Cochrane Db Syst Rev
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Primary postpartum haemorrhage (PPH) is one of the top five causes of maternal mortality in both developed and developing countries. ⋯ There is insufficient evidence to show that the addition of misoprostol is superior to the combination of oxytocin and ergometrine alone for the treatment of primary PPH. Large multi-centre, double-blind, randomised controlled trials are required to identify the best drug combinations, route, and dose of uterotonics for the treatment of primary PPH. Further work is required to assess the best way of managing women who fail to respond to uterotonics therapy.
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Cochrane Db Syst Rev · Jan 2007
ReviewTypes of indwelling urinary catheters for long-term bladder drainage in adults.
Prolonged urinary catheterisation is common amongst people in long-term care settings and this carries a high risk of developing a catheter-related urinary tract infection and associated complications. A variety of different kinds of urethral catheters are available. Some have been developed specifically to lower the risk of catheter-associated infection, for example antiseptic or antibiotic impregnated catheters. Ease of use, comfort and handling for the caregivers and patients, and cost-effectiveness are also important factors influencing choice. ⋯ Very few trials have compared types of catheter for long-term bladder drainage. All were small and showed methodically weaknesses. Therefore, the evidence was not sufficient as a reliable basis for practical conclusions. Further, better quality trials are needed to address the current lack of evidence in this clinically important area.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisRoutine abdominal drainage for uncomplicated liver resection.
The main reasons for inserting a drain after elective liver resections are (i) prevention of sub-phrenic or sub-hepatic fluid collection; (ii) identification and monitoring of post-operative bleeding; (iii) identification and drainage of any bile leak; and (iv) prevent the accumulation of ascitic fluid in cirrhotics. However, there are reports that drain use increases the complication rates. ⋯ There is no evidence to support routine drain use after uncomplicated liver resections.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisMethods of vascular occlusion for elective liver resections.
Vascular occlusion is used to reduce blood loss during liver resection surgery. There is considerable controversy regarding whether vascular occlusion should be used or not during elective liver resections. The method of vascular occlusion employed is also controversial. There is also considerable debate on the role of ischaemic preconditioning before vascular occlusion. ⋯ Intermittent vascular occlusion seems safe in liver resection. However, it does not seem to decrease morbidity. Among the different methods of vascular occlusion, intermittent portal triad clamping has most evidence to support the clinical application. Hepatic vascular exclusion cannot be recommended routinely. Ischaemic preconditioning before continuous portal triad clamping may be of clinical benefit in reducing intensive therapy unit and hospital stay.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisCup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed.
Breast milk provides optimal nutrition for newborn infants, and the ideal way for infants to receive breast milk is through suckling at the breast. Unfortunately, this may not always be possible, as there are numerous reasons why a newborn infant may not be able to breastfeed and, as a result, require supplemental feeding. Currently, there are a variety of ways in which newborn infants can receive supplemental feeds. Traditionally, bottles and nasogastric tubes have been used; however, more recently, cup feeding has become a popular practice in many nurseries in an attempt to improve breastfeeding rates. There is no consistency to guide the choice of supplementation. ⋯ Cup feeding cannot be recommended over bottle feeding as a supplement to breastfeeding because it confers no significant benefit in maintaining breastfeeding beyond hospital discharge and carries the unacceptable consequence of a longer stay in hospital.