Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisAntimicrobial prophylaxis for colorectal surgery.
Research shows that administration of prophylactic antibiotics before colorectal surgery prevents postoperative surgical wound infection (SWI). The best antibiotic choice, timing of administration and route of administration remain undetermined. ⋯ Antibiotics covering aerobic and aerobic bacteria should be delivered orally and intravenously prior to colorectal surgery. Antibiotics delivered within this framework will reduce the risk of postoperative SWI by at least 75%. Further research is required to establish the optimal timing and duration of dosing, and frequency of longer-term adverse effects such as Clostridium difficile pseudomembranous colitis.
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Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisInterventions for replacing missing teeth: different times for loading dental implants.
To minimize the risk of implant failure, osseointegrated dental implants are conventionally kept load-free during the healing period. During healing removable prostheses are used, however many patients find these temporary prostheses rather uncomfortable and it would be beneficial if the healing period could be shortened without jeopardizing implant success. Nowadays immediately and early loaded implants are commonly used in mandibles (lower jaws) of good bone quality. It would be useful to know whether there is a difference in success rates between immediately or early loaded implants compared with conventionally loaded implants. ⋯ It is possible to successfully load dental implants immediately or early after their placement in selected patients, though not all clinicians may achieve optimal results. It is unclear whether it is beneficial to avoid occlusal contacts during the osseointegration phase. Trends suggest that immediately loaded implants fail more often than those conventionally loaded, but less commonly than those loaded early. If a clinician wishes to load the implants early, it might be wiser to load them immediately (within 1 week) rather than waiting for 1 or 2 months. A high degree of primary implant stability (high value of insertion torque) seems to be one of the prerequisites for a successful immediate/early loading procedure. More well designed RCTs are needed and should be reported according to the CONSORT guidelines (www.consort-statement.org/).
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Very early mobilisation is performed in some stroke units and recommended in acute stroke clinical guidelines. It is unclear whether very early mobilisation independently improves outcome after stroke. ⋯ We found insufficient evidence to support or refute the efficacy of routine very early mobilisation after stroke, compared with conventional care. More research is required to determine the benefits and harms of very early mobilisation after stroke.
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Cochrane Db Syst Rev · Jan 2009
ReviewWITHDRAWN: Surgical treatment for meniscal injuries of the knee in adults.
Injuries to the knee menisci are common and operations to treat them are among the most common procedures performed by orthopaedic surgeons. ⋯ The lack of randomised trials means that no conclusions can be drawn on the issue of surgical versus non-surgical treatment of meniscal injuries, nor meniscal tear repair versus excision.In randomised trials so far reported, there is no evidence of difference in radiological or long term clinical outcomes between arthroscopic and open meniscal surgery, or between total and partial meniscectomy. Partial meniscectomy seems preferable to the total removal of the meniscus in terms of recovery and overall functional outcome in the short term.
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Cochrane Db Syst Rev · Jan 2009
ReviewImmunosuppressant and immunomodulatory treatments for multifocal motor neuropathy.
Multifocal motor neuropathy is characterised by progressive, predominantly distal, asymmetrical limb weakness and usually multiple partial motor nerve conduction blocks. Intravenous immunoglobulin is beneficial but the role of immunosuppressive agents is uncertain. ⋯ In the only randomised placebo-controlled trial of any immunosuppressive agent, mycophenolate mofetil did not produce significant benefit. Trials of other immunosuppressants should be undertaken.