GEM/cochrane-simplification huggingface dataset:
Abstract: We found 16 small RCTs (fewer than 100 patients enrolled) and 2 larger RCTs (more than 100 patients enrolled). These 18 studies looked at a total of 916 patients treated with a total of 12 different pharmaceutical agents. Overall methodology of the studies was poor, in part because of ethical dilemmas such as giving placebo injections to children. Two studies showed that placebo was not as good as active treatment in resolving the spasms. The strongest evidence suggested that hormonal treatment (prednisolone or tetracosactide depot) leads to resolution of spasms faster and in more infants than does vigabatrin. Responses without subsequent relapse may be no different. The same study suggests that hormonal treatments might improve the long-term developmental outcome compared with vigabatrin in infants not found to have an underlying cause for their infantile spasms. To date, few well-designed RCTs have considered the treatment of infantile spasms, and the numbers of patients enrolled have been small. In the majority, methodology has been poor, hence it is not clear which treatment is optimal in the treatment of this epilepsy syndrome. Hormonal treatment resolves spasms in more infants than vigabatrin, but this may or may not translate into better long-term outcomes. If prednisolone or vigabatrin is used, high dosage is recommended. Vigabatrin may be the treatment of choice in tuberous sclerosis. Resolution of the EEG features may be important, but this has not been proven. Further research using large studies with robust methodology is required.

Plain-language summary: The optimum treatment for infantile spasms has yet to be proven with confidence, in part because of the different aims of existing studies. However, some useful conclusions can be drawn from current evidence. Infantile spasms is a rare seizure disorder commonly associated with severe learning difficulties. Many different treatments are currently used worldwide in the treatment of this disorder, and many more have been tried in the past, often with little success. Not all treatments are licensed for use in all countries. Most treatments are associated with significant adverse effects. Additional research is needed to explore the long-term benefits of different therapies for seizure control and for neurodevelopment. Two studies have shown that a placebo is not as good as an active treatment in resolving the spasms. The strongest evidence suggests that hormonal treatment (prednisolone or tetracosactide depot) leads to resolution of spasms faster and in more infants than does vigabatrin. Responses without subsequent relapse may be no different, but one study suggested that hormonal treatment (prednisolone or tetracosactide) might improve long-term neurodevelopmental outcomes in infants and young children for whom no underlying cause for their infantile spasms has been identified. This makes hormonal treatment more attractive, at least for this group of infants. More information and further research are needed to compare currently available therapies.
Abstract: Three studies were eligible for inclusion (n = 339), all of which used agonist protocols. Neither live birth rate nor adverse events were reported by any of the included studies. There was insufficient evidence to determine whether there was a difference in the clinical pregnancy rate between the group who underwent ovarian cyst aspiration and the conservatively managed group (OR 1.19, 95% CI 0.33 to 4.29, two RCTs, 159 women, I2 = 0%, very low quality evidence). This suggested that if the clinical pregnancy rate in women with conservative management was assumed to be 6%, the chance following cyst aspiration would be between 2% and 22%. There was no evidence of a difference between the groups in the mean number of follicles recruited (0.55 follicles, 95% CI -0.48 to 1.59, 2 studies, 159 women, I2 = 0%, very low quality evidence) mean number of oocytes collected (0.41 oocytes, 95% CI -0.04 to 0.85, 3 studies, 339 women, I2 = 0%, low quality evidence) or cancellation rate (OR 0.99, 95% CI 0.42 to 2.33, one RCT, 122 women, very low quality evidence). The main limitations of the evidence were imprecision, risk of bias associated with poor reporting of study methods, and inconsistent reporting of study findings in one RCT which meant that some of the data could not be used. There is insufficient evidence to determine whether drainage of functional ovarian cysts prior to controlled ovarian hyperstimulation influences rates of live birth, clinical pregnancy, number of follicles recruited, or number of oocytes collected in women with a functional ovarian cyst. The findings of this review do not provide supportive evidence for this approach, particularly in view of the requirement for anaesthesia, extra cost, psychological stress and risk of surgical complications.

Plain-language summary: Three randomized controlled trials were included involving 339 women of reproductive age who required IVF treatment due to tubal factor infertility, anovulation, male factor infertility, endometriosis or fertility of unknown cause. These studies compared the outcome of IVF cycles in women whose cyst was drained versus the outcomes when the cyst was not drained. The evidence was current to April 2014. None of the included studies reported live birth rates or adverse event rates. There was insufficient evidence to determine whether there was any difference in the pregnancy rate, the number of follicles recruited, or the number of eggs retrieved, between women who had their cyst drained and women who did not. The quality of the evidence was low or very low for all comparisons, the main reasons for this being small study numbers, low numbers of events and poor reporting of study methods. There was inconsistent reporting of study findings in one RCT, which meant that some of the data could not be used
Abstract: Ten randomized controlled trials, all involving children only (total of 1417 children), fulfilled the inclusion criteria. The same investigator was involved in nine of the trials. Seven trials compared proprietary intrarectal with intravenous quinine, and seven trials compared it with intramuscular treatment. We detected no statistically significant difference between intrarectal and intravenous or intramuscular routes for death, parasite clearance by 48 hours and seven days, parasite clearance time, fever clearance time, coma recovery time, duration of hospitalization, and time to drinking. The trials reporting on these outcomes were small, which resulted in large confidence intervals for all outcomes apart from duration of hospitalization. One large trial (898 children) reported that intrarectal was less painful than intramuscular administration. We detected no difference in the effect on parasites and clinical illness for intrarectal quinine, but most trials were small. Pain may be less with intrarectal proprietary, buffered quinine preparations (made less acidic by adjustment of the pH to 4.5). Further larger trials in patients with severe malaria and in adults are required before the intrarectal route can be recommended.

Plain-language summary: The data reviewed also lead to the conclusion that a diluted proprietary quinine solution (made less acidic by adjustment to a pH of 4.5) given intrarectally using a syringe for two to three days has less harmful effects compared with intramuscular quinine given for the same time period. Administration of intrarectal quinine (made less acidic by adjustment to a pH of 4.5) is significantly less painful than intramuscular injection of quinine. More trials are needed for patients with severe malaria and in adults.
Abstract: A total of 1437 adult patients participated in the five randomized parallel group studies, with treatment durations ranging from 8 to 16 weeks. The daily doses of eplerenone ranged from 25 mg to 400 mg daily. Meta-analysis of these studies showed a reduction in systolic blood pressure of 9.21 mmHg (95% CI −11.08 to −7.34; I2 = 58%) and a reduction of diastolic pressure of 4.18 mmHg (95% CI −5.03 to −3.33; I2 = 0%) (moderate quality evidence). There may be a dose response effect for eplerenone in the reduction in systolic blood pressure at doses of 400 mg/day. However, this finding is uncertain, as it is based on a single included study with low quality evidence. Overall there does not appear to be a clinically important dose response in lowering systolic or diastolic blood pressure at eplerenone doses of 50 mg to 400 mg daily. There did not appear to be any differences in the number of patients who withdrew due to adverse events or the number of patients with at least one adverse event in the eplerenone group compared to placebo. However, only three of the five included studies reported adverse events. Most of the included studies were of moderate quality, as we judged multiple domains as being at unclear risk in the 'Risk of bias' assessment. Eplerenone 50 to 200 mg/day lowers blood pressure in people with primary hypertension by 9.21 mmHg systolic and 4.18 mmHg diastolic compared to placebo, with no difference of effect between doses of 50 mg/day to 200 mg/day. A dose of 25 mg/day did not produce a statistically significant reduction in systolic or diastolic blood pressure and there is insufficient evidence for doses above 200 mg/day. There is currently no available evidence to determine the effect of eplerenone on clinically meaningful outcomes such as mortality or morbidity in hypertensive patients. The evidence available on side effects is insufficient and of low quality, which makes it impossible to draw conclusions about potential harm associated with eplerenone treatment in hypertensive patients.

Plain-language summary: The doses of eplerenone used in these studies ranged from 25 mg to 400 mg daily. These studies followed patients for 8 to 16 weeks while on therapy. None of the studies reported on the clinically meaningful outcomes of eplerenone, such as whether eplerenone can reduce heart attacks, stroke, or death compared to placebo. Only three of the five studies reported on side effects. There is currently no evidence that eplerenone has a beneficial effect on life expectancy or complications rleated to hypertension (e.g. heart attack, stroke). Evidence for risk of side effects with eplerenone is limited and of poor quality; it is difficult to tell the extent of possible harm with eplerenone versus placebo. This meta-analysis shows that eplerenone 50 to 200 mg/day reduces systolic blood pressure by approximately 9 mmHg and diastolic blood pressure by 4 mmHg compared to taking no medication. We judged the five included trials to be of moderate quality, as authors did not extensively describe portions of their methodology.
Abstract: The only loop diuretic used in the six studies that met the selection criteria was furosemide. Most studies focused on pathophysiological parameters and did not assess effects on important clinical outcomes defined in this review, or the potential complications of diuretic therapy.  In preterm infants < 3 weeks of age developing CLD, furosemide administration has either inconsistent effects or no detectable effect.   In infants > 3 weeks of age with CLD, a single intravenous dose of 1 mg/kg of furosemide improves lung compliance and airway resistance for one hour. Chronic administration of furosemide improves both oxygenation and lung compliance. In view of the lack of data from randomized trials concerning effects on important clinical outcomes, routine or sustained use of systemic loop diuretics in infants with (or developing) CLD cannot be recommended based on current evidence.   Randomized trials are needed to assess the effects of furosemide administration on survival, duration of ventilatory support and oxygen administration, length of hospital stay, potential complications and long-term outcome.

Plain-language summary: The review analysed the effects of diuretics working on the deep part of the small kidney tubes (loop diuretics). The review of trials found that diuretics, given from a single dose to one week's treatment, inconsistently improved lung function and oxygen levels in the blood. There was not enough evidence to show any improvement in long-term outcome.
Abstract: Five trials involving a total of 3510 patients were included. The quality of the trials did not vary considerably. Sensitivity/subgroups analysis was not completely performed because of lack of data. Lubeluzole given at the doses of 5, 10 and 20 mg/day for five days was tested against a placebo-control group. There was no evidence that lubeluzole given at any dose either reduced the odds of death from all causes (odds ratio (OR) 0.93, 95% confidence interval (CI) 0.79 to 1.09) or reduced the odds of being dead or dependent at the end of follow up (OR 1.04, 95% CI 0.91 to 1.19). On the other hand, given at any dose, lubeluzole was associated with a significant excess of heart-conduction disorders (Q-T prolonged > 450 msec) at the end of follow up (OR 1.43, 95% CI 1.09 to 1.87). Lubeluzole, given in the acute phase of ischaemic stroke, is not associated with a significant reduction of death or dependency at the end of scheduled follow-up period but seems to be associated with a significant increase of heart-conduction disorders (Q-T prolonged > 450 msec).

Plain-language summary: The review focuses on the effects of lubeluzole, an inhibitor of excitatory amino acids. The review of trials did not find any benefit of lubeluzole in humans either to prevent death after acute ischaemic stroke or to reduce disability from it. Moreover, lubeluzole may cause heart-conduction disorders.
Abstract: Where trials with important co-interventions were excluded, there was no significant difference in the odds of beneficial outcomes for oral versus injectable ovulation induction agents - live birth per couple (OR 0.06, 95%CI 0.00 to 1.15), pregnancy per woman (OR 0.33, 95%CI 0.09 to 1.20); nor of detrimental outcomes for injectable versus oral agents - miscarriage (OR 0.11, 95%CI 0.00 to 2.84); there were no reported cases of multiple births, cases of ovarian hyperstimulation or discontinued cycles consequent upon overstimulation. Where trials with the co-intervention of a human chorionic gonadotrophin trigger injection (given only in the injectable ovulation induction agent treatment arm) were not excluded there was no significant difference in the odds of live birth per couple (OR 0.40, 95%CI 0.15 to1.08). However oral ovulation induction agents had significantly reduced odds of pregnancy per woman compared to injectable ovulation induction agents (OR 0.41, 95%CI 0.17 to 0.80). For detrimental outcomes, there were no significant differences in the odds of miscarriage (OR 0.61, 95%CI 0.09 to 4.01) and multiple birth (OR 1.08, 95%CI 0.16 to 7.03) for injectable versus oral agents. No data were available concerning the occurrence of ovarian hyperstimulation syndrome nor cycle cancellation. There is insufficient evidence to suggest that oral agents are inferior or superior to injectable agents in the treatment of unexplained subfertility. Information on harms is sketchy, and remains compatible with large differences in either direction. Much larger trials than have previously been undertaken are required to provide information on relative harms as well as benefits.

Plain-language summary: This review of trials looked at which type of these medications, oral-form or injection-form, were the best in producing the most successful outcome. The review found no significant benefit of using one type of medication (oral or injectable) over the other, although there were insufficient data from trials. More research is needed to examine this question.
Abstract: Thirty-nine randomised controlled trials involving a total of 3475 women were included in the review. A number of the trials were of small sample size and poor methodological quality. Results for Chinese herbal medicine compared to placebo were unclear as data could not be combined (3 RCTs). Chinese herbal medicine resulted in significant improvements in pain relief (14 RCTs; RR 1.99, 95% CI 1.52 to 2.60), overall symptoms (6 RCTs; RR 2.17, 95% CI 1.73 to 2.73) and use of additional medication (2 RCTs; RR 1.58, 95% CI 1.30 to 1.93) when compared to use of pharmaceutical drugs. Self-designed Chinese herbal formulae resulted in significant improvements in pain relief (18 RCTs; RR 2.06, 95% CI 1.80 to 2.36), overall symptoms (14 RCTs; RR 1.99, 95% CI 1.65 to 2.40) and use of additional medication (5 RCTs; RR 1.58, 95% CI 1.34 to 1.87) after up to three months of follow-up when compared to commonly used Chinese herbal health products. Chinese herbal medicine also resulted in better pain relief than acupuncture (2 RCTs; RR 1.75, 95% CI 1.09 to 2.82) and heat compression (1 RCT; RR 2.08, 95% CI 2.06 to 499.18). The review found promising evidence supporting the use of Chinese herbal medicine for primary dysmenorrhoea; however, results are limited by the poor methodological quality of the included trials.

Plain-language summary: The review found promising evidence for the use of Chinese herbal medicine in reducing menstrual pain in the treatment of primary dysmenorrhoea, compared to conventional medicine such as NSAIDs and the oral contraceptive pill, acupuncture and heat compression. No significant adverse effects were identified in this review. However the findings should be interpreted with caution due to the generally low methodological quality of the included studies.
Abstract: We included 33 trials enrolling 2973 children with acute diarrhoea. Twenty-nine trials were exclusively conducted on inpatients, all from high- or middle-income countries. Fifteen trials included children aged below 12 months, and 22 excluded children who were being breast-fed. Compared to lactose-containing milk, milk products, or foodstuffs, lactose-free products may reduce the duration of diarrhoea by an average of about 18 hours (MD -17.77, 95% CI -25.32 to -10.21, 16 trials, 1467 participants, low quality evidence). Lactose-free products probably also reduce treatment failure (defined variously as continued or worsening diarrhoea or vomiting, the need for additional rehydration therapy, or continuing weight loss) by around a half (RR 0.52, 95% CI 0.39 to 0.68, 18 trials, 1470 participants, moderate quality evidence). Diluted lactose-containing milk has not been shown to reduce the duration of diarrhoea compared to undiluted milk or milk products (five trials, 417 participants, low quality evidence), but may reduce the risk of treatment failure (RR 0.65, 95% CI 0.45 to 0.94, nine trials, 687 participants, low quality evidence). In young children with acute diarrhoea who are not predominantly breast-fed, change to a lactose-free diet may result in earlier resolution of acute diarrhoea and reduce treatment failure. Diluting lactose-containing formulas may also have some benefits but further trials are required to have confidence in this finding. There are no trials from low-income countries, where mortality for diarrhoea is high, and malnutrition is more common.

Plain-language summary: We looked for research up to 13 May 2013 and included 33 trials in our analyses. Twenty-two trials compared outcomes for children given a lactose-free feed with those for children given a lactose-containing feed and 11 trials compared outcomes for children fed a diluted milk feed with those for children given an undiluted milk feed. We found evidence that feeds that do not contain lactose may reduce the duration of diarrhoea by an average of about 18 hours (low quality evidence). Lactose-free feeds probably lower the risk of children having prolonged or worsening diarrhoea (moderate quality evidence). We did not find any evidence that diluted milk feeds reduce the duration of diarrhoea (low quality evidence) but these feeds may lower the risk of children having prolonged or worsening diarrhoea (low quality evidence). The majority of trials excluded breast fed infants, and none were conducted in low-income countries where diarrhoea can cause death, so the review is relevant to infants and young children who are receiving formula or are weaned in high- and middle-income countries.
Abstract: Five trials were included in comparison one (antidepressants versus psychological treatments), five in comparison two (antidepressants versus the combination) and seven in comparison three (psychological treatments versus the combination). Remission rates were 20% for single antidepressants compared to 39% for single psychotherapy (DerSimonian-Laird Relative Risk = 1.28; 95% Confidence Interval = 0.98;1.67). Dropout rates were higher for antidepressants than for psychotherapy (DerSimonian-Laird Relative Risk = 2.18; 95% Confidence Interval = 1.09;4.35). The NNH for a mean treatment duration of 17.5 weeks was 4 (95% confidence interval = 3;11). Comparison two found remission rates of 42% for the combination versus 23% for antidepressants (DerSimonian-Laird Relative Risk = 1.38; 95% Confidence Interval = 0.98;1.93). Comparison three showed a 36% pooled remission rate for psychological approaches compared to 49% for the combination (DerSimonian-Laird Relative Risk = 1.21; 95% Confidence Interval = 1.02;1.45). The NNT for a mean treatment duration of 15 weeks was 8 (95% Confidence Interval = 4;320). Dropout rates were higher for the combination compared to single psychological treatments (DerSimonian-Laird Relative Risk = 0.57; 95% Confidence Interval = 0.38;0.88). The NNH was 7 (95% Confidence Interval = 4;21). Using a more conservative statistical approach, combination treatments were superior to single psychotherapy. This was the only statistically significant difference between treatments. The number of trials might be insufficient to show the statistical significance of a 19% absolute risk reduction in efficacy favouring psychotherapy or combination treatments over single antidepressants. Psychotherapy appeared to be more acceptable to subjects. When antidepressants were combined with psychological treatments, acceptability of the latter was significantly reduced.

Plain-language summary: Psychotherapeutic approaches, mainly cognitive behavior therapy, and antidepressant medication are the two treatment modalities that have received most support in controlled outcome studies of bulimia nervosa. Using a more conservative statistical approach, combination treatments were superior to single psychotherapy. This was the only statistically significant difference between treatments. The number of trials might be insufficient to show the statistical significance of a 19% absolute risk reduction in efficacy favouring psychotherapy or combination treatments over single antidepressants. Psychotherapy appeared to be more acceptable to subjects. When antidepressants were combined with psychological treatments, acceptability of the latter was significantly reduced.