Cochrane Db Syst Rev
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People with intermittent claudication suffer from pain in the muscles of the leg occurring during exercise which is relieved by a short period of rest. Symptomatic relief can be achieved by (supervised) exercise therapy and pharmacological treatments. Ginkgo biloba is a vasoactive agent and is used to treat intermittent claudication. ⋯ Overall, there is no evidence that Ginkgo biloba has a clinically significant benefit for patients with peripheral arterial disease.
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Cochrane Db Syst Rev · Apr 2009
Review Meta AnalysisEducational, supportive and behavioural interventions to improve usage of continuous positive airway pressure machines for adults with obstructive sleep apnoea.
Although effective in the treatment of obstructive sleep apnoea (OSA), continuous positive airway pressure (CPAP) does not meet with universal acceptance by users. Educational, supportive and behavioural interventions may help people with obstructive sleep apnoea recognise the need for regular and continued use of continuous positive airway pressure. ⋯ There is some evidence that a supportive intervention which encourages people to continue to use their CPAP machines leads to greater levels of CPAP machine usage than control, although the variation across the studies introduces some uncertainty over how consistent this effect is. We could not find evidence that a short-term educational intervention led to improvements in usage. Cognitive behavioural therapy led to the largest increases in average machine usage, partly because more participants were prepared to try out the treatment. Studies generally recruited CPAP naive patients whose sleep apnoea was severe. Trials in patients who have struggled to persist with treatment are required, as there is currently little evidence in this population. This could make a valuable contribution to our understanding of the complex relationship between initial motivation, ongoing perception of benefit and long-term health benefits.
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Cochrane Db Syst Rev · Apr 2009
ReviewAlternatives to inpatient mental health care for children and young people.
Current policy in the UK and elsewhere places emphasis on the provision of mental health services in the least restrictive setting, whilst also recognising that some children will require inpatient care. As a result, there are a range of mental health services to manage young people with serious mental health problems who are at risk of being admitted to an inpatient unit in community or outpatient settings. ⋯ The quality of the evidence base currently provides very little guidance for the development of services. If randomised controlled trials are not feasible then consideration should be given to alternative study designs, such as prospective systems of audit conducted across several centres, as this has the potential to improve the current level of evidence. These studies should include baseline measurement at admission along with demographic data, and outcomes measured using a few standardised robust instruments.
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Cochrane Db Syst Rev · Apr 2009
Review Meta AnalysisNumber of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection.
Multiple embryo transfer during IVF has increased multiple pregnancy rates (MPR) causing maternal and perinatal morbidity. Elective single embryo transfer (SET) is now being considered as an effective means of reducing this iatrogenic complication. ⋯ In a single fresh IVF cycle, SET is associated with a lower LBR than DET. However there is no significant difference in CLBR following SET+ 1FZET and the LBR following a single cycle of DET. MPR are lowered following SET compared with other transfer policies. There are insufficient data on the outcome of two versus three and four embryo transfer policies.
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Cochrane Db Syst Rev · Apr 2009
Review Meta AnalysisAssisted hatching on assisted conception (IVF and ICSI).
Failure of implantation and conception may result from an inability of the blastocyst to escape from its outer coat, known as the zona pellucida. Artificial disruption of this coat is known as assisted hatching (AH) and has been proposed as a method for improving the success of assisted conception. ⋯ The improvement in clinical pregnancy rate (CPR) with AH means that a clinic with a success rate of 25% could anticipate improving the CPR to between 29% and 49%, all things being equal. The included trials provided insufficient data to investigate the impact of assisted hatching on several important outcomes.