Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Oct 2004
Review Meta AnalysisTechniques and materials for closure of the abdominal wall in caesarean section.
There is a variety of techniques for closing the abdominal wall during caesarean section. Some methods may be better in terms of postoperative recovery and other important outcomes. ⋯ Further trials are justified to investigate whether the apparent increased risk of haematoma or seroma with non-closure of the subcutaneous fat is real. These should use a broader range of short- and long-term outcomes, and ensure that they are adequately powered to detect clinically important differences. Further research comparing blunt and sharp needles is justified, as are trials evaluating suturing materials and suturing techniques for the rectus sheath.
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People suffering from acute psychotic illnesses, especially those associated with agitated or violent behaviour, may require urgent pharmacological tranquillisation or sedation. Droperidol, a butyrophenone neuroleptic, has been used for this purpose in several countries. ⋯ This is an important, and surprisingly under-researched, area. To date, use of droperidol for emergency situations has been justified by experience rather than evidence from well conducted and reported randomised trials, but, as world reserves diminish, droperidol will no longer be a treatment option.
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Cochrane Db Syst Rev · Oct 2004
ReviewCatechol-O-methyltransferase inhibitors for levodopa-induced complications in Parkinson's disease.
As Parkinson's disease progresses the control of motor symptoms often requires the addition of other drugs to levodopa. The principle aim of COMT inhibitor therapy is to increase the duration of effect of each levodopa dose and thus reduce the time patients spend in the relatively immobile 'off' phase. ⋯ In the management of the motor complications seen in Parkinson's disease, tolcapone and entacapone can be used to reduce off time, reduce levodopa dose, and modestly improve motor impairment and disability. This is based on, at best, medium term evidence. However some participants on tolcapone had raised liver enzymes. This combined with three cases of fatal hepatic toxicity found during post-marketing surveillance has raised concerns over the safety of tolcapone.
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Cochrane Db Syst Rev · Oct 2004
ReviewDisclosing to parents newborn carrier status identified by routine blood spot screening.
Newborn blood spot screening programmes are designed to detect serious conditions affecting individuals, where early treatment can improve health. It is suggested that screening can improve the experience of diagnosis for parents. For example, without newborn screening, when a child with cystic fibrosis becomes symptomatic a period of uncertainty can arise prior to diagnosis. These potential advantages of screening need to be weighed against potential disadvantages of screening at individual and population levels. Some newborn screening programmes inadvertently identify newborn infants who, although not affected by the condition, carry a gene for it and can pass on that gene to their children; these are 'genetic carriers'. Knowledge of newborn carrier status can lead to: testing of parents and family members, and concern about possible affected future siblings should both parents be identified as carriers; the possibility of such testing revealing the putative father is not the biological father; concern about the child's future reproductive choices; and unjustified anxiety about the health of the carrier newborn. There is an urgent need to develop clear guidance as to how to respond, with advances in technology fuelling the expansion of newborn blood spot screening and raised expectations of informed consent and disclosing test results. Depending on the condition for which screening is offered, options include: employing tests that do not identify carrier status, if available; identifying acceptable ways of disclosing carrier status; or identifying acceptable ways of not disclosing carrier status. These options are illustrated by screening programmes for sickle cell disorders and cystic fibrosis. Currently, there are no screening tests available for sickle cell disorders that do not identify carrier status. For cystic fibrosis, the policy choice is between an extended period of testing, and a screening result that is available sooner for most newborns, but inadvertently identifies carrier babies. ⋯ There is a need to develop and evaluate the effects of interventions to support the disclosure of carrier status to parents following newborn screening.
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Cochrane Db Syst Rev · Oct 2004
Review Meta AnalysisProphylactic intravenous preloading for regional analgesia in labour.
Reduced uterine blood flow from maternal hypotension may contribute to fetal heart rate changes which are common following regional analgesia (epidural or spinal or combined spinal-epidural (CSE)) during labour. Intravenous fluid preloading may help to reduce maternal hypotension but using lower doses of local anaesthetic, and opioid only blocks, may reduce the need for preloading. ⋯ Preloading prior to traditional high-dose local anaesthetic blocks may have some beneficial fetal and maternal effects in healthy women. Low-dose epidural and CSE analgesia techniques may reduce the need for preloading. The studies reviewed were too small to show whether preloading is beneficial for women having regional analgesia during labour using the lower-dose local anaesthetics or opioids. Further investigation of low-dose epidural or CSE (including opioid only) blocks, and the risks and benefits of intravenous preloading for women with pregnancy complications, is required.