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Replaces certain hormones when the body does not make enough, such as in Addison's disease. Sometimes used to treat low blood pressure. Belongs to a class of drugs called mineralocorticoids.

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Results: 14

A systematic review of the management of orthostatic hypotension after spinal cord injury

This review concluded that among pharmacologic interventions, there was supportive evidence for use of midodrine in management of orthostatic hypotension after spinal cord injury. Functional electrical stimulation was one of the only nonpharmacologic interventions with some evidence to support its utility. Small sample sizes and poor-quality included studies mean these conclusions may be not reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage

There is no evidence of benefit from corticosteroids for patients with stroke due to bleeding. About one fifth of all strokes are due to bursting of an artery. The burst artery causes bleeding into the brain itself (called intracerebral haemorrhage) or into the space around the brain (called subarachnoid haemorrhage). After either type of bleed the brain tissue may become swollen. The swelling causes a rise in pressure which can cause further brain damage or even death. Corticosteroids could reduce swelling after brain haemorrhage and so improve the chances of the patient recovering. However, corticosteroids can also have important adverse effects such as increased blood sugars, infection, and gastrointestinal bleeding. The trials included in this review had too few participants to provide reliable evidence on any benefits weighed against harms of this treatment for patients with stroke due to bleeding in the brain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Drugs and pacemakers for transient loss of consciousness

Neurally mediated reflex syncope (including fainting) is the most common cause of transient loss of consciousness. It is caused by a sudden decrease in blood pressure and/or lowering of heart rate. The main treatment goal therefore is to increase blood pressure and heart rate. In most patients, this can be achieved by non‐pharmacological treatment measures (e.g. adequate fluid and salt intake, physical counterpressure manoeuvres). In patients not responding to this treatment, pharmacological or pacemaker treatment might be considered. We investigated the effectiveness of these treatments for different subtypes of neurally mediated reflex syncope, namely vasovagal syncope (fainting), carotid sinus syncope (fainting due to pressure on the neck) and situational syncope (fainting when passing urine of faeces or swallowing). Where data were available, we determined the treatment effectiveness for different outcome measures including occurrence of syncope, amount of (pre‐)syncopes per year during follow‐up and quality of life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature

This review concluded that prolonged glucocorticoid treatment significantly improved outcomes when administered within 14 days to patients with acute lung injury-acute respiratory distress syndrome. Given several limitations with the included studies (such as small sample size and potential study differences) and poor reporting in the review, the authors' conclusions should be interpreted with caution as they may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Metastatic Spinal Cord Compression: Diagnosis and Management of Patients at Risk of or with Metastatic Spinal Cord Compression

It is difficult to know what the true incidence of metastatic spinal cord compression (MSCC) is in England and Wales because the cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Ontario, Canada, suggests that the incidence may be up to 80 cases per million population per year. This would mean around 4000 cases per year in England and Wales or more than 100 cases per cancer network per year.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: November 2008
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Efficacy of treatments for orthostatic hypotension: a systematic review

This review of 36 trials concluded that the 21 commonly recommended interventions for orthostatic hypotension had a limited evidence base supporting their use, so further large, high quality, randomised controlled trials were needed to underpin clinical practice for this condition. These conclusions reflect the evidence and are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Role of corticosteroids in the management of acute respiratory distress syndrome

This review found evidence to support the use of lower doses of corticosteroids for treating early and late phase acute respiratory distress syndrome, but not the use of short-course, high-dose corticosteroids. Given the lack of some methodological information, and the limitations of the evidence, the reliability of the authors' conclusions is unknown.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (or Encephalopathy): Diagnosis and Management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (or Encephalopathy) in Adults and Children [Internet]

The guideline covers care provided by healthcare professionals who have direct contact with and make decisions about the care of people with chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) (CFS/ME). It covers care provided in primary and secondary care, and in specialist centres/teams.

NICE Clinical Guidelines - National Collaborating Centre for Primary Care (UK).

Version: August 2007
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Lack of evidence for qualitative treatment by disease severity interactions in clinical studies of severe sepsis

This review assessed the evidence for a relationship between treatment efficacy and disease severity in patients with severe sepsis. The authors concluded that there is no evidence to support a relationship between the severity of disease and the effect of treatment on mortality. Poor reporting and a limited search mean it is not possible to determine the reliability of the conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care

This guideline covers bacterial meningitis and meningococcal septicaemia, focusing on management of these conditions in children and young people aged younger than 16 years in primary and secondary care, and using evidence of direct relevance to these age groups where available.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: 2010
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Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People [Internet]

There are a number of existing guidelines, for epilepsy, falls and cardiac arrhythmias; which all relate to transient loss of consciousness (TLoC), but there is no guideline which addresses the initial assessment and management of patients who blackout. As such patients may come under the care of a range of clinicians, the lack of a clear pathway contributes to their misdiagnosis, and inappropriate treatment.

NICE Clinical Guidelines - National Clinical Guideline Centre for Acute and Chronic Conditions (UK).

Version: August 2010
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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Updating Systematic Reviews

Systematic reviews are often advocated as the best source of evidence to guide both clinical decisions and healthcare policy, yet we know very little about the extent to which they require updating.

Technical Reviews - Agency for Healthcare Research and Quality (US).

Version: September 2007
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Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care

It is almost 200 years since James Parkinson described the major symptoms of the disease that came to bear his name. Slowly but surely our understanding of the disease has improved and effective treatment has been developed, but Parkinson’s disease remains a huge challenge to those who suffer from it and to those involved in its management. In addition to the difficulties common to other disabling neurological conditions, the management of Parkinson’s disease must take into account the fact that the mainstay of pharmacological treatment, levodopa, can eventually produce dyskinesia and motor fluctuation. Furthermore, there are a number of agents besides levodopa that can help parkinsonian symptoms, and there is the enticing but unconfirmed prospect that other treatments might protect against worsening neurological disability. Thus, a considerable degree of judgement is required in tailoring individual therapy and in timing treatment initiation. It is hoped that this guideline on Parkinson’s disease will be of considerable help to those involved at all levels in these difficult management decisions. The guideline has been produced using standard NICE methodology and is therefore based on a thorough search for best evidence.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: 2006
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Systematic Reviews in PubMed

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