Cochrane Db Syst Rev
-
Cochrane Db Syst Rev · Jan 2004
ReviewPercutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates.
Parenteral nutrition for newborn infants may be delivered via short peripheral cannulae or central venous catheters, which are usually sited percutaneously. The method of delivery may affect nutrient input, and consequently growth and development. Although potentially more difficult to site, percutaneous central venous catheters may be more stable than peripheral cannulae, and need less frequent replacement. These methods may also be associated with different risks of adverse events, including acquired systemic infection and extravasation injury. ⋯ Data from one small study suggest that the use of percutaneous central venous catheters to deliver parenteral nutrition in newborn infants improves nutrient input. The significance of this in relation to longer-term growth and developmental outcomes is unclear. Another study suggested that the use of percutaneous central venous catheters rather than peripheral cannulae decreases the number of catheters/cannulae needed to deliver the nutrition. We have not found any evidence that percutaneous central venous catheter use increases the risk of adverse events, particularly systemic infection.
-
Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisTypes of urethral catheters for management of short-term voiding problems in hospitalised adults.
Urinary tract infection is the most common hospital acquired infection. The major associated cause is indwelling urinary catheters. Currently there are many types of catheters available. A variety of specialised urethral catheters have been designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Other issues that should be considered when choosing a catheter are ease of use, comfort and the cost. ⋯ The results suggest that the use of silver alloy indwelling catheters for catheterising hospitalised adults short-term reduces the risk of catheter acquired urinary tract infection. Further economic evaluation is required to confirm that the reduction of infection compensates for the increased cost of silver alloy catheters.Catheters coated with a combination of minocycline and rifampin may also be beneficial in reducing bacteriuria in hospitalised men catheterised less than one week but this requires further testing. There was not enough evidence to suggest whether or not any standard catheter was better than another in terms of reducing the risk of urinary tract infection in hospitalised adults catheterised short-term. Siliconised catheters may be less likely to cause urethral side effects in men: however, this result should be interpreted with some caution as the trials were small and the outcome definitions and specific catheters compared varied.
-
Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisInterventions for idiopathic steroid-resistant nephrotic syndrome in children.
The majority of children, who present with their first episode of nephrotic syndrome, achieve remission with corticosteroid therapy. Children who fail to respond to corticosteroids may be treated with immunosuppressive agents such as cyclophosphamide, chlorambucil or cyclosporin or with non-immunosuppressive agents such as ACE inhibitors. Optimal combinations of these agents with least toxicity remain to be determined. The aims of this systematic review are to assess the benefits and harms of interventions used to treat idiopathic steroid resistant nephrotic syndrome (SRNS) in children. ⋯ Further adequately powered and well designed RCTs are needed to confirm the efficacy of cyclosporin and to evaluate other regimens for idiopathic SRNS including high dose steroids with alkylating agents or cyclosporin.
-
Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisTegaserod for the treatment of irritable bowel syndrome.
IBS is a complex disorder that encompasses a wide profile of symptoms. Current drug treatments for irritable bowel syndrome (IBS) are of limited value. Many target specific symptoms only. Tegaserod, a 5HT(4) partial agonist, represents a novel mechanism of action in the treatment of IBS. ⋯ Tegaserod appears to improve the overall symptomatology of IBS but there are currently few data on its effect on quality of life. In addition, more information is needed about its efficacy in men. It would also be of interest to know whether treatment with tegaserod leads either directly, or indirectly, to changes in visceral sensitivity or psychopathology, which are also considered important in the pathophysiology of this condition.
-
Cochrane Db Syst Rev · Jan 2004
Review Meta AnalysisEarly surfactant administration with brief ventilation vs selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome.
Both prophylactic and early surfactant replacement therapy, compared with later selective surfactant administration, reduce mortality and pulmonary complications in ventilated infants with respiratory distress syndrome (RDS). However, continued post-surfactant intubation and ventilation are risk factors for chronic lung disease. Whether prophylactic or early surfactant administration followed by prompt extubation, compared with later, selective use of surfactant followed by continued mechanical ventilation reduces the need for mechanical ventilation and the incidence of chronic lung disease is unknown. ⋯ Early surfactant replacement therapy with extubation to NCPAP compared with later, selective surfactant replacement and continued mechanical ventilation with extubation from low ventilator support is associated with a reduced need for mechanical ventilation and increased utilization of exogenous surfactant therapy. There is insufficient evidence at present to reliably evaluate effect on BPD or CLD.