Cochrane Db Syst Rev
-
Mechanical neck disorders (MND) are common, disabling and costly. Massage is a commonly used modality for the treatment of neck pain. ⋯ No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain. Pilot studies are needed to characterize massage treatment (frequency, duration, number of sessions, and massage technique) and establish the optimal treatment to be used in subsequent larger trials that examine the effect of massage as either a stand-alone treatment or part of a multimodal intervention. For multimodal interventions, factorial designs are needed to determine the relative contribution of massage. Future reports of trials should improve reporting of the concealment of allocation, blinding of outcome assessor, adverse events and massage characteristics. Standards of reporting for massage interventions, similar to CONSORT, are needed. Both short- and long-term follow-up are needed.
-
Cochrane Db Syst Rev · Jan 2006
ReviewOral antibiotics versus parenteral antibiotics for severe pneumonia in children.
Acute respiratory infection (ARI) is one of the leading causes of morbidity and mortality in children under five years of age in developing countries. When hospitalisation is required, the usual practice includes administering parenteral antibiotics if a bacterial infection is suspected. This has disadvantages as it causes pain and discomfort to the children, which may lead to treatment refusal or reduced compliance. It is also associated with needle-related complications. In some settings this equipment is in short supply or unavailable necessitating transfer of the child, which increases risks and healthcare costs. ⋯ Oral therapy appears to be an effective and safe alternative to parenteral antibiotics in hospitalised children with severe pneumonia who do not have any serious signs or symptoms.
-
Caesarean section rates are progressively rising in many parts of the world. One suggested reason is increasing requests by women for caesarean section in the absence of clear medical indications, such as placenta praevia, HIV infection, contracted pelvis and, arguably, breech presentation or previous caesarean section. The reported benefits of planned caesarean section include greater safety for the baby, less pelvic floor trauma for the mother, avoidance of labour pain and convenience. The potential disadvantages, from observational studies, include increased risk of major morbidity or mortality for the mother, adverse psychological sequelae, and problems in subsequent pregnancies, including uterine scar rupture and greater risk of stillbirth and neonatal morbidity. An unbiased assessment of advantages and disadvantages would assist discussion of what has become a contentious issue in modern obstetrics. ⋯ There is no evidence from randomised controlled trials, upon which to base any practice recommendations regarding planned caesarean section for non-medical reasons at term. In the absence of trial data, there is an urgent need for a systematic review of observational studies and a synthesis of qualitative data to better assess the short- and long-term effects of caesarean section and vaginal birth.
-
Cochrane Db Syst Rev · Jan 2006
ReviewRescue high frequency jet ventilation versus conventional ventilation for severe pulmonary dysfunction in preterm infants.
Chronic pulmonary disease is a major cause of mortality and morbidity in very low birth weight infants despite increased use of antenatal steroids and surfactant therapy. Ventilator injury and oxygen toxicity are thought to be important factors in the pathogenesis of chronic pulmonary disease. There is evidence in animal studies and adult human studies that high frequency jet ventilation may reduce the severity of lung injury associated with mechanical ventilation. ⋯ There was no significant difference in the overall mortality between rescue high frequency jet ventilation and conventional groups. In a secondary analysis, rescue treatment with HFJV, up until the time of cross-over, was associated with lower mortality. There was no significant increase in adverse effects like intraventricular hemorrhage, new air leaks, airway obstruction and necrotizing tracheobronchitis with rescue high frequency jet ventilation. The included study was done before the introduction of surfactant and widespread use of antenatal steroids. The number of infants included was small and there were high numbers of post randomization exclusions. Due to the crossover design and small numbers of infants in the included study, there is insufficient information to assess the effectiveness of rescue HFJV in preterm infants. Studies that target the most at-risk population and have appropriate power to assess some of the important outcomes are needed. These trials would also need to incorporate long term pulmonary and neurodevelopmental outcomes.
-
Cochrane Db Syst Rev · Jan 2006
ReviewWITHDRAWN: Injection therapy for subacute and chronic benign low-back pain.
Injection with anaesthetics and/or steroids is one of the treatment modalities used in patients with chronic low back pain which needs evaluation with respect to the effectiveness on short and long term pain relief. ⋯ Convincing evidence is lacking on the effects of injection therapies for low back pain. There is a need for more, well designed explanatory trials in this field.