Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2011
Review Meta AnalysisXylitol for preventing acute otitis media in children up to 12 years of age.
Acute otitis media (AOM) is the most common bacterial infection among young children in the United States with limitations and concerns over its treatment with antibiotics and surgery. Therefore, effective preventative measures are attractive. A potential preventative measure is xylitol, a natural sugar substitute that reduces the risk for dental decay. Xylitol can reduce the adherence of Streptococcus pneumoniae (S. pneumoniae) and Haemophilus influenzae (H. influenzae) to nasopharyngeal cells in vitro. ⋯ There is fair evidence that the prophylactic administration of xylitol among healthy children attending day care centres reduces the occurrence of AOM by 25%. This meta-analysis is limited since the data arise from a small number of studies, mainly from the same research group.
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Cochrane Db Syst Rev · Jan 2011
Review Meta AnalysisSocial skills training for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years.
Attention Deficit Hyperactivity Disorder (ADHD) in children is associated with hyperactivity and impulsitivity, attention problems, and difficulties with social interactions. Pharmacological treatment may alleviate symptoms of ADHD but seldom solves difficulties with social interactions. Social skills training may benefit ADHD children in their social interactions. We examined the effects of social skills training on children's social competences, general behaviour, ADHD symptoms, and performance in school. ⋯ The review suggests that there is little evidence to support or refute social skills training for adolescents with ADHD. There is need for more trials, with low risk of bias and with a sufficient number of participants, investigating the efficacy of social skills training versus no training for both children and adolescents.
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Cochrane Db Syst Rev · Jan 2011
Review Meta AnalysisTracheal suctioning without disconnection in intubated ventilated neonates.
Assisted mechanical ventilation is a necessity in the neonatal population for a variety of respiratory and surgical conditions. However, there are a number of potential hazards associated with this life saving intervention. New suctioning techniques have been introduced into clinical practice which aim to prevent or reduce these untoward effects. ⋯ There is some evidence to suggest suctioning without disconnection from the ventilator improves the short term outcomes; however the evidence is not strong enough to recommend this practice as the only method of endotracheal suctioning. Future research utilising larger trials needs to address the implications of the different techniques on ventilator associated pneumonia, pulmonary morbidities and neurodevelopment. Infants less than 28 weeks also need to be included in the trials.
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Cochrane Db Syst Rev · Jan 2011
Review Meta AnalysisInterventions to reduce haemorrhage during myomectomy for fibroids.
Uterine myomas (fibroids) are benign tumours of the uterus. Myomectomy, the surgical removal of myomas, can be associated with life-threatening bleeding and prolonged postoperative stay. Knowledge of the effectiveness of the interventions to reduce bleeding during myomectomy is essential to enable evidence-based clinical decisions. This is an update of the review published in The Cochrane Library Issue 3, 2009. ⋯ There is limited evidence that misoprostol, vasopressin, bupivacaine plus epinephrine, tranexamic acid, gelatin thrombin matrix, peri-cervical tourniquet, and mesna may reduce bleeding during myomectomy. Bupivacaine plus epinephrine has limited clinical importance compared with other interventions as the clinical impact was small. There is no evidence that oxytocin and morcellation reduce blood loss. Further well designed studies are required to establish effectiveness, safety and the costs of different interventions for reducing blood loss during myomectomy.
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Cochrane Db Syst Rev · Jan 2011
Review Meta AnalysisNon-clinical interventions for reducing unnecessary caesarean section.
Caesarean section rates are steadily increasing globally. The factors contributing to these observed increases are complex. Non-clinical interventions, those applied independent of patient care in a clinical encounter, may have a role in reducing unnecessary caesarean sections. ⋯ Implementation of guidelines with mandatory second opinion can lead to a small reduction in caesarean section rates, predominately in intrapartum sections. Peer review, including pre-caesarean consultation, mandatory secondary opinion and postcaesarean surveillance can lead to a reduction in repeat caesarean section rates. Guidelines disseminated with endorsement and support from local opinion leaders may increase the proportion of women with previous caesarean sections being offered a trial of labour in certain settings. Nurse-led relaxation classes and birth preparation classes may reduce caesarean section rates in low-risk pregnancies.