Cochrane Collaboration

About: Cochrane Collaboration is a nonprofit organization based out in Oxford, United Kingdom. It is known for research contribution in the topics: Systematic review & Randomized controlled trial. The organization has 1995 authors who have published 3928 publications receiving 382695 citations.

Omalizumab in patients with chronic spontaneous urticaria: a systematic review and GRADE assessment

Abstract: Summary Chronic spontaneous urticaria (CSU) is characterized by the occurrence of hives, angio-oedema or both for a period of at least 6 weeks. Many patients remain symptomatic despite treatment with H 1 antihistamines, even at higher doses. This systematic review assessed the quality of the evidence for the effects of omalizumab as treatment in patients with CSU. We searched PubMed, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials up to 7 August 2014. Three review authors independently carried out study selection, risk of bias assessment and data extraction. Two review authors analysed the data. Five randomized controlled trials (RCTs), which included 1116 participants, were evaluated. All the RCTs were judged as having a low risk of bias. There was a statistically significant improvement in measures of disease activity and quality of life following treatment with omalizumab when compared with placebo [mean difference (MD) -11·58, 95% confidence interval (CI) -13·39 to -9·77 and MD -13·12, 95% CI -16·30 to -9·95, respectively]. Complete response and partial response were more frequent after treatment with omalizumab [risk ratio (RR) 6·44, 95% CI 3·95-10·49 and RR 4·08, 95% CI 2·98-5·60, respectively]. There was no difference in the proportion of participants reporting adverse events between the omalizumab and placebo treatment groups (RR 1·05, 95% CI 0·96-1·16). There was high-quality evidence to support the effectiveness and safety of omalizumab 300 mg per month for the treatment of CSU for up to 6 months. What's already known about this topic? Despite available treatment options many patients with chronic spontaneous urticaria remain symptomatic The recently published EAACI/GA 2 LEN/EDF/WAO guideline recommends omalizumab as 'add-on' therapy to second-generation H 1 antihistamines as third line treatment What does this study add? A detailed GRADE assessment indicated high-quality evidence for the effectiveness and safety of omalizumab 300 mg per month for up to 6 months

Mini‐Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI)

Abstract: Background Dementia is a progressive global cognitive impairment syndrome. In 2010, more than 35 million people worldwide were estimated to be living with dementia. Some people with mild cognitive impairment (MCI) will progress to dementia but others remain stable or recover full function. There is great interest in finding good predictors of dementia in people with MCI. The Mini-Mental State Examination (MMSE) is the best-known and the most often used short screening tool for providing an overall measure of cognitive impairment in clinical, research and community settings. Objectives To determine the accuracy of the Mini Mental State Examination for the early detection of dementia in people with mild cognitive impairment SEARCH METHODS: We searched ALOIS (Cochrane Dementia and Cognitive Improvement Specialized Register of diagnostic and intervention studies (inception to May 2014); MEDLINE (OvidSP) (1946 to May 2014); EMBASE (OvidSP) (1980 to May 2014); BIOSIS (Web of Science) (inception to May 2014); Web of Science Core Collection, including the Conference Proceedings Citation Index (ISI Web of Science) (inception to May 2014); PsycINFO (OvidSP) (inception to May 2014), and LILACS (BIREME) (1982 to May 2014). We also searched specialized sources of diagnostic test accuracy studies and reviews, most recently in May 2014: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). No language or date restrictions were applied to the electronic searches and methodological filters were not used as a method to restrict the search overall so as to maximize sensitivity. We also checked reference lists of relevant studies and reviews, tracked citations in Scopus and Science Citation Index, used searches of known relevant studies in PubMed to track related articles, and contacted research groups conducting work on MMSE for dementia diagnosis to try to locate possibly relevant but unpublished data. Selection criteria We considered longitudinal studies in which results of the MMSE administered to MCI participants at baseline were obtained and the reference standard was obtained by follow-up over time. We included participants recruited and clinically classified as individuals with MCI under Petersen and revised Petersen criteria, Matthews criteria, or a Clinical Dementia Rating = 0.5. We used acceptable and commonly used reference standards for dementia in general, Alzheimer's dementia, Lewy body dementia, vascular dementia and frontotemporal dementia. Data collection and analysis We screened all titles generated by the electronic database searches. Two review authors independently assessed the abstracts of all potentially relevant studies. We assessed the identified full papers for eligibility and extracted data to create two by two tables for dementia in general and other dementias. Two authors independently performed quality assessment using the QUADAS-2 tool. Due to high heterogeneity and scarcity of data, we derived estimates of sensitivity at fixed values of specificity from the model we fitted to produce the summary receiver operating characteristic curve. Main results In this review, we included 11 heterogeneous studies with a total number of 1569 MCI patients followed for conversion to dementia. Four studies assessed the role of baseline scores of the MMSE in conversion from MCI to all-cause dementia and eight studies assessed this test in conversion from MCI to Alzheimer´s disease dementia. Only one study provided information about the MMSE and conversion from MCI to vascular dementia. For conversion from MCI to dementia in general, the accuracy of baseline MMSE scores ranged from sensitivities of 23% to 76% and specificities from 40% to 94%. In relationship to conversion from MCI to Alzheimer's disease dementia, the accuracy of baseline MMSE scores ranged from sensitivities of 27% to 89% and specificities from 32% to 90%. Only one study provided information about conversion from MCI to vascular dementia, presenting a sensitivity of 36% and a specificity of 80% with an incidence of vascular dementia of 6.2%. Although we had planned to explore possible sources of heterogeneity, this was not undertaken due to the scarcity of studies included in our analysis. Authors' conclusions Our review did not find evidence supporting a substantial role of MMSE as a stand-alone single-administration test in the identification of MCI patients who could develop dementia. Clinicians could prefer to request additional and extensive tests to be sure about the management of these patients. An important aspect to assess in future updates is if conversion to dementia from MCI stages could be predicted better by MMSE changes over time instead of single measurements. It is also important to assess if a set of tests, rather than an isolated one, may be more successful in predicting conversion from MCI to dementia.

Transurethral microwave thermotherapy vs transurethral resection for treating benign prostatic hyperplasia: A systematic review

Abstract: Technology has been used in the management of BPH, sometimes without much evidence to support its use. The first manuscript is a systematic review of the literature comparing transurethral microwave therapy to TURP. This shows that although microwave therapy is safe and effective in the short term, it is not as effective as TURP. Authors from London report on their long-term (up to 12-years of follow-up) results when using the Urolume wallstent for urethral stricture. They describe the results in detail, and conclude that the stent should only be used in patients who are unfit for or who refuse urethroplasty. OBJECTIVE To conduct a systematic review of randomized controlled trials evaluating the efficacy and safety of transurethral microwave thermotherapy (TUMT) compared with transurethral resection of the prostate (TURP) in treating men with symptomatic benign prostatic hyperplasia (BPH). METHODS We searched Medline, the Cochrane Library and reference lists of retrieved studies to identify randomized trials of ≥ 6 months duration with ≥ 10 patients in each treatment arm. Data were extracted on study design, patient and treatment characteristics, urinary symptoms, urinary flow, adverse events and repeat treatment for BPH. RESULTS Six studies were evaluated, involving 540 patients. The mean age (67.8 years), baseline symptom score (19.5), and peak urinary flow (PUF, 8.6 mL/s) did not differ by treatment group. The pooled mean urinary symptom score decreased by 65% with TUMT and 77% with TURP. The weighted mean (95% confidence interval) difference for the symptom score at the follow-up was −1.83 (−3.09 to −0.58) points, favouring TURP. The pooled mean PUF increased by 70% with TUMT and 119% with TURP. The weighted mean difference for the PUF at the follow-up was 5.37 (4.22–6.51) mL/s, favouring TURP. Retrograde ejaculation (57.6% vs 22.2%), transfusions (5.7% vs 0%) and re-treatment for strictures (relative hazard 9.76) were all significantly more common after TURP, but re-treatment for BPH was significantly more common after TUMT (relative hazard 10.0). CONCLUSIONS TUMT techniques are effective and safe short-term alternatives to TURP for treating BPH. However, TURP provided greater symptom and urinary flow improvements and fewer subsequent BPH treatments than TUMT.

The merits of blastocyst versus cleavage stage embryo transfer: a Cochrane review

Abstract: The merits of blastocyst versus cleavage stage embryotransfer: a Cochrane reviewD.A.Blake, M.Proctor and N.P.JohnsonHum. Reprod., 19, 795–807, 2004The authors wish to point out the following about their paperpublished in Human Reproduction 19/4:We have been contacted by a trial author concerning theabove review. The randomised controlled trial (RCT) pub-lished by Frattarelli et al 2003 entitled “Blastocyst transferdecreases multiple pregnancy rates in in-vitro fertilizationcycles: a randomized controlled trial” (2), has been incor-rectly listed in the excluded trials category Table 1. ThisRCT is indeed a high quality trial reporting valuable livebirth rate data per couple and fits the inclusion criteria formeta-analysis. The trial by Frattarelli et al (2) will beincluded in an update of the Cochrane library version that iscurrently under way and due to be published by the end of2004 (3).Results of the updated meta-analysis including thisadditional trial (2) are as follows:Day 2/3 versus Day 5/6:. Live birth rate per couple: 36.6% vs 44.4% (Peto OR0.72, 95% CI 0.44- 1.17). Pregnancy rate per couple: 39.8% vs 43.2% (Peto OR0.88, 95% CI 0.69- 1.12). Pregnancy rate per couple where fewer blastocysts thancleavage stage embryos were transferred: 39.3% vs 42.0%(Peto OR 0.93 95% CI 0.45- 1.94). Pregnancy rate per couple (good prognosis patients):46.0% vs 47.4% (Peto OR 0.94, 95% CI 0.71-1.24). Multiple pregnancy rate per couple: 14.4% vs 17.1%(Peto OR 0.82, 95% CI 0.57- 1.19). Multiple pregnancy rate per couple where fewer blasto-cysts than cleavage stage embryos were transferred: 15% vs18.8% (Peto OR 0.77, 95% CI 0.49 -1.22). There are no major differences between published dataand this re-analysed data.Inclusion of the data from Frattarelli et al (2) in our meta-analysis reinforces the conclusions stated in our paper: thatthe current evidence does not support a widespread change ofpractice from cleavage stage to blastocyst transfer to improvepregnancy rates (1,3). Although not confirmed by our meta-analysis, this study does highlight, however, the importantpossibility of reducing multiple births, yet maintaining acomparable pregnancy rate, by a policy of transferring fewerblastocysts than cleavage stage embryos (2), depending uponthe success of blastocyst culture at any given clinic. We wishto thank Dr Frattarelli and his group for their prompt corres-pondence and understanding regarding this omission.References

Iodine supplementation for preventing iodine deficiency disorders in children

Abstract: Iodine deficiency is the main cause of potentially preventable mental retardation in childhood, as well as causing goitre and hypothyroidism in people of all ages. It is still prevalent in large parts of the world. The objective of this review is to assess the effects of iodine supplementation overall, and of different forms and dosages of iodine supplementation separately, in the prevention of iodine deficiency disorders in children