Background
Chronic rhinosinusitis frequently occurs in people with cystic fibrosis. Several medical interventions are available for treating chronic rhinosinusitis in people with cystic fibrosis; for ...example, different concentrations of nasal saline irrigations, topical or oral corticosteroids, antibiotics ‐ including nebulized antibiotics ‐ dornase alfa and modulators of the cystic fibrosis transmembrane conductance regulator (CFTR) (such as lumacaftor, ivacaftor or tezacaftor). However, the efficacy of these interventions is unclear.
This is an update of a previously published review.
Objectives
The objective of this review is to compare the effects of different medical interventions in people diagnosed with cystic fibrosis and chronic rhinosinusitis.
Search methods
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference books. Date of last search of trials register: 09 September 2021.
We also searched ongoing trials databases, other medical databases and the reference lists of relevant articles and reviews. Date of latest additional searches: 22 November 2021.
Selection criteria
Randomized and quasi‐randomized trials of different medical interventions compared to each other or to no intervention or to placebo.
Data collection and analysis
Two review authors independently assessed trials identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with Cochrane methods and to independently rate the quality of the evidence for each outcome using the GRADE guidelines.
Main results
We identified no trials that met the pre‐defined inclusion criteria. The most recent searches identified 44 new references, none of which were eligible for inclusion in the current version of this review; 12 studies are listed as excluded and one as ongoing.
Authors' conclusions
We identified no eligible trials assessing the medical interventions in people with cystic fibrosis and chronic rhinosinusitis. High‐quality trials are needed which should assess the efficacy of different treatment options detailed above for managing chronic rhinosinusitis, preventing pulmonary exacerbations and improving quality of life in people with cystic fibrosis.
Background
Chronic rhinosinusitis frequently occurs in people with cystic fibrosis. Several medical interventions are available for treating chronic rhinosinusitis in people with cystic fibrosis; for ...example, different concentrations of nasal saline irrigations, topical or oral corticosteroids, antibiotics ‐ including nebulized antibiotics, dornase alfa and modulators of the cystic fibrosis transmembrane conductance regulator (CFTR) (such as lumacaftor, ivacaftor or tezacaftor). However, the efficacy of these interventions is unclear.
Objectives
The objective of this review is to compare the effects of different medical interventions in people diagnosed with cystic fibrosis and chronic rhinosinusitis.
Search methods
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and hand searching of journals and conference books. Date of last search of trials register: 22 May 2019.
We also searched ongoing trials databases, other medical databases and the reference lists of relevant articles and reviews. Date of latest additional searches: 20 May 2019.
Selection criteria
Randomized and quasi‐randomized trials of different medical interventions compared to each other or to no intervention or to placebo.
Data collection and analysis
Two review authors independently assessed trials identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with Cochrane methods and to independently rate the quality of the evidence for each outcome using the GRADE guidelines.
Main results
We identified no trials that met the pre‐defined inclusion criteria. The searches identified 47 trials, none of which were eligible for inclusion in the current version of this review.
Authors' conclusions
We identified no eligible trials assessing the medical interventions in people with cystic fibrosis and chronic rhinosinusitis. High‐quality trials are needed which should assess the efficacy of different treatment options detailed above for managing chronic rhinosinusitis, preventing pulmonary exacerbations and improving quality of life in people with cystic fibrosis.
Background
Dentistry is a profession with a high prevalence of work‐related musculoskeletal disorders (WMSD) among practitioners, with symptoms often starting as early in the career as the student ...phase. Ergonomic interventions in physical, cognitive, and organisational domains have been suggested to prevent their occurrence, but evidence of their effects remains unclear.
Objectives
To assess the effect of ergonomic interventions for the prevention of work‐related musculoskeletal disorders among dental care practitioners.
Search methods
We searched CENTRAL, MEDLINE PubMed, Embase, PsycINFO ProQuest, NIOSHTIC, NIOSHTIC‐2, HSELINE, CISDOC (OSH‐UPDATE), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) Search Portal to August 2018, without language or date restrictions.
Selection criteria
We included randomised controlled trials (RCTs), quasi‐RCTs, and cluster RCTs, in which participants were adults, aged 18 and older, who were engaged in the practice of dentistry. At least 75% of them had to be free from musculoskeletal pain at baseline. We only included studies that measured at least one of our primary outcomes; i.e. physician diagnosed WMSD, self‐reported pain, or work functioning.
Data collection and analysis
Three authors independently screened and selected 20 potentially eligible references from 946 relevant references identified from the search results. Based on the full‐text screening, we included two studies, excluded 16 studies, and two are awaiting classification. Four review authors independently extracted data, and two authors assessed the risk of bias. We calculated the mean difference (MD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% confidence intervals for dichotomous outcomes. We assessed the quality of the evidence for each outcome using the GRADE approach.
Main results
We included two RCTs (212 participants), one of which was a cluster‐randomised trial. Adjusting for the design effect from clustering, reduced the total sample size to 210. Both studies were carried out in dental clinics and assessed ergonomic interventions in the physical domain, one by evaluating a multi‐faceted ergonomic intervention, which consisted of imparting knowledge and training about ergonomics, work station modification, training and surveying ergonomics at the work station, and a regular exercise program; the other by studying the effectiveness of two different types of instrument used for scaling in preventing WMSDs. We were unable to combine the results from the two studies because of the diversity of interventions and outcomes.
Physical ergonomic interventions. Based on one study, there is very low‐quality evidence that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs (RR 0.57, 95% CI 0.23 to 1.42; 102 participants), or feet (RR 0.64, 95% CI 0.29 to 1.41; 102 participants) when compared to no intervention over a six‐month period. Based on one study, there is low‐quality evidence of no clear difference in elbow pain (MD −0.14, 95% CI −0.39 to 0.11; 110 participants), or shoulder pain (MD −0.32, 95% CI −0.75 to 0.11; 110 participants) in participants who used light weight curettes with wider handles or heavier curettes with narrow handles for scaling over a 16‐week period.
Cognitive ergonomic interventions. We found no studies evaluating the effectiveness of cognitive ergonomic interventions.
Organisational ergonomic interventions. We found no studies evaluating the effectiveness of organisational ergonomic interventions.
Authors' conclusions
There is very low‐quality evidence from one study showing that a multi‐faceted intervention has no clear effect on dentists' risk of WMSD in the thighs or feet when compared to no intervention over a six‐month period. This was a poorly conducted study with several shortcomings and errors in statistical analysis of data. There is low‐quality evidence from one study showing no clear difference in elbow pain or shoulder pain in participants using light weight, wider handled curettes or heavier and narrow handled curettes for scaling over a 16‐week period.
We did not find any studies evaluating the effectiveness of cognitive ergonomic interventions or organisational ergonomic interventions.
Our ability to draw definitive conclusions is restricted by the paucity of suitable studies available to us, and the high risk of bias of the studies that are available. This review highlights the need for well‐designed, conducted, and reported RCTs, with long‐term follow‐up that assess prevention strategies for WMSDs among dental care practitioners.
Antidepressants for menopausal symptoms Karanth, Laxminarayan; Chuni, Neena; Nair N, Sreekumaran
Cochrane database of systematic reviews,
05/2021, Volume:
2021, Issue:
5
Journal Article
Peer reviewed
Open access
This protocol for a Cochrane Review has been withdrawn as the subject matter of the proposed review is covered in another review "Non‐hormonal, pharmacological treatments for hot flushes in ...perimenopausal women".
Antidepressants for menopausal symptoms Karanth, Laxminarayan; Chuni, Neena; Nair, N Sreekumaran
Cochrane database of systematic reviews,
09/2019, Volume:
2019, Issue:
9
Journal Article
Peer reviewed
Open access
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To assess the effectiveness and safety of antidepressants in women having menopausal symptoms.
Background
Thalassaemia is a quantitative abnormality of haemoglobin caused by mutations in genes controlling production of alpha or beta globins. Abnormally unpaired globin chains cause membrane ...damage and cell death within organ systems and destruction of erythroid precursors in the bone marrow, leading to haemolytic anaemia. The life‐long management of the general health effects of thalassaemia is highly challenging, and failure to deal with dental and orthodontic complications exacerbates the public health, financial and personal burden of the condition. There is a lack of evidence‐based guidelines to help care seekers and providers manage such dental and orthodontic complications. This review aimed to evaluate the available evidence on methods for treating dental and orthodontic complications in people with thalassaemia to inform future recommendations. This is an update of a Cochrane Review first published in 2019.
Objectives
To assess different methods for treating dental and orthodontic complications in people with thalassaemia.
Search methods
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register in September 2022, and we searched nine online databases and trials registries in January 2022. We searched the reference lists of relevant articles and reviews and contacted haematologists, experts in fields of dentistry, organisations, pharmaceutical companies and researchers working in this field.
Selection criteria
We searched for published or unpublished randomised controlled trials (RCTs) that evaluated treatment of dental and orthodontic complications in individuals diagnosed with thalassaemia, irrespective of phenotype, severity, age, sex and ethnic origin.
Data collection and analysis
Two review authors independently screened the 37,242 titles retrieved by the search. After deduplication, we identified two potentially relevant RCTs. On assessing their eligibility against our inclusion and exclusion criteria, we excluded one and included the other.
Main results
We included one parallel‐design RCT conducted in Saudi Arabia and involving 29 participants (19 males, 10 females) with thalassaemia. It aimed to assess the effectiveness of photodynamic therapy as an adjuvant to conventional full‐mouth ultrasonic scaling for the treatment of gingivitis. The average age of participants was around 23 years.
There is very low‐certainty evidence from this trial that full‐mouth ultrasonic scaling plus photodynamic therapy compared to full‐mouth ultrasonic scaling alone may improve gingival index score and bleeding on probing after 12 weeks in people with thalassaemia.
We found no studies that assessed other interventions for the various dental or orthodontic complications of thalassaemia.
Authors' conclusions
Although the included study showed greater reduction in gingivitis in the group treated with full‐mouth ultrasonic scaling plus photodynamic therapy, the evidence is of very low certainty. The study had unclear risk of bias, a short follow‐up period and no data on safety or adverse effects. We cannot make definitive recommendations for clinical practice based on the limited evidence of a single trial. Future studies will very likely affect the conclusions of this review.
This review highlights the need for high‐quality RCTs that investigate the effectiveness of various treatment modalities for dental and orthodontic complications in people with thalassaemia. It is crucial that future trials assess adverse effects of interventions.
Background
Bleeding disorders are uncommon but may pose significant bleeding complications during pregnancy, labour and following delivery for both the woman and the foetus. While many bleeding ...disorders in women tend to improve in pregnancy, thus decreasing the haemorrhagic risk to the mother at the time of delivery, some do not correct or return quite quickly to their pre‐pregnancy levels in the postpartum period. Therefore, specific measures to prevent maternal bleeding and foetal complications during childbirth, are required. The safest method of delivery to reduce morbidity and mortality in these women is controversial. This is an update of a previously published review.
Objectives
To assess the optimal mode of delivery in women with, or carriers of, bleeding disorders.
Search methods
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference books. We also searched the Cochrane Pregnancy and Childbirth Group's Trials Register as well as trials registries and the reference lists of relevant articles and reviews.
Date of last search of the Group's Trials Registers: 21 June 2021.
Selection criteria
Randomised controlled trials and quasi‐randomised controlled clinical trials investigating the optimal mode of delivery in women with, or carriers of, any type of bleeding disorder during pregnancy were eligible for the review.
Data collection and analysis
No trials matching the selection criteria were eligible for inclusion.
Main results
No trials matching the selection criteria were eligible for inclusion.
Authors' conclusions
The review did not identify any randomised controlled trials investigating the safest mode of delivery and associated maternal and foetal complications during delivery in women with, or carriers of, a bleeding disorder. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials, case studies) to decide upon the optimal mode of delivery to ensure the safety of both mother and foetus.
Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised controlled trials to find the optimal mode of delivery in this population are unlikely to be carried out. Other high quality controlled studies (such as risk allocation designs, sequential design, and parallel cohort design) are needed to investigate the risks and benefits of natural vaginal and caesarean section in this population or extrapolation from other clinical conditions that incur a haemorrhagic risk to the baby, such as platelet alloimmunisation.
Background
Critical lower limb ischaemia (CLI) is a manifestation of peripheral arterial disease (PAD) that is seen in patients with typical chronic ischaemic rest pain or patients with ischaemic ...skin lesions ‐ ulcers or gangrene ‐ for longer than 2 weeks. Critical lower limb ischaemia is the most severe form of PAD, and interventions to improve arterial perfusion become necessary. Although surgical bypass has been the gold standard for revascularisation, the extent or the site of disease may be such that the artery cannot be reconstructed or bypassed. These patients require other modalities of treatment, for example, vasodilatation by drugs or lumbar sympathectomy to relieve pain at rest and to avoid amputations. A systematic review of randomised controlled trials is required to evaluate the effects of lumbar sympathectomy in treating patients with CLI due to non‐reconstructable PAD.
Objectives
The objective of this review is to assess the effects of lumbar sympathectomy by open, laparoscopic and percutaneous methods compared with no treatment or compared with any other method of lumbar sympathectomy in patients with CLI due to non‐reconstructable PAD.
Search methods
The Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (January 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 12). In addition, the CIS searched clinical trials databases for details of ongoing and unpublished studies.
Selection criteria
Randomised controlled trials (RCTs) comparing any of the treatment modalities of lumbar sympathectomy, such as open, laparoscopic and chemical percutaneous methods, with no treatment or with any other method of lumbar sympathectomy for CLI due to non‐reconstructable PAD were eligible. To decrease the bias of including participants that may be incorrectly diagnosed with CLI, review authors defined CLI as persistently recurring ischaemic rest pain requiring regular analgesia for more than two weeks, or ulceration or gangrene of the foot or toes, attributable to objectively proven arterial occlusive disease by measurement of ankle pressure of < 50 mmHg or toe pressure < 30 mmHg. We defined non‐reconstructable PAD as a resting ankle brachial index (ABI) < 0.9 when no reasonable open surgical or endovascular revascularisation treatment option is available, as determined by individual trial vascular specialists.
Data collection and analysis
Two review authors independently assessed studies identified for potential inclusion in the review. We planned to conduct data collection and analysis in accordance with the Cochrane Handbook for Systematic Review of Interventions.
Main results
We identified no studies that met the predefined inclusion criteria. To decrease the bias of including participants who may be incorrectly diagnosed with CLI, we based our inclusion criteria on objective tests, as described above. The randomised trials identified by the literature search were performed before such objective criteria for selection were applied and therefore were not eligible for inclusion in the review.
Authors' conclusions
We identified no RCTs assessing effects of lumbar sympathectomy by open, laparoscopic and percutaneous methods compared with no treatment or compared with any other method of lumbar sympathectomy in patients with CLI due to non‐reconstructable PAD. High‐quality studies are needed.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
To assess the effects of different antibiotic regimens in treating bacteraemia due to
S. aureus
in hospitalised ...patients.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
The objective of this review is to compare the effects of different medical interventions in people diagnosed ...with CF and CRS.
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