There is currently no information available from published RCTs on clinically relevant outcome measures with respect to the application of cricoid pressure during RSI in the context of endotracheal intubation. On the basis of the findings of non-RCT literature, however, cricoid pressure may not be necessary to undertake RSI safely, and therefore well-designed and conducted RCTs should nonetheless be encouraged to properly assess the safety and effectiveness of cricoid pressure.

Although we found evidence of an effect of glutamine on mortality reduction, this finding should be taken with care. The number of study participants analysed in this systematic review was not sufficient to permit conclusions that recommend or refute the use of glutamine. Glutamine may be effective in reducing mortality, but larger studies are needed to determine the overall effects of glutamine and other immunonutrition agents.

Objective-To conduct a systematic review of clinical trials that examined the effectiveness of interventions on balance self-efficacy among individuals with stroke. Design-Systematic reviewSummary of Review-Searches of the following databases were completed in December 2014: MEDLINE (1948-present), CINAHL (1982-present), EMBASE (1980-present) and PsycINFO (1987-present) for controlled clinical trials that measured balance self-efficacy in adults with stroke. Reference lists of selected papers were hand-searched to identify further relevant studies.Review Methods-Two independent reviewers performed data extraction and assessed the methodological quality of the studies using the Physical Therapy Evidence Database scale. Standardized mean differences (SMD) were calculated.Results-Nineteen trials involving 729 participants used balance self-efficacy as a secondary outcome. Study quality ranged from poor (n=3) to good (n=8). In the meta-analysis of 15 trials that used intensive physical activity interventions, a moderate beneficial effect on balance selfefficacy was observed immediately following the programs (SMD 0.44, 95% CI 0.11-0.77, P=0.009). In the studies that included follow-up assessments, there was no difference between groups across retention periods (8 studies, SMD 0.32, 95% CI −0. 17-0.80, P=0.20). In the 4 studies that used motor imagery interventions, there was no between-group difference in change in balance self-efficacy (fixed effects SMD 0.68, 95% CI −0.33-1.69, P=0.18) Conclusions-Physical activity interventions appear to be effective in improving balance selfefficacy after stroke.

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