Cochrane Db Syst Rev
-
Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisPsychosocial interventions for reducing fatigue during cancer treatment in adults.
Fatigue is a common symptom in cancer patients receiving active treatment. There are a limited number of reviews evaluating interventions for fatigue during active treatment, and they are restricted to patients with advanced cancer, or to patients during radiotherapy. To date there is no systematic review on psychosocial interventions for fatigue during cancer treatment. ⋯ There is limited evidence that psychosocial interventions during cancer treatment are effective in reducing fatigue. At present, psychosocial interventions specifically for fatigue are a promising type of intervention. However, there is no solid evidence for the effectiveness of interventions not specific for fatigue. Most aspects of the included studies were heterogeneous, and therefore it could not be established which other types of interventions, or elements were essential in reducing fatigue.
-
Cochrane Db Syst Rev · Jan 2009
ReviewThrombophilia testing for prevention of recurrent venous thromboembolism.
Tests for thrombophilia are being performed on a large scale in people after venous thromboembolism (VTE) even though the benefits of testing are still subject to debate. The most important benefit would be a reduction in the risk of recurrent VTE due to the use of additional prophylactic measures. ⋯ There are currently no randomized controlled trials or controlled clinical trials that have assessed the benefit(s) of testing for thrombophilia on the risk of recurrent VTE.
-
Cochrane Db Syst Rev · Jan 2009
Review Meta AnalysisBudesonide for maintenance of remission in Crohn's disease.
Corticosteroids have been shown to be effective for induction, but not maintenance of remission in Crohn's disease. However, significant concerns exist regarding their risk for adverse events, particularly when used for long treatment courses. Budesonide is a glucocorticoid with limited systemic bioavailability due to extensive first-pass hepatic metabolism. Budesonide has been shown to be effective for induction of remission in Crohn's disease. ⋯ Budesonide is not more effective than placebo or weaning prednisolone for maintenance of remission in Crohn's disease. Some modest benefits are noted in patients receiving budesonide compared with placebo in terms of lower CDAI scores and longer time to relapse of disease. However, these benefits are offset by higher treatment-related adverse event rates and more frequent adrenocorticoid suppression in patients receiving budesonide. Therefore, budesonide is not recommended for maintenance of remission in Crohn's disease.
-
Cochrane Db Syst Rev · Jan 2009
ReviewVision screening of older drivers for preventing road traffic injuries and fatalities.
Demographic data in North America, Europe, Asia, Australia and New Zealand suggest a rapid growth in the number of persons over the age of 65 years as the baby boomer generation passes retirement age. As older adults make up an increasing proportion of the population, they are an important consideration when designing future evidence-based traffic safety policies, particularly those that lead to restrictions or cessation of driving. Research has shown that cessation of driving among older drivers can lead to negative emotional consequences such as loss of independence and depression. Those older adults who continue to drive tend to do so less frequently than other demographic groups and are more likely to be involved in a road traffic crash, probably due to what is termed the 'low mileage bias'. There is universal agreement among researchers that vision plays a significant role in driving performance, and that there are age-related visual changes. Vision testing of all drivers, and in particular of older drivers, is therefore an important road safety issue. The components of visual function essential for driving are acuity, field, depth perception and contrast sensitivity, which are currently not fully measured by licensing agencies. Furthermore, it is not known how effective vision screening tools are, and current vision screening regulations and cut-off values required to pass a licensing test vary from country to country. There is, therefore, a need to develop evidence-based tools for vision screening for driving, thereby increasing road safety. ⋯ Most countries require a vision screening test for the renewal of an individual's driver's license. There is, however, insufficient evidence to assess the effect of vision screening tests on subsequent motor vehicle crash reduction. There is a need to develop valid and reliable tools of vision screening that can predict driving performance.
-
Thoracic aortic aneurysm (TAA) is an uncommon disease with an incidence of 10.4 per 100,000 inhabitants. It occurs mainly in older individuals and is evenly distributed among both sexes. There are no signs or symptoms indicative of the presence of the disease. Progressive but unpredictable enlargement of the dilated aorta is the natural course of the disease and can lead to rupture. Open chest surgical repair using prosthetic graft interposition has been a conventional treatment for TAAs. Despite improvements in surgical procedures perioperative complications remain significant. The alternative option of thoracic endovascular aneurysm repair (TEVAR) is considered a less invasive and potentially safer technique, with lower morbidity and mortality compared with conventional treatment. Evidence is needed to support the use of TEVAR for these patients, rather than open surgery. ⋯ Though stent grafting of the thoracic aorta is technically feasible and non-randomised studies suggest reduction of early outcomes such as paraplegia, mortality and hospital stay, high quality randomised controlled trials assessing all clinically relevant outcomes including open-conversion, aneurysm exclusion, endoleaks, and late mortality are needed.