Media Awareness and Screen Time Reduction in Children, Youth or Families: A Systematic Literature Review.

Excessive use of screen media is a global public health issue and especially extensive screen exposure during very early childhood. This review was conducted in order to update previous reviews on the effectiveness of interventions to reduce screen time. An electronic literature search was carried out in MEDLINE, COCHRANE LIBRARY and CINAHL for articles indexed from June 2011 until October 2019. The search identified 933 publications of which 11 publications were included in this review. There are studies showing interventions with a positive influence on reduction of screen time and the participants' awareness and behavior concerning the use of screen media, as well as studies without such effects. No intervention was identified to be superior. This warrants further investigation of potentially effective combinations of intervention components and long-term follow-up.

Changing knowledge and attitudes about childhood fever: testing a video instruction before its application in a health app.

Background: Although infantile fever is harmless in most cases, many parents feel insecure when having to deal with it because important information is often missing. For educational purposes, an information video on fever in children was developed, which is also intended to serve as an onboarding element of a health app. The aim of the present work was to record the attitude of parents and adults on the topic of fever before and after the presentation of the information video, as well as its evaluation. Methods: Between May and November 2020, a total of 123 adults from three groups with different backgrounds (students, parents and educators) were interviewed using a questionnaire that was completed before and after the one-time presentation of an educational information video clip. Results: Several significant outcomes were recorded in attitude change toward managing fever, with no significant difference between groups. After viewing the informational video clip, 74% of participants would take body temperature rectally more often. In the after-questionnaire, 83% of participants agreed that they would now be more cautious about using fever-reducing medications. Before the video clip, 75% of the participants thought fever was "rather useful"; after, 93%. The level of temperature played a minor role as a reason for fever reduction. The information content and quality of the video were rated positively. Discussion: This study shows that a short information video is capable of bringing about a subjectively perceived intentional change in the attitude to dealing with fever, motivating a change in behavior, and reducing uncertainty in dealing with fever. Since the change in attitude was measured immediately after viewing the video clip, no statement can be made about the medium to long-term effect. Conclusion: The information video clip can be classified as a short-term fever education tool for which at least short-term effective is demonstrated. Long-term and possible synergistic effects when integrated into a health app with further information still needs to be investigated.

Pediatric COVID-19 case with regard to the family infection chain and the psychosocial context.

The role of children in households, spreading SARS-CoV-2, may differ from measles or influenza, and therefore, these diseases are not directly comparable to COVID-19. The psychosocial aspect of infection and quarantine for families and children suggests that fear of social stigmatization can lead to not disclosing the infection.

A Systematic Review and Meta-Analysis on the Survival of Cancer Patients Treated with a Fermented Viscum album L. Extract (Iscador): An Update of Findings.

PURPOSE: We aimed at updating the evidence found in controlled studies addressing general and event-free survival of cancer patients treated with the fermented mistletoe extract Iscador. METHODS: The databases Embase, PubMed, CAMbase, Scopus, AMED and Cochrane were searched for clinical studies on cancer patients treated with Iscador. Quality of studies and risk of bias were evaluated according to the Cochrane guidelines and the Newcastle Ottawa Scale. Outcome data were expressed as hazard ratios (HR) and the respective 95% confidence intervals (CI). Meta-analysis was carried out using a random-effects model. RESULTS: Eighty-two controlled studies met the inclusion criteria, of which 32 with 55 strata provided data for extracting HR and CI. The overall HR was 0.59 (95% CI: [0.53; 0.65], p < 0.0001) in favour of Iscador treatment. Heterogeneity of study results was moderate (I2 = 50.9%; p < 0.0001, τ2 = 0.053). Meta-regression did not reveal significant effects of sample size or study design. However, significant differences were found between cancer entities (p < 0.01), with most pronounced effects in cervical (HR = 0.43) and less pronounced effects in lung cancer (HR = 0.84). CONCLUSIONS: We found almost identical effects on cancer survival based on a broader database of higher quality. However, none of the studies was blinded and, therefore, there might be risk of performance bias. Implications for cancer survivors are as follows: findings indicate that adjuvant treatment of cancer patients with Iscador can be associated with a better survival.

Effects of yoga on eating disorders-A systematic review.

BACKGROUND: The question of whether yoga practice ameliorates or even aggravates eating disorders is currently under debate. The aim of this review was to systematically assess and the effectiveness and safety of yoga in patients with eating disorders. METHODS: Medline/PubMed, PsycINFO, and the Psychological and Behavioral Science Collection were screened through July 2018 for randomized controlled trials, non-randomized controlled trials and longitudinal observational studies on yoga for patients with eating disorders and other individuals with disordered eating and/or body dissatisfaction. Risk of bias was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Quality Assessment Scale. RESULTS: Eight randomized trials and four uncontrolled trials involving a total of 495 participants were included. Risk of bias was mixed. Comparing yoga to untreated control groups, effect sizes ranged from negligible effects of d = 0.02 to very large effects of d = 2.15. However, most effects were small to moderately sized and in most cases not significant. No safety-related data were reported. CONCLUSIONS: There is limited evidence on the effectiveness and safety of yoga in patients with eating disorders. Yoga can be preliminarily considered as an additional treatment option in multimodal psychiatric treatment programs.

Does the model of additive effect in placebo research still hold true? A narrative review.

Personalised and contextualised care has been turned into a major demand by people involved in healthcare suggesting to move toward person-centred medicine. The assessment of person-centred medicine can be most effectively achieved if treatments are investigated using 'with versus without' person-centredness or integrative study designs. However, this assumes that the components of an integrative or person-centred intervention have an additive relationship to produce the total effect. Beecher's model of additivity assumes an additive relation between placebo and drug effects and is thus presenting an arithmetic summation. So far, no review has been carried out assessing the validity of the additive model, which is to be questioned and more closely investigated in this review. Initial searches for primary studies were undertaken in July 2016 using Pubmed and Google Scholar. In order to find matching publications of similar magnitude for the comparison part of this review, corresponding matches for all included reviews were sought. A total of 22 reviews and 3 clinical and experimental studies fulfilled the inclusion criteria. The results pointed to the following factors actively questioning the additive model: interactions of various effects, trial design, conditioning, context effects and factors, neurobiological factors, mechanism of action, statistical factors, intervention-specific factors (alcohol, caffeine), side-effects and type of intervention. All but one of the closely assessed publications was questioning the additive model. A closer examination of study design is necessary. An attempt in a more systematic approach geared towards solutions could be a suggestion for future research in this field.

Evaluation of 5536 patients treated in an integrative outpatient tinnitus treatment center-immediate effects and a modeling approach for sustainability.

BACKGROUND: Tinnitus is an increasingly serious problem for health care systems. According to epidemiological data, 7-14 % of outpatients have asked their physician about tinnitus and management strategies. Integrative outpatient treatments are currently regarded as promising therapeutic approaches for managing tinnitus. In this article we report on the treatment success of an outpatient tinnitus treatment center in Germany. METHODS: This cohort study included pre-post data of 5536 outpatients which were treated between 2003 and 2010 in the tinnitus-therapy center, Krefeld-Düsseldorf (TTZ). The intervention consisted of psychological immunization training as well as an auditory stimulation therapy component. The main outcome parameter was the score of the Tinnitus Questionnaire (TQ) which was assessed before and after a 9 days treatment and (in a small subsample) at a 6 months follow-up. Missing data were multiply imputed. Pre-post effect sizes were calculated and adjusted for regression to the mean (RTM). RESULTS: RTM-adjusted treatment effects at the end of treatment were estimated as -18.6 (CI: -18.9 to 18.2, p < 0.001) score points which corresponds to a standardized effect of d = -1.03 (CI: -1.05 to -1.01). These effects can be corroborated in various subgroups and all subscales of the TQ (d ranging from -0.31 to -0.97). CONCLUSION: The study suggests the effectiveness of this outpatient tinnitus therapy concept. Multiple imputations techniques and RTM analysis were helpful in carving out true treatment effects.

Placebo effects in medicine: A bibliometric analysis.

OBJECTIVE: It was the aim of this bibliometric analysis to identify all publications dealing with so-called 'context effects/placebo effects' to bring some organisation into the publication landscape of the past 35 years. DESIGN: An electronic database search was carried out in Pubmed from its inception to November 2011. PARTICIPANTS: Already published articles and their participants were included. SETTING: This review was carried out at an academic institution. MAIN OUTCOME MEASURES: Condition, country, year, journal, number of authors, type of publication and main focus of the publication. RESULTS: There are slight differences in the focus and the origin of research. Although the subject is multidimensional and covering all areas in healthcare, only a few research disciplines cover the field of placebo effects. The research field is shrinking as evident by the smaller number of researchers publishing in this field. It is suggested that the discussion regarding placebo and context effects is getting more homogenous and is turning into a specific field by itself. There is an increasing concentration of placebo effects being reproduced in experimental settings. CONCLUSION: It is debatable whether the complexity of the broad range of what produces placebo effects can be successfully detected in a randomized controlled trial setting.

Homeopathy in the treatment of fibromyalgia--a comprehensive literature-review and meta-analysis.

BACKGROUND: Coping with the complex nature of fibromyalgia symptoms (FMS) still remains a challenge for patients. Taking into account the possible adverse events of pharmacological treatments patients often seek additional treatments for the management of fibromyalgia and turn towards complementary and alternative medicine (CAM). OBJECTIVE: In this review, we aimed to investigate the current state of literature of homeopathy in the treatment of FMS. METHODS: We searched Medline, the Cochrane Register of Controlled Trials, Embase, AMED, PsycInfo and CAMbase for the terms "fibromyalgia AND homeopath$" through February 2013. In addition we searched Google Scholar, the library of the Carstens Foundation and that of the Deutsche Homöopathische Union (DHU). Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated and meta-analyzed using the generic inverse variance method. RESULTS: We found 10 case-reports, 3 observational studies, 1 non-randomized and 4 randomized controlled trials (RCTs) on homeopathy for fibromyalgia. Both case reports and observational studies are naturally predominated by the use of qualitative and not validated outcome measures. Meta-analyses of CCTs revealed effects of homeopathy on tender point count (SMD=-0.42; 95%CI -0.78, -0.05; P=0.03), pain intensity (SMD=-0.54; 95%CI -0.97, -0.10; P=0.02), and fatigue (SMD=-0.47; 95%CI -0.90, -0.05; P=0.03) compared to placebo. CONCLUSION: The results of the studies as well as the case reports define a sufficient basis for discussing the possible benefits of homeopathy for patients suffering from fibromyalgia syndrome although any conclusions based on the results of this review have to be regarded as preliminary.

Arts therapies for anxiety, depression, and quality of life in breast cancer patients: a systematic review and meta-analysis.

Background. Breast cancer is one of the most common types of cancer. However, only a few trials assess the effects of arts therapies. Material and Methods. We searched the Cochrane Central Register of Controlled Trials, PubMed, and Google Scholar from their start date to January 2012. We handsearched reference lists and contacted experts. All randomized controlled trials, quasi-randomized trials, and controlled clinical trials of art interventions in breast cancer patients were included. Data were extracted and risk of bias was assessed. Meta-analyses were performed using standardized mean differences. Results. Thirteen trials with a total of 606 patients were included. Arts therapies comprised music therapy interventions, various types of art therapy, and dance/movement therapies. The methodological quality ranged from poor to high quality with the majority scoring 3 of 4 points on the Jadad scale. Results suggest that arts therapies seem to positively affect patients' anxiety (standardized mean difference: -1.10; 95%, confidence interval: -1.40 to -0.80) but not depression or quality of life. No conclusion could be drawn regarding the effects of arts therapy on pain, functional assessment, coping, and mood states. Discussion. Our review indicates that arts interventions may have beneficial effects on anxiety in patients with breast cancer.

Regular consumption of sauerkraut and its effect on human health: a bibliometric analysis.

BACKGROUND: Sauerkraut is one of the most common and oldest forms of preserving cabbage and can be traced back as a food source to the 4th century BC. It contains a large quantity of lactic acid and tyramines, as well as vitamins and minerals, and has few calories. OBJECTIVE: We aimed to provide an overview regarding the evidence of the effects of sauerkraut on human health by means of a bibliometric analysis. METHODOLOGY: Electronic databases (Medline, AMED, CamBase, CamQuest, the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects, the Cochrane Database of Systematic Reviews, EMBASE, the Karger-Publisher and the Thieme-Publisher databases) were searched from their inception until September 2012. RESULTS: The search revealed 139 publications ranging over a 90-year period from 1921 to 2012. The majority of publications originated from Europe (48.6%), followed by the United States (30.7%) and Asia (10%). More than half of the research (56.8%) focused on food analysis, and 23.7% evaluated the impact of sauerkraut on health, including risk factors or digestive well-being. Direct research in humans was almost constant over time at about 11.5%. The studies found that sauerkraut induced inflammation locally, but repeated intake may result in diarrhea. Some studies pointed out anticarcinogenic effects of sauerkraut, while others concentrated on the interaction with monoamine oxidase inhibitors (MAOIs). DISCUSSION: Sauerkraut, one of the oldest traditional foods, has a variety of beneficial effects on human health. However, unwanted effects such as intolerance reactions must be considered when dealing with sauerkraut as a functional food.

Attitudes towards the eradication of measles and CAM orientation of general physicians. Is there a direct link? A decision tree analysis.

BACKGROUND: The goal of measles eradication is still broadly discussed by health care authorities. Several studies suggest negative attitudes of general physicians (GPs) oriented in complementary and alternative medicine (CAM) with regard to measles eradication. We intended to identify prognostic factors for positive/negative attitudes in a survey of German GPs. METHODS: In 2004, a total of 732 GPs received a questionnaire to evaluate their attitudes towards the eradication of measles asking for age, gender, medical qualification, license by health insurance, CAM orientation, monthly number of early detection checkups, patients per day, appraisal of significance of legal aspects and parents' autonomy. We carried out a QUEST decision tree analysis to identify predictors for a positive/negative attitude towards the eradication of measles. RESULTS: 621 GPs (348 conventional vs. 273 CAM-oriented GPs) sufficiently completed the questionnaire and were included in this analysis. 256 physicians (41%) had a negative attitude towards the eradication of measles. In a 3-level decision tree we found a high number of early detection checkups (U9) in children being the first predictor for a positive attitude, followed in the second node by the CAM orientation. Based on this decision tree only 27 attitudes of GPs (4.4%) were falsely classified as yielding to a kappa index of agreement of k = 0.91 (95% CI: 0.88-0.94). DISCUSSION: The CAM orientation of the physicians is not the only predictor for positive or negative attitudes towards measles eradication. In particular, the number of early detection checkups of children seems to play a major role in this context. Future research should focus on this aspect.

A systematic review and meta-analysis on the use of Hypericum perforatum (St. John's Wort) for pain conditions in dental practice.

BACKGROUND: Hypericum perforatum (St. John's Wort) has been used for a variety of medicinal indications. Most recent research has focussed on its use in herbal form for depression, but its claimed analgesic and anti-inflammatory properties in homeopathic form have also led to a number of studies in patients with acute pain conditions. This systematic review overviews the literature on the use of St. John's Wort for pain conditions in homeopathic dental practice. MATERIAL AND METHODS: PubMed, EMBASE, AMED, CAMbase and the electronic archives of Thieme Publishers were searched with the search terms "(Hypericum OR St. Johns Wort) AND pain". We reviewed and meta-analysed the evidence on Hypericum in pain after tooth extraction was carried out. RESULTS: Twenty one relevant articles were found: four described general recommendations, three basic research, six reported studies in dental care and eight were expert opinions or case reports. Four studies were eligible for the meta-analysis. There was marked high heterogeneity in the effects pain (Chi-Squared = 26.46; I(2) = 0.89). The overall effect of 0.24 (95% CI: [0.06; 1.03]) favours Hypericum but is not statistically significant. CONCLUSION: Although case reports suggest therapeutic potential of Hypericum for pain conditions in dental care, this effect is not currently supported by clinical studies. All studies included in this meta-analysis used Arnica montana as well as Hypericum the results are more influenced by Arnica than Hypericum. Further clinical controlled trials of Hypericum alone in dental practice should be performed.

Effects of yoga interventions on fatigue: a meta-analysis.

Background. Researchers aimed at systematically reviewing and meta-analyzing the effectiveness of yoga interventions for fatigue. Methods. PubMed/Medline was searched until January 2012 for controlled clinical studies. Two reviewers independently extracted the data. The methodological quality of the studies was assessed. A meta-analysis was performed. Results. Nineteen clinical studies (total n = 948) were included in this review. Investigated yoga styles included Hatha, Iyengar, Asanas, Patanjali, Sahaja, and Tibetan yoga. Participants were suffering from cancer, multiple sclerosis, dialysis, chronic pancreatitis, fibromyalgia, asthma, or were healthy. Yoga had a small positive effect on fatigue (SMD = 0.27, 59% CI = 0.23-0.31). Seven studies received 4 points on the Jadad score. There were baseline differences in at least 5 studies. Conclusion. Overall, the effects of yoga interventions on fatigue were only small, particularly in cancer patients. Although yoga is generally a safe therapeutic intervention and effective to attenuate other health-related symptoms, this meta-analysis was not able to define the powerful effect of yoga on patients suffering from fatigue. Treatment effects of yoga could be improved in well-designed future studies. According to the GRADE recommendations assessing the overall quality of evidence, there is a moderate effect of the confidence placed in the estimates of the effects discussed here.

The Use of Music Therapy During the Treatment of Cancer Patients: A Collection of Evidence.

BACKGROUND: Music therapy is one of the oldest forms of creative art therapy and has been shown to have effects in different clinical and therapeutic settings, such as schizophrenia, pain, cardiovascular parameters, and dementia. This article provides an overview of some of the recent findings in this field and also reports two single case vignettes that offer insight into day-to-day applications of clinical music therapy. MATERIAL AND METHODS: For the collection of clinical studies of music therapy in oncology, the databases AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX were searched with the terms "Study OR Trial" AND "Music Therapy" AND "Cancer OR Oncolog$." Studies were analyzed with respect to their design, setting and interventions, indications, patients, and outcomes. In addition, two case vignettes present the application of music therapy for a child with leukemia and an adult patient with breast cancer. RESULTS: We found a total of 12 clinical studies conducted between 2001 and 2011 comprised of a total of 922 patients. Eight studies had a randomized controlled design, and four studies were conducted in the field of pediatric oncology. Studies reported heterogeneous results on short-term improvements in patients' mood and relaxation and reduced exhaustion and anxiety as well as in coping with the disease and cancer-related pain. Case descriptions showed similar effects in expressing emotions, opening up new goals, and turning the mind toward a healthy process and away form a disease-centered focus. CONCLUSION: The use of music therapy in the integrative treatment of cancer patients is a therapeutic option whose salutogenetic potential is shown in many case studies such as those presented here. Study results, however, did not draw a conclusive picture of the overall effect of music therapy. In addition to further clinical trials, the evidence mosaic should be complemented with qualitative studies, single case descriptions, and basic research.

Aromatherapy as an adjuvant treatment in cancer care--a descriptive systematic review.

Claims of benefits of aromatherapy for cancer patients include reduced anxiety levels and relief of emotional stress, pain, muscular tension and fatigue. The objective of this paper is to provide an updated descriptive, systematic review of evidence from pre-clinical and clinical trials assessing the benefits and safety of aromatherapy for cancer patients. Literature databases such as Medline (via Ovid), the Cochrane database of systematic reviews, Cochrane Central were searched from their inception until October 2010. Only studies on cancer cells or cancer patients were included. There is no long lasting effect of aromatherapy massage, while short term improvements were reported for general well being, anxiety and depression up to 8 weeks after treatment. The reviewed studies indicate short-term effects of aromatherapy on depression, anxiety and overall wellbeing. Specifically, some clinical trials found an increase in patient-identified symptom relief, psychological wellbeing and improved sleep. Furthermore, some found a short-term improvement (up to 2 weeks after treatment) in anxiety and depression scores and better pain control. Although essential oils have generally shown minimal adverse effects, potential risks include ingesting large amounts (intentional misuse); local skin irritation, especially with prolonged skin contact; allergic contact dermatitis; and phototoxicity from reaction to sunlight (some oils). Repeated topical administration of lavender and tea tree oil was associated with reversible prepubertal gynecomastia.

Health economic evaluation in complementary medicine: development within the last decades concerning local origin and quality.

OBJECTIVES: This evaluation investigates characteristics of health economics evaluations in CAM. Particular emphasis is paid to differences regarding continental origin and time of publication of investigations. METHODS: Database searches to identify potential studies were carried out in Medline (via Pubmed), the Cochrane Central Register of Controlled Trials 1st Quarter 2010, the Cochrane Database of Systematic Reviews 2005 to January 2010, the Cochrane Methodology Register 1st Quarter 2010, the Database of Abstracts of Reviews of Effects 1st Quarter 2010, Health Technology Assessment (via OVID) and CAMbase. Data were screened, extracted and the methodological quality of the underlying publications was assessed. Univariate statistical analyses were carried out and Classification and Regression Tree (CART) analysis was performed. RESULTS: One hundred and forty-three studies were included in this review, 43 of which were randomised trials. Of all included studies 56% were carried out in primary care settings and 54% chose the perspective of health care provider/health insurance. When the study characteristics were stratified for the "year of publication" (before versus in/after 2002), locally significant differences were found for study setting (Chi-square p=0.014) and methodological quality (Mann/Whitney p=0.014). Furthermore, studies from America differed from those conducted in Europe with respect to the field of CAM (p<0.001, Chi-square). There were also differences in trial settings as the majority of European studies was carried out in primary care settings (n=54; 70%), whereas American studies had a broader scope with only 24 studies (42%) in the field of primary care. The CART analyses confirmed the findings of the univariate analysis. CONCLUSION: Differences in healthcare systems were mirrored by the observed differences in CAM related health economic evaluations. Basic requirements for reporting and conducting clinical trials ought to be met in more studies evaluating health economics. Such evaluations need to include validated quality of life estimates and preferably report the use of incremental cost effectiveness or net health benefit estimates.

Laetrile treatment for cancer.

BACKGROUND: Laetrile is the name for a semi-synthetic compound which is chemically related to amygdalin, a cyanogenic glycoside from the kernels of apricots and various other species of the genus Prunus. Laetrile and amygdalin are promoted under various names for the treatment of cancer although there is no evidence for its efficacy. Due to possible cyanide poisoning, laetrile can be dangerous. OBJECTIVES: To assess the alleged anti-cancer effect and possible adverse effects of laetrile and amygdalin. SEARCH METHODS: We searched the following databases: CENTRAL (2011, Issue 1); MEDLINE (1951-2011); EMBASE (1980-2011); AMED; Scirus; CancerLit; CINAHL (all from 1982-2011); CAMbase (from 1998-2011); the MetaRegister; the National Research Register; and our own files. We examined reference lists of included studies and review articles and we contacted experts in the field for knowledge of additional studies. We did not impose any restrictions of timer or language. SELECTION CRITERIA: Randomized controlled trials (RCTs) and quasi-RCTs. DATA COLLECTION AND ANALYSIS: We searched eight databases and two registers for studies testing laetrile or amygdalin for the treatment of cancer. Two review authors screened and assessed articles for inclusion criteria. MAIN RESULTS: We located over 200 references, 63 were evaluated in the original review and an additional 6 in this update. However, we did not identify any studies that met our inclusion criteria. AUTHORS' CONCLUSIONS: The claims that laetrile or amygdalin have beneficial effects for cancer patients are not currently supported by sound clinical data. There is a considerable risk of serious adverse effects from cyanide poisoning after laetrile or amygdalin, especially after oral ingestion. The risk-benefit balance of laetrile or amygdalin as a treatment for cancer is therefore unambiguously negative.

Thymic peptides for treatment of cancer patients.

BACKGROUND: Purified thymus extracts (pTE) and synthetic thymic peptides (sTP) are thought to enhance the immune system of cancer patients in order to fight the growth of tumour cells and to resist infections due to immunosuppression induced by the disease and antineoplastic therapy. OBJECTIVES: To evaluate the effectiveness of pTE and sTP for the management of cancer. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2010, Issue 3), MEDLINE, EMBASE, AMED, BIOETHICSLINE, BIOSIS, CATLINE, CISCOM, HEALTHSTAR, HTA, SOMED and LILACS (to February 2010). SELECTION CRITERIA: Randomised trials of pTE or sTP in addition to chemotherapy or radiotherapy, or both, compared to the same regimen with placebo or no additional treatment in adult cancer patients. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data from published trials. We derived odds ratios (OR) from overall survival (OS) and disease-free survival (DFS) rates, tumour response (TR) rates, and rates of adverse effects (AE) related to antineoplastic treatments. We used a random-effects model for meta-analysis. MAIN RESULTS: We identified 26 trials (2736 patients). Twenty trials investigated pTE (thymostimulin or thymosin fraction 5) and six trials investigated sTP (thymopentin or thymosin α(1)). Twenty-one trials reported results for OS, six for DFS, 14 for TR, nine for AE and 10  for safety of pTE and sTP. Addition of pTE conferred no benefit on OS (RR 1.00, 95% CI 0.79 to 1.25); DFS (RR 0.97, 95% CI 0.82 to 1.16); or TR (RR 1.07, 95% CI 0.92 to 1.25). Heterogeneity was moderate to high for all these outcomes. For thymosin α(1) the pooled RR for OS was 1.21 (95% CI 0.94 to 1.56, P = 0.14), with low heterogeneity; and 3.37 (95% CI 0.66 to 17.30, P = 0.15) for DFS, with moderate heterogeneity. The pTE reduced the risk of severe infectious complications (RR 0.54, 95% CI 0.38 to 0.78, P = 0.0008; I² = 0%). The RR for severe neutropenia in patients treated with thymostimulin was 0.55 (95% CI 0.25 to 1.23,  P = 0.15). Tolerability of pTE and sTP was good. Most of the trials had at least a moderate risk of bias. AUTHORS' CONCLUSIONS: Overall, we found neither evidence that the addition of pTE to antineoplastic treatment reduced the risk of death or disease progression nor that it improved the rate of tumour responses to antineoplastic treatment. For thymosin α(1), there was a trend for a reduced risk of dying and of improved DFS. There was preliminary evidence that pTE lowered the risk of severe infectious complications in patients undergoing chemotherapy or radiotherapy.

An overview of 45 published database resources for complementary and alternative medicine.

BACKGROUND: Complementary and alternative medicine (CAM) has succeeded to implement itself in the academic context of universities. In order to get information on CAM, clinicians, researchers and healthcare professionals as well as the lay public are increasingly turning to online portals and databases, which disseminate relevant resources. One specific type of online information retrieval systems, namely the database, is being reviewed in this article. QUESTION: This overview aims at systematically retrieving and describing all databases covering the field of CAM. One of the requirements for inclusion was that the database would also have to be published in a medical journal. DATA SOURCES: The databases AMED, CAMbase, EMBASE, and MEDLINE/PubMed were searched between December 2008 and December 2009 for publications relevant to CAM databases. The authors' specialist library was also searched for grey literature to be included. STUDY SELECTION: All included databases were then visited online and information on the context, structure and volume of the database was extracted. MAIN RESULTS: Forty-five databases were included in this overview. Databases covered herbal therapies (n = 11), traditional Chinese medicine (n = 9) and some dealt with a vast number of CAM modalities (n = 9), amongst others. The amount of time the databases had been in existence ranged from 4 to 53 years. Countries of origin included the USA (n = 14), UK (n = 7) and Germany (n = 6), amongst others. The main language in 42 of 45 databases was English. CONCLUSIONS: Although this overview is quite comprehensive with respect to the field of CAM, certain CAM practices such as chiropractic, massage, reflexology, meditation or yoga may not have been covered adequately. A more detailed assessment of the quality of the included databases might give additional insights into the listed resources. The creation of a personalised meta-search engine is suggested, towards which this overview could be seen as a first step.