Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2000
ReviewBiopsychosocial rehabilitation for upper limb repetitive strain injuries in working age adults.
Upper limb repetitive strain injury is a common problem in western countries, causing human suffering and huge economical losses. Patients with prolonged pain associated with repetitive tasks in the work place can face both psychological and physical difficulties. Different treatment programmes, physical, psychological, behavioural, social and occupational treatments have been developed and used to help these patients. ⋯ We conclude that presently there appears to be little scientific evidence for the effectiveness of biopsychosocial rehabilitation on repetitive strain injuries. As RCTs on more intensive and comprehensive biopsychosocial treatment programmes for RSI are lacking, there does not seem to be reliable data for these interventions. There is a need for high quality trials in this field.
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Cochrane Db Syst Rev · Jan 2000
Review Meta AnalysisNicotine replacement therapy for smoking cessation.
The aim of nicotine replacement therapy (NRT) is to replace nicotine from cigarettes. This reduces withdrawal symptoms associated with smoking cessation to help resist the urge to smoke cigarettes. ⋯ All of the commercially available forms of NRT (nicotine gum, transdermal patch, and in some countries, the nicotine nasal spray, nicotine inhaler and nicotine sublingual tablets) are effective as part of a strategy to promote smoking cessation. They increase quit rates approximately 1.5 to 2 fold regardless of setting. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the smoker. Since all the trials of NRT reported so far have included at least some form of brief advice to the smoker, this represents the minimum which should be offered in order to ensure its effectiveness. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT. There is promising evidence that bupropion may be more effective than NRT (either alone or in combination). (ABSTRACT
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Antibiotic treatment of acute bronchitis, which is one of the most common illnesses seen in primary care, is controversial. Most clinicians prescribe antibiotics in spite of expert recommendations against this practice. ⋯ Overall, antibiotics appear to have a modest beneficial effect in patients who are diagnosed with acute bronchitis. The magnitude of this benefit, however, is similar to that of the detriment from potential adverse effects. Furthermore, patients with other symptoms of the common cold who have been ill for less than one week are not likely to have any benefit from antibiotics.
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Toxoplasmosis is a widespread parasitic disease and usually causes no symptoms. However, infection of pregnant women may cause congenital infection, resulting potentially in mental retardation and blindness in the infant. ⋯ Despite the large number of studies performed over the last three decades we still do not know whether antenatal treatment in women with presumed toxoplasmosis reduces the congenital transmission of Toxoplasma gondii. Screening is expensive, so we need to evaluate the effects of treatment, and the impact of screening programmes. In countries where screening or treatment is not routine, these technologies should not be introduced outside the context of a carefully controlled trial.
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Cochrane Db Syst Rev · Jan 2000
ReviewModern combined oral contraceptives for pain associated with endometriosis.
Endometriosis is a major women's health-care problem. It causes pain and/or infertility, and affects millions of women worldwide. Endometriosis is defined according to histological criteria by the presence of tissue resembling endometrium in sites outside the uterus, most commonly the ovaries and peritoneum. The aim of treatment has been to remove the deposits of ectopic endometrium that are thought to be responsible for the symptoms of endometriosis. This can be achieved surgically by destroying or removing the implants; medical therapies induce atrophy within the hormonally-dependent ectopic endometrium. The duration of hormonal treatment may be limited by unwanted side effects. There is some evidence, however, from epidemiological research that current use of the combined oral contraceptive pill (OCP) is associated with a reduced incidence of endometriosis. The combined pill has the great advantage over other hormonal treatments that it can be taken indefinitely. ⋯ There is a paucity of data relating to the use of oral contraceptive preparations in the treatment of symptomtic endometriosis. The data such as it is supports the common practice of the use of the oral contraceptive pill as a first line therapy but further research is required to fully evaluate its role in the management of endometriosis.