GRADE working group
Working Group
INTRODUCTION: Open access publishing is becoming increasingly popular within the biomedical sciences. SciELO, the Scientific Electronic Library Online, is a digital library covering a selected collection of Brazilian scientific journals... more
INTRODUCTION: Open access publishing is becoming increasingly popular within the biomedical sciences. SciELO, the Scientific Electronic Library Online, is a digital library covering a selected collection of Brazilian scientific journals many of which provide open access to full-text articles.This library includes a number of dental journals some of which may include reports of clinical trials in English, Portuguese and/or Spanish. Thus, SciELO could play an important role as a source of evidence for dental healthcare interventions especially if it yields a sizeable number of high quality reports. OBJECTIVE: The aim of this study was to identify reports of clinical trials by handsearching of dental journals that are accessible through SciELO, and to assess the overall quality of these reports. MATERIAL AND METHODS: Electronic versions of six Brazilian dental Journals indexed in SciELO were handsearched at www.scielo.br in September 2008. Reports of clinical trials were identified and classified as controlled clinical trials (CCTs - prospective, experimental studies comparing 2 or more healthcare interventions in human beings) or randomized controlled trials (RCTs - a random allocation method is clearly reported), according to Cochrane eligibility criteria. CRITERIA TO ASSESS METHODOLOGICAL QUALITY INCLUDED: method of randomization, concealment of treatment allocation, blinded outcome assessment, handling of withdrawals and losses and whether an intention-to-treat analysis had been carried out. RESULTS: The search retrieved 33 CCTs and 43 RCTs. A majority of the reports provided no description of either the method of randomization (75.3%) or concealment of the allocation sequence (84.2%). Participants and outcome assessors were reported as blinded in only 31.2% of the reports. Withdrawals and losses were only clearly described in 6.5% of the reports and none mentioned an intention-to-treat analysis or any similar procedure. CONCLUSIONS: The results of this study indicate that a substantial number of reports of trials and systematic reviews are available in the dental journals listed in SciELO, and that these could provide valuable evidence for clinical decision making. However, it is clear that the quality of a number of these reports is of some concern and that improvement in the conduct and reporting of these trials could be achieved if authors adhered to internationally accepted guidelines, e.g. the CONSORT statement.
- by Raphael F de Souza and +3
- •
Abstract Background Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved and thickening of the skin with... more
Abstract
Background
Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some patients. A range of treatment options are available but it is unclear which are the most effective.
Objectives
To assess the evidence for the efficacy and safety of treatments for rosacea.
Search strategy
In February 2011 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers.
Selection criteria
Randomised controlled trials in people with moderate to severe rosacea.
Data collection and analysis
Study selection, data extraction, assessment of risk of bias, and analyses were carried out by two independent review authors.
Main results
Fifty-eight trials, including 27 from the original review, comprising 6633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. Only two studies assessed our primary outcome 'quality of life'.
Pooled data from physician assessments in three trials provided some evidence that metronidazole was more effective compared to placebo (RR 1.95, 95% CI 1.48 to 2.56). Three trials provided data, based on participants' assessments, illustrating azelaic acid was more effective than placebo (RR 1.52, 95% CI 1.32 to 1.76).
Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doses of doxycycline, but there was evidence of less adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54).
One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea (for all outcomes).
Authors' conclusions
Although the majority of included studies were assessed as being at high or unclear risk of bias there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required.
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Plain language summary
Interventions for Rosacea
Rosacea is a common skin condition causing flushing, redness, red pimples, and pustules on the face, which should not be confused with acne. It can also cause inflammation of the eyes or eyelids, or both. Some people can develop a thickening of the skin, especially of the nose, which is called rhinophyma. Because rosacea is a chronic disease the effect of treatment on quality of life is very important to the individual. A range of treatment options are available which include several topical and oral antibiotics, azelaic cream, topical and systemic retinoids, and light-based therapies, e.g. laser therapy.
This review found that in 3 clinical trials with 334 participants, topical metronidazole was more effective than placebo. Although most of the studies did not specifically address participants' satisfaction with treatment, they did nevertheless confirm the effectiveness of some of the treatments, expressed as a reduction in lesion counts, but these evaluations were largely physician-assessed. Three clinical trials involving 778 participants provided some evidence that topical azelaic acid cream was more effective than placebo. Two studies reported that the anti-inflammatory dose of doxycycline (40 mg) was more effective than placebo, confirmed by another study which also reported a lower risk of side-effects with the 40 mg dose rather than the 100 mg dose. Cyclosporine 0.05% ophthalmic emulsion appears to be more effective than artificial tears for rosacea of the eyes.
Future research should aim to provide reliable evidence for people to make informed decisions about whether other widely-available treatments are effective in managing rosacea, i.e. other oral tetracyclines, isotretinoin, and treatments used for rosacea of the eyes, in addition to investigating the potential role of sunscreens and dietary change.
Background
Rosacea is a common chronic skin condition affecting the face, characterised by flushing, redness, pimples, pustules, and dilated blood vessels. The eyes are often involved and thickening of the skin with enlargement (phymas), especially of the nose, can occur in some patients. A range of treatment options are available but it is unclear which are the most effective.
Objectives
To assess the evidence for the efficacy and safety of treatments for rosacea.
Search strategy
In February 2011 we updated our searches of the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers.
Selection criteria
Randomised controlled trials in people with moderate to severe rosacea.
Data collection and analysis
Study selection, data extraction, assessment of risk of bias, and analyses were carried out by two independent review authors.
Main results
Fifty-eight trials, including 27 from the original review, comprising 6633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. Only two studies assessed our primary outcome 'quality of life'.
Pooled data from physician assessments in three trials provided some evidence that metronidazole was more effective compared to placebo (RR 1.95, 95% CI 1.48 to 2.56). Three trials provided data, based on participants' assessments, illustrating azelaic acid was more effective than placebo (RR 1.52, 95% CI 1.32 to 1.76).
Physician-based assessments in two trials indicated that doxycycline appeared to be significantly more effective than placebo (RR 1.59, 95% CI 1.02 to 2.47 and RR 2.37, 95% CI 1.12 to 4.99). There was no statistically significant difference in effectiveness between 100 mg and 40 mg doses of doxycycline, but there was evidence of less adverse effects with the lower dose (RR 0.25, 95% CI 0.11 to 0.54).
One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea (for all outcomes).
Authors' conclusions
Although the majority of included studies were assessed as being at high or unclear risk of bias there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required.
--------------------------------------------------------------------------------
Plain language summary
Interventions for Rosacea
Rosacea is a common skin condition causing flushing, redness, red pimples, and pustules on the face, which should not be confused with acne. It can also cause inflammation of the eyes or eyelids, or both. Some people can develop a thickening of the skin, especially of the nose, which is called rhinophyma. Because rosacea is a chronic disease the effect of treatment on quality of life is very important to the individual. A range of treatment options are available which include several topical and oral antibiotics, azelaic cream, topical and systemic retinoids, and light-based therapies, e.g. laser therapy.
This review found that in 3 clinical trials with 334 participants, topical metronidazole was more effective than placebo. Although most of the studies did not specifically address participants' satisfaction with treatment, they did nevertheless confirm the effectiveness of some of the treatments, expressed as a reduction in lesion counts, but these evaluations were largely physician-assessed. Three clinical trials involving 778 participants provided some evidence that topical azelaic acid cream was more effective than placebo. Two studies reported that the anti-inflammatory dose of doxycycline (40 mg) was more effective than placebo, confirmed by another study which also reported a lower risk of side-effects with the 40 mg dose rather than the 100 mg dose. Cyclosporine 0.05% ophthalmic emulsion appears to be more effective than artificial tears for rosacea of the eyes.
Future research should aim to provide reliable evidence for people to make informed decisions about whether other widely-available treatments are effective in managing rosacea, i.e. other oral tetracyclines, isotretinoin, and treatments used for rosacea of the eyes, in addition to investigating the potential role of sunscreens and dietary change.
Background: Rosacea is a common chronic skin disease affecting the face. There are numerous treatment options, but it is unclear which are the most effective. Objective: To assess the evidence for the efficacy and safety of treatments... more
Background: Rosacea is a common chronic skin disease affecting the face. There are numerous treatment options, but it is unclear which are the most effective. Objective: To assess the evidence for the efficacy and safety of treatments for rosacea. Methods: Searches included the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, Science Citation Index, and Ongoing Trials Registers (updated February 2011). Randomized controlled trials in people with moderate to severe rosacea were included. Results: Fifty-eight trials, including 27 from the original review, comprising 6,633 participants were included in this updated review. Interventions included topical metronidazole, oral antibiotics, topical azelaic cream or gel, topical benzoyl peroxide and/or combined with topical antibiotics, sulphacetamide/sulphur, and others. There was some evidence that topical metronidazole and azelaic acid were more effective than placebo. Two trials indicated that doxycycline 40 mg was more effective than placebo. There was no statistically significant difference in effectiveness between doxycycline 40 mg and 100 mg and with evidence of less adverse effects. One study reported that cyclosporine ophthalmic emulsion was significantly more effective than artificial tears for treating ocular rosacea. Conclusions: Although the majority of included studies were assessed as being at high or unclear risk of bias, there was some evidence to support the effectiveness of topical metronidazole, azelaic acid, and doxycycline (40 mg) in the treatment of moderate to severe rosacea, and cyclosporine 0.05% ophthalmic emulsion for ocular rosacea. Further well-designed, adequately-powered randomised controlled trials are required.
BACKGROUND: Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract... more
BACKGROUND:
Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day care procedure.
OBJECTIVES:
To provide reliable evidence for the safety, feasibility, effectiveness and cost-effectiveness of cataract extraction performed as day care versus in-patient procedure.
SEARCH STRATEGY:
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 5), MEDLINE (January 1950 to May 2011), EMBASE (January 1980 to May 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 23 May 2011.
SELECTION CRITERIA:
We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation.
DATA COLLECTION AND ANALYSIS:
Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Adverse effects information was collected from the trials.
MAIN RESULTS:
We included two trials (conducted in Spain and USA), involving 1284 people. One trial reported statistically significant differences in early postoperative complication rates in the day care group, with an increased risk of increased intraocular pressure, which had no clinical relevance to visual outcomes four months postoperatively. The mean change in visual acuity (Snellen lines) of the operated eye four months postoperatively was 4.1 (standard deviation (SD) 2.3) for the day care group and 4.1 (SD 2.2) for the in-patient group and not statistically significant. The four-month postoperative mean change in quality of life score measured using the VF14 showed minimal differences between the two groups. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. One study only reported hotel costs for the non-hospitalised participants making aggregation of data on costs impossible.
AUTHORS' CONCLUSIONS:
This review provides some evidence that there is a cost saving but no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery. This is based on one detailed and methodologically sound trial conducted in the developed world. The success, safety and cost-effectiveness of cataract surgery as a day care procedure appear to be acceptable. Future research may well focus on evidence provided by high quality clinical databases and registers which would enable clinicians and healthcare planners to agree clinical and social indications for in-patient care and so make better use of resources, by selecting day case surgery unless these criteria are met.
Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day care procedure.
OBJECTIVES:
To provide reliable evidence for the safety, feasibility, effectiveness and cost-effectiveness of cataract extraction performed as day care versus in-patient procedure.
SEARCH STRATEGY:
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 5), MEDLINE (January 1950 to May 2011), EMBASE (January 1980 to May 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 23 May 2011.
SELECTION CRITERIA:
We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation.
DATA COLLECTION AND ANALYSIS:
Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Adverse effects information was collected from the trials.
MAIN RESULTS:
We included two trials (conducted in Spain and USA), involving 1284 people. One trial reported statistically significant differences in early postoperative complication rates in the day care group, with an increased risk of increased intraocular pressure, which had no clinical relevance to visual outcomes four months postoperatively. The mean change in visual acuity (Snellen lines) of the operated eye four months postoperatively was 4.1 (standard deviation (SD) 2.3) for the day care group and 4.1 (SD 2.2) for the in-patient group and not statistically significant. The four-month postoperative mean change in quality of life score measured using the VF14 showed minimal differences between the two groups. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. One study only reported hotel costs for the non-hospitalised participants making aggregation of data on costs impossible.
AUTHORS' CONCLUSIONS:
This review provides some evidence that there is a cost saving but no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery. This is based on one detailed and methodologically sound trial conducted in the developed world. The success, safety and cost-effectiveness of cataract surgery as a day care procedure appear to be acceptable. Future research may well focus on evidence provided by high quality clinical databases and registers which would enable clinicians and healthcare planners to agree clinical and social indications for in-patient care and so make better use of resources, by selecting day case surgery unless these criteria are met.
- by Esther van Zuuren and +1
- •
- Cataract surgery, Cataract
Abstract BACKGROUND: Systematic reviews are not an assembly of anecdotes but a distillation of current best available evidence on a particular topic and as such have an important role to play in evidence-based healthcare. A substantial... more
Abstract
BACKGROUND: Systematic reviews are not an assembly of anecdotes but a distillation of current best available evidence on a particular topic and as such have an important role to play in evidence-based healthcare. A substantial proportion of these systematic reviews focus on interventions, and are able to provide clinicians with the opportunity to understand and translate the best available evidence on the effects of these healthcare interventions into clinical practice. The importance of systematic reviews in summarising and identifying the gaps in evidence which might inform new research initiatives is also widely acknowledged. Their potential impact on practice and research makes their methodological quality especially important as it may directly infuence their utility for clinicians, patients and policy makers. The objectives of this study were to identify systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS) and to evaluate their methodological quality using the evaluation tool, AMSTAR.
METHODS: Potentially eligible systematic reviews in JAOS were identifed through an electronic search of the Scientific Electronic Library Online (SciELO). Details of the relevant aspects of methodology as reported in these systematic reviews were extracted from the full text publications. Methodological quality was assessed independently by two reviewers using the AMSTAR questionnaire.
RESULTS: Five systematic reviews were identifed, one of which was subsequently excluded as it was a review of a diagnostic test. Summary AMSTAR scores for the four included reviews were: 1, 5, 2 and 4 out of a maximum score of 11 (range 1-5, mean 3) with only one of the reviews scoring 5.
CONCLUSION: AMSTAR evaluation of the methodological quality of the relatively small number of systematic reviews published in JAOS illustrated that there was room for improvement. Pre-publication and editorial appraisal of future systematic reviews might beneft from the application of tools such as AMSTAR and is to be recommended.
PMID:21986647[PubMed - in process] Free full text
BACKGROUND: Systematic reviews are not an assembly of anecdotes but a distillation of current best available evidence on a particular topic and as such have an important role to play in evidence-based healthcare. A substantial proportion of these systematic reviews focus on interventions, and are able to provide clinicians with the opportunity to understand and translate the best available evidence on the effects of these healthcare interventions into clinical practice. The importance of systematic reviews in summarising and identifying the gaps in evidence which might inform new research initiatives is also widely acknowledged. Their potential impact on practice and research makes their methodological quality especially important as it may directly infuence their utility for clinicians, patients and policy makers. The objectives of this study were to identify systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS) and to evaluate their methodological quality using the evaluation tool, AMSTAR.
METHODS: Potentially eligible systematic reviews in JAOS were identifed through an electronic search of the Scientific Electronic Library Online (SciELO). Details of the relevant aspects of methodology as reported in these systematic reviews were extracted from the full text publications. Methodological quality was assessed independently by two reviewers using the AMSTAR questionnaire.
RESULTS: Five systematic reviews were identifed, one of which was subsequently excluded as it was a review of a diagnostic test. Summary AMSTAR scores for the four included reviews were: 1, 5, 2 and 4 out of a maximum score of 11 (range 1-5, mean 3) with only one of the reviews scoring 5.
CONCLUSION: AMSTAR evaluation of the methodological quality of the relatively small number of systematic reviews published in JAOS illustrated that there was room for improvement. Pre-publication and editorial appraisal of future systematic reviews might beneft from the application of tools such as AMSTAR and is to be recommended.
PMID:21986647[PubMed - in process] Free full text
The aims of this study were to assess and compare the methodological quality of Cochrane and non-Cochrane systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) using... more
The aims of this study were to assess and compare the methodological quality of Cochrane and non-Cochrane systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) using AMSTAR and to compare the prevalence of meta-analysis in both review types. A literature search was undertaken to identify SRs that consisted of hand-searching five major orthodontic journals [American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics and Orthodontics and Craniofacial Research (February 2002 to July 2011)] and the Cochrane Database of Systematic Reviews from January 2000 to July 2011. Methodological quality of the included reviews was gauged using the AMSTAR tool involving 11 key methodological criteria with a score of 0 or 1 given for each criterion. A cumulative grade was given for the paper overall (0-11); an overall score of 4 or less represented poor methodological quality, 5-8 was considered fair and 9 or greater was deemed to be good. In total, 109 SRs were identified in the five major journals and on the CDSR. Of these, 26 (23.9%) were in the CDSR. The mean overall AMSTAR score was 6.2 with 21.1% of reviews satisfying 9 or more of the 11 criteria; a similar prevalence of poor reviews (22%) was also noted. Multiple linear regression indicated that reviews published in the CDSR (P < 0.01); and involving meta-analysis (β = 0.50, 95% confidence interval 0.72, 2.07, P < 0.001) showed greater concordance with AMSTAR.
Abstract BACKGROUND: Urticaria is a common skin disease characterised by itching weals or hives, which can occur almost anywhere on the body. There are a number of different subtypes and a range of available treatment options. There is... more
Abstract
BACKGROUND:
Urticaria is a common skin disease characterised by itching weals or hives, which can occur almost anywhere on the body. There are a number of different subtypes and a range of available treatment options. There is lack of agreement on the efficacy of H2-receptor antagonists used in the treatment of urticaria.
OBJECTIVES:
To assess the safety and effectiveness of H2-receptor antagonists in the treatment of urticaria.
SEARCH METHODS:
We searched the following databases up to 7 October 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2011, Issue 4), MEDLINE (from 2005), EMBASE (from 2007), and LILACS (from 1982). We also searched online trials registries for ongoing trials.
SELECTION CRITERIA:
Randomised controlled trials of H2-receptor antagonists in people with a clinical diagnosis of urticaria of any duration or of any subtype. Studies including H1-antihistamines for chronic urticaria are the topic of a separate Cochrane review; thus, they were not included in this review.
DATA COLLECTION AND ANALYSIS:
Two reviewers independently assessed trial quality and extracted and analysed data.
MAIN RESULTS:
Four studies of a relatively small size, involving 144 participants, were included in this review. A combination of ranitidine with diphenhydramine was more effective at improving the resolution of urticaria than diphenhydramine administered alone (risk ratio (RR) 1.59, 95% confidence interval (CI) 1.07 to 2.36). Although there was a similar improvement in itching, weal size, and intensity, cimetidine provided no statistically significant greater overall improvement in symptoms of urticaria when compared to diphenhydramine. However, a combination of these medications was more effective than diphenhydramine alone (RR 2.02, 95% CI 1.03 to 3.94). Adverse events were reported with several of the interventions, i.e. ranitidine and diphenhydramine, causing drowsiness and sedation, but there was no significant difference in the level of sedation from baseline with either famotidine or diphenhydramine.
AUTHORS' CONCLUSIONS:
The very limited evidence provided by this review was based on a few old studies of a relatively small size, which we categorised as having high to unclear risk of bias. Thus, at present, the review does not allow confident decision-making about the use of H2-receptor antagonists for urticaria. Although some of these studies have reported a measure of relief of symptoms of urticaria and rather minimal clinical improvement in some of the participants, the evidence was weak and unreliable. We have emphasised the lack of precision and limitations in the reported data where appropriate in this review.
PMID: 22419335 [PubMed - in process]
BACKGROUND:
Urticaria is a common skin disease characterised by itching weals or hives, which can occur almost anywhere on the body. There are a number of different subtypes and a range of available treatment options. There is lack of agreement on the efficacy of H2-receptor antagonists used in the treatment of urticaria.
OBJECTIVES:
To assess the safety and effectiveness of H2-receptor antagonists in the treatment of urticaria.
SEARCH METHODS:
We searched the following databases up to 7 October 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2011, Issue 4), MEDLINE (from 2005), EMBASE (from 2007), and LILACS (from 1982). We also searched online trials registries for ongoing trials.
SELECTION CRITERIA:
Randomised controlled trials of H2-receptor antagonists in people with a clinical diagnosis of urticaria of any duration or of any subtype. Studies including H1-antihistamines for chronic urticaria are the topic of a separate Cochrane review; thus, they were not included in this review.
DATA COLLECTION AND ANALYSIS:
Two reviewers independently assessed trial quality and extracted and analysed data.
MAIN RESULTS:
Four studies of a relatively small size, involving 144 participants, were included in this review. A combination of ranitidine with diphenhydramine was more effective at improving the resolution of urticaria than diphenhydramine administered alone (risk ratio (RR) 1.59, 95% confidence interval (CI) 1.07 to 2.36). Although there was a similar improvement in itching, weal size, and intensity, cimetidine provided no statistically significant greater overall improvement in symptoms of urticaria when compared to diphenhydramine. However, a combination of these medications was more effective than diphenhydramine alone (RR 2.02, 95% CI 1.03 to 3.94). Adverse events were reported with several of the interventions, i.e. ranitidine and diphenhydramine, causing drowsiness and sedation, but there was no significant difference in the level of sedation from baseline with either famotidine or diphenhydramine.
AUTHORS' CONCLUSIONS:
The very limited evidence provided by this review was based on a few old studies of a relatively small size, which we categorised as having high to unclear risk of bias. Thus, at present, the review does not allow confident decision-making about the use of H2-receptor antagonists for urticaria. Although some of these studies have reported a measure of relief of symptoms of urticaria and rather minimal clinical improvement in some of the participants, the evidence was weak and unreliable. We have emphasised the lack of precision and limitations in the reported data where appropriate in this review.
PMID: 22419335 [PubMed - in process]
Abstract OBJECTIVE: To assess the evidence for the safety and effectiveness of antiemetics on gastroenteritis-induced vomiting in children and adolescents. DESIGN: Systematic review. DATA SOURCES: The Cochrane Central Register of... more
Abstract
OBJECTIVE:
To assess the evidence for the safety and effectiveness of antiemetics on gastroenteritis-induced vomiting in children and adolescents.
DESIGN:
Systematic review.
DATA SOURCES:
The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE searched from 1980 to March 2012.
METHODS:
Methods included comprehensive searches, data synthesis, meta-analysis and mixed treatment comparisons (MTC).
REVIEW METHODS:
Reference lists were checked, and missing or inconsistent data were sought from trial investigators. Randomised controlled trials comparing antiemetics in participants younger than 18 years and who were vomiting due to acute gastroenteritis. Four meta-analyses and three MTC were carried out.
RESULTS:
10 trials (1479 participants) and five treatments were included: dexamethasone, dimenhydrinate, granisetron, metoclopramide and ondansetron. There was clear evidence that ondansetron (oral or intravenous) compared with placebo increased the proportion of patients with cessation of vomiting (orally administered) (RR 1.44, 95% CI 1.29 to 1.61), reduced the immediate hospital admission rate (orally administered) (RR 0.40, 95% CI 0.19 to 0.83) and the need for intravenous rehydration therapy (orally administered) (RR 0.41, 95% CI 0.29 to 0.59). No significant difference was noted in the revisit rates, but ondansetron was associated with an increase in episodes of diarrhoea. There was no evidence for the use of dexamethasone or metoclopramide and limited evidence that dimenhydrinate or granisetron increased the cessation of vomiting. The MTC analysis suggested that ondansetron was the most likely treatment to stop the child vomiting. Nine studies were carried out in secondary care and one in primary care.
CONCLUSIONS:
This systematic review used a method novel to this clinical area and found clear evidence that ondansetron was the most likely treatment to allow oral rehydration therapy to commence. Given the significance of these results, the authors urge healthcare policy makers to consider the wider use of ondansetron in secondary care. Furthermore, randomised controlled trials are needed to investigate the effectiveness of antiemetic treatment in primary care (including ambulatory care interventions).
OBJECTIVE:
To assess the evidence for the safety and effectiveness of antiemetics on gastroenteritis-induced vomiting in children and adolescents.
DESIGN:
Systematic review.
DATA SOURCES:
The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE searched from 1980 to March 2012.
METHODS:
Methods included comprehensive searches, data synthesis, meta-analysis and mixed treatment comparisons (MTC).
REVIEW METHODS:
Reference lists were checked, and missing or inconsistent data were sought from trial investigators. Randomised controlled trials comparing antiemetics in participants younger than 18 years and who were vomiting due to acute gastroenteritis. Four meta-analyses and three MTC were carried out.
RESULTS:
10 trials (1479 participants) and five treatments were included: dexamethasone, dimenhydrinate, granisetron, metoclopramide and ondansetron. There was clear evidence that ondansetron (oral or intravenous) compared with placebo increased the proportion of patients with cessation of vomiting (orally administered) (RR 1.44, 95% CI 1.29 to 1.61), reduced the immediate hospital admission rate (orally administered) (RR 0.40, 95% CI 0.19 to 0.83) and the need for intravenous rehydration therapy (orally administered) (RR 0.41, 95% CI 0.29 to 0.59). No significant difference was noted in the revisit rates, but ondansetron was associated with an increase in episodes of diarrhoea. There was no evidence for the use of dexamethasone or metoclopramide and limited evidence that dimenhydrinate or granisetron increased the cessation of vomiting. The MTC analysis suggested that ondansetron was the most likely treatment to stop the child vomiting. Nine studies were carried out in secondary care and one in primary care.
CONCLUSIONS:
This systematic review used a method novel to this clinical area and found clear evidence that ondansetron was the most likely treatment to allow oral rehydration therapy to commence. Given the significance of these results, the authors urge healthcare policy makers to consider the wider use of ondansetron in secondary care. Furthermore, randomised controlled trials are needed to investigate the effectiveness of antiemetic treatment in primary care (including ambulatory care interventions).
Background Root canal treatment is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. As a treatment option it is an alternative to dental extraction. Mechanical preparation and irrigation with... more
Background
Root canal treatment is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. As a treatment option it is an alternative to dental extraction. Mechanical preparation and irrigation with antiseptic or antibacterial solutions destroys bacteria and cleans the infected root canal. Irrigants should be effective in deactivating bacteria in the entire root canal space without causing any adverse tissue reactions. Sodium hypochlorite (NaOCl) and chlorhexidine are commonly used but there is uncertainty as to which solution, concentration or combination is the most effective.
Objectives
To assess the effects of irrigants used in the non-surgical root canal treatment of mature permanent teeth.
Search methods
We searched the Cochrane Oral Health Group's Trials Register (to 5 July 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE via Ovid (1950 to 5 July 2012), EMBASE via Ovid (1980 to 5 July 2012), LILACS via BIREME (1980 to 5 July 2012). There were no restrictions regarding language or date of publication.
Selection criteria
Randomised controlled trials in single or multi-rooted permanent teeth with pulpal or periapical pathology or both, which require root canal treatment. Irrigants either against each other or against inactive irrigant or placebo. Combinations of irrigants were allowed and if used in conjunction with EDTA (ethylenediaminetetra-acetic acid) or similar chelating agents.
Data collection and analysis
Two review authors independently assessed risk of bias of included trials and extracted data.
Main results
We included 11 trials involving 851 participants with 879 teeth which had undergone root canal treatment and involved the use of irrigants. Two trials were assessed as being at low risk of bias, with six unclear and three high. Four trials compared sodium hypochlorite versus chlorhexidine, however, no primary outcomes and only one secondary outcome, bacterial growth cultures, was reported for two of these trials (20% and 50% of teeth in the control group had positive bacterial culture). The meta-analysis indicated no strong evidence of a difference in the existence of bacterial growth between the interventions (risk ratio 0.73; 95% confidence interval 0.34 to 1.56; P = 0.41).
The seven remaining trials each compared different interventions and only two of these trials included useable data on the primary outcomes of swelling and pain. One trial compared sodium hypochlorite 5.25% alone versus sodium hypochlorite 5.25% combined with hydrogen peroxide 3%, and versus normal saline and reported pain at 3 to 14 days after the procedure. There was no evidence of a difference in pain between the three groups. The other trial compared sodium hypochlorite 5% versus sodium hypochlorite with 'proteolytic enzyme', and there was no evidence of a difference in swelling between the groups. Two further trials reported bacterial growth, and three trials failed to report any data which could be used in the review. None of the included trials reported any data on adverse effects nor radiological changes in periapical radiolucency.
Authors' conclusions
Although root canal irrigants such as sodium hypochlorite and chlorhexidine appear to be effective at reducing bacterial cultures when compared to saline, most of the studies included in this review failed to adequately report these clinically important and potentially patient-relevant outcomes. There is currently insufficient reliable evidence showing the superiority of any one individual irrigant. The strength and reliability of the supporting evidence was variable and clinicians should be aware that changes in bacterial counts or pain in the early postoperative period may not be accurate indicators of long-term success. Future trials should report both clinician-relevant and patient-preferred outcomes at clearly defined perioperative, as well as long-term, time points.
Root canal treatment is carried out on teeth in which irreversible pulpitis has led to necrosis of the dental pulp. As a treatment option it is an alternative to dental extraction. Mechanical preparation and irrigation with antiseptic or antibacterial solutions destroys bacteria and cleans the infected root canal. Irrigants should be effective in deactivating bacteria in the entire root canal space without causing any adverse tissue reactions. Sodium hypochlorite (NaOCl) and chlorhexidine are commonly used but there is uncertainty as to which solution, concentration or combination is the most effective.
Objectives
To assess the effects of irrigants used in the non-surgical root canal treatment of mature permanent teeth.
Search methods
We searched the Cochrane Oral Health Group's Trials Register (to 5 July 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), MEDLINE via Ovid (1950 to 5 July 2012), EMBASE via Ovid (1980 to 5 July 2012), LILACS via BIREME (1980 to 5 July 2012). There were no restrictions regarding language or date of publication.
Selection criteria
Randomised controlled trials in single or multi-rooted permanent teeth with pulpal or periapical pathology or both, which require root canal treatment. Irrigants either against each other or against inactive irrigant or placebo. Combinations of irrigants were allowed and if used in conjunction with EDTA (ethylenediaminetetra-acetic acid) or similar chelating agents.
Data collection and analysis
Two review authors independently assessed risk of bias of included trials and extracted data.
Main results
We included 11 trials involving 851 participants with 879 teeth which had undergone root canal treatment and involved the use of irrigants. Two trials were assessed as being at low risk of bias, with six unclear and three high. Four trials compared sodium hypochlorite versus chlorhexidine, however, no primary outcomes and only one secondary outcome, bacterial growth cultures, was reported for two of these trials (20% and 50% of teeth in the control group had positive bacterial culture). The meta-analysis indicated no strong evidence of a difference in the existence of bacterial growth between the interventions (risk ratio 0.73; 95% confidence interval 0.34 to 1.56; P = 0.41).
The seven remaining trials each compared different interventions and only two of these trials included useable data on the primary outcomes of swelling and pain. One trial compared sodium hypochlorite 5.25% alone versus sodium hypochlorite 5.25% combined with hydrogen peroxide 3%, and versus normal saline and reported pain at 3 to 14 days after the procedure. There was no evidence of a difference in pain between the three groups. The other trial compared sodium hypochlorite 5% versus sodium hypochlorite with 'proteolytic enzyme', and there was no evidence of a difference in swelling between the groups. Two further trials reported bacterial growth, and three trials failed to report any data which could be used in the review. None of the included trials reported any data on adverse effects nor radiological changes in periapical radiolucency.
Authors' conclusions
Although root canal irrigants such as sodium hypochlorite and chlorhexidine appear to be effective at reducing bacterial cultures when compared to saline, most of the studies included in this review failed to adequately report these clinically important and potentially patient-relevant outcomes. There is currently insufficient reliable evidence showing the superiority of any one individual irrigant. The strength and reliability of the supporting evidence was variable and clinicians should be aware that changes in bacterial counts or pain in the early postoperative period may not be accurate indicators of long-term success. Future trials should report both clinician-relevant and patient-preferred outcomes at clearly defined perioperative, as well as long-term, time points.
"Female pattern hair loss (FPHL) or androgenic alopecia is the most common type of hair loss affecting women with reduced hair density and can have a serious psychological impact. It is characterized by progressive replacement of slow... more
"Female pattern hair loss (FPHL) or androgenic alopecia is the most common type of hair loss affecting women with reduced hair density and can have a serious psychological impact. It is characterized by progressive replacement of slow cycling terminal hair follicles by miniaturized, rapidly cycling vellus hair follicles. The frontal hair line may or may not be preserved.
The aim of this review was to assess the evidence for the effectiveness and safety of the treatments available for FPHL.
Searches included: Cochrane Skin Group Specialised Register, Cochrane Central Register of Controlled Clinical Trials in The Cochrane Library, MEDLINE,
EMBASE, AMED, PsycINFO, LILACS and several ongoing trials registries (October 2011).
Randomized controlled trials in women with FPHL were identified.
Twenty-two trials, comprising 2349 participants, were included. A range of
interventions was evaluated, with 10 studies examining varying concentrations of minoxidil. Pooled data from four studies indicated that a greater proportion of participants treated with minoxidil reported a moderate increase in their hair regrowth compared with placebo . There was no difference between the number of adverse events experienced in the twice daily minoxidil and the placebo intervention groups, except for a reported increase with minoxidil 5% twice daily.
Single studies accounted for most of the other comparisons, which were assessed as either having high risk of bias and ⁄or they did not address the prespecified outcomes for this review and provided limited evidence of either the effectiveness or safety of these interventions. Further well-designed, adequately powered randomized controlled trials investigating other treatment options are still required."
The aim of this review was to assess the evidence for the effectiveness and safety of the treatments available for FPHL.
Searches included: Cochrane Skin Group Specialised Register, Cochrane Central Register of Controlled Clinical Trials in The Cochrane Library, MEDLINE,
EMBASE, AMED, PsycINFO, LILACS and several ongoing trials registries (October 2011).
Randomized controlled trials in women with FPHL were identified.
Twenty-two trials, comprising 2349 participants, were included. A range of
interventions was evaluated, with 10 studies examining varying concentrations of minoxidil. Pooled data from four studies indicated that a greater proportion of participants treated with minoxidil reported a moderate increase in their hair regrowth compared with placebo . There was no difference between the number of adverse events experienced in the twice daily minoxidil and the placebo intervention groups, except for a reported increase with minoxidil 5% twice daily.
Single studies accounted for most of the other comparisons, which were assessed as either having high risk of bias and ⁄or they did not address the prespecified outcomes for this review and provided limited evidence of either the effectiveness or safety of these interventions. Further well-designed, adequately powered randomized controlled trials investigating other treatment options are still required."