Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2014
Review Meta AnalysisAnticoagulation for the long-term treatment of venous thromboembolism in patients with cancer.
Cancer increases the risk of thromboembolic events in patients including those receiving anticoagulation treatments. ⋯ For the long-term treatment of VTE in patients with cancer, LMWH compared with VKA reduces venous thromboembolic events but not mortality. The decision for a patient with cancer and VTE to start long-term LMWH versus oral anticoagulation should balance the benefits and harms and integrate the patient's values and preferences for the important outcomes and alternative management strategies.
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Cochrane Db Syst Rev · Jan 2014
Review Meta AnalysisSystemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults.
Dental pain can have a considerable detrimental effect on an individual's quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with symptomatic apical periodontitis or an acute apical abscess should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists continue to prescribe antibiotics for these conditions. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies both within the individual and within the community as a whole. ⋯ There is very low quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.
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Cochrane Db Syst Rev · Jan 2014
Review Meta AnalysisConservative management following closed reduction of traumatic anterior dislocation of the shoulder.
Acute anterior dislocation, which is the most common type of shoulder dislocation, usually results from an injury. Subsequently, the shoulder is less stable and is more susceptible to re-dislocation, especially in active young adults. This is an update of a Cochrane review first published in 2006. ⋯ Numerous conservative strategies may be adopted after closed reduction of a traumatic anterior dislocation of the shoulder, and many warrant investigation. However, our review reveals that evidence from randomised controlled trials is only available for a single approach: immobilisation in external rotation versus immobilisation in the traditional position of internal rotation. Moreover, this evidence is insufficient to demonstrate whether immobilisation in external rotation confers any benefit over immobilisation in internal rotation.We identified six unpublished trials and two ongoing trials that compare immobilisation in external versus internal rotation. Given this, the main priority for research on this question consists of the publication of completed trials, and the completion and publication of ongoing trials. Meanwhile, increased attention to other interventions is required. Sufficiently powered, good quality, well reported randomised controlled trials with long-term surveillance should be conducted to examine the optimum duration of immobilisation, whether immobilisation is necessary at all (in older age groups particularly), which rehabilitative interventions work best and the acceptability to participants of different care strategies.
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Cochrane Db Syst Rev · Jan 2014
Review Meta AnalysisDevices for preventing percutaneous exposure injuries caused by needles in healthcare personnel.
Needlestick injuries from devices used for blood collection or for injections expose healthcare workers to the risk of blood borne infections such as hepatitis B and C, and human immunodeficiency virus (HIV). Safety features such as shields or retractable needles can possibly contribute to the prevention of these injuries and it is important to evaluate their effectiveness. ⋯ For safe blood collection systems, we found very low quality evidence in one study that these decrease needlestick injuries (NSIs). For intravenous systems, we found very low quality evidence that they result in a decrease of NSI compared with usual devices but moderate quality evidence that they increase contamination with blood. For other safe injection needles, the introduction of multiple safety devices or the introduction of sharps containers the evidence was inconsistent or there was no clear evidence of a benefit. All studies had a considerable risk of bias and the lack of evidence of a beneficial effect could be due both to confounding and bias. This does not mean that these devices are not effective.Cluster-randomised controlled studies are needed to compare the various types of safety engineered devices for their effectiveness and cost-effectiveness, especially in low- and middle-income countries.
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Acute bacterial meningitis remains a disease with high mortality and morbidity rates. However, with prompt and adequate antimicrobial and supportive treatment, the chances for survival have improved, especially among infants and children. Careful management of fluid and electrolyte balance is an important supportive therapy. Both over- and under-hydration are associated with adverse outcomes. ⋯ The quality of evidence regarding fluid therapy in children with acute bacterial meningitis is not high-grade and there is a need for further research. Some evidence supports maintaining intravenous fluids rather than restricting them in the first 48 hours in settings with high mortality rates and where children present late. However, where children present early and mortality rates are lower, there is insufficient evidence to guide practice.