Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2010
ReviewCyanoacrylate microbial sealants for skin preparation prior to surgery.
Surgical site infections are a continuing concern in health care. Microbial sealant is a liquid applied to the skin immediately before surgery. It is thought to contribute to reducing surgical site infections by sealing in the skin flora to prevent contamination and infection of the surgical site. ⋯ There is currently insufficient evidence as to whether the use of microbial sealants reduces the risk of surgical site infection in people undergoing clean surgery and further rigorous RCTs are required.
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Healthcare workers need to be supported to maintain sufficient levels of motivation and productivity, and to prevent the debilitating effects of stress on mental and physical well-being. ⋯ There is insufficient evidence for the effectiveness of stress management training interventions to reduce job stress and prevent burnout among healthcare workers beyond the intervention period. Low quality evidence suggests that longer-term interventions with refresher or booster sessions may have more sustained positive effect, but this needs to be rigorously evaluated in further trials.Low quality evidence exists to show that management interventions may improve some measures of job satisfaction. However, further trials are needed to assess whether this finding is replicable in other settings. There was insufficient evidence of the benefit of management interventions on staff absenteeism.Rigorous trials are needed to assess the effects of longer-term stress management training and management interventions in primary care and developing country settings.
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Cochrane Db Syst Rev · Jan 2010
ReviewEarly versus late pre-intensive care unit admission broad spectrum antibiotics for severe sepsis in adults.
Severe sepsis and septic shock have recently emerged as particularly acute and lethal challenges amongst critically ill patients presenting to the emergency department (ED). There are no existing data on the current practices of management of patients with severe sepsis comparing early versus late administration of appropriate broad spectrum antibiotics as part of the early goal-directed therapy that is commenced in the first few hours of presentation. ⋯ Based on this review we are unable to make a recommendation on the early or late use of broad spectrum antibiotics in adult patients with severe sepsis in the ED pre-ICU admission. There is a need to do large prospective double blinded randomized controlled trials on the efficacy of early (within one hour) versus late broad spectrum antibiotics in adult severe sepsis patients. Since it makes sense to start antibiotics as soon as possible in this group of seriously ill patients, administering such antibiotics earlier as opposed to later is based on anecdotal suboptimal evidence.
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Cochrane Db Syst Rev · Jan 2010
ReviewTranscutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults.
Amputee pain may present in a body part that has been amputated (phantom pain) or at the site of amputation (stump pain), or both. Phantom pain and stump pain are complex and multidimensional and the underlying pathophysiology remains unclear. The mainstay treatments for phantom pain and stump pain are predominately pharmacological. The condition remains a severe burden for those who are affected by it. There is increasing acknowledgement of the need for non-drug interventions and Transcutaneous Electrical Nerve Stimulation (TENS) may have an important role to play. TENS has been recommended as a treatment option for phantom pain and stump pain. To date there has been no systematic review of available evidence and the effectiveness of TENS for phantom pain and stump pain is currently unknown. ⋯ There were no RCTs on which to judge the effectiveness of TENS for the management of phantom pain and stump pain. The published literature on TENS for phantom pain and stump pain lacks the methodological rigour and robust reporting needed to confidently assess its effectiveness. Further RCT evidence is required before such a judgement can be made.
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Cochrane Db Syst Rev · Jan 2010
Pharmacological interventions for obsessive-compulsive personality disorder.
This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the potential beneficial and adverse effects of pharmacological interventions for people with obsessive-compulsive personality disorder and to make recommendations for future areas of research.