Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jul 2009
Review Meta AnalysisInterventions for promoting smoking cessation during pregnancy.
Tobacco smoking in pregnancy remains one of the few preventable factors associated with complications in pregnancy, low birthweight, preterm birth and has serious long-term health implications for women and babies. Smoking in pregnancy is decreasing in high-income countries and increasing in low- to middle-income countries and is strongly associated with poverty, low educational attainment, poor social support and psychological illness. ⋯ Smoking cessation interventions in pregnancy reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birthweight and preterm birth. Smoking cessation interventions in pregnancy need to be implemented in all maternity care settings. Given the difficulty many pregnant women addicted to tobacco have quitting during pregnancy, population-based measures to reduce smoking and social inequalities should be supported.
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Cochrane Db Syst Rev · Jul 2009
Review Meta AnalysisGranulocyte-colony stimulating factors as adjunctive therapy for diabetic foot infections.
G-CSF increases the release of neutrophil endothelial progenitor cells from the bone marrow, and improves neutrophil functions, which are often impaired in people with diabetes. ⋯ The available evidence is limited, but suggests that adjunctive G-CSF treatment in people with a diabetic foot infection, including infected ulcers, does not appear to increase the likelihood of resolution of infection or healing of the foot ulcer. However, it does appear to reduce the need for surgical interventions, especially amputations, and the duration of hospitalisation. Clinicians might consider adding G-CSF to the usual treatment of diabetic foot infections, especially in patients with a limb-threatening infection, but it is not clear which patients might benefit.
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Cochrane Db Syst Rev · Jul 2009
Review Meta AnalysisAntihypertensive treatment for kidney transplant recipients.
In some nontransplant populations, effects of different antihypertensive drug classes vary. Relative effects in kidney transplant recipients are uncertain. ⋯ These data suggest that CCB may be preferred as first line agents for hypertensive kidney transplant recipients. ACEi have some detrimental effects in kidney transplant recipients. More high quality studies reporting patient centred outcomes are required.
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Cochrane Db Syst Rev · Jul 2009
Review Meta AnalysisEarly trophic feeding for very low birth weight infants.
The introduction of enteral feeds for very low birth weight (VLBW) infants is often delayed due to concern that early introduction may not be tolerated and may increase the risk of necrotising enterocolitis. However, enteral fasting may diminish the functional adaptation of the immature gastrointestinal tract and prolong the need for parenteral nutrition with its attendant infectious and metabolic risks. Early trophic feeding, giving infants very small volumes of milk during the first week after birth, may promote intestinal maturation, enhance feeding tolerance and decrease time to reach full enteral feeding independently of parenteral nutrition. ⋯ The available data cannot exclude important beneficial or harmful effects and are insufficient to inform clinical practice. Further large pragmatic randomised controlled trials are needed to determine how early trophic feeding compared with enteral fasting affects important clinical outcomes in VLBW infants.
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Cochrane Db Syst Rev · Jul 2009
Review Meta AnalysisTherapeutic interventions for disease progression in Huntington's disease.
Huntington's disease (HD) is an autosomal dominant neurodegenerative disease with an average onset between the fourth and fifth decade of life; it leads to death 15 to 20 years after the onset of symptoms. Although several drugs seem effective in controlling the incapacitating manifestations of HD, no specific therapy is known. The present review aims at analysing the best available data on therapeutic interventions investigated with the goal of modifying the progression of the disease as measured in terms of survival, disability or progression of HD core symptoms. ⋯ Only pharmacological interventions were included and none proved to be effective as a disease-modifying therapy for HD. Further trials with greater methodological quality should be conducted using more sensitive biological markers. Pre-symptomatic mutation carriers should be included in future studies.