Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Apr 2007
Review Meta AnalysisTreatment for superficial thrombophlebitis of the leg.
The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST. ⋯ Low molecular weight heparin and NSAIDs appear as the current best therapeutic options for ST of the legs. While the available data are too limited to make clear recommendations, an intermediate dose of LMWH for at least a month might be advised. Further research is needed to assess the role of NSAIDs and LMWH, the optimal doses and duration of treatment, and whether a combination therapy may be more effective than single treatment. Adequately designed and conducted studies are required to clarify the role of topical and surgical treatments.
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Cochrane Db Syst Rev · Apr 2007
Review Meta AnalysisAntiplatelet agents for preventing pre-eclampsia and its complications.
Pre-eclampsia is associated with deficient intravascular production of prostacyclin, a vasodilator, and excessive production of thromboxane, a vasoconstrictor and stimulant of platelet aggregation. These observations led to the hypotheses that antiplatelet agents, low-dose aspirin in particular, might prevent or delay development of pre-eclampsia. ⋯ Antiplatelet agents, largely low-dose aspirin, have moderate benefits when used for prevention of pre-eclampsia and its consequences. Further information is required to assess which women are most likely to benefit, when treatment is best started, and at what dose.
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Cochrane Db Syst Rev · Apr 2007
Review Meta AnalysisPreoperative chemotherapy for women with operable breast cancer.
Currently, preoperative chemotherapy is the standard of care in locally advanced breast cancer to achieve local tumour downsizing in order to make surgery possible. Since the early 1980s, the role of preoperative chemotherapy in early stage (or operable) breast cancer has been the subject of study. Potential advantages are early introduction of systemic therapy, determination of chemosensitivity, reduction of tumour volume and downstaging of surgical requirement. Concerns exist about local control after downsized surgery and the delay of local treatment in patients with tumours resistant to chemotherapy. ⋯ This review suggests safe application of preoperative chemotherapy in the treatment of women with early stage breast cancer in order to down-stage surgical requirement, to evaluate chemosensitivity and to facilitate translational research.
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Cochrane Db Syst Rev · Apr 2007
Review Meta AnalysisLong-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus.
Despite indications from epidemiological trials that higher blood glucose concentrations are associated with a higher risk for developing micro- and macrovascular complications, evidence for a beneficial effect of antihyperglycaemic therapy in patients with type 2 diabetes mellitus is conflicting. Two large studies, the United Kingdom Prospective Diabetes Study (UKPDS) and the University Group Diabetes Program (UGDP), did not find a reduction of cardiovascular endpoints through improvement of metabolic control. The theoretical benefits of newer insulin analogues might result in fewer macrovascular and microvascular events. ⋯ Our analysis suggests, if at all only a minor clinical benefit of treatment with long-acting insulin analogues for patients with diabetes mellitus type 2 treated with "basal" insulin regarding symptomatic nocturnal hypoglycaemic events. Until long-term efficacy and safety data are available, we suggest a cautious approach to therapy with insulin glargine or detemir.
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Cochrane Db Syst Rev · Apr 2007
Review Meta AnalysisBicycle helmet legislation for the uptake of helmet use and prevention of head injuries.
Evidence exists to suggest that bicycle helmets may reduce the risk of head injuries to cyclists, however helmets are not uniformly worn by all bicycle users. Legislation has been enacted in some countries to mandate helmet use by cyclists, however the issue remains controversial with opponents arguing that this may inhibit people from bicycle riding and thus from gaining the associated health benefits, or that other countermeasures may have been responsible for decline in head injuries. ⋯ Bicycle helmet legislation appears to be effective in increasing helmet use and decreasing head injury rates in the populations for which it is implemented. However, there are very few high quality evaluative studies that measure these outcomes, and none that reported data on an possible declines in bicycle use.