AFP DEPARTMENT COLLECTION

Cochrane for Clinicians

These are summaries of reviews from the Cochrane Library.

Sep 1, 2017 Issue
Vitamin D for the Management of Asthma
Despite the authors' caution that further data are needed to clarify the role of vitamin D in care, this Cochrane review found that its use reduces the average number of asthma exacerbations requiring corticosteroid treatment from 0.44 to 0.28 per person per year.


Sep 1, 2017 Issue
Pregabalin for Fibromyalgia Pain in Adults
There is high-quality evidence that pregabalin in daily dosages of 300 mg, 450 mg, and 600 mg reduces pain associated with fibromyalgia. The most effective dosage seems to be 450 mg daily; this dosage is more effective than placebo at reducing pain by at least 50% (number needed to treat [NNT] = 9.7).


Aug 1, 2017 Issue
Antiplatelet vs. Anticoagulation Therapy for Patients with Heart Failure in Sinus Rhythm
Heart failure increases the risk of thrombotic complications, but use of warfarin does not lower all-cause mortality more than aspirin in patients with heart failure with reduced ejection fraction in sinus rhythm.


Aug 1, 2017 Issue
Effects of Yoga in Patients with Asthma
Regular yoga improves quality of life as measured on the Asthma Quality of Life Questionnaire (mean difference = 0.57 units on a seven-point scale; 95% confidence interval [CI], 0.37 to 0.77); improves asthma symptoms (standardized mean difference = 0.37; 95% CI, 0.09 to 0.65); and reduces medication use (relative risk [RR] = 5.35; 95% CI, 1.29 to 22.11).


Jul 1, 2017 Issue
Acupuncture for Migraine Prevention
There is moderate-quality evidence that whole-body acupuncture is effective for migraine prevention. Compared with usual care, acupuncture is more effective at reducing headache frequency by at least 50% (number needed to treat [NNT] = 4).


Jul 1, 2017 Issue
Surgery vs. Medical Therapy for Heavy Menstrual Bleeding
In women of reproductive age with chronic heavy menstrual bleeding, hysterectomy is the most effective treatment for controlling symptoms. Conservative surgery is more effective for controlling bleeding symptoms at one and two years than oral medications or the levonorgestrel-releasing intrauterine system, but by five years there is no difference.


Jun 1, 2017 Issue
Self-Monitoring and Self-Management of Oral Anticoagulation
In patients taking warfarin (Coumadin) for anticoagulation, there is moderate-quality evidence that both self-monitoring (number needed to treat [NNT] = 100) and self-management (NNT = 53) reduce thromboembolic events, and that self-management reduces all-cause mortality (NNT = 67).


Jun 1, 2017 Issue
Physical Fitness Training for Patients with Stroke
There is moderate-quality evidence that physical fitness training improves disability after stroke. Cardiovascular training that includes only aerobic exercise has a moderate effect on disability (standard mean difference [SMD] = 0.52 on a pooled disability scale), although it is not clear whether this effect is sustained after patients stop training.


May 1, 2017 Issue
Citrate Salts for Preventing and Treating Calcium-Containing Kidney Stones in Adults
Citrate supplementation reduces stone size to less than 5 mm and prevents new stone formation when compared with placebo or no intervention. Citrate therapy also stabilizes existing stones and decreases the need for retreatment. These benefits come at the expense of upper gastrointestinal disturbances that lead to a higher dropout rate.


May 1, 2017 Issue
Beta2 Agonists for Acute Cough or a Clinical Diagnosis of Acute Bronchitis
There is insufficient evidence to determine whether beta2 agonists can improve symptoms for children with acute cough or bronchitis with wheeze. Beta2 agonists are not likely to benefit and may cause adverse effects in adults who do not have evidence of airflow restriction (number needed to harm [NNH] = 2).


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