Cochrane Collaboration

About: Cochrane Collaboration is a nonprofit organization based out in Oxford, United Kingdom. It is known for research contribution in the topics: Systematic review & Randomized controlled trial. The organization has 1995 authors who have published 3928 publications receiving 382695 citations.

Quinine for muscle cramps.

Abstract: Muscle cramps can occur anywhere and for many reasons. Quinine has been used to treat cramps of all causes. However, controversy continues about its efficacy and safety.

Positive end‐expiratory pressure (PEEP) during anaesthesia for the prevention of mortality and postoperative pulmonary complications

Abstract: Positive end-expiratory pressure (PEEP) is a mechanical technique that is often used when ventilating an unconscious patient. The technique involves adding a quantity of pressure into the lungs at the end of each breath. The process of ventilating a patient causes a degree of deflation in the lungs; between breaths the lungs contain less air than usual. By adding positive pressure at that time, we aim to re-inflate the airways. We know that PEEP can improve respiratory function during a general anaesthetic. We do not know whether patients who receive PEEP have a lower risk of postoperative mortality or respiratory complications, such as pneumonia. In this review, we aimed to assess the postoperative benefits and harms of using PEEP during general anaesthesia. After a search of the literature, we found eight randomized clinical trials (RCTs) involving 330 patients. Four trials reported mortality as an outcome. We pooled these data and found no difference between the group of patients who received PEEP and those who did not, but because of the small number of patients, and the fact that this outcome may be rare, these results did not allow us to make a conclusion about the effect of PEEP on mortality. There were two findings that suggested some benefit of PEEP. First, oxygenation was better on the day after surgery in the PEEP group. Second, radiological imaging showed less atelectasis (areas of collapsed lung) after surgery in the PEEP group. We did calculations to predict how many more patients would be needed in order to be able to make reliable conclusions about the application of PEEP on mortality. This number was 21,200. From the studies that we found, there was no suggestion that intraoperative PEEP causes harm. This finding is reassuring but, due to the small numbers, it is inconclusive. There is currently insufficient evidence to make conclusions about how intraoperative PEEP affects postoperative mortality and respiratory complications.

How patients' experiences contribute to decision making: illustrations from DIPEx (personal experiences of health and illness).

Abstract: Aim To describe how people use their and other people’s experiences (‘experiential evidence’) in making health care decisions. Background People faced with health decisions may employ not only clinical evidence and advice, but also their own previous experiences and the experiences of others who have faced similar decisions. Professionals have taken little notice of people’s use of such experiential evidence and its importance in practice; acknowledging it would improve communication with patients. Methods The data come from the DIPEx (personal experiences of health and illness) project, which involves rigorous analysis of narrative interviews of people with particular conditions, chosen to represent the widest practicable range of experiences of each condition. Each collection consists of 40–50 interviews. Results The analyses of people’s experiences are summarized for patients and professionals on a website (http://www.dipex.org) and illustrated by clips (video, audio or written) from the interviews. We draw on the qualitative research conducted for DIPEx to consider some of the different ways that people integrate experiential information when they face decisions about antenatal screening, childhood immunization and treatment for cancer. Conclusions Other patients’ experiences are an important part of the evidence that people use when making decisions about health care. People are naturally drawn to other people’s stories, which add salience to medical information and make facts palatable and memorable. Patients’ experiences are not an alternative to the evidence base – they are part of it; to dismiss them as ‘anecdotes’ is a serious misunderstanding. There are established methods, grounded in social science traditions, which can be used to research and report patients’ experiences. Health professionals, as well as patients, need to consider and value this experiential evidence. Implications for Nursing Management Managers and clinicians can help patients by guiding them to information resources, such as DIPEx, that present evidence-based health information through patients’ experiences.