Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisInterventions for smoking cessation and reduction in individuals with schizophrenia.
Patients with schizophrenia smoke more heavily than the general population and this contributes to their higher morbidity and mortality from smoking-related illnesses. It remains unclear what interventions can help them to quit or reduce smoking. ⋯ Bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardising their mental state. Bupropion may also reduce the amount these patients smoke. CR may help this group of patients to quit and reduce smoking. We failed to find convincing evidence that other interventions have a beneficial effect on smoking behaviour in schizophrenia.
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Recent evidence suggests an anti-nociceptive effect of botulinum toxin. ⋯ The results should be interpreted with caution due to few studies with small sample sizes and high risk of bias. Botulinum toxin A injections seem to reduce pain severity and improve shoulder function and range of motion when compared with placebo in patients with shoulder pain due to spastic hemiplegia or arthritis. It is unclear if the benefit of pain relief in post-stroke shoulder pain at three to six months but not at one month is due to limitations of the evidence, which includes small sample sizes with imprecise estimates, or a delayed onset of action. More studies with safety data are needed.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisDifferent antibiotic treatments for group A streptococcal pharyngitis.
Antibiotics provide only modest benefit in treating sore throat, although effectiveness increases in participants with positive throat swabs for group A beta-haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. ⋯ Evidence is insufficient for clinically meaningful differences between antibiotics for GABHS tonsillopharyngitis. Limited evidence in adults suggests cephalosporins are more effective than penicillin for relapse, but the NNTB is high. Limited evidence in children suggests carbacephem is more effective for symptom resolution. Data on complications are too scarce to draw conclusions. Based on these results and considering the low cost and absence of resistance, penicillin can still be recommended as first choice.
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Cochrane Db Syst Rev · Jan 2010
ReviewProvision of a surgeon's performance data for people considering elective surgery.
A consumer model of health supports that elective surgery patients should be informed about the past operative performance of their surgeon before making two important decisions: 1) to consent to the proposed surgery, and 2) to have a particular doctor perform the surgery. This information arguably helps empower patients to participate in their care. While surgeons' performance data are available in some settings there continues to be controversy over the provision of such data to patients, and the question of whether consumers should, or want to, be provided with this information. ⋯ We found no studies reporting the impact of the provision of a surgeon's performance data for people considering elective surgery. This is an important finding in itself. While the public reporting of a surgeon's performance is not a new concept, the efficacy of this data for individual patients has not been empirically tested. We recommend that a review of qualitative studies or new primary qualitative research be conducted to determine what interventions are currently in use and explore the attitudes of consumers and professionals towards such interventions.
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Croup, a common acute clinical syndrome in children up to the age of six, is thought to be triggered by a viral infection, and is characterised by a varying degree of respiratory distress due to upper airway inflammation and oedema of the subglottic mucosa. Corticosteroids, now part of the standard treatment for croup, improve symptoms but it takes time for their full effect to be achieved. Meanwhile, the child remains at risk of deterioration and developing respiratory failure necessitating emergency intubation and ventilation. Helium-oxygen (heliox) inhalation has been successful in the treatment of upper airway obstruction. Anecdotal evidence suggests that heliox relieves respiratory distress in children, but it remains unclear whether there is robust evidence to support the implementation of heliox for croup into clinical practice. ⋯ At present there is a lack of evidence to establish the effect of heliox inhalation in the treatment of croup in children. A methodologically well-designed and adequately powered RCT is needed to assess whether there is a role for heliox therapy in the management of children with croup.