Cochrane Db Syst Rev
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Trabeculectomy is performed as a treatment for many types of glaucoma in an attempt to lower the intra-ocular pressure. The surgery involves creating a channel through the sclera, through which intra-ocular fluid can leave the eye. If scar tissue blocks the exit of the surgically created channel intra-ocular pressure rises and the operation fails. Antimetabolites such as 5-Fluorouracil are used to inhibit wound healing to prevent the conjunctiva scarring down on to the sclera. ⋯ Post-operative injections of 5-Fluorouracil are now rarely used as a planned series but are increasingly used on an ad hoc basis. This presumably reflects an aspect of the treatment that is unacceptable to both patients and doctors. None of the trials reported on the participants' perspective of care which constitutes a serious omission for an invasive treatment such as this.
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Cochrane Db Syst Rev · Jan 2001
ReviewValproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder.
Although lithium has been the most commonly used maintenance treatment in bipolar disorder for several decades, valproate is being used increasingly - especially in the United States of America. There is a need to clarify whether the increasingly prominent prophylactic role of valproate in bipolar disorder is justified. ⋯ In view of the equivocal findings of this review, conclusions about the efficacy and acceptability of valproate compared to placebo and lithium cannot be made with any degree of confidence. With current evidence, patients and clinicians would probably wish to use lithium before valproate for maintenance treatment. At present, the observed shift of prescribing practice to valproate is not based on reliable evidence of efficacy
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Menière's disease is characterised by attacks of hearing loss, tinnitus and disabling vertigo. Betahistine is used by many people to reduce the frequency and severity of these attacks but there is conflicting evidence relating to its effects. ⋯ There is insufficient evidence to say whether betahistine has any effect on Menière's disease.
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The reinforcing properties of nicotine may be mediated through release of various neurotransmitters both centrally and systemically. Smokers report positive effects such as pleasure, arousal, and relaxation as well as relief of negative affect, tension, and anxiety. Opioid (narcotic) antagonists are of particular interest to investigators as potential agents to attenuate the rewarding effects of cigarette smoking. ⋯ Based on limited data from two trials it is not possible to confirm or refute whether naltrexone helps smokers quit. The confidence intervals are compatible with both clinically significant benefit and possible negative effects of naltrexone in promoting abstinence. Data from larger trials of naltrexone are needed to settle the question of efficacy for smoking cessation.
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Cochrane Db Syst Rev · Jan 2001
ReviewRestricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants.
Whilst the use of supplemental oxygen has a long history in neonatal care, resulting in both significant health care benefits and harms, uncertainty remains as to the most appropriate range to target blood oxygen levels in preterm and low birth weight infants. Potential benefits of higher oxygen targeting include more stable sleep patterns and improved long term growth and development. However, there may be significant deleterious pulmonary effects and health service use implications resulting from such a policy. ⋯ The results of this systematic review confirm the commonly held view of today's clinicians that a policy of unrestricted, unmonitored oxygen therapy has potential harms, without clear benefits. However, the question of what is the optimal target range for maintaining blood oxygen levels in preterm/LBW infants was not answered by the data available for inclusion in this review.