New and updated
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Blood thinners for the prevention of clots in patients with cancer
undergoing surgery
Posted: 25 Jun 2014 03:00 PM PDT
http://feedproxy.google.com/~r/NewAndUpdatedSummaries/~3/TsT8aKMrgK0/GYNAEC…
Updated
Akl EA, Kahale L, Sperati F, Neumann I, Labedi N, Terrenato I, Barba M,
Sempos EV, Muti P, Cook D, Schünemann H
Background
Patients with cancer undergoing surgical procedures are at an increased
risk of blood clots. The blood thinner administered to prevent these clots
can be either an unfractionated heparin (UFH) or low molecular weight
heparin (LMWH). These two blood thinners may have different effectiveness
and safety profiles.
Study characteristics
We searched scientific databases for clinical trials looking at the effects
of UFH and LMWH on death, pulmonary embolism (blood clot in the lungs),
deep vein thrombosis (blood clot in the veins of the legs), bruising,
bleeding, and need for blood transfusion in patients having operations. We
included people of any age or sex. The evidence is current to February 2013.
Key results
We found 16 studies of 12,890 patients with cancer. There was no evidence
to show that LMWH was better than UFH for death, asymptomatic deep vein
thrombosis, pulmonary embolism, or bleeding. There was less bruising around
the wound and more blood transfusion during the operation with LMWH
compared with UFH. Further trials are needed to clarify the effectiveness
of LMWH and UFH.
Quality of evidence
The overall quality of evidence of these studies was moderate.
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Different infusion durations for preventing platinum-induced hearing loss
in children with cancer
Posted: 25 Jun 2014 03:00 PM PDT
http://feedproxy.google.com/~r/NewAndUpdatedSummaries/~3/yUOemQXcXto/CHILDC…
New
van As JW, van den Berg H, van Dalen EC
Platinum-based chemotherapy, including cisplatin, carboplatin or
oxaliplatin, or a combination of these, is used to treat different types of
childhood cancer. Unfortunately, one of the most important adverse effects
of platinum chemotherapy is hearing loss. This can occur not only during
treatment but also years after the end of treatment. Although it is not
life-threatening, the loss of hearing, especially during the first three
years of life, may lead to difficulties with school performance and
psychosocial functioning. Therefore, prevention of platinum-induced hearing
loss is very important and might improve the quality of life of children
undergoing cancer treatment and those who have survived treatment with
platinum-based chemotherapy.
The review authors identified one randomised study comparing a continuous
cisplatin infusion with a one hour cisplatin bolus infusion in children
with neuroblastoma. For the continuous infusion, cisplatin was administered
on days 1 to 5 of the treatment cycle but it is not clear if the infusion
duration was a total of 5 days. The study had methodological problems and
only results from shortly after induction therapy were available. At the
moment there is no evidence showing that the use of a different cisplatin
infusion duration prevents hearing loss or adversely affects tumour
response and adverse effects. No data were available for the other outcomes
of interest (i.e. tinnitus, overall survival, event-free survival and
quality of life) or for other (combinations of) infusion durations or other
platinum analogues. We need more high quality research before definite
conclusions can be made about the usefulness of different platinum infusion
durations to prevent hearing loss in children with cancer.
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The effects of antibiotics on toothache caused by inflammation or infection
at the root of the tooth in adults
Posted: 25 Jun 2014 03:00 PM PDT
http://feedproxy.google.com/~r/NewAndUpdatedSummaries/~3/HAsm-BI4Oi0/ORAL_t…
New
Cope A, Francis N, Wood F, Mann MK, Chestnutt IG
This review, carried out by authors of the Cochrane Oral Health Group, has
been produced to assess the effects of antibiotics on pain and swelling in
two conditions commonly responsible for causing dental pain when given with
or without dental treatment (such as extraction, drainage of a swelling or
root canal treatment).
Background
Dental pain is a common problem and can arise when the nerve within a tooth
dies due to progressing decay or severe trauma. The tissue around the end
of the root then becomes inflamed and this can lead to acute pain, which
gets worse on biting. Without treatment, bacteria can infect the dead tooth
and cause a dental abscess, which can lead to swelling and spreading
infection that may be life threatening.
The recommended treatment of this form of toothache is the removal the dead
nerve and associated bacteria. This is usually done by dental extraction or
root canal treatment. Antibiotics should only be prescribed when there is
severe infection that has spread from the tooth. However, some dentists
still routinely prescribe oral antibiotics to people with acute dental
conditions that have no signs of spreading infection.
Minimising inappropriate antibiotic prescribing is plays a key role in
limiting the development of antibiotic-resistant bacteria. Since dentists
prescribe approximately 8% to 10% of all primary care antibiotics in
developed countries, dental prescribing may contribute to antibiotic
resistance. Therefore, it is important that antibiotics should only be used
when they are clinically beneficial for the person.
Study characteristics
The evidence on which this review is based was up to date as of 1 October
2013. We searched scientific databases and found two trials, with a 62
participants included in the analysis. Both trials were conducted at
university dental schools in the USA and evaluated the use of oral
antibiotics in the reduction of pain and swelling reported by adults after
having the first stage of root canal treatment under local anaesthetic. The
antibiotic used in both trials was penicillin VK and all participants also
received painkillers.
Key results
The two studies included in the review reported that there were no clear
differences in the pain or swelling reported by participants who received
oral antibiotics compared with a placebo (a dummy treatment) when provided
in conjunction with the first stage of root canal treatment and
painkillers, but the studies were small and we could not exclude
potentially important differences between groups. Neither study examined
the effect of antibiotics delivered by themselves, without dental treatment.
One trial reported side effects among participants: one person who received
the placebo medication had diarrhoea and one person who received
antibiotics experienced tiredness and reduced energy after their operation.
Quality of evidence
We judged the quality of evidence to be very low. There is currently
insufficient evidence to be able to determine the effects of antibiotics in
these conditions.
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