Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Oct 2008
Review Meta AnalysisDrugs for treating uncomplicated malaria in pregnant women.
Women are more vulnerable to malaria during pregnancy, and malaria infection may have adverse consequences for the fetus. Identifying safe and effective treatments is important. ⋯ Data are scant. Some combination treatments appear to be effective at treating malaria in pregnancy; however, safety data are limited.
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Cochrane Db Syst Rev · Oct 2008
Review Meta AnalysisDifferent corticosteroids and regimens for accelerating fetal lung maturation for women at risk of preterm birth.
Despite the widespread use of antenatal corticosteroids to prevent respiratory distress syndrome in preterm infants, there is currently no consensus as to the type of corticosteroid to use; nor the dose, frequency or timing of use or the route of administration. ⋯ Dexamethasone may have some benefits compared with betamethasone such as less intraventricular haemorrhage, although perhaps a higher rate of NICU admission (seen in only one trial). Apart from a suggestion from another small trial that the intramuscular route may have advantages over an oral route for dexamethasone, few other conclusions about optimal antenatal corticosteroid regimens were able to be made. Trials of commonly used corticosteroids are most urgently needed, followed by trials of dosages and other variations in regimens.
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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
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.