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Die 5 Minuten Evidenz - Cochrane Ausgabe 4/2011

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Ausgabe 4/2011 der Cochrane Library

 

Bitte wählen Sie Ihr Thema aus:
Aktivität Atmung Augen
Chirurgie Frauen Herz, Kreislauf, CVD
Infektion Kinder Knochen
Krebs Neurologie/Psychiatrie Schmerz
Sucht Urologie Zahn
Diverses

 

Zu ausgewählten Updates mit veränderter klinischer Konsequenz

 

Aktivität

  • Exercise training for adults with chronic kidney disease
    54 Studien (n= 1863)
    There is evidence for significant beneficial effects of regular exercise on physical fitness, walking capacity, cardiovascular dimensions (e.g. blood pressure and heart rate), health-related quality of life and some nutritional parameters in adults with CKD. Other outcomes had insufficient evidence due to the lack of data from RCTs. The design of the exercise intervention causes difference in effect size and should be considered when prescribing exercise with the aim of affecting a certain outcome.
  • Optimal intensity and type of leg exercise training for people with chronic obstructive pulmonary disease
    11 Studien (n= 598)
    Comparisons between the higher and lower training intensity were limited due to the small number of included studies and participants. Consequently, there are insufficient data to draw any conclusions on exercise capacity, symptoms and HRQoL for this comparison. For comparisons between continuous and interval training, both appear to be equally effective in improving exercise capacity, symptoms and HRQoL.
  • Physical training for McArdle disease
    Keine geeigneten Studien
    Evidence from non-randomised studies using small numbers of patients suggest that it would be safe and worthwhile for larger controlled trials of aerobic training to be undertaken in people with McArdle disease.

 

Atmung

  • Different durations of corticosteroid therapy for exacerbations of chronic obstructive pulmonary disease
    7 Studien (n= 288)
    We based assessment of the efficacy of short (seven days or less) compared to longer duration (more than seven days) systemic corticosteroid therapy for acute exacerbations of COPD in this review on four of the seven included studies for which data were available. Two studies were fully published and two were published as conference abstracts but trialists were able to supply data requested for the review. The finding in this review that there is no significant increase in treatment failure with shorter systemic corticosteroid treatment for seven days or less for acute exacerbations of COPD, does not give conclusive evidence to recommend change in clinical practice due to a wide confidence interval around the estimate of effect. The four studies which contributed to the meta-analysis were of relatively low quality and five of the seven studies were not published as full articles. Thus there are insufficient data to allow firm conclusions concerning the optimal duration of corticosteroid therapy of acute exacerbations of COPD to be drawn.
  • Home-based educational interventions for children with asthma
    12 Studien (n= 2342)
    We found inconsistent evidence for home-based asthma educational interventions compared to standard care, education delivered outside of the home or a less intensive educational intervention delivered at home. Although education remains a key component of managing asthma in children, advocated in numerous guidelines, this review does not contribute further information on the fundamental content and optimum setting for such educational interventions.
  • Inhaled corticosteroids versus long-acting beta2-agonists for chronic obstructive pulmonary disease
    7 Studien (n= 5997)
    Placebo-controlled trials have established the benefits of both long-acting beta-agonist and inhaled corticosteroid therapy for COPD patients as individual therapies. This review, which included trials allowing comparisons between LABA and ICS, has shown that the two therapies confer similar benefits across the majority of outcomes, including the frequency of exacerbations and mortality. Use of long-acting beta-agonists appears to confer a small additional benefit in terms of improvements in lung function compared to inhaled corticosteroids. On the other hand, inhaled corticosteroid therapy shows a small advantage over long-acting beta-agonist therapy in terms of health-related quality of life, but inhaled corticosteroids also increase the risk of pneumonia. This review supports current guidelines advocating long-acting beta-agonists as frontline therapy for COPD, with regular inhaled corticosteroid therapy as an adjunct in patients experiencing frequent exacerbations.

 

Augen

  • Interventions for visual field defects in patients with stroke
    13 Studien (n= 344)
    There is limited evidence which supports the use of compensatory scanning training for patients with visual field defects (and possibly co-existing visual neglect) to improve scanning and reading outcomes. There is insufficient evidence to reach a conclusion about the impact of compensatory scanning training on functional activities of daily living. There is insufficient evidence to reach generalised conclusions about the benefits of visual restitution training (VRT) (restitutive intervention) or prisms (substitutive intervention) for patients with visual field defects after stroke.
  • Face-down positioning or posturing after macular hole surgery
    3 Studien
    There is currently insufficient evidence from which to draw firm conclusions about the impact of postoperative face-down positioning on the outcome of surgery for macular hole. Of three RCTs, two suggested a benefit in larger holes but none demonstrated evidence of a benefit in smaller holes.
  • Surgical orbital decompression for thyroid eye disease
    2 Studien
    A single study showed that the transantral approach for orbital decompression was related to more complications than the endoscopic transnasal technique which is preferred by Ear, Nose and Throat (ENT) surgeons, usually as an adjunctive procedure. Intravenous steroids were reported in a single trial to be the most efficient intervention for dysthyroid optic neuropathy. The majority of published literature on orbital decompression for thyroid eye disease consists of retrospective, cohort, or case series studies. Although these provide useful descriptive information, clarification is required to show the relative effectiveness of each intervention for various indications.
    The two RCTs reviewed are not robust enough to provide credible evidence to our understanding of current decompressive surgery and to support recommendations for clinical practice. There is evidence from currently available uncontrolled studies that removal of the medial and lateral wall (balanced decompression) with or without fat removal may be the most effective surgical method related to only a few complications.
    There is a clear need for randomised studies evaluating the balanced two-wall, three-wall and orbital fat decompression techniques.

Nach oben


Chirurgie

  • Cooling for cerebral protection during brain surgery
    4 Studien (n= 1219)
    Although there is some evidence that mild hypothermia is safe, its effectiveness is not clear when compared with normothermia. We need to perform more clinical trials in order to establish the benefit, if any, of hypothermia for cerebral protection during brain surgery before making firm recommendations for the routine use of this intervention.
  • Appendectomy versus antibiotic treatment for acute appendicitis
    5 Studien (n= 901)
    The upper bound of the 95% CI of ABT for cure within two weeks without major complications crosses the 20% margin of appendectomy, so the outcome is inconclusive. Also the quality of the studies was low to moderate, for that reason the results should be interpret with caution and definite conclusions cannot be made. Therefore we conclude that appendectomy remains the standard treatment for acute appendicitis. Antibiotic treatment might be used as an alternative treatment in a good quality RCT or in specific patients or conditions were surgery is contraindicated.
  • Colorectal stents for the management of malignant colonic obstructions
    5 Studien (n= 207)
    The use of colonic stent in malignant colorectal obstruction seems to have no advantage over emergency surgery. The clinical success rate was statistically higher in emergency surgery group. However, use of colorectal stents seems to be as safe in the malignant colorectal obstruction as the emergency surgery with no statistically significant difference in the mortality and morbidity. Colorectal stents are associated with acceptable stent perforation, migration and obstruction rates. The advantages of colorectal stent includes shorter hospital stay and procedure time and less blood loss. However, due to the variability in the sample size and trial designs in the included studies, further randomised trials with bigger sample size and well defined trial design are needed to achieve the robust evidence.
  • Laparoscopic versus open nephrectomy for live kidney donors
    6 Studien (n= 596)
    LDN is associated with less pain compared with open surgery; however, there are equivalent numbers of complications and occurrences of perioperative events that require further intervention. Kidneys obtained using LDN procedures were exposed to longer warm ischaemia periods than ODN-acquired grafts, although this has not been reported as being associated with short-term consequences.
  • Prostaglandins for adult liver transplanted patients
    10 Studien (n= 652)
    We found no evidence that the administration of prostaglandins to liver transplanted patients reduces the risk of death, primary non-function of the allograft, or liver re-transplantation. Prostaglandins might reduce the risk of acute kidney failure requiring dialysis, but the quality of the evidence is considered only moderate due to high risk of bias in most of the included trials. Moreover, there are risks of outcome measure reporting bias and random errors. Therefore, further randomised, placebo-controlled trials are deemed necessary.
  • Surgical versus non-surgical interventions for treating patellar dislocation
    5 Studien (n= 339)
    There is insufficient high quality evidence to confirm any significant difference in outcome between surgical or non-surgical initial management of people following primary patellar dislocation, and none examining this comparison in people with recurrent patellar dislocation. Adequately powered randomised, multi-centre controlled trials, conducted and reported to contemporary standards are recommended.
  • Methods to decrease blood loss and transfusion requirements for liver transplantation
    33 Studien (n= 1913)
    Aprotinin, recombinant factor VIIa, and thromboelastography groups may potentially reduce blood loss and transfusion requirements. However, risks of systematic errors (bias) and risks of random errors (play of chance) hamper the confidence in this conclusion. We need further well-designed randomised trials with low risk of systematic error and low risk of random errors before these interventions can be supported or refuted.
  • Sclerotherapy for lower limb telangiectasias
    10 Studien (n= 484)
    The evidence did not suggest superior efficacy or patient satisfaction for any one sclerosing agent used in the treatment of telangiectasias of the lower limbs, but the agents studied showed superiority to a normal saline placebo. However, the amount of available evidence in this field is small and the overall methodological quality of the research was poor, as was the quality of reporting.

 

Frauen

  • Adjuvant chemotherapy for endometrial cancer after hysterectomy
    5 Studien (n= 2197)
    Postoperative platinum based chemotherapy is associated with a small benefit in progression-free survival and overall survival irrespective of radiotherapy treatment. It reduces the risk of developing a metastasis, could be an alternative to radiotherapy and has added value when used with radiotherapy.
  • Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes
    21 Studien (n= 16.602)
    Calcium supplementation is associated with a significant protective benefit in the prevention of pre-eclampsia, and should be used for this indication according to a previous review. This review indicates that there are no additional benefits for calcium supplementation in prevention of preterm birth or low infant birth weight. While there was a statistically significant difference of 80 g identified in mean infant birth weight, there was significant heterogeneity identified, and the clinical significance of this difference is uncertain.
  • Epidermal growth factor receptor blockers for the treatment of ovarian cancer
    1 Studie (n = 131)
    EGFR inhibitors, including pertuzumab, may add activity to conventional chemotherapy for treatment of platinum-resistant ovarian cancer. Certain subsets of women with particularly aggressive tumours resistant to conventional chemotherapy may benefit from EGFR inhibitor treatment. Further RCTs are necessary before EGFR inhibitors are introduced as first- or second-line treatment of ovarian cancer.
  • High dose versus low dose oxytocin for augmentation of delayed labour
    4 Studien (n= 660)
    Higher dose of oxytocin starting and increment dose (4 mU per minute or more) was associated with a reduction in the length of labour and in caesarean section, and an increase in spontaneous vaginal birth. However, there is insufficient evidence. The number of studies and the quality of the available evidence is of concern. Additionally, there is insufficient evidence for other maternal and neonatal outcomes, and how women feel about the higher doses of oxytocin. Therefore, no firm recommendation can be made. Further research should evaluate the effect of high dose oxytocin for women delayed in labour and should include these outcomes.
  • Luteal phase support for assisted reproduction cycles
    69 Studien (n =16.327)
    This review showed a significant effect in favour of progesterone for luteal phase support, favouring synthetic progesterone over micronized progesterone. Overall, the addition of other substances such as estrogen or hCG did not seem to improve outcomes. We also found no evidence favouring a specific route or duration of administration of progesterone. We found that hCG, or hCG plus progesterone, was associated with a higher risk of OHSS. The use of hCG should therefore be avoided. There were significant results showing a benefit from addition of GnRH agonist to progesterone for the outcomes of live birth, clinical pregnancy and ongoing pregnancy. For now, progesterone seems to be the best option as luteal phase support, with better pregnancy results when synthetic progesterone is used.
  • Statins for women with polycystic ovary syndrome not actively trying to conceive
    4 Studien (n= 244)
    Although statins improve lipid profiles and reduce testosterone levels in women with PCOS, there is no evidence that statins improve resumption of menstrual regularity or spontaneous ovulation, nor is there any improvement of hirsutism or acne. There is a need for further research to be performed with large sample sizes and well-designed RCTs to assess clinical outcomes.
  • Adjuvant gonadotropin-releasing hormone analogues for the prevention of chemotherapy induced premature ovarian failure in premenopausal women
    The use of GnRH agonists should be considered in women of reproductive age receiving chemotherapy. Intramuscular or subcutaneous GnRH analogues seem to be effective in protecting ovaries during chemotherapy and should be given before or during treatment, although no significant difference in pregnancy rates was seen.
  • Analgesia for amniocentesis or chorionic villus sampling
    12 Studien (n= 805)
    In general, women who undergo amniocentesis could be informed that pain during procedure is minor and that there is currently insufficient evidence to support the use of local anaesthetics, leg rubbing or subfreezing the needle for pain reduction during procedure.
  • Antenatal breastfeeding education for increasing breastfeeding duration
    14 Studien (n= 6932)
    Because there were significant methodological limitations and the observed effect sizes were small, it is not appropriate to recommend any antenatal BF education. There is an urgent need to conduct RCTs study with adequate power to evaluate the effectiveness of antenatal BF education.
  • Mechanical dilatation of the cervix at non-labour caesarean section for reducing postoperative morbidity
    3 Studien (n= 735)
    There was insufficient evidence of mechanical dilatation of the cervix at non-labour caesarean section for reducing postoperative morbidity.
  • Quadriphasic versus monophasic oral contraceptives for contraception
    1 Studie
    The available evidence is insufficient to determine whether quadriphasic differ from monophasic oral contraceptives in contraceptive effectiveness, bleeding pattern, minor side effects and acceptability. Studies that compare quadriphasic and monophasic oral contraceptives with an identical progestogen and estrogen type are needed to determine whether the quadriphasic approach differs from the monophasic approach. Studies that compare quadriphasic pills with monophasic pills containing 30 μg ethinylestradiol are indicated to determine whether quadriphasic oral contraceptives have an advantage over the current, first choice oral contraceptive. Until then, we recommend monophasic pills containing 30 μg estrogen as the first choice for women starting oral contraceptive use.
  • Risk scoring systems for predicting preterm birth with the aim of reducing associated adverse outcomes
    Keine geeigneten Studien
    The role of risk scoring systems in the prevention of preterm birth is unknown.
  • Comparisons of approaches to pelvic floor muscle training for urinary incontinence in women
    21 Studien (n= 1490)
    This review found that the existing evidence was insufficient to make any strong recommendations about the best approach to pelvic floor muscle training. We suggest that women are offered reasonably frequent appointments during the training period, because the few data consistently showed that women receiving regular (e.g. weekly) supervision were more likely to report improvement than women doing pelvic floor muscle training with little or no supervision.
  • Customised versus population-based growth charts as a screening tool for detecting small for gestational age infants in low-risk pregnant women
    Keine geeigneten Studien
    There is no randomised trial evidence currently available. Further randomised trials are required to accurately assess whether the improvement in detection shown is secondary to customised charts alone or an effect of the policy change. Future research in large trials is needed to investigate the benefits and harms (including perinatal mortality) of using customised growth charts in different settings and for both fundal height and ultrasound measurements.
  • Intermittent iron supplementation for reducing anaemia and its associated impairments in menstruating women
    21 Studien (n= 10.258)
    Intermittent iron supplementation in menstruating women is a feasible intervention in settings where daily supplementation is likely to be unsuccessful or not possible. In comparison with daily supplementation, the provision of iron supplements intermittently is less effective in preventing or controlling anaemia. More information is needed on morbidity (including malaria outcomes), side effects, work performance, economic productivity, depression and adherence to the intervention.
  • Perineal techniques during the second stage of labour for reducing perineal trauma
    8 Studien (n= 11651)
    The use of warm compresses on the perineum is associated with a decreased occurrence of perineal trauma. The procedure has shown to be acceptable to women and midwives. This procedure may therefore be offered to women.
  • Planned caesarean section for women with a twin pregnancy
    1 Studie
    There is a lack of robust evidence to guide clinical advice regarding the method of birth for twin pregnancies. Women should be informed of possible benefits and risks of either approach, including short-term and long-term consequences for both mother and babies. Future research should aim to provide unbiased evidence, including long-term outcomes.
  • Relaxation techniques for pain management in labour
    11 Studien (n= 1374)
    Relaxation and yoga may have a role with reducing pain, increasing satisfaction with pain relief and reducing the rate of assisted vaginal delivery. There was insufficient evidence for the role of music and audio-analgesia. However, there is a need for further research.
  • Topical interventions for genital lichen sclerosus
    7 Studien (n= 249)
    The current limited evidence demonstrates the efficacy of clobetasol propionate, mometasone furoate, and pimecrolimus in treating genital lichen sclerosus. Further RCTs are needed to determine the optimal potency and regimen of topical corticosteroids, examine other topical interventions, assess the duration of remission or prevention of flares, evaluate the reduction in the risk of genital squamous cell carcinoma or genital intraepithelial neoplasia, and examine the efficacy in improving the quality of the sex lives of people with this condition.

Nach oben

Herz, Kreislauf, CVD

  • Angioplasty versus stenting for subclavian artery stenosis
    Keine geeigneten Studien
    There is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.
  • Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for adults with early (stage 1 to 3) non-diabetic chronic kidney disease
    4 Studien (n= 2177)
    Our review demonstrated that there is currently insufficient evidence to determine the effectiveness of ACEi or ARB in patients with stage 1 to 3 CKD who do not have diabetes mellitus. We have identified an area of significant uncertainty for a group of patients who account for most of those labelled as having CKD.
  • Drugs and pacemakers for vasovagal, carotid sinus and situational syncope
    46 Studien
    There is insufficient evidence to support the use of any of the pharmacological or pacemaker treatments for vasovagal syncope and carotid sinus syncope. Larger studies using patient relevant outcomes are needed.
  • Evening versus morning dosing regimen drug therapy for hypertension
    21 Studien (n= 1993)
    No RCT reported on clinically relevant outcome measures - all cause mortality, cardiovascular morbidity and morbidity. There were no significant differences in overall adverse events and withdrawals due to adverse events among the evening versus morning dosing regimens. In terms of BP lowering efficacy, for 24-hour SBP and DBP, the data suggests that better blood pressure control was achieved with bedtime dosing than morning administration of antihypertensive medication, the clinical significance of which is not known.
  • Glucagon-like peptide analogues for type 2 diabetes mellitus
    17 Studien
    GLP-1 agonists are effective in improving glycaemic control.
  • Antiplatelet agents for intermittent claudication
    12 Studien (n= 12.168)
    Antiplatelet agents have a beneficial effect in reducing all cause mortality and fatal cardiovascular events in patients with IC. Treatment with antiplatelet agents in this patient group however is associated with an increase in adverse effects, including GI symptoms, and healthcare professionals and patients need to be aware of the potential harm as well as the benefit of therapy; more data are required on the effect of antiplatelets on major bleeding. Evidence on the effectiveness of aspirin versus either placebo or an alternative antiplatelet agent is lacking. Evidence for thienopyridine antiplatelet agents was particularly compelling and there is an urgent need for multicentre trials to compare the effects of aspirin against thienopyridines.
  • Compression stockings for the initial treatment of varicose veins in patients without venous ulceration
    7 Studien (n= 356)
    There is insufficient, high quality evidence to determine whether or not compression stockings are effective as the sole and initial treatment of varicose veins in people without healed or active venous ulceration, or whether any type of stocking is superior to any other type.
  • Creatine and creatine analogues in hypertension and cardiovascular disease
    11 Studien (n= 1474)
    Creatine kinase is an enzyme that regenerates cellular ATP, which is used for energy demanding processes. This review evaluated existing therapeutic strategies that target the creatine kinase system in cardiovascular disease. The available trials indicate an improvement in abnormal heart rhythm and shortness of breath in heart disease. The effect on death and the size of myocardial infarction and the heart function were unclear. Given the small sample size of the discussed trials and the heterogeneity of the population included in these reports, larger clinical studies are needed to confirm these observations.
  • Ayurvedic treatments for diabetes mellitus
    7 Studien (n= 354)
    Although there were significant glucose-lowering effects with the use of some herbal mixtures, due to methodological deficiencies and small sample sizes we are unable to draw any definite conclusions regarding their efficacy.
  • Cardiac testing for coronary artery disease in potential kidney transplant recipients
    34 Studien
    DSE may perform better than MPS but additional studies directly comparing these cardiac screening tests are needed. Absence of significant CAD may not necessarily correlate with cardiac-event free survival following transplantation. Further research should focus on assessing the ability of functional tests to predict postoperative outcome.
  • Computer-assisted versus oral-and-written dietary history taking for diabetes mellitus
    1 Studie (n=37)
    Based on one small study judged to be of moderate risk of bias, we tentatively conclude that CAHTS may be well received by study participants and potentially offer time saving in practice. However, more robust studies with larger sample sizes are needed to confirm these. We cannot draw on any conclusions in relation to any other clinical outcomes at this stage.
  • Computer-assisted versus oral-and-written family history taking for identifying people with elevated risk of type 2 diabetes mellitus
    Keine geeigneten Studien
    There is a need to develop an evidence base to support the effective development and use of computer-assisted history taking systems in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted family history taking for identifying people with elevated risk of type 2 diabetes may only rely on the clinicians' tacit knowledge, published monographs and viewpoint articles.
  • Local intramuscular transplantation of autologous mononuclear cells for critical lower limb ischaemia
    2 Studien (n=57)
    The data from the published trials suggest that there is insufficient evidence to support this treatment. These results were based on only two trials which had a very small number of participants. Therefore evidence from larger randomised controlled trials is needed in order to provide adequate statistical power to assess the role of intramuscular mononuclear cell implantation in patients with CLI.
  • Patient education in the management of coronary heart disease
    13 Studien (n=68.556)
    We did not find strong evidence that education reduced all cause mortality, cardiac morbidity, revascularisation or hospitalisation compared to control. There was some evidence to suggest that education may improve HRQofL and reduce overall healthcare costs. Whilst our findings are generally supportive of current guidelines that CR should include not only exercise and psychological interventions, further research into education is needed.
  • Statins for primary prevention of venous thromboembolism
    1 Studie (n=17.802)
    Available evidence showed that rosuvastatin was associated with a reduced incidence of VTE, but the evidence was limited to a single RCT. Randomised controlled trials of statins (including rosuvastatin) are needed to evaluate the efficacy of statins in the prevention of VTE.

Infektion

  • Intermittent preventive treatment regimens for malaria in HIV-positive pregnant women
    2 Studien (n= 722)
    Three or more doses of SP is superior to the standard two doses in HIV-positive pregnant women. However, since SP cannot be administered concurrently with co-trimoxazole - a drug often recommended for infection prophylaxis in HIV-positive pregnant women, new drugs and research is needed to address needs of HIV-positive pregnant women.
  • Interferon alpha for chronic hepatitis D
    6 Studien (n= 201)
    Interferon alpha does not seem to cure hepatitis D in most patients. The agent seems effective in suppressing viral and liver disease activity in some patients, but this improvement is not sustained in the majority of patients. We cannot exclude overestimation of benefits and underestimation of harms due to high risk of bias (systematic errors) and high risk play of chance (random errors). Therefore, more randomised trials with large sample sizes and less risk of bias are needed before interferon can be recommended or refuted.
  • Interventions to improve adherence to antiretroviral therapy in children with HIV infection
    4 Studien
    A home-based nursing intervention has the potential to improve ART adherence, but more evidence is needed. Medication diaries do not appear to have an effect on adherence or disease outcomes. Two interventions, an LPV/r-containing regimen and peer support therapy for adolescents, did not demonstrate improvements in adherence, yet demonstrated greater viral load suppression compared to control groups, suggesting a different mechanism for improved health outcomes. Well-designed evaluations of interventions to improve paediatric adherence to ART are needed.
  • Interventions to reduce risky sexual behaviour for preventing HIV infection in workers in occupational settings
    8 Studien (n= 11.164)
    Workplace interventions to prevent HIV are feasible. There is moderate quality evidence that VCT offered at the work site increases the uptake of testing. Even though this did no lower HIV-incidence, there was a decrease in self-reported sexual transmitted diseases and a decrease in risky sexual behaviour. There is low quality evidence that educational interventions decrease sexually transmitted diseases, unprotected sex and sex with commercial sex workers but not sex with multiple partners and the use of alcohol before sex.
    More and better randomised trials are needed directed at high risk groups such as truck drivers or workers in areas with a very high HIV prevalence such as Southern Africa. Risky sexual behaviour should be measured in a standardised way.
  • Probiotics for maintenance of remission in ulcerative colitis
    4 Studien (n= 587)
    Given the relatively small number of patients in the pooled analysis, the small number of events and the high risk and unclear risk of bias in the included studies, there is insufficient evidence to make conclusions about the efficacy of probiotics for maintenance of remission in UC. There is a lack of well-designed RCTs in this area and further research is needed.
  • Sargramostim (GM-CSF) for induction of remission in Crohn's disease

    3 Studien (n= 537)
    Sargramostim does not appear to be more effective than placebo for induction of clinical remission or clinical improvement in patients with active Crohn's disease. However, the GRADE analysis indicates that the overall quality of the evidence for the primary (clinical remission) and secondary outcomes (clinical response) was low indicating that further research is likely to have an impact on the effect estimates.

  • Systemic corticosteroids for acute sinusitis
    4 Studien (n= 1008)
    Current evidence suggests that oral corticosteroids as an adjunctive therapy to oral antibiotics are effective for short-term relief of symptoms in acute sinusitis. However, data are limited and there is a significant risk of bias. High quality trials assessing the efficacy of systemic corticosteroids both as an adjuvant and a monotherapy in primary care patients with acute sinusitis should be initiated.

Nach oben

Kinder

  • Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in developing countries
    7 Studien (n= 51.446)
    Considering mortality in early infancy being a major contributory cause of overall child mortality for the under five year old group in developing countries, it is critical to obtain sound scientific evidence of the effect of vitamin A supplementation in neonates. Evidence provided in this review does indicate a potential beneficial effect of supplementing neonates with vitamin A at birth for reducing mortality in the first half of infancy. Considering the absence of a clear indication of the biological mechanism and conflicting findings from individual studies in settings with varying levels of maternal vitamin A deficiency and infant mortality, and given four additional ongoing trials with approximately 100,000 neonates being enrolled, we propose a delay in any policy recommendations for neonatal vitamin A supplementation.
  • Vitamin A supplementation for the prevention of morbidity and mortality in infants six months of age or less
    18 Studien
    There is no convincing evidence that either maternal postpartum or infant vitamin A supplementation results in a reduction in infant mortality or morbidity in low and middle income countries.
  • Zinc supplementation as an adjunct to antibiotics in the treatment of pneumonia in children 2 to 59 months of age
    4 Studien (n= 3267)
    Evidence provided in this review is insufficient to recommend the use of zinc as an adjunct to standard antibiotic therapy for pneumonia in children aged two to 35 months.
  • Lasers or light sources for treating port-wine stains
    5 Studien (n= 103)
    The pulsed dye laser leads to clinically relevant clearance of port-wine stains. A limited number of RCTs evaluated the efficacy from intense pulsed light and other laser types. High-quality RCTs are needed to assess individual efficacy from different lasers and light sources, as well as participant satisfaction.
  • Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birth weight infants
    4 Studien (n= 614)
    The use of restrictive as compared to liberal haemoglobin thresholds in infants of very low birth weight results in modest reductions in exposure to transfusion and in haemoglobin levels. Restrictive practice does not appear to have a significant impact on death or major morbidities at first hospital discharge or at follow-up. However, given the uncertainties of these conclusions, it would be prudent to avoid haemoglobin levels below the lower limits tested here. Further trials are required to clarify the impact of transfusion practice on long term outcome.
  • Melatonin for non-respiratory sleep disorders in visually impaired children
    Keine geeigneten Studien
    There is currently no high quality data to support or refute the use of melatonin for sleep disorders in visually impaired children.
  • Xylitol for preventing acute otitis media in children up to 12 years of age
    4 Studien (n> 3000)
    There is fair evidence that the prophylactic administration of xylitol among healthy children attending day care centres reduces the occurrence of AOM by 25%. This meta-analysis is limited since the data arise from a small number of studies, mainly from the same research group.
  • Early additional food and fluids for healthy breastfed full-term infants
    6 Studien (n= 814)
    We were unable to fully assess the benefits or harms of supplementation or to determine the impact from timing and type of supplementation. We found no benefit to newborn infants and possible negative effects on the duration of breastfeeding from the brief use of additional water or glucose water. For infants at four to six months, we found no benefit from additional foods nor any risks related to morbidity or weight change. Future studies should examine the longer term effects on infants and mothers, though randomising infants to receive supplements without medical need may be considered unethical.
    We found no evidence for disagreement with the recommendation of international health associations that exclusive breastfeeding should be recommended for healthy infants for the first six months.
  • Home-based child development interventions for preschool children from socially disadvantaged families
    7 Studien (n= 723)
    This review does not provide evidence of the effectiveness of home-based interventions that are specifically targeted at improving developmental outcomes for preschool children from socially disadvantaged families. Future studies should endeavour to better document and report their methodological processes.
  • Intermittent iron supplementation for improving nutrition and development in children under 12 years of age
    33 Studien (n= 13.114)
    Intermittent iron supplementation is efficacious to improve haemoglobin concentrations and reduce the risk of having anaemia or iron deficiency in children younger than 12 years of age when compared with a placebo or no intervention, but it is less effective than daily supplementation to prevent or control anaemia. Intermittent supplementation may be a viable public health intervention in settings where daily supplementation has failed or has not been implemented. Information on mortality, morbidity, developmental outcomes and side effects, however, is still lacking.
  • Interventions to slow progression of myopia in children
    23 Studien (n= 4696)
    The most likely effective treatment to slow myopia progression thus far is anti-muscarinic topical medication. However, side effects of these medications include light sensitivity and near blur. Also, they are not yet commercially available, so their use is limited and not practical. Further information is required for other methods of myopia control, such as the use of corneal reshaping contact lenses or bifocal soft contact lenses (BSCLs) with a distance center are promising, but currently no published randomized clinical trials exist.
  • Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates
    6 Studien (n= 630)
    LED light source phototherapy is efficacious in bringing down levels of serum total bilirubin at rates that are similar to phototherapy with conventional (compact fluorescent lamp (CFL) or halogen) light sources. Further studies are warranted for evaluating efficacy of LED phototherapy in neonates with haemolytic jaundice or in the presence of severe hyperbilirubinaemia (STB ≥ 20 mg/dL).
  • Parent training interventions for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years
    5 Studien (n= 284)
    Parent training may have a positive effect on the behaviour of children with ADHD. It may also reduce parental stress and enhance parental confidence. However, the poor methodological quality of the included studies increases the risk of bias in the results. Data concerning ADHD-specific behaviour are ambiguous. For many important outcomes, including school achievement and adverse effects, data are lacking.
    Evidence from this review is not strong enough to form a basis for clinical practice guidelines. Future research should ensure better reporting of the study procedures and results.
  • Social skills training for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years
    11 Studien (n= 747)
    The review suggests that there is little evidence to support or refute social skills training for adolescents with ADHD. There is need for more trials, with low risk of bias and with a sufficient number of participants, investigating the efficacy of social skills training versus no training for both children and adolescents.
  • Treadmill interventions with partial body weight support in children under six years of age at risk of neuromotor delay
    5 Studien (n= 139)
    The current review provided only limited evidence of the efficacy of treadmill intervention in children up to six years of age. Few studies have assessed treadmill interventions in young children using an appropriate control group (which would be usual treatment or no treatment). The available evidence indicates that treadmill intervention may accelerate the development of independent walking in children with Down syndrome. Further research is needed to confirm this and should also address whether intensive treadmill intervention can accelerate walking onset in young children with cerebral palsy and high risk infants, and whether treadmill intervention has a general effect on gross motor development in the various subgroups of young children at risk for developmental delay.

 

Knochen

  • Bisphosphonates for osteoporosis in primary biliary cirrhosis
    6 Studien
    We did not find evidence to support or refute the use of bisphosphonates for patients with primary biliary cirrhosis. The data seem to indicate a possible positive intervention effect of bisphosphonates on decreasing urinary amino telopeptides of collagen I concentration compared with placebo or no intervention with no risk of random error.

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Krebs

  • Allogeneic hematopoietic cell transplantation for adult acute lymphoblastic leukemia (ALL) in first complete remission
    14 Studien (n= 3157)
    The results of this systematic review and meta-analysis support matched sibling donor allogeneic hematopoietic cell transplantation as the optimal post-remission therapy in ALL patients aged 15 years or over. This therapy offers superior overall survival and disease-free survival, and significantly reduces the risk of disease relapse, but does impose an increased risk of non-relapse mortality. Importantly these data are based on adult ALL treated with largely total body irradiation-based myeloablative conditioning and sibling donor transplantation and, therefore, cannot be generalized to pediatric ALL, alternative donors including HLA (human leukocyte antigen) mismatched or unrelated donors, or reduced toxicity or non-myeloablative conditioning regimens.
  • Low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer
    16 Studien (n= 11847)
    We found no difference between perioperative thromboprophylaxis with LMWH verus UFH in their effects on mortality and embolic outcomes in patients with cancer. Further trials are needed to more carefully evaluate the benefits and harms of different heparin thromboprophylaxis strategies in this population.
  • Information interventions for orienting patients and their carers to cancer care facilities
    4 Studien (n= 610)
    This review has demonstrated the feasibility and some potential benefits of orientation interventions. There was a low level of evidence suggesting that orientation interventions can reduce distress in patients. However, most of the other outcomes remain inconclusive (patient knowledge recall/ satisfaction). The majority of studies were subject to high risk of bias, and were likely to be insufficiently powered. Further well conducted and powered RCTs are required to provide evidence for determining the most appropriate intensity, nature, mode and resources for such interventions. Patient and carer-focused outcomes should be included.
  • Lamivudine with or without adefovir dipivoxil for postoperative hepatocellular carcinoma
    Keine geeigneten Studien
    Hepatocellular carcinoma (HCC) is among the most common types of cancer. Surgical resection is considered the first-line therapy in early HCC, relapse is the main postoperative problem. A large proportion of participants with HCC have hepatitis B virus infection. Lamivudine with or without adefovir dipivoxil are considered effective and tolerable for chronic hepatitis B by suppressing the viral load and to reduce fibrosis in the liver, and are widely used as adjuvant therapy postoperatively. As yet, there is no evidence that lamivudine with or without adefovir dipivoxil is effective or not for postoperative HCC. The authors found no randomised clinical trials that could be included in the present review. Hence, no conclusions could be drawn.
  • Pharmacologic interventions for treating phantom limb pain
    13 Studien (n= 255)
    The short- and long-term effectiveness of opioids, NMDA receptor antagonists, anticonvulsants, antidepressants, calcitonins, and anaesthetics for clinically relevant outcomes that include pain, function, mood, sleep, quality of life, satisfaction and adverse effects remains unclear. Morphine, gabapentin and ketamine demonstrate trends towards short-term analgesic efficacy. Memantine and amitriptyline were ineffective for PLP. Results, however, are to be interpreted with caution as these were based mostly on a small number of studies with limited sample sizes that varied considerably and also lacked long-term efficacy and safety outcomes. The direction of efficacy of calcitonin, anaesthetics and dextromethorphan need further clarification. Larger and more rigorous randomised controlled trials are needed to make stronger recommendations about which medications would be useful for clinical practice.

 

Neurologie/Psychiatrie

  • Dance/movement therapy for improving psychological and physical outcomes in cancer patients
    2 Studien (n = 68)
    We did not find support for an effect of dance/movement therapy on body image. The findings of one study suggest that dance/movement therapy may have a beneficial effect on QoL. However, the limited number of studies prevents us from drawing conclusions concerning the effects of dance/movement therapy on psychological and physical outcomes in cancer patients.
  • Interventions for disorders of eye movement in patients with stroke
    2 Studien (n = 28)
    There is insufficient evidence to reach conclusions about the effectiveness of interventions for patients with eye movement disorders after stroke.
  • Natalizumab for relapsing remitting multiple sclerosis
    3 Studien (n > 2000)
    Although one trial did not contribute to efficacy results due to its duration, we found robust evidence in favour of a reduction in relapses and disability at 2 years in RRMS patients treated with NTZ. The drug was well tolerated. There are current significant safety concerns due to reporting of an increasing number of PML cases in patients treated with NTZ. This review was unable to provide an up-to-date systematic assessment of the risk due to the maximum 2 year-duration of the trials included. An independent systematic review of the safety profile of NTZ is warranted. NTZ should be used only by skilled neurologists in MS centres under surveillance programs. All the data in this review came from trials supported by the Pharmaceutical Industry. In agreement with the Cochrane Collaboration policy, this may be considered a potential source of bias.
  • Non-pharmacological interventions for caregivers of stroke survivors
    8 Studien (n= 1007)
    It was not possible to carry out a meta-analysis of the evidence from RCTs because of methodological, clinical and statistical heterogeneity. One limitation across all studies was the lack of a description of important characteristics that define the informal caregiver population. However, 'vocational educational' type interventions delivered to caregivers prior to the stroke survivor's discharge from hospital appear to be the most promising intervention. However, this is based on the results from one, small, single-centre study.
  • Pharmacologic treatment for memory disorder in multiple sclerosis
    4 Studien
    Until the results of ongoing studies are available, there is no convincing evidence to support pharmacologic intervention as an effective treatment for memory disorder in MS patients. However, donepezil, Ginkgo biloba, memantine and rivastigmine resulted to be safe and well tolerated as adverse events such as nausea, diarrhea, somnolence, and constipation were not frequent, while no serious adverse effects were reported. Future high quality randomised controlled trials are needed.
  • Repetitive transcranial magnetic stimulation for tinnitus
    5 Studien (n= 233)
    There is very limited support for the use of low-frequency rTMS for the treatment of patients with tinnitus. When considering the impact of tinnitus on patients' quality of life, support is from a single study with a low risk of bias based on a single outcome measure at a single point in time. When considering the impact on tinnitus loudness, this is based on the analysis of pooled data with a large confidence interval. Studies suggest that rTMS is a safe treatment for tinnitus in the short-term, however there were insufficient data to provide any support for the safety of this treatment in the long-term.
  • Valproic acid and sodium valproate for neuropathic pain and fibromyalgia in adults
    3 Studien (n= 129)
    These three studies no more than hint that sodium valproate may reduce pain in diabetic neuropathy, and divalproex sodium in post-herpetic neuralgia, but the use of 'completer' analysis may overestimate efficacy, and there were too few data for pooled analysis of efficacy or harm, or to have confidence in the results of the individual studies. There is insufficient evidence to support the use of valproic acid or sodium valproate as a first-line treatment for neuropathic pain. There is more robust evidence of greater efficacy for a small number of other drugs.
  • Anti-hypertensive drugs as disease-modifying agents for Parkinson's disease: evidence from observational studies and clinical trials
    6 Studien nachrangiger Evidenz
    There is currently a lack of evidence for the use of antihypertensive drugs for either the primary or secondary prevention of PD. More observational studies are required to identify potential drugs to go forward for safety and tolerability studies in people with early PD. The results of the ongoing trial will help inform further research.
  • Cognitive reframing for carers of people with dementia
    Cognitive reframing for family carers of people with dementia seems to reduce psychological morbidity and subjective stress but without altering appraisals of coping or burden. The results suggest that it may be an effective component of individualised, multi-component interventions for carers. Identifying studies with relevant interventions was a challenge for this review. The impact of cognitive reframing might be higher when used alongside other interventions because this offers better opportunities to tailor cognitive reframing to actual everyday carer problems.
  • The effects of anaesthetic agents on cortical mapping during neurosurgical procedures involving eloquent areas of the brain
    Keine geeigneten Studien
    This review highlights the need for well-designed randomised controlled trials to assess the effect of anaesthetic agents on cortical mapping during neurosurgical procedures involving eloquent areas of the brain.
  • Helicobacter pylori eradication for Parkinson's disease
    3 Studien (n= 154)
    There is currently a lack of evidence on the effects of screening and treating H pylori in patients with Parkinson's disease. There is limited evidence to suggest that H Pylori eradication improves the absorption of levodopa and improves motor symptoms. Results from an ongoing trial will inform the evidence base and will be incorporated in an update of this review.
  • Neuropsychological rehabilitation for multiple sclerosis
    14 Studien (n= 770)
    The review indicates low level evidence for the positive effects of neuropsychological rehabilitation in MS. Interventions included in the review were heterogeneous. Consequently, clinical inferences can basically be drawn from single studies. Therefore, new trials may change the strength and direction of the evidence.
  • Non-steroidal anti-inflammatory drugs as disease-modifying agents for Parkinson's disease: evidence from observational studies
    14 Studien
    There is currently no evidence for the use of NSAIDs in the secondary prevention of PD. Non-aspirin NSAIDs, particularly ibuprofen, may reduce the risk of developing PD. However, little is known of the effects of other individual drugs and at present no recommendations can be made regarding their use in primary prevention.
  • Omega-3 fatty acids supplementation for autism spectrum disorders (ASD)
    2 Studien (n= 37)
    To date there is no high quality evidence that omega-3 fatty acids supplementation is effective for improving core and associated symptoms of ASD.
  • Pharmacological interventions for the treatment of anxiety disorders in chronic obstructive pulmonary disease
    4 Studien (n= 40)
    Due to the sub-optimal quality of the trials and statistically non-significant results, it is not possible to draw any conclusions for treatment.
  • Probiotics for patients with hepatic encephalopathy
    7 Studien (n= 550)
    The trials we located suffered from a high risk of systematic errors ('bias') and high risk of random errors ('play of chance'). While probiotics appear to reduce plasma ammonia concentration when compared with placebo or no intervention, we are unable to conclude that probiotics are efficacious in altering clinically relevant outcomes. Demonstration of unequivocal efficacy is needed before probiotics can be endorsed as effective therapy for hepatic encephalopathy. Further randomised clinical trials are needed.
  • Psychosocial interventions for the management of chronic orofacial pain
    17 Studien
    There is weak evidence to support the use of psychosocial interventions for chronic orofacial pain. Although significant effects were observed for outcome measures where pooling was possible, the studies were few in number and had high risk of bias. However, given the non-invasive nature of such interventions they should be used in preference to other invasive and irreversible treatments which also have limited or no efficacy. Further high quality trials are needed to explore the effects of psychosocial interventions on chronic orofacial pain.
  • Coenzyme Q10 for Parkinson's disease
    4 Studien (n =452)
    Coenzyme Q10 therapy with 1200 mg/d for 16 months was well tolerated by patients with Parkinson's disease. The improvements in ADL UPDRS and Schwab and England were positive, but it need to be further confirmed by larger sample. For total and other subscores of UPDRS, the effects of coenzyme Q10 seemed to be less clear.
  • Edaravone for acute ischaemic stroke
    3 Studien (n =496)
    The risk of bias in the included trials was moderate and the sample was small. Hence, although the data in this review show an effective treatment trend of edaravone for acute ischaemic stroke, further large, high-quality trials are required to confirm this trend.
  • Eslicarbazepine acetate add-on for drug-resistant partial epilepsy
    4 Studien (n =1146)
    Eslicarbazepine acetate reduces seizure frequency when used as an add-on treatment for people with drug-resistant partial epilepsy. The trials included in this review were of short-term duration and focused on adults.
  • Interventions for treating anxiety after stroke
    2 Studien (n =175)
    Anxiety after stroke occurs frequently and can be treated with antidepressants, other anxiety reducing drugs, or psychological therapy. This review of two trials, which included 175 participants, found that antidepressant and anxiety reducing drugs decreased the severity of anxiety symptoms. However, they also increased side effects. One trial showed that combining an antidepressant with psychotherapy also decreased anxiety symptom severity but not to a greater extent than antidepressant treatment alone. The findings are only applicable to stroke patients with both anxiety and depression as we did not find any studies that considered stroke patients with anxiety only. Future research will need to ensure that stroke patients with anxiety alone are also included in trials, and these trials should include a placebo control group.
  • Mirtazapine versus other antidepressive agents for depression
    29 Studien (n =4974)
    Some statistically significant and possibly clinically meaningful differences between mirtazapine and other antidepressive agents were found for the acute-phase treatment of major depression. Mirtazapine is likely to have a faster onset of action than SSRIs during the acute-phase treatment. Dropouts occur similarly in participants treated with mirtazapine and those treated with other antidepressants, although the adverse event profile of mirtazapine is unique.
  • Naftidrofuryl for dementia
    8 Studien (n =847)
    Oral administration of naftidrofuryl is well-tolerated by patients with dementia.The low-quality evidence shows that, by use of naftidrofuryl, people with dementia may benefit on performance, behaviour, cognition, and mood. However, the benefit on global impression is inconsistent and unconvincing.
  • Oxcarbazepine for acute affective episodes in bipolar disorder
    7 Studien (n =368)
    Currently, there are insufficient trials of adequate methodological quality on oxcarbazepine in the acute treatment of bipolar disorder to inform us on its efficacy and acceptability. Studies predominantly examine the treatment of mania: there are data from subgroup analysis on mixed affective, hypomania and rapid-cycling states.
    From the few studies included in this review, oxcarbazepine did not differ in efficacy compared to placebo in children and adolescents. It did not differ from other active agents in adults. It may have a poorer tolerability profile compared to placebo. No data were found on outcomes relevant to patients and clinicians, such as length of hospital admission.
  • Rituximab for relapsing-remitting multiple sclerosis
    1 Studie (n =104)
    We are unable to give any clear recommendations for the use of rituximab as a therapy for RR-MS. The beneficial effects of rituximab for RR-MS remain inconclusive because of the high attrition bias, the small number of participants and the short follow-up. However, short-term treatment with a single course of rituximab resulted to be safe for most patients with RR-MS. The potential benefits of rituximab for treating RR-MS need to be evaluated in large scale studies along with long-term safety. Disability progression and quality of life should be addressed in future research.
  • Second-generation antidepressants for seasonal affective disorder
    3 Studien (n =204)
    Evidence for the effectiveness of SGAs is limited to one small trial of fluoxetine compared with placebo, which shows a non-significant effect in favour of fluoxetine, and two small trials comparing fluoxetine against light therapy, which suggest equivalence between the two interventions. The lack of available evidence precludes the ability to draw any overall conclusions on the use of SGAs for SAD.

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Schmerz

  • Combination therapy for pain management in inflammatory arthritis (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, other spondyloarthritis)
    23 Studien (n=912)
    Based on 23 trials, all at high risk of bias, there is insufficient evidence to establish the value of combination therapy over monotherapy for people with IA. Importantly, there are no studies addressing the value of combination therapy for patients with IA who have persistent pain despite optimal disease suppression. Well designed trials are needed to address this question.
  • Non-pharmacological management of infant and young child procedural pain
    51 Studien (n= 3396)
    There is evidence that different non-pharmacological interventions can be used with preterms, neonates, and older infants to significantly manage pain behaviors associated with acutely painful procedures.
  • Pain management for rheumatoid arthritis and cardiovascular or renal comorbidity
    Keine geeigneten Studien
    There were no trials that specifically compared the efficacy and safety of pain pharmacotherapies for patients with rheumatoid arthritis, with and without comorbid cardiovascular or renal conditions.
    In the absence of specific evidence in rheumatoid arthritis, current guidelines recommend that NSAIDs be used with caution in the general rheumatoid arthritis population while highlighting the added need for extra vigilance in patients with established cardiovascular disease or risk factors for its development. Current guidelines regarding the use of NSAIDs and opioids in moderate to severe renal impairment should also be applied to the rheumatoid arthritis population.
  • Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain
    36 Studien (n= 3896)
    A single dose of both IV propacetamol and IV paracetamol provides around four hours of effective analgesia for about 37% of patients with acute postoperative pain. Both formulations are associated with few adverse events, although patients receiving IV propacetamol have a higher incidence of pain on infusion than both placebo and IV paracetamol.
  • Opioid therapy for treating rheumatoid arthritis pain
    11 Studien (n= 672)
    There is limited evidence that weak oral opioids may be effective analgesics for some patients with RA, but adverse effects are common and may offset the benefits of this class of medications. There is insufficient evidence to draw conclusions regarding the use of weak opioids for longer than six weeks, or the role of strong opioids.
  • Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years
    4 Studien (n= 330)
    Based on these four studies, two of which were subgroups of small numbers of eligible toddlers from larger studies, there is insufficient evidence of the analgesic effects of sweet tasting solutions or substances during acute painful procedures in children over one year of age. Further well-conducted RCTs are warranted in this population.
  • Antidepressants for pain management in rheumatoid arthritis
    8 Studien (n= 652)
    There is currently insufficient evidence to support the routine prescription of antidepressants as analgesics in patients with RA as no reliable conclusions about their efficacy can be drawn from eight placebo RCTs. The use of these agents may be associated with adverse events which are generally mild and do not lead to cessation of treatment. More high quality trials are needed in this area.

 

Sucht

  • Mentoring adolescents to prevent drug and alcohol use
    4 Studien (n=1194)
    All four RCTs were in the US, and included “deprived” and mostly minority adolescents. Participants were young (in two studies age 12, and in two others 9-16). All students at baseline were non-users of alcohol and drugs. Two RCTs found mentoring reduced the rate of initiation of alcohol, and one of drug usage. The ability of the interventions to be effective was limited by the low rates of commencing alcohol and drug use during the intervention period in two studies (the use of marijuana in one study increased to 1% in the experimental and to 1.6% in the control group, and in another study drug usage rose to 6% in the experimental and 11% in the control group). However, in a third study there was scope for the intervention to have an effect as alcohol use rose to 19% in the experimental and 27% in the control group. The studies assessed structured programmes and not informal mentors.

 

Urologie

  • Lycopene for the prevention of prostate cancer
    3 Studien /n= 154)
    Given that only three RCTs were included in this systematic review, and the high risk of bias in two of the three studies, there is insufficient evidence to either support, or refute, the use of lycopene for the prevention of prostate cancer. Similarly, there is no robust evidence from RCTs to identify the impact of lycopene consumption upon the incidence of prostate cancer, prostate symptoms, PSA levels or adverse events.

 

Zahn

  • Flossing for the management of periodontal diseases and dental caries in adults
    12 Studien (n= 582)
    There is some evidence from twelve studies that flossing in addition to toothbrushing reduces gingivitis compared to toothbrushing alone. There is weak, very unreliable evidence from 10 studies that flossing plus toothbrushing may be associated with a small reduction in plaque at 1 and 3 months. No studies reported the effectiveness of flossing plus toothbrushing for preventing dental caries.
  • Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children
    11 Studien (n= 7196)
    This review suggests that the use of fluoride supplements is associated with a reduction in caries increment when compared with no fluoride supplement in permanent teeth. The effect of fluoride supplements was unclear on deciduous teeth. When compared with the administration of topical fluorides, no differential effect was observed. We rated 10 trials as being at unclear risk of bias and one at high risk of bias, and therefore the trials provide weak evidence about the efficacy of fluoride supplements.

 

Diverses

  • Hematopoietic stem cell transplantation for people with ß-thalassaemia major
    Keine geeigneten Studien
    We were unable to identify any randomised controlled trials or quasi-randomised controlled trials on the effectiveness and safety of different types of allogeneic stem cell transplantation in people with severe transfusion-dependant ß-thalassaemia major or ß0/+- thalassaemia variants requiring chronic blood transfusion. The absence of high-level evidence for the effectiveness of these interventions emphasises the need for well-designed, adequately-powered, randomised controlled clinical trials.
  • Enzyme replacement therapy with idursulfase for mucopolysaccharidosis type II (Hunter syndrome)
    1 Studie (n= 96)
    The current evidence is limited. While the randomised clinical trial identified was considered to be of good quality, it failed to describe important outcomes. It has been demonstrated that enzyme replacement therapy with idursulfase is effective in relation to functional capacity (distance walked in six minutes and forced vital capacity), liver and spleen volumes and urine glycosaminoglycan excretion in patients with mucopolysaccharidosis type II compared with placebo. There is no available evidence in the included study and in the literature on outcomes such as improvement in growth, sleep apnoea, cardiac function, quality of life and mortality.
  • Interventions designed to prevent healthcare bed-related injuries in patients
    2 Studien (n= 22.106)
    The effectiveness of interventions designed to prevent patient injuries from their beds (including bed rails, low height beds and bed exit alarms) remains uncertain. The available evidence shows no significant increase or decrease in the rate of injuries with the use of low height beds and bed exit alarms. Limitations of the two included studies include lack of blinding and insufficient power. No randomised controlled trials of bed rails were identified. Future reports should fully describe the standard care received by the control group.
  • Methods for obtaining unpublished data
    5 Studien
    One observational comparative study assessed methods to obtain unpublished studies (i.e. data for studies that have never been published). Identifying unpublished studies ahead of time and then asking the drug industry to provide further specific detail proved to be more fruitful than sending of a non-specific request.
  • Ultrasound use for the placement of haemodialysis catheters
    7 Studien (n= 767)
    Use of real-time 2-D Doppler ultrasound guidance has significant benefits with respect to the number if catheters successfully inserted on the first attempt, reduction in the risk of arterial puncture and haematomas and the time taken for successful vein puncture.
  • Framing of health information messages
    35 Studien (n= 16.342)
    Contrary to commonly held beliefs, the available low to moderate quality evidence suggests that both attribute and goal framing may have little if any consistent effect on health consumers' behaviour. The unexplained heterogeneity between studies suggests the possibility of a framing effect under specific conditions. Future research needs to investigate these conditions.
  • Interventions for the management of dry mouth: topical therapies
    36 Studien (n= 1597)
    There is no strong evidence from this review that any topical therapy is effective for relieving the symptom of dry mouth. OGT spray is more effective than an aqueous electrolyte spray (SMD 0.77, 95% CI 0.38 to 1.15) which is approximately equivalent to a mean difference of 2 points on a 10-point VAS scale for mouth dryness. Chewing gums appear to increase saliva production in those with residual secretory capacity and may be preferred by patients, but there is no evidence that gum is better or worse than saliva substitutes. Integrated mouthcare systems and oral reservoir devices may be helpful but further research is required to confirm this.
  • Support surfaces for treating pressure ulcers
    18 Studien (n= 1309)
    There is no conclusive evidence about the superiority of any support surface for the treatment of existing pressure ulcers. Methodological issues included variations in outcomes measured, sample sizes and comparison groups. Many studies had small sample sizes and often there was inadequate description of the intervention, standard care and co-interventions. Individual study results were often inadequately reported, with failure to report variance data common, thus hindering the calculation of mean differences. Some studies did not report P values when reporting on differences in outcomes. In addition, the age of some trials (some being 20 years old), means that other technologies may have superseded those investigated.
  • Use of electronic health records to support smoking cessation
    11 Studien
    At least in the short term, documentation of tobacco status and increased referral to cessation counseling do appear to increase following the introduction of an expectation to use the EHR to record and treat patient tobacco use at medical visits. There is a need for additional research to further understand the effect of EHRs on smoking treatment in healthcare settings.

 

UPDATES

  • Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever) - Abstract
  • Graduated driver licensing for reducing motor vehicle crashes among young drivers - Abstract
  • Interventions to reduce haemorrhage during myomectomy for fibroids - Abstract
  • Non-legislative interventions for the promotion of cycle helmet wearing by children - Abstract
  • Nitric oxide donors for cervical ripening in first-trimester surgical abortion - Abstract

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