Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2002
ReviewProphylactic intravenous preloading for regional analgesia in labour.
Fetal heart rate changes are common following regional analgesia (epidural or spinal) during labour. Reduced uterine blood flow from maternal hypotension (low blood pressure) may contribute to this. Intravenous fluid preloading (volume expansion) may help to reduce maternal hypotension. Newer protocols using weaker solutions of local anaesthetic, and opioid only blocks, may reduce the need for preloading. ⋯ There are methodological limitations in the trials studied. However, preloading prior to high-dose local anaesthetic blocks may have beneficial fetal and maternal effects in healthy women. Further investigation of the effects in women receiving low-dose local anaesthetic or opioid only blocks, and the risks and benefits of intravenous preloading for women with pregnancy complications, is required.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisPulmonary rehabilitation for chronic obstructive pulmonary disease.
The widespread application pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function attributable to the programs. This review updates that reported by Lacasse et al Lancet 1996; 748:1115-1119. ⋯ Rehabilitation relieves dyspnea and fatigue and enhances patients' sense of control over their condition. These improvements are moderately large and clinically significant. The average improvement in exercise capacity was modest. Rehabilitation forms an important component of the management of COPD.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisAntibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women.
Urinary tract infections are common in elderly patients. Authors of non systematic literature reviews often recommend longer treatment durations (7-14 days) for older patients than for younger women, but the scientific evidence for such recommendations is not clear. ⋯ This review suggests that single dose antibiotic treatment is less effective but may be better accepted by the patients than longer treatment durations (3-14 days). In addition there was no significant difference between short course (3-6 days) versus longer course (7-14 days) antibiotics. The methodological quality of the identified trials was poor and the optimal treatment duration could not be determined. We therefore need more appropriately designed randomized controlled trials testing the effect, - on clinical relevant outcomes -, of different treatment durations of a given antibiotic in a strictly defined population of elderly women.
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Cochrane Db Syst Rev · Jan 2002
ReviewCardioselective beta-blockers for chronic obstructive pulmonary disease.
Beta-blocker therapy has a proven mortality benefit in patients with hypertension, heart failure and coronary artery disease, as well as during the perioperative period. These drugs have traditionally been considered contraindicated in patients with chronic obstructive pulmonary disease (COPD). ⋯ The available evidence suggests that cardioselective beta-blockers, given to patients with COPD do not produce a significant short-term reduction in airway function or in the incidence of COPD exacerbations. However, the trials were small and of short duration. Given their demonstrated benefit in conditions such as heart failure, coronary artery disease and hypertension, cardioselective beta-blockers should be considered for patients with COPD, but administered with careful monitoring since data concerning long term administration and their effects during exacerbations are not available.
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Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies have been described. As yet, no optimal strategy has been identified. Application of orthotic devices e.g. knee braces, knee straps, forms of taping of the knee, active training devices, knee sleeves and in-shoe orthotics to support the foot have been advocated to treat this condition. ⋯ The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of knee and foot orthotics for the treatment of patellofemoral pain. Future high quality trials in this field are warranted.