GEM/cochrane-simplification huggingface dataset:
Abstract: We included 22 randomized trials (2130 participants). The mean treatment duration was 2.3 ± 1.3 months (ranging from one to six months). Twenty trials were conducted in China and 18 trials were published in Chinese. Overall, the risk of bias of included trials was high or unclear. Five different herbal medicines were evaluated in the included trials, which compared herbs with conventional medicine in six comparisons (20 trials), or placebo (two trials). There were no outcome data in any of the trials on cardiovascular events and death from any cause. One trial each reported well-being (no significant differences) and economic costs. No serious adverse events were observed. Xuezhikang was the most commonly used herbal formula investigated. A significant effect on total cholesterol (two trial, 254 participants) was shown in favor of Xuezhikang when compared with inositol nicotinate (mean difference (MD) -0.90 mmol/L, 95% confidence interval (CI) -1.13 to -0.68) . Some herbal medicines may have cholesterol-lowering effects. Our findings have to be interpreted with caution due to high or unclear risk of bias of the included trials.

Plain-language summary: People with hypercholesterolemia have a higher risk of developing coronary artery disease, heart attacks, and stroke. Chinese herbal medicines have been commonly used and studied as cholesterol-lowering agents. To evaluate the effects of various herbal formulations (including single herbs, Chinese proprietary medicines, and mixtures of different herbs) for treating hypercholesterolemia, this review examined 22 randomized controlled trials of five different Chinese herbal medicines. The trials lasted from one to six months (average 2.3 months) and involved 2130 participants. There were no data on cardiovascular events and death from any cause. One trial each reported on well-being (no significant differences) and economic costs . No serious adverse events were observed. The available evidence suggests that several herbal medicines showed some cholesterol-lowering effect. However, due to considerable limitations in the quality of the included trials, further higher-quality and rigorously performed studies are required before any confident conclusions can be reached about the effects of Chinese herbal medicines for hypercholesterolemia.
Abstract: The previous update (2008) had identified 53 potential studies and included 37 combined for meta-analysis. In this latest update we identified a further 13 studies and included 11, summarizing the results of 50 trials including 4151 participants. Overall, succinylcholine was superior to rocuronium for achieving excellent intubating conditions: RR 0.86 (95% confidence interval (CI) 0.81 to 0.92; n = 4151) and clinically acceptable intubation conditions (RR 0.97, 95% CI 0.95 to 0.99; n = 3992, 48 trials). A high incidence of detection bias amongst the trials coupled with significant heterogeneity provides moderate-quality evidence for these conclusions, which are unchanged from the previous update. Succinylcholine was more likely to produce excellent intubating conditions when using thiopental as the induction agent: RR 0.81 (95% CI: 0.73 to 0.88; n = 2302, 28 trials). In the previous update, we had concluded that propofol was the superior induction agent with succinylcholine. There were no reported incidences of severe adverse outcomes. We found no statistical difference in intubation conditions when succinylcholine was compared to 1.2 mg/kg rocuronium; however, succinylcholine was clinically superior as it has a shorter duration of action. Succinylcholine created superior intubation conditions to rocuronium in achieving excellent and clinically acceptable intubating conditions.

Plain-language summary: We included in the review controlled trials from 1966 to February 2015 involving participants of all ages needing rapid intubation using rocuronium and succinylcholine . The minimum dose of rocuronium given was 0.6mg/kg and succinylcholine was 1mg/kg. We have combined the results of 50 trials, with a total of 4151 participants, which compared the effectiveness of succinylcholine versus rocuronium on intubation conditions. No major side effects from use of the drugs were reported. We have found that rocuronium is slightly less effective than succinylcholine for creating excellent and acceptable intubation conditions. Rocuronium should therefore only be used as an alternative to succinylcholine when it is known that succinylcholine should not be used and a more prolonged intubation is expected. The level of evidence is of moderate GRADE due to imperfect study designs and varying techniques used across trials .
Abstract: Two studies (n of 80), where n is the number of participants, met the inclusion criteria. Ultrasound to the palmar and dorsal aspects of the hand significantly increased grip strength, measured as weighted mean difference (WMD) from control [WMD 28.07 (95 CI: 13.37 to 42.77)]. Ultrasound to the palmar and dorsal aspects of the hand also appeared to have beneficial effects on the following outcome measures: wrist dorsal flexion [WMD 1.90 (95%CI: 0.64 to 3.16)], duration of morning stiffness [WMD 28.54 (95%CI: 0.18 to 56.90)], number of swollen joints [WMD 1.02 (95%CI: 0.45 to 1.59)], and the number of painful joints [WMD 1.20 (95%CI: 0.45 to 1.95)]. There was no significant difference between a) exercises and wax baths, b) exercises with ultrasound, c) exercises with ultrasound and faradic hand baths on the outcome measures: pain score, grip strength, circumference of proximal interphalangeal (PIP) joints, articular index, and range of motion or level of activity. The reviewers concluded that ultrasound in combination with exercises, faradic current and wax bath treatment modalities is not supported and cannot be recommended. Ultrasound alone can, however, be used on the hand to increase grip strength, and to a lesser extent and based on borderline results, increase wrist dorsal flexion, decrease morning stiffness, reduce the number of swollen joints, and reduce the number of painful joints. It is important to note that these conclusions are limited by methodological considerations such as poor quality of the included trials, the low number of clinical trials, and the small number of study participants.

Plain-language summary: This review of two randomized trials (RCTs) showed that continuous ultrasound applied in water to the dorsal and palmar aspects of the hand increased grip strength as compared with placebo. This benefit was not evident with combined therapy (exercise, wax bath, faradic hand baths). Ultrasound also produced a borderline increase in wrist dorsal flexion, decreased morning stiffness, and reduced the number of swollen and painful joints. The conclusions are limited by few studies, small sample size and limitations in study methodology.
Abstract: In the original 2010 review, we identified no relevant studies. This updated review included one RCT involving 245 participants that compared abdominal paracentesis and intraperitoneal infusion of catumaxomab versus abdominal paracentesis alone. The study was at high risk of bias in almost all domains. The data were not suitable for analysis. The median time to the first deterioration of QoL ranged from 19 to 26 days in participants receiving paracentesis alone compared to 47 to 49 days among participants receiving paracentesis with catumaxomab infusion (very low-certainty evidence). Adverse events were only reported among participants receiving catumaxomab infusion. The most common severe adverse events were abdominal pain and lymphopenia (157 participants; very low-certainty evidence). There were no data on the improvement of symptoms, satisfaction of participants and caregivers, and cost-effectiveness. Currently, there is insufficient evidence to recommend the most appropriate management of drainage for malignant ascites among women with gynaecological cancer, as there was only very low-certainty evidence from one small RCT at overall high risk of bias.

Plain-language summary: We searched for studies up to Novemeber 2019 that compared different ways of managing the drainage of fluid collected in the abdomen of women with gynaecological cancer (cancer that starts in a woman's reproductive organs). The original 2010 review found no relevant studies. This updated review included one randomised controlled trial (RCT: a type of study in which people are randomly assigned to receive different treatments) involving 245 women that compared drainage combined with catumaxomab (a medicine used to treatment malignant ascites) versus drainage alone. However, the results were insufficient to assess the difference between these treatments. Although women receiving drainage combined with catumaxomab had better quality of life (the general well-being of a person) for longer compared to drainage alone, we are very unsure of this evidence due to the small number of participants and trials. There were some side effects in the drainage plus catumaxomab group (e.g. pain, low white blood cell count), but they were not well reported. At present, there is insufficient data regarding the best management of drainage for malignant ascites among women with gynaecological cancer. The evidence is current to 4 November 2019.
Abstract: We identified 14 RCTs with 2422 eligible patients. For eight RCTs with 1049 patients (43.3%), we were able to obtain IPD. Perioperative chemotherapy was associated with significantly longer overall survival (hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.73 to 0.89). This corresponds to a relative survival increase of 19% or an absolute survival increase of 9% at five years. This survival advantage was consistent across most subgroups. There was a trend towards a more pronounced treatment effect for tumors of the GE junction compared to other sites, and for combined chemoradiotherapy as compared to chemotherapy in tumors of the esophagus and GE junction. Resection with negative margins was a strong predictor of survival. Multivariable analysis showed that tumor site, performance status, and age have an independent significant effect on survival. Moreover, there was a significant interaction of the effect of perioperative chemotherapy with age (larger treatment effect in younger patients). Perioperative chemotherapy also showed a significant effect on several secondary outcomes. It was associated with longer disease-free survival, higher rates of R0 resection, and more favorable tumor stage upon resection, while there was no association with perioperative morbidity and mortality. Perioperative chemotherapy for resectable gastroesophageal adenocarcinoma increases survival compared to surgery alone. It should thus be offered to all eligible patients. There is a trend to a larger survival advantage for tumors of the GE junction as compared to other sites and for chemoradiotherapy as compared to chemotherapy in esophageal and GE junction tumors. Likewise, there is an interaction between age and treatment effect, with younger patients having a larger survival advantage, and no survival advantage for elderly patients.

Plain-language summary: This systematic review uses the data of individual patients from eight and published data from another six randomized controlled trials. We found that the administration of chemotherapy before surgery leads to longer survival in patients with adenocarcinoma of the esophagus, the junction between esophagus and stomach, and the stomach. The findings suggest that patients whose tumor is in the junction between esophagus and stomach and younger patients benefit most from the chemotherapy. Moreover, the addition of radiation to the chemotherapy seems to yield an additional advantage to patients, at least in tumors of the esophagus and the junction between esophagus and stomach. Chemotherapy before surgery does not increase the risk of suffering a complication during or after surgery.
Abstract: We included 68 systematic reviews published in the Cochrane Library up to May 2018. All were of high quality. These reviews identified 38 interventions that were effective (n = 23) or promising (n = 15), and they identified 19 interventions that were ineffective (n = 2) or possibly ineffective (n = 17). For 15 interventions, review authors were unable to draw conclusions owing to lack of evidence. We identified an additional 11 protocols and four titles for future inclusion in this overview. This overview provides the most up-to-date evidence on ART cycles from systematic reviews of randomised controlled trials. Fertility treatments are costly, and the stakes are high. Using the best available evidence to optimise outcomes is best practice. Evidence from this overview could be used to develop clinical practice guidelines and protocols that can be applied in daily clinical practice to improve live birth rates and reduce rates of multiple pregnancy, cycle cancellation, and ovarian hyperstimulation syndrome.

Plain-language summary: We included 68 Cochrane systematic reviews on various stages of the ART cycle. All were of high quality. We included in the overview reviews of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). We did not include reviews of intrauterine insemination (placing sperm inside a woman's uterus to facilitate fertilisation) or ovulation induction (stimulation of ovulation by medication). This overview provides the most up-to-date evidence from randomised controlled trials on ART cycles. The overview is up-to-date to May 2018. The reviews identified 38 interventions that were effective (n = 23) or promising (n = 15), and they identified 19 interventions that were ineffective (n = 2) or possibly ineffective (n = 17). For 15 interventions, the reviews were unable to draw conclusions owing to lack of evidence. Use of evidence from this overview to guide clinical practice should help to improve live birth rates and reduce rates of multiple pregnancy, cycle cancellation, and ovarian hyperstimulation syndrome. All included reviews were of high quality. The quality of the evidence for specific comparisons ranged from very low to high.
Abstract: A systematic search of all available databases and other sources failed to identify any completed randomized, double-blind and placebo-controlled trials, assessing the efficacy of ibuprofen in AD eligible for inclusion in the review. One double-blind placebo-controlled trial investigating ibuprofen treatment for age-associated memory impairment has been identified, but is yet unfinished and no data are yet available. Other trials assessing the effect of ibuprofen on CSF beta amyloid in cognitively unimpaired individuals and the effect of other NSAIDs such as naproxen and rofecoxib for people with AD are currently underway. No evidence yet exists from randomized double-blind and placebo-controlled trials on whether ibuprofen is efficacious for patients diagnosed as having Alzheimer's disease. Ibuprofen, like other NSAIDs, has an identifiable and in some instances a significant side-effect profile which may include gastrointestinal bleeding. Therefore, it needs to be shown that the benefits of such a treatment outweighs the risk of side effects before ibuprofen can be recommended for people with Alzheimer's disease.

Plain-language summary: Animal and cell culture studies have produced evidence that inflammatory processes may be involved in the pathogenesis of AD. As a result, agents such as ibuprofen have been proposed for the treatment of people with AD. Although ibuprofen is better tolerated overall than some other NSAIDs, such as indomethacin, no randomized controlled trials investigating the efficacy of this drug for treatment of people with AD have been published. One such a trial is underway. The use of ibuprofen for the treatment of AD cannot at present be recommended.
Abstract: Six studies were identified that randomised 596 live kidney donors to either LDN or ODN arms. All studies were assessed as having low or unclear risk of bias for selection bias, allocation bias, incomplete outcome data and selective reporting bias. Four of six studies had high risk of bias for blinding. Various different combinations of techniques were used in each study, resulting in heterogeneity in the results. The conversion rate from LDN to ODN ranged from 1% to 1.8%. LDN was generally found to be associated with reduced analgesia use, shorter hospital stay, and faster return to normal physical functioning. The extracted kidney was exposed to longer warm ischaemia periods (2 to 17 minutes) with no associated short-term consequences. ODN was associated with shorter duration of procedure. For those outcomes that could be meta-analysed there were no significant differences between LDN or ODN for perioperative complications (RR 0.87, 95% CI 0.47 to 4.59), reoperations (RR 0.57, 95% CI 0.09 to 3.64), early graft loss (RR 0.31, 95% CI 0.06 to 1.48), delayed graft function (RR 1.09, 95% CI 0.52 to 2.30), acute rejection (RR 1.41, 95 % CI 0.87 to 2.27), ureteric complications (RR 1.51, 95% CI 0.69 to 3.31), kidney function at one year (SMD 0.15, 95% CI -0.11 to 0.41) or graft loss at one year (RR 0.76, 95% CI 0.15 to 3.85). 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.

Plain-language summary: Six studies randomising 596 healthy kidney donors to either keyhole or open surgery, found keyhole surgery to be associated with less pain for the donor but had similar numbers of complications that can require further treatment or surgery or both. Donor kidneys that were obtained using the keyhole surgical technique were deprived of nutrients for longer periods of time than kidneys obtained for transplant using open surgery, but this does not appear to have any short-term consequences.
Abstract: We included six trials involving 497 participants to study efficacy. They showed some benefit (e.g. reduction of cough at day seven) from mucolytic agents, although differences were of little clinical relevance. No conclusion was drawn about the subgroup of infants younger than two years because data were unavailable. Thirty-four studies, including the previous six trials involving 2064 children, were eligible to study safety. Overall safety was good but very few data were available to evaluate safety in infants younger than two years. However, 59 cases of paradoxically increased bronchorrhoea observed in infants were reported to the French pharmacovigilance system. The results have to be interpreted with caution because they are based on a limited number of participants included in studies whose methodological quality is questionable. Acetylcysteine and carbocysteine seem to have a limited efficacy and appear to be safe in children older than two years. These results should take into consideration the fact that acetylcysteine and carbocysteine are prescribed for self limiting diseases (for example, acute cough, bronchitis). Given strong concerns about safety, these drugs should only be used for acute upper and lower RTIs in the context of a RCT with regards to children younger than two years.

Plain-language summary: Forty-nine trials met the inclusion criteria. Six trials involving 497 participants were included to study efficacy, and compared acetylcysteine or carbocysteine to placebo. Thirty-four trials (including the previous six) were eligible to study safety and involved 2064 paediatric patients. The results of this review suggest actual but limited efficacy of acetylcysteine and carbocysteine (e.g. reduction of cough at day seven) and good overall safety (except for rare mild gastrointestinal side effects) among children older than two years of age. However, the number of participants included was limited and the methodological quality was questionable. These results should also take into consideration the fact that acetylcysteine and carbocysteine are prescribed for self limiting diseases (for example, acute cough, bronchitis). In children younger than two years, and given strong concerns about safety (increased instead of decreased bronchial secretions), these drugs should only be used for acute upper and lower respiratory tract infections in the context of a randomised controlled trial.
Abstract: We identified 60 studies, enrolling 3802 recipients. Twenty-nine studies (2262 participants) compared calcium channel blockers (CCB) to placebo/no treatment, 10 studies (445 participants) compared angiotensin converting enzyme inhibitors (ACEi) to placebo/no treatment and seven studies (405 participants) compared CCB to ACEi. CCB compared to placebo/no treatment (plus additional agents in either arm as required) reduced graft loss (RR 0.75, 95% CI 0.57 to 0.99) and improved glomerular filtration rate (GFR), (MD, 4.45 mL/min, 95% CI 2.22 to 6.68). Data on ACEi versus placebo/no treatment were inconclusive for GFR (MD -8.07 mL/min, 95% CI -18.57 to 2.43), and variable for graft loss, precluding meta-analysis. In direct comparison with CCB, ACEi decreased GFR (MD -11.48 mL/min, 95% CI -5.75 to -7.21), proteinuria (MD -0.28 g/24 h, 95% CI -0.47 to -0.10), haemoglobin (MD -12.96 g/L, 95% CI -5.72 to -10.21) and increased hyperkalaemia (RR 3.74, 95% CI 1.89 to 7.43). Graft loss data were inconclusive (RR 7.37, 95% CI 0.39 to 140.35). Other drug comparisons were compared in small numbers of participants and studies. These data suggest that CCB may be preferred as first line agents for hypertensive kidney transplant recipients. ACEi have some detrimental effects in kidney transplant recipients. More high quality studies reporting patient centred outcomes are required.

Plain-language summary: We found that calcium channel blockers (CCB) reduced the risk of graft loss by about 25% in randomised studies, compared to placebo or no treatment. CCB also improved the function of grafts, as measured by glomerular filtration rate (GFR) with GFR 4.5 mL/min higher on average in patients receiving CCB compared to placebo. There were fewer studies comparing angiotensin converting enzyme inhibitors (ACEi) to placebo and their results were inconclusive. In studies that compared ACEi to CCB, ACEi worsened GFR by about 11.5 mL/min on average. ACEi also lowered haemoglobin and increased the risk of elevated blood potassium compared to CCB. There were not enough studies of other classes of drugs to draw conclusions about their relative effects. On current evidence CCB might therefore be the best agents for kidney transplant patients.