Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jun 2011
Review Meta AnalysisHands-on therapy interventions for upper limb motor dysfunction following stroke.
Recent studies have attempted to disaggregate therapeutic intervention packages by looking at the impact of structure and process characteristics of environment upon outcome. However, what is commonly referred to as the 'black box' of therapy has yet to be comprehensively unpacked. This failure to analyse the components of therapy means that it remains unclear how much therapy should be provided, who should provide it, and which patients should be targeted to ensure that functional outcomes are maximized. This review, therefore, seeks to assess the effectiveness of specific therapeutic interventions in the rehabilitation of the paretic upper limb post stroke. ⋯ Overall, the review demonstrated that the limited evidence of benefit of stretching, passive exercises and mobilization, when applied to the hemiplegic upper limb following stroke, merits further research.
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Cochrane Db Syst Rev · Jun 2011
Review Meta AnalysisInterventions for enhancing consumers' online health literacy.
Access to health information is critical to enable consumers to participate in decisions on health. Increasingly, such information is accessed via the internet, but a number of barriers prevent consumers making effective use of it. These barriers include inadequate skills to search, evaluate and use the information. It has not yet been demonstrated whether training consumers to use the internet for health information can result in positive health outcomes. ⋯ Due to the small number of studies and their variable methodological quality, the evidence is too weak to draw any conclusions about implications for the design and delivery of interventions for online health literacy. There is a need for well-designed RCTs to investigate the effects of such interventions. These should involve different participants (in terms of disease status, age, socio-economic group and gender) to analyse the extent to which online health literacy reduces a barrier to using the internet for health information. Trials should be conducted in different settings and should examine interventions to enhance consumers' online health literacy (search, appraisal and use of online health information) like internet training courses, measuring outcomes up to at least one year after the intervention to estimate the sustainability of the intervention effects.
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Randomised clinical trials have addressed the question whether propylthiouracil has any beneficial effects in patients with alcoholic liver disease. ⋯ We could not demonstrate any significant beneficial effect of propylthiouracil on all-cause mortality, liver-related mortality, liver complications, or liver histology of patients with alcoholic liver disease. Propylthiouracil was associated with adverse events. Confidence intervals were wide. Thus, the risk of random errors and systematic errors was high. Accordingly, there is no evidence for using propylthiouracil for alcoholic liver disease outside randomised clinical trials.
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Proponents of early intervention have argued that outcomes might be improved if more therapeutic efforts were focused on the early stages of schizophrenia or on people with prodromal symptoms. Early intervention in schizophrenia has two elements that are distinct from standard care: early detection, and phase-specific treatment (phase-specific treatment is a psychological, social or physical treatment developed, or modified, specifically for use with people at an early stage of the illness).Early detection and phase-specific treatment may both be offered as supplements to standard care, or may be provided through a specialised early intervention team. Early intervention is now well established as a therapeutic approach in America, Europe and Australasia. ⋯ There is emerging, but as yet inconclusive evidence, to suggest that people in the prodrome of psychosis can be helped by some interventions. There is some support for specialised early intervention services, but further trials would be desirable, and there is a question of whether gains are maintained. There is some support for phase-specific treatment focused on employment and family therapy, but again, this needs replicating with larger and longer trials.
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Cochrane Db Syst Rev · Jun 2011
ReviewAdmission tests other than cardiotocography for fetal assessment during labour.
Evidence on the benefits of admission tests other than cardiotocography in preventing adverse perinatal outcomes has not been established. ⋯ There is not enough evidence to support the use of admission tests other than cardiotocography for fetal assessment during labour. Appropriate randomised controlled trials with adequate sample size of admission tests other than cardiotocography for fetal assessment during labour are required.