Cochrane Db Syst Rev
-
Cochrane Db Syst Rev · Jan 2010
ReviewProvision of a surgeon's performance data for people considering elective surgery.
A consumer model of health supports that elective surgery patients should be informed about the past operative performance of their surgeon before making two important decisions: 1) to consent to the proposed surgery, and 2) to have a particular doctor perform the surgery. This information arguably helps empower patients to participate in their care. While surgeons' performance data are available in some settings there continues to be controversy over the provision of such data to patients, and the question of whether consumers should, or want to, be provided with this information. ⋯ We found no studies reporting the impact of the provision of a surgeon's performance data for people considering elective surgery. This is an important finding in itself. While the public reporting of a surgeon's performance is not a new concept, the efficacy of this data for individual patients has not been empirically tested. We recommend that a review of qualitative studies or new primary qualitative research be conducted to determine what interventions are currently in use and explore the attitudes of consumers and professionals towards such interventions.
-
Cochrane Db Syst Rev · Jan 2010
ReviewDe-escalation of antimicrobial treatment for adults with sepsis, severe sepsis or septic shock.
Mortality rates among patients with sepsis, severe sepsis or septic shock ranges from 27% to 54%. Empirical broad-spectrum antimicrobial treatment is aimed at achieving adequate antimicrobial therapy and thus reducing mortality. However, there is a risk that empirical broad-spectrum antimicrobial treatment can expose patients to overuse of antimicrobials. De-escalation has been proposed as a strategy to replace empirical broad-spectrum antimicrobial treatment with a narrower antimicrobial therapy. This is done by either changing the pharmacological agent or discontinuing a pharmacological combination according to the patient's microbial culture results. ⋯ There is no adequate, direct evidence as to whether de-escalation of antimicrobial agents is effective and safe for adults with sepsis, severe sepsis or septic shock. Therefore, it is not possible to either recommend or not recommend the de-escalation of antimicrobial agents in clinical practice for septic patients. This uncertainty warrants further research via randomized controlled trials or cohort studies.
-
Cochrane Db Syst Rev · Jan 2010
ReviewInterventions for treating proximal humeral fractures in adults.
Proximal humeral fractures are common injuries. The management, including surgical intervention, of these fractures varies widely. ⋯ There is insufficient evidence to inform the management of these fractures. Early physiotherapy, without immobilisation, may be sufficient for some types of undisplaced fractures. It is unclear whether surgery, even for specific fracture types, will produce consistently better long term outcomes.
-
Cochrane Db Syst Rev · Jan 2010
ReviewClinically-indicated replacement versus routine replacement of peripheral venous catheters.
Centers for Disease Control Guidelines recommend replacement of peripheral intravenous (IV) catheters every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bacteraemia. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation. Costs associated with routine replacement may be considerable. ⋯ The review found no conclusive evidence of benefit in changing catheters every 72 to 96 hours. Consequently, health care organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would also be welcomed by patients, who would be spared the unnecessary pain of routine re-sites in the absence of clinical indications.
-
Cochrane Db Syst Rev · Jan 2010
ReviewInterventions for improving the appropriate use of imaging in people with musculoskeletal conditions.
Imaging is commonly performed for musculoskeletal conditions. Identifying interventions to improve the appropriate use of imaging for musculoskeletal conditions could potentially result in improved health outcomes for patients and reduced health care costs. ⋯ For improving the use of imaging in osteoporosis, most professional interventions demonstrated benefit, and patient mediated, reminder, and organisational interventions appeared to have most potential for benefit. For low back pain studies interventions showed varying effects. For other musculoskeletal conditions, no firm conclusions can be drawn.