Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2007
ReviewWITHDRAWN: Low level laser therapy (Classes III) for treating osteoarthritis.
Osteoarthritis (OA) affects a large portion of the population. Low Level Laser Therapy (LLLT) is a light source that generates extremely pure light, of a single wavelength. The effect is not thermal, but rather related to photochemical reactions in the cells. LLLT was introduced as an alternative non-invasive treatment for OA about 30 years ago, but its effectiveness has to be examined more closely, especially in the treatment of OA. ⋯ Five trials included in this review showed a statistically significant difference favoring laser treatment when compared to placebo for at least one outcome measure. Three trials did not report beneficial effects. The varying results of these trials may be due to the method of laser application and/or other features of LLLT application. Clinicians and researchers should consistently report the characteristics of LLLT devices and application techniques used. New trials on LLLT should make use of standardized, validated outcomes. There is clearly a need to investigate the effects of different dosages on LLLT effectiveness for OA in future randomized, controlled clinical trials. Also, more studies should be done to investigate the anti-inflammatory action of laser as well as the appropriate parameters needed to achieve an anti-inflammatory effect.
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Cochrane Db Syst Rev · Jan 2007
ReviewInterventions for preventing delirium in hospitalised patients.
Delirium is a common mental disorder with serious adverse outcomes in hospitalised patients. It is associated with increases in mortality, physical morbidity, length of hospital stay, institutionalisation and costs to healthcare providers. A range of risk factors has been implicated in its aetiology, including aspects of the routine care and environment in hospitals. Prevention of delirium is clearly desirable from patients' and carers' perspectives, and to reduce hospital costs. Yet it is currently unclear whether interventions for prevention of delirium are effective, whether they can be successfully delivered in all environments, and whether different interventions are necessary for different groups of patients. ⋯ Research evidence on effectiveness of interventions to prevent delirium is sparse. Based on a single study, a programme of proactive geriatric consultation may reduce delirium incidence and severity in patients undergoing surgery for hip fracture. Prophylactic low dose haloperidol may reduce severity and duration of delirium episodes and shorten length of hospital admission in hip surgery. Further studies of delirium prevention are needed.
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Cochrane Db Syst Rev · Jan 2007
ReviewPsychological and educational interventions for atopic eczema in children.
Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. There have been no relevant systematic reviews applicable to children. ⋯ A lack of rigorously designed trials (excluding one recent German study) provides only limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of children with atopic eczema. Evidence from included studies and also adult studies indicates that different service delivery models (multi-professional eczema school and nurse-led clinics) require further and comparative evaluation to examine their cost-effectiveness and suitability for different health systems.
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Cochrane Db Syst Rev · Jan 2007
ReviewInterventions to support the decision-making process for older people facing the possibility of long-term residential care.
The decision to enter long-term care is often a major life event for older people, made in the context of personal crisis and loss. We hypothesised that the process through which a decision to enter long-term residential care emerges affects the overall psycho-social adjustment to, and acceptance of, this decision, and may have an impact on a range of other outcomes for older persons and their carers, such as health status. ⋯ No eligible studies were identified to inform the use of interventions to support the decision-making process for older people facing the possibility of long-term residential care. This should not be interpreted as demonstrating that these interventions are not effective. The many related studies we identified which did not meet the study design criterion for this review indicate that there is substantial research interest in this topic. It would be useful to summarise the information available in the wider literature using newly-developing methods for synthesising qualitative studies. This could help identify interventions which warrant further research. Rigorously conducted randomised controlled trials of these interventions could then make a valuable contribution to the range of evidence surrounding this significant event in the lives of many older people, informing practice and policy development.
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Cochrane Db Syst Rev · Jan 2007
ReviewPsychological treatment for anxiety in people with traumatic brain injury.
Psychological treatments are commonly used in the management of anxiety. Certain types of psychological treatments are well suited to needs of people with traumatic brain injury (TBI). We have systematically reviewed studies examining the effectiveness of these approaches for TBI. ⋯ This review provides some evidence for the effectiveness of CBT for treatment of acute stress disorder following mild TBI and CBT combined with neurorehabilitation for targeting general anxiety symptomatology in people with mild to moderate TBI. These findings need to be viewed in light of the small number, small sample size and heterogeneous characteristics of current trials published in this area. More trials focusing on comparable psychological interventions, severity of injury of participants and diagnosis of anxiety disorder(s) are needed.