GEM/cochrane-simplification huggingface dataset:
Abstract: The studies analysed were in two groups: those comparing anticholinergics with placebo and those comparing the combination of anticholinergics with short acting ß2 -agonists versus short acting ß2 -agonists alone. The former group had 13 studies involving 205 participants included in this review, and the latter 9 studies involving 440 patients. Generally methodological quality was poorly reported, and there were some reservations with respect to the quality of the studies. Despite the limited number of studies that could be combined, anticholinergic agents in comparison with placebo resulted in more favourable symptom scores particularly in respect of daytime dyspnoea (WMD -0.09 (95%CI -0.14, -0.04, 3 studies, 59 patients). Daily peak flow measurements also showed a statistically significant improvement for the anticholinergic (e.g. morning PEF: WMD =14.38 litres/min (95%CI 7.69, 21.08; 3 studies, 59 patients). However the clinical significance is small and in terms of peak flow measurements equates to approximately a 7% increase over placebo. The more clinically relevant comparison of a combination of anticholinergic plus short acting ß2 -agonist versus short acting ß2 -agonist alone gave no evidence in respect of symptom scores or peak flow rates of any significant differences between the two regimes. Again there are reservations with respect to the quality of the information from which these conclusions are drawn. An update search in August 2004 did not identify any new studies. Overall this review provides no justification for routinely introducing anticholinergics as part of add-on treatment for patients whose asthma is not well controlled on standard therapies. This does not exclude the possibility that there may be a sub-group of patients who derive some benefit and a trial of treatment in individual patients may still be justified. The role of long term anticholinergics such as tiotropium bromide has yet to be established in patients with asthma and any future trials might draw on the messages derived from this review.

Plain-language summary: This review found that although this treatment was better than placebo, the size of the effect was rather small. When the drug was used in combination with more widely used bronchodilators (beta-agonists such as fenoterol), it did not appear to add much benefit. However, there are concerns about the quality of the studies that have been analysed. It could be that there are some adults with chronic asthma who respond to treatment with anticholinergic drugs, but the review has not been able to identify their common characteristics.
Abstract: Five studies involving 3,070 individuals met the criteria for inclusion in the meta-analysis. All interventions for promoting use of booster seats among 4 to 8 year olds demonstrated a positive effect (relative risk (RR) 1.43; 95% confidence intervals (CI) 1.05 to 1.96). Incentives combined with education demonstrated a beneficial effect (RR 1.32, 95% CI 1.12 to 1.55; n = 1,898). Distribution of free booster seats combined with education also had a beneficial effect (RR 2.34; 95% CI 1.50 to 3.63; n = 380) as did education-only interventions (RR 1.32; 95% CI 1.16 to 1.49; n = 563). One study which evaluated enforcement of booster seat law met the criteria for inclusion in the meta-analysis, but demonstrated no marked beneficial effect. Available evidence suggests that interventions to increase use of booster seats among children age four to eight years are effective. Combining incentives (booster seat discount coupons or gift certificates) or distribution of free booster seats with education demonstrated marked beneficial outcomes for acquisition and use of booster seats for four to eight year olds. There is some evidence of beneficial effect of legislation on acquisition and use of booster seats but this was mainly from uncontrolled before-and-after studies, which did not meet the criteria for inclusion in the meta-analysis.

Plain-language summary: The authors found five studies involving a total of 3,070 participants. All interventions investigated by the studies were found to increase the use of booster seats, compared to the group receiving no intervention. The distribution of free booster seats combined with education on their use, had a marked beneficial effect, as did incentives (for example, booster seat discount coupons or gift certificates) combined with education. Education-only interventions also produced beneficial outcomes. One of the studies evaluated the effectiveness of the enforcement of a booster seat law, but did not detect an effect on usage. The authors concluded that the current evidence suggests that several types of interventions aimed at increasing the use of booster seats among children aged four to eight years, are effective. However, there is still a need for further high quality trials, especially those conducted outside of the USA and Australia, where current research dominates.
Abstract: The database search identified 3,253 references. Sixteen trials fulfilled the inclusion criteria. Psychological interventions show a small beneficial effect on depression compared to usual care (range of SMD of depression scores across trials and time frames: -0.81;0.12). Based on one trial per outcome, no beneficial effects on mortality rates, cardiac events, cardiovascular hospitalizations and QoL were found, except for the psychosocial dimension of QoL. Furthermore, no differences on treatment outcomes were found between the varying psychological approaches. The review provides evidence of a small beneficial effect of pharmacological interventions with selective serotonin reuptake inhibitors (SSRIs) compared to placebo on depression outcomes (pooled SMD of short term depression change scores: -0.24 [-0.38,-0.09]; pooled OR of short term depression remission: 1.80 [1.18,2.74]). Based on one to three trials per outcome, no beneficial effects regarding mortality, cardiac events and QoL were found. Hospitalization rates (pooled OR of three trials: 0.58 [0.39,0.85] and emergency room visits (OR of one trial: 0.58 [0.34,1.00]) were reduced in trials of pharmacological interventions compared to placebo. No evidence of a superior effect of Paroxetine (SSRI) versus Nortriptyline (TCA) regarding depression outcomes was found in one trial. Psychological interventions and pharmacological interventions with SSRIs may have a small yet clinically meaningful effect on depression outcomes in CAD patients. No beneficial effects on the reduction of mortality rates and cardiac events were found. Overall, however, the evidence is sparse due to the low number of high quality trials per outcome and the heterogeneity of examined populations and interventions.

Plain-language summary: This review examined clinical trials on psychological treatments and antidepressant drugs in depressed patients with coronary artery disease. The objective was to determine the effects of these treatments on depression, death rates, cardiac events such as another heart attack or surgeries, healthcare costs and quality of life. Sixteen trials were identified as relevant for the review. Seven trials investigated psychological treatments, eight trials antidepressant medications and one trial comprised both psychological and drug treatments. Psychological treatments and antidepressant drugs proved to be slightly superior to usual care or placebo (inactive drug) with regard to depressive symptoms. Furthermore, antidepressant drugs might be superior to placebo in reducing subsequent hospitalization rates and emergency room visits. In contrast, there seems to be no positive effect on death rates and cardiac events. Results regarding quality of life are inconclusive. In summary, psychological treatments and antidepressant medications may have a small yet positive effect on depression outcomes in CAD patients. However, the evidence is sparse due to the low number of trials.
Abstract: One trial assessing smoking cessation advice for 94 infertile women smokers fulfilled the criteria for this review, but the trial did not report on the review's primary outcome of live birth or any other fertility-related outcomes. This trial of women attending a fertility clinic showed that smoking cessation advice tailored to a woman's "stage-of-change" (readiness to stop smoking) did not show significant evidence of a difference in stage (including smoking cessation rates) compared with standard clinical advice. No RCTs were located that assessed the effects of preconception advice on the chance of a live birth or other fertility outcomes in people who perceived that they may be infertile and were investigating the possibility of medical treatment to address subfertility. Given the lack of RCTs evaluating the effectiveness of preconception lifestyle advice for people in the afore-mentioned population, this review cannot provide guidance for clinical practice in this area. However, it does highlight the need for further research into this important subject.

Plain-language summary: There is no evidence from randomised controlled trials regarding the effects of preconception advice on the chances of a live birth in subfertile people. Infertility is a prevalent problem and has significant consequences for individuals, families and the wider community. People's chance of having a healthy, live birth may be impacted upon by factors such as weight, diet, smoking, other substance abuse, environmental pollutants, infections, medical conditions, medications and family medical history. However, there is no current guideline about what preconception advice should be offered to people presenting for infertility treatment. It is important to determine what preconception advice should be given about these types of factors to people presenting for fertility treatment in order to help them to make positive changes and hopefully improve their chances of conception and having a healthy baby. This review found no evidence from controlled clinical trials about the effect of preconception advice on the chance of a live birth in subfertile people.
Abstract: Two trials (involving 59 mothers) that examined the use of domperidone in a total of 59 mother-infant pairs met the inclusion criteria. Meta-analysis of these trials showed a modest increase in expressed breastmilk (EBM) of 99.49 mL/day (95% confidence intervals -1.94 to 200.92; random-effects, T² 3511.62, I² 63%) in mothers given domperidone. Both trials gave the same dose of domperidone (10 mg three times per day) with a duration of seven days in the smaller trial and 14 days in the larger. Neither trial showed significant improvements in longer-term outcomes of breastfeeding in a preterm population and no adverse effects were reported. Two studies with a total of 59 mothers suggest modest improvements in short-term EBM volumes when a medication is used after insufficient EBM occurs in mothers following preterm delivery. In both studies, the medication was commenced ≧14 days post delivery and following insufficient EBM supply with other lactation supports. Currently, no studies support prophylactic use of a galactagogue medication at any gestation. Use of any galactagogue medication has only been examined at more than 14 days post delivery and after full lactation support has been given. Further trials should examine larger groups of preterm mothers and consider breastfeeding outcomes over a longer period.

Plain-language summary: Trials of medications used to improve the breastmilk supply in mothers who have insufficient milk for their hospitalised preterm infants' needs have been reported in two randomised controlled studies involving 59 mothers. These two studies gave the women domperidone 10 mg three times a day when mothers had insufficient EBM, two to three weeks after delivery. These studies showed a modest improvement in EBM volume over the following one to two weeks. No side effects to mothers or infants were noted in these studies. These medications should only be considered in mothers who have received full lactation support and are more than 14 days post delivery but have insufficient EBM for their infants' needs.
Abstract: We found no randomised clinical trials comparing PAIR versus no or sham intervention. We identified only two randomised clinical trials, one comparing PAIR versus surgical treatment (n = 50 participants) and the other comparing PAIR (with or without albendazole) versus albendazole alone (n = 30 participants). Both trials were graded as 'adequate' for allocation concealment; however, generation of allocation sequence and blinding methods were 'unclear' in both. Compared to surgery, PAIR plus albendazole obtained similar cyst disappearance and mean cyst diameter with fewer adverse events (32% versus 84%, P < 0.001) and fewer days in hospital (mean + SD) ( 4.2 + 1.5 versus 12.7 + 6.5 days, P < 0.001). Compared to albendazole, PAIR with or without albendazole obtained significantly more (P < 0.01) cyst reduction and symptomatic relief. PAIR seems promising, but there is insufficient evidence to support or refute PAIR with or without benzimidazole coverage for treating patients with uncomplicated hepatic hydatid cyst. Further well-designed randomised clinical trials are necessary to address the topic.

Plain-language summary: Two randomised clinical trials on the puncture, aspiration, injection, and re-aspiration method for patients with uncomplicated hepatic hydatid cyst were identified. One trial compared puncture, aspiration, injection, and re-aspiration with surgical treatment. The other trial compared puncture, aspiration, injection, and re-aspiration with or without albendazole with albendazole alone. Both trials had high risk of bias. The number of participants enrolled and the follow-up duration are insufficient for a definite conclusion to be drawn. In general, there is insufficient evidence to support or refute the puncture, aspiration, injection, and re-aspiration method with or without benzimidazole coverage for patients with uncomplicated hepatic hydatid cyst.
Abstract: We included four RCTs with 167 participants. Risk of bias of the included studies was high, as none of them reported method of randomization, allocation concealment or blinding. Only one trial mentioned our primary outcome of duration of anaesthesia. The mean difference in duration of anaesthesia with use of adrenaline with lidocaine was 3.20 hours (95% confidence interval (CI) 2.48 to 3.92 hours; one RCT, 20 participants; low-quality evidence). No trial reported adverse events such as ischaemia distal to the injection site, and no trial reported cost analysis. One trial mentioned the secondary outcome of duration of postoperative pain relief, but available data were insufficient for analysis of the findings. Two trials reported the secondary outcome of reduced bleeding during surgery. Bleeding during surgery was observed in nine out of 52 participants as compared with 25 out of 51 participants in the adrenaline with lidocaine and plain lidocaine groups, respectively. The risk ratio for bleeding in the adrenaline with lidocaine group was 0.35 (95% CI 0.19 to 0.65; two RCTs, 103 participants; low-quality evidence). From the limited data available, evidence is insufficient to recommend use or avoidance of adrenaline in digital nerve blocks. The evidence provided in this review indicates that addition of adrenaline to lidocaine may prolong the duration of anaesthesia and reduce the risk of bleeding during surgery, although the quality of the evidence is low. We have identified the need for researchers to conduct large trials that focus on other important outcomes such as adverse events, cost analysis and duration of postoperative pain relief.

Plain-language summary: Evidence is current to November 2014. We included studies in children (aged older than 28 days and younger than 18 years) and adult patients (aged 18 years or older) of either gender undergoing surgery on digits (fingers and toes) under nerve blocks using adrenaline with lidocaine. We found four eligible studies with 167 participants. One small study reported the duration of anaesthesia and found that adrenaline prolonged the duration of anaesthesia, but the quality of the evidence was low. No study reported on adverse events such as ischaemia distal to the injection site or cost analysis with use of adrenaline with lidocaine. Duration of postoperative pain relief was reported by one study, but available data were insufficient for analysis of the findings. Two studies reported reduced bleeding during surgery with use of adrenaline with lidocaine. In the light of our results, we would expect that 17.2 out of 100 patients who received adrenaline with lidocaine (between 8.7 and 29.8 patients) would have bleeding during surgery compared with 49 patients who would have received plain lidocaine; however, the quality of the evidence was low, and further research is very likely to impact our confidence in this estimate. The quality of evidence is low for both duration of anaesthesia and bleeding during surgery with use of adrenaline with lidocaine. Further research is needed to prove the benefits of adding adrenaline to lidocaine.
Abstract: Three eligible studies were identified, all comparing the use of an FIS with a VLS. All studies were small, with only 131 participants in total across all trials. It was impossible for the intubators to be unaware of the device used, so all studies were at high risk of performance and detection bias for outcomes related to intubation. Because of substantial differences in design between the studies, we did not combine their results in meta-analyses. The results for all outcomes were inconclusive, with no differences noted between FIS and VLS. Two studies with experienced intubators reported first attempt success rates greater than 70% in both groups and less than 5% of participants requiring a change of intubation device. No evidence was found of any difference in difficulty or time taken between FIS and VLS intubation. No serious complications or airway trauma was reported, so we were unable to address these outcomes. Bleeding was uncommon, occurring in less than 5% of participants, and we found no evidence that it was more likely in the FIS group. One small study with a novice intubator reported no successful intubations using an FIS and compared with the use of an intubating SAD and stylet, as well as with a VLS. With only five participants in each group, no conclusions can be drawn from these additional comparisons. The evidence base is sparse, and the existing literature does not address the clinical questions of patient safety posed by this review. We are therefore unable to draw any conclusions on safety or effectiveness. More primary research is needed to investigate optimal intubation techniques in obese patients, and new studies should be powered to detect differences in complications and in success rates rather than process measures such as speed, which are of limited clinical importance.

Plain-language summary: These scopes allow the intubator to see the airway via a camera, but no reviews have examined the use of an FIS in this situation. Intubation with an FIS is considered an advanced method, requiring training and experience; therefore it may be underused in clinical practice. We aimed to compare the safety and effectiveness of an FIS used for tracheal intubation in obese patients with direct laryngoscopy and other intubation methods that give the intubator an indirect view of the larynx. These other methods include videolaryngoscopes (VLSs)—metal laryngoscopes that contain a camera. We found three small studies, with a total of 131 patients, that compared an FIS with a VLS. The results for all patient safety outcomes were inconclusive, and no differences were noted between intubation with a flexible scope and intubation with a videolaryngoscope. We are unable to make any recommendations for practice based on this review. More research is needed to identify the technique for intubating obese people that would offer the best success rate with the fewest complications.
Abstract: We identified six trials, involving 479 subjects, comparing incision and drainage of perianal abscess alone versus incision and drainage with fistula treatment. Metaanalysis showed a significant reduction in recurrence, persistent abscess/fistula or repeat surgery in favour of fistula surgery at the time of abscess incision and drainage (RR=0.13, 95% Confidence Interval of RR = 0.07-0.24). Transient manometric reduction in anal sphincter pressures, without clinical incontinence, may occur after treatment of low fistulae with abscess drainage. Incontinence at one year following drainage with fistula surgery was not statistically significant (pooled RR 3.06, 95% Confidence Interval 0.7-13.45) with heterogeneity demonstrable between the trials (Chi2 =5.39,df=3, p=0.14, I2 =44.4%). The published evidence shows fistula surgery with abscess drainage significantly reduces recurrence or persistence of abscess/fistula, or the need for repeat surgery. There was no statistically significant evidence of incontinence following fistula surgery with abscess drainage. This intervention may be recommended in carefully selected patients.

Plain-language summary: This systematic review assesses randomised trials that have addressed the benefits and risks of combined treatment of perianal abscesses and fistulae. Six studies have been published on this topic. The analyses show that combined treatment reduces the risk of persistent abscess or fistula, or repeat surgery without a statistically significant increase in postoperative incontinence.