Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisAntiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.
Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extrapyramidal reactions, which are associated with some of the earlier generation of antiemetics. ⋯ The small number of included trials provided some, albeit weak and unreliable, evidence which appeared to favor the use of ondansetron and metoclopramide over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. The increased incidence of diarrhea noted with both ondansetron and metoclopramide was considered to be as a result of retention of fluids and toxins that would otherwise have been eliminated through the process of vomiting.
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Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisOpioids for the management of breakthrough (episodic) pain in cancer patients.
Breakthrough pain is a transient increase in pain intensity over background pain. It is a common and distinct component of cancer pain that can have a negative impact for both the patient and carers' quality of life. Breakthrough pain is usually related to background pain and is typically of rapid onset, severe in intensity, and generally self-limiting with an average duration of 30 minutes. At present the current approach to managing breakthrough pain is using supplemental analgesia (also known as rescue medication) at a dose proportional to the total around-the-clock (ATC) opioid dose. ⋯ There is evidence that OTFC is an effective treatment in the management of breakthrough pain. The randomised trial literature for the management of breakthrough pain is small and no trials were found for other opioids. Given the importance of this subject, more trials need to be undertaken.
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Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisSingle, double or multiple injection techniques for axillary brachial plexus block for hand, wrist or forearm surgery.
Regional anaesthesia comprising axillary block of the brachial plexus is a common anaesthetic technique for distal upper extremity surgery. ⋯ This review provided some evidence that multiple injection techniques using nerve stimulation for axillary plexus block provide more effective anaesthesia than either double or single injection techniques. However, there was insufficient evidence for other outcomes, including safety.
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Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisEffectiveness and cost effectiveness of counselling in primary care.
The prevalence of mental health and psychosocial problems in primary care is high. This review examines the clinical and cost-effectiveness of psychological therapies provided in primary care by counsellors. ⋯ Counselling is associated with modest improvement in short-term outcome compared to usual care, but provides no additional advantages in the long-term. Patients are satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs.
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Cochrane Db Syst Rev · Jan 2006
Review Meta AnalysisIpratropium bromide versus long-acting beta-2 agonists for stable chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is a condition associated with high morbidity, mortality and cost to the community. Patients often report symptomatic improvement with long acting beta-2 agonists (LABAs) and anticholinergic bronchodilator medications, both of which are recommended in COPD guidelines. These medications have different mechanisms of action and therefore theoretically could have an additive effect when combined. As these medications are prescribed in COPD as long term therapy, it is important to assemble reliable evidence on their relative and additive effects. ⋯ The available data from the trials suggest that there is little difference between regular long term use of IpB alone and salmeterol if the aim is to improve COPD symptoms and exercise tolerance. However, salmeterol was more effective in improving lung function variables. In terms of post-bronchodilator lung function, combination therapy conferred modest benefits and a significant improvement in HRQL, and reduced supplemental short-acting beta-agonist requirement, although this effect was not consistent. Additional studies are needed to assess the relative effects of combining therapies, using validated subjective measurements, and should consider concordance and the convenience of people having to use different inhaler devices.