Outcome
|
Findings in words
|
Findings in numbers
|
Quality of evidence
|
Global outcome
|
Relapse (add-on glycine) |
At present it is not possible to be confident about the effect of adding the glutamatergic drug to standard antipsychotic treatment. Data supporting this finding are very limited. |
RR 0.39 (0.02 to 8.73) |
Very low
|
Service outcome
|
Hospital admission (add-on glycine) |
There is no clarity about the benefits or otherwise of adding a glutamatergic drug to antipsychotics for outcomes about how much hospital/community care is used. Data supporting this finding are based on low quality evidence.
|
RR 2.63 (0.12 to 59.40) |
Low
|
Mental state
|
No clinically significant improvement (add-on glycine) |
There is no evidence of clear advantage of using add-on glutamatergic to standard antipsychotic medication. These findings are based on data of low quality. |
RR 0.92 (0.79 to 1.08) |
Low
|
Adverse effects
|
Constipation (add-on glycine or D-serine) |
There is no clarity from very limited data. Additional glutamatergic could cause constipation or help avoid it. Data are very limited.
|
RR 0.61 (0.06 to 6.02) |
Very low
|
Insomnia (add-on glycine or D-serine) |
Additional glutamatergic may help or cause insomnia - it is not clear from the very limited data. |
RR 0.61 (0.13 to 2.84) |
Very low
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Missing outcomes
|
Quality of life |
This outcome was not reported in any studies |
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Depot pipotiazine palmitate and undecylenate for schizophrenia
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Pipotiazine palmitate compared to oral antipsychotics for schizophrenia[18]
Summary
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Although well-conducted and reported randomized trials are still needed to fully inform practice (no trial data exists reporting hospital and services outcomes, quality of life, satisfaction with care and economics) pipotiazine palmitate is a viable choice for both clinician and person with schizophrenia.[18]
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Outcome
|
Findings in words
|
Findings in numbers
|
Quality of evidence
|
Global outcomes
|
No important clinical response Follow-up: by 3 week) |
There is no clear difference between people given pipotiazine palmitate and those receiving oral antipsychotics. These findings are based on data of low quality. |
RR 2.57 (0.76 to 8.63) |
Low
|
Leaving the study early Follow-up: up to 5 weeks |
Pipotiazine palmitate may increase the chance of leaving the study early but the difference difference between people given pipotiazine palmitate and those receiving oral antipsychotics is not clear. These findings are based on data of low quality. |
RR 3.85 (0.46 to 32.22) |
Low
|
Mental state
|
Relapse Follow-up: by 18 months) |
Pipotiazine palmitate has not more - or less - effect on risk of relapse than oral antipsychotics. These findings are based on data of low quality. |
RR 1.55 (0.76 to 3.18) |
Low
|
Adverse effects
|
Tardive dyskinesia |
Oral antipsychotic drugs and pipotiazine palmitate carry similar risks of this problematic movement disorder. These findings are based on data of low quality. |
RR 1.03 (0.22 to 4.92) |
Low
|
Dystonia |
Pipotiazine palmitate may slightly reduce the chance of experiencing this movement disorder but there is no clear difference between people given pipotiazine palmitate and those receiving oral antipsychotics. These findings are based on data of low quality.
|
RR 0.32 (0.04 to 2.89) |
Low
|
|
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Perazine for schizophrenia
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Perazine versus other antipsychotic drugs for schizophrenia[19]
Summary
|
The number, size and reporting of randomized controlled perazine trials are insufficient to present firm conclusions about the properties of this antipsychotic. It is possible that perazine is associated with a similar risk of extrapyramidal side effects as some atypical antipsychotics but this is based on few comparisons of limited power.[19]
|
Outcome
|
Findings in words
|
Findings in numbers
|
Quality of evidence
|
Global state
|
No better or deterioration) Follow-up: average 4 weeks |
Perazine is not clearly different then other antipsychotic drugs for this outcome. These findings are based on data of low quality. |
RR 1.33 (0.36 to 4.97) |
Low
|
Mental state
|
Average score (BPRS) Follow-up: average 4 weeks |
The average overall mental state score in the perazine group was lower than for those given other antipsychotic drugs. These findings are based on data of low quality and the meaning of this outcome in day-to-day care remains unclear. |
MD 0.4 lower (0.74 to 0.06 lower) |
Low
|
Adverse effects
|
Needing antiparkinson medication Follow-up: average 4 weeks |
At present it is not possible to be confident about the difference between perazine and other antipsychotic drugs. Data supporting this finding are very limited. |
RR 1.21 (0.53 to 2.76) |
Very low
|
Leaving the study early - due to adverse events Follow-up: average 4 weeks |
There was not a clear difference between perazine and the other antipsychotic drugs for this general outcome reflecting overall adverse event 'load'. These findings are based on data of low quality. |
RR 0.87 (0.4 to 1.9) |
Low
|
Overall tolerability
|
Leaving the studies early - any reason Follow-up: 1-3 months |
Perazine and the comparison antipsychotic drugs were equally tolerated. These findings are based on data of low quality. |
RR 0.97 (0.68 to 1.38) |
Low
|
|
No study reported any data on outcomes such as quality of life or information relating to satisfaction with care. |
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Follow this link to a copy of the original Wikiarticle that contains this table!
Clotiapine for acute psychotic illnesses
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Clotiapine compared to other antipsychotic drugs for acute psychotic illnesses[20]
Summary
|
There was no evidence to support or refute the use of clotiapine in preference to other antipsychotic drug treatments for management of people with acute psychotic illness.[20]
|
Outcome
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Findings in words
|
Findings in numbers
|
Quality of evidence
|
General clinical impression
|
No significant improvement |
There is no clear difference between people given clotiapine and those receiving other antipsychotic drugs for acute psychotic illnesses. These findings are based on data of low quality.
|
RR 0.88 (0.39 to 1.98) |
Low
|
Not well enough to be discharged |
Clotiapine is not clearly different to other antipsychotic drugs for this outcome - for people who are acutely unwell. These findings are based on data of low quality.
|
RR 1.04 (0.93 to 1.16) |
Low
|
Adverse effects
|
Movement disorders - use of antiparkinsonian medication |
Clotiapine may reduce the use of antiparkinsonian drugs - implying that clotiapine causes less of this effect, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
|
RR 0.43 (0.05 to 3.53) |
Very low
|
Seizure |
Clotiapine may increase the risk of fits, but, the difference between the two treatments is not clear. This finding is based on data of low quality.
|
RR 3.67 (0.16 to 84.66) |
Low
|
Satisfaction with care
|
Leaving the study early - any reason |
There is no clear difference between people given clotiapine and those receiving other antipsychotics for acute psychotic illnesses. These findings are based on data of low quality.
|
RR 2.09 (0.81 to 5.42) |
Low
|
|
No study reported any data on outcomes as sedation and information relating to behavioral outcomes such as tranquillisation. |
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Penfluridol for schizophrenia
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Penfluridol compared to typical antipsychotics (oral) for schizophrenia[21]
Summary
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Although there are shortcomings and gaps in the data, there appears to be enough overall consistency for different outcomes. The effectiveness and adverse effects profile of penfluridol are similar to other typical antipsychotics; both oral and depot. Furthermore, penfluridol is shown to be an adequate treatment option for people with schizophrenia, especially those who do not respond to oral medication on a daily basis and do not adapt well to depot drugs. One of the results favouring penfluridol was a lower drop out rate in medium term when compared to depot medications. It is also an option for people with long-term schizophrenia with residual psychotic symptoms who nevertheless need continuous use of antipsychotic medication. An additional benefit of penfluridol is that it is a low-cost intervention.[21]
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Outcome
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Findings in words
|
Findings in numbers
|
Quality of evidence
|
Global state
|
No marked improvement (CGI) Follow-up: 3 to 12 months |
Penfluridol does not clearly change the chance of experiencing 'no marked improvement' when compared with receiving typical antipsychotic drugs. These findings are based on data of low quality.
|
RR 0.92 (0.68 to 1.24) |
Low
|
Global state - needing additional antipsychotic Follow-up: less than 3 months |
There is no clear difference between people given penfluridol and those receiving typical antipsychotics. These findings are based on data of low quality.
|
RR 1.35 (0.90 to 2.01) |
Low
|
Mental state
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Average score (BPRS) Follow-up: 3 to 12 months |
On average, people receiving penfluridol scored higher than people treated with typical antipsychotics (oral) but there was no clear difference between the groups and this finding is based on data of low quality. The meaning of this in day-to-day care is unclear. |
MD 1.24 higher (4.4 lower to 6.88 higher) |
Low
|
Adverse events
|
Needing antiparkinsonism medication Follow-up: less than 3 months |
There is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality.
|
RR 1.09 (0.61 to 1.97) |
Low
|
Insomnia Follow-up: less than 3 months |
There is no clear difference between people given penfluridol and those receiving typical antipsychotics (oral). These findings are based on data of low quality.
|
RR 1.07 (0.51 to 2.24) |
Low
|
|
No study reported any data on outcomes such as quality of life and information relating to time in services |
|
|
|
Follow this link to a copy of the original Wikiarticle that contains this table!
Perphenazine for schizophrenia
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Perphenazine compared with any antipsychotic drug for schizophrenia[22]
Summary
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Although perphenazine has been used in randomized trials for more than 50 years, incomplete reporting and the variety of comparators used make it impossible to draw clear conclusions. All data for the main outcomes were of very low quality evidence. At best it can be said that perphenazine showed similar effects - including adverse events - as several of the other antipsychotic drugs.[22]
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Outcome
|
Findings in words
|
Findings in numbers
|
Quality of evidence
|
Global state
|
No better or deterioration Follow-up: mean 8 weeks |
Perphenazine is not clearly different than other drugs for this global outcome and data supporting this finding are very limited. |
RR 1.04 (0.91 to 1.17) |
Very low
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Mental state
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Mental state - 'no effect' (BPRS score reduction) Follow-up: average 8 weeks |
At present it is not possible to be confident about the difference between perphenazine and any other antipsychotic drug. Data supporting this finding are very limited. |
RR 1.24 (0.61 to 2.52) |
Very low
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Adverse events
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Extrapyramidal adverse effects - dystonia Follow-up: average 10 weeks |
Perphenazine is not clearly different to other antipsychotic drugs and data supporting this finding are very limited. |
RR 1.36 (0.23 to 8.16) |
Very low
|
Any serious adverse event Follow-up: average 39 weeks |
It is also not possible to be confident about the difference between the two treatments. Data supporting this finding are very limited. |
RR 0.98 (0.68 to 1.41) |
Very low
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|
No study reported any data on outcomes such as death, economic outcomes and information relating to time in services |
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|
|
Follow this link to a copy of the original Wikiarticle that contains this table!
Pharmacological interventions for clozapine-induced hypersalivation
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Astemizole compared to control for clozapine-induced hypersalivation[23]
Summary
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There is no well-tested treatment for this difficult problem and no data to confidently inform clinical practice.[23]
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Outcome
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Findings in words
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Findings in numbers
|
Quality of evidence
|
Hypersalivation
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No effect / not cured / not markedly improved Control: propantheline |
Astemizole probably is probably worse than propantheline - increasing the risk of having 'no effect'. Data are based on moderate quality evidence.
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RR 2.46 (1.63 to 3.72) |
Moderate
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Change in hypersalivation scores (high = good) Control: propantheline |
On average, people receiving astemizole scored a little lower than people treated with control for clozapine-induced hypersalivation. There was a clear difference between the groups, but, at present the meaning of this in day-to-day care is unclear. |
MD 0.64 lower (1.14 lower to 0.14 lower) |
Low
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Adverse effects
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Tachycardia Control: doxepin |
Astemizole may increase the risk of experiencing fast heart rate, but, at present it is not possible to be confident about the difference between the two treatments because data supporting this finding are very limited.
|
RR 5.00 (0.25 to 99.16) |
Very low
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Constipation Control: propantheline |
Astemizole may reduce constipation but there is no clear difference between people given astemizole and those receiving propanthelinecontrol for clozapine-induced hypersalivation. These findings are based on data of low quality.
|
RR 0.60 (0.26 to 1.39) |
Low
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Missing outcomes
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|
No study reported any data on outcomes such as mental state, quality of life and information relating to time in services |
|
|
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Follow this link to a copy of the original Wikiarticle that contains this table!
Levomepromazine for schizophrenia
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Levomepromazine versus atypical antipsychotic drugs for schizophrenia[24]
Summary
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Data are few and not high quality and makes it impossible to be confident about on the effects of levomepromazine for schizophrenia.[24]
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Outcome
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Findings in words
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Findings in numbers
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Quality of evidence
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Global state
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Not much improved (CGI) Follow-up: short-term |
Levomepromazine may increase the risk of not seeing an improvement when compared with atypical antipsychotic drugs, but, at present there are only very limited data supporting this finding. |
RR 2.33 (1.11 to 4.89) |
Very low
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Mental state
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Any response (<20% decrease PANSS Follow-up: short-term |
At present it is not possible to be confident about the difference between people given levomepromazine and those receiving atypical antipsychotic drugs. There is very limited data to support this finding.
|
RR 2.5 (0.93 to 6.72) |
Very low
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Adverse events
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Constipation |
Levomepromazine may slightly reduce the risk of constipation but there is no clear difference between people given levomepromazine and those receiving atypical antipsychotics. These findings are based on data of low quality. |
RR 0.45 (0.07 to 2.94) |
Low
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Dizziness |
Levomepromazine may increase the chance of experiencing dizziness when compared with atypical antipsychotic drugs. Data are based on low quality evidence.
|
RR 2.59 (1.23 to 5.46) |
Low
|
Drowsiness |
There is no clear difference for the outcome of 'drowsiness' between people given levomepromazine and those receiving atypical antipsychotic drugs. These findings are based on data of low quality.
|
RR 0.62 (0.29 to 1.32) |
Low
|
Dry mouth |
Dry mouth is no more or less common with levomepromazine compared with those receiving atypical antipsychotic drugs. These findings are based on data of low quality.
|
RR 0.93 (0.45 to 1.95) |
Low
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Extrapyramidal symptoms - Needing antiparkinsonian medication |
Levomepromazine may reduce the risk of movement disorders but, with current data, there is no clear difference between people given levomepromazine and those receiving atypical antipsychotic drugs. These findings are based on data of very limited quality.
|
RR 0.6 (0.16 to 2.2) |
Very low
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Pericyazine for schizophrenia
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Pericyazine versus typical antipsychotic for schizophrenia[25]
Summary
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On the basis of very low quality evidence it is not possible to determine the effects of pericyazine in comparison with antipsychotics such as chlorpromazine or trifluoperazine for the treatment of schizophrenia. There is some evidence, however, that pericyazine may be associated with a higher incidence of extrapyramidal side effects than other antipsychotics.[25]
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Outcome
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Findings in words
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Findings in numbers
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Quality of evidence
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Global state
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Not improved Follow-up: 6-12 weeks |
Pericyazine may increase the risk of being 'not improved', but, at present it is not possible to be confident about the difference between people receiving pericyazine and those given chlorpromazine or trifluoperazine. Data supporting this finding are very limited.
|
RR 1.24 (0.93 to 1.66) |
Very low
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Adverse events
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Extrapyramidal side effect Follow-up: 6-12 weeks |
Pericyazine may reduce the chance of experiencing the movement disorder, compared with chlorpromazine or trifluoperazine, but, at present there is only very limited data supporting this finding.
|
RR 0.59 (0.38 to 0.89) |
Very low
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Leaving the study early
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For any reasons Follow-up: 9-12 weeks |
Pericyazine may reduce the chance of leaving the study early, but, at present it is not possible to be confident about the difference between the two treatments and data supporting this finding are very limited.
|
RR 0.46 (0.11 to 1.9) |
Very low
|
Missing outcomes
|
|
No study reported any data on outcomes such as relapse, mental state, cost-effectiveness, and information relating to behavior |
|
|
|
Follow this link to a copy of the original Wikiarticle that contains this table!
Depot fluspirilene for schizophrenia
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Fluspirilene decanoate compared to oral antipsychotics for schizophrenia[26]
Summary
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Participant numbers in each comparison were small so power to identify clear difference is limited. Randomized controlled trial data identified no clear differences between the long-acting injection of fluspirilene and oral medication for outcomes that include adverse effects.[26]
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Outcome
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Findings in words
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Findings in numbers
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Quality of evidence
|
Global outcome
|
Leaving the study early Follow up: 6 weeks to 5 months |
Fluspirilene decanoate may increase the risk of leaving the study (reasons not specified), but, the difference is not clear between people given fluspirilene decanoate and those receiving oral antipsychotics. These findings are based on data of low quality.
|
RR 1.18 (0.08 to 16.78) |
Low
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Mental state
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Relapse Follow up: 6 weeks to 5 months |
Using the depot, long-acting fluspirilene decanoate makes little difference for the outcome of 'relapse' compared with those receiving oral antipsychotics - at least for those willing to be engaged with trials. These findings are based on data of low quality.
|
RR 1.18 (0.08 to 16.78) |
Low
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Adverse effects
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Needing anticholinergic drugs Follow up: 6 weeks to 5 months |
The depot fluspirilene decanoate does not seem to cause any more movement disorders - for which anticholinergic drugs are used - compared with oral antipsychotics. These findings are based on data of low quality.
|
RR 0.07 (0.00 to 1.07) |
Low
|
Dizziness |
Fluspirilene decanoate may reduce the chance of experiencing dizziness compared with the oral antipsycotics. Data are based on low quality evidence.
|
RR 0.59 (0.37 to 0.95) |
Low
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Missing outcomes
|
|
Data on quality of life, and service use (e.g. hospitalization) were not reported in trials. |
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