Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2003
ReviewConservative interventions for treating distal radial fractures in adults.
Fracture of the distal radius is a common clinical problem particularly in elderly white women with osteoporosis. ⋯ There remains insufficient evidence from randomised trials to determine which methods of conservative treatment are the most appropriate for the more common types of distal radial fractures in adults. Therefore, at present, practitioners applying conservative management should use an accepted technique with which they are familiar, and which is cost-effective from the perspective of their provider unit. Patient preferences and circumstances, and the risk of complications should also be considered. Prioritising research questions to clarify the most appropriate conservative treatment for this common fracture is warranted. Researchers should differentiate between extra-articular and intra-articular, and non-displaced and displaced fractures, ascertain patient preferences, and agree a core outcome data set.
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Cochrane Db Syst Rev · Jan 2003
ReviewPlatelet-rich-plasmapheresis for minimising peri-operative allogeneic blood transfusion.
Concerns regarding the safety of transfused blood have generated considerable enthusiasm for the use of technologies intended to reduce the use of allogeneic blood (blood from an unrelated donor). Platelet-rich plasmapheresis (PRP) offers an alternative approach to blood conservation. ⋯ Although the results suggest that PRP is effective in reducing allogeneic RBC transfusion in adult patients undergoing elective surgery, there was considerable heterogeneity in treatment effects and the trials were of poor methodological quality. As the majority of trials were unblinded, transfusion practices may have been influenced by knowledge of the patient's allocation status, potentially exaggerating the true magnitude of the beneficial effect of PRP. The available studies provided inadequate data for firm conclusions to be drawn regarding the impact of PRP on clinically important endpoints.
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Cochrane Db Syst Rev · Jan 2003
ReviewTranscranial magnetic stimulation for the treatment of obsessive-compulsive disorder.
Transcranial magnetic stimulation (TMS) was introduced as a neurophysiological technique in 1985 when Anthony Barker and his team developed a compact machine that permitted non-invasive stimulation of the cerebral cortex (Barker 1985). Since its introduction, TMS has been used to evaluate the motor system, to study the function of several cerebral regions, and for the pathophysiology of several neuropsychiatric illnesses. In addition, it has been suggested that TMS might have therapeutic potential. Some controlled studies have evaluated the effects of repetitive TMS (rTMS) in patients with obsessive-compulsive disorder (OCD). Greenberg (Greenberg 1997) observed that a single session of right prefrontal cortex stimulation produced a significant decrease in compulsive urges in OCD patients lasting over eight hours. Other studies have reported transitory improvements in mood but there are no observations for changes in anxiety or obsessions. ⋯ There are currently insufficient data from randomised controlled trials to draw any conclusions about the efficacy of transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder.
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Cochrane Db Syst Rev · Jan 2003
ReviewTransient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics.
Spinal anaesthesia has been in use since the turn of the late 19th century. The most serious complication of this technique is damage to the spinal cord or nerve roots resulting in lasting neurologic sequelae. Such serious adverse effects seldom happen. There has been an increase in the number of reports during the last nine years implicating lidocaine as a possible cause of temporary and permanent neurologic complications after spinal anaesthesia. Follow-up of patients who received uncomplicated spinal anaesthesia revealed that some of them developed pain in the lower extremities after an initial full recovery. This painful condition that occurs in the immediate post-operative period was named "transient neurologic symptoms" (TNS). ⋯ The risk of developing TNS after spinal anaesthesia with lidocaine was significantly higher than when bupivacaine, prilocaine and procaine were used. The term "TNS", which implies a positive neurologic finding, should not be used for this painful condition, which is in fact comparable to another common adverse effect after spinal anaesthesia - lower back pain. How much the pain in the lower extremities influences patient satisfaction is not elucidated clearly in the literature.
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Cochrane Db Syst Rev · Jan 2003
ReviewSelf-management education for chronic obstructive pulmonary disease.
In asthma, self-management programmes have been proven to be effective. In COPD, their value is not clear. ⋯ The data available for this review are insufficient for forming recommendations. Further research on the effectiveness of self-management programmes should be focussed on behavioural change evaluated in well designed randomised controlled trials with standardised outcomes designed for use in COPD patients, and with long follow-up time so that definite conclusions can be made.