Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2001
ReviewAlpha-1 proteinase inhibitor (a1PI) for preventing chronic lung disease in preterm infants.
Inflammation of the pulmonary parenchyma is one of the important mechanisms implicated in development of chronic lung disease (CLD) in preterm neonates. Release of enzymes and other anti - oxidants following cell damage is considered to be responsible for the damage to lung tissue. Various strategies have been attempted to counteract enzymatic damage to pulmonary parenchyma and to prevent CLD. ⋯ Prophylactic administration of a1PI did not reduce the risk of CLD at 36 weeks or long term adverse developmental outcomes in preterm neonates.
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Studies in traumatic encephalopathy first led to the insight that the damage seen was not just due to direct consequences of the primary injury. A significant, and potentially preventable, contribution to the overall morbidity arose from secondary hypoxic-ischaemic damage. Brain swelling accompanied by raised intracranial pressure (ICP) resulted in inadequate cerebral perfusion with well-oxygenated blood. Detection of raised ICP could be useful in alerting clinicians to the need to improve cerebral perfusion, with consequent reductions in brain injury. ⋯ There are no data from randomised controlled trials that can clarify the role of ICP monitoring in acute coma.
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Cochrane Db Syst Rev · Jan 2001
ReviewNon-corticosteroid treatment for nephrotic syndrome in children.
Eighty to ninety per cent children with steroid sensitive nephrotic syndrome (SSNS) have one or more relapses. About half of these children relapse frequently and are at risk of the adverse effects of corticosteroids. Non-corticosteroid immunosuppressive agents are used to prolong periods of remission in children, who relapse frequently. However these non-corticosteroid agents also have significant potential adverse effects. Currently there is no consensus as to the most appropriate second line agent in children who are steroid sensitive, but who continue to relapse. In this systematic review of randomised controlled trials (RCTs), the benefits and harms of these immunosuppressive agents are evaluated. ⋯ Eight weeks courses of cyclophosphamide or chorambucil and prolonged courses of cyclosporin and levamisole reduce the risk of relapse in children with relapsing SSNS compared with corticosteroids alone. Clinically important differences in efficacy among these agents are possible and further comparative trials are still needed. Meanwhile choice between these agents depends on physician and patient preferences related to therapy duration and the type and frequency of complications.
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Many treatments are available for whiplash-patients, but to date, no evidence exists for their effectiveness. ⋯ It appears that "Rest makes rusty." In other words, rest and immobilization using collars are not recommended for the treatment of whiplash, while active interventions, such as advice to 'maintain usual activities' might be effective in whiplash-patients. Nevertheless, caution is needed when attempting to draw conclusions regarding the efficacy of conservative treatments in whiplash-patients, because of the paucity of high-quality studies. No conclusions can be drawn about the most effective therapy for chronic whiplash-patients because only one low quality trial was identified.
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Cochrane Db Syst Rev · Jan 2001
ReviewMultidisciplinary team interventions for delirium in patients with chronic cognitive impairment.
Delirium is common in hospitalized elderly people. In the frail elderly, delirium may occur in 60% of those hospitalized. In the cognitively impaired, 45% have been shown to develop delirium and these patients have longer lengths of hospital stay and a higher rate of complications which, with other factors, together contribute to an increase in cost of care. The combination of being elderly and chronically cognitively impaired leads to a high risk of delirium with the associated increased risk of prolonged hospital stay, complications, and poor outcomes. The management of delirium has commonly been multifaceted - the primary emphasis has always been on the diagnosis and therapy of the precipitating factors, but as these may not be immediately resolved, symptomatic and supportive care may become of major importance. ⋯ The management of delirium needs to be studied in a more clearly defined way before evidence-based guidelines can be developed. Insufficient data are available for the development of evidence based guidelines on diagnosis or management. There is scope for research in all areas - from basic pathophysiology and epidemiology to prevention and management. Though much recent research has focused on the problem of delirium, the evidence is still difficult to utilize in management programmes. Research needs to be undertaken targeting specific groups known to be at high risk of developing delirium, for example the cognitively impaired and the frail elderly. As has been highlighted by Inouye 1999, delirium has very important economic and health policy implications and is a clinical problem which affects all aspects of care of the elderly. Delirium, though a frequent problem in the hospitalised elderly patient, is still managed empirically and there is no evidence in the literature to support change to current practice at this time.