Cochrane for Clinicians

These are summaries of reviews from the Cochrane Library.

Feb 1, 2017 Issue
The Effect of Statins on Dementia and Cognitive Decline
Statins given in later life to patients at risk of vascular disease do not prevent dementia or cognitive decline compared with placebo. Adverse effects are similar between groups.

Feb 1, 2017 Issue
Interventions for Preventing Falls Among Older Adults Living in the Community
Structured exercise programs and home safety interventions reduce both the rate and the risk of falling among community-dwelling adults 65 years and older, whereas multifactorial assessment and intervention programs reduce the rate of falls but not the risk of falling. Vitamin D supplementation does not reduce the rate of falls or risk of falling in all patients. Education about fall prevention does not significantly reduce the rate or risk of falling.

Jan 1, 2017 Issue
Extended-Release Bupropion for Preventing Seasonal Affective Disorder in Adults
When started in the fall, extended-release bupropion, 300 mg once daily, is effective in preventing recurrent symptoms in high-risk adults with a history of SAD (number needed to treat [NNT] = 5), as well as those at lower risk (NNT = 8). Headaches, nausea, and insomnia may limit adherence to treatment.

Jan 1, 2017 Issue
Interventions to Facilitate Shared Decision Making to Address Antibiotic Use for Acute Respiratory Tract Infections in Primary Care
Interventions to facilitate shared decision making reduce the prescribing of antibiotics for acute respiratory tract infections in the short term (within six weeks of the consultation) without increasing return visits or decreasing patient satisfaction (number needed to treat [NNT] = 6).

Dec 1, 2016 Issue
Impact of Exercise-Based Cardiac Rehabilitation
Exercise-based cardiac rehabilitation reduces cardiovascular mortality and hospitalization. There is no evidence that it reduces the rates of total mortality, myocardial infarctions, coronary artery bypass grafts, or percutaneous coronary interventions.

Dec 1, 2016 Issue
Mini-Mental State Examination for the Detection of Dementia in Older Patients
When scores are adjusted based on a patient's education level, the MMSE may be useful to rule out a diagnosis of dementia in clinically unevaluated patients 65 years and older (sensitivity = 97%; specificity = 70%). Scores of less than 24 may also be useful to rule in dementia in patients 65 years and older (sensitivity = 85%; specificity = 90%).

Nov 1, 2016 Issue
Amiodarone for the Prevention of Sudden Cardiac Death
Although not a substitute for an implantable cardioverter-defibrillator (ICD), amiodarone is effective for the primary prevention of sudden cardiac death when compared with placebo (number needed to treat [NNT] = 47; 95% confidence interval [CI], 33 to 100), but it does not significantly lower all-cause mortality in those at high risk.

Nov 1, 2016 Issue
The Risk of MI and Ischemic Stroke with Combined Oral Contraceptives
The overall risk of MI and ischemic stroke is increased in women who use combined oral contraceptives. The relative risk of MI and ischemic stroke increases as estrogen dose rises, increasing by 60% with doses of 20 mcg and more than doubling when doses of 50 mcg or more are used.

Oct 1, 2016 Issue
Selective Serotonin Reuptake Inhibitors for Fibromyalgia
SSRIs may have a small to moderate effect on pain (number needed to treat [NNT] = 10), global improvement (NNT = 7), and depression (NNT = 13) in patients with fibromyalgia, but the quality of evidence is very low because of bias and small studies. SSRIs do not reduce fatigue related to fibromyalgia.

Oct 1, 2016 Issue
Topical Tacrolimus for Eczema
For children and adults with moderate to severe eczema, topical tacrolimus is an effective, albeit costly, alternative to topical corticosteroids. Both tacrolimus strengths (0.03% and 0.1%) are superior to low-potency topical corticosteroids, whereas tacrolimus 0.1% has similar effectiveness to moderate- to high-potency topical corticosteroids. A mild, self-limited, local burning sensation is common with use.

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