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International Journal of Dental Hygiene Nov 2008To review the literature concerning cetylpyridinium chloride (CPC) containing mouth rinses as effective adjuncts to toothbrushing in the prevention of plaque... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To review the literature concerning cetylpyridinium chloride (CPC) containing mouth rinses as effective adjuncts to toothbrushing in the prevention of plaque accumulation and gingival inflammation.
MATERIALS AND METHODS
Medline and the Cochrane Central Register of Controlled Trials were searched up to January 2008 to identify appropriate studies. The primary outcome measurements were plaque accumulation and gingivitis.
RESULTS
Independent screening of titles and abstracts of 3250 papers resulted in eight publications that met the criteria of eligibility. Mean values and standard deviations were obtained by data extraction. Descriptive comparisons are presented for brushing only or brushing and rinsing. Meta-analyses were performed when possible.
CONCLUSIONS
The existing evidence supports that CPC containing mouth rinses, when used as adjuncts to either supervised or unsupervised oral hygiene, provide a small but significant additional benefit in reducing plaque accumulation and gingival inflammation.
Topics: Anti-Infective Agents, Local; Cetylpyridinium; Dental Plaque; Dental Plaque Index; Gingivitis; Humans; Mouthwashes; Periodontal Index; Randomized Controlled Trials as Topic; Research Design; Smoking; Toothbrushing
PubMed: 19138180
DOI: 10.1111/j.1601-5037.2008.00344.x -
The Cochrane Database of Systematic... Mar 2010Liver transplantation has become a widely accepted form of treatment for numerous end-stage liver diseases. Bile acids may decrease allograft rejection after liver... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Liver transplantation has become a widely accepted form of treatment for numerous end-stage liver diseases. Bile acids may decrease allograft rejection after liver transplantation by changing the expression of major histocompatibility complex class molecules in bile duct epithelium and central vein endothelium.
OBJECTIVES
To assess the beneficial and harmful effects of bile acids for liver-transplanted patients.
SEARCH STRATEGY
We performed searches of The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Expanded to September, 2009.
SELECTION CRITERIA
Randomised clinical trials comparing any dose of bile acids or duration of treatment in liver-transplanted patients versus placebo, no intervention, or another intervention. We included randomised clinical trials irrespective of blinding, language, and publication status.
DATA COLLECTION AND ANALYSIS
Two review authors extracted and checked data independently. We evaluated the risk of bias of the trials from the method of allocation sequence generation, allocation concealment, blinding, outcome data analysis, outcome data reporting, and other potential sources of bias. We used the intention-to-treat principle to perform meta-analyses and presented the outcomes as relative risks (RR) or mean differences (MD), both with 95% confidence intervals (CI).
MAIN RESULTS
The updated search resulted in no new trials meeting the inclusion criteria of this review, thus leaving it to the seven already included randomised trials (six evaluating ursodeoxycholic acid versus placebo or no intervention, and one evaluating tauro-ursodeoxycholic acid versus no intervention) enrolling a total of 335 participants. The administration of bile acids began one day or more after liver transplantation. All patients received the standard triple-drug immunosuppressive regimen (steroids, azathioprine, and cyclosporine or tacrolimus) to suppress the allograft rejection response after liver transplantation. Bile acids compared with placebo or no intervention did not significantly change all-cause mortality (RR 0.85, 95% CI 0.53 to 1.36), mortality related to allograft rejection (RR 0.30, 95% CI 0.01 to 7.12), retransplantation (RR 0.76, 95% CI 0.20 to 2.86), acute cellular rejection, or number of patients with steroid-resistant rejection. Bile acids significantly reduced the number of patients who had chronic rejection in a fixed-effect model but not in a random-effects model meta-analysis. Bile acids were safe and well tolerated by liver-transplanted patients. However, this observation is based on data analysis from three trials with only 187 patients.
AUTHORS' CONCLUSIONS
We did not find evidence to support or refute bile acids for liver-transplanted patients. Further randomised trials are necessary before bile acids can be recommended to liver-transplanted patients.
Topics: Cholagogues and Choleretics; Graft Rejection; Humans; Liver Transplantation; Randomized Controlled Trials as Topic; Taurochenodeoxycholic Acid; Ursodeoxycholic Acid
PubMed: 20238339
DOI: 10.1002/14651858.CD005442.pub2 -
The Cochrane Database of Systematic... Sep 2015Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing.
OBJECTIVES
To assess the effects of hand washing promotion interventions on diarrhoeal episodes in children and adults.
SEARCH METHODS
We searched the Cochrane Infectious Diseases Group Specialized Register (27 May 2015); CENTRAL (published in the Cochrane Library 2015, Issue 5); MEDLINE (1966 to 27 May 2015); EMBASE (1974 to 27 May 2015); LILACS (1982 to 27 May 2015); PsycINFO (1967 to 27 May 2015); Science Citation Index and Social Science Citation Index (1981 to 27 May 2015); ERIC (1966 to 27 May 2015); SPECTR (2000 to 27 May 2015); Bibliomap (1990 to 27 May 2015); RoRe, The Grey Literature (2002 to 27 May 2015); World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), metaRegister of Controlled Trials (mRCT), and reference lists of articles up to 27 May 2015. We also contacted researchers and organizations in the field.
SELECTION CRITERIA
Individually randomized controlled trials (RCTs) and cluster-RCTs that compared the effects of hand washing interventions on diarrhoea episodes in children and adults with no intervention.
DATA COLLECTION AND ANALYSIS
Three review authors independently assessed trial eligibility, extracted data, and assessed risk of bias. We stratified the analyses for child day-care centres or schools, community, and hospital-based settings. Where appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random-effects model with 95% confidence intervals (CIs). We used the GRADE approach to assess the quality of evidence.
MAIN RESULTS
We included 22 RCTs: 12 trials from child day-care centres or schools in mainly high-income countries (54,006 participants), nine community-based trials in LMICs (15,303 participants), and one hospital-based trial among people with acquired immune deficiency syndrome (AIDS) (148 participants).Hand washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevents around one-third of diarrhoea episodes in high income countries (rate ratio 0.70; 95% CI 0.58 to 0.85; nine trials, 4664 participants, high quality evidence), and may prevent a similar proportion in LMICs but only two trials from urban Egypt and Kenya have evaluated this (rate ratio 0.66, 95% CI 0.43 to 0.99; two trials, 45,380 participants, low quality evidence). Only three trials reported measures of behaviour change and the methods of data collection were susceptible to bias. In one trial from the USA hand washing behaviour was reported to improve; and in the trial from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; three trials, 1845 participants, low quality evidence).Hand washing promotion among communities in LMICs probably prevents around one-quarter of diarrhoea episodes (rate ratio 0.72, 95% CI 0.62 to 0.83; eight trials, 14,726 participants, moderate quality evidence). However, six of these eight trials were from Asian settings, with only single trials from South America and sub-Saharan Africa. In six trials, soap was provided free alongside hand washing education, and the overall average effect size was larger than in the two trials which did not provide soap (soap provided: rate ratio 0.66, 95% CI 0.56 to 0.78; six trials, 11,422 participants; education only: rate ratio: 0.84, 95% CI 0.67 to 1.05; two trials, 3304 participants). There was increased hand washing at major prompts (before eating/cooking, after visiting the toilet or cleaning the baby's bottom), and increased compliance to hand hygiene procedure (behavioural outcome) in the intervention groups than the control in community trials (data not pooled: three trials, 3490 participants, high quality evidence).Hand washing promotion for the one trial conducted in a hospital among high-risk population showed significant reduction in mean episodes of diarrhoea (1.68 fewer) in the intervention group (Mean difference 1.68, 95% CI 1.93 to 1.43; one trial, 148 participants, moderate quality evidence). There was increase in hand washing frequency, seven times per day in the intervention group versus three times in the control in this hospital trial (one trial, 148 participants, moderate quality evidence).We found no trials evaluating or reporting the effects of hand washing promotions on diarrhoea-related deaths, all-cause-under five mortality, or costs.
AUTHORS' CONCLUSIONS
Hand washing promotion probably reduces diarrhoea episodes in both child day-care centres in high-income countries and among communities living in LMICs by about 30%. However, less is known about how to help people maintain hand washing habits in the longer term.
Topics: Adult; Child; Child Day Care Centers; Community-Acquired Infections; Cross Infection; Developed Countries; Developing Countries; Diarrhea; Hand Disinfection; Humans; Randomized Controlled Trials as Topic; Schools; Soaps
PubMed: 26346329
DOI: 10.1002/14651858.CD004265.pub3 -
The Cochrane Database of Systematic... Jul 2018Problems attributed to the accumulation of wax (cerumen) are among the most common reasons for people to present to their general practitioners with ear trouble.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Problems attributed to the accumulation of wax (cerumen) are among the most common reasons for people to present to their general practitioners with ear trouble. Treatment for this condition often involves use of a wax softening agent (cerumenolytic) to disperse the cerumen, reduce the need for, or facilitate syringing, but there is no consensus on the effectiveness of the variety of cerumenolytics in use.
OBJECTIVES
To assess the effectiveness of ear drops (cerumenolytics) for the removal of symptomatic ear wax.
SEARCH METHODS
We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008 issue 2); MEDLINE; EMBASE; CINAHL; ISI Proceedings; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was April 2008.
SELECTION CRITERIA
We identified all randomised controlled trials in which a cerumenolytic was compared with no treatment, a placebo, or other cerumenolytics in participants with obstructing or impacted ear wax, and in which the proportion of participants with sufficient clearance of the external canal to make further mechanical clearance unnecessary (primary outcome measure) was stated or calculable.
DATA COLLECTION AND ANALYSIS
The two authors reviewed all the retrieved trials and applied the inclusion criteria independently.
MAIN RESULTS
Nine trials satisfied the inclusion criteria. In all, 679 participants received one of 11 different cerumenolytics. One trial compared active treatments with no treatment, three compared active treatments with water or a saline 'placebo', and all nine trials compared two or more active treatments. Eight trials included syringing as a secondary intervention.Overall, results were inconclusive. The majority of comparisons showed no difference between treatments. Meta-analysis of two high quality trials produced a statistical difference in favour of triethanolamine polypeptide over saline in preventing the need for syringing, but no other significant differences between treatments.In three trials of high to moderate quality, no difference was found between the effectiveness of either sodium bicarbonate ear drops, chlorbutanol, triethanolamine polypeptide oleate condensate or docusate sodium liquid versus a sterile water or saline 'placebo'.One trial of moderate methodological quality found all three treatments - sodium bicarbonate ear drops, chlorbutanol and sterile water - to be significantly better than no treatment at preventing the need for syringing.None of the higher quality trials demonstrated superiority of one agent over another in direct comparisons.
AUTHORS' CONCLUSIONS
Trials have been heterogeneous and generally of low or moderate quality, making it difficult to offer any definitive recommendations on the effectiveness of cerumenolytics for the removal of symptomatic ear wax. Using drops of any sort appears to be better than no treatment, but it is uncertain if one type of drop is any better than another. Future trials should be of high methodological quality, have large sample sizes, and compare both oil-based and water-based solvents with placebo, no treatment or both.
Topics: Cerumen; Detergents; Humans; Randomized Controlled Trials as Topic; Solvents; Syringes
PubMed: 30040120
DOI: 10.1002/14651858.CD004326.pub3 -
The Cochrane Database of Systematic... Jul 2005Liver transplantation has become a widely accepted form of treatment for numerous end-stage liver diseases. Bile acids may decrease the degree of allograft rejection... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Liver transplantation has become a widely accepted form of treatment for numerous end-stage liver diseases. Bile acids may decrease the degree of allograft rejection after liver transplantation by changing the expression of major histocompatibility complex class molecules in bile duct epithelium and central vein endothelium.
OBJECTIVES
To assess the beneficial and harmful effects of bile acids for liver-transplanted patients.
SEARCH STRATEGY
We performed searches of the Cochrane Hepato-Biliary Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE to April 2003. We also searched The Chinese Biomedical Database to May 2002.
SELECTION CRITERIA
Randomised clinical trials comparing any dose of bile acids or duration of treatment in liver-transplanted patients versus placebo, no intervention, or another intervention. We included randomised clinical trials irrespective of blinding, language, and publication status.
DATA COLLECTION AND ANALYSIS
W Chen extracted the data and C Gluud validated them. We evaluated the methodological quality of the trials from the method for generation of the allocation sequence, allocation concealment, double blinding, and follow-up. We used the intention-to-treat principle to perform meta-analyses and presented the outcomes as relative risk (RR) or weighted mean difference (WMD), both with 95% confidence intervals (CI).
MAIN RESULTS
We identified seven randomised trials (six evaluating ursodeoxycholic acid versus placebo or no intervention and one evaluating tauro-ursodeoxycholic acid versus no intervention) with a total of 335 liver-transplanted patients. The administration of bile acids began one day or more after liver transplantation. All patients received the standard triple-drug immunosuppressive regimen (steroids, azathioprine, and cyclosporine or tacrolimus) to suppress the allograft rejection response after liver transplantation. Bile acids did not significantly reduce all-cause mortality, mortality related to allograft rejection, retransplantation, acute cellular rejection, or number of patients with steroid-resistant rejection. Bile acids significantly reduced the number of patients who had chronic rejection in a fixed-effect model but not in a random-effects model. Bile acids were safe and well tolerated by liver-transplanted patients.
AUTHORS' CONCLUSIONS
Bile acids do not seem to have significant beneficial effects in liver-transplanted patients.
Topics: Cholagogues and Choleretics; Graft Rejection; Humans; Liver Transplantation; Randomized Controlled Trials as Topic; Taurochenodeoxycholic Acid; Ursodeoxycholic Acid
PubMed: 16034975
DOI: 10.1002/14651858.CD005442 -
International Journal of Dental Hygiene Aug 2012The objective of this study is to systematically review the literature regarding the impact of mouthrinses on oral malodor and present evidence for the treatment effects... (Review)
Review
OBJECTIVE
The objective of this study is to systematically review the literature regarding the impact of mouthrinses on oral malodor and present evidence for the treatment effects of mouthrinses on oral malodor.
MATERIAL AND METHODS
PubMed-MEDLINE, the Cochrane-CENTRAL and EMBASE were searched through February 10, 2012 to identify appropriate studies. Volatile sulphur compound measurements, organoleptic measurements and tongue coating were selected as outcome variables. SEARCH RESULTS: The independent screenings of 333 unique titles and paper abstracts revealed 12 publications (12 experiments) that met the eligibility criteria. Means and standard deviations were extracted. The results were separated into short-term (<3 weeks) and longer-term (≥3 weeks) studies.
CONCLUSION
In this review, nearly all mouthwashes with active ingredients had beneficial effects in reducing oral malodor in both short- and longer-term studies. The most compelling evidence was provided for chlorhexidine mouthwashes, and those that contained a combination of cetyl pyridinum chloride and zinc provided the best evidence profile on oral malodor. Little data with respect to tongue coating were available, and none of the studies showed a beneficial effect for this parameter.
Topics: Cetylpyridinium; Chlorhexidine; Halitosis; Humans; Mouthwashes; Sulfur Compounds; Tongue; Volatile Organic Compounds; Zinc
PubMed: 22429551
DOI: 10.1111/j.1601-5037.2012.00546.x -
The Ocular Surface Jul 2011Benzalkonium chloride (BAK) is the principal preservative employed in topical ocular hypotensive medications, although alternative compounds recently have begun to be... (Review)
Review
Benzalkonium chloride (BAK) is the principal preservative employed in topical ocular hypotensive medications, although alternative compounds recently have begun to be employed or examined. Individual clinical trials have shown that exposure to BAK concentrations contained in ophthalmic solutions does not produce adverse sequelae in the majority of glaucoma patients, but concerns continue with regard to its long-term use. These concerns have resulted from an extensive research effort, including preclinical studies with in vitro and in vivo models, as well as recent clinical investigations dedicated specifically to this issue. The aim of this systematic literature review of both preclinical and clinical data was to determine the relevance of these findings to clinical practice. Most preclinical studies reported negative effects of BAK exposure, but with few exceptions, BAK concentrations and exposure times greatly exceeded those likely to be experienced by patients, given the normal physiological dilution by the tear film. In addition, consistent evidence of BAK-related toxicity did not emerge from our review of dedicated clinical investigations. Thus, taken together, current evidence supports the safety of BAK for most glaucoma patients, although subpopulations with abnormal tearing may benefit from alternative preservative compounds or preservative-free formulations. Further studies to identify these populations are needed.
Topics: Animals; Benzalkonium Compounds; Clinical Trials as Topic; Glaucoma; Humans; Ophthalmic Solutions; Preservatives, Pharmaceutical
PubMed: 21791189
DOI: 10.1016/s1542-0124(11)70024-6 -
Langmuir : the ACS Journal of Surfaces... Jun 2015Biosensors are ideally portable, low-cost tools for the rapid detection of pathogens, proteins, and other analytes. The global biosensor market is currently worth over... (Review)
Review
Biosensors are ideally portable, low-cost tools for the rapid detection of pathogens, proteins, and other analytes. The global biosensor market is currently worth over 10 billion dollars annually and is a burgeoning field of interdisciplinary research that is hailed as a potential revolution in consumer, healthcare, and industrial testing. A key barrier to the widespread adoption of biosensors, however, is their cost. Although many systems have been validated in the laboratory setting and biosensors for a range of analytes are proven at the concept level, many have yet to make a strong commercial case for their acceptance. Though it is true with the development of cheaper electrodes, circuits, and components that there is a downward pressure on costs, there is also an emerging trend toward the development of multianalyte biosensors that is pushing in the other direction. One way to reduce the cost that is suitable for certain systems is to enable their reuse, thus reducing the cost per test. Regenerating biosensors is a technique that can often be used in conjunction with existing systems in order to reduce costs and accelerate the commercialization process. This article discusses the merits and drawbacks of regeneration schemes that have been proven in various biosensor systems and indicates parameters for successful regeneration based on a systematic review of the literature. It also outlines some of the difficulties encountered when considering the role of regeneration at the point of use. A brief meta-analysis has been included in this review to develop a working definition for biosensor regeneration, and using this analysis only ∼60% of the reported studies analyzed were deemed a success. This highlights the variation within the field and the need to normalize regeneration as a standard process across the field by establishing a consensus term.
Topics: Antibodies; Aptamers, Nucleotide; Biosensing Techniques; Cost-Benefit Analysis; Detergents; Electrochemical Techniques; Electrodes; Equipment Reuse; Glycine; Hydrogen-Ion Concentration; Sound; Thermodynamics
PubMed: 25402969
DOI: 10.1021/la503533g -
The Journal of Trauma Jun 2006Both fresh frozen plasma (FFP) and platelets are heavily used in massive transfusion. Although FFP can partially correct abnormal coagulation, a recent systematic review... (Review)
Review
Both fresh frozen plasma (FFP) and platelets are heavily used in massive transfusion. Although FFP can partially correct abnormal coagulation, a recent systematic review revealed no randomized trials showing clinical benefit. Although the overall risks of FFP and platelets are low, they are the least safe blood components, due to immunologic reactions such as allergy/anaphylaxis, transfusion-related acute lung injury (TRALI) and hemolysis due to anti-A or anti-B if transfused across ABO groups. TRALI, an acute syndrome of dyspnoea, hypoxia and pulmonary 'white-out' is now a major cause of transfusion-related death. Since it is usually triggered by donor HLA antibodies, selecting non- immune donors for FFP production may be beneficial. For platelet components, risks may be reduced by platelet additive solution, allowing removal of 70% of plasma. Platelets have the additional hazard of bacterial contamination, with donor skin the predominant source. Improved arm cleansing, divert pouches for the first 30-50 mL blood and bacterial screening have been adopted internationally. Virus risks are now vanishingly low, although new agents e.g. West Nile virus can still appear. Pathogen reduction for FFP is now well established in Europe, with solvent detergent and methylene blue methods licensed, and the psoralen amotosalen in trial. Loss of clotting factors and natural anti-coagulants are recognized side effects. Amotosalen is also licensed for platelet concentrates, with the added benefit of bacterial killing. In the UK, concern regarding vCJD has led to importation of US FFP for children.
Topics: Bacterial Infections; Blood Component Transfusion; Creutzfeldt-Jakob Syndrome; Cytomegalovirus Infections; Hemolysis; Humans; Hypersensitivity; Respiratory Distress Syndrome; Wounds and Injuries
PubMed: 16763481
DOI: 10.1097/01.ta.0000199546.22925.31 -
Alimentary Pharmacology & Therapeutics Feb 2019A limited number of small-sized studies suggest that bile acid diarrhoea is frequent in patients with chronic watery diarrhoea and previous cholecystectomy. (Meta-Analysis)
Meta-Analysis
Systematic review with meta-analysis: the prevalence of bile acid malabsorption and response to colestyramine in patients with chronic watery diarrhoea and previous cholecystectomy.
BACKGROUND
A limited number of small-sized studies suggest that bile acid diarrhoea is frequent in patients with chronic watery diarrhoea and previous cholecystectomy.
AIM
To perform a systematic review and meta-analysis to assess the prevalence of bile acid diarrhoea in patients with chronic watery diarrhoea and previous cholecystectomy, and their response to colestyramine, including a new consecutive series of patients.
METHODS
MEDLINE and EMBASE were searched up to January 2018. Selected studies included patients with previous cholecystectomy and chronic watery diarrhoea assessed by the 23-seleno-25-homotaurocholic acid (SeHCAT) test. We calculated the pooled rate of bile acid diarrhoea using the inverse double arcsine square root method. Additionally, the medical records of 291 consecutive patients with chronic watery diarrhoea in whom a SeHCAT test was performed were retrospectively reviewed and 74 with previous cholecystectomy were included in the meta-analysis.
RESULTS
The search strategy identified eight relevant studies, which, together with the data of the present series, comprise 361 individuals. The pooled bile acid diarrhoea rate was 70% (95% CI 56%-82%), and was similar when using cut-offs of 10% or 15%. There was substantial heterogeneity (I = 84%). Five studies comprising 166 patients evaluated the effect of colestyramine in patients with bile acid diarrhoea. The pooled colestyramine response rate was 79% (95% CI 63%-91%) with substantial heterogeneity (I = 73%).
CONCLUSIONS
Two-thirds of patients with chronic watery diarrhoea and previous cholecystectomy have bile acid diarrhoea. Response to colestyramine in these patients is good.
Topics: Bile Acids and Salts; Cholecystectomy; Cholestyramine Resin; Diarrhea; Humans; Prevalence; Taurocholic Acid
PubMed: 30585336
DOI: 10.1111/apt.15099