Cochrane Db Syst Rev
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Prolonged labour can lead to increased maternal and neonatal mortality and morbidity due to increased risks of maternal exhaustion, postpartum haemorrhage and sepsis, fetal distress and asphyxia and requires early detection and appropriate clinical response. The risks for complications of prolonged labour are much greater in poor resource settings. Active management of labour versus physiological, expectant management, has shown to decrease the occurrence of prolonged labour. Administering antispasmodics during labour could also lead to faster and more effective dilatation of the cervix. Interventions to shorten labour, such as antispasmodics, can be used as a preventative or a treatment strategy in order to decrease the incidence of prolonged labour. As the evidence to support this is still largely anecdotal around the world, there is a need to systematically review the available evidence to obtain a valid answer. ⋯ There is low quality evidence that antispasmodics reduce the duration of first stage of labour and increase the cervical dilatation rate. There is very low quality evidence that antispasmodics reduce the total duration of labour. There is moderate quality evidence that antispasmodics do not affect the rate of normal vertex deliveries. There is insufficient evidence to make any conclusions regarding the safety of these drugs for both mother and baby. Large, rigorous randomised controlled trials are needed to evaluate the effect of antispasmodics on prolonged labour and to evaluate their effect on labour in a context of expectant management of labour.
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Cochrane Db Syst Rev · Jan 2012
Review Meta AnalysisPreoperative bathing or showering with skin antiseptics to prevent surgical site infection.
Surgical site infections (SSIs) are wound infections that occur after invasive (surgical) procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted procedure for reducing skin bacteria (microflora). It is less clear whether reducing skin microflora leads to a lower incidence of surgical site infection. ⋯ This review provides no clear evidence of benefit for preoperative showering or bathing with chlorhexidine over other wash products, to reduce surgical site infection. Efforts to reduce the incidence of nosocomial surgical site infection should focus on interventions where effect has been demonstrated.
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Cochrane Db Syst Rev · Jan 2012
Review Meta AnalysisPatellar taping for patellofemoral pain syndrome in adults.
Patellofemoral pain syndrome refers to the clinical presentation of knee pain related to changes in the patellofemoral joint. Patellofemoral pain syndrome usually has a gradual onset of pain with none of the features associated with other knee diseases or trauma. It is often treated by physiotherapists, who use a variety of techniques including patellar taping. This involves the application of adhesive sports medical tape applied directly to the skin over the patella on the front of the knee. Patients often report an instantaneous improvement in pain and function after the tape is applied, but its longer term effects are uncertain. ⋯ The currently available evidence from trials reporting clinically relevant outcomes is low quality and insufficient to draw conclusions on the effects of taping, whether used on its own or as part of a treatment programme. Further research involving large, preferably multi-centre, good quality and well reported randomised controlled trials that measure clinically important outcomes and long-term results is warranted. Before this, consensus is required on the diagnosis of patellofemoral pain syndrome, the standardisation of outcome measurement and an acceptable approach for patellar taping.
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Cochrane Db Syst Rev · Jan 2012
Review Meta AnalysisPsychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents.
Depressive disorders are common in children and adolescents and, if left untreated, are likely to recur in adulthood. Depression is highly debilitating, affecting psychosocial, family and academic functioning. ⋯ There is very limited evidence upon which to base conclusions about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these interventions. On the basis of the available evidence, the effectiveness of these interventions for treating depressive disorders in children and adolescents cannot be established. Further appropriately powered RCTs are required.
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Cochrane Db Syst Rev · Jan 2012
Review Meta AnalysisTiagabine add-on for drug-resistant partial epilepsy.
Epilepsy is a common neurological condition, affecting almost 0.5 to 1% of the population. Nearly 30% of people with epilepsy are resistant to currently available drugs. Tiagabine is one of the newer antiepileptic drugs and its effects as an adjunct (add-on) to standard drugs are assessed in this review. ⋯ Tiagabine reduces seizure frequency but is associated with some adverse effects when used as an add-on for people with drug-resistant localisation-related seizures.