Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2003
ReviewScreening programmes for the early detection and prevention of oral cancer.
Although the second half of the last century has generated a rich and complex body of knowledge, the burden of oral cancer is still largely present. As with other cancers, there has been a strong debate whether screening strategies for oral cancer such as visual examination, the use of toluidine blue or newer methods such as brush biopsy or fluorescence imaging are effective in reducing the mortality rate associated with oral cancer. ⋯ Given the limitation of evidence (only one included randomised controlled trial) and the potential methodological weakness in the included study, it is valid to say that there is no evidence to support or refute the use of a visual examination as a method of screening for oral cancer using a visual examination in the general population. Furthermore, no robust evidence exists to suggest other methods of screening, toluidine blue, fluorescence imaging or brush biopsy, are either beneficial or harmful. Further cost-effective, high quality studies to assess the efficacy and effectiveness of screening are required. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high risk groups are needed.
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Cochrane Db Syst Rev · Jan 2003
ReviewPsychological interventions for depression in adolescent and adult congenital heart disease.
Adult and adolescent congenital heart disease is increasing in prevalence as better medical care means more children are surviving to adulthood. People with chromic disease often also experience depression. There are several non-pharmacological treatments that might be effective in treating depression and improving quality of life for adults and young adults with congenital heart disease. The aim of this review was to assess the effects of treatments such as psychotherapy, cognitive behavioural therapies and talking therapies for treating depression in this population. ⋯ Depression is common in patients with congenital heart disease and can exacerbate the physical consequences of the illness. There are effective pharmacological and non-pharmacological treatments for depression, but we have not been able to identify any trials showing the effectiveness of non-pharmacological treatments. A well designed randomised controlled trial is needed to assess the effects of psychological interventions for depression in congenital heart disease.
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Cochrane Db Syst Rev · Jan 2003
ReviewInterventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy.
Following pelvic radiotherapy (RT), a proportion of women experience problems related to sexual function, which are multifactorial in origin. The physical components relate to distortion of the perineum and vagina, which may occur as a result of surgery and/or radiotherapy and compromise sexual activity resulting in considerable distress. ⋯ These findings reflect the quality of published data regarding interventions for this aspect of the management of radiation induced complications. Although there is grade IC evidence, these studies are not recent, the allocation concealment is unclear in the text, and overall there is a variable level of assessment of the response, emphasising the need for more studies to be conducted with improved designs to clarify the investigative process and support the final result.
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisAntiplatelet and anticoagulation for patients with prosthetic heart valves.
Patients with prosthetic heart valves are at increased risk for valve thrombosis and arterial thromboembolism. Oral anticoagulation alone, or the addition of antiplatelet drugs, has been used to minimize this risk. An important issue is the effectiveness and safety of the latter strategy. ⋯ Adding antiplatelet therapy, either dipyridamole or low-dose aspirin, to oral anticoagulation decreases the risk of systemic embolism or death among patients with prosthetic heart valves. The risk of major bleeding is increased with antiplatelet therapy. These results apply to patients with mechanical prosthetic valves or those with biological valves and indicators of high risk such as atrial fibrillation or prior thromboembolic events. The effectiveness and safety of low dose aspirin (100 mg daily) appears to be similar to higher dose aspirin and dipyridamole.
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisReduced dietary salt for prevention of cardiovascular disease.
Restricting sodium intake in elevated blood pressure over short periods of time reduces blood pressure. Long term effects (on mortality, morbidity or blood pressure) of advice to reduce salt in patients with elevated or normal blood pressure are unclear. ⋯ Intensive interventions, unsuited to primary care or population prevention programmes, provide only minimal reductions in blood pressure during long-term trials. Further evaluations to assess effects on morbidity and mortality outcomes are needed for populations as a whole and for patients with elevated blood pressure. Evidence from a large and small trial showed that a low sodium diet helps in maintenance of lower blood pressure following withdrawal of antihypertensives. If this is confirmed, with no increase in cardiovascular events, then targeting of comprehensive dietary and behavioural programmes in patients with elevated blood pressure requiring drug treatment would be justified.