Cochrane Db Syst Rev
-
Cochrane Db Syst Rev · Jul 2010
ReviewOrthodontics for treating temporomandibular joint (TMJ) disorders.
Temporomandibular disorders (TMD) relate to discomfort of the temporomandibular joint (TMJ). The disorder is multifactorial with a degree of psychogenic influence varying throughout an individual's life with phases of symptoms affecting the quality of life. In an attempt to treat this complex group of disorders many treatment modalities have been identified some of which are also considered in other Cochrane reviews. The disorder also has a normal cycle of events appearing to spontaneously improve without treatment. ⋯ There are insufficient research data on which to base our clinical practice on the relationship of active orthodontic intervention and TMD. There is an urgent need for high quality randomised controlled trials in this area of orthodontic practice.When considering consent for patients it is essential to reflect the seemingly random development/alleviation of TMD signs and symptoms.
-
Cochrane Db Syst Rev · Jul 2010
Review Meta AnalysisElastic compression stockings for prevention of deep vein thrombosis.
One of the settings where deep vein thrombosis (DVT) in the lower limb and pelvic veins occurs is in hospital with prolonged immobilisation of patients for various surgical and medical illnesses. Using graduated compression stockings (GCS) in these patients has been proposed to decrease the risk of DVT. This is an update of a Cochrane review first published in 2000 and updated in 2003. ⋯ GCS are effective in diminishing the risk of DVT in hospitalised patients. Data examination also suggests that GCS on a background of another method of prophylaxis is more effective than GCS on its own.
-
Cochrane Db Syst Rev · Jul 2010
ReviewCervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome.
This review is an update on 'Sympathectomy for neuropathic pain' originally published in Issue 2, 2003. The concept that many neuropathic pain syndromes (traditionally this definition would include complex regional pain syndromes (CRPS)) are "sympathetically maintained pains" has historically led to treatments that interrupt the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy ganglia of the sympathetic chain, while surgical ablation is performed by open removal or electrocoagulation of the sympathetic chain, or minimally invasive procedures using thermal or laser interruption. ⋯ The practice of surgical and chemical sympathectomy for neuropathic pain and CRPS is based on very little high quality evidence. Sympathectomy should be used cautiously in clinical practice, in carefully selected patients, and probably only after failure of other treatment options.
-
Cochrane Db Syst Rev · Jul 2010
Review Meta AnalysisProton pump inhibitor treatment initiated prior to endoscopic diagnosis in upper gastrointestinal bleeding.
There is conflicting evidence regarding the clinical efficacy of proton pump inhibitors (PPI) initiated before endoscopy for upper gastrointestinal bleeding. ⋯ PPI treatment initiated before endoscopy for upper gastrointestinal bleeding might reduce the proportion of participants with SRH at index endoscopy and significantly reduces requirement for endoscopic therapy during index endoscopy. However, there is no evidence that PPI treatment affects clinically important outcomes, namely mortality, rebleeding or need for surgery.
-
Cochrane Db Syst Rev · Jul 2010
Review Meta AnalysisEffect of outpatient pharmacists' non-dispensing roles on patient outcomes and prescribing patterns.
The roles of pharmacists in patient care have expanded from the traditional tasks of dispensing medications and providing basic medication counseling to working with other health professionals and the public. Multiple reviews have evaluated the impact of pharmacist-provided patient care on health-related outcomes. Prior reviews have primarily focused on in-patient settings. This systematic review focuses on services provided by outpatient pharmacists in community or ambulatory care settings. This is an update of the Cochrane review published in 2000. ⋯ Only one included study compared pharmacist services with other health professional services, hence we are unable to draw conclusions regarding comparisons 1 and 3. Most included studies supported the role of pharmacists in medication/therapeutic management, patient counseling, and providing health professional education with the goal of improving patient process of care and clinical outcomes, and of educational outreach visits on physician prescribing patterns. There was great heterogeneity in the types of outcomes measured across all studies. Therefore a standardized approach to measure and report clinical, humanistic, and process outcomes for future randomized controlled studies evaluating the impact of outpatient pharmacists is needed. Heterogeneity in study comparison groups, outcomes, and measures makes it challenging to make generalised statements regarding the impact of pharmacists in specific settings, disease states, and patient populations.