Die 5 Minuten Evidenz - Cochrane Ausgabe 1
Ausgabe 1/2008 der Cochrane Library
Alendronate for the primary and secondary prevention of osteoporotic
fractures in postmenopausal women
'gold' level evidence for clinically important reductions in vertebral, non-vertebral,
hip and wrist fractures for secondary prevention.
Antidepressants for non-specific low back pain
Ten trials
Conflicting evidence on the effect of antidepressants on pain intensity in chronic low-back pain, and no clear evidence that antidepressants reduce depression in chronic low-back pain patients.
Individual patient education for low back pain
24 studies
patients with subacute LBP, there is strong evidence that an individual 2.5 hour oral educational session is more effective on short-term and long-term return-to-work than no intervention.
Arthrographic distension for adhesive capsulitis (frozen shoulder)
Five trials, N=196
"silver" level evidence that arthrographic distension with saline and steroid provides short-term benefits in pain
Arthroscopic debridement for knee osteoarthritis
3 RCTs, N=271
'gold' level evidence that AD has no benefit for undiscriminated OA
Pharmacological agents (anti-inflammatory and analgesic) for managing symptoms in
people with cystic fibrosis-related arthritis
No relevant studies were identified.
Post-operative therapy for metacarpophalangeal arthroplasty
one controlled clinical trial, N=22
Results of one study (silver level evidence) suggest that continuous passive motion alone is not recommended for increasing motion or strength after MCP arthroplasty.
Depression, Nerven, Psychose
Antiglucocorticoid treatments for mood disorders
9 trials,
The use of antiglucocorticoids in the treatment of mood disorders is at the proof-of-concept stage.
Results in some diagnostic subtypes are promising.
Music therapy for depression
Five studies
Findings from individual randomised trials suggest that music therapy is accepted by people with depression and is associated with improvements in mood.
Aripiprazole versus typicals for schizophrenia
9 Studien, N=3122
Aripiprazole is not much different from typical antipsychotic drugs with respect to efficacy. However it presents significant advantages in terms of tolerability due to its favourable adverse effects profile.
Atypical antipsychotics for people with both schizophrenia and depression
3 Studien
There are too few data.
Haloperidol versus chlorpromazine for schizophrenia
14 Studien
Haloperidol and chlorpromazine are standard antipsychotic treatments for schizophrenia, it is surprising that less than 800 people have been randomised to a comparison.
Psychotherapeutic treatments for older depressed people
9 Studien
Only a small number of studies and patients were included in the meta-analysis.
Drug therapy for the management of cancer related fatigue
27 trials, N= 6746
Erythropoietin and darbopoetin (for anaemic patients on chemotherapy) and psychostimulant trials provide evidence for improvement in CRF at a clinically meaningful level.
Corticosteroids for preventing postherpetic neuralgia
Five trials, N=787
There was insufficient evidence to conclude that corticosteroids are safe or effective in the prevention of postherpetic neuralgia.
Oxcarbazepine in the maintenance treatment of bipolar disorder
2 RCTs
Not enough evidence
Pre-admission antibiotics for suspected cases of meningococcal disease
Pregabalin add-on for drug-resistant partial epilepsy
4 trials, N=1397
Pregabalin, when used as an add-on drug for treatment-resistant partial epilepsy, is significantly more effective than placebo at achieving a 50% or greater seizure reduction.
Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for
obsessive compulsive disorder (OCD)
17 RCTs, N=3097
SRIs are more effective than placebo for OCD, at least in the short-term.
Cholinesterase inhibitors for delirium
Ein trial, N=15
FCurrently no evidence from controlled trials that donepezil is effective in the treatment of delirium.
Corticosteroids for the long-term treatment in multiple sclerosis
3 trials, all at high risk of bias
Not enough evidence that long-term corticosteroid treatment delays progression of long term disability in patients with MS.
Information Compliance Education
Individual patient education for low back pain
Of the 24 studies included in this review, 14 (58%) were of high quality.Results showed that for patients with subacute LBP, there is strong evidence that an individual 2.5 hour oral educational session is more effective on short-term and long-term return-to-work than no intervention.
Mass media interventions for smoking cessation in adults
Eleven campaigns met the inclusion criteria for this review.
There is evidence that comprehensive tobacco control programmes which include mass media campaigns can be effective in changing smoking behaviour in adults, but the evidence comes from a heterogeneous group of studies of variable methodological quality.
Pharmaceutical policies: effects of cap and co-payment on rational drug use
We included 30 evaluations (in 21 studies).
Cap and co-payment polices can reduce drug use and save plan drug expenditures. However, although insufficient data on health outcomes were available, substantial reductions in the use of life-sustaining drugs or drugs that are important in treating chronic conditions may have adverse effects on health, and as a result increase the use of healthcare services and overall expenditures. Direct payments are less likely to cause harm if only non-essential drugs are included…
Audio-visual presentation of information for informed consent for participation in clinical trials
We included 4 trials involving data from 511 people.
The value of audio-visual interventions for people considering participating in clinical trials remains unclear.
Care delivery and self-management strategies for adults with epilepsy
There are 13 trials and 16 reports included in this review. Two intervention types, the specialist epilepsy nurse and self-management education, have some evidence of benefit.
Educational games for health professionals
Out of 55 potentially eligible citations, we included one RCT.
The findings of this systematic review do not confirm nor refute the utility of games as a teaching strategy for health professionals.
Interventions for preventing injuries in the agricultural industry
Five randomised controlled trials (RCTs) with 11,565 participants and three interrupted time series studies (ITSs) with 26.3 data points on average met the criteria.
The selected studies provided no evidence that educational interventions are effective in decreasing injury rates among agricultural workers. Financial incentives could reduce injury rates. Legislation to ban pesticides could be effective. Legislation expanding the use of safety devices (ROPS) on new tractors was associated with a decrease in fatal injuries.
Personal assistance for older adults (65+) without dementia
Four studies involving 1642 participants made three eligible comparisons:
This review indicates that personal assistance probably has some benefits for some recipients and caregivers. Paid assistance probably substitutes for informal care and may cost government more than alternatives
When and how to update systematic reviews
Little research has been conducted on when and how to update systematic reviews and the feasibility and efficiency of the identified approaches is uncertain.
Gefäße
Antibiotics and antiseptics for venous leg ulcers
22 RCTs
there is no evidence to support the routine use of systemic antibiotics to promote healing in venous leg ulcers.
Anticoagulation for the intial treatment of venous thromboembolism in patients with cancer
26 RCTs
Meta-analysis of 11 studies showed a statistically significant mortality reduction in patients treated with LMWH compared with those treated with UFH.
Pharmacological interventions for hypertensive emergencies
There is no RCT evidence demonstrating that anti-hypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies.
CVD
Psychosocial interventions for smoking cessation in patients with coronary heart disease
16 RCTs
Psychosocial smoking cessation interventions are effective in promoting abstinence at 1 year
Chinese herbal medicine suxiao jiuxin wan for angina pectoris
Fifteen trials involving 1776 people were included.
There was weak evidence that suxiao jiuxin wan compared with nitroglyerin (xiaoxintong) improved ECG measurements, reduced symptoms, reduced the frequency of acute attacks of angina, reduced diastolic pressure and reduced the need for supplementary nitroglycerin.
Hawthorn extract for treating chronic heart failure
Fourteen trials
significant benefit in symptom control and physiologic outcomes from hawthorn extract as an adjunctive treatment for chronic heart failure.
Interventions for minimal change disease in adults with nephrotic syndrome
Three RCTs (68 participants)
Only oral steroid treatment showed an increase in the number of patients who achieved complete remission.
Interventions for motor apraxia following stroke
Three RCTs including a total of 132
There is insufficient evidence
Interventions for preventing venous thromboembolism following abdominal aortic surgery
Two studies (n=147)
There is not enough evidence to make a definitive conclusion
Puerarin for acute ischaemic stroke
One trial, N= 98
There is not enough evidence
Relaxation therapies for the management of primary hypertension in adults
25 trials, 1,198 participants. Adequate randomisation was confirmed in only seven trials.
Poor quality of included trials. Some of the apparent benefit of relaxation was probably due to aspects of treatment unrelated to relaxation.
Vitamin C and superoxide dismutase (SOD) for diabetic retinopathy
No research to date has adequately examined the treatment of diabetic retinopathy with vitamin C or SOD
Kinder
Continuous infusion versus intermittent bolus doses of indomethacin for patent ductus arteriosus closure in symptomatic preterm infants
Only two small trials
Data was found to be insufficient to draw conclusions.
Prophylactic surgical ligation of patent ductus arteriosus for prevention of mortality and morbidity in extremely low birth weight infants
1 Studie, N=84
Prophylactic surgical ligation of the PDA resulted in a statistically significant reduction of severe stage II or III necrotizing enterocolitis
Probiotics for prevention of necrotizing enterocolitis in preterm infants
9 trials, N=1425
Probiotics reduced the risk of severe NEC and mortality in preterm infants.
Prophylactic systemic antibiotics to reduce morbidity and mortality in
neonates with central venous catheters
Three small studies
Prophylactic systemic antibiotics reduces the rate of septicaemia. However, this may not be clinically important in the face of no significant difference in overall mortality and the lack of data on long-term neurodevelopmental outcome.
Psychosocial interventions for recurrent abdominal pain (RAP) and irritable
bowel syndrome (IBS) in childhood
6 RCTs, N=167
CBT may therefore be worth considering for some children with recurrent abdominal pain.
Treatment Foster Care for improving outcomes in children and young people
5 RCTs, N=390
For TFC the evidence base is less robust than that usually reported.
Vitamin A for preventing acute lower respiratory tract infections in children up to seven years of age
Vitamin A caused an increased incidence of acute LRTI in one study; an increase in cough and fever; and increased symptoms of cough and rapid breathing in two others. Three reported no differences and no protective effect of vitamin A.
Influenza
Amantadine and rimantadine for influenza A in children and the elderly
Due to the small number of available studies we could not reach a definitive conclusion.
HIV
Abstinence-plus programs for HIV infection prevention in high-income countries
39 Trials, N= 37724
Many abstinence-plus programs appear to reduce short-term and long-term HIV risk behavior among youth in high-income countries.
Treatment of helminth co-infection in HIV-1 infected individuals in resource-limited settings
5 trials
Data from a single RCT and multiple observational studies suggest possible benefit in reducing plasma viral load.
Frauen, Sterilität, Unterbauchbeschwerden...
Intracervical prostaglandins for induction of labour
56 Trials, N= 7738
Intracervical prostaglandins are effective compared to placebo, but appear inferior when compared to intravaginal prostaglandins.
Techniques for caesarean section
Cohen based' methods have advantages compared to Pfannenstiel and to traditional (lower midline) CS techniques, which could translate to savings for the health system.
Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection
7 RCTs, N=1249
The effect of antepartum antiviral prophylaxis on neonatal herpes could not be estimated. Women who received antiviral prophylaxis had significantly less likely: recurrence of genital herpes, cesarean delivery.
Cycle regimens for frozen-thawed embryo transfer
7 RCTs, N=1120
insufficient evidence to support the use of one intervention in preference to another.
Long versus short course treatment with Metformin and Clomiphene Citrate for ovulation induction in women with PCOS
No randomised controlled trials were identified.
Oral contraceptives containing drospirenone for premenstrual syndrome
5 trials, N=1600
Drospirenone plus EE 20 μg may help treat premenstrual symptom, placebo also had a large effect.
Specialist breast care nurses for supportive care of women with breast cancer
5 trials
There is limited evidence to support the contention that interventions by Breast Care Nurses assist in the short-term with the recognition and management of psychological distress for women with breast cancer.
Surgical versus medical methods for second trimester induced abortion
Two studies
Dilation and evacuation is superior to instillation of prostaglandin F2α.
Chirurgie
Hand washing for preventing diarrhoea
14 RCTs
Hand washing can reduce diarrhoea episodes by about 30%.
Surgical hand antisepsis to reduce surgical site infection
Ten trials
The evidence from comparisons of aqueous scrubs with alcohol rubs which contain additional active ingredients is mixed, there is evidence from studies in favour of both forms of antisepsis.
Day-case versus overnight stay in laparoscopic cholecystectomy
5 trials, N=429
Day-case elective laparoscopic cholecystectomy seems to be a safe and effective intervention in selected patients with symptomatic gallstones. Because of the decreased hospital stay, it is likely to save costs.
Different methods of external fixation for treating distal radial fractures in adults
9 trials, N=510
There is insufficient robust evidence to determine the relative effects of different methods of external fixation.
Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people
No studies met the selection criteria Ischaemic preconditioning for liver transplantation
3 trials, N=162
There is currently no evidence to support or refute the use of ischaemic preconditioning in donor liver retrievals.
Spinal fixation surgery for acute traumatic spinal cord injury
No randomised controlled trials or controlled trials were identified.
Surgery for rotator cuff disease
14 RCTs, N=829
Effect of surgery for rotator cuff disease:
may not lead to any difference in pain compared with different exercise programs. Arthroscopic surgery may not lead to any difference in outcome in the long run compared with open surgery but people might recover sooner.
Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults
39 RCTs, N=4615
Six RCTs support the effect of Alvimopan
Treatment for peritoneal dialysis-associated peritonitis
36 studies, N=2089
Based on one study, IP administration of antibiotics is superior to IV dosing for treating PD peritonitis.
Tumor necrosis factor-alpha antibody for maintenace of remission in Crohn's disease
9 trials
Infliximab is effective for the maintenance of remission and maintenance of fistula healing in patients who have responded to infliximab induction therapy.
Diäten
Dietary exclusions for established atopic eczema
9 RCTs, N=421
Little evidence supports the use of various exclusion diets in unselected people with atopic eczema.
Whole grain foods for the prevention of type 2 diabetes mellitus
One randomised controlled trial and eleven prospective cohort studies.
The evidence from prospective cohort trials is considered to be too weak to to draw a definite conclusion about the preventive effect of whole grain foods on the development of T2DM.
Zahn
Full-mouth disinfection for the treatment of adult chronic periodontitis
7 RCTs
None of the studies included reported on tooth loss.
In chronic periodontitis slightly more favourable outcomes for pocket reduction and gain in probing attachment were found following FMD.
Interventions for the management of submucous cleft palate
1 trial, N=72
The trial provided some weak and unreliable evidence that there was no significant difference in the effectiveness of minimal incision palatopharyngoplasty versus the same procedure performed simultaneously.
Atemwege
Herbal interventions for chronic asthma in adults and children
27 RCTs, N=1925
The data that are available from the studies provide only a small insight into the long-term efficacy and harm profiles.
Interventions for noisy breathing in patients near to death
only one study met the inclusion criteria
Currently no evidence to show that any intervention, be it pharmacological or non-pharmacological, is superior to placebo in the treatment of death rattle.
Vitamin A supplementation for cystic fibrosis
No relevant studies were identified in the search.
Blut
Inhaled nitric oxide for acute chest syndrome in people with sickle cell disease
No studies were eligible for inclusion.
Karzinom
High-dose chemotherapy with autologous stem cell transplantation in the first line treatment of aggressive Non-Hodgkin Lymphoma (NHL) in adults
15 RCTs, N=3079
Despite higher CR rates, there is no benefit for high-dose chemotherapy with stem cell transplantation as a first line treatment in patients with aggressive NHL.
Verschiedenes
Medical interventions for fungal keratitis
Six trials
There is no evidence that the current available and investigational antifungal agents are effective.
Treatment for periodic paralysis
Three studies
Dichlorphenamide (DCP) was effective in the prevention of episodic weakness.
Probiotics for treatment of Clostridium difficile-associated colitis in adults
Four studies
There is insufficient evidence to recommend probiotic therapy as an adjunct to antibiotic therapy for C. difficile colitis.
Treatment for Charcot-Marie-Tooth disease
Only one trial with only eight participants
