Cochrane Db Syst Rev
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Physical fitness is low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. ⋯ The effects of training on death, dependence and disability after stroke are unclear. There is sufficient evidence to incorporate cardiorespiratory training, involving walking, within post-stroke rehabilitation in order to improve speed, tolerance and independence during walking. Further trials are needed to determine the optimal exercise prescription after stroke and identify any long-term benefits.
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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.
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Cochrane Db Syst Rev · Oct 2009
Review Meta AnalysisDynamic exercise programs (aerobic capacity and/or muscle strength training) in patients with rheumatoid arthritis.
An up-to-date overview of the effectiveness and safety of dynamic exercise therapy (exercise therapy with a sufficient intensity, duration, and frequency to establish improvement in aerobic capacity and/or muscle strength) is lacking. ⋯ Based on the evidence, aerobic capacity training combined with muscle strength training is recommended as routine practice in patients with RA.
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Risperidone is a widely used antipsychotic drug for people with schizophrenia. It is important to get a balance between gaining the most positive effects for the least negative outcomes. The optimal dose of risperidone is the focus of this review. ⋯ There is still lack of strong evidence for an optimal dose for clinical practice. The quality of trials suggests that an over estimate of effect is likely and we think this is most probably for the mid-range doses. One such dose (standard-lower dose range, 4-<6 mg/day) does seem optimal for clinical response and adverse effects. Weak evidence suggests that low doses (>==2-<4 mg/day) may be of value for people in their first episode of illness. High doses (>==10 mg/day) did not confer any advantage over any other dose ranges and caused more adverse effects, especially for movement disorders. Ultra low dose (<2 mg/day) seemed useless. We advise the use of dosages from low dose to standard-lower dose for different kinds of individual patients. Future trials should focus on specific populations, e.g. those in their first episode, with acute exacerbation, in relapse or refractory to treatment, and should also test the optimal dose of risperidone over a longer period of time and in the community.