Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2002
ReviewNerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures.
Various nerve blocks using local anaesthetic agents have been used in order to reduce pain after hip fracture. ⋯ Because of the small number of patients included in this review and the differing type of nerve blocks and timing of insertion, it is not possible to determine if nerve blocks confer any significant benefit when compared with other analgesic methods as part of the treatment of a hip fracture. Further trials with larger numbers of patients and full reporting of clinical outcomes would be justified.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisFluoride varnishes for preventing dental caries in children and adolescents.
Topically applied fluoride varnishes have been used extensively as an operator-applied caries-preventive intervention for over two decades. ⋯ The review suggests a substantial caries-inhibiting effect of fluoride varnish in both the permanent and the deciduous dentitions based largely on trials with no treatment controls. There is little information concerning acceptability of treatment or possible side effects in the included trials. Given the relatively poor quality of most of the included studies and the wide confidence intervals around the estimates of effect, there remains a need for further trials. It is important that these trials should be of high quality and include assessment of potential adverse effects.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisProtein and energy supplementation in elderly people at risk from malnutrition.
This review was carried out because evidence for the effectiveness of nutritional supplements containing protein and energy which are often prescribed for elderly people is limited. Furthermore malnutrition is more common in this age group and deterioration of nutritional status can occur during a stay in hospital. It is important to establish whether supplementing the diet with protein and energy is an effective way of improving outcomes for older people at risk from malnutrition. ⋯ Supplementation appears to produce a small but consistent weight gain. There was a statistically significant beneficial effect on mortality and a shorter length of hospital stay. Additional data from large-scale multi-centre trials are still required to provide clear evidence of benefit from protein and energy supplements on mortality and length of hospital stay. Too few data were reported and the time scale of most studies was too short to have a realistic chance of detecting differences in morbidity, functional status and quality of life. Furthermore, most trials do not address the organisational and practical challenges faced by practitioners trying to meet the individual needs and preferences of those at risk from malnutrition.
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In vitro fertilisation (IVF) is now a widely accepted treatment for unexplained infertility (RCOG 1998). However, with estimated livebirth rates per cycle varying between 13% and 28%, it's effectiveness has not been rigorously evaluated in comparison with other treatments. With increasing awareness of the role of expectant management and less invasive procedures such as intrauterine insemination, concerns about multiple complications and costs associated with IVF, it is extremely important to evaluate the effectiveness of IVF against other treatment options in couples with unexplained infertility. ⋯ Any effect of IVF relative to expectant management, clomiphene citrate, IUI with or without ovarian stimulation and GIFT in terms of livebirth rates for couples with unexplained subfertility remains unknown. The studies included are limited by their small sample size, so that even large differences might be hidden. Livebirth rates are seldom reported. Adverse effects such as multiple pregnancies and ovarian hyperstimulation syndrome have also not been reported in most studies. Larger trials with adequate power are warranted to establish the effectiveness of IVF in these women. Future trials should not only report rates per woman /couple but also include adverse effects and costs of the treatments compared as outcomes. Factors that have a major effect on these outcomes such as fertility treatment, female partner's age, duration of infertility and previous pregnancy history should also be considered.
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Naloxone, a specific opiate antagonist, is available for the management of newborn infants with respiratory depression that may be due to transplacentally-acquired opiates. However, it is unclear which groups of newborn infants may benefit from this therapy, and whether naloxone has any harmful effects. ⋯ There is a need for a randomised controlled trial to determine if naloxone confers any clinically important benefits to newborn infants with respiratory depression that may be due to trans-placentally acquired narcotic.