Cochrane Db Syst Rev
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Primary repair of penetrating colon injuries is an appealing management option, however uncertainty about its safety persists. ⋯ Meta-analysis of currently published randomized controlled trials favors primary repair over fecal diversion for penetrating colon injuries.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisTechniques for preventing hypotension during spinal anaesthesia for caesarean section.
Maternal hypotension is the most frequent complication of spinal anaesthesia for caesarean section. Most workers define hypotension as a maternal systolic blood pressure below 70-80% of baseline recordings and/or an absolute value of < 90 - 100mmHg. Hypotension is often associated with nausea and vomiting and, if severe, poses serious risks to mother (unconsciousness, pulmonary aspiration) and baby (hypoxia, acidosis and neurological injury). Several strategies are currently used to prevent or minimise hypotension but there is no established ideal technique. ⋯ No intervention reliably prevents hypotension during spinal anaesthesia for caesarean section. No conclusions are drawn regarding rare adverse effects of interventions due to their probable low incidence and the small numbers of women studied. Further trials are recommended, in particular assessing a combination of the beneficial interventions, ie colloid or crystalloid preloading, ephedrine administration and leg compression with bandages, stockings or inflatable boots.
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Cochrane Db Syst Rev · Jan 2002
Review Meta AnalysisOpiate treatment 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. ⋯ Opiates, as compared to supportive care only, appear to reduce the time to regain birth weight and reduce the duration of supportive care, but increase the duration of hospital stay; there is no evidence of effect on treatment failure. When compared to phenobarbital, opiates may reduce the incidence of seizures but, overall, there is no evidence of effect on treatment failure. When compared to diazepam, opiates reduce the incidence of treatment failure. A post-hoc analysis generates the hypothesis that treatment effects may vary according to whether the population includes infants born to all opiate users (i.e. with or without other drug exposure) or is restricted to infants of mothers who used opiates only. In view of the methodologic limitations of the included studies the conclusions of this review should be treated with caution. Further research is needed.
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Cochrane Db Syst Rev · Jan 2002
ReviewProphylaxis for venous thromboembolic disease in pregnancy and the early postnatal period.
Venous thromboembolic disease (TED), although very rare, is a major cause of maternal mortality and morbidity, hence methods of prophylaxis are often used for women at risk. This may include women delivered by caesarean section, those with a personal or family history of TED and women with inherited or acquired thrombophilias (conditions that predispose people to thrombosis). Many methods of prophylaxis carry a risk of side effects, and as the risk of thromboembolic disease is low, it is possible that the benefits of thromboprophylaxis may be outweighed by harm. Current guidelines for clinical practice are based on expert opinion only, rather than high quality evidence from randomised trials. ⋯ There is insufficient evidence on which to base recommendations for thromboprophylaxis during pregnancy and the early postnatal period. Large scale randomised trials of currently-used interventions should be conducted.
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Cochrane Db Syst Rev · Jan 2002
ReviewInterventions for helping patients to follow prescriptions for medications.
People who are prescribed self-administered medications typically take less than half the prescribed doses. Efforts to assist patients with adherence to medications might improve the benefits and efficiency of health care, but also might increase its adverse effects. ⋯ The full benefits of medications cannot be realised at currently achievable levels of adherence. Current methods of improving adherence for chronic health problems are mostly complex and not very effective. Innovations to assist patients to follow medication prescriptions are needed.