Cochrane Db Syst Rev
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Peer support telephone calls have been used for a wide range of health-related concerns. However, little is known about their effects. ⋯ Whilst this review provides some evidence that peer support telephone calls can be effective for certain health-related concerns, few of the studies were of high quality and so results should be interpreted cautiously. There were many methodological limitations thus limiting the generalisability of findings. Overall, there is a need for further well designed randomised controlled studies to clarify the cost and clinical effectiveness of peer support telephone calls for improvement in health and health-related behaviour.
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Cochrane Db Syst Rev · Oct 2008
ReviewAdrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.
Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may cause death. Adrenaline is recommended as the initial treatment of choice for anaphylaxis. ⋯ Based on this review, we are unable to make any new recommendations on the use of adrenaline for the treatment of anaphylaxis. Although there is a need for randomized, double-blind, placebo-controlled clinical trials of high methodological quality in order to define the true extent of benefits from the administration of adrenaline in anaphylaxis, such trials are unlikely to be performed in individuals with anaphylaxis. Indeed, they might be unethical because prompt treatment with adrenaline is deemed to be critically important for survival in anaphylaxis. Also, such studies would be difficult to conduct because anaphylactic episodes usually occur without warning, often in a non-medical setting, and differ in severity both among individuals and from one episode to another in the same individual. Consequently, obtaining baseline measurements and frequent timed measurements might be difficult, or impossible, to obtain. In the absence of appropriate trials, we recommend, albeit on the basis of less than optimal evidence, that adrenaline administration by intramuscular (i.m.) injection should still be regarded as first-line treatment for the management of anaphylaxis.
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Cochrane Db Syst Rev · Oct 2008
ReviewSurgical versus conservative management for odontoid fractures.
Fractures of the odontoid process of the second cervical vertebra can result in instability, neurological damage and death. Treatment includes conservative management (external immobilisation devices) or surgical treatment (internal fixation by posterior fusion or anterior screw fixation). ⋯ There is no evidence available from adequately controlled trials to inform the decision on whether the surgical treatment of odontoid fractures gives a better outcome. A sufficiently powered good quality multicentre randomised controlled trial comparing surgery versus conservative treatment is warranted.
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There have been many randomised trials of adjuvant tamoxifen among women with early breast cancer, and an updated overview of their results is presented. ⋯ For women with tumours that have been reliably shown to be ER-negative, adjuvant tamoxifen remains a matter for research. However, some years of adjuvant tamoxifen treatment substantially improves the 10-year survival of women with ER-positive tumours and of women whose tumours are of unknown ER status, with the proportional reductions in breast cancer recurrence and in mortality appearing to be largely unaffected by other patient characteristics or treatments.
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Cochrane Db Syst Rev · Oct 2008
ReviewRoutine ultrasound in late pregnancy (after 24 weeks' gestation).
Diagnostic ultrasound is used selectively in late pregnancy where there are specific clinical indications. However, the value of routine late pregnancy ultrasound screening in unselected populations is controversial. The rationale for such screening would be the detection of clinical conditions which place the fetus or mother at high risk, which would not necessarily have been detected by other means such as clinical examination, and for which subsequent management would improve perinatal outcome. ⋯ Based on existing evidence, routine late pregnancy ultrasound in low-risk or unselected populations does not confer benefit on mother or baby. It may be associated with a small increase in caesarean section rates. There is a lack of data about the potential psychological effects of routine ultrasound in late pregnancy, and limited data about its effects on both short- and long-term neonatal and childhood outcome. Placental grading in the third trimester may be valuable, but whether reported results are reproducible remains to be seen, and future research of late pregnancy ultrasound should include evaluation of placental textural assessment.