Latest Articles
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Intensive care medicine · Jun 1996
Meta AnalysisThe acute respiratory distress syndrome: definitions, severity and clinical outcome. An analysis of 101 clinical investigations.
To determine possible changes in outcome from acute respiratory distress syndrome (ARDS) and to compare severity of lung injury and methods of treatment from 1967 to 1994. ⋯ The mortality of ARDS patients remained constant throughout the period studied. Therefore, the standard for outcome in ARDS should be a mortality in the 50% range. Neither PaO2/FIO2 ratio nor lung injury score was a reliable predictor for outcome in ARDS. Patients might benefit from pressure-limited ventilatory support, as well as extracorporeal lung assist. Since crucial data were missing in most clinical studies, thus preventing direct comparison, we emphasize the importance of using standardized definitions and study entry criteria.
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Comment Meta Analysis Comparative Study
[Are proton pump inhibitors superior to H2 receptor antagonists within the scope of H. pylori eradication therapy? Meta analysis of current parallel group comparisons].
The combined treatment with acid lowering drugs and antibiotics is widely accepted for H. pylori-eradication therapy. There are, however, controversies regarding the influence of the acid lowering drug on H. pylori-eradication rates. Therefore, this meta-analysis aimed to assess the available parallel-group eradication studies with proton pump inhibitors and H2-receptor antagonists and to compare H. pylori-eradication rates for both classes of acid lowering drugs. ⋯ CONCLUSION. H. pylori-eradication rates for treatment protocols with one or two antibiotics in combination with an acid lowering drug are not different for the proton pump inhibitors or h2-receptor antagonists. Therefore, the question whether H2-receptor antagonists or proton pump inhibitors should be used in combination with antibiotics for H. pylori eradication therapy is without clinical relevance.
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Critical care medicine · May 1996
Meta AnalysisDoes selective decontamination of the digestive tract reduce mortality for severely ill patients?
To investigate the relationship between baseline risk of death and reduced mortality after selective decontamination of the digestive tract in intensive care unit patients. ⋯ Mortality reduction from selective decontamination of the digestive tract appears related to the mortality risk of patients at the time of study entry. Future trials should consider using baseline risk assessment as part of trial design and outcome analysis.
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The purpose of this study was to use a meta-analysis of the current literature to identify which patients with blunt cardiac trauma develop complications. All studies on myocardial contusion since 1967 were reviewed. Three separate meta-analyses were performed: one with only prospective studies, one with only retrospective studies, and one with all studies combined. ⋯ The data support the use of ECG and CPK-MB in the diagnosis of clinically significant myocardial contusion. Radionuclide scanning is not useful in the evaluation of patients with blunt cardiac trauma. Further studies need to define the role of echocardiography.
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Lateral epicondylitis (tennis elbow) is a common complaint, for which corticosteroid injections are a frequently applied therapy. However, there were no up-to-date reviews available that systematically addressed the effectiveness and adverse effects, including questions concerning optimal timing of injections and composition of the injection fluid. ⋯ The existing evidence on corticosteroid injections for the treatment of tennis elbow is not conclusive. Many trials were conducted in a secondary care setting and clearly had serious methodological flaws, and there was statistical heterogeneity among the trials. Corticosteroid injections appear to be relatively safe and seem to be effective in the short term (2-6 weeks). Although the treatment seems to be suitable for application in general practice, further trials in this setting are needed. As yet, questions regarding the optimal timing, dosage, injection technique and injection volume remain unanswered.