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Vaginal weights for training the pelvic floor muscles to treat urinary incontinence in women

Leaking urine when coughing, sneezing, or exercising (stress urinary incontinence) is a common problem for women. This is especially so after giving birth, when about one woman in three will leak urine. Training of the pelvic floor muscles is the most common form of treatment for this problem. One way that women can train these muscles is by inserting cone‐shaped weights into the vagina, and then contracting the pelvic floor muscles to stop the weights from slipping out again.

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

Version: 2013

Early versus late discontinuation of oxygen in preterm or low birth weight infants

Not enough evidence to show the benefits or adverse effects of early oxygen weaning in preterm or low birthweight babies. Babies born either prematurely (before 37 weeks) or with a low birthweight often have breathing problems and need extra oxygen. Oxygen supplementation has provided many benefits for these babies and the ability to measure oxygen levels accurately can help reduce adverse effects. The correct time to wean babies off oxygen supplementation has been unclear but is usually measured by their age, weight gain and breathing ability. The review did not find enough evidence from trials to show the benefits or adverse effects of early oxygen weaning in preterm or low birth weight babies. More research is needed.

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

Version: 2009

Glucocorticoid corticosteroid therapy in Duchenne muscular dystrophy (DMD) improves muscle strength and function for six months to two years.

Duchenne muscular dystrophy is an incurable disease of childhood. Muscle wasting and loss of walking lead to wheelchair dependence and eventually death. The precise way in which glucocorticoids increase strength is unknown. Randomised controlled trials have shown that glucocorticoid corticosteroids improved muscle strength and function for six months to two years. Short‐term side effects were significant but not severe and could be managed. Data from non‐randomized studies suggests functional benefit over a five year period in many treated patients, but the overall long‐term benefit remains unclear, and has to be weighed against the long‐term side effects of these drugs. Randomised controlled trials to clarify this uncertainty are desirable, but would require careful ethical consideration.

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

Version: 2009

Progressive resistance strength training for improving physical function in older adults

Older people generally lose muscle strength as they age. This reduction in muscle strength and associated weakness means that older people are more likely to have problems carrying out their daily activities and to fall. Progressive resistance training (PRT) is a type of exercise where participants exercise their muscles against some type of resistance that is progressively increased as their strength improves. The exercise is usually conducted two to three times a week at moderate to high intensity by using exercise machines, free weights, or elastic bands.This review sets out to examine if PRT can help to improve physical function and muscle strength in older people.

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

Version: 2009

Physical training for asthma

Some people with asthma may show less tolerance to exercise due to worsening asthma symptoms when they exercise or other reasons such as deconditioning. This can prevent them playing sports or attempting to keep fit. Physical training programs for people with asthma have been designed to improve physical fitness, muscle coordination and confidence.

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

Version: 2013

Enamel matrix derivative (Emdogain®) for periodontal tissue regeneration in intrabony defects

Emdogain might have some advantages over other methods of regenerating the tissue supporting teeth lost by gum disease, such as less postoperative complications, but has not been shown to save more compromised teeth or that patients noticed any aesthetic improvement 1 year after its application.

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

Version: 2011

Fact sheet: Exercise-induced asthma

Suddenly getting out of breath or gasping for air when doing sports can be frightening. These breathing problems may occur if someone is not physically fit. But they may also be caused by exercise-induced asthma. For some people with asthma this becomes a problem: Too much physical exertion can trigger asthma attacks – but too little physical activity can lead to reduced lung performance.

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

Version: January 17, 2013

No evidence to support the use of thioridazine for dementia

Behavioural problems are common in dementia and are a significant source of caregiver burden. Thioridazine has significant sedative effect, and it is thought that this is the main mechanism of action in calming and controlling the patient. However, pharmacologically, it also has marked anticholinergic properties that could potentially have a detrimental effect on cognitive function. The only positive effect of thioridazine when compared with placebo is to reduce anxiety. When compared with placebo, other neuroleptics, and other sedatives it has equal or higher rates of adverse effects. Thioridazine has minimal or no effect on global ratings, while other drugs such as chlormethiazole are superior to it on behavioural ratings. Clinicians should be aware that there is no evidence to support the use of thioridazine in dementia, and its use may expose patients to excess side effects.

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

Version: 2012

Ketamine as an adjuvant to opioids for cancer pain

The benefits and harms of adding ketamine to strong pain‐killers such as morphine for the relief of cancer pain are not yet established. Morphine‐like drugs (opioids) are frequently prescribed for moderate and severe cancer pain, but in some cases these drugs are not effective. Ketamine, an anaesthetic agent, is used to improve analgesia when opioids alone are ineffective. However, evidence for the effectiveness of this practice is limited. Two small studies suggest that when ketamine is given with morphine it may help to control cancer pain. However, these data are insufficient to assess the effectiveness of ketamine in this setting.

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

Version: 2012

Botulinum toxin Type A (BtA) is effective and safe for treating people with cervical dystonia.

Cervical dystonia is characterized by involuntary posturing of the head and frequently is associated with neck pain. Disability and social withdrawal are common. A single injection cycle of BtA is effective and safe for treating cervical dystonia and further injection cycles continue to work for most patients. Adverse effects include neck weakness, dysphagia, dry mouth/sore throat and voice changes/hoarseness and are dose dependent. Indirect comparisons showed in general no differences between Dysport(r) and Botox(r) in terms of benefits or adverse events.

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

Version: 2009

Perioperative ketamine for acute postoperative pain

Perioperative ketamine in subanaesthetic dose reduces postoperative morphine requirements and reduces postoperative nausea or vomiting (PONV). Adverse effects for perioperative ketamine are mild or absent. The current data cannot be translated into a specific treatment regime.

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

Version: 2010

Interventions for treating depression after stroke

Antidepressant drugs may be useful in treating depression after stroke, but also cause side effects. Depression is common after stroke and may be treated with antidepressant medication or psychological therapy. This review of 16 trials, including 1655 participants, found that antidepressant drugs may produce recovery or improve depression symptoms. However they also increase side effects. These drugs should be used with caution in people with persistent depressive symptoms after stroke, as little is known about the risks, especially of seizures, falls, and delirium. We found no evidence for the benefit of psychotherapy. Future research should include a broader group of stroke patients.

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

Version: 2008

No evidence of benefit of selegiline for Alzheimer's disease

Despite its initial promise, i.e. the potential neuroprotective properties, and its role in the treatment of Parkinson's disease, selegiline for Alzheimer's disease has proved disappointing. Although there is no evidence of a significant adverse event profile, there is also no evidence of a clinically meaningful benefit for people with Alzheimer's disease. There would seem to be no justification, therefore, to use it for Alzheimer's disease, nor for any further studies of its efficacy in Alzheimer's disease.

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

Version: 2008

Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit

There is no evidence to show the benefit of midazolam as a sedative for newborn babies in neonatal intensive care. Newborn babies undergoing uncomfortable procedures in intensive care units may need sedation to reduce stress and avoid complications. It is difficult to measure their pain so sedatives or pain killers are sometimes overlooked for newborn babies. Midazolam is a short‐acting sedative increasingly used in neonatal intensive care. The review of trials found no evidence to support the use of midazolam as a sedative for neonates undergoing intensive care. Babies receiving midazolam stayed in hospital longer and had more adverse effects. More research is needed to address the safety and effect of midazolam.

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

Version: 2014

Cholinesterase inhibitors are beneficial for people with Parkinson's disease and dementia

The clinical features of dementia with Lewy bodies (DLB) and Parkinson's disease with dementia (PDD) have much in common. As patients with DLB and PDD have particularly severe deficits in cortical levels of the neurotransmitter acetylcholine, blocking its breakdown using a group of chemicals known as cholinesterase inhibitors may lead to clinical improvement. Six trials showed a statistically significant improvement in global assessment, cognitive function, behavioural disturbance and activities of daily living rating scales in PDD and cognitive impairment in Parkinson's disease (CIND‐PD) patients treated with cholinesterase inhibitors. There was no current disaggregated evidence to support their use in CIND‐PD. In a single trial, no statistically significant improvement was observed in patients with DLB who were treated with cholinesterase inhibitors and further trials are necessary to clarify the effect of cholinesterase inhibitors in this patient group.

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

Version: 2014

Botulinum toxin type B for cervical dystonia or involuntary positioning of the head

Cervical dystonia is the most common form of focal dystonia and is characterized by involuntary posturing of the head. It is frequently associated with neck pain and may lead to physical disability and social withdrawal. Botulinum toxin type A (BtA) has become the first line therapy but some patients become resistant to this drug. Another serotype of Botulum toxin, type B (BtB) has been developed. Three randomized controlled studies of a single intramuscular injection of BtB (up to a dose of 10,000 Units) showed improvements in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score, which includes measures of disability, severity and pain, and patient assessed measures four weeks after injection and lasting about 16 weeks, even in patients resistant to BtA. Adverse events associated with how the drug works included difficulty in swallowing (dysphagia) and dry mouth.

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

Version: 2009

Insufficient data are available on the benefits of the COMT inhibitor tolcapone compared with the dopamine agonists bromocriptine and pergolide in relieving the symptoms of later Parkinson's disease.

As Parkinson's disease progresses the control of the symptoms often requires the addition of other drugs to levodopa. The principle aim of COMT inhibitor therapy is to increase the duration of effect of each levodopa dose and thus reduce the time patients spend in the relatively immobile 'off' phase. However other drugs such as dopamine agonists can also be used at this stage of the disease. This review found that the COMT inhibitor tolcapone as an adjuvant to levodopa treatment had a similar level of benefits as two dopamine agonists, bromocriptine and pergolide. There was no significant difference in efficacy between the adjuvant tolcapone and adjuvant bromocriptine or pergolide in the medium‐term. Tolcapone produced nausea less often than these agonists but there was some evidence of liver function abnormalities with tolcapone. Post‐marketing surveillance identified three cases of fatal hepatic toxicity in patients treated with tolcapone. As a result, tolcapone has been withdrawn from some countries and severe restrictions on its use have been imposed in others.

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

Version: 2009

Acupuncture for depression

Depression is widely experienced in our communities. In clinical depression, people report a lack of interest in life and activities which they otherwise normally enjoy. This can be accompanied by other symptoms including weight loss, over‐eating, feelings of uselessness, sleep disturbance, self neglect and social withdrawal, insomnia or hypersomnia (sleeping too much), loss of energy, low self esteem and poor concentration.

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

Version: 2010

Zinc supplementation for mental and motor development in children

Zinc deficiency is a significant public health problem in low‐ and middle‐income countries. Zinc is essential for the formation and migration of neurons, along with the formation of neuronal interconnections called synapses. Its deficiency could interfere with the formation of neural pathways and neurotransmission, thus affecting behavior and development. Zinc supplementation provided to infants and children is a possible strategy to improve the mental and motor development of infants and children at high risk of zinc deficiency.

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

Version: 2012

Tiotropium for stable chronic obstructive pulmonary disease

Tiotropium (Spiriva) is a bronchodilator drug that has been developed to open the airways in the lungs effectively with once daily dosing. The main aims of therapy in COPD are to reduce exacerbations and related hospitalisations, improve quality of life, and reduce the rate of decline in lung function. The evidence from the trials in the review indicates that, compared with a placebo and ipratropium, tiotropium does reduce exacerbations and related hospitalisations and improves quality of life and symptoms in people with moderately severe COPD, although the evidence with regards to decline in lung function is less clear. Tiotropium caused dry mouth. Compared with other commonly used drugs in COPD, such as long‐acting beta agonists (including salmeterol), there is not enough evidence for us to draw reliable conclusions. In order to better understand the effects of this drug we need long‐term studies (over several years), studies conducted in mild and severe COPD, and additional studies that measure outcomes in relation to other agents used in the treatment of this condition.

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

Version: 2012

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