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Metformin, a medication used to lower glucose levels in patients with diabetes mellitus, has long been thought to increase the risk for a metabolic disorder known as lactic acidosis. This review summarised data from all known comparative and observational studies lasting at least one month, and found no cases of fatal or nonfatal lactic acidosis in 70,490 patient‐years of metformin use, or in 55,451 patient‐years for those not on metformin. Average lactate levels measured during metformin treatment were no different than for placebo or for other medications used to treat diabetes. In summary, there is no evidence at present that metformin is associated with an increased risk for lactic acidosis when prescribed under the study conditions.

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

Version: April 14, 2010

Venous thromboembolism is the presence of a blood clot that blocks a blood vessel within the venous system; it includes deep vein thrombosis (DVT) and pulmonary embolism (PE) which can be fatal. Venous thromboembolism occurs in 44% to 90% of those patients who undergo total hip or knee replacement and who do not receive anticoagulants (blood thinning drugs).

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

Version: April 14, 2010

Topical treatment alone doesn’t always help enough in people with moderate to severe psoriasis. Then medications that have an effect throughout the entire body are considered. They can be taken as tablets or injected. Because of the possible side effects, it is a good idea to be well informed about their pros and cons. Mild plaque psoriasis can usually be effectively treated with topical medications. Additional treatment may be needed for moderate to severe psoriasis. UV light therapy is often tried first. If that doesn't help either, oral medications and injections are considered. This is called "systemic treatment" because the medicines enter the bloodstream and have an effect throughout the entire body (or “system”). The treatment typically begins with one of these drugs: Methotrexate (trade names: Lantarel, Metex, MTX Hexal, Methotrexat AL, for example)Fumaric acid esters (trade name: Fumaderm)Ciclosporin (trade names: Ciclosporin Pro, Ciqorin, Sandimmun, for example)Less common: Acitretin (trade name: Acicutan) If these medications don't provide enough relief for psoriasis or are unsuitable for some other reason, treatment with biological treatments (biologics) is possible. This group of drugs manufactured using biotechnology includes: Adalimumab (Humira)Etanercept (Benepali, Enbrel)Infliximab (Flixabi, Inflextra, Remicade, Remsima)Ixekizumab (Taltz)Secukinumab (Cosentyx)Ustekinumab (Stelara) Another option is apremilast (Otezla). It belongs to a separate class of drugs.

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

Version: May 18, 2017

Epidural analgesia involves the injection of medication just outside the spinal column. It is an effective form of pain relief during labour. The intensity of the pain increases as labour progresses. Epidural analgesia is an invasive procedure with side effects and more rarely complications. Reported side effects include muscle weakness, nausea, shivering, itching and headache. Epidural analgesia with low concentration infusions of bupivacaine has been shown to not increase the incidence of caesarean section but may increase the incidence of instrumental vaginal delivery and the duration of second stage of labour (Sia 2004). This Cochrane systematic review summarised the best available evidence (published before 12 February 2014) regarding the effectiveness and safety of early initiation versus late initiation of epidural analgesia for both spontaneous and augmented labour. Our meta‐analysis involved nine randomised controlled studies with a total of 15,752 women giving birth to their first baby and found no differences in the risk of caesarean section and instrumental birth with early initiation versus late initiation of epidural analgesia for pain relief during labour. Although the effects of early or late initiation of epidural analgesia on the duration of the second stage of labour are similar, we are unable to rule out early initiation leading to an appreciably shorter duration of labour. There was a lot of variation (heterogeneity) between the results of the studies for the duration of the first stage of labour. For the baby, Apgar scores and cord pH were not different. We conclude that it would appear to be advantageous to initiate epidural analgesia for labour early, when requested by the woman.

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

Version: October 9, 2014

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: February 3, 2016

Anti‐fungals are available for oral and intra‐vaginal treatment of uncomplicated vulvovaginal candidiasis (thrush). The primary objective of this review was to assess the relative effectiveness of oral versus intra‐vaginal anti‐fungals for the treatment of uncomplicated vulvovaginal candidiasis. The secondary objectives of the review were to assess the cost‐effectiveness, safety and patient preference of oral versus intra‐vaginal anti‐fungals. No statistically significant differences were observed in clinical cure rates of anti‐fungals administered by the oral and intra‐vaginal routes for the treatment of uncomplicated vaginal candidiasis. No definitive conclusion can be made regarding the relative safety of oral and intra‐vaginal anti‐fungals for uncomplicated vaginal candidiasis. The decision to prescribe or recommend the purchase of an anti‐fungal for oral or intra‐vaginal administration should take into consideration: safety, cost and treatment preference. Unless there is a previous history of adverse reaction to one route of administration or contraindications, women who are purchasing their own treatment should be given full information about the characteristics and costs of treatment to make their own decision. If health services are paying the treatment cost, decision‐makers should consider whether the higher cost of some oral anti‐fungals is worth the gain in convenience, if this is the patient's preference.

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

Version: October 17, 2007

Patients with ischaemic heart disease due to narrowing of coronary arteries can be treated with coronary artery bypass surgery. Coronary artery bypass surgery has traditionally been performed with cardiopulmonary bypass and an arrested heart. Development of cardiac stabilisers have made it possible to conduct the operation on the beating heart and thereby avoid cardiac arrest and cardiopulmonary bypass. By avoiding cardiac arrest and cardiopulmonary bypass, it was hoped that complications seen after coronary artery bypass could be reduced. Systematic review of 86 randomised clinical trials including 10,716 patients and statistical analyses of the data showed that coronary artery bypass surgery performed on the beating heart results in an increased risk of death. No firm evidence for benefit or harm was found regarding the outcome measures myocardial infarction, stroke, atrial fibrillation, renal insufficiency, or coronary reintervention. Our data raises a warning regarding coronary artery bypass surgery on the beating heart and cardiac arrest and cardiopulmonary bypass seem less risky. In patients with contraindications for cannulation of the aorta and cardiopulmonary bypass coronary artery bypass surgery on the beating heart may be a solution but we need randomised clinical trials in these patients to identify the most beneficial approach.

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

Version: March 14, 2012

Blood clots (venous thromboembolism) sometimes cause blockages in veins after surgery, during bed rest, or spontaneously. These clots can be fatal when they travel to the lungs. Vitamin K antagonists (VKAs), 99% of which consist of warfarin, are effective in preventing renewed blood clot formation, because they thin the blood. Low‐molecular‐weight heparins (LMWHs) are drugs that thin the blood and are used for people who are at risk of major bleeding, people who cannot take vitamin K antagonists, and pregnant women.

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

Version: July 24, 2017

HT is given for control of menopausal symptoms. It has also been used for the management and prevention of chronic diseases such as cardiovascular disease, osteoporosis and dementia.

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

Version: January 17, 2017

Regimen simplification can be defined as a change in established effective therapy to reduce pill burden and dosing frequency, to enhance tolerability, or to decrease specific food and fluid requirements. Many patients on suppressive antiretroviral therapy may be considered candidates for a simplification strategy and, among them, those who have achieved virologic suppression. We have reviewed clinical trials evaluating the efficacy and safety of abacavir‐containing triple nucleoside combination as a simplification therapy in HIV‐infected adult patients treated with a Protease‐Inhibitor (PI)‐containing regimen and  with undetectable viral load. Patients on a PI‐containing regimen had three possibilities: continue the PI regimen or switch to a simplification maintenance regimen with triple nucleoside combination (abacavir‐zidovudine‐lamivudine) or with non‐nucleoside (efavirenz or nevirapine) containing regimens. The review included 8 RCTs and 1675 HIV infected patients. Simplification with triple nucleoside regimen showed an overall failure rate comparable to that of  continuing  PI regimen or  to simplification with non‐nucleoside regimens. Rates of failure due to adverse events with triple nucleoside combinations were lower compared to controls, but the difference was not statistically significant. By contrast, rates of virologic failures   were more frequent with  triple nucleoside combination that with PI or NNRTI, but in both the comparisons the differences were  not statistically significant. Simplification with abacavir had a favourable and significant impact on lipid metabolism compared to control group. Simplification with triple nucleoside regimens should be still considered for individuals who are unable to tolerate or have contraindications to NNRTI or PI based regimens

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

Version: June 5, 2013

Of all people with gastric cancer, in countries where screening is not routinely performed, 80% to 90% are either diagnosed at an advanced stage when the tumour is inoperable, or develop a recurrence within five years after surgery. Before starting any systemic chemotherapy in advanced disease, testing for over expression of the Human Epidermal growth factor Receptor‐2 (abbreviated HER‐2) testing is mandatory, and people with HER‐2 over expression need, in the absence of contraindications, to be treated by a combination of a cisplatin/fluoropyrimidine‐based chemotherapy and trastuzumab (i.e. a monoclonal antibody directed against the human epidermal growth factor receptor II).

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

Version: August 29, 2017

The aim of this review was to examine how clonidine applied to the skin works in people with neuropathic pain. To answer this question, we searched medical databases up to 17 September 2014. We found only two studies that provided information. They lasted 8 weeks and 12 weeks and included a total of 344 participants with painful diabetic neuropathy (PDN). One drug manufacturer supported both studies, which were of low quality.

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

Version: September 2, 2015

Amputation of the leg is most often performed to remove dead tissue (gangrene), painful ulcers, tumours, or tissue with an inadequate blood supply. One of the most common causes of an inadequate blood supply is a narrowing of the arteries of the legs, which accounts for approximately 70% of amputations. In patients with this condition, blood clots are more likely to cause problems such as venous thromboembolism (VTE). This comprises two conditions, a blood clot in the legs (deep vein thrombosis (DVT)) or a blood clot in the arteries of the lungs (pulmonary embolism (PE)). The risk of these events occurring is higher in people undergoing amputations. There are two forms of preventive measures for VTE, drugs or compression devices. Drugs are proven to be effective in preventing VTE but are also associated with adverse side effects. Compression stockings or devices do not cause side effects but are not suitable for everyone. Current guidelines recommend that any person undergoing an amputation of the lower limb should be offered drugs to prevent a blood clot. However, in people with amputations it is not clear which method is best. This review aimed to establish the best method.

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

Version: December 16, 2013

Melanoma in situ (MIS) is the earliest stage of malignant melanoma. Over the past two decades, the incidence of MIS has increased. Lentigo maligna (LM) is a subtype of pre‐invasive melanoma associated with chronic exposure to ultraviolet radiation, primarily affecting the head and neck. It accounts for 79% to 83% of all MIS tumours. Delayed recognition is common.

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

Version: December 19, 2014

If a pregnant woman's waters break without contractions before 37 weeks of pregnancy there are two options: for the baby to be born as soon as possible, or to wait for labour to start naturally. We need to carefully look at the risks and benefits of both options.

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

Version: March 3, 2017

This is an updated version of the original Cochrane review published in Issue 11, 2010 (Derry 2010). New searches identified one additional study for inclusion; this study compared paracetamol with etodolac and did not contribute to any of the analyses in the review.

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

Version: April 30, 2013

Atrial fibrillation increases the risk of a stroke. This risk can be greatly reduced by taking medication. But it usually only makes sense to do so if you have other risk factors for cardiovascular disease too. Atrial fibrillation is the most common kind of irregular heartbeat, and usually doesn’t pose an immediate threat to your health. In the long term, though, it increases your risk of a stroke. This risk can be greatly reduced by taking tablets that inhibit blood clotting (oral anticoagulants). Before deciding on a treatment together with your doctor, it’s a good idea to calculate your personal risk of having a stroke. Treatment with medication isn’t always necessary.

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

Version: October 5, 2017

Colorectal cancer is one of the most common malignant tumour worldwide and approximately 50 % of patients will develop liver metastases (liver is the first site of metastatic disease). Hepatic resection is the only curative option, but only 15‐20% of patients with liver metastases from colorectal cancer are suitable for surgical standard treatment. Besides chemotherapy, several minimally invasive treatment techniques have been developed to treat patients with CRLMs: hepatic arterial infusion, cryotherapy, microwave ablation, selective internal radion treatment, radiofrequency ablation. During the past decade radiofrequency ablation has superseded other ablative therapies, due to its low morbidity, mortality, safety and patient acceptability. Radiofrequency ablation is a minimally invasive technique in which a needle is inserted into the tumour (liver metastases) either getting access by way of the skin (percutaneously) or via open approach (surgically). Alternating current is generated using radio waves and, through needle, create local tissue temperatures of 50‐100˚C temperature, that causes “coagulation” and tumour necrosis. According to several studies RFA is technically feasible and safe for the treatment of CRLMs, however little is known about its efficacy in terms of overall survival (OS), disease free survival (DFS) and local recurrence. The aim of this review was to see if the treatment of CRLMs with RFA provides more benefit in terms of overall survival, disease free survival and local recurrence. This review include 18 studies (10 observational studies, 7 CCTs and an additional 1 RCT) comparing radiofrequency ablation with any other treatment. The heterogeneity regarding interventions, comparisons and outcomes rendered the data unusable and unsuitable for drawing conclusions. There is insufficient evidence to recommend the use of radiofrequency ablation for a radical treatment of liver metastases from colorectal cancer. High quality randomised clinical trials are required to answer on the potential benefit and harms associated with the use of radiofrequency ablation in the treatment of liver metastases from colorectal cancer.

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

Version: June 13, 2012

Hypertrophic cardiomyopathy (HCM) is a genetic disease with an autosomal‐dominant inheritance, which can cause obstruction in the left ventricle outflow tract. This obstruction can lead to a variety of symptoms like dyspnoea, chest pain, syncope and palpitations. The prevalence of HCM in the general population, as determined from echocardiographic studies in the United States, Japan, and China, has ranged from 0.16 to 0.29 percent. Treatment options for HCM ranges from drugs to surgery with each having its own limitations. Active cardiac pacing was suggested as a treatment option in some trials. We conducted this review to assess the available evidence on the effects of active pacing in drug‐refractory or drug‐intolerant HCM patients. Five studies (reported in 10 papers) were found to be relevant. However, three of the five studies provided un‐usable data. Thus data from only two studies (reported in seven papers) with 105 participants was included for this review. There was insufficient data to compare results on all‐cause mortality, cost effectiveness, exercise capacity, Quality of life and Peak O2 consumption. There was no difference in exercise capacity when comparing active pacing versus placebo pacing. However left ventricular outflow tract obstruction decreased significantly in the active pacing group compared to placebo. New York Heart Association functional class increased in the active pacing group compared to the placebo group and this was also observed when comparing active pacing versus trancoronary ablation of septal hypertrophy. Interpretation of these data needs to be cautious because existing data is derived from small trials at high risk of bias, which concentrate on physiological measures. Their results are inconclusive. Further large and high quality trials with more appropriate outcomes are warranted.

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

Version: May 16, 2012

Endometrial cancer is usually diagnosed at an early stage and can be treated with surgery. Learn about the symptoms, diagnosis, prognosis, staging, and treatment for early- and advanced-stage endometrial cancer in this expert-reviewed summary.

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

Version: January 19, 2018

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