Cochrane Db Syst Rev
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Acupuncture is increasingly used in people with epilepsy. It remains unclear whether existing evidence is rigorous enough to support its use. This is an update of a Cochrane review first published in 2008. ⋯ Available RCTs are small, heterogeneous and have high risk of bias. The current evidence does not support acupuncture for treating epilepsy.
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Cochrane Db Syst Rev · May 2014
ReviewBotulinum toxin for upper oesophageal sphincter dysfunction in neurological swallowing disorders.
Adequate upper oesophageal sphincter (UOS) opening is critical to safe and efficient swallowing due to the close proximity of the UOS to the airway entrance. Many people with neurological conditions, progressive and non-progressive, present with UOS dysfunction. The consequences for the person include difficulty swallowing food with subsequent choking and aspiration (passage of material into the trachea beyond the level of the true vocal cords). Clinical complications include aspiration pneumonia, weight loss, dehydration and malnutrition. Tube feeding is often indicated but is associated with increased mortality. Quality of life is also frequently impacted. A range of interventions exist that aim to improve UOS function and swallowing. These include compensatory strategies, rehabilitation techniques, pharmacological interventions and surgery. Over the last two decades, botulinum toxin has been gaining popularity as an intervention for UOS dysfunction, with some evidence to suggest that it is successful in improving swallow function. Despite a number of studies investigating its efficacy, there is a lack of consensus regarding whether this intervention is effective in improving swallowing for individuals with UOS dysfunction associated with neurological disease. ⋯ It was not possible to reach a conclusion on the efficacy and safety of botulinum toxin as an intervention for people with UOS dysfunction and neurological disease. There is insufficient evidence to inform clinical practice. Directions for future research are provided.
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Cochrane Db Syst Rev · May 2014
Review Meta AnalysisWITHDRAWN: Psychological interventions for overweight or obesity.
Since the last update of this review multiple changes like new methods and other standards make it necessary to withdraw this review and register a new title on the same topic. The editorial group responsible for this previously published document have withdrawn it from publication.
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Cochrane Db Syst Rev · May 2014
Review Meta AnalysisCultural competence education for health professionals.
Cultural competence education for health professionals aims to ensure all people receive equitable, effective health care, particularly those from culturally and linguistically diverse (CALD) backgrounds. It has emerged as a strategy in high-income English-speaking countries in response to evidence of health disparities, structural inequalities, and poorer quality health care and outcomes among people from minority CALD backgrounds. However there is a paucity of evidence to link cultural competence education with patient, professional and organisational outcomes. To assess efficacy, for this review we developed a four-dimensional conceptual framework comprising educational content, pedagogical approach, structure of the intervention, and participant characteristics to provide consistency in describing and assessing interventions. We use the term 'CALD participants' when referring to minority CALD populations as a whole. When referring to participants in included studies we describe them in terms used by study authors. ⋯ Cultural competence continues to be developed as a major strategy to address health inequities. Five studies assessed the effects of cultural competence education for health professionals on patient-related outcomes. There was positive, albeit low-quality evidence, showing improvements in the involvement of CALD patients. Findings either showed support for the educational interventions or no evidence of effect. No studies assessed adverse outcomes. The quality of evidence is insufficient to draw generalisable conclusions, largely due to heterogeneity of the interventions in content, scope, design, duration, implementation and outcomes selected.Further research is required to establish greater methodological rigour and uniformity on core components of education interventions, including how they are described and evaluated. Our conceptual framework provides a basis for establishing consensus to improve reporting and allow assessment across studies and populations. Future studies should measure the patient outcomes used: treatment outcomes; health behaviours; involvement in care and evaluations of care. Studies should also measure the impact of these types of interventions on healthcare organisations, as these are likely to affect uptake and sustainability.
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Cochrane Db Syst Rev · May 2014
ReviewNeostigmine for reversal of neuromuscular block in paediatric patients.
Residual neuromuscular block is associated with serious postoperative complications. Some anaesthesiologists use neostigmine to reverse neuromuscular blockade for all paediatric surgical patients. However, the incidence of residual neuromuscular block may be lower in paediatric patients than in adults. The use of neostigmine has also caused complications, such as postoperative nausea, vomiting, excessive salivation and bradycardia. Therefore, whether neostigmine should be used routinely to reverse neuromuscular blockade in each paediatric patient is an important question for paediatric anaesthesiologists. ⋯ No RCTs were found that supported, or argued against, the routine use of neostigmine to reverse neuromuscular block in paediatric patients.