Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisTherapy-based rehabilitation services for stroke patients at home.
Stroke Unit care is now accepted as an effective service model for hospital care, but the effectiveness of outpatient care is less certain. This review focuses on therapy-based rehabilitation services targeted at stroke patients living at home. ⋯ Therapy-based rehabilitation services targeted towards stroke patients living at home appear to improve independence in personal activities of daily living. However, the evidence is derived from a review of heterogeneous interventions and therefore further exploration of the interventions is justifiable.
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Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progestogens. Therefore, progestational agents have been used, beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. ⋯ There is no evidence to support the routine use of progestogen to prevent miscarriage in early to mid pregnancy. However, further trials in women with a history of recurrent miscarriage may be warranted, given the trend for improved live birth rates in these women and the finding of no statistically significant difference between treatment and control groups in rates of adverse effects suffered by either mother or baby in the available evidence.
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Cochrane Db Syst Rev · Jan 2003
ReviewAlpha2 adrenergic agonists for the management of opioid withdrawal.
Withdrawal (detoxification) is necessary prior to drug-free treatment. It may also represent the end point of long-term treatment such as methadone maintenance. The availability of managed withdrawal is essential to an effective treatment system. ⋯ No significant difference in efficacy was detected for treatment regimes based on the alpha2 adrenergic agonists clonidine and lofexidine, and those based on reducing doses of methadone over a period of around 10 days, for the management of withdrawal from heroin or methadone. Participants stay in treatment longer with methadone regimes and experience less adverse effects. The lower incidence of hypotension makes lofexidine more suited to use in outpatient settings than clonidine. There are insufficient data available to support a conclusion on the efficacy of other alpha2 adrenergic agonists.
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisInterventions for mucous membrane pemphigoid and epidermolysis bullosa acquisita.
Mucous membrane pemphigoid and epidermolysis bullosa acquisita are acquired autoimmune blistering diseases of the skin. Although they are rare, both can result in scarring of mucous membranes, which may lead to blindness and life threatening respiratory complications. ⋯ There is limited evidence (from two small trials) that severe ocular mucous membrane pemphigoid responds best to treatment with cyclophosphamide combined with corticosteroids, and that mild to moderate disease in most patients seems effectively suppressed by treatment with dapsone. It is difficult to make any treatment recommendations for EBA in the absence of reliable evidence sources.
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Cochrane Db Syst Rev · Jan 2003
Review Meta AnalysisHigh versus low medium chain triglyceride content of formula for promoting short term growth of preterm infants.
In-hospital growth of most very low birth weight infants remains below the 10th percentile of reference intrauterine growth curves (Ehrenkranz 1999). To improve growth, fat is added to preterm formula in the form of medium chain triglycerides (MCT) or long chain triglycerides (LCT). MCT are easily accessible to the preterm infant with an immature digestive system while LCT are important in the development of the retina and visual acuity. Both have been incorporated into preterm formulas in varying amounts, but their effect on the preterm infant's short term growth is unclear. ⋯ There is no evidence of difference between MCT and LCT on short term growth, gastrointestinal intolerance, or necrotizing enterocolitis. Therefore, neither formula type could be concluded to improve short term growth or have less adverse effects. Further studies are necessary because the results from the included eight studies are imprecise due to small numbers and do not address important long term outcomes. Additional research should aim to clarify effects on formula tolerance and on long term growth and neurodevelopmental outcomes, and include larger study populations to better evaluate effect on NEC incidence.