Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2002
ReviewEarly postnatal discharge from hospital for healthy mothers and term infants.
Length of postnatal hospital stay has declined dramatically in the past thirty years. There is ongoing controversy concerning whether or not staying less time in hospital is harmful or beneficial. ⋯ The findings are inconclusive. There is no evidence of adverse outcomes associated with policies of early postnatal discharge, but methodological limitations of included studies mean that adverse outcomes cannot be ruled out. It remains unclear how important midwifery support at home is to the safety and acceptability of early discharge. Large well-designed trials of early discharge programs incorporating process evaluation to assess the uptake of co-interventions, and using standardised approaches to outcome assessment are needed.
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Since the condition was first described in 1965, the syndrome of normal pressure hydrocephalus (NPH) has conventionally been managed by placement of a cerebrospinal fluid (CSF) shunt. ⋯ There is no evidence to indicate whether placement of a shunt is effective in the management of NPH.
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Cochrane Db Syst Rev · Jan 2002
ReviewInhaled corticosteroid effects on bone metabolism in asthma and mild chronic obstructive pulmonary disease.
Inhaled corticosteroids form the main therapy for asthma, but there is increasing concern about the potential systematic effects of long-term inhaled corticosteroids including their effect on bone metabolism and bone loss. ⋯ In patients with asthma or mild COPD, there is no evidence of an effect of inhaled corticosteroid at conventional doses given for two or three years on BMD or vertebral fracture. Higher doses were associated with biochemical markers of increased bone turnover, but data on BMD and fractures at these doses are not available. There is a need for further, even longer term prospective studies of conventional and high doses of inhaled corticosteroids.
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The prevalence of sleep problems in adulthood increases with age. While not all sleep changes are pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for carers and increased healthcare costs. The most common treatment for sleep disorders (particularly insomnia) is pharmacological. The efficacy of non-drug interventions has been suggested to be slower than pharmacological methods, but with no risk of drug-related tolerance or dependency. Physical exercise, taken regularly, may promote relaxation and raise core body temperature in ways that are beneficial to initiating and maintaining sleep. ⋯ When the possible side-effects of standard treatment (hypnotics) are considered, there is an argument to be made for clinical use of alternative treatments in the elderly. Exercise, though not appropriate for all in this population, may enhance sleep and contribute to an increased quality of life. Research involving exercise programmes designed with the elderly in mind is needed.
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People with a history of rheumatic fever are at high risk of recurrent attacks of rheumatic fever and developing rheumatic heart disease following a streptococcal throat infection. Giving penicillin to these people can prevent recurrent attacks of rheumatic fever and subsequent rheumatic heart disease. However, there is no agreement on the most effective method of giving penicillin. ⋯ Intramuscular penicillin seemed to be more effective than oral penicillin in preventing rheumatic fever recurrence and streptococcal throat infections. Two-weekly or 3-weekly injections appeared to be more effective than 4-weekly injections. However, the evidence is based on poor quality of trials.