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Comparision of two techniques for the placement of a feeding tube to the stomach through the skin in an individual who has difficulty swallowing food

This systematic review was conducted to compare two different methods for placing a feeding tube to the stomach via an opening in the skin (known as percutaneous gastrostomy) in order to provide food to an individual with swallowing difficulties; the aim was to find the most effective and safe approach.

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

Version: 2016

Key‐hole (laparoscopic) versus standard cut (open) abdominal surgery for people with food‐pipe (oesophageal) cancer

The oesophagus (food pipe) is located mainly in the chest; it enters the abdomen (tummy) through an opening in the diaphragm (muscle that separates the chest from the abdomen). Removing tumours by surgery (oesophagectomy) is one of the recommended treatments for cancers that are limited to the oesophagus. The tumour can be removed through an abdominal opening, a chest opening, or a combination. When the tumour is removed through an abdominal opening, it is called transhiatal oesophagectomy (as the oesophagus is separated from its surrounding structures through the opening in the diaphragm). The abdominal surgery can be performed through either a key‐hole or a standard cut. Key‐hole surgery to remove oesophageal cancer (laparoscopic transhiatal oesophagectomy) is a relatively new procedure compared to the well‐established standard cut surgery (open transhiatal oesophagectomy). In operations on other parts of the body, laparoscopic surgery has been shown to reduce complications and length of hospital stays compared to open surgery.

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

Version: 2016

What are dietary supplements?

“Vitamins strengthen our immune system,” and “Omega 3 is good for your heart”: Dietary supplements are often marketed using a number of different promises, and they are available everywhere, from pharmacies and supermarkets to the internet. But do we really need all of these tablets, powders and capsules? What makes dietary supplements different from medicine and can they also be harmful?

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

Version: September 8, 2016

Overview of the safety of regular formoterol or salmeterol in adults with asthma

Asthma is a common condition that affects the airways. When a person with asthma comes into contact with an irritant, the muscles around the walls of the airways tighten and the lining of the airways becomes inflamed and starts to swell. This leads to the symptoms of asthma—wheezing, coughing and difficulty in breathing. No cure for asthma is known; however, there are medications that allow most people to control their asthma so they can get on with daily life.

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

Version: 2014

Effectiveness and safety of inhalers containing the drug aclidinium bromide for managing patients with stable COPD

We reviewed the evidence on the effectiveness and safety of aclidinium inhalers used by people with chronic obstructive pulmonary disease (COPD).

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

Version: 2014

How can head lice be treated?

Head lice don't go away on their own. But there are a number of safe treatments that can get rid of them effectively. Many delousing agents don't contain any insecticides.Head lice can cause itching, but they are not harmful to your health. Because they do not clear up on their own, treatment is necessary.There are a number of different options for treating head lice: special lice or nit combs, insecticides, or oil-based products that suffocate the lice. These treatments vary in their effectiveness and in their advantages and disadvantages.Head lice: Life cycle and reproductive cycle Illustration: Head lice: life and reproductive cycle

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

Version: December 3, 2015

Head lice: Overview

Head lice are tiny parasites that live in our hair and feed on blood from our scalp. Their bites can itch and some people find them quite repulsive. But there are a number of different effective treatments for getting rid of these bloodthirsty little creatures.

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

Version: December 3, 2015

Oral and sublingual immunotherapy (giving people small amounts of things they are allergic to via their mouth or under their tongue) for fruit allergy

We reviewed the evidence about the effect of oral and sublingual immunotherapy in people with a food allergy to fruit. Food allergy is an abnormal response to a food, usually after eating it. The main treatment for food allergy is to avoid the food, but in people with food allergy, accidentally eating the food can cause severe reactions.

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

Version: 2015

Surgical interventions for pharyngeal pouch

A pharyngeal pouch is a pocket which can develop in the pharynx (throat), just above the entrance to the oesophagus (gullet). It may cause difficulty in swallowing, sensation of a lump in the throat and troublesome regurgitation of food. Food may become lodged in the pouch and this, as well as regurgitation, may lead to weight loss, hoarseness of voice and recurrent chest infections. A pharyngeal pouch is treated by surgery which may either be 'open' (through an incision in the neck) or 'endoscopic' (through the mouth). The review found no evidence to show which surgical method is more effective.

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

Version: 2011

Botulinum toxin for swallowing disorders

Many people have problems swallowing because of an impairment of the upper oesophageal sphincter (UOS), a high pressure zone within the tube that carries food from the mouth to the stomach. Many people with neurological conditions such as stroke, traumatic brain injury, Parkinson's disease or multiple sclerosis can have UOS impairment. This results in difficulty swallowing food and liquids, resulting in choking and food entering into the lungs (aspiration). This has serious consequences for the patient and can cause dehydration, malnutrition and aspiration pneumonia. The person's quality of life can be affected as they are unable to have food or liquids safely by mouth. Tube feeding and hospitalisation is often required.

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

Version: 2014

Specially formulated foods for treating children with moderate acute malnutrition in low‐ and middle‐income countries

Moderate acute malnutrition (MAM) affects around 10% of children under five years of age in low‐ and middle‐income countries. Different food strategies have been used for the nutritional recovery of children with MAM, such as lipid‐based nutrient supplements or blended foods, which can be provided in full dose or in a low dose as a complement to the usual diet. However, there is no definitive consensus on the most effective way to treat children with MAM.

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

Version: 2014

The use of the monoclonal antibody Natalizumab (NTZ) in patients with relapsing remitting multiple sclerosis (RRMS)

It is currently thought that inflammation is crucial in MS, leading to a disruption in the ability of nerves to conduct impulses. NTZ is the first of a new generation of anti‐inflammatory treatments for MS, which is given intravenously every 4 weeks. It is usually prescribed once other drugs have failed or when the disease is rapidly worsening.

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

Version: 2011

Repetitive, increasing doses of daily milk for treatment of milk allergy

To date, the only option to treat food allergy is strict avoidance of the food and carrying an epinephrine injector (Epipen/Twinject) in case of an allergic reaction. For a food like cow's milk, avoidance is very difficult because it is found in many foods. The constant fear of accidentally eating or drinking cow's milk and anxiety related to carrying an injector has negative effects on quality of life. Accidentally having milk can cause life‐threatening reactions. Oral immunotherapy involves initially taking a very small amount of the allergen, in the case of milk allergy, cow's milk, and slowly increasing the amount each day until a full serving is reached. This may change the way the body's immune system sees the allergen, thereby increasing the amount of milk that can be eaten or drunk with no reaction.

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

Version: 2012

Daily administration of small, incremental amounts of egg protein for treatment of egg allergy

Until recently, the only practical option for people with food allergies was a strict avoidance of allergen‐containing food. It is difficult to avoid egg because it is found in many foods. Even with avoidance, the fear of accidental ingestion from mislabelled foods or cross‐contamination is an ever‐present fear for even the most careful of food‐allergic individuals. Accidental consumption of egg‐containing foods might cause a life‐threatening event. Although there are only a small number of published studies, there is a new type of treatment for egg allergy called 'oral immunotherapy' (also known as 'oral desensitization' or 'vaccination'). This is comprised of daily consumption of a small amount of egg protein, which is gradually increased over time until a full serving is reached. This method could alter the allergic response to the egg protein by the body’s immune system, increasing the amount of egg that can be eaten without inducing an adverse reaction.

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

Version: 2014

Feeding by tube into the stomach or intestine versus feeding by mouth for children with cerebral palsy

Children with cerebral palsy can have problems with sucking, chewing and swallowing. This can make it difficult to eat and lead eventually to undernutrition or problems caused by food going down the wrong way and getting into the lungs. Mealtimes may be long and distressing for the child and for their carer. Increasingly, feeding by a surgically‐inserted tube into the stomach (gastrostomy) or via a tube inserted into the middle of the small intestine (jejunostomy) is used to provide such children with nutrition. These processes can be costly, as well as being emotionally difficult for families, and complications are possible. We searched 12 databases in July 2012 but did not find any studies that randomly put children into two groups to investigate the effects of tube feeding via gastrostomy (or jejunostomy) compared to feeding by mouth only. Well‐designed studies are needed to help medical professionals and families make difficult decisions about how to treat children with cerebral palsy and physical difficulties in eating.

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

Version: 2013

Use of the antioxidant supplement Pycnogenol® to treat a variety of chronic disorders

Pycnogenol® is a herbal dietary supplement extracted from French maritime pine bark whose main ingredient is procyanidin. Procyanidin is a powerful antioxidant also found in food such as grapes, berries, pomegranates, red wine and various nuts. Supplements containing procyanidin are widely marketed worldwide for the promotion of health, and for the prevention and treatment of chronic disorders. The rationale for this is that antioxidants neutralise reactive oxygen species (ROS; frequently referred to as "free radicals") which, apart from performing important bodily functions, can cause damage to cells and tissues if present in excessive amounts. Available supplements vary in the source and quantity of procyanidin, as well as in number and type of other ingredients they contain. We chose to focus on Pycnogenol® as this supplement is a standardised product, many trials have been conducted, and it is extensively marketed internationally. Our review aimed to assess the efficacy and safety of Pycnogenol® as a treatment for chronic disorders. We identified 15 eligible randomised controlled trials with a total of 791 participants which addressed seven different chronic conditions: asthma (two studies); attention deficit hyperactivity disorder (one study), chronic venous insufficiency (two studies), diabetes (four studies), erectile dysfunction (one study), hypertension (two studies) and osteoarthritis (three studies). Due to small sample size, limited number of trials per condition, variation in outcomes evaluated and outcome measures used, as well as the risk of bias in the included studies, no definite conclusions regarding the efficacy and safety of Pycnogenol® are possible.

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

Version: 2012

How is acute pancreatitis treated?

Acute pancreatitis usually clears up within one to two weeks. Solid foods are usually not allowed for a while to avoid any additional strain on the pancreas. Supportive measures like infusion therapy to provide fluids and painkillers can help to relieve symptoms and prevent complications.The main signs of acute pancreatitis are sudden and severe pain in the upper abdomen, nausea and vomiting. It is usually caused by Gallstones blocking the opening in the pancreas or excessive consumption of alcohol.In 80 out of 100 cases the inflammation has either completely cleared up or shown significant improvement within one to two weeks. But sometimes it can become more severe and may even cause life-threatening complications, which is why pancreatitis is usually treated in the hospital.

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

Version: April 22, 2015

Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus

Short acting insulin analogues (Lispro, Aspart, Glulisine) act more quickly than regular human insulin. It can be injected immediately before meals and leads to lower blood sugar levels after food intake. Our analysis showed that short acting insulin analogues were almost identically effective to regular human insulin in long term glycaemic control and were associated with similar episodes of low blood sugar (hypoglycaemia). No information on late complications such as problems with the eyes, kidneys or feet are existing. Until long term safety data are available we suggest a cautious response to the vigorous promotion of insulin analogues.

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

Version: 2009

Regular treatment with formoterol versus regular treatment with salmeterol in chronic asthma: serious adverse events

Asthma is a common condition that affects the airways – the small tubes that carry air in and out of the lungs. When a person with asthma comes into contact with an irritant (an asthma trigger), the muscles around the walls of the airways tighten, the airways become narrower, and the lining of the airways becomes inflamed and starts to swell. This leads to the symptoms of asthma ‐ wheezing, coughing and difficulty in breathing. They can lead to an asthma attack or exacerbation. People can have underlying inflammation in their lungs and sticky mucus or phlegm may build up, which can further narrow the airways. There is no cure for asthma; however there are medications that allow most people to control their asthma so they can get on with daily life.

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

Version: 2013

Comparing Muscle Relaxants

How do muscle relaxants compare in treating spasticity caused by a neurological disorder?

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

Version: December 1, 2007

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