Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2004
ReviewPin site care for preventing infections associated with external bone fixators and pins.
Metal pins are used to apply skeletal traction or external fixation devices in the management of orthopaedic fractures. These pins protrude through the skin and are therefore described as 'percutaneous' and much has been written on the management of the associated skin wound. The way in which percutaneous pins are treated may affect the incidence of pin site infection. Recommendations for care are not necessarily evidence based. This review set out to summarise the research evidence on the effect of pin site care on infection rates. ⋯ There is very little evidence as to which pin site care regimen best reduces infection rates. Clearly there is a need for large RCTs to determine the best method of pin site management.
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Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisProstaglandins for prevention of postpartum haemorrhage.
Prostaglandins have mainly been used for postpartum haemorrhage when other measures fail. Misoprostol, a new and inexpensive prostaglandin E1 analogue, has been suggested as an alternative for routine management of the third stage of labour. ⋯ Neither intramuscular prostaglandins nor misoprostol are preferable to conventional injectable uterotonics as part of the active management of the third stage of labour especially for low-risk women. Future research on prostaglandin use after birth should focus on the treatment of postpartum haemorrhage rather than prevention where they seem to be more promising.
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Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisEffect of longer-term modest salt reduction on blood pressure.
Many randomised trials assessing the effect of salt reduction on blood pressure show reduction in blood pressure in individuals with high blood pressure. However, there is controversy about the magnitude and the clinical significance of the fall in blood pressure in individuals with normal blood pressure. Several meta-analyses of randomised salt reduction trials have been published in the last few years. However, most of these included trials of very short duration (e.g. 5 days) and included trials with salt loading followed by salt deprivation (e.g. from 20 to 1 g/day) over only a few days. These short-term experiments are not appropriate to inform public health policy which is for a modest reduction in salt intake over a prolonged period of time. A meta-analysis by Hooper et al is an important attempt to look at whether advice to achieve a long-term salt reduction (i.e. more than 6 months) in randomised trials causes a fall in blood pressure. However, most trials included in this meta-analysis achieved a small reduction in salt intake; on average, salt intake was reduced by 2 g/day. It is, therefore, not surprising that this analysis showed a small fall in blood pressure, and that a dose-response to salt reduction was not demonstrable. ⋯ Our meta-analysis demonstrates that a modest reduction in salt intake for a duration of 4 or more weeks has a significant and, from a population viewpoint, important effect on blood pressure in both individuals with normal and elevated blood pressure. These results support other evidence suggesting that a modest and long-term reduction in population salt intake could reduce strokes, heart attacks, and heart failure. Furthermore, our meta-analysis demonstrates a correlation between the magnitude of salt reduction and the magnitude of blood pressure reduction. Within the daily intake range of 3 to 12 g/day, the lower the salt intake achieved, the lower the blood pressure.
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Cochrane Db Syst Rev · Jan 2004
ReviewInterventions for replacing missing teeth: maintaining health around dental implants.
To maintain healthy tissues around dental implants it is important to institute an effective preventive regimen (supportive therapy). Different maintenance regimens have been suggested, however it is unclear which are the most effective. ⋯ There is only little reliable evidence for which are the most effective interventions for maintaining health around peri-implant tissues. There was no evidence that the use of powered or sonic toothbrushes was superior to manual toothbrushing. There is weak evidence that Listerine mouthwash, used twice a day for 30 seconds, as adjunct to routine oral hygiene is effective in reducing plaque formation and marginal bleeding around implants. There was no evidence that phosphoric etching gel offered any clinical advantage over mechanical debridement. These findings are based on RCTs having short follow-up periods and few subjects. There is not any reliable evidence for the most effective regimens for long term maintenance. More RCTs should be conducted in this area. In particular, there is a definite need for trials powered to find possible differences, using primary outcome measures and with much longer follow up. Such trials should be reported according the CONSORT guidelines (http://www.consort-statement.org/).
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Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisAzithromycin for acute lower respiratory tract infections.
The spectrum of acute lower respiratory tract infection ranges from acute bronchitis and acute exacerbations of chronic bronchitis to pneumonia. Annually approximately five million people die of acute respiratory tract infections. Among these, pneumonia represents the most frequent cause of mortality, hospitalization and medical consultation. Azithromycin is a new macrolide antibiotic, structurally modified from erythromycin and is noted for its activity against some gram-negative organisms associated with respiratory tract infections, particularly Haemophilus influenzae (H. influenzae). ⋯ There is unclear evidence that azithromycin is superior to amoxicillin or amoxicillin-clavulanic acid in treating acute LRTI. Future trials with high methodological quality are needed.