Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Oct 2006
Review Meta AnalysisPortosystemic shunts versus endoscopic therapy for variceal rebleeding in patients with cirrhosis.
Randomised clinical trials have compared portosystemic shunting procedures with endoscopic therapy for variceal haemorrhage, but there is no consensus as to which approach is preferable. ⋯ All shunts resulted in a significantly lower rebleeding rate at the expense of a higher incidence of encephalopathy. TIPS was complicated by a high incidence of shunt dysfunction. No survival advantage was demonstrated with any shunt.
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Cochrane Db Syst Rev · Oct 2006
Review Meta AnalysisInterventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants).
Dental implants can be placed in fresh sockets just after tooth extraction. These are called 'immediate' implants. 'Immediate-delayed' implants are those implants inserted after weeks up to about a couple of months to allow for soft tissue healing. 'Delayed' implants are those placed thereafter in partially or completely healed bone. The advantages of immediate implants are that treatment time can be shortened and that bone height might be maintained thus possibly improving the aesthetic results. The potential disadvantages are an increased risk of infection and failures of the immediately placed implants. ⋯ Despite that the evidence is derived from only two RCTs with a limited number of patients, it is possible to suggest that immediate implants and immediate-delayed implants may offer some advantages over conventional implants in healed sites in terms of patient satisfaction and aesthetics possibly by preserving alveolar bone. Immediate implants can work and are able to shorten treatment periods, however properly designed RCTs are still needed to fully evaluate the potential advantages and risks of this treatment modality since more complications and failures may occur.
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Cochrane Db Syst Rev · Oct 2006
ReviewTelephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home.
It is known that many patients encounter a variety of problems in the first weeks after they have been discharged from hospital to home. In recent years many projects have addressed discharge planning, with the aim of reducing problems after discharge. Telephone follow-up (TFU) is seen as a good means of exchanging information, providing health education and advice, managing symptoms, recognising complications early, giving reassurance and providing quality aftercare service. Some research has shown that telephone follow-up is feasible, and that patients appreciate such calls. However, at present it is not clear whether TFU is also effective in reducing postdischarge problems. ⋯ The low methodological quality of the included studies means that results must be considered with caution. No adverse effects were reported. Nevertheless, although some studies find that the intervention had favourable effects for some outcomes, overall the studies show clinically-equivalent results between TFU and control groups. In summary, we cannot conclude that TFU is an effective intervention.
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Cochrane Db Syst Rev · Oct 2006
Review Meta AnalysisCyclosporin versus tacrolimus for liver transplanted patients.
Most liver transplant recipients receive either cyclosporin or tacrolimus to prevent rejection. Both drugs inhibit calcineurin phosphatase which is thought to be the mechanism of their anti-rejection effect and principle toxicities. The drugs have different pharmacokinetic profiles and potencies. Several randomised clinical trials have compared cyclosporin and tacrolimus in liver transplant recipients, but it remains unclear which is superior. ⋯ Tacrolimus is superior to cyclosporin in improving survival (patient and graft) and preventing acute rejection after liver transplantation, but it increases the risk of post-transplant diabetes. Treating 100 recipients with tacrolimus instead of cyclosporin would avoid acute rejection and steroid-resistant rejection in nine and seven patients, respectively, and graft loss and death in five and two patients, respectively, but four additional patients would develop diabetes after liver transplantation.
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Cochrane Db Syst Rev · Oct 2006
Review Meta AnalysisLung volume reduction surgery for diffuse emphysema.
Lung volume reduction surgery (LVRS) has been re-introduced for treating patients with severe diffuse emphysema. It is a procedure that aims to improve long-term daily functioning, although it is costly and may also be associated with a high risk of mortality. ⋯ The evidence summarised in this review is drawn from one large study, and several smaller trials. The findings from the large study indicated that in patients who survive up to three months post-surgery, there were significantly better health status and lung function outcomes in favour of surgery compared with usual medical care. Patients identified post hoc as being of high risk of death from surgery were those with particularly impaired lung function and poor diffusing capacity and/or homogenous emphysema. Further research should address the effect of this intervention on exacerbations and rate of decline in lung function and health status.