Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisTopically applied anaesthetics for treating perineal pain after childbirth.
Perineal trauma is a major problem affecting millions of women around the world each year. The degree of perineal pain and discomfort associated with perineal trauma is often underestimated. Pain often interferes with basic daily activities for the woman such as walking, sitting and passing urine and also negatively impacts on motherhood experiences. ⋯ Evidence for the effectiveness of topically applied local anaesthetics for treating perineal pain is not compelling. There has been no evaluation for the long-term effects of topically applied local anaesthetics.
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Anticonvulsant drugs have been used in the management of pain since the 1960s. The clinical impression is that they are useful for chronic neuropathic pain, especially when the pain is lancinating or burning. ⋯ There is evidence to show that gabapentin is effective in neuropathic pain. There is limited evidence to show that gabapentin is ineffective in acute pain.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisEarly introduction of lipids to parenterally-fed preterm infants.
Lipids are essential components of parenteral nutrition for preterm infants. Parenteral lipids can be administered through a peripheral vein, and their early introduction offers the potential advantages of increasing energy intake and providing essential fatty acids and fat soluble vitamins. Concerns have been raised about potential adverse effects including chronic lung disease (CLD), increase in pulmonary vascular resistance, impaired pulmonary gas diffusion, bilirubin toxicity, sepsis and free radical stress. ⋯ No statistically significant effects of 'early introduction' of lipids on short term nutritional or other clinical outcomes, either benefits or adverse effects, were demonstrated in the studies reviewed. Based on the currently available evidence, 'early' initiation of lipids (= 5 days after birth) can not be recommended for short term growth or to prevent morbidity and mortality in preterm infants.
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Cochrane Db Syst Rev · Jan 2005
ReviewEthosuximide, sodium valproate or lamotrigine for absence seizures in children and adolescents.
Absence seizures are brief epileptic seizures which present in childhood and adolescence. They are characterised by sudden loss of awareness and an electroencephalogram (EEG) typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently used to treat absence seizures. This review aims to determine the best choice of anticonvulsant for a child with typical absence seizures. ⋯ Although ethosuximide, lamotrigine and valproate are commonly used to treat people with absence seizures we have insufficient evidence to inform clinical practice, and the few trials included in this review were of poor methodological quality and did not have sufficient number of participants. More trials of better quality are needed.
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Clinical decision support systems (CDSS) are computer-based information systems used to integrate clinical and patient information to provide support for decision-making in patient care. They may be useful in aiding the diagnostic process, the generation of alerts and reminders, therapy critiquing/planning, information retrieval, and image recognition and interpretation. CDSS for use in adult patients have been evaluated using randomised control trials and their results analysed in systematic reviews. There is as yet no systematic review on CDSS use in neonatal medicine. ⋯ There are very limited data from randomised trials on which to assess the effects of clinical decision support systems in neonatal care. Further evaluation of CDSS using randomised controlled trials is warranted.