Cochrane Db Syst Rev
-
Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisAntibiotics for exacerbations of chronic obstructive pulmonary disease.
Most patients with an exacerbation of chronic obstructive pulmonary disease (COPD) are treated with antibiotics. However the value of their use remains uncertain. Some controlled trials of antibiotics have shown benefit (Berry 1960; Pines 1972) while others have not (Elmes 1965b; Nicotra 1982). ⋯ This review shows that in COPD exacerbations with increased cough and sputum purulence antibiotics, regardless of choice, reduce the risk of short-term mortality by 77%, decrease the risk of treatment failure by 53% and the risk of sputum purulence by 44%; with a small increase in the risk of diarrhoea. These results should be interpreted with caution due to the differences in patient selection, antibiotic choice, small number of included trials and lack of control for interventions that influence outcome, such as use of systemic corticosteroids and ventilatory support. Nevertheless, this review supports antibiotics for patients with COPD exacerbations with increased cough and sputum purulence who are moderately or severely ill.
-
Cochrane Db Syst Rev · Jan 2006
Review Comparative StudyOperative versus non-operative treatment for thoracolumbar burst fractures without neurological deficit.
Spinal burst fractures result from the failure of both the anterior and the middle columns of the spine under axial compression loads. Conservative management is through bed rest, and immobilization with a brace once the acute symptoms have settled. Surgical treatment involves either anterior or posterior stabilization of the fracture with screws, often with decompression, an operation to remove bone fragments which have intruded into the vertebral canal. ⋯ There was no statistically significant difference on the functional outcome two years or more after therapy between operative and non-operative treatment for thoracolumbar burst fractures without neurological deficit. However, this review was able to include only one randomized controlled trial with a small sample size and poor quality, which precluded firm conclusions. More research with high quality trials is needed.
-
Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisContinuous positive airways pressure for obstructive sleep apnoea in adults.
Obstructive sleep apnoea is the periodic reduction (hypopnoea) or cessation (apnoea) of breathing due to narrowing or occlusion of the upper airway during sleep. The main symptom is daytime sleepiness and it has been suggested it is linked to premature death, hypertension, ischaemic heart disease, stroke and road traffic accidents. ⋯ CPAP is effective in reducing symptoms of sleepiness and improving quality of life measures in people with moderate and severe obstructive sleep apnoea (OSA). It is more effective than oral appliances in reducing respiratory disturbances in these people but subjective outcomes are more equivocal. Certain people tend to prefer oral appliances to CPAP where both are effective. This could be because they offer a more convenient way of controlling OSA. Short-term data indicate that CPAP leads to lower blood pressure than control. Long-term data are required for all outcomes in order to determine whether the initial benefits seen in short-term clinical trials persist.
-
Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisPlanned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more).
Prelabour rupture of membranes at term is managed expectantly or by elective birth, but it is not clear if waiting for birth to occur spontaneously is better than intervening. ⋯ Planned management (with methods such as oxytocin or prostaglandin) reduces the risk of some maternal infectious morbidity without increasing caesarean sections and operative vaginal births. Fewer infants went to neonatal intensive care under planned management although no differences were seen in neonatal infection rates. Since planned and expectant management may not be very different, women need to have appropriate information to make informed choices.
-
Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisLamotrigine versus carbamazepine monotherapy for epilepsy.
The choice of an antiepileptic drug (AED) for any individual should take into account reliable information about seizure control, adverse effects and cost. Carbamazepine is the usual drug of choice for people with newly-diagnosed partial onset seizures. Lamotrigine is a relatively new AED which is licensed in many countries for use as an initial monotherapy. ⋯ Lamotrigine was significantly less likely to be withdrawn than carbamazepine but results for time to first seizure suggested that carbamazepine may be superior in terms of seizure control. Trials were of too short a duration to measure important seizure outcomes such as time to 12 month remission. Further trials are needed in which longer-term outcome is assessed as well as measures such as psychosocial outcome and quality of life.