Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Oct 2008
Review Meta AnalysisBlood pressure lowering efficacy of angiotensin receptor blockers for primary hypertension.
Angiotensin receptor blockers (ARBs) are widely prescribed for hypertension so it is essential to determine and compare their effects on blood pressure (BP), heart rate and withdrawals due to adverse effects (WDAE). ⋯ The evidence from this review suggests that there are no clinically meaningful BP lowering differences between available ARBs. The BP lowering effect of ARBs is modest and similar to ACE inhibitors as a class; the magnitude of average trough BP lowering for ARBs at maximum recommended doses and above is -8/-5 mmHg. Furthermore, 60 to 70% of this trough BP lowering effect occurs with recommended starting doses. The review did not provide a good estimate of the incidence of harms associated with ARBs because of the short duration of the trials and the lack of reporting of adverse effects in many of the trials.
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Cochrane Db Syst Rev · Oct 2008
Review Meta AnalysisInhaled sodium cromoglycate for asthma in children.
Sodium cromoglycate has been recommended as maintenance treatment for childhood asthma for many years. Its use has decreased since 1990, when inhaled corticosteroids became popular, but it is still used in many countries. ⋯ There is insufficient evidence to be sure about the efficacy of sodium cromoglycate over placebo. Publication bias is likely to have overestimated the beneficial effects of sodium cromoglycate as maintenance therapy in childhood asthma.
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Cochrane Db Syst Rev · Oct 2008
Review Meta AnalysisInterval debulking surgery for advanced epithelial ovarian cancer.
Primary debulking surgery, a crucial step in the management of epithelial ovarian cancer, is not always possible in patients with advanced stage disease (stage III to IV). In some circumstances, surgery may have been attempted but generally does not yield good results with residual tumour masses > 1 to 2 cm (so called suboptimal surgery). Induction or neoadjuvant chemotherapy followed by interval debulking surgery (IDS) may have an alternative role in this setting. However, the advantage of IDS compared to conventional methods is still a controversial issue. ⋯ No conclusive evidence was found to determine whether IDS between cycles of chemotherapy would improve or decrease the survival of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in the patients whose primary surgery was not performed by gynecologic oncologists. Data on QOL and adverse events were inconclusive.
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Cochrane Db Syst Rev · Oct 2008
Review Meta AnalysisBisphosphonate therapy for osteogenesis imperfecta.
In osteogenesis imperfecta (OI) a genetic defect in type I collagen results in multiple fractures with little or no trauma. Bisphosphonates are used to attempt to reduce these fractures. ⋯ Evidence suggests oral or intravenous bisphosphonates increase BMD in children and adults with OI. These were not shown to be different in their ability to increase BMD; it is unclear whether either treatment decreases fractures. Additional studies may determine whether bisphosphonates improve clinical status (reduce fractures and pain; improve growth and functional mobility) in this population. Optimal method, duration of therapy and long-term safety of bisphosphonate therapy requires further investigation.
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Cochrane Db Syst Rev · Oct 2008
Review Meta Analysis Comparative StudySurgical versus non-surgical treatment for carpal tunnel syndrome.
Carpal tunnel syndrome results from entrapment of the median nerve in the wrist. Common symptoms are tingling, numbness, and pain in the hand that may radiate to the forearm or shoulder. Most symptomatic cases are treated non-surgically. ⋯ Surgical treatment of carpal tunnel syndrome relieves symptoms significantly better than splinting. Further research is needed to discover whether this conclusion applies to people with mild symptoms and whether surgical treatment is better than steroid injection.