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(Cochrane Database Syst Rev[TA])
13,933 results
  • Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 05; 12:CD009269
  • Klimas J, Fairgrieve C, … Cullen W
  • CONCLUSIONS: We found low to very low-quality evidence to suggest that there is no difference in effectiveness between different types of psychosocial interventions to reduce alcohol consumption among people who use illicit drugs, and that brief interventions are not superior to assessment-only or to treatment as usual. No firm conclusions can be made because of the paucity of the data and the low quality of the retrieved studies.
  • Vaccines for preventing invasive salmonella infections in people with sickle cell disease. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 05; 12:CD006975
  • Odey F, Okomo U, Oyo-Ita A
  • CONCLUSIONS: It is expected that salmonella vaccines may be useful in people with sickle cell disease, especially in resource-poor settings where the majority of those who suffer from the condition are found. Unfortunately, there are no randomized controlled trials on the efficacy and safety of the different types of salmonella vaccines in people with sickle cell disease. We conclude that there is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of the different types of salmonella vaccines as a means of improving survival and decreasing mortality from salmonella infections in people with sickle cell disease. However, we believe that there are unlikely to be any trials published in this area, therefore, this review will no longer be regularly updated.
  • Dual combination therapy versus long-acting bronchodilators alone for chronic obstructive pulmonary disease (COPD): a systematic review and network meta-analysis. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 03; 12:CD012620
  • Oba Y, Keeney E, … Dias S
  • CONCLUSIONS: The LABA/LAMA combination was the highest ranked treatment group to reduce COPD exacerbations although there was some uncertainty in the results. LAMA containing inhalers may have an advantage over those without a LAMA for preventing COPD exacerbations based on the rank statistics. Combination therapies appear more effective than monotherapies for improving symptom and quality-of-life scores. ICS-containing inhalers are associated with an increased risk of pneumonia.Our most comprehensive review including intraclass/group comparisons, free combination therapies, 99 studies, and 20 outcomes for each high- and low-risk population summarises the current literature and could help with updating existing COPD guidelines.
  • Pharmacological interventions for acute hepatitis C infection. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 03; 12:CD011644
  • Kalafateli M, Buzzetti E, … Gurusamy KS
  • CONCLUSIONS: Very low quality evidence suggests that interferon-alpha may decrease the incidence of chronic HCV infection as measured by sustained virological response. However, the clinical impact such as improvement in health-related quality of life, reduction in cirrhosis, decompensated liver disease, and liver transplantation has not been reported. It is also not clear whether this finding is applicable in the current clinical setting dominated by the use of pegylated interferons and direct-acting antivirals, although we found no evidence to support that pegylated interferons or ribavirin or both are effective in people with acute HCV infection. We could find no randomised trials comparing direct-acting antivirals with placebo or other interventions for acute HCV infection. There is significant uncertainty in the benefits and harms of the interventions, and high-quality randomised clinical trials are required.
  • Pre-emptive and preventive opioids for postoperative pain in adults undergoing all types of surgery. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 03; 12:CD012624
  • Doleman B, Leonardi-Bee J, … Williams JP
  • CONCLUSIONS: Due to the low quality of the evidence, we are uncertain whether pre-emptive opioids reduce postoperative pain. Based on the trials conducted thus far, there was no clear evidence that preventive opioids result in reductions in pain scores. It was unclear if there was a reduction in morphine consumption due to very low-quality of evidence. Too few studies reported adverse events to be able to draw any definitive conclusions. Once assessed, the two studies awaiting classification may alter the conclusions of the review.
  • Computer-assisted diagnosis techniques (dermoscopy and spectroscopy-based) for diagnosing skin cancer in adults. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 03; 12:CD013186
  • Ferrante di Ruffano L, Takwoingi Y, … Cochrane Skin Cancer Diagnostic Test Accuracy Group
  • CONCLUSIONS: In highly selected patient populations all CAD types demonstrate high sensitivity, and could prove useful as a back-up for specialist diagnosis to assist in minimising the risk of missing melanomas. However, the evidence base is currently too poor to understand whether CAD system outputs translate to different clinical decision-making in practice. Insufficient data are available on the use of CAD in community settings, or for the detection of keratinocyte cancers. The evidence base for individual systems is too limited to draw conclusions on which might be preferred for practice. Prospective comparative studies are required that evaluate the use of already evaluated CAD systems as diagnostic aids, by comparison to face-to-face dermoscopy, and in participant populations that are representative of those in which the test would be used in practice.
  • Optical coherence tomography for diagnosing skin cancer in adults. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 03; 12:CD013189
  • Ferrante di Ruffano L, Dinnes J, … Cochrane Skin Cancer Diagnostic Test Accuracy Group
  • CONCLUSIONS: Insufficient data are available on the use of OCT for the detection of melanoma or cSCC. Initial data suggest conventional OCT may have a role for the diagnosis of BCC in clinically challenging lesions, with our meta-analysis showing a higher sensitivity and higher specificity when compared to visual inspection plus dermoscopy. However, the small number of studies and varying methodological quality means implications to guide practice cannot currently be drawn.Appropriately designed prospective comparative studies are required, given the paucity of data comparing OCT with dermoscopy and other similar diagnostic aids such as reflectance confocal microscopy.
  • Exfoliative cytology for diagnosing basal cell carcinoma and other skin cancers in adults. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 03; 12:CD013187
  • Ferrante di Ruffano L, Dinnes J, … Cochrane Skin Cancer Diagnostic Test Accuracy Group
  • CONCLUSIONS: The utility of exfoliative cytology for the primary diagnosis of skin cancer is unknown, as all included studies focused on the use of this technique for confirming strongly suspected clinical diagnoses. For the confirmation of BCC in lesions with a high clinical suspicion, there is evidence of high sensitivity and specificity. Since decisions to treat low-risk BCCs are unlikely in practice to require diagnostic confirmation given that clinical suspicion is already high, exfoliative cytology might be most useful for cases of BCC where the treatments being contemplated require a tissue diagnosis (e.g. radiotherapy). The small number of included studies, poor reporting and varying methodological quality prevent us from drawing strong conclusions to guide clinical practice. Despite insufficient data on the use of cytology for cSCC or melanoma, it is unlikely that cytology would be useful in these scenarios since preservation of the architecture of the whole lesion that would be available from a biopsy provides crucial diagnostic information. Given the paucity of good quality data, appropriately designed prospective comparative studies may be required to evaluate both the diagnostic value of exfoliative cytology by comparison to dermoscopy, and its confirmatory value in adequately reported populations with a high probability of BCC scheduled for further treatment requiring a tissue diagnosis.
  • Visual inspection and dermoscopy, alone or in combination, for diagnosing keratinocyte skin cancers in adults. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 03; 12:CD011901
  • Dinnes J, Deeks JJ, … Cochrane Skin Cancer Diagnostic Test Accuracy Group
  • CONCLUSIONS: Dermoscopy may be a valuable tool for the diagnosis of BCC as an adjunct to visual inspection of a suspicious skin lesion following a thorough history-taking including assessment of risk factors for keratinocyte cancer. The evidence primarily comes from secondary-care (referred) populations and populations with pigmented lesions or mixed lesion types. There is no clear evidence supporting the use of currently-available formal algorithms to assist dermoscopy diagnosis.
  • Reflectance confocal microscopy for diagnosing keratinocyte skin cancers in adults. [Review]
  • CDCochrane Database Syst Rev 2018 Dec 03; 12:CD013191
  • Dinnes J, Deeks JJ, … Cochrane Skin Cancer Diagnostic Test Accuracy Group
  • CONCLUSIONS: There is insufficient evidence for the use of RCM for the diagnosis of BCC or cSCC in either population group. A possible role for RCM in clinical practice is as a tool to avoid diagnostic biopsies in lesions with a relatively high clinical suspicion of BCC. The potential for, and consequences of, misclassification of other skin cancers such as melanoma as BCCs requires further research. Importantly, data are lacking that compare RCM to standard clinical practice (with or without dermoscopy).
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