Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisProtein and energy supplementation in elderly people at risk from malnutrition.
This review was carried out because evidence for the effectiveness of nutritional supplements containing protein and energy which are often prescribed for elderly people is limited. Furthermore malnutrition is more common in this age group and deterioration of nutritional status can occur during a stay in hospital. It is important to establish whether supplementing the diet with protein and energy is an effective way of improving outcomes for older people at risk from malnutrition. ⋯ Supplementation appears to produce a small but consistent weight gain. There was a statistically significant beneficial effect on mortality and a shorter length of hospital stay. Additional data from large-scale multi-centre trials are still required to provide clear evidence of benefit from protein and energy supplements on mortality and length of hospital stay. Too few data were reported and the time scale of most studies was too short to have a realistic chance of detecting differences in morbidity, functional status and quality of life. Furthermore, most trials do not address the organisational and practical challenges faced by practitioners trying to meet the individual needs and preferences of those at risk from malnutrition.
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In vitro fertilisation (IVF) is now a widely accepted treatment for unexplained infertility (RCOG 1998). However, with estimated livebirth rates per cycle varying between 13% and 28%, it's effectiveness has not been rigorously evaluated in comparison with other treatments. With increasing awareness of the role of expectant management and less invasive procedures such as intrauterine insemination, concerns about multiple complications and costs associated with IVF, it is extremely important to evaluate the effectiveness of IVF against other treatment options in couples with unexplained infertility. ⋯ Any effect of IVF relative to expectant management, clomiphene citrate, IUI with or without ovarian stimulation and GIFT in terms of livebirth rates for couples with unexplained subfertility remains unknown. The studies included are limited by their small sample size, so that even large differences might be hidden. Livebirth rates are seldom reported. Adverse effects such as multiple pregnancies and ovarian hyperstimulation syndrome have also not been reported in most studies. Larger trials with adequate power are warranted to establish the effectiveness of IVF in these women. Future trials should not only report rates per woman /couple but also include adverse effects and costs of the treatments compared as outcomes. Factors that have a major effect on these outcomes such as fertility treatment, female partner's age, duration of infertility and previous pregnancy history should also be considered.
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Naloxone, a specific opiate antagonist, is available for the management of newborn infants with respiratory depression that may be due to transplacentally-acquired opiates. However, it is unclear which groups of newborn infants may benefit from this therapy, and whether naloxone has any harmful effects. ⋯ There is a need for a randomised controlled trial to determine if naloxone confers any clinically important benefits to newborn infants with respiratory depression that may be due to trans-placentally acquired narcotic.
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Cochrane Db Syst Rev · Jan 2002
ReviewIntravenous immunoglobulin for treating sepsis and septic shock.
Death from severe sepsis and septic shock is common, and researchers have explored whether antibodies to the endotoxins in some bacteria reduces mortality. ⋯ Polyclonal IVIG significantly reduced mortality and and is a promising adjuvant in the treatment of sepsis and septic shock. However, all the trials were small and the totality of the evidence is insufficient to support a robust conclusion of benefit. Adjunctive therapy with monoclonal IVIGs remains experimental.
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Cochrane Db Syst Rev · Jan 2002
ReviewExtracorporeal membrane oxygenation for severe respiratory failure in newborn infants.
Extracorporeal membrane oxygenation (ECMO) is a complex procedure of life support in severe but potentially reversible respiratory failure, used particularly in mature newborn infants. Although the number of babies requiring ECMO is small, and the ECMO policy invasive and potentially expensive, its benefits may be high. ⋯ A policy of using ECMO in mature infants with severe but potentially reversible respiratory failure would result in significantly improved survival without increased risk of severe disability amongst survivors. For babies with diaphragmatic hernia ECMO offers short term benefits but the overall effect of employing ECMO in this group is not clear. Further studies are needed to refine ECMO techniques; to consider the optimal timing for introducing ECMO; to identify which infants are most likely to benefit; and to address the longer term implications of neonatal ECMO during later childhood and adult life.