Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Apr 2009
ReviewEffects of changes in the pre-licensure education of health workers on health-worker supply.
The current and projected crisis because of a shortage of health workers in low and middle-income countries (LMICs) requires that effective strategies for expanding the numbers of health workers are quickly identified in order to inform action by policymakers, educators, and health managers. ⋯ The evidence to estimate the likely effects of interventions in pre-licensure education to increase health-worker supply is generally insufficient or unavailable, particularly in LMICs. Promising innovations from a high-income country include providing financial support to health professional students or introducing mechanisms to identify and encourage potential students and offering support to 'at risk' students. These and other promising interventions should be evaluated in LMIC.
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Cochrane Db Syst Rev · Apr 2009
Review Meta AnalysisSingle dose oral etoricoxib for acute postoperative pain in adults.
Etoricoxib is a selective cyclo-oxygenase-2 (COX-2) inhibitor prescribed for the relief of chronic pain in osteoarthritis and rheumatoid arthritis, and acute pain. The drug is believed to be associated with fewer upper gastrointestinal adverse effects than conventional non-steroidal anti-inflammatory drugs (NSAIDs). A number of studies in acute postoperative pain have now been published. ⋯ Single dose oral etoricoxib produces high levels of good quality pain relief after surgery. The 120 mg dose is as effective as, or better than, other commonly used analgesics.
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Cochrane Db Syst Rev · Apr 2009
Review Meta AnalysisPain control in first trimester surgical abortion.
First trimester abortions especially cervical dilation and suction aspiration are associated with pain, despite various methods of pain control. ⋯ Conscious sedation, GA and some non-pharmacological interventions decreased procedural and postoperative pain, while being safe and satisfactory to patients. Data on the widely used PCB is inadequate to support its use, and it needs to be further studied to determine any benefit.
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Enthusiasts suggest that labouring in water and waterbirth increase maternal relaxation, reduce analgesia requirements and promote a midwifery model of care. Sceptics cite the possibility of neonatal water inhalation and maternal/neonatal infection. ⋯ Evidence suggests that water immersion during the first stage of labour reduces the use of epidural/spinal analgesia. There is limited information for other outcomes related to water use during the first and second stages of labour, due to intervention and outcome variability. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring in water or waterbirth. The fact that use of water immersion in labour and birth is now a widely available care option for women threatens the feasibility of a large, multicentre randomised controlled trial.
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Cochrane Db Syst Rev · Apr 2009
Review Meta AnalysisStimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting.
Postoperative nausea and vomiting (PONV) are common complications following surgery and anaesthesia. Drugs to prevent PONV are only partially effective. An alternative approach is to stimulate the P6 acupoint on the wrist. This is an update of a Cochrane review first published in 2004. ⋯ P6 acupoint stimulation prevented PONV. There was no reliable evidence for differences in risks of postoperative nausea or vomiting after P6 acupoint stimulation compared to antiemetic drugs.