Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2000
ReviewTricyclic and related drugs for nocturnal enuresis in children.
Enuresis (bedwetting) is a socially unacceptable and stressful condition which affects around 15-20% of five year olds, and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs to the children can be great. ⋯ Treatment with tricyclic drugs (imipramine, amitriptyline, viloxazine, clomipramine and desipramine but not mianserin) was associated with a reduction of about one wet night per week while on treatment, but long term effectiveness is unknown. Desmopressin and tricyclics appeared equally effective while on treatment, but this effect was not sustained after treatment stopped. Alarms may be more effective in the long term. Comparisons between drug and behavioural treatments are needed, and should include relapse rates after treatment is finished.
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To determine therapeutically equivalent doses of inhaled versus oral steroids for adults with chronic asthma. ⋯ A daily dose of prednisolone 7.5-10 mg/day appears to be equivalent to moderate-high dose inhaled corticosteroids. Side-effects may be present on low doses, so if there is no alternative to oral steroids, the lowest effective dose should be prescribed.
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Cochrane Db Syst Rev · Jan 2000
Review Meta AnalysisPostoperative radiotherapy for non-small cell lung cancer.
The role of postoperative radiotherapy in the treatment of patients with completely resected non-small cell lung cancer was not clear. A systematic review and quantitative meta-analysis was therfore undertaken to evaluate the available evidence from randomised trials. ⋯ PORT is detrimental to patients with early stage completely resected non-small cell lung cancer and should not be used in the routine treatment of such patients. The role of PORT in the treatment of N2 tumours is not clear and may justify further research.
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The majority of strokes are due to blockage of an artery in the brain by a blood clot. Clot dissolving (or thrombolytic) drugs may reduce brain damage from the stroke, but may also cause serious bleeding in the brain. Thrombolytic therapy has now been evaluated in several randomised trials in acute ischaemic stroke. ⋯ Thrombolytic therapy increases deaths within the first seven to ten days, and deaths at final follow-up. Thrombolytic therapy also significantly increases symptomatic and fatal intracranial haemorrhage. These risks are offset by a reduction in disability in survivors, so that there is, overall, a significant net reduction in the proportion of patients dead or dependent in activities of daily living. The data from trials using intravenous recombinant tissue Plasminogen Activator, from which there is the most evidence on thrombolytic therapy so far, suggest that it may be associated with less hazard and more benefit. There was heterogeneity between the trials and the optimum criteria to identify the patients most likely to benefit and least likely to be harmed, the agent, dose, and route of administration, are not clear. (ABSTRACT TRUNCATED)
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Chlorpromazine, formulated in the 1950s, remains a benchmark treatment for those with schizophrenia. ⋯ This review will confirm much that clinicians and recipients of care already know but provides quantification to support clinical impression. Despite the humbling 40% improvement rate in those who were allocated to placebo, chlorpromazine's global position as the 'benchmark' treatment of those with psychoses is not threatened by this review. Chlorpromazine, in common use for nearly half a century, is a well established but imperfect treatment. Judicious use of this best available evidence should lead to better informed decisions both by carers and those with psychotic illnesses.