Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Oct 2009
Review Meta AnalysisDay hospital versus outpatient care for people with schizophrenia.
This review considers the use of day hospitals as an alternative to outpatient care. Two types of day hospital are covered by the review: 'day treatment programmes' and 'transitional' day hospitals. Day treatment programmes offer more intense treatment for people who have failed to respond to outpatient care. Transitional day hospitals offer time-limited care to people who have just been discharged from inpatient care. ⋯ Evidence is limited and dated. Day hospital care may help avoid inpatient care but data are lacking on missing on a raft of outcomes that are now considered important, such as quality of life, satisfaction, healthy days, and cost.
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Cochrane Db Syst Rev · Oct 2009
Review Meta AnalysisPneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age.
Pneumonia, caused by Streptococcus pneumoniae, is a major cause of morbidity and mortality among children in low-income countries. The effectiveness of pneumococcal conjugate vaccines (PCVs) against invasive pneumococcal disease (IPD), pneumonia, and mortality needs to be evaluated. ⋯ PCV is effective in preventing IPD, X-ray defined pneumonia, and clinical pneumonia among HIV-1 negative and HIV-1 positive children under two years. The impact was greater for VT-IPD than for all serotypes-IPD, and for X-ray defined pneumonia than for clinical pneumonia. An 11% reduction with a 95% CI of -1% to 21% and a P = 0.08 is compatible with reduction in all-cause mortality.
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Cochrane Db Syst Rev · Oct 2009
Review Meta AnalysisAromatase inhibitors for treatment of advanced breast cancer in postmenopausal women.
Endocrine therapy removes the influence of oestrogen on breast cancer cells and so hormonal treatments such as tamoxifen, megestrol acetate and medroxyprogesterone acetate have been in use for many years for advanced breast cancer. Aromatase inhibitors (AIs) inhibit oestrogen synthesis in the peripheral tissues and have a similar tumour-regressing effect to other endocrine treatments. Aminoglutethimide was the first AI in clinical use and now the third generation AIs, anastrozole, exemestane and letrozole, are in current use. Randomised trial evidence on response rates and side effects of these drugs is still limited. ⋯ In women with advanced (metastatic) breast cancer, aromatase inhibitors including those in current clinical use show a survival benefit when compared to other endocrine therapy.
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Cochrane Db Syst Rev · Oct 2009
ReviewProcessed versus fresh frozen bone for impaction bone grafting in revision hip arthroplasty.
Impaction grafting is a technique to restore bone loss both in the femur and the acetabulum during revision hip arthroplasty surgery. Initially impaction grafting was undertaken using fresh frozen femoral head allografts that were milled to create morselized bone pieces that could be impacted to create a neo-cancellous bone bed prior to cementation of the new implant. Results of medium and long term outcome studies have shown variable results using this technique. Currently both processed and non-processed allograft bone are used and the purpose of this review was to analyse the evidence for both. ⋯ Good quality randomised controlled trials are required in this area so that a surgeon's choice of bone graft can be informed by evidence rather than personal preference.
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Cochrane Db Syst Rev · Oct 2009
Review Meta AnalysisSubcutaneous unfractionated heparin for the initial treatment of venous thromboembolism.
Venous thromboembolism is a prevalent condition with potentially dire consequences. Its medical treatment requires anticoagulation, which is usually achieved with either unfractionated or low molecular weight heparin (LMWH). Unfractionated heparin (UFH) is usually administered intravenously, but can be applied subcutaneously as well. ⋯ Subcutaneous unfractionated heparin for the treatment of venous thromboembolism cannot be considered non-inferior to other treatment modalities in terms of recurrent DVT and PE at three months, but seems as safe and effective with regards to rates of major bleeding and death.