Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisAntibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section.
The single most important risk factor for postpartum maternal infection is cesarean section. Routine prophylaxis with antibiotics may reduce this risk and should be assessed in terms of benefits and harms. ⋯ Endometritis was reduced by two thirds to three quarters and a decrease in wound infection was also identified. However, there was incomplete information collected about potential adverse effects, including the effect of antibiotics on the baby, making the assessment of overall benefits and harms complicated. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is clearly beneficial for women but there is uncertainty about the consequences for the baby.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisOpioid antagonists under heavy sedation or anaesthesia for opioid withdrawal.
Withdrawal (detoxification) is necessary prior to drug-free treatment or as the end point of long-term substitution treatment. ⋯ Heavy sedation compared to light sedation does not confer additional benefits in terms of less severe withdrawal or increased rates of commencement on naltrexone maintenance treatment. Given that the adverse events are potentially life-threatening, the value of antagonist-induced withdrawal under heavy sedation or anaesthesia is not supported. The high cost of anaesthesia-based approaches, both in monetary terms and use of scarce intensive care resources, suggest that this form of treatment should not be pursued.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisBlood pressure lowering efficacy of potassium-sparing diuretics (that block the epithelial sodium channel) for primary hypertension.
Potassium-sparing diuretics, which block the epithelial sodium channel (ENaC), are widely prescribed for hypertension as a second-line drug in patients taking other diuretics (e.g. thiazide diuretics) and much less commonly prescribed as monotherapy. Therefore, it is essential to determine the effects of ENaC blockers on blood pressure (BP), heart rate and withdrawals due to adverse effects (WDAEs) when given as a first-line or second-line therapy. ⋯ ENaC blockers do not have a statistically or clinically significant BP lowering effect at low doses but trials at higher doses are not available. The review did not provide a good estimate of the incidence of harms associated with ENaC blockers.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisPsychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users.
Drug users (including both injection drug users and crack cocaine users), are at high levels of risk for contracting HIV. Therefore it is important to reduce the injection and/or sexual risk behaviours of these groups both for the benefit of themselves and for society as a whole. ⋯ There is limited support for the widespread use of formal multi-session psychosocial interventions for reducing injection and sexual risk behaviour. Brief standard education interventions appear to be a more cost-effective option. Further research is required to assess if there are particular groups of drug users more likely to respond to such interventions.
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Cochrane Db Syst Rev · Jan 2010
Review Meta AnalysisNutritional supplementation for hip fracture aftercare in older people.
Older people with hip fractures are often malnourished at the time of fracture, and have poor food intake subsequently. ⋯ Weak evidence exists for the effectiveness of protein and energy feeds. Adequately sized randomised trials with robust methodology are required. In particular, the role of dietetic assistants, and peripheral venous feeding require further evaluation.