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Testing Treatments: Better Research for Better Healthcare. 2nd edition

How do we know whether a particular treatment really works? How reliable is the evidence? And how do we ensure that research into medical treatments best meets the needs of patients? These are just a few of the questions addressed in a lively and informative way in Testing Treatments. Brimming with vivid examples, Testing Treatments will inspire both patients and professionals.

Pinter & Martin.

Version: 2011
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Interactive computer play as "motor therapy" for individuals with cerebral palsy

The aim of the study was to evaluate the quality of evidence for interactive computer play (ICP) to improve motor performance (including motor control, strength, or cardiovascular [CVS] fitness) in individuals with cerebral palsy. A computer-assisted literature search was completed, focusing on ICP as a therapeutic modality to improve motor outcomes in individuals of all ages with cerebral palsy with a specific focus on upper and lower extremity motor outcomes and promotion of CVS fitness. Articles were classified according to American Academy of Neurology guidelines and recommendation classifications were given based on the levels of evidence. Seventeen articles underwent full-text review including 6 on upper extremity motor function, 5 on lower extremity motor function, 1 on CVS fitness, and 5 on studies with a combination of upper or lower extremity or CVS fitness focus or both. Overall, there was level B (probable) evidence for ICP interventions to improve lower extremity motor control or function. However, there was inadequate evidence (level U) for ICP interventions improving upper limb motor control or function or CVS fitness. Although promising trends are apparent, the strongest level of evidence exists for the use of ICP to improve gross motor outcomes. Additional evidence is warranted especially when evaluating the effect of ICP on upper limb motor outcomes and CVS fitness.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Meta-analysis of treatment for child sexual behavior problems: practice elements and outcomes

This review concluded that the overall degree of change over the course of various treatments was estimated at a decline of 0.46 to 0.49 standard deviation in child patients' sexual behaviour problems and general behaviour problems. It was difficult to judge the reliability of the authors' conclusions given the lack of details on study quality and other methodological concerns.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Treatment of child neglect: a systematic review

The authors concluded that few studies had evaluated treatment programmes for child neglect and further research is required. There was some support for resilient peer treatment, imaginative play training, multisystemic therapy and a specific therapeutic day treatment programme. In the absence of results data, conclusions about the effectiveness of individual interventions could not be confirmed.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents. A systematic review

The review concluded that individual and group cognitive-behavioural therapy could decrease psychological harm among symptomatic children and adolescents exposed to trauma. Evidence was insufficient to determine the effectiveness of play, art, pharmacological and psychodynamic therapies, and psychological debriefing in reducing psychological harm. The authors’ conclusions appeared to be conservative and reflected the evidence, but there were concerns about study quality.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Interventions for Adolescents and Young Adults With Autism Spectrum Disorders [Internet]

We systematically reviewed evidence on therapies for adolescents and young adults (ages 13 to 30) with autism spectrum disorders (ASD). We focused on the outcomes, including harms and adverse effects, of interventions addressing the core symptoms of ASD; common medical and mental health comorbidities occurring with ASD; the attainment of goals toward functional/adult independence; educational and occupational/vocational attainment; quality of life; access to health and other services; and the transitioning process (i.e., process of transitioning to greater independent functioning). We also addressed the effects of interventions on family outcomes including parent distress and satisfaction with interventions.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: August 2012
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Constraint‐induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy

This therapy involves constraining the non‐affected arm to encourage performance of therapeutic tasks with the affected arm, which children normally tend to disregard. Two clinical trials showed positive trends in support of constraint‐induced movement therapy (CIMT) and Forced Use, whilst another demonstrated a positive treatment effect favouring modified CIMT as a treatment for children with hemiplegic cerebral palsy. This evidence is based on one small randomised controlled trial with methodological limitations, one trial with ambiguous methodology and reporting and one controlled clinical trial. There is a need for additional high quality research to adequately support the use of this therapy.

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

Version: 2009

Hypothalamic‐pituitary‐adrenal (HPA) axis suppression after treatment with glucocorticoid therapy for childhood acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is the most frequent type of cancer to occur in children. Glucocorticoids, like prednisone and dexamethasone, play a major role in the treatment of ALL. However, high‐dose glucocorticoids can cause HPA axis suppression. Suppression of the HPA axis resulting in inadequate cortisol production may cause an impaired response to stressors (for example trauma, surgery, or inflammation) and an inadequate host defence against infections, and remains a cause of morbidity and death in childhood. The occurrence and duration of HPA axis suppression after glucocorticoid therapy for childhood ALL are unclear.

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

Version: 2015

The impact of tuberculosis preventive therapy on tuberculosis and death in HIV‐infected children

Tuberculosis (TB) is a common cause of severe lung disease and death in children infected with HIV, particularly those living in areas of high tuberculosis prevalence. Hence preventing TB infection and disease in HIV‐infected children is desirable and potentially an important major public health intervention. Isoniazid, a medication used in the treatment of TB, has been effectively used to prevent TB in HIV‐uninfected children exposed to TB. However, it is unclear what impact TB preventive therapy such as isoniazid has on the rate of TB or death if given to HIV‐infected children with and without exposure to TB. This review aimed to assess the impact of any TB preventive therapy on the rate of TB or death when given to HIV‐infected children. We found only one published randomised controlled trial investigating TB preventive therapy in HIV‐infected children. The trial showed a marked reduction in TB incidence and death in the group of children who received isoniazid as primary preventive therapy. Few adverse events occurred during the study and none were related to the isoniazid therapy. However there are currently no long‐term follow up data on the durability of the protective effect or possible long term adverse events. This trial was also unable to assess the impact of isoniazid prophylaxis on children receiving antiretroviral therapy. Further studies are needed to assess whether TB preventive therapy is of benefit in all HIV‐infected children irrespective of use of antiretroviral treatment; the optimal duration of preventive therapy or long term adverse effects.

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

Version: 2009

Antiplatelet therapy for aneurysmal subarachnoid haemorrhage

A subarachnoid haemorrhage (SAH) is a type of stroke due to bleeding in the subarachnoid space, which is the small space between the brain and the skull, and which contains blood vessels that supply the brain. The cause of the bleeding is usually a rupture of a bulge in one of these vessels, which is called an aneurysm. The outcome of patients after SAH is generally poor: 50% of patients die within one month after the haemorrhage, and of those who survive the initial month, 50% remain dependent on someone else for help with activities of daily living (eg, walking, dressing, bathing). One of the causes of poor outcome is a complication of SAH called secondary ischaemia (ischaemia means lack of blood). This complication occurs four to 10 days after the haemorrhage (hence secondary). The cause is not exactly known, but besides contraction of the blood vessels in the brain, there is evidence that clotting of blood platelets plays a role as well. Therefore, trials have been performed with agents that prevent clotting of blood platelets (antiplatelet agents). In this review of seven trials, including 1385 patients, that studied the effects of antiplatelet agents on the outcome after SAH, we found that patients who were treated with antiplatelet agents had a poor outcome less often, and secondary ischaemia less often than patients that received no antiplatelet agent, but the results were not statistically significant and so no definite conclusion can be drawn. Moreover, patients who are treated with antiplatelet agents might have a slightly higher risk of bleeding. Based on these results we conclude that antiplatelet agents after SAH cannot be recommended at the present time.

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

Version: 2008

Educational and behavioural interventions to increase the time in the therapeutic range for patients with atrial fibrillation on anticoagulant therapy

We reviewed the evidence about the effects of educational and behavioural interventions in patients with atrial fibrillation who are taking oral anticoagulant medication.

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

Version: 2017

Can antibody induction therapy help to reduce organ rejection for lung transplant recipients?

People who receive transplanted lungs are at significant risk of organ rejection. To help reduce the risk of organ rejection, antibodies against T‐cells (a type of white blood cell that plays a central role in immunity) are given to patients within the first two weeks after transplantation. Several types of antibodies have been used, but their benefits and harms are unclear.

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

Version: 2013

Antiviral therapy for recurrent liver graft infection with hepatitis C virus

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 infection). Sometimes, the liver damage can be so severe that the liver is not able to carry out the normal functions, resulting in liver failure. Liver transplantation is an effective treatment for the treatment of 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 treat the recurrence of chronic hepatitis C virus infection in these patients is using antiviral treatments. The effectiveness of these treatments is not known. We performed a detailed review of the medical literature (to February 2013) to determine the benefits and harms of different antiviral treatments for patients with recurrent hepatitis C infection after undergoing liver transplantation for chronic hepatitis C virus infection. We sought evidence from randomised clinical trials only. When conducted properly, such trials provide the best evidence. Two 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: 2014

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

Can ultrasound therapy help to heal venous (varicose) leg ulcers and/or improve symptoms?

Venous leg ulcers are common wounds caused by damage or blockages in leg veins. This leads to pooling of blood and increased pressure in these veins. Eventually these changes can damage the skin and underlying tissue and form a long‐lasting wound, or ulcer. These ulcers can be painful and leak fluid. They can also become infected. People at risk of developing venous leg ulcers include the elderly and those with mobility problems. They can be distressing for patients and costly to healthcare systems.

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

Version: 2017

Eczema: Light therapy and oral medications

Eczema can usually be kept at bay by moisturizing your skin enough, applying anti-inflammatory ointments or creams, and avoiding irritants. If this isn't enough, light therapy with UV rays or treatment with tablets can be considered. Some people have such severe eczema flare-ups that using ointments or creams to reduce the inflammation doesn't relieve the symptoms enough. During acute phases like this, light therapy may be used. If this doesn't work well enough either, tablets that suppress the body's immune response are an option.

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

Version: February 23, 2017

Antibody induction therapy compared with corticosteroids for induction of immunosuppression after liver transplantation

Historically, corticosteroids have been the backbone of immunosuppression after liver transplantation, and corticosteroids are typically started immediately before or during transplantation. However, the use of corticosteroids is associated with several complications such as infection, hepatitis C virus recurrence, diabetes mellitus, hypertension, obesity, osteoporosis, fracture, and reduced quality of life. Hence, corticosteroid avoidance and corticosteroid reduction regimens for liver transplant recipients have been developed.

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

Version: 2014

Psychological therapy for parents of children and adolescents with a longstanding or life‐threatening physical illness

This is an update of a previously published review published in 2012 investigating the efficacy of psychological therapies for parents of children with a longstanding or life‐threatening physical illness. This review updates includes studies that have been conducted in the previous two years to give an up‐to‐date review of the evidence.

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

Version: 2015

The clinical effectiveness and cost-effectiveness of enzyme replacement therapy for Gaucher's disease: a systematic review

Enzyme replacement therapy (ERT; intravenous imiglucerase) is used in the treatment of people with symptomatic type I and type III Gaucher's disease in order to reduce symptoms of the disease and prevent long-term damage. The aim of this review is to determine the clinical effectiveness and cost-effectiveness of ERT in the treatment of symptomatic Gaucher's disease.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2006

Spasticity in Children and Young People with Non-Progressive Brain Disorders: Management of Spasticity and Co-Existing Motor Disorders and Their Early Musculoskeletal Complications

This guideline covers the management of spasticity and co-existing motor disorders and their early musculoskeletal complications in children and young people (from birth up to their 19th birthday) with non-progressive brain disorders.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: July 2012
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