Die 5 Minuten Evidenz - Cochrane Ausgabe 4/2008
Ausgabe 4/2008 der Cochrane Library
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Bitte wählen Sie Ihr Thema aus: |
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| Chirurgie |
Auge |
Kinder |
| Neurologie, Depression, Nerven, Psychose |
Herzkreislauf, CVD |
Darm |
| Cognition |
Atmung |
Infektionen |
| Haut |
Aktivität |
Zähne - |
| Frauen |
Krebs |
Knochen, Osteoporose - |
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Ausgewählte Updates mit veränderter klinischer Konsequenz: |
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|---|---|---|
| Herz, Kreislauf |
Infektionen |
Zähne |
| Depression | Sucht |
Schmerz |
| Kinder | Neurologie, Psychiatrie |
Chirurgie |
Chirurgie
2 trials (n=185)
There is evidence that different designs are better for men and women. Diapers are the most cost-effective disposable design for men. Disposable pull-ups are most preferred for women but are expensive: disposable inserts are a cheaper alternative.
There is evidence that different designs are better for men and women. Diapers are the most cost-effective disposable design for men. Disposable pull-ups are most preferred for women but are expensive: disposable inserts are a cheaper alternative.
26 RCTs
Evidence from small trials, many with methodological limitations, suggests that superficial and partial thickness burns may be managed with hydrocolloid, silicon nylon, antimicrobial (containing silver), polyurethane film and biosynthetic dressings. There was no evidence to support the use of silver sulphadiazine.
Evidence from small trials, many with methodological limitations, suggests that superficial and partial thickness burns may be managed with hydrocolloid, silicon nylon, antimicrobial (containing silver), polyurethane film and biosynthetic dressings. There was no evidence to support the use of silver sulphadiazine.
19 trials (n=2554)
Honey may improve healing times in mild to moderate superficial and partial thickness burns compared with some conventional dressings. Honey dressings as an adjuvant to compression do not significantly increase leg ulcer healing at 12 weeks. There is insufficient evidence to guide clinical practice in other areas.
Early laparoscopic cholecystectomy decreases the morbidity during the waiting period for elective laparoscopic cholecystectomy. Further randomised clinical trials are necessary to confirm or refute this finding.
Propofol for sedation during colonoscopy
10 Studien
This review found that use of propofol for sedation during colonoscopy can lead to faster recovery after the procedure and higher patient satisfaction, without any increase in side-effects as compared to the use of drugs traditionally used (narcotics and/or benzodiazepines) for sedation during colonoscopy.
10 Studien
This review found that use of propofol for sedation during colonoscopy can lead to faster recovery after the procedure and higher patient satisfaction, without any increase in side-effects as compared to the use of drugs traditionally used (narcotics and/or benzodiazepines) for sedation during colonoscopy.
7 Studien, n=614
Currently, there is no clear evidence for any intervention offering significant benefits in the reduction of bacterial infections and wound complications in liver transplantation. Selective bowel decontamination increases the risk of infection and hospital stay compared to prebiotics and probiotics. The use of prebiotics and probiotics offers promise.
Neurologie Depression, Nerven, Psychose
23 Studien (n=907)
The pooled SMD was -0.82 (95% CI -1.12, -0.51), indicating a large clinical effect.
However, when we included only the three trials with adequate allocation concealment and intention to treat analysis and blinded outcome assessment, the pooled SMD was -0.42 (95% CI -0.88, 0.03) i.e. moderate, non-significant effect.
11 Studien
Relaxation techniques were more effective at reducing self-rated depressive symptoms than no or minimal treatment. However, they were not as effective as psychological treatment. Data on clinician-rated depressive symptoms were less conclusive.
2 Studien mit 170 Teilnehmern
There is insufficient evidence to support the use of acupuncture for the symptomatic treatment of restless legs syndrome.
Antipsychotics for acute and chronic pain in adults
11 Studien (n=770), Heterogenität
Weighted Mean Difference (WMD) -1.78 (95% CI -2.71 to -0.85) for the continuous data and Relative Risk (RR) 0.43 (95% CI 0.25 to 0.73), number-needed-to-treat-to-benefit (NNT) 2.6 for the dichotomous data.
24 studien, n=1153
Touch therapies may have a modest effect in pain relief. More studies on HT and Reiki in relieving pain are needed.
No studies could be included.
1 Studie, n=16
Limited evidence from this small RCT suggests an improvement in psychotic symptoms, but not other outcome measures, with the use of an antipsychotic.
6 trials (n = 544)
Patients with stable spines retaining the ability to walk may be treated with radiotherapy.
Keine Studien
There is no evidence available from adequately controlled trials to inform the decision on whether the surgical treatment of odontoid fractures gives a better outcome.
10 Studien
This review has not shown effectiveness for educational interventions in various disorder types and follow-up periods, including advice to activate, advice on stress coping skills, and 'neck school'.
This review has not shown effectiveness for educational interventions in various disorder types and follow-up periods, including advice to activate, advice on stress coping skills, and 'neck school'.
There are no randomized or quasi-randomized controlled clinical trials of treatment for POEMS syndrome on which to base practice.
Cognition
2 Studien
This review suggests that the evidence for detrimental effects of procaine and its preparations is stronger than the evidence for benefit in preventing and/or treating dementia or cognitive impairment.
This review suggests that the evidence for detrimental effects of procaine and its preparations is stronger than the evidence for benefit in preventing and/or treating dementia or cognitive impairment.
Haut
12 RCTs, n= 781
The evidence suggests that probiotics are not an effective treatment for eczema, and probiotic treatment carries a small risk of adverse events.
Frauen
10 Studien
There is evidence of benefit when acupuncture is performed on the day of embryo transfer (ET) on the live birth rate (OR 1.89, 95% CI 1.29 to 2.77).
This could be attributed to placebo effect and the small number of women included in the trials.
There is evidence of benefit when acupuncture is performed on the day of embryo transfer (ET) on the live birth rate (OR 1.89, 95% CI 1.29 to 2.77).
This could be attributed to placebo effect and the small number of women included in the trials.
There is no evidence of benefit on pregnancy outcomes when acupuncture is performed around the time of oocyte retrieval.
2 Studien
Not sufficient evidence that routine antenatal psychosocial assessment by itself leads to improved perinatal mental health outcomes.
Not sufficient evidence that routine antenatal psychosocial assessment by itself leads to improved perinatal mental health outcomes.
Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression
1 Studie, n=61
1 Studie, n=61
The evidence is inconclusive to allow us to make any recommendations for massage therapy or depression-specific acupuncture for the treatment of antenatal depression.
15 Studien, n=6181 women (3040 PFMT, 3141 controls)
There is some evidence that PFMT in women having their first baby can prevent urinary incontinence in late pregnancy and postpartum. In common with older women with stress incontinence, there is support for the widespread recommendation that PFMT is an appropriate treatment for women with persistent postpartum urinary incontinence.
6 Studien, n=397
Mothers appear to obtain greater total volumes of milk in six days after birth using the electric or foot powered pump tested compared to hand expression, and a greater volume at one expression during the second week when provided with a relaxation tape.
10 trials (n=1089)
Dexamethasone may have some benefits compared with betamethasone such as less intraventricular haemorrhage, although perhaps a higher rate of NICU admission (seen in only one trial). Apart from a suggestion from another small trial that the intramuscular route may have advantages over an oral route for dexamethasone, few other conclusions about optimal antenatal corticosteroid regimens were able to be made.
5 Studien, n= 6187
There was no evidence of any difference between partogram and no partogram in caesarean section (risk ratio (RR) 0.64, 95% confidence interval (CI) 0.24 to 1.70); instrumental vaginal delivery (RR 1.00, 95% CI 0.85 to 1.17) or Apgar score less than seven at five minutes.
7 Studien, N=5390
The CS rate was slightly lower in the active management group compared to the group that received routine care, but this difference did not reach statistical significance (RR 0.88, 95% CI 0.77 to 1.01).
Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional.
Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births
Trial of instrumental delivery in theatre versus immediate caesarean section for anticipated difficult assisted births
Keine Studien
There is no current evidence from randomised trials to influence practice.
There is no current evidence from randomised trials to influence practice.
5 RCTs, n= 474
Preterm birth less than 37 weeks was significantly decreased with management based on knowledge of FFN results (15.6%) versus controls without such knowledge (28.6%; risk ratio 0.54; 95% confidence interval 0.34 to 0.87).
Although FFN is commonly used in labor and delivery units to help in the management of women with symptoms of preterm labor, currently there is not sufficient evidence to recommend its use.
Although FFN is commonly used in labor and delivery units to help in the management of women with symptoms of preterm labor, currently there is not sufficient evidence to recommend its use.
11trials (n=12.276)
Women who had midwife-led models of care were less likely to experience antenatal hospitalisation,
were more likely to experience spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06)
There were no statistically significant differences between groups for overall fetal loss/neonatal death (RR 0.83, 95% CI 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53).
Three RCTs, n= 853
No conclusive evidence was found to determine whether IDS between cycles of chemotherapy would improve or decrease the survival of women with advanced ovarian cancer. IDS appeared to yield benefit only in the patients whose primary surgery was not performed by gynecologic oncologists.
No RCTs ans three observational studies were identified.
This review has found no evidence to help quantify the value of laparoscopy for the management of early stage ovarian cancer as routine clinical practice.
14 RCTs mit fast 12.000 prämenopausalen Frauen
For premenopausal women with early breast cancer who are not known to be ER negative, the use of an LHRH agonist, with or without tamoxifen as adjuvant therapy is likely to lead to a reduction in the risk of recurrence and a delay in death. The evidence is insufficient to support the LHRH agonists over chemotherapy.
3 Studien, n=286
All three interventions (intramuscular prostigmine, an antacid preparation and an antacid plus ranitidine) produced positive findings in favour of the intervention groups. It was not possible to pool findings from studies to produce an overall treatment effect.
Auge
7 Studien, keine Metaanalyse
In some cases of unilateral refractive amblyopia it appears that there is a treatment benefit from refractive correction alone. Where amblyopia persists there is some evidence that adding occlusion further improves vision.
1 unverblindete Studie, n=50
There is insufficient evidence from randomised controlled trials on the effectiveness of macular translocation, which is also not free of important risks.
Herzkreislauf, CVD
Blood pressure lowering efficacy of angiotensin converting enzyme (ACE) inhibitors for primary hypertension
92 trials mit 14 ACE Hemmern bei 12 954 Patienten
92 trials mit 14 ACE Hemmern bei 12 954 Patienten
There are no clinically meaningful BP lowering differences between different ACE inhibitors.
46 Studien zu 9 ARBS bei 13 451 Patienten
There are no clinically meaningful BP lowering differences between available ARBs.
There are no clinically meaningful BP lowering differences between available ARBs.
6 trials (N=3694)
Aliskiren has a dose-related blood pressure lowering effect better than placebo. This effect is similar to that determined for ACE inhibitors and ARBs.
11 Studien, davon 6 RCTs, n=7431
Compared with pharmacological prophylaxis alone, combined modalities reduce significantly the incidence of DVT but the effect on PE is unknown. The results of the current review support, especially in high-risk patients, the use of combined modalities.
Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization
6 RCTs, n=1490
6 RCTs, n=1490
Use of LMWH in outpatients significantly reduces VTE when immobilization of the lower leg is required.
6 RCTs, n=119
There is currently no evidence that beta blockers adversely affect walking distance in people with intermittent claudication. However, due to the lack of large published trials beta blockers should be used with caution if clinically indicated.
9 Studien (n= 723)
dengzhanhua injection showed a statistically significant benefit on the outcome 'marked neurologic improvement' (relative risk 1.53; 95% confidence interval 1.36 to 1.72). No serious adverse effects were reported.
Due to the generally low methodological quality and small sample size of the included trials in this systematic review, we could not draw a firm conclusion.
2 Studien (n=161)
There is insufficient evidence to suggest any clinical recommendations.
There is insufficient evidence to suggest any clinical recommendations.
8 Studien (n=660)
Sanchi appears to be beneficial and safe for acute ischaemic stroke in this review, but the small sample and inferior quality of studies prevented a definite conclusion.
2 Studien mit reduzierter Qualität (n=232)
High quality trials are required to assess the efficacy and safety of tongxinluo capsule for acute ischaemic stroke.
11 trials (n=328)
Keine geeigneten Studien
We are unable to make any new recommendations on the use of adrenaline for the treatment of anaphylaxis.
We are unable to make any new recommendations on the use of adrenaline for the treatment of anaphylaxis.
13 RCTs (n=811)
There was however a consistent pattern indicating that BMSC treatment generally improves short-term LVEF.
There was however a consistent pattern indicating that BMSC treatment generally improves short-term LVEF.
The results of this systematic review suggest that there is little evidence to assess the clinical effects of this treatment.
Atmung
22 Studien (n=8032)
In comparison with placebo, we have found an increased risk of serious adverse events with regular formoterol, and this does not appear to be abolished in patients taking inhaled corticosteroids. The effect on serious adverse events of regular formoterol in children was greater than the effect in adults.
Aktivität
23 Studien (n=907)
The pooled SMD was -0.82 (95% CI -1.12, -0.51), indicating a large clinical effect.
However, when we included only the three trials with adequate allocation concealment and intention to treat analysis and blinded outcome assessment, the pooled SMD was -0.42 (95% CI -0.88, 0.03) i.e. moderate, non-significant effect.
2 Studien, n=85
Physical training is safe for people with ILD. Improvements in functional exercise capacity, dyspnoea and quality of life are seen immediately following training, with benefits also evident in IPF. There is little evidence regarding longer-term effects of physical training.
Krebs
Immunoglobulin prophylaxis in hematological malignancies and hematopoietic stem cell transplantation
40 Studien
In patients undergoing HSCT, routine prophylaxis with IVIG is not supported. Its use may be considered in LPD patients with hypogammaglobulinemia and recurrent infections, for reduction of clinically documented infections.
In patients undergoing HSCT, routine prophylaxis with IVIG is not supported. Its use may be considered in LPD patients with hypogammaglobulinemia and recurrent infections, for reduction of clinically documented infections.
Three RCTs, n= 853
No conclusive evidence was found to determine whether IDS between cycles of chemotherapy would improve or decrease the survival of women with advanced ovarian cancer. IDS appeared to yield benefit only in the patients whose primary surgery was not performed by gynecologic oncologists.
29 trials, n=5530
Platinum-based chemotherapy regimens did not offer a statistically significant benefit in survival or overall tumour response compared with non-platinum-based regimens.
These data suggest non-platinum chemotherapy regimens have a more advantageous risk-benefit profile. This systematic review highlights the lack of quality of life data in trials involving chemotherapy treatment for SCLC. With poor long-term survival associated with both treatment groups, the issue of the quality of the survival period takes on even more significance.
2 RCTs (n=703)
Temozolomide is an effective therapy in GBM for prolonging survival and delaying progression as part of primary therapy without impacting on QoL and with a low incidence of early adverse events.
Kinder
Avoidance of bottles during the establishment of breast feeds in preterm infants
5 trials (n=543)
Supplementing breast feeds by cup confers no breastfeeding benefit beyond discharge home and delays discharge considerably.
5 trials (n=543)
Supplementing breast feeds by cup confers no breastfeeding benefit beyond discharge home and delays discharge considerably.
2 Studien, n=148
Ventilation tubes have a significant role in maintaining a 'disease-free' state in the first six months after insertion.
Inspiratory muscle training for cystic fibrosis
6 Studien, n=140
6 Studien, n=140
We have not found any evidence to suggest that this treatment is either beneficial or not.
4 trials, n=254
Current evidence suggests nebulized 3% saline may significantly reduce the length of hospital stay and improve the clinical severity score in infants with acute viral bronchiolitis.
Darm
This review highlights the absence of evidence for the use of antimotility agents and adsorbents in controlling diarrhoea in people with HIV/AIDS.
Infektionen
Acyclovir for treating primary herpetic gingivostomatitis
2 Studien (n=92)
2 Studien (n=92)
Only weak evidence that acyclovir is an effective treatment in reducing the number of oral lesions, preventing the development of new extraoral lesions, decreasing the number of individuals with difficulties experienced in eating and drinking and reducing hospital admission for children under 6 years of age with primary herpetic gingivostomatitis.
7 Studien, n=770
Azithromycin appears better than fluoroquinolone drugs in populations that included participants with drug-resistant strains. Azithromycin may perform better than ceftriaxone.
Azithromycin appears better than fluoroquinolone drugs in populations that included participants with drug-resistant strains. Azithromycin may perform better than ceftriaxone.
1 Studie, n=15
We found no evidence that anti-viral agents have a beneficial effect on outcomes in Ramsay Hunt syndrome, despite their widespread use in this condition.
7 Studien mit 901 Patienten
The overall sensitivity of an Optical Density Index was 78% and overall specificity was 81%.
The overall sensitivity of an Optical Density Index was 78% and overall specificity was 81%.
49 trials, n=5559
In Leishmania major infections, there was good RCT evidence of benefit of cure around 3 months after treatment when compared to placebo for 200 mg oral fluconazole.
In Leishmania tropica infections, there was good evidence of benefit for the use of 200 mg oral itraconazole for 6 weeks compared with placebo.
Most trials have been designed and reported poorly, resulting in a lack of evidence for potentially beneficial treatments.
9 RCTs, n = 3396
In people who are nasal carriers of S. aureus, the use of mupirocin ointment results in a statistically significant reduction in S. aureus infections.
Nutritional supplements for people being treated for active tuberculosis
Nutritional supplements for people being treated for active tuberculosis
12 trials (n=3393)
There is limited evidence that high energy supplements and some combinations of zinc with other micronutrients may help people with tuberculosis to gain weight. There is not enough evidence to assess the effect of other combinations of nutrients. A number of relevant trials are in progress.
6 trials, n=1601
This review showed insufficient evidence to judge whether once or twice daily doses of amoxicillin, with or without clavulanate, were comparable with three or four daily doses for the treatment of AOM.
5 RCTs (n=1367)
There is no evidence that the use of quantitative cultures of respiratory secretions results in reduced mortality, reduced time in ICU and on mechanical ventilation, or higher rates of antibiotic change when compared to qualitative cultures in patients with VAP. Similar results were observed when invasive strategies were compared with non-invasive strategies.
6 Studien
The recommended treatment for CM is a combination of AmB and flucytosine. The optimal dosing of AmB remains unclear.
Zähne
5 RCTs, n= 293
Mouthrinses containing antibacterial agents such as chlorhexidine and cetylpyridinium chloride may play an important role in reducing the levels of halitosis-producing bacteria on the tongue, and chlorine dioxide and zinc containing mouthrinses can be effective in neutralisation of odouriferous sulphur compounds.
No studies were found that met the inclusion criteria.
There is no evidence to support one surgical technique over the other in terms of dental health, aesthetics, economics and patient factors.
Knochen, Osteoporose
8 Studien (403 Teinehmer)
It is unclear whether treatment decreases fractures. Intravenous bisphosphonates increase BMD in children and adults with OI.
Diverses
Admission avoidance hospital at home
10 RCTs (n=1333)
10 RCTs (n=1333)
There is no evidence from these analyses to suggest that admission avoidance hospital at home leads to outcomes that differ from inpatient hospital care.
Stem cell transplantation is a form of treatment that offers the potential of permanent cure. However, there are no clinical trials that have assessed the safety and efficacy of stem cell transplantation in comparison to other conservative measures (enzyme replacement therapy, substrate reduction therapy) now in use.
8 Studien, aber keine homogenen Interventionen
There are currently no well designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems.
There are currently no well designed studies focusing on organising the health services of persons with an intellectual disability and concurrent physical problems.
Keine geeigneten Studien
This review highlights the current lack of empirical evidence to support or refute the use of smart home technologies within health and social care.
This review highlights the current lack of empirical evidence to support or refute the use of smart home technologies within health and social care.
7 Studien, n=2492
Peer support telephone calls may increase mammography screening in women over 40 years, may help patients change their diet and cease smoking after a heart attack; and may help reduce depressive symptoms among mothers with postnatal depression.
9 Studien, n=5257
The included trials show significantly better outcomes among those tuberculosis patients for which late patient tracers and reminders are used.
4 trials, n=971
Intravenous pain regimens and levobupivacaine may have greater efficacy when compared to control for the management of pain related to femoral sheath removal.
5 randomisierte oder quasi-randomisierte double-blind trials
There is no evidence to show a significant beneficial effect of calcium antagonists on muscle function in DMD.
32 Studien, davon 1 RCT
Thus existing evidence, although supportive, does not firmly establish whether increased police patrols, implemented with or without other intervention elements, reduce the adverse consequences of alcohol-impaired driving.
2 Studien, n=87
The lack of reliable evidence for the effectiveness of any specific interventions for the management of oral submucous fibrosis is illustrated by the paucity, and poor methodological quality, of trials retrieved for this review.
No RCTs or prospective controlled studies
There are insufficient good quality trials to make any recommendations for practice with regards to the use of medically assisted nutrition in palliative care patients.
There are insufficient good quality trials to make any recommendations for practice with regards to the use of medically assisted nutrition in palliative care patients.
Keine geeigneten Studien
There is no clear evidence that parenteral calcium supplementation impacts the outcome of critically ill patients.
There is no clear evidence that parenteral calcium supplementation impacts the outcome of critically ill patients.
Ausgewählte Updates mit veränderter klinischer Konsequenz, laut Cochrane:
Herz Kreislauf
Antiplatelet therapy with aspirin had a slight beneficial effect on the patency of peripheral bypass grafts but seemed to have an inferior effect on venous graft patency compared with artificial grafts. The effect of aspirin on cardiovascular outcomes and survival was small and not statistically significant.
Depression
16 Studien, n=1655
A small but significant effect of pharmacotherapy (not psychotherapy) on treating depression and reducing depressive symptoms was found, as was a significant increase in adverse events.
29 Studien, n=5489
Hypericum extracts a) are superior to placebo in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants. The association of country of origin and precision with effects sizes complicates the interpretation.
Kinder
Fluticasone at different doses for chronic asthma in adults and children
51 Studien, n=10.797
51 Studien, n=10.797
High dose FP did not lead to clear improvements in symptoms over the lower dose and increased the risk of a hoarse voice and fungal mouth infections. In people with severe asthma, very high doses FP (2000 microgram per day) appeared to allow more people on oral steroids to stop or reduce their dose of oral steroid tablets compared to lower doses of FP
86 Studien, n=16.160
Doses of FP in the range 100-1000 mcg/day are effective. In most patients with mild-moderate asthma improvements with low dose FP are only a little less than those associated with high doses when compared with placebo. High dose FP appears to have worthwhile oral-corticosteroid reducing properties. FP use is accompanied by an increased likelihood of oropharyngeal side effects.
23 Studien, n=1026
There is insufficient evidence to be sure about the efficacy of sodium cromoglycate over placebo. Publication bias is likely to have overestimated the beneficial effects of sodium cromoglycate as maintenance therapy in childhood asthma.
There is insufficient evidence to be sure about the efficacy of sodium cromoglycate over placebo. Publication bias is likely to have overestimated the beneficial effects of sodium cromoglycate as maintenance therapy in childhood asthma.
Infektionen
3 Studien, N= 996
Vaccines against Pseudomonas aeruginosa cannot be recommended.
Sucht
Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment, use of opiate, results at follow-up and compliance.
Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence
28 Studien, n=2945
28 Studien, n=2945
Results suggest that adding any psychosocial support to maintenance treatments improve the number of participants abstinent at follow up; no differences for the other outcome measures.
Only one RCT of treatment for amphetamine psychosis has been published. Outcomes from this trial indicate that antipsychotic medications effectively reduce symptoms of amphetamine psychosis.
Neurologie/Psychiatrie
8 Studien
The small number of studies which have been done provide no consistent evidence either way that folic acid, with or without vitamin B12, has a beneficial effect on cognitive function of unselected healthy or cognitively impaired older people.
3 Studien
Data on mortality were only available in one study; RR 1.48 [1.00, 2.19]
Data on mortality were only available in one study; RR 1.48 [1.00, 2.19]
There is currently no evidence to support the use of magnesium salts in patients with acute traumatic brain injury.
Zahn
Keine Studien
This review illustrates the current lack of published or ongoing randomised controlled trials and the unavailability of high level evidence, based on clinically relevant outcomes, for the effectiveness of ultrasonic instrumentation used alone or as an adjunct to hand instrumentation for orthograde root canal treatment.
Schmerz
8 Studien, n=1380
Single dose oral celecoxib is an effective means of postoperative pain relief. The 400 mg dose has similar efficacy to ibuprofen 400 mg. The NNT for celecoxib 200 mg and 400 mg compared with placebo for at least 50% pain relief over four to six hours was 4.2 (CI 3.4 to 5.6) and 2.5 (2.2 to 2.9) respectively.
Single dose oral celecoxib is an effective means of postoperative pain relief. The 400 mg dose has similar efficacy to ibuprofen 400 mg. The NNT for celecoxib 200 mg and 400 mg compared with placebo for at least 50% pain relief over four to six hours was 4.2 (CI 3.4 to 5.6) and 2.5 (2.2 to 2.9) respectively.
Chirurgie
52 Studien
The review found that people lying on ordinary foam mattresses are more likely to get pressure ulcers than those on higher specification foam mattresses. Rigorous research comparing different support surfaces is needed.
10 Studien, n=2059
In patients with CT-proven primary supratentorial intracerebral haemorrhage, surgery added to medical management reduces the odds of being dead or dependent compared with medical management alone, but the result is not very robust.
4 RCTs, n=317
Surgical treatment of carpal tunnel syndrome relieves symptoms significantly better than splinting.
Diverses
29 Studien, multiple Interventionen
In this update an additional study that compared PN and Glutamine versus standard PN showed that the certain benefits of parenteral nutrition with added glutamine compared to standard PN for reducing hospital stay are no longer definite.
14 Studien
Exercise programs starting four to six weeks post-surgery seem to lead to a faster decrease in pain and disability than no treatment. High intensity exercise programs seem to lead to a faster decrease in pain and disability than low intensity programs. There were no significant differences between supervised and home exercises for pain relief, disability, or global perceived effect. There is no evidence that active programs increase the re-operation rate after first-time lumbar surgery.
