March 2017
Latest Reviews...
MORE RESEARCH NEEDED!
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Cochrane Clinical Answers:
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Provides clinicians with a condensed nonstatistical overview of the most clinically relevant
results of a Cochrane Review
Focuses on the needs of clinicians in order to aid
the decision-making process
Makes the information a clinician will be most interested in more accessible
Increases the usage of Cochrane Reviews to inform healthcare decisions
Key Features:
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Question and Answer format
Outcome-focused presentation of impact of interventions on patient
GRADE Summary of findings statements of quality of evidence
Link to full Cochrane Review on which Answer is
based
Narrative statement of number of patients and
studies contributing data on each outcome
Links to forest plots for each outcome
breastfeeding education and support for women with
twins or higher order multiples, or the most effective
way to provide education and support . There was no
evidence about the best way to deliver the intervention,
the timing of care, or the best person to deliver the care.
There is a need for well-designed, adequately powered
studies of interventions designed for women with twins
or higher order multiples to find out what types of education and support are effective in helping these mothers to breastfeed their babies.
http://onlinelibrary.wiley.com/
doi/10.1002/14651858.CD012003.pub2/full?
campaign=highlighted-reviews-clib-RSS
Psychosocial interventions for supporting women
to stop smoking in pregnancy
Authors' conclusions: Psychosocial interventions to support women to stop smoking in pregnancy can increase
the proportion of women who stop smoking in late pregnancy and the proportion of infants born low birthweight.
Counselling, feedback and incentives appear to be effective, however the characteristics and context of the
interventions should be carefully considered. The effect
of health education and social support is less clear. New
trials have been published during the preparation of this
review and will be included in the next update.
http://onlinelibrary.wiley.com/
doi/10.1002/14651858.CD001055.pub5/full?
campaign=highlighted-reviews-clib-RSS
www.cochraneclinicalanswers.com
The Cochrane Library and other sources regularly
publish new reviews, some of which highlight the
lack of good quality studies on which to base
recommendations. This is a good starting point for
identifying a new area of research. The second step
is to find out what else has been published. If you
would like a literature search on any of these topics
please contact the Library Service on ext 3831.
Breastfeeding education and support for women
with twins or higher order multiples
Authors' conclusions: We found no evidence from randomised controlled trials about the effectiveness of
Interventions to improve antibiotic prescribing practices for hospital inpatients
Authors' conclusions: We found high-certainty evidence
that interventions are effective in increasing compliance
with antibiotic policy and reducing duration of antibiotic
treatment. Lower use of antibiotics probably does not
increase mortality and likely reduces length of stay. Additional trials comparing antibiotic stewardship with no
intervention are unlikely to change our conclusions. Enablement consistently increased the effect of interventions, including those with a restrictive component. Although feedback further increased intervention effect, it
was used in only a minority of enabling interventions.
Interventions were successful in safely reducing
reducing unnecessary antibiotic use in hospitals, despite the fact that the majority did not use the most effective behaviour change techniques. Consequently,
effective dissemination of our findings could have considerable health service and policy impact. Future research should instead focus on targeting treatment and
assessing other measures of patient safety, assess different stewardship interventions, and explore the barriers and facilitators to implementation. More research is
required on unintended consequences of restrictive interventions.
(SMD: 0.57; 95% CI: 0.17 to 0.97; P = 0.005), and mental health (SMD 4.12; 95% CI: -0.50 to 8.73; P = 0.08).
Moreover, TCE was not associated with serious adverse events.
CONCLUSIONS: Our systematic review revealed that
short-term TCE was potentially beneficial in terms of
reducing pain, improving physical function and alleviating stiffness. These results may suggest that TCE could
prove useful as an adjuvant treatment for patients with
knee OA. Further studies are urgently needed to confirm these results.
http://onlinelibrary.wiley.com/
doi/10.1002/14651858.CD003543.pub4/full?
campaign=highlighted-reviews-clib-RSS
https://www.ncbi.nlm.nih.gov/pubmed/28121996
FROM OTHER SOURCES
D-Cycloserine Augmentation of Exposure-Based
Cognitive Behavior Therapy for Anxiety, ObsessiveCompulsive, and Posttraumatic Stress Disorders: A
Systematic Review and Meta-analysis
Results: Individual participant data were obtained for 21
of 22 eligible trials, representing 1047 of 1073 eligible
participants. When controlling for antidepressant use,
participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, -3.62; 95% CI, -0.81 to -6.43; P = .01; d = -0.25)
but not from pretreatment to midtreatment (mean difference, -1.66; 95% CI, -1.60 to 4.92; P = .32; d = -0.14) or
from pretreatment to follow-up (mean difference, -2.98,
95% CI, -0.03 to 5.99; P = .05; d = -0.19). Additional
analyses showed that participants assigned to DCS
were associated with lower symptom severity than
those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of
DCS. None of the prespecified patient-level or studylevel moderators was associated with outcomes.
Conclusions and Relevance: D-cycloserine is associated with a small augmentation effect on exposure-based
therapy. This effect is not moderated by the concurrent
use of antidepressants. Further research is needed to
identify patient and/or therapy characteristics associated
with DCS response.
Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet
Interventions on the Behaviour of Children with
ADHD
CONCLUSION: Considering the small average ESs
PUFA supplementation is unlikely to provide a tangible
contribution to ADHD treatment, while further research
is required for AFC elimination before advising this intervention as ADHD treatment. The average FFD ES is
substantial, offering treatment opportunities in subgroups of children with ADHD not responding to or too
young for medication. Further FFD research should focus on establishing the underlying mechanisms of food
(e.g. incrimination of gut microbiota) to simplify the FFD
approach in children with ADHD.
https://www.ncbi.nlm.nih.gov/pubmed/28121994
https://www.ncbi.nlm.nih.gov/pubmed/28122091
The Effects of Traditional Chinese Exercise in Treating Knee Osteoarthritis: A Systematic Review and
Meta-Analysis
RESULTS: Eight randomized controlled trials with a
sample size of 375 cases met the criteria to be included
in the study indicating that high quality literature is lacking in this field. Results of the meta-analysis showed
that short-term TCE could relieve pain (SMD: -0.77;95%
CI: -1.13 to -0.41; P<0.0001), improve physical function
(SMD -0.75; 95% CI: -0.98 to -0.52; P<0.00001), and
alleviate stiffness (SMD: -0.56; 95%: CI -0.96 to -0.16;
P<0.006), but had no significant effect on quality of life
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