points on a zero to 10 scale.• People who had placebo rated their pain as 3.7 points.• People who had autologous blood or PRP injection rated their pain as 3.9 points. Function (0 to 100; lower scores mean better function or less disability) (8 studies, 502 participants; moderate-certainty evidence). Function improved by 2% (5% better to 1% worse), or by 2 points on a zero to 100 scale.• People who had placebo rated their function as 27 points.• People who had autologous blood or PRP injection rated their function as 29 points. Treatment success (4 studies, 372 participants; very low-certainty evidence). 0% more people rated their treatment a success (11% fewer to 12% more), or zero more people out of 100.• 65 out of 100 people considered treatment as successful after placebo injection.• 67 out of 100 people considered treatment as successful after autologous blood or PRP injection. Health-related quality of life (higher scores mean better quality of life). None of the studies measured this outcome. Pain relief (> 30% or > 50%). None of the studies reported this outcome at three months. Withdrawals due to adverse events (1 study, 80 participants; very low-certainty evidence). 5% fewer people withdrew from the study because of an adverse event (7.5% fewer to 14.8% more), or 5 fewer people out of 100.• 7 out of 100 people withdrew from the study due to an adverse event after placebo injection.• 2 out of 100 people withdrew from the study due to an adverse event after autologous blood or PRP injection. Adverse events (typically transient injection site pain) (5 studies, 425 participants; low-certainty evidence). 2% more people had adverse events (4% fewer to 11% more), or 2 more people out of 100.• 17 out of 100 people reported adverse events after placebo injection.• 19 out of 100 people reported adverse events after autologous blood or PRP injection. Certainty of the evidence For people with lateral elbow pain, moderate-certainty evidence (downgraded for bias, i.e. methodological shortcomings in the included studies) shows that autologous blood or PRP injection probably provides little or no clinically important benefit for pain or function compared with placebo injection, and low-certainty evidence (downgraded due to risk of bias, i.e. methodological shortcomings; and imprecision, i.e. too few data to estimate the precise difference) suggests that autologous blood or PRP injection may not cause higher risk for adverse events. We are uncertain whether autologous blood or PRP injection is associated with a higher proportion of people reporting treatment success, or if this treatment increases withdrawals due to adverse events.
      PubDate: Thu, 30 Sep 2021 00:00:00 +020
       
  • CHIVA method for the treatment of varicose veins

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      Authors: Bellmunt-Montoya S;Escribano JM;Pantoja Bustillos PE;Tello-Díaz C;Martinez-Zapata MJ
      Abstract: Updated
      Authors :  Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, Tello-Díaz C, Martinez-Zapata MJ Background Chronic venous insufficiency (CVI) is a disorder in which veins fail to pump blood back to the heart adequately. As a result, it can cause varicose veins, skin ulcers, and superficial or deep vein thrombosis in the legs, and symptoms such as pain, fatigue, heaviness, warmth and swelling of the leg. The ambulatory conservative hemodynamic correction of venous insufficiency (CHIVA) method is a minimally invasive surgical technique to treat varicose veins. The CHIVA treatment aims to eliminate venous-venous shunts (abnormal connections between veins) by disconnecting the escape points, preserving the saphenous vein (a vein from the top of the foot to the upper thigh area) and normal venous drainage of the limb's superficial tissues. How did we identify and evaluate the evidence' First, we searched the medical literature for randomized controlled trials (RCTs), clinical studies where people are randomly put into one or more treatment groups. This type of study provides the most robust evidence about the effects of treatment. We compared the results and summarized the evidence from all the studies. Finally, we assessed how certain the evidence was. To do this, we considered factors such as the way studies were conducted, study sizes and consistency of findings across studies. Based on our assessments, we categorized the evidence as very low, low, moderate or high certainty. What did we find' We found six RCTs that included 1160 participants who had CVI. Three RCTs compared the CHIVA method with vein stripping, one RCT compared the CHIVA method with compression dressings in people with venous ulcers. The newly included studies included three comparisons, one compared CHIVA with vein stripping (where a vein is removed or tied off) and radiofrequency ablation (RFA; which destroys the nerve fibres carrying pain signals to the brain), and one compared CHIVA with vein stripping and endovenous laser therapy (where veins are heated by a laser). The results showed that the CHIVA method may make little or no difference to the recurrence of varicose veins and may reduce slightly nerve injury and bruising in the lower limb compared to stripping. The CHIVA method showed similar numbers of limb infection and superficial vein thrombosis (inflammation and clotting in a vein) as vein stripping. Compared to RFA, CHIVA may make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma (a severe bruise within the soft tissues), but may cause more bruising. Compared to endovenous laser, CHIVA may make little or no difference to recurrence and numbers of side effects. How reliable is the evidence' Further studies are needed to confirm these conclusions since they are based on a small number of clinical trials with methodological limitations such as a high risk of bias. In addition, participants and outcome assessors were not blinded to what treatments groups were given, and the results were imprecise due to the low number of events. How up to date is this review' The evidence in this Cochrane Review is current to 19 October 2020.
      PubDate: Thu, 30 Sep 2021 00:00:00 +020
       
  • Surgery for deep venous insufficiency

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      Authors: Goel RR;Hardy SC;Brown T
      Abstract: Updated
      Authors :  Goel RR, Hardy SC, Brown T Background Deep venous insufficiency is a problem in the veins of the legs that can lead to leg ulcers (sores), pain and swelling. It may be caused by a problem with the valves of the vein, by a blockage of the veins or a combination of these events. For most people, wearing special compression stockings and treating the ulcers is enough. When this does not ease the problem, surgery is sometimes tried. It is unclear how much benefit there is from surgery. Study characteristics and key results We looked for studies treating deep venous insufficiency with surgery (searched 23 June 2020). We found four studies that randomised 273 participants to treatment or control interventions. All included studies reported on outcomes following surgical repair of venous valves (valvuloplasty). All included studies investigated primary valve incompetence (when valves do not close properly). We found no studies investigating other surgical procedures for treatment or the results of surgery for secondary valvular incompetence (for example, when valves are damaged as a result of deep vein thrombosis and do not close properly), or for venous obstruction. As different outcomes were reported, we could not combine the results of these studies. No studies reported ulcer healing and ulcer recurrence. One study did not investigate this, and the remaining three studies did not include people with ulcers or active ulceration. Three studies reported no major complications of surgery or no incidence of deep vein thrombosis (a blood clot that forms in a deep vein, usually in the leg or pelvis) during follow-up.We assessed clinical changes using the 'clinical, aetiological, anatomical and pathophysiological' (CEAP) classification score. One study reported an improved CEAP score three years after surgery in both groups, and a greater improvement from before surgery in limbs that had undergone valvuloplasty plus ligation (where a vein is tied off) compared with ligation alone. In another study, participants with worsening deep vein incompetence over the five years before surgery had higher rates of improvement in clinical condition with valvuloplasty plus ligation compared with ligation only after seven years, but in participants with stable deep vein incompetence, there was no additional benefit from the valvuloplasty.One study reported improvement in patient-reported quality of life (including pain) in both groups and a greater improvement compared to before surgery in people who had undergone external valvuloplasty using a technique called limited anterior plication at 10 years' follow-up. A second study reported that leg heaviness and pain was resolved completely in 36/40 limbs treated with valvuloplasty plus ligation and 22/40 limbs treated with ligation alone at three years' follow-up. Reliability of the evidence The reliability of the evidence was very low or low because there were only four studies with small numbers of participants, and there was a high risk of bias (information regarding how it was decided what treatment a participant received and who knew this was missing in three of the four studies). Conclusion There is not enough evidence to determine the effectiveness of surgery on the treatment of people with deep venous insufficiency. The included studies did not include people with severe deep venous insufficiency (venous obstruction). Trials investigating the effects of other surgical procedures on the deep veins are needed.
      PubDate: Thu, 30 Sep 2021 00:00:00 +020
       
  • Administration of antimalarial drugs to whole populations for reducing
           malaria

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      Authors: Shah MP;Hwang J;Choi L;Lindblade KA;Kachur SP;Desai M
      Abstract: Updated
      Authors :  Shah MP, Hwang J, Choi L, Lindblade KA, Kachur SP, Desai M What is mass drug administration (MDA) for malaria' MDA for malaria consists of giving a full treatment course of antimalarial medicine (even to persons with no symptoms of malaria and regardless of whether malaria is present) to every member of a defined population or every person living in a defined geographical area (except to those for whom the medicine could be harmful) at approximately the same time and often at repeated intervals. How can MDA reduce malaria transmission in a population' The life cycle of the malaria parasite consists of human liver, human blood, and mosquito stages. Malaria infection begins with the bite of an Anopheles species mosquito carrying the malaria parasite. During the bite, the infective mosquito injects the malaria parasite into the human host. After initially replicating in the liver, the parasites are released into the bloodstream. During the blood stage, parasites multiply in red blood cells, sometimes causing fever and other symptoms characteristic of malaria. Some of these parasites become a form which is infectious to mosquitoes. When the infected person is bitten again, the mosquito ingests blood containing the parasites, which then restarts the transmission cycle.MDA with antimalarial drugs temporarily prevents new and clears existing malaria infections in the population. Depending on the characteristics of the antimalarial drug used, MDA targets parasites at different stages, which can lead to reduced disease burden and transmission in the population. Whether MDA can successfully reduce or interrupt malaria transmission may depend on how much malaria there is in the area; the use of other tools to control malaria, including preventing mosquito bites; the proportion of the population who receive at least one round of MDA; population movement; and when MDA rounds occur in relation to the peak malaria transmission season. What was the aim of the review' To guide policy-making and future research for malaria control and elimination, the aim of this review was to update the evidence evaluating the effect of MDA compared to no MDA on malaria outcomes in moderate- to high-transmission settings and very low- to low-transmission settings. Our search of relevant published and unpublished literature identified 13 studies that met our inclusion criteria. What are the main findings of the review' Malaria burden was compared in people receiving MDA and those who did not receive MDA, at different time points. The findings differed by malaria transmission setting. In areas with malaria prevalence of 10% or higher (moderate- to high-transmission areas), based on one trial, MDA did not reduce malaria in the population (low-certainty evidence). In areas with malaria prevalence under 10% (very low- to low-endemicity areas), evidence from seven trials indicates that MDA reduced malaria in the population immediately after MDA has stopped (low-certainty evidence), but we are uncertain if the decline continues long-term because the number of malaria cases in both intervention and control groups were low (very low-certainty evidence).In all settings of malaria transmission, the type of antimalarial drug used for MDA, co-interventions such as mosquito control, coverage of MDA, and risk of re-introduction may have an impact on the effect of MDA compared to no MDA. However, we were unable to explore these factors due to the limited number of studies. How up to date is the review' We included studies available up to 11 February 2021.
      PubDate: Wed, 29 Sep 2021 00:00:00 +020
       
  • Blood thinners in people with multiple myeloma

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      Authors: Kahale LA;Matar CF;Tsolakian I;Hakoum MB;Yosuico VED;Terrenato I;Sperati F;Barba M;Hicks LK;Schünemann H;Akl EA
      Abstract: New
      Authors :  Kahale LA, Matar CF, Tsolakian I, Hakoum MB, Yosuico VED, Terrenato I, Sperati F, Barba M, Hicks LK, Schünemann H, Akl EA Background The risk of blood clots is high in people with blood cancer, especially in those who have multiple myeloma, cancer that begins in plasma cells, a type of white blood cell. Lenalidomide, pomalidomide, and thalidomide are common treatments for multiple myeloma, which when combined with other chemotherapy agents, have been shown to increase the risk of blood clots. Study characteristics We searched the scientific databases for clinical trials looking at the effects of different blood thinners on blood clots in people with multiple myeloma receiving immunomodulatory agents (lenalidomide, pomalidomide, and/or thalidomide). The studies looked at survival, blood clots in the limbs or in the lung, and/or bleeding. The evidence is current to 14 June 2021. Key results We included four studies enrolling a total of 1042 people with multiple myeloma. The included studies made the following comparisons: aspirin (oral medication used to prevent blood clots) to vitamin K antagonist (VKA) (oral blood thinner) (one study); aspirin to low molecular weight heparin (LMWH) (injectable blood thinner) (two studies); VKA to LMWH (one study); and aspirin to direct oral anticoagulants (oral blood thinner) (two studies). In people with multiple myeloma receiving thalidomide, the data do not provide a clear answer about the comparative effect of these drugs on all of the studied outcomes (death, blood clots, bleeding). Certainty of the evidence When comparing aspirin to VKA, aspirin to LMWH, or VKA to LMWH, the certainty of the evidence was very low for all studied outcomes (death, blood clots in the limbs or the lung, and bleeding). When comparing aspirin to direct oral anticoagulants, the certainty of the evidence was very low for all of the studied outcomes (death, blood clots in the limbs or the lung, and bleeding).Editorial note: This is a living systematic review. Living systematic reviews offer a new approach to review updating in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
      PubDate: Tue, 28 Sep 2021 00:00:00 +020
       
  • Drug treatments for chronic hair-pulling (trichotillomania)

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      Authors: Hoffman J;Williams T;Rothbart R;Ipser JC;Fineberg N;Chamberlain SR;Stein DJ
      Abstract: Updated
      Authors :  Hoffman J, Williams T, Rothbart R, Ipser JC, Fineberg N, Chamberlain SR, Stein DJ Trichotillomania (TTM) is a common and disabling condition characterised by repeated hair-pulling leading to hair loss. TTM can be associated with much distress and impairment. It may also be associated with other psychiatric conditions (known as comorbidities) such as depression and anxiety disorders. Researchers have proposed that medication may be useful to treat this condition. Who will be interested in this review' - People with TTM or other common comorbidities.- Families and friends of people who have TTM or other common comorbidities.- Mental health clinicians, general practitioners, psychiatrists, psychologists and pharmacists. What questions does this review aim to answer' - Is medication an effective treatment for TTM in adults or children and adolescents' That is, does it have the intended result'- Does medication reduce the severity of symptoms for adults or children and adolescents with TTM'- Does medication aid in treating symptoms of depression in adults or children and adolescents with TTM'- Is medication effective and tolerable for people with TTM in terms of side effects'- Does medication improve quality of life and reduce disability' Which studies were included in the review' - We included nine studies comparing a medication with a placebo (control substance/not an active drug) for the treatment of TTM in adults.- We included one study comparing two different antidepressant drugs with each other for the treatment of TTM in adults.- We included one study comparing a medication with a placebo for the treatment of TTM in children and adolescents aged 8 to 17 years.- We included one study comparing a medication with a placebo for the treatment of TTM in adolescents and adults aged 12 to 65 years.- A total of 298 adults were included from the 11 studies conducted in adults, and a total of 43 children and adolescents were included from the two trials conducted with participants in this age group. What does the evidence from the review tell us' There was insufficient evidence from analysis of individual studies or across multiple scientific studies (known as meta-analysis) to confirm or refute the effectiveness of any specific agent or class of medication for the treatment of TTM in adults, children or adolescents. In adults, evidence suggests tricyclic antidepressants (TCAs; a type of antidepressant) with predominantly serotonin reuptake inhibitor (SRI; increasing serotonin levels in the brain) actions may show a beneficial treatment effect compared to other TCAs, with reduction in TTM symptom severity. However, certainty in the estimate of effect was low and is based on a single trial comparing clomipramine with desipramine. Antipsychotics in adults may show a beneficial treatment effect and possible reduction of TTM symptom severity, with low-certainty in the estimate of effect, based on a single trial of olanzapine. Glutamate modulators (a type of amino acid modulator) in adults showed a probable beneficial treatment effect and a likely reduction in TTM symptom severity, with moderate-certainty in the estimate of effect, although based on a single trial of N-acetylcysteine (NAC; a glutamate modulator). Glutamate modulators in children and adolescents (8 to 17 years old) showed no evidence for beneficial effect in terms of the percentage of participants responding to treatment in a single study of NAC. However, evidence suggests a potential large reduction in TTM symptom severity; however, with low-certainty in the estimate. There was little to no evidence for beneficial treatment effects in terms of the percentage of participants responding to treatment or reduction of TTM symptom severity reported for antioxidants, cell signal transducers, opioid antagonists or selective serotonin reuptake inhibitors (SSRIs; a type of antidepressant) in adults, children or adolescents.Attrition due to adverse events was only reported for SSRIs and TCAs with predominantly SRI actions in adults and for glutamate modulators in children and adolescents. Glutamate modulators had the least severe side effect profile in adults, while antipsychotics were associated with several adverse side effects, although with low-certainty in the effect estimate, and based on individual trials for each medication class. There was low-certainty evidence showing no difference in dropouts due to adverse events between the glutamate modulator group and placebo group in the single study exclusively in children and adolescents. What should happen next' There is some evidence that NAC (a glutamate modulator) probably demonstrates efficacy in TTM in adults and possible symptom severity reduction in children and adolescents. There is some evidence that olanzapine (an antipsychotic) and clomipramine (a TCA with predominantly SRI actions) may demonstrate efficacy in TTM in adults, although based on individual trials and therefore not generalisable to other agents in the same medication classes. Studies are few and sample sizes are small, and as a result it is not possible to draw high-quality conclusions from meta-analysis. Additional studies, with rigorous designs and appropriately powered samples are needed, particular...
      PubDate: Tue, 28 Sep 2021 00:00:00 +020
       
  • Palliative care for people with advanced dementia

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      Authors: Walsh SC;Murphy E;Devane D;Sampson EL;Connolly S;Carney P;O'Shea E
      Abstract: Updated
      Authors :  Walsh SC, Murphy E, Devane D, Sampson EL, Connolly S, Carney P, O'Shea E Review question In this research, we wanted to see if palliative care helps people with advanced dementia or helps their family or carers. We also wanted to describe how researchers tried to measure the effect of palliative care. Background People with dementia experience a gradual decline in their mental abilities and their ability to take care of themselves. The decline occurs over an extended period, so it is often difficult to identify the final, terminal phase of the disease. During the advanced stage of dementia, people are unable to communicate verbally, are completely dependent on others, have difficulty swallowing and often experience double incontinence. People with advanced dementia often become confined to a chair or bed and are at increased risk of infections, such as pneumonia.Palliative care is a particular way of caring for people who have diseases that cannot be cured. The main aims of palliative care are to reduce pain and to maintain the best possible quality of life as death approaches. Palliative care is used a lot with people with cancer but is not used much for people with advanced dementia. Study characteristics We examined the research published up to October 2020. We found nine suitable studies that involved 2122 people. The studies came from the USA, Canada, the UK and Europe. Two studies were carried out in hospitals and seven in nursing homes or long-term care facilities. Key results Six studies tested changes to the way care for people with advanced dementia is organised and delivered. Five studies found that these changes may increase comfort in dying, but problems with study design and differences in outcome between studies make this result very uncertain, so it is possible that overall they may make little or no difference. Changes to care organisation and delivery may also mean that people with advanced dementia are more likely to have a plan in place for their care, but this result came from only one study, and again we are very uncertain about it. Making changes to how care is organised and delivered probably has no effect on the use of non-palliative approaches to care and may have little or no effect on whether discussions take place between people with dementia, their family caregiver, and their doctors and nurses on the nature and type of palliative care they would like to receive.Two studies found that helping the person with dementia and their family to plan ahead probably makes it more likely that the person with dementia has a written document giving instructions on the types of treatments they want to receive (an advance care plan), and that they have spoken to their doctors and nurses about what they would like from their care. One of these studies also found that advance planning may mean that there is slightly more agreement between what the doctors and nurses believe are the care goals and what the person with dementia believes. However, based on one study, planning may not impact on how well family caregivers feel the person with dementia’s symptoms are managed. Conclusions Overall, the research done so far does not give a clear picture about how palliative care can best be used to help either the person with advanced dementia or their family. Little research has been done about people with advanced dementia, often because of ethical concerns. However, although it is hard to do research with people with dementia, more well-designed studies are required to work out how palliative care can be used best in this special population.
      PubDate: Tue, 28 Sep 2021 00:00:00 +020
       
  • Periodic measurement of the containment volume of the stomach during tube
           feeding

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      Authors: Yasuda H;Kondo N;Yamamoto R;Asami S;Abe T;Tsujimoto H;Tsujimoto Y;Kataoka Y
      Abstract: New
      Authors :  Yasuda H, Kondo N, Yamamoto R, Asami S, Abe T, Tsujimoto H, Tsujimoto Y, Kataoka Y Review question Is it necessary to measure the containment volume of the stomach periodically during tube feeding' If so, what is the best way to monitor the volume' How frequently does the monitoring need to be' How large would a volume be regarded as safe' Background People with acute illnesses may not be able to consume food due to several reasons (e.g. unconsciousness, need for mechanical ventilation). To maintain sufficient levels of energy and nutrients for this population, tube feeding, that is, administering liquidized dense nutrients through a flexible tube that reaches the stomach via the nose, is commonly used. Tube feeding is currently recommended as a first-line treatment for critically ill people with acute illnesses because such a technique can provide non-nutritional (e.g. protecting the immune system against suppression due to acute disease) as well as nutritional benefits.However, people with acute illnesses often have a dysfunction of the stomach and intestines, and thus are unable to empty stomach contents. When increasing amounts of liquid nutrients are fed into the stomach via a tube, it can cause reflux (where contents travel back up the food pipe) or vomiting and may lead to aspiration pneumonia (when contents are breathed into the lungs or airways leading to the lungs).One method to avoid these complications of tube feeding is to periodically monitor the gastric residual volume (GRV), which is the amount of liquid contents drained from the stomach. The speed of tube feeding can then be adjusted according to the volume.Although monitoring of GRV may minimize the complications of tube feeding, and this technique has been recommended in many intensive care units (ICUs) for decades, we lack sufficient data to support a universal approach. Some research findings show that monitoring of GRV had no effects on tube-feeding complications; moreover, the technique was found to reduce the amount of nutrients delivered, thereby affecting the overall treatment goals of tube feeding.We designed this review in the hope of answering the following questions. Is monitoring of GRV effective and safe' What is the best way to monitor GRV (how often should GRV be measured per day; how large a threshold should be set for GRV)' Key findings We included evidence published up to 3 May 2021. We included findings from eight studies involving 1585 adults, with most being men (1019 men versus 506 women) with average ages 60 to 69 years. All studies were conducted in the ICU settings, and many people were severely ill and required mechanical ventilation and tube feeding for more than 48 hours. The duration of the studies ranged from three to 90 days.Two studies (417 participants) compared less-frequent GRV monitoring with a more-frequent regimen. Two studies (500 participants) compared no GRV monitoring with frequent monitoring. One trial (329 participants) assessed the effects of GRV threshold by comparing a higher threshold at the time of aspiration against a lower threshold. Two studies (140 participants) compared the technique of returning versus discarding the aspirated/drained GRV.We found that the evidence is uncertain about GRV monitoring (less frequent versus more frequent; no monitoring versus frequent monitoring) on mortality, pneumonia, vomiting, and length of hospital stay. Reliability of the evidence Five of the eight included studies assessed mortality as an outcome measure. Most studies were poorly conducted with sparse data, which made interpretation difficult. Thus, the overall reliability of the included evidence for our review outcomes was very low, and our findings should be treated with caution.
      PubDate: Mon, 27 Sep 2021 00:00:00 +020
       
  • Interventions throughout life for the prevention or treatment of anaemia

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      Authors: da Silva Lopes K;Yamaji N;Rahman MO;Suto M;Takemoto Y;Garcia-Casal MN;Ota E
      Abstract: New
      Authors :  da Silva Lopes K, Yamaji N, Rahman MO, Suto M, Takemoto Y, Garcia-Casal MN, Ota E What is the issue' Anaemia (low iron levels in the blood) is a health problem worldwide, caused by nutritional (e.g. nutrient deficiencies) or non-nutritional (e.g. diseases or genetic disorders) factors. Its health consequences include fatigue, loss of productivity and adverse pregnancy and child outcomes. Why is this important' Iron deficiency (ID) is a common cause of nutritional anaemia, resulting from a lack of iron in the diet or reduced absorption of iron in the body (e.g. components in coffee, tea or cocoa inhibit iron absorption, while beverages and foods high in vitamin C, such as fruits and vegetables, enhance iron absorption). Some types of anaemia are preventable or controllable with iron supplementation (via capsules or drops), fortification (food enriched with sprinkles or powders containing iron) or improvements to diet diversity and quality (e.g. education or counselling). What evidence did we find' Infants (6 to 23 months) Two reviews suggested that iron supplementation increased haemoglobin (Hb) levels, and reduced the risk of anaemia and iron deficiency anaemia (IDA) compared with placebo, no intervention or other interventions. Six reviews suggested that iron fortification of milk or cereals, multiple-micronutrient powder (MMNP), home fortification of complementary foods and supplementary feeding increased Hb levels and reduced the risk of anaemia. In one review apiece, lipid-based nutrient supplementation (LNS) reduced the risk of anaemia, while caterpillar cereal increased Hb levels and IDA prevalence. Preschool and school-aged children (2 to 10 years) Two reviews suggested that daily or intermittent (e.g. 1 to 3 times per week) iron supplementation increased Hb levels and reduced the risk of anaemia and ID. For daily versus intermittent iron supplementation, one review found no difference in Hb levels, but an increased risk of anaemia and ID for the intermittent regime. One review apiece found higher Hb levels and reduced risk of anaemia and ID for zinc plus iron supplementation versus zinc alone, multiple-micronutrient (MMN)-fortified beverages, and point-of-use fortification of food with iron-containing micronutrient powder (MNP). Adolescent children (11 to 18 years) Three reviews for prevention or treatment suggested that intermittent iron supplementation alone or in combination with other micronutrients, iron supplementation with or without folic acid supplementation, or other micronutrient supplementation increased Hb levels and reduced the risk of anaemia. One review suggested that nutritional supplementation and counselling reduced IDA. In one review for prevention, iron supplementation with or without folic acid appeared to increase Hb levels but have no effect on the incidence of anaemia. Non-pregnant women of reproductive age (19 to 49 years) Two reviews suggested that iron therapy (oral, intravenous, intramuscular) increased Hb levels. One review found that intravenous iron increased Hb levels compared with oral iron, and another that daily iron supplementation with or without folic acid or vitamin C increased Hb levels and reduced the risk of anaemia and ID. Pregnant women of reproductive age (15 to 49 years) In one review, daily iron supplementation with or without folic acid increased Hb levels in the third trimester or at delivery, and in the postpartum period, and reduced the risk of anaemia, IDA and ID in the third trimester or at delivery. Six reviews suggested that intravenous iron versus oral iron or intramuscular iron increased Hb levels. In one review, vitamin A supplementation alone versus placebo, no intervention or other micronutrient increased Hb levels and reduced the risk of anaemia for the mother. One review found that supplementation with oral bovine lactoferrin versus oral ferrous iron preparations increased Hb levels and reduced gastrointestinal side effects. In one review, compared to iron or folic acid and MMNs, LNS increased the risk of anaemia. Mixed population (all ages) Iron supplementation versus placebo or control increased Hb levels in healthy children, adults, and elderly people in four reviews. In two reviews, MMN fortification versus placebo or no treatment increased Hb levels in children, as did iron supplementation, but Hb levels decreased for those receiving dietary interventions. Intravenous iron resulted in higher Hb levels than oral iron in one review. In another, vitamin B12 or folic acid supplementation did not increase Hb levels. Each review suggested that iron fortification of food, iron-fortified soy sauce, double-fortified salt with iron and iodine, and fortified condiments or noodles increased Hb levels and reduced the risk of anaemia. In one review, foods prepared in iron pots showed the potential to increase Hb levels in children.No review focused on older adult women (50 to 65 years plus) or men (19 to 65 years plus), and anaemia and malaria prevalence were rarely reported. What does this mean' Compared to no treatment, daily iron supplementation may increase Hb levels and reduce the risk of...
      PubDate: Sun, 26 Sep 2021 00:00:00 +020
       
  • Silicone gel sheeting for treating hypertrophic scars

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      Authors: Jiang Q;Chen J;Tian F;Liu Z
      Abstract: New
      Authors :  Jiang Q, Chen J, Tian F, Liu Z Background A scar is a mark left on the skin after a wound or injury has healed, for example, after surgery or after a burn. Most scars will fade and become paler over time, but some scars may become red and raised (called hypertrophic scars). Hypertrophic scars may take several years to flatten and fade.Scars can be itchy, painful or unsightly, and may restrict movement. Scarring can affect people physically and emotionally, and can affect a person's well-being.Treatments aim to improve a scar’s appearance and help to make it less visible. They include: wearing clothing that fits tightly around the skin (pressure garments); treatments applied to the scar; laser therapy and silicone gel sheets.Silicone gel sheets are soft wound dressings containing an elastic form of silicone. They have a soft, rubbery texture and stick to the skin. They are commonly used on healing skin to help soften and flatten a hypertrophic scar. What did we want to find out' In this Cochrane Review, we wanted to find out how well silicone gel sheets worked in treating hypertrophic scars. Our methods We searched for studies that investigated the use of silicone gel sheets to treat hypertrophic scars. We searched for randomised controlled trials only, in which the treatment each person receives is chosen at random. These studies give the most reliable evidence about the effects of a treatment. What we found We found 13 studies with 468 people (425 of them completed the study) with hypertrophic scars caused by surgery, injury, burns or scalding. The studies compared the effects of silicone gel sheets with: giving no treatment with silicone gel sheets; wearing pressure garments; applying silicone gel or onion extract; polyurethane dressings; steroid injections;  laser therapy; intense pulsed light or Gecko Nanoplast (a silicone gel bandage).All studies were conducted in hospitals, in Europe (6 studies), China (2), the USA (1), Canada (1), Iran (1), Turkey (1) and India (1). They lasted for different lengths of time: from 3 months to 12 months.Four studies reported assessments of scars by healthcare professionals in way that was usable for this review. No studies reported useful results for the person's own assessment of their scar after treatment.No studies reported useful results for people's well-being (quality of life): for whether people stayed on the treatment (adherence), whether the treatments had any unwanted effects; or whether the treatments were cost-effective (the benefits of treatment outweighed any extra costs).The studies did not give enough information to compare silicone gel sheets with steroid injections, laser therapy or pulsed light. What are the main results of our review' Silicone gel sheets may slightly improve the appearance of hypertrophic scars compared with onion extract.  We are uncertain whether silicone gel sheets improve a scar's appearance better than no treatment with silicone gel sheets, or silicone gel, or polyurethane. Silicone gel sheets may reduce pain levels compared with pressure garments. Silicone gel sheets may also result in a slight reduction in pain levels compared with no treatment with silicone gel sheets. We are uncertain whether silicone gel sheets decrease pain compared with self-adhesive propylene glycol and hydroxyethyl cellulose sheeting.  The evidence is also very uncertain about the effect of silicone gel sheets on pain compared with Gecko Nanoplast. Certainty of the evidence Our certainty (confidence) in the evidence was low, or very low. The evidence we found comes from a few studies (sometimes only one), often in small numbers of people, with poorly reported results, so we are not sure how reliable the results are. We therefore think our conclusions would be likely to change if results from further studies become available. Conclusions We are uncertain about whether silicone gel sheets work better than most other treatments for hypertrophic scars. Silicone gel sheets may improve the appearance of scars slightly compared with applying onion extract , and may reduce pain compared with no treatment with silicone gel sheets or pressure garments. Search date This review includes evidence published up to 21 April 2021.
      PubDate: Sun, 26 Sep 2021 00:00:00 +020
       
  • Instruments for assisted vaginal birth

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      Authors: Verma GL;Spalding JJ;Wilkinson MD;Hofmeyr GJ;Vannevel V;O'Mahony F
      Abstract: Updated
      Authors :  Verma GL, Spalding JJ, Wilkinson MD, Hofmeyr GJ, Vannevel V, O'Mahony F We used evidence from randomised controlled trials to assess the different forceps and vacuum suction cups used to achieve a vaginal birth. What is the issue' Late in labour, when the cervix (neck of the womb) is fully dilated, it is sometimes necessary to assist the birth of the baby through the vagina with an instrument. This may be because the mother is exhausted, suspected distress of the baby, or the mother has a medical condition preventing prolonged pushing.Two types of instruments can be used: forceps or vacuum suction cups. Forceps are further divided into 'ordinary forceps' for when the baby's head is in the correct position and 'rotational forceps', which are used to turn the baby's head into the correct position. Vacuum cups can be divided into ones with rigid or flexible cups and into ones containing a handheld suction device or ones connected to a foot-operated or electric pump by a tube. This choice of instrument is often dictated by the clinical situation, but there is sometimes a choice. Why is it important' All types of instruments can cause complications for the mother or baby and all can also fail. It is therefore important to choose the correct instrument for the clinical situation with the best chance of ensuring a successful vaginal birth with the least risk of significant complications. What evidence did we find'  We conducted a search on 14th May 2021. Our findings are based on 31 studies with a total of 5754 women and their babies.Twelve studies involving 3129 women compared any type of forceps with any vacuum cup. Forceps were more likely to achieve vaginal birth, but with a greater number of perineal tears including those affecting the anus or rectum (both low-certainty evidence). The was no evidence of a difference in rates of postpartum haemorrhage (heavy bleeding after birth) between groups (low-certainty evidence). There was no evidence of difference in the chances of low Apgar scores (a scoring system used to assess the baby's well-being at 1 and 5 minutes to determine how well they are coping after the birth) and low umbilical artery pH (blood test from the cord to assess the baby's oxygen levels immediately before birth) (both low-certainty evidence). Women who had forceps had higher pain relief requirements, although babies were less likely to be jaundiced. Two small studies in 218 women compared low forceps to any vacuum cup, but most of the evidence was of very low certainty, so we could draw no meaningful conclusion. Nine studies involving 1148 women compared rigid cups with soft cups and found that rigid cups may be more likely to result in a successful delivery (low-certainty evidence), whilst there is probably no evidence of a difference in the rates of perineal tears affecting the anus or rectum or postpartum haemorrhages (low- and moderate-certainty evidence). In addition there is no evidence of a difference in the rates of low Apgar and low umbilical artery pH (low-certainty evidence).In four studies with a total of 962 women we found no evidence of difference in the chances of a failed delivery between the handheld vacuum-cup group compared to the standard vacuum-cup devices (low-certainty evidence). In addition there was no evidence of differences in the risk of maternal rectal tissue trauma (low-certainty evidence). Finally, there was no evidence of difference in the rates of postpartum haemorrhage, low umbilical artery pH or low Apgar between the two groups (low-certainty evidence). What does this mean' The decision on which instrument to use is multifactorial and needs to consider the skills and resources available and the urgency for the birth. The clinician needs to choose the instrument that is most likely to achieve a successful birth with the least trauma to the mother and baby.
      PubDate: Fri, 24 Sep 2021 00:00:00 +020
       
  • Do school-based physical activity interventions increase moderate to
           vigorous physical activity and improve physical fitness among children and
           adolescents'

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      Authors: Neil-Sztramko SE;Caldwell H;Dobbins M
      Abstract: Updated
      Authors :  Neil-Sztramko SE, Caldwell H, Dobbins M Key messages School-based interventions may improve physical fitness but may have little to no impact on body mass index (which is used to assess whether body weight is in a healthy range), although we do not have confidence in the evidence. Very few studies have reported on any potential harmful effects. Careful consideration is needed about the type of school-based physical activity programme to be implemented, and future studies should seek to identify the best types of physical activity interventions for school settings. Why is it important to promote physical activity in children' It is estimated that as many as 5.3 million deaths worldwide are caused by not getting enough exercise (physical inactivity), and this is a big risk factor leading to most long-lasting diseases and cancers. This is a topic of concern, particularly because it is known that physical activity patterns in childhood can lead to similar patterns in adulthood. Programmes that encourage children to exercise while at school are thought to be a way to increase activity levels of all children, regardless of other factors such as parent behaviours and social or financial factors of a child’s early lifetime.  What did we find' We found 89 studies that looked at the effects of programmes in schools that focused on increasing physical activity, which included 66,752 children and adolescents (between the ages of 6 and 18) from around the world. The length of programme time varied from 12 weeks to 6 years. No two school-based physical activity programmes used the same combination of intervention parts. How often and how long each part of a programme was run varied a lot across studies.Across all included studies, only very small changes were noted in the number of students undertaking physical activity or in minutes per day of moderate to vigorous physical activity or sedentary time, although these programmes were found to improve students’ physical fitness. These programmes were found to have little to no impact on measurements used to assess whether body weight is in a healthy range. Not many studies reported on any potential harmful effects, such as injury or psychological harm.  What are the limitations of the evidence' We have little confidence in the evidence because studies were done in different ways and interventions were delivered and assessed in different ways. Also, people in the studies may have been aware of which interventions they were getting, and this can sometimes affect the outcomes reported. In addition, not all studies provided data about everything we were interested in. How up-to-date is the evidence'  The evidence is up-to-date to June 2020 (although we did run a new search for studies in February 2021 and found studies that may be included in a future update and are now described in the “Studies awaiting classification” table).
      PubDate: Thu, 23 Sep 2021 00:00:00 +020
       
  • Non-invasive positive airway pressure therapy to improve erectile
           dysfunction in men with obstructive sleep apnoea

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      Authors: Barbosa FT;Silva MP;Fontes LES;Pachito DV;Melnik T;Riera R
      Abstract: New
      Authors :  Barbosa FT, Silva MP, Fontes LES, Pachito DV, Melnik T, Riera R Review question The purpose of this review was to assess the effectiveness and acceptability of non-invasive positive airway pressure therapy for improving erectile dysfunction (ED) in men with obstructive sleep apnoea (OSAS). Background OSAS is a clinical condition in which repeated throat obstructions occur during sleep, leading to pauses in breathing. Erectile dysfunction is the inability of a man to achieve and maintain a sufficient erection to allow satisfactory sexual activity. The association of OSAS and ED is far more common than might be found by chance. Non-invasive positive airway pressure therapy is a device that is attached to a mask that delivers oxygen. The device helps air enter the airways and help breathing. There are a few different types of devices including continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), or variable positive airway pressure (VPAP). CPAP is widely recognised as the first-line treatment for OSAS. However, it is uncertain whether CPAP or other non-invasive positive airway pressure therapy device have an effect on ED experienced by men with OSAS. Search date We last searched for evidence on 14 June 2021. Study characteristics We included six studies, that included 315 men with OSAS and ED. They compared the use of CPAP with either: no CPAP; with sham device (a device similar to CPAP without positive pressure, as a placebo); or with phosphodiesterase type 5 inhibitors (first-line oral medications for the treatment of ED), for at least month. We evaluated the following primary outcomes (remission of ED and serious adverse events); and secondary outcomes (sex-related quality of life, health-related quality of life, and minor adverse events). Key results CPAP device versus no CPAP We are uncertain about the effects of CPAP on erectile dysfunction after 4 and 12 weeks, and on sex-related quality of life after 12 weeks. None of the groups reported any serious side effects after 12 weeks. CPAP versus sham CPAP One study (61 participants) compared CPAP with a sham device, but we were unable to analyse data because of the design and reporting of this trial. CPAP versus sildenafil (phosphodiesterase type 5 inhibitors) Sildenafil may improve erectile function and sex-related quality of health more than CPAP after 12 weeks compared to phosphodiesterase 5 inhibitors (sildenafil). None of the groups reported serious side effects; both groups reported some mild, transient side effects after 12 weeks. Quality of the evidence We are uncertain about the results, because of limitations in how the studies were conducted, the small sample sizes, and imprecise results.
      PubDate: Thu, 23 Sep 2021 00:00:00 +020
       
 
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