Cochrane Db Syst Rev
-
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.
-
Cochrane Db Syst Rev · Jan 2000
Review Meta AnalysisExtramedullary fixation implants for extracapsular hip fractures.
Extramedullary fixation of hip fractures refers to the application of a plate and screws to the lateral side of the proximal femur. ⋯ The fixed nail plate has higher risks of implant breakage and fixation failure than the SHS. Though insufficient evidence on other outcomes is available from randomised trials, the increased fixation failure rate is a major consideration and thus the SHS appears preferable. Insufficient information is available to draw firm conclusions of the clinical significance of differences between the SHS and either the RAB plate, the Pugh nail or the Medoff plate.
-
Cochrane Db Syst Rev · Jan 2000
ReviewExpanding the roles of outpatient pharmacists: effects on health services utilisation, costs, and patient outcomes.
In recent years pharmacists' roles have expanded from packaging and dispensing medications to working with other health care professionals and the public. ⋯ Only two studies compared pharmacist services with other health professional services. Both had some bias and did not allow us to draw conclusions about comparisons 1 and 3. The other studies supported the expanded roles of pharmacists in patient counselling and physician education. However, doubts about the generalisability of the studies, the poorly defined interventions, and the lack of cost assessments and patient outcome data, indicate that more rigorous research is needed to document the effects of outpatient pharmacist interventions.
-
Cochrane Db Syst Rev · Jan 2000
ReviewEarly administration of inhaled corticosteroids for preventing chronic lung disease in ventilated very low birth weight preterm neonates.
Chronic lung disease remains a common complication amongst preterm infants. There is increasing evidence that inflammation play an important role in the pathogenesis of CLD. Due to their strong anti-inflammatory properties corticosteroids is an attractive intervention strategy. However, there are growing concerns regarding short and long term effects of systemic corticosteroids. Theoretically, administration of inhaled corticosteroids may allow for beneficial effects on the pulmonary system with a lower risk of undesirable systemic side effects. ⋯ There is no evidence from the trials reviewed that early administration (in the first 2 weeks of life) of inhaled steroids to ventilated preterm neonates was effective in reducing the incidence of CLD. There was a reduction in the need for systemic steroids. Although this difference was statistically significant, there was significant heterogeneity between studies and the upper limit of the 95% CI for this outcome was very close to no effect. Currently, use of inhaled steroids in this population cannot be recommended. Studies are needed to identify the risk/benefit ratio of different delivery techniques and dosing schedules for the administration of these medications. Studies need to address both the short-term and long-term benefits and adverse effects of inhaled steroids with particular attention to neurodevelopmental outcome.
-
Cochrane Db Syst Rev · Jan 2000
ReviewRescue high frequency oscillatory ventilation versus conventional ventilation for pulmonary dysfunction in preterm infants.
This section is under preparation and will be included in the next issue. ⋯ There is insufficient information on the use of rescue HFOV to make recommendations for practice. The small amount of data that exists suggest that harm might outweigh any benefit. Any future use of HFOV as rescue therapy for preterm infants with severe RDS should be within randomized controlled trials and address important outcomes such as longer term pulmonary and neurological function.