Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisPsychological therapies for the management of chronic and recurrent pain in children and adolescents.
Headache, recurrent abdominal pain, and musculoskeletal pain affect many children, who report severe pain, distressed mood, and disability. Psychological therapies are emerging as effective interventions to treat children with chronic or recurrent pain. This is a substantially updated and expanded version of the Cochrane review published in 2003. ⋯ Psychological treatments are effective in pain control for children with headache and benefits appear to be maintained. Psychological treatments may also improve pain control for children with musculoskeletal and recurrent abdominal pain. There is little evidence available to estimate effects on disability or mood.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisParacervical local anaesthesia for cervical dilatation and uterine intervention.
Cervical dilatation and uterine intervention can be performed under sedation, local or general anaesthesia for obstetrics and gynaecological conditions. Many gynaecologists use paracervical local anaesthesia (PLA) but its effectiveness is unclear. ⋯ No technique provided reliable pain control in the 17 included studies. Some studies reported that women experienced severe pain (mean scores of 7 to 9 out of 10) during uterine intervention, irrespective of the analgesic technique used. We concluded that the available evidence fails to show whether paracervical block is inferior, equivalent or superior to alternative analgesic techniques, in terms of efficacy and safety, for women undergoing uterine interventions.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisRapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department.
Pediatric acute respiratory infections (ARIs) represent a significant burden on pediatric emergency departments (ED) and families. Most of these illnesses are due to viruses. However, investigations (radiography, blood and urine testing) to rule out bacterial infections and antibiotics are often ordered because of diagnostic uncertainties. This results in prolonged ED visits and unnecessary antibiotic use. The risk of concurrent bacterial infection has been reported to be negligible in children over three months of age with a confirmed viral infection. Rapid viral testing in the ED may alleviate the need for precautionary testing and antibiotic use. ⋯ Current evidence is insufficient, although promising, to support routine rapid viral testing as a means to reduce antibiotic use in pediatric EDs. Results suggest that rapid viral testing may be beneficial but are not statistically significant due to lack of power. A large trial addressing these outcome measures is needed.
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Cochrane Db Syst Rev · Jan 2009
ReviewSurgical interventions for treating acute fractures or non-union of the middle third of the clavicle.
This review covers two conditions. These are acute fractures and non-union resulting from failed fracture healing. Clavicle or collarbone fractures account for around 4% of all fractures. While treatment of these fractures is usually non-operative, some types of fractures, as well as non-union of the middle third of the clavicle, are often treated surgically. ⋯ There is limited evidence, from single trials only, regarding the effectiveness of different methods of surgical fixation of fractures and non-union of the middle third of the clavicle.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisSurgery for thumb (trapeziometacarpal joint) osteoarthritis.
This is an update of a Cochrane Review first published in 2005. Surgery has been used to treat persistent pain and dysfunction at the base of the thumb. However, there is no evidence to suggest that any one surgical procedure is superior to another. ⋯ Although it appears that no one procedure produces greater benefit in terms of pain and physical function, there was insufficient evidence to be conclusive. Trapeziectomy has fewer complications than trapeziectomy with LRTI.