ABSTRACT
OBJECTIVES: To perform a systematic bibliographic review of the literature assessing the quality of life and complications of robotic prostatectomy (RP) versus low-dose rate brachytherapy (LDR-BT) in patients with localized prostate cancer (PCa). PubMed, EMBASE and Cochrane, Centre for Reviews and Dissemination, Emergency Care Research Institute, Web of Knowledge, Technology Evaluation Center, Clinical Evidence, Uptodate, Hayes and Drug Effectiveness Review Project. Systematic reviews and prospective studies comparing RP to LDR-BT in men with localized PCa were included. The primary outcome was quality of life and the secondary endpoint complications rate. RESULTS: Three systematic reviews and four prospective studies were included. RP showed better results than LDR-BT for SF-12-physical domain (p<0.01) and faster recovery to pre-operative scores. LDR-BT improved scores for UCLAPCI questionnaire-urinary and sexual domains compared to RP during the first three years of follow-up (p<0.001). First postoperative year urinary incontinence rate was favorable for LDR-BT (88.0% vs 84.5%, p<0.001). No differences for intestinal function scores for the first three post-intervention years (p = 0.02) were found. Major complications of LDR-BT were gastrointestinal and genitourinary toxicity, although pooled weighted events rate of the studies was not analyzed. CONCLUSIONS: LDR-BT improves quality of life in terms of urinary and sexual function in patients with localized PCa vs RP during the first three years post-intervention.
Subject(s)
Brachytherapy , Prostatectomy/methods , Prostatic Neoplasms/radiotherapy , Prostatic Neoplasms/surgery , Quality of Life , Robotic Surgical Procedures , Humans , Male , Prospective Studies , Prostatic Neoplasms/pathologyABSTRACT
INTRODUCTION: Vulvovaginal candidiasis is estimated to be the second most common cause of vaginitis after bacterial vaginosis. Candida albicans accounts for 85% to 90% of cases. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for acute vulvovaginal candidiasis in non-pregnant symptomatic women? What are the effects of alternative or complementary treatments for acute vulvovaginal candidiasis in non-pregnant symptomatic women? What are the effects of treating asymptomatic non-pregnant women with a positive swab for candidiasis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 23 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: alternative or complementary treatments; douching; drug treatments; garlic; intravaginal preparations (nystatin, imidazoles, tea tree oil); oral fluconazole; oral itraconazole; and yoghurt containing Lactobacillus acidophilus (oral or intravaginal).
Subject(s)
Candidiasis, Vulvovaginal/therapy , Antifungal Agents/therapeutic use , Candidiasis, Vulvovaginal/drug therapy , Complementary Therapies , Female , Fluconazole/therapeutic use , Humans , Itraconazole/therapeutic use , Yogurt/microbiologyABSTRACT
El objetivo de esta guía es establecer un conjunto de recomendaciones basadas en la evidencia científica de mayor calidad disponible para mejorar la salud de las mujeres embarazadas y puérperas, así como la salud de los y las recién nacidos.
Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/prevention & control , Prenatal Care , Primary Health Care , Postpartum Period , Maternal-Child Health Services/standards , Pregnancy Complications, Infectious/prevention & control , Immunotherapy, Active , Prenatal Nutrition , GRADE ApproachABSTRACT
La guía tiene por objetivo ofrecer a los profesionales implicados en el manejo de la artroplastia de rodilla un conjunto de recomendaciones basadas en la mejor evidencia científica disponible, como herramienta de ayuda a la toma de decisiones, con el fin último de optimizar los resultados en salud, disminuir la variabilidad de la práctica clínica y maximizar la eficiencia. Como objetivos específicos se formulan los siguientes: valorar la efectividad de la artroplastia de rodilla para disminuir el dolor, la rigidez y la limitación funcional de los pacientes con artrosis en dicha articulación, así como para mejorar su calidad de vida; valorar la seguridad de la artroplastia de rodilla -en términos de complicaciones incluyendo mortalidad- en pacientes con artrosis; determinar las características de los pacientes con artrosis de rodilla, en los que la artroplastia de rodilla ha resultado efectiva en la disminución del dolor y complicaciones, así como en la mejora de la rigidez, limitación funcional y calidad de vida.
