Home > Search Results
  • Added to PubMed Health

    clear
    • Custom range...

Results: 14

Polyethylene Glycol should be used in preference to Lactulose in the treatment of Chronic Constipation.

Constipation is a common clinical problem, encompassing much more than reduced stool frequency. In this review we compared two commonly used osmotic laxatives, Lactulose and Polyethylene Glycol (PEG).

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

Version: 2011

Pegloticase for chronic gout

‐        it is unknown whether pegloticase can improve the pain and function of people with chronic gout.

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

Version: 2010

Antiviral treatment for chronic hepatitis C in patients with HIV infection

End‐stage liver disease due to chronic hepatitis C is the leading cause of death among patients with stable HIV. The recommended treatment for chronic hepatitis C among patients without HIV is peginterferon plus ribavirin. Based on evidence from trials on HIV‐negative patients with hepatitis C, the viral genotype, dose of treatment and duration of therapy may affect the treatment response. This review is the first to evaluate the antiviral effect of peginterferon, ribavirin or amantadine administered in different combinations for a patient group, which has not previously been treated for hepatitis C. A total of 14 randomised clinical trials with at total of 2269 patients have been included in this review.The present review suggests that peginterferon plus ribavirin may also be considered if patients have HIV. The dose of peginterferon was similar to that assessed in trials on patients without HIV (180 microgram or 1.5 microgram/kg once weekly), but the dose of ribavirin was somewhat lower in most trials (800 mg daily). There were considerable differences between the trials possibly related to the dose and duration of treatment or the proportion of patients with different hepatitis C virus genotypes. The benefit of treatment was seen when assessing the proportion of patients with a sustained loss of the hepatitis C virus from the blood and the proportion with improved liver biopsies. No significant differences were seen in clinical outcome measures, including mortality (1%, irrespective of treatment). There were several adverse events. Fatal lactic acidosis and liver failure occurred. Other adverse events included anaemia and flu‐like symptoms that occurred more frequently among patients receiving peginterferon plus ribavirin. No significant differences were seen regarding the risk of depression, mortality, and progression to cirrhosis or to AIDS. Additional randomised trials are necessary to assess the effect in HIV and HCV co‐infected patients of peginterferon plus ribavirin in relation to the duration of therapy, especially in patients with hepatitis C genotype 2 or 3. Additional trials comparing peginterferon plus ribavirin versus interferon plus ribavirin or peginterferon alone do not seem warranted.

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

Version: 2010

Early versus delayed selective surfactant treatment for neonatal respiratory distress syndrome

Giving early selective surfactant to newborn babies on assisted ventilation who have early signs of respiratory distress syndrome (RDS) reduces the risk of short‐term and longer‐term lung injury.

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

Version: 2012

Tumor necrosis factor‐alpha antibody for maintenance of remission in Crohn's disease

Crohn's disease is a chronic inflammatory disease of the intestines. Crohn's disease frequently occurs in the lower part of the small intestine (the ileum), however it can affect any part of the digestive tract, from the mouth to the anus. The most common symptoms of Crohn's disease are abdominal pain, often in the lower right region of the abdomen, and diarrhea. TNF is a molecule secreted by white blood cells that increases inflammation. High levels of TNF‐alpha have been associated with the development of intestinal inflammation in Crohn's disease. TNF‐alpha blocking agents (infliximab, adalimumab, certolizumab pegol and CDP571) bind with TNF‐alpha molecules thereby neutralizing the biological activity of TNF‐alpha resulting in the healing of intestinal inflammation. All four molecules are synthetic antibodies that bind TNF. Infliximab (Remicade®) is an antibody of mouse origin that has been humanized, as is CDP571. Adalimumab (Humira®) is an antibody of human origin. Certolizumab is a humanized antibody fragment that is complexed with polyethylene glycol to extend the length of time the drug is in the body. Nine studies were reviewed. The studies compared TNF‐alpha blocking agents with placebo (inactive intravenous infusions or injections) and found that infliximab, adalimumab, and certolizumab pegol were effective in maintaining remission in patients with Crohn's disease who respond to induction therapy with these agents. There is no evidence that CDP571 is an effective maintenance therapy. The TNF‐alpha blocking agents appear to be safe for patients with Crohn's disease with equal numbers of patients receiving TNF‐alpha blocking agents or placebo reporting side effects such as headache, abdominal pain, nausea, and pain at injection site. There were some serious side effects reported with the use of these agents including infections such as tuberculosis. However, patients can be screened for inactive tuberculosis prior to treatment with TNF‐alpha. A link between long term treatment with TNF‐alpha blocking agents and cancer is possible but not proven. Data obtained from observational studies including the Crohn's Therapy, Resource, Evaluation and Assessment Tool (TREAT) registry show no increased risk of cancer with the use of TNF‐alpha blocking agents in patients with inflammatory bowel disease. The current evidence suggests that the TNF‐alpha blocking agents infliximab, adalimumab, and certolizumab pegol are effective maintenance therapy in Crohn's disease. However, the use of these medications needs to be weighed against the potential risk of serious side effects, particularly infection.

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

Version: 2009

Topotecan is an active second line chemotherapeutic drug, used to treat patients with relapsed ovarian carcinoma

It appears to have a similar level of effectiveness as paclitaxel and pegylated liposomal doxorubicin, though with different patterns of side effects. Larger, well‐designed randomised controlled trials (RCTs) are required to define an optimal regime.

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

Version: 2010

Sclerotherapy (injection techniques) for spider veins on the legs

Sclerotherapy has been used for centuries to treat spider veins. The technique involves the injection of a chemical into the veins. This is sometimes followed by compression with bandages or stockings.

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

Version: 2012

Animal derived surfactant compared to protein‐free synthetic surfactant preparations in preterm infants that have or are at high risk for respiratory distress syndrome.

Background: Pulmonary surfactant is a substance that prevents the air sacs of the lungs from collapsing by reducing surface tension. Newborn babies with respiratory distress syndrome (RDS) have immature lungs and are often lacking in pulmonary surfactant. Commercially available surfactant preparations (either animal derived surfactant preparations or synthetic surfactant preparations that may or may not contain protein) can be given to these babies and have been proven to decrease the severity of RDS and increase the survival rates of babies with RDS. However, it is unclear whether significant differences in clinical outcome exist among the available animal derived surfactant preparations or the protein‐free synthetic surfactant preparations.

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

Version: 2015

Laxatives for the management of childhood constipation

Constipation within childhood is an extremely common problem. Despite the widespread use of laxatives by health professionals to manage constipation in children, there has been a long standing lack of evidence to support this practice.This review included eighteen studies with a total of 1643 patients that compared nine different agents to either placebo (inactive medications) or each other. The results of this review suggest that polyethylene glycol preparations may increase the frequency of bowel motions in constipated children. Polyethylene glycol was generally safe, with lower rates of minor side effects compared to other agents. Common side effects included flatulence, abdominal pain, nausea, diarrhoea and headache. There was also some evidence that liquid paraffin (mineral oil) increased the frequency of bowel motions in constipated children and was also safe. Common side effects with liquid paraffin included abdominal pain, distention and watery stools. There was no evidence to suggest that lactulose is superior to the other agents studied, although there were no trials comparing it to placebo. The results of the review should be interpreted with caution due to methodological quality and statistical issues in the included studies. In addition, these studies were relatively short in duration and so it is difficult to assess the long term effectiveness of these agents for the treatment of childhood constipation. Long term effectiveness is important, given the often chronic nature of this problem in children.

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

Version: 2012

Extended treatment for 72 weeks versus standard treatment for 48 weeks in chronic hepatitis C genotype 1 infected slow responders

Chronic hepatitis C is a leading cause of liver‐related morbidity and mortality. The standard length of treatment with peginterferon plus ribavirin for hepatitis C virus genotype 1 infected patients is 48 weeks, but the number of patients who are treated successfully with regard to disappearance of the virus from the blood (sustained virological response) is limited. In order to improve it, extending the length of the treatment period has been suggested. We attempted to identify whether extending treatment duration to 72 weeks is better than the standard 48 weeks in a subgroup of patients who have shown a slow viral response.

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

Version: 2012

Antiviral therapy to prevent the recurrence of chronic hepatitis C infection in patients undergoing liver transplantation

The liver is an important organ of the body and has various functions including generation of energy from food, production of material necessary for congealing, processing and excretion of drugs and waste products in blood, and filtering out the harmful bacteria that enter the body through the gut. Hepatitis C virus can cause damage to the liver usually in an insidious manner (chronic hepatitis C virus infection). Sometimes, the liver damage can be so severe that the liver is not able to carry out the normal functions, which results in liver failure. Liver transplantation is effective in treating liver failure due to chronic hepatitis C infection. However, liver transplantation does not eradicate the virus and the virus can affect the donor liver graft. One of the proposed strategies to prevent the recurrence of chronic hepatitis C infection in these patients is to give drug treatment before the donor liver graft is affected by chronic hepatitis C infection. The effectiveness of these preventive treatments is not known. The review authors performed a detailed review of the medical literature to February 2013 to determine the benefits and harms of different preventive antiviral treatments for patients undergoing liver transplantation for chronic hepatitis C virus infection. The review authors sought evidence from randomised clinical trials only. When conducted properly, such trials provide the best evidence. Two review authors independently identified the trials and obtained the information from the trials to minimise error.

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

Version: 2013

Certolizumab pegol for treating adults with rheumatoid arthritis

We conducted an updated review of the effect of certolizumab pegol for adults with RA. We searched all relevant studies until June 2014 and found 11 studies with 4324 people.

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

Version: 2014

Interferon for interferon nonresponding and relapsing patients with chronic hepatitis C

Antiviral treatment for chronic hepatitis C infections is currently judged as being successful if, at least six months after therapy, blood tests for hepatitis C viral RNA are negative; this has been called a sustained viral response. In the past, other outcomes for treatment have included improvements in biochemical tests (especially liver enzyme tests such as the serum alanine aminotransferase) or evidence of reduced inflammation and/or fibrosis on subsequent liver biopsies. All of these outcomes are tests, and it has been assumed that if the test gets better the patient will as well. However, there is no direct evidence that has proven that these outcomes are valid because there have been no long‐term trials that have shown that an improvement in these tests translates into reduced mortality or morbidity. Patients who fail to have sustained viral responses after an initial course of therapy do become potential candidates for retreatment; some of them may be intolerant to ribavirin, and possibly even the newer protease inhibitors, so retreatment would have to be with interferon alone. It has also been speculated that long‐term treatment (namely treatment for several years) might be beneficial; such long‐term therapy would be further complicated if multiple drugs were used because of the additional drug toxicities and costs, so interferon alone could be considered. This review addressed the ability of interferon monotherapy to favorably alter the clinical course of chronic hepatitis C when it is used to retreat patients who failed at least one previous course of therapy. Seven trials were identified, including two large ones (a total of 1676 patients), known as "HALT‐C" and "EPIC3", that specifically were designed to use low‐dose pegylated interferon for three to five years in patients with evidence on liver biopsy of severe fibrosis and who had failed to have a sustained viral response to a course of standard combination (pegylated interferon plus ribavirin) therapy in the past. Both trials were at low risk of bias. A third trial designed to address the use of pegylated interferon monotherapy for 48 weeks in improving survival in patients with cirrhosis (Childs A or B) was terminated early because of the results of the HALT‐C and EPIC3 trials, so three trials have provided mortality and hepatic morbidity data. When all three trials were considered, there was no significant effect of the treatment on either all‐cause mortality (78/843 (9.3%) versus 62/867 (7.2%); risk ratio (RR) 1.30, 95% confidence interval (CI) 0.95 to 1.79; 3 trials) or hepatic mortality (41/532 (7.7%) versus 40/552 (7.2%); RR 1.07, 95% CI 0.70 to 1.63; 2 trials); however, all‐cause mortality was higher in the recipients of the pegylated interferon (78/828 (9.4%) versus 5 7/848 (6.7%); RR 1.41, 95% CI 1.02 to 1.96) when only the two low risk of bias trials were considered. The excess deaths appeared to be from non‐liver causes. Variceal bleeding occurred less often in the treated patients (4/843 (0.5%) versus 18/867 (2.1%); RR 0.24, 95% CI 0.09 to 0.67), but there were no differences seen with regard to the subsequent development of other manifestations of end‐stage liver disease (that is, encephalopathy, ascites, hepatocellular carcinoma, liver transplantation). One trial reported quality of life data; the treated patients had increases in their pain scores. No cost data were available. The recipients of the pegylated interferon generally had more adverse events; statistically significant differences were seen for the occurrence of hematologic complications, infections, flu‐like symptoms, and rashes. Those receiving interferon were more likely to have sustained viral responses (20/557 (3.6%) versus 1/579 (0.2%); RR 15.38, 95% CI 2.93 to 80.71) and were also more likely to have improvements in markers of inflammation. No difference was demonstrated regarding the effect of the treatment on markers of fibrosis. The use of longer‐term (several years) interferon monotherapy in patients with severe underlying hepatic fibrosis who have failed previous courses of treatment is not supported by the evidence; no trials providing data regarding clinical outcomes were identified in other potential treatment scenarios. Two of the commonly employed surrogate markers, sustained viral response and markers of inflammation, failed to be validated since they improved even though the clinical outcomes did not (or may even have become worse). This failure to validate the sustained viral response in this group of patients with a low sustained viral response rate suggests that the presumed validity of the use of sustained viral responses in other groups of patients with chronic hepatitis C viral infections who receive treatment must be formally validated.

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

Version: 2013

Comparing Drugs for Chronic Constipation

How do the drugs used to treat chronic constipation and irritable bowel syndrome with predominant constipation compare?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: November 1, 2007

Recent Activity