Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2003
ReviewAnticholinergics for symptomatic management of Parkinson's disease.
Anticholinergics were the first drugs available for the symptomatic treatment of Parkinson's disease and they are still widely used today, both as monotherapy and as part of combination regimes. They are commonly believed to be associated with a less favourable side effect profile than other antiparkinsonian drugs, in particular with respect to neuropsychiatric and cognitive adverse events. They have been claimed to exert a better effect on tremor than on other parkinsonian features. ⋯ As monotherapy or as an adjunct to other antiparkinsonian drugs, anticholinergics are more effective than placebo in improving motor function in Parkinson's disease. Neuropsychiatric and cognitive adverse events occur more frequently on anticholinergics than on placebo and are a more common reason for withdrawal than lack of efficacy. Results regarding a potentially better effect of the anticholinergic drug on tremor than on other outcome measures are conflicting and data do not strongly support a differential clinical effect on individual parkinsonian features. Data is insufficient to allow comparisons in efficacy or tolerability between individual anticholinergic drugs.
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Cochrane Db Syst Rev · Jan 2003
ReviewEffect(s) of assisted hatching on assisted conception (IVF & ICSI).
Failure of implantation and thus conception might result from inability of the blastocyst to escape from its zona pellucida. Artificial disruption of this coat has been proposed as a method of improving the success of assisted conception. ⋯ There is insufficient evidence to determine any effect of AH on the 'take-home-baby rate' of assisted conception. There are also very few data regarding miscarriage rates and other adverse events. This prevents us from extrapolating the impact of AH on live births from our finding of improved odds of clinical pregnancy.
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Cochrane Db Syst Rev · Jan 2003
ReviewContinuous negative extrathoracic pressure or continuous positive airway pressure for acute hypoxemic respiratory failure in children.
Acute hypoxemic respiratory failure (AHRF) is an important cause of mortality and morbidity in the pediatric age group. Despite varied etiologies and different population characteristics the aims of therapy are to achieve adequate oxygenation and ventilation. Positive pressure ventilation is currently the standard of care. It is ordinarily provided by intubation and mechanical ventilation, which is associated with a number of well recognized complications. Continuous negative extrathoracic pressure ventilation (CNEP) or continuous positive airway pressure ventilation delivered via non-invasive approaches (Ni-CPAP) have shown certain beneficial effects in animal and uncontrolled human studies. In a systematic review of studies involving neonates, continuous distending pressure using either CNEP or CPAP (applied via face mask) was associated with reduction in mortality but with an increased incidence of pneumothoraces, in neonates. ⋯ There is a lack of well designed, large controlled experiments comparing use of noninvasive modes of respiratory support in children with AHRF. Uncontrolled evidence of reduction in the intubation and hospital stay needs confirmation in proper studies evaluating risks involved with these practices. Implication for research: It is unlikely that CNEP or Ni-CPAP will have significant impact on mortality in AHRF, however, even a small reduction may be very important. Studies assessing other outcomes such as avoidance of intubation and its associated complications, reduction in hospital stay and improvement in patient comfort are also valuable in assessing the overall impact of these strategies.
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Cochrane Db Syst Rev · Jan 2003
ReviewCommunication skills training for health care professionals working with cancer patients, their families and/or carers.
Research suggests communication skills do not reliably improve with experience and considerable effort is dedicated to courses improving communication skills for health professionals. The evaluation of such courses is of importance to enable evidence-based teaching and practice. ⋯ The training programmes assessed by these trials appear to be effective in improving cancer care professionals communication skills. It is not known whether the training would be effective if taught by other educators, nor has any trial compared the efficacy of both programmes.
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Cochrane Db Syst Rev · Jan 2003
ReviewMale circumcision for prevention of heterosexual acquisition of HIV in men.
The findings from observational studies, reviews and meta-analyses, supported by biological theories, that circumcised men appear less likely to acquire human immunodeficiency virus (HIV) has contributed to the recent ground swell of support for considering male circumcision as a strategy for preventing sexually acquired infection. We sought to elucidate and appraise the global evidence from published and unpublished studies that circumcision can be used as an intervention to prevent HIV infection. ⋯ We found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The results from existing observational studies show a strong epidemiological association between male circumcision and prevention of HIV, especially among high-risk groups. However, observational studies are inherently limited by confounding which is unlikely to be fully adjusted for. In the light of forthcoming results from RCTs, the value of IPD analysis of the included studies is doubtful. The results of these trials will need to be carefully considered before circumcision is implemented as a public health intervention for prevention of sexually transmitted HIV.