Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2009
ReviewInterventions for increasing the proportion of health professionals practising in rural and other underserved areas.
The inequitable distribution of health professionals, within and between countries, poses an important obstacle to the achievement of optimal attainable health for all. ⋯ There are no studies in which bias and confounding are minimised to support any of the interventions that have been implemented to address the inequitable distribution of health care professionals. Well-designed studies are needed to confirm or refute findings of various observational studies regarding educational, financial, regulatory and supportive interventions that may influence health care professionals' choice to practice in underserved areas. Governments and educators should ensure that where interventions are implemented this is done within the context of a well-planned study so that the true effects of these measures on recruitment and long term retention can be determined in various settings.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisInterventions for preventing late postnatal mother-to-child transmission of HIV.
Worldwide, mother-to-child transmission (MTCT) of human immunodeficiency virus type 1 (HIV) represents the most common means by which children acquire HIV infection. Efficacious and effective interventions to prevent in utero and intrapartum transmission of HIV infection have been developed and implemented. However, a large proportion of MTCT of HIV occurs postnatally, through breast milk transmission. ⋯ Complete avoidance of breastfeeding is efficacious in preventing MTCT of HIV, but this intervention has significant associated morbidity (e.g., diarrheal morbidity if formula is prepared without clean water). If breastfeeding is initiated, two interventions 1). exclusive breastfeeding during the first few months of life; and 2) chronic antiretroviral prophylaxis to the infant (nevirapine alone, or nevirapine with zidovudine) are efficacious in preventing transmission.
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Cochrane Db Syst Rev · Jan 2009
ReviewInterventions for treating painful sickle cell crisis during pregnancy.
Sickle cell disease is a group of genetic haemoglobin disorders. All over the world, about 300,000 children with these disorders are born each year. Acute sickle cell pain episodes are the most common cause of hospitalisation. Pregnancy in women with sickle cell disease is associated with an increased incidence of maternal and fetal morbidity and mortality. The painful crisis is a severe complication of this illness, and it requires several interventions: packed red cell transfusion, fluid replacement therapy, analgesic drugs, oxygen therapy and steroids; but the approach is not standardised. ⋯ This review found no randomised clinical trials on the safety and efficacy of interventions for treating painful sickle cell crisis during pregnancy. The effects of interventions need to be tested in randomised clinical trials.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisTechniques for liver parenchymal transection in liver resection.
Blood loss during elective liver resection is one of the main factors affecting the surgical outcome. Different parenchymal transection techniques have been suggested to decrease blood loss. ⋯ Clamp-crush technique is advocated as the method of choice in liver parenchymal transection because it avoids special equipment, whereas the newer methods do not seem to offer any benefit in decreasing the morbidity or transfusion requirement.
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Cochrane Db Syst Rev · Jan 2009
ReviewWITHDRAWN: Orthotic devices for treating patellofemoral pain syndrome.
Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies have been described. As yet, no optimal strategy has been identified. Application of orthotic devices e.g. knee braces, knee straps, forms of taping of the knee, active training devices, knee sleeves and inlay soles to support the foot have been advocated to treat this condition. ⋯ The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of knee and foot orthotics for the treatment of patellofemoral pain. Future high quality trials in this field are warranted.