Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2001
ReviewFormula milk versus term human milk for feeding preterm or low birth weight infants.
Term (mature) human breast milk, compared with artificial formula milks, may provide insufficient nutrition for growth and development in preterm or low birth weight infants. However, human milk may confer advantages to infants in terms of a decreased incidence of adverse outcomes. ⋯ In preterm and low birth weight infants, feeding with formula milk, compared with unfortified term human milk, leads to a greater rate of growth in the short term. The limited data available do not allow definite conclusions on whether adverse outcomes, including necrotising enterocolitis, are increased in infants who receive formula milk compared with term human milk. There are no data from randomised trials on the comparison of feeding with formula milk versus nutrient-fortified breast milk. This limits the implications for practice of this review as nutrient fortification of breast milk is now a common practice in neonatal care. Future trials may compare growth, development and adverse outcomes in infants who receive adapted "preterm" formula milks versus nutrient-fortified human breast milk.
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A variety of manual therapies with similar postulated biologic mechanisms of action are commonly used to treat patients with asthma. Manual therapy practitioners are also varied, including physiotherapists, respiratory therapists, chiropractic and osteopathic physicians. A systematic review across disciplines is warranted. ⋯ There is insufficient evidence to support the use of manual therapies for patients with asthma. There is a need to conduct adequately-sized RCTs that examine the effects of manual therapies on clinically relevant outcomes. Future trials should maintain observer blinding for outcome assessments, and report on the costs of care and adverse events. Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma.
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Cochrane Db Syst Rev · Jan 2001
ReviewAnti-fibrinolytic use for minimising perioperative allogeneic blood transfusion.
Concerns regarding the safety of transfused blood have prompted re-consideration of the use of allogeneic (blood from an unrelated donor) blood transfusion. ⋯ From this review it appears that aprotinin reduces the need for red cell transfusion, and the need for re-operation due to bleeding, without serious adverse effects. However, there was significant heterogeneity in trial outcomes, and some evidence of publication bias. Similar trends were seen with TXA and EACA, although the data were rather sparse. The poor evaluation of these latter drugs is unfortunate as results suggest they may be equally as effective as aprotinin, but are significantly cheaper. The evidence reviewed here supports the use of aprotinin in cardiac surgery. Further small trials of this drug are not warranted. Future trials should be large enough to compare the efficacy and cost-effectiveness of aprotinin with that of TXA and EACA.
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Cochrane Db Syst Rev · Jan 2001
ReviewEarly versus late antiepileptic drug withdrawal for people with epilepsy in remission.
Antiepileptic drugs ( AEDs) are used to prevent seizures but are associated with both short and long term adverse effects. When epilepsy is in remission, it may be in the patient's best interest to discontinue medication. However, the optimal timing of AED discontinuation is not known. ⋯ There is evidence to support waiting for at least two or more seizure free years before discontinuing AEDs in children, particularly if individuals have an abnormal EEG and partial seizures. There is insufficient evidence to establish when to withdraw AEDs in pediatric patients with generalized seizures. There is no evidence to guide the timing of withdrawal of AEDs in adult seizure free patients. Further blinded randomized controlled trials are needed to identify the optimal timing of AED withdrawal and risk factors predictive of relapse.
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Pre-operative traction following an acute hip fracture remains standard practice in some hospitals. ⋯ From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential advantages for traction, in particular for specific fracture types, or to confirm additional complications due to traction use. Further, high quality trials would be required to confirm or refute the absence of benefits of traction.