Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2001
ReviewSpeech and language therapy for dysarthria in Parkinson's disease.
Dysarthria is a common manifestation of Parkinson's disease which increases in frequency and intensity with the progress of the disease (Streifler 1984). Up to 20% of Parkinsonian patients are referred for speech and language therapy (S & L T), its aim being to improve the intelligibility of the patient's speech. ⋯ Considering the small number of patients examined, the methodological flaws in many of the studies, and the possibility of publication bias, there is insufficient evidence to support or refute the efficacy of speech and language therapy for dysarthria in Parkinson's disease. A Delphi-style survey is needed to develop a consensus as to what is 'standard' S< for dysarthria in Parkinson's disease. Then a large well designed placebo-controlled RCT is needed to demonstrate speech and language therapy's effectiveness for dysarthria in Parkinson's disease. The trial should conform to CONSORT guidelines. Outcome measures with particular relevance to patients should be chosen and the patients followed for at least 6 months to determine the duration of any improvement.
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Cochrane Db Syst Rev · Jan 2001
ReviewStrategies for partner notification for sexually transmitted diseases.
Partner notification has been practiced for decades, with substantial resources directed towards it, and with little evidence on whether it has made a public health impact on disease transmission. Most of the evaluations were not randomized controlled trials, and were conducted in the United States, prior to the HIV/AIDS epidemic. There are reasons to question whether partner notification for gonorrhoea and chlamydia is applicable to HIV. It is also questionable whether interventions for the developed world are applicable to the developing world. ⋯ There is a need for evaluations of interventions combining provider training and patient education, and for evaluations conducted in developing countries. All partner notification evaluations, but especially those among HIV positive patients, need to measure potential harmful effects, such as domestic violence, to ensure that partner notification does more good than harm.
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Cochrane Db Syst Rev · Jan 2001
ReviewHeparins and mechanical methods for thromboprophylaxis in colorectal surgery.
Colorectal surgery implies higher risk of postoperative thromboembolic complications as deep venous thrombosis (DVT) and pulmonary embolism (PE) than general surgery. The best prophylaxis in general surgery is heparin and graded compression stockings. No systematic review on combination prophylaxis or on thrombosis prophylaxis in colorectal surgery has been published. ⋯ The optimal prophylaxis in colorectal surgery is the combination of graduated compression stockings and low-dose unfractionated heparin. The unfractionated heparin can be replaced with low molecular weight heparin.
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Illness-related malnutrition has been reported in 10-55% of people in hospital and in ill people in the community in areas of food sufficiency. It has been suggested that dietary counseling to encourage the use of energy- and protein-rich foods should be used in preference to oral nutritional supplements in the management of illness-related malnutrition. ⋯ This review highlights the lack of evidence for the provision of dietary advice in the management of illness-related malnutrition. The available data suggest that oral nutritional supplements have a greater role than dietary advice in the improvement of body weight and energy intake. A large adequately powered randomised controlled trial is needed to compare the efficacy of different forms of therapy to increase dietary intake in people with illness-related malnutrition and to examine the impact of this on clinical function and survival.
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Cochrane Db Syst Rev · Jan 2001
ReviewPreoperative chemotherapy for resectable thoracic esophageal cancer.
Carcinoma of the esophagus is a relatively uncommon but lethal cancer that continues to kill over 90% of its victims within 5 years. Surgery is the treatment of choice for most localized esophageal cancer patients. However, despite curative resection, the 5-year survival rate ranges from 15% to 39%. The failure of surgery to cure clinically localized esophageal cancer is because of the advanced state of the disease before symptoms occur, high frequency of lymph node involvement, and the common occurrence of submucosal spread and extension to surrounding structures. Preoperative chemotherapy has been used in an attempt to decrease tumour activity, increase resectability, and improve disease-free and overall survival. A number of studies have investigated whether preoperative chemotherapy followed by surgery leads to an improvement in cure rates, but the individual reports have not been encouraging. The role of preoperative chemotherapy in the treatment of resectable thoracic esophageal cancer remains undefined. ⋯ The results of this review suggest that there is no strong evidence to recommend preoperative chemotherapy in the treatment of surgically resectable carcinomas of the thoracic esophagus. (ABSTRACT TRUNCATED)