Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisMechanical traction for neck pain with or without radiculopathy.
Neck pain is a frequently reported complaint of the musculoskeletal system which can be disabling and costly to society. Mechanical traction is often used as an adjunct therapy in outpatient rehabilitation. ⋯ The current literature does not support or refute the efficacy or effectiveness of continuous or intermittent traction for pain reduction, improved function or global perceived effect when compared to placebo traction, tablet or heat or other conservative treatments in patients with chronic neck disorders. Large, well conducted RCTs are needed to first determine the efficacy of traction, then the effectiveness, for individuals with neck disorders with radicular symptoms.
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisInterventions for treating wrist fractures in children.
Approximately a third of all fractures in children occur at the wrist, usually from falling onto an outstretched hand. ⋯ Limited evidence supports the use of removable splintage for buckle fractures and challenges the traditional use of above-elbow casts after reduction of displaced fractures. Although percutaneous wire fixation prevents redisplacement, the effects on longer term outcomes including function are not established. Further research is warranted on the optimum approach, including splintage, for buckle fractures; and on the use of below-elbow casts and indications for surgery for displaced wrist fractures in children.
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisLocal versus general anaesthesia for carotid endarterectomy.
Carotid endarterectomy reduces the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant perioperative risks which may be lessened by performing the operation under local rather than general anaesthetic. This is an update of a Cochrane review first published in 1996, and previously updated in 2004. ⋯ There is insufficient evidence from randomised trials comparing carotid endarterectomy performed under local and general anaesthetic. Non-randomised studies suggest potential benefits with the use of local anaesthetic, but these studies may be biased.
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisBypass surgery for chronic lower limb ischaemia.
Surgical bypass of an occluded arterial segment is one of the mainstay treatments for patients with critical limb ischaemia (CLI). However, it was introduced without formal evaluation. ⋯ There is limited evidence for the effectiveness of bypass surgery compared with other treatments; no studies compared bypass to no treatment. Further large trials are required.
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisEffect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.
Policies for timing of cord clamping vary, with early cord clamping generally carried out in the first 60 seconds after birth, whereas later cord clamping usually involves clamping the umbilical cord greater than one minute after the birth or when cord pulsation has ceased. ⋯ One definition of active management includes directions to administer an uterotonic with birth of the anterior shoulder of the baby and to clamp the umbilical cord within 30-60 seconds of birth of the baby (which is not always feasible in practice). In this review delaying clamping of the cord for at least two to three minutes seems not to increase the risk of postpartum haemorrhage. In addition, late cord clamping can be advantageous for the infant by improving iron status which may be of clinical value particularly in infants where access to good nutrition is poor, although delaying clamping increases the risk of jaundice requiring phototherapy.