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    1 OF 31

    Rheumatoid arthritis: previously untreated early disease.
    BMJ Clin Evid 2016 Aug 1;2016. Epub 2016 Aug 1.
    Department of Rheumatology, Peterborough and Stamford NHS Foundation Trust, Peterborough, UK.
    Introduction: Rheumatoid arthritis is a chronic autoimmune disease, which most often presents as a symmetrical polyarthritis of the hands and feet. Pharmacological treatments include non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCs) and other disease-modifying anti-rheumatoid drugs (DMARDs), which may be synthetic (either conventional [csDMARDs] or targeted [tsDMARDs]) or biological (bDMARDs).

    Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of methotrexate in combination with other csDMARDs versus methotrexate monotherapy in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs as monotherapy versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs in combination with methotrexate versus methotrexate monotherapy or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of glucocorticoids in combination with methotrexate or with other csDMARDs versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). Read More

    Diabetic retinopathy: intravitreal vascular endothelial growth factor inhibitors for diabetic macular oedema.
    BMJ Clin Evid 2016 Mar 16;2016. Epub 2016 Mar 16.
    Ophthalmology Department, Gloucestershire NHS Foundation Trust, Gloucester, UK.
    Introduction: Diabetic retinopathy is the most common microvascular complication of diabetes. It is also the most common cause of blindness in working-age adults in industrialised nations. Older people and those with worse diabetes control, hypertension, and hyperlipidaemia are most at risk. Read More

    Malaria: fluid therapy in severe disease.
    BMJ Clin Evid 2016 Jan 22;2016. Epub 2016 Jan 22.
    University of Oxford, Oxford, UK.
    Introduction: Severe malaria mainly affects children aged under 5 years, non-immune travellers, migrants to malarial areas, and people living in areas with unstable or seasonal malaria. Cerebral malaria, causing encephalopathy and coma, is fatal in around 20% of children and adults, and may lead to neurological sequelae in survivors. Severe malarial anaemia may have a mortality rate of over 13%. Read More

    Age-related macular degeneration: anti-vascular endothelial growth factor treatment.
    BMJ Clin Evid 2016 Feb 24;2016. Epub 2016 Feb 24.
    Marsden Eye Specialists, Parramatta, New South Wales, Australia.
    Introduction: Sight-threatening (late) age-related macular degeneration (AMD) is found in about 1.4% of people of European ancestry aged 70 years, with prevalence increasing with age. Early-stage disease is marked by normal vision but retinal changes (drusen and pigment changes). Read More

    MRSA: treating people with infection.
    BMJ Clin Evid 2016 Feb 16;2016. Epub 2016 Feb 16.
    Ninewells Hospital and Medical School, Dundee, UK.
    Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has a gene that makes it resistant to methicillin, as well as to other beta-lactam antibiotics, including flucloxacillin, beta-lactam/beta-lactamase inhibitor combinations, cephalosporins, and carbapenems. MRSA can be part of the normal body flora (colonisation), especially in the nose, but it can cause infection, particularly in people with prolonged hospital admissions, with underlying disease, or after antibiotic use. About 8% of S aureus in blood cultures in England, Wales, and Northern Ireland is resistant to methicillin. Read More

    Trachoma.
    BMJ Clin Evid 2016 Feb 9;2016. Epub 2016 Feb 9.
    Introduction: Active trachoma is caused by chronic infection of the conjunctiva by Chlamydia trachomatis, and is the world's leading infectious cause of blindness. Infection can lead to: scarring of the tarsal conjunctiva; inversion of the eyelashes (trichiasis), so that they abrade the cornea; and corneal opacity, resulting in blindness. Trachoma is a disease of poverty, overcrowding, and poor sanitation. Read More

    Headache (chronic tension-type).
    BMJ Clin Evid 2016 Feb 5;2016. Epub 2016 Feb 5.
    The Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
    Introduction: Chronic tension-type headache (CTTH) is a disorder that evolves from episodic tension-type headache, with daily, or very frequent, episodes of headache lasting hours or they may be continuous. It affects up to 4% of the general population, and is more prevalent in women (up to 65% of cases).

    Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of drug treatments for CTTH? What are the effects of non-drug treatments for CTTH? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2013 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). Read More

    Colonic diverticular disease: medical treatments for acute diverticulitis.
    BMJ Clin Evid 2016 Feb 4;2016. Epub 2016 Feb 4.
    Department of Surgery, University of Nottingham, Nottingham, UK.
    Introduction: Diverticula (mucosal outpouchings through the wall of the colon) are rare before the age of 40 years, after which prevalence increases steadily and reaches over 25% by 60 years. However, only 10% to 25% of affected people will develop symptoms such as lower abdominal pain. Recurrent symptoms are common, and 5% of people with diverticula eventually develop complications such as perforation, obstruction, haemorrhage, fistulae, or abscesses. Read More

    Sickle cell disease.
    BMJ Clin Evid 2016 Jan 22;2016. Epub 2016 Jan 22.
    Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
    Introduction: Sickle cell disease causes chronic haemolytic anaemia, dactylitis, and painful acute crises. It also increases the risk of stroke, organ damage, bacterial infections, and complications of blood transfusion. In sub-Saharan Africa, up to one third of adults are carriers of the defective sickle cell gene, and 1% to 2% of babies are born with the disease. Read More

    Malignant melanoma (non-metastatic): sentinel lymph node biopsy.
    BMJ Clin Evid 2016 Jan 19;2016. Epub 2016 Jan 19.
    Lead Clinician, Plastic Surgery Department, Royal Berkshire Hospital, Reading, UK.
    Introduction: The incidence of malignant melanoma has increased over the past 25 years in the UK, but death rates have remained fairly constant. The 5-year survival rate ranges from 20% to 95%, depending on disease stage. Risks are greater in white populations and in people with higher numbers of skin naevi. Read More

    Generalised anxiety disorder in children and adolescents.
    BMJ Clin Evid 2016 Jan 13;2016. Epub 2016 Jan 13.
    Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
    Introduction: Generalised anxiety disorder (GAD) in a child or adolescent is excessive worry and tension about everyday events that the child or adolescent cannot control and that is expressed on most days for at least 6 months, to the extent that there is distress or difficulty in performing day-to-day tasks.

    Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of pharmacological treatments for generalised anxiety disorder in children and adolescents? 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 review).

    Results: At this update, searching of electronic databases retrieved 949 studies. Read More

    Asthma in adults (acute): magnesium sulfate treatment.
    BMJ Clin Evid 2016 Jan 13;2016. Epub 2016 Jan 13.
    Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK.
    Introduction: About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild to moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. Read More

    Burning mouth syndrome.
    BMJ Clin Evid 2016 Jan 7;2016. Epub 2016 Jan 7.
    Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, UCLH NHS Foundation, London, UK.
    Introduction: Burning mouth syndrome mainly affects women, particularly after the menopause, when its prevalence may be 18% to 33%.

    Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of selected treatments for burning mouth syndrome? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2015 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).

    Results: At this update, searching of electronic databases retrieved 70 studies. Read More

    Testicular cancer: germ cell tumours.
    BMJ Clin Evid 2016 Jan 7;2016. Epub 2016 Jan 7.
    Assistant Professor, Radiation Oncology, University of Toronto, Toronto, Canada.
    Introduction: More than half of painless solid swellings of the body of the testis are malignant, with a peak incidence in men aged 30 to 34 years. Most testicular cancers are germ cell tumours and half of these are seminomas, which tend to affect older men and have a good prognosis.

    Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments following orchidectomy in men diagnosed with stage 1 germ cell tumours (confined to testis)? 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). Read More

    Primary prevention of CVD: modification of diet in people with hypertension.
    BMJ Clin Evid 2016 Jan 5;2016. Epub 2016 Jan 5.
    Department of Medicine, University of Alberta, Edmonton, Canada.
    Introduction: Hypertension (persistent diastolic blood pressure of 90 mmHg or greater or systolic blood pressure 140 mmHg or greater) affects 20% to 35% of the world's adult population and increases the risk of cardiovascular disease, end-stage renal disease, and mortality.

    Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of selected dietary modification for people with hypertension? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).

    Results: At this update, searching of electronic databases retrieved 669 studies. Read More

    Amblyopia in children (aged 7 years or less).
    BMJ Clin Evid 2016 Jan 5;2016. Epub 2016 Jan 5.
    Southampton General Hospital, Southampton, UK.
    Introduction: Amblyopia is reduced visual acuity not immediately correctable by glasses, in the absence of ocular pathology. It is commonly associated with squint (strabismus) or refractive errors resulting in different visual inputs to each eye during the sensitive period of visual development (aged <7-8 years). The cumulative incidence is estimated at 2% to 4% in children aged up to 7 years. Read More

    Neck pain with radiculopathy.
    BMJ Clin Evid 2015 Dec 23;2015. Epub 2015 Dec 23.
    Oxford University Hospitals, Oxford, UK.
    Introduction: Non-specific neck pain has a postural or mechanical basis and affects about two-thirds of people at some stage, especially in middle age. Acute neck pain resolves within days or weeks, but may become chronic in about 10% of people. Whiplash injuries follow sudden acceleration-deceleration of the neck, such as in road traffic or sporting accidents. Read More

    Cardiorespiratory arrest in children (out of hospital).
    BMJ Clin Evid 2015 Dec 18;2015. Epub 2015 Dec 18.
    Memorial University of Newfoundland Faculty of Medicine, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland and Labrador, Canada.
    Introduction: Cardiorespiratory arrest outside hospital occurs in approximately 1/10,000 children per year in resource-rich countries, with two-thirds of arrests occurring in children under 18 months of age. Approximately 45% of cases have undetermined causes, including sudden infant death syndrome. Of the rest, 20% are caused by trauma, 10% by chronic disease, and 6% by pneumonia. Read More

    Systemic lupus erythematosus: lupus nephritis.
    BMJ Clin Evid 2015 Dec 18;2015. Epub 2015 Dec 18.
    Glasgow Royal Infirmary, Glasgow, UK.
    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). Read More

    Out-of-hospital cardiac arrest in adults: lowering body temperature.
    BMJ Clin Evid 2015 Dec 15;2015. Epub 2015 Dec 15.
    Cumming School of Medicine, University of Calgary, Calgary, Canada.
    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). Read More

    Pressure ulcers: treatment.
    BMJ Clin Evid 2015 Dec 11;2015. Epub 2015 Dec 11.
    Geriatric Medicine, University of California at San Francisco, San Francisco, California, US.
    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). Read More

    Pre-eclampsia: reducing the risk with calcium supplements.
    BMJ Clin Evid 2015 Dec 7;2015. Epub 2015 Dec 7.
    Oxford University Hospitals NHS Trust, Oxford, UK.
    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. Read More

    Community-acquired pneumonia: pneumococcal vaccine.
    BMJ Clin Evid 2015 Dec 3;2015. Epub 2015 Dec 3.
    Departments of Pathology & Molecular Medicine and Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada.
    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). Read More

    Helicobacter pylori eradication: gastric cancer prevention.
    BMJ Clin Evid 2015 Dec 1;2015. Epub 2015 Dec 1.
    Division of Gastroenterology, McMaster University, Hamilton, ON, Canada.
    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).

    Results: At this update, searching of electronic databases retrieved 208 studies. Read More

    Organophosphorus insecticide poisoning.
    BMJ Clin Evid 2015 Nov 30;2015. Epub 2015 Nov 30.
    National Poisons Information Service (Birmingham Unit) and West Midlands Poisons Unit, City Hospital Birmingham and University of Birmingham, Birmingham, UK.
    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). Read More

    Plantar heel pain and plantar fasciitis.
    BMJ Clin Evid 2015 Nov 25;2015. Epub 2015 Nov 25.
    La Trobe University, Victoria, Australia.
    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. Read More

    Colic in infants.
    BMJ Clin Evid 2015 Aug 11;2015. Epub 2015 Aug 11.
    Department of General Practice, Radboud University Nijmegen, Nijmegen, The Netherlands.
    Introduction: Colic in infants leads one in six families (17%) with children to consult a health professional. One systematic review of 15 community-based studies found a wide variation in prevalence, which depended on study design and method of recording.

    Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments for colic in infants? We searched: Medline, Embase, The Cochrane Library, and other important databases up to February 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). Read More

    Cellulitis and erysipelas: prevention.
    BMJ Clin Evid 2015 Nov 18;2015. Epub 2015 Nov 18.
    Singapore General Hospital, Singapore, Republic of Singapore.
    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. Read More

    Tubal ectopic pregnancy.
    BMJ Clin Evid 2015 Nov 16;2015. Epub 2015 Nov 16.
    University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
    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. Read More

    MRSA colonisation (eradicating colonisation in people without active invasive infection).
    BMJ Clin Evid 2015 Nov 13;2015. Epub 2015 Nov 13.
    Internal Medicine, Divisions of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI, US.
    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. Read More

    Menière's disease.
    BMJ Clin Evid 2015 Nov 5;2015. Epub 2015 Nov 5.
    UCL Ear Institute, London, UK.
    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. Read More

    Kidney stones: flexible ureteroscopy.
    BMJ Clin Evid 2015 Oct 30;2015. Epub 2015 Oct 30.
    University of Texas Health Science Center at San Antonio, San Antonio, TX, US.
    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). Read More

    Hodgkin's lymphoma (relapsed or refractory): autologous stem cell therapy.
    BMJ Clin Evid 2015 Oct 26;2015. Epub 2015 Oct 26.
    Faculty of Medicine, Imperial College, London, UK.
    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. Read More

    Paracetamol (acetaminophen) poisoning.
    BMJ Clin Evid 2015 Oct 19;2015. Epub 2015 Oct 19.
    MRC Centre for Drug Safety Science, University of Liverpool, Liverpool, UK.
    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).

    Results: At this update, searching of electronic databases retrieved 127 studies. Read More

    Obesity in children: bariatric surgery.
    BMJ Clin Evid 2015 Oct 15;2015. Epub 2015 Oct 15.
    University of Oxford, Oxford, UK.
    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. Read More

    Chronic fatigue syndrome.
    BMJ Clin Evid 2015 Sep 28;2015. Epub 2015 Sep 28.
    King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, Department of Psychological Medicine, London, UK.
    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). Read More

    Menorrhagia.
    BMJ Clin Evid 2015 Sep 18;2015. Epub 2015 Sep 18.
    Obstetrician and Gynaecologist, Campbell River and District General Hospital, Campbell River, BC, Canada.
    Introduction: Menorrhagia (also known as heavy menstrual bleeding) limits normal activities, affects quality of life, and causes anaemia in two-thirds of women with objective menorrhagia (loss of 80 mL blood per cycle). Prostaglandin disorders may be associated with idiopathic menorrhagia and with heavy bleeding due to fibroids, adenomyosis, or use of intrauterine devices (IUDs). Fibroids have been found in 10% of women with menorrhagia overall and in 40% of women with severe menorrhagia; but half of women having a hysterectomy for menorrhagia are found to have a normal uterus. Read More

    Constipation: opioid antagonists in people prescribed opioids.
    BMJ Clin Evid 2015 Sep 11;2015. Epub 2015 Sep 11.
    Department of Oncology, The University of Sheffield, Sheffield, UK.
    Introduction: Constipation is a common adverse effect of opioids. As an example, constipation is reported in 52% of people with advanced malignancy, and this figure rises to 87% in people who are terminally ill and taking opioids. There is no reason to believe that people with chronic non-malignant disease who are prescribed opioids will be any less troubled by this adverse effect. Read More

    Heartburn in pregnancy.
    BMJ Clin Evid 2015 Sep 8;2015. Epub 2015 Sep 8.
    Instituto Nacional de Endocrinologia, Zapata y D, Vedado, La Habana, Cuba.
    Introduction: Heartburn is a common complaint during pregnancy; the incidence is reported to be between 17% and 45%.

    Methods And Outcomes: We conducted a systematic overview and aimed to answer the following clinical question: What are the effects of interventions to prevent or treat heartburn in pregnancy? We searched Medline, Embase, The Cochrane Library, and other important databases up to December 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review).

    Results: At this update, searching of electronic databases retrieved 80 studies. Read More

    Chronic bacterial prostatitis and chronic pelvic pain syndrome.
    BMJ Clin Evid 2015 Aug 27;2015. Epub 2015 Aug 27.
    Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, US.
    Introduction: Chronic prostatitis can cause pain and urinary symptoms, and can occur either with an active infection (chronic bacterial prostatitis [CBP]) or with only pain and no evidence of bacterial causation (chronic pelvic pain syndrome [CPPS]). Bacterial prostatitis is characterised by recurrent urinary tract infections or infection in the prostate with the same bacterial strain, which often results from urinary tract instrumentation. However, the cause and natural history of CPPS are unknown and not associated with active infection. Read More

    Premenstrual syndrome.
    BMJ Clin Evid 2015 Aug 25;2015. Epub 2015 Aug 25.
    University of London, London, UK.
    Introduction: A woman has premenstrual syndrome (PMS) if she complains of recurrent psychological and/or physical symptoms occurring during the luteal phase of the menstrual cycle, and often resolving by the end of menstruation. Symptom severity can vary between women. Premenstrual symptoms occur in 95% of women of reproductive age. Read More

    Constipation in adults.
    BMJ Clin Evid 2015 Aug 5;2015. Epub 2015 Aug 5.
    Hull Royal Infirmary, Hull, UK.
    Introduction: Although there are defined criteria for the diagnosis of constipation, in practice, diagnostic criteria are less rigid and depend in part on the perception of normal bowel habit. Constipation is highly prevalent, with approximately 12 million general practitioner prescriptions for laxatives in England in 2001.

    Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of medications in people with idiopathic chronic constipation? 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). Read More

    Irritable bowel syndrome: dietary interventions.
    BMJ Clin Evid 2015 Jul 30;2015. Epub 2015 Jul 30.
    Leeds Gastroenterology Institute, St James's University Hospital, and Leeds Institute of Biomedical and Clinical Sciences, Leeds, UK.
    Introduction: The prevalence of irritable bowel syndrome (IBS) varies depending on the criteria used to diagnose it, but it ranges from about 5% to 20%. IBS is associated with abnormal gastrointestinal motor function and enhanced visceral perception, as well as psychosocial and genetic factors. People with IBS often have other bodily and psychiatric symptoms, and have an increased likelihood of having unnecessary surgery compared with people without IBS. Read More

    Ankle sprain: the effects of non-steroidal anti-inflammatory drugs.
    BMJ Clin Evid 2015 Jul 28;2015. Epub 2015 Jul 28.
    Academic Medical Center, Amsterdam, The Netherlands.
    Introduction: Injury of the lateral ligament complex of the ankle joint occurs in about one in 10,000 people per day, accounting for a quarter of all sports injuries.

    Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of acute ankle sprains? 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).

    Results: At this update, searching of electronic databases retrieved 158 studies. Read More

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