Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2025
Review Meta AnalysisDiuretics for preventing and treating acute kidney injury.
Acute kidney injury (AKI) is a well-known complication of critical illnesses, significantly affecting morbidity and the risk of death. Diuretics are widely used to ameliorate excess fluid accumulation and oliguria associated with AKI. Their popularity stems from their ability to reduce the energy demands of renal tubular cells by inhibiting transporters and flushing out intratubular casts. Numerous studies have assessed the effects of diuretics in the context of AKI prevention and treatment. However, a comprehensive systematic review addressing this topic has yet to be conducted. ⋯ When used for the prevention of AKI, diuretics may reduce the risk of AKI. However, our confidence in the effect estimate is limited. Diuretics probably reduce the incidence of KRT use, and we are moderately confident in the effect estimate. When used for the treatment of AKI, diuretics may make little or no difference to any use of KRT, and our confidence in the effect estimate is limited. More RCTs are needed to explore the role of diuretics for treating established AKI.
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Cochrane Db Syst Rev · Jan 2025
Review Meta AnalysisInterventions to reduce non-prescription antimicrobial sales in community pharmacies.
Antimicrobial resistance (AMR) is a major global health concern. One of the most important causes of AMR is the excessive and inappropriate use of antimicrobial drugs in healthcare and community settings. Most countries have policies that require antimicrobial drugs to be obtained from a pharmacy by prescription. The term 'non-prescription antimicrobial sale' refers to the dispensing and selling of antimicrobial drugs without a prescription in countries where the pharmaceutical policy does not permit the sale of antimicrobial drugs without a prescription. Pharmacies, drugstores, and other medicine outlets are major sources of non-prescription antimicrobial sales in the community setting. ⋯ No firm conclusions can be drawn about the effects of single-component interventions due to limited evidence. Multicomponent interventions may not reduce the sales of non-prescription antimicrobial drugs in community pharmacies, drugstores, and other medicine outlets; however, the evidence is of very low certainty. Further studies on this topic are needed, particularly to assess the effects of important single interventions such as improving pharmaceutical policies.
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Cochrane Db Syst Rev · Jan 2025
Review Meta AnalysisInterventions to reduce non-prescription antimicrobial sales in community pharmacies.
Antimicrobial resistance (AMR) is a major global health concern. One of the most important causes of AMR is the excessive and inappropriate use of antimicrobial drugs in healthcare and community settings. Most countries have policies that require antimicrobial drugs to be obtained from a pharmacy by prescription. The term 'non-prescription antimicrobial sale' refers to the dispensing and selling of antimicrobial drugs without a prescription in countries where the pharmaceutical policy does not permit the sale of antimicrobial drugs without a prescription. Pharmacies, drugstores, and other medicine outlets are major sources of non-prescription antimicrobial sales in the community setting. ⋯ No firm conclusions can be drawn about the effects of single-component interventions due to limited evidence. Multicomponent interventions may not reduce the sales of non-prescription antimicrobial drugs in community pharmacies, drugstores, and other medicine outlets; however, the evidence is of very low certainty. Further studies on this topic are needed, particularly to assess the effects of important single interventions such as improving pharmaceutical policies.
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Cochrane Db Syst Rev · Jan 2025
Review Meta AnalysisInterrupted versus uninterrupted anticoagulation for cardiac rhythm management device insertion.
Guideline-recommended strategies to interrupt chronic anticoagulation with warfarin or direct oral anticoagulants (DOAC) during the perioperative period of cardiac implantable electronic device (CIED) surgery differ worldwide. There is uncertainty concerning the benefits and harms of interrupted and uninterrupted anticoagulation in patients undergoing CIED surgery. ⋯ Interrupted anticoagulation in people undergoing elective CIED surgery had similar outcomes to uninterrupted anticoagulation with either warfarin or DOAC medications. Certainty of evidence was judged to be low to very low for most of the assessed outcomes. Further RCTs are particularly needed to help identify whether IAC significantly impacts the risks of thromboembolic events and device-pocket hematoma.
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Cochrane Db Syst Rev · Jan 2025
Review Meta AnalysisInterrupted versus uninterrupted anticoagulation for cardiac rhythm management device insertion.
Guideline-recommended strategies to interrupt chronic anticoagulation with warfarin or direct oral anticoagulants (DOAC) during the perioperative period of cardiac implantable electronic device (CIED) surgery differ worldwide. There is uncertainty concerning the benefits and harms of interrupted and uninterrupted anticoagulation in patients undergoing CIED surgery. ⋯ Interrupted anticoagulation in people undergoing elective CIED surgery had similar outcomes to uninterrupted anticoagulation with either warfarin or DOAC medications. Certainty of evidence was judged to be low to very low for most of the assessed outcomes. Further RCTs are particularly needed to help identify whether IAC significantly impacts the risks of thromboembolic events and device-pocket hematoma.