Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisOmega-3 fatty acids for intermittent claudication.
Omega-3 fatty acids are established as being effective in the treatment and prevention of coronary artery disease. It is possible that they may also benefit people with peripheral arterial disease, since the pathogenesis of the two conditions is similar. ⋯ Omega-3 fatty acids appear to have limited haematological benefits in people with intermittent claudication but there is no evidence of consistent improved clinical outcomes which are the primary outcomes of this review (quality of life, PFWD, MWD, ABPI, angiographic findings). Supplementation may also cause adverse effects such as increased total and LDL cholesterol levels. Further research is needed in this area, to evaluate short- and long-term effects on more clinically relevant outcomes.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisPercutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates.
Parenteral nutrition for neonates may be delivered via a short peripheral cannula or a central venous catheter. The latter may either be inserted via the umbilicus or percutaneously. Because of the complications associated with umbilical venous catheter use, many neonatal units prefer to use percutaneously inserted catheters following the initial stabilisation period. The method of parenteral nutrition delivery may affect nutrient input and consequently growth and development. Although potentially more difficult to place, percutaneous central venous catheters may be more stable than peripheral cannulae, and need less frequent replacement. These delivery methods may also be associated with different risks of adverse events, including acquired systemic infection and extravasation injury. ⋯ Data from one small study suggest that the use of a percutaneous central venous catheter to deliver parenteral nutrition in newborn infants improves nutrient input. The significance of this in relation to long-term growth and developmental outcomes is unclear. Another study suggested that the use of a percutaneous central venous catheter rather than a peripheral cannula decreases the number of catheters/cannulae needed to deliver the nutrition. No evidence was found to suggest that percutaneous central venous catheter use increased the risk of adverse events, particularly systemic infection.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisUse of plastic adhesive drapes during surgery for preventing surgical site infection.
Surgical site infection has been estimated to occur in about 15% of clean surgery and 30% of contaminated surgery. Using plastic adhesive drapes to protect the wound from organisms that may be present on the surrounding skin during surgery is one strategy used to prevent surgical site infection. Results from non-randomised studies have produced conflicting results about the efficacy of this approach but no systematic review has been conducted to date to guide clinical practice. ⋯ There was no evidence from the seven trials that plastic adhesive drapes reduces surgical site infection rate and some evidence that they increase infection rates. Further trials may be justified using blinded outcome assessment to examine the effect of adhesive drapes on surgical site infection based on different wound classifications.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisAnticholinergic drugs versus other medications for overactive bladder syndrome in adults.
Overactive bladder syndrome is defined as "urgency with or without urge incontinence, usually with frequency and nocturia". It is a common condition with significant economic and quality of life implications. While the condition's pathophysiology remains to be fully elucidated, pharmacotherapy is the main treatment option. Despite uncertainty as to drug treatment of choice, anticholinergics are increasingly being used in primary and secondary care settings. This review compares anticholinergic drugs with other types or classes of drugs for treating overactive bladder syndromes. ⋯ Many of the drugs considered in trials in this review are no longer used in clinical practice (and this includes the most commonly tested - flavoxate). There is inadequate no evidence as to whether any of the available is better or worse than anticholinergic medications. Larger randomised controlled trials in clinical settings are required to further establish the role of these other medications in the management of overactive bladder syndrome.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisAnti-fibrinolytic use for minimising perioperative allogeneic blood transfusion.
Concerns regarding the safety of transfused blood have led to the development of a range of interventions to minimise blood loss during major surgery. Anti-fibrinolytic drugs are widely used, particularly in cardiac surgery and previous reviews have found them to be effective in reducing blood loss and the need for transfusion. Recently, questions have been raised regarding the comparative performance of the drugs and the safety of the most popular agent, aprotinin. ⋯ Anti-fibrinolytic drugs provide worthwhile reductions in blood loss and the need for allogeneic red cell transfusion. Based on the results of randomised trials their efficacy does not appear to be offset by serious adverse effects. In most circumstances the lysine analogues are probably as effective as aprotinin and are cheaper; the evidence is stronger for tranexamic acid than for aminocaproic acid. In high risk cardiac surgery, where there is a substantial probability of serious blood loss, aprotinin may be preferred over tranexamic acid. Aprotinin does not appear to be associated with an increased risk of vascular occlusion and death, but the data do not exclude an increased risk of renal failure. There is no need for further placebo-controlled trials of aprotinin or lysine analogues in cardiac surgery. The principal need is for large comparative trials to assess the relative efficacy, safety and cost-effectiveness of anti-fibrinolytic drugs in different surgical procedures.