Latest Articles
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Meta Analysis Comparative Study
Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? A systematic overview and meta-analysis.
The purpose of this meta-analysis was to quantitatively assess the conflicting body of literature concerning the efficacy of incentive spirometry (IS), intermittent positive pressure breathing (IPPB), and deep breathing exercises (DBEX) in the prevention of postoperative pulmonary complications in patients undergoing upper abdominal surgery. ⋯ Incentive spirometry and DBEX appear to be more effective than no physical therapy intervention in the prevention of postoperative pulmonary complications. There is no evidence to support a significant difference between any of the three modalities. [Thomas JA, McIntosh JM. Are incentive spirometry, intermittent positive pressure breathing, and deep breathing exercises effective in the prevention of postoperative pulmonary complications after upper abdominal surgery? a systematic overview and meta-analysis.
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356 children below 16 yrs of age with CS/PS IA, IB, and IIA were treated in the studies HD-78, HD-82, HD-85, HD-87, and OEPA-pilot 87 between June 1978 and Sept 1990. All patients received combined modality treatment (CMT) with 2 courses of chemotherapy (CT). In HD-78 and HD-82, the MOPP-derived drug combination OPPA (ADR instead of mechlorethamine) was applied. Extended-field radiotherapy (RT) was given in HD-78 using 36-40 Gy to involved-fields (IF) and 36-40 Gy vs. 18-20 Gy to adjacent fields. In HD-82 only IF-RT was applied using 35 Gy. When gonadotoxic effects of procarbazine (PC) in boys was detected in follow-up examinations, this drug was eliminated in studies HD-85 and HD-87 (OPA). Dosages of IF-RT were 35 Gy in HD-85 and 30 Gy in HD-87. With HD-87 a simultaneous pilot study was initiated to test the new combination OEPA (E = etoposide) together with 25 Gy IF-RT. ⋯ 2 OPPA plus IF-RT using < 30 Gy can presently be considered optimal therapy for girls with localized HD. 2 OEPA plus 25 Gy IF-RT are being evaluated for boys in a phase III study (HD-90). In summary, there are good reasons to use CMT in early stages of HD in children, provided a highly effective CT of short duration and low long-term toxicity with low-dose IFI is applied.
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Bleeding from oesophageal varices has a high death rate. Injection sclerotherapy is the most appropriate treatment but facilities for this are not always available. Balloon tamponade and vasoactive therapy may be used as stop gap measures. ⋯ A meta analysis of the group of trials of placebo or H2 antagonists v somatostatin or octreotide showed a significant advantage of somatostatin or octreotide in terms of efficacy, but no difference in mortality. The trials discussed seem to show that somatostatin and octreotide are at least as effective as other treatments, with the benefit of fewer adverse effects, and thus represent the best vasoactive agents. Additionally, they may have a role as adjuvant treatment to emergency sclerotherapy for active bleeders and this must be further investigated.
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Eur. J. Clin. Pharmacol. · Jan 1994
Meta AnalysisThe effectiveness of topically applied capsaicin. A meta-analysis.
To undertake a quantitative overview of trials of topical capsaicin for the treatment of diabetic neuropathy, osteoarthritis, post-herpetic neuralgia, and psoriasis. A systematic search of the literature using both computerized and manual methods for identifying clinical trials of capsaicin. The trials identified were abstracted for response data, which then were analysed using established meta-analytic methods for both fixed and random effects modelling. ⋯ Using a random effect model the rate difference (RD) in favour of capsaicin cream was RD = 0.25 (95% CI = 0.15, 0.35). Capsaicin cream was also better than placebo in providing pain relief in osteoarthritis: OR = 4.36 (95% CI = 2.77, 6.88) and RD = 0.29 (95% CI = 0.20, 0.37) and in psoriasis: OR = 2.80 (95% CI = 1.69, 4.62) and RD = 0.35 (95% CI = 0.14, 0.56). There was, however, evidence of heterogeneity in the individual RDs in psoriasis, and complete binding was difficulty because of the initial discomfort associated with topical capsaicin.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1994
Meta Analysis[Selective digestive decontamination in patients under reanimation].
Nosocomial infections increase morbidity and mortality in hospitalized patients. ICU patients are at high risk of sustaining them, due to the high rate of invasive procedures and their poor health state. Conventional methods for decreasing the incidence of infection in ICU patients include handwashing, catheter care, strict antibiotic policy, and reduction of environmental sources of infection. ⋯ This benefit is most obvious in trauma patients, severely burned patients and after orthopic liver transplantation. Several studies reported a significant decrease in the overall rate of infections, especially extrapulmonary infections, including blood, urinary tract, wounds, abdominal, and catheter related infections. Despite a major decrease in infection rates with SDD, most studies did not show lowered mortality rates.(ABSTRACT TRUNCATED AT 400 WORDS)