ABSTRACTBACKGROUND: Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy.OBJECTIVES: To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy.METHODS:Search methods:On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies.Selection criteria:We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy.We excluded trials that had a high risk of bias in several domains.Data collection and analysis:Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures.MAIN RESULTS: Eleven trials, including 2883 participants, met the inclusion criteria and are included in the final analysis. We added four studies to the previous review for this update. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recovery:We found no significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.47 to 1.02, n = 1715). For people with severe Bell's palsy (House Brackmann scores of 5 and 6 or the equivalent in other scales), we found aMotor synkinesis or crocodile tears:In three trials comparing antivirals and corticosteroids with corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour or antivirals plus corticosteroids (RR 0.73, 95% CI 0.54 to 0.99, n = 869). Three trials comparing antivirals alone with corticosteroids alone investigating this outcome showed fewer sequelae with corticosteroids (RR 1.44, 95% CI 1.11 to 1.85, n = 873). We found no data on long-term sequelae for other comparisons.Adverse events:Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment; antivirals versus corticosteroids; antivirals plus corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results.AUTHORS' CONCLUSIONS: Moderate-quality evidence from randomised controlled trials showed no additional benefit from the combination of antivirals with corticosteroids compared to corticosteroids alone or with placebo, and no benefit from antivirals alone compared to placebo, for the treatment of Bell's palsy. Moderate-quality evidence showed a small but just significant benefit of combination therapy compared with corticosteroids alone in severe Bell's palsy. We found no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids.

OBJECTIVE: To systematically review the literature on the implementation of e-health to identify: (1) barriers and facilitators to e-health implementation, and (2) outstanding gaps in research on the subject. METHODS: MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework. FINDINGS: Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (1) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (2) factors promoting or inhibiting engagement and participation; (3) effects on roles and responsibilities; (4) risk management, and (5) ways in which implementation processes might be reconfigured by user-produced knowledge. CONCLUSION: The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.

OBJETIVO: Realizar una revisión sistemática de la literatura existente sobre la implementación de la telemedicina para identificar: (1) los obstáculos y estímulos para la implementación de la telemedicina, y (2) las lagunas pendientes en la investigación sobre el tema. MÉTODOS: Se realizó una búsqueda en MEDLINE, EMBASE, CINAHL, PSYCINFO y la Cochrane Library de revisiones publicadas entre el 1 de enero de 1995 y el 17 de marzo de 2009. Los estudios debían ser revisiones sistemáticas, revisiones narrativas, metasíntesis cualitativas o metaetnografías sobre la implementación de la telemedicina. Los resúmenes y documentos se investigaron doblemente y se extrajeron los datos del país de origen, el área de la telemedicina, la fecha de publicación, los objetivos y métodos, las bases de datos buscadas, los criterios de inclusión y exclusión y el número de documentos. Se analizaron los datos de forma cualitativa mediante un proceso de normalización como marco de codificación explicativo. RESULTADOS: De los documentos analizados, 37 cumplían con los criterios de inclusión, 20 habían sido publicados entre 1995 y 2007 y, 17, entre 2008 y 2009. La calidad metodológica fue escasa: 19 documentos no especificaban los criterios de inclusión y exclusión y 13 no indicaban el número concreto de artículos examinados. El uso de un proceso de normalización como marco conceptual reveló la poca atención que se había prestado a: (1) el trabajo dirigido a dotar de sentido a los sistemas de telemedicina, especificando sus objetivos y beneficios, estableciendo su valor para los usuarios y planificando su implementación; (2) los factores que promueven o dificultan el compromiso y la participación; (3) los efectos sobre las funciones y responsabilidades; (4) la gestión del riesgo, y (5) los modos en los que los procedimientos de implementación podrían reconfigurarse con los conocimientos generados por los usuarios. CONCLUSIÓN: La literatura publicada se centró en cuestiones organizativas, descuidando el vasto marco social que debe tenerse en consideración a la hora de introducir nuevas tecnologías.

RÉSUMÉ OBJECTIF: Analyser de façon systématique la documentation sur l'implémentation de l'e-santé afin d'identifier: (1) les éléments entravant et soutenant l'implémentation de l'e-santé, et (2) les lacunes majeures dans la recherche sur le sujet. MÉTHODES: Des recherches ont été réalisées dans MEDLINE, EMBASE, CINAHL, PSYCINFO et la bibliothèque Cochrane afin de trouver les revues publiées entre le 1er janvier 1995 et le 17 mars 2009. Les études devaient consister en des revues systématiques, des revues narratives, des métasynthèses ou des méta-ethnographies qualitatives d'implémentation d'e-santé. Une double analyse fouillée a été effectuée parmi les résumés et les journaux, et les données ont été extraites par pays d'origine, domaine d'e-santé, date de publication, objectifs et méthodes, bases de données analysées, critères d'inclusion et d'exclusion et nombre de journaux inclus. Les données ont été analysées qualitativement au moyen d'une théorie du processus de normalisation comme cadre de codification explicatif. RÉSULTATS: Les critères d'inclusion ont été respectés par 37 journaux, 20 avaient été publiés entre 1995 et 2007, et 17 entre 2008 et 2009. La qualité méthodologique était faible: 19 journaux ne spécifiaient pas les critères d'inclusion et d'exclusion, et 13 n'indiquaient pas le nombre exact d'articles analysés. L'utilisation de la théorie du processus de normalisation comme cadre conceptuel a permis de révéler le peu d'attention portée à: (1) le travail visant à justifier les systèmes d'e-santé, en spécifiant leurs objectifs et leurs avantages, en établissant leur valeur pour les utilisateurs et en planifiant leur implémentation; (2) les facteurs soutenant ou entravant l'engagement et la participation; (3) les effets sur les rôles et les responsabilités; (4) la gestion des risques, et (5) les moyens par lesquels les processus d'implémentation pourraient être reconfigurés par les connaissances des utilisateurs. CONCLUSION: La documentation publiée se concentrait sur les problèmes organisationnels, négligeant le cadre social plus large qui doit être pris en compte en cas d'introduction de nouvelles technologies.