Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Aug 2020
Review Meta AnalysisMultiple versus fewer antiplatelet agents for preventing early recurrence after ischaemic stroke or transient ischaemic attack.
Stroke is a leading cause of morbidity and mortality worldwide. Antiplatelet agents are considered to be the cornerstone for secondary prevention of stroke, but the role of using multiple antiplatelet agents early after stroke or transient ischaemic attack (TIA) to improve outcomes has not been established. ⋯ Multiple antiplatelet agents are more effective in reducing stroke recurrence but increase the risk of haemorrhage compared to one antiplatelet agent. The benefit in reduction of stroke recurrence seems to outweigh the harm for dual antiplatelet agents initiated in the acute setting and continued for one month. There is lack of evidence regarding multiple versus multiple antiplatelet agents. Further studies are required in different populations to establish comprehensive safety profiles and long-term outcomes to establish duration of therapy.
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Cochrane Db Syst Rev · Aug 2020
ReviewMobility management to prevent, reduce, or delay driving a car in teenagers.
Rates of injury and death caused by car crashes with teenage drivers remain high in most high-income countries. In addition to injury and death, car use includes other non-traffic risks; these may be health-related, such as physical inactivity or respiratory disease caused by air pollution, or have global significance, such as the environmental impact of car use. Research demonstrates that reducing the amount of time driving reduces the risk of injury, and it is expected that it would also reduce other risks that are unrelated to traffic. Mobility management interventions aim to increase mobility awareness and encourage a shift from private car use to active (walking, cycling, skateboarding), and public (bus, tram, train), transportation. 'Soft' mobility management interventions include the application of strategies and policies to reduce travel demand and may be instigated locally or more widely, to target a specific or a non-specific population group; 'hard' mobility management interventions include changes to the built environment or transport infrastructure and are not the focus of this review. Between the ages of 15 to 19 years, young people enter a development stage known as the 'transition teens' in which they are likely to make long-lasting lifestyle changes. It is possible that using this specific time point to introduce mobility management interventions may influence a person's long-term mobility behaviour. ⋯ We found only two small studies, and could not determine whether mobility management interventions were effective to prevent, reduce, or delay car driving in teenagers. The lack of evidence in this review raises two points. First, more foundational research is needed to discover how and why young people make decisions surrounding their personal transport, in order to find out what might encourage them to delay licensing and driving. Second, we need longitudinal studies with a robust study design - such as RCTs - and with large sample sizes that incorporate different socioeconomic groups in order to evaluate the feasibility and effectiveness of relevant interventions. Ideally, evaluations will include an assessment of how attitudes and beliefs evolve in teenagers during these transition years, and the potential effect of these on the design of a mobility management intervention for this age group.
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Cochrane Db Syst Rev · Aug 2020
ReviewEndometrial injection of embryo culture supernatant for subfertile women in assisted reproduction.
Despite substantial improvements in the success of assisted reproduction techniques (ART), live birth rates may remain consistently low, and practitioners may look for innovative treatments to improve the outcomes. The injection of embryo culture supernatant in the endometrial cavity can be undertaken at various time intervals before embryo transfer. It provides an altered endometrial environment through the secretion of factors considered to facilitate implantation. It is proposed that injection of the supernatant into the endometrial cavity prior to embryo transfer will stimulate the endometrium and provide better conditions for implantation to take place. An increased implantation rate would subsequently increase rates of clinical pregnancy and live birth, but current robust evidence on the efficacy of injected embryo culture supernatant is lacking. ⋯ We are uncertain whether the addition of endometrial injection of embryo culture supernatant before embryo transfer as a routine method for the treatment of women undergoing ART can improve pregnancy outcomes. This conclusion is based on current available data from five RCTs, with evidence quality ranging from very low to moderate across studies. Further large well-designed RCTs reporting on live births and adverse clinical outcomes are still required to clarify the exact role of endometrial injection of embryo culture supernatant before embryo transfer.
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Cochrane Db Syst Rev · Aug 2020
Review Meta AnalysisErythropoietin plus iron versus control treatment including placebo or iron for preoperative anaemic adults undergoing non-cardiac surgery.
Approximately 30% of adults undergoing non-cardiac surgery suffer from preoperative anaemia. Preoperative anaemia is a risk factor for mortality and adverse outcomes in different surgical specialties and is frequently the reason for blood transfusion. The most common causes are renal, chronic diseases, and iron deficiency. International guidelines recommend that the cause of anaemia guide preoperative anaemia treatment. Recombinant human erythropoietin (rHuEPO) with iron supplementation has frequently been used to increase preoperative haemoglobin concentrations in patients in order to avoid the need for perioperative allogeneic red blood cell (RBC) transfusion. ⋯ Moderate-quality evidence suggests that preoperative rHuEPO + iron therapy for anaemic adults prior to non-cardiac surgery reduces the need for RBC transfusion and, when given at higher doses, increases the haemoglobin concentration preoperatively. The administration of rHuEPO + iron treatment did not decrease the mean number of units of RBC transfused per patient. There were no important differences in the risk of adverse events or mortality within 30 days, nor in length of hospital stay. Further, well-designed, adequately powered RCTs are required to estimate the impact of this combined treatment more precisely.
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Cochrane Db Syst Rev · Aug 2020
Review Meta AnalysisMetformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome.
Metformin has been proposed as possibly a safer and more effective long-term treatment than the oral contraceptive pill (OCP) in women with polycystic ovary syndrome (PCOS). It is important to directly compare the efficacy and safety of metformin versus OCP in the long-term treatment of women with PCOS. This is an update of a Cochrane Review comparing insulin sensitising agents with the OCP and only includes studies on metformin. ⋯ In adult women with PCOS, metformin may be less effective in improving hirsutism compared to the OCP in the subgroup BMI 25 kg/m2 to 30 kg/m2 but we are uncertain if there was a difference between metformin and the OCP in subgroups BMI < 25 kg/m2 and BMI > 30kg/m2. Compared to the OCP, metformin may increase the incidence of severe gastro-intestinal adverse events and decrease the incidence of severe other adverse events with no trials reporting on minor adverse events. Either metformin alone or the OCP alone may be less effective in improving hirsutism compared to metformin combined with the OCP. We are uncertain whether there is a difference between the OCP alone and metformin alone compared to metformin combined with the OCP for severe or minor adverse events except for the OCP versus metformin combined with the OCP where the OCP may decrease the incidence of severe and minor gastro-intestinal adverse events. In adolescent women with PCOS, we are uncertain whether there is a difference between any of the comparisons for hirsutism and adverse events due to either no evidence or very low-quality evidence. Further large well-designed RCTs that stratify for BMI are needed to evaluate metformin versus the OCP and combinations in women with PCOS, in particular adolescent women.