Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review

2017 ◽  
Vol 131 (12) ◽  
pp. 1065-1092 ◽  
Author(s):  
I Z Iqbal ◽  
G H Jones ◽  
N Dawe ◽  
C Mamais ◽  
M E Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Care Setting ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Economic Effects ◽  
Review Of The Literature ◽  
Limited Evidence ◽  
Nasal Pack ◽  
Appropriate Care ◽  
Haemostatic Agents

AbstractBackground:The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use.Method:A systematic review of the literature was performed using standardised methodology.Results:Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non-dissolvable packs.Conclusion:Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use.

scholarly journals The use of olanzapine as an antiemetic in palliative medicine: a systematic review of the literature

2020 ◽  
Author(s):  
Gaëtan Saudemont ◽  
Chloé Prod'Homme ◽  
Arlette Da Silva ◽  
Stephanie Villet ◽  
Michel Reich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Palliative Medicine ◽  
Statistical Power ◽  
Care Setting ◽  
Case Series ◽  
Review Of The Literature ◽  
Palliative Care Setting ◽  
Initial Work ◽  
Bibliographic Search

Abstract Background: Olanzapine is an atypical antipsychotic that has affinity for many central nervous system receptors. Its efficacy is supported by several studies in the prevention and treatment of chemotherapy-induced nausea and vomiting. No recommendations exist on the antiemetic use of olanzapine in the palliative care setting. The aim of this work is to complete the initial work of Fonte et al. published in 2015, to determine whether the literature supports the use of olanzapine as an antiemetic in palliative situations and, in practice, to propose a therapeutic schema adapted to the palliative setting. Methods: Systematic review of the literature according to the PRISMA criteria. We searched the PubMed, Cochrane, RefDoc, EMBase databases and the gray literature databases. The bibliographic search was conducted between November 2016 and August 2017. Results: Thirteen articles were included: 2 case studies, 3 case series, 3 retrospective studies, 2 prospective studies, 2 literature reviews. All studies concluded on the efficacy of olanzapine as an antiemetic in the palliative care setting. No serious adverse effects were reported. Based on the data from the literature review, we propose a therapeutic scheme adapted to the palliative care context. Conclusion : Action of olanzapine on many receptors and its tolerance profile make it an interesting antiemetic treatment in palliative medicine. But to date, studies are scarce and have a low statistical power. Further investigation is therefore needed to determine the benefit of this treatment in palliative care patients, compared to usual treatments.

scholarly journals The use of olanzapine as an antiemetic in palliative medicine: a systematic review of the literature

2019 ◽  
Author(s):  
Gaëtan Saudemont ◽  
Chloé Prod'Homme ◽  
Arlette Da Silva ◽  
Stephanie Villet ◽  
Michel Reich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Palliative Medicine ◽  
Statistical Power ◽  
Care Setting ◽  
Case Series ◽  
Review Of The Literature ◽  
Palliative Care Setting ◽  
Initial Work ◽  
Bibliographic Search

Abstract Background: Olanzapine is an atypical antipsychotic that has affinity for many central nervous system receptors. Its efficacy is supported by several studies in the prevention and treatment of chemotherapy-induced nausea and vomiting. No recommendations exist on the antiemetic use of olanzapine in the palliative care setting. The aim of this work is to complete the initial work of Fonte et al. published in 2015, to determine whether the literature supports the use of olanzapine as an antiemetic in palliative situations and, in practice, to propose a therapeutic schema adapted to the palliative setting. Methods: Systematic review of the literature according to the PRISMA criteria. We searched the PubMed, Cochrane, RefDoc, EMBase databases and the gray literature databases. The bibliographic search was conducted between November 2016 and August 2017. Results: Thirteen articles were included: 2 case studies, 3 case series, 3 retrospective studies, 2 prospective studies, 2 literature reviews. All studies concluded on the efficacy of olanzapine as an antiemetic in the palliative care setting. No serious adverse effects were reported. Based on the data from the literature review, we propose a therapeutic scheme adapted to the palliative care context. Conclusion: Action of olanzapine on many receptors and its tolerance profile make it an interesting antiemetic treatment in palliative medicine. But to date, studies are scarce and have a low statistical power. Further investigation is therefore needed to determine the benefit of this treatment in palliative care patients, compared to usual treatments.

Surgical and interventional radiological management of adult epistaxis: systematic review

2017 ◽  
Vol 131 (12) ◽  
pp. 1108-1130 ◽  
Author(s):  
C Swords ◽  
A Patel ◽  
M E Smith ◽  
R J Williams ◽  
I Kuhn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effect ◽  
Interventional Radiology ◽  
Search Strategy ◽  
Database Search ◽  
Economic Effects ◽  
Success Rates ◽  
Review Of The Literature ◽  
Artery Ligation ◽  
Sphenopalatine Artery

AbstractBackground:There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery.Method:A systematic review of the literature was performed using a standardised published methodology and custom database search strategy.Results:Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73–100 per cent and 75–92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1–1.5 per cent). No articles directly compared the two techniques.Conclusion:Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.

scholarly journals Should We Use Antibiotic Prophylaxis for Flexible Cystoscopy? A Systematic Review and Meta-Analysis

2015 ◽  
Vol 95 (3) ◽  
pp. 249-259 ◽  
Author(s):  
Michelle M. Carey ◽  
Abdullah Zreik ◽  
Neil J. Fenn ◽  
Piotr L. Chlosta ◽  
Omar M. Aboumarzouk
Keyword(s):  
Systematic Review ◽  
Antibiotic Prophylaxis ◽  
Meta Analysis ◽  
Asymptomatic Bacteriuria ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Control Group ◽  
Number Needed To Treat ◽  
Flexible Cystoscopy ◽  
Antibiotic Group

Introduction: The role of antibiotic prophylaxis for routine flexible cystoscopy (FC) is not clear due to the varying practices of individual clinicians. There are no formal guidelines, and this may be due to a lack of formal summary of the data. Methods: A systematic review was conducted in April 2014 including all randomised control trials on prophylactic antibiotic use for FC. The main outcome measures were confirmed bacteriuria on mid-stream urine (MSU), asymptomatic bacteriuria and symptomatic bacteriuria. A meta-analysis was conducted with difference between groups expressed as an odds ratio (OR) and control group risk. Results: 5,107 patients were included, 2,173 in placebo and 2,934 in the antibiotic group. The OR for all three outcomes favoured the antibiotic group; the risk of developing symptomatic bacteriuria was 0.06 times more likely in the control group (OR 0.34), 0.054 (OR 0.40) for developing asymptomatic bacteriuria and 0.109 for confirming bacteriuria on MSU (OR 0.36). The number needed to treat (NNT) was 15 (13-19) for MSU positive bacteriuria; 32 (27-42) for symptomatic bacteriuria and 26 (23-33) for asymptomatic bacteriuria. Conclusions: Antibiotic prophylaxis did confer a reduction in cases of symptomatic and asymptomatic bacteriuria but the NNT were high. Therefore, the authors cannot advocate the use of antibiotic prophylaxis for routine FC procedures.

scholarly journals Current prophylactic perioperative antibiotic guidelines in trauma: a review of the literature and outcome data

2009 ◽  
Vol 9 (1) ◽  
pp. S46-S53 ◽  
Author(s):  
Lejla Hadzikadic
Keyword(s):  
Trauma Surgery ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Outcome Data ◽  
Standards Of Care ◽  
Review Of The Literature ◽  
The Past ◽  
Perioperative Antibiotics ◽  
Prophylactic Use ◽  
Evidence Based Guidelines

A comprehensive review of prophylactic use of perioperative antibiotics in trauma from the 1970s to the present was performed. Evidence based guidelines were used to analyze the data from the past 32 years and define standards of care in the field. Recommendations and suggestions are provided to offer guidelines for prophylactic antibiotic use in trauma. Highlighted topics include general trauma surgery, with focus placed on abdominal and thoracic surgery in trauma, and non-trauma surgery, including subspecialties, for comparison.

scholarly journals P.057 A systematic review of the prophylactic antibiotic use in endoscopic endonasal transsphenoidal surgery for pituitary lesions

2018 ◽  
Vol 45 (s2) ◽  
pp. S30-S31
Author(s):  
ID Moldovan ◽  
C Agbi ◽  
S Kilty ◽  
F Alkherayf
Keyword(s):  
Systematic Review ◽  
Transsphenoidal Surgery ◽  
Observational Studies ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Series Data ◽  
Inclusion Criteria ◽  
Endoscopic Endonasal ◽  
Number Of Patients ◽  
Endoscopic Endonasal Transsphenoidal Surgery

Background: The benefit of prophylactic antibiotic use in endoscopic endonasal transsphenoidal surgery (EETS) for pituitary lesions is controversial. Many surgeons administer antibiotics perioperatively not based on clear guidelines but “to be safe”. Methods: A systematic review using PRISMA guidelines was performed to assess the efficacy of perioperative antibiotic use to prevent infectious complications in patients undergoing EETS. Inclusion criteria: randomized controlled trials, systematic reviews, observational studies, and case series. Data extracted: study design, year of publication, sample size, surgery type, perioperative antibacterial treatment (antibiotic, dose, and duration), number of patients with 30-days post-operative meningitis and/or sinusitis. End points: rates of meningitis and sinusitis post-EETS. Results: A total of 280 articles were identified. Four observational studies met inclusion criteria. Based on GRADE score these studies were considered low in quality. 633 patients were -included in those studies. The most common antibiotics used were cefazolin and ceftazidime. The rate of infection ranged from 0.5% to 3.1 % for meningitis as the most common infection. Conclusions: The need to use antibiotic(s) perioperatively is not clear in patients with pituitary lesions undergoing EETS. Randomized control trials are needed to evaluate the efficacy of prophylactic antibiotic use in patients with pituitary lesions undergoing EETS.

Intranasal cautery for the management of adult epistaxis: systematic review

2017 ◽  
Vol 131 (12) ◽  
pp. 1056-1064 ◽  
Author(s):  
R W J Mcleod ◽  
A Price ◽  
R J Williams ◽  
M E Smith ◽  
M Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Search Strategy ◽  
Controlled Trial ◽  
Economic Assessment ◽  
Success Rates ◽  
Review Of The Literature ◽  
Limited Evidence ◽  
Patient Tolerance ◽  
Randomised Controlled ◽  
Chemical Cautery

AbstractBackground:Cauterisation techniques are commonly used and widely accepted for the management of epistaxis. This review assesses which methods of intranasal cautery should be endorsed as optimum treatment on the basis of benefits, risks, patient tolerance and economic assessment.Method:A systematic review of the literature was performed using a standardised methodology and search strategy.Results:Eight studies were identified: seven prospective controlled trials and one randomised controlled trial. Pooling of data was possible from 3 studies, yielding a total of 830 patients. Significantly lower re-bleed rates were identified (p < 0.01) using electrocautery (14.5 per cent) when compared to chemical cautery (35.1 per cent). No evidence suggested that electrocautery was associated with more adverse events or discomfort. Limited evidence supported the use of a vasoconstrictor agent and operating microscope during the procedure. The included studies had considerable heterogeneity in terms of design and outcome measures.Conclusion:Consistent evidence suggests that electrocautery has higher success rates than chemical cautery, and is not associated with increased complications or patient discomfort. Lower quality evidence suggests that electrocautery reduces costs and duration of hospital stay.

scholarly journals Prophylactic antibiotic use following cardiac arrest: A systematic review and meta-analysis

Resuscitation ◽  
2019 ◽  
Vol 141 ◽  
pp. 166-173 ◽  
Author(s):  
Keith Couper ◽  
Ryan Laloo ◽  
Richard Field ◽  
Gavin D. Perkins ◽  
Matthew Thomas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Meta Analysis ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use
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