STORRE Collection: Electronic copies of Faculty of Health Sciences and Sport Systematic Reviews.
http://hdl.handle.net/1893/2087
Electronic copies of Faculty of Health Sciences and Sport Systematic Reviews.2024-03-29T05:55:34ZWashout policies in long-term indwelling urinary catheterisation in adults
http://hdl.handle.net/1893/25538
Title: Washout policies in long-term indwelling urinary catheterisation in adults
Author(s): Hagen, Suzanne; Sinclair, Lesley; Cross, Stephen
Abstract: BACKGROUND: People requiring long-term bladder draining with an indwelling catheter can experience catheter blockage. Regimens involving different solutions can be used to washout catheters with the aim of preventing blockage. OBJECTIVES: To determine if certain washout regimens are better than others in terms of effectiveness, acceptability, complications, quality of life and economics for the management of long-term indwelling urinary catheterisation in adults. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, CINAHL and EMBASE (searches last updated April 2009). Additionally, we examined all reference lists of identified trials. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing catheter washout policies (e.g. washout versus no washout, different washout solutions, frequency, duration, volume, concentration, method of administration) in adults (16 years and above) in any setting (i.e. hospital, nursing/residential home, community) with an indwelling urethral or suprapubic catheter for more than 28 days. DATA COLLECTION AND ANALYSIS: Data were extracted by three reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the data in trials were not fully reported, clarification was sought from the authors. For categorical outcomes, the numbers reporting an outcome were related to the numbers at risk in each group to derive an risk ratio (RR). For continuous outcomes, means and standard deviations were used to derive weighted mean differences (WMD). No meta-analysis of study results was possible. MAIN RESULTS: Five trials met the inclusion criteria involving 242 patients (132 completed) in two cross-over and three parallel-group randomised controlled trials. Only three of the eight pre-stated comparisons were addressed in these trials. Some trials addressed more than one comparison (e.g. washout versus no washout and one type of washout solution versus another). The analyses reported for the two cross-over trials were inappropriate as they were based on differences between groups rather than differences within individuals receiving sequential interventions. Two parallel-group trials had limited value: one combined results for suprapubic and urethral catheters and one had data on only four participants. Only one trial was free of significant methodological limitations, but its sample size was small. Three trials compared no washout with one or more washout solution (saline or acidic solutions) and authors tended to conclude no difference in clinical outcomes between washout and no washout. In the one trial which had data of sufficient quality to allow interpretation, no difference was detected between washout and no washout groups in the rate of symptomatic urinary tract infection or time to first catheter change. Three trials compared different types of solution: saline versus acidic solutions (two trials); saline versus acidic solution versus antibiotic solution (one trial). Authors tended to report no difference between different washout solutions but the data were too few to support their conclusions. The one trial which warranted consideration concluded no difference between saline and an acidic solution in terms of symptomatic urinary tract infections or time to first catheter change. AUTHORS' CONCLUSIONS: The data from five trials comparing differing washout policies were sparse and trials were generally of poor quality or poorly reported. The evidence was too scanty to conclude whether or not washouts were beneficial. In the first instance we require further rigorous, high quality trials with adequate power to detect any benefit from washout being performed as opposed to none. Then trials comparing different washout solutions, washout volumes, frequencies/timings and routes of administration are needed.2010-01-01T00:00:00ZDebridement for surgical wounds
http://hdl.handle.net/1893/20573
Title: Debridement for surgical wounds
Author(s): Smith, Fiona; Dryburgh, Nancy; Donaldson, JH; Mitchell, Melloney
Abstract: Background: Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue will expedite wound healing. There are numerous methods available but no consensus on which one is most effective for surgical wounds. Objectives: To determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds. Search methods: In March 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. Selection criteria: We included randomised controlled trials (RCTs) with outcomes including at least one of the following: time to complete debridement or time to complete healing. Data collection and analysis: Two review authors independently reviewed the abstracts and titles obtained from the search, extracted data independently using a standardised extraction sheet and independently assessed methodological quality. One review author was involved in all stages of the data collection and extraction process, thus ensuring continuity. Main results: Five RCTs (159 participants) were eligible for inclusion; all compared treatments for infected surgical wounds and reported time required to achieve a clean wound bed (complete debridement). One trial compared an enzymatic agent (streptokinase/streptodornase) with saline-soaked dressings. Four trials compared the effectiveness of dextranomer beads or paste with other products (different comparator in each trial) to achieve complete debridement. Meta-analysis was not possible due to the unique comparisons within each trial. One trial reported that dextranomer achieved a clean wound bed significantly more quickly than Eusol, and one trial comparing enzymatic debridement with saline-soaked dressings reported that the enzyme-treated wounds were cleaned more quickly. However, methodological quality was poor in these two trials. Authors' conclusions: There is a lack of large, high-quality published RCTs evaluating debridement per se, or comparing different methods of debridement for surgical wounds, to guide clinical decision-making.2013-06-13T00:00:00ZCranberries for treating urinary tract infections
http://hdl.handle.net/1893/2469
Title: Cranberries for treating urinary tract infections
Author(s): Jepson, Ruth; Mihaljevic, Lara; Craig, Jonathan C
Abstract: Background Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). The aim of this review is to assess the effectiveness of cranberries in treating such infections. Objectives To assess the effectiveness of cranberries for the treatment of UTIs. Search strategy The search strategy developed by the Cochrane Renal Group was used. Also, companies involved with the promotion and distribution of cranberry preparations were contacted; electronic databases and the Internet were searched using English and non English language terms; reference lists of review articles and relevant studies were also searched. Date of last search: December 2007 Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs of cranberry juice or cranberry products for the treatment of UTIs. Studies of men, women or children were included. Data collection and analysis Titles and abstracts of studies that were potentially relevant to the review were screened by one author, RJ, who discarded studies that were clearly ineligible but aimed to be overly inclusive rather than risk losing relevant studies. Authors RJ and LM independently assessed whether the studies met the inclusion criteria. Further information was sought from the authors where papers contained insufficient information to make a decision about eligibility. Main results No studies were found which fulfilled all of the inclusion criteria. Two studies were excluded because they did not have any relevant outcomes and two studies are currently being undertaken. Authors' conclusions After a thorough search, no RCTs which assessed the effectiveness of cranberry juice for the treatment of UTIs were found. Therefore, at the present time, there is no good quality evidence to suggest that it is effective for the treatment of UTIs. Well-designed parallel group, double blind studies comparing cranberry juice and other cranberry products versus placebo to assess the effectiveness of cranberry juice in treating UTIs are needed. Outcomes should include reduction in symptoms, sterilisation of the urine, side effects and adherence to therapy. Dosage (amount and concentration) and duration of therapy should also be assessed. Consumers and clinicians will welcome the evidence from these studies.2009-01-01T00:00:00ZCranberries for preventing urinary tract infections
http://hdl.handle.net/1893/2460
Title: Cranberries for preventing urinary tract infections
Author(s): Jepson, Ruth; Craig, Jonathan C
Abstract: Background Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). Objectives To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations. Search strategy We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library) and the Internet. We contacted companies involved with the promotion and distribution of cranberry preparations and checked reference lists of review articles and relevant studies. Selection criteria All randomised controlled trials (RCTs) or quasi-RCTs of cranberry products for the prevention of UTIs in all populations. Data collection and analysis Two authors independently assessed and extracted information. Information was collected on methods, participants, interventions and outcomes (UTIs - symptomatic and asymptomatic, side effects, adherence to therapy). Risk ratio (RR) were calculated where appropriate, otherwise a narrative synthesis was undertaken. Quality was assessed using the Cochrane criteria. Main results Ten studies (n = 1049, five cross-over, five parallel group) were included. Cranberry/cranberry-lingonberry juice versus placebo, juice or water was evaluated in seven studies, and cranberries tablets versus placebo in four studies (one study evaluated both juice and tablets). Cranberry products significantly reduced the incidence of UTIs at 12 months (RR 0.65, 95% CI 0.46 to 0.90) compared with placebo/control. Cranberry products were more effective reducing the incidence of UTIs in women with recurrent UTIs, than elderly men and women or people requiring catheterisation. Six studies were not included in the meta-analyses due to methodological issues or lack of available data. However, only one reported a significant result for the outcome of symptomatic UTIs. Side effects were common in all studies, and dropouts/withdrawals in several of the studies were high. Authors' conclusions There is some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period, particularly for women with recurrent UTIs. It's effectiveness for other groups is less certain. The large number of dropouts/withdrawals indicates that cranberry juice may not be acceptable over long periods of time. It is not clear what is the optimum dosage or method of administration (e.g. juice, tablets or capsules). Further properly designed studies with relevant outcomes are needed.2008-01-01T00:00:00Z