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Evidence on interventions for paracetamol (acetaminophen) overdose patients is weak

Poisoning with paracetamol (acetaminophen) is a common cause of hepatic injury. The evidence for all interventions for paracetamol overdose is weak. Activated charcoal, gastric lavage, and ipecacuanha are able to reduce absorption of paracetamol if started within one to two hours of paracetamol ingestion, but the clinical benefit is unclear. Activated charcoal seems to be the best choice if the patient is compliant. N‐acetylcysteine seems superior to no intervention and other antidotes (dimercaprol, cysteamine) and should be administered to patients at significant risk of hepatic damage. However, N‐acetylcysteine superiority to methionine is unclear. Liver transplantation will clearly benefit patients with irreversible hepatic failure. However, identifying such patients early is problematic and the long‐term outcomes in this group of patients have not been reported. Other interventions have not shown any clinical benefit for paracetamol overdose.

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

Version: 2009

Noninvasive Treatments for Low Back Pain: A Summary of the Research for Adults

This summary will answer these questions: What is low back pain? How is low back pain treated? » Medicines » Nonmedicine treatments such as heat, exercise, and massage What have researchers found about treatments for low back pain? What are possible side effects of medicines to treat low back pain? What should I discuss with my health care professional about treating my low back pain?

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 15, 2016

Depression: How effective are antidepressants?

Like psychological approaches, antidepressants are a key part of treating depression. They aim to relieve symptoms and prevent depression from coming back.Opinions vary on how effective antidepressants are in relieving the symptoms of depression. Some people doubt they help, while others consider them to be essential. But as is true for many other treatments, these medications may help in some situations, and not in others. They are effective for moderate, severe and chronic depression, but probably not for mild cases. They can also have side effects. It is important to discuss the pros and cons of antidepressants with your doctor.The main aim of treatment with antidepressants is to relieve the symptoms of depression, such as feeling very sad and exhausted, and prevent them from coming back. The medications are designed to restore emotional balance and help people to get on with everyday life. They are also taken to relieve symptoms such as restlessness, anxiety, sleep problems and suicidal thoughts.This information deals with using medication to treat the most common form of depression, namely unipolar depression. The treatment of manic depression (bipolar disorder) is not discussed here.

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

Version: January 12, 2017

Which talking therapies (counselling) work for drug users with alcohol problems?

We wanted to determine whether talking therapies have an impact on alcohol problems in adult users of illicit drugs (mainly opiates and stimulants) and whether one type of therapy is more effective than another.

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

Version: 2014

Aerosolized prostacyclin for acute lung injury (ALI) and acute respiratory distress syndrome (ARDS)

The clinical research is insufficient to support the routine use of inhaled prostacyclin for acute lung injury and acute respiratory distress syndrome in critically ill children or adults with low blood oxygen levels. Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical respiratory conditions that are triggered by respiratory viral infections or develop following burns, massive transfusions, multiple trauma, aspiration of gastric contents, pancreatitis, inhalation injury, sepsis, drug overdose and near drowning.

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

Version: 2013

Cancer Pain (PDQ®): Patient Version

Expert-reviewed information summary about pain as a complication of cancer or its treatment. Approaches to the management and treatment of cancer-associated pain are discussed.

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

Version: September 23, 2016

Methadone maintenance at different dosages for opioid dependence

People who are addicted to opioids have high risks of receiving an overdose of opioid, HIV, hepatitis B and C infections and criminal activity. This has led to a harm reduction treatment approach to drug addiction. Treatment is aimed at a reduction in these risks and relapses to opioid and polysubstance use and promoting psychosocial adjustment. Methadone maintenance treatment is a long‐term opioid replacement therapy that is used to manage opioid dependence, reduce illicit opioid use and promote retention in treatment. Taken by mouth and active over 24 to 36 hours, it is an opioid drug that removes the euphoric effects of heroin and reduces withdrawal symptoms as well as being compatible with normal activities at work or school. The review authors identified 21 controlled trials involving a total of 5994 opioid users. In 11 of these trials, all from the USA, 2279 participants were randomised to methadone treatment at different doses or another treatment (buprenorphine or levomethadyl). Treatment was for between seven and 53 weeks. A further 10 controlled trials did not randomly assign the total of 3715 participants to a treatment. These were from various diverse countries and followed opioid users for one to 10 years. Higher doses of methadone (60 to 100 mg/day) were more effective than lower doses (1 to 39 mg/day) in retaining opioid users in therapy and in reducing illicit use of heroin and cocaine during treatment. Side effects of methadone appeared to be similar at the different doses, in one trial only.

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

Version: 2008

Hemodialysis for lithium poisoning

Lithium salts, particularly lithium carbonate, are frequently used to treat bipolar disorder and mania. Lithium poisoning, whether due to reduced excretion by the kidneys or overdose, can cause permanent injury to the nervous system. Hemodialysis is a process in which a person's blood is filtered outside of their body, by a machine, and then returned to the person's body. Hemodialysis effectively removes lithium from the body, and has been used to treat lithium poisoning for at least 40 years. However, it is not known whether hemodialysis, performed in addition to standard therapy with intravenous fluids, reduces or eliminates damage to the nervous system.

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

Version: 2015

Supervised‐dosing strategies versus take‐home opioid substitution treatment for people dependent on opioid drugs

We reviewed the evidence about the effectiveness of supervised dosing strategies in opioid substitution treatment for people dependent on opioid drugs.

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

Version: 2017

Oral naltrexone as maintenance treatment to prevent relapse in opioid addicts who have undergone detoxification

Opioid dependence is considered to be a lifelong, chronic relapsing disorder. Substantial therapeutic efforts are needed to keep people drug free. Methadone treatment plays a vital role in detoxification or maintenance programs but some individuals who are on methadone continue to use illicit drugs, commit crime and engage in behaviours that promote the spread of communicable diseases. Naltrexone is a long acting opioid antagonist that does not produce euphoria and is not addicting. It is used in accidental heroin overdose and for the treatment of people who have opioid dependence. Naltrexone is particularly suitable to prevent a relapse to opioid use after heroin detoxification for those for whom failure to comply with treatment has major consequences, for example health professionals, business executives and individuals under legal supervision. Medication compliance and retention rates with naltrexone treatment are however low.

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

Version: 2011

Drugs and natural products for self‐harm in adults

We have reviewed the international literature regarding pharmacological (drug) and natural product (dietary supplementation) treatment trials in this field. A total of seven trials meeting our inclusion criteria were identified. There is little evidence of beneficial effects of either pharmacological or natural product treatments. However, few trials have been conducted and those that have are small, meaning that possible beneficial effects of some therapies cannot be ruled out.

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

Version: 2015

Low back pain: Medication for chronic back pain

Over-the-counter painkillers can sometimes relieve chronic low back pain. Studies have also found that some prescription painkillers like opioids may have a benefit. There is no proof that muscle relaxants or antidepressants help relieve chronic low back pain.Low back pain is one of the ten most common diagnoses made by family doctors. It often goes away on its own without treatment, but sometimes it persists or keeps coming back. The causes of chronic low back pain are usually unclear, and treating it is often difficult.Good-quality studies have so far found that only few treatments help. Besides medication, treatments such as exercise therapy, psychological therapy, physiotherapy and acupuncture are used. The medications used include over-the-counter and prescription painkillers, muscle relaxants and antidepressants.Because medication can have side effects – especially when taken over longer periods of time – experts recommend not taking it continuously, but rather only for a short while, for example if the pain is especially severe.

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

Version: December 2, 2015

Pharmacological therapies for maintenance treatments of opium dependence

Opium is obtained from the unripe seed capsules of the poppy plant. Opium is usually used by smoking or by swallowing to create a feeling of euphoria, to provide pleasure or as an analgesic or hypnotic. Cultural attitudes affect the patterns of opioid use among different countries. In the Middle East and south east Asia, opium is used in many cases in social settings and the users do not suffer from considerable social dysfunction. It is used occasionally and mainly in male gatherings but regular use can cause dependence. Opium users have a more stable life style than heroin users and, of those who come for treatment, a higher proportion are married and live with their family.

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

Version: 2012

Opioid maintenance medicines for the treatment of dependence on opioid pain medicines

Use of pharmaceutical opioids (medicines that are used to treat pain) has increased dramatically in some parts of the world since the mid‐1990s. With the increased use, there has been increasing numbers of people seeking treatment for dependence (addiction) on pharmaceutical opioids. Currently, most treatment guidelines are based on research that was conducted in people who were dependent on heroin (a highly addictive opioid). This review sought to compare different opioid agonist maintenance treatments (i.e. treatments such as methadone or buprenorphine that are given for at least 30 days to help the person to reduce their unsanctioned drug use) for the treatment of pharmaceutical opioid dependence. We also compared results from maintenance treatment to short term treatments such as detoxification (removal of the drug from the body) or psychological treatments (e.g. talking therapy, counselling).

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

Version: 2016

Antidepressants for the treatment of children and adolescents with functional abdominal pain

Abdominal pain‐related functional gastrointestinal disorders (FGIDs) are common in childhood and adolescence. In most cases no medical reason for the pain can be found. Various drug treatment approaches for the different types of abdominal pain‐related FGIDs exist. These drug treatments include: prokinetics and antisecretory agents for functional dyspepsia; pizotifen, propranolol, cyproheptadine or sumatriptane for abdominal migraine; and antispasmodic and antidiarrhoeal regimen for irritable bowel syndrome. Antidepressants have been shown to be effective in some studies of adults with functional gastrointestinal disorders. As a result young patients with similar complaints are sometimes treated with antidepressants. The purpose of this review was to examine the evidence assessing the advantages and disadvantages of such an approach. Only two studies met the inclusion criteria. Both of these studies were randomised controlled trials and assessed the effectiveness and safety of amitriptyline in children with FGIDs. Amitriptyline is a first generation antidepressant (tricyclic antidepressant). Amitriptyline is no longer an agent of first choice for the treatment of depressive disorders because of potentially serious side effects including overdose. Amitriptyline has not been approved for the treatment of functional abdominal pain in children or adolescents.

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

Version: 2011

Pregnancy and birth: Do all pregnant women need to take iron supplements?

Iron supplements are particularly important for pregnant women who have anemia. In women who have normal blood values, taking iron supplements as a precautionary measure probably does not have any health benefits. They can get enough iron in their diet.

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

Version: March 19, 2014

What treatments are there for bedwetting?

Bedwetting is more common among children and teenagers than you might think. Regular “accidents” in the middle of the night can be troubling for the entire family. But the problem usually goes away on its own over time. There are various things you can do to help your child in the meantime. Regardless of the approach you choose, the main thing you will need is patience.There is a big market for products and remedies designed to help with bedwetting. Some of these products work, but many are overpriced and advertised with false claims. Because just about every child will eventually make it through the night without wetting the bed on their own, it is difficult to tell whether a particular approach actually helped, or whether the child’s bladder control developed on its own during that time.Research has shown that only a few of these approaches are helpful. In particular, these include electronic alarm systems such as alarm sensors in the child’s underwear or on special mats, as well as certain types of medication. It is important to keep in mind that none of these methods can guarantee that a child will stop wetting the bed sooner, but some can help in at least some children.When is it a good idea to consider treatment? Many children who still wet the bed at the age of five end up stopping on their own by the time they are seven. The problem often becomes more urgent when a child starts school. As well as the child’s age, other factors also play a role when deciding for or against treatment: How much of a problem is the bedwetting for the child and parents? Does the child want to stop wetting the bed? Is he or she willing to give treatment a try?If a child’s self-confidence is noticeably affected by the bedwetting, treatment may be a good idea even if the incidents are quite rare, or if the treatment only leads to a small improvement. And there is little point in trying a treatment if the child does not want to, or is not yet mature enough.

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

Version: February 6, 2014

Preventing colorectal cancer: What role does lifestyle play?

There is no lack of advice on preventing colorectal cancer: The long list of recommendations includes more fiber, less meat, extra vitamins and even medication. But which of the most common claims are backed by scientific research?You can lower your risk of colorectal cancer by having colorectal cancer screening. Screening is typically done for people over the age of 50 and has been proven to lower the risk of colorectal cancer.People in this age group might also try to avoid getting colorectal cancer by following a healthier lifestyle. But what can be made of all of this advice, especially the tips on diet? Does eating a lot of fruits and vegetables and less red meat really help? And will taking more vitamins make a difference?

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

Version: December 3, 2014

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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Family Caregivers in Cancer (PDQ®): Patient Version

Expert-reviewed information summary about the challenges faced by family caregivers of cancer patients. This summary focuses on typical caregiver roles and concerns, and helpful interventions for caregivers.

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

Version: July 14, 2015

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