Cochrane Db Syst Rev
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Approximately half of all patients with metastatic cancer develop a malignant pleural effusion which is likely to lead to a significant reduction in quality of life secondary to symptoms such as dyspnoea and cough. The aim of pleurodesis in these patients is to prevent re-accumulation of the effusion and thereby of symptoms, and avoid the need for repeated hospitalization for thoracocentesis. Numerous clinical studies have been performed to try to determine the optimal pleurodesis strategy, and synthesis of the available evidence should facilitate this. ⋯ The available evidence supports the need for chemical sclerosants for successful pleurodesis, the use of talc as the sclerosant of choice, and thoracoscopic pleurodesis as the preferred technique for pleurodesis based on efficacy. There was no evidence for an increase in mortality following talc pleurodesis.
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Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisPre-operative education for hip or knee replacement.
Hip or knee replacement is a major surgical procedure which can be physically and psychologically stressful for patients. It is hypothesised that education before surgery reduces anxiety and enhances postoperative outcomes. ⋯ There is little evidence to support the use of pre-operative education over and above standard care to improve postoperative outcomes in patients undergoing hip or knee replacement surgery, especially with respect to pain, functioning and length of hospital stay. There is evidence that preoperative education has a modest beneficial effect on preoperative anxiety. There may also be beneficial effects when preoperative education is tailored according to anxiety, or targeted at those most in need of support (e.g. those who are particularly disabled, or have limited social support structures).
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Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisIntra-pleural fibrinolytic therapy versus conservative management in the treatment of parapneumonic effusions and empyema.
Effusions and empyema may complicate lower respiratory tract infections. Loculation of fluid is a major problem with this condition and treatments have included surgical drainage and the use of intra-pleural fibrinolysis to break down fibrin bands that may cause loculation. ⋯ The numbers of patients in the controlled trials are small. In meta-analysis of these trials, intrapleural fibrinolytic therapy confers significant benefit when compared with normal saline control. Although lesser levels of evidence suggest that intrapleural fibrinolysis can be considered as an important adjunctive therapy to intercostal tube drainage in these conditions, on the basis of RCT evidence alone, we cannot recommend the routine use of fibrinolysis in their management as the trial numbers are too small. Both streptokinase and urokinase are equally efficacious but streptokinase has a slightly higher non-fatal complication rate. Life-threatening complications are rare and were not seen in the RCTs.
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Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisIntramuscular arteether for treating severe malaria.
Quinine and artemisinin drugs are used in severe malaria, but quinine resistance is increasing. Arteether is a recently developed artemisinin derivative that is oil soluble, has a long elimination half life, and is more stable than other derivatives. ⋯ More trials with a larger number of participants are needed before a firm conclusion about the efficacy and safety of arteether can be reached.
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Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisPharmacotherapy for patellofemoral pain syndrome.
Patellofemoral pain syndrome (PFPS) is common among adolescents and young adults. It is characterised by pain behind or around the patella and crepitations, provoked by ascending or descending stairs, squatting, prolonged sitting with flexed knees, running and cycling. The symptoms impede function in daily activities or sports. Pharmacological treatments focus on reducing pain symptoms (non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids), or restoring the assumed underlying pathology (compounds containing glucosamine to stimulate cartilage metabolism, anabolic steroids to increase bone density of the patella and build up supporting muscles). In studies, drugs are usually applied in addition to exercises aimed at building up supporting musculature. ⋯ There is only limited evidence for the effectiveness of NSAIDs for short term pain reduction in PFPS. The evidence for the effect of glycosaminoglycan polysulphate is conflicting and merits further investigation. The anabolic steroid nandrolone may be effective, but is too controversial for treatment of PFPS.