Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2000
ReviewExpanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes.
In recent years pharmacists' roles have expanded from packaging and dispensing medications to working with other health care professionals and the public. ⋯ Only two studies compared pharmacist services with other health professional services. Both had some bias and did not allow us to draw conclusions about comparisons 1 and 3. The other studies supported the expanded roles of pharmacists in patient counselling and physician education. However, doubts about the generalisability of the studies, the poorly defined interventions, and the lack of cost assessments and patient outcome data, indicate that more rigorous research is needed to document the effects of outpatient pharmacist interventions.
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Cochrane Db Syst Rev · Jan 2000
Review Meta AnalysisExtramedullary fixation implants for extracapsular hip fractures.
Extramedullary fixation of hip fractures refers to the application of a plate and screws to the lateral side of the proximal femur. ⋯ The fixed nail plate has higher risks of implant breakage and fixation failure than the SHS. Though insufficient evidence on other outcomes is available from randomised trials, the increased fixation failure rate is a major consideration and thus the SHS appears preferable. Insufficient information is available to draw firm conclusions of the clinical significance of differences between the SHS and either the RAB plate, the Pugh nail or the Medoff plate.
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When pregnant women near term lie in the supine position the uterus can compress the inferior vena cava, interfering with venous return to the heart. This can result in hypotension, reduced placental perfusion and decreased fetal oxygenation. ⋯ There is not enough evidence from these trials to evaluate use of lateral tilt during caesarean section.
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Cochrane Db Syst Rev · Jan 2000
Review Meta AnalysisNebulised hypertonic saline for cystic fibrosis.
The lung disease in cystic fibrosis is characterised by impaired mucociliary clearance, recurrent bronchial infection and airway inflammation. Hypertonic saline has been shown to enhance mucociliary clearance in-vitro and this may act to lessen the destructive inflammatory process in the airways. ⋯ Nebulised hypertonic saline improves mucociliary clearance immediately after administration which may have a longer term beneficial effect in cystic fibrosis. The maximum time data were recorded for was only three weeks. Most of the patients had mild to moderate lung disease and the effect on severe lung disease remains unclear. Further studies of hypertonic saline should be carried out to determine the effect on pulmonary function tests, quality of life, frequency of exacerbations of respiratory disease and efficacy comparisons with nebulised deoxyribonuclease, with larger numbers and for longer duration. At this stage there is insufficient evidence to support the use of hypertonic saline in routine treatment for patients with cystic fibrosis.
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Cochrane Db Syst Rev · Jan 2000
ReviewNocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders.
Chronic alveolar hypoventilation is a common complication of many neuromuscular and chest wall disorders. Long term nocturnal mechanical ventilation is used to treat an increasing number of patients. ⋯ Current evidence about the therapeutic benefit of mechanical ventilation is weak, but consistent, suggesting alleviation of the symptoms of chronic hypoventilation in the short term, and in two small studies survival was prolonged. Mechanical ventilation should be offered as a therapeutic option to patients with chronic hypoventilation due to neuromuscular diseases. Further larger randomized trials are needed to confirm long term beneficial effects of nocturnal mechanical ventilation on quality of life, morbidity and mortality, to assess its cost-benefit ratio, and to compare the different types and modes of ventilation.