Cochrane meta-analysis

D Amico, G., Pietrosi, G., Tarantino, I., Pagliaro, L. Emergency sclerotherapy versus vasoactive drugs for variceal bleeding in cirrhosis a Cochrane meta-analysis. Gastroenterology 2003 124 1277-1291... 

A Cochrane meta-analysis from 2004 of 20 studies including 1,811 patients with type 2 diabetes concluded that the quality of the studies was low, with no assessment of morbidity or mortality... 

El-Tawil S, Valli FI, Al Musa T, Luim MPT, Weber M (2011) Is quinine useful in muscle cramps A Cochrane meta-analysis. J Neurol Neurosurg Psychiatry 82 e4. doi 10.1136/ jnnp-2011-300645.28... 

The serious adverse effects of salmeterol when added to ICS, in asthmatic adults and children, were assessed by another Cochrane meta-analysis [36 ]. The meta-analysis included 40 randomised controlled trials studies, with a total population of 15,309 participants and was foxmd to have a low risk of bias. Salmeterol with ICS was not associated with mortality (adults Peto OR = 0.90, 95% Cl = 0.31, 2.60, children no reported deaths). Furthermore, there was no significant association between salmeterol with ICS and the risk of serious adverse effects, in adults (Peto OR = 1.15,95% Cl = 0.91,1.44), or in children (Peto OR = 1.20,95% Cl = 0.37,3.91). No between-group difference was found in asthma-related serious adverse effects in those receiving salmeterol with ICS compared to ICS only (adults Peto OR = 1.12,95% Cl = 0.65,1.94. Children only one asthma related event in each group). 

The comparative safety of salmeterol versus formoterol was assessed in another Cochrane meta-analysis [37 ]. Based on four studies involving 1116 adults and 156 children, the investigators did not find any between group difference in the serious adverse effects in adults (Peto OR = 0.77, 95% Cl = 0.46,1.28), children (Peto OR = 0.95, 95% Cl = 0.06,15.33). Only one death was reported in the included studies. Although methodologically correct, the results of this study may be limited by the lack of available data. 

Upper Respiratory Tract A Cochrane meta-analysis studied the effect of intranasal ipratropium versus placebo on the severity of rhinorrhea and nasal congestion in children and adults with the common cold [45 ]. Seven trials, studying 2144 patients were included in the study. Safety assessment showed an association of ipratropium with nasal dryness (OR = 2.55, 95% Cl = 1.50, 4.33), mouth dryness (OR = 3.59, 95% Cl = 1.38, 9.38) and epistaxis (OR = 3.21,95% Cl - 1.68,6.13). 

A Cochrane meta-analysis studied the efficacy and safety of mucolytic agents in COPD patients. The meta-analysis included 30 trials and 7436 patients [93 ]. Mucolytics appeared to have a safe profile, without any effect on mortality (OR = 0.75, 95% Cl = 0.35,1.64) or the frequency of adverse effects. 

Although a Cochrane meta-analysis (73) does not recommend the institution of NIV for symptomatic sleep hypopneas, a prospective study from Mellies et al. (74) and a randomized controlled trial by Ward et al. (72) support the indication of NIV for patients with NMD and nocturnal hypercapnia. The consensus conference of the American College of Chest Physicians on MV beyond the ICU recommended that patients who develop symptomatic nocturnal hypercapnia, even in the absence of daytime hypercapnia, are candidates for long-term ventilatory assistance (75). 

Kranzler HR, Bauer LO, Hersh D, et al Carbamazepine treatment of cocaine dependence a placebo-controlled trial. Drug Alcohol Depend 38 203-211, 1995 Levin FR, Lehman AF Meta-analysis of desipramine an adjunct in the treatment of cocaine addiction. J Clin Pharmacol 11 374-378, 1991 Lima MS, Reisser AA, Soares BG, et al Antidepressants for cocaine dependence. Cochrane Database Syst Rev 4 CD002950, 2001 Ling W, Shoptaw S, Majewska D Baclofen as a cocaine anti-craving medication a preliminary clinical study 0etter). Neuropsychopharmacology 18 403 04, 1998... 

Cochrane Library. The Cochrane Library [44] includes The Cochrane Database of Systematic Reviews, a collection of regularly updated, systematic reviews of the effects of health care. It is maintained by contributors to the Cochrane Collaboration. Cochrane reviews are reviews mainly of randomized controlled trials. To minimize bias, evidence is included or excluded on the basis of explicit quality criteria. Data are often combined statistically, with meta-analysis, to increase the power of the findings of numerous studies, each too small to produce reliable results individually. Database of Abstracts of Reviews of Effectiveness is also included. It consists of critical assessments and structured abstracts of good systematic reviews published elsewhere. The Cochrane Controlled Trials Register with bibliographic information on controlled trials and other sources of information on the science of reviewing research and evidence-based health care are part of the Cochrane Library. It is commercially available on CD-ROM or the Internet. 

Leontiadis GI, Sharma VK, Howden CW. Systematic review and meta-analysis proton pump inhibitor treatment for ulcer bleeding reduces transfusion requirements and hospital stay-results from the Cochrane Collaboration. Aliment Pharmacol Ther 2005 22 169-74. 

Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localised resectable soft tissue sarcoma in adults. Cochrane Database Syst Rev 1999. Issue 4. 

A systematic review of the use of misoprostol for induction of labor has been published (16). The meta-analysis included all randomized clinical trials registered in the Cochrane Pregnancy and Childbirth Group. Vaginal misoprostol was associated with increased uterine hyperstimulation, both without fetal heart changes (RR = 1.67 Cl = 1.30, 2.14) and with associated fetal heart rate changes (RR = 1.45 Cl = 1.04, 2.04). There was also an increase in meconium-stained amniotic fluid (RR = 1.38 Cl = 1.06,1.79). 

A compelling amount of evidence indicates that melatonin is useful for ameliorating jet-lag symptoms in air travelers (see meta-analysis at Cochrane Data Base [45]). We examined the timely use of three factors (melatonin treatment, exposure to tight, physical exercise) to hasten the resynchronization of in a group of elite sports competitors after a transmeridian flight comprising 12 time zones [46], More recently, we published a retrospective analysis of the data obtained from normal volunteers flying from Buenos Aires to Sydney, or from Sydney to Buenos Aires, by a transpolar route in the last 9 years [47], Mean resynchronization rate was about... 

However, the validity of these findings has been questioned, because some papers chosen for meta-analysis by the Cochrane group were suggested to have been incorrectly included (14,15). The results obtained from the meta-analysis have also been challenged by another meta-analysis of albumin administration in critically ill patients, which showed no increased risk in mortality (16). This illustrates the need for high-quality, randomized, controlled trials to generate definitive evidence. 

In July 1998, The Cochrane Injuries Group Albumin Reviewers published a meta-analysis comparing the use of albumin with the use of crystalloids or no treatment in critically ill patients (12). The review was based on 30 randomized, controlled studies, involving a total of 1419 patients with hypovolemia due to trauma, surgery, burns, or hypoalbuminemia. There was excess mortality in the albumin group of about 6%, and the authors concluded that albumin should not be used outside rigorously conducted randomized controlled trials. The review elicited numerous mostly critical comments. For example, it was commented that a meta-analysis is not exact and that in this specific studythe study had conflated three separate indications that were not comparable (5). 

In a Cochrane Collaboration meta-analysis of trials of zonisamide, levetiracetam, oxcarbazepine, and rema-cemide, there were no significant differences in efficacy among the four drugs (4). The relative risks for treatment withdrawal were also not significantly different. 

Ram FSF, Sestini P. Regular inhaled short acting p2 agonists for the management of stable chronic obstructive pulmonary disease Cochrane systematic review and meta-analysis. Thorax 2003 58 580-584. 

Lightowler JV, Wedzicha JA, Elhott MW, et al. Noninvasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease Cochrane systemic review and meta-analysis. Br Med J 2003 326 185-189. 

The Cochran group performed a meta-analysis [52]. The analysis included those studies that used t-PA (NINDS, ECASS, and ECASS II), and also those studies that evaluated SK, MAST -I, MAST-E, and the Australian SK study. The meta-analysis included patients who were treated within 3 h after symptom onset. In this analysis, there were 126 fewer dead or dependent stroke patients for every 1,000 patients treated with thrombolytic agents. 

Since then the importance of meta-analysis has grown. Not only has there been an explosion in published analyses over the past twenty years, but initiatives such as that of the Cochrane collaboration of databases as well as the trend towards evidence-based medicine make it both easier to use meta-analysis on the one hand and less acceptable not to do so on the other. In drug development, while being satisfied with an expert s judgement alone in the past, the regulator now expects to see it backed up with a formal overview of all studies. (See, for example, ICH E9 (International Conference on Harmonisation, 1999).) Like them or hate them, meta-analyses are here to stay. 

Whitehead A (2002) Meta-analysis of Controlled Clinical Trials. John Wiley Sons, Ltd, Chichester. Yates F, Cochran WG (1938) The analysis of groups of experiments. Journal of Agricultural Science 28 556-580. 

Systematic reviews In a Cochrane review of 28 trials in 7042 patients with COPD, oral mucolytic treatment was not associated with an increase in adverse events compared with placebo [IIS ]. In fact, the meta-analysis showed a significant effect in favor of the mucolytic drugs (OR = 0.81 ... 

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