Cochrane Db Syst Rev
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Admission avoidance hospital at home is a service that provides active treatment by health care professionals in the patient's home for a condition that otherwise would require acute hospital in-patient care, and always for a limited time period. In particular, hospital at home has to offer a specific service to patients in their home requiring health care professionals to take an active part in the patients' care. If hospital at home were not available then the patient would be admitted to an acute hospital ward. Many countries are adopting this type of care in an attempt to reduce the demand for acute hospital admission. ⋯ We performed meta-analyses where there was sufficient similarity among the trials and where common outcomes had been measured. There is no evidence from the analysis to suggest that admission avoidance hospital at home leads to outcomes that differ from inpatient hospital care.
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Cochrane Db Syst Rev · Oct 2008
ReviewAdrenaline (epinephrine) for the treatment of anaphylaxis with and without shock.
Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may cause death. Adrenaline is recommended as the initial treatment of choice for anaphylaxis. ⋯ Based on this review, we are unable to make any new recommendations on the use of adrenaline for the treatment of anaphylaxis. Although there is a need for randomized, double-blind, placebo-controlled clinical trials of high methodological quality in order to define the true extent of benefits from the administration of adrenaline in anaphylaxis, such trials are unlikely to be performed in individuals with anaphylaxis. Indeed, they might be unethical because prompt treatment with adrenaline is deemed to be critically important for survival in anaphylaxis. Also, such studies would be difficult to conduct because anaphylactic episodes usually occur without warning, often in a non-medical setting, and differ in severity both among individuals and from one episode to another in the same individual. Consequently, obtaining baseline measurements and frequent timed measurements might be difficult, or impossible, to obtain. In the absence of appropriate trials, we recommend, albeit on the basis of less than optimal evidence, that adrenaline administration by intramuscular (i.m.) injection should still be regarded as first-line treatment for the management of anaphylaxis.
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The integration of smart home technology to support health and social care is acquiring an increasing global significance. Provision is framed within the context of a rapidly changing population profile, which is impacting on the number of people requiring health and social care, workforce availability and the funding of healthcare systems. ⋯ This review highlights the current lack of empirical evidence to support or refute the use of smart home technologies within health and social care, which is significant for practitioners and healthcare consumers.
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Cochrane Db Syst Rev · Oct 2008
Review Meta AnalysisAbsorbent products for moderate-heavy urinary and/or faecal incontinence in women and men.
Incontinence is a common and embarrassing problem which has a profound effect on social and psychological well-being. Many people wear absorbent products to contain urine and/or faeces and protect their clothes and dignity. Users of absorbent pads are very diverse, including younger women, particularly those who have had children, older men with prostate disease, people with neurological conditions and older people with mobility and mental impairment. Whilst small absorbent pads for light incontinence are adequate for some users with low volumes of urine loss, for others with higher volumes more absorbent products are needed. A practical definition of moderate-heavy incontinence is urine or faecal loss that requires a large absorbent pad (typically with a total absorbent capacity of 2000 g to 3000 g) for containment. ⋯ Although data were available from only two eligible trials the data were sufficiently robust to make some recommendations for practice. There is evidence that different designs are better for men and women. Diapers are the most cost-effective disposable design for men. Disposable pull-ups are most preferred for women but are expensive: disposable inserts are a cheaper alternative (except in nursing homes where diapers are preferred to inserts at night). Washable diapers are the cheapest design but have limited acceptability, confined mainly to some men at night. There were not enough people in the trials to draw any conclusions about which designs are best for faecal incontinence and no particular design seemed to be better or worse for skin health. People have different preferences for absorbent product designs and using a combination (different designs for day/night, going out/staying in) may be more effective and less expensive than using one design all the time.
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Cochrane Db Syst Rev · Oct 2008
Review Meta AnalysisCaudal epidural block versus other methods of postoperative pain relief for circumcision in boys.
Techniques to minimize the postoperative discomfort of penile surgery, such as circumcision, include caudal block; penile block; systemic opioids and topical local anaesthetic cream, emulsion or gel. ⋯ Differences in the need for rescue or other analgesia could not be detected between caudal, parenteral and penile block methods. In day-case surgery, penile block may be preferable to caudal block in children old enough to walk due to the possibility of temporary leg weakness after caudal block. Evidence from trials is limited by small numbers and poor methodology. There is a need for properly designed trials comparing caudal epidural block with other methods such as morphine, simple analgesics and topical local anaesthetic creams, emulsions or gels.