Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2000
ReviewElective high frequency jet ventilation versus conventional ventilation for respiratory distress syndrome in preterm infants.
This section is under preparation and will be included in the next issue. ⋯ The overall analysis shows a benefit in pulmonary outcomes in the group electively ventilated with HFJV. Of concern is the significant increase in acute brain injury in one trial which used lower mean airway pressures when ventilating with HFJV. There are as yet no long term pulmonary or neurodevelopmental outcomes from any of the trials. Until further studies ascertain the most appropriate strategy to routinely ventilate premature infants with HFJV safely, ventilation with HFJV cannot be recommended for preterm infants with RDS.
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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
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.
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Carbamazepine and valproate are drugs of first choice for epilepsy. Despite the lack of hard evidence from individual randomized controlled trials, there is strong clinical belief that valproate is the drug of choice for generalized epilepsies and carbamazepine for partial epilepsies. ⋯ We have found some evidence to support the policy of using carbamazepine as the first treatment of choice in partial epilepsies, but no evidence to support the choice of valproate in generalized epilepsies, but confidence intervals are too wide to confirm equivalence. Misclassification of patients may have confounded our results, and has important implications for the design and conduct of future trials.
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Cochrane Db Syst Rev · Jan 2000
ReviewAnti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma.
Inhaled corticosteroids are the cornerstone of anti-inflammatory asthma treatment. Anti-leukotrienes agents are currently being studied as alternative first line agents in the management of mild to moderate chronic asthma. ⋯ Anti-leukotriene agents had a similar rate of exacerbations compared to inhaled corticosteroids, but inhaled steroids produced better lung function and quality of life as well as reduced symptoms, night awakenings and need for rescue beta2-agonist. Reliable conclusions cannot yet be drawn regarding the efficacy of this treatment due to the paucity of trials published in full text.