Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisAnticholinergic drugs versus other medications for overactive bladder syndrome in adults.
Overactive bladder syndrome is defined as "urgency with or without urge incontinence, usually with frequency and nocturia". It is a common condition with significant economic and quality of life implications. While the condition's pathophysiology remains to be fully elucidated, pharmacotherapy is the main treatment option. Despite uncertainty as to drug treatment of choice, anticholinergics are increasingly being used in primary and secondary care settings. This review compares anticholinergic drugs with other types or classes of drugs for treating overactive bladder syndromes. ⋯ Many of the drugs considered in trials in this review are no longer used in clinical practice (and this includes the most commonly tested - flavoxate). There is inadequate no evidence as to whether any of the available is better or worse than anticholinergic medications. Larger randomised controlled trials in clinical settings are required to further establish the role of these other medications in the management of overactive bladder syndrome.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisHeparin-bonded catheters for prolonging the patency of central venous catheters in children.
Central venous catheters (CVCs) are a mainstay in the management of critically ill children. However, these catheters are associated with mechanical and infectious complications which reduce their life span. Heparin bonding of catheters has shown promise in animal studies and in adults. ⋯ Two eligible studies on the use of heparin-bonded catheters versus placebo in children were identified. The use of heparin-bonded catheters is a promising therapy but warrants further studies.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisIntermittent versus continuous renal replacement therapy for acute renal failure in adults.
Renal replacement therapy (RRT) for acute renal failure (ARF) can be applied intermittently (IRRT) or continuously (CRRT). It has been suggested that CRRT has several advantages over IRRT including better haemodynamic stability, lower mortality and higher renal recovery rates. ⋯ In patients who are haemodynamically stable, the RRT modality does not appear to influence important patient outcomes, and therefore the preference for CRRT over IRRT in such patients does not appear justified in the light of available evidence. CRRT was shown to achieve better haemodynamic parameters such as MAP. Future research should focus on factors such as the dose of dialysis and evaluation of newer promising hybrid technologies such as SLED. Triallists should follow the recommendations regarding clinical endpoints assessment in RCTs in ARF made by the Working Group of the Acute Dialysis Quality Initiative Working Group.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisInterventions for non-oliguric hyperkalaemia in preterm neonates.
Non-oliguric hyperkalaemia of the newborn is defined as a plasma potassium level > 6.5 mmol/L in the absence of acute renal failure. Hyperkalaemia is a common complication in the first 48 hours of life in very low birth weight (birth weight < 1500 g) and/or very preterm newborns (< 32 weeks gestational age). ⋯ In view of the limited information from small studies of uncertain quality, no firm recommendations for clinical practice can be made. It appears that the combination of insulin and glucose is preferred over treatment with rectal cation-resin for hyperkalaemia in preterm infants. Both the combination of insulin and glucose and albuterol inhalation deserve further study. The two interventions could possibly be tested against each other. The effectiveness of other potentially effective interventions for non-oliguric hyperkalaemia (diuretics, exchange transfusion, peritoneal dialysis and calcium) have not been tested in randomized controlled trials.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisConstraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy.
Children with hemiplegic cerebral palsy learn strategies to manage daily tasks (for example play) using one hand and often the affected limb is disregarded or not used. Constraint-induced movement therapy (CIMT) is emerging as a treatment approach for use with children with hemiplegic cerebral palsy. It aims to increase spontaneous use of the affected upper limb and thereby limit the effects of developmental disregard. CIMT is based on two fundamental principles: constraint of the non-affected limb and massed practice of therapeutic tasks with the affected limb. ⋯ This systematic review found a significant treatment effect using modified CIMT in a single trial. A positive trend favouring CIMT and Forced Use was also demonstrated. Given the limited evidence, the use of CIMT, modified CIMT and Forced Use should be considered experimental in children with hemiplegic cerebral palsy. Further research using adequately powered RCTs, rigorous methodology and valid and reliable outcome measures is essential to provide higher level support of the effectiveness of CIMT for children with hemiplegic cerebral palsy.