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Effects of low salt diet on blood pressure, hormones and lipids in people with normal blood pressure and in people with elevated blood pressure

We are commonly advised to cut down on salt. The previous version of this review looked at mostly short‐term strategies to reduce salt intake. In the present updated version separate analyses of studies with a duration of 2 to 4 weeks or longer were performed. Low salt diets reduced systolic blood pressure by 1% in white people with normal blood pressure and by 3.5% in white people with elevated blood pressure. The effect was similar in trials of 4 weeks or longer. There were increases in some hormones and lipids which could be harmful if persistent over time. However, the studies were not designed to measure long‐term health effects. Therefore we do not know if low salt diets improve or worsen health outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Cilostazol versus aspirin for secondary prevention of vascular events after a stroke of arterial origin

Stroke is a public health problem. As lower and middle income countries make rapid economic progress they face the additional health burden of diseases of affluence like stroke and heart attacks. Unlike heart attack, stroke is a disease caused by more than one mechanism. In Asians, a larger proportion of ischaemic stroke is due to narrowing of the arteries at the base of the brain. Compared to Caucasians, Asians are more likely to have bleeds into their brain matter causing stroke, because of uncontrolled high blood pressure. The medication cilostazol thins the blood by blocking platelet accumulation and appears, from early reports, to be more effective than aspirin in the prevention of stroke, heart attacks and death from vascular causes in patients with stroke. This may be due to its inherent effectiveness, as well as chances of fewer brain bleeds. In this review of two randomised trials involving 3477 participants, we found that cilostazol was more effective for the prevention of stroke, heart attack and death from vascular causes in Asian patients with stroke. In terms of safety, it causes more side effects than aspirin but less serious bleeding in the brain and the body.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Treating hypertension greatly reduces the risk of serious health problems such as heart disease or stroke in African American women and in older women

Hypertension (high blood pressure) is a risk factor for heart disease and stroke. Several treatments exist, including many drugs, to try to lower blood pressure and reduce the risk of serious health problems. Hypertension is a significant risk for heart disease in women, and certain groups such as African American women or older women (over 55 years) are more likely to suffer from hypertension. The review found that treating women for hypertension greatly reduced the risk of heart disease and stroke in older women and in African American women of all ages. Treating hypertension in these women is therefore important.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus

In upper‐middle‐income and high‐income countries, minority ethnic groups often have a higher prevalence of type 2 diabetes mellitus than is seen in the local population. They also tend to come from lower socioeconomic backgrounds, with attendant difficulties in accessing good‐quality health care. In some cases, cultural and communication barriers increase the problems that minority ethnic communities experience when attempting to access good‐quality diabetes health education, which is vital for those who wish to understand diabetes and use available services to gain empowerment and bring about behaviour change toward a healthier lifestyle. In this review, 'culturally appropriate' health education is taken to mean any type of health education that has been specifically tailored to the cultural needs of a target minority group with type 2 diabetes mellitus.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

The effectiveness of blood testing in the management of pyelonephritis in pregnancy for improving outcomes

Urinary tract infections (UTIs) are a common infection among women, with most women having developed a UTI at least once in their lifetime. Pyelonephritis, a UTI which affects the upper urinary tract and kidneys, is one of the most prevalent conditions that require hospitalisation among pregnant women. In general, both urine and blood samples are taken for diagnosis and to tailor the necessary antibiotic therapy to the needs of the patient. Some severe cases of pyelonephritis require hospitalisation and intravenous administration of antibiotics. Several previous studies have reported that excluding blood testing or 'blood culture' samples and using only urine samples in managing the condition could be as safe and effective as the current approach, in which both urine and blood samples are analysed. Previous research has also suggested that urine samples render blood samples superfluous, as blood samples offer no additional clinical value for the management of pyelonephritis. Testing only urine samples could also be significantly cost‐saving.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antifungal agents for preventing fungal infections in critically ill adults and children with a normal number of neutrophils in the blood

We reviewed the evidence about the effect of giving antifungal medications before a definitive diagnosis of fungal infections on mortality from all causes and development of severe infections due to fungi (invasive fungal infections) in adults and children who are critically ill but non‐neutropenic, i.e. with a normal number of neutrophils in their blood.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Understanding urine tests

Most people will have already given a urine sample  at some point in their lives. Urine samples are needed for urine tests, which are used for things like testing for particular diseases or monitoring their progress. For instance, urine test strips can be used to indicate whether you have a urinary tract infection.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 22, 2013

Adjustment of antimicrobial agents for adults with sepsis, severe sepsis or septic shock

Broad‐spectrum antimicrobial treatment is defined as the use of an antibiotic or a combination of antibiotics which act against a wide range of disease‐causing bacteria. Broad‐spectrum antimicrobial treatment can reduce mortality rates in patients with sepsis, severe sepsis or septic shock. Sepsis is a serious medical condition which is characterized by an inflammatory response to an infection that can affect the whole body. The patient may develop this inflammatory response to microbes in their blood, urine, lungs, skin or other tissues. However, there is a risk that empirical broad‐spectrum antimicrobial treatment can expose patients to overuse of antimicrobials and increase the resistance of micro‐organisms to treatment. De‐escalation has been proposed as a means of adjusting initial, adequate broad‐spectrum treatment by changing the antimicrobial agent or discontinuing an antimicrobial combination according to the patient's culture results (a means of identifying the microbe causing the infection). In this updated Cochrane review we searched the databases until October 2012. We found no published randomized controlled trials (RCTs). We found one ongoing RCT. There is no adequate or direct evidence on whether de‐escalation of antimicrobial agents is effective and safe for adults with sepsis, severe sepsis or septic shock. Appropriate studies are needed to investigate the potential benefits proposed by de‐escalation treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Late Effects of Treatment for Childhood Cancer (PDQ®): Patient Version

Expert-reviewed information summary about the health problems that continue or appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 26, 2016

Nutritional support for patients who have had a bone marrow transplant

Bone marrow transplant patients can experience prolonged poor appetite with vomiting and diarrhoea. Malnutrition is a consequence. To prevent this, patients can receive nutritious fluids orally or via a nasogastric tube, or intravenously as parenteral nutrition. The benefits of either route are unclear. Studies were found that compared these interventions but missing data prevents proper assessment of the benefits. However, the limited data available indicates that when patients undergo bone marrow transplantation and are given intravenous fluids and are encouraged to have an oral diet they are less likely to experience infections and are more likely to go home earlier than if they are given standard parenteral nutrition routinely. In the event that patients nutritional intake is inadequate because of an inadequate oral intake or because they are unable to tolerate tube feeding and are given parenteral nutrition with added glutamine they are likely to have less infections but may not necessarily leave hospital earlier.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

What is the performance of rapid tests for the diagnosis of strep throat in children?

Sore throat is very common in children. It can be caused by viruses or bacteria. The bacterium most frequently identified during sore throat in children is group A streptococcus ('strep throat'). Amongst children with sore throat, antibiotic treatment is only useful in those with strep throat.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Antibiotics for brain abscesses in people with cyanotic congenital heart disease

Serious congenital heart disease leads to abnormal blood flow through the heart and lungs. This results in an inability to carry enough oxygen around the body which makes patients blue (cyanotic) and severely limits their physical activity. People with cyanotic congenital heart disease are at risk of developing brain abscess. This condition is serious and can lead to death because the abscess causes abnormal brain function. Treatment includes antibiotic therapy to kill the bacteria that cause the infection. In people with a large abscess, an operation to drain the abscess may be carried out. Antibiotic therapy for brain abscess should include drugs that penetrate into the abscess cavity. The drugs chosen should also be matched to the sensitivity of the bacteria obtained from the abscess in laboratory culture. There is no evidence from randomized controlled trials to show the best antibiotic regimen for treating people with cyanotic congenital heart disease who develop brain abscess.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Catheter lock treatments for catheter‐related infections in children with cancer

Oncology patients require frequent venous access for their cancer treatment. Therefore, more permanent catheters (central venous catheters (CVCs)) are often inserted. However, these can become infected and once the CVC becomes occupied by bacteria it is difficult to eradicate these micro‐organisms. Lock solutions are medicines that are placed in the CVC and left to dwell for a certain time period. These locks only treat the CVC and high concentrations can be achieved. In this review we investigated the effect of lock treatments on CVC‐related infections. We identified three studies: two investigating the effect of urokinase lock treatments in addition to antibiotics and one study investigating the effect of ethanol locks in addition to antibiotics. We could detect no effect of urokinase or ethanol locks. However, the groups were very small. A similar study with a larger participant population might have different results.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Urethral Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of urethral cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: July 19, 2016

Intraventricular antibiotics for bacterial meningitis in neonates

Infection of the membranes and the fluid surrounding the brain (meningitis) and of the fluid‐filled spaces in the brain (ventriculitis) may be caused by bacteria, especially gram‐negative bacteria. This type of infection is difficult to eradicate using safe doses of antibiotics given into the blood stream. In theory, intraventricular administration of antibiotics (administration of antibiotics into the fluid‐filled spaces in the centre of the brain) would produce higher antibiotic concentrations in the fluid in the brain than intravenous administration alone, and eliminate the bacteria more quickly. However, taps of the fluid‐filled spaces may cause harm as the needle has to penetrate the brain tissue. Only one trial was identified. In this trial enrolling infants with gram‐negative meningitis and ventriculitis, the use of intraventricular antibiotics in addition to intravenous antibiotics resulted in a three‐fold increased risk for mortality compared to standard treatment with intravenous antibiotics alone. Based on this result, intraventricular antibiotics should be avoided. Further trials comparing these interventions are not justified in newborn infants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Early skin‐to‐skin contact for mothers and their healthy newborn infants

Skin‐to‐skin contact between a mother and her baby at birth reduces crying, and helps the mother to breastfeed successfully.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Prophylactic antibiotics to reduce the risk of urinary tract infections after urodynamic studies

Urodynamics is an invasive test which involves inserting a catheter into the bladder in order to help with diagnosis of bladder symptoms. It carries the risk of causing a urinary tract infection. We need to balance the risk of a urinary tract infection and the symptoms associated with such an infection (such as fever, pain passing urine) against the risk and cost of giving prophylactic antibiotics. Some people also pick up an increased number of bacteria in the urine but do not develop the signs of an infection (asymptomatic bacteriuria). We looked at the use of prophylactic antibiotics for the prevention of urinary tract infections and bacteriuria. We identified nine trials including 973 people. We found that people were less likely to have bacteria in their urine after urodynamic studies if they had antibiotics (4% versus 12%). While they did have fewer urinary tract infections (20% compared with 28% with no antibiotics), this did not reach statistical significance. There were too few adverse effects, such as fever, pain when passing urine or a reaction to the antibiotics, for the findings to be reliable. However, people were less likely to have blood in their urine with antibiotics. There was no information about other treatments which might help reduce infections, nor about different doses or types of antibiotics.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Procalcitonin, C‐reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children

In some children with urinary tract infection (UTI), the infection is localized to the bladder (lower urinary tract). In others, bacteria ascend from the bladder to the kidney (upper urinary tract). Only children with upper urinary tract involvement are at risk for developing permanent kidney damage. If non‐invasive biomarkers could accurately differentiate children with lower urinary tract disease from children with upper urinary tract disease, treatment and follow‐up could potentially be individualized. Accordingly, we examined the usefulness of three widely available blood tests (procalcitonin, C‐reactive protein, erythrocyte sedimentation rate) in differentiating upper from lower urinary tract disease. We found 24 relevant studies of which 17 provided data for our primary outcome. Six studies (434 children) provided data for the procalcitonin test; 13 studies (1638 children) provided data for the C‐reactive protein test, and six studies (1737 children) provided data for the erythrocyte sedimentation rate test. We found all three tests to be sensitive (summary sensitivity values ranged from 86% to 95%), but not very specific (summary specificity values ranged from 38% to 71%). None of the tests were accurate enough to allow clinicians to confidently differentiate upper from lower urinary tract disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Athlete's foot: Overview

Nearly everyone has had experience with athlete’s foot. The warm and moist spaces between our toes are the perfect place for fungi to grow and spread, typically causing skin redness and cracking. It can be treated effectively with creams, gels and sprays. We provide information on the various treatments.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: January 14, 2015

Fluoroquinolones for treating enteric fever

Researchers in The Cochrane Collaboration conducted a review of the effect of fluoroquinolone antibiotics in people enteric fever. After searching for relevant studies, they identified 26 studies involving 3033 patients. Their findings are summarized below.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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