Cochrane Db Syst Rev
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There are at least two theoretical reasons to believe antidepressants might help in smoking cessation. Nicotine withdrawal may produce depressive symptoms or precipitate a major depressive episode and antidepressants may relieve these. Nicotine may have antidepressant effects that maintain smoking, and antidepressants may substitute for this effect. Alternatively, some antidepressants may have a specific effect on neural pathways underlying nicotine addiction, independent of their antidepressant effects. ⋯ The antidepressants bupropion and nortriptyline aid long term smoking cessation but selective serotonin reuptake inhibitors (e.g. fluoxetine) do not. The fact that only some forms of antidepressants aid cessation and that they do so regardless of depressive symptoms strongly suggests that their mode of action is independent of their antidepressant effect.
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Cochrane Db Syst Rev · Oct 2004
Review Meta AnalysisSelenium supplementation for critically ill adults.
Selenium is a trace mineral essential to human health, which has an important role in the immune response, defence against tissue damage and thyroid function. Improving selenium status could help protect against overwhelming tissue damage and infection in critically ill adults. ⋯ There is insufficient evidence to recommend supplementation of critically ill patients with selenium or ebselen. Trials are required which overcome the defects of the reviewed studies, particularly inadequate size and methodology. This review will be updated when four ongoing trials are completed.
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Cochrane Db Syst Rev · Oct 2004
Review Meta AnalysisEffectiveness of intermediate care in nursing-led in-patient units.
The Nursing led inpatient Unit (NLU) is one of a range of services that have been considered in order to manage more successfully the transition between hospital and home for patients with extended recovery times. ⋯ There is some evidence that patients discharged from a NLU are better prepared for discharge but it is unclear if this is simply a product of an increased length of inpatient stay. No statistically significant adverse effects were noted but the possibility of increased early mortality cannot be discounted. More research is needed.
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Cochrane Db Syst Rev · Oct 2004
ReviewAntipsychotic medication versus placebo for people with both schizophrenia and learning disability.
Antipsychotic medication is the standard treatment for people with learning disability and schizophrenia. ⋯ Using the methods described we found no randomised controlled trial evidence to guide the use of antipsychotic medication for people with both learning disability and schizophrenia. Until the urgent need for randomised controlled trials is met, clinical practice will continue to be guided by extrapolation of evidence from randomised controlled trials involving people with schizophrenia, but without learning disability, and non-randomised trials of those with learning disability and schizophrenia.
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Cochrane Db Syst Rev · Oct 2004
Review Meta AnalysisProphylactic intravenous preloading for regional analgesia in labour.
Reduced uterine blood flow from maternal hypotension may contribute to fetal heart rate changes which are common following regional analgesia (epidural or spinal or combined spinal-epidural (CSE)) during labour. Intravenous fluid preloading may help to reduce maternal hypotension but using lower doses of local anaesthetic, and opioid only blocks, may reduce the need for preloading. ⋯ Preloading prior to traditional high-dose local anaesthetic blocks may have some beneficial fetal and maternal effects in healthy women. Low-dose epidural and CSE analgesia techniques may reduce the need for preloading. The studies reviewed were too small to show whether preloading is beneficial for women having regional analgesia during labour using the lower-dose local anaesthetics or opioids. Further investigation of low-dose epidural or CSE (including opioid only) blocks, and the risks and benefits of intravenous preloading for women with pregnancy complications, is required.