Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisOpioids for neonates receiving mechanical ventilation.
Mechanical ventilation is a potentially painful intervention widely used in neonatal intensive care units. Since newborn babies (neonates) demonstrate increased sensitivity to pain, which may affect clinical and neurodevelopmental outcomes, the use of drugs which reduce pain might be very important. ⋯ There is insufficient evidence to recommend routine use of opioids in mechanically ventilated newborns. Opioids should be used selectively, when indicated by clinical judgment and evaluation of pain indicators. If sedation is required, morphine is safer than midazolam. Further research is needed.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisMegestrol acetate for the treatment of anorexia-cachexia syndrome.
Megestrol acetate (MA) is currently used to improve appetite and to increase weight in cancer-associated anorexia. In 1993 MA was approved by the USA's Federal Drug Administration for the treatment of anorexia, cachexia, or unexplained weight loss in patients with AIDS. The mechanism by which MA increases appetite is unknown, and its effectiveness for anorexia and cachexia in neoplastic and AIDS patients is under investigation. ⋯ This review demonstrates that MA improves appetite and weight gain in patients with cancer. No overall conclusion about quality of life (QOL) could be drawn due to heterogeneity. The small number of patients, methodological shortcomings and poor reporting have not allowed us to recommend megestrol acetate in AIDS patients or with other underlying pathologies.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisNon-steroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief following tonsillectomy in children. However, as they inhibit platelet aggregation and prolong bleeding time, they could cause increased perioperative bleeding. The overall risk remains unclear. ⋯ NSAIDs did not cause any increase in bleeding requiring a return to theatre. There was significantly less nausea and vomiting when NSAIDs were used compared to alternative analgesics.
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Venous leg ulceration is a common and disabling condition which often recurs. It affects up to one in 100 adults at some time. The usual treatments are simple dressings and compression bandages or stockings. Unfortunately, in some cases this treatment is unsuccessful, with ulcers remaining open for months or years. Sometimes skin grafts are used to stimulate healing. These skin grafts may be taken from the patient's own uninjured skin, may be grown from the patient's skin cells into a dressing (autografts), or applied as a sheet of bioengineered skin grown from donor cells (allograft). Preserved skin from other animals, such as pigs, has also been used; these grafts are known as xerografts. ⋯ There is evidence that a bilayer artificial skin, used in conjunction with compression bandaging, increases the chance of healing a venous ulcer compared with compression and a simple dressing. Further research is needed to assess whether other forms of skin grafts increase ulcer healing.
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Cochrane Db Syst Rev · Jan 2005
Review Meta AnalysisPsychological treatment of post-traumatic stress disorder (PTSD).
Psychological interventions are widely used in the treatment of post-traumatic stress disorder (PTSD). ⋯ There was evidence that individual TFCBT, stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There was some evidence that individual TFCBT is superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT was also more effective than other therapies. There was insufficient evidence to determine whether psychological treatment is harmful. There was some evidence of greater drop-out in active treatment groups.