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Br J Obstet Gynaecol · Jan 1998
Meta AnalysisThe prevalence of chronic pelvic pain in women in the United Kingdom: a systematic review.
To obtain a prevalence estimate for chronic pelvic pain in women in the United Kingdom by analysing published data. ⋯ Because chronic pelvic pain can reduce the quality of life and general wellbeing, there is a need for a community-based study into the prevalence of chronic pelvic pain and its effect upon the lives of women in the UK.
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The purpose of this paper was to contribute to a new conceptual understanding of delirium by reviewing evidence related to its prevention, treatment, and outcome. The review process involved a systematic search of the literature on each topic, assessment of the validity of the studies retrieved, and examination of their results. ⋯ Abroad spectrum of interventions appeared to be modestly effective in preventing delirium in young and old surgical patients but not elderly medical patients; systematic detection and intervention programs and special nursing care appeared to add large benefits to traditional medical care in young and old surgical patients and modest benefits in elderly medical patients; haloperidol, chlorpromazine, and mianserin appeared to be useful in controlling the symptoms of delirium in both surgical and medical patients; and good levels of premorbid function seemed to be related to better outcomes. Although the above findings do not contribute to a new conceptual understanding of delirium, they do suggest directions for further research on the treatment of delirium.
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The regional application of opioids close to the spinal cord by using pumps induces a pain reduction comparable to the systemic medication of the WHO analgesic ladder. However, this method does not reduce the side effects of these drugs, e.g. nausea, vomiting, dysfunctional bladder emptying, and obstipation. ⋯ Catheters and port systems have to be revised in 15% of all cases. Therefore, the indication for this method has to be considered carefully and includes the following criteria: pain of somatic origin, exclusion of mental diseases and psychogenic causes of pain, causal therapy is exhausted, insufficient effects of peripheral analgesics and co-analgesics, oral or transdermal opioids are insufficient despite dosages resulting in side-effects, pain is sensible to opioids, regional application of opioids has been tested effective before implantation.
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Meta Analysis
Systematic review of factors affecting the ratios of morphine and its major metabolites.
In a systematic review of 57 studies with information on 1232 patients we examined the effect of age, renal impairment, route of administration, and method of analysis on the ratios of morphine-3-glucuronide:morphine (M3G:M) and morphine-6-glucuronide:morphine (M6G:M) and the relative concentrations of M3G and M6G. Across all studies the range of the ratios of metabolites to morphine was wide (0.001-504 for M3G:M, and 0-97 for M6G:M). Neonates produced morphine glucuronides at a lower rate than older children or adults. ⋯ There was no evidence of differences between methods of assay. There was a high correlation between the two glucuronide metabolites in spite of the different situations studied, supporting a single glucuronidating enzyme. Morphine was present in CSF at a fourfold higher concentration than the glucuronide metabolites.
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Meta Analysis
Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy.
To evaluate the efficacy of benzodiazepines and zolpidem tartrate in chronic insomnia based on a quantitative review of literature. ⋯ Benzodiazepines and zolpidem produced reliable improvements in commonly measured parameters of sleep in patients with chronic insomnia. Relative to the chronic and recurring course of insomnia, both the limited duration of treatments studied and the lack of follow-up data from controlled trials represent challenges for developing evidence-based guidelines for the use of hypnotics in the management of chronic insomnia.