Cochrane Db Syst Rev
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Malignant pleural mesothelioma is a relatively uncommon disease, but the incidence is increasing and is expected to peak in many developed countries in the next two decades. The management of patients with malignant mesothelioma is controversial. Very few patients are suitable for any potentially curative treatment and the effectiveness of radical therapy with surgery, radiotherapy and/or chemotherapy in curing patients or prolonging survival is uncertain. The role of radiotherapy is controversial although it has been used as part of multimodal therapy. The present review will try to clarify these uncertainties. ⋯ As radiotherapy has never been compared to chemotherapy or surgery or to best supportive care (as part of combination therapy) in a prospective, randomised trial, no data exist supporting one or the other treatment as a better option for patients with malignant pleural mesothelioma. There is a need for multicentre controlled randomised trials assessing the role of radiotherapy in the radical treatment of malignant pleural mesothelioma. The studies should be limited to patients with malignant pleural mesothelioma, classified by stage, cytology and type of radiotherapy. The type of radiotherapy should be defined in advance and variables of radiotherapy dose definition and delivery should be carefully controlled.
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Cochrane Db Syst Rev · Jul 2006
ReviewErgonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults.
Conservative interventions such as physiotherapy and ergonomic adjustments (such as keyboard adjustments or ergonomic advice) play a major role in the treatment of most work-related complaints of the arm, neck or shoulder (CANS). ⋯ There is limited evidence for the effectiveness of keyboards with an alternative force-displacement of the keys or an alternative geometry, and limited evidence for the effectiveness of exercises compared to massage; breaks during computer work compared to no breaks; massage as an add-on treatment to manual therapy; and manual therapy as an add-on treatment to exercises.
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Cochrane Db Syst Rev · Jul 2006
ReviewPsychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings.
Cannabis use disorder is the most common illicit substance use disorder in general population. Despite that, only a minority seek assistance from a health professional, but the demand for treatment is now increasing internationally. Trials of treatment have been published but to our knowledge, there is no published systematic review . ⋯ The included studies were too heterogenous and could not allow to draw up a clear conclusion. The studies comparing different therapeutic modalities raise important questions about the duration, intensity and type of treatment. The generalizability of findings is also unknown because the studies have been conducted in a limited number of localities with fairly homogenous samples of treatment seekers. However, the low abstinence rate indicated that cannabis dependence is not easily treated by psychotherapies in outpatient settings.
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Stimulus deprivation amblyopia (SDA) develops due to an obstruction to the clear passage of light, preventing clear formation of an image on the retina for example, cataract, ptosis (droopy eyelid). It is particularly severe and can be resistant to treatment and the visual prognosis is often poor. Stimulus deprivation amblyopia is rare and precise estimates of prevalence difficult to come by; it probably constitutes less than 3% of all cases of amblyopia. In developed countries most patients present under the age of one; in less developed parts of the world presentation is likely to be significantly later than this.The mainstay of treatment is patching of the better-seeing eye but regimes vary, treatment is difficult to execute and results are often disappointing. ⋯ It is not possible to conclude how effective treatment for SDA is or which treatment regime produces the best results. There is a need for further study in this area.
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Angle-closure glaucoma is characterized by obstruction to the outflow of aqueous humor and consequent rise in intraocular pressure. The obstruction may result from an anatomical predisposition of the eye or may be due to pathophysiologic processes in any part of the eye. The former is considered the primary form and the latter a secondary form of angle closure. Relative pupillary block obstructing free flow of aqueous from the posterior chamber of the eye to the anterior chamber is considered to be the most common mechanism of angle closure. Crowding of the angle is another mechanism, which often coexists with pupillary block. This can result from an anterior placement of the lens due to an increase in the thickness of the lens (as occurs with aging), anterior displacement by a posterior force (for example choroidal effusion), or laxity of the zonules. ⋯ There is no evidence from good quality randomized trials or non-randomized studies of the effectiveness of lens extraction for chronic primary angle-closure glaucoma.