Tiffany Wong, Antonia S. Stang, Heather Ganshorn, Lisa Hartling, Ian K. Maconochie, Anna M. Thomsen, David W. Johnson
Cochrane Review: Combined and alternating paracetamol and ibuprofen therapy for febrile children Wong T, Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM, Johnson DW. Combined and alternating paracetamol and ibuprofen therapy for febrile children. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD009572. DOI: 10.1002/14651858.CD009572.pub2
This companion piece to the review, “Combined and alternating paracetamol and ibuprofen therapy for febrile children,” contains the following pieces:
对乙酰氨基酚和布洛芬联用和交替治疗儿童发热的临床研究:黄涛，Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM, Johnson DW。对乙酰氨基酚和布洛芬联合及交替治疗发热儿童。Cochrane Database of Systematic Reviews 2013，第10期。艺术。不。: CD009572。cd009572 DOI: 10.1002/14651858.。这篇综述的配套文章“发热儿童对乙酰氨基酚和布洛芬的联合和交替治疗”包含以下文章:
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Cochrane Review: Probiotics for prevention of necrotizing enterocolitis in preterm infants AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD005496. DOI: 10.1002/14651858.CD005496.pub4.
This companion piece to the review, “Probiotics for prevention of necrotizing enterocolitis in preterm infants,” contains the following pieces:
{"title":"Cochrane in context: Probiotics for prevention of necrotizing enterocolitis in preterm infants","authors":"Joan Robinson","doi":"10.1002/ebch.1977","DOIUrl":"10.1002/ebch.1977","url":null,"abstract":"<p><b>Cochrane Review: Probiotics for prevention of necrotizing enterocolitis in preterm infants</b> AlFaleh K, Anabrees J. Probiotics for prevention of necrotizing enterocolitis in preterm infants. <i>Cochrane Database of Systematic Reviews</i> 2014, Issue 4. Art. No.: CD005496. DOI: 10.1002/14651858.CD005496.pub4.</p><p>This companion piece to the review, “Probiotics for prevention of necrotizing enterocolitis in preterm infants,” contains the following pieces:\u0000\u0000 </p>","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1977","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eco-paediatrics is an occasional feature in Evidence-Based Child Health: A Cochrane Review Journal. Our goal is to contribute to the worldwide discussion on reducing waste in health care. In each instalment, we will select a recent Cochrane review highlighting a practice, still in use, which the available evidence tells us should be discontinued.
{"title":"Glucocorticoids for bronchiolitis—should they be used?","authors":"Eyal Cohen","doi":"10.1002/ebch.1973","DOIUrl":"10.1002/ebch.1973","url":null,"abstract":"Eco-paediatrics is an occasional feature in Evidence-Based Child Health: A Cochrane Review Journal. Our goal is to contribute to the worldwide discussion on reducing waste in health care. In each instalment, we will select a recent Cochrane review highlighting a practice, still in use, which the available evidence tells us should be discontinued.","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1973","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cochrane in context: Pharmacological interventions for hypertension in children","authors":"Swasti Chaturvedi, Deborah H. Lipszyc, Christoph Licht, Jonathan C. Craig, Rulan S. Parekh","doi":"10.1002/ebch.1975","DOIUrl":"10.1002/ebch.1975","url":null,"abstract":"<p><b>Cochrane Review: Pharmacological interventions for hypertension in children</b> Chaturvedi S, Lipszyc DH, Licht C, Craig JC, Parekh RS. Pharmacological interventions for hypertension in children. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD008117. DOI: 10.1002/14651858.CD008117.pub2.</p><p>This companion piece to the review, “Pharmacological interventions for hypertension in children,” contains the following pieces:\u0000\u0000 </p>","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1975","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Swasti Chaturvedi, Deborah H Lipszyc, Christoph Licht, Jonathan C Craig, Rulan Parekh
Background
Hypertension is a major risk factor for stroke, coronary artery disease and kidney damage in adults. There is a paucity of data on the long-term sequelae of persistent hypertension in children, but it is known that children with hypertension have evidence of end organ damage and are at risk of hypertension into adulthood. The prevalence of hypertension in children is rising, most likely due to a concurrent rise in obesity rates. In children with hypertension, non-pharmacological measures are often recommended as first-line therapy, but a significant proportion of children will eventually require pharmacological treatment to reduce blood pressure, especially those with evidence of end organ damage at presentation or during follow-up. A systematic review of the effects of antihypertensive agents in children has not previously been conducted.
Objectives
To determine the dose-related effects of different classes of antihypertensive medications, as monotherapy compared to placebo; as combination therapy compared to placebo or a single medication; or in comparisons of various doses within the same class, on systolic or diastolic blood pressure (or both) in children with hypertension.
Search methods
We searched the Cochrane Hypertension Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 9), Ovid MEDLINE (1946 to October 2013), Ovid EMBASE (1974 to October 2013) and bibliographic citations.
Selection criteria
The selection criteria were deliberately broad due to there being few clinical trials in children. We included randomised controlled trials (RCTs) of at least two weeks duration comparing antihypertensive agents either as monotherapy or combination therapy with either placebo or another medication, or comparing different doses of the same medication, in children with hypertension. Hypertension was defined as an average (over a minimum of three readings) systolic or diastolic blood pressure (or both) on the 95th percentile or above for age, height and gender.
Data collection and analysis
Two authors independently selected relevant studies, extracted data and assessed risk of bias. We summarised data, where possible, using a random-effects model. Formal assessment of heterogeneity was not possible because of insufficient data.
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Necrotizing enterocolitis (NEC) and nosocomial sepsis are associated with increased morbidity and mortality in preterm infants. Through prevention of bacterial migration across the mucosa, competitive exclusion of pathogenic bacteria, and enhancing the immune responses of the host, prophylactic enteral probiotics (live microbial supplements) may play a role in reducing NEC and the associated morbidity.
Objectives
To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC or sepsis, or both, in preterm infants.
Search methods
For this update, searches were made of MEDLINE (1966 to October 2013), EMBASE (1980 to October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 10), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2013).
Selection criteria
Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age or < 2500 g birth weight, or both, were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome.
Data collection and analysis
Standard methods of The Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials and for data collection and analysis.
Main results
Twenty-four eligible trials were included. Included trials were highly variable with regard to enrolment criteria (that is birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical relative risk (RR) 0.43, 95% confidence interval (CI) 0.33 to 0.56; 20 studies, 5529 infants) and mortality (typical RR 0.65, 95% CI 0.52 to 0.81; 17 studies, 5112 infants). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.91, 95% CI 0.80 to 1.03; 19 studies, 5338 infants). The included trials reported no systemic infection with the supplemental probiotic
背景:坏死性小肠结肠炎(NEC)和院内败血症与早产儿发病率和死亡率增加有关。预防性肠内益生菌(活菌补充剂)可通过防止细菌跨粘膜迁移、竞争性排除致病菌和增强宿主的免疫反应，在减少NEC和相关发病率方面发挥作用。目的比较预防性肠内益生菌与安慰剂或不治疗预防早产儿严重NEC或败血症的疗效和安全性。检索方法:检索MEDLINE(1966年至2013年10月)、EMBASE(1980年至2013年10月)、Cochrane图书馆Cochrane中央对照试验登记册(Central)(2013年第10期)和儿科研究学会年会摘要(1995年至2013年)。选择标准:仅纳入早产儿的随机或准随机对照试验;37周孕龄或2500克出生体重，或者两者都考虑过。如果试验涉及肠内给药任何活微生物补充剂(益生菌)并测量至少一个预先指定的临床结果，则纳入试验。数据收集和分析采用Cochrane协作网及其新生儿组的标准方法来评估试验的方法学质量以及数据收集和分析。主要结果纳入24项符合条件的试验。纳入的试验在入组标准(即出生体重和胎龄)、对照组NEC基线风险、时间、剂量、益生菌制剂和喂养方案方面变化很大。在试验数据的荟萃分析中，补充肠道益生菌可显著降低严重NEC (II期或以上)的发生率(典型相对危险度(RR) 0.43, 95%可信区间(CI) 0.33 ~ 0.56;20项研究，5529名婴儿)和死亡率(典型RR 0.65, 95% CI 0.52至0.81;17项研究，5112名婴儿)。没有证据表明院内败血症显著减少(典型RR 0.91, 95% CI 0.80 ~ 1.03;19项研究，5338名婴儿)。纳入的试验报告补充益生菌有机体没有全身性感染。益生菌制剂中单独含有乳酸菌或与双歧杆菌的组合被发现是有效的。作者的结论肠内补充益生菌可以预防早产儿严重NEC和全因死亡。我们对现有证据的最新审查强烈支持改变实践。需要进行头对头的比较研究，以评估最有效的制剂、时间和治疗时间。摘要益生菌预防早产儿坏死性小肠结肠炎(NEC)是一种严重的疾病，在生命的最初几周内影响早产儿的肠道。虽然NEC的病因尚不完全清楚，但母乳喂养和细菌生长起了一定作用。益生菌(含有潜在有益细菌或酵母的膳食补充剂)已被用于预防NEC。我们对研究的回顾发现，益生菌的使用减少了体重低于1500克的早产儿NEC和死亡的发生。关于对出生时体重小于1000克的高危婴儿的益处和潜在不良影响的数据不足。
{"title":"Probiotics for prevention of necrotizing enterocolitis in preterm infants","authors":"Khalid AlFaleh, Jasim Anabrees","doi":"10.1002/ebch.1976","DOIUrl":"10.1002/ebch.1976","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Necrotizing enterocolitis (NEC) and nosocomial sepsis are associated with increased morbidity and mortality in preterm infants. Through prevention of bacterial migration across the mucosa, competitive exclusion of pathogenic bacteria, and enhancing the immune responses of the host, prophylactic enteral probiotics (live microbial supplements) may play a role in reducing NEC and the associated morbidity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To compare the efficacy and safety of prophylactic enteral probiotics administration versus placebo or no treatment in the prevention of severe NEC or sepsis, or both, in preterm infants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search methods</h3>\u0000 \u0000 <p>For this update, searches were made of MEDLINE (1966 to October 2013), EMBASE (1980 to October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) in <i>The Cochrane Library</i> (2013, Issue 10), and abstracts of annual meetings of the Society for Pediatric Research (1995 to 2013).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection criteria</h3>\u0000 \u0000 <p>Only randomized or quasi-randomized controlled trials that enrolled preterm infants < 37 weeks gestational age or < 2500 g birth weight, or both, were considered. Trials were included if they involved enteral administration of any live microbial supplement (probiotics) and measured at least one prespecified clinical outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data collection and analysis</h3>\u0000 \u0000 <p>Standard methods of The Cochrane Collaboration and its Neonatal Group were used to assess the methodologic quality of the trials and for data collection and analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main results</h3>\u0000 \u0000 <p>Twenty-four eligible trials were included. Included trials were highly variable with regard to enrolment criteria (that is birth weight and gestational age), baseline risk of NEC in the control groups, timing, dose, formulation of the probiotics, and feeding regimens. In a meta-analysis of trial data, enteral probiotics supplementation significantly reduced the incidence of severe NEC (stage II or more) (typical relative risk (RR) 0.43, 95% confidence interval (CI) 0.33 to 0.56; 20 studies, 5529 infants) and mortality (typical RR 0.65, 95% CI 0.52 to 0.81; 17 studies, 5112 infants). There was no evidence of significant reduction of nosocomial sepsis (typical RR 0.91, 95% CI 0.80 to 1.03; 19 studies, 5338 infants). The included trials reported no systemic infection with the supplemental probiotic","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1976","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ricardo M. Fernandes, Marta Oleszczuk, Charles R. Woods, Brian H. Rowe, Christopher J. Cates, Lisa Hartling
Background
Acute respiratory conditions are a leading cause of childhood morbidity and mortality. Corticosteroids are effective and established treatments in some acute respiratory infections (e.g. croup) and asthma exacerbations; however, their role is controversial in other conditions owing to inconsistent effectiveness or safety concerns (e.g. bronchiolitis, acute wheeze).
Objectives
To examine clinically relevant short-term safety outcomes related to acute single or recurrent systemic short-term (<2 weeks) corticosteroid use based on systematic reviews of acute respiratory conditions.
Methods
We searched the Cochrane Database of Systematic Reviews in February 2013 for systematic reviews comparing systemic corticosteroids with placebo for children (aged 0–18 years) with acute asthma, preschool wheezing, bronchiolitis, croup, pharyngitis/tonsillitis or pneumonia. We selected the following outcomes a priori: gastrointestinal (GI) bleeding and abdominal pain; behavioural effects (tremor or hyperactivity, jitteriness, irritability or emotional distress); hypertension; serious adverse events, including death, length of stay in hospital; and relapse leading to hospitalization. One reviewer extracted data and another reviewer independently verified data. Results were combined using Peto odds ratios and risk differences (RD) for dichotomous outcomes and mean differences for continuous outcomes.
Main results
Seven reviews containing 44 relevant randomized controlled trials were included. Three reviews were on asthma and one each on bronchiolitis, croup, wheeze and pharyngitis/tonsillitis. Six trials (2114 patients) assessed GI bleeding and/or abdominal pain and showed no significant differences between corticosteroids and placebo (1.5% vs. 1.8%, respectively). Various behavioural effects and hypertension/blood pressure were measured in four trials each (838 and 1617 patients, respectively), with no significant differences reported. None of the trials reported deaths in any of the treatment groups. Based on 17 trials (2056 patients), there were significantly fewer admissions at day 1 with corticosteroids (risk differences = −0.11, 95% confidence interval −0.18 to −0.05; Peto odds ratios = 0.63, 95% confidence interval 0.52 to 0.78). Based on 16 trials (1502 patients) corticosteroids resulted in over 8 fewer hours in hospital compared with placebo (mean differences = −8.49 hours, 95% confidence interval −1.76 to −3.23). There were significantly fewer relapses leading to hospitalization (1
{"title":"The Cochrane Library and safety of systemic corticosteroids for acute respiratory conditions in children: an overview of reviews","authors":"Ricardo M. Fernandes, Marta Oleszczuk, Charles R. Woods, Brian H. Rowe, Christopher J. Cates, Lisa Hartling","doi":"10.1002/ebch.1980","DOIUrl":"10.1002/ebch.1980","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute respiratory conditions are a leading cause of childhood morbidity and mortality. Corticosteroids are effective and established treatments in some acute respiratory infections (e.g. croup) and asthma exacerbations; however, their role is controversial in other conditions owing to inconsistent effectiveness or safety concerns (e.g. bronchiolitis, acute wheeze).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To examine clinically relevant short-term safety outcomes related to acute single or recurrent systemic short-term (<2 weeks) corticosteroid use based on systematic reviews of acute respiratory conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched the Cochrane Database of Systematic Reviews in February 2013 for systematic reviews comparing systemic corticosteroids with placebo for children (aged 0–18 years) with acute asthma, preschool wheezing, bronchiolitis, croup, pharyngitis/tonsillitis or pneumonia. We selected the following outcomes <i>a priori</i>: gastrointestinal (GI) bleeding and abdominal pain; behavioural effects (tremor or hyperactivity, jitteriness, irritability or emotional distress); hypertension; serious adverse events, including death, length of stay in hospital; and relapse leading to hospitalization. One reviewer extracted data and another reviewer independently verified data. Results were combined using Peto odds ratios and risk differences (RD) for dichotomous outcomes and mean differences for continuous outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main results</h3>\u0000 \u0000 <p>Seven reviews containing 44 relevant randomized controlled trials were included. Three reviews were on asthma and one each on bronchiolitis, croup, wheeze and pharyngitis/tonsillitis. Six trials (2114 patients) assessed GI bleeding and/or abdominal pain and showed no significant differences between corticosteroids and placebo (1.5% vs. 1.8%, respectively). Various behavioural effects and hypertension/blood pressure were measured in four trials each (838 and 1617 patients, respectively), with no significant differences reported. None of the trials reported deaths in any of the treatment groups. Based on 17 trials (2056 patients), there were significantly fewer admissions at day 1 with corticosteroids (risk differences = −0.11, 95% confidence interval −0.18 to −0.05; Peto odds ratios = 0.63, 95% confidence interval 0.52 to 0.78). Based on 16 trials (1502 patients) corticosteroids resulted in over 8 fewer hours in hospital compared with placebo (mean differences = −8.49 hours, 95% confidence interval −1.76 to −3.23). There were significantly fewer relapses leading to hospitalization (1","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1980","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32679799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lisa Hartling, Ben Vandermeer, Ricardo M Fernandes
Background
The Cochrane Collaboration has been at the forefront of developing methods for knowledge synthesis internationally.
Objectives
We discuss three approaches to synthesize evidence for healthcare interventions: systematic reviews (SRs), overviews of reviews and comparative effectiveness reviews.
Methods
We illustrate these approaches with examples from knowledge syntheses on interventions for bronchiolitis, a common acute paediatric condition. Some of the differences among these approaches are subtle and methods are not necessarily mutually exclusive to a single review type.
Results and Conclusions:
Systematic reviews bring together evidence from multiple studies in a rigorous fashion for a single intervention or group of interventions. Systematic reviews, as they have developed within healthcare, often focus on single or select interventions and direct pairwise comparisons; therefore, end-users may need to read several individual SRs to inform decision making. Overviews of reviews compile information from multiple SRs relevant to a single health problem. Overviews provide the end-user with a quick overview of the available evidence; however, overviews are dependent on the methods and decisions employed at the SR level. Furthermore, overviews do not often integrate evidence from different SRs quantitatively. Comparative effectiveness reviews, as we define them here, synthesize relevant evidence from individual studies to describe the relative benefits (or harms) of a range of interventions. Comparative effectiveness reviews may use statistical methods (network meta-analysis) to incorporate direct and indirect evidence; therefore, they can provide stronger inferences about the relative effectiveness (or safety) of interventions. While potentially more expensive and time-consuming to produce, a comparative effectiveness review provides a synthesis of a range of interventions for a given condition and the relative efficacy across interventions using consistent and standardized methodology.
{"title":"Systematic reviews, overviews of reviews and comparative effectiveness reviews: a discussion of approaches to knowledge synthesis","authors":"Lisa Hartling, Ben Vandermeer, Ricardo M Fernandes","doi":"10.1002/ebch.1968","DOIUrl":"10.1002/ebch.1968","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Cochrane Collaboration has been at the forefront of developing methods for knowledge synthesis internationally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We discuss three approaches to synthesize evidence for healthcare interventions: systematic reviews (SRs), overviews of reviews and comparative effectiveness reviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We illustrate these approaches with examples from knowledge syntheses on interventions for bronchiolitis, a common acute paediatric condition. Some of the differences among these approaches are subtle and methods are not necessarily mutually exclusive to a single review type.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results and Conclusions:</h3>\u0000 \u0000 <p>Systematic reviews bring together evidence from multiple studies in a rigorous fashion for a single intervention or group of interventions. Systematic reviews, as they have developed within healthcare, often focus on single or select interventions and direct pairwise comparisons; therefore, end-users may need to read several individual SRs to inform decision making. Overviews of reviews compile information from multiple SRs relevant to a single health problem. Overviews provide the end-user with a quick overview of the available evidence; however, overviews are dependent on the methods and decisions employed at the SR level. Furthermore, overviews do not often integrate evidence from different SRs quantitatively. Comparative effectiveness reviews, as we define them here, synthesize relevant evidence from individual studies to describe the relative benefits (or harms) of a range of interventions. Comparative effectiveness reviews may use statistical methods (network meta-analysis) to incorporate direct and indirect evidence; therefore, they can provide stronger inferences about the relative effectiveness (or safety) of interventions. While potentially more expensive and time-consuming to produce, a comparative effectiveness review provides a synthesis of a range of interventions for a given condition and the relative efficacy across interventions using consistent and standardized methodology.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1968","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32820370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Connecting with our readers—a look at what is most often downloaded","authors":"Joan Robinson, Denise Thomson","doi":"10.1002/ebch.1969","DOIUrl":"10.1002/ebch.1969","url":null,"abstract":"","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1969","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32822030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta.
Objectives
To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012).
Selection criteria
All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of non-dietary aspects of the infant's environment.
Data collection and analysis
We extracted data from published reports, supplemented by additional information received from the trialists we contacted.
Main results
The evidence from five trials, involving 952 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a non-significantly higher risk of preterm birth, and a non-significant reduction in mean birthweight.
The evidence from two trials, involving 523 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk, egg, or peanut antigen at one, two, or seven years.
One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity.
{"title":"Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child","authors":"Michael S Kramer, Ritsuko Kakuma","doi":"10.1002/ebch.1972","DOIUrl":"10.1002/ebch.1972","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search methods</h3>\u0000 \u0000 <p>We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection criteria</h3>\u0000 \u0000 <p>All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of non-dietary aspects of the infant's environment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data collection and analysis</h3>\u0000 \u0000 <p>We extracted data from published reports, supplemented by additional information received from the trialists we contacted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main results</h3>\u0000 \u0000 <p>The evidence from five trials, involving 952 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a non-significantly higher risk of preterm birth, and a non-significant reduction in mean birthweight.</p>\u0000 \u0000 <p>The evidence from two trials, involving 523 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk, egg, or peanut antigen at one, two, or seven years.</p>\u0000 \u0000 <p>One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity.</p>\u0000 </section>\u0000 \u0000 ","PeriodicalId":12162,"journal":{"name":"Evidence-based child health : a Cochrane review journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/ebch.1972","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32820368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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