Cochrane Db Syst Rev
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Prostate cancer is the most common cancer in men in many western countries. It is characterized by its propensity for bone metastases which occur in more than 80% of patients with advanced disease. Patients are at risk of complications including pain, hypercalcaemia, bone fracture and spinal cord compression. Hormonal treatment is the mainstay of treatment for these patients but most of them will then become hormone refractory. Bisphosphonates act by inhibiting osteoclast activities and are a potential therapeutic option for metastatic prostate cancer. In addition, they have been shown to reduce pain in patients with bone metastases as a consequence of multiple myeloma. Early uncontrolled studies of bisphosphonates in metastatic prostate cancer patients have shown encouraging results. ⋯ Bisphosphonates should be considered for patients with metastatic prostate cancer for the treatment of refractory bone pain and prevention of skeletal events. More research is needed to guide the choice of bisphosphonates, optimal treatment schedule as well as cost-benefit comparisons. Combining results from different studies is difficult because different tools were used to assess pain, and also, bisphosphonates vary considerably in potency. This review highlights the need for standardisation and co-ordination among researchers in cancer pain studies.
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Cochrane Db Syst Rev · Oct 2006
Review Meta AnalysisPharmacological interventions for non-ulcer dyspepsia.
The commonest cause of upper gastrointestinal symptoms is non-ulcer dyspepsia (NUD) and yet the pathophysiology of this condition has been poorly characterised and the optimum treatment is uncertain. It is estimated that pound450 million is spent on dyspepsia drugs in the UK each year. ⋯ There is evidence that anti-secretory therapy may be effective in NUD. The trials evaluating prokinetic therapy are difficult to interpret as the meta-analysis result could have been due to publication bias. The effect of these drugs is likely to be small and many patients will need to take them on a long-term basis so economic analyses would be helpful and ideally the therapies assessed need to be inexpensive and well tolerated.
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This review is one in a series of Cochrane reviews of interventions for shoulder pain in adults. ⋯ Available data from two placebo-controlled trials and one no-treatment controlled trial provides "Silver" level evidence (www.cochranemsk.org) that oral steroids provides significant short-term benefits in pain, range of movement of the shoulder and function in adhesive capsulitis but the effect may not be maintained beyond six weeks.
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The purpose of low vision rehabilitation is to allow people to resume or to continue to perform daily living tasks, reading being one of the most important. This is achieved by providing appropriate optical devices and special training in the use of residual vision and low vision aids, which range from simple optical magnifiers to high power video magnifiers. ⋯ Further research is needed on the comparison of different types of low vision aids. It will be also necessary to delineate patient's characteristics that predict performance with costly electronic devices as well as their sustained use in the long term compared to simpler and cheaper optical devices.
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Cochrane Db Syst Rev · Oct 2006
ReviewOrthodontic treatment for deep bite and retroclined upper front teeth in children.
Correction of the type of dental problem where the bite is deep and the upper front teeth are retroclined (Class II division 2 malocclusion) may be carried out using different types of orthodontic treatment. However, in severe cases, surgery to the jaws in combination with orthodontics may be required. In growing children, treatment may sometimes be carried out using special upper and lower dental braces (functional appliances) that can be removed from the mouth. In many cases this treatment does not involve taking out any permanent teeth. Often, however, further treatment is needed with fixed braces to get the best result. In other cases, treatment aims to move the upper first permanent molars backwards to provide space for the correction of the front teeth. This may be carried out by applying a force to the teeth and jaws from the back of the head using a head brace (headgear) and transmitting this force to a part of a fixed or removable dental brace. This treatment may or may not involve the removal of permanent teeth. In some cases, neither functional appliances nor headgear are required and treatment may be carried out without extraction of any permanent teeth. Instead of using a headgear, in certain cases, the back teeth are held back in other ways such as with an arch across or in contact with the front of the roof of the mouth which links two bands glued to the back teeth. Often in these cases, two permanent teeth are taken out from the middle of the upper arch (one on each side) to provide room to correct the upper front teeth. It is important for orthodontists to find out whether orthodontic treatment only, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion produces a result which is any different from no orthodontic treatment or orthodontic treatment only involving extraction of permanent teeth. ⋯ It is not possible to provide any evidence-based guidance to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children.