Category Archives: Cochrane Database Syst Rev

Vitamin A and beta (β)-carotene supplementation for cystic fibrosis.

Related Articles

Vitamin A and beta (β)-carotene supplementation for cystic fibrosis.

Cochrane Database Syst Rev. 2018 Aug 09;8:CD006751

Authors: de Vries JJ, Chang AB, Bonifant CM, Shevill E, Marchant JM

Abstract
BACKGROUND: People with cystic fibrosis (CF) and pancreatic insufficiency are at risk of a deficiency in fat-soluble vitamins, including vitamin A. Vitamin A deficiency predominantly causes eye and skin problems, while excessive levels of vitamin A can harm the respiratory and skeletal systems in children and interfere with the metabolism of other fat-soluble vitamins. Most CF centres administer vitamin A as supplements to reduce the frequency of vitamin A deficiency in people with CF and to improve clinical outcomes such as growth, although the recommended dose varies between different guidelines. Thus, a systematic review on vitamin A and vitamin A-like supplementation (carotenes or other retinoids) in people with CF would help guide clinical practice. This is an update of an earlier Cochrane Review.
OBJECTIVES: To determine if supplementation with vitamin A, carotenes or other retinoid supplements in children and adults with CF reduces the frequency of vitamin A deficiency disorders, improves general and respiratory health and affects the frequency of vitamin A toxicity.
SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Cystic Fibrosis Trials Register compiled from electronic database searches and handsearching of journals and conference abstract books. Additionally we searched several ongoing trials registries, including ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform and the International Standard Randomised Controlled Trial Number Registry.Most recent database searches: 01 June 2018.
SELECTION CRITERIA: All randomised or quasi-randomised controlled studies comparing all preparations of oral vitamin A, carotenes or retinoids (or in combination), used as a supplement compared to placebo at any dose, for at least three months, in people with CF (diagnosed by sweat tests or genetic testing) with and without pancreatic insufficiency.
DATA COLLECTION AND ANALYSIS: Two authors individually assessed study quality and extracted data on outcome measures. The authors assessed the quality of the evidence using the GRADE system. Investigators were contacted to retrieve missing quantitative data.
MAIN RESULTS: No studies of vitamin A or other retinoid supplementation were eligible for inclusion. However, one randomised study of beta (β)-carotene supplementation involving 24 people with CF who were receiving pancreatic enzyme substitution was included. The study compared successive β-carotene supplementation periods (high dose followed by low dose) compared to placebo. The results for the low-dose supplementation period should be interpreted with caution, due to the lack of a wash-out period after the high-dose supplementation.The included study did not report on two of the review’s primary outcomes (vitamin A deficiency disorders and mortality); results for our third primary outcome of growth and nutritional status (reported as z score for height) showed no difference between supplementation and placebo, mean difference (MD) -0.23 (95% confidence interval (CI) -0.89 to 0.43) (low-quality evidence). With regards to secondary outcomes, supplementation with high-dose β-carotene for three months led to significantly fewer days of systemic antibiotics required to treat pulmonary exacerbations, compared to controls, MD -15 days (95% CI -27.60 to -2.40); however, this was not maintained in the second three-month section of the study when the level of β-carotene supplementation was reduced, MD -8 days (95% CI -18.80 to 2.80) (low-quality evidence). There were no statistically significant effects between groups in lung function (low-quality evidence) and no adverse events were observed (low-quality evidence). Supplementation affected levels of β-carotene in plasma, but not vitamin A levels. The study did not report on quality of life or toxicity.
AUTHORS’ CONCLUSIONS: Since no randomised or quasi-randomised controlled studies on retinoid supplementation were identified, no conclusion on the supplementation of vitamin A in people with CF can be drawn. Additionally, due to methodological limitations in the included study, also reflected in the low-quality evidence judged following the specific evidence grading system (GRADE), no clear conclusions on β-carotene supplementation can be drawn. Until further data are available, country- or region-specific guidelines regarding these practices should be followed.

PMID: 30091146 [PubMed – as supplied by publisher]

Continue reading

Posted in Cochrane Database Syst Rev | Tagged , | Leave a comment

Interventions for preventing recurrent urinary tract infection during pregnancy.

Interventions for preventing recurrent urinary tract infection during pregnancy.
Cochrane Database Syst Rev. 2015 Jul 26;7:CD009279
Authors: Schneeberger C, Geerlings SE, Middleton P, Crowther CA
Abstract
Continue reading

Posted in Cochrane Database Syst Rev | Leave a comment

Dehydroepiandrosterone for women in the peri- or postmenopausal phase.

Dehydroepiandrosterone for women in the peri- or postmenopausal phase.

Cochrane Database Syst Rev. 2015;1:CD011066

Authors: Scheffers CS, Armstrong S, Cantineau AE, Farquhar C, Jordan V

Abstract
BACKGROUND: During menopause a decreasing ovarian follicular response generally causes a fluctuation and eventual decrease in estrogen levels. This can lead to the development of various perimenopausal and postmenopausal symptoms (for example hot flushes, night sweats, vaginal dryness). Dehydroepiandrosterone (DHEA) is one of the main precursors of androgens, which in turn are converted to testosterone and estrogens. It is possible that the administration of DHEA may increase estrogen and testosterone levels in peri- and postmenopausal women to alleviate their symptoms and improve general wellbeing and sexual function (for example libido, dyspareunia, satisfaction). Treatment with DHEA is controversial as there is uncertainty about its effectiveness and safety. This review should clearly outline the evidence for DHEA in the treatment of menopausal symptoms and evaluate its effectiveness and safety by combining the results of randomised controlled trials.
OBJECTIVES: To assess the effectiveness and safety of administering DHEA to women with menopausal symptoms in the peri- or postmenopausal phase.
SEARCH METHODS: The databases that we searched (3 June 2014) with no language restrictions applied were the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS. We also searched conference abstracts and citation lists in the ISI Web of Knowledge. Ongoing trials were searched in the trials registers. Reference lists of retrieved articles were checked.
SELECTION CRITERIA: We included randomised controlled trials comparing any dose and form of DHEA by any route of administration versus any other active intervention, placebo or no treatment for a minimal treatment duration of seven days in peri- and postmenopausal women.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data after assessing eligibility for inclusion and quality of studies. Authors were contacted for additional information.
MAIN RESULTS: Twenty-eight trials with 1273 menopausal women were included in this review. Data could be extracted from 16 trials to conduct the meta-analysis. The overall quality of the studies was moderate to low with the majority of studies that were included in the meta-analysis having reasonable methodology. Compared to placebo, DHEA did not improve quality of life (standardised mean difference (SMD) 0.16, 95% confidence interval (CI) -0.03 to 0.34, P = 0.10, 8 studies, 287 women (132 from parallel and 155 from crossover trials), I² = 0%, moderate quality evidence; one trial of the nine that reported on this outcome was removed in a sensitivity analysis as it was judged to be at high risk of bias). DHEA was found to be associated with androgenic side effects (mainly acne) (odds ratio (OR) 3.77, 95% CI 1.36 to 10.4, P = 0.01, 5 studies, 376 women, I² = 10%, moderate quality evidence) when compared to placebo. No associations were found with other adverse effects. It was unclear whether DHEA affected menopausal symptoms as the results from the trials were inconsistent and could not easily be pooled to provide an overall effect due to different types of measurement (for example continuous, dichotomous, change and end scores). DHEA was found to improve sexual function (SMD 0.31, 95% CI 0.07 to 0.55, P = 0.01, 5 studies, 261 women (239 women from parallel trials and 22 women from crossover trials), I² = 0%; one trial judged to be at high risk of bias was removed during sensitivity analysis) compared to placebo.There was no difference in the acne associated with DHEA when comparing studies that used oral DHEA (OR 2.16, 95% CI 0.47 to 9.96, P = 0.90, 3 studies, 136 women, I² = 5%, very low quality evidence) to one study that used skin application of DHEA (OR 2.74, 95% CI 0.10 to 74.87, P = 0.90, 1 study, 22 women, very low quality evidence). The effects did not differ for sexual function when studies using oral DHEA (SMD 0.11, 95% CI -0.13 to 0.35, P = 0.36, 5 studies, 340 women, I² = 0) were compared to a study using intravaginal DHEA (SMD 0.42, 95% CI 0.03 to 0.81, 1 study, 218 women). Test for subgroup differences: Chi² = 1.77, df = 1 (P = 0.18), I² = 43.4%. Insufficient data were available to assess quality of life and menopausal symptoms for this comparison.There were insufficient data available to compare the effects of DHEA to hormone therapy (HT) for quality of life, menopausal symptoms, and adverse effects. No large differences in treatment effects were found for sexual function when comparing DHEA to HT (mean difference (MD) 1.26, 95% CI -0.21 to 2.73, P = 0.09, 2 studies, 41 women, I² = 0%).
AUTHORS’ CONCLUSIONS: There is no evidence that DHEA improves quality of life but there is some evidence that it is associated with androgenic side effects. There is uncertainty whether DHEA decreases menopausal symptoms, but DHEA may slightly improve sexual function compared with placebo.

PMID: 25879093 [PubMed – in process]

Continue reading

Posted in Cochrane Database Syst Rev | Leave a comment

Dehydroepiandrosterone for women in the peri- or postmenopausal phase.

Dehydroepiandrosterone for women in the peri- or postmenopausal phase.

Cochrane Database Syst Rev. 2015 Jan 22;1:CD011066

Authors: Scheffers CS, Armstrong S, Cantineau AE, Farquhar C, Jordan V

Abstract
BACKGROUND: During menopause a decreasing ovarian follicular response generally causes a fluctuation and eventual decrease in estrogen levels. This can lead to the development of various perimenopausal and postmenopausal symptoms (for example hot flushes, night sweats, vaginal dryness). Dehydroepiandrosterone (DHEA) is one of the main precursors of androgens, which in turn are converted to testosterone and estrogens. It is possible that the administration of DHEA may increase estrogen and testosterone levels in peri- and postmenopausal women to alleviate their symptoms and improve general wellbeing and sexual function (for example libido, dyspareunia, satisfaction). Treatment with DHEA is controversial as there is uncertainty about its effectiveness and safety. This review should clearly outline the evidence for DHEA in the treatment of menopausal symptoms and evaluate its effectiveness and safety by combining the results of randomised controlled trials.
OBJECTIVES: To assess the effectiveness and safety of administering DHEA to women with menopausal symptoms in the peri- or postmenopausal phase.
SEARCH METHODS: The databases that we searched (3 June 2014) with no language restrictions applied were the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS. We also searched conference abstracts and citation lists in the ISI Web of Knowledge. Ongoing trials were searched in the trials registers. Reference lists of retrieved articles were checked.
SELECTION CRITERIA: We included randomised controlled trials comparing any dose and form of DHEA by any route of administration versus any other active intervention, placebo or no treatment for a minimal treatment duration of seven days in peri- and postmenopausal women.
DATA COLLECTION AND ANALYSIS: Two authors independently extracted data after assessing eligibility for inclusion and quality of studies. Authors were contacted for additional information.
MAIN RESULTS: Twenty-eight trials with 1273 menopausal women were included in this review. Data could be extracted from 16 trials to conduct the meta-analysis. The overall quality of the studies was moderate to low with the majority of studies that were included in the meta-analysis having reasonable methodology. Compared to placebo, DHEA did not improve quality of life (standardised mean difference (SMD) 0.16, 95% confidence interval (CI) -0.03 to 0.34, P = 0.10, 8 studies, 287 women (132 from parallel and 155 from crossover trials), I² = 0%, moderate quality evidence; one trial of the nine that reported on this outcome was removed in a sensitivity analysis as it was judged to be at high risk of bias). DHEA was found to be associated with androgenic side effects (mainly acne) (odds ratio (OR) 3.77, 95% CI 1.36 to 10.4, P = 0.01, 5 studies, 376 women, I² = 10%, moderate quality evidence) when compared to placebo. No associations were found with other adverse effects. It was unclear whether DHEA affected menopausal symptoms as the results from the trials were inconsistent and could not easily be pooled to provide an overall effect due to different types of measurement (for example continuous, dichotomous, change and end scores). DHEA was found to improve sexual function (SMD 0.31, 95% CI 0.07 to 0.55, P = 0.01, 5 studies, 261 women (239 women from parallel trials and 22 women from crossover trials), I² = 0%; one trial judged to be at high risk of bias was removed during sensitivity analysis) compared to placebo.There was no difference in the acne associated with DHEA when comparing studies that used oral DHEA (OR 2.16, 95% CI 0.47 to 9.96, P = 0.90, 3 studies, 136 women, I² = 5%, very low quality evidence) to one study that used skin application of DHEA (OR 2.74, 95% CI 0.10 to 74.87, P = 0.90, 1 study, 22 women, very low quality evidence). The effects did not differ for sexual function when studies using oral DHEA (SMD 0.11, 95% CI -0.13 to 0.35, P = 0.36, 5 studies, 340 women, I² = 0) were compared to a study using intravaginal DHEA (SMD 0.42, 95% CI 0.03 to 0.81, 1 study, 218 women). Test for subgroup differences: Chi² = 1.77, df = 1 (P = 0.18), I² = 43.4%. Insufficient data were available to assess quality of life and menopausal symptoms for this comparison.There were insufficient data available to compare the effects of DHEA to hormone therapy (HT) for quality of life, menopausal symptoms, and adverse effects. No large differences in treatment effects were found for sexual function when comparing DHEA to HT (mean difference (MD) 1.26, 95% CI -0.21 to 2.73, P = 0.09, 2 studies, 41 women, I² = 0%).
AUTHORS’ CONCLUSIONS: There is no evidence that DHEA improves quality of life but there is some evidence that it is associated with androgenic side effects. There is uncertainty whether DHEA decreases menopausal symptoms, but DHEA may slightly improve sexual function compared with placebo.

PMID: 25609024 [PubMed – as supplied by publisher]

Continue reading

Posted in Cochrane Database Syst Rev | Leave a comment

Synchronised approach for intrauterine insemination in subfertile couples.

Synchronised approach for intrauterine insemination in subfertile couples.
Cochrane Database Syst Rev. 2014 Dec 21;12:CD006942
Authors: Cantineau AE, Janssen MJ, Cohlen BJ, Allersma T
Abstract
BACKGRO… Continue reading

Posted in Cochrane Database Syst Rev | Tagged , | Leave a comment

Osteotomy for treating knee osteoarthritis.

Osteotomy for treating knee osteoarthritis.
Cochrane Database Syst Rev. 2014 Dec 13;12:CD004019
Authors: Brouwer RW, Huizinga MR, Duivenvoorden T, van Raaij TM, Verhagen AP, Bierma-Zeinstra SM, Verhaar JA
Abs… Continue reading

Posted in Cochrane Database Syst Rev | Leave a comment

Antigen-specific active immunotherapy for ovarian cancer.

Related Articles

Antigen-specific active immunotherapy for ovarian cancer.

Cochrane Database Syst Rev. 2014 Sep 17;9:CD007287

Authors: Leffers N, Daemen T,…

Continue reading

Posted in Cochrane Database Syst Rev | Tagged | Leave a comment

Intrauterine insemination versus fallopian tube sperm perfusion for non-tubal infertility.

Related Articles
Intrauterine insemination versus fallopian tube sperm perfusion for non-tubal infertility.
Cochrane Database Syst Rev. 2013;10:CD001502
Authors: Cantineau AE, Cohlen BJ, Heineman MJ, Marjoribanks J, … Continue reading

Posted in Cochrane Database Syst Rev | Tagged , | Leave a comment

Natural cycle in vitro fertilisation (IVF) for subfertile couples.

Related Articles
Natural cycle in vitro fertilisation (IVF) for subfertile couples.
Cochrane Database Syst Rev. 2013;8:CD010550
Authors: Allersma T, Farquhar C, Cantineau AE
Abstract
BACKGROUND: Subfertility af… Continue reading

Posted in Cochrane Database Syst Rev | Tagged , | Leave a comment

Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease.

Related Articles
Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease.
Cochrane Database Syst Rev. 2013;6:CD002878
Authors: Struik FM, Lacasse Y, Goldstein R, Kerstjens HM, Wijk… Continue reading

Posted in Cochrane Database Syst Rev | Tagged , | Leave a comment

Routine surgery in addition to chemotherapy for treating spinal tuberculosis.

Related Articles

Routine surgery in addition to chemotherapy for treating spinal tuberculosis.

Cochrane Database Syst Rev. 2013;5:CD004532

Authors: Jutte PC, van Loenhout-Rooyackers JH

Abstract
BACKGROUND: Tuberculosis is generally curable with chemotherapy, but there is controversy in the literature about the need for surgical intervention in the one to two per cent of people with tuberculosis of the spine.
OBJECTIVES: To compare chemotherapy plus surgery with chemotherapy alone for treating people diagnosed with active tuberculosis of the spine.
SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register (February 2010), CENTRAL (The Cochrane Library 2010,Issue 1), MEDLINE (1966 to February 2010), EMBASE (1974 to February 2010), LILACS (1982 to February 2010), conference proceedings, and reference lists. A search update in November 2012 revealed no new studies.
SELECTION CRITERIA: Randomized controlled trials with at least one year follow up that compared chemotherapy plus surgery with chemotherapy alone for treating active tuberculosis of the thoracic and/or lumbar spine.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial eligibility, methodological quality, and extracted data.We analysed data using odds ratio with 95% confidence intervals.
MAIN RESULTS: Two randomized controlled trials (331 participants) met the inclusion criteria. They were conducted in the 1970s and 1980s with follow-up reports available after 18 months, three years, and five years; one trial also reported 10 years follow up. Completeness of follow up varied at the different time points, with less than 80% of participants available for analysis at several time points. There was no statistically significant difference for any of the outcome measures: kyphosis angle, neurological deficit (none went on to develop this), bony fusion, absence of spinal tuberculosis, death from any cause, activity level regained, change of allocated treatment, or bone loss. Neither trial reported on pain. Of the 130 participants allocated to chemotherapy only, 12 had a neurological deficit and five needed a decompression operation. One trial suggested that an initial kyphosis angle greater than 30° is likely to deteriorate, especially in children.
AUTHORS’ CONCLUSIONS: The two included trials had too few participants to be able to say whether routine surgery might help. Although current medication and operative techniques are now far more advanced, these results indicate that routine surgery cannot be recommended unless within the context of a large, well-conducted randomized controlled trial. Clinicians may judge that surgery may be clinically indicated in some groups of patients. Future studies need to address these topics as well as the patient’s view of their disease and treatment.

PMID: 23866317 [PubMed – indexed for MEDLINE]

Continue reading

Posted in Cochrane Database Syst Rev | Tagged , | Leave a comment

Interventions to facilitate return to work in adults with adjustment disorders.

Related Articles

Interventions to facilitate return to work in adults with adjustment disorders.

Cochrane Database Syst Rev. 2012;12:CD006389

Authors: Arends I, Bruinvels…

Continue reading

Posted in Cochrane Database Syst Rev | Tagged | Leave a comment

Interventions for preventing recurrent urinary tract infection during pregnancy.

Related Articles
Interventions for preventing recurrent urinary tract infection during pregnancy.
Cochrane Database Syst Rev. 2012;11:CD009279
Authors: Schneeberger C, Geerlings SE, Middleton P, Crowther CA
Abstract
Continue reading

Posted in Cochrane Database Syst Rev | Tagged , | Leave a comment