Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2015
ReviewLow dose versus high dose stavudine for treating people with HIV infection.
Stavudine remains a component of combination antiretroviral therapy (ART) in resource-constrained countries due to its relatively low cost despite the WHO recommendation for its phasing out as a strategy to reduce stavudine associated toxicities. Where stavudine is still in use, it is recommended at a dose lower than the standard dose in order to reduce stavudine related toxicity. ⋯ This systematic review identified only three small trials that evaluated virologic efficacy and safety of high dose versus low dose stavudine. All three trials were conducted in developed countries and none reported from developing countries yet stavudine remains a component of ART combination therapy in many developing countries. It was not possible to perform a meta-analysis on these trails. Individual results from the trials were imprecise and have not identified a clear advantage in virologic efficacy or safety between low and high dose stavudine. Furthermore, enrolled participants were treatment experienced with sustained virologic suppression and so existing data cannot be generalized to settings where stavudine is currently used in ART naive patients with high viral loads. Stavudine dose reduction trials in ART naive patients, in developing countries where stavudine is still being used are warranted as the phasing out of stavudine that is recommended by WHO may not be immediately universally feasible.
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Cochrane Db Syst Rev · Jan 2015
Review Meta AnalysisAntibiotic prophylaxis during the second and third trimester to reduce adverse pregnancy outcomes and morbidity.
Several studies have suggested that prophylactic antibiotics given during pregnancy improved maternal and perinatal outcomes, while others have shown no benefit and some have reported adverse effects. ⋯ Antibiotic prophylaxis did not reduce the risk of preterm prelabour rupture of membranes or preterm delivery (apart from in the subgroup of women with a previous preterm birth who had bacterial vaginosis). Antibiotic prophylaxis given during the second or third trimester of pregnancy reduced the risk of postpartum endometritis, preterm rupture of membranes and gonococcal infection when given routinely to all pregnant women. Substantial bias possibly exists in the review's results because of a high rate of loss to follow-up and the small numbers of studies included in each of our analyses. There is also insufficient evidence on possible harmful effects on the baby. Therefore, we conclude that there is not enough evidence to recommend the use of routine antibiotics during pregnancy to prevent infectious adverse effects on pregnancy outcomes.
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Cochrane Db Syst Rev · Jan 2015
Review Meta AnalysisPercutaneous ethanol injection or percutaneous acetic acid injection for early hepatocellular carcinoma.
Hepatocellular carcinoma (HCC) is the fifth most common global cancer. When HCC is diagnosed early, interventions such as percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), or radiofrequency (thermal) ablation (RF(T)A) may have curative potential and represent less invasive alternatives to surgery. ⋯ PEI versus PAI did not differ significantly regarding benefits and harms in people with early HCC, but the two included trials had only a limited number of participants and one trial was judged a high risk of bias. Thus, the current evidence precludes us from making any firm conclusions.There was also insufficient evidence to determine whether PEI versus surgery (segmental liver resection) was more effective, because conclusions were based on a single randomised trial. While some data from this single trial suggested that PEI was safer, the high risk of bias and the lack of any confirmatory evidence make a reliable assessment impossible.We found no trials assessing PEI or PAI versus no intervention, best supportive care, or sham intervention.There is a need for more randomised clinical trials assessing interventions for people with early stage HCC. Such trials should be conducted with low risks of systematic errors and random errors.
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Cochrane Db Syst Rev · Jan 2015
Review Meta AnalysisWorkplace interventions for reducing sitting at work.
The number of people working whilst seated at a desk keeps increasing worldwide. As sitting increases, occupational physical strain declines at the same time. This has contributed to increases in cardiovascular disease, obesity and diabetes. Therefore, reducing and breaking up the time that people spend sitting while at work is important for health. ⋯ At present there is very low quality evidence that sit-stand desks can reduce sitting time at work, but the effects of policy changes and information and counselling are inconsistent. There is a need for high quality cluster-randomised trials to assess the effects of different types of interventions on objectively measured sitting time. There are many ongoing trials that might change these conclusions in the near future.
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Cochrane Db Syst Rev · Jan 2015
ReviewProsthetic rehabilitation for older dysvascular people following a unilateral transfemoral amputation.
Dysvascularity accounts for 75% of all lower limb amputations in the UK. Around 37% of these are at transfemoral level (mid-thigh), with the majority of people being over the age of 60 and having existing co-morbidities. A significant number of these amputees will be prescribed a lower limb prosthesis for walking. However, many amputees do not achieve a high level of function following prosthetic rehabilitation. This is the second update of the review first published in 2005. ⋯ There is a lack of evidence from randomised controlled trials to inform the choice of prosthetic rehabilitation, including the optimum weight of prosthesis, after unilateral transfemoral amputation in older dysvascular people. A programme of research, including randomised controlled trials to examine key interventions, is urgently required in this area.