GEM/cochrane-simplification huggingface dataset:
Abstract: We included 3684 patients from 53 studies. SEMS insertion was safer and more effective than plastic tube insertion. Thermal and chemical ablative therapy provided comparable dysphagia palliation but had an increased requirement for re-interventions and for adverse effects. Anti-reflux stents provided comparable dysphagia palliation to conventional metal stents. Some anti-reflux stents might have reduced gastro-oesophageal reflux and complications. Newly-designed double-layered nitinol (Niti-S) stents were preferable due to longer survival time and fewer complications compared to simple Niti-S stents. Brachytherapy might be a suitable alternative to SEMS in providing a survival advantage and possibly a better quality of life, and might provide better results when combined with argon plasma coagulation or external beam radiation therapy. Self-expanding metal stent insertion is safe, effective and quicker in palliating dysphagia compared to other modalities. However, high-dose intraluminal brachytherapy is a suitable alternative and might provide additional survival benefit with a better quality of life. Some anti-reflux stents and newly-designed stents lead to longer survival and fewer complications compared to conventional stents. Combinations of brachytherapy with self-expanding metal stent insertion or radiotherapy are preferable due to the reduced requirement for re-interventions. Rigid plastic tube insertion, dilatation alone or in combination with other modalities, and chemotherapy alone are not recommended for palliation of dysphagia due to a high incidence of delayed complications and recurrent dysphagia.

Plain-language summary: The review included randomised controlled studies comparing the use of different interventions to improve dysphagia among patients with inoperable or unresectable primary oesophageal cancer. To find new studies for this updated review, in January 2014 we searched, according to the Cochrane Upper Gastrointestinal and Pancreatic Diseases model, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and CINAHL; and major conference proceedings (up to January 2014). The review updates the previous version but still fails to present any obvious superiority of one technique over another among the different kinds of interventions. Self-expanding metal stents provided safer and more effective relief of dysphagia compared to rigid plastic stents. Other techniques like radiotherapy or brachytherapy were also suitable alternatives and might be favourable in improving quality of life and prolonging survival. Individual differences should be emphasised when the intervention type was determined. Half of the studies included in this review were of high quality. Most studies did not state the methods used to seek and report quality of life outcomes and adverse effects.
Abstract: We included five RCTs (733 women) comparing exercise with no active treatment, exercise with yoga and exercise with HT. The evidence was of low quality: Limitations in study design were noted, along with inconsistency and imprecision. In the comparison of exercise versus no active treatment (three studies, n = 454 women), no evidence was found of a difference between groups in frequency or intensity of vasomotor symptoms (SMD -0.10, 95% CI -0.33 to 0.13, three RCTs, 454 women, I2 = 30%, low-quality evidence). Nor was any evidence found of a difference between groups in the frequency or intensity of vasomotor symptoms when exercise was compared with yoga (SMD -0.03, 95% CI -0.45 to 0.38, two studies, n = 279 women, I2 = 61%, low-quality evidence). It was not possible to include one of the trials in the meta-analyses; this trial compared three groups: exercise plus soy milk, soy milk only and control; results favoured exercise relative to the comparators, but study numbers were small. One trial compared exercise with HT, and the HT group reported significantly fewer flushes in 24 hours than the exercise group (mean difference 5.8, 95% CI 3.17 to 8.43, 14 participants). None of the trials found evidence of a difference between groups with respect to adverse effects, but data were very scanty. Evidence was insufficient to show whether exercise is an effective treatment for vasomotor menopausal symptoms. One small study suggested that HT is more effective than exercise. Evidence was insufficient to show the relative effectiveness of exercise when compared with HT or yoga.

Plain-language summary: Five studies randomly assigned 762 women experiencing hot flushes/night sweats. Three trials and two trials, respectively, were included in pooled comparisons of exercise versus control (n = 454 women) and exercise versus yoga (n = 279 women). One small study (14 women) compared exercise versus hormone therapy. When exercise was compared with no intervention, no evidence was found of any difference in their effect on hot flushes. One small study suggested that HT is more effective than exercise. Evidence was insufficient to show whether exercise was more effective than yoga. None of the trials found any evidence of differences between groups with respect to adverse effects, but data were very scanty. The methodological quality of the studies was variable. We assessed the evidence as of low quality: The main limitations were poor reporting of study methods, inconsistent results and lack of precision.
Abstract: Four trials, in which a total of 1800 infants participated, compared oral/topical non-absorbed antifungal prophylaxis (nystatin or miconazole) with placebo or no drug. These trials had various methodological weaknesses including quasi-randomisation, lack of allocation concealment, and lack of blinding of intervention and outcomes assessment. The incidence of invasive fungal infection was very high in the control groups of three of these trials. Meta-analysis found a statistically significant reduction in the incidence of invasive fungal infection (typical risk ratio 0.20, 95% confidence interval 0.14 to 0.27; risk difference −0.18, −0.21 to −0.15) but substantial statistical heterogeneity was present. We did not find a statistically significant effect on mortality (typical risk ratio 0.87, 0.72 to 1.05; risk difference −0.03, −0.06 to 0.01). None of the trials assessed posthospital discharge outcomes. Three trials (N = 326) assessed the effect of oral/topical non-absorbed versus systemic antifungal prophylaxis. Meta-analyses did not find any statistically significant differences in the incidences of invasive fungal infection or all-cause mortality. The finding of a reduction in risk of invasive fungal infection in very low birth weight infants treated with oral/topical non-absorbed antifungal prophylaxis should be interpreted cautiously because of methodological weaknesses in the included trials. Further large randomised controlled trials in current neonatal practice settings are needed to resolve this uncertainty. These trials might compare oral/topical non-absorbed antifungal agents with placebo, with each other, or with systemic antifungal agents and should include an assessment of effect on long-term neurodevelopmental outcomes.

Plain-language summary: Study characteristics: Four trials, in which a total of 1800 infants participated, examined whether giving VLBW infants a drug to prevent fungi growing on the skin or in the gut reduced the risk of bloodstream or other severe infection. The trials used one of two commonly available drugs (nystatin or miconazole) and compared these with either a placebo ("dummy" drug) or no drug. These trials, however, had some design weaknesses that make it less certain that their results can be taken at face value. Key results: The overall analysis suggested that this treatment might reduce severe infection rates in VLBW infants but there was no evidence of a reduction in the risk of dying. Conclusions: Larger and higher quality trials are needed to resolve this uncertainty.
Abstract: We included four trials with 271 patients undergoing open liver resections. The patients were randomised to ischaemic preconditioning (n = 135) and no ischaemic preconditioning (n = 136) prior to continuous vascular occlusion (portal triad clamping in three trials and hepatic vascular exclusion in one trial). All the trials excluded cirrhotic patients. We assessed all the four trials as having high risk of bias. There was no difference in mortality, liver failure, other peri-operative morbidity, hospital stay, intensive therapy unit stay, and operating time between the two groups. The proportion of patients requiring blood transfusion was lower in the ischaemic preconditioning group. There was also a trend towards a lower amount of red cell transfusion favouring ischaemic preconditioning group. There was no difference in the haemodynamic changes, blood loss, bilirubin, or prothrombin activity between the two groups. The enzyme markers of liver injury were lower in the ischaemic preconditioning group on the first post-operative day. Currently, there is no evidence to suggest a protective effect of ischaemic preconditioning in non-cirrhotic patients undergoing liver resection under continuous vascular occlusion. Ischaemic preconditioning reduces the blood transfusion requirements in patients undergoing liver resection.

Plain-language summary: The aim of this review was to assess the role of ischaemic preconditioning in liver resections performed utilising vascular occlusion. Four randomised clinical trials including 271 patients undergoing open liver resections fulfilled the inclusion criteria of this review. The patients were randomised to ischaemic preconditioning (n = 135) and no ischaemic preconditioning (n = 136) prior to continuous vascular occlusion. All the trials excluded cirrhotic patients. We assessed all the four trials as having high risk of bias (high risk of systematic error). There was no difference in mortality, liver failure, post-operative complications, hospital stay, intensive therapy unit stay, and operating time between the two groups. The proportion of patients requiring blood transfusion was lower in the ischaemic preconditioning group. The reasons for this are not clear. There was no difference in blood loss or enzyme markers of liver function between the two groups. The enzyme markers of liver injury were lower in the ischaemic preconditioning group on the first post-operative day. Currently, there is no evidence to suggest a protective effect of ischaemic preconditioning in non-cirrhotic patients undergoing liver resection under continuous vascular occlusion. Ischaemic preconditioning reduces the blood transfusion requirements in patients undergoing liver resection. Further high quality randomised clinical trials are necessary to assess the role of ischaemic preconditioning. Further studies are necessary to understand the mechanism of ischaemic preconditioning.
Abstract: A total of 75 trials were included. Overall, the use of cell salvage reduced the rate of exposure to allogeneic RBC transfusion by a relative 38% (RR 0.62; 95% CI 0.55 to 0.70). The absolute reduction in risk (ARR) of receiving an allogeneic RBC transfusion was 21% (95% CI 15% to 26%). In orthopaedic procedures the RR of exposure to RBC transfusion was 0.46 (95% CI 0.37 to 0.57) compared to 0.77 (95% CI 0.69 to 0.86) for cardiac procedures. The use of cell salvage resulted in an average saving of 0.68 units of allogeneic RBC per patient (WMD -0.68; 95% CI -0.88 to -0.49). Cell salvage did not appear to impact adversely on clinical outcomes. The results suggest cell salvage is efficacious in reducing the need for allogeneic red cell transfusion in adult elective cardiac and orthopaedic surgery. The use of cell salvage did not appear to impact adversely on clinical outcomes. However, the methodological quality of trials was poor. As the trials were unblinded and lacked adequate concealment of treatment allocation, transfusion practices may have been influenced by knowledge of the patients' treatment status potentially biasing the results in favour of cell salvage.

Plain-language summary: The authors found 75 studies investigating the effectiveness of cell salvage in orthopaedic (36 studies), cardiac (33 studies), and vascular (6 studies) surgery. Overall, the findings show that cell salvage reduces the need for transfusions of donated blood. The authors conclude that there appears to be sufficient evidence to support the use of cell salvage in cardiac and orthopaedic surgery. Cell salvage does not appear to cause any adverse clinical outcomes. As the methodological quality of the trials was poor, the findings may be biased in favour of cell salvage. Large trials of high methodological quality that assess the relative effectiveness, safety, and cost-effectiveness of cell salvage in different surgical procedures should be the focus of future research in this area.
Abstract: Four studies involving 971 participants were included. All results were reported using a zero to 10 pain scale. Three studies (four treatment arms) involving 498 participants compared subcutaneous lignocaine with control with no significant difference between pain scores; MD 0.12 (95% confidence interval (CI) -0.46 to 0.69). Two studies (three treatment arms) involving 399 participants compared intravenous pain regimens with control. A significant reduction in pain score was observed with intravenous opioid and anxiolytic; MD -0.90 (95% CI -1.54 to -0.27). One study involving 60 participants compared levobupivacaine with placebo. Longer-acting local anaesthetic significantly lowered the pain score by a MD of -1.10 (95% CI -1.26 to -0.94). The data are insufficient to identify any influence of pain regimens on vascular and procedural complication rates. No studies reported appropriate blinding for all treatment arms. The largest study, comprising 661 participants, was unblinded with a quality score of two out of five. No new studies have been found since the last version of this review and the conclusions therefore remain the same. Intravenous pain regimens and levobupivacaine may have greater efficacy when compared to control for the management of pain related to femoral sheath removal. However, a definitive study is still required because the clinical difference is small. There is no evidence to support the use of subcutaneous lignocaine. There is insufficient evidence to determine if pain relief influences the rate of complications. One new study has been included as a 'study awaiting assessment' as we await further information from the study authors.

Plain-language summary: In this systematic review of randomised controlled trials four studies were reviewed. Three studies involving 498 participants compared subcutaneous lignocaine, a short-acting local anaesthetic, with a control group (participants received either no pain relief or an inactive substance known as a placebo). Two studies involving 399 people compared intravenous opioids (fentanyl or morphine) and an anxiolytic (midazolam) with a control group. One study involving 60 people compared subcutaneous levobupivacaine, a long-acting local anaesthetic, with a control group. Intravenous pain regimens and subcutaneous levobupivacaine appear to reduce the pain experienced during femoral sheath removal. However, the size of the reduction was small. A significant reduction in pain was not experienced by participants who received subcutaneous lignocaine or who were in the control group. There were insufficient data to determine a correlation between pain relief administration and either adverse events or complications. Some patients may benefit from routine pain relief using levobupivacaine or intravenous pain regimens. Identifying who may potentially benefit from pain relief requires clinical judgement and consideration of patient preference. The mild level of pain generally experienced during this procedure should not influence the decision as some people can experience moderate levels of pain with the conventional wound care.
Abstract: Only one quasi-randomized controlled study with 121 study participants comparing two types of IPC devices met the inclusion criteria. The authors found no cases of symptomatic DVT or PE in either the calf-thigh compression group or the plantar compression group during the first three weeks after the THR. The calf-thigh pneumatic compression was more effective than plantar compression for reducing thigh swelling during the early postoperative stage. The strength of the evidence in this review is weak as only one trial was included and it was classified as having a high risk of bias. There is a lack of evidence from randomized controlled trials to make an informed choice of IPC device for preventing venous thromboembolism (VTE) following total hip replacement. More research is urgently required, ideally a multicenter, properly designed RCT including a sufficient number of participants. Clinically relevant outcomes such as mortality, imaging-diagnosed asymptomatic VTE and major complications must be considered.

Plain-language summary: We looked for randomized controlled trials which compared different types of IPC devices for preventing venous thromboembolism in patients after THR. We found one study with 121 participants comparing a calf-thigh compression device with a foot (plantar) compression device. There were no cases of symptomatic DVT or PE either in the calf-thigh compression group or the plantar compression group in the first three weeks after the THR. The calf-thigh pneumatic compression was more effective than plantar compression for reducing thigh swelling one week following surgery. The postoperative swelling in the calf-thigh pump group was reduced earlier than in the plantar pump group. However, other outcomes such as imaging-diagnosed asymptomatic VTE were not determined and it is not possible to draw reliable conclusions from this single study with a high risk of bias. We therefore suggest that more primary research is required to allow an informed choice of IPC device for preventing venous thromboembolism following THR.
Abstract: No additional studies were included or excluded in the updated review. Twenty papers detailing 18 trials were considered. Only three trials were randomised controlled trials and were included in the review. The remaining fifteen studies were excluded for various reasons. All three included trials had a small sample size and reported the trial design, outcome measures and analysis poorly. There were also variations in the outcome measures used between the trials. In addition, there was no consistency on the reporting of mean and medians for blood loss during the operation. It was therefore not possible to pool the data to perform meta-analysis. However, the reported blood loss when using a tourniquet was between 0 and 16 ml compared to between 107 to 133 ml when not using a tourniquet (P < 0.01). Although there were significant quality issues with the available evidence, the use of a tourniquet would appear to reduce blood loss during surgery. There were no reported differences between the use or non-use of a tourniquet in terms of complications and morbidity. However, the available trials were not of sufficient size to detect rarer complications such as nerve damage.

Plain-language summary: This review found that the amount of blood loss was clearly reduced when a tourniquet was used during surgery for varicose veins, with no overall increase in operative time, reported adverse events or change in patient reported pain and activity after surgery. Three trials were included in the review, in which a total of 176 men and women (211 legs) were randomised to either use or non-use of a tourniquet. All trials took place in the UK between 1989 and 2000. Those patients who did not have a tourniquet had a wider range of total blood loss and patients in the upper limits lost a significant amount of blood. A reduction in blood loss may also result in a reduction in post-operative bruising but only one of the trials (50 patients) looked at this. It found a clear reduction in the area of bruising with the use of a tourniquet. The trials did not have a large enough number of participants to determine any rarer complications of surgery with the use of a tourniquet such as nerve damage or arterial injury, especially in older patients.
Abstract: One hundred and twenty one trials with 6700 participants were included. In most trials, PRT was performed two to three times per week and at a high intensity. PRT resulted in a small but significant improvement in physical ability (33 trials, 2172 participants; SMD 0.14, 95% CI 0.05 to 0.22). Functional limitation measures also showed improvements: e.g. there was a modest improvement in gait speed (24 trials, 1179 participants, MD 0.08 m/s, 95% CI 0.04 to 0.12); and a moderate to large effect for getting out of a chair (11 trials, 384 participants, SMD -0.94, 95% CI -1.49 to -0.38). PRT had a large positive effect on muscle strength (73 trials, 3059 participants, SMD 0.84, 95% CI 0.67 to 1.00). Participants with osteoarthritis reported a reduction in pain following PRT(6 trials, 503 participants, SMD -0.30, 95% CI -0.48 to -0.13). There was no evidence from 10 other trials (587 participants) that PRT had an effect on bodily pain. Adverse events were poorly recorded but adverse events related to musculoskeletal complaints, such as joint pain and muscle soreness, were reported in many of the studies that prospectively defined and monitored these events. Serious adverse events were rare, and no serious events were reported to be directly related to the exercise programme. This review provides evidence that PRT is an effective intervention for improving physical functioning in older people, including improving strength and the performance of some simple and complex activities. However, some caution is needed with transferring these exercises for use with clinical populations because adverse events are not adequately reported.

Plain-language summary: Evidence from 121 randomised controlled trials (6,700 participants) shows that older people who exercise their muscles against a force or resistance become stronger. They also improve their performance of simple activities such as walking, climbing steps, or standing up from a chair more quickly. The improvement in activities such as getting out of a chair or stair climbing is generally greater than walking speed. Moreover, these strength training exercises also improved older people's physical abilities, including more complex daily activities such as bathing or preparing a meal. PRT also reduced pain in people with osteoarthritis. There was insufficient evidence to comment on the risks of PRT or long term effects.