Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2000
ReviewGeneral versus spinal/epidural anaesthesia for surgery for hip fractures in adults.
The majority of hip fracture patients are treated surgically, requiring anaesthesia. ⋯ Regional anaesthesia and general anaesthesia appear to produce comparable results for most of the outcomes studied. Regional anaesthesia may reduce short-term mortality but no conclusions can be drawn for longer term mortality.
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Cochrane Db Syst Rev · Jan 2000
ReviewProgesterone/progestogen releasing intrauterine systems versus either placebo or any other medication for heavy menstrual bleeding.
Heavy menstrual bleeding (HMB) is an important cause of ill health in women and it accounts for 12% of all gynaecology referrals in the UK. Heavy menstrual bleeding is clinically defined as greater than, or equal to, 80mls blood loss per menstrual cycle but women may complain of excessive bleeding when their blood loss is less than 80ml. Hysterectomy is often used to treat women with this complaint but medical therapy may be a successful alternative. The intrauterine coil device was originally developed as a contraceptive but the addition of uterine relaxing hormones, or progestogens, to these devices resulted in a large reduction in menstrual blood loss. Case studies of 2 types of progesterone/progestogen releasing systems, Progestasert and Mirena, report reductions of up to 90% and dysmenorrhoea may be improved. Insertion, however, may be regarded as invasive by some women affecting its acceptability as a treatment and frequent intermenstrual bleeding and spotting is likely during the first few months. ⋯ Progesterone/progestogen-releasing intrauterine systems have not been compared to placebo or no treatment. Progestasert has been compared to a number of different medical therapies in one small study but no conclusions can be made about effectiveness. The levonorgestrel-releasing intrauterine device (LNG IUS) has been compared to oral cyclical norethisterone (NET) administered on days 5-26 in one trial and was significantly more effective although there was a large reduction from baseline in both groups and these differences were not perceived by the women undergoing the treatment. Some side effects were more common in the LNG IUS group but a significantly greater proportion of women in this group were satisfied and willing to continue with their treatment. In one trial of women awaiting hysterectomy where the LNG IUS was compared with a control group taking their existing medical therapy, a higher proportion of the women in the former group cancelled their planned surgery after 6 months of treatment. The levonorgestrel-releasing intrauterine device has been compared to a surgical procedure (transcervical resection of the endometrium (TCRE)) in two trials. (ABSTRACT TRUNCATED)
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Cochrane Db Syst Rev · Jan 2000
ReviewFetal electrocardiogram plus heart rate recording for fetal monitoring during labour.
It is thought that adding fetal electrocardiography (ECG) to cardiotocography (CTG) alone may provide better information about fetal heart activity. ⋯ Analysis of the fetal electrocardiographic waveform during labour may be associated with reduced obstetric intervention without jeopardising fetal outcome.
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When pregnant women near term lie in the supine position the uterus can compress the inferior vena cava, interfering with venous return to the heart. This can result in hypotension, reduced placental perfusion and decreased fetal oxygenation. ⋯ There is not enough evidence from these trials to evaluate use of lateral tilt during caesarean section.
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Since the introduction of the Swedish back school in 1980, the content of back schools has changed and appears to vary widely today. Back schools are frequently used in the treatment of low back pain patients. ⋯ Back schools may be effective for patients with recurrent and chronic low back pain in occupational settings, but little is known about the cost-effectiveness of back schools.