Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisAntibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding.
Bacterial infections are a frequent complication in patients with cirrhosis and gastrointestinal bleeding. Antibiotic prophylaxis seems to decrease the incidence of bacterial infections. Oral antibiotics, active against enteric bacteria, have been most often used as antibiotic prophylaxis in cirrhotic patients with gastrointestinal bleeding. ⋯ Antibiotic prophylaxis for cirrhotic inpatients with gastrointestinal bleeding is efficacious in reducing the number of deaths and bacterial infections, are well tolerated, and should be advocated.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisSedatives for opiate withdrawal in newborn infants.
Neonatal abstinence syndrome (NAS) due to opiate withdrawal may result in disruption of the mother-infant relationship, sleep-wake abnormalities, feeding difficulties, weight loss and seizures. Treatments used to ameliorate symptoms and reduce morbidity include opiates, sedatives and non-pharmacological treatments. ⋯ In newborn infants with NAS, there is no evidence that phenobarbital, compared with supportive care alone, reduces treatment failure; however, phenobarbital may reduce the daily duration of supportive care needed. Phenobarbital, compared to diazepam, reduces treatment failure. There is insufficient evidence to support the use of chlorpromazine or clonidine in newborn infants with NAS. Clonidine and chlorpromazine should only be used in the context of a randomised clinical trial. The results of this review, taken in conjunction with the related review, Opiate treatment for opiate withdrawal in newborn infants (Osborn 2002), indicate that treatment with opiates is the preferred initial therapy for NAS. It is hypothesised that this is particularly true for infants whose mothers have used only opiates during pregnancy. If a sedative is used, phenobarbital is preferred to diazepam. The results of an ongoing trial of the addition of phenobarbital to an opiate are awaited.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisRemacemide for drug-resistant localization related epilepsy.
Epilepsy is a common neurological condition, affecting 0.5 to 1% of the population. Nearly 30 per cent of people with epilepsy have seizures that are refractory to currently available drugs. In response to this problem, potential new drugs are being developed. Remacemide is one of these. ⋯ Given the modest effect on seizure frequency and significant withdrawal rate it is unlikely that remacemide will be further developed as an antiepileptic drug.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisProtein and energy supplementation in elderly people at risk from malnutrition.
This review was carried out because evidence for the effectiveness of nutritional supplements containing protein and energy which are often prescribed for elderly people is limited. Furthermore malnutrition is more common in this age group and deterioration of nutritional status can occur during a stay in hospital. It is important to establish whether supplementing the diet with protein and energy is an effective way of improving outcomes for older people at risk from malnutrition. ⋯ Supplementation appears to produce a small but consistent weight gain. There was a statistically significant beneficial effect on mortality and a shorter length of hospital stay. Additional data from large-scale multi-centre trials are still required to provide clear evidence of benefit from protein and energy supplements on mortality and length of hospital stay. Too few data were reported and the time scale of most studies was too short to have a realistic chance of detecting differences in morbidity, functional status and quality of life. Furthermore, most trials do not address the organisational and practical challenges faced by practitioners trying to meet the individual needs and preferences of those at risk from malnutrition.
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Cochrane Db Syst Rev · Jan 2002
ReviewProphylactic intravenous preloading for regional analgesia in labour.
Fetal heart rate changes are common following regional analgesia (epidural or spinal) during labour. Reduced uterine blood flow from maternal hypotension (low blood pressure) may contribute to this. Intravenous fluid preloading (volume expansion) may help to reduce maternal hypotension. Newer protocols using weaker solutions of local anaesthetic, and opioid only blocks, may reduce the need for preloading. ⋯ There are methodological limitations in the trials studied. However, preloading prior to high-dose local anaesthetic blocks may have beneficial fetal and maternal effects in healthy women. Further investigation of the effects in women receiving low-dose local anaesthetic or opioid only blocks, and the risks and benefits of intravenous preloading for women with pregnancy complications, is required.