Cochrane Db Syst Rev
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Low-back pain (LBP) is a common reason for consulting a general practitioner, and advice on daily activities is an important part of the primary care management of low-back pain. ⋯ For people with acute LBP, advice to rest in bed is less effective than advice to stay active. For patients with sciatica, there is little or no difference between advice to rest in bed and advice to stay active. There is little or no difference in the effect of bed rest compared to exercises or physiotherapy, or seven days of bed rest compared with two to three.
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Cochrane Db Syst Rev · Oct 2004
Review Meta AnalysisLong versus short inspiratory times in neonates receiving mechanical ventilation.
When intermittent positive pressure ventilation (IPPV) was introduced in newborn infants with hypoxic respiratory failure from hyaline membrane disease (HMD), mortality was high and air leaks problematic. This barotrauma was caused by the high peak inspiratory pressures (PIP) required to oxygenate stiff lungs. The primary determinants of mean airway pressure (and thus oxygenation) on a conventional ventilator are the inspiratory time (IT), PIP, positive end expiratory pressure and gas flow rates. In the 1970s uncontrolled studies on a small number of infants demonstrated a benefit in reducing barotrauma using a long IT and slow rates. This strategy was subsequently widely adopted. Current neonatal ventilators have been designed to minimise lung injury but rates of bronchopulmonary dysplasia (BPD) remain high. It is therefore important that the inspiratory time causing least harm is used. ⋯ Caution should be exercised in applying these results to modern neonatal intensive care, because the studies included in this review were conducted prior to the introduction of antenatal steroids, post natal surfactant and the use of synchronised modes of ventilatory support. Most of the participants had single pathology (HMD) and no studies examined the effects of IT on newborns ventilated for other reasons such as meconium aspiration and congenital heart disease (lungs with normal compliance). However, the increased rates of air leaks and deaths using long ITs are clinically important; thus, infants with poorly compliant lungs should be ventilated with a short IT.
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Cochrane Db Syst Rev · Oct 2004
Review Meta AnalysisInterventions to improve compliance with continuous positive airway pressure for obstructive sleep apnoea.
Continuous Positive Airways Pressure (CPAP) is currently considered to be the cornerstone of therapy for sleep apnoea (OSA). However compliance with this treatment is frequently poor, which may lead to ongoing symptoms of sleep disruption, daytime sleepiness and poor waking cognitive function. Mechanical and psychological/educational interventions have been proposed to try to increase the hours of use of CPAP therapy. ⋯ The effect of Auto-CPAP in increasing hours of use in unselected patients starting this treatment remains unclear. Different pooled analyses gave conflicting results and it may be that carefully selected participants may respond more favourably than others. The evidence in support of Bi-PAP, self-titration and humidification is lacking and studies are required in these areas. There is some evidence that psychological/educational interventions improve CPAP usage. This requires confirmation in larger studies of longer duration, with rigorous follow-up. The cost-benefit ratio of such interventions requires assessment. Future studies need to consider the effects of treatment in participants who are poorly compliant. The studies assembled were characterised by high machine usage in the control groups, and low withdrawal rates making it less likely that any benefit could be demonstrated.
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Cochrane Db Syst Rev · Oct 2004
Review Meta AnalysisInterventions for preventing oral candidiasis for patients with cancer receiving treatment.
Treatment of cancer is increasingly more effective but is associated with short and long term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent and treat them. One of these side effects is oral candidiasis. ⋯ There is strong evidence, from randomised controlled trials, that drugs absorbed or partially absorbed from the GI tract prevent oral candidiasis in patients receiving treatment for cancer. There is also evidence that these drugs are significantly better at preventing oral candidiasis than drugs not absorbed from the GI.
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Cochrane Db Syst Rev · Oct 2004
Review Meta AnalysisOmega 3 fatty acids for prevention and treatment of cardiovascular disease.
It has been suggested that omega 3 (W3, n-3 or omega-3) fats from oily fish and plants are beneficial to health. ⋯ It is not clear that dietary or supplemental omega 3 fats alter total mortality, combined cardiovascular events or cancers in people with, or at high risk of, cardiovascular disease or in the general population. There is no evidence we should advise people to stop taking rich sources of omega 3 fats, but further high quality trials are needed to confirm suggestions of a protective effect of omega 3 fats on cardiovascular health. There is no clear evidence that omega 3 fats differ in effectiveness according to fish or plant sources, dietary or supplemental sources, dose or presence of placebo.