Cochrane Db Syst Rev
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Venous leg ulceration is a common problem, representing a significant burden on the patient and the healthcare system. They are caused by venous insufficiency and tend to be chronic and recurring. Management usually includes use of wound dressings plus compression stockings or bandages. It has been suggested that therapeutic ultrasound may have an adjuvant effect and promote healing however its effects are unclear. ⋯ The available evidence suggests that ultrasound may increase healing of venous leg ulcers. These conclusions are based on the results of only eight small studies of generally poor quality and therefore should be interpreted with caution.
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisLocomotor training for walking after spinal cord injury.
Locomotor training for walking is used in rehabilitation after spinal cord injury (SCI) and might help to improve walking. ⋯ There is insufficient evidence from RCTs to conclude that any one locomotor training strategy improves walking function more than another for people with SCI. Research in the form of large RCTs is needed to address specific questions about the type of locomotor training which might be most effective in improving walking function of people with SCI.
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Cochrane Db Syst Rev · Jan 2008
Review Meta Analysis Comparative StudyPeribulbar versus retrobulbar anaesthesia for cataract surgery.
Cataract is a major cause of blindness worldwide. Unless medically contraindicated, cataract surgery is usually performed under local (regional) anaesthesia. Local anaesthesia involves the blockage of a nerve subserving a given part of the body by infiltration of the area around the nerve with local anaesthetic. The two main approaches in the eye are retrobulbar and peribulbar. There is debate over whether the peribulbar approach provides more effective and safer anaesthesia for cataract surgery than retrobulbar block. ⋯ There is little to choose between peribulbar and retrobulbar block in terms of anaesthesia and akinesia during surgery in terms of acceptability to patients, need for additional injections and development of severe complications. Severe local or systemic complications were rare in PB and RB.
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Cochrane Db Syst Rev · Jan 2008
Review Meta Analysis Comparative StudyConservative versus operative treatment for hip fractures in adults.
Until operative treatment involving the use of various implants was introduced in the 1950s, hip fractures were managed using conservative methods based on traction and bed rest. ⋯ Although there is a lack of available evidence to inform practice for undisplaced intracapsular fractures, variation in practice has reduced and most fractures are treated surgically. The limited available evidence from randomised trials does not suggest major differences in outcome between conservative and operative management programmes for extracapsular femoral fractures, but operative treatment is associated with a reduced length of hospital stay and improved rehabilitation. Conservative treatment will be acceptable where modern surgical facilities are unavailable, and will result in a reduction in complications associated with surgery, but rehabilitation is likely to be slower and limb deformity more common. Currently, it is difficult to conceive circumstances in which future trials would be practical or viable.
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Cochrane Db Syst Rev · Jan 2008
Review Meta AnalysisAntibiotics to reduce post-tonsillectomy morbidity.
Tonsillectomy continues to be one of the most common surgical procedures performed in children and adults. Despite improvements in surgical and anaesthetic techniques, postoperative morbidity, mainly in the form of pain, remains a significant clinical problem. Postoperative bacterial infection of the tonsillar fossa has been proposed as an important factor causing pain and associated morbidity, and some studies have found a reduction in morbid outcomes following the administration of perioperative antibiotics. ⋯ The present review suggests that there is little or no evidence that antibiotics reduce the main morbid outcomes following tonsillectomy (i.e. pain, the need for analgesia or secondary haemorrhage rates). They do however appear to reduce fever. Some important methodological shortcomings exist in the included trials which are likely to have produced bias favouring antibiotics. We therefore advocate caution when prescribing antibiotics routinely to all patients undergoing tonsillectomy. Whether a subgroup of patients who might benefit from selective administration of antibiotics exists is unknown and needs to be explored in future trials.