Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jul 2009
Review Meta AnalysisInterventions in the management of serum lipids for preventing stroke recurrence.
Studies have shown that interventions which reduce total and low-density lipoprotein cholesterol levels also reduce coronary heart disease (CHD) and stroke events in those with a history of CHD. However, it is uncertain whether treatment to alter cholesterol levels can prevent recurrence of either stroke or subsequent cardiovascular events and whether differences in outcomes exist between classes of lipid-lowering therapy. This is an update of a Cochrane review first published in 2002. ⋯ There is evidence that statin therapy in patients with a history of ischaemic stroke or TIA significantly reduces subsequent major coronary events but only marginally reduces the risk of stroke recurrence. There is no clear evidence of beneficial effect from statins in those with previous haemorrhagic stroke and it is unclear whether statins should be started immediately post stroke or later. In view of this and the evidence of the benefit of statin therapy in those with a history of CHD, patients with ischaemic stroke or TIA, with or without a history of established CHD, should receive statins.
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Acute ischaemic stroke is a common cause of death and disability. A number of studies published in China have shown that acanthopanax is beneficial for acute ischaemic stroke. ⋯ The risk of bias in all the included trials was high, and hence the data were not adequate to draw reliable conclusions about the efficacy of acanthopanax in acute stroke. Much larger trials of greater methodological quality are needed.
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Cochrane Db Syst Rev · Jul 2009
Review Meta AnalysisInterventions for preventing and treating kidney disease in Henoch-Schönlein Purpura (HSP).
To determine the benefits and harms of therapies used to prevent or treat kidney disease in Henoch-Schönlein Purpura (HSP). ⋯ Data from RCTs for any intervention used in improve kidney outcomes in children with HSP are very sparse except for short-term prednisone. There was no evidence of benefit of prednisone in preventing serious long-term kidney disease in HSP.
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Cochrane Db Syst Rev · Jul 2009
Review Meta AnalysisProgressive resistance strength training for improving physical function in older adults.
Muscle weakness in old age is associated with physical function decline. Progressive resistance strength training (PRT) exercises are designed to increase strength. ⋯ This review provides evidence that PRT is an effective intervention for improving physical functioning in older people, including improving strength and the performance of some simple and complex activities. However, some caution is needed with transferring these exercises for use with clinical populations because adverse events are not adequately reported.
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Cochrane Db Syst Rev · Jul 2009
Review Meta AnalysisClozapine combined with different antipsychotic drugs for treatment resistant schizophrenia.
Although clozapine has been shown to be the treatment of choice in people with schizophrenia that are resistant to treatment, one third to two thirds of people still have persistent positive symptoms despite clozapine monotherapy of adequate dosage and duration. The need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine is the most common reason for simultaneously prescribing a second antipsychotic drug in combination with clozapine. ⋯ In this review we considered the risk of bias too high because of the poor quality of the retrieved information (small sample size, heterogeneity of comparisons, flaws in the design, conduct and analysis). Although clinical guidelines recommend a second antipsychotic in addition to clozapine in partially responsive patients with schizophrenia, the present systematic review was not able to show if any particular combination strategy was superior to the others. New, properly conducted, randomised controlled trials independent from the pharmaceutical industry need to recruit many more patients to give a reliable estimate of effect or of no effect of antipsychotics as combination treatment with clozapine in patients who do not have an optimal response to clozapine monotherapy.