GEM/cochrane-simplification huggingface dataset:
Abstract: Twenty eight short-term (average of seven weeks) randomised controlled trials (740 participants) were included in the review, 20 of which investigated augmentation of medication for treatment-resistant obsessive compulsive disorder (OCD). Summary statistics for responder status from nine trials demonstrate overall superiority of a variety of medication agents to placebo (relative risk of non-response (RR) 3.16, 95% CI 1.08 to 9.23). Similarly, symptom severity was significantly reduced in the medication groups, relative to placebo (number of trials (N) = 14, standardised mean difference (SMD) -0.87, 95% CI -1.37 to -0.36). There is no evidence of a difference between medication and placebo in total dropout rate, or in the number of dropouts due to adverse events. Medication augmentation can be an effective and well-tolerated short-term treatment strategy for non-responders to first-line pharmacotherapy of anxiety disorders. However, any conclusions must be tentative in view of methodological and clinical heterogeneity, and the fact that much of the relevant database is based on antipsychotic augmentation trials in OCD patients resistant to serotonin reuptake inhibitors (SRIs). Additional data are needed to address several areas, including the efficacy of augmentation over the longer-term, and the value of medication augmentation in comparison to other strategies (eg switching medication, adding psychotherapy).

Plain-language summary: This was a systematic review of 28 short-term randomised controlled trials of medication augmentation for the treatment of such individuals (740 participants). A significantly larger proportion of patients responded to medication (31.8%) than to placebo (13.6%), (nine trials, 250 participants). Symptom severity was also significantly reduced (14 trials, 337 participants). A substantial proportion of the efficacy evidence base was for the augmentation with antipsychotics of serotonin reuptake inhibitors for obsessive compulsive disorder.
Abstract: We included four RCTs with a total of 463 participants (aged 42 years to 93 years); one report was only available as a published abstract. Meta-analysis of three RCTs suggests an increase in the proportion of ulcers completely healed with sulodexide as an adjuvant to local treatment (including wound care and compression therapy) compared with local treatment alone (rate of complete healing with sulodexide 49.4% compared with 29.8% with local treatment alone; RR 1.66; 95% CI 1.30 to 2.12). This evidence for sulodexide increasing the rate of complete healing is low quality due to risk of bias. It is unclear whether sulodexide is associated with any increase in adverse events (4.4% with sulodexide versus 3.1% with no sulodexide; RR 1.44; 95% CI 0.48 to 4.34). The evidence for adverse events is very low quality, downgraded twice for risk of bias and once for imprecision. Sulodexide may increase the healing of venous ulcers, when used alongside local wound care, however the evidence is only low quality and the conclusion is likely to be affected by new research. It is not clear whether sulodexide is associated with adverse effects. The standard dosage, route and frequency of sulodexide reported in the trials was unclear. Further rigorous, adequately powered RCTs examining the effects of sulodexide on healing, ulcer recurrence, quality of life and costs are necessary.

Plain-language summary: The review includes four studies involving 463 people with venous leg ulcers aged between 42 and 93 years old. The studies compared sulodexide used in combination with local treatment (including wound care and compression therapy) with local treatment alone. The duration of the four studies ranged from one month to three months. Three studies (438 participants) indicated that sulodexide might help to improve ulcer healing, as the proportion of ulcers that were completely healed was increased from 29.8% with local treatment to 49.4% when the participants also received sulodexide. It is unclear whether sulodexide results in more adverse effects (4.4% with sulodexide versus 3.1% without sulodexide). The overall quality of evidence for each outcome varied between low and very low, due to risk of bias, and imprecision (that is, for some outcomes, results from only one, small study were available). This plain language summary is up to date as of 1 July 2015.
Abstract: We included seven studies (662 participants) in this review. All except one study was assessed as being at high risk of bias. Three studies assessed atorvastatin, three assessed simvastatin and one investigated rosuvastatin. All studies collected data during the immediate perioperative period only; data collection to hospital discharge and postoperative biochemical data collection ranged from 24 hours to 7 days. Overall, pre-operative statin treatment was not associated with a reduction in postoperative AKI, need for RRT, or mortality. Only two studies (195 participants) reported postoperative SCr level. In those studies, patients allocated to receive statins had lower postoperative SCr concentrations compared with those allocated to no drug treatment/placebo (MD 21.2 µmol/L, 95% CI -31.1 to -11.1). Adverse effects were adequately reported in only one study; no difference was found between the statin group compared to placebo. Analysis of currently available data did not suggest that preoperative statin use is associated with decreased incidence of AKI in adults after surgery who required cardiac bypass. Although a significant reduction in SCr was seen postoperatively in people treated with statins, this result was driven by results from a single study, where SCr was considered as a secondary outcome. The results of the meta-analysis should be interpreted with caution; few studies were included in subgroup analyses, and significant differences in methodology exist among the included studies. Large high quality RCTs are required to establish the safety and efficacy of statins to prevent AKI after cardiac surgery.

Plain-language summary: This review aims to evaluate evidence on the use of statins at the time of heart surgery to investigate if use can help to prevent kidney failure and how well statins are tolerated among patients. We searched the literature to January 2015 and included seven studies that involved a total of 662 participants to inform our assessment. In these studies, patients planned for heart surgery received statins or placebo (or no treatment at all). Five studies (467 participants) reported rates of kidney failure. We found that there was a high risk of bias in six of the seven included studies. We found no difference in the rate of kidney failure between patients who received statins and those who did not. Two studies (195 patients) reported serum creatinine (a marker of kidney function) after the operation. We found that serum creatinine was lower in patients in the statin group (indicating better kidney function). Other conclusions were limited by the small number of studies. However, patients who received statins did not seem to need less dialysis. They did not have a higher rate of death in hospital and did not have an increased rate of adverse events.
Abstract: Twelve trials were included (2514 patients, average follow-up six years), 11 using selegiline. The methodological quality was reasonable although concealment of allocation was definitely adequate in only five trials. MAO-B inhibitors were not associated with a significant increase in deaths (odds ratio (OR) 1.12; 95% confidence interval (CI) 0.90 to 1.41). They provided small benefits over control in impairment (weighted mean difference (WMD) for change in motor UPDRS score 3.79 points less with MAO-B inhibitors; 95% CI 2.27 to 5.30) and disability (WMD for change in UPDRS ADL score 1.49 less; 95% CI 0.49 to 2.49) at one year which may not be clinically significant. There was a levodopa-sparing effect with MAO-B inhibitors, which was associated with a significant reduction in motor fluctuations (OR 0.73; 95% CI 0.58 to 0.91) but not dyskinesia (OR 0.96; 95% CI 0.76 to 1.22). The reduction in motor fluctuations was, however, not robust in sensitivity analyses. There was a trend to more withdrawals due to adverse events with MAO-B inhibitors (OR 1.72; 95% CI 0.98 to 3.01). MAO-B inhibitors (more specifically selegiline which contributes most of the data) do not appear to delay disease progression in terms of improved survival but may reduce later motor fluctuations. At present, we do not feel these drugs can be recommended for routine use in the treatment of early Parkinson's disease.

Plain-language summary: We reviewed 11 controlled trials with a total of 2514 patients that compared giving MAO-B inhibitors with not giving them in people with early Parkinson's to see if it was safe and effective. The results show that, although MAO-B inhibitors do improve symptoms of Parkinson's and delay the need for levodopa by a few months, they are too weak to have a major effect and do not seem to delay the progression of the condition. They may, however, reduce motor fluctuations although more information is needed to be certain of this. Although they can cause some side-effects, these are generally mild.
Abstract: Five studies (182 children) met the inclusion criteria, and four contributed data to at least one meta-analysis. The included studies were overall at low risk of bias, but our confidence in the evidence was generally low, mainly due to the small sample sizes. Treatment with IV MgSO4 reduced the odds of admission to hospital by 68% (odds ratio (OR) 0.32, 95% confidence interval (CI) 0.14 to 0.74; children = 115; studies = 3; I2 = 63%). This result was based on data from just three studies including 115 children. Meta-analysis for the secondary outcomes was extremely limited by paucity of data. We performed meta-analysis for the outcome 'return to the emergency department within 48 hours', which showed a very imprecise effect estimate that was not statistically significant (OR 0.40, 95% CI 0.02 to 10.30; children = 85; studies = 2; I2 = 0%). Side effects and adverse events were not consistently reported and meta-analysis was not possible, however few side effects or adverse events were reported. IV MgSO4 may reduce the need for hospital admission in children presenting to the ED with moderate to severe exacerbations of asthma, but the evidence is extremely limited by the number and size of studies. Few side effects of the treatment were reported, but the data were extremely limited.

Plain-language summary: We found five studies in children that compared an infusion of MgSO4 to a placebo infusion when other treatments had not relieved the attack (usually inhaled bronchodilators, steroids, and sometimes oxygen). These five studies included a total of 182 children. Only three of the studies reported the outcome we were most interested in, which was the need to be admitted to hospital. The studies were published between 1996 and 2000; these were the most current studies we could find when we searched in February 2016. Fewer children who had an infusion of MgSO4 needed to be admitted to hospital compared with placebo. In fact, for every five children treated with the MgSO4, one admission to hospital was prevented. However, the included studies were small, with only 115 children in the main analysis, and the results did vary, so we cannot be absolutely sure of the benefits and harms. As there were so few studies, we also could not tell whether the reduction in hospital admissions was associated with age, severity of the asthma exacerbation, or whether it made a difference what other treatments were given. There were no reports of harm when the children received MgSO4. The review therefore supports the use of MgSO4 in children, however it must be noted that the evidence for its use is very weak.
Abstract: Three trials with 102 participants were identified and met the criteria for inclusion in this review. These trials compared stilboestrol to placebo, sildenafil to placebo and ephedrine or etilefrine to placebo and ranged in duration from two weeks to six months. All of the trials were conducted in an outpatient setting in Jamaica, Nigeria and the UK. None of the trials measured our first primary outcome, detumescence but all three trials reported on the reduction in frequency of stuttering priapism, our second primary outcome. No significant effect of any of the treatments was seen compared to placebo. Immediate side effects were not found to be significantly different from placebo in the two trials where this information was reported. We considered the quality of evidence to be low to very low as all of the trials were at risk of bias and all had low participant numbers. There is a lack of evidence for the benefits or risks of the different treatments for both stuttering and fulminant priapism in sickle cell disease. This systematic review has clearly identified the need for well-designed, adequately-powered, multicentre randomised controlled trials assessing the effectiveness of specific interventions for priapism in sickle cell disease.

Plain-language summary: We found three trials set in Jamaica, Nigeria and the UK involving 102 people. In the trials, four different drug treatments (stilboestrol, sildenafil, ephedrine and etilefrine) were compared to placebo. The trials all looked at whether the treatments reduced how often attacks of priapism occurred. There was no difference between any of the treatments compared to placebo. Due to lack of evidence, we are not able to conclude the best treatment of priapism in sickle cell disease. More research is needed. We considered the quality of evidence to be low to very low as all of the trials were at risk of bias and all had low participant numbers.