Cochrane Db Syst Rev
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Surgical investigations and interventions account for as much as one third of the health care costs for spinal disorders, but the scientific evidence for most procedures is still unclear. ⋯ There is no scientific evidence about the effectiveness of any form of surgical decompression or fusion for degenerative lumbar spondylosis compared with natural history, placebo, or conservative treatment.
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Cochrane Db Syst Rev · Jan 2000
ReviewPatient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS.
Highly active antiretroviral therapy is associated with improved health outcomes for people living with HIV/AIDS. Unfortunately, full therapeutic benefit from HAART may require near-perfect adherence to prescribed regimens. ⋯ Implications for practice Currently a pharmacist-led program of educational and supportive counseling is the only available intervention which has been shown in a controlled study to improve adherence to HAART, with less evidence that viral load is subsequently reduced. Implications for research Controlled trials are urgently needed to determine which interventions can significantly improve adherence to HAART. Whether interventions that improve adherence also suppress viral load and improve clinical outcomes should also be considered.
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Cochrane Db Syst Rev · Jan 2000
Review Meta AnalysisExtramedullary fixation implants for extracapsular hip fractures.
Extramedullary fixation of hip fractures refers to the application of a plate and screws to the lateral side of the proximal femur. ⋯ The fixed nail plate has higher risks of implant breakage and fixation failure than the SHS. Though insufficient evidence on other outcomes is available from randomised trials, the increased fixation failure rate is a major consideration and thus the SHS appears preferable. Insufficient information is available to draw firm conclusions of the clinical significance of differences between the SHS and either the RAB plate, the Pugh nail or the Medoff plate.
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A number of different anticonvulsants are used to control eclamptic fits and to prevent future seizures. ⋯ Magnesium sulphate appears to be substantially more effective than diazepam for treatment of eclampsia.
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Cochrane Db Syst Rev · Jan 2000
ReviewLiquid and fluid agents for preventing adhesions after surgery for subfertility.
Pelvic surgery is associated with high rates of both de novo adhesion formation and adhesion reformation. Although the role of pelvic and/or tubal surgery in the management of infertility is more limited since the development of in-vitro fertilisation such surgery remains indicated for a number of selected patients. Other forms of pelvic surgery will remain prevalent in women of reproductive age (e.g. endometriosis surgery, ovarian cystectomy, myomectomy). Since subsequent fertility is reduced with increasing severity of periadnexal adhesions, pelvic adhesions will remain a clinical problem in infertility patients. Adjuvant therapy has been promoted for many years to prevent adhesion formation. Numerous substances have been used experimentally in animal models, many have been advocated for use during human surgery, and some are widely used in clinical practice. Steroids and antihistamines are given in the belief that they will promote fibrinolysis during healing without preventing healing. ⋯ The routine use of pharmacological agents to prevent post-operative adhesions after infertility surgery cannot be recommended on the basis of the available evidence derived from RCTs. In connection with adhesion prevention, the evidence with regard to steroids is far from perfect but tentatively suggests that they may be beneficial. Further randomised studies should be conducted to investigate this further.