Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2001
ReviewCorticosteroids for chronic inflammatory demyelinating polyradiculoneuropathy.
Chronic inflammatory demyelinating polyradiculoneuropathy is an autoimmune peripheral neuropathy and would be expected to benefit from corticosteroids. Non-randomised studies suggest that corticosteroids are often beneficial. ⋯ A single randomised controlled trial with 35 participants provided weak evidence to support the common opinion derived from non-randomised studies that oral corticosteroids reduce impairment in chronic inflammatory demyelinating polyradiculoneuropathy. Corticosteroids are known to have serious long term side effects. The long term risks and benefits have not been adequately studied.
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People with acute psychotic illnesses, especially when associated with agitated or violent behaviour, may require urgent pharmacological tranquillisation or sedation. Droperidol, a butyrophenone neuroleptic, is used for this purpose in several countries. ⋯ This is an important and surprisingly under-researched area. Use of droperidol for the emergency situation is currently justified on experience rather than evidence from well conducted and reported randomised trials.
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Cochrane Db Syst Rev · Jan 2001
ReviewFormula milk versus preterm human milk for feeding preterm or low birth weight infants.
Preterm human breast milk, compared with artificial formula milk, may provide insufficient nutrition for preterm or low birth weight infants. However, human milk may confer advantages in terms of a decreased incidence of gastrointestinal and neurodevelopmental adverse outcomes. ⋯ There are very limited data from randomised trials of feeding preterm or low birth weight infants with formula milk compared with preterm human milk. This may relate to a perceived difficulty of allocating an alternative enteral feed to an infant in cases where the infant's mother wishes to feed with expressed breast milk.
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Cochrane Db Syst Rev · Jan 2001
Review Meta AnalysisEarly use of inhaled corticosteroids in the emergency department treatment of acute asthma.
Systemic corticosteroid therapy is central to the management of acute asthma The use of ICS may also be beneficial in this setting. ⋯ Inhaled steroids reduced admission rates in patients with acute asthma, but it is unclear if there is a benefit of ICS when used in addition to systemic corticosteroids. There is insufficient evidence that ICS therapy results in clinically important changes in pulmonary function or clinical scores when used in acute asthma. Similarly, there is insufficient evidence that ICS alone is as effective as CS. Further research is needed to clarify if there is a benefit of ICS when used in addition to CS.
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Cochrane Db Syst Rev · Jan 2001
Review Comparative StudyNasal intermittent positive pressure ventilation (NIPPV) versus nasal continuous positive airway pressure (NCPAP) for preterm neonates after extubation.
Previous randomised trials and meta-analyses have shown nasal continuous positive airway pressure (NCPAP) to be a useful method of respiratory support after extubation. However, infants managed in this way sometimes "fail" and require endotracheal reintubation with its attendant risks and expense. Nasal intermittent positive pressure ventilation (NIPPV) is a method of augmenting NCPAP by delivering ventilator breaths via the nasal prongs. Older children and adults with chronic respiratory failure have been shown to benefit from NIPPV and the technique has been applied to neonates. However severe side effects including gastric perforation have been reported and clinicians remain uncertain about the role of NIPPV in neonatology. It has recently become possible to synchronise delivery of NIPPV with the infant's own breathing efforts which may make the modality more useful in this patient group. ⋯ Future trials should enrol sufficient infants to detect differences in important outcomes such as chronic lung disease and gastrointestinal perforation. The impact of synchronisation of NIPPV on the technique's safety and efficacy should be established in future trials.