Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jul 2008
ReviewImmunosuppressive treatment for focal segmental glomerulosclerosis in adults.
Corticosteroids remain the mainstay of treatment in idiopathic nephrotic syndrome, including focal and segmental glomerulosclerosis (FSGS). However, only about 20% of patients with FSGS experience a partial or complete remission of nephrotic syndrome despite treatment. ⋯ Adult patients treated with CSA at an initial dose of 3.5-5 mg/kg/d in two divided doses perhaps in combination with oral prednisolone 0.15 mg/kg/d are more likely to achieve a partial remission of the nephrotic syndrome compared with symptomatic treatment or prednisolone alone. However, there is a probability of deterioration of kidney function due to the nephrotoxic effect of CSA in the long term. For CSA, a larger controlled trial with longer follow-up should be performed to prove the benefit of this regimen not only on proteinuria but also on the preservation of kidney function. Present available data do not support the general use of alkylating substances for the treatment of FSGS in adults.
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The diagnostic criteria for Childhood Apraxia of Speech (CAS), and the underlying cause(s) for this disorder, remain heavily debated. Some agreement exists that children with CAS may have impairments in one or more of the following domains: non-speech oral motor function, motor speech function, speech sounds and structures (i.e., syllable and word shapes), prosody, language, phonemic awareness / metalinguistic skills, and literacy . Recently consensus has been reached that only three features across these domains have diagnostic validity: (1) inconsistent error production on both consonants and vowels across repeated productions of syllables or words, (2) lengthened and impaired coarticulatory transitions between sounds and syllables, and (3) inappropriate prosody (ASHA 2007). Perhaps due to the ongoing deliberation over aetiology and diagnosis, little evidence on intervention for CAS is published. ⋯ The review demonstrates a critical lack of well controlled treatment studies addressing treatment efficacy for CAS, making it impossible for conclusions to be drawn about which interventions are most effective for treating CAS in children or adolescents.
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Cochrane Db Syst Rev · Jul 2008
ReviewBicycle 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.
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Occlusal interventions may be used in adults with periodontitis. At present there is little consensus regarding the indications and effectiveness of occlusal interventions in periodontal patients. ⋯ There is only one randomised trial that has addressed this question. The data from this study are inconclusive. We therefore conclude there is no evidence for or against the use of occlusal interventions in clinical practice. This question can only be addressed by adequately powered bias-protected randomised controlled trials.
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Cochrane Db Syst Rev · Jul 2008
ReviewBehavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with learning disabilities.
Outwardly directed aggressive behaviour is a significant part of problem behaviours presented by people with learning disabilities. Prevalence rates between 3.3% to 36% have been reported in the literature. Such behaviours often run a long term course and are a major cause of social exclusion. ⋯ The existing evidence on the efficacy of cognitive behavioural and behavioural interventions on outwardly directed aggression in children and adults with learning disabilities is scant. There is a paucity of methodologically sound clinical trials. Given the impact of such behaviours on the affected individual, his or her carers and on service providers, effective interventions are essential. It is also important to investigate cost efficacy of treatment models against existing treatments. We recommend that randomised controlled trials of sufficient power are carried out using primary outcomes of reduction in outward directed aggression, improvement in quality of life and cost efficacy as measured by standardised scales.