Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2000
ReviewProphylactic syntometrine versus oxytocin for delivery of the placenta.
The routine prophylactic administration of an oxytocic agent is an integral part of active management of the third stage of labour. These agents help prevent postpartum haemorrhage. ⋯ The use of the combination preparation syntometrine (oxytocin and ergometrine) as part of the routine active management of the third stage of labour appears to be associated with a statistically significant reduction in the risk of postpartum haemorrhage when compared to oxytocin where blood loss is less than 1000ml. No difference was seen between the groups using either five or 10 international units for blood loss equal to or greater than 1000 millilitres. This needs to be weighed against the more common adverse effects associated with the use of syntometrine.
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Cochrane Db Syst Rev · Jan 2000
ReviewHolding chambers versus nebulisers for beta-agonist treatment of acute asthma.
In acute asthma inhaled beta-agonists are often administered to relieve bronchospasm by wet nebulisation, but some have argued that metered-dose inhalers with a holding chamber (spacer) can be equally effective. In the community setting nebulisers are more expensive, require a power source and need regular maintenance. ⋯ Metered-dose inhalers with holding chamber produced outcomes that were at least equivalent to nebuliser delivery. Holding chambers may have some advantages compared to nebulisers for children with acute asthma.
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Cochrane Db Syst Rev · Jan 2000
ReviewThienopyridine derivatives (ticlopidine, clopidogrel) versus aspirin for preventing stroke and other serious vascular events in high vascular risk patients.
The most widely studied and prescribed antiplatelet agent for the prevention of stroke and other serious vascular events among high vascular risk patients is aspirin. Aspirin inhibits platelet activation by inhibiting platelet cyclooxygenase and thromboxane production, and reduces the odds of a serious vascular event by about a quarter. The thienopyridines (ticlopidine and clopidogrel) inhibit platelet activation by a different mechanism to aspirin (blocking the ADP receptor on platelets), and so may be more effective than aspirin. ⋯ The available randomised evidence shows that the thienopyridine derivatives are modestly but significantly more effective than aspirin in preventing serious vascular events in patients at high risk (and specifically in TIA/ischaemic stroke patients), but there is uncertainty about the size of the additional benefit. The thienopyridines are also associated with less gastrointestinal haemorrhage and other upper gastrointestinal upset than aspirin, but an excess of skin rash and diarrhoea. The risk of skin rash and diarrhoea is greater with ticlopidine than with clopidogrel. Ticlopidine, but not clopidogrel, is associated with an excess of neutropenia and of thrombotic thrombocytopenic purpura.
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Cochrane Db Syst Rev · Jan 2000
ReviewProstaglandins versus oxytocin for prelabour rupture of membranes at or near term.
The conventional method of induction of labour is with intravenous oxytocin. More recently, induction with prostaglandins, followed by an infusion of oxytocin if necessary, has been used. ⋯ Women with prelabour rupture of membranes at or near term having their labour induced with prostaglandins appear to have a lower risk of epidural analgesia and fetal heart rate monitoring. However there appears to be an increased risk of chorioamnionitis and nausea/vomiting with prostaglandins compared to oxytocin.
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Cochrane Db Syst Rev · Jan 2000
ReviewHuman albumin solution for resuscitation and volume expansion in critically ill patients. The Albumin Reviewers.
Human albumin solutions are used in a range of medical and surgical problems. Licensed indications are the emergency treatment of shock and other conditions where restoration of blood volume is urgent, burns, and hypoproteinaemia. Human albumin solutions are more expensive than other colloids and crystalloids. ⋯ There is no evidence that albumin administration reduces the risk of death in critically ill patients with hypovolaemia, burns or hypoalbuminaemia, and a strong suggestion that it may increase the risk of death. These data suggest that the use of human albumin in critically ill patients should be urgently reviewed and that it should not be used outside the context of a rigorously conducted randomised controlled trial.