Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Oct 2006
Review Meta AnalysisHepatic artery adjuvant chemotherapy for patients having resection or ablation of colorectal cancer metastatic to the liver.
Colorectal cancer metastatic to the liver, when technically feasible, is resected with a moderate chance of cure. The most common site of failure after resection is within the remaining liver. With this pattern of clinical failure in mind and in order to enhance survival, chemotherapy has been delivered directly to the liver post resection via the hepatic artery. ⋯ Though recurrence in the remaining liver happened less in the hepatic artery chemotherapy group, overall survival was not improved, and even favoured the control group, though not significantly. This added intervention cannot be recommended at this time.
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Worldwide, the prevalence of obesity and overweight in industrialized countries and in a substantial number of developing countries is increasing at an alarming rate. Rimonabant is a selective cannabinoid-1 receptor antagonist that has been investigated for its efficacy in reducing body weight and associated risk factors in obese people. Phase III trials are now under way to test the use of rimonabant for long-term weight-loss. Given the prevalence of overweight and obesity, it is important to establish the efficacy and safety of rimonabant. ⋯ The use of rimonabant after one year produces modest weight loss of approximately 5%. Even modest amounts of weight loss may be potentially beneficial. The observed results should be interpreted with some caution, though, since the evaluated studies presented some deficiencies in methodological quality. Studies with longer follow-ups after the end of treatment and of more rigorous quality should be done before definitive recommendations can be made regarding the role of this new medication in the management of overweight or obese patients.
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Cochrane Db Syst Rev · Oct 2006
ReviewPalliative radiotherapy regimens for non-small cell lung cancer.
Palliative radiotherapy to the chest is often used in patients with lung cancer, but radiotherapy regimens are more often based on tradition than research results. ⋯ The majority of patients should be treated with short courses of palliative radiotherapy, of 1 or 2 fractions. Care should be taken with the dose to the spinal cord. The use of high dose palliative regimens should be considered for and discussed with selected patients with good performance status. More research is needed into reducing the acute toxicity of large fraction regimens and into the role of radical compared to high dose palliative radiotherapy. In the future, large trials comparing different RT regimens may be difficult to set up because of the increasing use of systemic chemotherapy. Trials looking at how best to integrate these two modalities, particularly in good PS patients, need to be carried out.
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Cochrane Db Syst Rev · Oct 2006
ReviewWeight reduction for primary prevention of stroke in adults with overweight or obesity.
Obesity is seen as a worldwide chronic disease with high prevalence that has been associated with increased morbidity from many conditions including stroke, which is the third leading cause of death in developed countries and a leading cause of severe long-term disability. The causal association between overweight or obesity and stroke is unclear and there is no definite study clarifying the role of obesity treatment in the prevention of a first stroke (primary prevention). Given the prevalence of stroke and the enormous health and economic cost of the disease, it is important to establish the possible impact of weight reduction per se on stroke incidence. ⋯ Obesity seems to be associated with an increased risk of stroke and it has been suggested that weight loss may lead to a reduction of stroke occurrence. However, this hypothesis is not based on strong scientific evidence resulting from randomised controlled clinical trials. This systematic review identified the urgent need for well-designed, adequately-powered, multi centre randomised controlled trials assessing the effects of weight reduction in persons with overweight or obesity on stroke occurrence.
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There has been a significant reduction in the number of people with severe mental illness who spend extended periods in long-stay hospitals. District health authorities, local authorities, housing associations and voluntary organisations are jointly expected to provide support for people with severe mental disorder/s. This 'support' may well involve some kind of special housing. ⋯ Dedicated schemes whereby people with severe mental illness are located within one site or building with assistance from professional workers have potential for great benefit as they provide a 'safe haven' for people in need of stability and support. This, however, may be at the risk of increasing dependence on professionals and prolonging exclusion from the community. Whether or not the benefits outweigh the risks can only be a matter of opinion in the absence of reliable evidence. There is an urgent need to investigate the effects of supported housing on people with severe mental illness within a randomised trial.