PubMed · 10215359
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J J Deeks. 1999-03-06. Commentary: "Switchback" allocation--dangerous bends ahead!. https://pubmed.ncbi.nlm.nih.gov/10215359/
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OBJECTIVE: To assess the use of fibre-optic transillumination (FOTI) as a diagnostic tool in general dental practice. DESIGN: A cross-over quantitative study for the diagnosis of approximal carious lesions by two clinical methods with a qualitative component. SUBJECTS AND METHODS: Seven GDPs were trained to use FOTI as an adjunct to their usual clinical examination to diagnose approximal caries. After 12 weeks of use in their practices four of the GDPs took part in two assessment sessions, set a week apart, using 29 volunteer patients. Each patient was examined on two separate occasions by each GDP using either their standard clinical examination technique alone or supplemented by FOTI examination. The order of the techniques was randomised. Radiographs of each patient were also examined separately. An experienced FOTI user also examined the patients to provide a benchmark. From standard charts the number of enamel and dentinal lesions on approximal surfaces was summed and comparisons made between the techniques. Six GDPs took part in one-to-one interviews. MAIN OUTCOME MEASURES: Mean numbers ofcarious lesions recorded by each clinician using each technique. RESULTS: There was a trend for all GDPs to find more enamel and dentinal lesions using FOTI, than with their standard clinical examination with or without radiographs. All GDPs found the FOTI technique a useful adjunct. They used FOTI in different ways and found a variety of uses for it other than caries diagnosis. CONCLUSIONS: The
BACKGROUND: Assisted mechanical ventilation is the mainstay of management of a variety of conditions affecting the neonate. However there are a number of potential hazards associated with this life saving intervention. New suctioning techniques have been introduced into clinical practice which aim to prevent or reduce these untoward effects. OBJECTIVES: To assess the effects of endotracheal suctioning without disconnection in intubated ventilated neonates. SEARCH STRATEGY: The review has drawn on the search strategy for the Cochrane Neonatal Review Group. A comprehensive search of MEDLINE, Cochrane Library, MEDLINE and CINAHL databases was undertaken by the reviewers. SELECTION CRITERIA: All trials utilizing random or quasi-random patient allocation in which suctioning with or without disconnection from the ventilator is compared in the neonatal population. DATA COLLECTION AND ANALYSIS: Standard methods of the Cochrane Neonatal Group were used. Each author reviewed trials for eligibility and quality and extracted data separately, then compared and resolved differences. Analysis was performed using the fixed effects model and outcomes were reported using relative risk for categorical data and weighted mean difference for outcomes measured on a continuous scale. MAIN RESULTS: Two trials (22 infants) were included in this review. The trials employed a cross-over design in which suctioning with or without disconnection was compared. Suctioning without disconnection resulted in a reduction in episodes of hypoxia (RR 0.30, 95% CI 0.11, 0.80) and a smaller percentage decrease in the TcPO2 (WMD 18.5%, 95% CI 8.11, 28.89). There were also fewer infants who experienced episodes where TcPO2 decreased by > 10% (RR 0.36, 95% CI 0.17, 0.79). Suctioning without disconnection resulted in a smaller percentage decrease in heart rate (WMD 11.53%, 95% CI 3.64, 19.43) and a reduction in the number of infants experiencing a decrease in heart rate by > 10% (RR 0.56, 95% CI 0.32, 0.99). REVIEWER'S CONCLUSIONS: Based upon the results of this review, there is insufficient evidence to decide between endotracheal suctioning with or without disconnection. There is, however, evidence of some benefit from performing suctioning without disconnection for some specific short-term outcomes. Further research should be undertaken to fully assess this practice with particular focus on extremely low birth weight infants and different modes of mechanical ventilation, and to address clinically important outcomes.