Cochrane Db Syst Rev
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Congenital syphilis is an increasing problem in many developing countries and in the transitional economies of Eastern Europe and the former Soviet Union. In several countries this increase has been aggravated by HIV/AIDS. While the effectiveness of penicillin in the treatment of syphilis in pregnant women and the prevention of congenital syphilis was established shortly after the introduction of penicillin in the 1940s, there is uncertainty about the optimal treatment regimens. ⋯ While there is no doubt that penicillin is effective in the treatment of syphilis in pregnancy and the prevention of congenital syphilis, uncertainty remains about what are the optimal treatment regimens. Further studies are needed to evaluate treatment failure cases with currently recommended regimens and this should include an assessment of the role of HIV infection in cases of prenatal syphilis treatment failure. The effectiveness of various antibiotic regimens for the treatment of primary and secondary syphilis in pregnant women need to be assessed using randomised controlled trials which compare them with existing recommendations.
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Cochrane Db Syst Rev · Jan 2001
ReviewTherapeutic ultrasound for treating patellofemoral pain syndrome.
Therapeutic ultrasound is one of several rehabilitation interventions suggested for the management of pain due to patellofemoral pain syndrome. ⋯ Ultrasound therapy was not shown to have a clinically important effect on pain relief for patients with patellofemoral pain syndrome. These conclusions are limited by the poor reporting of the therapeutic application of the ultrasound and low methodological quality of the trial included. No conclusions can be drawn concerning the use or non use of ultrasound for treating patellofemoral pain syndrome. More well-designed studies are needed.
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Cochrane Db Syst Rev · Jan 2001
Review Comparative StudyHospital at home versus in-patient hospital care.
Hospital at home is defined as a service that provides active treatment by health care professionals, in the patient's home, of a condition that otherwise would require acute hospital in-patient care, always for a limited period. ⋯ This review does not support the development of hospital at home services as a cheaper alternative to in-patient care. Early discharge schemes for patients recovering from elective surgery and elderly patients with a medical condition may have a place in reducing the pressure on acute hospital beds, providing the views of the carers are taken into account. For these clinical groups hospital length of stay is reduced, although this is offset by the provision of hospital at home. The evidence supporting hospital at home for patients recovering from a stroke is conflicting. There is some evidence that admission avoidance schemes may provide a less costly alternative to hospital care. Future research should focus on admission avoidance schemes, and the effect of early discharge hospital at home schemes for patients recovering from a stroke.
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Cochrane Db Syst Rev · Jan 2001
ReviewIntravenous immunoglobulin for preventing infection in preterm and/or low-birth-weight infants.
Nosocomial infections continue to be a significant cause of morbidity and mortality among preterm and/or low birth weight infants. Maternal transport of immunoglobulins to the fetus mainly occurs after 32 weeks gestation and endogenous synthesis does not begin until several months after birth. Administration of intravenous immunoglobulin provides IgG that can bind to cell surface receptors, provide opsonic activity, activate complement, promote antibody dependent cytotoxicity, and improve neutrophilic chemoluminescence. Intravenous immunoglobulin thus has the potential of preventing or altering the course of nosocomial infections. ⋯ IVIG administration results in a 3% reduction in sepsis and a 4 % reduction in any serious infection, one or more episodes, but is not associated with reductions in other important outcomes: sepsis, NEC, IVH, or length of hospital stay. Most importantly IVIG administration does not have any effect on mortality from any cause or from infections. Prophylactic use of IVIG is not associated with any short term serious side effects. From a clinical perspective a 3-4% reduction in nosocomial infections without a reduction in mortality or other important clinical outcomes is of marginal importance. The decision to use prophylactic IVIG will depend on the costs and the values assigned to the clinical outcomes. There is no justification for further RCTs testing the efficacy of previously studied IVIG preparations to reduce nosocomial infections in preterm and/or LBW infants. The results of these meta-analyses should encourage basic scientists and clinicians to pursue other avenues to prevent nosocomial infections.
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Cochrane Db Syst Rev · Jan 2001
Review Meta AnalysisAntidepressants versus placebo for people with bulimia nervosa.
Bulimia Nervosa (BN) represents an important public health problem and is related to serious morbidity and even mortality. This review attempted to systematically evaluate the use of antidepressant medications compared with placebo for the treatment of bulimia nervosa. ⋯ The use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared to placebo, with an overall greater remission rate but a higher rate of dropouts. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.