archive-org.com » ORG » C » CLINICALEVIDENCE.ORG

Total: 95

Choose link from "Titles, links and description words view":

Or switch to "Titles and links view".
  • Overview - Out-of-hospital cardiac arrest in adults: lowering body temperature
    been proposed that earlier induction of hypothermia may have a positive impact on clinical outcomes Historically therapeutic hypothermia has been viewed as a valuable treatment relative to other important interventions such as glucose control goal directed haemodynamic management oxygenation ventilation and PCI 1 Top Comments on evidence Numerous studies have examined therapeutic hypothermia compared to normothermia Many studies utilised conventional cooling methods for attainment of hypothermia and only one study used haemofiltration The likely higher health care costs and intensive resources required for haemofiltration are important to bear in mind Two RCTs evaluated pre hospital cooling with cold IV fluids compared to standard care or in hospital cooling There was significant variability in the amount of IV fluids given in the pre hospital setting therefore it is difficult to interpret the results In the pre hospital setting it is likely to be an on going difficulty to consistently initiate therapeutic hypothermia due to variables of transport time staff resources and re arrest events in the ambulance We found one RCT the largest multi centre RCT to date aimed at determining whether one lower body temperature was better than another Unlike in other studies which mainly focused on ventricular fibrillation and pulseless ventricular tachycardia only the authors of this study included all initial rhythms in their cardiac arrest protocols They had broader inclusion criteria in comparison to previous trials which makes their results more generalisable to a diverse patient population However the ideal length of time for targeted temperature management remains unclear Top Search and appraisal summary The update literature search for this overview was carried out from the date of the last search February 2010 to November 2014 A back search from 1966 was performed for the new options added to the scope at this update For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview please see the Methods section Searching of electronic databases retrieved 222 studies After deduplication and removal of conference abstracts 114 records were screened for inclusion in the overview Appraisal of titles and abstracts led to the exclusion of 89 studies and the further review of 25 full publications Of the 25 full articles evaluated one systematic review included in a previous version was updated and three RCTs were added at this update Top Additional information Therapeutic hypothermia is a resource intensive intervention It requires higher multi disciplinary staff resources higher intensity of monitoring and potential management of adverse effects The complexity of this procedure would make it difficult to effectively initiate in the pre hospital setting due to limited staff resources It should be noted that hypothermia can lead to coagulopathy sepsis severe electrolyte abnormalities cardiac dysfunction and prolonged ICU stays Therefore induced hypothermia cannot be regarded as being without risk Top Substantive changes at this update Therapeutic hypothermia targeted temperature management with or without standard therapy including anti arrhythmics One systematic review updated 7 and one RCT 9 added Categorisation unchanged likely

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/0216/overview.html (2016-02-01)
    Open archived version from archive

  • Overview - Essential tremor
    of drug treatments Many of the trials we found were small short term and were crossover in design In addition most of the trials were old with few published recently Top Search and appraisal summary The update literature search for this overview was carried out from the date of the last search December 2006 to January 2014 For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview please see the Methods section Searching of electronic databases retrieved 56 studies After deduplication and removal of conference abstracts 31 records were screened for inclusion in the overview Appraisal of titles and abstracts led to the exclusion of 18 studies and the further review of 13 full publications Of the 13 full articles evaluated two RCTs were added at this update Top Additional information All medications have a trade off between benefit and side effects For example propranolol can cause depression and hypotension primidone can cause problems with initial titration and the side effects can be difficult to manage and alprazolam has abuse potential Adverse effects may be particularly difficult to manage in older patients Propranolol and primidone are recommended in clinical guidelines as the first line pharmacological therapy for essential tremor but still a significant portion of patients might not respond There are also multiple medications that have not been found beneficial for tremor More effective pharmacological therapy is needed Top Substantive changes at this update Alprazolam New option Two RCTs added that were included in a previous version of this overview 8 9 Categorised as unknown effectiveness Beta blockers other than propranolol Evidence re evaluated No new evidence found Categorisation unchanged unknown effectiveness Botulinum A toxin haemagglutinin complex Evidence re evaluated Categorisation unchanged trade off between benefits and harms Clonazepam New option One RCT added that was included in a previous version of this overview 23 Categorised as unknown effectiveness Diazepam New option No evidence found Categorised as unknown effectiveness Gabapentin Evidence re evaluated No new evidence found Categorisation unchanged unknown effectiveness Levetiracetam New option Two RCTs added 27 28 Categorised as unknown effectiveness Lorazepam New option No evidence found Categorised as unknown effectiveness Phenobarbital Evidence re evaluated No new evidence found Categorisation changed from trade off between benefits and harms to unknown effectiveness Primidone Evidence re evaluated No new evidence found Categorisation changed from trade off between benefits and harms to likely to be beneficial Propranolol Evidence re evaluated No new evidence found Categorisation unchanged likely to be beneficial Sodium oxybate New option No evidence found Categorised as unknown effectiveness Topiramate Evidence re evaluated No new evidence found Categorisation unchanged trade off between benefits and harms All systematically reviewed interventions for Essential tremor Abstract INTRODUCTION Essential tremor is one of the most common movement disorders in the world with prevalence in the general population of 0 4 to 3 9 METHODS AND OUTCOMES We conducted a systematic overview aiming to answer the following clinical question What are the effects

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1206/overview.html (2016-02-01)
    Open archived version from archive

  • Overview - Pressure ulcers: treatment
    We evaluated interventions for which they were available Top Search and appraisal summary The update literature search for this review was carried out from the date of the last search June 2010 to January 2014 A back search from 1966 was performed for the new options added to the scope at this update For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview please see the Methods section Searching of electronic databases retrieved 307 studies After deduplication and removal of conference abstracts 203 records were screened for inclusion in the overview Appraisal of titles and abstracts led to the exclusion of 163 studies and the further review of 40 full publications Of the 40 full articles evaluated seven systematic reviews and two RCTs were added at this update Top Substantive changes at this update Air fluidised support Two systematic reviews added 9 10 Categorisation unchanged likely to be beneficial Alternating pressure surfaces Two systematic reviews added 9 10 Categorisation unchanged unknown effectiveness Dressings hydrocolloid and non hydrocolloid versus each other One systematic review added 10 Categorisation unchanged unknown effectiveness Electrotherapy Two systematic reviews added 10 18 and one subsequent RCT 19 Categorisation unchanged unknown effectiveness Hyperbaric oxygen therapy New option Five systematic reviews added 8 10 23 24 25 Categorised as unknown effectiveness Low air loss beds Two systematic reviews added 9 10 Categorisation unchanged unknown effectiveness Low tech constant low pressure supports Two systematic reviews added 9 10 Categorisation unchanged unknown effectiveness Nutritional supplements vitamin A Vitamin C vitamin E arginine protein zinc and total calorie One systematic review added 10 Categorisation unchanged unknown effectiveness Seat cushions Two systematic reviews added 9 10 Categorisation unchanged unknown effectiveness Surgery One systematic review added 10 Categorisation unchanged unknown effectiveness Therapeutic ultrasound One systematic review added 10 Categorisation unchanged unknown effectiveness Topical negative pressure Two systematic reviews added 10 38 and one additional RCT 39 Categorisation unchanged unknown effectiveness All systematically reviewed interventions for Pressure ulcers treatment Abstract INTRODUCTION Unrelieved pressure or friction of the skin particularly over bony prominences can lead to pressure ulcers in up to one third of people in hospitals or community care and one fifth of nursing home residents Pressure ulcers are more likely in people with reduced mobility and poor skin condition such as older people or those with vascular disease METHODS AND OUTCOMES We conducted a systematic overview aiming to answer the following clinical question What are the effects of treatments in people with pressure ulcers We searched Medline Embase The Cochrane Library and other important databases up to January 2014 BMJ Clinical Evidence overviews are updated periodically please check our website for the most up to date version of this overview RESULTS At this update searching of electronic databases retrieved 307 studies After deduplication and removal of conference abstracts 203 records were screened for inclusion in the overview Appraisal of titles and abstracts led to the exclusion of 163 studies and the further

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1901/overview.html (2016-02-01)
    Open archived version from archive

  • Overview - Glaucoma: acute and chronic primary angle-closure
    no treatment and medical surgical and laser treatments with each other Top Comments on evidence We found few RCTs comparing different treatments with no treatment or with each other The trials we did find were small and of limited quality There is a need for further high quality RCTs in this field Further trials are under way and their results awaited e g the EAGLE trial which will compare cataract surgery to the standard treatment including laser iridotomy for people with newly diagnosed primary angle closure glaucoma One issue making evaluation of the evidence more difficult has been the lack of consistency over terminology for these conditions Glaucoma is an optic neuropathy In a patient with open angles elevated pressure would be termed ocular hypertension and only those with evidence of structural or functional changes to the nerve and field respectively would be described as having glaucoma However common text book definitions for acute angle closure glaucoma have included those with high pressure and scarring of the drainage channel but with no optic nerve or field changes The use of the term glaucoma to include those populations with and without glaucomatous optic neuropathy or only those with optic neuropathy makes studies difficult to interpret and compare Top Search and appraisal summary The update literature search for this overview was carried out from the date of the last search May 2010 to February 2014 A back search from 1966 was performed for the new options added to the scope at this update For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview please see the Methods section Searching of electronic databases retrieved 683 studies After deduplication and removal of conference abstracts 490 records were screened for inclusion in the review Appraisal of titles and abstracts led to the exclusion of 467 studies and the further review of 23 full publications Of the 23 full articles evaluated three systematic reviews and one RCT were added at this update Top Substantive changes at this update Medical treatment any route in primary chronic angle closure glaucoma New option Three systematic reviews added 10 18 19 Categorised as unknown effectiveness Surgical treatment any type in primary chronic angle closure glaucoma New option Three systematic reviews added 10 18 19 Categorised as unknown effectiveness Laser treatment iridotomy or iridoplasty in primary chronic angle closure glaucoma New option Three systematic reviews 10 19 18 and one RCT 20 added Categorised as unknown effectiveness All systematically reviewed interventions for Glaucoma acute and chronic primary angle closure Abstract INTRODUCTION Glaucoma is characterised by progressive optic neuropathy and peripheral visual field loss The main risk factor for glaucoma is elevated intraocular pressure This overview is focused on primary acute angle closure and primary chronic angle closure glaucoma The number of people diagnosed with primary angle closure glaucoma is predicted to rise over the next few years due to an increasingly ageing population and increased awareness of the condition METHODS

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/0703/overview.html (2016-02-01)
    Open archived version from archive

  • Overview - Depression in children and adolescents: complementary therapies
    efficacy As a starting point we have focused on six complementary treatments for which the review identified at least one efficacy study in young people Top Comments on evidence Many of the trials identified in the literature search did not meet the inclusion criteria for this overview Some studies of light therapy suggest benefit in reducing depressive symptoms but the participants in these trials were mostly suffering seasonal affective disorder The studies are out of scope as the focus of the chapter is treatment for major depression The only trial of omega 3 polyunsaturated fatty acids did not meet BMJ Clinical Evidence inclusion criteria as the attrition rate of the sample exceeded 20 Studies of glutamine s adenosylmethionine St John s wort Hypericum perforatum and vitamin C were not RCTs Most complementary treatments are classified as dietary supplements rather than pharmaceuticals hence manufacturers are not obliged to provide evidence of efficacy and safety prior to marketing There is no financial incentive to run any clinical trials therefore it is unsurprising that evidence is sparse One way to stimulate more clinical trials of complementary treatments would be to require the manufacturers of dietary supplements to provide the same level of evidence to support claims of efficacy as that required of manufacturers of pharmaceutical products As this would drive up prices it might not be popular with consumers Top Search and appraisal summary The update literature search for this overview was carried out from the date of the last search July 2011 to August 2014 A back search from 1966 was performed for the new options added to the scope at this update For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview please see the Methods section Searching of electronic databases retrieved 141 studies After deduplication and removal of conference abstracts 103 records were screened for inclusion in the overview Appraisal of titles and abstracts led to the exclusion of 60 studies and the further review of 43 full publications Of the 43 full articles evaluated two systematic reviews were added at this update Top Additional information Complementary treatments are not inert pharmacologically therefore there is the potential for interaction with pharmaceuticals Prior to prescribing medication clinicians should ask all patients whether they have been taking complementary treatment Top Substantive changes at this update Glutamine New option One systematic review added 5 Categorised as unknown effectiveness Light therapy New option Two systematic reviews added 5 15 Categorised as unknown effectiveness Omega 3 polyunsaturated fatty acids fish oil One systematic review added 5 Categorisation unchanged unknown effectiveness St John s wort One new systematic review added 5 Categorisation unchanged unknown effectiveness S adenosylmethionine New option One systematic review added 5 Categorised as unknown effectiveness Vitamin C New option One systematic review added 5 Categorised as unknown effectiveness All systematically reviewed interventions for Depression in children and adolescents complementary therapies Abstract INTRODUCTION Depression is the world s leading cause of disability adjusted

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1008/overview.html (2016-02-01)
    Open archived version from archive

  • Overview - Pre-eclampsia: reducing the risk with calcium supplements
    of calcium supplementation does reduce the risk of pre eclampsia pre term birth and the composite outcome of maternal death or severe morbidity Although most trials in the systematic review were of good quality they included only nulliparous or primiparous women and were conducted largely in the US and South America with most women classified at low risk of pre eclampsia and with low dietary calcium While not necessarily applicable to the UK population this evidence supports the use of calcium supplementation in women with low calcium diets and those at higher risk of pre eclampsia The timing of starting these supplements and the adherence to the high doses used which are often unpalatable and unacceptable to women needs further research Top Search and appraisal summary The update literature search for this overview was carried out from the date of the last search February 2010 to November 2014 For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview please see the Methods section Searching of electronic databases retrieved 109 studies After deduplication and removal of conference abstracts 55 records were screened for inclusion in the overview Appraisal of titles and abstracts led to the exclusion of 30 studies and the further review of 25 full publications Of the 25 full articles evaluated one update of a previously included systematic review was added Top Additional information The evidence has led to the World Health Organisation recommending calcium supplementation of 1 5 to 2 0 g daily for pregnant women with low calcium diets Top Substantive changes at this update Calcium supplementation versus placebo in pregnant women at risk of pre eclampsia One systematic review updated 17 Evidence re evaluated Categorisation unchanged beneficial Different doses of calcium supplementation versus each other in pregnant women at risk of pre eclampsia New option No evidence found Categorised as unknown effectiveness Pre conception calcium supplementation versus placebo in women at risk of pre eclampsia New option No evidence found Categorised as unknown effectiveness All systematically reviewed interventions for Pre eclampsia reducing the risk with calcium supplements Abstract INTRODUCTION Pre eclampsia raised blood pressure and proteinuria complicates 2 to 8 of pregnancies and increases morbidity and mortality in the mother and child Pre eclampsia is more common in older women women with a high body mass index and women with multiple pregnancy Pre eclampsia risk is also increased in women with underlying medical conditions particularly conditions associated with microvascular disease METHODS AND OUTCOMES We conducted a systematic overview aiming to answer the following clinical questions Does oral calcium supplementation during pregnancy reduce the risk and or severity of pre eclampsia What are the effects of preventive calcium supplements pre conception in women at risk of pre eclampsia We searched Medline Embase The Cochrane Library and other important databases up to November 2014 BMJ Clinical Evidence reviews are updated periodically please check our website for the most up to date version of this review RESULTS At

    Original URL path: http://www.clinicalevidence.org/x/systematic-review/1402/overview.html (2016-02-01)
    Open archived version from archive

  • BMJ Clinical Evidence Handbook
    return prtflo click id addtoplanlink rel nofollow Add to Portfolio Add new note View notes Feedback Please complete the form below First Name Surname Occupation Email Phone Company BMJ Clinical Evidence Message Please wait Notes Remove Edit Notes Please do not record person identifiable clinical or staff information and other sensitive information in this field Update Cancel Remove Notes Please do not record person identifiable clinical or staff information and other sensitive information in this field Save Cancel BMJ Clinical Evidence Handbook 12 Month Subscription Personal 150 203 293 Student nurse 77 102 147 BMA members UK 135 183 264 BMA student members 38 52 75 All Euro and USD prices quoted above are exclusive of VAT sales tax Containing summary and background information for each systematic review and enhanced to be more efficient at the point of care this Handbook previously named Clinical Evidence Concise provides an instant overview of treatment options accessible whenever you need it All subscriptions include 2 print issues June December Institutional customers who wish to purchase online access please contact consortiasales bmjgroup com If you would like further information on VAT please contact our Customer Service department on Tel 44 0 20 7383 6270

    Original URL path: http://www.clinicalevidence.org/x/set/static/cms/ce-handbook.html (2016-02-01)
    Open archived version from archive

  • BMJ Clinical Evidence
    Clinical Evidence Nuts bolts and screws how CE works Clinical Evidence efficacy categorisations Editors choice articles that impressed us Withdrawn CE reviews Team and advisors About citations Citations disclaimer Site disclaimer Help Training and support Institutional access Search tips General FAQ NHS and student Print Online Mobile Info for advertisers Subscribe to Clinical Evidence CE online On demand Institutional access and trial Email and RSS Contact us Print Bookmarked Bookmark class portfolio target blank onclick return prtflo click id addtoplanlink rel nofollow Add to Portfolio Add new note View notes Feedback Please complete the form below First Name Surname Occupation Email Phone Company BMJ Clinical Evidence Message Please wait Notes Remove Edit Notes Please do not record person identifiable clinical or staff information and other sensitive information in this field Update Cancel Remove Notes Please do not record person identifiable clinical or staff information and other sensitive information in this field Save Cancel The BMJ Clinical Evidence mobile app is no longer in service Apologies for any inconvenience If you have any questions please contact our customer services team at support bmj com navbar Follow us on Blogs Podcasts Twitter Facebook RSS Email YouTube Google BMJ Clinical Evidence About us

    Original URL path: http://www.clinicalevidence.org/x/set/static/cms/ce-on-the-move.html (2016-02-01)
    Open archived version from archive