Die 5 Minuten Evidenz - Cochrane Ausgabe 3/2008
Ausgabe 3/2008 der Cochrane Library
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Bitte wählen Sie Ihr Thema aus: |
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| Chirurgie | Atmung | Darm |
| Neurologie, Depression, Nerven, Psychose | Diabetes | Zähne |
| Cognition | Aktivität | Diverses |
| Frauen | Krebs | - |
| Auge | Kinder | - |
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Ausgewählte Updates mit veränderter klinischer Konsequenz: |
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|---|---|---|
| Kinder | Neurologie/Psychatrie | Darm |
| Infektion | Information | Fraktur |
| Sucht | Zahn | Diverses |
Chirurgie
5 RCTs
Enzyme treated wounds were cleaned more quickly. Lack of large, high quality published RCTs evaluating debridement
8 Trials (n= 1141 Patienten)
Good evidence from three trials that open mesh repair is superior to suture repair in terms of recurrences, but inferior when considering wound infection.
Neurologie Depression, Nerven, Psychose
Cannabis and schizophrenia HTML
1 RCT
Insufficient evidence use of cannabis/cannabinoid compounds for people suffering with schizophrenia.
15 Studien mäßiger Qualität
kein klinisch bedeutender Effekt der Interventionen
kein klinisch bedeutender Effekt der Interventionen
2 Trials (n= 272 Patienten)
Gliadel® results in a prolongation of survival without an increased incidence of adverse events.
Gliadel® results in a prolongation of survival without an increased incidence of adverse events.
Kein RCT
There is no evidence from randomised controlled trials about the management of pain in ALS.
There is no evidence from randomised controlled trials about the management of pain in ALS.
7 RCTs (n = 958), davon 1 (N = 100) mit geringem Risiko des Bias.
No statistically significant difference between continuous traction and placebo traction in reducing pain or improving function for chronic neck disorders with radicular symptoms.
There is no evidence that interventions aimed at reducing body temperature to between 35 ºC and 37.5 ºC in the first week after TBI improves patient outcomes.
9 Trials (n= 201 Patienten)
Some evidence that HBOT was effective for acute migraine in an unselected population, and weak evidence that NBOT was similarly effective in cluster headache.
11 Trials (n= 747)
Patients treated with vigabatrin were significantly more likely to obtain a 50% or greater reduction in seizure frequency compared with those treated with placebo (RR 2.58 (95% CI 1.87 to 3.57)).
Patients treated with vigabatrin were significantly more likely to obtain a 50% or greater reduction in seizure frequency compared with those treated with placebo (RR 2.58 (95% CI 1.87 to 3.57)).
Treatment for meralgia paraesthetica HTML
Kein RCT
Observationale Evidenz mit hohen Heilungsraten bei Zuwarten, Cortison, Operation
Vitamin B for treating peripheral neuropathy HTML
Kein RCT
Observationale Evidenz mit hohen Heilungsraten bei Zuwarten, Cortison, Operation
Vitamin B for treating peripheral neuropathy HTML
13 Trials (n= 741)
Only one study suggested possible short-term benefit from eight-week treatment with benfotiamine (a derivative of vitamin B1).
Cognition
10 Studien, nachrangige Qualität
No evidence that adjunctive therapies had any effect on the patients; without any harmful effect on the patients.
No evidence that adjunctive therapies had any effect on the patients; without any harmful effect on the patients.
Frauen
Amniotic fluid index versus single deepest vertical pocket as a screening test for preventing adverse pregnancy outcome HTML
4 Trials (N=3125)
When the amniotic fluid index was used, significantly more cases of oligohydramnios were diagnosed ( RR 2.33, 95% CI 1.67 to 3.24), and more women had inductions of labor (RR 2.10) and caesarean delivery for fetal distress (RR 1.45).
A systematic review of the diagnostic accuracy is required.
A systematic review of the diagnostic accuracy is required.
All six studies were excluded. Therefore no trials are included in this review.
There is no information on which to base practice in the treatment of women with ketosis during labour.
No articles met the inclusion criteria.
The review question remains unanswered.
15 Studien (n=4694)
Delivery of the placenta with cord traction at caesarean section has more advantages compared to manual removal.
Rapid versus stepwise negative pressure application for vacuum extraction assisted vaginal delivery HTML
1 Studie (n=94)
The rapid negative pressure application for vacuum assisted vaginal birth reduces the duration of the procedure whilst there is no evidence of differences in maternal and neonatal outcome.
15 Studien (n=3972)
Overall, trials focussed on blood loss and duration of the procedure rather than clinical outcomes for the women.
The use of an auto-suture instrument was associated with no difference in the amount of blood loss (one study, n=200), but a statistically significant increase in the duration of the procedure (one study, 197).
Single layer closure compared with double layer closure was associated with a statistically significant reduction in mean blood loss (three studies, 527 women).
The use of an auto-suture instrument was associated with no difference in the amount of blood loss (one study, n=200), but a statistically significant increase in the duration of the procedure (one study, 197).
Single layer closure compared with double layer closure was associated with a statistically significant reduction in mean blood loss (three studies, 527 women).
1 RCT (n=200)
Uterine massage after delivery of the placenta is advised to prevent PPH
No randomised controlled trials
Breastfeeding is beneficial for both mother and infant. However, there is no evidence to support the notion that antenatal breast examinations are effective in promoting breastfeeding.
2 Studien (n=2644), 2 für Update
Evidence from two (4ß) high quality randomised trials that the use of unconventional fractionation regimes (greater than 2 Gy per fraction) does not affect breast appearance or toxicity and does not seem to affect local recurrence for selected women treated with breast conserving therapy.
Evidence from two (4ß) high quality randomised trials that the use of unconventional fractionation regimes (greater than 2 Gy per fraction) does not affect breast appearance or toxicity and does not seem to affect local recurrence for selected women treated with breast conserving therapy.
1 controlled trial (n=362)
Evidence of very low quality of a positive effect on psychological well-being for both groups at one year follow up.
Evidence of very low quality of a positive effect on psychological well-being for both groups at one year follow up.
2 RCTs
There is inadequate evidence to recommend or refute the use of urinary hCG, as an ovulation trigger, in anovulatory women being treated with clomiphene citrate.
No articles met the inclusion criteria.
The review did not find any evaluations of preconception counselling and educational interventions that were of sufficient quality
No suitable randomised controlled trials were identified.
The available research is not adequate to determine the effectiveness of tubal surgery compared to either IVF or expectant management.
Auge
Surgery for post-vitrectomy cataract HTML
No RCTs
There is no evidence from randomized or quasi-randomized controlled trials on which to base clinical recommendations for surgery for post-vitrectomy cataract.
No RCTs
There is no evidence from randomized or quasi-randomized controlled trials on which to base clinical recommendations for surgery for post-vitrectomy cataract.
There is currently no strong evidence for laser peripheral iridoplasty’s use in treating angle-closure.
6 Studien (n=1438)
Retrobulbar or peribulbar anaesthesia were largely effective. Conjunctival chemosis was more common after peribulbar block and lid haematoma was more common after retrobulbar block.
Herzkreislauf, CVD
1 2 Studien (n=778)
Only a small number of people suffered acute heart disease in these trials, so it is difficult to reach any conclusions about the effect of influenza vaccination for preventing heart disease.
4 Studien (n=108)
Adult patients treated with CSA (Cyclosporin A) perhaps in combination with oral prednisolone are more likely to achieve a partial remission of the nephrotic syndrome compared with symptomatic treatment or prednisolone alone. However, there is a probability of deterioration of kidney function due to the nephrotoxic effect of CSA in the long term.
13 Studien (n=702)
Plasma exchange is effective in patients with severe ARF secondary to vasculitis. On current data, the use of pulse CPA results in an increased risk of relapse when compared to continuous use but a reduced total dose.
1 Studie (n=66)
Not enough evidence to make any conclusion
Atmung
Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary edema HTML
21 Studien (n=1071)
Compared to standard medical care, NPPV significantly reduced hospital mortality (RR 0.6, 95% CI 0.45 to 0.84) and endotracheal intubation (RR 0.53, 95% CI 0.34 to 0.83).
26 Studien (n=62.630)
In comparison with placebo, we have found an increased risk of serious adverse events with regular salmeterol. There is also a clear increase in risk of asthma-related mortality.
The failure to demonstrate a beneficial effect for oxygen breathing over air breathing in cancer or cardiac failure was limited by the small volume of research studies
Pelargonium sidoides extract for acute respiratory tract infections HTML
7 Studien (n=746), 3 Studien (819 children)
There is limited evidence for the effectiveness of P. sidoides in the treatment of ARIs. The herbal preparation may be effective in relieving symptoms in acute bronchitis in adults and children, and sinusitis in adults.
Diabetes
Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups HTML
11 Studien (n=1603)
11 Studien (n=1603)
Diabetes health education appears to have short term effects on glycaemic control and knowledge of diabetes and healthy lifestyles. Clinically important long-term outcomes could not be studied.
Intermediate acting versus long acting insulin for type 1 diabetes mellitus HTML
23 Studien (n>6000)
The currently available data can not substantiate conclusions on the benefits and risks of long acting insulins.
This review suggest that the role of decompressive surgery for diabetic symmetric distal neuropathy is unproven.
No high quality data on the efficacy of dietary intervention for the prevention of type 2 diabetes.
In the 6-year Da Qing IGT & Diabetes study, the incidence of type 2 diabetes in the control group was 67.7% which was reduced to 43.8% in the diet group. Overall, the dietary intervention group had a 33% reduction in the incidence of diabetes after six years (P < 0.03).
8 Studien (1-6 Jahre) mit exercise plus diet (2241) gegen ususal care (2509).
1 Studie mit diet only (167 participants), 1 mit exercise only arm (178 participants).
Exercise plus diet reduced the risk of diabetes (RR 0,63, 95% CI 0,49 – 0,79).
No study reported relevant data on diabetes and cardiovascular related morbidity, mortality and quality of life.
1 Studie mit diet only (167 participants), 1 mit exercise only arm (178 participants).
Exercise plus diet reduced the risk of diabetes (RR 0,63, 95% CI 0,49 – 0,79).
No study reported relevant data on diabetes and cardiovascular related morbidity, mortality and quality of life.
Aktivität
2 Studien
The results from this review suggest that there is insufficient evidence of the effectiveness of physical activity programs in managing or improving cognition, function, behaviour, depression, and mortality in people with dementia.
Physical therapy for Bell´s palsy (idiopathic facial paralysis) HTML
6 Studien (n>500)
There is no evidence of significant benefit or harm from any physical therapy for idiopathic facial paralysis.
Krebs
There was no improvement in overall survival in the pooled analysis. With regards to disease-free survival, the pooled relative risk ratio was 0.83 (95% confidence interval 0.75, 0.92).
Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults HTML
2 RCT, N=64
The results of this systematic review are inconclusive.
2 RCT, N=64
The results of this systematic review are inconclusive.
Kinder
Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children HTML
6 Studien, N=254
6 Studien, N=254
Aprotinin, tranexamic acid and aminocaproic acid seem to be similarly effective in reducing blood loss. The effect on mortality could not be assessed.
Chest physiotherapy for reducing respiratory morbidity in infants requiring ventilatory support HTML
3 Studien, N=106
The results of this review do not provide sufficient evidence on which to base clinical practice.
Combination antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis HTML
1Studie, N=132
1Studie, N=132
Insufficient evidence to determine effect of choosing antibiotics based on combination antimicrobial susceptibility testing compared to choosing antibiotics based on conventional antimicrobial susceptibility testing.
Combination fluticasone and salmeterol versus fixed dose combination budesonide and formoterol for chronic asthma in adults and children HTML
5 Studien, N=5537
The width of the confidence intervals for the primary outcomes justify further trials in order to better determine the relative effects of these drug combinations
The review demonstrates a critical lack of well controlled treatment studies
Intervention for dysarthria associated with acquired brain injury in children and adolescents HTML
Intervention for dysarthria associated with acquired brain injury in children and adolescents HTML
The review demonstrates a critical lack of studies, let alone RCTs
18 Studien, N= 6165
Research evidence shows zinc is clearly of benefit in children aged six months or more.
Research evidence shows zinc is clearly of benefit in children aged six months or more.
2 Studien, N=167
The limited results in Chinese suggest that a gland specific lower dosage of radioiodine treatment is potentially effective for pediatric GD
Vaccines for post-exposure prophylaxis against varicella (chickenpox) in children and adults HTML
3 Studien, N=110
3 Studien, N=110
These small trials suggest varicella vaccine reduces infection rates and severity of cases.
Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy HTML
5 Studien (n=349)
5 Studien (n=349)
Limited evidence suggests that intranasal corticosteroids may significantly improve nasal obstruction symptoms in children with moderate to severe adenoidal hypertrophy.
Nicht medizinische Assistenz- insgesamt sehr wenig Evidenz
1 Studie, n= 817
Research in this field is limited.
Personal assistance for children and adolescents (0-18) with both physical and intellectual impairments HTML
Keine passenden Studien gefunden
Keine passenden Studien gefunden
Keine passenden Studien gefunden.
Personal assistance for children and adolescents (0-18) with intellectual impairments HTML
1 Studie, n= 1002
Paid assistance probably substitutes for informal care and may cost government more than alternatives.
Darm
1 Studie, N=11
There is insufficient evidence to make any conclusions
There is insufficient evidence to make any conclusions
Tacrolimus (FK506) for induction of remission in refractory ulcerative colitis HTML
1 Studie
Tacrolimus may be effective for short-term clinical improvement in patients with refractory ulcerative colitis.
1 Studie
Tacrolimus may be effective for short-term clinical improvement in patients with refractory ulcerative colitis.
4 Studien
The existing literature does not support the efficacy of type I IFNs for induction of remission in patients with UC
The existing literature does not support the efficacy of type I IFNs for induction of remission in patients with UC
Zähne
1 Studie
The data from this study are inconclusive.
The data from this study are inconclusive.
Diverses
Psychosocial interventions for prevention of psychological disorders in law enforcement officers HTML
10 Studien
There is evidence only from individual small and low quality trials with minimal data suggesting that police officers benefit from psychosocial interventions, in terms of physical symptoms and psychological symptoms such as anxiety, depression, sleep problems, cynicism, anger, PTSD, marital problems and distress.
23 Studien mit sehr unterschiedlichen Interventionen
Printed educational materials (PEMs) may have a beneficial effect on process outcomes but not on patient outcomes. There is insufficient information about how to optimise educational materials.
Printed educational materials (PEMs) may have a beneficial effect on process outcomes but not on patient outcomes. There is insufficient information about how to optimise educational materials.
20 RCTs, N=3458; 13 von den Studien mit erhöhtem Risiko für bias
AT III cannot be recommended for critically ill patients based on the available evidence.
Corticosteroids as adjuvant to antiviral treatment in Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults HTML
This is an empty review as no trials were found.
Corticosteroids for preventing graft-versus-host disease after allogeneic myeloablative stem cell transplantation HTML
5 Studien, N=604
The addition of corticosteroids reduces the incidences of acute GvHD grade I to IV and II to IV. This reduction, however, did not show any effect on overall survival and disease-free survival.
11 Studien, N= 1332
There is limited evidence on which to base clinical decisions regarding the prescription of custom-made foot orthoses for the treatment of foot pain.
There is limited evidence on which to base clinical decisions regarding the prescription of custom-made foot orthoses for the treatment of foot pain.
There is a lack of high quality research in the field of ulcer prevention and treatment in leprosy.
21 Studien, N=1018
31 Studien
Heterogeneity prevented meta-analyses in most instances. There is no evidence of improved function from other therapies such as electrotherapy, hypnosis or stretching.
Heterogeneity prevented meta-analyses in most instances. There is no evidence of improved function from other therapies such as electrotherapy, hypnosis or stretching.
Target-controlled infusion versus manually-controlled infusion of propofol for general anaesthesia or sedation in adults HTML
20 Studien, N=1759 (poor quality)
Insufficient evidence for firm recommendations about the use of TCI versus MCI in clinical anaesthetic practice.
Ausgewählte Updates mit veränderter klinischer Konsequenz:
Kinder
This review suggests a beneficial effect of antibiotics in preventing complications such as pneumonia, purulent otitis media and tonsillitis in children with measles.
Erythromycin for the prevention and treatment of feeding intolerance in preterm infants HTML
10 Studien
There is insufficient evidence to recommend the use of erythromycin.
10 Studien
There is insufficient evidence to recommend the use of erythromycin.
Infektionen
Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women HTML
15 Studien, N=1644
Short-course treatment (3 to 6 days) could be sufficient for treating uncomplicated UTIs in elderly women
Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men HTML
44 Studien, N=18.585
Behavioral interventions reduce self-reported unprotected anal sex among MSM. These results indicate that HIV prevention for this population can work and should be supported.
24 Studien, N=6315
Praziquantel and metrifonate are effective treatments for urinary schistosomiasis and have few adverse events.
Sucht
Interventions in the alcohol server setting for preventing injuries HTML
1 RCT
There is no reliable evidence that interventions in the alcohol server setting are effective in reducing injury.
There is no reliable evidence that interventions in the alcohol server setting are effective in reducing injury.
9 Studien (N=7267) für Vareniclin, eine für Cytisin
RR für Abstinenz nach 6 Monaten für Vareniclin versus Placebo 2,33 (95% CI: 1,95 – 2,80, versus Bupropion nach 1 Jahr 1,52, versus NRT 1,31.
RR für Abstinenz nach 6 Monaten für Vareniclin versus Placebo 2,33 (95% CI: 1,95 – 2,80, versus Bupropion nach 1 Jahr 1,52, versus NRT 1,31.
Neurologie/Psychiatrie
Aripiprazole versus typical antipsychotic drugs for schizophrenia HTML
9 RCTs (N=3122)
Aripiprazole differs little from typical antipsychotic drugs with respect to efficacy, however it presents significant advantages in terms of tolerability.
CBT is effective in reducing the symptoms of fatigue at post-treatment compared with usual care, and may be more effective in reducing fatigue symptoms compared with other psychological therapies. The evidence base at follow-up is limited to a small group of studies with inconsistent findings.
Interventions for preventing depression after stroke HTML
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003689/frame.html
14 Studien (N=1515)
A small but significant effect of psychotherapy on improving mood and preventing depression was identified.
Information
23 Artikel und 26 Interventionen
This review suggests that computerized advice for drug dosage has some benefits.
Zahn
Interventions for replacing missing teeth: bone augmentation techniques for dental implant treatment HTML
17 Studien (N=455)
There is not enough evidence supporting or refusing the need of augmentation procedures when single extracted teeth are immediately replaced with dental implants, nor is it known whether any augmentation procedure is better than the others.
Darm
12 Studien
Budesonide is more effective than placebo or mesalamine for induction of remission in Crohn's disease.
Budesonide is more effective than placebo or mesalamine for induction of remission in Crohn's disease.
Fraktur
5 Studien (N=488)
Although there is a lack of available evidence to inform practice for undisplaced intracapsular fractures, variation in practice has reduced and most fractures are treated surgically. The limited available evidence from randomised trials does not suggest major differences in outcome between conservative and operative management programmes for extracapsular femoral fractures.
Gamma and other cephalocondylic intramedullary nails versus extramedullary implants for extracapsular hip fractures in adults HTML
22 Studien (N=3871)
The sliding hip screw appears to be a better implant for fixing the more common types of extracapsular hip fractures.
Diverses
5 Studien
Bicycle helmet legislation appears to be effective in increasing helmet use and decreasing head injury rates
Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment HTML
11 Studien
There is evidence that aerobic physical activities which improve cardiorespiratory fitness are beneficial for cognitive function in healthy older adults, with effects observed for motor function, cognitive speed, auditory and visual attention. However, the majority of comparisons yielded no significant results.
