Cochrane Db Syst Rev
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Urinary incontinence is a common and distressing problem. Bladder training aims to increase the interval between voids and is widely used for the treatment of urinary incontinence. ⋯ The limited evidence available suggests that bladder training may be helpful for the treatment of urinary incontinence, but this conclusion can only be tentative as the trials were of variable quality and of small size with wide confidence intervals around the point estimates of effect. There was also not enough evidence to determine w evidence to determine whether bladder training was useful as a supplement to another therapy. Definitive research has yet to be conducted: more research is required.
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Mallet finger, also called drop or baseball finger, is where the end of a finger cannot be actively straightened out due to injury of the extensor tendon mechanism. Treatment commonly involves splintage of the finger for six or more weeks. Less frequently, surgical fixation is used to correct the deformity. ⋯ There was insufficient evidence from comparisons tested within randomised trials to establish the relative effectiveness of different, either custom-made or off-the-shelf, finger splints used for treating mallet finger injury. There was a useful reminder that splints used for prolonged immobilisation should be robust enough for everyday use, and of the central importance of patient adherence to instructions for splint use. There was insufficient evidence to determine when surgery is indicated.
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Cochrane Db Syst Rev · Jan 2004
ReviewParacetamol versus nonsteroidal anti-inflammatory drugs for rheumatoid arthritis.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually preferred for simple analgesics such as paracetamol for rheumatoid arthritis. It is not clear, however, whether the trade-offs between benefits and harms of NSAIDs are preferable to those of paracetamol (paracetamol is also called acetaminophen). ⋯ When considering the trade off between the benefits and harms of non-steroidal anti-inflammatory drugs and paracetamol/acetaminophen, it is not known whether one is better than the other for rheumatoid arthritis. But people with rheumatoid arthritis and the researchers in the study did prefer non-steroidal anti-inflammatory drugs more than acetaminophen/paracetamol. There is a need for a large trial, with appropriate randomisation, double-blinding, test of the success of the blinding, and with explicit methods to measure and analyse pain and adverse effects.
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Cochrane Db Syst Rev · Jan 2004
ReviewOpioid switching to improve pain relief and drug tolerability.
Patients with cancer, and increasingly chronic non-cancer pain frequently require strong opioids for pain relief. Morphine is the first-line strong opioid of choice for these patients. While most achieve adequate analgesia with morphine, a significant minority either suffer intolerable side-effects, inadequate pain relief, or both. For these patients switching to an alternative opioid is becoming established clinical practice. However, the evidence for the effectiveness of opioid switching does not appear to be established. ⋯ For patients with inadequate pain relief and intolerable opioid-related toxicity/adverse effects, a switch to an alternative opioid may be the only option for symptomatic relief. However, the evidence to support the practice of opioid switching is largely anecdotal or based on observational and uncontrolled studies. Randomised trials, including 'N of 1' studies, where a patient acts as their own control, are needed: firstly, to establish the true effectiveness of this clinical practice; secondly, to determine which opioid should be used first-line or second-line; and thirdly, to standardise conversion ratios when switching from one opioid to another.
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Cochrane Db Syst Rev · Jan 2004
ReviewMinilaparotomy and endoscopic techniques for tubal sterilisation.
Worldwide, the most commonly used method of fertility regulation is tubal sterilisation. In developed countries sterilisation is generally performed by laparoscopy rather than by minilaparotomy, based on the belief that this approach is both safe and effective. In developing countries, where the resources are limited for the purchase and maintenance of the more sophisticated laparoscopic equipment, minilaparotomy may still be the most common approach. In both resource poor and industrialised countries using the technique with the greatest effectiveness and safety, together with the least costs, is extremely important. Though both methods are widely used, the advantages and disadvantages of laparoscopic sterilisation compared to mini-laparotomy have not been systematically evaluated. The ideal method would be one which is highly effective, economical, able to be performed on an outpatient basis, allowing rapid resumption of normal activity, producing a minimal or invisible scar and having a potential for reversibility. This review considers the methods to enter the abdominal cavity through the abdominal wall, either by minilaparotomy, laparoscopy or culdoscopy regardless of the technique used for tubal sterilisation. ⋯ Major morbidity seems to be a rare outcome for both, laparoscopy and minilaparotomy. The included studies had limited power to demonstrate significant differences especially for the relatively rare but potentially serious outcomes. Personal preference of the woman and/or of the surgeon can guide the choice of technique. Practical aspects (e.g. cost, maintenance, and sterilisation of the instruments) must be taken into account before implementing the more sophisticated endoscopic techniques in settings with limited resources. Culdoscopy is not recommended as it carries a higher complication rate.