Cochrane Db Syst Rev
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Standard treatment for high grade glioma (HGG) usually entails biopsy or surgical resection where possible followed by radiotherapy. Systemic chemotherapy is usually only given in selected cases and its use is often limited by side effects. Implanting wafers impregnated with chemotherapy agents into the resection cavity represents a novel means of delivering drugs to the central nervous system (CNS) with fewer side effects. It is not clear how effective this modality is or whether it should be recommended as part of standard care for HGG. ⋯ Gliadel(R) results in a prolongation of survival without an increased incidence of adverse events when used as primary therapy. There is no evidence of enhanced progression free survival (PFS) or QOL. In recurrent disease, Gliadel(R) does not appear to confer any added benefit. These findings are based on the results of three RCTs with approximately 500 patients in total.
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisHaloperidol versus chlorpromazine for schizophrenia.
Chlorpromazine and haloperidol are benchmark antipsychotic drugs. Both are said to be equally effective when used at equivalent doses, but have different side-effect profiles. ⋯ Given that haloperidol and chlorpromazine are global standard antipsychotic treatments for schizophrenia, it is surprising that less than 800 people have been randomised to a comparison and that incomplete reporting still makes it difficult for anyone to draw clear conclusions on the comparative effects of these drugs. However, it seems that haloperidol causes more movement disorders than chlorpromazine, while chlorpromazine is significantly more likely to lead to hypotonia. We are surprised to have to say that we feel further, large, well designed, conducted and reported studies are required.
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Acute traumatic brain injury is a leading cause of death and disability in young adults. Numerous pharmacological and non-pharmacological tools have been investigated and considered as potential mechanisms for improving neurological outcome. Magnesium has been considered as one of these potential therapeutic tools because of its activity on NMDA-receptors, calcium channels and neuron membranes. Animal studies have indicated a beneficial effect of magnesium on outcome after brain injury, but its efficacy in humans is unknown. ⋯ There is currently no evidence to support the use of magnesium salts in patients with acute traumatic brain injury.
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisGlucocorticoid corticosteroids for Duchenne muscular dystrophy.
Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy of childhood. This incurable disease is characterised by muscle wasting and loss of walking ability leading to complete wheelchair dependence by 13 years of age. Prolongation of walking is one of the major aims of treatment. ⋯ There is evidence from randomised controlled studies that glucocorticoid corticosteroid therapy in Duchenne muscular dystrophy improves muscle strength and function in the short-term (six months to two years). The most effective prednisolone regime appears to be 0.75 mg/kg/day, given daily. In the short term, adverse effects were significantly more common but not clinically severe. Long-term benefits and hazards of glucocorticoid treatment cannot be evaluated from the currently published randomised studies. Non-randomised studies support the conclusions of functional benefits but also identify clinically significant adverse effects of long-term treatment. These benefits and adverse effects have implications for future research studies and clinical practice.
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisTarget-controlled infusion versus manually-controlled infusion of propofol for general anaesthesia or sedation in adults.
Continuous infusions of the intravenous anaesthetic propofol are commonly used to induce and maintain sedation and general anaesthesia. Infusion devices can be manually controlled (MCI) where the anaesthetist makes each change to the infusion rate or target-controlled (TCI) where the anaesthetist sets a target blood or effect-site concentration and the computerised infusion device makes the necessary changes to the infusion rate. Randomized trials have explored the differences in quality of anaesthesia, adverse event rate and cost between TCI and MCI but the effectiveness of TCI compared with MCI remains controversial. As TCI is in widespread international use, and potentially may be more expensive without added benefit, a systematic review of randomized controlled trials comparing TCI and MCI is warranted. ⋯ This systematic review does not provide sufficient evidence for us to make firm recommendations about the use of TCI versus MCI in clinical anaesthetic practice.