Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisRemacemide for drug-resistant localization related epilepsy.
Epilepsy is a common neurological condition, affecting 0.5 to 1% of the population. Nearly 30 per cent of people with epilepsy have seizures that are refractory to currently available drugs. In response to this problem, potential new drugs are being developed. Remacemide is one of these. ⋯ Given the modest effect on seizure frequency and significant withdrawal rate it is unlikely that remacemide will be further developed as an antiepileptic drug.
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Cochrane Db Syst Rev · Jan 2002
ReviewNocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease.
Nocturnal non-invasive positive pressure ventilation (NIPPV) might be beneficial in stable hypercapnic patients with chronic obstructive pulmonary disease (COPD). However, evidence remains equivocal as conflicting results have been published. ⋯ Nocturnal NIPPV for at least 3 months in hypercapnic patients with stable COPD had no consistent clinically or statistically significant effect on lung function, gas exchange, respiratory muscle strength, sleep efficiency or exercise tolerance. However, the small sample sizes of these studies precludes a definite conclusion regarding the effects of NIPPV in COPD.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisOpen mesh versus non-mesh for repair of femoral and inguinal hernia.
Inguinal hernia repair is the most frequent operation in general surgery. Until recently the standard procedure has been open musculo-aponeurotic repair using sutures under tension to close the defect but 'tension-free' repair using prosthetic mesh is becoming increasingly common in many countries. ⋯ There is evidence that the use of open mesh repair is associated with a reduction in the risk of recurrence of between 50% and 75%. Although the trials were heterogeneous there is also some evidence of quicker return to work and of lower rates of persisting pain following mesh repair.
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Cochrane Db Syst Rev · Jan 2002
ReviewHypertonic versus isotonic crystalloid for fluid resuscitation in critically ill patients.
Hypertonic solutions are considered to have a greater ability to expand blood volume and thus elevate blood pressure and can be administered as a small volume infusion over a short time period. On the other hand, the use of hypertonic solutions for volume replacement may also have important disadvantages. ⋯ This review does not give us enough data to be able to say whether hypertonic crystalloid is better than isotonic crystalloid for the resuscitation of patients with trauma, burns, or those undergoing surgery. However, the confidence intervals are wide and do not exclude clinically significant differences. Further trials are needed comparing hypertonic to isotonic crystalloid. Trials need to be large enough to detect a clinically important difference.
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Cochrane Db Syst Rev · Jan 2002
ReviewOpioid antagonists with minimal sedation for opioid withdrawal.
Managed withdrawal (detoxification) is necessary prior to drug-free treatment. It may also represent the end point of long-term opioid replacement treatment such as methadone maintenance. ⋯ The use of opioid antagonists combined with alpha2 adrenergic agonists is feasible and probably increases the likelihood of transfer to naltrexone compared to withdrawal managed primarily with an adrenergic agonist. A high level of monitoring and support is desirable for several hours following administration of opioid antagonists because of the possibility of vomiting, diarrhoea and delirium. Further research is required to confirm the relative effectiveness of antagonist-induced regimes, as well as variables influencing the severity of withdrawal, adverse effects, the most effective antagonist-based treatment regime, and approaches that might increase retention in subsequent naltrexone maintenance treatment.