Clinical Evidence

INTRODUCTION: Systemic lupus erythematosus (SLE) occurs predominantly in young women, but also in children. The prevalence of SLE varies worldwide, ranging from about 1 in 3500 women (regardless of race) in the UK, to 1 in 1000 women in China, to 1 in 250 African-American women in the US. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of immunosuppressants in people with proliferative lupus nephritis? What are the effects of different immunosuppressants compared with each other in people with proliferative lupus nephritis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: Essential tremor is one of the most common movement disorders in the world, with prevalence in the general population of 0.4% to 3.9%. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of drug treatments in people with essential tremor of the hand? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: Post-resuscitation care after return of spontaneous circulation is critical to improving patient outcomes in sudden cardiac death. Therapeutic hypothermia has been a mainstay of treatment after successful cardiopulmonary resuscitation in the setting of ventricular fibrillation or pulseless ventricular tachycardia. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of lowering body temperature for comatose survivors of out-of-hospital cardiac arrest associated with ventricular tachycardia or ventricular fibrillation? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: Unrelieved pressure or friction of the skin, particularly over bony prominences, can lead to pressure ulcers in up to one third of people in hospitals or community care, and one fifth of nursing home residents. Pressure ulcers are more likely in people with reduced mobility and poor skin condition, such as older people or those with vascular disease. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments in people with pressure ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: Depression is the world's leading cause of disability-adjusted life years lost among adolescents. Depression may affect 2% to 8% of children and adolescents, with a peak incidence around puberty. It may be self-limiting, but about 40% of affected children experience a recurrent attack, one third of affected children will make a suicide attempt, and 3% to 4% will die from suicide. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of complementary treatments for depression in children and adolescents? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: Pre-eclampsia (raised blood pressure and proteinuria) complicates 2% to 8% of pregnancies, and increases morbidity and mortality in the mother and child. Pre-eclampsia is more common in older women, women with a high body mass index, and women with multiple pregnancy. Pre-eclampsia risk is also increased in women with underlying medical conditions, particularly conditions associated with microvascular disease. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: Does oral calcium supplementation during pregnancy reduce the risk and/or severity of pre-eclampsia? What are the effects of preventive calcium supplements pre-conception in women at risk of pre-eclampsia? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review)...

INTRODUCTION: In the Northern Hemisphere about 12/1000 people per year (on average) contract pneumonia while living in the community, with most cases caused by Streptococcus pneumoniae. Mortality ranges from about 5% to 35% depending on severity of disease, with a worse prognosis in older people, men, and people with chronic diseases. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of pneumococcal vaccine to prevent community-acquired pneumonia? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: The principal effect of Helicobacter pylori infection is lifelong chronic gastritis, affecting up to 20% of younger adults but 50% to 80% of adults born in resource-rich countries before 1950. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of H pylori eradication treatment on the risk of developing gastric cancer? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review)...

INTRODUCTION: Acetylcholinesterase inhibition by organophosphorus insecticides can cause acute parasympathetic system dysfunction, muscle weakness, seizures, coma, and respiratory failure. Prognosis depends on the dose and relative toxicity of the specific compound, as well as pharmacokinetic factors. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of oxime treatment for acute organophosphorus insecticide poisoning? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: Plantar heel pain, also known as plantar fasciitis, causes soreness or tenderness of the sole of the foot under the heel, which sometimes extends into the medial arch. Pain associated with the condition may cause substantial disability and poor health-related quality of life. The prevalence and prognosis are unclear, but the symptoms seem to resolve over time in most people. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of conservative treatments for plantar heel pain? What are the effects of non-conservative treatments for plantar heel pain? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review)...

INTRODUCTION: Cellulitis is a common problem caused by spreading bacterial inflammation of the skin, with redness, pain, and lymphangitis. Up to 40% of affected people have systemic illness. Erysipelas is a form of cellulitis with marked superficial inflammation, typically affecting the lower limbs and the face. The most common pathogens in adults are streptococci and Staphylococcus aureus. Cellulitis and erysipelas can result in local necrosis and abscess formation. Around one quarter of affected people have more than one episode of cellulitis within 3 years...

INTRODUCTION: Approximately 1/100 pregnancies are ectopic, with the conceptus usually implanting in the fallopian tube. Some ectopic pregnancies resolve spontaneously, but others continue to grow and can lead to rupture of the tube. Risks are higher in women who smoke or have damage to the fallopian tubes due to pelvic infections, surgery, or previous ectopic pregnancy. METHODS AND OUTCOMES: We conducted a systematic overview aiming to answer the following clinical question: What are the effects of treatments for unruptured tubal ectopic pregnancy on subsequent fertility? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) contains a gene that makes it resistant to methicillin as well as to other beta-lactam antibiotics, including flucloxacillin, cephalosporins, and carbapenems. MRSA can be part of the normal body flora (colonisation), especially in the nose, but it can cause infection. Until recently, MRSA has primarily been a problem associated with exposure to the healthcare system, especially in people with prolonged hospital admissions or underlying disease, or after antibiotic use...

INTRODUCTION: Menière's disease causes feelings of fullness or pressure in the ear, hearing loss, tinnitus, and recurrent bouts of vertigo, and mainly affects people aged 30-60 years. Menière's disease is at first progressive but fluctuating, and episodes can occur in clusters. Vertigo usually resolves eventually, but the hearing deteriorates and the tinnitus and pressure may persist regardless of treatment. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of combination treatment (betahistine plus thiazide diuretic) to prevent attacks and delay disease progression of Menière's disease? What are the effects of intratympanic interventions to prevent attacks and delay disease progression of Menière's disease? What are the effects of non-drug interventions to prevent attacks and delay disease progression of Menière's disease? What are the effects of dietary interventions to prevent attacks and delay disease progression of Menière's disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: The age of peak incidence for stone disease is 20 to 40 years, although stones are seen in all age groups. There is a male to female ratio of 3:2. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of flexible ureteroscopy for the removal of renal stones? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: People with Hodgkin's lymphoma usually present with a lump in the neck or upper chest, but a quarter of people also have fever, sweating, weight loss, fatigue, and itch. Almost all people with localised disease can be cured and, even among people with relapsed advanced disease, almost 50% to 60% survive event-free for 4 years or more. However, a proportion of patients with early Hodgkin's lymphoma with poor prognostic factors (up to 15%) or with advanced disease (40%-50%) still relapses or has refractory disease...

INTRODUCTION: Paracetamol directly causes around 150 deaths per year in UK. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments for acute paracetamol poisoning? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: The prevalence of childhood obesity in the UK and in many countries worldwide remains high. Behavioural interventions to modify lifestyle, such as diet and physical activity, usually form part of weight management strategies for obese children. Whether or not surgical interventions are effective and safe in treating childhood obesity is unclear. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of surgical interventions for the treatment of childhood obesity? We searched Medline, Embase, The Cochrane Library, and other important databases up to August 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this overview)...

INTRODUCTION: Chronic fatigue syndrome affects between 0.006% and 3% of the population depending on the criteria of definition used, with women being at higher risk than men. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of selected treatments for chronic fatigue syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review)...

INTRODUCTION: Adherence to medication is generally defined as the extent to which people take medications as prescribed by their healthcare providers. It can be assessed in many ways (e.g., by self-reporting, pill counting, direct observation, electronic monitoring, or by pharmacy records). This overview reports effects of prompting mechanisms on adherence to cardiovascular medications, however adherence has been measured. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of prompting mechanisms to improve adherence to long-term medication for cardiovascular disease in adults? We searched Medline, Embase, The Cochrane Library, and other important databases up to May 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review)...