Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2012
ReviewPropofol versus thiopental sodium for the treatment of refractory status epilepticus.
Failure to respond to antiepileptic drugs in uncontrolled seizure activity such as refractory status epilepticus (RSE) has led to the use of anaesthetic drugs. Coma is induced with anaesthetic drugs to achieve complete control of seizure activity. Thiopental sodium and propofol are popularly used for this purpose. Both agents have been found to be effective. However, there is substantial lack of evidence as to which of the two drugs is better in terms of clinical outcome. ⋯ There is lack of robust and randomised controlled evidence that can clarify the efficacy of propofol and thiopental sodium over each other in the treatment of RSE. There is a need for large, randomised controlled trials for this serious condition.
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Cochrane Db Syst Rev · Jan 2012
ReviewDifferent types of intermittent pneumatic compression devices for preventing venous thromboembolism in patients after total hip replacement.
Total hip replacement (THR) is an effective treatment for reducing pain and improving function and quality of life in patients with hip disorders. While this operation is very successful, deep vein thrombosis (DVT) and pulmonary embolism (PE) are significant complications after THR. Different types of intermittent pneumatic compression (IPC) devices have been used for thrombosis prophylaxis in patients following THR. Available devices differ in compression garments, location of air bladders, patterns of pump pressure cycles, compression profiles, cycle length, duration of inflation time and deflation time, or cycling mode such as automatic or constant cycling devices. Despite the widely accepted use of IPC for the treatment of arterial and venous diseases, the relative effectiveness of different types of IPC systems as prophylaxis against thrombosis after THR is still unclear. ⋯ There is a lack of evidence from randomized controlled trials to make an informed choice of IPC device for preventing venous thromboembolism (VTE) following total hip replacement. More research is urgently required, ideally a multicenter, properly designed RCT including a sufficient number of participants. Clinically relevant outcomes such as mortality, imaging-diagnosed asymptomatic VTE and major complications must be considered.
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Cochrane Db Syst Rev · Jan 2012
ReviewSurgical removal versus retention for the management of asymptomatic impacted wisdom teeth.
The prophylactic removal of asymptomatic impacted wisdom teeth is defined as the (surgical) removal of wisdom teeth in the absence of local disease. Impacted wisdom teeth may be associated with pathological changes, such as inflammation of the gums around the tooth, root resorption, gum and alveolar bone disease, damage to the adjacent teeth and the development of cysts and tumours. Other reasons to justify prophylactic removal have been to prevent late incisor crowding. When surgical removal is carried out in older patients, following the development of symptoms, the risk of postoperative complications, pain and discomfort increases. Nevertheless, in most developed countries prophylactic removal of trouble-free wisdom teeth, either impacted or fully erupted, has long been considered as 'appropriate care' and is a very common procedure. There is a need to determine whether there is evidence to support this practice. ⋯ Insufficient evidence was found to support or refute routine prophylactic removal of asymptomatic impacted wisdom teeth in adults. A single trial comparing removal versus retention found no evidence of a difference on late lower incisor crowding at 5 years, however no other relevant outcomes were measured.Watchful monitoring of asymptomatic third molar teeth may be a more prudent strategy.
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Cochrane Db Syst Rev · Jan 2012
ReviewRecombinant human activated protein C for severe sepsis in neonates.
Sepsis is a common problem in preterm and term infants. The incidence of neonatal sepsis has declined, but mortality remains high. Recombinant human activated protein C (rhAPC) possess a broad spectrum of activity modulating coagulation and inflammation. In septic adults it may reduce mortality, but no significant benefit has been reported in children with severe sepsis. ⋯ Despite the scientific rationale for its use, there is insufficient data to use rhAPC for the management of severe sepsis in newborn infants. Due to the results among adults with lack of efficacy, an increase in bleeding and resulting withdrawal of rhAPC from the market, neonates should not be treated with rhAPC and further trials should not be conducted.
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Asthma and obesity are both public health problems with increasing prevalence globally. Several epidemiological studies have shown an association between asthma and obesity, however there is no good quality evidence on the effect of weight loss on asthma control. ⋯ Implications for practice This review found one randomized trial that showed that weight loss may be beneficial for improving asthma control in overweight and obese patients, in conjunction with weight loss in intervention groups in the short term. Applying the GRADE system to the results of this review however, shows that the quality of evidence is low, because although all four studies are RCTs there were serious methodological limitations in the studies (unclear risk of selection bias and high risk of detection bias) and imprecision (small sample size). There is inadequate evidence to comment on the effect of weight loss interventions on quality of life and health care utilization. In addition, there was inadequate reporting of data on adverse effects to permit proper balancing of harms and benefits of the interventions. On account of this low quality of evidence, the benefit of weight loss as an intervention for asthma control remains uncertain, and as such, clinicians should be prepared to help patients to make a decision that is consistent with their own values.Implications for research The finding that most of the included studies were of low methodological quality highlights the need for further well designed RCTs, with emphasis on adequate methods of allocation sequence generation as well as allocation concealment and longer follow-up periods. These studies need to report more fully on relevant outcomes (both statistically significant and otherwise) such as: asthma symptoms/control, use of rescue medication, change in lung function parameters (actual mean/median values), hospital utilization, quality of life, and adverse effects. There is also a need for longer intervention as well as follow-up durations to evaluate the effect of sustained measures to achieve weight loss, and to determine if these effects are still significantly present after a considerable period of time.There is also a need for these well designed studies in children and adolescents, as well as in low-income countries such as Africa, where the prepackaged, low energy diets, as well as structured physical activity-based interventions utilized in these included studies, may not be feasible or applicable.