Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisSub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery.
Local anaesthesia for cataract surgery can be provided by either sub-Tenon or topical anaesthesia. Although there is some work suggesting advantages to both techniques, there has been no recent systematic attempt to compare both techniques for all relevant outcomes. ⋯ Sub-Tenon anaesthesia provides better pain relief than topical anaesthesia for cataract surgery.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisHealing by primary versus secondary intention after surgical treatment for pilonidal sinus.
Pilonidal sinus arises in the hair follicles in the buttock cleft at the bottom of the backbone. The estimated incidence is 26 per 100,000, people, affecting men twice as often as women. The mean age of presentation is 21 years (men) and 19 years (women) respectively.Pilonidal sinus results in chronic discharging wounds that cause pain and impact upon quality of life and social function. These sinuses may become infected and present as acute abscesses. Management of these abscesses is uncontroversial and revolves around incision and drainage, however, the mode of surgical management of the chronic discharging sinus is debatable. Surgical strategies traditionally centre on excision of the sinus tracts followed by primary closure and healing by primary intention or leaving the wound open to heal by secondary intention. There is uncertainty as to whether open or closed surgical management is more effective. ⋯ No clear benefit was shown for surgical management by primary closure or open healing by secondary intention. A clear benefit was shown for off-midline closure rather than midline closure after pilonidal sinus surgery. Off-midline closure should be the standard management when primary closure is the desired surgical option.
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Hypochondriasis is associated with significant medical morbidity and high health resource use. Recent studies have examined the treatment of hypochondriasis using various forms of psychotherapy. ⋯ Cognitive therapy, behavioural therapy, cognitive behavioural therapy and behavioural stress management are effective in reducing symptoms of hypochondriasis. However, studies included in the review used small numbers of participants and do not allow estimation of effect size, comparison between different types of psychotherapy or whether people are "cured". Most long-term outcome data were uncontrolled. Further studies should make use of validated rating scales, assess treatment acceptability and effect on resource use, and determine the active ingredients and nonspecific factors that are important in psychotherapy for hypochondriasis.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisNocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders.
Chronic alveolar hypoventilation is a common complication of many neuromuscular and chest wall disorders. Long-term nocturnal mechanical ventilation is increasingly used to treat it. ⋯ Current evidence about the therapeutic benefit of mechanical ventilation is weak, but consistent, suggesting alleviation of the symptoms of chronic hypoventilation in the short-term. In three small studies survival was prolonged mainly in participants with motor neuron diseases. With the exception of motor neuron disease, further larger randomised trials are needed to confirm long-term beneficial effects of nocturnal mechanical ventilation on quality of life, morbidity and mortality, to assess its cost-benefit ratio in neuromuscular and chest wall diseases and to compare the different types and modes of ventilation.
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Cochrane Db Syst Rev · Jan 2007
Review Meta AnalysisProphylactic steroids for pediatric open heart surgery.
The immune response to cardiopulmonary bypass in infants and children can lead to a series of postoperative morbidities and mortality i.e. hemodynamic instability, increased infection and tachyarrhythmias. Administration of prophylactic doses of corticosteroids is sometimes used to try and ameliorate this pro-inflammatory response. However, the clinical benefits and harms of this type of intervention in the pediatric patient remains unclear. ⋯ The use of prophylactic steroids in pediatric patients to reduce postoperative complications commonly experienced following cardiopulmonary bypass surgery is not supported by the existing evidence. Further well designed and adequately powered randomized controlled trials are needed to more accurately estimate the benefit and harm of this intervention.