Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2000
Review Meta AnalysisInositol for respiratory distress syndrome in preterm infants.
Inositol is an essential nutrient required by human cells in culture for growth and survival. Inositol promotes maturation of several components of surfactant and may play a critical role in fetal and early neonatal life. ⋯ Inositol supplementation results in statistically significant and clinically important reductions in important short-term adverse neonatal outcomes. A multi-center RCT of appropriate size is justified to confirm these findings.
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Cochrane Db Syst Rev · Jan 2000
ReviewAudit and feedback versus alternative strategies: effects on professional practice and health care outcomes.
Audit and feedback has been identified as having the potential to change the practice of health care professionals. ⋯ It is not possible to recommend a complementary intervention to enhance the effectiveness of audit and feedback. Reminders might be more effective than audit and feedback to improve the delivery of some preventive services but the results are not striking. Few trials have investigated the effect of varying different characteristics of the audit and feedback process. Consideration should be given to testing the effects of modifying important characteristics such as the content, source, timing, recipient and format.
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Cochrane Db Syst Rev · Jan 2000
ReviewElective high frequency jet ventilation versus conventional ventilation for respiratory distress syndrome in preterm infants.
This section is under preparation and will be included in the next issue. ⋯ The overall analysis shows a benefit in pulmonary outcomes in the group electively ventilated with HFJV. Of concern is the significant increase in acute brain injury in one trial which used lower mean airway pressures when ventilating with HFJV. There are as yet no long term pulmonary or neurodevelopmental outcomes from any of the trials. Until further studies ascertain the most appropriate strategy to routinely ventilate premature infants with HFJV safely, ventilation with HFJV cannot be recommended for preterm infants with RDS.
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Cochrane Db Syst Rev · Jan 2000
ReviewPatient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS.
Highly active antiretroviral therapy is associated with improved health outcomes for people living with HIV/AIDS. Unfortunately, full therapeutic benefit from HAART may require near-perfect adherence to prescribed regimens. ⋯ Implications for practice Currently a pharmacist-led program of educational and supportive counseling is the only available intervention which has been shown in a controlled study to improve adherence to HAART, with less evidence that viral load is subsequently reduced. Implications for research Controlled trials are urgently needed to determine which interventions can significantly improve adherence to HAART. Whether interventions that improve adherence also suppress viral load and improve clinical outcomes should also be considered.
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Cochrane Db Syst Rev · Jan 2000
ReviewLiquid and fluid agents for preventing adhesions after surgery for subfertility.
Pelvic surgery is associated with high rates of both de novo adhesion formation and adhesion reformation. Although the role of pelvic and/or tubal surgery in the management of infertility is more limited since the development of in-vitro fertilisation such surgery remains indicated for a number of selected patients. Other forms of pelvic surgery will remain prevalent in women of reproductive age (e.g. endometriosis surgery, ovarian cystectomy, myomectomy). Since subsequent fertility is reduced with increasing severity of periadnexal adhesions, pelvic adhesions will remain a clinical problem in infertility patients. Adjuvant therapy has been promoted for many years to prevent adhesion formation. Numerous substances have been used experimentally in animal models, many have been advocated for use during human surgery, and some are widely used in clinical practice. Steroids and antihistamines are given in the belief that they will promote fibrinolysis during healing without preventing healing. ⋯ The routine use of pharmacological agents to prevent post-operative adhesions after infertility surgery cannot be recommended on the basis of the available evidence derived from RCTs. In connection with adhesion prevention, the evidence with regard to steroids is far from perfect but tentatively suggests that they may be beneficial. Further randomised studies should be conducted to investigate this further.